Nasal Endoscopic Examination Research Articles

Rhinoplasty Video Library, Volume II: Structural Grafting for Definitive Management of the Unilateral Cleft Lip Nasal Deformity

As a service to our readers, Plastic and Reconstructive Surgery® reviews books, DVDs, practice management software, and electronic media items of educational interest to reconstructive and aesthetic surgeons. All items are copyrighted and available commercially. The Journal actively solicits information in digital format for review. Reviewers are selected on the basis of relevant interest. Reviews are solely the opinion of the reviewer; they are usually published as submitted, with only copy editing. Plastic and Reconstructive Surgery® does not endorse or recommend any review so published. Send books, DVDs, and any other material for consideration to: Arun K. Gosain, M.D., Review Editor, Plastic and Reconstructive Surgery, Brookriver Executive Center, 8150 Brookriver Drive, Suite S-415, Dallas, Texas 75247. Arun K. Gosain, M.D. Review Editor Dr. Toriumi is an internationally recognized name within the field of rhinoplasty who has provided countless classic educational articles on the structural approach to rhinoplasty. As one of the modern pioneers in structural rhinoplasty, he now introduces a clear, concise, and detailed DVD series on the topic. Each video provides a unique perspective on the philosophy of structural rhinoplasty through the eyes of a renowned expert via surgical case examples. Volume II, the subject of this review, guides the viewer through structural grafting of the unilateral cleft lip nasal deformity.The DVD begins with a comprehensive facial analysis in which each patient’s deficiencies are categorized. This transitions into an honest appraisal of potential improvements and limitations using preoperative morphing computer software. This initial evaluation serves as an outline for the upcoming surgery. The first portion of the video concludes with detailed surgical markings to explain the options for rib harvesting along with pertinent anatomy. This will serve as a roadmap for Dr. Toriumi’s short-scar costal cartilage harvesting technique performed later in the surgery. Before surgical incision, an endoscopic nasal examination is performed and the pertinent aspects are discussed as relevant to the upcoming surgery. The objectives of the procedure are explicitly laid out, and the surgery commences with injection of local anesthesia. The direction provided in the video on how to open a cleft nose without violating the underlying asymmetric cartilage is very instructive. After elevation of the nasal flap, key points are provided so as to gently elevate around the nasal floor and bony spurs without perforation. In describing osteotomy techniques, the video explains in detail how to adjust the nasal bones and then realign the lower third of the nose to give the appearance of a straight dorsum on the anterior view. With the foundation of the rhinoplasty set, the operation then moves to cartilage harvesting. One of the prior drawbacks to rib cartilage harvesting was the traditional 3- to 5-cm incision used for access. Dr. Toriumi’s keyhole approach to costal cartilage harvesting with a 1.2-cm incision significantly enhances harvest of rib cartilage. Careful filming of this portion of the surgery provides insight on how the sixth rib is approached, the perichondrium elevated, and the rib safely lifted off the underlying perichondrium then delivered through the incision. The technique for creating cartilage grafts may be the most important aspect of the video. Dr. Toriumi has been using rib cartilage for more than two decades; he imparts key observations on how to recognize the bend of the cartilage and use this bend to facilitate the surgical outcome, as well as techniques to prevent long-term cartilage warping. During this process, the creation of asymmetric spreader grafts, lateral crural strut grafts, and caudal septal extension grafts is demonstrated. The operative technique concludes by focusing on final nasal tip definition. The adage “as the tip goes, then so goes the rhinoplasty” is apparent with the meticulous attention given to this portion of the procedure. The feedback loop of rhinoplasty is also appreciated during execution of the tip work, as each adjustment triggers a repeated evaluation and another adjustment until the tip is ideal. With this and every step of the rhinoplasty, clear explanations are provided and are of value for surgeons irrespective of their past level of experience. This video is an excellent addition to any educational library, and we would recommend it to all surgeons treating cleft nasal deformities.

Evaluation of the application of rhino-septal splints in endoscopic transsphenoidal skull base surgery.

