Po-Hung Chang

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.

Desmoglein 3 is overexpressed in inverted papilloma and squamous cell carcinoma of sinonasal cavity.

We sought to investigate the role of desmoglein 3 in pathogenesis of sinonasal inverted papilloma (IP) and its malignant transformation.

Characteristics of isolated sphenoid sinus aspergilloma: report of twelve cases and literature review.

Objectives: Isolated sphenoid sinus aspergilloma (ISSA) is a form of fungal sinus infection that is distinct from allergic fungal sinusitis, invasive fungal disease, and Aspergillus granulomas. In this study, we identify the characteristics of patients with ISSA to achieve timelier intervention for this easily neglected disease. Methods: In a retrospective study of patients with ISSA in our institution (1995 to 2006), 12 were identified. Results: Sixty-seven percent of our patients were more than 50 years of age, and a female preponderance was noted. Headache and postnasal drip were the two most common symptoms, and the samples from 78% of our patients with postnasal drip were blood-tinged. Computed tomographic scanning provided a sensitivity of 64%, whereas endoscopic examination failed to identify abnormalities in any patients. Conclusions: Four characteristics were identified in the diagnosis of ISSA: Female; usually above 50 years of age; with postnasal drip (especially blood-tinged); and headache (particularly periorbital or retro-orbital).

Non–sinusitis-related rhinogenous headache: a ten-year experience

PURPOSE This study aimed to investigate the role of anatomical abnormalities in non-sinusitis-related rhinogenous headache and to evaluate response to surgery. MATERIALS AND METHODS Between January 1995 and December 2004, 71 patients were diagnosed with non-sinusitis-related rhinogenous headache preoperatively and treated with endoscopic sinus surgery and/or septoplasty if other underlying diseases could be ruled out and if long-term medical treatment failed. Data from this group were analyzed retrospectively. RESULTS Multiple sinonasal anomalies were noted by endoscopy and sinus computed tomographic scans in the 66 patients in the study. These included nasal septum deviation in 46 (69.7%), concha bullosum in 33 (48.5%), and Haller cell in 11 (16.7%). Thirty of the patients with nasal septum deviation needed surgical intervention. Fifty-four (81.8%) of the 66 patients in the study showed significant improvement after surgery and did not require further medical therapy. CONCLUSIONS Our experience demonstrates that non-sinusitis-related rhinogenous headache can be significantly minimized with surgical management, as long as a precise identification of the etiologic anatomical factor can be made.

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.

Influence of hydrogenation on surface morphologies, transport, and optical properties of InN epifilms

We report the investigation of surface morphologies and transport and optical properties of hydrogenated InN epifilms. The average rms surface roughness decreases from 24nm on the as-grown sample to 13.2nm after hydrogenation. The free electron concentration can be increased or decreased depending on the duration of hydrogenation. The linewidth of the photoluminescence spectra can be reduced, and the peak intensity can be enhanced by about three times. All our results indicate that the physical properties of InN films can be improved by hydrogenation. Possible origins of the underlying mechanism have been proposed to explain the improvement.