Search

From the first days of life, a female newborn suffered from nasal congestion and a runny nose. The first MRI, at 42 days of life, revealed a solid and expansive mass of 1 cm in the left nasal fossa. The radiological examination repeated at 4 months of life showed an increase in volume, up to 2 cm (

Implant migration into the nasal fossa is a rare complication and it requires extraction by anterior rhinoscopy. We report a clinical case of placement of short dental implants, fixed or intruded in the nasal fossa floor, which was aspirated by the patient and spontaneously expelled a few days later. To the best of our knowledge, there have been no reports of spontaneously expulsion through the nasal cavity. Key words:Dental implant, nasal cavity, accidental migration.

Endonasal balloon‐assisted dacryoplasty is a minimally invasive technique that uses a high‐pressure balloon catheter introduced into the lacrimal pathway through the nasal fossa into the neorhinostomy to treat recurrent epiphora after primary dacryocystorhinostomy. This procedure can be considered to be a reliable technique in patients unfit for general anesthesia.

Ear, nose, and throat examination is important in early diagnosis of leprosy, due to the frequent involvement of upper airways and external ear. In lepromatous and borderline clinical forms, untreated or with insufficient treatment, upper respiratory and digestive tract involvement is frequent and extensive, unlike the indeterminate and tuberculoid polar forms, where the lesions are rare and localized.

La concha bullosa es una variante anatómica del cornete medio nasal. Se reporta un caso de una mujer de 21 años con síntomas de obstrucción nasal severa de ambas fosas nasales. Al examen físico se aprecia gran masa que ocupa la fosa nasal izquierda y una severa desviación septal a la derecha. La tomografía computarizada muestra una concha bullosa gigante izquierda, con neumatización del cornete superior izquierdo y una desviación y adelgazamiento septal severos hacia la fosa nasal derecha. Se realiza cirugía endoscópica con resección de la concha bullosa y corrección de la neumatización del cornete superior, antrostomía maxilar derecha y se lleva a cabo septoplastia como reto quirúrgico, por su grado de dificultad y por laposibilidad de causar complicaciones como la perforación septal.

Sinonasal inverting papilloma is a rare benign, locally aggressive tumour, arising from sinus and/or nasal fossa mucosa, with high recurrence rate, and risk of malignant transformation. This is a case of orbital invasive, lateral extending inverting papilloma approached via combined external and endoscopic surgery.

Rhinoliths are rare calcified entities in the nasal fossa, frequently originating around a nidus near the midway point in the inferior meatus, where the passage is the narrowest. They can be clinically asymptomatic and undetected for years. In this study, we present a rare case of large rhinolith mimicking atypical odontogenic pain in a 40-year-old Caucasian female in the left nasal cavity. The lesion was detected in the CBCT and removed uneventfully.

Mucormycosis is an opportunistic fungal infection involving among others the paranasal sinuses, nasal fossa and brain parenchyma. Mucor can invade the brain parenchyma by either contiguous spread from the paranasal sinuses or through vascular invasion. We report a case of fatal rhino-cerebral mucormycosis in whom cytotoxic edema at magnetic resonance diffusion-weighted imaging was symmetrically restricted to both neocortical and paleocortical primary areas of olfactory projection at earliest phase of the disease process. Shortly later tissue damage extended into the whole brain. This undescribed observation raised the hypothesis of preferential way of brain invasion by Mucor through the olfactory tract.

OBJECTIVES/HYPOTHESIS The objective of this radiological/anatomical study was to evaluate the feasibility of a new endoscopic technique that uses the anterior pedicled lateral nasal flap (APLNW) for the endonasal lining in complex nasal reconstructions. STUDY DESIGN An anatomical study was performed on 20 nasal fossae of cadaverous specimens to measure the area and lengths of the anterior pedicled nasal lateral wall flap. In addition, a radiological analysis with computed tomography was performed in 150 nostrils to determine the potential donor of the simple and extended flap in the nasal fossa floor. Complex nasal reconstruction with nasofrontal flap and internal lining using the lateral wall pedicled flap was performed in 3 patients. RESULTS Complete reconstruction for the inner lining of the nasal tip and lateral nasal wall was achieved in the cadaveric study (10 specimens). The surface areas of the simple and extended APLNW flaps were 7.53 (standard deviation [SD] 1.25) cm2 and 24.6 (SD 3.14) cm2 , respectively. Using computed tomography scans, we determined that to reconstruct defects secondary to full-thickness nasal defects, the APLNW flap surface for the simple and extended versions was 7.90 (SD 1.68) cm2 and 23.64 (SD 4.7) cm2 . We present one case were the APLNW flap was used. CONCLUSIONS The simple or expanded APLNW flap represents a feasible option to reconstruct the internal lining in complex nasal reconstruction. LEVEL OF EVIDENCE NA Laryngoscope, 131:E1462-E1467, 2021.

Endodontic microsurgery is a predictable and successful procedure when using techniques that have been developed over the past several years. One of the steps during surgery involves curettage of the entire lesion. However, there are cases in which the lesion has advanced to invade anatomic structures like the nasal fossa, maxillary sinus, mandibular canal, neighboring vital teeth, or through and through to the palate. These lesions make endodontic microsurgery difficult for the operator to execute and have inherent risks to the patient. Selective curettage is a conservative approach to treat such cases by removing approximately 50%-70% of the granulomatous tissue while avoiding complications and damage to the neighboring structures. Three-dimensional cone-beam computed tomographic imaging, 2-dimensional periapical radiographs, and clinical follow-ups of the selective curettage lesions showed complete or incomplete (scar tissue) healing in all cases with no untoward results.

