Dorsum Of Nose Research Articles

Fibromyxomatous Tumour of Nose: A Combined Approach to this Enigmatic Mass.

Fibromyxomatous spindle cell neoplasms are an unusual form of dysplasia. It is extremely rare in the nose and paranasal sinuses. We present a 60 year lady with swelling over the dorsum of nose and nasal block for 4 years. She underwent combined approach excision of mass. Histopathology revealed fibromyxomatous spindle cell tumour.

Management of Nodular Nasal Basal Cell Carcinoma with Wide Excision, Transpositional Median Forehead Flap, Forehead Split Thickness Skin Graft: Case Report

Introduction: Basal cell carcinoma (BCC) is the most common skin type cancer with an incidence rate of around 75-80%. The most common location is in the head and neck area around 70-80% and followed by other body parts around 25% consist of the penis, vulva or perianal area and 5% on the skin. BCC occurs more frequently in light-skinned individuals compared to dark-skinned individuals. The incidence rate is relatively lower in Asians, blacks ethnic, and Hispanics.
 Case Presentation: A 66 years-old woman complained of scabs on the right side of her nose which had become increasingly widespread for the past 2 years. The wound was initially the size of a mole and was scratched until it spread until the patient was hospitalized. Physical examination showed a wound in the nasal area measuring 4 x 5 x 1 cm, irregular wound edges, cartilaginous wound base with necrotic tissue and pus. The first biopsy examination showed poorly differentiated basal cell carcinoma. The patient was treated with Nasal Reconstruction surgery consisting of wide excision was performed by surgical oncologist, transpositional median forehead Flap and forehead Split Thickness Skin Graft were performed by reconstructive plastic surgeon.
 Discussion: The diagnosis of BCC in this patient was based on regarding history taking, physical examination and histopathological examination. However, for defects with a diameter of more than 1.5 to 2 cm, generally recommended using axial pattern flaps such as forehead flaps, nasolabial flaps and dorsal nose flaps. In this case, the patient was treated with wide excision followed by nasal reconstruction with a transpositional forehead flap and forehead split thickness skin graft.
 Conclusion: Nevertheless, regional flaps remain the recommended procedure for nasal reconstruction after wide excision of the tumor. Accurate analysis of the damage combined with evaluation of the patient's clinical condition is necessary to select the best surgical technique. Thorough knowledge of regional vascular anatomy and a comprehensive multidisciplinary approach are important first steps for proper treatment of nasal skin cancer, so that the procedure for wide excision of nasal basal cell carcinoma followed by nasal reconstruction with transpositional forehead flap and split thickness skin graft, can provide satisfactory result.

Nose dorsum augmentation with diced cartilage graft versus Block cartilage graft in mild saddle nose.

Objective: To compare the aesthetic results of diced cartilage and block cartilage when they both use for nose dorsum augmentation in mild saddle nose deformity. Study Design: Retrospective Comparative study. Setting: Department of Plastic Surgery, Liaquat National Hospital, Karachi. Period: January 2017 to December 2019. Material & Methods: Two groups selected for this procedure diced graft (n=11) and segment cartilage graft (n=13), total 24 patient. Retrospective data of these patient were analyze, aesthetic outcome recorded as fair, good and excellent on remark of two plastic surgeon (blinded to graft placed) not involve in surgery by pre and postoperative picture at last follow up and patient satisfaction via S-VAS recorded. Average follow up was 6 month. Results: Aesthetic outcome of dice cartilage graft versus block cartilage graft are excellent in 81.8% versus 76.9 %, good 9% versus 7.6%, fair 9% versus 15% respectively. Patient satisfaction grade extremely satisfied 72.7% versus 69.2%, satisfied 27.2% versus 30.7%, no patient was unsatisfied. Conclusion: Our clinical experience support that the free diced cartilage graft technique presents an effective and easily reproducible method for nose dorsum augmentation in aesthetic and reconstructive rhinoplasty for mild saddle deformity.

Eccrine Porocarcinoma of Dorsum of Nose: A Rare Case Report.

