Histological Evaluation of Gore-Tex(R) used in Nasal Augmentation of Human / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although Gore-Tex is popularly used in nasal augmentation in human, studies about the histological changes have been carried out only in animal models. The purpose of this study is to investigate histological changes of Gore-Tex used in nasal augmentation in human. SUBJECTS AND METHODS: Gore-Tex of 24 patients who underwent nasal augmentation using Gore-Tex (non-reinforced sheets) 2-36 months ago and had re-operated for the sole cosmetic problems was obtained. Histologic examination was performed from specimens including Gore-Tex and the surrounding soft tissue with light microscope and electromicroscope. RESULTS: Histologically, connective tissue ingrowth was observed in all specimen. But the degree of foreign body reaction and collagen deposit varied from specimen to specimen and had no relationship with the duration. Neovascularization was observed from specimen whose duration was longer than 12 months and degenerative calcification was observed from 36 month old specimen. CONCLUSION: Unlike the findings of previous reports, individual differences and partial degenerative lesions in Gore-Tex were observed. Additional studies are required to confirm the stability of Gore-Tex as an implant to be used in human.

A Case of Rhinophyma / 대한이비인후과학회지

Rhinophyma is a disfiguring soft tissue hypertrophy of the nose. It is an uncommon disease that primarily affects Caucasian men in the fifth to seventh decades of life. Many treatment methods have been advocated, often with acceptable success, but there appears to be no one modality that is universally endorsed. We present a case of a 70 year old male who was treated with dermabrasion for rhinophyma in the nose.

Analysis of the Complication of Expanded-Polytetrafluoroethylene(e-PTFE) as Augmentation Material in Oriental / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although the complication of using e-PTFE as augmentation material in rhinoplasty for occidental patients have been reported, but only a little information is available for oriental patients. The aim of the present study is to analyze complications of e-PTFE for nasal augmentation in rhinoplasty for oriental patients. MATERIALS AND METHOD: The subjects consisted of 1376 patients who had been performed augmentation rhinoplasty with e-PTFE between January 1994 and October 2002. The subjects were classified according to experience of rhinoplasty. The first group included primary cases and second group revision cases. The revision group was divided into two groups according to the different techniques performed, one being the minor group that had been performed the simple technique, and the other group that had been performed the complicated technique. We reviewed postoperative complications of augmentation rhinoplasty with artificial implants including displacement, surface irregularity, infection, dorsal line and height problem, soft tissue reaction, extrusion and resorption. RESULTS: Side effects occurred in 127 (9.2%) of the 1376 patients: 38 (29.9%) was displacement, 29 (22.8%) dorsal height problem, 23 (18.1%) surface irregularity, 18 (14.2%) dorsal line and 18 (14.2%) infection and others. CONCLUSION: Compared with other autogenous and artificial materials, the study found e-PTFE as a good material for augmentation rhinoplasty for the orientals.

A Case of Multiple Intramuscular Lipoma of the Tongue / 대한이비인후과학회지

Although lipomas are among the most common benign tumors, their occurrences in the oral cavity has been reported infrequently, accounting for only 2.2% to 4.4% of all benign tumors in this site. Especially, lipomas of the tongue are rare tumors that are represented by less than 0.5% of all benign tumors in the oral cavity. There are two types of solitary lipomas, the cutaneous (superficial) type and the deep-seated (subfascial) type. The deep and soft tissue-infiltrating lipomas are classified into between-muscle groups (intermuscular lipoma) or within-muscle groups (intramuscular lipoma). Intramuscular lipoma is composed of mature adipose tissues that infiltrate into muscles in a diffuse manner, and the entrapped muscle fibers exhibited varying degrees of atrophic change. We experienced a case of bilateral multiple intramuscular lipomas of the tongue which was cured by surgery.

Psychoanalysis of the Aesthetic Nasal Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although there are many different reasons for rhinoplasty, there has not been any been systematic research conducted about different motivations patients have. The motivation for the surgery, the preferred shape of nose, the concerns about surgery, the terms needed to make the decision were different and greatly depended on the circumstances. MATERIALS AND METHODS: Two hundred and seventeen persons who have been operated in the Inha Hospital from 1996 to 2000 have been consulted. The survey paper is constituted by fifty-one multiple-choice questions. RESULTS: For the question asking the main reason for wanting rhinoplasty, the majority answered it was to restore their injured nose. The next popular answer was the desire to have a better-shaped nose. For male patients, their deviated nose was caused by injury or accident, and thus desired to have the normal or the original shape of nose by operation. The survey revealed a different result for the opposite sex. The main reason for female patients' wanting rhinoplasty was to have a good-looking nose, and for that purpose they expressed their desire to heighten their nose. Interestingly, the concern about the side effects after the surgery was the greatest reason for avoiding rhinoplasty. CONCLUSION: Every surgery should be well-prepared with the exact analysis of the patient's nasal history and his special request.

