Nasal Cartilage Research Articles

Use of Nasal Septal Cartilage in Type 1 Tympanoplasty: Early Anatomical and Functional Outcomes

Use of Nasal Septal Cartilage in Type 1 Tympanoplasty: Early Anatomical and Functional Outcomes

Effect of nasal swell body on nasal airflow and Artemisia pollen deposition

Objective:The nasal swell body（NSB） consists of the nasal septal cartilage, nasal bone, and swollen soft tissue, all of which are visible during endoscopic and imaging examinations. Although the function of the NSB remains uncertain, there is evidence to suggest that it plays a vital role in regulating nasal airflow and filtering inhaled air. Based on anatomical and histological evidence, it is hypothesized that the NSB is indispensable in these processes. This study aims to investigate the impact of NSB on nasal aerodynamics and the deposition of allergen particles under physiological conditions. Methods:The three-dimensional （3D） nasal models were reconstructed from computed tomography （CT） scans of the paranasal sinus and nasal cavity in 30 healthy adult volunteers from Northwest China, providing basis for the construction of models without NSB following virtual NSB-removal surgery. To analyze the distribution of airflow in the nasal cavity, nasal resistance, heating and humidification efficiency, and pollen particle deposition rate at various anatomical sites, we employed the computed fluid dynamics（CFD） method for numerical simulation and quantitative analysis. In addition, we created fully transparent segmented nasal cavity models through 3D printing, which were used to conduct bionic experiments to measure nasal resistance and allergen particle deposition. Results:①The average width and length of the NSB in healthy adults in Northwest China were （12.85±1.74） mm and （28.30±1.92） mm, respectively. ②After NSB removal, there was no significant change in total nasal resistance, and cross-sectional airflow velocity remained essentially unaltered except for a decrease in topical airflow velocity in the NSB plane. ③There was no discernible difference in the nasal heating and humidification function following the removal of the NSB; ④After NSB removal, the deposition fraction（DF） of Artemisia pollen in the nasal septum decreased, and the DFs post-and pre-NSB removal were（22.79±6.61）% vs （30.70±12.27）%, respectively; the DF in the lower airway increased, and the DFs post-and pre-NSB removal were（24.12±6.59）% vs （17.00±5.57）%, respectively. Conclusion:This study is the first to explore the effects of NSB on nasal airflow, heating and humidification, and allergen particle deposition in a healthy population. After NSB removal from the healthy nasal cavities: ①nasal airflow distribution was mildly altered while nasal resistance showed no significantly changed; ②nasal heating and humidification were not significantly changed; ③the nasal septum's ability to filter out Artemisia pollen was diminished, which could lead to increased deposition of Artemisia pollen in the lower airway.

Correction of Short Nose Using M-shaped Cartilage in Asian Patients: Finite Element Analysis and Recommendations for Surgery.

Using M-shaped cartilage grafts is a new method for the correction of short nose deformity with good effect for Asians. Although the basic approach to M-shaped cartilage surgery is well understood, there is a great deal of uncertainty when plastic surgeons perform the procedure, and still a lack of standard guidance on the specific details. In this study, the authors used finite element analysis to explore and compare postoperative cartilage stability of different fixing methods, different suturing positions, and different sizes of M-shaped cartilage. The authors applied a 0.01 N load to a 1 cm2 area of the nasal tip to simulate nasal tip palpation and compared the maximum deformations of different groups, which were used to make stability judgments. The maximum deformation of the model was the leastwhen the M-shaped cartilage was fixed medially to the septal cartilage and laterally to the outer crura of the lower lateral cartilage. At the same time, the maximum deformation was the least when the M-shaped cartilage was sutured to the middle of the nasal septal cartilage. Besides, the length of M-shaped cartilage was preferably around 30 mm, while its width was not worthy of being overly concerned. For optimal postoperative stability of Asian short nose correction, the M-shaped cartilage should be sutured and fixed medially to the middle of the septal cartilage and laterally to the lateral crura of the lower lateral cartilage, and the length of the M-shaped cartilage should be controlled at around 30 mm. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Modified Drilled Extended Spreader Grafts in Asian Rhinoplasty: Clinical Application and Histopathological Analysis.

