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ABSTRACT: OBJECTIVES/HYPOTHESIS: 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. STUDY DESIGN: Forty-three patients with nasal NKTL were enrolled. The patients' data were collected retrospectively. METHODS: All patients underwent contrast-enhanced CT scans and endoscopic examinations. Symptoms were noted and recorded in detail. RESULTS: Patients with lymphoma limited to their nasal cavity or paranasal sinus (N/PN) presented symptoms similar to chronic rhinosinusitis, such as nasal obstruction and purulent nasal discharge. Patients with lymphoma of the nasopharynx or oropharynx (NPx/OPx) tended to present more frequently with epistaxis or blood-tinged sputum. On CT, NKTL was usually nonenhanced (79.1%), homogenous (100%), unilateral (61.9%), infiltrative (67.4%), and without central necrosis. Only 30.2% of the patients presented with a prominent mass. One disease-specific sign, different from patients with chronic rhinosinusitis, was that the mucosa of the nasal cavity was thickened without involvement of the mucosa of the paranasal sinus (40.6%). CONCLUSIONS: The thickening of the mucosa of the nasal cavity without similar involvement of the paranasal sinuses is easily overlooked in patients with NKTL. In addition, the imaging findings of thickened mucosa of the nasal floor and/or nasal septum near the inferior meatus, a prominent mass, and bony destruction should raise suspicion of this diagnosis. Laryngoscope, 2012.
The Laryngoscope 09/2012; · 1.75 Impact Factor
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ABSTRACT: Inverted papilloma is associated with sinonasal squamous cell carcinoma. This study aimed to investigate the epigenetic regulation of the tumour suppressor gene DLEC1 in inverted papilloma and sinonasal squamous cell carcinoma.
DLEC1 gene expression was investigated by quantitative real-time polymerase chain reaction (QRT-PCR) in normal mucosa, inverted papilloma, and squamous cell carcinoma tissues. Methylation-specific PCR and subsequent autosequencing were also used to examine the methylation status of DLEC1 promoter and the involved mechanism. DLEC1 expression in a large validation set was evaluated by immunohistochemistry (n = 25 in each group).
DLEC1 was downregulated in inverted papilloma and squamous cell carcinoma tissues compared to normal mucosa (p < .01 in QRT-PCR and immunohistochemistry), with squamous cell carcinoma more repressed (p < .05 in QRT-PCR and immunohistochemistry) than inverted papilloma tissues. DLEC1 promoter hypermethylation was found in squamous cell carcinoma tissues.
Repression of DLEC1 in squamous cell carcinoma tissues is associated with promoter hypermethylation. DLEC1 is downregulated in sinonasal squamous cell carcinoma and inverted papilloma and has a distinct mechanism.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 04/2012; 41(2):94-101. · 0.71 Impact Factor
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ABSTRACT: To evaluate the incidence of concomitant otitis media with effusion (OME) in children with cleft palate in Taiwan and the reliability of preoperative tympanometry.
Individual prospective cohort study.
We included 319 patients who underwent palatoplasty for cleft palate from 2005 to 2010. All received tympanometry 1 day before surgery, and myringotomy was performed before palatoplasty. Grommet was inserted if there was OME, the amount and content of which were graded and recorded. All data, including the tympanometry results, were analyzed for statistical significance.
The incidence of OME accompanying cleft palate during palatoplasty was 71.92% in Asian patients, which was lower than in previous studies. The content of OME was serous fluid in 47.8%, mucoid in 33.1%, and mucopus in 19.1%. Type-B tympanogram had high sensitivity (0.956) in all age groups. However, its specificity was poor in children younger than 9 months (0.375), fair in children aged 9 to 14 months (0.582), and good in children older than 14 months (0.857).
The incidence of OME accompanying cleft palate has decreased in Asian patients in the past 5 years. Tympanometry is not a very reliable tool for evaluating OME in children with cleft palate younger than 14 months, especially those younger than 9 months. Meticulous examination of the middle ear during palatoplasty is necessary for making a definite diagnosis and deciding on the use of a grommet.
