A Case of Nasopharyngeal Schwannoma Treated with Endoscopic Tumor Resection

Schwannoma is generally known as benign tumor originated from Schwann cells of peripheral nerve sheaths. This tumor is characterized by well-circumscribed, encapsulated, and slow growing. It is reported that it mainly appears in the head and neck area, but it is known that paranasal sinus and sinus are rarely seen within 4%. We describe an incidental schwannoma case arising from the nasopharyngeal level of a 41-year-old woman. The patient visited the out-patient clinic with a nasopharyngeal mass found incidentally on a health check. The tumor was then totally removed by endoscopic surgery without complications and diagnosed as a schwannoma. She had no sequelae or recurrence for 1year after surgery.ope

Can drug-induced sleep endoscopy improve the success rates of tongue base surgery?

BACKGROUND: The purpose of this study was to determine the therapeutic value of drug-induced sleep endoscopy (DISE) by comparing the outcomes of tongue base surgery based on Muller's maneuver (MM) and those based on DISE in obstructive sleep apnea (OSA) patients. METHODS: Ninety-five patients who underwent the tongue base surgery in combination with palatal surgery for OSA at a tertiary referral hospital between March 2012 and March 2019 were enrolled in this retrospective comparative study. Forty-seven patients underwent MM for surgical decision and 48 patients underwent DISE in addition to MM for surgical decision. Surgical success was defined according to the Sher criteria (postoperative apnea-hypopnea index [AHI] < 20/h and ≥ 50% reduction in preoperative AHI), and AHI improvement (%) was defined as (preoperative AHI-postoperative AHI) × 100/preoperative AHI. For comparison between the MM and DISE groups, p-values were calculated using independent or paired t-tests for continuous variables and using chi-square test for categorical variables. RESULTS: By comparing the results of MM and DISE, consensus on the tongue base level showed insignificant concordance (kappa = 0.017, p = 0.865), whereas that on the oropharynx level showed fair agreement (kappa =0.241, p = 0.005). AHI, supine AHI, rapid eyeball movement (REM) AHI, non-REM AHI, and nadir oxygen saturation were all significantly improved after the tongue base surgery in both groups. The MM group showed a significant improvement in the Epworth sleepiness scale after the tongue base surgery (p = 0.014), whereas the DISE group did not (p = 0.165). However, there was no significant difference in the AHI improvement (MM group = 47.0 ± 32.0, DISE group = 48.3 ± 35.4, p = 0.852) and surgical success (MM group = 42.6%, DISE group = 45.8%, p = 0.748) between the groups. Tonsil grade (p < 0.05) and occlusion at the oropharynx lateral wall (p = 0.031) were significantly related to surgical success in the MM group. CONCLUSIONS: In the judgment of the tongue base surgery, MM and DISE findings showed poor agreement. DISE might affect the surgical decision on the tongue base surgery in OSA patients; however, there was a lack of evidence regarding the superiority of DISE over MM with respect to the surgical outcomes.ope

A Case of Horizontal Partial Laryngectomy for Laryngeal Trauma

Laryngeal trauma is rare compared to other head and neck traumas, but it occurs, it can be life threatening. As for treatment, a laryngeal fracture that involves displacement of cartilage or extensive injury requires appropriate surgical treatments. For severe laryngeal fractures, conservative management is usually preferred with placing a stent to prevent laryngeal stenosis. But the downside of placing stents in the larynx includes the risk of granulation and infection. In this report, the authors describe a 35-year-old patient, who was diagnosed with blunt laryngeal trauma and treated by Horizontal partial laryngectomy. The patient's post-operative breathing and voice were fair, and airway stenosis did not occur afterwards.ope

