Bilateral Nasal Cavity Research Articles

Clinical Study and Management of Epistaxis.

Epistaxis is the most common emergency in otorhinolaryngology affecting up to 60% of the population in their lifetime. There are various local and systemic cause and includes both medical and surgical management. This study has been undertaken to study various etiopathogenesis and management of epistaxis. This is a prospective hospital-based study conducted on 100 patients of all age groups and both genders presenting with epistaxis to the Department of Otorhinolaryngology both on outpatient and inpatient basis. A detailed history taking with clinical examination is done. Data is entered in a structured performa, master chart prepared and is subjected to statistical analysis by SPSS software version 23. The most common age group was first decade (26%) followed by fourth decade (15%) with male (71%) predominance. Anterior epistaxis (87%) and bilateral nasal cavity involvement (65%) was predominantly seen. Most common causes for epistaxis are trauma (20%) followed by nasal infections (18%) and hypertension (17%). Majority of the patients underwent medical line of treatment (80%) followed by anterior nasal packing (12%), surgical intervention (7%), posterior nasal packing (1%). Epistaxis needs immediate restoration of hemodynamic parameters with first aid, airway assessment and control of bleeding. Majority of the cases were managed conservatively which is safe and cost effective method. Patients should be advised to avoid strenuous activity, nose picking and vigorous nose blowing. Severe recurrent epistaxis needed invasive interventions like nasal packing and blood transfusion.

Clinical characteristics, diagnosis and treatment of nasal cartilage mesenchymal hamartoma in infants

Objective: To explore the clinical characteristics, pathological features, and diagnosis and treatment strategies of nasal chondromesenchymal hamartoma (NCMH) in infants and young children. Methods: A retrospective analysis was conducted on seven cases of NCMH infants and young children admitted to Beijing Children's Hospital, Capital Medical University from April 2015 to January 2022. The cohort included 5 males and 2 females, aged from 6 days to 2 years and 3 months. General information, clinical symptoms, imaging findings, treatment plans, postoperative complications, recurrence and follow-up time were collected, summarized and analyzed. Additionally, immunohistochemical characteristics of the lesion were examined. Results: The clinical symptoms of 7 children included nasal congestion, runny nose, open mouth breathing, snoring during sleep, difficulty feeding, and strabismus. All patients underwent electronic nasopharyngoscopy examination, with 5 cases of tumors located in the right nasal cavity and 2 cases in the left nasal cavity. No case of bilateral nasal cavity disease was found. All 7 patients underwent complete imaging examinations, with 5 patients underwent MRI and CT examinations, 1 patient underwent CT examination only, and 1 patient underwent MRI examination only. The CT results showed that all tumors were broad-based, with uneven density, multiple calcifications and bone remodeling, and some exhibited multiple cystic components. The MRI results showed that the tumor showed low signal on T1 weighted imaging and high or slightly high signal on T2 weighted imaging. All patients were diagnosed through histopathological examination and immunohistochemistry, including 7 cases of Ki-67 and SMA (+), 5 cases of S-100 and Vimentin (+), and all EMA and GFAP were negative. All patients underwent endoscopic resection surgery through the nasal approach, with 3 cases using navigation technology. Five cases of tumors were completely removed, and two cases of tumors were mostly removed. No nasal packing was performed after surgery, and no postoperative nasal, ocular, or intracranial complication occurred in all patients. Follow up assessments conducted 6 to 84 months post-surgery revealed no instances of tumor recurrence in any of the patients. Conclusions: The clinical symptoms of children with NCHM mainly depend on the size and location of the tumor. Nasal endoscopic surgery is the main treatment method. In cases where critical structures like the skull base or orbit are implicated, staged surgical interventions may be warranted. Long-term follow-up is strongly advised to monitor for any potential recurrence or complications.