Eccrine porocarcinoma (EPC) is an uncommon malignant tumor derived from the eccrine sweat glands. Because of its various pathological features, it is often confused with other malignant cutaneous tumors. We present a case of 78-year- old female having ulcerative lesion over external nasal pyramid. Biopsy suggested of squamous cell carcinoma. Tumor was excised and reconstruction was done using paramedian forehead flap. Post operative Histopathological Examination (HPE) suggested of eccrine porocarcinoma.

Comparison of three canine nose guards for reduction of ultraviolet (UVA and UVB) solar radiation.

Protection from solar ultraviolet (UV) radiation is paramount for some dermatological conditions, yet there are no studies assessing UV nose guards for dogs. Compare the ability of three nasal guards to block solar UV radiation (UVR) from the canine nose, using two commercial products and one created by the authors. Four fabric model dogs were used in this prospective controlled trial. Each model had a UV dosimeter applied to the dorsal nose and anterior nasal planum. Three models had nose protectors applied: (1) a mesh hood (OutFox Field Guard, OutFox For Dogs); (2) a fabric nose shield (Nose Protector, Dog Nose Protectors); or (3) a basket muzzle with ultraviolet protection factor (UPF) 50+ fabric developed by the authors. The control had no protective device applied. All the models were placed in direct sunlight and measurements taken over nine 2h time periods. Total cumulative UVR was analysed for each location and type of guard or control. All guards provided statistically significant UV protection compared to control at all time points (p< 0.001). The basket muzzle with UPF 50+ guard was consistent in protecting the dorsal and anterior nose, blocking 94.2% and 94.3% UVR, respectively. The fabric nose protector blocked 99.2% UVR from the dorsal and 82.9% anterior. The mesh hood blocked 72.5% of UVR dorsal and 71.4% anterior. Two guards were superior in blocking UVR; however, the choice of UV guard in a clinical setting depends on an individual's disease location and tolerance of the device.

Lipoblastoma nose: a rare case report

&lt;p class="abstract"&gt;Lipoblastoma is a rare exclusively benign encapsulated tumor arising from embryonic white fat. Tumor occurs primarily in infancy and early childhood. It often presents as painless swelling in extremities and trunk, and rarely develops in head and neck and other sites. We report case of a 15 months old boy with a gradually enlarging, painless swelling over the left side of the dorsum of nose. Computed tomography scan revealed a subdermal soft tissue mass. Treatment remains complete surgical excision. Diagnosis is determined by histopathologic findings. Histologically, lipoblastoma reveals immature adipose cells in varying stages of maturity arranged into lobules separated by septa. No recurrence of tumor has been noted over 6 months of follow-up of this patient.&lt;/p&gt;

P-67606156-131 - Nasal dorsum strut plate: A case series

<h3>Purpose</h3> Severe injury to the nasal bones and structures may lead to a depressed nasal dorsum, so-called "saddle-nose deformity," which is generally caused by medium and high-intensity impacts to this area, resulting in aesthetic and functional complaints. The present study aims to describe a case series of strut plates implementation to restore nasal projection. <h3>Methods</h3> A case series of patients with naso-orbital-ethmoid fractures associated with panfacial fractures and severe saddle-nose deformity with comminuted nasal dorsum were followed for 36 months after the correction of the nasal projection with a nasal dorsum strut plate, coated by a pericranium flap. <h3>Results</h3> Nine male patients, victims of M.V.A., were enrolled in the study. In all cases, a strut titanium plate was applied vertically at the nasal root to reconstruct its dorsum. No signs of infection or plate exposure were observed; in other words, the complication rate was 0% in all nine cases. The nose dorsum projection was re-gained for all the patients. <h3>Conclusion</h3> The main goal of the treatment is to obtain restoration of aesthetic form and function. The three-years follow-up, alongside the satisfactory outcomes, indicate that the use of a strut plate for dorsal nasal height restoration, associated with pericranium flap coating is an excellent corrective technique to saddle-nose deformity and can be performed by the maxillofacial surgeon during the surgical intervention.

Papillary Carcinoma: A Rare Cause of Cutaneous Lesion on Dorsum of Nose

The skin of the nose is a common site for various benign and malignant lesions. Herein, we report a cutaneous nodular lesion on the dorsum of the nose in an 80-year-old female, which was surgically excised under local anesthesia. On histopathological examination, she was diagnosed with papillary carcinoma, a very rare disorder at such a location. The patient was followed-up and no recurrence was noted.

