Endoscopic medial maxillectomy (EMM) and its modifications are surgical techniques are used to treat recalcitrant maxillary sinusitis as well as maxillary sinus tumors. In this report, we propose a simple and efficient modification of EMM, called endoscopic trans-turbinal medial maxillectomy (ETTMM), by which the inferior turbinate (IT), nasolacrimal duct, and anatomical integrity of the nasal valve area are preserved. A total of 10 patients (five tumorous and five nontumorous maxillary diseases) underwent ETTMM. Briefly, a turbinate mucosal flap on the superior aspect of the IT was elevated after middle meatal antrostomy. Then a trans-turbinal window was developed to expose the inferior meatus, after which an extended maxillary antrostomy was generated. Finally, the turbinate mucosal flap was repositioned after complete removal of the antral lesions. All lesions were successfully treated using ETTMM. Our modification was easy to perform, and we achieved good endoscopic visualization and accessibility throughout the whole antrum by creating a trans-turbinal window and extended maxillary antrostomy. We could perform postoperative surveillance easily through the wide antrostomy using rigid endoscopes of various angles. ETTMM is a simple and useful modification of EMM that provides clear visualization and great accessibility to most aspects of the maxillary antrum while preserving the nasal functional units, including the IT and nasal valve area.

Inverted papilloma is a rare sinonasal tumor that mainly occurs in adults during the 5th decade. Three characteristics make this tumor very different from other sinonasal tumors: a relatively strong potential for local destruction, high rate of recurrence, and a risk of carcinomatous evolution. Etiology remains little understood, but an association with human papilloma virus has been reported in up to 40% of cases, raising the suspicions of implication in the pathogenesis of inverted papilloma. Treatment of choice is surgery, by endonasal endoscopic or external approach, depending on extension and tumoral characteristics. We experienced a case of 42-year-old male with inverted papilloma which originated from the ethmoid roof and spread into the frontal sinus. He was treated successfully by unilateral osteoplastic flap surgery without obliteration, and we report on the treatment of this case, along with a review of literature.
Adult ; Frontal Sinus* ; Humans ; Male ; Papilloma, Inverted* ; Papillomaviridae ; Recurrence ; Surgical Procedures, Operative

Small cell carcinoma commonly originates in the lung, with only about 4% of cases arising at extrapulmonary sites. Furthermore, small cell carcinoma of the sinonasal tract is extremely rare. In Korea, only 2 cases of primary sinonasal small cell carcinoma have been reported in the nasal cavity and the nasal septum, respectively. Recently, we have experienced a rare case of small cell carcinoma arising from the right maxillary sinus coexisting with a fungal ball lesion. Herein, we report this case with a review of the literature.
Aspergillosis ; Carcinoma, Small Cell* ; Fungi* ; Korea ; Lung ; Maxillary Sinus* ; Nasal Cavity ; Nasal Septum

Epistaxis is a common disease encountrered in Otorhinolaryngology; however, life-threatening epistaxis during pregnancy is rare, and there are no specific guidelines regarding the management of such patients. We encountered a 38-year-old female patient in the second trimester of her pregnancy, who presented with nosebleeds. No definite focus of bleeding was identified by nasal endoscopy, thus several conservative measures were used to stop nosebleeds including bed rest with head elevation, ice pack application, and nasal packing. Despite such treatments, nosebleeding continued. Endoscopic sphenopalatine artery ligation was conducted under general anesthesia and the results were successful. In obstetric assessment, there was no evidence of fetal distress. The patient delivered a healthy baby at 40 weeks, and there was no recurrence of epistaxis through postoperative 18 months.
Adult ; Anesthesia, General ; Arteries* ; Bed Rest ; Endoscopy ; Epistaxis* ; Female ; Fetal Distress ; Head ; Hemorrhage ; Humans ; Ice ; Ligation* ; Otolaryngology ; Pregnancy Trimester, Second ; Pregnancy* ; Recurrence

