Intraoral Approach for Parapharyngeal Branchial Cleft Cysts.

Branchial cleft cyst (BCC) most frequently arises from the second branchial cleft and is located anterior to the sternocleidomastoid muscle at the mandibular angle. However, very rarely, this may occur in the parapharyngeal space. Interestingly, the parapharyngeal BCC is frequently misdiagnosed as a peritonsillar abscess. In this study, we reported 2 cases of parapharyngeal BCC misdiagnosed as peritonsillar abscess.

Long-term bidirectional association between asthma and attention deficit hyperactivity disorder: A big data cohort study.

Background: Previous studies have argued that attention deficit hyperactivity disorder (ADHD) is associated with asthma. However, reliable evidence to verify this association has not yet been reported. Objectives: To investigate the bidirectional association between asthma and ADHD through a 12-year big data cohort study. Methods: The independent variable group was extracted from 3.5 million individuals randomly sampled by the National Health Insurance Service (NHIS). In Study 1, the incidence of ADHD according to asthma was evaluated, while in Study 2, the incidence of asthma according to ADHD was analyzed. Propensity score (PS) matching with several variables was used to obtain a control group. Measurements and main results: In Study 1, the asthma group included 131,937 individuals and the non-asthma group included 131,937 individuals. The adjusted hazard ratio (aHR) for ADHD in the asthma group was 1.17 [95% confidence interval (CI): 1.11-1.23]. In subgroup analysis, the aHRs for ADHD of individuals in the subgroups male sex, 0-5 years old, 6-10 years old, atopic dermatitis, allergic rhinitis, Charlson comorbidity index (CCI) 1, and CCI > 2 were significant (aHR: 2.83, 1.70, 1.79, 1.09, 1.15, 1.06, and 1.49, respectively). In Study 2, ADHD was found to significantly affect asthma in all age groups (aHRs of the subgroups 0∼60 and 0∼17 years old were 1.10 and 1.09, respectively). In the 0∼17 years old subgroup, the association of ADHD with asthma was greater with younger age (aHRs of the subgroups 0∼5 and 6∼10 years old were 2.53 and 1.54, respectively). Conclusion: From long-term follow-up, the incidence of ADHD was 1.17 times higher in the asthma group than in the control group. The incidence of asthma was 1.10 times higher in the ADHD group than in the control group. Asthma and ADHD have a bidirectional relationship, and childhood asthma and ADHD should be rigorously managed.

Complete restoration of congenital conductive hearing loss by staged surgery: A case report.

BACKGROUND: Stapedial tendon ossification is a rare disease, with only a few reports. The stapedial tendon originates from the apex of the pyramidal eminence and is attached to the neck of the stapes. In stapedial tendon ossification, the stapes is fixed, causing conductive hearing loss. In most cases, complete hearing restoration is achieved by dividing the stapedial tendon after exploratory tympanotomy. CASE SUMMARY: A 28-year-old woman presented to our hospital with the major complaint of bilateral hearing loss that started during childhood. Exploratory tympanotomy was performed due to suspicion of otosclerosis or middle ear anomalies. We found bilateral conductive hearing loss due to stapedial tendon ossification with a middle ear anomaly during surgery. There have been several reports of complete recovery of hearing after resection of the stapedial tendon. However, in this case, recovery of hearing was insufficient, even with the division of the stapedial tendon. In the second surgery, the stapes anomaly and footplate fixation were confirmed, and hearing was completely recovered after stapedotomy. Therefore, we report this case with a review of the relevant literature. CONCLUSION: This is the first case of stapedial tendon ossification and fixation of the footplate surgically diagnosed on both sides. With surgical treatment, successful results are expected.

Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a multilevel problematic disease. Major septal deviation (SD) can lead to severe nasal congestion, which, in turn, can lead to sleep apnea. Although SD seems to be related to OSA, very few studies have quantitatively examined this relationship. In this study, we investigate this using a 9-year large-scale cohort study. METHODS: The SD group was selected out of 1 million individuals randomly extracted by the National Health Insurance Service. The non-SD group was obtained through propensity score matching considering several variables. The primary end point was OSA diagnosis. RESULTS: The study (SD) group included 11,238 individuals and the non-SD group (control group) included 22,476 persons. The overall hazard ratio for OSA in the SD group was 4.39 (95% confidence interval [CI]: 3.56-5.42). In subgroup analysis, the hazard ratio for OSA of male individuals was 3.77 (95% CI: 2.83-5.03), high economic status was 1.27 (95% CI: 1.05-1.56), metropolitan area was 1.31 (95% CI: 1.07-1.62), young age was 0.79 (95% CI: 0.64-0.98), hypertension was 1.00 (95% CI: 0.37-2.7), and diabetes mellitus was 2.44 (95% CI: 1.15-5.21). In the SD group, the hazard ratio for OSA after septoplasty was 0.71 (95% CI: 0.54-0.94). CONCLUSIONS: From long-term follow-up, the prevalence of OSA was 4.39 times higher in the SD group compared with the control group. This phenomenon was more pronounced with increasing body mass index and decreased significantly after septoplasty. CITATION: Yeom SW, Chung SK, Lee EJ, et al. Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study. J Clin Sleep Med. 2021;17(10):2099-2106.

