Dysphagia and Trismus After Tooth Extraction : Clinical Conondrum.

Clinicians should consider disorders of masticatory muscle including lateral pterygoid muscle as a differential diagnosis in patients presenting with dysphagia and trismus after tooth extraction.

Decreased Tip Projection and Tip Stiffness Due to A Calcified Septal Extension Graft.

A septal extension graft is frequently applied in esthetic rhinoplasty in Asia. Autologous cartilage is usually selected for the graft material, and nasal septal cartilage is the most commonly used in septal extension grafts. Although the complication rate is reported to be very low, the authors recently encountered a patient who complained of decreased nasal tip projection and stiffness of the nasal tip. The patient had previously undergone a rhinoplasty, including dorsal augmentation with silicone implant and septal extension graft with septal cartilage. Based on the images, the authors hypothesized that the septal extension graft was calcified, and the intraoperative findings confirmed severe calcification of the previously inserted septal cartilage graft. Herein, the authors report the case of a patient with decreased tip projection and stiffness due to calcification of a previous septal extension graft that used septal cartilage and share the lessons the authors learned from this case.

Delayed Diagnosis of Septal Ulcer after Hyaluronic Acid Nasal Filler Injection.

The utilization of fillers, notably hyaluronic acid, has increased due to their proven effectiveness, versatility, and generally favorable safety profile. In the field of rhinoplasty, hyaluronic acid dermal fillers have been employed for the correction of nasal deformities and surface irregularities. Nevertheless, the intricate vascular network of the nasal region, involving anastomoses between the external and internal carotid arteries, predisposes it to serious vascular complications. We report a case of a severe septal ulcer secondary to local ischemia following an injection of a hyaluronic acid nasal filler. The patient presented with immediate pain and nasal discomfort; however, there was an unfortunate delay in diagnosis and treatment. This report discusses the intricacies of the case and imparts crucial insights gleaned from the incident.

Infratemporal Fossa Abscess Managed by Nasal Endoscopic Drainage Using a Navigation System.

The infratemporal fossa (ITF) is an area surrounded by bony structures and contains vital organs. Although a large abscess in the ITF is not common, it requires prompt surgical management. Recently, the authors had a patient who presented with fever, pain, and trismus. The patient was diagnosed with an abscess in the ITF, although the authors were not able to determine the exact cause of the infection. The lesion was accessed through the posterolateral maxillary wall using nasal endoscopy with a navigation system. The abscess was safely drained through a small bony window. This case suggests that the nasal endoscopic approach, combined with the use of a navigation system, allows for an easy and safe surgical approach to the ITF. In addition, the authors' observations indicate that minimal mucosal thickening without definite evidence of sinusitis could result in an abscess in the ITF in immune-compromised patients, as was the case with the authors' patients.

Complications of a Barbed Thread in Rhinoplasty.

Rhinoplasty using threads has been popular for the benefits of being free from anesthesia, shortness of post-surgical recovery process, and surgery-related complications. Compared with its beneficial aspects, studies that evaluated thread rhinoplasty-related complications are relatively limited. Recently, we experienced a patient who underwent barbed thread rhinoplasty in 12 months before visiting our clinic. She presented with a firm mass-like lesion palpated through the nasal dorsum, making hump-looking appearance. During revision rhinoplasty, we found that previously inserted threads were identified from the nasal dorusam and tip area not being resorted. Threads and soft tissue on nasal dorsal area formed firm mass-like lesion and were firmly attached to surrounding soft tissues. Herein, we introduce our case in which the formation of nasal mass on dorsal area is a later complication of thread rhinoplasty.

Factors associated with impaired psychophysical gustatory function.

OBJECTIVE: To investigate the clinical characteristics associated with measured gustatory dysfunction in patients with chemosensory (smell and taste) discomfort. STUDY DESIGN: Retrospective study. DESIGN: Hospital-based cohort. SETTING: The clinical characteristics associated with the measured diagnosis of gustatory dysfunction were statistically analysed. PARTICIPANTS: Patients who underwent all the psychophysical olfactory and chemical gustatory function tests (YSK olfactory function test and chemical gustometry exam) and the subjective questionnaires between October 2021 and February 2023. MAIN OUTCOME MEASURES: YSK olfactory function test and chemical gustometry results, subjective questionnaire score about chemosensory (smell and taste) functions. The Medical records of patients who visited the smell and taste centre in a tertiary. RESULTS: A total of 219 patients were enrolled; 180 were diagnosed as having normal gustatory function, and 39 were diagnosed as having gustatory dysfunction. Subjective recognition of gustatory function was not associated with the measured gustatory function. Age, sex, measured olfactory function and the threshold and discrimination scores for the olfactory function test were significant factors in the multivariate analysis. When the patients were further divided according to age, the threshold test scores rather than other subsets in the olfactory function test were significantly associated with measured gustatory dysfunction in patients 60 and older. CONCLUSION: In older adult male patients with olfactory dysfunction, gustatory function should be considered regardless of subjective gustatory dysfunction.

