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IntroductionThe physical modification of cartilage grafts during rhinoplasty risks chondrocyte death at the margins where the tissue is cut. This study compares chondrocyte viability between diced, scaled, and pate samples in human models, and further computes percent chondrocyte viability as a function of sequential dicing size in a computational model.MethodsSeptal cartilage from 11 individuals was prepared as follows: diced (1 mm cubic), scaled (shaved to  0.05). Conversely, pate samples had significantly less viability compared to positive controls, diced samples, and scaled samples (all p

ABSTRACT Objective Methods Results Conclusion It is often recommended that, in children with bilateral epistaxis, only one side of the nasal septum should be cauterised at a time in order to reduce the risk of septal perforation. This advice may have been reasonable when hot wire electrocautery was in common use. The risk of septal perforation after silver nitrate cautery is unknown but probably low.Retrospective case note review of children attending the nurse‐led epistaxis clinic between 2019 and 2022.Nine hundred and twenty children were seen in the nurse‐led clinic between January 2019 and December 2022. Six hundred and one children (79%) underwent nasal cautery. Simultaneous bilateral nasal cautery was carried out in 176 (29%) children. Our follow up period ranged between 303 and 1744 days, with a median of 809.5 days. No child presented to emergency or ENT services with septal perforation or any other complication of simultaneous bilateral nasal cautery.To the author's knowledge, this is the largest study assessing the safety of simultaneous bilateral nasal cautery with silver nitrate in children. No adverse results have been found after cauterising both sides of the septum at the same sitting, and doing so potentially saves time and money for patients and the health service. [ABSTRACT FROM AUTHOR]

The purpose of this study is to underline the importance of Concha Bullosa (CB), a pathological condition frequently missed in the analysis of human remains in archeological studies. We studied three cases from the Ancient Egyptian necropolis of Dra Abu-el Naga, located on Luxor's (Ancient Thebes) West Bank of the Nile. The sample object of this study belongs to different chronologies, but all were over 2,000 years old. The analysis included both macroscopic and radiological examinations of three skulls, all of adult males, showing different degrees of involvement of the middle turbinate. One presented with extensive bilateral CB without deviation of the nasal septum. The others showed unilaterally without affecting and deviating the nasal septum. The maxillary sinuses were not affected. The embalming technique varied throughout Ancient Egyptian history, with brain extraction first practiced among elites and then spreading across all social classes. This removal of the brain, if carried out through the nose, involved the destruction of the nasal bones. That may be the reason for the paucity of the described cases in the high number of individuals examined, added to the lack of familiarity of the investigators with this entity. These three new cases add to the body of existing evidence on CB and stresses the importance of not missing its identification during paleopathological studies. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Diagnosis of empty nose syndrome (ENS) relies on the ENS six‐item questionnaire (ENS6Q) with a score of ≥11, followed by a “positive” cotton test yielding seven‐point reduction from baseline ENS6Q score via cotton placement to the inferior meatus (IM). Given the intricacies of diagnosing ENS and the propensity for false positives with the standard cotton test, we modified the classic single‐step cotton test into a four‐part Stepwise Empty Nose Syndrome Evaluation (SENSE) cotton test to reduce bias and evaluate the placebo effect.Individuals diagnosed with ENS underwent the SENSE test, a single‐blinded, four‐step, office‐based cotton test, without topical anesthesia or decongestants. Conditions included: (1) placebo/no cotton placed; (2) complete cotton‐blockade of nasal vestibule; (3) cotton placed medially against the nasal septum; and (4) cotton placed laterally in the IM (site of inferior turbinate tissue loss). With each condition, patients completed an ENS6Q.Forty‐eight ENS patients were included. Twenty‐nine percent demonstrated a placebo effect (p < 0.001), 40.4% had a positive response to complete cotton‐blockade (p < 0.001), 64.4% to septum‐placed cotton, and 79.1% to IM‐placed cotton (p < 0.001), corresponding to a mean ENS6Q reduction of 11.9 points (p < 0.001). Notably, the mean difference in ENS6Q scores between septum and IM placement was 1.7 (p < 0.001).The SENSE test offers further insight into subtleties of nasal breathing experienced by ENS patients. The placebo effect can be prominent and important to consider with individual patients. While most ENS patients prefer any intranasal cotton placement over baseline, blinded testing reveals these patients can accurately discriminate minimal changes in nasal aerodynamics. [ABSTRACT FROM AUTHOR]

Background: Some children with a deviated nasal septum show no symptoms, but up to 30% have breathing problems. Septal deviation is usually caused by microtrauma during delivery, but in severe cases, trauma is the main cause. Many people fail to recognize septal damage after trauma, &children with untreated septal abnormalities often have severe problems. Thus, we can see why symptoms increase with age. Objective: Through the available literature, this review seeks to establish the effect of nasal septoplasty among pediatric patients on nasal breathing and the need for revision surgery. Subjects and methods: Prospective and retrospective studies published in peer-reviewed journals including clinical trials, cohort studies, cases, and cross-sectional. Results: Five studies. 4, 5, 6, 8, 9 151 people assessed NOSE pre- and post-pediatric septoplasty. The pooled mean NOSE score difference between pre- and postoperative evaluations was -50.26 (95% CI, -62.55 to -37.97), showing a substantial decrease. In Saeed et al. (Ann Coll Med Mosul June 45(1):70-79, 2023), mean differences ranged from -71 points (95% CI, -75.41 to -66.59) to -30 points in Lee (2017). Surgicalft benefits were regularly shown. Each year of follow-up did not substantially lower NOSE score improvement by 0.39 (SE = 0.29; P = 0.17; I2 = 89.6%) in a meta-regression analysis in children, NOSE score improvement increased by 6.36 per year (SE = 1.14; P = < 0.001; I2 = 34.45%). In meta-regression research on revision rates following pediatric septoplasty, each year of follow-up raised the rate by 0.13 (SE 0.02; P < 0.001; I2 = 4.78%). However, revision rates were not significantly associated with each year of pediatric age (coefficient, -0.39; SE 0.22; P = 0.075; I2 = 86.25%). Conclusion: This comprehensive meta-analysis shows that septoplasty improves nasal airway function and obstruction in children. NOSE Scale disease-specific QOL improved significantly after pediatric septoplasty. According to the meta-regression analysis, each year of follow-up time resulted in a 0.39 drop in NOSE score improvement (SE = 0.29; P = 0.17; I2 = 89.6%). Each year of pediatric age increased NOSE score improvement by 6.36. [ABSTRACT FROM AUTHOR]

Septal perforation is an anatomical defect of the nasal septum that leads to impaired nasal function, including obstruction and respiratory issues. In this study, a novel surgical approach was introduced to address septal perforations, focusing on the use of costal composite chondro-perichondrial grafts bilaterally in a symmetric manner. This composite graft, composed of costal cartilage and perichondrium, provides mechanical support, aids vascularization, and minimizes perichondrial shrinkage. A case study of a 23-year-old patient with septal perforation resulting from multiple rhinoplasty procedures is presented. The surgical procedure involved the use of a composite graft to close the septal perforation and correct the nasal deformity. The postoperative results demonstrated successful septal perforation closure and relief from nasal discomfort. This study highlights the advantages of this method, particularly its simplicity and straightforward surgical procedures for closing septal perforations of various sizes, and its suitability for rhinoplasty surgeons who are familiar with costal cartilage harvesting. [ABSTRACT FROM AUTHOR]

