Nasal Septal Mucosa Research Articles

Treatment of primary nasal tuberculosis with anti-tumor necrosis factor immunotherapy: A case report

BACKGROUND Primary nasal tuberculosis (TB) is a rare form of extrapulmonary TB, particularly in patients receiving anti-tumor necrosis factor (TNF) immunotherapy. As a result, its diagnosis remains challenging. CASE SUMMARY A 58-year-old male patient presented to the ear, nose, and throat department with right-sided nasal obstruction and bloody discharge for 1 month. He was diagnosed with psoriatic arthritis and received anti-TNF immunotherapy for 3 years prior to presentation. Biopsy findings revealed chronic granulomatous inflammation and a few acid-fast bacilli, suggestive of primary nasal TB. He was referred to our TB management department for treatment with oral anti-TB agents. After 9 months, the nasal lesions had disappeared. No recurrence was noted during follow-up. CONCLUSION The diagnosis of primary nasal TB should be considered in patients receiving TNF antagonists who exhibit thickening and crusting of the nasal septum mucosa or inferior turbinate, particularly when pathological findings suggest granulomatous inflammation.

Microsurgical anatomy of the olfactory filaments in the nasal mucosa.

The aim of this study was to examine the distribution of olfactory filaments (OFs) in the nasal mucosa to facilitate preservation of olfactory function in endonasal approaches and preparation of a nasoseptal flap. One formalin-fixed and 9 fresh cadaveric silicone-injected specimens with 20 total sides were studied to measure the distance of the OFs to the anatomical landmarks and compare the OF presence in the nasal septum mucosa (NSM) and ethmoidal mucosa (EM). The mean distance from the first to the last OF was 19.37 ± 2.16 mm in the NSM and 23.44 ± 5.42 mm in the EM. The NSM had a mean of 7.55 ± 1.31 OFs and the EM had 14.3 ± 1.78. Average OF lengths were measured at 6.44 ± 1.48 (range 3.75-12.40) mm in the NSM and 8.05 ± 1.76 (range 4.14-13.20) mm in the EM. The mean values of the EM measurements were compared with those of the NSM; the number of OFs, the distance between the first and last OF, the average OF length, and the number of OFs between anterior and posterior ethmoidal arteries in the NSM were significantly less (p < 0.05) than those in the EM. The distance between the first OF to the nasal bone on the NSM was greater than on the EM. Compared with the EM, the OFs are significantly fewer in number and smaller in size in the NSM. The uppermost edge of the nasoseptal flap incision in the NSM might be safer to start below 12 mm from the cribriform plate for OF protection.

Mesenchymal Stem Cell Exosome-Integrated Antibacterial Hydrogels for Nasal Mucosal Injury Treatment.

Hydrogels have emerged as appealing prospects for wound healing due to their superior biocompatible qualities. However, the integration of antibacterial active substances into hydrogels for effective wound repair remains challenging. Here, we present a novel double-network hydrogel for nasal mucosal injury repair with antibacterial and self-healing capabilities. This hydrogel is the result of mixing aldehyde polyethylene glycol (PEG) and a carboxymethyl chitosan (CMCS)-based hydrogel with a photocured methylacrylate gelatin (GelMA) hydrogel to envelop mesenchymal stem cell exosomes (MSC-Exos). CMCS is rich in amino groups and facilitates antibacterial repair. Given the dynamically reversible Schiff base connections between the amino group of chitosan and the aldehyde group of modified PEG, the hydrogel can be easily injected into the lesion site because of its excellent injection and shear thinning properties. GelMA introduces an additional network layer for the hydrogel, which enhances its strength and extends the duration of stem cell exosomes on the wound surface. On the basis of these characteristics, we provide evidence that this compound hydrogel can substantially increase cell proliferation and regeneration, inhibit scar hyperplasia, and stimulate angiogenesis in rabbit nasal septum mucosa trauma models. These results suggest that MSC exosome-loaded hydrogels (ME-Gel) have substantial clinical potential for the repair and regeneration of nasal mucosa after surgery or trauma.

Transplantation of Induced Pluripotent Stem Cell-Derived Airway Epithelia with a Collagen Scaffold into the Nasal Cavity.

