The Variant Type of Preauricular Sinus: Postauricular Sinus

Choi, Seong Jun,Choung, Yun-Hoon,Park, Keehyun,Bae, Junho,Park, Hun Yi The American Laryngological, Rhinological Otologic 2007 The Laryngoscope Vol.117 No.10

OBJECTIVE:: Preauricular sinuses (PAS) are common congenital malformations that usually occur at the anterior margin of the ascending limb of the helix, but the positions of PAS and directions on the fistular tracts are rarely posterior to the external auditory canal (EAC), which presents as a postauricular swelling. We named these cases as the variant type of PAS (‘postauricular sinuses’), and compared their clinical manifestations with those of the classical type. STUDY DESIGN:: A retrospective study. METHODS:: We retrospectively reviewed the charts of patients who had undergone preauricular fistulectomy from 2002 to 2006. These patients were then categorized into two groups according to the position of the preauricular sinus sac. The classical group was defined as the group of patients with sacs located on the (superior) anterior to the EAC, and the variant group as those whose sacs are located on the posterior site of the EAC. We analyzed the incidence, previous histories, clinical manifestations, recurrence rates, and surgical techniques of the variant type of preauricular sinuses and compared them with those of the classical type. RESULTS:: Eleven (10.9%) of 101 patients were diagnosed with preauricular sinuses of the variant type. The male to female ratios of the classical and the variant groups were 44:46 and 7:4, respectively. The average age of the patients was approximately 11 to 13 years in both groups. All variant types of preauricular sinuses showed preauricular pits located posterior to the imaginary line that connects the tragus with the posterior margin of the ascending limb of the helix, unlike the classical type. Most (72.8%) of the fistular tracts of the variant type were directed in the posterior-middle direction from the pits. The variant types were operated with a dual approach using preauricular and retroauricular incisions, unlike the classical type, and the recurrence rate was 0% (compared with 2.2% in the classical type). CONCLUSION:: Frequent postauricular infected swellings may indicate the presence of the variant type of preauricular sinuses. The variant type of preauricular sinuses presenting in the postauricular area were found to have an unusual location of the fistula pit that was positioned posterior to the imaginary tragal extended line. A comprehensive physical examination of the preauricular pits should be performed to avoid incomplete excision of the variant types.

D2-40 Immunohistochemical Assessment of Lymphangiogenesis in Normal and Edematous Sinus Mucosa and Nasal Polyp

Kim, Tae Hoon,Lee, Sang Hag,Lee, Heung Man,Lee, Seung Hoon,Jung, Hak Hyun,Cho, Woo Sung,Cinn, Young Gi,Choe, Hwan,Kim, Moo Pil,Yoo, Ik One,Hwang, Ho Yeon The American Laryngological, Rhinological Otologic 2007 The Laryngoscope Vol.117 No.3

OBJECTIVE:: The lymphatic system plays an important role in the maintenance of tissue fluid homeostasis, which facilitates interstitial protein transport. Until recently, the lymphatic system of the sinonasal mucosa has been relatively poorly studied. The authors aimed to investigate the distributional and quantitative changes of the lymphatic vessels in inflammatory sinus mucosa and nasal polyps in comparison with healthy sinus mucosa using D2-40 antibody. METHODS:: Immunohistochemistry and Western blotting with D2-40 antibody were applied to normal and edematous ethmoid sinus mucosa and nasal polyps. The number, size, and length densities of lymphatic vessels were evaluated using tissue sections and whole mount preparations. RESULTS:: Most lymphatic vessels in normal and edematous ethmoid sinus mucosa were distributed in the subepithelial layer. Some of these vessels were dilated, whereas others were compressed and had a slit-like lumen. No D2-40 positive vessels were found in samples of nasal polyps. Lymphatic vessels showed no statistically significant difference in their number, size, or length density between normal and edematous ethmoid sinus mucosa. Western blot also showed no differences in their expression levels. CONCLUSION:: These findings indicate that lymphangiogenesis does not occur in edematous ethmoid sinus mucosa, which may not reuptake interstitial fluid efficiently in inflammatory conditions, resulting in the formation of mucosal edema in chronic inflammation.