PRIMARY CUTANEOUS MUCORMYCOSIS IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT

Zygomycosis is an infrequently encountered locally invasive, aggressive fungal infection that frequently occurs in patients with an underlying immunodeficiency. It is usually diagnosed on histopathology and treated with systemic antifungals. We report a case of 16 years old female who presented with swelling on the dorsum of nose with overlying redness and tenderness. As she did not respond to antibiotics and conventional treatment, computed tomography (CT) scan and fine needle aspiration cytology (FNAC) were performed which revealed an inflammatory lesion. However, her histopathological examination was a surprise for all of us as it came out to be zygomycosis. She was started on oral antifungal, and responded well. Although a rare entity, primary cutaneous zygomycosis should always be kept in mind while evaluating any swelling if it doesn’t improve on conventional treatments and dealt accordingly.

FRONTONASAL EPIDERMOID CYST WITH PATENT DERMAL SINUS TRACT OPENING ON THE DORSUM OF NOSE AND INTRACRANIAL EXTENSION THROUGH CRIBRIFORM PLATE DEFECT: A RARE CASE REPORT WITH REVIEW OF LITERATURE

Congenital midface anomalies are rare. Multiple congenital midface anomalies occur in children. Imaging techniques like computed tomography (CT) and magnetic resonance imaging (MRI) help in characterising the lesions, making definite diagnosis and knowing about intracranial extension. We present a case report of 8 year old female child with Frontonasal Epidermoid Cyst with patent dermal sinus tract opening on the dorsum of nose and intracranial extension through cribriform plate defect.

The role of internal sutures in stabilization of nasal dorsum in primary rhinoplasty

Nasal dorsum anatomy is disrupted in rhinoplasty operations. Nasal dorsum restoration is critical in providing a natural, smooth, and stable nasal dorsum. In this article, a dorsum restoration technique for protecting anatomical structures and 1-year postoperative outcome assessment is presented. A total of 324 patients who all had a dorsal hump > 3 mm and required dorsal hump reduction were included in the study. All patients underwent dorsum restoration using the same technique, which included medial, lateral, and horizontal osteotomies, and nasal dorsal and mucosal approximating by polydioxanone sutures. At 1 year follow-up, dorsal irregularities and symmetry of dorsal aesthetic lines were evaluated by analysis of standard pictures. Evaluations were performed by two other plastic surgeons. Patients also completed a Rhinoplasty Outcome Evaluation (ROE) questionnaire with high scores indicating greater patient satisfaction. The average duration of operations was 168 min. At follow-up, dorsal aesthetic lines of 299 patients (92.2%) were symmetrical. Unacceptable dorsum irregularity was detected by palpation in 12 (3.7%) patients and 18 (5.5%) patients underwent revision rhinoplasty. All patients (n = 324) completed ROE questionnaire (score range 0–24) and the mean ROE score was 21.45. The results of the ROE scores show that 65% and 28% of patients gave 4 points and 3 points for ROE questionnaire, respectively, which shows that 93% of points were 3 and higher. Only seven patients scored their appraisal of nasal appearance < 3 while 237 patients reported a maximum score for social admiration. The aesthetic and functional results were satisfactory for patients and the surgeon. Reconstruction of disrupted nose dorsum anatomy in rhinoplasty surgery is necessary for successful results. The protective and restorative techniques for nasal dorsum described using this technique provided a stable, permanent, soft, symmetrical, and natural nose dorsum at 1-year follow-up. Level of evidence: Level IV; therapeutic study

Rhinofacial entomophthoromycosis: a case report

&lt;p class="abstract"&gt;Rhinofacial entomophthoromycosis or conidiobolomycosis is a rare subcutaneous mycosis seen in immunocompetent people and shows significant male preponderance. It is caused by a saprophytic fungus ‘conidiobolus coronatus’ or rarely conidiobolus incogruus. The mode of transmission is probably inhalation of fungal spores, which implant in nasal mucosa and cause an orofacial granulomatosis. It is reported mainly in tropical and subtropical countries. The infection is frequently underreported since it requires high level of clinical suspicion. Histopathology and fungal culture are the diagnostic modalities. No single antifungal drug has been found to give consistent results against this infection. Here we present a case of rhinofacial entomophthoromycosis (conidiobolomycosis) in an adult male with a disfiguring lesion over the dorsum of nose. The patient was started on itraconazole initially. Following no response to the treatment, he was administered potassium iodide solution. The patient was observed to have symptomatic improvement, but was lost to follow up. &lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Favre-racouchot syndrome: Case report

