Lateral Wall Of Nasal Cavity Research Articles

Outcome of External Dacryocystorhinostomy Operation with and without Posterior Nasal Mucosal Flap Suturing Technique in Combined Military Hospitals of Bangladesh

Introduction: External Dacryocystorhinostomy is an anastomosing operation which creates a fistula between the medial wall of lacrimal sac and lateral wall of nasal cavity. Objectives: To compare the success rate by suturing both the anterior and posterior nasal mucosal flaps and without suturing the posterior nasal mucosal flap in External DCR surgery of 50 cases in different Combined Military Hospitals (CMH) of Bangladesh. Methods: The study included 50 cases of Chronic Dacryocystitis patients with symptoms of epiphora and blocked Sac Patency Test (SPT). External Dacryocysto- rhinostomy (DCR) surgery was done by same surgeon in different CMH over the period of 02 years extending from January 2016 to December 2017. Total 50 patients were divided into equal 02 groups. Group A underwent External DCR with silicone tube intubation and both anterior and posterior nasal mucosal flaps were sutured. Group B underwent similar DCR surgery where only anterior nasal mucosal flaps were sutured with lacrimal sac flap and posterior mucosal flap was excised completely. Results: External DCR surgery success rate was evaluated by a patent SPT at 03 months, 06 months and 12 months post operatively in both groups. SPT was successful in 92% cases in group A and 96% in group B at 3 months follow up after silicone tube removal. At 6 months reduction of epiphora occurred in 90% cases in Group A and 96% cases in Group B with unchanged SPT percentage. At 12 months follow up result remained unchanged as found at 6 months. There was significant difference in success rate of two different surgical technique. Quality of surgery improved with less intraoperative complications with shorter surgical time when only anterior nasal mucosal flap was sutured with excision of posterior nasal flap. Conclusion: This study suggested that comparing both the techniques of with and without suturing anterior and posterior nasal mucosal flaps in external DCR surgery, the later one makes considerable improvement in success rate of DCR. Excising the posterior nasal mucosal flaps can reduce operation time, improve operation technique and reduced epiphora post surgically. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 31-33

Unveiling the Rarity: A Fascinating Case of Chondro-Osseous Respiratory Epithelial Adenomatoid Hamartoma (COREAH) in the Sinonasal Tract.

Chondro-osseous respiratory adenomatoid hamartoma (COREAH) are extremely rare benign lesions of the sinonasal tract. It is present in 3 to 83-year-olds. It originates from various sites of the sinonasal tract; the most common site is the posterior lateral wall of the nasal cavity. Imaging calcification is an important finding in COREAH. In this case report, we present an exceptionally rare occurrence involving a 55-year-old female patient who exhibited symptoms of nasal obstruction, bleeding from the left side of the nasal cavity and loss of smell. We aim to share our experience in managing this unique condition. Diagnostic nasal endoscopic examination of the patient revealed a reddish, fleshy polypoidal mass in the left nasal cavity arising from the lateral wall of the left nasal cavity posteriorly and extending anteriorly into the left nasal cavity. The patient underwent an excisional biopsy. Upon microscopic examination, we observed a hamartomatous proliferation of respiratory-type glands exhibiting mucinous metaplasia. Additionally, numerous spicules of mature bone were present, a distinctive feature of COREAH. The patient underwent a 6-month follow-up, during which no recurrent growth was detected within the nasal cavity.