Airway Reconstruction With Carrier-Free Cell Sheets Composed of Autologous Nasal Squamous Epithelium

Koo, Jaseok P.,Kim, Chang-Hoon,Lee, Jeung-Gweon,Kim, Kyung-Su,Yoon, Joo-Heon The American Laryngological, Rhinological Otologic 2007 The Laryngoscope Vol.117 No.10

OBJECTIVES/HYPOTHESIS:: Although skin has been the most effective graft material for reconstructing the airway lumen, the use of squamous epithelium has many problems. If autologous airway squamous epithelium could differentiate into mucociliary epithelium after in vivo grafting, it could be an answer to these problems. In this study, we wanted to examine whether carrier-free nasal epithelial cell sheets composed of autologous squamous epithelium could be used as a substitute for skin in airway luminal reconstruction in three maxillectomy patients. STUDY DESIGN:: In vitro biochemical experiments with in vivo applications. METHODS:: We cultured nasal squamous epithelium from three maxillary cancer patients prior to maxillecotmy. These squamous cell sheets were grafted on the forearm free flap, and, after maxillectomy, the surgical defect was reconstructed with a prefabricated myocutaneous radial forearm free flap with the cultured nasal squamous epithelium. At 1 and 3 month intervals after the reconstructive surgery, the cultured cell grafted area was investigated with histologic phenotype, comparing the skin grafted area. RESULTS:: The autologous nasal squamous epithelial cell sheet differentiated into mucociliary epithelium without the crust or mucus stagnation that is usually observed in cases in which skin graft is used for airway reconstruction. CONCLUSIONS:: We suggest that autologous cultured nasal squamous epithelium, which differentiates into mucociliary epithelium after in vivo grafting, can be used as a clinically relevant substitute for skin graft in airway luminal reconstruction.

Secondary Apoptosis of Spiral Ganglion Cells Induced by Aminoglycoside: Fas–Fas Ligand Signaling Pathway

Bae, Woo Yong,Kim, Lee Suk,Hur, Dae Young,Jeong, Sung Wook,Kim, Jae Ryong The American Laryngological, Rhinological Otologic 2008 The Laryngoscope Vol.118 No.9

OBJECTIVES/HYPOTHESIS:: Hair cell loss results in the secondary loss of spiral ganglion neurons (SGNs), over a period of several weeks. The death of the SGNs themselves results from apoptosis. Previous studies have shown that several molecules are involved in the apoptosis of SGNs that occurred secondary to hair cell loss. However, the precise mechanism of apoptosis of the SGNs remains unclear. The aim of this study was to ascertain the secondary apoptosis of spiral ganglion cells induced by aminoglycoside and to investigate the role of the Fas–FasL signaling pathway using guinea pigs as an experimental animal model. STUDY DESIGN:: Laboratory study using experimental animals. METHODS:: Guinea pigs weighing 250 to 300 g (n = 21) from 3 to 4 weeks of age were used. Gentamicin (60 μL) was injected through a cochleostomy site on their left side. At 1 (n = 7), 2 (n = 7), and 3 (n = 7) weeks after gentamicin treatment, their cochleas were obtained from their temporal bone. Hematoxylin and eosin and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining were performed to observe apoptosis. To investigate the involvement of the Fas–FasL signaling pathway in the secondary apoptosis of SGNs, we performed reverse transcription-polymerase chain reaction (RT-PCR), western blotting, and immunohistochemistry. RESULTS:: A progressive loss of spiral ganglion cells with increasing time after gentamicin treatment was observed on light microscopic examination. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining demonstrated induction of apoptotic cell death in SGNs after gentamicin treatment. Expression of FasL increased over time after gentamicin treatment as determined by RT-PCR and western blotting. On immunohistochemical staining, we observed the localization of FasL in the SGNs. The proapoptotic molecules Bax and Bad were increased, but levels of the antiapoptotic molecule Bcl-2 were decreased at increasing survival times after gentamicin treatment on RT-PCR. The gentamicin-treated group displayed initial activation of caspase-8 and increased the cleavage of caspase-3, caspase-8, and PARP protein in a time-dependent manner. CONCLUSIONS:: The secondary apoptosis of SGNs could be a result of the apoptotic Fas–FasL signaling pathway. Blocking the Fas–FasL signaling pathway could be considered as a method for preventing secondary degeneration of SGNs, and further studies are needed to confirm this.

Characteristics of Tissue-Engineered Cartilage on Macroporous Biodegradable PLGA Scaffold

Baek, Chung-Hwan,Ko, Ye-Jeung The American Laryngological, Rhinological Otologic 2006 The Laryngoscope Vol.116 No.10

BACKGROUND:: The purpose of this study was to establish in vivo culture of chondrocytes on biodegradable, poly-D,L-lactic-co-glycolic acid (PLGA) scaffolds and to analyze the characteristics of the reconstructed cartilage. METHODS:: In vitro cultured chondrocytes that were grown on a polyhydroxyethyl methacrylate (poly-HEMA) coated dish were seeded onto the PLGA scaffolds to make a cell–polymer construct before implantation. One cell scaffold construct was carefully implanted in the subcutaneous pocket of a nude mouse and another cell-free scaffold was implanted in the opposite side of the same nude mouse as the control. Morphologic, biochemical, and immunohistochemical characteristics of cells cultured within the PLGA constructs were examined after 8 weeks and 16 weeks of harvesting in the nude mouse. RESULTS:: New cartilage began to be generated in the period of 8 weeks and the neocartilage formation was accomplished in 4 months with the exact dimensions of the original scaffold in this in vivo study. All the explants showed the irregular shape of viable chondrocytes within normal lacunae and a mature cartilaginous matrix, and they positively immunostained for collagen type II. CONCLUSION:: The new tissue-engineered cartilage in vivo on PLGA scaffolds displayed the biochemical characteristics of cartilage tissue, and it showed chondrocyte-specific phenotypes and morphology that were similar to the native cartilage.