Extended Spreader Grafts (ESGs) are widely used for both esthetic and functional purpose in rhinoplasty. This study aims to examine the effects of drilling on ESGs in rhinoplasty and their clinical benefits, as well as to analyze their histologic characteristics. We conducted a retrospective review of patients undergoing esthetic rhinoplasty using drilled ESGs with autologous costal cartilage by a senior surgeon from January 2018 to April 2022. A total of 80 patients were included, with a mean follow-up period of 26 months. Revision operations were performed on 4 patients. The phenomenon of tissue ingrowth from the septum mucoperichondrium to the septal cartilage through the holes of the drilled ESGs was observed in all 4 patients. Specimens of the ingrown tissue were taken from 3 patients during their revision surgeries. Vascular structures and connective tissue were observed in the specimens after fixation, paraffin embedding, and staining with hematoxylin-eosin. No other complications were observed except for 2 cases presenting cartilage warping after surgery. Application of the drilled ESGs is a simple but effective approach, which has 3 significant advantages in rhinoplasty: enhancing the stability of the cartilaginous framework through connective tissue ingrowth, preserving the septal cartilage, and providing septum vitality by allowing the formation of vascular structures between the perichondrium and the septal cartilage; reducing the probability of warping in early stages through release the tension force of the cartilage itself. Level IV.

PS12 A new meaning to ‘picking your nose’: the use of N-acetylcysteine to treat trigeminal trophic syndrome

Abstract Trigeminal trophic syndrome (TTS) is a rare condition in which patients induce unilateral facial ulceration by persistent physical manipulation. Peripheral or central damage to the trigeminal nerve causes anaesthesia, paraesthesia, formication or pruritus. Compulsive skin picking leads to ulceration of the ala nasi, cheek, scalp or mouth in the distribution of the trigeminal nerve. Patients with TTS are often subjected to extensive investigations and can be misdiagnosed as having a psychocutaneous disorder, such as dermatitis artefacta, skin-picking disorder or delusional parasitosis. We describe a 90-year-old woman who developed TTS following rhizotomy and radiofrequency treatment for trigeminal neuralgia. Underlying infectious, malignant and vasculitic causes for her ala nasi and cheek ulceration were ruled out through six incisional biopsies and two punch biopsies over 8 years. Previous treatment of TTS has included patient education and physical barriers (e.g. face masks and occlusive dressings). Treatment to date has been challenging, with trials of medications to address paraesthesia, including carbamazepine, gabapentin and amitriptyline. This patient re-presented to dermatology in 2022 with significantly worsened ulceration to her cheek and severe loss of nasal cartilage. In September 2022, the patient was started on N-acetylcysteine (NAC) 600 mg twice daily, and within 3 months, there was a considerable improvement. This drug is a mucolytic that has historically been used as an antidote for paracetamol overdose. It has antioxidant properties by replenishing glutathione and maintaining redox balance within cells. It also modulates neurotransmitters and can increase glutamate and alter dopamine levels. In addition, it has anti-inflammatory action by inhibiting interleukins (ILs), including IL-6 (Adil M, Amin SS. N-acetylcysteine in dermatology. Indian J Dermatol Venereol Leprol 2018; 84:652). In recent years, NAC has been reported to be successful in small case series and case reports among patients with trichotillomania, skin-picking disorders, onychotillomania, toxic epidermal necrolysis, alopecia, contact dermatitis, atopic dermatitis and wound healing (Grant JE, Chamberlain SR, Redden SA, Leppink EW. N-Acetylcysteine in the treatment of excoriation disorder. JAMA Psychiatry 2016; 73:490). It is an inexpensive drug that appears to be well tolerated and effective. To our knowledge, this is the first case report of the use of NAC in TTS. In summary, this was a case of TTS in a 90-year-old woman who successfully responded to NAC. The drug has antioxidant, anti-inflammatory and neurotransmitter modulatory effects. Reliable randomized controlled studies are needed to confirm the efficacy and optimum dose of NAC. Increased awareness of this rare syndrome and potential treatment options will ensure prompt diagnosis and prevention of permanent disfiguration.

Preparation, structure characterization, and stability analysis of peptide-calcium complex derived from porcine nasal cartilage type II collagen.

