Translation, cultural adaptation, and validation of the Standardized Cosmesis and Health Nasal Outcomes Survey in Japanese (J-SCHNOS).

BACKGROUND: Rhinoplasty is one of the most popular plastic surgery techniques. The evaluation of both functional and cosmetic aspects of rhinoplasty is essential for planning and assessing surgery results. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) is a validated questionnaire used to assess both functional and aesthetic symptoms in patients with nasal problems, and it has been translated into several languages. The purpose of this study was to translate, culturally adapt, and validate the SCHNOS in Japanese among patients undergoing rhinoplasty. METHODS: This was a prospective validation study of the Japanese version of the SCHNOS (J-SCHNOS). The first phase involved translation and cross-cultural adaptation of the SCHNOS. The second phase included validation of the J-SCHNOS among native Japanese speakers. RESULTS: In total, 357 participants completed the final version of the J-SCHNOS (219 males and 138 females; mean age 43.4 years). The J-SCHNOS showed high internal consistency with excellent Cronbach's alpha values for both obstruction (SCHNOS-O) (0.96) and cosmetic (SCHNOS-C) (0.93) domains. The reproducibility was high, with an excellent intraclass correlation coefficient (ICC) >0.9 for all items. Exploratory factor analysis showed unidimensional structures in both the SCHNOS-O and the SCHNOS-C. CONCLUSION: The J-SCHNOS is a reliable and valid tool to assess the severity of nasal problems in patients undergoing rhinoplasty.

X -linked inheritance of primary ciliary dyskinesia and retinitis pigmentosa due to RPGR variant: A case report and literature review.

Bronchiectasis is a chronic respiratory condition characterized by irreversible bronchial dilation, often caused by infection or inflammation. It can be associated with primary ciliary dyskinesia (PCD), a hereditary disorder affecting cilia function in various organs and flagella. PCD's genetic heterogeneity leads to varying disease severity. PCD may be more prevalent in Asia, but its diagnosis is often delayed in Japan. This study reviewed a case of PCD and retinitis pigmentosa (RP) with the relevant literature. The patient had a persistent cough, sputum, and diffuse bronchiectasis. He was diagnosed with a combination of PCD and RP, with the presence of an X-linked retinitis pigmentosa GTPase regulator (RPGR) variant confirmed through electron microscopy, retinal scan, and genetic testing. Although co-occurrence of bronchiectasis and RP is rare, PCD should be considered in cases of persistent wet cough in childhood or unidentified bronchiectasis aetiology. Ophthalmologists should consider concomitant PCD in RP patients.

Caudal Septal Deviation: A Computed Tomography-Based Evaluation Method.

OBJECTIVE: Caudal septal deviation (CSD) correction during septorhinoplasty is challenging, and various surgical modifications and evaluations remain controversial. This study aimed to introduce an objective evaluation method based on computed tomography (CT) images to measure the effectiveness of septorhinoplasty for CSD treatment. METHODS: We retrospectively analyzed preoperative and postoperative CT images of patients who had undergone functional open septorhinoplasty by the plastic surgery and otorhinolaryngology teams between January and September 2019. Using OsiriX Lite (Pixmeo, Switzerland), CSD was calculated as the distance between the septum midline and palatal plane. Deformation was categorized as C-shaped unilateral or S-shaped bilateral deviations. The change in the distance between preoperative and postoperative images was considered because of surgical intervention. RESULTS: Twenty patients (mean age, 35 years; 13 males [65%], 7 females [35%]) were included. The median deviation was 3.01 mm (range, 0.45-7.34 mm) preoperatively and 1.6 mm (range, 0.5-2.86 mm) postoperatively, indicating a reduction of 1.26 mm (median, P < 0.05) due to surgical intervention. C- and S-shaped deviations were seen preoperatively in 9 (45%) and 11 (55%) patients and postoperatively in 6 (30%) and 14 (70%) patients, respectively. The mean ± SD time of analysis was 7 ± 2.1 minutes. CONCLUSIONS: Caudal septal deviation showed significant changes from preoperative to postoperative CT images, based on the distance between the actual septum midline and the constructed straight septum. This allowed effective evaluation of surgical efficacy for septum straightening. Although additional studies are needed, this method allows clearer stratification of surgical outcomes.

Lost or fragmented bony septum of the optic canal facing the sphenoid sinus: a histological study using elderly donated cadavers.