Paranasal sinus osteomas are rare, slow-growing and benign lesions with potentially serious complications. They usually remain asymptomatic but when osteomas grow they can lead to local complications and cause evident aesthetic deformity due to the direct mass effect and in these situations, surgery is required. This is a report of a 30-year-old man with a rare giant post-traumatic osteoma that occupies the right nasal fossa, ethmoidal cells and frontal sinuses with extension into the right orbit.

Abstract: Introduction: The usefulness of nasal packing after endoscopic sinus surgery is still debated in the literature. Aim: Our aim was to evaluate the effects of a new chitosan-based nasal dressing in animal model. Methods: Standard mucosal damage was caused in both nostrils during endoscope-assisted procedure in ten rabbits. Chitosan nasal packing was inserted in a randomly selected nasal fossa of each animal, while the other side was left unpacked. Symptoms were evaluated during nasal endoscopy on the 12th postoperative week. The degree of mucosal oedema, crusting, adhesions and the nasal discharge were observed according to the modification of the grading system of Berlucchi et al. The higher scores indicated the worse complaints. Results: Assessing the adhesion formation, 1 point was given (mean: 0.1; standard deviation [SD]: 0.32) for the unpacked side, while in the tamponated side no adhesion formation was observed. The total score of crusting in the non-packed side was lower with 1 point (total score: 9, mean: 0.90; SD: 0.74) than in the chitosan side (total score: 10, mean 1.00; SD: 0.82). Discharge or mucosal oedema were not observed during the follow-up period. The mean rate, measured with electronmicroscopy, was 22.06% (SD: 0.25) in the chitosan side, while in the non-packed side it was 36.11% (SD: 0.48). The differences did not show any significance (p = 0.806). Conclusion: During the examinations, none of the animals suffered complications. The symptoms of the packed and the non-packed nasal cavities did not differ significantly on the basis of our examinations. Orv Hetil. 2018; 159(47): 1981–1987.

The aim of this work is to review the spectrum of sinonasal lesions that extend to the endocranium and to present key points that may narrow the differential diagnosis. The most frequent sinonasal lesions that extend into the endocranium are malignant; however, benign entities are not unusual. Imaging diagnosis is difficult because malignant lesions and benign entities share similar clinical, epidemiologic, and imaging features. Tumor features in relation to bone, intratumor homogeneity and structure, magnetic resonance imaging signal, along with clinical and epidemiologic aspects may allow an appropriate diagnostic focus with important management implications.

Common anatomic variants of the middle nasal turbinate include its pneumatization (i.e. concha bullosa media) and its paradoxical curvature. We report here two cases of differently combined variations of the middle turbinate which were documented in cone beam computed tomography (CBCT). The first report presents the vertical combination of a double or septated lamellar concha bullosa with the paradoxical curvature of middle turbinate. This combined variant associated (coincidental findings): ipsilateral paradoxical superior turbinate and contralateral paradoxical middle turbinate, concha bullosa superior and concha bullosa suprema. In the second case was found the sagittal combination of successive anterior concha bullosa media and posterior paradoxical curvature of the middle turbinate. An ethmoidal sinolith was found embedded in lamella basalis. The contralateral superior turbinate was pneumatized. These rare findings demonstrate that sound knowledge of possible anatomical variations, supported by a complete use of the tools available for the CBCT documentation of cases, is able to enrich the picture of human anatomic variations, with a direct impact on clinical and surgical practice. The septa-containing lamellar concha bullosa and paradoxical middle concha combination is a variation that affects surgical practice.

Sinonasal mucosal melanoma is a rare and highly aggressive tumour. This tumour often carries a poor prognosis because of local invasion and early distant metastasis. It’s, in fact, an aggressive, fortunately rare, disease. It’s more common among population in their seventies, with a prolonged course due to innocuous symptoms. We report a case of sinonasal mucosal melanoma in a 56-years old male who presented with a brownish sinonasal mass involving right nasal fossa, swelling and spontaneous epistaxis. We report this case for the one-time reconstruction treatment performed by our team.

Purpose: The study was performed to evaluate variability in nasopalatine canal using cone beam computed tomography (CBCT) in relation to age and gender. The study also provides an insight while considering anterior maxillary implants. Materials and Methods: The study included 200 subjects aged between 19 and 67 years who were divided into the following 3 groups: 1) 19 - 34 years old; 2) 35 - 49 years old; 3) >50 years old. The male and female subjects were 104 and 96 respectively. After obtaining a prior consent, CBCT was performed using a standard exposure and patient positioning protocol. The CBCT volume was sliced in three planes (X, Y, and Z) and was sequentially analyzed for the location, morphology and morphometric dimensions of the nasopalatine canal. The correlation of age and gender with all the variables were evaluated. Results: The present study revealed statistically significant differences in the length of the nasopalatine canal based on the age group. The slanted and the cylindrical variety of the nasopalatine canal were commonly observed in the study. However, no statistical differences were noted in the other variables such as number of openings at the nasal fossa, diameter of the incisive fossa, angulation of the canal as viewed in the sagittal sections and antero-posterior dimensions of the canal in the sagittal sections. Conclusion: The present study demonstrates the variability observed in the anatomy and morphology of the nasopalatine canal which is an important landmark for placing dental implants in the anterior maxillary region.

