Journal of Rhinology最新文献

Digital twins were initially introduced in the aerospace industry, but they have been applied to the medical field in the 2020s. The development of the Internet of Things, sensor technology, cloud computing, big data analysis, and simulation technology has made this idea feasible. Essentially, digital twins are virtual representations of real-world data that can generate virtual outcomes related to a patient based on their actual data. With this technology, doctors can predict treatment outcomes, plan surgery, and monitor patients' medical conditions in real time. While digital twins have endless potential, challenges include the need to deal with vast amounts of data and ensure the security of personal information. In the field of rhinology, which deals with complex anatomy from the sinus to the skull base, the adoption of digital twins is just beginning. Digital twins have begun to be incorporated into surgical navigation and the management of chronic diseases such as chronic rhinosinusitis. Despite the limitless potential of digital twins, challenges related to dealing with vast amounts of data and enhancing the security of personal data need to be surmounted for this method to be more widely applied.

An inverted papilloma of the frontal sinus is a challenging lesion for surgeons, for both anatomical and pathological reasons. Despite the trend away from an external approach and towards an endonasal endoscopic approach, indications for an external approach remain. The options for an external approach include endoscopic frontal trephination, transpalpebral orbital craniotomy, a supraorbital transeyebrow approach, an osteoplastic flap, and bifrontal craniotomy with cranialization. Each approach has advantages and disadvantages. Deciding on the appropriate approach is important for the patient's prognosis and risk of complications. We report two cases of frontal sinus inverted papilloma treated with a combined bifrontal craniotomy with cranialization and endonasal endoscopic approach. We also present a general review of the external approaches mentioned above.

Background and objectives: Endoscopic sinus surgery is commonly performed for maxillary sinus (MS) disease, and the surgical extent of the MS medial wall or ostium varies. We examined the effect of MS surgery on nasal airflow and air-conditioning using computational fluid dynamics in five nasal cavity numerical models.

Methods: Four types of unilateral virtual MS surgery were conducted on the right MS based on computed tomography images of a 49-year-old man with normal anatomy. The five models were as follows: baseline (normal), middle meatal antrostomy (MMA), MMA with inferior meatal antrostomy (MMA+IMA), mega-antrostomy (MEGA), and endoscopic medial maxillectomy (EMM). Virtual simulator software and a stereoscopic display with haptic device were used for virtual surgery. Meshing software and computer fluid dynamics software were used to generate meshes and analyze airflow.

Results: The MMA and MMA+IMA results were similar to the baseline model. However, EMM and MEGA exhibited some physiological changes. The amount of airflow moving into the MS was largest in the EMM model, followed by the MEGA model. The distributions of wall shear stress and surface water-vapor increased near the enlarged MS ostium in EMM and MEGA. Skewed airflow partition and different airflow rates between the operated and unoperated sites of the nose also changed the air-conditioning characteristics. EMM substantially reduced the relative humidity in the nasopharynx, and MEGA showed a smaller reduction.

Conclusion: Among four surgery techniques, EMM produced the largest increase in wall shear stress and surface water vapor flux on the posterior surface of the MS and the greatest deterioration in the nasal cavity's air-conditioning capacity. MEGA reduced the local airflow disturbance inside the MS and prevented excessive degeneration of the cavity's overall air-conditioning capacity. In conclusion, MEGA and modified EMM approaches have physiological advantages over EMM, while securing a sufficient spatial extent of resection for surgery.

A nasal polyp is a distinct mucosal pathology that obstructs the nasal cavity and paranasal sinuses, with various phenotypes and endotypes. Nasal polyps should be distinguished from inverted papillomas, squamous cell carcinomas, juvenile angiofibromas, lymphomas, and olfactory neuroblastomas. A choanal polyp is a solitary benign lesion that originates in the paranasal sinus and extends to the choana through the natural ostium of the sinus. Choanal polyps usually originate from the maxillary sinus; however, we recently experienced the case of 41-year old women with sinochoanal polyp originated from the ethmoid sinus. As choanal polyps can recur even after appropriate surgery, complete resection, including the surrounding mucosa at the site of origin, is required. Therefore, it is essential to consider anatomical differences in polypectomy. We recently diagnosed and successfully performed surgery on an ethmochoanal polyp; herein, we report our experience and present a literature review.

