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ABSTRACT: Objective
Traditionally, rhinoseptoplasty for nasal bone fracture is only considered after an unsatisfactory outcome from initial closed reduction. However, better surgical outcomes may be achieved if rhinoseptoplasty is performed at the same time as the nasal bone fracture reduction. This study investigated the surgical outcomes of patients who underwent rhinoseptoplasty concomitantly with nasal bone fracture reduction according to their computed tomography image-based nasal bone fracture classifications.Study DesignCase series with chart review.SettingAcademic tertiary care medical center.Subjects and Methods
Fifty-six patients who underwent rhinoseptoplasty concomitantly with nasal bone fracture reduction were enrolled in this study. Nasal bone fractures were classified into 6 types by computed tomography scans. Two independent facial plastic surgeons evaluated the outcomes 6 months postoperatively using a visual analog scale. The nasal tip projection and rotation were measured using the pre- and postoperative profile views.ResultsThe satisfaction scores of type I, IIo, and IIIo fractures without septal fracture were significantly higher than those of type II, III, and IV fractures with septal fractures. Among the patients, 82.1% underwent lower vault surgery. The nasal tip projection and rotation were increased after surgery in patients without septal fractures, whereas the tip rotation was elevated but the projection was unchanged postoperatively in patients with septal fractures.Conclusion
Rhinoseptoplasty for acute nasal bone fractures can be performed at the same time as nasal bone fracture reduction. However, nasal bone fracture with septal fracture should be managed carefully.
Otolaryngology Head and Neck Surgery 05/2013; · 1.72 Impact Factor
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ABSTRACT: Abstract Conclusion: Open reduction through an intercartilaginous incision was useful for treating delayed-diagnosed nasal bone fractures because it resulted in a successful outcome with minimal complications. Objectives: Nasal bone fractures are generally managed with closed reduction, which is usually inadequate and results in airway obstruction with a delayed diagnosis of nasal bone fracture when bone healing and fibrotic adhesions around the bone fragment have progressed. This study investigated the surgical outcome of open reduction through an intercartilaginous incision for delayed-diagnosis nasal bone fractures. Methods: The study enrolled 18 patients who underwent open reduction through an intercartilaginous incision to correct delayed-diagnosis nasal bone fractures. Three independent otorhinolaryngologists evaluated the outcomes 4-35 months (average 12.7 months) postoperatively as excellent, fair or poor. Results: The time from injury to surgery was 11-39 days (20-39 days in adults and 11-30 days in children). The 18 cases included 16 primary repairs and two revisions. A Kirschner wire was inserted in six (33.3%) patients who had unstable reduced nasal bones. Postoperatively, l5 (83%) patients had excellent results, two (11%) had fair, and one (6%) had a poor outcome. No patient experienced any complication.
Acta oto-laryngologica 01/2013; 133(1):77-81. · 0.98 Impact Factor
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ABSTRACT: OBJECTIVES To introduce the surgical technique of 1-point fixation at the zygomaticomaxillary buttress (ZMB) and to verify its effectiveness using 3-dimensional computed tomography (3D CT). DESIGN Case series with chart review. SETTING Academic tertiary care medical center. PATIENTS AND METHODS The study included 29 patients who underwent 1-point fixation at the ZMB for zygomaticomaxillary complex fractures without comminution of lateral orbital rim fractures. Preoperative and postoperative 3D CT scans were obtained to evaluate vertical and horizontal changes of the zygoma, which were were analyzed according to preoperative 3D CT findings. RESULTS The ZMB area was fixed with a resorbable system in 26 patients and with a metal system in 3 patients. After surgery, the mean vertical change improved from 1.28° to 0.58° (P < .001), and the mean horizontal change improved from 1.71° to 0.92° (P < .001). Postoperative vertical movement of the zygoma was not significantly affected by comminution of the inferior orbital wall, zygomaticofrontal process displacement, or comminution of the ZMB area and zygomatic arch (P > .05 for each). However, comminution of the ZMB area had an adverse effect on horizontal movement of the zygoma (P = .03). Complications after surgery included facial cellulitis associated with acute sinusitis in 1 patient, who was treated successfully. No patient required revision reduction because of facial deformity. CONCLUSION Our findings suggest that 1-point fixation at the ZMB provides sufficient stability of the zygomaticomaxillary complex without comminuted fractures of the lateral orbital rim.
