To develop knowledge of the basic concept of endoscopic sinus surgery (ESS), we developed a new training method using volume rendering and browsing software for cone beam computed tomography, i-view^TM (J. MORITA MFG Corp., Kyoto, Japan); with the latter in its drilling mode, it is possible to delete an orbicular space with an arbitrary point as its center by clicking the mouse. The characteristics of i-view^TM allow unique learning approaches, such as recognizing danger points by coloring marginal regions. Although it is not yet applicable as a surgical simulator for the treatment of sinusitis, as it is difficult to differentiate between healthy mucosa and lesional sites, this method may be useful to develop an understanding of basic surgical procedures and anatomy. In fact, ESS training using i-view^TM for 5 novice medical officers belonging to our department markedly improved their ethmoidectomy skills and recognition of danger points, which had initially been insufficient. On the other hand, difficulty in reproducing endoscope-forceps relationships remained. This paper discusses the usefulness and future challenges of the new training method.

[Introduction] Odontogenic maxillary sinusitis (OMS) is a common type of sinusitis. However, the change to OMS can be prevented with early detection of periapical disease of the upper teeth and early dental therapeutic intervention. We suspect that routine assessment of periapical disease of the upper teeth with computed tomography (CT) of the sinus would be useful for preventing and shortening the duration of OMS. Although OMS is usually diagnosed by otorhinolaryngologists, they can overlook periapical disease of the upper teeth. In this study, we evaluated the periapical disease of the upper teeth on the basis of detailed CT scans to determine whether patients with OMS had previously undergone dental treatment.

[Methods] A total of 1,112 patients underwent sinus CT examinations from October 2012 through May 2014 at our hospital. On sinus CT images, we searched for periapical disease of the upper teeth, root apices of the upper teeth opening to the maxillary sinus, and shadows of the maxillary sinuses. OMS were diagnosed when patients met all criteria. We examined the rates of periapical lesions of the upper teeth and a history of dental treatment and patient’s characteristics.

[Results] A total of 882 (79.3%) of the 1,112 patients had shadows of sinuses, and 169 (19.1%) patients had odontogenic maxillary sinusitis diagnosed with radiological findings. Dental treatment had been received by only 12.4% of the patients (21 of 169).

[Conclusion] We believe that a routine assessment of the periapical disease of the upper teeth by sinus CT might be useful for preventing the change from periapical disease to OMS.

Extracranial meningioma in the paranasal sinus is rare. Ectopic meningiomas are difficult to diagnose, partly due to their rarity, and they are often confused with nasal polyps. A case of extracranial meningioma in the frontal sinus is reported. A 50-year-old woman had undergone an operation for a frontal cortex meningioma 15 years ago and gamma knife treatment 3 years ago. She had complained of forehead dullness for 2 years, and inflammation of the frontal sinus had been detected on follow-up magnetic resonance imaging 6 months ago. Although she received oral treatment, her forehead dullness did not change. Thus, she consulted our hospital. Computed tomography suggested that the above mentioned inflammation might have been due to a paranasal papilloma or paranasal mycosis. The patient underwent endoscopic sinus surgery (Draf III) at our hospital. A polypoid lesion in the frontal sinus was removed surgically. A pathological examination of the surgical specimen revealed spindle-shaped tumor cells and cellular whorls. The polypoid lesion was diagnosed as a fibrous meningioma. There has been no recurrence in the 8 months since the procedure. However, we consider that careful and continuous observation on an outpatient basis are required. We suggest that the invasiveness of the previous operation for frontal cortex meningioma and the subsequent gamma knife treatment might have contributed to the development of the present extracranial meningioma.

Juvenile angiofibroma (JA) is usually treated with the Caldwell-Luc operation, lateral rhinotomy, or skull-base surgery, among other treatment options. Due to significant improvements in surgical techniques and instruments, endoscopic sinus surgery (ESS) has become the most common surgical treatment for JA. We report the case of a 16-year-old male who was diagnosed with JA. Computed tomography indicated that the tumor had obstructed the right nasal cavity, filled the nasopharynx, and eroded the skull base as well as the pterygoid fossa. Angiography was performed prior to the operation, and the right maxillary artery which was feeding the tumor, was embolized in order to reduce intraoperative bleeding. The operation was performed via an endoscopic approach. We clipped the right maxillary artery, performed a medial maxillectomy, and ablated the right Vidian artery with bipolar electrocautery after resecting the anterior and inferior bones of the right sphenoid sinus. The tumor was completely resected after removing the medial pterygoid plate and debulking the tumor. Some cases of JA that erode the skull base and pterygoid fossa can be resected with ESS alone. It is important to reduce bleeding by controlling the feeding artery, and to resect the stalk of the tumor during JA resection.

Objective: The present study was aimed at evaluating the usefulness of a high frequency bipolar system (Coblator system) as a cutting device for posterior nasal neurectomy (PNN) in patients with allergic rhinitis.

Methods: Nineteen patients with intractable allergic rhinitis who underwent PNN in our hospitals were enrolled in this study. There were 16 men and 3 women ranging in age from 14 to 73 years old. The Coblator system was used in 9 patients (Coblator group) and the ultrasonic scalpel was used in the other 10 patients (control group). All surgical procedures were performed endoscopically under general anesthesia. The middle meatus mucosa posterior to the maxillary sinus ostium was cut and elevated to approach the posterior nasal nerve. A cord-like structure emerging from the sphenopalatine foramen that included the sphenopalatine artery and posterior nasal nerve was identified and severed using the Coblator system or ultrasonic scalpel. Patients’ medical records were reviewed and analyzed retrospectively.

