Anterior Nasal Cavity Research Articles

Clinical and functional features of the nasal cavity, paranasal sinuses and pharynx in patients with chronic obstructive pulmonary disease in remission

Aim. To assess functional condition of the nasal cavity, paranasal sinuses, pharynx in patients with remission of chronic obstructive pulmonary disease. Methods. Patients were distributed to 2 groups. The main group included 49 patients with stages II and III of chronic obstructive pulmonary disease in remission, control group included 50 healthy non-smoking volunteers without any known respiratory diseases. Patients underwent general examination, completed by rigid endoscopic examination, examination of ciliary clearance, anterior active rhinomanometry, olfactometry, nasal cavity and paranasal sinuses computed tomography. Pharynx examination included nasal cavity posterior endoscopy, mesopharyngoscopy, lower part of the parynx was examined by rigid endoscope with viewing angle of 70°. Results. Ciliary clearance was 26.7±3.06 minutes in patients of the main group, compared to 16.4±1.11 minutes in patients of the control group. Smell acuity was 1.86±0.11 units in patients of the main group, compared to 2.3±0.15 units in patients of the control group. Signs of nasal and pharyngeal diseases, including signs of chronic inflammation of nasal mucosa and chronic catarrhal pharyngitis was found in 30 patients. Conclusion. Patients with chronic obstructive pulmonary disease had higher prevalence of chronic rhinitis and pharyngitis, worse smell acuity and impaired ciliary clearance compared to healthy controls.

A Large Submucosal Mass With Prominent Superficial Vessels

A man in his 40s presented with a multiple-year history of difficulty breathing throughhis left nostril. Severalmonthsprior topresentation, he began to experience left-sided epistaxis occurring up to 10 times per month, which was controlled with direct pressure. More recently, a friend noticed bulging of his left lateral nasal sidewall. Physical examination revealed a large submucosal mass with prominent superficial vessels within the mucosa almost completely filling the left anterior nasal cavity. Axial computed tomography (CT) showed a well-circumscribedoval-shaped lesionwith intermediate attenuation in the left anterior nasal cavity that shifted the septum to the right with remodelingof thenasalbone (Figure, A). The lesionhadmostlyhigh signalonaxialT2-weightedmagnetic resonance imaging(MRI)within which therewas a reticular pattern of septawith low signal (Figure, B). The lesionhadheterogeneous,mostly low signal on coronal fatsuppressed T1-weighted imaging (Figure, C), as well as prominent heterogeneous contrast enhancement using the same sequence (Figure,D).The lesionwas resectedviaanendoscopicendonasal approach andwas found to be originating from the left superior nasal septumwithnoextensionbeyond the left lateral nasalwallmucosa or the right septal mucosa. What is your diagnosis? A B

Mucocele of the Sphenoid, Ethmoid and Frontal Sinuses Presenting with Proptosis, Visual Impairment and Diplopia

Mucocele of the paranasal sinus is accumulation of the mucoid secretion within the sinus caused by obstruction of the sinus ostium. We report a case of paranasal sinus mucocele presented with proptosis in right eye, diplopia, visual impairment and headache. Magnetic resonance imaging(MRI) revealed a polyp in right anterior ethmoid sinus and nasal cavity resulted in mucocele of the sphenoid, ethmoid and right frontal sinuses.

Regional deposition of mometasone furoate nasal spray suspension in humans.

