Retrospective comparison of first-line treatments for odontogenic sinusitis based on duration of symptoms.

Objectives: To investigate the clinical efficacy of dental treatment and endoscopic sinus surgery (ESS), each primary/combined treatment modality, in patients with odontogenic sinusitis (ODS), according to its phase, acute or chronic. Materials and methods: We retrospectively reviewed clinical data on 172 patients diagnosed with ODS. They were divided into two groups: acute (≤ 3 months; 90 patients) and chronic (> 3 months; 82 patients) ODS. The success rate and time to resolution of each primary/combined treatment modality were compared between the two groups. Results: In both ODS groups, the success rate was highest with combined ESS and dental therapy, followed by ESS alone and dental therapy alone. ESS outperformed dental therapy (96.6% vs 65.5% for acute ODS, p = 0.011; 80.6% vs 56.5% for chronic ODS, p = 0.046) and led to quicker resolution of symptoms for acute ODS than dental therapy (0.9 vs 1.7 months, p = 0.012). In the comparison between ESS alone and combined therapy, no significant difference was observed for acute ODS, whereas combined therapy demonstrated a superior success rate for chronic ODS (100% vs 80.6%, p = 0.046). Conclusions: In our study, the clinical utility of dental treatment and/or ESS depended on the morbidity period of ODS. For chronic ODS, combined ESS and dental treatment seems to be an effective first-line treatment.

Impact of long-term nasal airflow deprivation on sinonasal structures and chronic rhinosinusitis in total laryngectomy patients.

Objective: Total laryngectomy (TL) patients are good models in which to evaluate the effects of nasal airflow cessation on the sinonasal tract. Here, we evaluated changes in sinonasal structures and association with sinus opacification in the computed tomography (CT) images 3 years post-TL. Methods: Patients who underwent TL from 2005 to 2017 in a teaching academic center were reviewed retrospectively. Patients with a final follow-up CT taken less than 3 years after TL, tracheoesophageal puncture, inadequate CT image, or history of sinonasal surgery were excluded. The control group included patients who underwent a partial laryngectomy or hypopharyngectomy without requiring a tracheotomy for more than a month. Altogether, 45 TL patients and 38 controls were selected. The volume of all four paranasal sinuses, inferior turbinate soft tissue volume (ITSTV), maxillary sinus natural ostium (MSNO) mucosal width, and Lund-Mackay scores (LMS) were measured on preoperative and postoperative CT scans. Results: The mean duration between surgery and the final CT scan was 6.3 ± 2.4 and 5.5 ± 2.3 years for the TL and control groups, respectively. Neither group showed significant changes in the four paranasal sinuses' volume or MSNO mucosa width. The ITSTV decreased significantly, from 4.6 ± 1.3 to 2.8 ± 1.1 mL (p < .001), in the TL group, regardless of the presence of nasal septal deviation, showing ITSTV reduction on both concave and convex sides. By contrast, the control group showed no significant changes in ITSTV. Postoperative LMS changes in both groups were insignificant. The number of patients with LMS aggravation or alleviation was the same in both groups, regardless of preoperative sinus opacification. Conclusions: Paranasal sinus structures and sinus opacification are not affected significantly by nasal airflow cessation; however, the inferior turbinate mucosa is affected by long-term discontinuation of nasal airflow. Level of Evidence: 4 (case-control study).

Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients.

INTRODUCTION: Sinonasal organizing hematoma (OH) is a rare, nonneoplastic lesion that often presents with epistaxis, a reddish mass, and destruction of the involved sinonasal structures. Due to its rarity, the demographics, diagnostic modalities, treatment strategies, and outcomes have not yet been studied in a large, long-term study. MATERIALS AND METHODS: Retrospect cohort of 112 sinonasal OH patients treated between 1997 and 2020 in a tertiary, university hospital were evaluated. Demographics, systemic comorbidities, sinonasal surgery history, serum laboratory tests, radiological findings, and treatment results were collected. The present study aimed to assess the accuracy of preoperative computed tomography (CT), Gadolinum-enhanced magnetic resonance (MR), and punch biopsies in detecting sinonasal OH as the most likely diagnosis. In addition, incidental differences by age and year of diagnosis were calculated using the Poisson log-linear regression model. RESULTS: The median age was 44, and 58% were male. Fewer than 20% of these cases had a chronic systemic comorbidity, bleeding tendency, or sinonasal surgery history. MR had the highest accuracy of (87%) to detect sinonasal OH as the most likely diagnosis, compared with contrast-enhanced-CT (53%), punch biopsy (49%), and non-enhanced-CT (16%) (all <0.05). Sinonasal OH incidence did not vary by age, but the yearly rate significantly increased by 1.05 times over 23 years (p < 0.05). Notably, 84% of 112 patients received surgical removal through the assistance of an endoscope, and none had substantial bleeding without preoperative embolization. CONCLUSION: Sinonasal OH was observed regardless of age, sex, systemic comorbidities, bleeding tendency, prior sinonasal surgery, or trauma. Preoperative MR gives the highest accuracy for detecting this disease. Sinonasal OH may be safely managed with endoscopic-assisted surgery removal without embolization. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1581-1590, 2024.