PURPOSE: To histologically describe a direct contact (the so-called dehiscence) of the optic nerve (ON) and/or internal carotid artery (ICA) to the mucosa of posterior paranasal sinuses represented by the sphenoid sinus (SS). METHODS: Observations of histological sections of unilateral or bilateral skull bases (parasellar area and orbital apex) from 22 elderly cadavers were made. RESULTS: A bony septum was less than 300 µm between the SS and ICA and 200 µm between the SS and optic nerve. Parts of the septa were sometimes absent due to fragmentation and holes of the bony lamella (2/22 facing the ICA; 4 facing the ICA in combination with an absent bony septum facing the nerve). In these dehiscence sites, the SS submucosal tissue attached to a thick sheath (50-100 µm in thickness) enclosing the optic nerve and ophthalmic artery and/or the ICA adventitia (50-200 µm in thickness). The ICA sometimes contained a sclerotic plaque that attached to or even protruded into the SS. With or without dehiscence, the SS mucosa was always thin (50-100 µm in thickness) and accompanied no mononuclear cellular infiltration or tumor. CONCLUSIONS: A thin bony septum of the optic nerve or ICA had been notable as a danger point during surgery, but even a 0.05-mm-thick bone lamella might be an effective barrier against cellular infiltration or bacterial invasion from the SS. Fragmentation and holes of the bony lamella in 4 cadavers might allow cellular invasion to the optic nerve. Accordingly, unknown immunological cross talks might occur to cause demyelination.

Effectiveness of modified cutting and suture technique for endonasal caudal septoplasty in correcting nasal obstruction and preventing nasal tip projection loss.

PURPOSE: Caudal septoplasty is a difficult procedure. The cutting and suture technique is suitable for caudal septoplasty, but a batten graft is always necessary and bears the risk of nasal tip projection loss. We established a modified cutting and suture technique (MCAST), without using a batten graft, and investigated its effectiveness in correcting nasal obstruction and preventing nasal tip projection loss. METHODS: We retrospectively reviewed the medical records of 22 patients who underwent caudal septoplasty using MCAST. Subjective assessment by Nasal Obstruction Symptom Evaluation (NOSE) score and objective assessment by computed tomography (CT) were performed before and after the surgery. For evaluating nasal tip projection, we asked patients about their awareness of external nasal deformity. Additionally, the nasal tip projection was measured by CT and compared before and after surgery. RESULTS: The median preoperative NOSE score reduced significantly after MCAST (P < 0.001). On CT, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity increased significantly after MCAST (P < 0.001). All patients were unaware of external nasal deformity. There were no significant differences in the mean preoperative and postoperative nasal tip height and nasolabial angle. The mean supra tip height was significantly greater postoperatively than preoperatively (P = 0.02). CONCLUSIONS: The MCAST was useful for correcting nasal obstruction with caudal septal deviation. There was no postoperative loss of nasal tip projection. The MCAST can be suitable for correcting C-shaped caudal deviations without dislocating the caudal septum from the anterior nasal septum.

Comparison of Current Staging Systems for Sinonasal Inverted Papilloma.

BACKGROUND: A staging system is essential for determining the optimal surgical approach and predicting postoperative outcomes for inverted papilloma (IP). Although staging systems based on the extent to which the location is occupied by an IP have been widely used, an origin site-based classification of IP using unsupervised machine learning algorithms has recently been reported. OBJECTIVE: To determine the most appropriate of five staging systems for sinonasal IP by comparing recurrence rates for each stage according to each of those systems. METHODS: Eighty-seven patients with sinonasal IP were enrolled in the study. Their tumors were retrospectively categorized according to the Krouse, Oikawa, Cannady, and Han staging systems, which are based on the extent of IP, and the Meng system, which is based on the site of origin. The rates of recurrence for each stage of the five systems were compared. RESULTS: Seven of the 87 patients (8.0%) had recurrences during an average 45.5 months (12-138 months) of follow-up. There were significant differences in disease-free survival between the stages specified by Han and Meng (p = 0.027 and p < 0.001, respectively), but not between the stages specified by Krouse, Oikawa, and Cannady (p = 0.236, 0.062, and 0.130, respectively). Cox proportional hazard models revealed that Meng system (adjusted hazard ratio [aHR] 4.32, 95% confidence interval [CI] 1.10-17.04) and presence of dysplasia (aHR 7.42, 95% CI 1.15-47.85) were significantly associated with recurrence. CONCLUSION: The staging systems proposed by Han and Meng were found to be accurate in terms of tumor recurrence. We recommend use of the Han staging system before surgery and the Meng system after intraoperative identification of the origin of the tumor.

Endoscopic endonasal approach for repairing an outwardly herniated blow-out fracture lateral to the infraorbital nerve.