It is also known as nodular elastosis with cyst and comedones. The pathophysiology of disease causation is unknown, the condition may arises due to prolonged sun exposure. We report a case of 68 year old male agriculturist who presented with dark colored raised lesions along with thickening of facial skin which was increasing progressively since past three years. Physical examination showed the presence of thickened inelastic skin along with deep furrows and wrinkles involving the entire face, along with multiple open and closed comedones yellowish papules and nodules clustered especially around periocular region and dorsum of nose. On histopathological examination epidermis showed epidermal cyst formation containing laminated keratin and superficial dermis shows follicular infundibular plugging and large nodules filled with keratinous material. Keywords: Prolonged sun exposure, Bilateral, Nodular elastoidosis with cyst and comedones.

Endoscopic Repair of Nasal Septal Perforation by Mucoperichondrial Advancement Flap

25 years female presented to ENT OPD with complaints of pain on dorsum of nose and repeated crustng in nasal cavity for the past 6-8 months. On examinaton a medium sized septal perforaton was notced in the cartlaginous septum with septal spur on right side. In This case we did repair of medium sized perforaton under local anesthesia by Mucoperichondrial Advancement ?ap.

A novel approach to embed eye shields in customized bolus on nasal dorsum treatment for electron radiotherapy

We aim to demonstrate the unique use of embedded lead eye shields in an electron wax bolus when treating the nasal dorsum. A patient presented to the clinic with squamous cell carcinoma of the nasal dorsum requiring treatment with en face electrons. A 3D customized wax bolus was designed and imported into the treatment planning system (TPS) to calculate the dose distribution. Due to high lens dose, the bolus was customized further to create 2 milled open slots in the wax, over the lens of eye, to allow lead sheets totaling 4 mm to be slid into the wax. The patient was brought back to the clinic to be scanned with the wax bolus fitting snugly over the nose, eyes, and cheek regions. The 3D milled insert holes were contoured on the CT in the TPS, assigned HU of 2758, to mimic the lead insertion. The lens dose with lead inserts was compared to the plan without lead insert. To further confirm the lens dose, EBT3 films were placed on the right and left eye under the bolus, and nose dorsum on the first day of treatment. The maximum dose of right lens, as calculated in the TPS with the simulated lead shields in place, decreased from 989.5cGy to 457cGy. The maximum dose of left lens decreased from 1085.4cGy to 501cGy. The dose readings from EBT3 films were in good agreement with the TPS, with deviation of 3.32%, 0.26%, and 3.44% for right lens, left lens, and nose, respectively. Daily positioning deviations compared to the plan were 0.65 ± 0.16cm and 0.63 ± 0.29cm for right eye and left eye, respectively. This novel device demonstrated the feasibility, in terms of dose calculation accuracy in the TPS and fabrication, of using customized bolus with lead inserts to conveniently shield the lens of the eyes in an electron treatment for the nose, enabling a streamlined daily setup.

Paramedian forehead flap reconstruction for skin tumors involving central subunit of face: An analysis of 37 cases

IntroductionTumors of facial skin are common in upper part of central subunit of face. Defects after resection require a flap, which is pliable, thin, and has a good colour match. Among the various local flaps available paramedian forehead flap is a good option. Patients and methodsPatients reconstructed with paramedian forehead flap during the period from January 2015 to March 2020 were included in the study. Data regarding the demographic, clinical characteristics, and treatment details was recorded, and analyzed for postoperative complications and cosmetic outcomes. ResultsParamedian forehead flap reconstruction was performed in 37 patients who were resected for tumor involving upper central subunit of face. Median age of patients was 57 years. Male to female ratio was 1.4:1. All tumors were resected with a negative margin. Nodal disease was managed by superficial parotidectomy only (4/37), superficial parotidectomy along with supra-omohyoid neck dissection (6/37) and modified neck dissection (1/37). In five patients additional buccal mucosa graft was used to reconstruct conjunctiva. Additional flaps were required in two patients in whom nasolabial and mustarde flaps were used. Partial flap loss occurred in one patient. There was no major flap loss. Surgical site infection developed in only one patient, who had partial flap loss. On subjective assessment, nearly 60% patients described their appearance as good. ConclusionFacial reconstruction in area of dorsum of nose and medial aspect of both eyelids using paramedian forehead flaps is a simple and quick procedure.

