Nasal valve collapse is one of the causes of nasal obstruction and must be considered in patients with nasal obstruction. There are several surgical procedures available to treat nasal valve collapse. Spreader grafts can be used in the treatment of nasal valve collapse by widening the internal nasal valve angle and maintaining the widened angle. However, this procedure requires sufficient amount of cartilage harvested from the nasal septum. Especially, in cases of secondary rhinoplasty or some primary nasal surgery with thin septal cartilage, it is difficult to harvest an appropriate amount of cartilage from the septum. Here, we describe an effective technique for using septal cartilage and TnR Nasal Mesh® (T&R Biofab Co., Ltd) for spreader grafts with appropriate thickness in nasal valve collapse.

Cogan’s syndrome is a rare inflammatory disease characterized by non-syphilitic keratitis and vestibulo-auditory symptoms including hearing loss, tinnitus, and vertigo. Although its precise pathogenesis is not known, Cogan’s syndrome is generally considered an autoimmune disease. This hypothesis is supported by the frequently successful remission of hearing loss after steroid administration and the association with other autoimmune disorders such as rheumatoid arthritis. Medical treatment of Cogan’s syndrome depends on disease severity and on how extensive the disease is. The involvement of inner ear pathology requires systemic corticosteroid therapy. In cases of treatment failure or the need for a corticosteroid-sparing effect, other immunosuppressive drugs can be used. We experienced two patients with typical Cogan’s syndrome, presenting bilateral progressive sensorineural hearing loss and dizziness with ocular involvement, which we have successfully treated with systemic steroid administration and immunosuppressive therapy.

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) is common in the elderly. There are increasing evidence that endoscopic sinus surgery (ESS) can be used to manage geriatric patients safely, although there are still concerns about complications after ESS. Therefore, the clinical effect and the safety of ESS in old patients was evaluated in the present study. SUBJECTS AND METHOD: Retrospective observational studies were performed based on medical records of patients over the age of 70 and who underwent ESS for CRS from January 2009 to December 2017. The clinical effect of ESS was assessed by comparing the sino-nasal outcome test (SNOT-22) scores before and 3 months after surgery. The safety of the operation was evaluated by the occurrence of postoperative major surgical (skull base, orbital and hemorrhage) and medical (ventricular fibrillation, ischemic attack, primary cardiac arrest, cerebrovascular accident, pneumonia, other organ failure and death) complications. RESULTS: Seventy three subjects were enrolled in this study. Bilateral disease was observed in 37 cases (50.7%), and CRS with nasal polyp was found in 31 cases (42.5%). Eight patients (11.0%) had revision cases. The majority (93.2%) had at least one comorbid condition and got prescribed related medicine (87.7%). There was a significant decrease in SNOT-22 score after surgery. Furthermore, there were no major surgical or medical complications except two cases with epistaxis. CONCLUSION: CRS in geriatric patients can also be treated effectively and safely by ESS as it is done for younger adults. However, as the incidence of comorbidities is high in elderly subjects, it is important to evaluate the risk factors preoperatively.
Adult ; Aged ; Comorbidity ; Epistaxis ; Heart Arrest ; Humans ; Incidence ; Medical Records ; Methods ; Nasal Polyps ; Nasal Surgical Procedures ; Orbit ; Pneumonia ; Quality of Life ; Retrospective Studies ; Risk Factors ; Stroke

