Myeong Sang Yu

Human papillomavirus and p16 detection in cervical lymph node metastases from an unknown primary tumor

OBJECTIVES Human papillomavirus (HPV), a causative agent of oropharyngeal squamous cell carcinoma (SCC), may be detected in metastatic cervical lymph nodes (MCNs). We investigated whether HPV and p16 expression in MCNs can help identify oropharyngeal primaries in patients with cervical lymph node metastases from an unknown primary tumor (CUP) and predict their survival outcomes. MATERIALS AND METHODS SCC MCNs of 58 patients with CUP were assayed for HPV by in situ hybridization and for p16 and p53 expression by immunohistochemistry. The presence of HPV and p16 in MCN was correlated with oropharyngeal tumor location and prognosis. RESULTS Oropharyngeal primaries were found in 20 patients. The sensitivity and negative predictive value (NPV) of HPV for oropharyngeal localization were 90.0% and 92.6%, respectively, and the sensitivity and NPV of p16 were 80.0% and 86.2%, respectively. Multivariate analyses showed that the location of the largest MCN (P=0.035) and HPV (P=0.004) were independent predictors of oropharyngeal tumors. Multivariate analyses showed that p16 expression was an independent predictor of disease-free survival (P=0.030; hazard ratio (HR)=0.286; 95% CI, 0.092-0.887) and that p53 expression (P=0.017; HR=3.154, 95% CI=1.288-8.103) and extracapsular extension of MCN (P=0.010; HR=3.924, 95% CI=1.387-11.097) were independent predictors of overall survival. CONCLUSION Detection of HPV and p16 may help identify hidden oropharyngeal primaries in CUP patients and predict their survival outcomes.

Effect of aerosolized fibrin sealant on hemostasis and wound healing after endoscopic sinus surgery: a prospective randomized study.

Background The purpose of this study was to investigate the effect of aerosolized fibrin sealant (FS) compared with that of polyvinyl acetal sponge packing on hemostasis and wound healing after functional endoscopic sinus surgery (FESS). Methods We conducted a prospective randomized controlled trial of the use of aerosolized FS in 41 consecutive patients who underwent bilateral FESS between February 2011 and March 2012. The patients were randomized to receive FS applied via an aerosol spray in one nasal cavity and polyvinyl acetal sponge packing in the opposite cavity. The patients were followed up at 1, 2, 4, 8, and 12 weeks postoperatively. Crusting, adhesion, bleeding, granulation tissue formation, infection, and frontal sinus ostium stenosis after endoscopic surgery were assessed using a grading scale. Subjective symptoms related to nasal packing were evaluated using questionnaires quantified by visual analog scales. Results The degree of granulation and crusting was significantly reduced in the side treated with FS compared with the polyvinyl acetal sponge side, as were bleeding and pain during nasal packing removal (p < 0.05). In addition, general satisfaction and willingness to reuse the material were significantly higher for the FS-treated side than for the polyvinyl acetal sponge-packed side (p < 0.001). Conclusions Compared with polyvinyl acetal sponge, aerosolized FS shows beneficial effects on hemostasis and wound healing after FESS. The application of FS resulted in a high degree of patient satisfaction without additional morbidity.

Histomorphological Changes of Tutoplast-Processed Fascia Lata Grafts in a Rabbit Rhinoplasty Model

Objectives Tutoplast-processed fascia lata (TPFL) is a commercially available homograft that has been successfully used as graft tissue for rhinoplasty. The present study evaluates the histomorphological changes of TPFL in a rabbit rhinoplasty model. Study Design Prospective study using a rabbit model. Setting Animal laboratory of the Asan Medical Center. Subjects and Methods The study used 15 New Zealand White rabbits. Each rabbit was implanted with a TPFL (experimental group) and autologous fascia lata (control group) graft of equal size into the nasal dorsum. Rabbits were killed at 1, 3, and 6 months, and the grafts were removed and microscopically assessed for fibroblast proliferation, neovascularization, inflammation, and thickness. Results For TPFL grafts, the degree of inflammation significantly decreased between 1 and 3 months (P = .041). The degree of fibroblast proliferation continually increased over time. There was a mild degree of neovascularization for the TPFL graft at 1 month. The degree of neovascularization increased between 3 and 6 months (P = .041). For the degree of inflammation, fibroblast proliferation, and neovascularization, there was no significant difference between TPFL and autologous fascia lata at 6 months. Mean thickness analysis showed that there was no significant thickness reduction in both TPFL and autologous fascia lata grafts at 6 months. Conclusion The TPFL grafts showed negligible resorption rates and favorable tissue reactions in the rabbit rhinoplasty model.