Maxillary Sinus Measurements in Different Age Groups of Human Cadavers

The maxillary air sinus is the largest air sinus among the four air paranasal sinuses, which is a cavity in the body of maxilla. It is pyramidal in shape co nsisting of base, apex and four sides; its base comprises the thin lateral wall of nasal cavity. This study carried out at the Institute of Forensic Medicine in Baghdad and the Forensic Medicine Unit in Tikrit Teaching Hospital during the period from January 2010 to July 2011. A randomized sample of 110 human cadavers that arranged in four different age groups and dissected to study the three dimensions of both maxillary sinuses in both sexes by using a standard flexible tape measure or vernier caliper. The mean v alue of the maxillary sinus length in males was (36.4 ± 4.6 mm) and in females was (33.9 ± 4.2 mm); from these results, the mean value of males was significantly greater than that of females. On the other side, the mean value of the maxillary sinus width in males was (27.4 ± 4 mm) and in females was (25.3 ± 3.9 mm); therefore, these results demonstrate that the maxillary sinuses were wider in males than females. For males, the mean value of the maxillary sinus height was (35.1 ± 3.9 mm) and for females was (30.8 ± 3.6 mm). From these findings, a higher significant difference between the mean values was found; also there was a high significant difference between the two genders because the mean value of the maxillary sinus height for males was significantly higher than that for females. According to age groups of the present study, group 1 of maxillary sinus found to be still in growing state and not reaching its full size. Group 2 showing an extensive growth in maxillary sinus length and width, especially on the right side. Group 3 might partly showing growth in maxillary sinus length and height, which indicates that at this age the maxillary sinus reaches its full height. Finally, group 4 might partly indicates that the maxillary sinus reaches its full growth if it fails to reach it in group 3. The findings of the present study disagree with that done by Parks who mademeasurements for the maxillary sinuses on normal Korean adults using computed tomography, since these differences were may be due to ethnic variations. Also due to race differences, this study disagree with Fernandes (2) who studied the maxillary sinus in European and Zulu using computed tomography.

Surgical approach analysis of endoscopic resection of juvenile nasopharyngeal angiofibroma

Objective:To investigate the surgical approach for the resection of juvenile nasopharyngeal angiofibroma（JNA） under nasal endoscopy. Methods:The clinical data of 87 patients undergoing endoscopic resection of nasopharyngeal fibroangioma were retrospectively analyzed. We classified JNA according to tumor site, size, invasion scope and anatomic position relationship between tumor and midline of pupil. Three endoscopic surgical approaches were selected according to the classification, and the postoperative symptoms, complications and recurrence were investigated and analyzed. Results:The tumor resection rate of 87 cases by nasal endoscopic surgery was 100%. Thirty-five cases were approached through the middle nasal passage（small tumors located in the nasal sinuses and pterygopalatine fossa）, forty-five cases were approached through the lateral wall of the nasal cavity（tumor invaded the pterygopalatine fossa but did not exceed the midline of the pupil） , and seven cases were approached via the lateral wall of nasal cavity + ipsilateral anterior wall of maxillary sinus（tumor invaded the infratemporal fossa beyond the midline of pupil or invaded the cavernous sinus and the middle cranial fossa epidural）, Postoperative patients with nasal congestion, nasal bleeding, headache, dizziness, vision loss and other symptoms showed varying degrees of improvement. No surgical death or intracranial infection occurred. The postoperative follow-up was 6-78 months, and the recurrence rate was 3.44%. Conclusion:Endoscopic resection of nasopharyngeal fibroangioma is the main treatment method for JNA. Selecting suitable endoscopic approach to resect JNA, To maximize the advantage of nasal endoscopic equipment according to the inherent anatomical space of the human nasal cavity, In order to achieve the purpose of JNA resection, reduce intraoperative and postoperative complications, reduce the recurrence rate and improve the prognosis.

A Rare Case of Complicated Sinonasal Meliodosis Mimicking Sinonasal Lymphoproliferative Disease.

Unilateral nasal obstruction with purulent nasal discharge is one of the presentations for sinonasal melioidosis. However, it may mimic nasal NK/T cell lymphoma. Both causing tissue destruction involving nasal septum, lateral nasal wall and palate. Here, we report a case of disseminated melioidosis involving sinonasal mimicking nasal lymphoma in a 32-year-old immunocompetent lady. She presented with prolonged fever, unilateral nasal blockage, painful facial swelling and knee pain. Clinical findings revealed extensive necrotic tissue and crusting involving right lateral wall of nasal cavity. Tissue and blood culture and sensitivity (C + S) grew Burkholderia pseudomallei. Recovery was complete after surgery and antibiotics.