Extra nasopharyngeal angiofibroma: A deviant clinical presentation of angiofibroma

Nasopharyngeal angiofibroma is a benign vascular locally aggressive lesion that arises from a hamartomatous nidus, with nasopharynx being the most common and earliest site of presentation. However deviance to such presentation have been reported although rare, such as turbinates, nasal septum and retroantral space. Classical nasopharyngeal angiofibroma routinely presents with chief complaints of nasal obstruction and characteristic painless, recurrent and spontaneous epistaxis with choanal banking effect. Our case depicts the unique and rare presentation of angiofibroma as a progressive cheek swelling in an adolescent male without any nasal symptoms. Diagnostic nasal endoscopy revealed a normal bilateral nasal cavity and nasopharynx. Contrast Enhanced Computed Tomography (CECT) of PNS and face aided the diagnosis. Complete surgical clearance was achieved post embolization via maxillary swing approach. Diagnosis was confirmed on histopathology. Extra nasopharyngeal angiofibroma may be a rare entity however must be considered as a differential diagnosis in vascular skull base tumours.

Clinicopathological features of intravascular large B-cell lymphoma and collision tumors of five cases

Objective: To investigate the clinicopathological characteristics, diagnosis and differential diagnosis of intravascular large B-cell lymphoma (IVLBCL) and its collision tumors. Methods: Five cases of IVLBCL were collected, including 2 cases of collision tumors, and 1 case complicated with liver cirrhosis. The morphology and immunophenotype were analyzed. The related literature was reviewed. Results: There were 2 females and 3 males, aged from 53 to 73 years, with a median age of 65 years. The tumors were located in the lower extremities, right cerebellar hemisphere, left kidney, bilateral nasal cavity, and liver, respectively. Cases 2 and 3 were incidentally found in meningioma and renal cell carcinoma tissues, respectively. Case 5 had a background of liver cirrhosis. Morphologically, atypical large lymphoid cells were located in small blood vessels and capillary lumen, with little cytoplasm, hyperchromasia, prominent nucleoli, and obvious mitotic figures. Immunohistochemically, the IVLBCL tumor cells expressed CD20 and PAX5; 2 cases were CD5 positive. One of the 5 cases was GCB phenotype, and 4 cases were non-GCB phenotype. All cases expressed C-MYC (positive rate was 10%-40%). PD-L1 was positive in 4 cases (positive rate was 60%-90%). Ki-67 proliferation index was 70%-90%. CKpan, CD3, TDT, and CD34 were negative. In case 2, meningioma cells were positive for PR, EMA, and vimentin, but negative for CKpan and PD-L1. In case 3, renal carcinoma cells were positive for CKpan, PAX8, EMA, vimentin, CAⅨ and CD10, while PD-L1 was negative. No EBER expression (by in situ hybridization) or C-MYC gene translocation (FISH, break-apart probe) was detected in any of the 5 cases. Three patients were followed up, and all died within 1-13 months. Conclusions: IVLBCL is a highly aggressive lymphoma, with occult clinical manifestations and poor prognosis. Collision tumors of IVLBCL are extremely rare. A better understanding of IVLBCL would help pathologists avoid misdiagnoses.