BACKGROUND: To repair a blow-out fracture, the endonasal approach is indicated when the center of the fracture occurs in the orbital floor medial to the infraorbital nerve, or when the orbital tissue is herniated inwards; additionally, the combined endonasal and transmaxillary approach is indicated for fractures of the anterior and lateral parts of the orbital floor. METHOD AND CONCLUSION: The use of endoscopic modified medial maxillectomy and special instruments enabled the surgeon to repair an outwardly herniated blow-out fracture by the endonasal approach alone, despite the center of the fracture being in the orbital floor lateral to the infraorbital nerve.

Ten-year adherence to continuous positive airway pressure treatment in patients with moderate-to-severe obstructive sleep apnea.

PURPOSE: This study aimed to evaluate the 10-year adherence to and identify the predictors of dropout from continuous positive airway pressure (CPAP) treatment for patients with moderate-to-severe obstructive sleep apnea (OSA). METHODS: We retrospectively analyzed the continuity, dropout, or other behaviors of 181 patients who initiated CPAP treatment at the Tokyo Dental College Ichikawa General Hospital from January 2003 to June 2005. RESULTS: Among a total of 181 patients, 56 (30.9%) dropped out of the treatment. Among the 125 patients who did not dropout, 54 continued CPAP treatment for > 10 years, 16 completed the treatment with OSA improvement, and 7 could not complete the treatment owing to unavoidable reasons such as death, dementia, hospitalization for serious illness, or migration to other countries. Further, 47 patients moved to another facility, whereas 1 patient purchased a CPAP device and stopped visiting our facility. Among the 56 patients who dropped out, approximately 50% of the patients dropped out within a year, and all dropped out within 76 months. Comparing demographics, OSA parameters, and CPAP parameters between the patients who did and did not drop out of the treatment, Cox regression analysis indicated that body mass index (BMI) and the first-month utilization rate were clinical variables that were independently associated with discontinuation of CPAP treatment. CONCLUSION: The results of this study show that BMI and the first-month utilization rate of CPAP treatment are the predictors of the long-term adherence to this treatment.

A new "J septoplasty" technique for correction of mild caudal septal deviation.

OBJECTIVE: A major drawback of the Killian incision is its inability to access the caudal septum and correct caudal septal deviation. Open and hemitransfixion septorhinoplasty are considered necessary in such cases. We developed a new septoplasty method that can be successfully applied in patients with mild caudal septal deviation. In this study, we evaluated the outcome of this technique. METHODS: We prospectively collected data of 16 patients with mild caudal septal deviation who underwent endoscopic septoplasty between November 2015 and October 2017. A modified Killian incision was made on the concave side of the septum. The central part of the cartilage was preserved, and excess cartilage was resected; the central part of the cartilage was sutured to the caudal cartilage. RESULTS: Postoperatively, the ratio of the area of the convex side to that of the concave side in the anterior portion of the nasal cavity was significantly improved, as revealed on CT analysis (p < 0.001). Nasal obstruction was significantly reduced or eliminated in all patients (p < 0.001). CONCLUSION: The J septoplasty method for the correction of mild caudal septal deviation is easy to perform through a modified Killian incision, and seems to be useful in selected cases.

Evaluation of behavioral change after adenotonsillectomy for obstructive sleep apnea in children with autism spectrum disorder.

BACKGROUND AND OBJECTIVE: Obstructive sleep apnea (OSA) may affect daily cognitive functioning in children. The aims of our study were two-fold. The first aim was to detect, using the Child Behavior Checklist (CBCL), whether adenotonsillectomy (AT) for the treatment of OSA improved the behavior of children with autism spectrum disorder (ASD). The second aim was to identify characteristics for behavioral improvement following the treatment of OSA in these children with ASD. METHODS: The behaviors of ASD children aged 5-14 years diagnosed as having OSA (n=30) were evaluated using CBCL before and after AT. CBCL evaluation of ASD children without OSA at two time points with the same interval served as a control (n=24). We statistically examined the two groups. In addition, we conducted a paired t-test to assess changes in CBCL Tscores between the improved group and unchanged/deteriorated group to identify characteristics that may affect behavioral changes following OSA treatment. RESULTS: After AT, T-scores of the CBCL scales were significantly improved in the OSA group, but no change was observed in the control. A paired t-test revealed that the improved group had significantly higher scores on the CBCL pre-AT than the unchanged/deteriorated group in ASD children with OSA after OSA treatment. CONCLUSIONS: Behavioral problems were significantly improved following AT in ASD children with OSA. Early detection and treatment of children with OSA is essential to prevent behavioral problems and to support mental development.

