Chia-Hsiang Fu

Extensive paranasal sinus mucoceles: a 15-year review of 82 cases

PURPOSE The aim of the study was to report the clinical characteristics, management, and outcome of patients with extensive paranasal sinus mucoceles. MATERIALS AND METHODS In a retrospective study, 82 patients with intracranial or intraorbital extension due to paranasal sinus mucoceles who were surgically treated between 1993 and 2007 were studied. In addition, clinical data, presenting symptoms, clinical features, management, and outcome were analyzed. RESULTS The study population included 42 males and 40 females, with a mean age of 52.7 years (range, 15-87 years). The most common presenting symptoms were ptosis (27/82, 32.9%) and periorbital swelling (24/82, 29.3%). The main radiologic finding on computed tomography scan was bony defect of lamina papyracea and/or medial superior orbital rim. Sixty-six patients underwent endoscopic sinus surgery; among them, 3 patients had recurrence (3/77, 3.9%) during follow-up periods. CONCLUSION In our study, a majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic symptoms before treatment (81/82, 98.8%). Computed tomography scanning was a feasible tool for preoperative assessment. A satisfactory outcome can be achieved after surgical treatment of endoscopic sinus surgery.

The difference in anatomical and invasive characteristics between primary and secondary paranasal sinus mucoceles

Objective To evaluate the difference in anatomical and invasive characteristics of primary and secondary paranasal sinus mucoceles. Study Design A retrospective chart review at a tertiary academic center. Results During a 10-year period, 57 and 109 patients with primary and secondary mucoceles were enrolled, respectively. Thirty-five (61.4%) of primary and 26 (23.9%) of secondary mucoceles had intraorbital extension (IOE), while seven (12.3%) of primary and two (1.8%) of secondary mucoceles had intracranial extension (ICE). In comparison of tendency for IOE or ICE between primary and secondary mucoceles in each sinus, only primary maxillary mucoceles were shown to have a significantly higher probability of IOE than secondary maxillary mucoceles. Among primary mucoceles, ethmoid mucoceles had a significantly greater capability to cause IOE while maxillary mucoceles had the least. Among secondary mucoceles, frontal and ethmoid mucoceles had a greater ability to cause IOE while maxillary mucoceles had the least. As for ICE, sphenoid mucoceles had a greater potential in both groups. Conclusions Primary mucoceles seem to have a greater potential to cause IOE and ICE than secondary mucoceles. In both groups, ethmoid mucoceles have a higher potential of IOE, while sphenoid mucoceles have a greater tendency to cause ICE.

Evaluation of depression and anxiety in empty nose syndrome after surgical treatment

Empty nose syndrome (ENS) is often associated with psychological symptoms. With the absence of psychiatric instruments utilized in the current literature, the assessment of psychological disorder is limited, and the effectiveness of surgical intervention in improving such disorders in ENS are not well understood. The aim of this study was to evaluate the change in depression and anxiety before and after surgical treatment for ENS

Medially originated inverted papilloma.

Objectives: The objective of this study was to determine the characteristics of medially originated inverted papilloma (MOIP) and compare them with laterally originated inverted papilloma (LOIP). Methods: A retrospective review of the charts for a total of 83 patients with sinonasal inverted papilloma (IP) was conducted. Tumors originating from the nasal septum or the turbinates were categorized as MOIP, whereas tumors originating from the four sinuses were categorized as LOIP. Results: Twenty-eight (34%) and 55 (66%) cases were categorized as MOIP and LOIP. MOIP from the middle turbinate behaved more aggressively than LOIP from the ethmoid sinus (P = 0.009), but less aggressively than LOIP from the maxillary medial wall (P < 0.05). Radical procedures were implemented in 14 patients with LOIP, but not in any patients with MOIP (P = 0.002). The recurrence rates were comparable in both groups (P = 0.472). Conclusions: The categorization of IP on the basis of tumor origin enabled a better surgical design and more accurate excision of the tumor. Although in some cases MOIP may behave more aggressively, radical procedures were indicated in only the late Krouse stage LOIP without compromising the recurrence rate.

Extranodal natural killer/T-cell lymphoma, nasal type: Clinical and computed tomography findings in the head and neck region†

In patients with nasal natural killer/T‐cell lymphoma (NKTL), it is commonly without an obvious mass found in the nasal cavity by clinical or computed tomography (CT) findings. As a result, it takes longer to make a definite diagnosis when compared with other nasal malignancy. This study was designed to investigate clinical and CT findings of nasal NKTL.

Nasal nitric oxide in relation to quality-of-life improvements after endoscopic sinus surgery.

Background The level of nasal nitric oxide (nNO) in patients with chronic rhinosinusitis (CRS) has been proven to increase after surgical treatment. The relationship between nNO and treatment outcome has not been documented to date. Objective To evaluate the levels of and changes in nNO after sinus surgery and its effects on quality-of-life improvements for patients with CRS after surgical treatment. Methods By using a clinical cohort study design, we identified patients who were receiving bilateral endoscopic sinus surgery for CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) with a 1-year follow-up. We assessed the demographics, preoperative prognostic predictors, pre- and postoperative nNO levels, and disease-related quality of life via a questionnaire. Results Sixty-nine patients were enrolled, including 53 with CRSwNP and 16 with CRSsNP. The CRSwNP group had lower initial nNO levels and higher endoscopic and image scores but similar demographics and questionnaire scores. In the patients with CRSwNP, nNO levels recovered and reached a plateau at the third month after surgery. However, nNO levels in the CRSsNP group continued to increase until 6 months after surgery before reaching a steady level. Higher preoperative nNO levels were significantly related to better quality-of-life improvements at 3 months after surgery in both groups. Conclusion The nNO levels in patients with CRS increased and reached a plateau after sinus surgery for both groups. Under similar subjective disease severity, the CRSsNP group had higher preoperative nNO levels and maintained a continuously longer rise before reaching a steady level after surgery. For both CRS groups, a higher initial nNO level brought better quality-of-life improvements and could be provided as a preoperative prognostic indicator.