The endoscopic transnasal route for the surgical removal of tumors in the sellar region is frequently associated with nasal complications such as synechiae or impaired nasal breathing. In this study, we investigated the impact of septal splints on avoiding surgery-related co-morbidities. 49 patients in whom endoscopic transnasal, transsphenoidal surgery for sellar tumors was performed between 2012 and 2014 were studied. In 30 of these, nasal septal splints were applied at the end of surgery to both sides of the septum and left in situ for 10days (group 1), 19 patients received no splints (group 2). A standardized postsurgical follow-up investigation with endoscopic nasal examination, rhinomanometry and olfactory testing was performed on average 2months postoperatively. Patients' subjective nose-related discomfort at follow-up was assessed descriptively using a set of standardized self-rating statements on nasal problems. Synechias occurred less likely with nasal septal splints (n=15; 50%) than without (n=16; 84.2%). Moreover, multiple synechiae were predominantly observed in the group without septal splints (n=10 vs. n=2). Rhinomanometry showed improved flow-V150-inspiration scores when splints were used (with significant differences between groups for the left nostril: p=0.039 and p=0.022, resp.). In accordance, impaired nasal breathing after surgery was reported more frequently by 76.9% of patients without splints, but only 56% of patients with splints. Our results provide support for the application of nasal septal splints when operating endoscopically on tumors in the sellar region to reduce postoperative synechias and to improve nasal breathing.

Evaluation and treatment of isolated sphenoid sinus diseases.

To review cause, clinical evaluation, medical and surgical management of isolated sphenoid sinus diseases. Early diagnosis of isolated sphenoid sinus diseases requires a high index of clinical suspicion and appropriate radiological imaging. Sphenoid sinus can be approached endoscopically via a few different surgical techniques. Isolated sphenoid sinus diseases are uncommon, with nonspecific clinical presentation. Early diagnosis requires a high index of clinical suspicion, proper endoscopic nasal examination, and appropriate radiological imaging. Surgical intervention is the primary treatment modality for most of the isolated sphenoid sinus diseases. Endoscopic endonasal approach to sphenoid sinus is the technique of choice. The location of sphenoid sinus disease, the extent of the surgery, and anatomic configuration of the sphenoid sinus are the main factors that help to decide the most suitable surgical approach to the sphenoid sinus.

Aetiology, diagnosis and treatment of chronic rhinosinusitis: a study in a teaching hospital in Telangana

<p class="abstract"><strong>Background:</strong> Chronic rhinosinusitis is one of the common problems in ENT Department which can be caused due to infections or anatomical blockage or allergy. We performed this study to assess the cause, clinical features and the effect of treatment on rhinosinusitis.</p><p class="abstract"><strong>Methods:</strong> 60 patients of chronic sinusitis with symptoms persisting beyond three months, Nasal Endoscopic findings with Polyps/Discharge/edematous mucosa were included in the study. A detailed clinical history, with complete Ear, Nose, Throat, and Head and Neck examination, blood tests like complete blood picture, Blood sugar levels, ESR and Hepatitis profile. X ray of paranasal sinuses, (water’s view) and lateral view, Chest x-ray –PA View and CT scan of paranasal sinuses (axial and coronal section with 3mm cuts at OMC) was done for all patients. Diagnostic Nasal Endoscopic examination (DNE) for detection of polyps / discharge / edematous mucosa in middle meatus was also done for the patients where it was necessary. The patients were given medical or surgical treatment according to the symptom and followup was done for 3 months for all patients. </p><p class="abstract"><strong>Results:</strong> Over 75% of the patients had incidence of sinusitis in the age group of 16 – 45 years. The most common etiology was sinusitis caused by infections (26 – 44%) followed by anatomical obstruction (22 – 36%). Of the 22 anatomical obstruction the most common was Deviated nasal septum in 14 (62%) of the cases followed by 4 (19%) CB, 3 (15%) pradixical MT and 1 (4%) prominent aggernasi. The most common sign and symptom was headache and polypoidal changes observed in 36 patients each (60%), followed by nasal obstruction in 35 patients (50%). 12 (20%) of the patients were treated with polypectomy + FESS while 14 (23%) of them were treated with septoplasty + FESS. 34 (57%) were treated with only FESS.</p><strong>Conclusions:</strong> Chronic sinusitis doesnot affect a particular age or sex and is more common among patietns with an upper respiratory tract infection. CT scan of the paranasal sinuses is the most useful tool in diagnosing the disease and FESS is the treatment of choice.

