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In dorsal augmentation, costal cartilage can be used in a number of different ways: monobloc, fascia wrapped, or glued diced cartilage grafting (GDCG). The authors developed a mold to make the use of GDCG more convenient. This report describes their experience with GDCG using a novel mold for dorsal augmentation.The study involved 80 patients who underwent dorsal augmentation with the molded GDCG. Facial photographs and medical records were reviewed to assess patient satisfaction and postoperative complications. For the 23 patients who had three-dimensional scanned imaging, dorsal widths and dorsal heights at the radix and rhinion levels were measured to investigate changes in the implants over time. Resorption of the graft was assessed comparing the 3-month postoperative photograph with the latest photograph taken at the last follow-up (at least 1 year after the surgery). Serial changes of the dorsum were assessed with three-dimensional scanned images.A total of 66 patients (82.5 percent) were satisfied with their surgical outcomes. Complications were encountered in 19 patients (23.8 percent) and eight revision procedures (10 percent) were performed. One patient underwent revision surgery because of resorption of the GDCG. Analysis using a three-dimensional scanning device showed a significant increment of the dorsal height ( p0.05) without dorsal widening when comparing preoperative with 1-year postoperative follow-up data. There were no significant reductions in dorsal height between postoperative 3 months and 1 year.The use of a novel mold for shaping glued diced cartilage appears to be a useful technique for dorsal augmentation in rhinoplasty.Therapeutic, IV.

The effectiveness of turbinate surgery has been proven in patients with allergic rhinitis (AR).This study evaluated the long-term efficacy of turbinoplasty in AR and to compare the results with those of medical treatment.This study included 192 patients diagnosed with AR who underwent surgical or medical treatment. Medical records were reviewed to assess pre-treatment and 2-year post-treatment frequency and severity of AR symptoms, prescription frequency for AR medication, and satisfaction score for treatment. Parameters for 5-year post-treatment efficacy were acquiredPatients in the turbinoplasty group demonstrated significant improvements in all allergic symptom scores, while those in the medication group showed significant symptom improvement only in nasal obstruction on long-term follow-up. Patients in the turbinoplasty group also showed a lower prescription frequency after treatment and higher subjective satisfaction scores than those in the medication group.This long-term follow-up study demonstrated that turbinoplasty for AR appears to be an effective treatment option compared with medical therapy alone.

Well-characterized in chronic rhinosinusitis, type 2 inflammation is frequently associated with nasal polyps, comorbid asthma, and nonsteroidal anti-inflammatory drug hypersensitivity. Despite medical and surgical treatment, it recurs in a significant proportion of patients. Thus, severe uncontrolled type 2 chronic rhinosinusitis with nasal polyps is the most difficult-to-treat phenotype of chronic rhinosinusitis. Recently, dupilumab, a monoclonal antibody against IL-4 receptor α, and omalizumab, a monoclonal antibody against immunoglobulin E, were approved for patients with chronic rhinosinusitis with nasal polyps in the United States, Europe, and Korea. Therefore, rhinologists should understand novel biologics and their use. Here, we provide a literature review of several biologics with their indications, effectiveness, and safety.

Background Low-level light therapy (LLLT) is widely used for the photobiomodulation of cell behavior. Recent studies have shown that LLLT affects the proliferation and migration of various types of mesenchymal stem cells (MSCs). However, there is a lack of studies investigating the effect of LLT on enhancing the immunomodulatory properties of tonsil-derived MSCs (T-MSCs). Objective The aim of this study was to investigate the immunomodulatory effects of conditioned media from T-MSCs (T-MSCs-CM) treated with LLLT in allergic inflammation. Methods We isolated T-MSCs from human palatine tonsils and evaluated the ingredients of T-MSCs-CM. The effect of T-MSCs-CM treated with LLLT was evaluated in a mouse model of allergic rhinitis (AR). We randomly divided the mice into four groups (negative control, positive control, T-MSCs-CM alone, and T-MSCs-CM treated with LLLT). To elucidate the therapeutic effect, we assessed rhinitis symptoms, serum immunoglobulin (Ig), the number of inflammatory cells, and cytokine expression. Results We identified increased expression of immunomodulatory factors, such as HGF, TGF-β, and PGE, in T-MSCs-CM treated with LLLT, compared to T-MSCs-CM without LLLT. Our animal study demonstrated reduced allergic symptoms and lower expression of total IgE and OVA-specific IgE in the LLLT-treated T-MSCs-CM group compared to the AR group and T-MSCs-CM alone. Moreover, we found that T-MSCs-CM treated with LLLT showed significantly decreased infiltration of eosinophils, neutrophils, and IL-17 cells in the nasal mucosa and reduced IL-4, IL-17, and IFN-γ expression in OVA-incubated splenocytes compared to the AR group. Conclusions The present study suggests that T-MSCs-CM treated with LLLT may provide an improved therapeutic effect against nasal allergic inflammation than T-MSCs-CM alone.