Role of Surgical Salvage for Regional Recurrence in Laryngeal Cancer

Jeong, Woo-Jin,Jung, Young Ho,Kwon, Seong Keun,Hah, J Hun,Kwon, Tack-Kyun,Sung, Myung-Whun,Kim, Kwang Hyun The American Laryngological, Rhinological Otologic 2007 The Laryngoscope Vol.117 No.1

OBJECTIVES:: The aims of this study were to analyze the pattern of regional recurrence in laryngeal cancer, evaluate the role of surgical salvage, and identify factors affecting salvage outcome. METHODS:: Retrospective analysis was conducted on medical records from a 16-year period. Of 463 patients diagnosed with laryngeal cancer, 25 patients with regional recurrence managed with salvage neck dissection were identified and subject to study. Isolated local recurrences and all distant metastases were excluded. RESULTS:: All patients were male with a median age of 61 years. The overall rate of regional recurrence was 5.4%. Median time to regional recurrence was 13 months. Isolated regional recurrence occurred in 76% of cases, whereas locoregional recurrence occurred in 24%. A 5-year survival rate for patients undergoing neck dissection as salvage management was 61.2%. Patients with recurrence in the contralateral neck were definitely associated with poor prognosis. Although standard statistical significance was not met, trends for poorer salvage result were identified in patients with a history of local recurrence before regional recurrence, recurrence in a previously dissected neck, and recurred node size of 3 cm or above. CONCLUSIONS:: Our study shows that salvage neck dissection for regional recurrence in laryngeal cancer is an acceptable approach. Surgical eradication of disease should be warranted whenever possible. Prudent planning of management is mandatory in the presence of history of local recurrence before regional recurrence, previously dissected neck, large size of recurrent node, and contralateral neck recurrence.

Treatment Outcomes for Radiotherapy Alone are Comparable With Neoadjuvant Chemotherapy Followed by Radiotherapy in Early-Stage Nasopharyngeal Carcinoma

Song, Chang Hoon,Wu, Hong-Gyun,Heo, Dae Seog,Kim, Kwang Hyun,Sung, Myung-Whun,Park, Charn Il The American Laryngological, Rhinological Otologic 2008 The Laryngoscope Vol.118 No.4

OBJECTIVES:: To analyze the impact of neoadjuvant chemotherapy (CT) on the treatment of early-stage nasopharyngeal carcinoma (NPC) as compared with radiotherapy (RT) alone. METHODS:: We analyzed retrospectively the outcome of 60 previously untreated and histologically confirmed early-stage NPC patients treated with either RT alone or with neoadjuvant CT followed by RT (CT/RT) at the Seoul National University Hospital between 1986 and 2004. Neoadjuvant CT consisted of three cycles with 5-fluourouracil and cisplatin. RT was given to the nasopharynx and neck nodes. The median dose to the primary site, involved nodes, and elective nodes was 70.2 Gy, 63 Gy, and 45 Gy, respectively. According to the 1997 American Joint Committee on Cancer staging system, 9 patients had stage I or IIA disease, and 22 patients had stage IIB disease in the RT group. For the CT/RT group, 8 patients had stage I or IIA disease, and 21 patients had stage IIB disease. The median follow-up for all patients was 124.5 (range, 5–239) months. RESULTS:: The 5-year locoregional failure-free (LRFF), distant metastasis-free (DMF), disease-free survival (DFS), and overall survival (OS) rate was 84%, 93%, 81%, and 84% for the RT group and 77%, 86%, 71%, and 79% for the CT/RT group, respectively. There were no significant differences in LRFF (P = .728), DMF (P = .433), DFS (P = .562), and OS (P = .625) rates between the RT and CT/RT groups. Multivariate analysis revealed that delaying RT for more than 81 days was significantly associated with an increased risk of locoregional failure in the subgroup of patients with stage IIB disease (P = .044). CONCLUSIONS:: In our retrospective analysis, the use of neoadjuvant CT showed no additional benefit to treatment with RT alone. Neoadjuvant CT may cause deleterious effect on stage IIB disease by delaying RT.