Reliability assessment of the endoscopic examination in patients with allergic rhinitis.

Objective:To study if nasal endoscope can be a reliable tool in assessing patients with allergic rhinitis.Materials and Methods:A prospective study. Patients who were diagnosed with allergic rhinitis underwent a nasal endoscopic examination performed by two physicians blinded to the scoring of each other. A correlation was made among symptom severity, endoscopic findings, and interrater variability.Results:Ninety patients were included in the study: 34 patients had mild disease and 56 had moderate-to-severe allergic rhinitis according to the Allergic Rhinitis and its Impact on Asthma guidelines. Increases in mucosal edema and bluish discoloration were predictive of the severity of allergic rhinitis disease (p < 0.05). The presence of nasal secretions was not predictive of allergic rhinitis. Interrater reliability was fair for mucosal edema, moderate-to-almost perfect for the rest of the endoscopic findings.Conclusion:Nasal endoscopy may reveal signs that are predictive of the severity of allergic rhinitis. A detailed checklist is needed for the nasal endoscopic examination to decrease interrater variability.

Pleomorphic adenoma of the nasal septum: a case report and review of the literature

Intranasal pleomorphic adenomas are quite rare and are frequently misdiagnosed . We report a nasal septal pleomorphic adenoma in a 60-year-old man. Rigid endoscopy of the nose revealed a large polypoid mass filling the right posterior nasal cavity. Computed tomography scan of the paranasal sinuses demonstrated well-pneumatized paranasal sinuses and a soft tissue mass in the posterior aspect of the right nasal cavity arising from the posterior part of the septum. A submucous resection was used as an approach to the tumor and as a method of excising the mass with the segment of septum attached to it. After 4 years, the patient had experienced no further problems with the nasal airway, and repeated nasal endoscopic examination revealed no recurrence of the disease.

Thornwaldt Cyst: Case Report

Thornwaldt cyst is benign, mucosal congenital cyst which is located in upper nasopharynx. It developed in nasopharyngeal bursa if opening of bursa is occluded due to infection or inflammation. It is rare congenital cyst present in nasopharyngeal bursa. Its incidence is 3% in adults [1]. The usual age of presentation is 2nd and 3rd decade [1]. It is usually asymptomatic and incidental finding on MRI but it can present as nasal obstruction, post nasal drip, halitosis, occipital headache, foreign body sensation in throat [1] [2]. Here we are presenting a case report of 23 years old male presented with foreign body sensation in throat since 5 months. On oral and nasal endoscopic examination cystic mass in nasopharynx seen, bulging in oropharynx. MRI shows cystic mass arising from left side of nasopharynx popping up in oropharynx. Cyst then excised with diode laser with both endonasal and transoral approach with zero degree rigid endoscope. Histopathology confirmed the cyst as thornwaldt cyst.

Change in nasal congestion index after treatment in patients with chronic rhinosinusitis with nasal polyposis.

Background:The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) involves both surgical and medical approaches, and remains a controversial subject.Objective:The objective of this prospective, randomized, controlled trial was to compare the medical and surgical treatments of CRSwNP in terms of their effect on the nasal congestion index (NCI).Methods:Forty-eight patients with CRSwNP were randomized either to medical or surgical therapy. Pretreatment and 3- and 6-month posttreatment assessments of the visual analog scale score, the 20-Item Sino-Nasal Outcome Test, saccharine clearance time, nasal endoscopy, and NCI measurement with acoustic rhinometry were performed. Forty-one subjects were included in the analysis.Results:Both the medical and surgical interventions for CRSwNP resulted in significant improvement in the visual analog scale score, 20-Item Sino-Nasal Outcome Test, saccharine clearance time, and nasal endoscopic examination scores. There was no difference between the two groups in terms of the percentage change from baseline for any of the parameters at the 6-month posttreatment assessment. NCI showed no significant difference from baseline. Similarly, no significant difference was found between the medical and surgical groups in terms of their effect on the NCI (p > 0.05).Conclusion:Because NCI does not correlate with standard subjective measures in outcomes for this group of patients, it cannot be used as an outcome measurement of treatment of subjects with CRSwNP. Results of this prospective randomized study did not find any additional benefit of surgical therapy over medical therapy in subjects with CRSwNP.