BACKGROUND AND OBJECTIVES: Most cases of epistaxis can be controlled by conservative management such electrocautery or nasal packing. However, for some cases of the posterior epistaxis, invasive procedures like endoscopic sphenopalatine artery ligation (SPAL) or arterial embolization are needed. In this study, risk factors present in patients who were hospitalized due to posterior epistaxis and postoperative complications and causes of recurrence after SPAL were analyzed. SUBJECTS AND METHOD: A retrospective chart review of 75 patients who were admitted to Gyeongsang National University Hospital for the treatment of posterior epistaxis between 2009 and 2014 was performed. Demographic factors, seasonal variation, comorbid diseases, and laboratory results were analyzed. Furthermore, 35 patients who have undergone SPAL were surveyed by telephone regarding postoperative complications, and preoperative computerized tomography (CT) images were reviewed to figure out the causes of the recurrence after SPAL. RESULTS: Among 75 patients, 53 (70.7%) were males. Male preponderance (80%) was more definite among those who have undergone SPAL (p=0.04). Age over 40 as well as the winter season and the underlying disease such as hypertension were also critical risk factors for posterior epistaxis. Four out of 35 patients who had undergone SPAL showed recurrence. The bleeding was detected in the branches of sphenopalatine artery in three out of the four patients who experienced recurrent bleeding following SPAL, which were controlled by revision surgery or arterial embolization. CONCLUSION: Posterior epistaxis occurred frequently in men over 40 years of age and in winter. A careful preoperative review of CT images and meticulous dissection during SPAL might be helpful for preventing recurrence after SPAL.
Arteries* ; Demography ; Electrocoagulation ; Epistaxis* ; Hemorrhage ; Humans ; Hypertension ; Ligation* ; Male ; Methods ; Postoperative Complications ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Seasons ; Telephone

Systemic corticosteroids currently represent the most effective treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), but their long-term use is constrained due to their detrimental side effects. Until recently, development of novel drugs for CRSwNP has been difficult partly due to the absence of a standard animal model of CRSwNP. Exotoxins of Staphylococcus aureus such as staphylococcal enterotoxin B (SEB), are well-known superantigens which can induce a strong immune response; there have been many studies on the association of staphylococcal enterotoxins and development of CRSwNP over the past two decades. Based on previous studies, we invented a mouse model of CRSwNP using SEB. Herein, we explain the protocol development for the mouse model, as well as identify histological and immunological similarities between this mouse model and humans. Furthermore, we describe a study that analyzed the risk factors for CRSwNP such as smoking, and also elaborate on a series of studies that searched for new potential drugs for CRSwNP, including resveratrol, anti-periostin antibody, topical hypoxia-inducible factors, and topical cyclosporine. Based on preceding studies, we have concluded that this mouse model might be a useful tool to investigate the pathophysiology and development of novel drugs for CRSwNP.
Adrenal Cortex Hormones ; Animals ; Cyclosporine ; Enterotoxins ; Exotoxins ; Humans ; Mice* ; Models, Animal ; Nasal Polyps* ; Risk Factors ; Smoke ; Smoking ; Staphylococcus aureus ; Superantigens

A 56-year-old male was admitted with an acute headache and sudden ptosis on the right side. No ophthalmological or neurological etiologies were apparent. A mucocele of the right posterior ethmoid sinus was observed with radiology. After the marsupialization of the mucocele via a transnasal endoscopic approach, the patient's symptoms (oculomotor nerve paralysis and headache) resolved in 4 weeks. Oculomotor paralysis is a rare symptom of an ethmoidal mucocele. In this article, we report this rare case along with a literature review.
Blepharoptosis ; Ethmoid Sinus ; Headache ; Humans ; Male ; Mucocele ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Ophthalmoplegia ; Paralysis