Nasal deposition studies can demonstrate whether nasal sprays treating allergic rhinitis and polyposis reach the ciliated posterior nasal cavity, where turbinate inflammation and other pathology occurs. However, quantifying nasal deposition is challenging, because in vitro tests do not correlate to human nasal deposition; gamma scintigraphy studies are thus used. For valid data, the radiolabel must distribute, as the drug, into different-sized droplets, remain associated with the drug in the formulation after administration, and not alter its deposition. Some nasal deposition studies have demonstrated this using homogenous solutions. However, most commercial nasal sprays are heterogeneous suspensions. Using mometasone furoate nasal suspension (MFS), we developed a technique to validate radiolabel deposition as a surrogate for nasal cavity drug deposition and characterized regional deposition and nasal clearance in humans. Mometasone furoate (MF) formulation was spiked with diethylene triamine pentacaetic acid. Both unlabeled and radiolabeled formulations (n = 3) were sprayed into a regionally divided nasal cast. Drug deposition was quantified by high pressure liquid chromatography within each region; radiolabel deposition was determined by gamma camera. Healthy subjects (n = 12) were dosed and imaged for six hours. Scintigraphic images were coregistered with magnetic resonance imaging scans to quantify anterior and posterior nasal cavity deposition and mucociliary clearance. The ratio of radiolabel to unlabeled drug was 1.05 in the nasal cast and regionally appeared to match, indicating that in vivo radiolabel deposition could represent drug deposition. In humans, MFS delivered 86% (9.2) of metered dose to the nasal cavity, approximately 60% (9.1) of metered dose to the posterior nasal cavity. After 15 minutes, mucociliary clearance removed 59% of the initial radiolabel in the nasal cavity, consistent with clearance rates from the ciliated posterior surface. MFS deposited significant drug into the posterior nasal cavity. Both nasal cast validation and mucociliary clearance confirm the radiolabel deposition distribution method accurately represented corticosteroid nasal deposition.

English

Trans-sellar trans-sphenoidalencephaloceles are rare and the trans-sellar variety is the least common. We present a 9-year-old male patient with trans-sellar trans-sphenoidal nasopharyngeal encephalocele which herniated into the nasopharynx through the congenital defect in the floor of sella. Patient presented with complains of nasal obstruction, nystagmus& visual disturbance in left eye. A trans-sellar trans-sphenoidal nasopharyngeal encephalocele was found on computed tomography (CT) and magnetic resonance imaging (MRI).We discuss our clinical findings and the results of preoperative computed tomography and magnetic resonance imaging along with review of this rare condition. INTRODUCTION: Encephaloceles occur in approximately1 in 3000 to 5000 live births1, 2, 3. Basal meningoencephaloceles are rare anomalies, reportedly constituting 1% 10% of all encephaloceles and originate from a congenital opening in the midline region of the skull base, which permits meninges, neural tissue or both to herniated from the intracranial space 4, 5, 6, 7. Basal encephaloceles occur with an estimated incidence of one in every 35, 000 live births1. Pollock classifies them as follows:(1) Sphenopharyngeal or trans-sphenoidal, when they protrude into the epipharynx and/or sphenoidalsinus; (2) spheno-orbital, when the protrusion is through the superior orbital fissure into the superior orbit producing unilateral exophthalmus; (3) sphenoethmoidal, when the cerebral mass herniates through the sphenoid and ethmoidal bones into the posterior nasal cavity; (4) transethmoidal, whenencephalocele extends into the anterior nasal cavity; and (5) sphenomaxillary, when the meningo-encephalocele passes through the superior orbital fissure into the orbit and through the inferior orbital fissure into the pterygopalatine fossa8, 9. Transsphenoidalencephaloceles are rare and the transsellar variety is the least common variety. Wediscuss our clinical findings and the results of preoperativecomputed tomography and magnetic resonance imaging of trans-sellartrans-sphenoidal nasopharyngeal encephalocele along with review of this rare condition. CASE REPORT: A 9 year old patient with normal built for age presented with complaints of nasal obstruction with anterior nasal discharge, nystagmus, headacheand visual disturbances more in left eye since 1 year. Clinical examination showed large nasopharyngeal soft tissue mass lesion causing near total occlusion of nasopharynx. Thesite of origin of the mass was not able to make out.Visual examination showed horizontal nystagmus in both eyes with decreased vision on left side.He had no history of CSF rhinorrhea, meningitis/seizures. His physical exam was unremarkable and the patient was referred for further work-up. Radiograph of skull showed defect in the floor of sella [Fig.1]. Axial non enhanced computer tomography (NECT) showed large cerebrospinal fluid (CSF) density cystic lesion extending from sella, sphenoid sinus into nasopharynx[Fig 2] Bony defect noted in thesellar floor with widening of sella [Fig.3].Rest of the brain was normal. Diagnosis of trans-sphenoidalencephalocele was made.