The spectrum of nasal involvement in systemic lupus erythematosus and its association with the disease activity.

The purpose of this study was to determine the spectrum of nasal involvement in systemic lupus erythematosus (SLE) and its association with the disease activity of SLE based on the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). This was a cross-sectional and observational study involving 73 stable SLE patients. All subjects were evaluated for the SLEDAI scores and had nasal endoscopic examination. The most commonly reported symptom was nasal congestion (31.5%) followed by nasal itchiness (26.0%), runny nose (20.5%) and nasal dryness (19.2%). Almost half (42.9%) of the subjects had nasal mucosal abnormalities, which included mucositis, crusting, ulceration, bifid middle turbinate, septal spur, Jacobson's organ, deviated nasal septum, bilateral inferior turbinate hypertrophy, everted uncinate process, nasopharynx cleft and torus palatinus. The median SLEDAI score for subjects with nasal symptoms was significantly higher than subjects without nasal symptoms (p < 0.05). Similarly, subjects with moderate to high activity (SLEDAI scores of 6-19) had a significantly higher frequency of both nasal symptoms and nasal mucosal abnormalities (p < 0.05) compared to subjects with no to mild activity (SLEDAI scores of 0-5).

Nasal and Tracheal Microbial Colonization in Laryngectomized Patients.

Complete separation of upper and lower respiratory tract after total laryngectomy results in loss of physiological nasal functions and presence of "unconditioned" inspired air in lower airways. Aim of this study is evaluating the presence of a microbial colonization of nasal cavities and trachea in laryngectomized long-term survivors. Twenty-five laryngectomized patients underwent symptoms' anamnestic evaluation, endoscopic fiber optic nasal and tracheal examination, specimen collection for microbiological exam, and culture. Enrolled patients had at least a 2-year follow-up period in order to evaluate long-term microflora. Gram positive polimicrobic flora represented the main finding in nasal cavities and trachea (92% and 48% of patients, respectively). Other bacteria were non-fermenters Gram negative bacteria, Enterobacteriaceae and Staphylococcus aureus. The same microflora was demonstrated in nasal cavity and trachea in 5 patients (20%), while sterile nasal cavity and trachea were seen in 3 (12%) and 4 (16%) cases, respectively. No fungi were observed in nasal cavity and trachea. Nasal cavities and trachea of laryngectomized patients are colonized by nonpathogenic and/or potentially pathogenic bacteria, in absence of signs and symptoms of infection. Colonizer microflora should be kept in mind when a culture from nasal or tracheal swabs is needed in daily practice.

Distal lakrimal kanal tıkanıklığına eşlik eden lateral nazal duvar patolojilerinin incelenmesi

Objective: In this study, the role of lateral nasal wall and sinus pathologies in the etiology of distal lacrimal duct disease has been investigated. Methods: Seventeen female and 11 male patients who were scheduled for endoscopic endonasal dacryocystorhinostomy and silicon tube intubation between April 1999 and September 2003 were included in the study. The patients underwent general ophthalmologic examinations such as Schirmer test, fluorescein dye disappearance test, Jones I-II tests, canalicular irrigation, canalicular probing, dacryocystography, dacryoscintigraphy for the diagnosis of lacrimal duct obstruction. In the clinics of ENT, for the detection of nasal cavity pathologies, anterior rhinoscopy and diagnostic nasal endoscopic examinations were performed. All patients were evaluated during paranasal computed tomographic examinations regarding osteomeatal complex disease, ethmoid cell opacification, concha bullosa and presence of agger nasi cells and data obtained were compared with findings of 50 control subjects using Fisher’s chi-square tests. Results: On the side where lacrimal duct obstruction exists, agger nasi cells were detected in 17 (60.7%) patients, concha bullosa in 10 (35.7%) patients, ethmoid cell opacification in 6 (21.4%) patients, osteomeatal complex disease in 4 (14.2%) patients, and one or more than one symptom were detected in 21 (75%) patients. Despite higher number of lateral nasal wall and sinus pathologies in the study group when compared with the control group, intergroup difference was not statistically significant (p>0.05). Conclusion: We have concluded that despite the higher rates of lateral nasal wall and sinus pathologies in patients with distal nasolacrimal system obstruction, its etiology has not been adequately expounded and paranasal computed tomographies will have increasing importance in the evaluation of these patients.