Maxillectomy following tumors or, more rarely, traumatic injuries may result in maxillary defects that may determine physical dysfunctions and functional impairment of speech and swallowing. The aim of our study was to present our experience in the management of post-maxillectomy patients by the use of obturator prostheses that were obtained by 3D digital casts via an intraoral scanner. Patients with maxillary defects following maxillary and/or palatal resection or maxillary traumatic avulsion were selected for this clinical study between 2015 and 2018. Five to 6 months after surgery, a definitive obturator prosthesis was fabricated thanks to an intraoral scanner. The following parameters of clinical outcome were considered: the absence of fluid leakage, the recovery of phonation, the recovery of swallowing, and personal satisfaction. Twenty-eight patients (20 males, 8 females) fulfilled the inclusion criteria and were included in the study. Most patients had a maxillary and/or palatal defect because of a malignant tumor. On the whole, 93% of patients reported a complete absence of fluid leakage between maxillary sinuses or nasal fossa and oral cavity; most patients reported a good or complete recovery of phonation and swallowing. Digital technology for the fabrication of maxillary obturator prosthesis may be effective and useful. The reduced laboratory working time, the avoidance of the risk of aspiration of impression materials, and the overcome of the difficulties associated with whole tissue undercut impression are just some of the most important advantages that have been encountered thanks to this promising technology.

Nasopalatine canal (NPC) is an important anatomical structure present in the anterior mid maxilla. It has the synonyms of incisive canal or anterior palatine canal. The objective of this study was to identify the morphometric characteristics of the NPC in group of Sri Lankan people using Cone beam computer tomography (CBCT) and to determine normal morphological course and anatomical variations. Fifty Maxillary CBCT images of anterior maxilla, obtained from the archives of the University Dental Hospital, Peradeniya were retrospectively analyzed to determine the position of the NPC. Morphology, canal dimension of NPC and its relation to the maxilla. Majority had a single opening (48%) or 2 openings (46%). Average diameter of the canal was 3.692 mm with a range of 2–6 mm. Majority of the canals had funnel shape and were vertically curved. Average length of canal was 12.142 mm and angulations of the curvature was 115.6940. Average antero-posterior diameter at nasal fossa was 2.852 mm, at mid-palate 2.366 mm and at hard palate 3.034 mm. Our findings were different from the findings reported in the literature. This may be due to the differences in ethnicity or limited size of sample. Within the limits of this study, we conclude that the form of the NPC is variable; predominantly funnel shaped with a single or two openings and with an average diameter of 3.7 mm in Sri Lankan population. Identification of variations in the position and shape will help in clinical practice specially in introducing local anesthetic block injections during dental treatment.

Background: The aim of this study is to demonstrate the effectiveness of the Endoscopic Medial Maxillectomy technique with the preservation of the nasal anatomy and function of the inferior turbinate. Methods: From January 2005 to December 2016, the authors performed 27 Endoscopic Medial Maxillectomy with preservation of inferior turbinate on 26 patients. The most frequent pathologies diagnosed were inverted papillomas (13/27) and antrochoanal polyps (7/27). There were 21 primary lesions and 6 patients had been previously treated. There were 19 males and 7 females. On 11 patients the authors could perform an acoustic rhinometry at 4 months postoperatively. Results: The authors did not find any recurrences. In all cases the authors note the presence of the C-notch being the narrowest area of the nasal cavity, on both the surgical and nonsurgical nasal fossa. The mean area for the C-notch in the nonsurgical nasal cavities was 0.50 cm(2) (0.18-0.82) and it was 0.57 cm(2) (0.08-1.06) in the surgical nasal cavities. The increase of the C-notch after nasal decongestion was 0.10 cm(2) in nonsurgical cavities and it was 0.03 cm(2) in the surgical cavities. The mean distance for the C-notch was 2.18 cm and 2.36 cm before and after nasal decongestion in the nonsurgical fossae. In the surgical cavities were 2.31 and 2.37 cm respectively. Conclusions: The authors' rhinometrics data suggest that Endoscopic Medial Maxillectomy with preservation of inferior turbinate is an effective technique that preserves the anatomic structure and the functions of the inferior turbinate after its resection and reposition.

Fracture of an endodontic instrument within the root canal system can occur due to incorrect use of instruments, and clinicians are confronted with a few removal options when considering this situation. The purpose of this article is to present the removal of a fractured endodontic file from the periapical region of the right upper central incisor, that caused a nasal floor perforation and otorhinolaryngological symptoms, with the aid of a dental operating microscope (DOM) and cone bean computed tomography (CBCT). Success was achieved when the fragment was visible and removed from the nasal fossa. The standardized techniques of removal or bypassing fracture file were not effective, and success was obtained with the aid of CBCT that made possible the visualization of the broken file inside the nasal fossa. A fratura de um instrumento endodôntico dentro do sistema de canais radiculares pode ocorrer devido ao uso incorreto dos instrumentos. O clínico se depara com algumas opções de remoção ao considerar essa situação. O objetivo deste artigo é apresentar a retirada de uma lima endodôntica fraturada da região periapical do incisivo central superior direito, acarretando em uma perfuração da fossa nasal associado a sintomas otorrinolaringológicos, com o auxílio de microscópio cirúrgico odontológico e tomografia computadorizada de feixe cônico (TCFC). O sucesso foi alcançado quando o fragmento foi visível e empurrado para fora da fossa nasal. As técnicas padronizadas utilizadas neste caso para a retirada ou transpassando a lima fraturada não foram eficazes, e o sucesso foi obtido com o auxílio da TCFC e o fragmento foi visível no interior da fossa nasal.