Introduction: Chronic rhinosinusitis (CRS), with or without nasal polyps, is characterized by the inflammation of the nose and paranasal sinuses. To make the diagnosis of CRS, a patient must exhibit 2 or more of the following symptoms for at least 12 weeks time period: nasal obstruction, nasal blockage, or congestion, and/or nasal discharge (which could be anterior or posterior nasal drip), along with possible facial pain or pressure, and/or a reduction or loss of smell. This diagnosis must be supported by observable disease signs, which can be identified through an endoscopic examination showing nasal polyps, mucopurulent discharge, or edema/mucosal obstruction. Methods: A prospective study will be conducted on all the patients with clinical diagnosis and suspicious of CRS, referred from OPD / wards of ENT and HNS to the department of radiodiagnosis of Muzaffarnagar Medical college, for diagnosis and evaluation of patients. Diagnosis will be made based on clinical and radiological findings. A brief clinical history of the patient will be taken from the patient or by the attendant. Results: In this study involving 40 participants, nasal mass was observed in 42.5%, while nasal bleed occurred in 47.5% of participants. X-ray opacification of sinuses varied, with opacification in all sinuses seen in 22.5% of cases and various bilateral and unilateral patterns in others. Polypoidalmass was present in 12.5% of participants. Bony changes included erosion in5% and sclerosis in 22.5% of cases. Deviated nasal septum was observed, with left deviation noted in 10% and right deviation in 15% of participants. Conclusion: this study of 40 participants revealed a male predominance and a mean age of 39.8 years, with no significant age difference between genders. Common symptoms included nasal obstruction, nasal discharge, sneezing, headache, facial puffiness, and altered smell. Nasal mass and nasal bleed were frequent, while X-ray opacification of sinuses showed diverse patterns. Polypoidal masses were observed in a notable percentage of participants. [ABSTRACT FROM AUTHOR]

Background. Chronic Suppurative Otitis Media (CSOM) is the persistent inflammation of the mucosa in the middle ear cleft. Sinusitis, in particular, plays a significant role as a focal sepsis in the majority of cases. The current study aims to investigate the clinical profile and diagnostic techniques for these individuals, specifically focussing on sinusitis as the main source of infection. Methods. A clinical trial was done at the Department of Otorhinolaryngology, National Institute of Medical Science Research and Hospital, Jaipur, from June 15, 2022, to December 31, 2023, after obtaining clearance from the Board of Studies and Ethical Committee. The main aim was to assess the significance of previous diagnostic nasal endoscopy in these patients. Results. A total of 300 patients were selected. The most prevalent anatomical alteration seen in the study was a deviated nasal septum, which was found in 118 individuals, representing 39.3% of the entire sample (p=0.002). Seventy patients, accounting for 23.3%, were determined to have a disease that is confined to the ostiomeatal complex at Grade 1. The most predominant characteristic detected in 98 patients was the incomplete opacification of one or more sinuses at Grade 2. Conclusion. This study clarifies the complex factors involved in chronic otitis media active mucoses, highlighting the importance of thorough clinical, anatomic, and radiological evaluations in determining appropriate treatment approaches. The notable discoveries emphasise the necessity for continuous investigation and improvement of diagnostic and treatment procedures to optimise patient outcomes in this complex ailment. [ABSTRACT FROM AUTHOR]

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is an uncommon histiocytic disease with idiopathic etiology and unique pathology. Extra-nodal RDD that occurs in the nasal cavity is extremely unusual and the characteristic clinical features are unknown. Herein, we report a case of nasal septum RDD, with intermittent epistaxis from the left nasal cavity, which led to collapse of the nasal bridge. The patient underwent surgical biopsy, and a diagnosis of nasal septum RDD was established. No further treatment was performed. An enlarged mass was found in the second postoperative year which was treated by surgical excision in the third postoperative year. To improve the current diagnostic and therapeutic approach of extra-nodal RDD, we incorporate previous reports from the literature to discuss the pathological characteristics, pathogenesis, clinical manifestations, diagnosis, and therapy for this rare disease. [ABSTRACT FROM AUTHOR]

Objectives: Sphenomaxillary plate (SMP) is an inconstant bony septum separating the maxillary and sphenoid sinuses. Neglecting the SMP during endoscopic sinus surgery may lead to mistaking the sphenoid sinus for the posterior ethmoid cell with potentially dangerous consequences. However, its proper identification may allow planned sphenoidotomy through the posterior wall of the maxillary sinus or to enlarge transnasal or transethmoidal sphenoidotomy. The aim of this study was to evaluate (1) the incidence and morphology of the SMP and (2) possibility and safety of trans-SMP sphenoidotomy. Methods: In the radioanatomical part of the study multiplanar reconstruction analysis of 117 consecutive paranasal sinus CT scans was conducted. In the clinical part of the research, trans-SMP sphenoidotomy was performed in consecutive patients operated on for chronic rhinosinusitis. Results: The SMP was found in 25% of sides (34% of patients). It was constantly located superolateral to the posterior insertion of the middle turbinate. The SMP formed the prominence on the posterior wall of the maxillary sinus that could be identified using volume rendering in 11% of sides (19% of patients). 30 trans-SMP sphenoidotomies were performed in 18 patients. The SMP prominence was identified in 15 sides. In absence of SMP prominence, identification of the SMP was still possible using other anatomical landmarks. Conclusions: The SMP is present in over 30% Caucasian subjects at least on one side. Sphenoidotomy through the SMP is feasible and safe. [ABSTRACT FROM AUTHOR]

Endoscopic endonasal surgical resection is an effective therapeutic approach for olfactory neuroblastoma (ONB). Unilateral excision of ONBs with limited extension has been reported with the purpose of preserving olfactory function. We aimed to review implications of surgical management, olfactory preservation feasibility, and survival outcomes in patients who underwent endoscopic unilateral resection of ONB. A systematic literature review was conducted using the search terms [("Olfactory neuroblastoma") OR ("Esthesioneuroblastoma")] AND [("Unilateral resection") OR ("Olfaction preservation")]. Studies reporting cases of unilateral ONB endoscopic resection with postoperative olfaction assessment were included. Concurrently, records of patients who met inclusion criteria at our institution were reviewed retrospectively. The survival and olfactory outcomes were analyzed in both cohorts. Thirty-three patients were identified in the published literature. Twenty-three (69.7%) reported postoperative olfaction preservation. Olfactory function after surgery did not show an association with Kadish stage (P = 0.128). No evidence of disease was observed at the latest follow-up in this group of patients. Nine patients who met inclusion criteria were identified at our institution. The extent of resection influenced the level of olfaction preservation when cribriform plate and nasal septum resection coexisted (P = 0.05). A single patient at our institution developed recurrence after being lost to follow-up for 22 months. Olfaction preservation can be achieved in patients who undergo endoscopic unilateral resection and adjuvant radiotherapy. The extent of resection should aim for negative margins, particularly in the midline. Larger studies are required to assess the risk of contralateral microscopic disease, and, hence, close follow-up is advised. [ABSTRACT FROM AUTHOR]

Nasal septal abscess in a newborn is a rare condition. This case report describes a case of nontraumatic, nasal septal abscess in a newborn baby with no evidence of sinusitis or other localized trauma/ infections. A 15-day-old newborn was admitted to a tertiary care hospital with a history of nasal blockage and swelling of the nasal septum. Physical examination revealed a fusiform swelling involving the nasal septum. The patient underwent Diagnostic Nasal Endoscopy with Incision and Drainage followed by 48-hour nasal packing. Neonates being obligate nasal breathers, after drainage, due to the bilateral nasal packs, the otolaryngology and paediatric team had to find a way to make the neonate breathe and swallow simultaneously. The neonate showed gradual improvement following nasal pack removal and had a normal nasal airway on follow-up at 14 days and one-month post-drainage. Even though the septal abscess in neonates is a rare entity however, it can significantly compromise the nasal airway in an obligatory nasal breather, and with limited space for intervention also poses a challenge in managing the condition. [ABSTRACT FROM AUTHOR]