Nasal endoscopic evaluation and its impact on survival in patients with stage I/II extranodal natural killer/T-cell lymphoma, nasal type.

Endoscopic findings of extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, are heterogeneous, but not fully understood. The objective of this study was to evaluate the role of nasal endoscopic examination and its implications for treatment of stage I/II ENKTL. This retrospective study included 60 consecutive patients diagnosed with stage I/II ENKTL, nasal type, from 2000 to 2011. The endoscopic findings were classified into early (45%) and advanced (55%) lesions. Furthermore, the primary tumor extent assessed by endoscopy was significantly correlated with the radiologic imaging (p < 0.001). The results of univariate analysis showed that the patients with advanced lesions had worse overall survival (p = 0.004) and disease-free survival (p = 0.001) than those with early lesions. In multivariate analysis, advanced lesions on nasal endoscopy was an independent prognostic factor (p = 0.024; hazard ratio 5.29; 95% confidence interval, 1.25-22.39). We found that nasal endoscopic findings were important prognostic factors in stage I/II ENKTL, nasal type, suggesting that comprehensive endoscopic evaluation of primary tumor should be performed in this setting.

English

Thornwaldt's cyst is almost always asymptomatic and usually diagnosed incidentally on nasal endoscopy examination. Radiological examination particularly MR imaging is useful to diagnose the cyst & differentiated from meningocele or menigoencephalocele. Various therapeutic approaches for removal of cyst have been described. We present a case of Thornwaldt's cyst which was managed successfully by the endoscopic approach.

Role of Nasal Endoscopy in Sinonasal Diseases

ABSTRACT Aims and objectives To evaluate sinunasal diseases with the help of nasal endoscopy. To study efficacy of nasal endoscopy in diagnosing nasal pathology over clinical examination. To define medical and surgical functional endoscopic sinus surgery (FESS), management according to type of nasal pathology. To define applications of nasal endoscopy (biopsy, swab, epistaxis control, foreign body removal, rhinolith removal, follow-up). Materials and methods Total 100 patients were studied. Patients came with complaints of nasal blocking, nasal discharge, mass in nasal cavity, bleeding etc, included in study. Pre-endoscopic assessment was carried out like history, examination, investigation. Endoscopic was done after consent under necessary anesthesia. Endoscopy was done using 0 and 30° endoscope with three standard passes. Result Total 100 patients were studied. Male to female ratio was 1.8:1. Out of 100 patients maximum number of patients had chronic sinusitis on nasal endoscopy examination (22); followed by nasal polyp (27) and deviated nasal septum and epistaxis (10). Nasal endoscopy was an excellent diagnostic aid in condition like epistaxis, nasal mass, nasal obstruction, foreign body, nasopharyngeal tumor. Conclusion Diagnostic nasal endoscopy offers high diagnostic accuracy in patient with sinonasal complaints. Diagnostic nasal endoscopy is gold standard tool in patient having sinonasal complaints. It has high accuracy due to vision control, has less bleeding, minimal complication, and early postoperative recovery. It is a good tool for diagnosing anatomical variation. How to cite this article Shelkar R, Vedi J, Patel S, Dasgupta KS, Lanjewar K. Role of Nasal Endoscopy in Sinonasal Diseases. Clin Rhinol An Int J 2015;8(1):8-11.

Late sensorial alterations in different radiotherapy techniques for nasopharyngeal cancer.