Gustatory dysfunction perceptions versus objective gustatory dysfunction among older adults.

BACKGROUND: Research on gustatory dysfunction among older adults has been scarce relative to research on olfactory dysfunction, and the relationship between subjective and objective gustatory dysfunction has not been studied in detail. We aimed to evaluate whether subjective recognition of gustatory dysfunction correlates with objective diagnosis of gustatory dysfunction among older adults. METHODS: In this retrospective, cross-sectional study, we reviewed the medical records of 138 patients of ages ≥ 60 years for whom data were available on self-reported and objectively measured gustatory and olfactory function from January 2018 through April 2021 at a specialized smell/taste center of a single institution. We reviewed self-reported and measured outcomes of gustatory and olfactory function using patient data including clinical characteristics, including age, sex, smoking history, and medical history. RESULTS: We found that the subjective recognition of gustatory dysfunction does not correlate with the objective diagnosis of gustatory dysfunction based on the measured results of gustatory function tests. Subjective gustatory dysfunction, however, was correlated with subjective olfactory dysfunction. Among clinical and demographic characteristics, age and sex were significantly associated with measured gustatory function outcomes. CONCLUSION: We suggest that subjective gustatory dysfunction underestimates objective dysfunction and recommend that older men with diminished olfactory function undergo gustatory function testing regardless of their self-reported gustatory function status.

Correction of a Visible Silastic Implant Using the Dual-layered Capsular Flaps.

Alloplastic implants used for dorsal augmentations can induce surgical and cosmetic complications. One of these cosmetic complications is when the implant is visible through the skin. In these cases, it is recommended to use an autologous soft tissue to reinforce the area between the skin and the implant. Recently, a patient visited our institute complaining of a previously inserted silastic implant being visible through the skin. Based on the implant, we hypothesized that the surrounding soft tissue might have formed 2 capsular layers, and the implant might have separated from the capsular. During the revision rhinoplasty, we peeled off the 2 capsular layers and used them to reinforce the area between the implant and skin without harvesting autologous tissue. This procedure had a satisfactory surgical outcome and a shorter operative time than harvesting autologous tissue. Here, we describe our experience and share lessons from this case.

Benign Nasal Mass as a Delayed Complication of Barbed Thread Rhinoplasty.

ABSTRACT: Barbed thread rhinoplasty for nasal tip projection, dorsal length elongation, and nostril correction is usually performed at private clinics. The procedure is minimally invasive and does not cause permanent external scarring, which is a common challenge in rhinoplasty. Limited studies have described the complications of this procedure, with no reports on its late complications. A patient presented to the authors' clinic with a nasal septal mass, which had developed 3 months before the visit. She had undergone rhinoplasty 10 years prior. During excisional biopsy, the authors found barbed threads impacted in the mass, which may have been inserted during the rhinoplasty. The mass was pathologically demonstrated as a chronic inflammatory lesion that may have originated due to the foreign body. The use of barbed threads in rhinoplasty can induce complications as late as 10 years after surgery; clinicians should consider this and explain the possible late complications to patients before surgery.

Unrecognized Fracture of a Silicone Implant During Closed Rhinoplasty.

ABSTRACT: Rhinoplasty via a closed approach is rarely performed due to provide limited exposure and inadequate operative field. Nevertheless, there are some cases in which closed approach is performed using L-shaped silicone implants. The authors recently encountered an interesting complication in a 33-year-old woman who had previously undergone rhinoplasty via a closed approach and who sought revision rhinoplasty at our institution. The authors accidently found a fractured silicone implant on lateral nasal x-ray. She had no nasal trauma history since previous rhinoplasty. The authors assumed that the silicone implant can be fractured as 1 of complications during the rhinoplasty via a closed approach.

Th2 cytokines-DUOX2-ROS-HMGB1 translocation axis is important in the pathogenesis of allergic rhinitis.