Pou2f3/Skn-1a Is Necessary for the Generation or Differentiation of Solitary Chemosensory Cells in the Anterior Nasal Cavity

Solitary chemosensory cells in the non-neuronal epithelium of the anterior nasal cavity have bitter taste cell-like molecular characteristics and are involved in the detection of noxious substances. Here, we demonstrate that Pou2f3/Skn-1a, which is necessary for generation of sweet, umami, and bitter taste cells, is also necessary for the generation or differentiation of solitary chemosensory cells.

Hairy Polyp of the Anterior Nasal Cavity

Hairy Polyp of the Anterior Nasal Cavity

Is There a Relationship between Epistaxis and Staphylococcus aureus Colonization in the Nasal Vestibule?

Objectives:Although epistaxis is still very common in children and adults, its cause in most non‐traumatic cases remains unknown. We aimed to find out if nasal colonization with Staphylococcus aureus leads to inflammation, crusting, and new vessel formation and ends with epistaxis in association. We also wanted to investigate the relationship between positive cultures and seasons.Methods:One hundred twenty‐nine patients were recruited for the study group (86 had crusting in the nasal vestibule while 43 did not) and compared with 40 healthy control subjects. A microbial swab was taken from the anterior nasal cavity of each subject. The same procedure was repeated at each season.Results:S aureus was found to be more common in the epistaxis group when compared with the control group, with a percentage of 37% and 19% respectively. There was no difference in the prevalence of S aureus between crust and noncrust groups. When positive cultures were grouped and compared according to season, we observed that the positive culture with epistaxis was much higher (44.82 %) in autumn.Conclusions:A positive correlation between nasal colonization with S aureus with epistaxis highlights the importance of healthcare and preventive care. Further studies should be performed to decrease epistaxis by diminishing the colonization of S aureus. Special attention should be given in autumn.

Phenotypic methods for determination of methicillin resistance in Staphylococcus spp. from health care workers

INTRODUCTION: Staphylococcus spp. is an important healthcare-associated pathogen and the identification of methicillin-resistant strains in samples of colonization may provide data to assist in the antimicrobial therapy success. OBJECTIVES: To determine the occurrence of colonization by methicillin-resistant Staphylococcus spp. (MRS), through the detection of the mecA gene and to evaluate different phenotypic methods for the presumptive detection of methicillin resistance in samples of the anterior nasal cavity and hands of the health care personnel of a university hospital in the state of Pernambuco, Brazil. METHODS: We selected the 28 isolates of Staphylococcus spp., which showed an intermediate or resistant phenotypic profile for oxacillin, detected by the Kirby Bauer technique. The methods used were disk-diffusion tests for cefoxitin, minimal inhibitory concentration by E-test for oxacillin, screening for oxacillin resistance and mecA gene detection by polymerase chain reaction (PCR). RESULTS: About the phenotypic methods utilized, only the E-test of oxacillin did not show a statistically significant difference in relation to PCR for the mecA gene detection, considered the gold standard. CONCLUSION: The E-test of oxacillin was the best of the phenotypic methods utilized. It is necessary to correctly detect MRS in healthy individuals, because they can act as carriers and can therefore be a potential source of microorganisms involved in hospital infections.

Low prevalence of methicillin-resistant Staphylococcus aureus among men who have sex with men attending an STI clinic in Amsterdam: a cross-sectional study

ObjectiveCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is common among men who have sex with men (MSM) in the USA. It is unknown whether this is also the case in Amsterdam, the...

