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We investigated the correlation between the incidence of anatomical variations in the nasal cavity and mucosal inflammation in the paranasal sinuses, using computed tomography (CT). In total, 239 patients (478 sides; 138 men and 101 women; age range, 8-89 years) underwent coronal plane CT for screening from November 2001 to October 2006. Patients with facial trauma, paranasal sinus carcinoma, inverted papilloma, or previous sinus surgery were excluded from this study. We evaluated the incidence of agger nasi air cells, Haller's cells, middle and superior turbinate pneumatization, paradoxically curved uncinate processes, paradoxically curved middle turbinates, and septal deviation. The mucosal condition and ostiomeatal complex were evaluated by the Lund-Mackay staging system, and correlations between groups were analyzed using Mann-Whitney's U tests. The incidence of nasal septal deviation was 14.6% and the incidences of agger nasi air cells, concha bullosa (pneumatization of the middle nasal turbinate) and Haller's cells were 47.7%, 22.4% and 10.7%, respectively. Paranasal CT showed partial or total opacification of the sinuses in approximately 40% of the anterior and posterior ethmoid and maxillary sinuses. Concha bullosa increased the CT opacification of the paranasal sinuses, except for the sphenoid sinus. There was no significant association between the occurrence of concha bullosa and nasal septal deviation. Our results suggest anatomical variations in the nasal cavity induce mucosal inflammation in the paranasal sinuses.

We report a case of acute rhinosinusitis complicated by epidural abscess. A 33-year-old woman consulted her local otorhinolaryngology clinic complaining of left eye pain and left periorbital swelling. After visiting additional clinics and receiving treatment she did not obtain relief from her symptoms. Thereafter, she was referred to our hospital. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) were conducted and it was found that acute rhinosinusitis had caused an epidural abscess in the left frontal tip. The patient was admitted to the hospital and endoscopic sinus surgery (ESS) as well as septoplasty were performed under general anesthesia. A neurosurgeon was consulted regarding the brain lesion and treatment with antibiotics was selected. Intravenous PAPM/BP (panipenem/betamipron) and hydrocortisone sodium succinate were administered postoperatively. On the fifth postoperative day, the patient's condition had improved and the nasal inflammation had almost disappeared. She was discharged from hospital on the tenth postoperative day.

Fisher syndrome (FS) is an autoimmune peripheral neuropathy that occurs in 1 person per 2 million population. The present report is of a patient with FS who presented with diplopia and discomfort of the right cheek and in whom differentiation from maxillary sinus cysts was necessary. The patient was a 43-year-old man with a history of radical surgery of the right maxillary sinus, so we suspected that his symptoms were due to postoperative maxillary sinus cysts. Although computed tomography demonstrated right maxillary sinus cysts, these cysts were not likely to be the cause of the patient's diplopia. Close neurological examination revealed external ophthalmoplegia, cerebellar ataxia, and the absence of a deep tendon reflex; on this basis, a diagnosis of FS was made. Diplopia is caused by various disorders and FS should be taken into consideration when making a differential diagnosis.

In our department, we provide treatment for malignant head and neck tumors with the goal of preserving organs and function. We report the treatment outcomes for five patients with maxillary cancer who underwent S-1 and nedaplatin treatment with concurrent radiation therapy (SN therapy) in our department from April 2005 to March 2009. The patients included one case classified as T2N0M0 and four cases classified as T4N0M0. All patients were male and were aged between 29 and 67 years with a mean age of 55.6 years. Among the five cases, four achieved cancer-free survival with preservation of all functions after undergoing treatment. In the remaining case, the tumor did not disappear but was locally controlled via superselective arterial injection and CyberKnife treatment; however, pulmonary metastasis occurred and the patient is surviving with cancer. SN therapy has allowed a reduction in the extent of surgery required and the preservation of organs and function. It will be necessary to study an increased number of cases in the future to determine the survival rate and the effectiveness of organ and function preservation in maxillary cancer patients after SN therapy.

Objectives. Osteopontin (OPN), a multifunctional glycoprotein secreted from a wide variety of cells after inflammatory stimulation, is well accepted to contribute to the development of allergic diseases. However, the influence of histamine H1 receptor antagonists (antihistamines) on OPN functions is not well understood. The present study was undertaken to examine the influence of antihistamines on OPN functions in vitro. Methods. Human nasal epithelial cells (5 × 105 cells) were stimulated with 250 ng/mL OPN in the presence of either desloratadine (DL), fexofenadine (FEX), or levocetirizine (LCT). The levels of OPN, GM-CSF, Eotaxin, and RANTES in 24 h culture supernatants were examined by ELISA. The influence of LCT on mRNA expression and transcription factor activation in cells were also examined by real-time RT-PCR and ELISA, respectively. Key Findings. The antihistamines examined significantly suppressed the production of GM-CSF, Eotaxin, and RANTES from cells after OPN stimulation. LCT also exhibited the suppression of mRNA expression for chemokines and transcription factor, NF-κB and AP-1, activation, which were increased by the stimulation of cells with OPN. Conclusions. The suppressive activity of LCT on OPN functions on nasal epithelial cells may be responsible for the attenuating effect of the agent on allergic diseases.

There is established concept that dendritic cells (DCs) play essential roles in the development of allergic immune responses. However, the influence of H 1 receptor antagonists on DC functions is not well defined. The aim of the present study was to examine the effect of epinastine hydrochloride (EP), the most notable histamine H 1 receptor antagonists in Japan, on Dermatophagoides farinae (Der f)-pulsed mouse bone marrow-derived DCs in vitro and in vivo. EP at more than 25 ng/mL could significantly inhibit the production of IL-6, TNF- 𝛼 and IL-10 from Der f-pulsed DCs, which was increased by Der f challenge in vitro. On the other hand, EP increased the ability of Der f-pulsed DCs to produce IL-12. Intranasal instillation of Der f-pulsed DCs resulted in nasal eosinophilia associated with a significant increase in IL-5 levels in nasal lavage fluids. Der f-pulsed and EP-treated DCs significantly inhibited nasal eosinophila and reduced IL-5. These results indicate that EP inhibits the development of Th2 immune responses through the modulation of DC functions and results in favorable modification of clinical status of allergic diseases.