치아 임플란트 후 발생한 상악동염의 중증도에 영향 미치는 요인들

Dept. of Medicine/석사Objective The aim of this study was to identify factors affecting the severity of dental implant related sinusitis using a modified Lund-Mackay scoring system. Materials and Methods Fifty-one sinuses from 45 patients who were diagnosed with dental implant-related maxillary sinusitis were retrospectively evaluated. Their medical records were reviewed and computerized tomography scans were evaluated using modified Lund-Mackay scores. Factors that may affect severity of dental implant-related maxillary sinusitis were analyzed using multivariate linear regression analysis. Results Diabetes and sinus augmentation were independent factors that affected severity of dental implant-related maxillary sinusitis. Conclusion Patients with diabetes and sinus augmentation should be carefully evaluated and treated properly for a sinus infection before and after dental implants. 연구 목적 본 연구의 목적은 치아 임플란트 시술 후 발생한 상악동염의중증도에 영향 미치는 요인을 확인하고자 하는 것이다. 재료 및 방법 임플란트 상악동염을 진단 받은 45명의 환자의 51개 부비동을 후향적으로 분석하였다. 각 환자의 CT 검사 결과를 Lund-Mackay score를 응용하여 중증도를 평가하였다. 다중 선형 회귀 분석을 이용하여 각 환자의 Lund-Mackay score에 유의미한 영향을 미치는 요인들을 확인하였다. 결과 당뇨와 상악동 거상술은 임플란트 상악동염의 중증도에 영향을 미친다. 결론 당뇨 환자 그리고 상악동 거상술을 받은 환자는 치아 임플란트 시술 전후로 주의깊은 평가가 필요하며 부비동염 발생시 적절한 치료가 필요하다.ope

Development of Central Sleep Apnea After Sleep Surgery

Central sleep apnea (CSA) is defined as an absence of breathing without respiratory drive during sleep. It can occur after treatment of obstructive sleep apnea (OSA), a phenomenon known as treatment-emergent central sleep apnea (TECSA). We present a case of a 23-year-old male who developed CSA after pharyngeal and nasal surgery for severe OSA. High loop gain and increased ventilations from frequent arousal are likely explanations for our patient’s central apnea, which resolved with positive airway pressure therapy that possibly alleviated residual airway obstruction and ventilatory instability. This case suggests that effectiveness of treatment for OSA should be based on careful long-term observation with multiple follow-up polysomnography tests, especially in patients at high risk of TECSA.ope

A Case of Lemierre Syndrome Following Oropharyngeal Infection

Lemierre syndrome is characterized by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of pathogens, mainly Fusobacterium necrophorum. Septic emboli resulting from infected thrombophlebitis of the internal jugular vein leads to metastatic infections involving lung, liver, kidney, bone and central nervous system. Before the advent of antibiotics, the disease used to be common, incurring a high mortality rate. The disease is less frequently seen nowadays, but it is still a life-threatening disease, requiring a high index of suspicion and prompt treatment. We report a case of Lemierre syndrome, which showed oropharyngeal infection, and internal jugular vein thrombosis.ope

A Case of Chronic Invasive Rhinocerebral Mucormycosis with Pott’s Puffy Tumor

Mucormycosis is one of the most fatal and rapidly progressive fungal infections in humans; among its many forms. rhinocerebral mucormycosis is the most common. It is known to occur as opportunistic infection in patients with uncontrolled diabetes, metabolic disorders, organ transplantation, or autoimmune disease with prolonged steroid use. Pott’s puffy tumor is the subperiosteal abscess of the frontal bone caused by trauma complication or frontal sinusitis. It is considered as a very rare complication since the dawn of antibiotic treatments. We report a case of chronic rhinocerebral mucormycosis involving Pott’s puffy tumor in a patient receiving immunosuppressive therapy after lung transplantation.ope

Neural Dynamics of Olfactory Perception: Low- and High-Frequency Modulations of Local Field Potential Spectra in Mice Revealed by an Oddball Stimulus

Recent brain connectome studies have evidenced distinct and overlapping brain regions involved in processing olfactory perception. However, neural correlates of hypo- or anosmia in olfactory disorder patients are poorly known. Furthermore, the bottom-up and top-down processing of olfactory perception have not been well-documented, resulting in difficulty in locating the disease foci of olfactory disorder patients. The primary aim of this study is to characterize the bottom-up process of the neural dynamics across peripheral and central brain regions in anesthetized mice. We particularly focused on the neural oscillations of local field potential (LFP) in olfactory epithelium (OE), olfactory blub (OB), prefrontal cortex (PFC), and hippocampus (HC) during an olfactory oddball paradigm in urethane anesthetized mice. Odorant presentations evoked neural oscillations across slow and fast frequency bands including delta (1-4 Hz), theta (6-10 Hz), beta (15-30 Hz), low gamma (30-50 Hz), and high gamma (70-100 Hz) in both peripheral and central nervous systems, and the increases were more prominent in the infrequently presented odorant. During 5 s odorant exposures, the oscillatory responses in power were persistent in OE, OB, and PFC, whereas neural oscillations of HC increased only for short time at stimulus onset. These oscillatory responses in power were insignificant in both peripheral and central regions of the ZnSO4-treated anosmia model. These results suggest that olfactory stimulation induce LFP oscillations both in the peripheral and central nervous systems and suggest the possibility of linkage of LFP oscillations in the brain to the oscillations in the peripheral olfactory system.ope