Costal cartilage has many advantages over other grafting materials because of its large quantity and high biocompatibility. As a result, it has been considered as a good option for Asian rhinoplasty. However, costal cartilage is difficult to use and is associated with a high complication rate. To avoid the disadvantages and complications of costal cartilage graft, several techniques have been proposed in the literature. This review addresses the conventional uses of costal cartilage in Asian rhinoplasty and recent updates.Different techniques have been reported for Asian rhinoplasty using costal cartilage. Solid-block costal cartilage and diced cartilage with or without wrapping materials are widely used for dorsal augmentation. Many different grafting techniques for the tip and septal reconstruction have been reported by numerous surgeons. When using costal cartilage graft, surgeons should pay attention to both graft complications, such as warping or infection, and donor-site morbidity. Several strategies have recently been developed to avoid these complications.This article summarises grafting options for Asian rhinoplasty using costal cartilage and possible complications. This information may assist with proper selection of appropriate techniques for harvesting, carving and grafting costal cartilage.

Allergic rhinitis (AR) is one of the most prevalent chronic diseases in children. Patients with AR tend to have more persistent symptoms after adenotonsillectomy (TA).This study was aimed to evaluate the outcome of additional concurrent coblation-assisted turbinoplasty with adenotonsillectomy (TA + T) in patients with AR.This study included 104 children who underwent TA, and 67 who underwent TA + T. All patients were diagnosed as AR and were aged12 years at the time of surgery. Symptoms (snoring, mouth breathing, nasal obstruction, rhinorrhea, itching, and sneezing) were evaluated preoperatively and postoperativelyNone of the six symptoms investigated differed significantly between the two groups preoperatively, and all evaluated symptoms exhibited dramatic improvements after the surgery in both groups. The TA + T group showed significantly greater difference of improvement in mouth breathing and nasal obstruction than TA group. There were no significant difference of improvements in snoring, rhinorrhea, itching and sneezing postoperatively between two groups. In multiple regression analysis, postoperative obstructive symptoms including mouth breathing and nasal obstruction were significantly associated with concurrent turbinoplasty.Concurrent turbinoplasty should be considered especially in patients who have AR and adenotonsillar hypertrophy to improve obstructive symptoms.

Nasal profile line has central importance in forming an aesthetically balanced facial profile. Thus, rhinoplasty is a critically necessary surgery in shaping ideal profile line. For successful rhinoplasty, meticulous preoperative evaluation and proper planning should be performed before surgery. The nasal dorsum is the broadest and most prominent part of the nose; any minor imperfection is readily appreciated by an observer. Thus, dorsal augmentation is one of the most challenging areas in rhinoplasty as there is virtually no single ideal graft material and method for the nasal dorsum, which is free of aesthetic complication The surgeon should be able to discern the pattern of the abnormal nasal profile and to strategize the best possible surgical option to create a long-lasting, aesthetically pleasing dorsal line in good harmony with the overall facial profile. This study addresses our strategy to deal with various types of aesthetically unpleasant nasal profile line. The characteristics of augmentation materials and considerations in surgical technique are also addressed.

Background Management of the neck in patients with salivary gland cancer is controversial. This study aimed to identify clinicopathologic characteristics associated with regional metastases and regional recurrence in patients with salivary gland carcinoma. Methods Of 363 study patients, 51 underwent therapeutic neck dissection (TND) and 312 underwent either elective neck dissection (END, n = 110) or no neck dissection (NoND, n = 202). Univariate and multivariate analyses were performed to identify clinicopathologic characteristics associated with regional metastases and recurrence. Results Pathologic neck metastases were identified in 17/110 (15.5%) END patients and neck recurrence was identified in 5/202 (2.5%) NoND patients. Histologic grade (P