Vascular Anatomy of Little?s Area in Children with Epistaxis

Epistaxis in children in more than 90% of the cases from the anterior nasal cavity. In the majority of the paediatric population Epistaxis is due to trauma (accidents, manipulation, secondary hemorrhages after surgery), bleeding disorders (v.-Willebrand´s disease, side-effects of medication), dry climate (low humidity, heating period), rhinitis, vascular abnormities and rarely it is due to hereditary syndromes. In contrast to Epistaxis in adults, blood pressure changes play no essential role in paediatric nosebleeds. The present publication analyses the vascular anatomy of the anterior nasal septum (Little´s area) based on video endoscopic findings in affected children. Video endoscopies of 16 children could be analysed for the study. Twelve of 16 children had a prominent vessel shining through the mucosa at the anterior or lower edge of the nasal septum and teleangiectic vessels appeared in 4/16 cases. The endoscopic examinations showed that the dominant vessels for the anterior septum were emerging from the floor of the nose, making a 90° cranial direction turn towards Little’s area. In contrast to most descriptions in literature, anastomoses with vessels coming from the cranial parts of the nose, deriving from the anterior ethmoidal artery, could not be found. According to the findings of the present analysis, Little’s area therefore is predominantely supplied by the septal branch of the superior labial artery and inferior septal branches of the sphenopalatine artery. Results in Epistaxis therapy might be improved, if the respective terminal branches of these vessels can be obliterated succesfully.

Histopathologic and Morphometric Evaluation of the Nasal and Pulmonary Airways of Cats with Experimentally Induced Asthma

Background: Allergic rhinitis frequently occurs as a comorbid condition in asthmatic people, suggesting that the upper and lower airways may be immunologically linked. Our research group has developed an experimental aeroallergen model of asthma in cats. We hypothesized that aeroallergen sensitization and challenge would induce morphologic changes in the nasal airways of cats that mimic those observed in the bronchial airways. Methods: Five mixed breed cats were sensitized to Bermuda grass allergen and then serially challenged with aerosolized Bermuda grass allergen to induce an asthmatic phenotype. Four control cats were similarly treated with saline vehicle. Nasal tissues and lungs were processed for histopathological and morphometric analyses. Results: Eosinophilic inflammation, epithelial hypertrophy and mucous cell metaplasia were observed along the pulmonary axial airway mucosa of allergen-sensitized (asthmatic) cats. Mild eosinophilic inflammation was observed in the nasal airways of asthmatic cats. This alteration was confined primarily to the anterior nasal cavity, resulting in an increase in tissue eosinophils at this site compared to controls (p < 0.05). A marked increase in tissue mast cells was observed throughout all regions of the nasal airways of asthmatic cats compared to control cats (p < 0.05). There was no difference in intraepithelial mucosubstances between the nasal airways of controls and asthmatic cats. There was no correlation between upper and lower airway eosinophils or mast cells. Conclusion: Cats with experimentally induced asthma exhibit morphologic changes in the nasal airways that are distinct from the alterations observed in the lungs. These results are similar to those observed in people with comorbid asthma and allergic rhinitis.

CD20-positive NK/T-cell lymphoma with indolent clinical course: report of case and review of literature

CD20-positive T-cell lymphoma is extremely rare and only two cases of CD20-positive NK/T-cell lymphoma with aggressive clinical courses have been described in the literature. We present a case of unusual NK/T-cell lymphoma with CD20 expression in nasal cavity occurring in an elder female patient. The patient had presented with left nasal cavity nodule for 10 years. CT scan revealed a mass was located at the left anterior nasal cavity and was observed to extend into the ethmoid sinus. There was no regional lymph node involvement. Biopsy was performed and microscopical inspection revealed the lesion was composed of small- to middle-size atypical lymphoid cell, histiocytes, eosinophils, and neutrophils. The lymphoid cells were strongly immunoreactive to CD3, CD20, CD56, TIA-1 and granzyme-B. The Epstein-Barr virus genomes were also found in tumor cells by in situ hybridization. By genetic analysis, however, no clonal rearrangement of the T cell receptor-γ genes (TCRG), or the immunoglobulin heavy chain (IgH) gene was found. A diagnosis of CD20-positive extranodal NK/T-cell lymphoma, nasal type was made. The patient refused chemotherapy, and had been only on regular follow-up for 6 months. There was no sign of enlargement of tumor and extra-nasal dissemination by whole body positron emission tomography/computed tomography (PET/CT) study. The accurate diagnosis of NK/T-cell lymphoma with CD20 expression is important, but the indolent behavior of the present case is more unusual. A long-term follow-up is suggested to be performed to inspect the progression for this tumor.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1320848277788495