The beneficial effects of an adenotonsillectomy upon upper respiratory tract infections, asthma and rhinitis in children: a national database study in Korea.

BACKGROUND: Adenotonsillectomy is the most commonly performed surgery in children. AIMS: To evaluate the effects of pediatric adenotonsillectomy on health care utilization. METHODS: From 2006 to 2017, age/sex-matched adenotonsillectomy participants (n = 243.396) and controls (n = 730.188) were selected (62% of male and 38% of female. 47% age≦ 6, 16% 7-9years, 8% 10-12years, 29% 13-18years). The changes in outpatient visits, hospitalization days, and drug prescriptions due to a URI, asthma, and rhinitis before and after the surgery date (from 13 months to 1 month) were compared. RESULTS: Outpatient visits decreased more in the surgery group than the control group (mean change, 3.24 ± 8.61 d and 1.16 ± 6.57 d for URI, 2.07 ± 8.63 d and 0.51 ± 6.47 d for rhinitis, and 0.72 ± 4.81 d and 0.42 ± 3.91 d for asthma, p < .001 for all). Hospitalizations also showed greater decreases in the surgery group (mean change, 0.31 ± 2.96 d and 0.04 ± 1.70 d for URI, 0.13 ± 2.40 d and 0.02 ± 1.48 d for rhinitis, 0.11 ± 2.32 d and 0.04 ± 1.83 d for asthma, p < .001 for all). The prescription of antihistamines, leukotriene modulators, oral antibiotics, oral steroids, and expectorants, cough suppressants and oral bronchodilators was also decreased after surgery. CONCLUSIONS: The adenotonsillectomy group showed a greater decrease in post-operative outpatients visits, hospital days and drug prescriptions associated with URI, rhinitis and asthma than the control group.

Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC).

INTRODUCTION: Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. MATERIAL AND METHODS: Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. RESULTS: The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. CONCLUSION: IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:2502-2510, 2023.

Features of Odontogenic Sinusitis Associated With Dental Implants.

OBJECTIVES: With the increase in dental implants for tooth loss, odontogenic sinusitis following maxillary dental implants is frequently encountered in otorhinolaryngology practice. The authors aimed to reveal the association between implant extrusion into maxillary sinus, along with implant-related complications in patients diagnosed with implant-related odontogenic sinusitis (IR-ODS). STUDY DESIGN: Case-control study. METHODS: This study enrolled 60 patients who received functional endoscopic sinus surgery due to IR-ODS. The preoperative sinus computed tomography was retrospectively reviewed. Among the 120 maxillary sinuses of the 60 patients, 68 sides were diagnosed with IR-ODS sides, whereas 27 sides showed no clinical or radiological evidence of this condition after the implant insertion and were defined as the control sides. Statistical analysis between these two groups was conducted, in addition to odds ratio (OR) calculations for associations with IR-ODS. RESULTS: The mean age of the IR-ODS subjects was 59.5 ± 19.1, with a male to female ratio of 32/28 (53.3%/46.7%). Implants extruding by more than 4 mm into the maxillary sinus, peri-implantitis, bone graft disruption-extrusion were associated with a significantly higher incidence in the IR-ODS (p = 0.035, p = 0.003, p = 0.011, respectively). The IR-ODS sides showed an adjusted-OR (95% confidence interval) of 27.4 (2.7-276.5) for extrusion length >4 mm, 11.8 (3.0-46.5) for peri-implantitis, and 34.1 (3.3-347.8) for bone graft disruption (p = 0.005, p < 0.001, and p = 0.003, respectively). CONCLUSION: Maxillary dental implants extruding more than 4 mm into the maxillary sinus, peri-implantitis, and disrupted-extruded bone grafts show significant association with IR-ODS. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:237-243, 2023.