Objectives There are many studies on clinical prognosis following endoscopic sinus surgery (ESS) for the treatment of chronic rhinosinusitis with nasal polyp (CRSwNP). However, there are no independent reports on bacterial infection as a factor that influences surgical outcomes. We investigated the association between bacterial infection and surgical outcomes following ESS. Methods This retrospective review of medical records was performed on 71 patients with CRSwNP that was refractory to medical treatment and who were diagnosed between July 2007 and June 2012. The extent of the polyps and the Lund–Mackay CT score (L–M score) were preoperatively evaluated in all the patients. For this analysis, patients were classified into three groups (normal flora, culture-positive, and culture-negative) according to their intraoperative bacterial culture results. We compared the objective endoscopic findings between these groups at 6-months postsurgery. Results Bacteria were cultured in 55 of the 71 patients (77%). Of these, 43 patients (61%) demonstrated endoscopic improvement at the 6-month follow-up examination. The preoperative L–M score and polyp grade demonstrated no significant statistical differences in terms of surgical outcome, but the cure rate was statistically higher in culture-negative patients in comparison with normal flora and culture-positive patients (87.5% vs. 46.2% vs. 54.8, respectively). Conclusion Intraoperative culture results can be a prognostic factor for the clinical outcomes of ESS in CRSwNP patients. Hence, the intraoperative culturing of pathologic secretions and the postoperative administration of susceptible antibiotics could improve surgical results.

The aim of this study was to compare the short-term audiologic results of the ossiculoplasty using partial or total ossicular replacement prostheses (PORP or TORP) made of hydroxyapatite (HA) and titanium (Ti). Fifty-two consecutive patients who underwent ossiculoplasty due to chronic otitis media with or without cholesteatoma were enrolled. Patients were assessed at 6 months postoperatively to establish short-term audiologic results. Preoperative and postoperative air-conduction and bone-conduction thresholds were measured at five frequencies: 0.25, 0.5, 1, 2, and 3 kHz. Postoperative air-bone gap (ABG) of less than 20 dB was considered as successful. Success rates for HA PORP versus Ti PORP and HA TORP versus Ti TORP were compared. Postoperative ABGs at each frequency according to the types of prostheses were also compared. All types of prostheses showed a significant decrease of ABG postoperatively. Regarding PORP, the success rate of postoperative ABG of less than 20 dB was non-significantly higher in Ti group (89%) than in HA group (72%). Regarding TORP, HA group showed non-significantly higher success rate (100%) than Ti group (67%). Comparing postoperative ABGs at each frequency, there was no significant difference in ABGs between HA and Ti groups. There was no difference between the two materials. Both HA and Ti gave good functional results and operator can choose any types of prostheses by personal preference and affordability. Further randomized controlled long-term trials with large sample sizes are needed to establish the difference exactly.

Cancer incidence in the elderly population has been continuously rising, and their treatment is an increasing concern among oncologists. This study aimed to evaluate the incidence and risk factors for morbidity and mortality after major oncological surgery in elderly patients with head and neck squamous cell carcinoma (HNSCC). The 196 HNSCC patients aged 55 and older who underwent major curative surgery. Patients were categorized into three groups: far-old (≥75 years; n = 41); old (65–74 years; n = 72); or middle-aged (55–64 years; n = 83). The rates of early and late postoperative complications, hospital stays, and mortality were compared among groups. Univariate and multivariate analyses were performed to identify the factors associated with early postoperative complications. No study patients had mortality during surgery or within 3-month postoperation. Karnofsky performance status, frail functional status, comorbidity, and index cancer and noncancer mortality were the poorest in the far-old group. The far-old group demonstrated significantly higher rates of early overall complications, readmission within 1 month, and recurrence rates (P

Management of the neck in patients with salivary gland cancer is controversial. This study aimed to identify clinicopathologic characteristics associated with regional metastases and regional recurrence in patients with salivary gland carcinoma.Of 363 study patients, 51 underwent therapeutic neck dissection (TND) and 312 underwent either elective neck dissection (END, n = 110) or no neck dissection (NoND, n = 202). Univariate and multivariate analyses were performed to identify clinicopathologic characteristics associated with regional metastases and recurrence.Pathologic neck metastases were identified in 17/110 (15.5%) END patients and neck recurrence was identified in 5/202 (2.5%) NoND patients. Histologic grade (P 0.001), tumor site (P = 0.008), and lymphovascular invasion (P 0.001) were independent risk factors for neck metastases. Nodal metastases were more common in high-grade tumors (P 0.001), at levels I-III in END patients and levels I-V in TND patients. Multivariate analyses identified histologic grade (P = 0.020), clinical N2 classification (P = 0.007), and extranodal extension (P = 0.005) as independent factors for regional recurrence after treatment.Patients with high-grade cancers should receive END involving levels I-III, whereas patients with node-positive salivary cancers should receive comprehensive TND involving all levels (I-V).