Improved outcomes after low-concentration hypochlorous acid nasal irrigation in pediatric chronic sinusitis.

OBJECTIVES/HYPOTHESIS: We aimed to evaluate the effectiveness of low-concentration hypochlorous acid (HOCl) nasal irrigation compared to isotonic normal saline for pediatric chronic rhinosinusitis. STUDY DESIGN: This was a randomized, prospective, active-controlled study. METHODS: This study investigated the effectiveness of 4 weeks of low-concentration hypochlorous irrigation by analyzing five categorized subjective symptoms and x-ray findings in pediatric patients with rhinosinusitis. Thirty-seven patients were enrolled, and 26 patients successfully completed the study. RESULTS: Total symptom scores significantly improved with both HOCl and normal saline nasal irrigation, but there was no difference between the two groups. X-ray scores also improved in both groups; improvement was much greater in the HOCl group than the placebo group. CONCLUSIONS: Nasal irrigation with HOCl is an effective adjuvant treatment compared to isotonic normal saline for pediatric sinusitis. LEVEL OF EVIDENCE: 1b.

Surgical outcomes of primary and revision augmentation rhinoplasty using a processed fascia lata.

BACKGROUND: Dorsal augmentation is the most commonly performed procedure in rhinoplasty for Asian patients. Due to the anatomic features of the Asian nose, the use of nonautologous materials to obtain a proper degree of augmentation is inevitable in most cases. Because the use of nonautologous materials possesses a higher risk of complications, surgeons are concerned about selecting suitable materials for the procedure, especially in revision rhinoplasty. Therefore, this study was designed to evaluate the suitability and usefulness of a homologous material, Tutoplast-processed fascia lata (TPFL), in revision augmentation rhinoplasty. METHODS: Retrospective analysis of 104 rhinoplasty patients (primary, 86; revision, 18) who had undergone dorsal augmentation using TPFL was conducted. The comparison of surgical outcomes between primary and revision surgery was made using objective [dorsal height (DH) and radix height (RH), complication rate] and subjective (patient satisfaction) parameters. RESULTS: The degree of augmentation represented by DH and RH was comparable between primary and revision rhinoplasty using TPFL. In comparing the rate of postoperative complications, only minor incidents were noted, in six cases after primary surgery and in one case after revision surgery. Patient satisfaction was measured in both primary and revision augmentation, with a significant difference observed between the two groups (40.57 ± 9.25 versus 31.48 ± 7.59; p < 0.05). CONCLUSION: TPFL is a feasible implant material that delivers suitable augmentation and patient satisfaction with minimal morbidity in both primary and revision rhinoplasty.

Immediate re-insertion of non-autologous materials in revision augmentation rhinoplasty.

OBJECTIVE: This paper aims to study whether immediate re-insertion of non-autologous augmentation material in revision augmentation rhinoplasty is a safe surgical strategy creating a successful and functional aesthetic outcome. STUDY DESIGN: Retrospective review and analysis of medical records. SETTING: Tertiary referral hospital. SUBJECTS AND METHODS: A retrospective analysis of 11 consecutive patients who had undergone removal of previous augmentation material and immediate re-insertion of non-autologous material in revision augmentation rhinoplasty was performed. Demographics, surgical approaches, augmentation materials, material-related complications, time interval between surgeries, surgical outcome, and follow-up period were included in the analysis to evaluate our surgical strategy. RESULTS: A successful surgical outcome with respect to both functional and aesthetic aspects was obtained in nine of the 11 enrolled patients. In 1 patient, there was a recurrence of material-related complication, while another patient experienced unsatisfactory graft displacement. The unsuccessful cases had 2 common features in that silicone and endonasal approaches were used in the primary and revision surgeries, respectively. CONCLUSION: Removal of previous augmentation material and immediate re-insertion of non-autologous material for dorsal augmentation in revision rhinoplasty is feasible with respect to functional and aesthetic aspects of patient outcome.