Archives of otolaryngology--head & neck surgery 09/2012; 138(9):828-32. · 1.92 Impact Factor
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ABSTRACT: Controlled biodegradability of biomaterials is very important because different functionality and durability are required for various purposes and for specific tissues and organs. From this point of view, silk-based biomaterials have poor usability because of uncontrollable degradability, even though silk fibroin (SF) is highly biocompatible and a number of studies on silk biomaterials have been published to date. In this study, we prepared SF nanofiber mats that were recrystallized in different ways. These mats were fabricated by electrospinning with ethanol/propanol mixtures of various blend ratios, and their biodegradabilities in vitro and in vivo were evaluated using rats. As a result, we can suggest an established method to modulate the degradability of SF nanofibrous materials based on long-term (12 months) observations. In particular, we elucidated how the SF nanofibers are degraded and incorporated with surrounding tissue by observation of fluorescein isothiocyanate-labeled SF nanofiber in vivo. Our findings suggest a method for controlling the degradation rate of SF for medical applications. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part A 100A:3287-3295, 2012.
Journal of Biomedical Materials Research Part A 06/2012; 100(12):3287-95. · 2.63 Impact Factor
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ABSTRACT: From this study, we suggest that male gender and complete type of cleft palate contribute to the recurrence of otitis media with effusion (OME) in the patients with cleft palate.
It is well known that children with cleft palate have a high prevalence of OME due to anatomic dysfunction of the eustachian tube. Our goal was to determine clinical manifestations and risk factors for children with cleft palate who received additional ventilating tube insertions after initial tube insertion during palatoplasty.
We retrospectively reviewed the medical and operation records of 213 patients who received ventilating tube insertion during palatoplasty from January 1993 to June 2006. The single-VT group (n = 140) included patients who had one ventilating tube insertion only, and the repeated-VT group (n = 73) included patients who received ventilating tube insertion repeatedly because of recurring chronic OME. We analyzed age, sex, types of cleft palate, preoperative tympanogram, characteristics of discharge during myringotomy, and duration of first ventilating tube in situ.
There were significant differences between the single- and repeated-VT groups in the rate of male patients (43.6 vs 72.6%), the rate of complete cleft palate (30.0 vs 61.6%) and incomplete cleft palate (61.4 vs 26.0%), the rate of preoperative type A tympanogram (30.0 vs 13.7%) and type B tympanogram (57.1 vs 75.3%), the proportion of discharge during myringotomy (72.1 vs 86.3%), and the mean indwelling period of the first ventilating tube (12.7 ± 9.6 vs 10.5 ± 6.5 months). In addition, sex and type of cleft palate were proved to affect the repetition of VT independently. However, when we performed multivariate analysis, only complete type of cleft palate and male gender showed significant differences between single- and repeated-VT groups.
Acta oto-laryngologica 06/2012; 132(7):702-7. · 0.98 Impact Factor
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ABSTRACT: Silk fibroin (SF) from silkworms has been widely studied as a biomaterial. The degradation behavior of silk biomaterials is important for medical applications, but few studies have examined long-term degradation behavior in vivo. In this study, we investigated the degradation behavior of SF membranes in vitro and in vivo. For the in vitro assay, we observed degradation of silk membranes in phosphate buffered saline, culture media, and an enzyme (proteinase K) solution. In the proteinase K solution, 80% of the silk membranes degraded within 10 days. Silk membranes exhibited no cytotoxicity toward L929 cells and rat tissues. To investigate the degradation of silk membranes in vivo, they were implanted subcutaneously in rats and harvested 19 months after surgery. Scanning electron microscopy imaging and histological analysis of silk membrane explants showed that they broke into several pieces after 16 months. Results show that silk membranes are biocompatible and display excellent long-term degradation behavior when used as biomaterials.
Journal of Biomedical Materials Research Part A 05/2012; 100(8):2018-26. · 2.63 Impact Factor
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ABSTRACT: Changes in expression and function of the cystic fibrosis transmembrane conductance regulator (CFTR) and epithelial sodium channel (ENaC) have been found to cause airway surface liquid (ASL) derangement and to impair mucociliary clearance, both of which have been linked to the pathogenesis of rhinovirus (RV) infection.
The effects of RV infection on the expression and function of CFTR and ENaC in nasal epithelial cells were investigated.