Multiple nerve root metastasis of breast carcinoma: a report of two cases.

Nerve root metastases are extremely rare with only a handful of cases ever reported. Metastasis to sites other than the primary site is common in malignant tumors whereas spinal ganglion metastasis is extremely rare and has been only reported in individual cases. The lumbar spine tends to be more common areas of presentation whereas breast cancer metastasis has been rarely reported. We herein reported two cases of breast carcinoma metastasis to multiple spinal nerve roots. The metastasis sites were S1 nerve root in Case 1 and left L5 and bilateral cervical nerve roots in Case 2. On magnetic resonance imaging (MRI), the nerve roots in the intervertebral foramen zones appeared thickened and contrast-enhanced MRI exhibited intense enhancement. Pathological examination showed that these primary lesions were breast cancer in both cases, and there were intracranial multiple metastases in both cases, including preoperative metastasis to multiple nerve roots (lumbar and cervical) and postoperative recurrence. The clinical course was characterized by worsening radicular symptoms-especially intractable pain. The radiologic appearance might mimic a neurogenic tumor, which is performed intervertebral foraminal area lesion, and the corresponding ganglion/nerve root became thickened and was enhanced significantly. Surgical intervention with tumor debulking followed by radiotherapy provides local tumor control and palliation from pain, but it is palliative. Therefore, for patients with radiological manifestations of radiculopathy, the possibility of metastatic tumors should be considered.

The risk of intracranial infection in adults with hydrocephalus after ventriculoperitoneal shunt surgery: A retrospective study.

Infection remains the most significant complication of ventriculoperitoneal shunt (VPS) surgery. The objective of this study was to investigate intracranial infections complicating VPS surgery in adults with hydrocephalus. Patients who underwent VPS surgery for hydrocephalus between 2000 and 2016 were included. Clinical data and follow-up evaluations were examined and analysed retrospectively. A total of 502 patients with hydrocephalus who underwent VPS surgery were included. They were followed up for at least 2 years. Twelve patients with incomplete data were excluded. Four hundred and ninety patients were included in the final analysis. Twenty-five cases of intracranial infection occurred, accounting for 5.1% of patients with VPS surgery. The mean age of the patients was 57.1 ± 10.1 years (range, 39-72 years). The incidence of intracranial infection in patients over 60 years of age was higher than that in patients under 60 years of age (P = .007). Age (P = .007), diabetes (P = .026), skin infection (P = .028), bed-ridden (P = .007), and modified operation (P = .011) were highly correlated with the incidence of intracranial infection. The findings of this retrospective study show that age, diabetes, skin infection, bed-ridden, and modified operation of hydrocephalus significantly and independently correlated with the incidence of infection. Prospective studies are needed to assess the relationship between the incidence of infection and risk factors in patients with hydrocephalus after VPS.

miR-204 reverses temozolomide resistance and inhibits cancer initiating cells phenotypes by degrading FAP-α in glioblastoma.

Malignant gliomas are treated with temozolomide (TMZ) at present, but often exhibit resistance to this agent. Cancer-initiating cells (CICs) have been suggested to lead to TMZ resistance. The mechanisms underlying CICs-based TMZ resistance are not fully understood. MicroRNAs (miRNAs) have been demonstrated to serve important roles in tumorigenesis and TMZ resistance. In the present study, a sphere forming assay and western blot analysis were performed to detect the formation of CICs and fibroblast activation protein α (FAP-α) protein expression. It was revealed that TMZ resistance promoted the formation of CICs and upregulated FAP-α expression in glioblastoma cells. Over-expressing FAP-α was also demonstrated to promote TMZ resistance and induce the formation of CICs in U251MG cells. In addition, using a reverse transcription-quantitative polymerase chain reaction, it was observed that miR-204 was downregulated in U251MG-resistant (-R) cells. miR-204 expression negatively correlated with the FAP-α levels in human glioblastoma tissues, and it may inhibit the formation of CICs and reverse TMZ resistance in U251MG-R cells. Therefore, it was concluded that miR-204 reversed temozolomide resistance and inhibited CICs phenotypes by degrading FAP-α in glioblastoma.