The role of the superior turbinate flap in skull base reconstruction

We describe surgical treatment of a hemangiopericytoma in the anterior skull base and nasal cavity. The patient underwent a novel method of anterior skull base reconstruction, using the superior turbinate and cerebral falx, which was successful. The patient did not develop a cerebrospinal fluid leak or intracranial infection.

Pleomorphic adenoma of the lateral nasal wall: A case report and review

Pleomorphic adenomas arising in the nasal cavity are extremely uncommon, despite the large numbers of minor mucous and serous glands in the region. We present a rare case of a pleomorphic adenoma arising from the lateral nasal wall. A 67-year-old Chinese woman complained of right nasal obstruction for 6months. Flexible nasal endoscopy showed a prominent swelling which was in continuity with the anterior part of the right inferior turbinate. Computed tomography revealed a well-defined, soft tissue dense lesion in the right anterior nasal cavity. The patient underwent a formal surgery to obtain definite diagnosis via a lateral rhinotomy incision. Intra-operatively, a soft mass was seen arising from the lateral nasal wall and the final histology confirmed a pleomorphic adenoma with a predominant stromal component. The main treatment modality is surgical resection with histological clear margins. Good exposure is necessary to ensure complete excision of the tumour, more so when its cellular pattern shows stromal predominance. In our case, the patient demonstrated satisfactory cosmetic results with no evidence of recurrence.

Neurovascular anatomical variations in the anterior palate observed on CBCT images

This study aimed to assess the presence of additional foramina and canals in the anterior palate region, through cone beam computed tomography (CBCT) images, describing their location, direction, and diameter. CBCT exams of 178 subjects displaying the anterior maxilla were included and the following parameters were registered: gender; age group; presence of additional foramina in the anterior palate (AFP) with at least 1mm in diameter; location and diameter of AFP; and direction of bony canals associated with AFP. Twenty-eight patients (15.7%) presented AFP and in total 34 additional foramina were registered. No statistical differences between patients with or without AFP were found for gender or age. The average diameter of AFP was 1.4mm (range from 1 to 1.9mm). Their location was variable, with most of the cases occurring in the alveolar process near the incisors or canines (n=27). In 18 cases, AFP was associated with bony canals with upward or oblique direction toward the anterior nasal cavity floor. In 14 cases, the canal presented as a direct extension of the canalis sinuosus, in an upward direction laterally to the nasal cavity aperture. In two cases, the canal was observed adjacent to the incisive and joined the nasopalatine canal superiorly. CBCT images have a crucial role in the recognition of anatomical variations by allowing detailed tridimensional evaluations. Additional foramina and canals in the anterior region of the upper jaw are relatively frequent. Practitioners should be aware and trained to identify these variations. Over 15% of the population studied had additional foramina in the anterior palate, between 1mm and 1.9mm wide, with variable locations. In most cases the canals associated with these foramina either presented as a direct extension of the canalis sinuosus, or coursed towards the nasal cavity floor.

Simultaneous combined single stage removal of immature teratoma at anterior skull base: A case report

Immature teratoma consists of immature and undifferentited fetal tissues and has a high potential to undergo malignant hange. Immature teratoma at anterior skull base with extenion into anterior cranial fossa and nasal cavity is a rare entity. ifferential diagnosis of tumors at this site includes olfactory neuoblastoma, juvenile angiofibroma, fungal granuloma and dermoid yst. Malignant tumors arising from nasal and sinus mucosa like denocarcinoma and squamous cell carcinoma, sarcomas of anteior skull base, bony tumor like chondrosarcoma and metastatic eposits are other rare differential diagnoses to be included in the ist [1].

