Faculty Bibliography

Endoscopic sinus surgery has been shown to be safe and effective when used appropriately for the management of chronic rhinosinusitis. However, in cases of revision surgery or advanced sinonasal polyposis or both, the usual anatomical landmarks that guide the endoscopic sinus surgeon can be distorted or obstructed from view, making dissection difficult and potentially dangerous if the surgeon does not have a method and understanding of the anatomy to navigate their way safely through the sinonasal cavity. In this article, we describe several consistent landmarks for orienting the surgeon during challenging cases. The use of these landmarks will aid the surgeon in safely navigating through the sinonasal cavity. 2014 Elsevier Inc

BACKGROUND: The olfactory epithelium is a self-renewing tissue, able to produce new neurons as needed from stem and progenitor cells in its basal layers. In addition, there exists a mesenchymal-like stem cell (MSC) located within the underlying lamina propria. Little is known about the function of this nasal MSC, or its relationship to the olfactory lineage, but there is considerable interest in using the nasal MSC for cell-based therapies. We sought to further explore the biology of the nasal MSC by establishing neurosphere cultures from adult human nasal biopsies, and to examine the anatomic distribution of nasal MSCs. METHODS: Nasal biopsies from human patients (n = 5) were obtained from superior, middle, and inferior turbinates or septum. Tissue was cultured to obtain nasal MSCs. Cultures were analyzed by immunocytochemistry and flow cytometry, as well as for differentiation capacity. RESULTS: Although olfactory sensory neuroepithelium is restricted to superior regions in the nasal cavity, neurosphere-forming MSC cultures were, surprisingly, obtained from olfactory as well as non-olfactory regions. These MSC cultures exhibit characteristic robust neurosphere formation and express CD90, CD105, STRO-1, and nestin. Nasal MSCs were found to give rise to neuronal-like cells under differentiation conditions. CONCLUSION: The unanticipated broad anatomic distribution of nasal MSCs has implications for cell-based therapy research.

Primary malignant melanoma arising from the eustachian tube is extremely rare. We report the case of a 63-year-old white man who presented with a 1-month history of left-sided hearing loss and aural fullness. Flexible fiberoptic laryngoscopy detected a blue-purple mass that appeared to arise from the left lateral nasopharynx. Computed tomography demonstrated an enhancing mass arising from an orifice of the left eustachian tube. The tumor was debulked endoscopically and was confirmed to have originated in the left eustachian tube. Histologically, the tumor was made up of heavily pigmented pleomorphic spindle cells with frequent mitoses. The tumor cells were immunohistochemically positive for S-100 protein, HMB-45, Melan-A, and PNL-2. The final diagnosis was a mucosal malignant melanoma. We also performed a nested polymerase chain reaction assay for several genes of interest, including CTLA-4, IL-17A, IL-17B, IL-17C, IL-17D, IL-17E, IL-17F, PLZF, Foxp3, RORgammat, CD27, and CD70. These genes have been studied mainly in cutaneous melanomas, especially for the development of immunotherapy, but only very limited studies have been done on mucosal melanomas. Our investigation found upregulation of CTLA-4, IL-17A, IL-17C, and IL-17E. Based on our finding of CTLA-4 upregulation, it may be suggested that our patient might have had low antitumor immunity and that he might have benefited from CTLA-4 blockade. On the other hand, upregulation of IL-17A and IL-17E might reflect increased antitumor immunity, which could suggest that patients with a mucosal melanoma might benefit from immunomodulators associated with the effect of Th17. These genes also have great potential to help melanoma patients obtain tailored treatment, and they can be used as biomarkers for predicting prognosis.

BACKGROUND: First bite syndrome is a known complication after parapharyngeal space surgery. This syndrome is usually encountered when the surgery is extensive but the parotid gland is preserved. A disruption in the balance between sympathetic and parasympathetic innervation to the parotid gland has been posited to play a role. METHODS: We report a 74-year-old woman with a parapharyngeal space malignancy who presented with first bite syndrome prior to any surgical intervention. The tumor and left parotid gland were resected via a transcervical approach. During the operation, the sympathetic chain was found to be directly involved with the tumor. RESULTS: The patient reported complete resolution of first bite syndrome immediately after the operation, and remained free of this symptom at 6 months' follow-up. CONCLUSION: To our knowledge, this is the first report of first bite syndrome presenting prior to any surgical intervention. Parotidectomy, if included in the surgical plan, may lead to the resolution of first bite syndrome

Mycotoxins are toxic secondary metabolites produced by a variety of fungi including Aspergillus, Alternaria, and Penicillium species. The presence of mycotoxins in sinonasal tissue and secretions and any possible link to chronic rhinosinusitis (CRS) or other diseases of the head and neck have not been reported. The authors performed an exploratory study to determine the presence and levels of mycotoxins in the sinonasal tissue and secretions of 18 subjects undergoing endoscopic sinus surgery for CRS. Using commercial enzyme-linked immunosorbent assay kits, samples were analyzed for the following mycotoxins: aflatoxin, deoxynivalenol, zearalenone, ochratoxin, and fumonisin. All specimens were negative for aflatoxin, deoxynivalenol, zearalenone, and fumonisin. Four (22%) of 18 specimens were positive for ochratoxin. The clinical significance of this finding remains to be determined