Inverted papilloma (IP), as the name suggests, is coined from the histological appearance of the epithelium inverting into the stroma. It is usually unilateral, with a male preponderance. Although it is more common in the sixth and seventh decades of life, isolated cases have been reported in the paediatric age group. Majority of the papillomas originate from the mucosal lining of the sino-nasal tract, occurring commonly in the ethmoids, lateral wall of the nasal fossa and the maxillary sinus. IP may arise primarily from the nasolacrimal duct (NLD) and the lacrimal sac, as they have similar mucosal lining. NLD and the lacrimal sac may be affected secondarily due to extension from the adjacent nasal mucosa or sinuses. Early detection gives the best chance of cure. High index of suspicion can lead to diagnosis during an unsuspected DCR, when the lacrimal sac epithelium is abnormal. An endoscopic resection, in collaboration with an otolaryngologist, may be the best approach on such cases.

The characteristics of extra-nasopharyngeal angiofibromas tend to be different from angiofibromas of the nasopharynx according to patient gender, patient age, prevalence, affected site, pathogenesis, and clinical and epidemiological features. We report a case of an extra-nasopharyngeal angiofibroma in a 28-year-old man referred to the ENT Clinic for right-sided epistaxis, airflow impairment and nasal swelling. The right nostril was completely occluded works by a reddish-yellow mass that bled easily. The computed tomography scan revealed an “inhomogeneous solid lesion in the nasal fossa”. With the patient under general anesthesia, the formation in the anterior portion of the right side of the nasal septum was removed up to its vascular base. Although electrical cauterization efficiently controlled the bleeding, we abraded the sub-perichondral area to prevent further bleeding as well as recurrence. The histological exam report confirmed the diagnosis of angiofibroma. As in our case, epistaxis is commonly the presenting sign of angiofibroma. Yet its onset was peculiar, given that the bleeding started with a low impact trauma. The nasal swelling was also a relevant feature as well as the breathing impairment. Although uncommon, nasal septal angiofibromas should considered in patients with epistaxis.

Background There is a lack of evidence regarding success of implants placed in atrophic premaxilla using the nasal floor elevation technique. Purpose This study aimed to compare implants placed in augmented bone in the anterior maxilla using the nasal floor elevation technique with implants placed in the maxillary sinus region using the sinus lift technique. Materials and Methods A within-patient controlled clinical trial was performed on 14 patients receiving 78 implants. The implants were assigned to one of two study groups on the basis of implant location. A total of 37 implants were placed in the nasal fossa region (NF group), and 41 implants were placed in the maxillary sinus region (MS group). Patients were followed up for 4.5 ± 2.2 years, with comparable follow-up times for implants in NF and MS groups (4.7 ± 2.1 and 4.9 ± 2.1 years, respectively; p > .05). Treatment outcomes were assessed and statistically analyzed. Results Implant success rate was 89.2% in the NF group and 95.0% in the MS group, with no statistically significant difference between them (p > .05). No nasal or sinus membrane perforation or other complications were reported within the follow-up period. Significant differences were found between the two groups in terms of residual bone height, augmented bone height, and implant diameter. Conclusions Nasal floor elevation is an effective and safe procedure that can be used for implant placement in atrophic premaxilla with success rates that are comparable to those of implants placed in the maxillary sinus.

Background Active surveillance systems are effective in reducing health care-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Nonetheless, some patients develop MRSA infection despite control measures. We tried to identify risk factors related to the appearance of MRSA at sites other than the nasal fossa in patients who were nasal carriers of MRSA. Methods A retrospective case-control study was conducted in an active surveillance program for MRSA between January 2009 and December 2010 at a Spanish teaching hospital. Cases were patients with MRSA in the anterior nares and a length of stay of at least 5 days who developed MRSA-positive clinical culture after decolonization treatment had started. Controls were patients with the same characteristics as the case group, except that they did not develop MRSA-positive clinical culture as verified by negative clinical cultures. Results After intrinsic and extrinsic risk factors were analyzed, the emergence of mupirocin-resistant MRSA clones after decolonization treatment, and residence in a nursing home were marginally significant in the univariate analysis. The detection of the emergence of mupirocin-resistant MRSA clones was independently associated with the detection of MRSA in other clinical locations. Conclusions In an active surveillance program for MRSA it is important to determine the mupirocin susceptibility of the isolates to determine appropriate treatment and to verify negativity after decolonizing treatment has been completed.

Introduction Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. Observation We report a case of intracranial and intraorbitar EHE. A 3-year-old girl presented with a 3-month history of progressive left exophthalmia. Neuroradiologic imaging (CT scan and MRI) showed an intraorbitar process with an intense enhancement extending to temporal fossa, ethmoidal bone, nasal fossa, maxillary sinus and cavernous sinus. The angiogram was normal. The tumor was operated through subfrontal approach but only a partial resection was performed. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact 2 months after surgery without exophtalmia. However 4 months after surgery, he displayed a fall of the right eye vision with intense headache. Control CT scan showed persistence of important tumoral residue. Discussion–conclusion Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close follow-up. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported.

Rhinolith is a stone that form in the nose. It is an uncommon disease that may present asymptomatically. It is usually occur secondary to retained foreign bodies. Sometimes, it can be cause by fungal infection. It can be seen on radiographs as a radiopaque object in the nasal fossa and may be confused with several pathologic entities that will call for more invasive surgical procedures. Here we present a case of giant rhinolith possibly arising from retained foreign body, and discuss its clinical and radiologic features.

AIM: To suggest a new classification system for sinonasal papilloma based on a critical analysis of surgical indications and results obtained. METHODS: We analysed surgical data from 84 cases of sinonasal papilloma treated endoscopically. RESULTS: In 58 males and 26 females, between 25 and 85 years, the ethmoid sinus (63 cases), the maxillary sinus (43), and the nasal fossa (22) were mostly involved. No case of endocranial extension or carcinoma was reported. Complications were reported in 15.4% of patients, as well as 5 recurrences (5.9%). Median follow up was 39,5 months. To categorise the tumour for the most appropriate surgical treatment, we propose a classification based on 6 main categories that depend on the location, origin and extension of the tumour. CONCLUSION: The classification that we propose presents advantages for prognosis and surgical indication in comparison with other classifications.