The nasal septum, composed of bone and cartilage, maintains nasal alignment and airflow. Deviation, common but potentially problematic, can lead to symptoms like congestion and sinusitis. Maxillary sinus, a key paranasal sinus, influences airflow and drainage. Nasal septum deviation can alter maxillary sinus volume, affecting airflow dynamics and drainage. Cone beam computed tomography (CBCT) and CT imaging are essential for assessing these conditions accurately, providing detailed 3D images and aiding in diagnosis and treatment planning. The study aims to review the radiographic association of maxillary sinus volume in patients with deviated nasal septum. The present review has been registered with PROSPERO—An international prospective register of systematic review CRD42023467988. Eligibility criteria: Studies from 2013 to 2022, in English, on maxillary sinus volume in deviated nasal septum patients. Exclusions: Animal studies, case reports, non-English articles. The Meta-analysis found that consistent association between nasal septum deviation and reduced maxillary sinus volume and no publication bias. The radiographic association of maxillary sinus volume in patients with deviated nasal septum was found to be statistically meaningful. [ABSTRACT FROM AUTHOR]

This study aims to investigate the prevalence of chronic rhino sinusitis in patients with concha bullosa, a common anatomical variation characterised by pneumatization of the middle turbinates. Chronic rhino sinusitis is an inflammatory disorder of the paranasal sinuses and the linings of the nasal passages that lasts for 12 weeks or longer. The incidence of chronic rhino sinusitis was assessed among patients with diagnosed concha bullosa, focusing on the presence of symptoms, and severity. There seems to be a strong relationship between concha bullosa and the development of chronic rhino sinusitis To screen the patients of concha bullosa for chronic rhino sinusitis. To find out of the percentage of chronic rhino sinusitis in patients with concha bullosa. To determine the sinuses affected and their respective sides. This is a retrospective study to investigate the incidence of chronic rhino sinusitis in patients diagnosed with concha bullosa. The study was conducted at Vydehi institute of medical science and research centre, Whitefield, Bangalore and the data from 01/02/23 to 01/09/23 were analyzed. Medical records of patients with diagnosed concha bullosa were identified through electronic medical records and imaging databases (CT scan paranasal sinuses). Inclusion criteria consisted of patients with a confirmed diagnosis of concha bullosa based on radiological imaging (CT scans) and clinical assessment.Exclusion criteria: patients with previous sinus surgeries and malignancy. The study's methods focused on retrospectively assessing the incidence of chronic rhino sinusitis in patients diagnosed with concha bullosa. In the above study it is concluded that concha bullosa plays major role in development of chronic rhino sinusitis. Thus after confirming the presence of concha bullosa practitioner should keep in mind the possibility of development of chronic rhino sinusitis. [ABSTRACT FROM AUTHOR]

Anaplastic lymphoma kinase (ALK)-rearranged mesenchymal neoplasms (non-inflammatory myofibroblastic tumor and non-epithelioid fibrous histiocytoma) have been recently described which tend to occur in the superficial and deep soft tissues. Occurrence as a primary sinonasal neoplasm has not been reported thus far. Herein, we describe the first case of sinonasal ALK-rearranged mesenchymal tumor that harbored remarkable epithelioid and spindle cell morphology. The tumor affected a 40-year-old man who presented with flu-like symptoms and was thought to have influenza A. However, computed tomography demonstrated a nasal polypoid lesion causing curvature of the nasal septum. Histological examination revealed a heterogeneous tumor composed of round to epithelioid cells with foci of spindle cells. The tumor cells exhibited moderate pleomorphism and mitotic activity. By immunohistochemistry, they showed diffuse staining of CD34, S100, ALK (D5F3) and CD30. Fluorescence in situ hybridization analysis demonstrated ALK rearrangement. Subsequent next-generation sequencing (RNA-seq) identified a rare PLEKHH2exon6::ALKexon20 fusion. This study further demonstrates the importance of molecular profiling in identifying kinase fusion-positive soft tissue tumors, particularly for those that arise at unusual sites and display atypical cytomorphology. [ABSTRACT FROM AUTHOR]

This experimental animal model study investigates the impact of different methods employed in preservation rhinoplasty (PR) on the strength of the nasal roof, focusing on three techniques: high strip, low strip, and intermediate strip. Using 15 lamb heads as surgical models, the study addresses key questions related to the strengths of each PR techniques, the influence of septal cartilage harvesting on septum strength, and the effectiveness of spreader grafts for stability. The research involves detailed dissection steps and measurements at various nasal points, evaluating the resistance at each stage. Results indicate that the low strip technique demonstrates the most significant reduction in strength. Furthermore, the combination of PR techniques with structural grafts, specifically spreader grafts, is assessed, revealing the classical rectangular spreader graft to be more effective in stabilizing the dorsum. Despite the limitation of using the lamb heads as models, this study offers valuable insights into the effects of PR on nasal septum strength and provides a foundation for further research on the biomechanics of preservation techniques. [ABSTRACT FROM AUTHOR]

Purpose: Nasal Septum Deviation (NSD), which is defined as a dislocated septum, is a prevalent condition that is mostly asymptomatic; however, it can cause difficulties such as nasal obstruction and rhinosinusitis symptoms. Other Paranasal Sinuses (PNS) disorders, e.g., Osteo Meatal Complex (OMC) obstruction, have been assumed to be correlated with NSD. This study investigates the possible correlation of specific radiological findings of PNS pathologies in patients with or without the existence and direction of NSD. We also discussed the different types of NSD and their incidence among different groups stored by age, gender, etc. Materials and Methods: This is a cross-sectional study conducted at multiple imaging centers in Iran between July 2019 and February 2020 to estimate the prevalence of deviated nasal septum and correlate between NSD and other findings using paranasal sinus scans. All the individuals who met the inclusion and exclusion criteria were included in the study. NSD types have been classified based on Mladina's method. Results: We prospectively reviewed PNS Computed Tomography (CT) scans obtained from 254 cases (82 men and 172 women), aged 18 to 81 years (mean: 35.53), evaluated over seven months. Out of 254 cases, 135 (53 %) patients had NSD, without any direction predominance (right-sided vs. left-sided), and equally distributed between genders. The most common NSD types were type V with a frequency of 42.22% and type III with a frequency of 24.44%. Other PNS CT findings were also investigated in our patients, like OMC obstruction, pansinusitis, mucocele, air-fluid level, mucosal thickening, and concha bullosa. There was no statistically significant correlation between any of these pathologies and NSD (P-value > 0.05). Conclusion: Although NSD was observed in more than half of our cases' PNS CTs, there was no significant correlation between NSD and other findings in most subjects. This reveals that the effectiveness of septal repair surgeries in relieving patients' symptoms might not be as high as expected. [ABSTRACT FROM AUTHOR]

Dr Deborah Auer discusses the ways in which traumatic expriences impact patient decision-making and motivations for elective surgery [ABSTRACT FROM AUTHOR]