BACKGROUND AND OBJECTIVES: Partial intracapsular tonsillectomy and adenoidectomy (PITA) has become a well-recognized technique for tonsillectomy in children. Several studies have reported that PITA shows better postoperative morbidity compared to the conventional technique. However, there is still concern about the regrowth of remnant tonsil tissues. The authors evaluated the postoperative results of PITA, combined extracapsular and intracapsular tonsillectomy, and conventional tonsillectomy. SUBJECTS AND METHOD: The authors studied 97 children (male: 62, female: 35) aged 2 to 13 years old, who underwent tonsillectomy and adenoidectomy (PITA, combined extracapsular and intracapsular tonsillectomy, and conventional tonsillectomy). The degree of adenotonsillar hypertrophy, apnea-hypopnea index and lowest oxygen saturation was confirmed for all subjects. Operation time, quality of life, scale for postoperative pain, frequency of postoperative bleeding, and recurrence with tonsillar regrowth were compared after surgery performed by different surgical procedures. RESULTS: Regardless of the surgical technique, all the cases presented significant improvement in the quality of life before and after surgery. On the day of surgery and four days after surgery, PITA showed superior results in terms of postoperative pain level compared to the conventional technique. There were no statistically significant results with respect to the operation time and postoperative bleeding. Six months after the surgery, the recurrence of sleep apnea due to the regrowth of remaining tonsil was not obvious. CONCLUSION: Tonsillectomy technique preserving tonsillar capsule may show better results on early postoperative pain. It can be a good alternative to the conventional technique in surgical treatment for pediatric obstructive sleep apnea in terms of early postoperative pain control.
Adenoidectomy ; Child ; Female ; Hemorrhage ; Humans ; Hypertrophy ; Methods ; Oxygen ; Pain, Postoperative ; Palatine Tonsil ; Pediatrics ; Quality of Life ; Recurrence ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Tonsillectomy

BACKGROUND AND OBJECTIVES: Partial intracapsular tonsillectomy and adenoidectomy (PITA) has become a well-recognized technique for tonsillectomy in children. Several studies have reported that PITA shows better postoperative morbidity compared to the conventional technique. However, there is still concern about the regrowth of remnant tonsil tissues. The authors evaluated the postoperative results of PITA, combined extracapsular and intracapsular tonsillectomy, and conventional tonsillectomy.SUBJECTS AND METHOD: The authors studied 97 children (male: 62, female: 35) aged 2 to 13 years old, who underwent tonsillectomy and adenoidectomy (PITA, combined extracapsular and intracapsular tonsillectomy, and conventional tonsillectomy). The degree of adenotonsillar hypertrophy, apnea-hypopnea index and lowest oxygen saturation was confirmed for all subjects. Operation time, quality of life, scale for postoperative pain, frequency of postoperative bleeding, and recurrence with tonsillar regrowth were compared after surgery performed by different surgical procedures. RESULTS: Regardless of the surgical technique, all the cases presented significant improvement in the quality of life before and after surgery. On the day of surgery and four days after surgery, PITA showed superior results in terms of postoperative pain level compared to the conventional technique. There were no statistically significant results with respect to the operation time and postoperative bleeding. Six months after the surgery, the recurrence of sleep apnea due to the regrowth of remaining tonsil was not obvious. CONCLUSION Tonsillectomy technique preserving tonsillar capsule may show better results on early postoperative pain. It can be a good alternative to the conventional technique in surgical treatment for pediatric obstructive sleep apnea in terms of early postoperative pain control.

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) is common in the elderly. There are increasing evidence that endoscopic sinus surgery (ESS) can be used to manage geriatric patients safely, although there are still concerns about complications after ESS. Therefore, the clinical effect and the safety of ESS in old patients was evaluated in the present study.SUBJECTS AND METHOD: Retrospective observational studies were performed based on medical records of patients over the age of 70 and who underwent ESS for CRS from January 2009 to December 2017. The clinical effect of ESS was assessed by comparing the sino-nasal outcome test (SNOT-22) scores before and 3 months after surgery. The safety of the operation was evaluated by the occurrence of postoperative major surgical (skull base, orbital and hemorrhage) and medical (ventricular fibrillation, ischemic attack, primary cardiac arrest, cerebrovascular accident, pneumonia, other organ failure and death) complications. RESULTS: Seventy three subjects were enrolled in this study. Bilateral disease was observed in 37 cases (50.7%), and CRS with nasal polyp was found in 31 cases (42.5%). Eight patients (11.0%) had revision cases. The majority (93.2%) had at least one comorbid condition and got prescribed related medicine (87.7%). There was a significant decrease in SNOT-22 score after surgery. Furthermore, there were no major surgical or medical complications except two cases with epistaxis. CONCLUSION CRS in geriatric patients can also be treated effectively and safely by ESS as it is done for younger adults. However, as the incidence of comorbidities is high in elderly subjects, it is important to evaluate the risk factors preoperatively.