Treatment Outcomes of Sinonasal Malignancies Involving the Orbit.

Objective Orbital invasion is associated with a poor prognosis in cases of sinonasal malignancy. This study aimed to analyze the oncological outcomes of sinonasal malignancies involving the orbit. Patients and Methods We reviewed the medical records of 116 patients with a sinonasal malignancy who had orbital invasion at initial diagnosis and followed up at least 6 months between June 1991 and October 2017 at a single institute. The overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) rates according to the clinicopathological factors, extent to orbit, and treatment modality were compared. Results Patients were mainly treated with surgery and postoperative radiation ( n = 39, 33.6%) and concurrent chemoradiation ( n = 72, 62.1%). Only five patients (5.1%) underwent orbital exenteration. The OS, DSS, and PFS rates significantly decreased in patients older than 60 years of age and in patients with a higher Charlson Comorbidity Index Score (each p < 0.001). The OS and DSS rates were higher in patients at clinical T3 and N0 stage than in patients at clinical T4 and N1-2 stage (each p < 0.05). There were no significant differences in survival and local control rates according to the extent of orbital invasion, treatment modalities, and orbital preservation. However, neoadjuvant chemotherapy and adjuvant radiation or concurrent chemoradiation increased survival rates in the patients treated with surgery. Conclusion Orbit preservation and relatively successful oncological outcome could be obtained with surgery and adjuvant radiation or concurrent chemoradiation.

The Migration of Human Follicular Dendritic Cell-Like Cell Is Facilitated by Matrix Metalloproteinase 3 Expression That Is Mediated through TNFα-ERK1/2-AP1 Signaling.

Follicular dendritic cells are important stromal components of the germinal center (GC) and have pivotal roles in maintaining the GC microenvironment for high-affinity antibody production. Tumor necrosis factor-α (TNFα) is essential for the development and functions of follicular dendritic cells. Despite the importance of follicular dendritic cells in humoral immunity, their molecular control mechanisms have yet to be fully elucidated due to the lack of an adequate investigation system. Here, we have used a unique human primary follicular dendritic cell-like cell (FDCLC) to demonstrate that the migration of these cells is enhanced by TNFα-mediated metalloproteinase 3 (MMP3) expression. MMP3 was found to be highly expressed in normal human GCs and markedly upregulated in human primary FDCLCs by TNFα. TNFα induced ERK1/2 phosphorylation and the transcription of MMP3 through AP1. TNFα treatment increased FDCLC migration, and a knockdown of MMP3 significantly reduced the TNFα-induced migration of FDCLCs. Overall, we have newly identified a control mechanism for the expression of MMP3 in FDCLCs that modulates their migration and may indicate an important role in GC biology. Since GCs are observed in the lesions of autoimmune diseases and lymphomas, targeting the MMP3/TNFα-mediated migration of stromal cells in the B cell follicle may have great potential as a future therapeutic modality against aberrant GC-associated disorders.

Counterclockwise Rotational Orthognathic Surgery for the Obstructive Sleep Apnea in Class II Dentofacial Deformity: Polysomnography and 3D Computed Tomographic Analysis.

ABSTRACT: Traditionally, maxillomandibular advancement is an orthognathic surgical procedure that has been used to manage obstructive sleep apnea in patients not able or willing to maintain adherence to continuous positive airway pressure therapy or for patient who are not able to adhere to treatment. However, maxillomandibular advancement often leads to unsatisfactory cosmetic results.This prospective study investigated functional and esthetic outcomes using polysomnography and 3-dimensional computed tomography, after counterclockwise rotational orthognathic surgery. We enrolled 17 patients with obstructive sleep apnea, who underwent orthognathic surgery at single institution between March 2013 and December 2018.After 12 months, the patients' mean self-rated score for facial appearance, using a 10-step visual analog scale, was 7.36. The preoperative apnea-hypopnea index and respiratory disturbance index were 34.70 and 37.45, respectively; postoperative indices were 11.60 and to 12.69, respectively (P = 0.003, 0.003). The mean posterior pharyngeal airway space increased from 5357.88 mm3 preoperatively to 8481.94 mm3 after 6 postoperative months.Counterclockwise rotational orthognathic surgery for the correction of obstructive sleep apnea turned out to be the ideal solution not only in the correction of the sleep apnea, but also in the facial esthetics.