Nasal epithelial cells obtained from 14 turbinoplasty patients were infected with RV serotype 16 (RV-16) for 4 hours. Expression of CFTR, α-ENaC, β-ENaC, and γ-ENaC was determined by real-time polymerase chain reaction, Western blot analysis, and confocal immunofluorescence microscopy. Functional changes in the CFTR and ENaC proteins were assessed by measuring transepithelial resistance (TER) using a voltmeter combined with ion channel modulators.
Rhinovirus infection increased expression of CFTR, α-ENaC, β-ENaC, and γ-ENaC messenger RNA (mRNA) and protein compared with controls (P < .05 each) and increased the expression of all 4 proteins on confocal immunofluorescence microscopy. Treatment of cells with the ENaC blocker amiloride and the CFTR activator forskolin increased TER in RV-infected cells, whereas forskolin decreased TER in uninfected cells. The CFTR inhibitor NPPB, however, blocked CFTR more in RV-infected than in noninfected cells.
Rhinovirus increased the expression of CFTR and appeared to alter its function. In contrast, ENaC expression and function were increased by RV infection. Therefore, RV infection may impair mucociliary transport of nasal epithelium by these alterations.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 03/2012; 108(3):182-7. · 2.83 Impact Factor
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ABSTRACT: Patients with profound sudden sensorineural hearing loss (SSNHL) have a poor prognosis regardless of the type of treatment they receive. However, there is evidence that a proportion of patients with profound hearing loss may exhibit variable degrees of recovery, and this has yet to be specifically investigated. Here, we report a comparison of levels of hearing improvement in patients stratified according to their level of hearing threshold before treatment. We divided patients with severe to profound SSNHL into three groups: patients with an initial hearing threshold of 80-89 dB (n = 18), 90-99 dB (n = 16), and ≥100 dB (n = 34). We compared improvements in hearing threshold at different frequencies and recovery rates between the three groups. No significant differences were observed in hearing threshold improvements at different frequencies in the three groups after treatment. However, in the group with an initial hearing threshold of ≥100 dB, significantly less complete and partial recoveries occurred compared to those in the 80-89 or 90-99 dB groups. Our results suggest that initial hearing threshold in excess of 100 dB alters the likelihood of satisfactory recovery in patients with severe to profound SSNHL.
Archives of Oto-Rhino-Laryngology 12/2011; 269(9):2057-60. · 1.29 Impact Factor
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ABSTRACT: Several materials have been used for nasal augmentation surgery. Expanded polytetrafluoroethylene (e-PTFE) (Gore-Tex; W. L. Gore & Associates, Flagstaff, AZ) has proven to be an ideal synthetic material for nasal augmentation. Gore-Tex contains numerous pores that stabilize an implant, but this advantage has been tempered by unpredictable outcomes. The purpose of this study was to evaluate morphologic and histologic changes in nonreinforced Gore-Tex in a rabbit model.
In vivo study using a rabbit model.
To analyze histologic changes, we used 20 New Zealand white rabbits. Gore-Tex was implanted into the nasal dorsum of the rabbits. Then, en bloc specimens containing the implant and surrounding soft tissues were sampled 1, 3, 6, and 12 months after implantation. We evaluated the three-dimensional size of the implants over time using light and electron microscopy to investigate histologic and morphologic changes.
Following gross analysis, none of the implants were lost or extruded, and there was no evidence of wound infection. Diminution rates of thickness, width, and height in the implants were 22%, 2%, and 5%, respectively. Histologically, connective tissue growth was observed in all specimens, and the internodal space decreased owing to connective tissue ingrowth over time. Neovascularization was observed 3 months after implantation, and degenerative changes were also observed after 6 months.
Gore-Tex should be carefully trimmed for use in augmentation because of its potential to decrease in size over time. Additional studies are necessary before these results can be applied in clinical practice.
The Laryngoscope 11/2011; 122(1):17-22. · 1.75 Impact Factor
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ABSTRACT: To describe the radiologic characteristics of empty nose syndrome (ENS) and to assess outcomes of endonasal microplasty using cartilage implants in patients with ENS.
A retrospective clinical chart review.
We assessed 17 patients diagnosed with ENS who had undergone prior nasal turbinate surgery. The presence of sinus opacity and the nasal mucosal thickening on the lesion side was evaluated with computed tomography in 11 patients and compared with control. To assess the effect of sinusitis on the nasal mucosal thickening, the thickness of lesion-side mucosae in unilateral sinusitis patients were compared with their contralateral mucosae. Twelve patients were managed by submucosal implantation of cartilage at the inferolateral nasal wall, just below the turbinate remnant, to create a neoturbinate. Symptom scores expressed as visual analogue scale (VAS) were compared before and after surgery.