New Forceps for Insertion of Implants in Augmentation Rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In general, Asians have noses characterized by a wide flat dorsum, a bulbous thick nasal tip, thick subcutaneous tissues with alar flare, and a short, retracted columella. Such anatomical characteristics have resulted in augmentation rhinoplasty to be the most popular procedure for Asian noses. In augmentation rhinoplasty, it is important to choose proper implant material and insert it into the exact position. But it is hard to insert relatively soft graft or implant such as cartilage and Gore-tex in the exact site. A new kind of forceps, named Jung's forceps, has been developed for implant insertion in augmentation rhinoplasty. We will introduce a new insertion technique using the Jung's forceps. MATERIALS AND METHODS: More than 300 cases of augmentation rhinoplasty was performed using the new forceps since January, 1999. The forceps was designed for grasping whole graft materials. It has 2 mm chink at the tip. This 2 mm chink was designed for passing the 26 gauge needle. When inserting a graft using the forceps, the 26 gauge needle could fix the graft percutaneously at the exact site by passing it through the chink of forceps. We compared the new technique with several previous methods and examined the differences among them. RESULTS: The procedure using the forceps was very easy, exact, and took less time than any other techniques. CONCLUSION: We concluded that the new forceps are useful in augmentation rhinoplasty and other cosmetic surgery.

A Case of Dorsal Nasal Cyst after Augmentation Rhinoplasty / 대한이비인후과학회지

Augmentation rhinoplasty is one of the most popular aesthetic procedures for orientals. Various materials have been used for augmenting the nasal dorsum. Complications that may occur right after rhinoplasty are generally attributed to failure to obtain the desired aesthetic, functional and psychological results. Other complications include postoperative hemorrhage and infection including cellulitis, abscess formation and toxic shock. Serious life-threatening complications such as intracranial or general infection that occurred in the preantibiotic era are fortunately infrequent. Dorsal nasal cyst formation is also considered a rare complication of augmentation rhinoplasty. The cause of this complication is not well known untill now; however, the entrapment of nasal mucosa and subsequent growth through osteotomy sites are thought to be the basis for the formation of these mass. Dorsal nasal cyst formation of post-augmentaion rhinoplasty was reported in a few case around the world but not in Korea. However, we experienced one case of dorsal nasal cyst formation after augmentation rhinoplasty in our clinic. Therefore, we present the case report of dorsal nasal cyst formation as a rare post-augmentation rhinoplasty with inferior turbinate bone and cartilage.

Rhinoplasty in combination with the total septal reconstruction of the severe septal & external deformities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Caudal and/or dorsal septal deformities cause blockage of nasal passages and result in the external deformities of the nose. As these septal deformities can not be corrected by submucosal resection or septoplasty, the surgical correction of these nasal deformities is a difficult challenge. Functional and aesthetic results of total septal reconstruction provide the validity of total septal reconstruction. Material and Methods : This retrospective study reviewed the patients' records in case of "total septal cartilage reconstruction" for severely twisted scoliotic nose. Fifteen cases were detected as "total septal reconstruction" between January, 1998 and December, 1999. All cases were approached externally, and we followed up the patients from three months to one year by analyses with photography, rhinologic examination, and patients' survey. RESULTS: All patients noted marked improvement of nasal obstruction. Aesthetic improvement of the nose was mostly obtained in fourteen cases. No infection, hematoma, graft extrusion, saddle nose deformity, or distortion occurred in this series. CONCLUSION: Total septal reconstruction through external rhinoplasty approach is a suitable technique to obtain satisfactory aesthetic and functional results in severely deformed noses with caudal and/or dorsal septal deformities

Acute Frontal Osteomyelitis Managed by Endoscopic Sinus Surgery: A Case Report / 대한이비인후과학회지

Frontal osteomyelitis, frequently characterized by the classical sign of Pott's puffy tumor, is a serious life-threatening complication of frontal sinus infection. Anterior extension of the frontal sinus infection leads to osteomyelitis of the frontal bone and subperiosteal abscess. Surgical options are necessitated by the location and extent of infection, and include trephination, frontal sinus obliteration, and craniotomy. Recent advances in endoscopic sinus surgery have provided surgeons another access to the frontal recess. Examination of the frontal recess and removal of obstructive ethmoidal cells or diseased mucosa becomes feasible with nasal endoscopes. We report a recent encounter with a case of frontal osteomyelitis managed by endoscopic sinus surgery in a 22-year-old healthy male. We think that endoscopic sinus surgery is a good approach which can be carried out for the treatment of frontal sinus diseases and its complication.