Intensity-modulated radiation therapy (IMRT) for nasopharyngeal cancer (NPC) allowed a better distribution of the dose to the tumor volume, sparing surrounding structures. Aim of the study is the objective evaluation of olfactory and gustatory impairments in patients who underwent chemo-radiotherapy for NPC. Correlation between smell and taste alterations, xerostomy, and radiation technique was investigated. Thirty healthy subjects and 30 patients treated with chemo-radiation therapy for NPC, with at least a 2-years follow-up period, were evaluated. All subjects underwent symptoms evaluation, endoscopic fiber optic nasal examination, taste strips, Sniffin' sticks tests, Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring system. Patients were divided in 2 groups: 2-dimensional radiotherapy/conformal 3-dimensional radiotherapy and IMRT. A higher percentage of rhinorrhea, nasal obstruction, xerostomy, hyposmia, hypogeusia, mucosal hyperemia, and presence of nasopharyngeal secretions was found in irradiated subjects (P < 0.05). Concerning olfactory and gustatory scores, we demonstrated a statistically significant difference between healthy subjects and irradiated patients (P < 0.05), with lower gustatory total score in IMRT group (P < 0.01). In conclusion, chemo-radiotherapy for NPC induces long-term smell and taste impairments, which can compromise quality of life. Although based on small samples, it is also important to consider that IMRT can induce higher taste dysfunction compared with traditional techniques.

Impact of educational intervention on the interrater agreement of nasal endoscopy interpretation.

Nasal endoscopy is integral to the evaluation of sinonasal disorders. However, prior studies have shown significant variability in the interrater agreement of nasal endoscopy interpretation among practicing rhinologists. The objective of the current study is to evaluate the interrater agreement of nasal endoscopy among otolaryngology residents from a single training program at baseline and following an educational intervention. Eleven otolaryngology residents completed nasal endoscopy grading forms for eight digitally recorded nasal endoscopic examinations. An instructional lecture reviewing nasal endoscopy interpretation was subsequently provided. The residents then completed grading forms for eight different nasal endoscopic examinations. Interrater agreement among residents for the pre- and postlecture videos was calculated using the unweighted Fleiss' kappa (Kf) statistic and intraclass correlation agreement (ICC). Interrater agreement improved from a baseline level of fair (Kf range 0.268-0.383) to a posteducational level of moderate (Kf range 0.401-0.547) for nasal endoscopy findings of middle meatus mucosa, middle turbinate mucosa, middle meatus discharge, sphenoethmoid recess mucosa, sphenoethmoid recess discharge, and atypical lesions (ICC, P < 0.001). The baseline level of agreement for evaluation of nasal septum deviation was poor/fair and did not improve following educational intervention. This study demonstrates a limited baseline level of interrater agreement of nasal endoscopy interpretation among otolaryngology residents. The interrater agreement for the majority of the characteristics that were evaluated improved after educational intervention. Further study is needed to improve nasal endoscopy interpretation. N/A.

Clinical analysis of 18 coma patients with occult cerebrospinal fluid rhinorrhea after tracheotomy in severe traumatic brain injury

Objective To discuss the clinical feature, diagnosis and treatment of the occult cerebrospinal fluid rhinorrhea after tracheotomy in patients with severe traumatic brain injury. Methods The clinical data of 18 cases of the occult cerebrospinal fluid rhinorrhea after tracheotomy in patients with severe traumatic brain injury were retrospectively analyzed. Results 15 cases showed involuntary swallowing movements, frequentstimuluslike cough,abnormal increased secretions in the oral and nasal;3 cases performance of aspiration, hypoxemia, respiratory distress. After a three- dimensional thin skull CT,cisternography,nasal endoscopic examination can confirm the diagnosis. After the treatment with replacing the tracheostomy tube with a balloon, continuous lumbar drainage, endoscopic repair leak, the cerebrospinal fluid rhinorrhea were cured. Conclusion Patients with occult cerebrospinal fluid rhinorrhea performance the diversity and easily missed, early detection and timely treatment can prevent cerebrospinal fluid rhinorrhea delayed healing and intracranial infection and promote patient recovery. Key words: Coaniocerebral injury; Coma; Tracheotomy; Occult; Cerebrospinal fluid rhinorrhea

Nasal cytological changes as late effects of radiotherapy for nasopharyngeal cancer.

