BACKGROUND: Eosinophilic chronic rhinosinusitis (ECRS) is characterized by nasal polyposis and mucosal eosinophilic infiltration. Although the local or systemic administration of glucocorticoids is considered to be a potent treatment strategy for preventing the relapse of nasal polyposis, its efficacy remains controversial.
OBJECTIVE: The aim of the study was to examine whether the presence of bronchial asthma may influence the therapeutic efficacy of postoperative treatment with the topical application of beclomethasone dipropionate (BDP) dry powder in ECRS patients. The histological features of the local expression of glucocorticoid receptor isoforms in the paranasal sinus mucosa were also observed.
STUDY DESIGN: Twenty patients with ECRS and with or without bronchial asthma who underwent endoscopic sinus surgery (ESS) at Hiroshima University Hospital were examined. All the patients had received postoperative treatment with the topical application of BDP dry powder. The therapeutic effects were evaluated based on the endoscopic findings and the computed tomography (CT) scores.
RESULTS: The overall remission rate as assessed using nasal endoscopy was 87%. The degree of improvement in the postoperative endoscopy score was less in asthmatic patients, compared with non-asthmatic patients, and the difference was statistically significant (p<0.01). The average of the total sinus CT scores decreased remarkably from 9.4 to 3.2 after treatment with topical BDP application. The postoprative CT scores remained higher in asthmatic patients as compared with non-asthmatic patients (3.9 vs. 2.1, p<0.05). The immunohistological expression of GRβ was mainly observed in the inflammatory cells of the ethmoid sinus mucosa. CONCLUSION; The present results reveal that postoperative treatment with the topical application of BDP dry powder is effective for controlling the inflammatory process that persists in the sinonasal cavity after surgery. The remission rate was higher in asthmatic paatients as compared with non-asthmatic patients. Thus, after endoscopic sinus surgery, patients with bronchial asthma require certain additional treatment.

View full abstract

Head and neck chondrosarcoma accounts for 10% of all cases. We report such a case. A 71-year-old woman with nasal septum chondrosarcoma reported the right nostril to have been “stuffy” for 1 year. A local otolaryngologist found a large nasal septum mass that was then biopsied. Histological results showed chondrosarcoma grade I. Computed tomography (CT) findings showed calcified plaque within the tumor, which was entirely resected endoscopically with a navigation system. No recurrence has occurred in 2-year-follow-up. Postoperative care and hospital stay after endoscopic surgery were shorter than in conventional treatment. Endoscopic chondrosarcoma resection is viable when skull base invasion of intracranial extension is not significant.

View full abstract

A few previous reports of severe reactions after carbon ion radiotherapy have been made. Herein, a case of nasal melanoma with various adverse effects after carbon ion radiotherapy is reported. The patient was a 70-year-old man with epistaxis and left nasal congestion. A white mass was found in the right nasal cavity over the nasal septum arising from the left nasal cavity. The histological diagnosis was malignant melanoma of the left nasal cavity. Magnetic resonance imaging revealed that the tumor protruded through the left nasal cavity and into the epipharynx. The enhanced mass showed a mild high signal intensity on T1-weighted images and a mild low signal intensity on T2-weighted images. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed a high uptake by the mass from the posterior nasal cavity to the pharynx, and the uptake included the left maxilla. High uptake was also noted in the left subaural and submental regions. The patient underwent carbon ion radiotherapy at the Hyogo Ion Beam Medical Center (Hyogo, Japan). The patient was treated with 60.8GyE/16 fractions to the primary lesion and 56 GyE/8 fractions to the left cervical lymph node metastasis. A complete response was achieved for the primary lesion, while a partial response was achieved in the left cervical lymph node. Thereafter, various acute and late reactions (oral mucosal ulcer, epistaxis, sinusitis, orbital abscess) developed because of necrosis at the radiation site.

View full abstract

To determine the importance of preoperative diagnosis of inverted papilloma in nasal and paranasal sinus mucosa and recurrence cases, we studied preoperative diagnosis, treatment, recurrence site, time to recurrence, and diagnostic tools for detecting the recurrence.
We retrospectively reviewed 31 cases diagnosed inverted papilloma pathologically after surgery between 2000 and 2008 at Iwaki Kyoritsu General Hospital. Among the 31 cases, 17 (55%) were correctly diagnosed preoperatively by biopsied specimens (group A). The remaining 14 cases which had not been correctly diagnosed as inverted papilloma were categorized according to the types of additional treatment: Complete removal of the tumor was successfully achieved in group B (6 cases), whereas that was not in group C (8 cases).
The rate of self-interruption of visiting hospital after the treatment was the lowest in group A (12%) and the highest in group C (25%). Although statistical significance was not achieved regarding the recurrence rate, group A (27%) tended to show higher recurrence rate than group B (0%). Recurrences of the complete removal group (group A and B) were noted in four cases, and the period between first treatment and recurrence were 5.4-45 months (average 18.0 months). Recurrences were diagnosed by endoscopy except for one case of frontal sinus.
Preoperative diagnosis is thus recommended both for cases of self-interruption of visiting hospital after the treatment and recurrence. Implying preoperatively the possible diagnosis of neoplasm could be helpful to explain why postoperative treatment is needed after achieving the diagnosis of inverted papilloma. Several reports point that recurrence tend to occur within 2 years after the surgery, thus careful post-operative observation are mandatory. Given the possibility of late-stage recurrence, regular follow-up is also recommended in such cases. Recurrences have been reported to occur often in the same areas as those encountered in the first treatment, follow-up using endoscopy are mandatory. Computed tomography (CT) and magnetic resonance imaging (MRI) are also useful for cases whose examination is difficult due to frontal sinus disease or inflammation.

View full abstract

Septoplasty for posttraumatic nasal septum deviation is quite difficult because of the septal thickness, caudal septum deviation, and coexisting nasal deformity. We report three cases with nasal deviation as a result of previous trauma. Injury to the nasal septum causes the fracture of the septum cartilage as well as dislocation from the nasal spine. In such cases, an open rhinoplasty approach combined with an intranasal endoscopic approach provides the surgeon with the best view to correct the nasal septum structure.

View full abstract

[in Japanese]

View full abstract