Background: Certain gastrointestinal and extra-intestinal diseases are caused by the gram-negative bacterium Helicobacter pylori (H. pylori). We aimed to determine the potential H. pylori role in chronic rhinosinusitis (CRS) with or without nasal polyposis. This cross-sectional study was conducted on 80 subjects of any age and sex diagnosed with CRS (CRSWNP and CRSSNP) who had failed medical treatment and scheduled for surgery. Patients were further categorised into two equal groups: study group (n = 40) were diagnosed with CRS with or without nasal polyposis (CRSWNP and CRSSNP) who had failed medical treatment and scheduled for surgery, and control group (40 patients) were admitted for septoplasty. All patients had clinical assessment, physical assessment, diagnosis of rhinosinusitis (according to EPOS), based on symptoms, rhinoscopic/endoscopic findings, CT scan findings, questionnaire for gastroesophageal reflux disease (GERD), and questionnaire for laryngopharyngeal reflux (LPR). Samples were collected in the operating room during surgery from both groups and PCR tissue was done. Results: The study group patients demonstrated significantly higher history of GERD, LPR, and H. pylori. H. pylori patients had significantly lower ages than those without (P = 0.03). Patients with H. pylori revealed significantly higher GERD history (P < 0.001) and LPR (P = 0.002) than those without H. pylori. History of GERD (P = 0.003), LPR (P = 0.043), and H. pylori presence (P = 0.028) were significant predictors, controlling for the abovementioned variables. Conclusions: We concluded that a significant correlation was observed between the H. pylori presence in the sinonasal mucosa and nasal polyps and the development of chronic rhinosinusitis with or without nasal polyps. [ABSTRACT FROM AUTHOR]

Objective: Nasal septoplasty is one of the most performed procedures within ENT. Nasal obstruction secondary to a deviated nasal septum is the primary indication for functional septoplasty. Since the coronavirus disease 2019 pandemic, waiting lists have increased and are now long. This study assessed patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery using the Nasal Obstruction Symptom Evaluation instrument. Method: Patients on our waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool to assess symptom severity. Results: Eighty-six out of a total of 88 patients (98 per cent) had Nasal Obstruction Symptom Evaluation scores of 30 or more. In addition, 78 (89 per cent) and 50 (57 per cent) patients were classified as having 'severe' or 'extreme' nasal obstruction, respectively. Two patients scored less than 30 and were classified as having non-significant nasal obstruction. Conclusion: The Nasal Obstruction Symptom Evaluation instrument is a quick and easy way to validate septoplasty waiting lists. In this study, two patients were identified who no longer required surgery. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV)–related multiphenotypic sinonasal carcinoma (HMSC) is a recently described neoplasm entity that presents only in the sinonasal tract. Histologically, it displays features of both a surface-derived carcinoma and a salivary gland carcinoma, and is associated with high-risk HPV, specifically HPV type 33. Whereas majority of the cases display high-grade histologic features, HMSC paradoxically behaves in a relatively indolent fashion. It is important and meaningful to distinguish HMSC from other histopathologic mimickers as the clinical features and management are distinctive. A 64-year-old woman presented having intermittent left-side epistaxis and progressive nasal obstruction. A well-defined, solitary, friable mass with an irregular surface that easily bled upon contact was found in the posterior part of the left nasal cavity. Endoscopic excision of the tumor which was originated from left nasal septum was done and the tumor was confirmed as HMSC. After surgery, definitive radiotherapy was performed in 28 fractions. HMSC is a histopathological type that has been rarely reported so that we report this case with literature review. [ABSTRACT FROM AUTHOR]

Chondromas are benign cartilaginous tumors that frequently occur in the long bones, pelvis, sternum, ribs, and scapula. They seldom develop in the head and neck region, and there have been rare reports of them arising in the nasal septum. Although the mainstay of management is surgery, surgical treatment strategies vary depending on the size, location, and extent of the disease. Herein, we describe a case of huge chondroma originated from the anterior nasal septum, which was completely removed by endoscopic septoplasty approach thorough modified Killian incision. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy of autologous costal cartilage cortex as a nasal tip support and modification graft in improving the nasal tip morphology. Methods From March 2021 to June 2022, 89 patients who underwent rhinoplasty with a focus on nasal tip shaping were enrolled. CT scans were used as an auxiliary examination, and costal cartilage was harvested. The cortical layer of the costal cartilage was shaped into "plate-like" and "cap-like" grafts to sculpt the nasal tip morphology, while expanded polytetrafluoroethylene (ePTFE) or silicone implants were used to elevate the nasal dorsum. Photometric methods were employed to obtain the patients' nasofacial parameters, which were then compared before and after surgery to observe patient satisfaction and the occurrence of complications. Results All 89 patients were followed up for 6 to 24 months, with an average of 9 months. Postoperatively, there were no intranasal occupations or graft protrusions. Patients reported no foreign body sensation in the external nasal valve upon self-examination, and the nasal tip was able to move laterally. The nasal tip exhibited distinct tip-defining points, a full lower lateral cartilage lobule, and no complications such as cartilage visibility, exposure, or infection. Two patients experienced deviation of the nasal columella and asymmetrical nostrils due to unaddressed septal deviation. Measurement results showed significant improvements in postoperative nasal length, nasal tip rotation, nasofrontal angle, and nasal tip projection, with statistically significant differences compared to preoperative values (P<0.05). Conclusion The application of autologous costal cartilage cortex as a nasal tip support and modifying graft to improve nasal tip morphology is a good surgical technique. The shaped nasal tip is soft and movable without affecting the airway, making it worthy of clinical application. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the bleeding sites and their relationship with clinical characteristics in hospitalized epistaxis patients. Methods: We retrospectively reviewed the data of 646 hospitalized epistaxis patients. Results: The bleeding sites were identified in 395 (61.1%) patients and unidentified in 251 (38.9%). We found that age > 50 years (P = 0.030) and the history of cardiovascular diseases (P = 0.027) were more frequent in patients with unidentified bleeding sites. Among patients with identified sites, inferior meatus (n = 130, 32.9%) was the most common site, followed by the septal surface of the olfactory region (n = 102, 25.8%), nasal septum (n = 80, 20.3%), middle meatus (n = 60, 15.2%), and others (n = 23, 5.8%). After dividing patients into five groups by the area of the bleeding sites, we found significant differences in age (P = 0.026), history of hypertension (P = 0.001), cardiovascular diseases (P = 0.032), and nasal packing (P = 0.011). The logistic regression also revealed that these four factors were predictors for different bleeding sites. Conclusion: The bleeding sites can be identified in most epistaxis patients. Age > 50 years and the history of cardiovascular diseases are more frequent in patients with unidentified bleeding sites. In our patients, the most common bleeding site is inferior meatus, followed by the septal surface of the olfactory region, nasal septum, and middle meatus. Age, histories of hypertension, cardiovascular diseases, and nasal packing are factors associated with the bleeding risks of different bleeding sites. According to the different clinical characteristics of patients, the order of the nasal endoscopic examination should be adjusted to develop their treatment plans. [ABSTRACT FROM AUTHOR]

Aim To determine the frequency of anatomic variations of the nasal septum using computed tomography (CT) scans. Materials and Methods The present study was conducted using CT imaging of the lateral nasal wall, nasal septum, and paranasal air sinuses. The study population comprised patients referred to the radiology departments of Government ENT Hospital, Koti, Hyderabad, and Gandhi Hospital, Musheerabad, Secunderabad over a period of six months, from May 1st, 2016, to September 30th, 2016. Results In this study, the nasal septum was categorized under three headings: no deviation, unilateral deviation, and bilateral deviation. Among these categories, unilateral septal deviation was the most prevalent, observed in 82% of cases. Bilateral septal deviation was the least common, found in only 2% of cases. These findings are consistent with those reported in previous studies. Conclusion The study highlights the prevalence of unilateral septal deviation as the most common anatomic variation of the nasal septum, with bilateral deviation being rare. The results align with existing literature on the subject, underscoring the utility of CT scans in identifying and categorizing septal deviations. [ABSTRACT FROM AUTHOR]