Effects of mini-implant assisted rapid palatal expansion on the deviated nasal septum and inferior nasal meatus: A CBCT study

Objective: The purpose of this study was to evaluate the effects of the mini-implant assisted rapid palatal expansion on the nasal septum and the inferior nasal meatus (INM) in the patients with nasal septal deviation. Methods: The CBCT images were taken before (T0), after (T1), and more than 5 months after (T2) MARPE in 17 patients who had NSD. According to the direction of the NSD, the concave side was set as group 1 and the convex side was set as group 2 by patient. The volume of the INM, nasal septal tortuosity ratio were calculated. Also, to evaluate 3-dimensional changes of the nasal septum, distance between C point (The junction of perpendicular plate of ethmoid bone and vomer) and three vertical planes were calculated. And distance between C point and lateral wall of nasal cavity was measured. Results: The total volume of the INM increased significantly after MARPE (p < 0.001). The distance from the C point to the vertical plane increased significantly after MARPE (p < 0.01). Also, there was a significant difference between the groups in the distance between the C point and the lateral wall of nasal cavity (p < 0.001) before and after treatment. But there was no significant difference in the increase ratio. Conclusion: After MARPE, the volume of INM was significantly increased. The nasal septum was more displaced to the deviated side without a significant morphological change. But the increase ratio of both group was similar.

Cavernous haemangioma of right nasal cavity: a case report

Hemangiomas are common, benign tumors which arise from the proliferation of endothelial cells surrounding blood-filled cavities. Cavernous hemangioma of the nasal cavity is a rare clinical entity but it should be considered in the differential diagnosis of the nasopharyngeal mass and in cases with epistaxis. This lesion is usually found on the lateral wall of nasal cavity and are more common in elderly with no sex preponderance. We present a case of cavernous hemangioma arising from the sphenopalatine area in a 54-year-old female. The tumour was successfully excised by trans-nasal endoscopic approach with pre-operative surgical embolization.

A Case Report of Inverting Papilloma of Lacrimal Sac

Purpose To report a rare case of Inverting Papilloma originating from the Lacrimal Sac in Tertiary Hospital. Method Case report. Results Inverting papilloma is uncommon in lacrimal sac. More often presents in Maxillary sinus, Ethmoid sinus and lateral wall of nasal cavity. This case of 69 years old, Filipino male, who presented with a two-year history of gradually enlarging left medial canthal mass, and tearing. There were no ophthalmoplegia, visual disturbances, proptosis or pain but there was globe displacement superolaterally. Other ophthalmologic examinations were unremarkable at that time of examination. Orbital CT-scan revealed: Heterogenously enhancing mass extending to ipsilateral nasolacrimal canal and nasal cavity causing mass effect. There was note of a suspicious area of hyperostosis. Patient was referred to the Department of Otolaryngology Head and Neck Surgery for co-management. Punch biopsy was done and histopathology revealed Inverting papilloma. Combined surgical management of anterior Maxillectomy via lateral Rhinotomy approach and Dacryocystectomy was done. Intraoperatively, there was note of adhesions to bone in the area of the Lacrimal Sac corresponding to the area of hyperostosis on CT-scan. Post-operative recovery was unremarkable with unchanged visual acuity and extraocular muscle movement. Conclusions This is a case of an inverting papilloma involving the lacrimal sac and nasolacrimal duct that was managed with combined anterior maxillectomy via Lateral Rhinotomy approach and dacryocystectomy for complete resection. We recommended complete resection of the tumor to minimize recurrence. Origin in the Lacrimal Sac area was confirmed by intraoperative findings which correlated with CT- scan findings.

Morphometric evaluation and surgical implications of the infraorbital groove, canal and foramen on cone-beam computed tomography and a review of literature.