Radiation therapy is a cornerstone in nasopharyngeal cancer treatment. However, it can induce acute and long-term adverse effects, such as acute mucositis and late submucosal fibrosis. Late toxicities could not only affect submucosa but also mucosal cells, determining long-term cytological changes. Evaluation of delayed nasal cytological alterations in patients who underwent radiation therapy for nasopharyngeal carcinoma (NPC). In this case-control study, we analyzed 30 healthy subjects and 30 patients treated with chemotherapy and radiotherapy for NPC between 2003 and 2011, with a median follow-up of 59 months. All subjects underwent symptoms anamnestic evaluation (rhinorrea, nasal obstruction), endoscopic fiber optic nasal examination, skin-prick tests, and nasal scraping for cytological exam. A higher percentage of rhinorrhea, nasal obstruction, mucosal hyperemia, and presence of nasopharyngeal secretions at fiber optic endoscopic exam was found in radiated subjects (p < 0.05). Nasal cytology analysis demonstrated a higher percentage of neutrophilic inflammation and squamous cell metaplasia and mucous cell metaplasia in treated patients (p < 0.05). No cytological atypia was seen. No statistically significant correlation between nasal cytological changes and objective findings, patients' age, tobacco smoking, and gastroesophageal reflux has been found in the radiotherapy group (p > 0.05). Radiation therapy induces late nasal mucosal changes, which may be related to clinical consequences, such as abundant mucus production and its consequent endonasal stagnation. In the future, detailed knowledge of cytological changes in patients' nasal mucosa could represent a key prerequisite for the choice of effective interventions for late radiation-induced rhinitis.

Clinical features and treatment outcomes of dental implant-related paranasal sinusitis: A 2-year prospective observational study.

As dental implant-related paranasal sinusitis has different pathophysiology and clinical features from primarily rhinogenic paranasal sinusitis, the standard treatment protocol for dental implant-related paranasal sinusitis has not yet been established. The aim of this study was to analyze the clinical characteristics and treatment results of dental implant-related paranasal sinusitis. We conducted a prospective single-center study of 19 patients who were treated for odontogenic sinusitis developing in relation to dental implant from September 2008 through May 2012. The age of the patients ranged from 33 to 78years, with the mean age of 54.5years. Foul odor and postnasal dripping were the two most common complaints. All patients underwent nasal endoscopic examination and paranasal sinus CT before treatment, and initial conservative treatment for 1week. Patients unresponsive to medical treatment underwent endoscopic sinus surgery (ESS). All patients were classified into the conservative and surgical groups for analysis and followed up for 2years after initial diagnosis. Four patients (21%) were successfully treated conservatively, while 15 patients (79%) underwent surgical treatment. One of these 15 patients required revision surgery. After 2years, all patients were successfully treated, so there were no more clinical signs of recurrent sinusitis in any patients. The survival rate of implants was 100%. Compared to those of the conservative group, symptom duration, the Lund-MacKay CT score, status of the ostiomeatal unit (OMU), and the condition of the maxillary sinus floor were significantly more severe in the surgical group. In our study, the majority of patients who once developed paranasal sinusitis associated with dental implants required surgical treatment. Findings of paranasal sinus CT may be important in determining treatment option.

Unilateral Choanal Atresia Diagnosed During Operation: Case Report [Peroperatif Tani Konulan Unilateral Koanal Atrezi: Olgu Sunumu

Choanal atresia is the unilateral or bilateral obstruction of the passage between nasal cavity and nasopharynx. Transnasal surgery of choanal atresia in a patient with unilateral choanal atresia diagnosed accidentally during operation of septorinoplasti for septal deviation and external nasal deformity in Plastic Surgery Clinic is presented. A 25-year-old female referred to plastic surgery clinic with external nasal deformity and difficulty in breathing through nose. Although concha bullosa at middle concha and polipoid degeneration at lower concha are observed in computerized tomography of paranasal sinus, the patient referred to our clinic. In physical examination, due to advanced septal deviation, endoscopic examination of left nasal cavity could not be established. It was planned to examine the left nasal cavity in operating room after septoplasty. In the endoscopic examination after septoplasty, choanal atresia at left nasal cavity observed. Atresia was repaired with transnasal approach. At follow-up period, the choanal opening was intact. Unilateral choanal atresia is a disorder which can reach at the adolesant ages without diagnosis. Although the symptoms of the disease can be interfere in lots of diseases, the diagnosis is simple with nasal endoscopic examination. If nasal endoscopic examination is difficult because of nasal septal deviation, it must be performed in operating room before ending the operation to reveal the additional disorders.