OBJECTIVES: Postoperative wound healing status has not been considered in earlier studies on olfactory changes after surgery. This may be a factor accounting for the equivocal postoperative olfactory results. The aim of this study was to investigate postoperative olfactory results according to wound healing status. METHODS: Fifty patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps with smelling disturbance were examined preoperatively, and at 6 months after surgery. Patients were divided into two groups according to postoperative Lund-Kennedy score: favorable and unfavorable wound healing. Preoperative ostiomeatal unit computed tomography (CT), such as Lund-Mackay score and olfactory cleft opacification score, clinical characteristics and olfactory function tests such as the butanol threshold test and cross-cultural smell identification test, and questionnaire responses were compared between the two groups. RESULTS: There were no differences in preoperative clinical characteristics between the favorable and unfavorable wound healing groups. The favorable wound healing group displayed greater improvement of olfactory results after surgery than the unfavorable wound healing group. Postoperative olfactory improvement patterns showed a hierarchy from subjective to objective improvement and from threshold to identification improvement. Patients who had postoperative favorable wound healing but showed no success of olfaction were characterized by more severe preoperative subjective symptoms and higher olfactory cleft opacification, especially in the upper part of olfactory cleft on preoperative CT scan. CONCLUSION: Wound healing status is an apparent risk factor for postoperative olfactory improvement. Moreover, preoperative opacification in the olfactory cleft may predict bad olfactory results after surgery, even in patients with favorable wound healing.
Accounting ; Humans ; Nasal Polyps ; Risk Factors ; Smell ; Wound Healing ; Surveys and Questionnaires

PURPOSE: Radiotherapy for head and neck cancer does not impair the voice quality as much as laser treatment or surgery, but it can induce muscle wasting and fibrosis and symptoms of dry mouth. We investigated the effect of irradiation on the myosin heavy chain (MyHC) expression in laryngeal muscles. MATERIALS AND METHODS: Rats were irradiated with one dose of 10, 15, 20, 25, 30, or 35 Gy and other rats were irradiated with 20 Gy. The thyroarytenoid (TA), posterior cricoarytenoid (PCA), and cricothyroid (CT) muscles were subjected to reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Two weeks after irradiation with 10, 15, or 20 Gy, all the MyHC type expressions had decreased in a dose-dependent manner in the TA, PCA, and CT muscles, and especially the expression of MyHC IIa decreased much more than the expressions of the other MyHC isoforms in all muscles. In the 20 Gy-irradiated rats, almost all the MyHC isoform expressions declined over 12 weeks in the TA, PCA, and CT muscles, except for the MyHC I expression in the PCA and CT muscle. The MyHC IIa expression was markedly decreased in all the muscles. CONCLUSION: The laryngeal muscles responded differently to radiation, but they showed a time-dependent and long-lasting decrease in the expressions of all the MyHC isoforms in the TA, PCA, and CT muscles. In particular, the expression of the MyHC IIa isoform in all the muscles may be more sensitive to irradiation than the expressions of the other MyHC isoforms.
Animals ; Body Weight/radiation effects ; Gene Expression/radiation effects ; Laryngeal Muscles/*metabolism/*radiation effects ; Myosin Heavy Chains/*metabolism ; Protein Isoforms/*metabolism ; Rats ; Rats, Sprague-Dawley ; Reverse Transcriptase Polymerase Chain Reaction

The expanded endonasal approach (EEA) to the ventral skull base provides endoscopic access from the frontal sinus to the second cervical vertebra. Potential advantages of the EEA include not only improved cosmesis but more importantly, the potential for reduced neurovascular manipulation. EEA is based on the principle of extracapsular dissection with full visualization of important neurovascular structures. There are significant risks of neural and vascular injury associated with EEA, and the reconstruction of dural defects is challenging. Experienced teams including rhinologists and neurosurgeons are needed for successful implementation of EEA. The surgical team must have adequate endoscopic skills to achieve hemostasis and address vascular emergencies. Advantages of having a skilled second surgeon to provide endoscopic visualization include dynamic adjustments of the endoscope to ensure the best view and avoid contact interference of instruments, second surgical opinions in complex anatomical areas, and maintenance of endoscopic views in cases of crisis such as vascular injury. Complications of the EEA such as neurovascular injury, cerebrospinal fluid leaks and infection are the same as those of open approaches. With the advent of the nasoseptal flap, problematic cases involving huge bony defects subsequent to the resection of skull base tumors have been greatly resolved.
Dietary Sucrose ; Emergencies ; Endoscopes ; Frontal Sinus ; Hemostasis ; Reconstructive Surgical Procedures ; Sella Turcica ; Skull Base ; Spine ; Surgical Flaps ; Vascular System Injuries