The purpose of this study is to evaluate the anatomy, morphometry, and variations of infraorbital groove (IOG), infraorbital canal (IOC) and infraorbital foramen (IOF) on the cone-beam computed tomography (CBCT) images and to investigate their relations with surrounding structures. IOG, IOC and IOF were evaluated retrospectively in CBCT images of 75 female (F) and 75 male (M) cases with a range of 18-65 years (F: 37.62 ± ± 13.55, M: 37.53 ± 15.87) by Planmeca Romexis programme. IOG, IOC and IOF were examined bilaterally (300 sides) in the cases. The 13 parameters were measured on these images in axial, sagittal and coronal planes. There was a very weak positive correlation between the age and the angle between IOC and IOG (p = 0.015, r = 0.198), there was a weak positive correlation between the age and skin thickness (p = 0.001, r = 0.281), and there was no correlation between the age and other parameters. A total of 21 (7%) IOCs were detected in maxillary sinus, bilaterally in 6 cases and unilaterally in 9 cases (5 on the left, 4 on the right). In 1 case, bilaterally, IOC was separated 2 canals while running anteriorly in the maxillary sinus. The larger one was directed to IOF in its normal course and the smaller one was directed to lateral wall of nasal cavity and opened to the inferior nasal meatus in front of the opening of nasolacrimal duct. We suggest that the parameters found in the present study may facilitate prediction of the location of the infraorbital nerve. Knowledge of this exact position in relation to easily measurable parameters may decrease the risk of infraorbital nerve injury during surgical approaches directed to this region and might serve as a guide during local anaesthetic interventions for dentistry, ophthalmology, plastic surgery, rhinology, neurosurgery and dermatology.

A blind area of origins of epistaxis: technical or cognitive?

To investigate common origins and features of anterior epistaxis. Patients (168) with anterior nose bleed were studied from May to October 2013. Endoscopic examination with angled endoscope and then subsequent management (radiofrequency, selective packing,) was performed. Under thorough nasal endoscopy, anterior nasal bleeding origin was ranked in turn as follows: the anterior nasal septum (NS 83.3%), the small area of anterior lateral wall of nasal cavity corresponding to the nasal back (NB 7.1%), the anterior end of the inferior turbinate (IT 5.4%), and the nasal part of the nasal cavity roof (NR 4.2%). Arterial lesion and hypertension led to large instant quantity of bleeding; hypertension and negligible bleeding origin prolonged bleeding duration. Bleeding was successfully controlled with nasal endoscopy and radiofrequency or selective packing. The arterial bleeding small area of anterior lateral wall of nasal cavity corresponding to the nasal back and the nasal part of the nasal cavity roof accounted for more than 10% of anterior epistaxis and a thorough endoscopic examination should include these area with angled endoscope. Then radiofrequency and selective packing will sharply reduce the bleeding duration.

Endoscopic evaluation of bleeding points in epistaxis: a cross sectional study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Epistaxis is one of the most common emergencies that come to casualty department and of which some are difficult to treat. Rigid nasal endoscopy plays a paramount role in managing epistaxis. The present study was done to map bleeding points with regard to its location, to identify the common areas and to discover the hidden areas. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">56 patients with epistaxis were examined using nasal endoscope under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were included in the study. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">18 (32%) patients had bleeding point in right side and 24 (42.8%) patients it was in left side<strong>. </strong>51.7% patients had bleeding point located on medial wall of nasal cavity and 19.6% patients had bleeding points on lateral wall of nasal cavity. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Nasal endoscopy plays a vital role in management of epistaxis. Most common bleeding point locations are on septum, near middle turbinate area.</span></p>

Basic Research and Clinical Application of Pterygoplatione Fossa Projection on Lateral Nasal Wall