Porcine nasal cartilage type II collagen-derived peptides (PNCPs) may be complexed with calcium to provide a highly bioavailable, low-cost, and effective calcium food supplement. However, the calcium-binding characteristics of PNCPs have not yet been investigated. In the present study, calcium-binding peptides were derived from porcine nasal cartilage type II collagen and the resulting PNCPs-Ca complex was characterized. The study reveals that the calcium-binding capacity of PNCPs is closely related to enzymatic hydrolysis conditions. The highest calcium-binding capacity of PNCPs was observed at a hydrolysis time of 4 h, temperature of 40 °C, enzyme dosage of 1%, and solid-to-liquid ratio of 1:10. Scanning electron microscopy and energy dispersive X-ray spectroscopy revealed that the PNCPs had a pronounced capacity for calcium binding, with the PNCPs-Ca complex exhibiting a clustered structure consisting of aggregated spherical particles. Fourier-transform infrared spectroscopy, fluorescence spectroscopy, X-ray diffraction, dynamic light scattering, amino acid composition, and molecular weight distribution analyses all indicated that the PNCPs and calcium complexed via the carboxyl oxygen and amino nitrogen atoms, leading to the formation of a β-sheet structure during the chelation process. In addition, the stability of the PNCPs-Ca complex was maintained over a range of pH values consistent with those found in the human gastrointestinal tract, facilitating calcium absorption. These research findings suggest the feasibility of converting by-products from livestock processing into calcium-binding peptides, providing a scientific basis for the development of novel calcium supplements and the potential reduction of resource waste. © 2023 Society of Chemical Industry.

The Effect of Trans-Sutural Distraction Osteogenesis on Nasal Bone, Nasal Septum, and Nasal Airway in the Treatment for Midfacial Hypoplasia in Growing Patients.

The purposes of this study were to analyze the effect of trans-sutural distraction osteogenesis (TSDO) on nasal bone, nasal septum, and nasal airway in the treatment of midfacial hypoplasia. A total of 29 growing patients with midfacial hypoplasia who underwent TSDO by a single surgeon were enrolled. The 3-dimensional measurement of nasal bone and nasal septum changes was performed using computed tomography (CT) images obtained preoperatively (T0) and postoperatively (T1). One patient was selected to establish 3-dimensional finite element models to simulate the characteristics of nasal airflow field before and after traction. After traction, the nasal bone moved forward significantly (P<0.01). The septal deviation angle was lower than that before traction (14.43±4.70 versus 16.86 ±4.59 degrees) (P<0.01). The length of the anterior and posterior margin of the vomer increased by 21.4% (P<0.01) and 27.6% (P<0.01), respectively, after TSDO. The length of the posterior margin of the perpendicular plate of ethmoid increased (P<0.05). The length of the posterior inferior and the posterior superior margin of the nasal septum cartilage increased (P<0.01) after traction. The cross-sectional area of nasal airway on the deviated side of nasal septum increased by 23.0% after traction (P<0.05). The analysis of nasal airflow field showed that the pressure and velocity of nasal airflow and the nasal resistance decreased. In conclusion, TSDO can promote the growth of the midface, especially nasal septum, and increase the nasal space. Furthermore, TSDO is conductive to improve nasal septum deviation and decrease nasal airway resistance.

Concha-Type Microtia: New Surgical Incision.

Reconstruction of auricles for conchal-type microtia is challenging but rewarding. Many plastic surgeons consider autogenous rib cartilage as the standard material for framework fabrication. A healthy, scar-free skin envelope and a defined cartilaginous framework are also critical to successful ear reconstruction. The aim of this study was to improve the outcome of the reconstruction and minimize complications by proposing a new surgical incision. Thirty-three patients who underwent auricular reconstruction of concha-type microtia of various etiologies with the new skin flap incision between 2017 and 2022 were included in the study. Patients' clinical data, detailed surgical techniques, and postoperative care were recorded. Thirty-three patients (21 male, 12 female) were enrolled in the study. The mean age of the patients was 21.51 years at the time of reconstruction. The microtia was on the right side in 17 cases, on the left side in 12 cases, and 4 cases were bilateral; 12 cases were traumatic amputations of the helical component of the auricle, 11 cases were deformities after a burn, and 10 cases were congenital. The mean follow-up time was 17.43 months. A good initial projection without obvious scarring on the anterior surface of the auricle was achieved, with an overall complication rate of 5.42%. The surgical incision recommended in the study improves the final aesthetic result of the technique without any additional surgical risk.

Second Harmonic Imaging of Nasal, Auricular, and Costal Cartilage.

