Journal of Rhinology最新文献

Background and objectives: Measurement of sleep parameters in both supine and non-supine positions is important for the diagnosis of positional obstructive sleep apnea (OSA). However, the influence of right and left lateral decubitus positions (RLDP and LLDP, respectively) on sleep parameters is relatively unknown and has not been well investigated. This study was performed to verify the associations between sleep parameters and lateral decubitus sleep position.

Methods: A retrospective study was performed on 38 patients who were diagnosed with OSA and underwent surgical interventions from January 2014 to December 2016. Preoperative sleep parameters were evaluated with WatchPAT, and patients who slept sufficiently in both RLDP and LLDP to accurately analyze sleep parameters were enrolled in the study. Basic clinical data including body mass index (BMI) and nasal endoscopic findings of patients were assessed.

Results: The difference in peripheral arterial tonometry apnea-hypopnea index (pAHI) and PAT respiratory disturbance index (pRDI) between RLDP and LLDP showed no association with the side of deviated nasal septum. Patients with higher BMI showed higher pRDI in LLDP than RLDP (p=0.038). The difference in sleep position percentage between RLDP and LLDP was negatively correlated with the difference in pRDI (p=0.023).

Conclusion: Higher BMI patients with OSA might benefit more from sleeping in RLDP than LLDP. Patients slept longer in the lateral decubitus position that produced lower pRDI. Not only supine and non-supine positions, but also RLDP and LLDP need to be evaluated in patients with OSA.

Background and objectives: With the ongoing development of intraoral surgical treatment and invasive dental treatments such as implants, odontogenic rhinosinusitis (ORS) is on the rise. ORS related to dental implants accounts for 8% to 37% of cases. The purpose of this study is to define the characteristics of patients with ORS related to dental implants.

Methods: From 2015 to 2019, the medical records of 15 patients who developed maxillary sinus disease after receiving dental implants were retrospectively analyzed among patients who visited the ear nose and throat and dentistry departments. We reviewed the chief complaint, assessment, diagnosis, treatment and prognosis of these patients.

Results: Of the 15 patients, all were diagnosed with ORS. One patient with a post-operative cheek cyst, 1 with fungal sinusitis, 1 with an inverted papilloma, 1 with chronic rhinosinusitis, and 1 with a radicular cyst were diagnosed after surgery. Endoscopic sinus surgery was performed in 14 patients and 2 patients underwent a combined operation. One patient improved after medical treatment. The follow-up period was about 8.6 months. No recurrence was found in any of the patients.

Conclusion: If an implant problem is suspected based on history-taking and physical examination, active consultation with dentistry is needed to diagnose ORS.

Background and objectives: Retinoids are naturally occurring vitamin A derivatives that regulate cellular processes and metabolism. In particular, retinoids play a key role in cellular proliferation by binding to retinoic acid receptors (RAR)-alpha, beta, and gamma. Considering the functional role of nasal mucosa where active cell regeneration occurs, RAR may play a role in tissue remodeling of the human nasal mucosa.

Methods: In this study, we investigated the expression and distribution pattern of RAR using reverse transcription-polymerase chain reaction (RT-PCR), immunohistochemistry (IHC) and Western blot in normal ethmoid mucosa (NE), chronic rhinosinusitis (IE) and polyp (P).

Results: IE and P samples showed higher expression levels of RAR in RT-PCR and Western blot than NE samples. RAR reactivity was also observed in the NE group, which indicates that cell regeneration also occurs in normal condition. Through IHC, we found the localization of RAR. RAR-α was distributed in the epithelial cells, submucosal glands, and endothelial cells. RAR-β was located in the basal epithelium, while RAR-γ was present in goblet cells and submucosal glands. The staining intensity of RAR-α, β and γ was higher than that in the NE group. Especially in the P group, RARs were abundantly distributed in the stalks of polyps.

Conclusion: The stalk region contains a lot of collagen and fibroblasts to support polyp formation, and the greater amount of RAR in the stalk suggested that RARs may be associated with angiogenesis and cell proliferation. Accordingly, elevated RAR levels in chronic rhinosinusitis could indicate that RARs play a critical role in cell regeneration, angiogenesis and immunomodulation under inflammatory conditions in the human nasal mucosa.

[This corrects the article on p. 158 in vol. 28.].

The transseptal approach to the maxillary sinus has been described for resection of extensive tumours of the nose and paranasal sinuses. We describe a modification of this method in a patient diagnosed with inverted papilloma for which he had undergone two previous operations. This method provides complete access to the maxillary sinus, particularly the anterior wall, to provide adequate reach and ensure complete removal of tumours. We describe a technique modifying the existing transseptal approach used as an adjunct to prelacrimal recess approach, wherein a hemitransfixation incision placed in the contralateral nasal cavity along the septum provides access to the maxillary sinus with angled instruments. This modified transseptal approach provided better reach and access to the maxillary sinus. Postoperatively, there was no evidence of septal scarring or perforation and no evidence of lesion recurrence. Our technique is an easy modification to the transseptal approach that is a useful tool to access hidden areas of the maxillary sinus without associated morbidity.