The function of high-mobility group box 1 (HMGB1) varies according to its location. However, the translocation mechanism behind HMGB1 remains unclear. We hypothesize that type 2 helper T cell (Th2) cytokines are involved in the translocation of HMGB1 in the upper airway epithelium. We investigated the mechanism behind HMGB1 translocation using Th2 cytokine stimulation and examined the clinical significance of HMGB1 translocation in allergic rhinitis (AR). Cytoplasmic and extracellular HMGB1 were increased in AR. Inhibiting HMGB1 translocation with glycyrrhizic acid (GA) decreased the level of antigen-specific immunoglobulin E (IgE), the degree of Periodic Acid-Schiff (PAS), and Sirius Red staining in the murine model. The in vivo reactive oxygen species (ROS) level in the nasal mucosa was higher in the mice with AR than in the controls. Th2 cytokine-induced up-regulation of the ROS and translocation of HMGB1 by Th2 cytokines was dependent on the generated ROS. The ROS level also increased in the murine model. We suggest that the Th2 cytokine-dual oxidase (DUOX)2-ROS-HMGB1 translocation axis is important in AR pathogenesis.

Concentrations of HMGB1 and Hsp70 of healthy subjects in upper and lower airway: Literature Review and Meta-analysis.

Although high-mobility group box 1 and heat-shock protein 70 are implicated in airway diseases and suggested as relevant diagnostic biomarkers, their control concentrations in the airways have not yet been determined. This study aimed to evaluate concentration of healthy subjects for both these proteins in the upper and lower airways via meta-analysis. We searched MEDLINE, EMBASE, and Google Scholar for articles describing concentration of healthy subjects for these proteins. Data from healthy populations were combined using a random-effects model, and subgroup and sensitivity analyses were performed to determine between-study heterogeneity. We analyzed 22 studies involving 485 patients. Concentration of healthy subjects of high-mobility group box 1 and heat-shock protein 70 varied from "not detected" to 326.13 ng/mL and from 0.20 pg/mL to 9240.00 pg/mL, respectively, with the values showing significant heterogeneity. Subgroup analysis for high-mobility group box 1 revealed 13.63 ng/mL (95% CI 12.13-15.14), 100.31 ng/mL (95% CI -31.28-231.91), 9.54 ng/mL (95% CI 8.91-10.17), and 65.82 ng/mL (95% CI 55.51-76.14) for the lower airway, upper airway, pediatric populations, and adults, respectively, whereas that for heat-shock protein 70 revealed 20.58 pg/mL (95% CI 7.87-33.29) for the lower airway and 9240.00 ±11820 pg/mL for the upper airway. Although concentrations of healthy subjects of these proteins varied in the upper and lower airways, the levels of both these proteins were higher in the upper airway than in the lower airway, and these concentrations differed according to the age and sampling procedure. Our findings support the further evaluation of these proteins as biomarkers for airway-related diseases.

The sniffing bead system, an olfactory dysfunction screening tool for geriatric subjects: a cross-sectional study.

BACKGROUND: This study aimed to develop a simple and one-off olfactory screening test, the sniffing bead system, for general clinical use in older adults. METHODS: In this cross-sectional study, geriatric subjects (aged > 50 years) who underwent neurocognitive and olfactory function tests were included. Overall, 137 subjects were enrolled, and the study was conducted at Chung-Ang University, Seoul, Korea. Olfactory function was measured by obtaining the scores of the sniffing bead system using 2-phenylethyl alcohol, n-butanol, and the YSK olfactory function test. Time taken for each olfactory function test was also measured. RESULTS: The score of the 2-phenylethyl alcohol sniffing bead test was 2.58 ± 1.52, which was significantly associated with the YSK_threshold (2.41 ± 1.79) (p < 0.001, Pearson's correlation coefficient = 0.429), YSK_identification (8.93 ± 3.25) (p = 0.014, Pearson's correlation coefficient = 0.208) and YSK_threshold-discrimination-identification (17.46 ± 5.49) (p < 0.001, Pearson's correlation coefficient = 0.316) test scores. In the normal cognitive function group, YSK_threshold (p < 0.001, Pearson's correlation coefficient = 0.479), YSK_identification (p = 0.003, Pearson's correlation coefficient = 0.316), and YSK_threshold-discrimination-identification (p < 0.001, Pearson's correlation coefficient = 0.429) were significantly correlated with the scores of the 2-phenylethyl alcohol sniffing bead system. In the impaired cognitive function group, the YSK_threshold (p = 0.002, Pearson's correlation coefficient = 0.415) and YSK_ threshold-discrimination-identification (p = 0.004, Pearson's correlation coefficient = 0.385) were significantly correlated with the scores of the 2-phenylethyl alcohol sniffing bead system. Time taken for the 2-phenylethyl alcohol sniffing bead system was 5.00 ± 1.51 min, which was significantly lower than that for the YSK_threshold-discrimination-identification (20.43 ± 5.29 min) (p < 0.001). The scores of the 2-phenylethyl alcohol sniffing bead system were significantly correlated with those of the n-butanol sniffing bead system (3.50 ± 1.21) (p < 0.001, Pearson's correlation coefficient = 0.315). CONCLUSIONS: This sniffing bead system was specifically designed for screening olfactory function in older adults, and it may allow for the rapid and accurate assessment of olfactory dysfunction.