Features of sinonasal hemangioma: A retrospective study of 31 cases.

OBJECTIVE: Although hemangiomas are common lesions of the head and neck, sinonasal hemangiomas are rare. The purpose of this study was to analyze the clinical features (sex, age, symptoms, and size and anatomical location of the lesion) and the histological findings of sinonasal hemangioma cases, to assess preoperative transarterial embolization, and to evaluate the outcome (recurrence or no recurrence) of endoscopic sinus surgery. METHODS: Clinical records of 31 patients who underwent endoscopic sinus surgery for resection of sinonasal hemangioma between January 2010 and June 2015 were retrospectively reviewed. RESULTS: The study group consisted of 19 men and 12 women. Mean age was 53.3±15.9years. The principal symptom was epistaxis (81%). Mean tumor size was 12.6±8.2mm. The most common origin of hemangioma was the inferior turbinate (45%), followed by the nasal septum (39%), and, in both locations, the origin had a tendency to be located in the anterior portion. Thirty-one specimens were histologically categorized as 9 cavernous hemangiomas and 22 capillary hemangiomas. Preoperative transarterial embolization was performed in 2 cases. Only one recurrence was observed among 31 cases. In the recurrent case, the hemangioma of the nasal septum was resected during pregnancy. CONCLUSION: According to our results, the transnasal endoscopic approach can be useful for the resection of sinonasal hemangioma. However, sinonasal hemangioma in connection with pregnancy must be addressed with care to decide the appropriate time for treatment.

Study of hemostasis procedures for posterior epistaxis.

OBJECTIVE: Hemostasis is difficult in patients with bleeding emanating from the deep regions in the nasal cavity; however, there is no standard treatment method. We studied hemostasis procedures in patients who visited our outpatient department and presented with idiopathic epistaxis extending from the posterior nasal cavity to Kiesselbach's area. METHODS: The subjects were patients with epistaxis who visited our hospital between June 2008 and May 2010. We asked specific questions at the time of the hospital visit and examined patients using a nasal speculum, a flexible endoscope, and a rigid endoscope (0 or 70 degree) to identify bleeding sites. Hemostasis using electrocoagulation was selected as the first-line therapy for patients in whom a bleeding point had been identified, whereas hemostasis using a gauze tampon was performed in patients in whom the bleeding point was unknown. The subjects were analyzed by multivariate logistic regression analysis. RESULTS: The bleeding point was unknown in most cases of recurrent posterior epistaxis. Electrocoagulation was the best hemostasis procedure. Identifying the bleeding points as much as possible and performing electrocoagulation at these sites was the preferred procedures. CONCLUSION: We propose the treatment procedure for refractory epistaxis. When it is difficult to identify a bleeding point in a patient with refractory epistaxis due to a deviated nasal septum, a bleeding point should be identified after septoplasty; for bleeding from the sphenopalatine artery region, electrocoagulation or endoscopic cauterization of the sphenopalatine artery should be performed.

Development of AR Surgical Navigation Systems for Multiple Surgical Regions.

The purpose of our research is to develop surgical navigation systems to enhance surgical safety. Our systems make use of augmented reality technology to superimpose, on the surgery screen on a real time basis, patients' organ models reconstructed in 3D from their X-ray CT data taken before surgery. By doing so, the systems display anatomical risk materials, tumors and blood vessels which surgeons cannot see with their naked eyes. This will in turn lead to surgeons intuitively grasping the inner structures of the operational fields. We so far have been developing navigation systems that can conduct surgeries in various fields. The basic structure of the navigation systems are the same. The navigation systems uses different peripheral equipment and different methods to display navigation images which best meet the demands of each type of surgery. In this thesis, we report on our navigation systems for 2 types of surgery - endoscopic sinus surgery and hepatobilialy-pancreatic surgery.

Risk factors for recurrent epistaxis: importance of initial treatment.