There is little knowledge about the histological organization of facial and costal cartilages in terms of matrix structure and cell morphology. Second harmonic generation (SHG) imaging is a nonlinear imaging technique that capitalizes on signal generation from highly ordered macromolecules such as collagen fibers. The purpose of this study was to use SHG microscopy to image collagen extracellular matrix (ECM) structure, chondrocyte size, and density of these cartilages. Experimental. Surgical remnants of septal, lower lateral, rib, and auricular cartilages were collected following surgery, sectioned into 0.5-1 mm thick samples and fixed to facilitate batch process imaging. A Leica TCS SP8 MP Microscope and multiphoton laser were used to image the specimens. Images were analyzed for cell size, cell density, and collagen fiber directionality patterns using ImageJ. SHG images of septal specimens show mesh-like structure of the ECM. There appears to be a superficial layer, characterized by flattened lacunae and middle zone, marked by circular lacunae clusters, similar to what is observed in articular cartilage. The structure of the ECM depicts a visible orientation perpendicular to the surface of the perichondrium. Cell size and density analysis through ImageJ suggests variety across cartilage types. Directionality analysis indicates that the collagen in the ECM displays preferred direction. This study establishes clear extracellular models of facial and costal cartilages. Limitations include heterogeneous cartilage thickness due to processing difficulties. Further studies include automating the cutting process to increase uniformity of tissue thickness and increasing sample size to further validate results. 2 Laryngoscope, 133:3370-3377, 2023.

Role of Rib Graft for Tip Shaping in Primary Rhinoplasty: A Retrospective Case Series of 30 Patients.

In primary rhinoplasty, use of harvested septal cartilage often precludes the need for rib graft. Nonetheless, there are a number of indications for the use of rib graft in primary rhinoplasty. The purpose of this study was to identify the indications and techniques for rib graft use in primary rhinoplasty. A retrospective review was performed on all patients who underwent primary rhinoplasty performed by a single surgeon over a 5-year period. From these patients, those who required the use of fresh frozen allograft rib cartilage were identified. Medical record review was performed to identify demographics, ethnicity, and history of nasal trauma. Photographic analysis was also performed. Thirty of 638 consecutive primary rhinoplasties (4.7%) required rib graft. Of these, 7 patients (23.3%) demonstrated a history of nasal trauma. Furthermore, a high proportion of primary rhinoplasty patients requiring rib graft were from Asian ( n = 7 [23.3%]), Middle Eastern ( n = 4 [13.3%]), Hispanic ( n = 7 [23.3%]), and African American ( n = 9 [30%]) backgrounds. White patients were in the minority ( n = 2 [6.7%]). All primary rhinoplasties using rib graft implemented a septal extension graft. The present study demonstrates that patients requiring a rib graft in primary rhinoplasty invariably receive a septal extension graft. Furthermore, certain ethnicities associated anatomical characteristics correlated with the need for a rib graft for tip shaping. Ultimately, the use of a septal extension graft in primary rhinoplasty allows for precise and robust projection, rotation, and tip shaping in noses with thick skin, weak cartilaginous framework, and history of nasal trauma. Risk, IV.

Effect of targeted responsibility system nursing combined with psychological intervention on compliance and complications of patients with autologous nasal septum and ear cartilage transplantation.

The purpose was to explore the effect of targeted responsibility system nursing combined with psychological intervention on compliance and complications of patients with autologous nasal septum cartilage and ear cartilage transplantation filling. A retrospective analysis of the clinical data of 80 patients who underwent rhinoplasty with autologous septal cartilage and ear cartilage graft filling was conducted. Patients before the implementation of the "targeted accountable care combined with psychological intervention" program from January 2020 to December 2020 were set up as the control group (N.=40), and patients after the implementation of the program from January 2021 to December 2021 were set up as the study group (N.=40). The Hamilton Anxiety Scale (HAMA), Lund-Kennedy Endoscopy Score, Hamilton Depression Scale (HAMD), treatment compliance, and complications were compared between the two groups. At two weeks postoperatively, HAMA and HAMD were lower in the study group than in the control group (t=9.087, 9.265, P<0.05), and bilateral Lund-Kennedy scores were lower in the study group than in the control group (t=8.761, 10.267, P<0.05). The study group had a higher compliance excellence rate (75.00% vs. 52.50%) than the control group (χ2=4.021, P<0.05) and a lower complication rate (7.50% vs. 27.50%) than the control group (χ2=4.242, P<0.05). Targeted accountable care combined with psychological intervention can alleviate negative emotions in patients with nasal septum cartilage and ear cartilage graft filling, reduce the risk of postoperative soft tissue edema and other complications, and improve patient compliance with treatment.

