Salvage of impending rhinostomy failure after dacryocystorhinostomy with office-based microdebrider treatment.

PURPOSE: This article is to introduce office-based salvage revision of impending rhinostomy failure after endoscopic dacryocystorhinostomy (EN-DCR), using a microdebrider. METHODS: The authors conducted retrospective medical chart review of 27 eyes of 26 patients who underwent microdebrider treatment for impending rhinostomy failure in an office setting. After local anesthesia, obstructive soft tissue, interfering with ostium function (granuloma, cicatrization, synechia), was treated with a microdebrider (Osseoduo s120, Bien-Air Surgery, Le Noirmont, Switzerland) within 6 months after primary EN-DCR. Anatomical improvement and functional relief of epiphora were evaluated after revision. RESULTS: The causes of impending rhinostomy failure were granuloma formation (17/27 eyes, 63.0%), cicatrization (8/27 eyes, 29.6%), and synechial formation (2/27 eyes, 7.4%). The surgery did not exceed 5 min in all cases, and partial damage to pre-placed silicone tubes occurred in the first two cases (7.4%). Salvage revision resulted in anatomical success in all eyes, based on patent syringing and a positive functional endoscopic dye test. All cases showed improvement of epiphora after revision surgery. CONCLUSIONS: Office-based salvage revision using a microdebrider provided effective management of impending rhinostomy failure during early follow-up period after primary EN-DCR. It enabled prompt management of excessive wound healing interfering with ostium function, while performing the routine postoperative nasal debridement.

Surgical Correction of Lower Lid Epiblepharon With Skin-Only Resection Using a Novel Design.

ABSTRACT: This study is to report the surgical outcome of lower lid epiblepharon repair with skin-only resection using a newly designed incision line. A retrospective, noncomparative, interventional case series analysis of 134 eyes of 67 patients, who underwent surgical correction of lower lid epiblepharon with skin-only resection using the new incision design, was performed. After marking the 4 vertical lines at the medial canthus, punctum, midpoint, and lateral canthus, the upper and lower incision lines were drawn from the medial canthus through punctum to the lateral canthus with novel design. After incising the skin along the marked line, gentle dissection of the skin flap from the underlying orbicularis muscle was performed. Only skin flap was excised and closed. The patients were followed up for more than 6months. The mean age of patients was 7.9 ± 3.7 years (range 4-13 years) and the mean follow-up period was 18.0 ± 5.7 months (range 13-31 months). During the follow-up period, recurrence of the epiblepharon was not observed. There was no occurrence of complications such as lower lid ectropion or retraction. Skin-only resection using a newly designed incision line is a simple and effective method to fully correct the medial portion of the lower lid epiblepharon and prevent dog-ear formation or overcorrection at the lateral portion, and prominent lid crease.

The Degree of Stress in Patients With Empty Nose Syndrome, Compared With Chronic Rhinosinusitis and Allergic Rhinitis.

BACKGROUND: Depression is a mental health disease of growing public health concern because depressive mood affects the sufferer's daily life and is also associated with productivity decline. Depression that is caused by other diseases or substances is referred to as secondary depression, which is an important distinction because curing the underlying cause could subsequently regulate depressive mood. Empty nose syndrome (ENS), also known as "paradoxical obstruction of the nose," is a condition in which the major symptom is difficulty breathing, despite having sufficient breathing space in the nose. Empty nose syndrome has been increasing in prevalence in Korea. We found that patients with this ENS have a tendency toward depressive mood, which can escalate so far as to lead to suicide attempts. Thus, herein, we aimed to investigate the psychological burden on patients with ENS. METHODS: We divided patients into 4 groups: ENS (group A), chronic rhinosinusitis with polyp (CRS c polyp, group B), chronic rhinosinusitis without polyp (CRS s polyp, group C), and allergic rhinitis (AR, group D). We estimated and compared Beck Depression Inventory (BDI) scores among the 4 groups, and we investigated the relationship between depression index and nasal cavity area in patients with ENS. RESULTS: The ENS group (A) had depression prevalence of 71% with varying severity, which was much higher than group B (19%), group C (15%), and group D (27%). The correlation between nasal cavity volume and BDI score for the ENS group was not statistically significant. CONCLUSION: The degree and severity of depression in patients with ENS was higher than in patients with CRS or AR. Furthermore, there was no relationship between depression severity and nasal cavity volume in the patients with ENS. Thus, physicians should be careful not to dismiss the accompanying mental health problems of patients with ENS.

Saddle Deformity After Septoplasty and Immediate Correction.