Coincidence of chronic rhinosinusitis with nasal polyps and neurofibroma

Background: Nasal polyps are painless inflammatory lesions originated from around the middlemeatus or paranasal sinus cavity; while neurofibroma is benign peripheral nerve sheath tumor. Purpose:To report a rare case of neurofibroma concurrently with nasal polyps in chronic rhinosinusitis. Casereport: A 64-year-old female with chief complaint congestion on the right nose cavity. There was a mass on both nasal cavities. Patient diagnosed with benign mass at right nasal cavity and chronic rhinosinusitis with nasal polyps at left nasal cavity; with a differential diagnosis of chronic rhinosinusitis with bilateral nasal polyps. Computer tomography scan results showed homogeneous isodense lesion in the right nasal cavity, and mucosal thickening in left nasal cavity and maxillary sinus. Patient was managed with total extirpation of the bilateral nasal cavity mass and functional endoscopic sinus surgery. Pathological examination revealed neurofibroma in the right nasal cavity and polyps in the left nasal cavity. Clinical question: “How to differentiate inflammation with tumor of nasal and paranasal sinuses? Is there a causal relationship?” Review method: Literature searching was performed with the keywords “nasal cavity neurofibroma”, AND “nasal polyps”, AND ”chronic rhinosinusitis” through database Google Scholar, PubMed, and hand searching/e-book. Result: There were 11 literatures published in the last 5 years, and 7 articles relevant with the subject. Conclusion: Chronic rhinosinusitis with nasal polyps, along with neurofibroma on nasal cavity is a rare co-incidence, and there was no correlation between those lesions. Pathological examination is a gold standard in differentiating a definite diagnosis of neurofibromas and polyps.Keywords: nasal cavity neurofibroma, nasal polyps, chronic rhinosinusitis

Effect of Septum Deviation on the Airflow Distribution for a Patient Specific Model using Numerical Methods

Septal deviation (SD) in nasal cavity plays a crucial role in symptoms related to nasal obstruction, aesthetic appearance of the nose, and increase in nasal resistance, and may induce snoring. The aim of the present study was to evaluate the significance of SD on the air flow behaviour and compare its deviation with a healthy nasal cavity by using CFD. A 3D CAD model of subject specific nasal cavity was generated from CT images of patient with septal deviation. The variation of maximum WSS observed in the present study was higher when compared with that of normal subjects. In contrast to the healthy subject, the airflow in the septal deviation models showed asymmetry in bilateral nasal cavities. The maximum velocity inside the nasal cavity exceeded the value that was usually found at the nasal valve region. The findings from this study help understand the basic aerodynamics in a severely deviated septum.

An Unusual Clinical Presentation of Extranodal Rosai-Dorfman Disease – A Rare Case Report

Rosai-Dorfman disease is a rare, idiopathic, benign, histiocytic proliferation, usually seen in children and younger adults. Most common site of involvement is cervical lymph node. However, extra nodal manifestations are seen in significant proportion of cases.This case report discusses the unusual presentation of Rosai-Dorfman disease as mass lesion involving bilateral nasal cavities, paranasal sinuses and orbit along with multiple deposits in dura and cervical lymph node.

A Case of Woakes' Syndrome With A Bilateral, Large Nasal Polyp.

Woakes' syndrome, first reported by Edward Woakes in 1885, is an extremely rare, recurrent sinonasal polyposis leading to bone erosion of the sinus walls with consequent nasal pyramid deformity and facial disfigurement. We report a 66-year-old man who presented with severe nasal obstruction. His external nose was deformed and distended with complete obstruction of the bilateral nasal cavities by nasal polyps. The normal structure of the nose was disrupted. Thus, super-selective embolization was performed before surgery to minimize bleeding. The day after the embolization, polypectomy was performed with the navigation system. The progression was uneventful, and the patient was discharged on postoperative day 7. Pathological examination revealed inflammatory polyps with no eosinophil infiltration. Thus, we diagnosed it as Woakes' syndrome. Although there have been few reports of Woakes' syndrome in the past, these are the largest polyps reported to the best of our knowledge.

A randomized controlled trial on triamcinolone versus saline impregnated merocel post endoscopic sinus surgery: Our experience in a tertiary care centre.