Treatment outcomes in acute invasive fungal rhinosinusitis extending to the extrasinonasal area.

Acute invasive fungal rhinosinusitis (AIFRS) can spread beyond the sinonasal cavity. It is necessary to analyze the association between the specific site involved in the extrasinonasal area and the survival rate to predict patient prognosis. We investigated 50 patients who had extrasinonasal lesions on preoperative gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) scan and underwent wide surgical resection of AIFRS. The specific sites with loss of contrast enhancement (LoCE) on Gd-enhanced MRI were analyzed for AIFRS-specific survival rate. The most common underlying disease was diabetes mellitus followed by hematological malignancy. The most common symptoms were headache and facial pain. Seven patients (14.0%) expired because of AIFRS progression. Poor prognosis was independently associated with LoCE at the skull base on preoperative MRI (HR = 35.846, P = 0.004). In patients with AIFRS extending to the extrasinonasal area, LoCE at the skull base was an independent poor prognostic factor.

Recurrence patterns of sinonasal cancers after a 5-year disease-free period.

OBJECTIVES/HYPOTHESIS: Sinonasal cancers are rare but have a poor prognosis. Most previous studies of these cancers have focused on 5-year disease-free survival, but recurrences are also known to occur after this period. We examined the post-5-year recurrence patterns in sinonasal cancer patients by histologic type to determine the indicators for extended and close follow-up requirements. STUDY DESIGN: Retrospective chart review. METHODS: A cohort of 241 sinonasal cancer patients was included. Demographic data, cancer site and stage, pathology and treatment results, and follow-up and survival data were collected. RESULTS: Of the 241 patients, a complete remission occurred in 163 (72.4%) patients, but 83 (50.9%) of these cases developed recurrence, which occurred beyond the 5-year follow-up period in 19 cases (11.7%). The most common post-5-year recurrences were adenoid cystic carcinoma (six patients, 33.3%), followed by melanoma (three patients, 21.4%), poorly differentiated carcinoma (two patients, 18.2%), squamous cell carcinoma (six patients, 6.7%), and olfactory neuroblastoma (no patients, 0%). Post-5-year local recurrence was highest in adenoid cystic carcinoma (six patients, 33.3%), followed by melanoma (three patients, 21.4%), poorly differentiated carcinoma (two patients, 18.2%), and squamous cell carcinoma (five patients, 5.5%). Post-5-year regional recurrence occurred in one squamous carcinoma patient (1.1%), and distant metastasis was seen in one adenoid cystic carcinoma patient (5.5%). CONCLUSIONS: Sinonasal cancer shows an 11.7% recurrence rate after a 5-year disease-free period. As this recurrence pattern varies by tumor pathology, a specific follow-up plan is needed for each cancer type. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:2451-2457, 2019.

Human Plasmablast Migration Toward CXCL12 Requires Glucose Oxidation by Enhanced Pyruvate Dehydrogenase Activity via AKT.

Migration of human plasmablast to the bone marrow is essential for the final differentiation of plasma cells and maintenance of effective humoral immunity. This migration is controlled by CXCL12/CXCR4-mediated activation of the protein kinase AKT. Herein, we show that the CXCL12-induced migration of human plasmablasts is dependent on glucose oxidation. Glucose depletion markedly inhibited plasmablast migration by 67%, and the glucose analog 2-deoxyglucose (2-DG) reduced the migration by 53%; conversely, glutamine depletion did not reduce the migration. CXCL12 boosted the oxygen consumption rate (OCR), and 2-DG treatment significantly reduced the levels of all measured tricarboxylic acid (TCA) cycle intermediates. AKT inhibitors blocked the CXCL12-mediated increase of OCR. CXCL12 enhanced the pyruvate dehydrogenase (PDH) activity by 13.5-fold in an AKT-dependent manner to promote mitochondrial oxidative phosphorylation. The knockdown and inhibition of PDH confirmed its indispensable role in CXCL12-induced migration. Cellular ATP levels fell by 91% upon exposure to 2-DG, and the mitochondrial ATP synthase inhibitor oligomycin inhibited CXCL12-induced migration by 85%. Low ATP levels inhibited the CXCL12-induced activation of AKT and phosphorylation of myosin light chains by 42%, which are required for cell migration. Thus, we have identified a mechanism that controls glucose oxidation via AKT signaling and PDH activation, which supports the migration of plasmablasts. This mechanism can provide insights into the proper development of long-lived plasma cells and is, therefore, essential for optimal humoral immunity. To our knowledge, this study is the first to investigate metabolic mechanisms underlying human plasmablast migration toward CXCL12.