OBJECTIVE: The aim of this study is to assess the saddle deformity after septoplasty and the usefulness of immediate correction. DESIGN: Retrospective study. SETTING: University medical center. PATIENTS: Of 658 patients who underwent endonasal septoplasty from January 2011 to July 2018, 14 underwent immediate cartilage dorsal augmentations following septoplasty for saddle deformity and were enrolled in this study. MAIN OUTCOME MEASURES: A total of 14 patients received immediate cartilage augmentation and were followed for >3 months after surgery. External nose status, patterns of septal deformity, and surgical results were investigated with profile view photographs, paranasal sinus computed tomography scans, and nasal endoscopy. Symptom improvement was measured using the Nasal Obstruction Symptom Evaluation scale. RESULTS: All patients had middle to high site septal deviation. Anterior deviation and central deviation have statistical significance compared to posterior part deviation (P = 0.025, P = 0.002) and mid part deviation has statistical significance compared to basal part deviation (P = 0.005). Postoperative subjective nasal symptoms of the 14 patients were improved from preoperation (18.54 ±â€Š2.46) to 1 month (7.54 ±â€Š2.16) and 3 months (1.72 ±â€Š1.55) postoperatively. CONCLUSIONS: Immediate endonasal cartilage augmentation for iatrogenic saddle deformity after septoplasty is easy, safe, and effective. Furthermore, this corrective treatment for post op complication is very important for both of surgeon and patient. Predispositions to postoperative saddle deformity included site and severity of preoperative nasal septal deviation.

Near-Infrared Autofluorescence Image-Guided Parathyroid Gland Mapping in Thyroidectomy.

BACKGROUND: Studies to date have shown that near-infrared autofluorescence imaging (NIR) can detect the parathyroid gland during thyroidectomy. However, there are no reports that NIR imaging can identify the parathyroid gland when it's covered with fibrofatty tissue before identification by a surgeon's naked eye. In this study, we investigated the feasibility of parathyroid gland mapping to facilitate early identification of the parathyroid gland during thyroidectomy. STUDY DESIGN: Seventy parathyroid glands from 38 patients who underwent thyroidectomy for papillary thyroid cancer were included in this prospective study. Near-infrared with infrared illumination (NIR-IR) imaging using a 780-nm light-emitting diode was conducted at the predicted locations of the superior or inferior parathyroid glands. Parathyroid mapping was conducted in 3 stages. Stages P1, P2, and P3 were defined as imaging before identification of the gland by direct visualization, imaging after identification, and imaging in the removed specimen, respectively. RESULTS: Sixty-four parathyroid glands (92.8%) could be localized in stage P1 before surgical dissection and exposure of the gland. Five parathyroid glands that were not detected at stage P1 were identified in stages P2 (4 cases, 5.8%) and P3 (1 case, 1.4%). One parathyroid gland was not identified in either the NIR imaging or the pathologic examination. The sensitivity, specificity, and accuracy of parathyroid gland mapping in stages P1, P2, and P3 were all 100%. CONCLUSIONS: Parathyroid gland mapping using our NIR-IR imaging technique was feasible, with an excellent accuracy rate. This technique may be helpful for early identification of parathyroid glands during thyroidectomy.

Development of a Prototype Robotic System for Radiosurgery with Upper Hemispherical Workspace.

This paper introduces a specialized robotic system under development for radiosurgery using a small-sized linear accelerator. The robotic system is a 5-DOF manipulator that can be installed above a patient to make an upper hemispherical workspace centered in a target point. In order to determine the optimal lengths of the link, we consider the requirements for the workspace of a linear accelerator for radiosurgery. A more suitable kinematic structure than conventional industrial manipulators is proposed, and the kinematic analysis is also provided. A graphic simulator is implemented and used for dynamic analysis. Based on those results, a prototype manipulator and its control system are under development.

Effects of seed layer patterns on the structural characteristics of hydrothermally grown ZnO nanorods.

We investigated the effects of surface pattern size and shape on the characteristics of hydrothermally grown ZnO nanorods. For this purpose, the structural characteristics of ZnO nanorods were examined using X-ray diffraction and scanning electron microscopy. The sputtered ZnO seed layer was patterned using photolithography techniques on a Si substrate. ZnO nanorods with a [0001] texturing structure were successfully grown on selective areas by hydrothermal processes. In our experiments, however, it was observed that the diameter and the texture of the ZnO nanorods were strongly influenced by the size of the surface pattern.

Activation of lipopolysaccharide-TLR4 signaling accelerates the ototoxic potential of cisplatin in mice.

Dysfunction in immune surveillance during anticancer chemotherapy of patients often causes weakness of the host defense system and a subsequent increase in microbial infections. However, the deterioration of organ-specific function related to microbial challenges in cisplatin-treated patients has not yet been elucidated. In this study, we investigated cisplatin-induced TLR4 expression and its binding to LPS in mouse cochlear tissues and the effect of this interaction on hearing function. Cisplatin increased the transcriptional and translational expression of TLR4 in the cochlear tissues, organ of Corti explants, and HEI-OC1 cells. Furthermore, cisplatin increased the interaction between TLR4 and its microbial ligand LPS, thereby upregulating the production of proinflammatory cytokines, such as TNF-α, IL-1ß, and IL-6, via NF-κB activation. In C57BL/6 mice, the combined injection of cisplatin and LPS caused severe hearing impairment compared with that in the control, cisplatin-alone, or LPS-alone groups, whereas this hearing dysfunction was completely suppressed in both TLR4 mutant and knockout mice. These results suggest that hearing function can be easily damaged by increased TLR expression and microbial infections due to the weakened host defense systems of cancer patients receiving therapy comprising three to six cycles of cisplatin alone or cisplatin combined with other chemotherapeutic agents. Moreover, such damage can occur even though patients may not experience ototoxic levels of cumulative cisplatin concentration.