Results: There was no significant difference in the peripheral blood eosinophil count or total serum IgE level between the two groups. The Coblator systems exhibited maneuverability, caused less bleeding and provided a less obstructed operative view compared to the ultrasonic scalpel. Mean operation time was significantly shorter in the Coblator group compared to the control group (8.6 ± 1.3 min vs. 17.9 ± 1.7 min; P<0.001). The percentage of patients with nasal discharge significantly decreased after surgery in the Coblator group (9/9 preoperatively vs. 3/9 postoperatively; P = 0.009).

Conclusion: The Coblator system is a more useful device compared to the ultrasonic scalpel for PNN.

The effectiveness of Japanese cedar antigen-specific immunotherapy for Japanese cedar pollinosis is conventionally shown, but the efficacy against Japanese cypress pollen which has a high degree of homology with Japanese cedar pollen has not been fully explored. We examined symptom transitions of patients under Japanese cedar antigen-specific subcutaneous immunotherapy for the cedar and cypress pollen scattering period in 2013 and 2014, investigated an exacerbation during the cypress pollen season, studied the effectiveness of the therapy in comparison with the group on initial medical treatment, and obtained the following results.

1) In the comparison of the immunotherapy group in 2013 and 2014, the score of symptom and quality of life (QOL) showed an increase for the cedar pollen scattering period in 2013 with much airborne pollen, whereas an aggravation was seen in only eye symptoms in 2014. Despite the amount of cypress airborne pollen was larger than cedar pollen among both years no remarkable symptom exacerbation was seen in total research during the cypress pollen season, which indicated the effectiveness of immunotherapy for Japanese cypress pollen allergy. However, in 2013 with much airborne pollen, individual difference was observed in patients’ condition from aggravation to remission. QOL deterioration was seen during the ceder pollen season in 2013, but QOL deterioration was not seen during the cypress pollen season in 2013 and 2014, which indicated QOL may decrease in the years with much airborne pollen. QOL was remained at a low score in all of the period.

2) Compared with the group of initial medical treatment, the score of symptom and QOL in immunotherapy patients were low during the cedar and cypress pollen season and it showed the efficacy of the immune therapy.

Those results implied a possibility that immunotherapy against Japanese cedar pollen is effective against Japanese cypress pollen but suggested there are individual differences in the effectiveness during the cypress pollen season in the year with high number of airborne pollen.

Graves’ ophthalmopathy is an autoimmune disease with enlargement of the orbital fat and extraocular muscles. The retrobulbar pressure and enlargement of the extraocular muscles could lead to compression of the optic nerve and result in optic neuropathy. Decompression surgery is required if high-dose corticosteroids do not lead to improvement. Although the endoscopic transnasal approach by otolaryngologists has been widely employed for orbital decompression, only a few publications have been reported from Japan. Hence, we report two patients with optic neuropathy from Graves’ disease who underwent endoscopic orbital decompression. One patient was a 53-year-old woman who suffered sudden failing vision and diplopia in the right eye. The other patient was a 51-year-old woman with Graves’ disease who suffered sudden failing vision in both eyes just after second radioiodine therapy. Because high-dose steroid pulse treatment did not improve their vision, endoscopic decompression surgery was performed. Standard endoscopic sinus surgery technique was used to expose the bilateral lamina papyracea and orbital floor. The lamina papyracea and medial portion of the orbital floor were removed. After the periorbit was exposed along the entire length of the ethmoid sinus, a horizontal incision was made parallel to the skull base. Just after the surgery, the visual acuity of both patients recovered. But because diplopia in both patients worsened after surgery, they needed strabismus surgery one year after the decompression surgery. Endoscopic transnasal decompression can be an easy and safe procedure for surgeons who are familiar with endoscopic sinus surgery.

We previously reported on a hands-on seminar on basic research organized at the 53rd Annual Meeting of the Japanese Rhinologic Society (Osaka, Japan) in order to not only improve individual skills and knowledge but also enhance interaction and collaboration between researchers. A questionnaire survey was also conducted following this seminar. Moreover, we investigated the shift in the number of basic oral and poster presentations at the annual meetings of the Japanese Rhinologic Society from 2000 to 2014. In this previous report, 97% of participants agreed that the seminar was useful and most hoped to continue such seminars in the future. The percentage of basic oral and poster presentations at the 2014 meeting decreased to 10% compared with 28% at the 2000 meeting. Thus, to further develop this seminar on basic research, we again organized at the 54th Annual Meeting of the Japanese Rhinologic Society (Hiroshima, Japan) a second hands-on seminar on basic research for clinicians, focusing on how to prepare good frozen sections, obtain good DNA and RNA, and perform reverse transcription polymerase chain reaction (RT-PCR). Here, we present an outline of this second seminar and discuss detailed procedures for performing Kawamoto’s film method, which is a new technique with adhesive film for the preparation of multipurpose fresh-frozen sections from hard tissues, and for collecting DNA and RNA from nasal tissue. Additionally, we present the results of a questionnaire survey and the percentage of basic oral and poster presentations in this seminar as last year, as well as discuss perspective of this trial.