The nasal cavity is covered with respiratory epithelia, including ciliated cells that eliminate foreign substances trapped in the mucus. In hereditary diseases such as primary ciliary dyskinesia and cystic fibrosis, respiratory epithelial functions are irreversibly impaired; however, no radical treatment has been established yet. Thus, we considered that the transplantation of normal airway epithelia (AE) into the nasal epithelia is one of the strategies that could lead to radical treatment in the future. In our previous study, human induced pluripotent stem cell-derived AE (hiPSC-AE) on the vitrigel membrane were transplanted into the scraped area of the nasal septal mucosa of nude rats. Although human-derived ciliated cells, club cells, and basal cells were observed, they were located in the cysts within the submucosal granulation tissue but not in the nasal mucosal epithelia and the transplanted cells may not contribute to the function of the nasal mucosa with this condition. Therefore, to achieve more functional transplantation, we prepared the graft differently in this study by wrapping the collagen sponge in hiPSC-AE on the vitrigel membrane. As a result, we found the transplanted cells surviving in the nasal mucosal epithelia. These results suggest that hiPSC-AE transplanted into the nasal cavity could be viable in the nasal mucosa. In addition, our method leads to the establishment of nasal mucosa-humanized rats that are used for the development of the drugs and therapeutic methods for hereditary diseases of nasal respiratory epithelia.

Fibroepithelial Polyp Arising From the Nasal Septum: A Case Report and a Literature Review

Fibroepithelial polyp (FEP) is a benign tumor of mesodermal origin, which is mostly found on the skin. FEPs in the upper respiratory system are reported mostly originating from the oropharynx and larynx, and are rarely found in the nasal cavity. A 57-year-old female presented with a polyp-like lesion on the right nasal septal mucosa adjacent to the mucocutaneous junction. The mass was surgically removed, and a diagnosis of FEP was made based on the histopathological review. This is the first report of FEP arising from the nasal septum.

Usefulness of the Three-step Simple Binostril Approach in Endoscopic Endonasal Transsphenoidal Surgery.

We describe a three-step, simple binostril approach to endoscopic endonasal transsphenoidal surgery in cases of sellar/parasellar lesions. In the first step, the mucosa of the lower third of the ethmoid bulla on the outside was coagulated with monopolar microdissection needle and opened to create space on the outside of the middle turbinate. The middle turbinate was moved outward using this space, and the natural ostium of the sphenoid sinus could be confirmed easily. In the second step, a less than 10 mm incision was made from the right natural ostium of the sphenoid sinus to the right nasal septal mucosa. The anterior wall of the sphenoid sinus was removed to free the sphenoid sinus. In the third step, the instrument was inserted through the left nostril using a hole connected to the natural ostium of the sphenoid sinus to reach the sellar floor via both nostrils. It took longer for the trainee than for the instructor to reach the sellar floor in the first four cases. However, there was no significant difference in the approach time after the fifth case. Approach-related postoperative complications were observed in 52 cases of sellar/parasellar lesions performed. This approach was considered to provide sufficient space and was simple and less burdensome to the patient.

Evaluating the Developed Model of Experimental Rhinitis in Laboratory Rats: Pre-Clinical Experimental Randomized Study

Background. Among the damaging factors affecting the mucociliary system of the nasal cavity, surgical wound is of particular relevance in the practice of an otorhinolaryngologist. The clinical assessment of regeneration of the mucociliary system is associated with certain diffi culties, since the intravital morphological examination of the nasal mucosa in patients is traumatic. Therefore, the development of animal models of experimental rhinitis is considered to be highly relevant in order to study the dynamics of mucociliary pathomorphological changes and assess the epithelium regeneration.Objectives. To evaluate the developed model of experimental rhinitis in laboratory rats by studying clinical, morphological and biochemical changes in the infl ammatory process.Methods. The experimental rhinitis model was developed and tested on 60 mature male Wistar rats. All animals were randomized into two groups: experimental group #1 (n = 30) — rats in which experimental rhinitis modeling was performed and group #2 (n = 30) — control, intact animals. In the course of the experiment, the authors examined the content of CRP in blood, evaluated the differential blood cell count, and studied a morphology of the nasal septum mucosa in 2, 5, 10 days after the injury to assess the dynamics of the infl ammatory process in rats of both groups. Statistical analysis of the study results was carried out by means of Statistica 8.0 (StatSoft Inc., USA).Results. After injury, the rats from group #1 developed acute rhinitis, which was clinically manifested by the release of mucous or mucopurulent secretion from the nostrils, sneezing and scratching the nose. An increase in CRP, band and segmented neutrophils, and a decrease in lymphocytes were observed in blood of the rats from group #1 in comparison with the control group. Microscopic analysis of changes in the nasal septum mucosa showed that the acute phase of exudative infl ammation developed on the second day: vascular congestion, edema, neutrophilic infl ammatory infi ltration of the submucosal membrane were observed against the background of foci of epithelial necrosis. The proportion of lymphocytes and macrophages in the infl ammatory infi ltrate increased by the fi fth day, initial signs of restoration of epithelial tissue — the formation of an undifferentiated regenerating epithelium — appeared by the tenth day.Conclusion. The results of the study show that an adequate experimental model of acute rhinitis in laboratory animals have been obtained. An acute infl ammatory process is characterized by clinical manifestations and changes in blood parameters. Particular destructive and reparative-proliferative changes develop in the mucous membrane of the nasal septum of experimental animals as a result of a surgical wound.

