Hyo Yeol Kim

Histopathologic characteristics of chronic sinusitis with bronchial asthma.

Conclusion These findings suggest that patients with both sinusitis and asthma present the histopathologic characteristic of a marked chronic inflammatory reaction, and that eosinophil infiltration may play a significant role in this marked inflammation of the sinus mucosa. Objective Chronic sinusitis and bronchial asthma are known to be closely related. However, the appearance of the mucosa in chronic sinusitis patients with asthma is somewhat different from that in patients without asthma. Material and methods We compared the sinus mucosal histopathologies of asthmatic patients with those of non-asthmatic patients. Fifty-three sinusitis patients with a diagnosis of asthma and 54 sinusitis patients without asthma, who served as controls, were enrolled in the study. All of these patients underwent endoscopic sinus surgery. The following seven light microscopic findings were compared in the asthmatic and non-asthmatic groups: the thickness of the basement membrane, goblet cell hyperplasia, subepithelial edema, submucous gland formation, eosinophil infiltration, lymphocyte infiltration and polymorphonuclear leukocyte infiltration. In addition, we explored a possible link between asthma and sinusitis by comparing the following factors in asthmatic and non-asthmatic patients: the presence of allergy, the degree of preoperative polyposis and the extent of preoperative disease as scored by means of ostiomeatal unit CT findings. Results No statistically significant differences were found between the two groups in terms of the presence of allergy, the degree of preoperative polyposis or the extent of preoperative disease. Basement membrane thickening, goblet cell hyperplasia and eosinophil infiltration were more prominent in the asthmatic compared to the non-asthmatic group (p<0.05).

Challenging reconstructive techniques for skull base defect following endoscopic endonasal approaches

ObjectiveWe assessed the outcomes of various reconstructive methods for skull base defect after endoscopic endonasal approaches (EEA) depending on the degree of intraoperative cerebrospinal fluid (CSF) leaks.MethodsBetween Jan. 2008 and Sep. 2009, 122 consecutive patients underwent 124 EEA for sellar and extra-sellar lesions. Intraoperative CSF leaks were classified as grade 0, no intraoperative CSF leak; grade 1, low output; and grade 2, high-output based on the degree of CSF leakage and size of opening in the arachnoid membrane (<5 or ≥5xa0mm).ResultsPostoperative CSF leaks or meningitis occurred in 13 of 124 cases (10.5%). In 77 patients with grade 0, there was no postoperative CSF leak. Among 20 patients with grade 1 CSF leaks, four patients developed meningitis or postoperative CSF leak. Postoperative CSF leaks occurred in nine of 26 patients (34.6%) with grade 2 leaks. Comparison of reconstructive methods revealed that gasket-seal method provided better control of CSF leaks than free-fat graft in patients with grade 2 leaks (11.8% vs. 66.7%, pu2009=u20090.028). However, in grades 0 and 1, we found no difference among the various reconstructive methods.ConclusionThe selection of reconstructive methods for skull base defects should be determined by the degree of CSF leaks. Although grade 0 or 1 leak requires relatively conservative management such as simple closure or free-tissue grafting, a more aggressive reconstructive technique is required to prevent postoperative complication in grade 2 CSF leak.

Prevalence of lower airway diseases in patients with chronic rhinosinusitis.

Conclusion. There is high prevalence of lower airway diseases in patients with chronic rhinosinusitis and frequently co-existing lower airway diseases have not been diagnosed before. Objectives. To examine the prevalence of lower airway diseases in patients with chronic rhinosinusitis. Methods. Seventy-three consecutive patients with chronic rhinosinusitis were enrolled in this prospective study. With routine physical examination, spirometry and methacholine bronchial provocation test were performed and chest simple radiograph or chest computed tomography was taken. Results. Thirty patients (41.1%) had lower airway diseases. There were 8 patients with asthma, 5 with asymptomatic bronchial hyperresponsiveness, 11 with small airway disease, 2 with chronic obstructive pulmonary disease and 4 with bronchiectasis. Of these 30 patients, 21 patients (70.0%) were first diagnosed as having lower airway diseases in this study.

Computed tomography anatomy of the anterior ethmoid canal.