Plasmacytomas are malignant tumours characterised by abnormal monoclonal proliferation of plasma cells. They may be osseous or may arise from soft tissues. Extramedullary plasmacytoma (EMP) accounts for only 1% of all head and neck malignancies. Septal plasmacytomas are extremely rare. Here, we report a case of an 80-year-old male patient with alocalised plasmacytoma arising from the nasal septum, which was resected endoscopically, with post-op radiotherapy and no recurrence in 1 year of follow-up. A multidisciplinary approach is required for the optimal diagnosis and management. It is essential to exclude any systemic involvement before arriving at a diagnosis of solitary plasmacytoma. Depending on lesion resectability, a combined therapy is the treatment of choice. [ABSTRACT FROM AUTHOR]

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We report a rare case of multiple benign minor salivary gland tumors in a 60-year-old woman, presenting with progressive left nasal obstruction, intermittent anterior nasal discharge, and postnasal drip. Diagnostic nasal endoscopy and computed tomography (CT) scan revealed sessile, pale, non-pulsating masses in the left nasal cavity, septum, and nasopharynx. Histopathological examination confirmed ectopic minor salivary glands. The tumors were successfully removed via endoscopic excision, and the patient experienced resolution of symptoms with no evidence of recurrence during follow-up. This case highlights the importance of a systematic approach involving clinical assessment, imaging, and histopathological analysis for accurate diagnosis and management of nasal salivary masses. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the presence and correlation of paranasal sinus pneumatization among patients with and without nasal septal deviations (NSD), to enhance clinical understanding of sinonasal anatomical variations. Materials and methods: It is descriptive, retrospective study under a monocentric, utilizing institutional archives. 30 subjects with NSD and 30 without NSD were selected. Inclusion criteria required diagnostic quality Cone Beam Computed Tomography (CBCT) images, while exclusion criteria included developmental anomalies, central pathology, previous sinonasal surgery, fractures, and non-diagnostic images. The Assessment of Pneumatization of the Paranasal Sinuses (APPS) score was used to evaluate anatomical variations in paranasal sinuses based on CBCT scans. Statistical analysis was performed using the Chi-square test and independent t-test via SPSS version 23. Results: A significant association between NSD and certain anatomical variations was observed. Notably, higher prevalence rates of variations such as pneumatization of the maxillary floor, middle turbinate concha bullosa, and superior frontal sinus wall were found in subjects with NSD. Statistical significance was confirmed in seven out of nine parameters, with p-values < 0.001 for most comparisons. The left side exhibited greater pneumatization than the right. The total APPS scores showed strong statistical significance between groups (p < 0.001). Conclusion: The study reveals a significant relationship between nasal septal deviation and paranasal sinus pneumatization, suggesting that septal deviations may influence the extent of pneumatization in the sinonasal complex. [ABSTRACT FROM AUTHOR]

Aim: We present a new, simple, and effective method for the closure of nasal septal perforations based on prolonged isolation of the surgical site. Nasal septal perforation usually results after rhinological surgical operations, primarily to correct septum deviation. When symptomatic, conservative and surgical treatments are required. Current techniques more often attempt direct mucosal closure by mobilizing local nasal mucosal flaps with or without interposed grafts. The reported success rates are sufficiently high approaching ≥ 90%. Method: Our current practice includes the insertion of a temporalis fascia graft between the septal mucosal flaps to cover the perforation, avoiding any effort to achieve mucosal closure. Instead of using sophisticated techniques and multiple synthetic grafts, we propose that the entire septum remains protected after perforation repair for 6 weeks between two thin silicone sheets which permit surgical site inspection and mucosal regrowth. We present our experience with 10 consecutive patients, two of whom had fairly large defects. Results: All cases, except one, had a successful outcome with complete closure of the defect after one year's follow up. No serious complications were reported and the silicone sheets were well tolerated by the patients. Conclusion: Our method is simple and consequently fast, resulting in high success rates, low morbidity, and high tolerance from the patients. Key Messages: • Nasal septum perforations must be repaired occasionally. So far, sophisticated surgical techniques are proposed. • Using a simple surgical technique with a temporalis fascia graft yields the same success rates as with a sophisticated vascular flap provided the surgical site is isolated for a long period. • Silicone sheets permit surgical site inspection and protection of the mucosa during the regrowth process. • Prolonged isolation and protection of the surgical site is the key for a successful repair irrelevant the surgical technique or the graft. [ABSTRACT FROM AUTHOR]

Introduction The development of endoscopic techniques has made endoscopic endonasal approaches (EEAs) to the anterior cranial fossa (ACF) increasingly popular. Still, the steps and nuances involved in the approach may be difficult to understand for trainees. Thus, we aim to didactically describe the EEAs to the ACF in an anatomically based, step-by-step manner with supplementary clinical cases. Methods Six cadaveric head specimens were dissected. Endoscopic endonasal Draf I, IIA, IIB, and III frontal sinusotomies, endoscopic endonasal superior ethmoidectomy, and endoscopic endonasal transcribriform and transplanum approaches were modularly performed. The specimens were photodocumented with endoscopic techniques. Results Draf I frontal sinusotomy started with the complete removal of the anteromedial portion of the agger nasi cell, exposing the medial orbital wall, cranial base, and anterior cribriform plate. Draf II frontal sinusotomy proceeded with the removal of the floor of the frontal sinus between the lamina papyracea and the middle turbinate (IIa), and the nasal septum (IIb) until the first olfactory filaments were exposed. Draf III proceeded by creating a superior septal window just below the floor of the frontal sinus. The bone of the ACF bounded by the limbus sphenoidale posteriorly, frontal sinus anteriorly, and the medial orbital walls bilaterally was removed; the cribriform plate was removed; and the crista galli was dissected free from the dural leaflets of the falx cerebri and removed. Conclusion We provide a step-by-step dissection describing basic surgical steps and anatomy of the EEAs to the ACF to facilitate the learning process for skull base surgery trainees. [ABSTRACT FROM AUTHOR]

Summary A 20‐year‐old Warmblood broodmare was admitted to evaluate bilateral nasal discharge (primarily left) and difficulty masticating grain, without weight loss. During oral endoscopy, thick purulent discharge (pus) was seen along the palatal gingival attachment of the left maxillary third and fourth premolars (207, 208 Triadan). Nasal endoscopy encountered difficulties owing to an expansile lesion at the level of the left ventral conchal bullae, preventing examination of caudal structures. This enlargement also displaced the nasal septum to the right, obstructing the right common nasal meatus at the level of the right ventral conchal bulla. Radiography localised the anomaly to the left maxillary region, extending over the apices of the left maxillary third and fourth premolars (Triadan 207, 208) and first molar (Triadan 209). The abnormality was large, solitary, round and delineated by a thin bony rim. Further characterisation through computed tomography showed suspected origination from the hard palate, specifically the palatine process of the left maxilla. The abnormality had a mixed attenuation later confirmed to represent gas, pus and feed material. The abnormality communicated with the oral and left nasal cavities and was associated with complete absence of alveolar and compact bone on the medial (palatal) aspect of 207, 208 and 209. Based on the purulent discharge and imaging findings, the abnormality was interpreted as a presumed intraosseous abscess of the hard palate with impacted foreign material and concurrent ipsilateral sinorhinitis and periodontitis. The abscess was debrided, and the horse was treated medically for osteomyelitis, sinorhinitis and periodontitis. All clinical signs resolved within 16 months post‐surgery, and the precise source of infection leading to abscess formation remained inconclusive. This case report underscores the role of advanced imaging in diagnosing horses with chronic nasal discharge and explores potential pathogenic mechanisms underlying the development of intraosseous abscesses of the hard palate. [ABSTRACT FROM AUTHOR]