Infection, neoplasms, and tumor-like lesion in pterygoplatione fossa (PPF) are common in Chinese people. Owing to its deep anatomic location, surgery through this region is difficult. Maxillary sinus pathway is widely used, but the obvious disadvantage of destroying maxillary sinus even disfigurement cannot be avoided. This study provides a new method to locate PPF by choosing some landmarks situated at lateral wall of nasal cavity as reference points to obtain credible and detailed information for clinical management. The authors measured the location of anterior wall, posterior wall, and medial wall of PPF in the planes of middle nasal concha osseous extremity, inferior nasal concha osseous extremity, and middle nasal meatus. In addition, the authors measured the distance and the angle between the upper and lower bound of the PPF and the apertura sinus maxillaris. All PPF and landmarks of 196 patients were well demonstrated on computed tomographic angiography images. The new location method is stable and direct. As for the shape of PPF, the line connecting anterior wall in different planes is curve, convex backward, and concave frontward. Pterygoplatione fossa tapers gradually. The authors also found that with the traditional method, after entering the maxillary sinus, the needle should be inserted <26 mm when aimed at the upper bound and 30 mm in women and 31 mm in men when aimed at the lower bound.

Deposition of intranasal glucocorticoids--preliminary study.

Intranasal glucocorticoids are the treatment of choice in the therapy of rhinitis. The differences in efficiency of particular medications proven by therapeutic index may result from differences in composition of particular formulations as well as from diverse deposition in nasal cavities. Intranasal formulations of glucocorticoids differ in volume of a single dose in addition to variety in density, viscosity and dispenser nozzle structure. The aim of this report was to analyze the deposition of most often used intranasal glucocorticoids in the nasal cavity and assessment of the usefulness of a nose model from a 3D printer reflecting anatomical features of a concrete patient. Three newest and most often used in Poland intranasal glucocorticoids were chosen to analysis; mometasone furoate (MF), fluticasone propionate (FP) and fluticasone furoate (FF). Droplet size distribution obtained from the tested formulations was determined by use of a laser aerosol spectrometer Spraytec (Malvern Instruments, UK). The model of the nasal cavity was obtained using a 3D printer. The printout was based upon a tridimensional reconstruction of nasal cavity created on the basis of digital processing of computed tomography of paranasal sinuses. The deposition of examined medications was established by a method of visualization combined with image analysis using commercial substance which colored itself intensively under the influence of water being the dominant ingredient of all tested preparations. On the basis of obtained results regions of dominating deposition of droplets of intranasal medication on the wall and septum of the nasal cavity were compared. Droplet size of aerosol of tested intranasal medications typically lies within the range of 25-150 µm. All tested medications deposited mainly on the anterior part of inferior turbinate. FP preparation deposited also on the anterior part of the middle nasal turbinate, marginally embracing a fragment of the central part of this turbinate as well together with deposition in the middle and superior nasal meatus reaching the region of nasal ceiling and olfactory field. MF preparation deposited on the anterior part of the inferior turbinate and central part of this turbinate alike. The area of mucous membrane of lateral wall of nasal cavity on which MF deposited was similar to the area achieved after the application of FP preparation but much greater than in the case of FF preparation. FF drug deposition concentrates only on the anterior part of the inferior turbinate. Despite directing the drug to the lateral wall of the nasal cavity a great proportion of examined preparations deposit also on the nasal septum. The practical application of tridimensional representation (3D printout) of actual geometry of nasal cavity to establish the deposition of inGKS was proven. Droplet size and the geometry of the aerosol cloud introduced into the nostril determine the significant deposition of medication droplets in the anterior part of the nasal cavity. Both physical properties of the drug as well as spraying system applied influence spatial distribution of the drug. The interaction of the air flow with the layer of deposited fluid plays a major role in the deposition of the drug in the nasal cavity, therefore it is so important that the drug does not drain by gravity but remains at the site of deposition which may be reinforced by thixotropic properties of the preparation.