The last decade has seen the emergence of immune checkpoint inhibitors for the treatment of a wide variety of cancer types. While these medications are generally speaking well tolerated, the full long-term side effect profiles of these medications have not been fully elucidated. We describe a case of chronic rhinosinusitis with nasal polyposis induced treatment with pembrolizumab, the first reported case. We present the case of a 48-year-old man with a background history of stage IV non-small cell lung cancer with bone metastases. He was commenced on pembrolizumab and over the course of the subsequent 5 years he developed significant nasal polyps bilaterally, and was commenced on medical therapy. Sinus CT scan demonstrated bilateral total opacification of all his sinuses and nasal cavity. He subsequently underwent bilateral functional endoscopic sinus surgery. He remains symptom-free and at his last clinical follow-up visit 1 year later. There are limited case reports of nasal polyposis occurring in patients receiving immune checkpoint inhibitors, with only one case requiring surgery. We describe the first case of severe nasal polyps due to pembrolizumab and successfully treated with polypectomy. From our review, there were no cases that required a cessation of therapy.

Background and objectives: Cancer organizations worldwide have recently released care guidelines for cancer patients with coronavirus disease 2019 (COVID-19). Several studies have reported higher mortality rates in cancer patients with COVID-19. However, drawing robust conclusions remains challenging due to a lack of research on clinical prognostic factors in this patient group.

Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Cochrane databases. We searched the keywords in the following combination: ("COVID-19" or "coronavirus" or "wuhan virus") and ("cancer"). The search was performed on August 1, 2020, and only papers written in English were included in this study. We collected data from 3,215 cancer patients with COVID-19 from 16 studies and analyzed overall mortality after COVID-19 infection in cancer patients compared to controls, as well as prognostic factors for severity and mortality after COVID-19 infection. The prognostic factors analyzed encompassed demographics, comorbidities, symptoms, cancer treatment within 4 weeks of COVID-19 diagnosis, and treatment for COVID-19 infection.

Results: This meta-analysis evaluated mortality rates and related prognostic factors in cancer patients infected with COVID-19. First, 15 of the 16 studies reported mortality data; 663 patients died among a total of 3,215 people, resulting in a combined mortality rate of 21%. Second, the following poor prognostic factors were identified: male sex, older age (≥65 years), respiratory symptoms (e.g., cough and dyspnea), and other comorbidities (e.g., cardiovascular disease, hypertension, and chronic obstructive pulmonary disease).

Conclusion: The mortality of cancer patients infected with COVID-19 can reach about 20%.

Background and objectives: Sternberg's canal is known to result from incomplete fusion of bony compartments constituting the sphenoid bone during the developmental process. This study aimed to evaluate the prevalence and clinical implications of Sternberg's canal.

Methods: A retrospective review of patients over the age of 18 years who had undergone endoscopic sinus surgery from 2014 to 2019 at a single institution was performed. Patients (n=98) were categorized into those with sphenoid fungal ball (SFB) (n=39), those with primary chronic rhinosinusitis (CRS) (n=39), and controls (n=20) and were evaluated radiologically. A small pit in the lateral wall, located medial to the maxillary division of the trigeminal nerve (V2), in front of the opticocarotid recess was regarded as Sternberg's canal. Children under the age of 12 years (n=39) without any sinus disease were also evaluated to determine the prevalence of Sternberg's canal in the pediatric population.