The Laryngoscope 01/2012; 122(1):220-4. · 1.75 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the efficacy of transnasal endoscopic marsupialization as a treatment modality in patients with postoperative maxillary mucoceles and to compare the efficacy of marsupialization via middle meatal antrostomy with that of marsupialization via inferior meatal antrostomy. The study design was a retrospective clinical series and the setting was a tertiary referral center. After obtaining approval from the local ethics committee, we reviewed the medical records of 39 consecutive patients with postoperative maxillary mucoceles who were diagnosed and treated at the Department of Otolaryngology, Chang Gung Memorial Hospital, Taiwan, from 2004 to 2009. Transnasal endoscopic marsupialization was performed on 32 patients (34 sides) with postoperative maxillary mucoceles. All patients were followed for more than 12 months after surgery, and recurrence was noted in five patients (14.9%). Recurrence was experienced by five patients who underwent inferior meatal antrostomy and zero patients who underwent middle meatal antrostomy; thus, a statistically significant difference (p = 0.04) was observed. Transnasal endoscopic marsupialization is an effective modality for postoperative maxillary mucoceles and results in reduced morbidity. The use of middle meatal antrostomy in particular is preferred.
Archives of Oto-Rhino-Laryngology 05/2011; 268(11):1583-7. · 1.29 Impact Factor
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ABSTRACT: Nasal 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.
A 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.
The 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).
Our 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.
American journal of otolaryngology 03/2011; 33(1):14-9. · 0.77 Impact Factor
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Archives of otolaryngology--head & neck surgery 07/2010; 136(7):740, 742. · 1.92 Impact Factor
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Chi-Che Huang MD,
Ta-Jen Lee MD,
Po-Hung Chang MD,
Yun-Shien Lee PhD,
Chi-Cheng Chuang MD,
You-Jia Jhang,
Yi-Wei Chen MD,
Chiang-Wen Chen MD,
Chi-Neu Tsai PhD,
Chi‐Che Huang,
Ta‐Jen Lee, Po‐Hung Chang,
Yun‐Shien Lee,
Chi‐Cheng Chuang,
Yi‐Wei Chen,
Chiang‐Wen Chen,
Chi‐Neu Tsai
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ABSTRACT: Objectives/Hypothesis:We sought to investigate the role of desmoglein 3 in pathogenesis of sinonasal inverted papilloma (IP) and its malignant transformation.Methods:Fifteen subjects with sinonasal IP and 15 subjects of normal sphenoid sinus mucosa were enrolled. Each specimen was divided into two portions: one for mRNA expression analysis by real-time polymerase chain reaction, and the other for detection of targeted proteins by immunohistochemistry analysis. In addition, another 10 cases of IP with squamous cell carcinoma (SCC) were added for immunohistochemistry analysis.Results:The mRNA expression level of desmoglein 3 was significantly higher in IP tissues than in the normal sinus mucosa (P < .001). In immunohistochemistry study, desmoglein 3 was detected in plasma membrane areas of IP and IP with SCC tissues, but no obvious expression was found in normal sinus mucosa (total score; both P < .001). Positive desmoglein 3 staining was strongly present in nearly all malignant transformation areas of IP with SCC cases (90%), but only in scattered areas of some cases of IP (53%) (total score; P < .001).Conclusions:Desmoglein 3 was overexpressed in IP and IP with SCC, and the overexpression was correlated with malignant transformation of IP. It may provide valuable insight into the pathobiology of this disease, and can potentially provide a venue to predict malignant transformation in sinonasal IP. Laryngoscope, 2010
The Laryngoscope 12/2009; 120(1):26 - 29. · 1.75 Impact Factor
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ABSTRACT: Intracavernous carotid hemorrhage is a rare cause of epistaxis. We present a case of epistaxis caused by postradiotherapy and nontraumatic cavernous internal carotid artery (ICA) hemorrhage. An 80-year-old man was admitted to our hospital with a one week history of recurrent left-sided epistaxis and a past history of radiotherapy after radical maxillectomy. Emergent angiography revealed a leak in the cavernous segment of the ICA and subsequent detachable balloon occlusion embolization of the left internal carotid artery was performed without sequelae. We conclude that carotid artery hemorrhage must be considered in the differential diagnosis of profuse and recurrent epistaxis, especially for patients after craniofacial radiotherapy. ICA embolization is the definitive treatment provided cross circulation is adequate.