Opacity of the ipsilateral maxillary sinus was observed in seven of 11 patients. All lesion sides of ENS showed mucosal thickening of the nasal cavity, with an average thickness significantly greater than that in controls, whereas mucosal thickening was not found in the lesion-side mucosae of unilateral sinusitis patients. Patients reported significantly improved VAS score in excessive airflow, nasal obstruction, and nasal or facial pain. Complications of surgery included undercorrection in three patients.
Radiologic abnormalities associated with ENS include ipsilateral sinus opacity and nasal mucosal thickening. Endonasal microplasty by submucosal implantation of cartilage may be a useful treatment option in the management of ENS.
The Laryngoscope 06/2011; 121(6):1308-12. · 1.75 Impact Factor
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ABSTRACT: Objectives/Hypothesis:To describe the radiologic characteristics of empty nose syndrome (ENS) and to assess outcomes of endonasal microplasty using cartilage implants in patients with ENS.Study Design:A retrospective clinical chart review.Methods:We assessed 17 patients diagnosed with ENS who had undergone prior nasal turbinate surgery. The presence of sinus opacity and the nasal mucosal thickening on the lesion side was evaluated with computed tomography in 11 patients and compared with control. To assess the effect of sinusitis on the nasal mucosal thickening, the thickness of lesion-side mucosae in unilateral sinusitis patients were compared with their contralateral mucosae. Twelve patients were managed by submucosal implantation of cartilage at the inferolateral nasal wall, just below the turbinate remnant, to create a neoturbinate. Symptom scores expressed as visual analogue scale (VAS) were compared before and after surgery.Results:Opacity of the ipsilateral maxillary sinus was observed in seven of 11 patients. All lesion sides of ENS showed mucosal thickening of the nasal cavity, with an average thickness significantly greater than that in controls, whereas mucosal thickening was not found in the lesion-side mucosae of unilateral sinusitis patients. Patients reported significantly improved VAS score in excessive airflow, nasal obstruction, and nasal or facial pain. Complications of surgery included undercorrection in three patients.Conclusions:Radiologic abnormalities associated with ENS include ipsilateral sinus opacity and nasal mucosal thickening. Endonasal microplasty by submucosal implantation of cartilage may be a useful treatment option in the management of ENS.
The Laryngoscope 05/2011; 121(6):1308 - 1312. · 1.75 Impact Factor
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ABSTRACT: Maxillary sinus hypoplasia (MSH) is a radiologically detectable abnormality of the maxillary sinus that can be associated with sinusitis. Symptomatic MSH patients with a patent ostiomeatal complex (MSHPO) constitute a particular therapeutic challenge.
Ostiomeatal unit CT scans of 1293 patients with various sinonasal symptoms such as purulent discharge, postnasal drip, facial pain or headache were reviewed to determine the incidence, clinical symptoms and outcomes of MSHPO following medical treatment.
Seventy-five cases (5.8%) were found to have MSHPO. Excluding patients with nasal septal deviation and positive allergy test, 37 of those 75 patients (2.86% of the original cohort) had MSHPO as the only definable sinonasal abnormality. Radiographs showed all patients had antral mucosal thickening. Postnasal drip (43.2%) was the most common symptom, followed by nasal obstruction (40.5%), purulent rhinorrhea (32.4%), hyposmia or anosmia (32.4%), cough (21.6%) and headache (18.9%). Medical treatment consisted of clarithromycin and ebastine for all patients. Medical treatment resulted in complete symptom resolution in only 24.3% of patients.
Primary MSHPO was present in approximately 3% of patients with sinonasal symptoms. The response rate to medical treatment was poor. MSHPO should be considered a differential diagnosis in patients presenting with non-specific sinonasal complaints.
Auris, nasus, larynx 05/2011; 39(2):175-9. · 0.58 Impact Factor
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ABSTRACT: Tutoplast-processed fascia lata (TPFL) is a commercially available homograft that has been successfully used as human graft tissue for dorsal augmentation in rhinoplasty. The present study evaluated the use of TPFL as an onlay tip graft material in rhinoplasty.
Case series with chart review.
Academic tertiary care medical center.