Change in Posterior Pharyngeal Space After Counterclockwise Rotational Orthognathic Surgery for Class II Dentofacial Deformity Diagnosed With Obstructive Sleep Apnea Based on Cephalometric Analysis.

Although maxillomandibular advancement (MMA) is an orthognathic surgical procedure used to manage obstructive sleep apnea (OSA) in individuals who are noncompliant with continuous positive airway pressure therapy, simple MMA encounters problems in terms of aesthetic outcomes in Asian populations with preexisting dentoalveolar protrusion. Our current prospective investigation describes changes in posterior pharyngeal space and aesthetic outcomes after counterclockwise rotational orthognathic surgery, which is known to be quite difficult in terms of the maintenance of the skeletal stability in skeletal class II patients with OSA. This prospective study investigated the surgical outcome of patients who suffered from OSA following counterclockwise rotational orthognathic surgery. The patients were skeletal class II patients who underwent orthognathic surgery between March 2013 and December 2014. Cephalometric posterior airway analysis and a questionnaire for facial perception were used to assess pharyngeal airway and patient perception of facial appearance. A total of 14 patients were included. Satisfactory results were achieved without complications in all OSA patients. The airway parameters for anteroposterior length significantly increased. Thirteen patients answered a questionnaire on their facial appearance, and the visual analog scale averaged 7.31 points, indicating a favorable facial appearance. Counterclockwise rotational orthognathic surgery without maxilla advancement for the correction of OSA can effectively increase the posterior pharyngeal space, with favorable aesthetic results. With thoughtful application, this novel approach may be an alternative to standard approaches for the correction of OSA using orthognathic surgery.

Androgen receptor-positive ductal adenocarcinoma of the nasolacrimal duct: A case report.

PURPOSE: Primary ductal adenocarcinoma arising in the structures of the lacrimal apparatus is extremely rare, and the entity is considered a lacrimal counterpart of salivary duct carcinoma, of which the majority are known to express androgen receptor (AR). Less than 10 cases of AR-positive carcinomas of lacrimal gland or lacrimal sac have been described. OBSERVATIONS: We present a primary ductal adenocarcinoma with AR expression involving the nasolacrimal duct of a middle-aged patient who had suffered from right eyelid swelling, diplopia and epiphora for 4 months. Although the tumor histologically resembled oncocytic carcinoma, electron microscopic examination did not show cytoplasmic accumulation of mitochondria, which excluded the diagnosis of oncocytic carcinoma with AR positivity. CONCLUSIONS AND IMPORTANCE: We concluded that this is the first case of AR-positive ductal adenocarcinoma arising from nasolacrimal duct. It is possible that some of the previously documented oncocytic carcinomas of the lacrimal drainage system may include ductal adenocarcinomas with oncocytic features.

Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study.

OBJECTIVES: To evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA. METHODS: We enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a ≥50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of ≥4 hours per night and ≥5 days per week. RESULTS: A total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects. CONCLUSION: The extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery.

Engagement of CD99 Reduces AP-1 Activity by Inducing BATF in the Human Multiple Myeloma Cell Line RPMI8226.

CD99 signaling is crucial to a diverse range of biological functions including survival and proliferation. CD99 engagement is reported to augment activator protein-1 (AP-1) activity through mitogen-activated protein (MAP) kinase pathways in a T-lymphoblastic lymphoma cell line Jurkat and in breast cancer cell lines. In this study, we report that CD99 differentially regulated AP-1 activity in the human myeloma cell line RPMI8226. CD99 was highly expressed and the CD99 engagement led to activation of the MAP kinases, but suppressed AP-1 activity by inducing the expression of basic leucine zipper transcription factor, ATF-like (BATF), a negative regulator of AP-1 in RPMI8226 cells. By contrast, engagement of CD99 enhanced AP-1 activity and did not change the BATF expression in Jurkat cells. CD99 engagement reduced the proliferation of RPMI8226 cells and expression of cyclin 1 and 3. Overall, these results suggest novel CD99 functions in RPMI8226 cells.