Objective: The irrigation of the upper third of the nasal fossa is supplied by the anterior ethmoidal artery. We describe a surgical technique to deal with epistaxis due to anterior ethmoidal artery bleeding. Patients and Methods: From January 2006 to March 2010 transcaruncular coagulation of the anterior ethmoidal artery was done on nine patients with epistaxis of the upper third of the nasal fossa. Results: The procedure was successful on all cases. No bleeding relapse, major complications, or nasal or orbital sequelae were present in any of the patients. Discussion/Conclusions: Transcaruncular electrocoagulation of the anterior ethmoidal artery is a safe and effective technique to deal with upper third nasal fossa bleeding. Laryngoscope, 2011

Extranodal NK/T-cell lymphoma, nasal type (ENKL) is a rare lymphoid neoplasm, which in the past has been grouped with a variety of granulomatous diseases. It is an aggressive non-Hodgkin's type characterized clinically by aggressive, nonrelenting destruction of the midline structures of the palate and nasal fossa. Despite the malignant clinical course, histological diagnosis can be difficult because of extensive tissue necrosis and multiple biopsies that are often required and has an ominous prognosis, as the average survival rate is between 6 and 25 months as reported with a large number of Asian studies. Several American and European studies have shown similar results. This is the case report of a 60-year-old male patient who presented with nasal obstruction and foul smelling, ulcerative lesion over the palate of 6 months duration, which had been treated with antibiotics and anti-inflammatories without success. After performing a number of diagnostic tests, it was found histologically and confirmed by immunohistochemical analysis that the patient had an ENKL, nasal type (also known as angiocentric T-cell lymphoma).

The nasal septoplasty is a very current intervention in otorhinolaryngology surgery. The infectious complications of this intervention are rare and mostly mild. We report here the case of a patient hospitalized in ambulatory surgery within a fracture of the nose with luxation of the septum in the nasal fossa. This patient was operated for a reduction of this fracture with septoplasty. Twelve hours after the intervention the patient presented septic arthritis due to Streptococcus pyogenes. The tracks of prevention are presented.

Objective:To determine the effect of embolisation on endoscopic resection of angiofibroma.Subjects and method:A partially blinded trial was undertaken. Twenty-three patients with angiofibroma (nine embolised and 14 not embolised) underwent endoscopic resection between January 2007 and August 2008 in two tertiary referral centres. Demographic data were collected, the pre-operative tumour extent was assessed by computed tomography, and tumours were staged according to their computed tomography appearance (Radkowski scale). In addition, we evaluated the duration of surgery, amount of haemorrhage, blood pressure during surgery, duration of hospitalisation, complications of surgery and embolisation, cost of treatment, and number of post-operative recurrences, as well as the angiographic characteristics in the embolisation group.Results:There was no significant difference between the general characteristics of both groups. At the end of the study period, we could find no significant difference between the two groups regarding haemorrhage, number of recurrences or complications. The only significant difference was cost of treatment, which was significantly higher in the embolisation group.Conclusion:Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolisation in every case of endoscopic angiofibroma resection.

Resume De tres nombreuses maladies infectieuses peuvent se developper au niveau de la sphere naso-sinusienne, incluant des infections bacteriennes, virales, mycotiques et parasitaires. Ces infections sont responsables de lesions inflammatoires aigues et/ou chroniques. Elles peuvent survenir chez le sujet immunocompetent ou immunodeprime. Les consequences sont tres variables, mais certaines d’entre elles necessitent un diagnostic histologique tres rapide pour une prise en charge therapeutique adaptee. Cette mise au point decrit les images histologiques des principales maladies infectieuses que les pathologistes peuvent etre amenes a analyser a partir de biopsies naso-sinusiennes.

Resume Objectifs Dans le but d’ameliorer la lutte contre le Staphylococcus aureus resistant a la meticilline (SARM) en dermatologie, nous avons mene une etude afin de : 1) preciser la prevalence du portage nasal du SARM dans la population hospitalisee ; 2) evaluer l’acquisition de ce portage lors de l’hospitalisation ; 3) identifier le profil type des patients porteurs ; 4) etudier la morbimortalite associee. Malades et methodes Nous avons realise une etude prospective sur trois mois incluant l’ensemble des patients hospitalises plus de 24 heures en dermatologie. Un prelevement nasal etait realise a l’entree, une fois par semaine et a la sortie d’hospitalisation. Les donnees clinico-epidemiologiques etaient recueillies grâce a un questionnaire type. Resultats Chez 310 patients hospitalises au moins une fois pendant la periode d’etude, la prevalence du portage nasal de SARM a l’admission etait de 6,5 %. Une acquisition pendant l’hospitalisation etait observee chez 1,9 % des malades. Les porteurs de SARM etaient, par rapport aux non porteurs, significativement plus âges, avaient ete plus souvent hospitalises dans les 12 mois precedents, en particulier en reanimation, en soins de suite ou en long sejour et etaient plus frequemment porteurs d’une dermatose erosive ou ulceree. Trois cas d’infection a SARM ont ete observes, d’evolution favorable sous antibiotherapie. Discussion Le taux de portage de SARM est proche de celui observe dans les services de reanimation (7 %). Prelever systematiquement a l’entree les patients atteints d’une dermatose erosive ou ulceree permettrait de depister 50 % de porteurs en plus, mais avec une rentabilite faible et un surcout important. Ainsi, il ne nous a pas paru souhaitable de modifier notre politique de depistage du SARM en hospitalisation de dermatologie : ecouvillonnage nasal a l’admission de chaque patient ayant ete hospitalise en reanimation, en soins de suite ou en long sejour dans les 12 derniers mois ou pour lequel un SARM a ete anterieurement isole.