Acinic cell carcinoma of the nasal cavity

Acinic cell carcinoma presenting in the nasal cavity is a rare entity. Here we report a case of a 65-year-old female patient who presented with a history of epistaxis and nasal obstruction. The case was diagnosed as acinic cell carcinoma. The tumor was found to be arising from the lateral wall of the right nasal cavity and it was treated by surgical excision and regular follow-up. This tumor is usually found in the major salivary glands and has a low grade behavior with the best survival rate of any salivary malignancy. We present a rare case presenting in the lateral wall of the nasal cavity. The clinical, histopathological features, and the management of this tumor is described with a review of the relevant literature.

Rhino-orbito-cerebral mucormycosis in a child with diabetic ketoacidosis.

Sir, Rhino-orbito-cerebral mucormycosis is an unusual complication of diabetic ketoacidosis (DKA). Most of them have been fatal. High index of suspicion is critical for diagnosis and early treatment. A 9-year-old, female child presented with fever, abdominal pain, and vomiting for 2 days. Examination revealed acidotic breathing and multiple furuncles over the face. She had hyperglycemia of 485 mg/dl, ketonuria, wide anion gap metabolic acidosis (pH 6.8) and polymorphonuclear leucocytosis. She was diagnosed as Type 1 diabetes with DKA and treated according to the DKA management protocol of the unit. In view of persistent altered sensorium anti-edema measures were initiated. At 48 h of admission, she had a dark colored bloody nasal discharge. Injection amphotericin B was started empirically for suspected mucormycosis. At 72 h, the child developed ophthalmoplegia of the right eye. A black necrotic palatal lesion was noted at 96 h [Figure 1]. Computed tomography (CT) brain was normal. CT paranasal sinuses showed right maxillary sinusitis. Nasal endoscopy revealed black necrotic eschar over the right middle and inferior turbinates, floor and lateral wall of nasal cavity. Despite surgical debridement child worsened with right facial palsy and left hemiparesis. Repeat CT brain revealed massive infarct involving right frontal, temporal and parietal regions. The child expired on day 9. Figure 1 Black necrotic eschar in palate Histopathology of the necrotic lesion revealed broad, aseptate hyphae, branching at right angles with vascular invasion. Culture on saboraud dextrose agar medium grew black colonies typical of Rhizopus. On lactophenol cotton blue mount presence of sporangium and rhizoids typical of Rhizopus was seen. Postmortem cerebral spinal fluid was unusually orange-red colored with no cells, with 1250 mg% proteins and 35 mg% sugar. Hemoglobin A1c was high (12.6%). Mucormycosis is an acute, frequently fatal, fungal disease in immunocompromised children due to Rhizopus[1] followed by Mucor. Risk factors include DKA, prolonged neutropenia, malignancy, chronic corticosteroid therapy and deferoxamine therapy. Rhinocerebral (most common in DKA),[2] pulmonary, cutaneous, gastrointestinal, and disseminated involvement can be seen. In DKA, the chemotactic activity of neutrophils and their ability to produce reactive oxygen species is diminished. Acidosis disrupts the transferrin binding to iron,[3] releasing free iron favoring Rhizopus growth. As the advanced glycosylation end products increases the transendothelial migration of neutrophils decreases. Following inhalation, the disease begins with facial pain and numbness followed by sinusitis and dark bloody nasal discharge. In this child, nasal discharge was the first sign. The infected tissue appears normal initially then become erythematous, violaceous and finally turns black due to thrombosis and tissue infarction.[4] Rapid progression of the disease occurs in hours to days. Direct microscopic examination of the specimen and culture are diagnostic. Management includes reversal of the risk factor, surgical debridement along with antifungal therapy. Amphotericin B (polyene) is the drug of choice given over few weeks. Amphotericin B liposomal complex, echinocandins with polyenes, posaconazole and deferasirox can also be used. Clinical suspicion warrants treatment without awaiting confirmation. Mortality is more than 40% with cerebral involvement. It is less than 10% without cerebral involvement.[2] Poor prognostic factors are delayed diagnosis, inadequate surgical debridement, spread beyond sinonasal cavity, and cerebral involvement.