Treatment outcomes of sinonasal adenoid cystic carcinoma: 30 cases from a single institution.

OBJECTIVE: To establish the clinical features and prognostic factors of sinonasal adenoid cystic carcinoma (ACC). MATERIAL AND METHODS: Thirty patients with histopathological diagnosis of sinonasal ACC who were treated at Severance Hospital between 1990 and 2010 were included in this retrospective chart review study. RESULTS: The 5-year disease-specific survival and disease-free survival rates were 75.3% and 37.2%, respectively. The maxillary sinus (63.3%) and nasal cavity (23.3%) were the most common sites of primary tumour. Most patients were diagnosed with advanced-stage (III/IV) disease (80.0%) and had undergone surgery and postoperative radiotherapy (70.0%). The most common histopathological subtype was cribriform type (40.9%). Local recurrence rate and distant metastasis rates were 26.7% and 23.3%, respectively. The mean time from primary treatment to recurrence was 44.5 months. Sinonasal ACC patients with stage IV and T4 disease had significantly worse survival than those with low stage and T disease. Patients with local recurrence had worse disease-specific survival than those with distant recurrence. Distant metastasis was associated with disease-free survival but not disease-specific survival. CONCLUSION: Despite the frequent occurrence of distant metastasis, early diagnosis and effective local control seemed to be the most important factors influencing the survival of sinonasal ACC.

Prevalence and risk factors of chronic rhinosinusitis in Korea.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common inflammatory diseases with multiple etiologies. Despite its high prevalence, risk factors influencing its prevalence have not been thoroughly revealed. Therefore, we investigated the prevalence and risk factors of CRS in Korea. METHODS: The 4098 subjects that participated in the Korea National Health and Nutrition Examination Survey were included in the study. Risk factors were categorized into sociodemographic and personal medical factors. Univariate and multivariate analyses were performed to identify significant risk factors of CRS. In addition, population attributable risks of the significant factors were calculated to estimate the effect on the population level. RESULTS: The prevalence of CRS in Korea was 6.95%. Among sociodemographic factors, male sex, old age, and heavy stress were significantly related with CRS. Influenza vaccination, septal deviation, and persistent allergic rhinitis were significant personal medical risk factors of CRS. Among these risk factors, persistent/moderate to severe allergic rhinitis was proven to be the most significant risk factor for CRS at the population level. CONCLUSION: Although the prevalence and risk factors vary according to time, place, and diagnostic criteria, periodic epidemiological study on CRS is necessary to reduce socioeconomic expenditure and establish an improved national health care policy.

Double reversing Z-plasty with inferiorly widening stomaplasty for the management of tracheostomal stenosis.

OBJECTIVES: To present a surgical technique for the management of tracheostomal stenosis: double reversing Z-plasty with inferiorly widening stomaplasty. METHODS: This study was a retrospective review of five patients (four males, one female) submitted for tracheostomal widening procedure using "double reversing Z-plasty with inferiorly widening stomaplasty" at our department between May 2003 and April 2009. Skin incision was made on each lateral side of the stoma. The skin flap was elevated, and the subcutaneous and scar tissue at the infrastomal area was removed along with the redundant skin. Vertical incision was made on each side of the trachea as a mirror image, and the trachea was splayed. The inferiorly mobilized trachea was sutured to the new tissue bed inferior to the stoma, and both skin flaps were secured to the depths of the tracheal cut (double reversing Z-plasty). RESULTS: All five patients showed widened tracheostoma without any complications, and their phonatory prostheses functioned well after the procedure. In no case was it necessary to keep the tracheal tubes beyond the first day after the surgery. CONCLUSION: This technique, "double reversing Z-plasty with inferiorly widening stomaplasty", provides a safe procedure for enlarging the tracheostomal size and easing the excessive tension without disturbing the posterosuperior stomal profile and the tracheoesophageal puncture for phonatory prosthesis.