Nitric oxide and peroxynitrite formation in nasal secretion after allergen challenge in the allergic rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recent evidence has shown that nitric oxide (NO) levels are increased in allergic rhinitis. However, the role of this molecule in the pathophysiology of allergic rhinitis is still poorly understood. Peroxynitrite (OONO-), the reactive metabolites of NO, causes nitrotyrosine formation by the nitration of tyrosine residues, and promotes deleterious effects on protein function. We attempted in this study to clarify whether NO and nitrotyrosine in the nasal secretion could be increased in the early or the late phase reaction after allergen challenge. MATERIALS AND METHODS: Samples were obtained from thirteen patients with allergic rhinits to Dermatophagoides Pteronyssinus with the filter paper absorption method. The samples were collected right before, 30 minutes after, and 8 hours after the allergen challenge. Then we estimated the concentrations of nitrite (NO2-) and nitrate (NO3-). Nitrotyrosine in nasal secretions was determined by Western blot analysis in three patients. RESULTS: The nitrite/nitrate concentration in nasal secretions did not show significant changes between the baseline, the early, and the late phase (p>0.05). In the Western blot analysis, the concentration of nitrotyrosine was increased in the late phase. CONCLUSIONS: Although the NO was not increased after the allergen challenge, nitrotyrosine, the evidence of the peroxynitrite effect to tyrosine residues of the protein, was increased in the late phase of the reaction rather than the early phase. Because the peroxynitrite is an metabolite of NO, we can estimate that the overall NO effect has an influence on the late phase of the allergic reaction, and it can be presumed that NO has an influence on the long-term deterioration on the nasal mucosa by cytotoxic effect of peroxynitrite, rather than on the immediate reaction of allergic rhinitis.

Biologic changes of implants and grafts in rhinoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An array of materials have been used for rhinoplasty, however, the fate of these materials after rhinoplasty is not all clear. This study was performed to find post-operative gross and microscopic changes of the implants and grafts (cartilage, Gore-Tex , and Alloderm), and to guide selection of implants and graft. MATERIALS AND METHODS: We took the implants and grafts out from nine patients who underwent revision rhinoplasty for cosmetic problems, and studied gross and microscopic charaterizations. RESULTS: Autologous cartilages showed minor volume reduction and remodeling in gross examination, and mild degeneration, peripheral fibrosis, and fibroblast in-growth without inflammation under microscopic examination. Gore-Tex , which was a little difficulty to remove, had good volume preservation with focal in-growth of fibroblasts and inflammatory cells. A gross examination of Alloderm showed preserved volume, but thin, soft and weak appearance. A microscopic examination of Alloderm showed well preserved collagen materials without inflammation. CONCLUSIONS: Cartilages have good biocompatibility and stabilization, but it is necessary to study absorption and remodeling. We found that Gore-Tex is a good volume filler for dorsal augmentation, whereas Alloderm is a good material for camouflage.

Correlation between Clinical History, Skin Test, RAST and Nasal Provocation Test in Patients with Perennial Allergic Rhinitis

BACKGROUND AND OBJECTIVES: Correct diagnosis for allergic rhinitis is important for optimal management. A thorough history should be taken, followed by general and endoscopic examinations and confirmatory investigations. The role of diagnostic tests in the evaluation of patients with allergic rhinitis continues to evolve. This clinical study was performed to identify the relationship between clinical history and diagnostic tests. MATERIALS AND METHODS: Questionnaire surveys for clinical history, skin test, RAST, and nasal provocation test (acoustic rhinometry and symptom score) to the house dust mites (Dermatophagoides pteronyssinus) were performed in 100 patients from July, 1996 to August, 1998 at Inha University Hospital. The relationship between clinical history (change of syagoides pteronyssinus antigen (Allergopharma, Reinbeck, USA) was sprayed and 15 with PC-SAS. (ver 6.120) RESULTS: There was no correlation between clinical history and the diagnostic tests. However there was a correlation between the results of either skin or RAST testing and those of nasal provocation test. CONCLUSIONS: More careful and complete history taking is needed for diagnosis of allergic rhinitis. The combined use of RAST, skin testing and nasal provocation test yields more information.