Pleomorphic adenoma of dorsum of the nose: a rare occurrence

&lt;p class="abstract"&gt;Pleomorphic adenoma are common benign salivary gland tumours, which are found in majority in major salivary glands such as parotids and submandibular glands. However, Pleomorphic adenoma to originate from dorsum of the nose is a rare entity. In rare cases, it can be found in unusual sites such as upper aero digestive tracts, palate and lacrimal glands. Complete surgical resection is the treatment of choice. Though, the evolution to malignancy and recurrence is not usually encountered, still a long-term follow-up is recommended. Here, we report a 53 year old female , complained of swelling in the left side of dorsum of nose for 10 years with a feeling of heaviness over the left side of face and difficulty in vision on the side of swelling due to the enlarged size of the swelling which gave a feeling of vision disruption , also had a prior history of incision and drainage 4 years ,done elsewhere. On clinical examination, nodular mass was palpated on left side dorsum of nose which was freely mobile, and Skin over the swelling had blackish pigmentation. Anterior rhinoscopy revealed no abnormalities. Complete surgical excision via a lateral rhinotomy incision was performed. Cytological and histological evaluation revealed the presence of pleomorphic adenoma. We observed a decent cosmetic outcome with no evidence of recurrence.&lt;/p&gt;

Follow‐up study of nasal deformity in cleft lip and palate patients: Morphological changes and image analysis with growth

AbstractPurposeThere are no long‐term reports on morphologic changes of nasal deformity in patients with cleft lip and palate (CLP). This retrospective study was conducted to clarify changes in the nose morphology of patients with CLP.Materials and MethodsWe investigated 47 patients in our department. The evaluation time was as follows: T1 (before or after attending elementary school), T2 (after puberty growth), and T3 (after rhinoplasty). We evaluated the dorsal nose deviation angle, the nasal tip angle, and the nasolabial angle with standardized facial photographs, and nasal septum with computed tomography (CT) images. Computer software ImageJ was used for measurements. For statistical analysis, the Mann‐Whitney U test was used (significance level; P &lt; 0.05).ResultsAnalysis showed that in patients with unilateral cleft lip and palate (UCLP), twisted nose and reduction of the nasolabial angle became more prominent after puberty. In patients with bilateral cleft lip and palate (BCLP), the nasal tip was larger than in patients with UCLP and tended to be directed upward. The nasolabial angle in BCLP was more obtuse than the general mean value, but that in UCLP tended to be more acute. CT showed that in UCLP patients, the nasal septum was displaced toward the affected side, and the inferior nasal turbinate on the unaffected side was thickened. Nasal septum deviation was less severe in BCLP patients.ConclusionsUCLP and BCLP patients showed different nasal morphology at T1 and they grew differently from T1 to T2.

A Case of Spindle Cell Lipoma on Nasal Dorsum of Nose

Spindle cell lipoma is a benign, lipomatous tumor arising most frequently in the subcutaneous on the back of the neck and shoulders in males aged in the third through seventh decade of life. However, we encountered a case of an unusual spindle cell lipoma arising in the subcutaneous and skin layer in the dorsum of nose. A total of two reports of spindle cell lipoma have been found in the nasal and nasal dorsum regions. To our knowledge, this is the first report of spindle cell lipoma in the nasal dorsum.

Reconstruction of dorsum of nose after excision of basal cell carcinoma

&lt;p&gt;Basal cell carcinoma, squamous cell carcinoma and melanoma are the most common malignant tumors of the face. The paramedian forehead flap is the standard reconstructive choice for closing large-sized defects of the distal half of the nose. A melolabial interpolation flap and bilobed or trilobed flaps are another option. The dorsal nasal (Rieger) flap is suitable at this location for the closure of small-sized defects, particularly when they are located medially. Here we are discussing an ulcus rodens case we observed in an elderly patient which was treated with a Rieger’s flap.&lt;/p&gt;