American journal of otolaryngology 12/2009; 32(2):162-4. · 0.77 Impact Factor
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Otolaryngology Head and Neck Surgery 11/2009; 141(5):659-60. · 1.72 Impact Factor
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ABSTRACT: We sought to investigate the role of desmoglein 3 in pathogenesis of sinonasal inverted papilloma (IP) and its malignant transformation.
Fifteen subjects with sinonasal IP and 15 subjects of normal sphenoid sinus mucosa were enrolled. Each specimen was divided into two portions: one for mRNA expression analysis by real-time polymerase chain reaction, and the other for detection of targeted proteins by immunohistochemistry analysis. In addition, another 10 cases of IP with squamous cell carcinoma (SCC) were added for immunohistochemistry analysis.
The mRNA expression level of desmoglein 3 was significantly higher in IP tissues than in the normal sinus mucosa (P < .001). In immunohistochemistry study, desmoglein 3 was detected in plasma membrane areas of IP and IP with SCC tissues, but no obvious expression was found in normal sinus mucosa (total score; both P < .001). Positive desmoglein 3 staining was strongly present in nearly all malignant transformation areas of IP with SCC cases (90%), but only in scattered areas of some cases of IP (53%) (total score; P < .001).
Desmoglein 3 was overexpressed in IP and IP with SCC, and the overexpression was correlated with malignant transformation of IP. It may provide valuable insight into the pathobiology of this disease, and can potentially provide a venue to predict malignant transformation in sinonasal IP.
The Laryngoscope 08/2009; 120(1):26-9. · 1.75 Impact Factor
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ABSTRACT: The goal of this article is to investigate the factors leading to protracted nasal discharge after pediatric endoscopic sinus surgery.
A retrospective chart review of all pediatric patients who had received endoscopic sinus surgery for chronic rhinosinusitis between January 2002 and September 2006 was conducted. The patients were assigned to the "protracted" group if they demonstrated persistent mucopurulent nasal discharge for more than 3 months after endoscopic sinus surgery, and otherwise to the "resolved" group.
There were 21 "protracted" patients (39.6%) and 32 "resolved" patients (60.4%). Among these patients, age at diagnosis or operation, time from initial diagnosis to operation, and blood eosinophil count did not differed significantly between the "protracted" and the "resolved" groups. On the other hand, sinonasal polyposis (80.9% vs. 53.1%, P=0.039), history of allergic rhinitis (52.4% vs. 12.5%, P=0.002) and gender (male vs. female=80.9% vs. 43.7%, P=0.007) were more frequently observed in the "protracted" group than in the "resolved" group. These associations remained significant in a multivariate logistic regression (odds ratio=9.36, 10.69 and 14.84, respectively).
Sinonasal polyposis, history of allergic rhinitis and gender were significant and independent risk factors for protracted nasal discharge after pediatric endoscopic sinus surgery. These risk factors should be taken into consideration during preoperative counseling.
Auris, nasus, larynx 06/2009; 36(6):655-60. · 0.58 Impact Factor
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ABSTRACT: 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.
In a retrospective study of patients with ISSA in our institution (1995 to 2006), 12 were identified.
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.
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).
The Annals of otology, rhinology, and laryngology 04/2009; 118(3):211-7. · 1.05 Impact Factor
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ABSTRACT: 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).
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.
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).
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.
Otolaryngology Head and Neck Surgery 03/2009; 140(3):324-9. · 1.72 Impact Factor
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ABSTRACT: To determine the feasibility of the use of a topical vasoconstrictor for hemostasis during functional endoscopic sinus surgery.
Case-control study.
From May 1998 to August 2002, 226 patients (injection group) with bilateral chronic rhinosinusitis received an adrenaline injection for hemostasis during functional endoscopic sinus surgery at our tertiary referral center. After September 2002, topical adrenaline was applied for hemostasis in 226 consecutive patients (noninjection group) who underwent the same surgery. The two groups were matched by age, sex, body weight, stage of chronic rhinosinusitis, and pre-anesthesia blood pressure. The hemostatic effects in each group were analyzed.