CT and MRI diagnosis of lesions in unilateral maxillary sinus

To study the CT and MRI findings of lesions in unilateral maxillary sinus, and to compare the effect of CT and MRI in the differential diagnosis of lesions in unilateral maxillary sinus. Retrospective analysis of CT and contract-enhanced MRI imaging data from 34 patients with lesions in unilateral maxillary sinus which were diagnosed by endoscopic sinus surgery and postoperative pathology. The CT and contract-enhanced MRI's value in the differential diagnosis in lesions in unilateral maxillary sinus was analysed. All 34 patients had unilateral maxillary sinus lesions. On CT: soft tissue density shadow in the unilateral maxillary sinus was found in all 34 cases. Five cases showed spot high density with thickening bone in the maxillary sinus wall. Eleven cases showed expansion of the opening of maxillary sinuses. Two cases showed broken lateral wall of nasal cavity . One case showed soft tissue density shadow in the maxillary sinus with curve edge with high density shadow which had a tooth shadow in it. Other 14 cases showed only soft density shadow in the maxillary sinuses. On MRI: all 34 cases revealed lower signals on T1WI compared to gray matter. Little loss signal were found in the inner of the maxillary sinus fungal balls on T1WI. Enhanced MR imaging showed no enhanced in nasal sinusitis, sinus cysts and polyp of posterior naris. In homogenous enhancing and "the cerebral convolution sign" were found in the hemorrhagic and necrotic nasal polyp, the nasal inverted papilloma and the malignant tumor cases. Higher signals were seen in the nasal sinusitis, fungal balls and the polyp of posterior naris cases on T2WI. In homogenous signal with different levels were found in the hemorrhagic and necrotic nasal polyp, the nasal inverted papilloma and the malignant tumor cases on T2WI. CT and MRI examination are important in the diagnosis of the unilateral maxillary sinus lesions. Both CT and MRI had more differential diagnostic value in the unilateral maxillary sinus lesions than only CT used.

Removal of Schwannoma in the pterygopalatine and infratemporal fossa via endoscopic prelacrimal recess approach

To sum up and analyze the results of surgical removal of Schwannoma in the pterygopalatine and infratemporal fossa (PPF and ITF) through postero-lateral wall via prelacrimal recess approach (PLRA). The surgical technique and indications were presented and discussed. Six patients aged from 29-59 year-old with Schwannoma in the PPF and ITF, who received the tumor resection via PLRA under endoscope, were enrolled in this paper. Three were female and 3 were male. All of them received preoperative CT and MRI. The PPF and ITF were approached via prelacrimal recess endoscopically under general anesthesia. Schwannoma was histopathologically confirmed after surgery. The postoperative periodical CT and MRI follow up was conducted. The tumors were removed completely in these 6 patients. No recurrence was found during 19.3 months follow up on the average. Three patients had obvious numbness in the V2 innervation area 1 or 2 weeks after operation and disappeared afterwards. Only 1 patient had mild altercation numbness at the end of follow up. Schwannoma involved PPF and ITF can be removed endoscopically via PLRA. The lateral wall of nasal cavity might be kept intact. It is a novel minimally transnasal invasive approach to PPF and ITF with less damage and complications.

Obraz epidemiologiczny i kliniczny czerniaka złośliwego jam nosa i zatok przynosowych – analiza 6 przypadków