To assess the potential benefit of impregnating Merocel (a non-absorbable nasal dressing) with a topical steroid solution, for use as a direct and slow local delivery system of steroids after sinus surgery to improve postoperative wound healing. In this randomized controlled trial, 40 patients with bilateral chronic rhinosinusitis with nasal polyposis were subjected to functional endoscopic sinus surgery. Following the completion of the surgery, Merocel packs were inserted in the bilateral nasal cavities and infiltrated with 4 mL triamcinolone (40 mg/mL) in one nasal cavity (treatment group) and 4 mL normal saline in the other (control group). Nasal packs were removed on the third postoperative day and postoperative healing assessment was done on postoperative Weeks 1, 2, 4, and 12. The findings were noted as per Lund Kennedy (LKES) and perioperative sinus endoscopy (POSE) scores and compared on both sides. Significant (P < 0.05) improvement was noted in Lund Kennedy score for crusting and polyp at Week 12, for edema at Week 1, and nasal discharge at Weeks 1 and 12, but there was no significant improvement in scarring at any week. Overall, the difference between the treatment and control arms was statistically significant at all postoperative visits except at Week 4. Also, there was a significant improvement in POSE scores at Weeks 1, 2, and 12 but not at Week 4. This study positively concludes that the nasal cavity packed with drug-soaked packs had less scarring and edema in the postoperative period and the overall wound healing was much better as compared to saline-soaked packs.

Arginine-Rich Cell-Penetrating Peptide-Mediated Transduction of Mouse Nasal Cells with FOXP3 Protein Alleviates Allergic Rhinitis.

Intranasal corticosteroids are effective medications against allergic rhinitis (AR). However, mucociliary clearance promptly eliminates these drugs from the nasal cavity and delays their onset of action. Therefore, a faster, longer-lasting therapeutic effect on the nasal mucosa is required to enhance the efficacy of AR management. Our previous study showed that polyarginine, a cell-penetrating peptide, can deliver cargo to nasal cells; moreover, polyarginine-mediated cell-nonspecific protein transduction into the nasal epithelium exhibited high transfection efficiency with minimal cytotoxicity. In this study, poly-arginine-fused forkhead box P3 (FOXP3) protein, the "master transcriptional regulator" of regulatory T cells (Tregs), was administered into the bilateral nasal cavities of the ovalbumin (OVA)-immunoglobulin E mouse model of AR. The effects of these proteins on AR following OVA administration were investigated using histopathological, nasal symptom, flow cytometry, and cytokine dot blot analyses. Polyarginine-mediated FOXP3 protein transduction induced Treg-like cell generation in the nasal epithelium and allergen tolerance. Overall, this study proposes FOXP3 activation-mediated Treg induction as a novel and potential therapeutic strategy for AR, providing a potential alternative to conventional intranasal drug application for nasal drug delivery.

Nasal and laryngeal sporotrichosis in an immunocompetent individual: a case report

BackgroundSporotrichosis is a subcutaneous mycosis caused by a dimorphic fungus, Sporothrix schenckii infection, that usually results from the traumatic implantation of the fungus into the skin and subcutaneous tissue. Disseminated cutaneous sporotrichosis is a rare entity that usually presents in the immunosuppressed individual. They are sometimes mimicking malignancy and tuberculosis. Here, a rare case of disseminated cutaneous sporotrichosis involving the larynx and nasal cavity in an immunocompetent patient is reported.Case presentationA 54-year-old healthy lady presented with hoarseness and globus sensation over the throat with prior history of multiple skin lesions over the face, limbs, and trunk. Examination revealed erythematous papular lesions over the face, limbs, and trunk. Nasoendoscopy showed sloughy mucosa over bilateral nasal cavities, nasopharynx, base of the tongue, arytenoids, and both vocal folds with bony hard mass at the left frontal recess opening. Overall imaging features were suggestive of generalized fungal infections. Multiple biopsies from multiple sites revealed Sporothrix schenckii infection. She had resolution of the lesion after being treated with intravenous Amphotericin B for a month, oral Voriconazole for another month then oral Itraconazole for 6 months.ConclusionDiagnosis of disseminated sporotrichosis can be tricky and difficult to diagnose as it can mimic other diagnoses. Education is paramount important in identifying the illness as it can be seen in immunocompetent individuals, although it is more common in the immunosuppressed individual.