No statistically significant differences in operation time and intraoperative blood loss were reached between the two groups of patients.
Topical use of adrenaline achieved similar hemostatic effect compared with injection of adrenaline. Intranasal injection of a vasoconstrictor, in consideration of its adverse effects, may be avoided during surgery.
Otolaryngology Head and Neck Surgery 03/2009; 140(2):209-14. · 1.72 Impact Factor
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ABSTRACT: Basal encephaloceles are rare entities that can present as congenital diseases; however, traumatic lesions due to head injuries or iatrogenic causes have been described in the literature. In this study the authors aimed to define placement techniques for free grafts in repairing traumatic basal encephaloceles and to describe the long-term effectiveness of endoscopic treatment.
Between September 1997 and December 2006, 8 patients with traumatic encephaloceles underwent endoscopic surgery. A free graft following an underlay (2 cribriform plate and 4 ethmoid fovea defects) or obliteration (2 sphenoid defects) procedure was used as the repair material.
All traumatic basal encephaloceles with the associated skull base defects and cerebrospinal fluid (CSF) leakage were successfully treated via the endoscopic approach. There were no major complications or recurrence of meningitis or leakage of CSF encountered after an average follow-up of 77 months.
Long-term follow-up results demonstrated that endoscopic surgery was suitable for the treatment of traumatic basal encephaloceles. The underlay procedure is more appropriate than the overlay procedure in repairing large defects of the anterior skull base. Meticulous manipulations of the endoscope following precise autograft placement are mandatory for the successful repair of traumatic basal encephaloceles.
Journal of Neurosurgery 05/2008; 108(4):729-35. · 2.96 Impact Factor
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ABSTRACT: To evaluate the efficacy of the limited approach of functional endoscopic sinus surgery (FESS) in pediatric patients with chronic rhinosinusitis (CRS) and to interpret the indications for second-look endoscopy.
A retrospective review of medical records of patients who received pediatric FESS between January 1995 and September 2002 and a comprehensive parental questionnaire were used to assess postoperative symptom improvement at a mean postoperative follow-up of 27.2 months after surgery.
A university-affiliated medical center.
We studied 101 patients who received treatment of pediatric CRS refractory to optimal medical treatment.
We analyzed preoperative and postoperative nasal obstruction, purulent rhinorrhea, postnasal drip, headache, hyposmia, and chronic cough.
Patients underwent a limited surgical approach of FESS, basically a drainage rather than an extirpation procedure, for the treatment of pediatric CRS refractory to optimal medical treatment. Additionally, 29 patients (28%) underwent second-look endoscopy.
The proportions of patients whose symptoms improved were as follows: nasal obstruction, 91%; purulent rhinorrhea, 90%; postnasal drip, 90%; headache, 97%; hyposmia, 89%; and chronic cough, 96%. Of the 101 patients, parents of 87 (86%) were satisfied with the surgery.
Our literature review did not reveal any other large series in the Asian population. The limited approach to FESS was effective in treating medically recalcitrant CRS in the children we studied. Second-look endoscopy was indicated for selected cases to ensure the extirpation of residual disease and the patency of ostiomeatal complex and sinus ostia.
Archives of Otolaryngology - Head and Neck Surgery 10/2004; 130(9):1033-6. · 1.63 Impact Factor
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American Journal of Otolaryngology 28(4):238-41. · 0.87 Impact Factor
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ABSTRACT: The aim of the study was to report the clinical characteristics, management, and outcome of patients with extensive paranasal sinus mucoceles.
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.
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.
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.
American journal of otolaryngology 30(4):234-8. · 0.77 Impact Factor
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ABSTRACT: This study aimed to investigate the role of anatomical abnormalities in non-sinusitis-related rhinogenous headache and to evaluate response to surgery.
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.
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.
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.
American journal of otolaryngology 29(5):326-32. · 0.77 Impact Factor
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ABSTRACT: The 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.
Medical 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.
The 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.
The 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.
American journal of otolaryngology 30(5):300-4. · 0.77 Impact Factor