Results: Patients with SFB showed the highest prevalence of Sternberg's canal (56.4%), followed by those with CRS (20.5%) and controls (10.0%) (p<0.001). Logistic regression revealed that Sternberg's canal was associated with osteitis of the sphenoid wall, and not with age, sex, or sphenoid sinus pathology. Children under the age of 12 years showed a significantly higher prevalence of the defect than adult controls (46.2%, p<0.001).

Conclusion: Sternberg's canal was frequently identified in children under the age of 12 years. Sphenoid sinus pathology was often accompanied by osteitis. However, the presence of the canal alone did not predict skull base involvement in patients with SFB. A comprehensive evaluation should hence be performed if skull base involvement is suspected in such patients. Additionally, other clinical implications of Sternberg's canal should be further evaluated.

Chronic rhinosinusitis (CRS) is a relatively common inflammatory disease of the nasal and paranasal sinus mucosa. Several epidemiological studies have established an association between particulate matter (PM) and CRS. Based on those data, PM has emerged as an important environmental factor in the development of CRS. Recent research has investigated the mechanisms and treatment options for CRS caused by PM through cellular experimentation. Therefore, the authors would like to explain the definition of PM, present research investigating the relationship between PM and CRS, and summarize the involved mechanisms reported to date.

Although iatrogenic skull base injuries after endoscopic sinus surgery (ESS) are rare (overall complication rate, 0.5%), they can be fatal or cause significant morbidity. Conventionally, skull base injuries were repaired using an external approach. However, in recent years, most skull base injuries after ESS have been repaired using an endoscopic transnasal approach due to its lower morbidity, lower risk of postoperative complications, and shorter hospital stay. We report two cases of iatrogenic skull base injury accompanied by brain injury following ESS and describe the skull base repair techniques employed for each case. In both cases, the skull base defects were successfully repaired using an endoscopic transnasal approach, although craniotomy was also performed in the first case to remove bone fragments from the right frontal base and lateral ventricle. Both patients recovered without residual neurologic deficits.

Background and objectives: Evidence bearing on the safety and efficacy of dupilumab treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) has recently been presented by researchers from various institutions. Therefore, we compared the safety and efficacy of dupilumab treatment to those of endoscopic sinus surgery.

Methods: The PubMed, Scopus, Embase, Web of Science, and Cochrane databases were searched independently by two authors from the dates of their inception to December 2022. We retrieved the clinical results of CRSwNP patients after dupilumab administration, including changes in patient symptoms and the effects on the quality of life, and compared the results of dupilumab (treatment group) to those of endoscopic sinus surgery (control group).

Results: Eight articles (1,251 patients) were ultimately included. Dupilumab significantly improved nasal symptoms (nasal congestion) (mean difference [MD], -1.4433; 95% confidence interval [CI], -1.7233 to -1.1632; I²=94.2%), the visual analog sinusitis score (MD, -5.0506; 95% CI, -5.4744 to -4.6267; I²=84.0%), olfactory function (standardized MD, 1.2691; 95% CI, 1.1549 to 1.3833; I²=18.4%), the quality of life (SNOT-22 score) (MD, -34.4941; 95% CI, -39.4187 to -29.5695; I²=90.8%), the Lund-Mackay computed tomography score (MD, -7.2713; 95% CI, -8.9442 to -5.5984; I²=87.7%), and the nasal polyp score (MD, -3.1021; 95% CI, -3.7066 to -2.4977; I²=95.6%) at about 12 months after treatment compared to the pretreatment values. Compared to endoscopic sinus surgery, dupilumab similarly improved olfactory function (MD, 1.9849; 95% CI, -1.6190 to 5.5888; I²=0.0%) but was less effective in terms of reducing the SNOT-22 score (MD, 3.8472; 95% CI, 1.9872 to 5.7073; I²=96.7%) and reducing nasal congestion (MD, 0.6519; 95% CI, 0.5619 to 0.7420; I²=97.7%).

Conclusion: Dupilumab reduced subjective symptom scores and improved the quality of life and objective measures of progression compared to the preoperative values.