Resume Introduction Les lymphomes T des fosses nasales et des sinus sont rares posant souvent un probleme de diagnostic differentiel avec les autres processus destructeurs et necrosants du tractus nasosinusien. Materiel et methodes C’est une etude retrospective de 11 observations de lymphomes T des fosses nasales et des sinus, colliges au service d’ORL de l’hopital F. Hached a Sousse en Tunisie, cela sur une periode de dix ans (1995–2004). Resultats Les patients etaient âges en moyenne de 41 ans. Le siege de predilection etait les fosses nasales. La symptomatologie etait non specifique. L’etude anatomopathologique a conclu a un lymphome T/NK chez deux patients et a un lymphome T peripherique sans autre indication (SAI) chez neuf patients. La recherche du virus d’Epstein Barr dans les cellules tumorales, utilisant l’immunohistochimie et l’hybridation in situ, effectuee chez sept malades, etait revenue positive. Le bilan d’extension, effectue chez dix patients, trouvait des metastases a distance dans trois cas. Le traitement, instaure chez neuf malades, consistait-en : une radiotherapie exclusive (un malade), une association radiochimiotherapie (trois malades) et une polychimiotherapie seule (cinq malades). Deux patients n’ont pas pu beneficier de traitement en raison d’une evolution rapidement defavorable. Apres un suivi moyen de 11 mois, l’evolution etait marquee par : la survenue du deces chez sept patients ; une remission chez trois patients. Un patient a ete perdu de vue. Conclusion Les lymphomes T des fosses nasales et des sinus sont rares en Tunisie. Le diagnostic repose essentiellement sur la clinique, les caracteristiques immunophenotypiques et moleculaires. L’aspect morphologique a l’examen histopathologique est peu specifique. Ces lymphomes sont agressifs et necessitent une prise en charge multidisciplinaire.

Resume Objectifs Le carcinome epithelial–myoepithelial est une tumeur rare representant moins de 1 % des tumeurs des glandes salivaires. Il se localise principalement au niveau de la glande parotide. La localisation extra-orale est exceptionnelle. Le but est de decrire une localisation nasale qui est exceptionnellement rapportee dans la litterature. Materiel et methodes Nous presentons l'observation anatomoclinique d'une femme de 54 ans presentant un carcinome epithelial–myoepithelial de la cavite nasale. Resultats La patiente a consulte pour des epistaxis recidivantes droites. La rhinoscopie anterieure a objective une formation polypoide occupant la cavite nasale droite. La tomodensitometrie du massif facial a conclu a une formation tissulaire sans extension au niveau du rhinopharynx ni lyse osseuse associee. L'etude anatomopathologique de la formation tumorale a conclu a une proliferation carcinomateuse agencee en massifs et structures tubuleuses et trabeculaires bordees par une double couche cellulaire. Les cellules occupant le centre des massifs et la couche tubuleuse interne etaient eosinophiles. Celles occupant la peripherie des massifs et la couche tubuleuse externe etaient claires. L'etude immunohistochimique a demontre la nature epitheliale des cellules eosinophiles et celle myoepitheliale des cellules claires. Conclusion La localisation nasale d'un carcinome epithelial–myoepithelial est possible bien qu'exceptionnelle. Dans les rares cas publies, aucune recidive ni metastase n'a ete rapportee dans cette localisation.

Summary Experimental models for clinical studies of rhinosinusitis are needed. Aim: to define a reliable, solid and reproducible experimental model for inflammatory rhinosinusitis with no innoculation of infectious agents in rabbits. Study design: Experimental. Material and Method: Twenty 20 rabbits were divided into 4 groups submitted to 4 different interventions: the placement of a unilateral nasal fossa sponge, unilateral obliteration of the nasal ostium with cyanoacrylate, unilateral placement of antigens in the maxillary cavity and unilateral placement of blood in the maxillary cavity. The animals were monitored for 15 days and then anesthetized and sacrificed; the maxillary sinuses were evaluated histologicaly and results were compared with controls and between the intervention groups. Conclusion: Sponje and glue as agents of meatal obstruction and toxoid aplied in the antrum are efficient as methods for rhinosinusitis modeling. Blood was not efficient in producing sinusitis.

Objective: The aim of the study was to establish the dynamics of changes in the intranasal spaces of children and adults by gender and age. Materials and methods: Each side of the nasal cavity was evaluated separately in 366 healthy subjects 9 to 74 years old. The following acoustic rhinometry parameters were analyzed: 1) I-C, distance between the isthmus nasi (I) and the head of the inferior turbinate (C); 2) CA-I, cross-sectional area at the isthmus nasi; 3) CA-C, at the head of the inferior turbinate; and 4) CA-F, the highest point on the rhinometric curve between points I and C. Results: Before age 11 years, the intranasal spaces were slightly larger in girls than in boys. After age 11 years the nasal parameters were larger in boys than in girls. The growth rates before age 17 years were as follows: I-C: 0.073 cm/yr, 0.135 cm/yr, CA-F: 0.055 cm2/yr, 0.133 cm2/yr (P < .00001), and CA-C: 0.010 cm2/yr, 0.034 cm2/yr (P < .02) in girls and boys, respectively. In subjects older than 16 years, the mean values of I-C were 1.707 cm, 1.934 cm (P < .0001), and of CA-C, 0.493 cm2, 0.611 cm2 (P < .0001) in women and men, respectively, and changed slightly over the year. Conclusions: The parameters of intranasal spaces depend on age and gender. The dynamics of the changes is greater in boys than in girls and usually the growth is completed by the age of 16. After this age, nasal cavities are bigger in men than in women.