Treatment outcomes of concurrent chemoradiotherapy for locally advanced sinonasal squamous cell carcinoma: A single-institution study.

CONCLUSIONS: CCRT is a potential treatment option for locally advanced sinonasal SCC in terms of organ preservation. OBJECTIVES: Concurrent chemoradiotherapy (CCRT) is increasingly used for patients with advanced head and neck cancer to preserve organ function and improve survival. In the present study, treatment outcomes were compared between surgery and post-operative radiotherapy (PORT) and CCRT in patients with locally advanced sinonasal squamous cell carcinoma (SCC). METHODS: The records of 30 patients with non-metastatic stage III and IV sinonasal SCC were retrospectively reviewed. Fifteen patients were treated with CCRT and 15 patients underwent PORT. RESULTS: The locoregional recurrence-free, distant metastasis-free, disease-free, disease-specific, and overall survival rates did not differ between PORT and CCRT groups. In addition, there were no significant differences in incidence rates of acute and chronic toxicities between the two groups.

The utility of three screening questionnaires for obstructive sleep apnea in a sleep clinic setting.

PURPOSE: The aim of this study was to determine the diagnostic value of three screening questionnaires in identifying Korean patients at high risk for obstructive sleep apnea (OSA) in a sleep clinic setting in Korea. MATERIALS AND METHODS: Data were collected from 592 adult patients with suspected OSA who visited a sleep center. All patients completed the Sleep Apnea of Sleep Disorder Questionnaire (SA-SDQ), the Berlin questionnaire, and the STOP-Bang questionnaire. Estimated OSA risk was compared to a diagnosis of OSA. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each questionnaire. RESULTS: The prevalence of OSA was 83.6% using an apnea-hypopnea index (AHI) ≥5/h and 58.4% for an AHI ≥15/h. The STOP-Bang questionnaire had a high sensitivity (97% for AHI ≥5/h, 98% for AHI ≥15/h), but the specificity was low (19% and 11%, respectively). In contrast, the sensitivity of the SA-SDQ was not high enough (68% for AHI ≥5/h, 74% for AHI ≥15/h) to be useful in a clinical setting, whereas the specificity was relatively good (66% and 61%, respectively). The sensitivity and specificity values of the Berlin questionnaire fell between those of the STOP-Bang questionnaire and the SA-SDQ. CONCLUSION: The STOP-Bang questionnaire may be useful for screening OSA in a sleep clinic setting, but its specificity is lower than the acceptable level for this purpose. A new screening questionnaire with a high sensitivity and acceptable specificity is therefore needed in a sleep clinic setting.

The prognostic value of gadolinium-enhanced magnetic resonance imaging in acute invasive fungal rhinosinusitis.

OBJECTIVES: This study aimed to assess the prognostic value of gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) in acute invasive fungal rhinosinusitis (AIFRS) and offer recommendations for determining surgical extent based on loss of contrast enhancement (LoCE), which reveals tissue ischemia from fungal invasion. METHODS: Preoperative and postoperative Gd-enhanced MRI was evaluated in 21 patients with confirmed AIFRS who underwent wide debridement and antifungal therapy. Patients were subdivided by AIFRS-specific survival. LoCE and contrast enhancement (CE) of intrasinonasal and extrasinonasal sites in preoperative and postoperative MRI were compared between the two groups. RESULTS: All patients had preoperative intrasinonasal LoCE and CE lesions, which did not differ between survivors and non-survivors. Bone destruction on CT was detected in 8 of 16 survivors (50%) and 4 of 5 non-survivors (80%). Intrasinonasal LoCE lesions were completely removed by surgery in all cases. Postoperative extrasinonasal LoCE lesions were found in all non-survivors but no survivors (p < 0.001). However, postoperative intrasinonasal and extrasinonasal CE lesions were detected in both survivors and non-survivors (p = 0.119 and p = 0.111, respectively). In addition, remission of hematologic diseases at the time of diagnosis of AIFRS and blood sugar control in diabetic patients were significantly associated with AIFRS-specific survival (p = 0.028 and p = 0.023, respectively). CONCLUSIONS: LoCE lesions, which have to be surgically removed, should be screened using Gd-enhanced MRI for an earlier diagnosis of AIFRS, determination of surgical extent, and management of follow-up. Remnant LoCE lesions after surgery, active hematologic diseases, and poorly controlled blood sugar adversely affect the AIFRS-survival.