Nasal Cavity Eosinophilic Angiocentric Fibrosis: CT and MR Imaging Findings

EAF consists of exceedingly rare lesions and presently lacks specific imaging reports. The purpose of this study was to determine the CT and MR imaging features of nasal cavity EAF. We retrospectively reviewed 6 patients with histology-proven EAF in the nasal cavity. All 6 patients underwent CT and 3 patients also underwent MR imaging. The following imaging features were reviewed: 1) location, 2) shape, 3) margin, 4) CT attenuation, and 5) MR imaging signal intensity. In addition, the accompanying changes and the TIC of the DCE MR imaging were analyzed. All occurrences of EAF were located at the anterior nasal cavity, arising from the nasal septum in 4 patients, with irregular shape, and the lateral nasal wall in 2, with oval configuration. The mean size was 29.8 mm (range 12-52 mm). On nonenhanced CT, EAF lesions appeared isoattenuated relative to gray matter. On the T1-weighted image, the lesions were isointense in 3 (100%) patients. On the T2-weighted image, the lesions were isointense in 1 (33.3%) patient and hypointense in 2 (66.7%) patients. Occurrences of EAF revealed moderate inhomogeneous contrast enhancement. Three patients underwent DCE MR imaging and the TICs exhibited a rapidly enhancing and slow washout pattern. One patient had bilateral lacrimal gland enlargement, which displayed low signal intensity on the T2-weighted image. A familiarity with imaging findings, including lesion location, isoattenuation and bony changes, and hypointensity on T2-weighted images may help to accurately diagnose this rare entity.

O1-S03.05 Community-acquired methicillin-resistant and susceptible Staphylococcus aureus among men who have sex with men

BackgroundCommunity Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) has been found more often among men who have sex with men (MSM) in some studies (USA). This study assesses the prevalence and...

Prospective evaluation of aerosol delivery by a powered nasal nebulizer in the cadaver model

The objective of this study was to compare the distribution of aerosol delivered via a powered nasal nebulizer device in 5 fresh frozen-cadaver heads (10 total sides). Nasoneb® (Medinvent, St. Paul, MN) was used to deliver a total volume of 10 mL (9 mL saline and 1 mL of 10% fluorescein). Aerosol distribution was assessed in 3 trials: (1) unoperated nose; (2) post-functional endoscopic sinus surgery (FESS); and (3) post-FESS with endoscopic modified Lothrop procedure (EML). Two independent observers rated the distribution of the fluorescein-dyed saline in the anterior nasal cavity (ANC), olfactory cleft (OC), middle meatus (MM), sphenoethmoid recess (SER), nasopharynx (NP), along with maxillary sinus (MS), ethmoid cavity (EC), sphenoid sinus (SS), frontal sinus (FS), and frontal neo-ostium (F-NEO) in the operated specimens. The nebulizer consistently delivered aerosolized saline to the ANC, MM/EC, and SER/SS across the 3 trials. A statistically significant increase in delivery was noted to the MM (p = 0.044) post-FESS. In addition, a statistically significant increase in delivery to the F-NEO was noted post-FESS with EML (p = 0.001). Multiplicity adjustment done for the FESS group showed statistically superior delivery to the EC vs OC (p = 0.031) and FS (p = 0.02) and to the SS vs FS (p = 0.031). Multiplicity adjustment after FESS with EML improved delivery to the FS, resulting in no statistical difference in aerosol delivery between F-NEO and EC or SS. The nebulizer consistently delivered aerosolized saline to multiple nasal subsites, with improvement in delivery seen to the middle meatal region after FESS and F-NEO after FESS with EML. This may have important implications for the delivery of topical medications to the paranasal sinuses in the postoperative setting.