An animal model of obstructive sleep apnea in rabbit

An animal model of obstructive sleep apnea (OSA) may help to investigate the pathophysiology of this disorder and develop appropriate treatments. We investigated the feasibility of a rabbit model of OSA.

Preoperative Computer Simulation for Asian Rhinoplasty Patients: Analysis of Accuracy and Patient Preference

BACKGROUND Preoperative computer simulation (PCS) is a tool for demonstrating potential rhinoplasty results to patients and determining the patients preferred external nasal appearance. OBJECTIVES The authors evaluated the effectiveness of PCS in Asian rhinoplasty patients. METHODS The records of 224 patients who underwent rhinoplasty were reviewed. Sixty-eight (30.4%) of these patients had received PCS. To evaluate the accuracy of PCS in predicting postoperative results, postoperative photographs and PCS images were graded on a 4-point scale by a panel of 3 otolaryngologists. Postoperative patient satisfaction was compared between the PCS and non-PCS groups. Aesthetic parameters were assessed in the PCS images to determine the patients preferred external nasal appearance. RESULTS The mean overall accuracy of PCS was 86.0% according to the otolaryngologist panels ratings: 41.2% of the surgical results were rated as identical, 44.1% as similar, 13.2% as approximate, and 1.5% as poor. There were no significant differences between the PCS and non-PCS groups in terms of patient satisfaction or revision rates (P > .05). The most favored nasal appearances were straight dorsum (63.2%), straight columella (50.0%), and convergent alar axis (64.7%). The mean (± standard deviation) preferred nasofrontal and nasolabial angles were 137.5° ± 6.9° and 97.3° ± 8.6°, respectively. CONCLUSIONS Preoperative computer simulation is an accurate tool for assessing preferred external nasal appearance and can be a reliable predictor of postoperative rhinoplasty results in Asian patients. LEVEL OF EVIDENCE 3.

Feasibility of septal body volume reduction for patients with nasal obstruction.

Septal body hypertrophy, like inferior turbinate hypertrophy, can result in changes to the nasal cross‐sectional area and resistance to airflow. The aim of this study is to evaluate the efficacy of septal body volume reduction (SBVR) for the treatment of septal body hypertrophy in patients with nasal obstruction.

Combined use of scoring incisions and 2-octylcyanoacrylate adhesive during endonasal septoplasty to correct cartilaginous deviations.

Background Applying 2-octylcyanoacrylate (2-OCA) tissue adhesive onto scoring incisions may increase efficacy and prevent concavity recurrence after septal deviation treatment. The present study evaluates the utility of 2-OCA adhesive application during endonasal septoplasty. Methods The postoperative outcomes were compared between two consecutive periods in a single surgical department. Between March 2011 and March 2012, 23 consecutive patients underwent septoplasty using scoring incisions without 2-OCA application (scoring alone group), and between April 2012 and April 2013, the scoring incision gaps were filled with 2-OCA in 27 patients (scoring + CA group). The patients were followed up for more than six months. Results A straight septum was achieved in 37.0% of patients in the scoring alone group versus 58.3% in the scoring + CA group. The postoperative symptom score for nasal obstruction was significantly improved in both groups. Persistent septal swelling developed in three (12.5%) patients in the scoring + CA group. Neither group experienced major complications such as septal hematoma, abscess, or septal perforation. Conclusions Application of 2-OCA adhesive onto scoring incisions appears to be a reliable and effective technique to correct deviated cartilage during endonasal septoplasty. However, the volume of 2-OCA applied onto the septum should be minimized to avoid potential foreign body reaction. A long-term follow-up study is warranted.