Septoplasty is one of the most frequently performed surgical procedures in otorhinolaryngology to overcome nasal obstruction. Following septal surgery, nasal packs are commonly inserted by surgeons to support and appose septal flaps the types of which depend on the preference and experience of the surgeon. Background We conducted a study to compare the Merocel sponge with that of a newly developed septal clip with the splint in patients who underwent septoplasty or submucosal resection to find out which one is better. A total of 50 patients were included in the study over a period of 3 years. Patients were divided into 2 groups of 25 each where group M is for patients receiving Merocel after surgery and group C is for patients receiving septal clips with splints. Aim The aim of this study was to assess and compare the effects of a Merocel pack on nasal functions with that of the septal clip and their eventual complications and outcome in the post-operative period. Results The main observations that were found in both groups in the immediate postoperative period were (1) pain (2) nasal obstruction (3) sleep disturbance (4) headache (5) epiphora (6) dryness of mouth and (7) postnasal drip. Pain was mild to moderate in the case of group M (MPS was 2.4) and moderate to severe degree in the case of group C (MPS was 5.7). Nasal obstruction was more common in Merocel group patients. Sleep disturbance, headache, epiphora, post-nasal drip, and dryness of mouth were also more in the Merocel group. After pack removal in both groups, the nasal examination was done to see crusts, vestibulitis, and septal ulcers. All these findings were more in the septal clip with the splint group. Conclusions It was observed that Merocel nasal packing causes significant morbidity and discomfort in the immediate post-operative period as compared to septal clips. It is also expensive. The new septal clips with splints can be used as an effective alternative to Merocel for approximation of flaps after septal surgery. [ABSTRACT FROM AUTHOR]

Background: Rhinological procedures demand a high degree of technical expertise and anatomical knowledge. Because of limited surgical opportunities, ethical considerations and the complexity of these procedures, simulation-based training has become increasingly important. This review aimed to evaluate the effectiveness of simulation models used in rhinology training. Methods: Searches were conducted on PubMed, Embase, Cochrane and Google Scholar for studies conducted between July 2012 and July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis ('PRISMA') protocol defined a final list of articles. Each validated study was assigned a level of evidence and a level of recommendation based on the Oxford Centre of Evidence-Based Medicine classification. Results: Following exclusions, 42 articles were identified which encompassed six types of simulation models and 26 studies evaluated validity. The rhinological skills assessed included endoscopic sinus surgery (n = 28), skull base/cerebrospinal fluid leak repair (n = 14), management of epistaxis and/or sphenopalatine artery ligation (n = 8), and septoplasty and septorhinoplasty (n = 6). All studies reported the beneficial impact of their simulation models on trainee development. Conclusion: Simulation training in rhinology is a valuable adjunct to traditional surgical education. Although evidence is of moderate quality, the findings highlight the importance of simulation-based training in rhinology training. [ABSTRACT FROM AUTHOR]

Background: Deviation of the nasal septum (DNS) is defined as any deviation of the septum from the midline and is one of the most common variations of the sinonasal anatomy. Aims and Objectives: The purpose of this study was to observe the prevalence of DNS and its relation with age, gender, and sidedness. Materials and Methods: Sinonasal computed tomographic images of 100 subjects obtained from the Department of Radiodiagnosis, King George's Medical University, Lucknow, UP, in the period August 2013-July 2014 were analyzed to determine the prevalence of DNS and its relation with age, gender, and sidedness. Results: Of a total of 100 subjects, normal midline nasal septum was seen in 27 subjects whereas 73 subjects (73%) displayed a deviation in its position. The prevalence of nasal septal deviation (NSD) was significantly higher in females (84.21%) as compared to males (66.13%) (P=0.048). We also compared the prevalence of NSD in different age groups and found it to be higher in subjects aged >46 years (83.33%) as compared to other age groups but this difference was not found to be statistically significant (P=0.619). Conclusion: Nasal septum deviation was found to be more frequent in females and observed deviations were more toward the left side as compared to the deviations of the septum toward the right. No correlation between age intervals and prevalence of DNS was found. [ABSTRACT FROM AUTHOR]

We report a case of a 58-year-old man with a history of nasal obstruction and recurrent epistaxis who underwent videonasolaryngoscopy after 9 months of symptoms. The frst images showed a hyperemic mass affecting the left middle turbinate up to the nasal cleft. Computed tomography described a mass with an expansive effect occupying the entire left frontal sinus and most of the left ethmoid cells, widening the frontal sinus drainage path, and creating a continuity break of the cribriform plate, the left papyraceous lamina, and the upper-third of the nasal septum. Magnetic resonance imaging suggested T1-isointensity and T2-hyperintensity, intense contrast uptake, and no involvement of meningeal or brain tissues. The patient underwent extended endoscopic surgery without previous endovascular embolization or adjuvant therapies. A contralateral inferior turbinate graft was applied over the cribriform plate. Histopathological examination suggested glomangiopericytoma (GPC), and immunohistochemistry confrmed the diagnosis with positive beta-catenin, smooth muscle actin, and cyclin D1. The patient presented no nasal symptoms up to a 9-month follow-up. Nasal endoscopy showed no tumor recurrence signal. Although fronto-ethmoidal GPC is a rare tumor and presents challenging surgical access, it can be safely excised by endoscopic surgery. However, careful short- and long-term endoscopic follow-ups remain necessary to prevent postoperative complications and maintain surveillance of recurrences. [ABSTRACT FROM AUTHOR]

Tumors in the nasal septum originating from salivary glands are uncommon, and among them, pleomorphic adenomas represent a distinctive manifestation.This case study explores a female in her early thirties with a right-sided nasal mass, nasal obstruction, and intermittent bleeding. CT imaging revealed a lesion arising from the nasal septum with bony erosion. Histopathology confirmed pleomorphic adenoma,emphasizing the importance of thorough clinical evaluation, imaging, and biopsy for accurate diagnosis. Pleomorphic adenomas, typically found in major salivary glands, can occur in the respiratory tract, presenting challenges in distinguishing them from malignant tumors. Treatment involves wide local resection, and postoperative recurrence may necessitate radiotherapy. While intranasal pleomorphic adenomas generally have a favorable prognosis, those arising from the nasal septum have an elevated likelihood of malignancy. Vigilant monitoring is crucial due to the potential for recurrence, malignant transformation, and metastasis. [ABSTRACT FROM AUTHOR]

This is a retrospective study exploring the demographics and the role of nasal septum deviation in acute invasive fungal rhinosinusitis (AIFS); and if this deviation contributes to the laterality predilection of this opportunistic infection. Fifty-six craniofacial CT scans were evaluated by two radiologists blinded to the clinical data and outcome for laterality of the disease; and nasal septal deviation (NSD). NSD was graded based on the measured septal angle of deviation into mild, moderate, and severe and furtherly classified into one of seven types based on Mladina's classification. High prevalence of remarkable nasal septum deviation existed in our population with AIFS, with type 7 Mldina NSD represented the most prevalent in this population. We found no significant statistical relation between the side of deviation and the initial side of the fungal disease. We recommend screening for early manifestations of AIFS in similar debilitated patients; with high degrees of nasal septum deviation for considering it as an anatomical risk factor. [ABSTRACT FROM AUTHOR]