The study involved a retrospective analysis of rhinoplasty cases using TPFL as a tip onlay graft. The study included 82 patients (46 men and 36 women) who underwent tip surgery using TPFL from February 2006 to June 2008. By comparing facial photographs before and after the operation, 2 independent rhinoplastic surgeons assessed outcomes of 8 months postoperative time as being excellent, fair, or poor. Using the pre- and postoperative profile view, anthropometric measurements were also made.
The 82 subjects included 71 primary and 11 revision patients. TPFL was used as a tip onlay graft in final tip modification. Postoperative assessment found that only 6 (7%) patients had excellent results, 51 (62%) had fair results, and 25 (31%) had poor results. Pre- and postoperative anthropometric measurements showed the technique resulted in an overall increased nasal tip projection postoperatively (0.56 ± 0.09 vs 0.60 ± 0.08; P < .05). However, the overall nasolabial angle was not changed after surgery (91.35 ± 10.36° vs 93.05 ± 8.3°; P = .08). No patient experienced infection, visible graft contour, or migration.
TPFL was not that satisfactory in terms of aesthetic outcome when used as a tip onlay graft material in rhinoplasty patients.
Otolaryngology Head and Neck Surgery 04/2011; 144(4):528-32. · 1.72 Impact Factor
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ABSTRACT: A new classification system for dorsal humps in Korean patients with nasal dorsum deformities was designed. Patients were treated based on these classifications, and their treatment outcomes were assessed.
A total of 164 patients, who underwent rhinoplasty for correction of convex nasal dorsum deformities, were analysed. Convex dorsum deformities were classified based on anthropometric measurement, nasal length, hump length and tip projection. The three classifications were generalised hump, isolated hump and relative hump because of a low tip. Postoperative photographs were analysed to assess hump reduction outcomes.
Generalised hump was the most common deformity, occurring in 88 (53.7%) patients; an isolated hump was observed in 67 (40.9%) patients and a relative hump, with a low tip, was observed in nine (5.5%) patients. Successful surgical outcomes were achieved in 65.9% of generalised hump cases and 80.6% of isolated hump cases (p=0.014). Of the fair or poor outcomes, 89.6% were attributable to hump undercorrection.
Our classification system could help surgeons tailor management of convex nasal dorsum deformities. The present study showed that the milder the deformity, the better was the outcome. It was also found that excessive conservation in hump reduction was the main factor predictive of unsatisfactory outcome.
Journal of Plastic Reconstructive & Aesthetic Surgery 03/2011; 64(3):301-6. · 1.49 Impact Factor
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ABSTRACT: Nasal dermoid sinus cysts are the most common congenital midline nasal lesion, accounting for 1% to 3% of all dermoid cysts, and 4% to 12% of all head and neck dermoids. Selection of the appropriate reconstruction technique, after dermoid resection, is important for treatment. Here we describe the successful management of a case with a nasal dermoid sinus cyst using an open rhinoplasty approach, and primary reconstruction using Tutoplast-processed fascia lata and crushed septal cartilage.
Clinical and Experimental Otorhinolaryngology 03/2010; 3(1):48-51. · 0.92 Impact Factor
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ABSTRACT: Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients.
We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7(R) of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors.
After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other.
The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.
Clinical and Experimental Otorhinolaryngology 07/2009; 2(2):90-6. · 0.92 Impact Factor
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ABSTRACT: We aimed to investigate the clinical results of atticoantrotomy in patients with an attic cholesteatoma.
Ninety-eight ears in 98 patients were operated on using atticoantrotomy between October 2002 and December 2006. A retrospective review of the otology database (operative findings and methods, postoperative physical examination and pre- and postoperative audiometry) was performed.
There were 58 female and 40 male patients with a mean age of 40 yr. The cholesteatoma was limited to the attic region in 24 patients (24.5%); attic with antrum in 18 (18.4%); and attic with antrum and middle ear in 56 (57.1%). Attic obliteration was performed in 59 patients (60.2%), attic reconstruction in 39 (39.8%) and ossicular reconstruction was performed in 59 (60.2%). The mean preoperative and postoperative air-bone gaps were 29.2+/-13.5 dB and 25.0+/-15.4 dB, respectively (P=0.01) and the mean preoperative and postoperative high-tone bone conduction levels were 14.5+/-9.7 dB and 15.23+/-14.0 dB, respectively (P=0.411). A recurrent cholesteatoma was detected in 3 ears (3%) and revision surgery was performed on these patients.