Recurrent rhinosporidiosis: A case report from Malaysia and review of literature

Over the decades, rhinosporidiosis has remained an enigma. It is a recalcitrant disease caused by Rhinosporidium seeberi, primarily affecting the nasal cavity, conjunctiva, and less frequently involved sites, including skin, urethra, and others. We report a case of a local from Sabah who has presented with recurring symptoms of nasal obstruction and epistaxis for two decades. He had previously undergone multiple endoscopic excisional surgeries before receiving treatment at our centre. Otorhinolaryngeal examination revealed polypoidal masses occupying bilateral nasal cavities with a perforation of the nasal septum. He underwent surgical resection of the lesions, and the histopathological examination confirmed recurrent rhinosporidiosis. Due to its sporistatic effects, dapsone was chosen as the pharmacological treatment in this case. However, after a year of follow-up, he developed similar symptoms and the endoscopic findings, indicated a recurrence of the disease. The histopathological samples obtained during the repeated surgery for recurrent polypoidal masses, confirmed the diagnosis of rhinosporiodiosis. As the disease poses diagnostic and therapeutic challenges, clinicians should be prudent in establishing the diagnosis in non-endemic areas, such as Malaysia, and evaluating the possibility of recurrence.

Kartagener’s syndrome: a rare case report

&lt;p class="abstract"&gt;Kartagener's syndrome is an autosomal recessive primary ciliary dyskinesia. It is due to ciliary dysfunction consisting of triad of situs inversus, bronchiectasis, chronic sinusitis. Normal ciliary function is critical for respiratory host defence, motility of sperm and ensures proper visceral orientation during embryogenesis. In Kartagener syndrome, the gene mutation is at DNAI1 and DNAH5 leading to pathophysiological changes like ciliary immobility causing accumulation of secretions and consequent recurrent sinusitis. The severity of symptoms and the age at which the condition is diagnosed is quite variable, even though the symptoms are present from birth. We are reporting a case of 12-year-old male who came to ear, nose and throat outpatient department (ENT OPD) with complaints of bilateral nasal obstruction for the past 6 years associated with bilateral mucopurulent nasal discharge, having pale, greyish white polyps filling bilateral nasal cavities. Clinical examination and imaging findings revealed ethmoidal polyposis with chronic sinusitis, bronchiectasis, and situs inversus totalis. Patient underwent revision endoscopic intranasal ethmoidectomy with functinal endoscopic sinus surgery.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Republication de : Endoscopic modified transseptal bi-nostril approach for pituitary tumors. Efficacy of complex preservation of every turbinate and olfaction: A STROBE analysis

Endoscopic modified transseptal bi-nostril approach minimizes turbinate and olfactory mucosal invasion and ensures preservation of the turbinates and bilateral olfaction. The main objective of this study was to investigate the pre- and postoperative variations in olfactory function in patients using this approach, and the secondary objective was to investigate the complications associated with the surgical procedure. This study is a single-center prospective cohort study using STROBE analysis. To completely protect the bilateral turbinates and olfactory epithelium, this procedure provided access to the sphenoid sinus by a transseptal approach via the left nasal cavity and by the olfactory cleft approach via the right nasal cavity without any turbinate resection. A T&T olfactometer was used to assess the mean recognition threshold of the left, right, and bilateral nasal passages before and after surgery, and complications associated with the surgical approach were investigated. We included 27 patients who underwent endoscopic modified transseptal pituitary surgery with an olfactory and turbinate preservation approach at our hospital between April 2018 and December 2019. The mean postoperative recognition threshold of the right, left, and bilateral nasal cavities did not worsen (P < 0.001 for all) relative to the preoperative values, and there was no difference in values between the right and left nasal cavities (P = 0.85). The nasal turbinates were preserved in all patients during the study period, and no recurrence was observed. Our modified EETSA could be implemented as an approach for turbinate and olfaction preservation.