Development of a Korean Culture-Friendly Olfactory Function Test and Optimization of a Diagnostic Cutoff Value

Objectives: Cultural familiarity and safety must be considered when assessing olfactory ability. The YSK olfactory function (YOF) test is a new olfactory function test using culturally familiar odorants to Koreans. Methods: The YOF test comprises three subtests for threshold (T), discrimination (D), and identification (I). The identification test included eight universal and four Korean culture-friendly odorants, which were selected considering eight major functional groups. Data were obtained from 1,127 subjects over 19 years old. Subjects were classified as having normosmia (n=542), hyposmia (n=472), and anosmia (n=113) by self-reported olfactory function. The YOF test and the Korean version of the Sniffin' stick test (KVSS-II) were performed on the same day in random order. Diagnostic cutoffs for anosmia and hyposmia were calculated using the Youden index (J). Results: The mean values for each T/D/I subtest and the total TDI score were as follows: normosmia (T, 4.6±2.3; D, 8.6±2.1; I, 11.1±1.7; TDI score, 24.2±4.5); hyposmia (T, 3.3±2.2; D, 7.1±2.5; I, 9.2±3.1; TDI score, 19.5±6.4); and anosmia (T, 1.7±1.2; D, 5.1±2.5; I, 5.0±3.2; TDI score, 11.8±5.6). The correlation coefficients between the YOF test and KVSS-II were 0.57, 0.65, 0.80, and 0.86 for T, D, I, and the TDI score, respectively (P<0.001). The diagnostic cutoffs were a TDI score ≤14.5 (J=0.67) for anosmia and 14.5(TDI score ≤21.0 (J=0.38) for hyposmia. The diagnostic efficacy of the YOF test (area under the curve [AUC], 0.88) was equivalent to that of the KVSS-II (AUC, 0.88; P=0.843; DeLong method). Conclusion: The YOF test is a new olfactory test using safe and Korean culture-friendly odorants. It showed equivalent validity with the conventional olfactory function test. Furthermore, the YOF test provides information on the major functional groups of odorants, potentially enabling a more comprehensive interpretation for patients with olfactory disorders.ope

Association between obesity and chronic rhinosinusitis with nasal polyps: a national population-based study

Objectives: We performed a cross-sectional analysis of data from the nationwide Korea National Health and Nutrition Examination Survey to evaluate the association between obesity and chronic rhinosinusitis with nasal polyps (CRSwNP) or without nasal polyp (CRSsNP). Design: Retrospective cross-sectional analysis of health survey data. Setting: Voluntary survey of representative South Korean populations. Participants: In total, 32 384 individuals aged 19 years or older with available data on CRS and obesity were included. Primary and secondary outcome measures: Diagnosis of CRSwNP or CRSsNP was performed by trained otolaryngologists through sinus endoscopy and surveys of medical history. General and central obesity was diagnosed using body mass index (BMI) and waist circumference (WC), respectively. Methods: A multivariate logistic regression analysis was used to clarify the association between CRSwNP or CRSsNP and obesity according to BMI and WC. Non-obese individuals were recruited as controls. Results: The prevalence of CRSwNP was higher in the general (OR, 1.438; 95% CI, 1.170 to 1.768; p<0.001) and central (OR, 1.251; 95% CI, 1.031 to 1.520; p=0.033) obesity groups than in the control group. Prevalence of CRSsNP was not correlated with obesity. In a logistic regression analysis, olfactory dysfunction (OR, 1.329; 95% CI, 1.137 to 1.553; p<0.001) and purulent discharge (OR, 1.383; 95% CI, 1.193 to 1.603; p<0.001) showed a higher incidence in the central obesity group than in the control group. Conclusions: We demonstrated an association between CRSwNP and general and central obesity. Further investigations on the mechanism underlying this correlation are necessary for an improved understanding of the pathogenesis of CRSwNP.ope