Detection of Specific lgE Antibody from Nasal Secretion in Allergic Rhinitis with Negative Results of Skin Test and RAST on D.P / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The diagnosis of allergic rhinitis due to specific antibody is essentially dependent upon the patients' clinical histories, physical examinations, skin test results, and especially on the immunological technique in vitro used for the detection for specific IgE antibody in serum. However, some patients with positive results from nasal provocation tests with allergen can have the negative results from skin tests and the immunological technique in vitro. Therefore, systemic allergic reactions are not completely correlative to those of the localized allergy. MATERIALS AND METHODS: This study was therefore designed to explore the relationship between RAST (radioallergosorbent test) results in nasal secretion of 6 localized allergic patients and 10 controls (5 systemic allergic and 5 non-allergic patients). The nasal secretion was collected by nasal suction method each in three groups before and 20 minutes after antigen (Dermatophagoides pteronyssinus) nasal spray, respectively. RESULTS: There were negative RAST results in nasal secretion of localized allergic patients and controls (5 non- allergy patients) before the antigen nasal spray but, positive RAST results in those of localized allergic patients and controls (5 systemic allergic patients) after the antigen nasal spray. This means that there was statistically a significant difference between localized allergic patients and controls of non-allergy patients after the antigen nasal spray (p<0.01). CONCLUSION: We suggest that localized al1ergic reaction is a specific antigen-antibody allergic immunologic reaction and RAST in nasal secretion is good assistant diagnostic technique in localized allergy.

Lengthening of Short Noses

BACKGROUND AND OBJECTIVES: Lengthening of short noses is one of the therapeutic dilemmas in facial plastic surgery. Aesthetically, short noses are characterized by a decreased distance from the root of the nose to the tip-defining point, and this extends less than one third the vertical height of the face. Also, concavity of the dorsum, a low and deep nasion, an overprojected tip, and an obtuse nasolabial angle of the nose will give a shortened appearance. Considering aesthetical and facial analytic factors, we discuss three techniques for the correction of this problem and propose useful procedure for the desired effect of lengthening in this study. MATERIALS AND METHODS: We have experienced eleven cases of lengthening of the short nose during the last 2 years. We categorized these patients into three groups according to nasolabial angle and tip projection which make a distribution in selecting procedure. On-lay graft on the caudal margin of the lower lateral cartilage is used to the patients with mild overrotated tip and proper nasal projection. Cartilage graft between the caudal septum and the lower lateral cartilge combined with on-lay graft on the caudal margin of the lower lateral cartilage is used to the patients with moderately overrotated tip. Full-length dorsal augmentation is applied to the patients with severely overroatated tip and problematic tip projection. RESULTS: We used three techniques aimed at the correction of the short nose. These techniques treated short nose patients and we obtained effective substantial lengthening results in this study. CONCLUSION: Aesthetical and facial analytic factors must be considered in properly selecting a procedure to lengthen the short nose.

Vascular Anatomy on the Nasal Tip in Koreans / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The blood supply of the nasal tip and columella was examined to determine whether the blood supply to the nasal tip could be damaged from transcolumellar incision during an external rhinoplasty approach in Koreans. MATERIALS AND METHODS: The blood vessels that supply the nasal tip were examined by dissecting 51 cadavers, and their corresponding 102 nasal sections were injected with red latex prior to the dissection. The size and distribution of the vessels were measured with unaided eyes to determine the primary supplying vessels. The subdermal layer in which the vessels lie and the course of the vessels were also investigated. RESULTS: The main vessels of the nasal tip proved to be the lateral nasal artery (78%) and the dorsal nasal artery (22%). Columellar branches were narrower in diameter than the lateral nasal and dorsal nasal arteries and varied in their size and appearance, and therefore they appeared insufficient to be main vessels to supply blood. These arteries passed through the musculoaponeurotic layer, but they were also close to the main surgical plane in the dome of the lower lateral cartilage. CONCLUSIONS: We speculate that the blood supply to nasal tip in Koreans is primarily derived from the lateral nasal or dorsal nasal arteries, with variable contribution from the columellar arteries. Therefore, it is the most important to determine the surgical plane below the musculoaponeurotic layer in order to prevent necrosis of skin flap or deformity due to damage of vessels in the case of external rhinoplasty.