The Mystery of the Disappearing Nasal Packs

Nasal packing is commonly used for hemostasis post nasal surgeries. It is cheap, easily available and is routinely practiced in many centres. However, they may be associated with complications. Some of the complications include pain during nasal packing removal, damage or injury to the nasal mucosa leading to synechiae formation, crusting, and septal perforation. We describe a case of a 39-year-old gentleman who underwent a septoturbinoplasty procedure, to address his nasal problem and subsequently nasal packing was inserted into bilateral nasal cavity for hemostasis. However, prior to extubation, it was noted that the nasal packing were not in situ. Nasoendoscopy and direct laryngoscopy were performed but were unable to trace the missing nasal packs. An Oesophagogastroduodenoscopy (OGDS) was done and revealed the presence of the nasal packing in the stomach. This case highlighted the risk of nasal packing to be dislodged from the nasal cavity into the stomach if not secured properly, and therefore we recommended securing the nasal packing in its position by tying a knot using the strings attached with the nasal packing together.International Journal of Human and Health Sciences Vol. 06 No. 04 Oct’22 Page: 442-444

Endoscopic modified transseptal bi-nostril approach for pituitary tumors. Efficacy of complex preservation of every turbinate and olfaction: A STROBE analysis

AimsEndoscopic modified transseptal bi-nostril approach minimizes turbinate and olfactory mucosal invasion and ensures preservation of the turbinates and bilateral olfaction. The main objective of this study was to investigate the pre- and postoperative variations in olfactory function in patients using this approach, and the secondary objective was to investigate the complications associated with the surgical procedure. Material and methodsThis study is a single-center prospective cohort study using STROBE analysis. To completely protect the bilateral turbinates and olfactory epithelium, this procedure provided access to the sphenoid sinus by a transseptal approach via the left nasal cavity and by the olfactory cleft approach via the right nasal cavity without any turbinate resection. A T&T olfactometer was used to assess the mean recognition threshold of the left, right, and bilateral nasal passages before and after surgery, and complications associated with the surgical approach were investigated. ObjectivesWe included 27 patients who underwent endoscopic modified transseptal pituitary surgery with an olfactory and turbinate preservation approach at our hospital between April 2018 and December 2019. ResultsThe mean postoperative recognition threshold of the right, left, and bilateral nasal cavities did not worsen (P<0.001 for all) relative to the preoperative values, and there was no difference in values between the right and left nasal cavities (P=0.85). The nasal turbinates were preserved in all patients during the study period, and no recurrence was observed. ConclusionOur modified EETSA could be implemented as an approach for turbinate and olfaction preservation.

Allergic Fungal Sinusitis with Bilateral Optic Neuropathy

Introduction Allergic Fungal Rhinosinusitis (AFRS) is characterized by an inflammatory response to a non-invasive fungus which leads to sinus obstruction. Ophthalmic manifestations of AFRS are rare but can be of grave consequence. Case Report A 22-year-old female patient presented with a 5-day history of headache and decreased vision in both eyes (right- perception of light; left-6/18), along with a past history of nasal blockage and recurrent rhinorrhoea. She had thick viscid mucous secretion with polyposis in bilateral nasal cavities. Computed tomography showed pansinusitis with heterogenous opacification and polypoidal mucosal hypertrophy. Bony erosion was seen in bilateral orbital apices with oedematous optic nerves. MRI was suggestive of bilateral optic neuritis. Patient underwent emergency surgical debridement via endoscopic sinus surgery. Histopathological examination of the specimen showed cellular debris, eosinophilic prominence and numerous Charcot-Leyden crystals, with presence of branched septate fungal hyphae. Fungal culture grew Aspergillus flavus. Patient was treated with steroids (injectable followed by oral in gradually tapering doses). Over a period of 3 months vision returned to normal. Conclusion Vision loss is a rare complication of AFRS and constitutes an emergency. Prompt treatment with surgical debridement and corticosteroids is essential for reversal of visual complications.