A Case of Granulomatosis with Polyangiitis in a Child

Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. GPA in childhood is very rare, so that early diagnosis is difficult in pediatric patients. We report the case of a 14-year-old boy who presented with rapidly progressive disease. He was referred to our department with persistent severe right orbital pain and nasal obstruction despite receiving medication for a month. Right-sided sinusitis and bilateral orbital masses were confirmed on computed tomography (CT) and magnetic resonance imaging (MRI), and endoscopic sinus surgery was performed both the purpose of treating the sinusitis and performing biopsy. Histopathological examination revealed findings suggesting non-specific inflammation of the sinus, while the orbital pain and eyelid swelling continued to worsen, the sinusitis persisted, and the patient also complained of cough. As we suspected GPA, we performed biopsy of the right orbital mass and nasal septal mucosa, and also serology for PR-3 ANCA. As the histopathological results were typical of GPA and serology for PR-3 ANCA was positive, the patient was diagnosed as having GPA three weeks after his first visit to our hospital. The prognosis of GPA is very poor, with 90% of patients dying within a year if left untreated. As early diagnosis and start of treatment are crucial, the attending physician shohld have a high index of suspicion for GPA, even in pediatric patients.

Analysis of clinical prognosis of endoscopic salvage surgery in patients with rT2 recurrent nasopharyngeal carcinoma

Objective: To investigate the feasibility of endoscopic salvage surgery for patients with rT2 recurrent nasopharyngeal carcinoma (rNPC) and to analyze their prognostic factors. Methods: The clinical data of 33 patients with rT2 rNPC who underwent endoscopic extended nasopharyngectomy in Eye & ENT Hospital Affiliated to Fudan University from January 2015 to July 2020 were analyzed, including 29 males (87.9%) and 4 females (12.1%), aging (51.7±10.6) years. The clinicopathological characteristics of these patients were recorded and analyzed, in terms of gender, sex, alcohol and cigarette use, interval between primary treatment to recurrence, adjuvant therapy, lymph node metastasis, internal carotid artery (ICA) invasion, necrosis, margin and reconstruction materials. Kaplan Meier analysis was used to plot the overall survival rate and progression free survival rate curve, Log-rank test was used to analyze the prognostic factors among patients, and multivariate Cox proportional hazards regression was used to determine the independent risk factors of tumor progression free survival. Results: Among 33 patients with rT2 rNPC, the recurrence interval of 24 patients with rNPC after primary radiotherapy was more than 2 years. A total of 25 patients received primary radiotherapy and adjuvant chemotherapy at the same time. There were 6 cases with cervical lymph node metastasis, 12 cases with ICA invasion, 8 cases with positive surgical margin, 7 cases underwent ICA embolization before operation. A total of 18 cases underwent pedicled tissue flap repairment after operation, including 12 pedicled nasal septal mucosa flaps and 6 temporalis muscle flaps. The median follow-up time was 15 months. Five patients died because of disease progression (in 2 cases), post surgical ICA hemorrhage (in 1 case), liver metastasis (in 1 case) and dysphagia (in 1 case). The 1-year, 2-year and 3-year overall survival rates of all patients were 93.9%, 81.8% and 81.8%, respectively. The 1-year, 2-year and 3-year progression free survival rates were 74.7%, 59.7% and 40.9%, respectively. Log-rank statistical analysis showed that the positive surgical margin (P=0.060) and recurrence interval (P=0.151) were possibly related to the prognosis of rT2 rNPC. Multivariate Cox regression analysis showed that the positive surgical margin was an independent risk factor for patients with rT2 rNPC (P=0.034). Nasopharynx hemorrhage occurred in 4 patients, skull base bone necrosis occurred in 2 patients, trismus occurred in 3 patients, and no obvious brain complications occurred in 7 patients with ICA embolization. Conclusion: Endoscopic salvage surgery for rT2 rNPC is a safe and effective surgical option, but the long-term effect still needs long-term follow-up in bulk cases.