OBJECTIVE: A retrospective study of risk factors for recurrent epistaxis and initial treatment for refractory posterior bleeding was performed. Based on the results, proposals for appropriate initial treatment for epistaxis by otolaryngologists are presented. METHODS: The data of 299 patients with idiopathic epistaxis treated during 2008-2009 were analyzed by multivariate logistic regression analysis. Treatment data for 101 cases of posterior bleeding were analyzed using the chi-square test. RESULTS: Recurrent epistaxis occurred in 32 cases (10.7%). Unidentified bleeding point (adjusted odds ratio (OR) 5.67, 95% confidence interval (CI) 1.83-17.55, p=0.003) was predictive of an increased risk of recurrent epistaxis, and electrocautery (adjusted odds ratio (OR) 0.07, 95% confidence interval (CI) 0.03-0.17, p=0.000) was predictive of a decreased risk of recurrent epistaxis. In terms of initial treatment for posterior bleeding, the rate of recurrent epistaxis was significantly lower for patients who underwent electrocautery as initial treatment compared with those who did not (6.4% vs. 40.7%, p<0.01), and it was significantly higher for those who underwent endoscopic gauze packing compared with those who did not (39.5% vs. 15.9%, p<0.01). CONCLUSION: In the present study, the risk factors for recurrent epistaxis were unidentified bleeding point. Thus, it is important to identify and cauterize a bleeding point to prevent recurrent epistaxis. The present results also suggest the effectiveness of electrocautery and the higher rate of recurrent epistaxis for patients who underwent gauze packing as initial treatment for posterior bleeding. Electrocautery should be the first-choice treatment of otolaryngologists for all bleeding points of epistaxis, and painful gauze packing may be inadvisable for posterior bleeding. More cases of posterior bleeding are needed for future studies involving multivariate analyses and appropriate analyses of factors related to hospitalization, surgery, and embolization.

[Evaluation of clinical features of antrochoanal polyps].

Current knowledge on the prevalence and clinical features of antrochoanal polyps (ACPs), benign lesions arising in the maxillary sinus and extending into the choana, is very limited in Japan. We prospectively evaluated prevalence and clinical features in 15 subjects with ACPs from among 728 undergoing endoscopic endonasal sinus surgery between April 2007 and March 2008, and prospectively enrolled in this study. The 15 subjects, who accounted for 2.1% of the total, had nasal obstruction, rhinorrhea, and postnasal drip. Symptoms significantly reduced postoperatively. Maxillary-sinus-origin ACP distribution was 40% from the maxillary sinus floor to the posterior wall, 26.7% from maxillary sinus floor, and 20% from the maxillary sinus floor to the internal wall. Postoperative recurrence was 13.3%. Endoscopic endonasal sinus surgery for ACPs was most effective for polyp is originating in the maxillary sinus determined carefully and excised as completely as possible, followed by appropriate postoperative treatment.

[Endoscopic sinus surgery complications a prospective multicenter study].

OBJECTIVE: Our objective was to determine the rate of complications in endoscopic sinus surgery (ESS) and associated risk factors. METHODS: We prospectively studied 1,382 subjects undergoing ESS for rhinosinusitis and cystic sinus disease at 16 hospitals during 2007 and 2008. Surgeons provided information on peri-and postoperative complication occurrence. RESULT: Results of complications were seen in 80 subjects (5.8%), the most frequent was perioperative lamina papyracea injury. Analysis showed the complication rate to be linked to gender, and anesthesia type, but not the grade of surgeon. CONCLUSIONS: While care should be taken to avoid them, complications should be identified and treated in a timely and accurate manner.

Development of a real-time image-guided surgery system for stereo-endoscopic sinus surgery.

We describe an image-guided surgery system for endoscopic sinus surgery. The system has three components: stereoscopic endoscope, optical location sensor and graphic workstation. The optical location sensor measures the movement of the endoscope and the patient's head. Using the sensor's data, the graphic workstation captures the endoscopic video image and superimposes 3D organ models onto the image in real-time. After a phantom experiment, we used this system during endoscopic sinus surgery. The surgeons were able to observe the inner structure of the patient stereoscopically in a 3D field of view.

[Surgical management of subperiosteal abscess of the orbit].

Subperiosteal abscess is generally defined as the collection of pus between the periorbita and the orbital wall, and usually results from paranasal sinus infection. Early, appropriate evaluation and management observing signs and symptoms of orbital inflammation are required to prevent blindness. We report 5 cases of subperiosteal abscess caused by paranasal sinus problems. We used endoscopic ethmoidectomy with puncture or endonasal endoscopic drainage of the abscess and found orbital complications in 4. We used conservative therapy in 1 with no visual acuity. We discuss pathogenesis and surgical indications and approaches. Three of 4 patients with mild visual acuity and treated with surgical procedure were cured without sequalae. We successfully managed the superior subperiosteal abscess with an endoscopic endonasal approach. One of 4 patients who had severe vision loss, however, was cured without any recovery of loss of vision after surgical drainage to decrease orbital pressure. The endscopic endonasal approach is more useful in managing both sinus disease and orbital complications than external ethmoidectomy.