Radiography, CT, and MRI Diagnosis of Enzootic Nasal Tumor in Goats Infected With Enzootic Nasal Tumor Virus.

The aim of this study was to describe radiography, computed tomography (CT), and magnetic resonance imaging (MRI) findings of enzootic nasal tumors in goats infected with enzootic nasal tumor viruses. Five of six goats with a mean age of 2 years, showed clinical signs of respiratory disease. Head radiographs showed increased density of the unilateral or bilateral nasal cavity in four goats, and a CT scan showed that the space-occupying lesion of the nasal cavity originated from the ethmoid bone and was enhanced homogeneously postcontrast in all goats. The nasal concha was destroyed and the paranasal sinus mucosa was thickened and filled with fluid in some goats. On MRI, the mass exhibited equal or slightly higher signal intensity on T2 weighted images, equal signal intensity on T1 weighted images, a high signal on fluid-attenuated inversion recovery images and heterogeneous enhancement postcontrast. After dissection, histopathological examination of the mass and virus genome detection of the nasal secretions confirmed that the intranasal mass was a low-grade adenocarcinoma and that the goats were infected with enzootic nasal tumor virus type 2. In conclusion, CT and MRI have high diagnostic values for enzootic nasal tumors because they match the postmortem findings and are more accurate than radiography.

Rapid Maxillary Expansion Has a Beneficial Effect on the Ventilation in Children With Nasal Septal Deviation: A Computational Fluid Dynamics Study.

Nasal septal deviation (NSD) is one of the most common nasal diseases. Different from common clinical examination methods, computational fluid dynamics (CFD) can provide visual flow information of the nasal cavity. The dimension and volume of the nasal cavity are easily affected by rapid maxillary expansion (RME). The purpose of this study was to use CFD to evaluate the effect of RME on the aerodynamics of the nasal cavity in children with maxillary transverse deficiency and NSD. Computational fluid dynamics was implemented after 3D reconstruction based on the CBCT of 15 children who have completed RME treatment. After treatment, the volume increases in the nasal cavity, nasopharynx, oropharynx, and pharynx were not statistically significant. The wall shear stress of the nasal cavity after RME, 1.749 ± 0.673 Pa, was significantly lower than that before RME, 2.684 ± 0.919 Pa. Meanwhile, the maximal negative pressure in the pharyngeal airway during inspiration was smaller after RME (−31.058 Pa) than before (−48.204 Pa). This study suggests that RME has a beneficial effect on nasal ventilation. The nasal airflow became more symmetrical in the bilateral nasal cavity after RME. Pharyngeal resistance decreased with the reduction in nasal resistance and the increase in the volume of oropharynx after RME.

Sinonasal aneurysmal bone cyst mimicking hemangioma

BackgroundAneurysmal bone cyst (ABC) is a benign, expansile bony lesion, primarily found in long bones. It is uncommon in facial bones and exceptionally rare in the sphenoethmoid sinus.Case presentation: A 28-year-old male presented with complaints of bilateral nasal block and recurrent epistaxis. Rhinoscopy examination showed a lobulated lesion in the bilateral posterior nasal cavity and nasopharynx. A nasopharyngeal angiofibroma was suspected on radiological assessment. Pre-operative incisional biopsy revealed the tumor as hemangioma. With a probable diagnosis of hemangioma, the lesion was explored under general anesthesia. An endoscopic endonasal excision of a tumor mass attached to the sphenoid skull base was undertaken. Histopathological examination of the resected tissue confirmed the diagnosis of an aneurysmal bone cyst.Conclusion ABC should be considered a rare differential for a hemorrhagic sinonasal mass in a young adult. Histopathological examination of the excised tissue is mandatory for a confirmatory diagnosis. Radiologic assessment and pre-operative incisional biopsy are essential from the diagnostic point of view; however, they can often cause a diagnostic dilemma with other vascular tumors such as nasopharyngeal angiofibroma or hemangioma.