Ta-Jen Lee

Prolonged visual disturbance secondary to isolated sphenoid sinus disease

Objectives/Hypothesis: The objective was to evaluate the efficacy of endoscopic sinus surgery in patients with isolated sphenoid sinus disease with visual disturbances of more than 72 hours duration.

Endoscopic surgery for recurrent inverted papilloma.

Objectives/Hypothesis Inverted papilloma of the nose and paranasal sinuses is noted for its high rate of recurrence. The feasibility of endoscopic treatment for inverted papilloma has been shown in the literature; however, reports discussing the efficacy of endoscopic surgery for recurrent diseases are rare. The study determined the effectiveness of endoscopic surgery for recurrent inverted papilloma and described when endoscopic medial maxillectomy was indicated.

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.

Management of Nasolabial Cysts by Transnasal Endoscopic Marsupialization

OBJECTIVEnTo evaluate hospitalization rates and duration of surgery associated with transnasal endoscopic marsupialization compared with sublabial excision in treating nasolabial cysts.nnnDESIGNnRetrospective clinical series.nnnSETTINGnLarge urban community hospital.nnnPATIENTSnConsecutive sample of 57 patients with nasolabial cysts treated from January 1, 2000, to February 29, 2008.nnnINTERVENTIONSnSublabial excision in 23 patients (sublabial group) and transnasal endoscopic marsupialization in 34 patients (transnasal group). Among 57 patients, 47 underwent preoperative computed tomography.nnnMAIN OUTCOME MEASURESnHistory, clinical presentation, preoperative condition, histopathologic findings, treatment, complications, and outcomes.nnnRESULTSnThe mean duration of surgery was 91.3 minutes in the sublabial group and 29.5 minutes in the transnasal group (P = .003). The hospitalization rate was 100% (23 of 23) in the sublabial group and 59% (20 of 34) in the transnasal group (P < .001). The medical costs were significantly lower in the transnasal group than in the sublabial group (P = .002). The follow-up period ranged from 6 to 85 months. Neither group of patients experienced any major complications or recurrences during the follow-up period.nnnCONCLUSIONnTransnasal endoscopic marsupialization is an effective treatment for nasolabial cysts, is less costly, and has fewer complications than sublabial excision.

Is otitis media with effusion almost always accompanying cleft palate in children?: The experience of 319 Asian patients†‡

To evaluate the incidence of concomitant otitis media with effusion (OME) in children with cleft palate in Taiwan and the reliability of preoperative tympanometry.

Postirradiation Sinus Mucosa Disease in Nasopharyngeal Carcinoma Patients

Objectives/Hypothesis: We sought to determine the incidence, progression, and risk factors for postirradiation sinus mucosa diseases (SMD) incidentally found on follow‐up magnetic resonance images (MRIs) in nasopharyngeal carcinoma (NPC) patients.

Acute Rhinosinusitis―Related Orbital Infection in Pediatric Patients: A Retrospective Analysis

Objectives: Periorbital infection frequently originates from acute rhinosinusitis in children. We tried to find the characteristics of pediatric patients who are likely to develop subperiosteal orbital abscesses and to need emergency surgery for acute orbital swelling. Methods: In an observational retrospective cohort study, we reviewed 64 children less than 18 years of age who visited emergency rooms for periorbital swelling and were hospitalized with a diagnosis of periorbital cellulitis and subperiosteal orbital abscess between 1996 and 2007 at Chang Gung Memorial Hospital. The presence of periorbital abscess was diagnosed radiographically, and all of the patients had concomitant sinusitis that was proved by computed tomographic scan. Results: The mean age of the patients was 6.95 years, and 42 (65.63%) were male (male-to-female ratio, 1.91). Thirty patients (46.88%) had surgical drainage, and 34 (53.13%) received antibiotic therapy only. The factors associated on bivariate analysis with abscess formation were age of 6 years or less (p = 0.023), proptosis (p = 0.012), fever (p < 0.001), and a white blood cell count of more than 11,100 cells per microliter (p = 0.004). On multivariate analysis, fever and proptosis were independent factors that predicted abscess formation. In patients who underwent surgical drainage, the most frequently cultured microbes were Staphylococcus aureus, Streptococcus viridans, and coagulase-negative staphylococci, and 29% of our patients had polymicrobial pus cultures. Conclusions: The most important factor in predicting the failure of antibiotic treatment of sinusitis-related periorbital infections is abscess formation. Patients with fever and proptosis are prone to develop subperiosteal orbital abscesses.

Similar cellular proliferation activities in nasal polyps and adjacentinferior turbinate

INTRODUCTIONnNasal polyps (NP) are regulated by proinflammatory transcription factors such as activator protein-1 (AP-1), which comprises members of the proto-oncogene Jun and Fos protein families. The binding of AP-1 proteins to the 12-O-tetradecanoylphorbol-13-acetate (TPA)-response element can activate target genes and regulate many critical cellular processes. The proliferating cell nuclear antigen (PCNA) gene contains AP-1 sites, and its expression is regulated by AP-1 activity. In this study, NP and inferior turbinate (IT) were evaluated, compared with normal mucosa, to see if diffuse inflammation and active cellular proliferation exist.nnnMATERIALS AND METHODSnA diseased group of 20 subjects and control group of 20 subjects were enrolled in this study. NP and IT were evaluated with expression of phospho-c-Jun, c-Fos, PCNA, major basic protein by immunohistochemistry, and eosinophil numbers by cell counts.nnnRESULTnThe expression of phospho-c-Jun, c-Fos, PCNA, major basic protein, and eosinophil numbers showed no significant difference in IT and NP of the same patients, but all were significantly higher in IT and NP compared with normal mucosa (P < .05).nnnCONCLUSIONnOur result demonstrated strong evidence that diffuse mucosal inflammation and active cellular proliferation do exist in rhinosinusitis with nasal polyposis. As the degree of the disease severity increases, the difference of eosinophilic infiltration and cellular proliferation activity between NP and its adjacent mucosa decreases. An integrated anti-inflammatory treatment may be more important than surgical intervention.

Preirradiation sinus mucosal disease in patients with nasopharyngeal carcinoma.

PURPOSEnThe objective of this study was to evaluate the incidence and the possible risk factors for preirradiation abnormalities of the sinus mucosa in patients with nasopharyngeal carcinoma (NPC) by magnetic resonance imaging.nnnMATERIALS AND METHODSnMedical records and magnetic resonance imaging results were reviewed and compared between a group of patients with NPC and a control group. The Lund-Mackay system for staging of rhinosinusitis (Lund score) was used as a tool for the investigation.nnnRESULTSnThe incidence of sinus mucosal abnormalities was 32.1% in the NPC group and 20.7% in the control group (P = .041). The patients with NPC demonstrated a higher incidence of sinus abnormalities in nearly all sinuses. However, only the incidence of disease in the posterior ethmoid (P = .002) and sphenoid sinus (P = .006) was significantly increased in patients with NPC. The incidence and the severity of sinus abnormalities in male patients with NPC were significantly higher than that in female patients. Patients with advanced T stage showed significantly higher Lund scores (P = .015) than patients with early T stage.nnnCONCLUSIONnThe results supported the hypothesis that patients with NPC might be prone to have chronic infection and might be partially immunocompromised by Epstein-Barr virus. Female patients may have an inherited genetic advantage that protects against Epstein-Barr virus infection or lessens its devastating effects.

A paradigm for evaluation and management of the maxillary sinus before dental implantation

To determine a paradigm for evaluating and managing maxillary sinus conditions before dental implantation via preoperative sinonasal assessment.