Rhinosinusitis in granulomatosis with polyangiitis (GPA) is categorised as a secondary, diffuse and inflammatory chronic rhinosinusitis (CRS). It is one of the conditions that impacts the nasal microbiota. This study aimed to compare the nasal microbiomes of patients with GPA, CRS and NSP. A total of 31 patients were included in the study (18 GPA, 6 CRS and 7 nasal septum perforation (NSP)). In all patients, SNOT 22, a nasal endoscopy (Lund–Kennedy scale) and a brush swab were performed. The metagenomic analysis was carried out based on the hypervariable V3-V4 region of the 16S rRNA gene. At the genus level, statistically significant differences were observed in two comparisons: the GPA/NSP and the GPA/CRS groups. In the GPA/NSP group, the differences were related to four genera (Actinomyces, Streptococcus, Methylobacterium-Methylorubrum, Paracoccus), while in the GPA/CRS group, they were related to six (Kocuria, Rothia, Cutibacterium, Streptococcus, Methylobacterium-Methylorubrum, Tepidimonas). Patients with GPA had lower diversity compared to CRS and NSP patients. There were no statistically significant differences found for the Staphylococcus family and Staphylococcus aureus between the three groups. [ABSTRACT FROM AUTHOR]

Background: The Nasal Obstruction Symptom Evaluation (NOSE) is a questionnaire to assess patients with nasal obstruction. The aim of this study was to translate and validate NOSE to the Malay version NOSE (M-NOSE). Methods: The NOSE questionnaire was translated to Malay language and back to English. Psychometric properties consisting of reliability, reproducibility, validity, responsiveness were appraised in patients with nasal obstruction due to deviated nasal septum and healthy asymptomatic controls. Results: A total of 126 participants were recruited. There was significant difference between patients and controls for all items and the total score (all p < 0.001). The correlation was moderate to strong between all items and total score (r = 0.71 to 0.8) and fair to moderate for the inter-items correlations (r= 0.31 to 0.70). Internal consistency for M-NOSE was good (α = 0.81). The test–retest for each item demonstrated no significant difference. There was significant difference of the pre- and post-operative mean for each item and total score (all p < 0.001) with good response sensitivity (effect size, d = 4.91). Conclusions: The M-NOSE has satisfactory reliability, internal consistency, reproducibility and responsiveness. It is a valid and convenient tool in the assessment of the impact and treatment outcome of nasal obstruction. [ABSTRACT FROM AUTHOR]

Objective: The objective is to investigate the effects of unilateral and bilateral concha bullosa (CB) on lateral nasal wall asymmetries and septal deviation. Methods: Our study was designed retrospectively and included a total of 90 patients: 30 patients without CB (Group 1), 30 with unilateral CB (Group 2), and 30 with bilateral CB (Group 3). Septal deviation angles (SDAs), severities of nasal septal deviation (NSD) based on the NSD angle, deviation shapes, lateral nasal wall lengths, lateral nasal wall-septum distances, and lateral nasal wall morphologies were evaluated on paranasal computed tomography scans. Results: A significant difference was observed in the SDA values among the 3 groups (P = .000). The NSD severity was different among the 3 groups (P = .003): severe deviation was observed in 5 patients (16.7%) in Group 1, 10 patients (33.3%) in Group 2, and 6 patients (20%) in Group 3. In Group 2, a significant difference was observed in the lengths of the lateral nasal walls between the side with and without CB (P = .000). Conclusion: In patients with unilateral CB, lateral nasal wall asymmetries are frequently observed, necessitating planning for osteoplasty, osteotomy, and CB surgery before the procedure. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the effects of nasal septum deviation and inferior turbinate hypertrophy on nasal obstruction by utilizing the Nose Obstruction Symptom Evaluation (NOSE) values and paranasal sinus computed tomography (PSCT) findings for correct preoperative evaluation. Methods: Ninety-six patients (57 males and 39 females) aged between 18 and 54 years (mean age, 30.3 ± 9.7 years) participated in this study. Among them, 56 patients underwent septoplasty combined with inferior turbinate outfracture, while 40 patients underwent septoplasty alone. Preoperative nasal examinations were performed on all patients. The direction, location, nasal septum deviation classification, and inferior turbinate hypertrophy size classification were carefully evaluated and compared with the NOSE survey results. PSCT of 56 patients were evaluated and classified by calculating the coronal location of septum deviation, the axial location of septum deviation, the coronal angle of septum deviation, and the axial angle of septum deviation. Results: A positive correlation was found between the coronal location of the septal deviation and the preoperative NOSE 2, and the NOSE total, and the difference of postoperative and preoperative NOSE (p = 0.032, p = 0.007, p = 0.021, respectively). There was a statistically significant relationship between the coronal location of the septal deviation classification and the NOSE preoperative total values (p = 0.26). A negative statistically significant correlation was found between inferior turbinate hypertrophy and preoperative NOSE 5 values (p = 0.029). Conclusion: We conclude that the combination of PSCT and the NOSE scale is helpful in determining the severity of nasal obstruction prior to surgery. Specifically, we found that nasal septum deviations located in the anterior and coronal planes have a greater impact on nasal obstruction compared to deviations in the axial plane. Inferior turbinate fracture does not provide more benefit than septoplasty alone in treating patients' nasal obstruction. These findings emphasize the importance of a comprehensive approach in addressing nasal obstruction for optimal patient outcomes. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsDiscussionTo assess a novel Virtual Reality (VR) tool designed to enhance understanding of the nasal anatomy in patients eligible for DCR surgery.Preoperative Computed Tomography (CT) scans of the orbit were obtained and loaded as DICOM (Digital Imaging and Communications in Medicine) files onto the D2P software (3D Systems Inc. Littleton, CO) for tissue segmentation and 3D model preparation. Segmentation was performed on several anatomical structures, including the skull, lacrimal sac, nasal septum, inferior and middle turbinate. The resulting 3D model was visualized using a VR headset. After completing the segmentation procedure, ten cases were evaluated by a panel of six surgeons, including both senior and resident physicians from ENT and oculoplastic specialties.The dataset under examination comprised images from 10 preoperative CT scans of the orbits of patients eligible for Endo-DCR. When evaluating the CT using the VR tool, in 73.3% of the cases ENT surgeons were right about the side of pathology, while only 43.3% ophthalmologists were right (chi-square, p = .018). In 72.8% of the cases ENT surgeons were evaluated right that there is a septum deviation, while only in 47.2% of the cases the ophthalmologists were right (chi-square, p = .094).When evaluating the CT using the VR tool, in 60% of the cases consultants were right about the pathology, while 57.7% of the residents were right (chi-square, p = .853). In 81.7% of the cases consultants were evaluated right that there is a septum deviation, while only in 58.3% of the cases the ophthalmologists were right (chi-square, p = .198).ENT surgeons, as well as consultants, interpreted the CT better than the ophthalmologists and residents. Surprisingly, the VR system did not help them to interpret the CT better. Further, more extensive studies should be done to build a VR system that assists in the correct interpretation of the preoperative CT before DCR surgery as well as during DCR surgery. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the frequency of maxillary sinus pathologies and their relationship with each other using cone beam computed tomography (CBCT) and to make a new grade according to the number of affected walls. 1000 maxillary sinuses of 500 patients with CBCT images were included in the study. Anatomical variations and pathological formations of the maxillary sinuses were examined. Images were evaluated for the presence of flat, polypoidal, partial and generalized mucosal thickening, partial and total opacification, polyps and mucous retention cysts. Maxillary sinus pathologies were graded according to the number of walls affected. In the examined CBCT images, no pathology was found in 54.2% of the maxillary sinuses, while pathology was observed in 45.8%. The most common sinus pathologies were mucous retention cyst (12.3%) and polypoidal thickening (12.2%). While pneumatization, ostium obstruction, and the presence of sinus-related roots were associated with sinus pathology, no relationship was found with nasal septum deviation and the presence of septa. Before dental implant and sinus surgery applications, the presence of sinus pathologies and their relationship with anatomical variations can be evaluated with CBCT, a three-dimensional technique, and complications such as sinus membrane perforation, infection, failure to break the bone window due to the presence of antral septa, graft loss and oroantral fistula formation can be reduced. [ABSTRACT FROM AUTHOR]