The mucosal malignant melanoma (MM), represent a rare group of tumors (0.2%--8% of all MM), with predominant localization on the mucosal surface of head and neck region, where the localization on the mucosa of nasal cavity, paranasal sinuses and oral cavity are the most common. The mucosal MM within the nose and paranasal sinuses represent approximately 4% of all malignant tumors in these localizations, affecting predominantly the age group over 60-es, equally in both sexes. The treatment of choice in mucosal MM is surgery followed by Rtg-therapy in cases of small or doubtful margins of resection. The prognosis of mucosal MM is poor with 8% to 30% of 5-years survival. 6 cases of mucosal MM, selected from 72 of all MM in the head and neck region, diagnosed and treated from 2001 to 2007 in Dept. of ORL H&N Surgery, Holy Cross Cancer Center in Kielce. In group of mucosal MM which was taken to analysis there was 5 female and 1 male patient, with range of age from 55 to 80 (mean--69.4) with following localization: nasal septum--2 cases; lateral wall of nasal cavity--2; and paranasal sinuses--2. In 1 case an extremely rare pathologic form of amelanotic MM was diagnosed. The surgical resection of tumor followed by Rtg-therapy was performer in 4 cases. In 1 case, the radical surgery was the only method of treatment, and in 1 case the palliative Rtg-therapy was only applied. Within the observation period (4-96 months) 3 patients died, all due to the fatal progression of the MM. (1) Mucosal MM localized in the nasal cavity and paranasal sinuses, present a very rare, but highly diversified group of malignant tumors. (2) The surgery, followed by Rtg-therapy is still the treatment method of choice. (3) The prognosis of mucosal MM in the nose and paranasal sinuses is bad.

A current survey on the use of intranasal splints among uk consultants

Objectives: A survey 12 years ago revealed that 64% of UK consultants routinely use intranasal splints primarily to prevent postoperative adhesions. There is increasing evidence that routine intranasal splints does not reduce postoperative intranasal adhesion rates and instead may increase patient morbidity. We conduct a similar survey to assess the current practice amongst UK consultants with regards to the application of splints. Methods: Postal questionnaires were sent out randomly to UK consultants asking about their usage of postoperative intranasal splints. The questions included the frequencies of splint usage in various intranasal operations, indications and types of splint used, and how long they were used for. Results: A total of 135 (68%) questionnaires were returned. Only 123 (62%) were completed and analyzed. Majority (72%) felt that the main indication of the splints was prevention of reformation of adhesions in patients who required adhesion division. Almost 70% of consultants performing division of adhesions would routinely apply splints. Although overall 80% rarely or never use intranasal splints, nearly half (48%) still believe that splints could prevent postoperative adhesions. An average 26% routinely use splints for operations involving both the septum and lateral wall of nasal cavity (eg, septoplasty+submucous resection). The most common splints used are flat silicone rubber (69%). Most would leave the splints intranasally for 1–2 weeks; 71% advocate saline nasal douching. Conclusion: The current practice among UK consultants regarding intranasal splint application appears to be leaning toward evidence-based practice.

稀なる鼻腔側壁多形腺腫の一例 本邦における鼻腔多形腺腫の統計的観察

Pleomorphic adenoma, which is also called mixed tumor is considered to occur favorably in major salivary glands such as parotid and submandibular glands, and rarely in the nasal cavity, pharynx, larynx, trachea, and lacrimal gland. We reported here a rare case of pleomorphic adenoma (2.9 X 2.2 X 1.7 cm3) developed from the lateral wall of right nasal cavity in a 43-year-old woman. Statistical observation of pleomorphic adenoma of the nasal cavity in Japan was made and comparative study was also made between such adenoma and that in the parotid gland. In Japan, 41 cases of pleomorphic adenoma originated in the nasal cavity have been reported so far including ours. These cases had age of onset of 16-74 years, averaging 44.6 years. Sex ratio showed female predominance. No significant difference was noted in affected sides sites. Chief complaints were represented mostly by nasal obstruction (29 cases; 71%) and nasal bleeding (23 cases; 56%). Tumors were surgically extirpated in all cases. One recurrent case (2.4%) was reported and another malignant case (2.4%) was also reported. 4 cases (9.8%) were originated in the lateral wall of nasal cavity and all of the other cases were in the nasal septum. In comparison with pleomorphic adenoma developed in parotid gland in Japan, sex ratio was 1:1.8 compared with 1:2.1 for parotid gland with almost similar tendency. Age of onset averaged 44.6 compare with 32.8 years for parotid gland, with a little advance in age.(ABSTRACT TRUNCATED AT 250 WORDS)