Atticoantrotomy showed a low recurrence rate and no deterioration in hearing levels. If there is a intact malleus head or body of incus, attic reconstruction was possible and this procedure could lead to improved hearing. However, postoperative retraction occurred in 18% of patients, a problem that will need to be solved in the future.
Clinical and Experimental Otorhinolaryngology 04/2009; 2(1):39-43. · 0.92 Impact Factor
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ABSTRACT: Intratympanic dexamethasone (ITD) within 1 month after initial treatment failure should be utilized as salvage treatment for refractory sudden sensorineural hearing loss (SSNHL).
To investigate the therapeutic efficacy over time of ITD as salvage treatment in SSNHL.
We retrospectively reviewed the medical records and audiograms of 99 SSNHL patients who were refractory to 2 weeks of oral steroid treatment, from August 2003 to October 2006. Patients were divided into those receiving no further treatment (control group) and those receiving ITD within 2 weeks (early-ITD), between 2 weeks and 1 month (mid-ITD), and between 1 and 2 months (late-ITD) after initial treatment failure. ITD was performed in the supine position on four separate occasions over the course of 2 weeks. Final assessment of hearing was carried out 3 months after outbreak of SSNHL. Hearing improvement was defined as a > 15 dB decrease in four-tone average (FTA).
Overall hearing improvement was observed in 8 of 50 (16.0%) control patients, 7 of 16 (43.8%) early ITD patients, 6 of 20 (30.0%) mid ITD patients, and 2 of 13 (15.4%) late ITD patients.
Acta Oto-Laryngologica 08/2007; 128(2):128-31. · 1.08 Impact Factor
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ABSTRACT: Up-regulation of matrix metalloproteinases (MMPs), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF) beta, may contribute to the formation of nasal polyps (NPs). Rhinovirus (RV) infection enhances expression of MMP-2, MMP-9, and VEGF in NP fibroblasts and of TGF-beta in respiratory epithelial cells. We investigated the inhibitory effects of levocetirizine (LCT) on the RV-induced expression of (1) fibrogenic (MMPs and TGF-beta) and (2) angiogenic (VEGF and TGF-beta) factors in NP fibroblasts.
NP fibroblasts obtained from 11 male patients with chronic rhinosinusitis with NPs (CRSwNPs), were infected with RV serotype 16 (RV-16) for 4 hours. Cells were treated with 50 nM of LCT 24 hours before infection and for 48 hours thereafter. Expression of MMP-2, MMP-9, VEGF, and TGF-β mRNA and protein were determined by real-time polymerase chain reaction and enzyme-linked immunosorbent assays, respectively.
LCT significantly inhibited RV-induced increases in MMP-2, MMP-9, VEGF, and TGF-beta mRNA, and protein expression, in NP fibroblasts (p < 0.05 for each comparison).
LCT inhibits RV-induced up-regulation of fibrogenic and angiogenic factors in NP fibroblasts, suggesting that LCT may prevent NP formation in patients with CRSwNP caused by RV infection.
American Journal of Rhinology and Allergy 25(6):416-20.
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ABSTRACT: This study evaluated surgical outcomes after endonasal septoplasty using caudal septal batten grafting for caudal septal deviation.
Fifty-six patients completed questionnaires to assess nasal obstruction by telephone interviews 8-63 months postoperatively (12.2 months on the average). In addition, patients assessed the severity of nasal symptoms (i.e., mouth breathing, mouth dryness, hyposmia, rhinorrhea, epistaxis, trouble sleeping, snoring, and being concerned about nasal problems) preoperatively and postoperatively using a visual analog scale (VAS). These VAS scores were compared with those of patients who underwent endonasal septoplasty using the cutting and suture technique. Complications were analyzed.
Thirty-four (60.7%) patients reported their nasal obstruction was much improved, 17 (30.3%) reported their condition was improved, and 5 (8.9%) reported no change postoperatively. Patients reported a decrease in severity of all nasal symptoms (p < 0.05 for each). Their nasal obstruction improvement was not significantly different from that of patients managed by the cutting and suture technique. Complications after surgery included hyposmia in two cases, small septal perforation in one case, chondritis in one case, and septal abscess in one case, and all were managed successfully. No patient required revision septoplasty due to recurrence during the follow-up period.
Endonasal septoplasty using caudal septal batten grafting for caudal septal deviation resulted in improvement in nasal obstruction and nasal symptoms and was associated with an acceptable complication rate.
American Journal of Rhinology and Allergy 25(4):e166-70.