The characteristics and new treatment paradigm of dental implant-related chronic rhinosinusitis.

Background Because dental implantation and sinus augmentation are widely performed in recent years, one of their possible complications, maxillary sinusitis, has become a major concern for both dentists and otolaryngologists. This study evaluates the characteristics of dental implant–related chronic rhinosinusitis (DIrCRS) and the outcome of endoscopic sinus surgery (ESS) for these patients. Methods Eighteen patients diagnosed with DIrCRS from 2007 to 2012 and who were recommended for operation were included. ESS served as the first surgical choice. Dental implants were not routinely removed unless there was severe periimplantitis. All data, including CT and surgical findings, were collected and analyzed. Results All 18 patients had findings of maxillary sinus floor perforation or penetration by dental implants on CT. Fifteen of the 18 patients underwent ESS. Two patients had the dental implants removed before ESS and did not experience recurrence. Four patients had recurrence and the dental implants were removed before revised ESS. They did not experience recurrence again after the revised operation. The other nine patients had their dental implants preserved and did not experience recurrence during follow-up. None of the 15 patients required a Caldwell-Luc operation. Conclusion In patients with DIrCRS, ESS can be used as the first surgical choice with good prognosis and low morbidity. Although most cases of DIrCRS are caused by dental implants penetrating into the maxillary sinus, the dental implants can be preserved unless there is severe periimplantitis or recurrence of sinusitis. Nonetheless, the sinus mucosa above the dental implants must be kept intact during ESS.

Surgical outcome for empty nose syndrome: Impact of implantation site

Endonasal submucosal implantation has been confirmed to be beneficial for patients with empty nose syndrome (ENS). However, the optimal implantation site has not been defined. This study aimed to evaluate whether lateral nasal wall implantation is superior to inferior nasal wall implantation in terms of clinical benefits and improvements in quality of life.

Simvastatin Inhibited the IL-5–Induced Chemotaxis toward Eotaxin and CCR3 Expression of HL-60–Derived Eosinophils

Objectives: IL-5-induced chemotaxis of eosinophils is an important feature for atopic diseases. Lipid lowering agents, statins, have been shown with inhibitory ability for inflammatory process and leukocyte accumulation. We herein investigate their effects on chemotaxis of eosinophils and the possible regulating mechanisms. Methods: Eosinophils were derived by treating HL-60 clone 15 (HC15) with butyric acid in an alkaline condition. The 2 most potent chemokine and cytokine receptors for eosinophils, CC-chemokine receptor-3 (CCR3) and IL-5 receptor (IL5R), were verified on the cell line. Dose effect of IL-5 stimulation for chemotactic ability toward eotaxin and CCR3 presentation was measured. Simvastatin effect for IL-5 induced chemotaxis and these two receptors was analyzed in RNA and protein level. Mevalonate effect for the behaviors of simvastatin was also evaluated. Results: IL-5 in the dosage of 10 ng/mL had the most impressive enhancement on chemotaxis and CCR3 presentation for eosinophils harvested from HC15. Simvastatin inhibited IL-5-induced chemotaxis and CCR3 presentation in both mRNA and protein level but had no effect on IL5R. Mevalonate could reverse those inhibitory effects of simvastatin. Conclusions: Simvastatin inhibited IL-5-induced chemotaxis of HC15-derived eosinophils by repression of CCR3 presentation instead of IL5R. This inhibitory effect of simvastatin acted via mevalonate pathway which could be reversed by mevalonate replacement.

Correlation between Nasal Nitric Oxide and Quality-of-Life Improvements after Sinus Surgery

Objectives: Analyze the correlation between preoperative nasal nitric oxide (nNO) level, its postoperative change, and symptom scores in patients with chronic rhinosinusitis (CRS). Methods: We collected pre- and postoperative 3 and 6 months nNO level for patients who received bilateral endoscopic sinus surgery. They were classified according to existence of nasal polyps (NPs) and allergy test. Subjective symptoms were provided as Sino-Nasal Outcome Test-22 (SNOT-22) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Associated medical parameters were analyzed. Results: Fifty-four patients completed the follow-up, including 16 CRS without NPs (CRSsNPs) and 38 CRS with NPs (CRSwNPs). Allergic patients had higher preoperative nNO level (P = .042), but existence of NPs didn’t make any difference. The nNO level correlated well with computed tomography score (P = .001), endoscopy score (P < .001), and current smoking (P = .038). Baseline nNO correlated with postoperative 3-month improvement in nose blowing (P = .029) and nasal discharge (P = .007) in CRSwNPs. In nonallergic patients, higher baseline nNO had better improvement in olfaction (P = .039) and nasal discharge (P = .035). Postoperative 3 month nNO change had significant correlation with improvement of olfaction only in CRSwNPs (P = .036). The nNO change in postoperative 6 month had no correlation with any individual symptom score change in either group. Conclusions: Baseline nNO was significantly correlated to some of the symptom improvements in CRSwNPs and nonallergic group within 3 months postoperatively. Postoperative 3 month nNO change related to olfaction improvement in CRSwNPs group; however, no significant correlation could be detected in the 6-month period after surgery.