The Nasal Cavity Mass with Oropharyngeal Extension Causing Progressive Dysphagia.

Although dysphagia and lump sensation in the throat caused by intranasal benign tumors with oropharyngeal extension is a rare condition, we suggest that clinicians should thoroughly examine the presence of nasal pathologies using various endoscopes for the differential diagnosis.

Severe Chemosis: Initial Misdiagnosis of an Emergent Complication of Acute Rhinosinusitis.

BACKGROUND: Orbital findings such as cellulitis, ophthalmoplegia, and proptosis are possible complications of sinusitis. Acute sinusitis can also cause a conjunctival cyst-like lesion induced by severe chemosis; however, it is an uncommon complication. CASE REPORT: We report the case of a 53-year-old man who presented to our facility's emergency department. The patient complained of orbital discomfort resulting from an inability to close both eyes, and orbital discharge, accompanied by general weakness. On physical examination, cyst-like-appearing lesions with erythema of the eyelids were identified bilaterally and initially misdiagnosed as inflammatory lesions of the orbital area. However, orbital pathology was excluded by the ophthalmologist, and it was found that the patient had bilateral pansinusitis on the imaging studies. It was suspected that the sinusitis was responsible for the ocular symptoms. The patient was treated with emergent endoscopic sinus surgery, and the symptoms were promptly relieved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although it is well known that orbital complications of sinusitis can occur, a conjunctival cyst-like-appearing lesion induced by severe chemosis is uncommon and is difficult to diagnose at first sight. Emergent surgical drainage is needed to prevent permanent orbital damage and other sinusitis-related complications. Therefore, recognizing the unique clinical presentation of a conjunctival cyst-like lesion resulting from severe chemosis is the key to appropriate diagnosis and management.

IL-17C expression and its correlation with pediatric adenoids: a preliminary study.

Objective: Interleukin-17 (IL-17) C is a cytokine expressed by epithelial cells in response to bacterial stimulation. In contrast to other members of the IL-17 family of cytokines, IL-17C is upregulated early during infection, maintains integrity of the epithelial layer barrier, and mediates the innate immune response. We investigated the expression profile of IL-17C in pediatric adenoids. Methods: Pediatric adenoid tissues and lavage fluids were collected from a total of 38 subjects. The Limulus amebocyte lysate test and real-time PCR using Staphylococcus aureus primers were performed to evaluate bacterial contents in adenoids. Expression of IL-17RE in adenoids was analyzed using real-time polymerase chain reaction and western blot. The expression of IL-17C was evaluated by western blot and immunohistochemistry and compared between allergic rhinitis (AR) and control subjects. The levels of Hsp27, Hsp70, and IL-17C in adenoid lavage fluids were evaluated by enzyme-linked immunosorbent assay, and the correlation between these molecules was statistically analyzed. Results: The pediatric adenoids were found to be exposed to bacteria and had a normal flora comprising both gram-negative and -positive bacteria. IL-17RE, an IL-17C specific receptor, was highly expressed in the epithelium of adenoids. IL-17C was expressed in all evaluated adenoid tissue samples, irrespective of the allergic status of the patient. IL-17C secretion was detected in half of the adenoid lavage fluid samples and was associated with Hsp70 level. Conclusion: Our findings indicate the possible role of pediatric adenoids in innate immunity modulation via an innate immunity-associated cytokine.

Differential Nasal Expression of Heat Shock Proteins 27 and 70 by Aerobic Exercise: A Preliminary Study.