The Causes and Frequency of Neonatal Septal Deformities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal septal deformities have been reported at all ages and in all races. Many factors have been reported as being causative factors in nasal septal deformities. Among the factors, birth trauma was first reported by Metzenbaum as being a causative factor in nasal septal deformities, and has since been reported by many other authors. The aim of this study was to find if birth trauma is a cause of nasal septal deformities and to assess the frequency of neonatal septal deformities in Korean neonates. MATERIAL AND METHOD: The experiment was performed in a randomized group of neonates. A number of 602 neonates aged 1- 2 days have been examined in a two-month period. A number of 278 neonates were born by natural vaginal delivery (group A), 264 by elective cesarean section (group B) and 60 by emergency cesarean section (group C). The nasal septa of neonates were examined by otoscope, cotton wool test and strut test. RESULT: The septal deformities have been found in 66 neonates of group A (23.74%), in 32 of group B (12.12%) and in 11 of group C (18.33%). The Frequency of septal deformities was higher in group A compared to group B and C (p<0.05). In the group A neonates with septal deformity, however, the correlations between parity and septal deformity and between birth weight and septal deformity were not statistically significant (p <0.05). The overall incidence of septal deformities in the investigated neonates was 18.1% in this study. CONCLUSION: Birth trauma is a causative factor of neo natal septal deformities.

Five Cases of Reconstructive Rhinoplasty for Nasal Defects Caused by Neoplasm Resection

The nose plays a significant role in the determination of one's physical appearance as well as various other important functions such as respiration, olfaction, and resonance. It also occupies the most prominent position on the face, a position that makes it vulnerable to distortion by trauma, and incidentally, it is a feature that is most frequently predisposed to skin tumors. The surgical reconstruction for nasal defects caused by the resection of these neoplasms should be considered from two viewpoints : the aesthetic and the functional aspect of the nose. For aesthetic reconstruction of the nose, the tissues for reconstruction should match the surrounding tissue in terms of color and texture. For functional reconstruction, the mucosal layer and the cartilage framework should be reconstructed. We have reconstructed nasal defects in five cases of nasal neoplasms using the forehead flap, full-thickness skin graft, nasolabial flap, buccal mucosal flap, and local flap. We are reporting these cases along with reviews of the relevant references.

Treatment of the Nasal Valve Stenosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal obstruction is most often caused by the problems in the nasal valves which are located in the anterior part of the nose. Without careful evaluation of this part of the nose, the effort to improve nasal breathing may be fruitless. However, relatively little attention has been paid to the nasal valve problems. In the present study, we investigated the causes that underlie various problems in the nasal valve and looked for treatment procedures. MATERIALS AND METHODS: A total of 20 patients who had nasal obstruction due to valve problems were studied retrospectively. Various surgical procedures such as spreader graft, alar batten graft, auricular composite graft and Z-plasty were performed for the patients. RESULTS: All patients have experienced reduction in the nasal obstruction. Also, the widening of the valve area was observed. CONCLUSION: Surgery of the internal or external nasal valve is a key factor in functional rhinoplasty. It can significantly improve the nasal breathing of patients with nasal dysfunction leading to obstruction, insufficiency, and nasal valve collapse. With proper diagnosis of the problem, various surgical maneuvers can be used to repair a damaged valve and to correct breathing problems.

2 Cases of Leiomyoma of the Nasal Cavity / 대한이비인후과학회지

Leiomyoma may occur wherever smooth muscle is present. The most common locations are the uterus, alimentary tract, skin and subcutaneous tissue. Leiomyoma of the nasal cavity and paranasal sinus is rare because of the paucity of smooth muscle in the nose. It may have originated from the smooth muscular tissue existing in the middle layer of the blood vessles supplying sinus. We experienced 2 cases of leiomyomas excised by endoscopic removal and external approach, respectively.

A Case of Pneumocele in the Ethmoid Sinus / 대한이비인후과학회지

Pneumocele is the pathologic expansion of an air-containing paranasal sinus that causes thinning of the bony sinus walls and displacement of nearby structures. This abnormality probably results from a physiological block in the rapid equilibration of intrasinus air pressure through the major sinus ostium and as a result of some abnormality producing a one-way valvular mechanism. A 41-year-old man had complained of headache, diplopia and periorbital pain on left side which aggravated after nose blowing. A computed tomographic scan showed a hyperlucent, expanded left ethmoid sinus. We treated the condition by endoscopic marsupialization of the anterior ethmoid sinus. Six months later, headache and periorbital pain have subsided, but diplopia has remained.