Case Report: Case report: An unusual presentation of granulomatosis with polyangiitis

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

Comparison of growth factors isolated from exosomes present in maternal blood of cleft and non-cleft infants for identification and quantification of growth factors involved in the growth and development of cartilage.

Background: Cleft lip and palate (C.L.P.) is a common congenital condition which affects the orofacial region. The aetiology of C.L.P. is multifaceted and involves genetic and environmental factors that impact the shape and position of the nasal cartilage, resulting in an asymmetrical appearance of the nose. Growth factors are crucial in regulating cartilage synthesis and repair. Exosomes have emerged as a promising cell-free drug delivery system that facilitates intercellular communication and maintains tissue homeostasis. This study identifies and quantifies the growth factors present in exosomes derived from lactating maternal blood of cleft and non-cleft infants and compares them to evaluate the differences. The study aims to assess the potential of these exosomes as a therapeutic approach for C.L.P. management. Methods: Blood samples were collected from lactating mothers at Sharad Pawar Dental College and isolating plasma using centrifugation. Exosome and total protein isolation will be conducted in the laboratory, and immunoblotting will evaluate growth factors. Quantitative and comparative protein and growth factor analysis will be conducted separately for maternal blood samples. Results: The growth factors responsible for cartilage growth and development will be present in maternal exosomes, potentially leading to novel therapies for C.L.P. management. The study aims to demonstrate the therapeutic potential of exosomes, as carriers of intra-cellular factors, in transporting growth factors to the required site for managing C.L.P. Conclusions: Overall, by understanding the roles played by growth factors, intercellular communication, and genetic and environmental factors in the aetiology of C.L.P., this research can contribute to creating effective treatment strategies for C.L.P. management. Finding growth factors in exosomes made from the blood of nursing mothers could be a cutting-edge therapeutic strategy for treating C.L.P.

Disruption of BMP4 signaling is associated with laryngeal birth defects in a mouse model

Laryngeal birth defects are considered rare, but they can be life-threatening conditions. The BMP4 gene plays an important role in organ development and tissue remodeling throughout life. Here we examined its role in laryngeal development complementing similar efforts for the lung, pharynx, and cranial base. Our goal was to determine how different imaging techniques contribute to a better understanding of the embryonic anatomy of the normal and diseased larynx in small specimens. Contrast-enhanced micro CT images of embryonic larynx tissue from a mouse model with Bmp4 deletion informed by histology and whole-mount immunofluorescence were used to reconstruct the laryngeal cartilaginous framework in three dimensions. Laryngeal defects included laryngeal cleft, laryngeal asymmetry, ankylosis and atresia. Results implicate BMP4 in laryngeal development and show that the 3D reconstruction of laryngeal elements provides a powerful approach to visualize laryngeal defects and thereby overcoming shortcomings of 2D histological sectioning and whole mount immunofluorescence.

Characterization of collagen in salmon nasal cartilage: enzymatic solubilization with fungal acid protease

Characterization of collagen in salmon nasal cartilage: enzymatic solubilization with fungal acid protease

Investigation on Filaments for 3D Printing of Nasal Septum Cartilage Implant.

Septoplasty is a widely used method in treating deviated septum. Although it is successfully implemented, there are problems with excessive bleeding, septal perforation, or infections. The use of anatomically shaped implants could help overcome these problems. This paper focuses on assessing the possibility of the usage of a nasal septum cartilage implant 3D printed from various market-available filaments. Five different types of laments were used, two of which claim to be suitable for medical use. A combination of modeling, mechanical (bending, compression), structural (FTIR), thermal (DSC, MFR), surface (contact angle), microscopic (optical), degradation (2 M HCl, 5 M NaOH, and 0.01 M PBS), printability, and cell viability (MTT) analyses allowed us to assess the suitability of materials for manufacturing implants. Bioflex had the most applicable properties among the tested materials, but despite the overall good performance, cell viability studies showed toxicity of the material in MTT test. The results of the study show that selected filaments were not suitable for nasal cartilage implants. The poor cell viability of Bioflex could be improved by surface modification. Further research on biocompatible elastic materials for 3D printing is needed either by the synthesis of new materials or by modifying existing ones.