Purpose: Exercise modifies airway immune responses and susceptibility to infection. We investigated the effects of exercise on two HSPs (heat shock proteins), quantifying expression levels in nasal mucosa of both professional competitive athletes and non-athletes for comparison. Method: We used western blot technique to determine expression levels of HSPs in primary human nasal epithelial cells (HNECs). Nasal lavage (NAL) fluids were collected from 12 male professional volley ball players and 6 healthy males pre-submaximal exercise (running for 30 min at 70-80% of maximal heart rate) and post-submaximal exercise. Expression levels of HSP27, HSP70, Interleukin (IL)-8, and Tumor necrosis factor (TNF)-α in NAL fluids were quantified by enzyme-linked immunosorbent assay (ELISA), and difference of the level between pre-submaximal exercise and post-submaximal exercise was statistically analyzed. Antibacterial assay using Staphylococcus aureus was performed to assess the immunological role of HSPs in NAL fluids. Results:. In non-athlete controls, HSP27, HSP70, and IL-8 were unchanged after exercise. In the professional athletes, HSP70 expression was declined significantly (p<0.05), but HSP27 was not significantly changed. IL-8 and TNF-α did not show significant difference, either. By antibacterial assay, it was found that the number of active bacterial populations were influenced by the presence or absence of HSP27 and HSP70 in NAL fluids. Conclusion: HSP27 and HSP70 were present in NAL fluids of enrolled subjects, and the effect of exercise on the level HSPs was different between professional athletic competitors and non-athletes. As the number of active bacterial population was influenced by the presence or absence of nasal HSP27 and HSP70, we suggest that HSP27 and HSP70 may play immunological function in NAL fluids.

Pyogenic Granuloma of the Hard Palate.

As the authors recently experienced a patient with pyogenic granuloma arising from the hard palate, they tried to review all the previously reported literatures with the emphasis on its clinical characteristics that can help the accurate diagnosis of this unusual lesion. Based on our experience and literatures review, clinicians should keep in mind that pyogenic granuloma should be taken into consideration in the differential diagnosis of the hard palatal mass despite its rarity. Although histopathological examination of the mass is the only way to arrive at a definitive diagnosis, the knowledge of the gross appearances of pyogenic granuloma with clinical features may be helpful for differential diagnosis.

First recognized n-butanol concentration may be simple and useful index for assessing olfactory dysfunction in geriatric patients.

The KVSSII is widely used to evaluate olfactory function in the Korean population. We evaluated the usefulness of the first recognized n-butanol concentration, which is obtained at the beginning part of KVSS II, in predicting olfactory dysfunction. Three hundred seventy two subjects were enrolled in our study. The results of KVSS II and the demographic characteristics were statistically analyzed. The first recognized n-butanol concentration was positively correlated with the result of KVSS II. The mean value of first recognized n-butanol concentration was 5.59 ± 1.42 in normosmia, 4.10 ± 1.40 in hyposmia, and 0.84 ± 1.68 in the anosmia group. By ROC curve, cut-off value of 2.5 showed sensitivity of 85.9% and specificity of 90.6% for anosmia, and cut-off value of 4.5 showed sensitivity of 77.6% and specificity of 69.8% for hyposmia. Consequently, we suggest that it may be useful in assessing olfactory function, in geriatric patients who are not able to tolerate conventional KVSS II.

Profiling of heat shock proteins 27 and 70 in adenoids of children.

PURPOSE: Heat shock protein (HSP)27 and 70 are molecular chaperones that may have immunomodulatory functions. We determined if and at what levels each are expressed in the adenoids of pediatric subjects. We also examined tissue distributions, associated clinical characteristics, and antibacterial effects. METHODS: Western blot, enzyme-linked immunosorbent assay (ELISA), and immunohistochemistry were applied to adenoidal tissues and lavage fluids obtained from children (N = 40) undergoing adenotonsillectomy. RESULTS: Via western blot and ELISA, both HSP27 and 70 were regularly detected in adenoidal tissue and in lavage fluid samples. HSP27 was highly expressed in epithelium, whereas HSP70 showed strong subepithelial positivity and bore a significant relation to adenoidal size. Assayed levels of HSP27 and 70 correlated inversely, and their addition to culture media independently increased bacterial numbers (Staphylococcus aureus). Upon the precipitation of each from adenoidal lavage fluids, bacterial counts declined. CONCLUSIONS: HSP27 and 70 are readily expressed in the adenoids of children and may be implicated in immunologic responses.