Orbital hematic cyst is characterized by cystic accumulation of hematogenous debris surrounded by a wall of fibrous tissue without an epithelial lining. It is a relatively uncommon benign cyst and occurs secondary to blunt trauma in most cases. We experienced a case of 53-year-old male who presented with proptosis of the left eye. A cystic lesion was found at the superolateral orbital rim of the patient. We report a case of orbital hematic cyst that was resected completely through the sub-brow approach.

Oropharyngeal squamous cell carcinoma (OSCC) with metastasis to the cavernous sinus (CS) is uncommon, and only a few cases have been described in the literature. The highest age-adjusted incidence rate for OSCC including the tonsil in males occurs in South Asians, and more cases should be reported to establish earlier identification and treatment. We report a case of OSCC in a 59-year-old male who underwent prompt endoscopic biopsy and early palliative radiation therapy to allow complete recovery of cranial nerve palsies to improve his quality of life, despite having a poor prognosis. Furthermore, this report emphasizes his dramatic resolution of symptoms after radiation therapy, highlighting the importance of rapid recognition and proper management.

Background and objectives: Osteomas are the most common benign tumors of the nasal cavity and paranasal sinuses (PNSs). In this study, clinical features and imaging findings were analyzed in patients with osteoma confirmed by ostiomeatal unit (OMU) computed tomography (CT) and PNS CT, and the surgical treatment performed at our hospital was introduced.

Methods: The Severance Clinical Research Analysis Portal (SCRAP) service of Severance Hospital was used to collect research data. A total of 128 cases of osteomas of the nasal cavity or PNSs confirmed by OMU CT or PNS CT was retrospectively reviewed, including the location and size of the osteoma, clinical features, accompanying findings on imaging tests, and cases of surgical treatment.

Results: In this study, osteomas were found in about 0.55% of patients who underwent computed tomography. Osteomas were most frequently found in the ethmoid sinus, followed by the frontal sinus, fronto-ethmoid sinus, maxillary sinus, intranasal sphenoid sinus, and maxillary sinus-ethmoid sinus. Patients with osteomas complained of symptoms such as rhinorrhea, postnasal drip, nasal congestion, hyposmia, headache, visual disturbance, and lacrimal duct obstruction.

Conclusion: Surgical treatment was considered for patients presenting with severe headache, visual field symptoms, or accompanying rhinosinusitis. Surgery was performed by endoscopic or external approaches depending on location and size of the osteoma.

Background and objectives: The purpose of this study was to classify radiological findings of patients diagnosed with maxillary sinus fungus ball and to analyze the differences in surgical approach methods and postoperative results.

Methods: As a retrospective study, we reviewed the medical records of 221 patients (unilateral in 216: bilateral in 5).

Results: On computed tomography (CT), 49% of the lesions had an irregular surface or a protruding part. There was a significant difference in surgical approach according to pneumatization of the maxillary sinus when middle meatal antrostomy (MMA) was performed alone or combined with MMA and inferior meatal antrostomy (IMA) (p=0.042). Extension of a maxillary sinus lesion caused by fungus ball was not associated with stenosis of the MMA (p=0.328).

Conclusion: Diagnosis of maxillary sinus fungus on CT was associated with irregular lesion surface or a protruding calcification. In patients with fungus ball of the maxillary sinus, the more severe is the maxillary sinus pneumatization, the larger is the extent of IMA needed.

Background and objectives: The prelacrimal window approach (PLWA) is useful for treating anterior maxillary sinus lesions. A previous study reported that the feasibility of PLWA in Chinese patients was 93.0%, which is higher than that in the European population (68.5%). This study aimed to compare the ease of PLWA between a patient group and healthy controls and to analyze the results for Koreans compared to those of previous studies. Differences between the patient and control groups and the distribution of types in the Korean population were evaluated.

Methods: We analyzed 89 paranasal computed tomography (CT) scans from 51 controls and 38 patients (178 sides). We measured the distance distribution between the anterior wall of the maxillary sinus and the anterior wall of the lacrimal duct (D1) and its thickness (T). We compared the values in the control and patient groups.

Results: D1 and D2 were similar between the patient and control groups (p=0.395, p=0.344), though T was greater in the patient group (p<0.001). In the patient group, sinus with inverted papilloma (IP) and normal sinus were not significantly different for any of these measures. The D1 distribution in Koreans did not differ significantly from that of Chinese but did differ from that of Europeans.

Conclusion: The ease of PLWA was 92.2% in Koreans, which is more similar to that of Chinese (93.0%) than to that of Europeans (68.5%). D1 and D2 of the patient group did not differ from those of the control group, but T was greater in the patient group. In the patient group, D1 and D2 were not significantly different between sinus with IP and normal sinus. The frequency of type 2+3 in patients was similar to that of the control group.