Angiofibroma is benign hypervascular tumor that usually occurs in the nasopharynx of adolescent male patient and rarely originates from outside of the nasopharynx, called extranasopharyngeal angiofibroma. The clinical and radiologic findings of extranasopharyngeal angiofibroma are similar to other hypervascular tumors, which may delay diagnosis and treatment. We present a case of extranasopharyngeal angiofibroma arising from nasal septum of a 43-year-old male who complained of right nasal obstruction. Contrast enhancement CT revealed a hypervascular tumor of the nasal septum and the tumor was removed by endoscopic resection. Histopathologic examination confirmed the diagnosis of angiofibroma.

BACKGROUND AND OBJECTIVES: In clinical settings, some deep neck infections may be managed by conservative treatment but some still require surgical treatment. In this study, we use univariate and multivariate analysis to discuss whether or not there are significant differences between conservative treatment and surgical treatment on patients with deep neck infections. SUBJECTS AND METHOD: We conducted a retrospective analysis using medical records of 88 patients with deep neck infections from January 2010 to December 2015. Among 88 patients, 56 patients were managed by conservative treatment with antibiotics and 32 patients were managed by surgical treatment via transcervical approach with antibiotics. As for data analysis, Mann-Whitney U test and multiple logistic regression analysis was used. RESULTS: Age, duration from symptom onset to hospitalization, hospital days, incidence of underlying disease, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) were found higher in the surgical treatment group than in the conservative treatment group. But there was no statistical significance except for the incidence of high blood pressure and CRP. CONCLUSION: CRP and incidence of high blood pressure were significant predictive factors for choosing the surgical treatment in deep neck infection. Contrary to our expectations, the incidence of diabetes mellitus was not a significant factor that determined the treatment options for the patients with deep neck infection.
Anti-Bacterial Agents ; Blood Sedimentation ; C-Reactive Protein* ; Cohort Studies* ; Diabetes Mellitus ; Hospitalization ; Humans ; Hypertension* ; Incidence ; Leukocyte Count ; Logistic Models ; Medical Records ; Methods ; Multivariate Analysis ; Neck* ; Regression Analysis ; Retrospective Studies* ; Statistics as Topic

Low-grade fibromyxoid sarcoma (LGFMS), a soft tissue tumor that has high recurrence and metastasizing potential, rarely occurs in the head and neck region. Therefore, the treatment for LGFMS in the facial area is challenging in terms of cosmetic and functional maintenance. The authors report a case of LGFMS in the posterior nasal cavity. It was completely removed in parallel with the nasal endoscopic and oral approach, but the lower margin was closed by preserving the soft palate. The patient is well without any recurrence or metastasis after 5 years of follow-up.
Follow-Up Studies ; Head ; Humans ; Nasal Cavity* ; Neck ; Neoplasm Metastasis ; Palate, Soft ; Recurrence ; Sarcoma*

Epithelioid hemangioendothelioma is a rare vascular tumor with intermediate malignity and metastasis risk. It presents epithelioid cells with intracytoplasmic vacuoles and low mitotic activity. Its vascular nature can be confirmed by immunohistochemical studies (vimentin, CD31, CD34, and factor VIII). It is extremely rare in the nasal cavity, with only one case reported on the middle turbinate in Korea. The authors present a case of epithelioid hemangioendothelioma on the choana with a size of 2mm, which easily coult have been misdiagnosed as a blood clot.
Epistaxis ; Epithelioid Cells ; Hemangioendothelioma, Epithelioid* ; Korea ; Nasal Cavity ; Neoplasm Metastasis ; Turbinates ; Vacuoles