Objectifs Le papillome inverse nasosinusien est une tumeur benigne rare des fosses nasales et des sinus pour laquelle le traitement chirurgical par voie endonasale endoscopique a deja montre son efficacite dans la litterature. Toutefois, les auteurs ont pour objectifs dans ce travail d’evaluer les avantages de cette voie d’abord et ses limites, d’analyser les echecs et les recidives et de preciser les indications de l’association de cette voie d’abord a une voie externe ou dissimulee. Methodes Quarante-deux patients operes d’un papillome inverse nasosinusien, sur une periode de dix ans, ont ete inclus dans cette etude retrospective. Le choix de la technique operatoire a ete decide en fonction des donnees de l’examen endonasal et de l’imagerie (TDM et IRM). La surveillance a ete superieure a un an pour tous les patients. Resultats Vingt-huit patients ont ete operes par voie endonasale endoscopique exclusive. Quatorze patients ont ete operes par voie combinee associant soit une voie vestibulaire (9 cas), soit une voie paralateronasale (3 cas), soit une voie fronto-sourcilliere (2 cas), a la voie endonasale endoscopique. Dans deux cas, l’association a un carcinome epidermoide a ete notee. Notre taux de recidive est de 9,5 % pour l’ensemble de la serie et de 14,2 % pour les patients operes par voie endonasale exclusive. Conclusion La chirurgie endoscopique endonasale est une voie d’abord validee pour le traitement des papillomes inverses nasosinusiens, dans la mesure ou l’exerese peut etre complete. Cette voie d’abord est particulierement destinee aux papillomes medians sans extension frontale ou maxillaire. Dans tous les autres cas, l’association a une voie externe ou dissimulee est souvent necessaire.

A rhinolith is a stone that forms in the nose. It occurs as a result of the solidification of mucus and nasal debris by mineral salts, calcium, magnesium phosphate and carbonate. It can be seen on radiographs as a radiopaque object in the nasal fossa and may be confused with several pathologic entities that will call for more invasive surgical procedures. We present the first case of a giant rhinolith, possibly arising from aspergillosis, and discuss its clinical and radiologic features.

The purpose of the study was to measure nasal passageway dimensions in guinea pigs and rats by use of acoustic rhinometry (AR) and by a previously described fluid-displacement method (FDM) (Straszek SP, Taagehoej F, Graff S, and Pedersen OF. J Appl Physiol 95: 635–642, 2003) to investigate the potential of AR in pharmacological research with these animals. We measured the area-distance relationships by AR of nasal cavities postmortem in five guinea pigs (Duncan Hartley, 400 g) and five rats (Wistar, 250 g) by using custom-made equipment scaled for the purpose. Nosepieces were made from plastic pipette tips and either inserted into or glued onto the nostrils. We used liquid perfluorocarbon in the fluid-displacement study, and it was carried out subsequent to the acoustic measurements. We found for guinea pigs that AR measured a mean volume of 98 mm3 (95–100 mm3) (mean and 95% confidence interval) of the first 2 cm of the cavity. FDM measured a mean volume of 146 mm3 (117–175 mm3), meaning that AR only measured 70% (50–90) of the volume by FDM. For rats, the volume from 0 to 2 cm was 58 mm3 (55–61 mm3) by AR and 73 mm3 (60–87 mm3) by FDM, resulting in AR only measuring 83% (66–100%) of volume by FDM (see Table 2 ). We conclude that absolute nasal cavity dimensions are underestimated by AR in guinea pigs and rats. This does not preclude that relative changes may be correctly measured. In vivo trials with AR using rats have not yet been published. The FDM is possibly the most accurate alternative to AR for measurements of the nasal cavity geometry in small laboratory animals, but it can only be used postmortem.