The roof of the anterior ethmoid swings up anteriorly from its more or less horizontal course at the point where the anterior ethmoid canal (AEC) is situated. The AEC is an important structure in endoscopic sinus surgery since its injury results in bleeding into the nasal cavity and may result in intraorbital bleeding. We therefore investigated the location of this canal and the anatomic characteristics of the area surrounding the canal using coronal computed tomography (CT) of the paranasal sinuses. One hundred sides of 50 paranasal coronal CT images in patients with sinusitis were analyzed to assess the location of the AEC, the shape of the superolateral wall of the ethmoid sinus anterior and posterior to the AEC, and pneumatization of the roof of the anterior ethmoid sinus. The AEC is situated in the second quarter of the roof of the ethmoid sinus. The superolateral wall anterior to the AEC demonstrated an acute angle in 99% of sides, while the superolateral wall posterior to the AEC showed an obtuse angle in 87% of sides. The ethmoid cell anterior to the AEC pneumatized posteriorly over the AEC in 26% of sides. We conclude that coronal CT confirmation of the anatomic characteristics of the AEC, and the area surrounding the canal, is invaluable for preoperative planning for endoscopic sinus surgery.

Olfactory outcomes after endoscopic pituitary surgery with nasoseptal "rescue" flaps: electrocautery versus cold knife.

Background Olfaction has been shown to have a large impact on patients’ lives. Endoscopic pituitary surgery is associated with potentially significant damage to olfactory tissues. The objective of this study was to determine the effect of cauterization on olfactory function when performing endoscopic pituitary surgery with a nasoseptal “rescue” flap. Methods A retrospective review was performed of prospectively collected data. Olfaction was the primary outcome and was measured using the subjective visual analog scale (VAS; 0-100) and Cross-Cultural Smell Identification Test (CC-SIT) before and 3 months after surgery. Significant olfactory deficit was defined as >20% loss compared with preoperative functions. Patients who underwent an endoscopic transsphenoidal approach with NSRFs for pituitary adenoma from June 2012 to March 2013 were included. Included patients were divided into two groups; group 1 underwent rescue flaps raised by monopolar cautery and group 2 underwent rescue flaps by cold knife. Results Forty-nine patients were included in this study. There were 19 patients in group 1 and 30 patients in group 2. There was no significant difference in subjective olfactory change between the two groups (p = 0.386; group 1, 13.68 ± 17.7, versus group 2, 6.83 ± 8.25). However, 5 of 19 patients (26.3%) had significant olfactory loss in group 1 and 1 of 30 (3.3%) in group 2. This difference was statistically significant (p = 0.027). None of the patients showed a significant decrease in CC-SIT score. Conclusion Raising the rescue flap by cold knife could reduce the rate of hyposmia compared with using an electrocautery postoperatively.

The effect of anatomically directed topical steroid drops on frontal recess patency after endoscopic sinus surgery: a prospective randomized single blind study.

Background The failure rate for frontal sinusotomy is higher than that of overall endoscopic sinus surgery (ESS). To prevent frontal sinus obstruction, systemic or topical steroids are commonly used, but systemic steroid therapy can cause significant morbidity and topical sprays can not be distributed to the frontal ostium. This study was designed to determine the efficacy of anatomically directed topical steroid drops in reducing frontal ostium stenosis compared with topical steroid sprays after ESS. Methods A prospective, randomized, single-blind study was conducted in 43 patients (77 nasal cavities) who had undergone ESS, including frontal sinusotomy. Twenty-one patients (39 nasal cavities) used steroid drops applied with the Mygind technique, and 22 patient 8 nasal cavities) used steroid sprays for 8 weeks postoperatively. The patency of the frontal ostium was evaluated endoscopically 3 months postoperatively. Results The study included 29 men and 14 women (mean age, 48.2 years; range, 19–62 years). Endoscopic scores in terms of polypoid change, edema, and scar in the middle meatus and frontal recess were not significantly different between the groups, although the drop group showed a tendency to superior scores when compared with the spray group (p > 0.05). The frontal sinus patency of the drop group was significantly higher than of the spray group (p < 0.05). Conclusion Topical steroid drops using the Mygind technique led to a 16% improvement in frontal sinus patency rates in 3 month after ESS in this study compared with postoperative topical steroid use.

Histologic changes to olfactory epithelium in hypothyroid rats.

OBJECTIVEnThe purpose of this study was to immunohistochemically evaluate the effects of thyroid hormones on the olfactory epithelium (OE) in adult rats. Study design and setting Hypothyroidism was induced in rats by propylthiouracil (PTU) administration. Animals were grouped into 5 consisting of a control group, and 4 groups that had been treated with PTU for 3, 6, 9, or 12 weeks, respectively. The thickness and cell densities of the OE were examined according to the duration of PTU treatment. Changes to OE cell properties were investigated with immunohistochemical stains.nnnRESULTSnNo statistically significant differences were found in the thickness and cell densities of the OE among the 5 groups. The number of olfactory receptor neurons positive for neuron-specific enolase or protein gene product 9.5, however, decreased with increasing duration of PTU treatment.nnnCONCLUSIONnThyroid hormones play an important role in the maturation of olfactory receptor neurons.

