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Central skull base osteomyelitis (CSBO) is a rare, fatal condition seen mostly in elderly diabetic or immunocompromised patients; it mainly involves the sphenoid or occipital bones and diagnosis is often delayed. A 72-year-old male with diabetes was referred to our department with severe pain in the maxillary gingiva. Endoscopic biopsy of the pterygoid bone confirmed the presence of mucormycosis combined with Klebsiella pneumoniae infection. Sinus surgery was performed with bilateral alveolar bone sequestrectomy. Long-term intravenous broad-spectrum antibiotic therapy using meropenem and ampicillin/sulbactam and antifungal therapy using amphotericin B (100 mg/day) was administered; an oral antifungal agent, posaconazole (800 mg/day), was also prescribed for 11 weeks. At the 6-month follow-up visit, there were no complications and no progression of the CSBO lesion was observed. Timely diagnosis and multidisciplinary treatment including endoscopic surgery, alveolar bone sequestrectomy, and combined antifungal and antibiotic therapy can reduce mortality and minimize complications associated with CSBO Central skull base osteomyelitis (CSBO) is a rare, fatal condition seen mostly in elderly diabetic or immunocompromised patients; it mainly involves the sphenoid or occipital bones and diagnosis is often delayed. A 72-year-old male with diabetes was referred to our department with severe pain in the maxillary gingiva. Endoscopic biopsy of the pterygoid bone confirmed the presence of mucormycosis combined with Klebsiella pneumoniae infection. Sinus surgery was performed with bilateral alveolar bone sequestrectomy. Long-term intravenous broad-spectrum antibiotic therapy using meropenem and ampicillin/sulbactam and antifungal therapy using amphotericin B (100 mg/day) was administered; an oral antifungal agent, posaconazole (800 mg/day), was also prescribed for 11 weeks. At the 6-month follow-up visit, there were no complications and no progression of the CSBO lesion was observed. Timely diagnosis and multidisciplinary treatment including endoscopic surgery, alveolar bone sequestrectomy, and combined antifungal and antibiotic therapy can reduce mortality and minimize complications associated with CSBO.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that causes granulomatous inflammation in the mucous membrane of the intestinal tract, especially in the colon. Additionally, UC can be accompanied by extraintestinal manifestation (EIM). EIM of UC includes cutaneous lesions such as pyoderma gangrenosum, and rarely, systemically occurring aseptic abscesses (AA) have been reported in a few cases. Nasal involvement of UC as an extraintestinal manifestation of IBD is rare, and few reports of nasal mucosa and septal cartilage involvement have been documented in the literature. However, aseptic nasal abscess involving septal cartilage associated with UC and pyoderma gangrenosum resulting in saddle nose deformity have not been reported. The author presents a case of a 52 year-old woman with UC and pyoderma gangrenosum and an aseptic abscess in the nasal septal cartilage resulting in saddle nose deformity, which was corrected by augmentation rhinoplasty.
Congenital anomalies of the nose are distinctly unusual and appear at an incidence of 1 in 20,000 to 40,000 live births. Embriologically, developmental defects in the lateral nasal processes result in anomalies of the alar region. The defects of the lower lateral cartilage on one side and the different sizes of lower lateral cartilages cause problems in nasal tip support, contour, and symmetry. We present a case of congenital defect of the lateral crus of the right lower lateral cartilage of a 43-year-old male. The defect of the right lateral crus was reconstructed with the cartilage graft and the upper portion and the lateral crus of the left lower lateral cartilage were partially resected for symmetry of the nasal tip.
Background and Objectives: Although many studies have assessed factors related to adherence of PAP therapy, there were no studies about factors related to doctors or device managers. The purpose of this study was to investigate the relationship between PAP therapy adherence and doctor or device manager. Subjects and Methods: Between February 2013 and June 2015, 163 patients newly diagnosed with moderate to severe OSA in one of five hospitals were enrolled in this study. All patients received 4 weeks of PAP treatment with intervention consisting of mechanical support and motivation by doctor and device manager. Data from the PAP device were obtained following a minimum of an initial 30 days, with adherence defined as >4 h/night on 70% of nights. Results: After 30 days, total adherence rate to PAP therapy was 35.6% (n=58). The adherence rate of device manager ① was 26.3% (31/118), and that of device manager ② was 60% (27/45), and there was statistically significant difference between the two device managers. Furthermore, there were statistically significant differences in the adherence to PAP therapy ranging from 85.6% to 0.0% according to doctor. Conclusion: Our study demonstrates that the device manager and doctor may be important factors for good adherence to PAP therapy in patients with OSA.