Endoscopic laryngotracheoplasty (Maddern procedure) for idiopathic subglottic stenosis

•Endoscopic laryngotracheoplasty (Maddern procedure) is a scarless and durable therapy for iSGS. •Maddern procedure avoids risks associated with cricotracheal resection. •Surgery includes endoscopic scar excision with placement of a split-thickness skin graft and stent. •Exclusion criteria are dense posterior scar, glottic involvement, and long segment stenosis. Endoscopic laryngotracheoplasty, also known as the “Maddern procedure,” is a definitive endoscopic treatment for subglottic stenosis via a scarless approach. This technique focuses on endoscopic resection of the subglottic mucosa and scar without disturbing the cartilaginous framework of the larynx and trachea. A split-thickness skin graft is then used to reline the tracheal lumen, in order to facilitate healing and avoid scar recurrence. The skin graft is held in place by a silastic stent. This article describes the surgical technique of endoscopic laryngotracheoplasty, as well as peri-operative considerations and possible complications. Endoscopic laryngotracheoplasty, also known as the “Maddern procedure,” is a definitive endoscopic treatment for subglottic stenosis via a scarless approach. This technique focuses on endoscopic resection of the subglottic mucosa and scar without disturbing the cartilaginous framework of the larynx and trachea. A split-thickness skin graft is then used to reline the tracheal lumen, in order to facilitate healing and avoid scar recurrence. The skin graft is held in place by a silastic stent. This article describes the surgical technique of endoscopic laryngotracheoplasty, as well as peri-operative considerations and possible complications.

Effect of Locally Administered Estradiol on Wound Healing in a Nasal Septal Perforation Animal Model.

We aimed to investigate the effect of estradiol on wound healing in an experimental nasal septal perforation (NSP) model created in rats. Twenty-two Sprague Dawley healthy male rats were separated into two groups. NSP, approximately 2 mm in diameter, was created in each animal. The 0.1 mL 0.12% estradiol (12 g/L) (study group) and 0.1 mL 0.9% saline (9 g/L) (control group) were applied topically once a day for 14 days. The rats were sacrificed on the 14th day and the cartilage nasal septum of each animal was excised for histopathological examination. The nasal mucosal epithelial regeneration and degeneration, acute inflammatory cell count, fibroblast number, vascularization, granulation tissue formation, giant cell number, eosinophil number, degeneration and regeneration of the nasal cartilage, and collagen density were examined. The macroscopic closure rate of the perforations and histopathological parameters were evaluated statistically. In this study, the epithelial regeneration, the fibroblast count, the granulation tissue formation, and the amount of collagen were significantly higher in the study group than in the saline group (p < 0.05). The acute inflammatory activity was lower in the estradiol group than in the saline group (p < 0.05). There was no statistically significant difference in the closure rate of perforation between the two groups (p = 0.163). No significant difference was found in other comparisons (p > 0.05). The locally administered estradiol may improve wound healing of the nasal septum in an experimental NSP animal model. LEVEL OF EVIDENCE: Not applicable.

Case Report: An unusual presentation of granulomatosis with polyangiitis

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

PREDICTABLE FACIAL ESTHETICS BY PRESURGICAL NASOALVEOLAR MOULDING IN NEONATES - A CASE REPORT

A Cleft is a congenital abnormal space or gap in the upper lip and palate. Although plastic surgery has made great advances in the area of cleft surgery, aesthetical corrections of the decient columella and nasal cartilages were difcult. presurgical naso-alveolar molding (PNAM) at an early stage is used to reduce soft tissue and cartilaginous deformity. This article presents a case report of a 6-day-old baby boy with a left-sided unilateral incomplete cleft lip and palate, with no signicant medical history or any associated systemic illness. He was referred with the primary need for a feeder plate. The width of the cleft was measured from the base of the alveolus on one side to the other and was approximately 7 mm. The nal impression was made with a custom tray. NAM appliance was fabricated and inserted in the patient's mouth. Orthodontic wire of 21 gauzes was used for wire bending to support the acrylic forming a nasal bulb. In 2 months, the followup patient was recalled at each 15 days intervals for 1 and a half months for activation and modication of the plate to gradually approximate the alveolar segments. After 2 months of follow-up, it was shown that the cleft palate gap was reduced to 3mm from 7mm. PNAM allows overall improvement in the aesthetics of nasolabial complex in cleft conditions and minimizes the extent and the numbers of surgery. The cleft deformity was signicantly reduced in size with the NAM therapy in the present case