Evaluation of inferior turbinate outfracture outcomes using computed tomography.

BACKGROUNDnOutfracture of the inferior turbinate (IT) presents numerous advantages, but it is generally believed that the lateralized IT will resume its original position. The purpose of this study was to evaluate the outcome of IT outfracture objectively using computed tomography (CT).nnnMETHODOLOGYnFifteen patients who underwent bilateral IT outfracture for the removal of pituitary adenomas by the endonasal approach were enrolled. The angles between the lateral wall of the nasal cavity (NC) and IT on both sides were measured from CT scans before and at least 6 months after operation. In addition, we evaluated the effects of variables including age, thickness of IT attachment site and width of the nasal floor, on the angles.nnnRESULTSnRegardless of the side where a Hardy retractor was placed, the angle between the lateral wall of the NC and IT decreased significantly within 6 months after the outfracture compared to preoperative values on both sides. Other variables showed no significant correlations with the angle between the IT and the lateral wall of the NC.nnnCONCLUSIONnThe outfracture procedure effectively lateralized the IT and it maintained that position for at least 6 months after the operation.

Modified mattress suturing technique for correcting the septal high dorsal deviation around the keystone area.

Background High dorsal deflection of the nasal septum around the bony–cartilaginous junction (“keystone area”) is often missed and difficult to treat because of the importance of septal support. This study introduces a new technique of septoplasty to correct this dorsal deviation. Methods Forty-two patients with severe dorsal septal deviation around the bony–cartilaginous junction were included in the study. The surgical process was as follows: after elevation of mucoperichondrial flap, deflected bony septum and surplus cartilage were removed. Then, partial thickness scorings were performed on the concave side of the deviated cartilaginous septum. For correcting the dorsal deviation around bony–cartilaginous junction, greenstick fracture and two suture holes were made at higher bony septum. Modified mattress suture was performed across the deflected bony–cartilaginous junction while pushing the deviated septum to the midline gently. Subjective and objective improvements were evaluated with questionnaires and acoustic rhinometry at least 3 months after the surgery. Results Significant improvements in nasal obstruction (4.61-2.42) and discomfort (1.82-1.39) were achieved. On acoustic rhinometry, cross-sectional area (CSA1; 0.41 ± 0.18 to 0.64 ± 0.22 cm2) and CSA2 (0.83 ± 0.37 to 1.39 ± 0.36 cm2) at the narrower sides showed significant improvements and the ratio of the wider to narrower sides in CSA1 (2.61 ± 1.91 to 1.47 ± 0.61) and CSA2 (2.07 ± 1.51 to 1.33 ± 0.40) showed significant improvements. Conclusion The proposed “modified mattress suture technique” provides positive initial results for correction of the high dorsal deviation of septum around the bony–cartilaginous junction.

Extraocular muscle injury during endoscopic sinus surgery: a series of 10 cases at a single center.

BACKGROUNDnExtraocular muscle (EOM) injury is a rare but serious complication of endoscopic sinus surgery (ESS). The aim of this study is to describe the clinical characteristics and course of EOM injury occurring during ESS.nnnDESIGNnRetrospective case series.nnnMETHODSnMedical records and CT images of patients who suffered from EOM injury after ESS between 2006 and 2012 were retrospectively reviewed. Patient demographics, endoscopic anatomy, type of surgery (primary or revision), predisposing risk factors, site and extent of injury on CT imaging, and associated complications were evaluated. In addition, data regarding ophthalmologic management and clinical outcomes were collected.nnnRESULTSnTen patients with EOM injuries after ESS were included in this study. One patient was undergoing revision ESS. All patients sustained medial rectus muscle injury and one patient suffered concurrent ipsilateral inferior rectus muscle injury. A microdebrider was used in nine cases. Right-sided injury (90% of patients) was more prevalent than left-sided injury, and 70% of injured medial rectus muscles were completely transected. After subsequent strabismus surgery, 8/9 patients regained binocular single vision in primary gaze despite residual diplopia in some gaze positions.nnnCONCLUSIONnAlthough proper ophthalmologic surgery after EOM injury may improve deviation in the primary gaze position, none of the patients regained normal EOM movement. Therefore, prevention of this complication through adequate surgical technique and precautions is important.