Phantosmia is defined as the false perception of odors without any environmental odor stimulus. It is a very rare phenomenon, but it can be caused by a wide variety of conditions, such as viral or allergic rhinosinusitis, head trauma, brain tumor, migraine, temporal lobe epilepsy, stroke, and psychiatric conditions. If it is caused by a brain tumor such as glioblastoma, it can be controlled with steroids or antiepileptic drugs. Phantosmia can also be treated with surgical resection or adjuvant radiotherapy combined with chemotherapy. We report a case of glioblastoma presenting with phantosmia.
Background and Objectives: To measure the accuracy of Embletta X100, a level 2 portable sleep monitoring device, for diagnosis of obstructive sleep apnea and assessment of sleep structure. Materials and Method: We enrolled 200 consecutive patients who had been referred due to habitual snoring or witnessed apnea during sleep and had undergone standard polysomnography (PSG). We created a simulated situation similar to that of the Embletta X100 using only data from PSG and scored the sleep stage and the apnea-hypopnea index (AHI). Thereafter, the results of PSG and simulated Embletta X100 were compared. Results: Sensitivity, specificity, and positive and negative predictive values of simulated Embletta X100 based on PSG were nearly 100% at three different cutoff values of AHI (5, 15, and 30). Intraclass correlation (ICC) of simulated Embletta X100 based on PSG was also excellent (≥0.9) for most of the sleep-related parameters and respiratory index. However, ICC of sleep stage percent was variable according to sleep stage (>0.9 for N1 and N2, 0.664 for N3, and 0.864 for R). Conclusion: Although sleep staging is not very precise, Embletta X100 matches well with PSG overall.
Solitary fibrous tumor is a rare spindle cell neoplasm of mesenchymal origin that occurs most commonly in the pleura. This tumor can be found in various extrathoracic sites that contain soft tissue. There are few reports of solitary fibrous tumors in the head & neck and only 5 cases of solitary fibrous tumors of the cheek have been reported. A 53-year-old man visited our department complaining of a firm mass in the left cheek. We suspected a schwannoma originating from the infraorbital nerve. The mass was removed via a gingivobuccal approach and was diagnosed as a solitary fibrous tumor.
Retention cyst of the maxillary sinus is a benign lesion produced from obstruction of a seromucous gland or duct. It is mostly asymptomatic but sometimes is accompanied by facial pain, headache, nasal obstruction, and other symptoms. However, there are some debates on whether the symptoms are directly related with retention cyst. These cysts typically do not require treatment. However, when accompanied by symptoms, treatment can be administered for diagnostic and therapeutic purposes. We report a case in which facial pain is caused by a maxillary retention cyst suspended from an infraorbital nerve.
Background and Objectives: Septoplasty is a commonly performed operation in otolaryngological practice. In cases of septal mucosal tearing, septal perforation can easily occur. The aim of this study was to investigate patients who underwent an autologous cartilage securing suture technique to prevent nasal septal perforation. Subjects and Methods: A total of 403 patients who underwent septoplasty alone or with endoscopic sinus surgery for the past three years were enrolled in this study. Septal mucosal tearing occurred in 27 patients. In group 1 (15 patients), autologous cartilage was inserted between the injured mucosa. In group 2 (12 patients), autologous cartilage was inserted between the injured mucosa with a securing suture technique. We investigated the septal perforation rate between the two groups. Results: In group 1, septal perforation occurred in 7 of 15 patients (46.6%) and in group 2 there were no perforations. The occurrence rate of perforation in group 2 was significantly lower than that in group 1 (p<0.01). Conclusion: The securing suture technique of autologous cartilage can be an effective method for prevention of septal perforation during septal surgery.
Postoperative maxillary cyst (POMC) is relatively common complication among patients who underwent Caldwell-Luc surgery. Patients with POMC usually have no symptoms, although cyst extension can result in bone destruction or cystic infection withpain. The trigeminal nerve consists of the ophthalmic nerve, maxillary nerve, and mandibular nerve. Among these branches, themaxillary nerve runs to the lateral and frontal sides of the maxillary sinus wall. POMC can rarely lead to trigeminal neuropathycaused by cyst enlargement that compresses some branches of the trigeminal nerve. Recently, we experienced a case with trigeminalneuralgia due to POMC. The patient was successfully treated with inferior meatal antrostomy. We report this rare casewith a literature review.