Resume Nasofibroscopes et optiques rigides se sont banalises. Ils ont revolutionne l'abord clinique de la pathologie nasale. Parallelement, l'evolution des imperatifs medico-legaux et de securite impose des contraintes de desinfection et sterilisation indissociables de leur utilisation quotidienne. La radiographie standard (« face haute » et « Blondeau ») garde l'avantage de la rapidite et de la simplicite dans l'exploration des cavites sinusiennes. La numerisation y ajoute une meilleure qualite et une plus faible irradiation. Cependant, la tomodensitometrie (TDM) detient ici la place de choix : deux plans de coupes sont necessaires : frontal et transversal. Le contraste iode est reserve a l'etude des tumeurs ou des complications de la pathologie inflammatoire. La dose d'irradiation et le risque de cataracte restent faibles. L'endoscopie virtuelle est un developpement dont l'interet pratique reste a evaluer. Seul le bilan de lesions tumorales justifie le complement d'imagerie qu'apporte l'imagerie par resonance magnetique (IRM). La rhinometrie acoustique mesure de facon fiable et non invasive les dimensions des cinq premiers centimetres des fosses nasales (avant et apres vasoconstricteurs). La mesure du debit nasal inspiratoire de pointe (DNIP) est particulierement simple et economique. Elle reste encore sous-utilisee en comparaison avec ses indications potentielles. La rhinomanometrie, plus souvent anterieure que posterieure, a du mal a confirmer sa place reelle en rhinologie clinique quotidienne. L'etude de la fonction mucociliaire repose sur une mesure de clairance plus ou moins sophistiquee (saccharine, colorant, isotopes). L'etude du battement ciliaire in vitro est un examen reserve pour l'instant a la recherche d'un syndrome de dyskinesie ciliaire. Cette meme etude in vivo reste actuellement au stade experimental. L'etude ultrastructurelle (microscopie electronique) est indispensable au diagnostic de dyskinesie ciliaire primitive. La cytologie nasale selon qu'elle est realisee sur un mouchage, un lavage, une aspiration, une empreinte, un frottis, un brossage ou un grattage concerne des sous-compartiments cellulaires differents. Les resultats en termes de compte cellulaire total ou de comptage differentiel sont differents. En pratique clinique, pour l'instant, seule l'eosinophilie secretoire (plus de 10 a 20 % selon les auteurs) a une reelle incidence diagnostique en l'absence d'allergie. D'un point de vue bacteriologique, le prelevement des fosses nasales permet d'identifier une flore commensale assez riche. La ponction de la cavite maxillaire, sinon le prelevement au meat moyen (fiabilite de 70 a 80 %) montre la flore en cause dans les sinusites, avec plus de polymicrobisme et d'anaerobie dans les sinusites chroniques. La presence de champignons dans le mucus nasal, parfois importante, ne permet pas actuellement de leur attribuer ou non un role pathogene. La mesure de la concentration de monoxyde d'azote nasale (NO nasal) fait l'objet de nombreux travaux de recherche. Aucune utilisation clinique n'est actuellement demontree. Les tests de provocation nasale (TPN) utilisent des methodes d'evaluation variees : clinique, rhinomanometrie, rhinometrie acoustique, voire cytologie. Ces tests realises avec des pneumallergenes souffrent actuellement d'un manque de standardisation. Les TPN pharmacologiques ou physicochimiques restent du domaine de la recherche. Enfin, pour un meilleur rendement de l'analyse anatomopathologique, il convient, des le conditionnement du prelevement d'envisager les techniques d'analyse necessaires (analyse standard, immunomarquage, biologie moleculaire).

Tumors of the nasal cavity are located at a complex anatomic site and show a huge histological diversity. Although dealing with a rare malignancy, the last decade has brought – besides new histological and clinical classifications – a variety of new insights into etiological agents, tumor biology and therapeutic concepts as well as valuable overviews of rare histological subtypes. This review tries to disentangle the different medical and scientific aspects of the most frequently encountered histological types of tumors in the nasal cavity and the paranasal sinuses. We concentrate on epidemiology, classification, etiology, cytogenetics and molecular genetics, outcome and prognosis as well as treatment modalities, as far as the past few years have brought considerable new insights. Our principal aim is to provide the clinician with important data from publications of the last decade.

Rhinoplasty is performed to improve the appearance of the nose. However, conventional procedures may result in impairment of nasal breathing. The purpose of this article is to describe a "functional and esthetic" rhinoplasty technique designed to avoid adverse effects on ventilation by preserving the structure of the nasal vault. The main indication for this technique is treatment of cyphotic or tension nose. Since this procedure does not correct nasal obstruction due to septo-turbinal abnormalities and narrow nasal fossa, turbinoplasty must be performed concurrently if necessary. Our series of >1000 cases over a 15-year period demonstrates that this conservative rhinoplasty technique prevents most functional complications associated with conventional procedures and often improves ventilation. Immediate and long-term cosmetic outcome is excellent with a natural-looking appearance and fewer tip revisions.

Objective: This study was performed for knowledge about the vascular supply of the nasal fossa and a description of the site of division and number of branches of the sphenopalatine artery. Study Design: This study was performed on 10 fresh nonembalmed cadavers. Anatomic variations of nasal fossa arteries were studied. Methods: First, 10 cephalic anatomic preparations were injected with red color latex into the right and left carotid arteries. Then, these specimens were sagittally cut to dissect the sphenopalatine artery. Twenty vascularization cases were studied for the external branch of the sphenopalatine artery, and 10 cases were studied for the internal branch. Results: The principal observations were: 1, the sphenopalatine artery division is 18 times in the infratemporal fossa and twice in the nasal fossa; 2, the nasopalatine artery supplies blood to the lower part of the septum and its anterosuperior area; and 3, the vascularization of the external wall is via the sphenopalatine artery through the arteries of the meatus and conchae. Conclusion: This study defines the vascular territories of the nasal fossa arteries and includes photographs of dissections. (Otolaryngol Head Neck Surg 2003;128:236-9.)

Severe epistaxis management remains a challenge to otolaryngologists. Despite the large choice of treatment strategies to control epistaxis, the method of regional haemostasis via edoscopic arterial ligation has become frequently used. Arterial supply occlusion is usually performed by electrocautery or application of titanium clips. After placement of titanium clips, they will remain in place forever and could surprisingly be rediscovered later on CT-scan. Most of otolaryngologists are familiar with this method and are able to identify these clips, however, it could be more difficult for radiologists and other practitioners. In order to draw the attention of other specialists to the existence of this method and to help them correctly interpret such CT-scans, the authors present an example of a case that troubled radiologists. In addition, the authors also discussed the vascular supply of the nasal fossa and methods of severe epistaxis management.

Solitary plasmocytoma is a rare tumour that belongs to the myeloid dysplasia group. The authors present an unusual evolution of this pathology through a clinical case. A 42-year-old patient was diagnosed with solitary nasosinusal plasmocytoma following biopsy of the right nasal fossa process; several weeks after this the tumour spontaneously regressed. Extramedullar plasmocytoma is a myeloid dysplasia that seldom evolves into multiple myeloma. Spontaneous regression has been described for some malignancies, implying immunological factors, but not previously for extramedullary plasmocytoma.