Squamous cell carcinoma associated with inverted papilloma of the maxillary sinus: our experience with 21 patients

RG.2.1.1205.5761 9 Hogsbro M., Agger A. & Johansen L.V. (2015) Bone-anchored hearing implant surgery: randomized trial of dermatome versus linear incision without soft tissue reduction-clinical measures.Otol. Neurotol. 36, 805–811 10 Mowinckel M.S., Moller M.N., Wielandt K.N. et al. (2016) Clinical outcome of a wide-diameter bone-anchored hearing implant and a surgical technique with tissue preservation. Otol. Neurotol. 37, 374–379 11 van de Berg R., Stokroos R.J., Hof J.R. et al. (2010) Bone-anchored hearing aid: a comparison of surgical techniques.Otol. Neurotol. 31, 129–135 12 Hultcrantz M. (2011) Outcome of the bone-anchored hearing aid procedure without skin thinning: a prospective clinical trial. Otol. Neurotol. 32, 1134–1139

Radiofrequency turbinoplasty for nonallergic rhinitis in geriatric patients.

Background and Objective Radiofrequency (RF) turbinoplasty may be effective in treating nonallergic rhinitis in elderly patients. The present study evaluated the efficacy of nasal turbinate surgery with RF for the treatment of nonallergic rhinitis in elderly patients refractory to medical therapy. Methods A total of 35 consecutive patients older than 65 years of age (mean subject age, 75.5 ± 9.6 [standard deviation] years) with nonallergic rhinitis refractory to medical therapy who underwent RF turbinate surgery were enrolled in this study. The efficacy of RF turbinoplasty in treating nonallergic rhinitis in elderly patients was evaluated by using rhinoscopy and a visual analog scale score of nasal symptoms. Results The response rate of primary RF turbinate surgery for nonallergic rhinitis refractory to medical therapy was 68.6%. Postoperative symptom scores for rhinorrhea and nasal obstruction were significantly improved. Persistent crust formation developed in seven patients (20.0%). No patient experienced major complications (e.g., septal hematoma, abscess, septal perforation), but partial bone necrosis was observed in one patient. Conclusion RF turbinoplasty appeared to be effective for treating some nonallergic rhinitis symptoms in elderly patients, including rhinorrhea and nasal obstruction. These preliminary results are encouraging and warrant further investigation.

Management and Outcomes of Chronic Otitis Media in Patients Who Received Solid Organ Transplantation

Objectives. Control of perioperative infection can increase the success rate of organ transplant. The incidence, clinical features, and optimal management of chronic otitis media (COM) in solid organ transplant recipients have not been adequately evaluated. We therefore assessed the incidence and clinical course of COM in solid-organ transplant recipients. Design. Case series with chart review. Setting. Tertiary referral center. Subjects and Methods. We reviewed the medical records of 3278 patients who underwent solid organ transplantations between February 1995 and December 2007 to identify those diagnosed with COM before and after transplant. We analyzed the long-term clinical course and management of COM in these patients. Results. Of 3278 solid organ transplant recipients, 65 (2.0%) were diagnosed with pretransplant COM with a perforated ear drum, including 31 liver, 28 renal, and 6 heart transplant recipients. The primary symptom was otorrhea, followed by hearing disturbance, otalgia, and tinnitus. Middle ear swab culture showed bacterial growth in 17 of the 40 patients (42.5%) with suppurative COM. Of these 40 patients, 14 underwent tympanomastoid surgery (operation group) and 26 were prescribed antibiotics (medication group). The remaining 25 patients, with dry perforated ear drums and well-pneumatized mastoids, were observed without treatment (observation group). After transplantation, the incidence of otorrhea was significantly lower in the operation group (11.1%) than in either the medication (26.9%) or observation (26.7%) group (P = .040, .048, respectively). Conclusions. Precise diagnosis and proper surgical intervention for COM may reduce the rate of otorrhea and exacerbation of COM in solid organ transplant recipients.