Introduction: The clinical importance of olfactory evoked potentials (OERPs) and trigeminal evoked potentials (TERPs) in the diagnosis of olfactory disorders has recently increased. The advantage of the objective method is that OERPs are less biased than routinely used psychophysical olfactory tests. The clinical olfactometer gives precisely defined olfactory stimuli needed to elicit OERPs and TERPs. The principle of the method is based on the presentation of an odorant by a special device in the patient's nasal cavity and the registration of the brain response by electroencephalography (EEG) to the olfactory and trigeminal stimuli. For OERPs and TERPs, we evaluate the latencies and amplitudes of individual peaks and the N1–P2 interval. The absence of OERPs is a strong predictor of the presence of olfactory dysfunction. Aim of this study: These data will be a good basis for further research projects in the field of olfactory disorders. Materials and methods: Between 3/2021 and 6/2024, 187 subjects (99 females and 88 males) were enrolled in a prospective study. A clinical olfactometer OL 024 Burghart and an 8-channel EEG system OL 026 Burghart were used for measurements. Results: We present sample OERPs and TERPs curves from single groups of enrolled subjects. The 1st group of normosmic subjects – healthy participants, subjects with a deviation of the nasal septum. The 2nd group consists of subjects with chronic rhinosinusitis with nasal polyposis. The 3rd group includes subjects after undergoing COVID-19. The 4th group of enrolees are subjects with neurodegenerative disease, Parkinson's disease, and multiple sclerosis. The 5th group includes subjects with tumors of the paranasal sinuses, olfactory region, and pituitary gland. The 6th group consists of subjects with olfactory disorders who were indicated for examination for medico-legal reasons. The 7th group consists of subjects with post-traumatic loss of smell. Conclusion: Sample OERPs and TERPs curves are demonstrated. The data obtained may very well be applied in the future as an internal guide for our other ongoing olfaction research studies. The absence of olfactory evoked potentials is a robust predictor of the presence of olfactory dysfunction. Objective olfactometry appears to be a method with increasing potential, especially in persons who have difficulty with commonly available psychophysical testing of the sense of smell, in patients with neurodegenerative disease, and in the medicolegal field. [ABSTRACT FROM AUTHOR]

Plasmacytomas are malignant tumors characterized by the abnormal monoclonal proliferation of plasma cells. They originate either in the bone (solitary bone plasmacytoma) or in soft tissues (extramedullary plasmacytoma). Extramedullary plasmacytomas account for less than 1% of all malignant conditions of the head and neck. We present a case of extramedullary plasmacytoma of the nasal septum in a 63-year-old woman who experienced progressive difficulty breathing through her nose and frequent severe epistaxis on the left side. The tumor was removed through a transnasal endoscopic approach, and the postoperative CT scan confirmed the complete removal of the mass. A PET-CT scan performed three months postoperatively did not reveal any signs of local recurrence or secondary involvement. Given these conditions, the oncologist decided to adopt a cautious approach regarding the initiation of radiotherapy or other adjunctive oncology treatments and opted for active case monitoring. Extramedullary plasmacytoma of the nasal cavity poses a diagnostic and therapeutic challenge for any ENT surgeon. Depending on the efficiency with which the lesion can be removed, the accepted treatment is combined therapy; however, a conservative approach may also be considered in cases where tumor resection is complete and within oncological safety limits. [ABSTRACT FROM AUTHOR]

While primarily observed in adults, this case contributes valuable insights into the manifestation and management of this benign salivary gland tumor within the pediatric population. This paper reports the first documented case of sinonasal pleomorphic adenoma in pediatric otolaryngology, presenting a unique perspective on this rare nasal tumor in a 9-year-old boy. The patient presented with progressive nasal obstruction and epistaxis and underwent a smooth endoscopic resection of a 2-cm pleomorphic adenoma on the right anterior nasal septum. The subsequent discussion covered background, histology, imaging, and management strategies. Surgical removal with clear margins, particularly through the endoscopic approach, emerged as the primary and successful treatment method, minimizing morbidity and reducing recurrence risk. Long-term clinical surveillance is recommended due to an estimated 8.8% recurrence rate. In conclusion, this paper explains the challenges and solutions in diagnosing and treating sinonasal pleomorphic adenomas in children. It emphasizes the critical importance of early diagnosis, precise surgical intervention, and continuous monitoring, which are essential for achieving optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome. [ABSTRACT FROM AUTHOR]

Introduction Functional endoscopic sinus surgery and endoscopic skull base surgery are frequently performed surgeries today. Nasal septal deviation is a common finding and can affect the surgical area. Therefore, it is important to examine the effect of this deviation on other anatomical structures. Objectıve The aim of the present study was to determine whether there is a relationship between the degree of nasal septal deviation and anterior skull base structures using computed tomography (CT). Methods A total of 312 patients (aged 18 to 65 years old) whose paranasal sinus CT images were available were included in the study. Measurements were obtained on images retrieved from Picture Archiving and Communication System (PACS) and Horos image archive systems in the bone window in the coronal and axial plane. Results The mean age of 312 patients was 33.00 years old (standard deviation [SD] 11.22 years). The presence of septal deviation was not associated with changes in olfactory fossa (OF) depths, Keros degrees, and the angle between the lateral lamella and the cribriform lamella. However, OF depths and Keros degrees on the deviated side of the septum were found to change at a significant level (p < 0.05). No significant association was observed between the degree of septal deviation and cribriform lamella-lateral lamella angle. Conclusion The study showed significantly increased OF depth and Keros degree on the deviated side of the nasal septum. Performing CT scans before endoscopic sinus surgery and endoscopic skull base surgery is important to increase the chances of a successful surgical outcome and to reduce complications. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effects of nasal septum deviation on the pharyngeal airway and craniocervical posture measurements using cone beam computed tomography (CBCT). This retrospective study analyzed the CBCTs of 25 patients with and without nasal septum deviation. Various parameters defining the pharyngeal airway and craniocervical and facial skeletal morphology were measured and compared between the groups after confirming intra-examiner reliability. Compared to the control group, the group with nasal septum deviation had a statistically significantly shorter nasopharyngeal length (p < 0.001), longer vertical airway length (p < 0.002), and larger cervical column curvature angle (p < 0.006). Children with a nasal septum deviation of 4 mm or more on their CBCT scan are susceptible to unfavorable pharyngeal airway and craniocervical postural changes. [ABSTRACT FROM AUTHOR]