P153 Comparison of clinical presentation of 2 cases of paracoccidioidomycosis in Shushufindi, Ecuador

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesDiscuss the diagnosis of two cases of paracoccidioidomycosis (PMC) for the first time in the city of Shushufindi, Ecuador.Report two different clinical presentations in two male patients diagnosed with PMC.MethodsThe diagnosis and treatment of two male patients with PMC is retrospectively described. Individual informed consents were obtained from each patient.ResultsThe first case is a 39-year-old male patient, with a history of previous armadillo hunting, with no relevant history. Born and resident in Shushufindi, Amazon area of the province of Sucumbíos, Ecuador. He presents lesions of ∼ 7 years of evolution, characterized by ulcerated plaques with meliceric crusts in the nose and in the mouth at the level of the upper lip (Figs. 1a and b).This patient had had several visits to different medical doctors, who unfortunately diagnosed other diseases. Due to his long clinical evolution, he was referred to a dermatological referral center in Quito. During the initial examination, a differential diagnosis of oncologic pathology, mycosis, mycobacteria, and cutaneous leshmaniasis was considered. A punch biopsy of the affected region was requested, and specimens were sent for culture, histopathology, and smears from the margins of the lesion to rule out leshmaniasis. As shown in Figure 1c, a histopathology report was submitted with yeast-like structures with multiple branches and a positive culture for Paracoccidiodes (Fig. 1d). Other clinical laboratory studies or chest imaging were within normal parameters.The second case is a 54-year-old male patient, a farmer, with no relevant history. Born and resident in Shushufindi. No clinical or geographical relationship with case number 1. He presented lesions of ∼ 2.5 years of evolution, characterized by ulcerated plaques with meliceric crusts in the lower part of the nose, with lytic destruction of the anterior nasal septum and left nasal ala (Figs. 2a and b).This patient has also consulted many physicians. At his last visit, he was treated for cutaneous leshmaniasis without a positive result. He was admitted to a specialized dermatological center in the city of Quito, 3 weeks after the first patient, so a similar protocol was used. Patient number two had a slight elevation of liver enzymes, other laboratory, and imaging tests were within normal parameters. Unfortunately, culture showed no fungal growing, and histopathology of a punch biopsy of the nasal septal mucosa showed yeast-like structures with multiple extensions suggestive of PCM (Fig. 2c).In both patients, treatment was started with oral itraconazole 200 mg per day. In the first 2 months, the treatment showed little success, so it was decided to increase trimethopine-sulfamethoxazole to 8 mg/kg per day for 6 months.ConclusionParacoccidioidomycosis is an endemic disease in South America characterized by infection with Paraccocidioides lutzi and Paracoccidioides brasiliensis. Several articles have described cases in Ecuador, but this is the first report from the city of Shushufindi. The patients had different orofacial manifestations. In the patient with the shortest duration of infection, lytic damage to the nasal septum was observed (Fig. 2b).

The Genotoxic Effect of Nasal Steroids on Human Nasal Septal Mucosa and Cartilage Cells In Vitro.

To determine whether budesonide (Bud) and triamcinolone acetate (TA) cause DNA fractures in the nasal mucosa and septal cartilage cells through examinations using the comet assay technique. Prospective, controlled experimental study. University hospital. Septal mucosal epithelial and cartilage tissue samples were taken from 9 patients. Cell cultures were prepared from these samples. Then, budesonide and triamcinolone acetate active ingredients at 2 different doses of 0.2 and 10 µM were separately applied to the cell cultures formed from both tissues of each patient, except the control cell culture, for 7 days in one group and 14 days in one group. After the applications, genotoxic damage was scored with the comet assay technique and the groups were compared. In both the budesonide and triamcinolone acetate groups, the comet scores at low and high doses, on the 7th and 14th days were found to be significantly higher in both cartilage and epithelial tissue than in the control group. The study results showed that budesonide and triamcinolone acetate lead to a significantly high rate of genotoxic damage in both epithelial tissue and cartilage tissue.

Recurrent oncocytic papilloma of the middle ear: A case report and literature review

Schneiderian papillomas commonly occur in the nasal sinuses and septal mucosa. This type of papilloma rarely develops in the middle ear, with only 51 previously reported cases. The oncocytic papilloma (OP) subtype is even rarer, with only seven cases. We present a case of primary OP in the middle ear that recurred during long-term postoperative follow-up. The patient was a 31-year-old man who experienced papilloma recurrence after three surgeries. These recurrences appeared as a shadow on computed tomography. No recurrence has been observed since his fourth surgery. Our review showed increased recurrence and malignant transformation rates in inverted papillomas that occur in the middle ear. In contrast, OPs occurring in the middle ear were reported to have a high recurrence rate and no malignant transformation. Close and careful follow-up is necessary for any type of papilloma.

Dermoid Cyst of Nasal Tip and Nasal Septum.

:Dermoid cyst is a congenital and benign disease with most occur on the head and neck. It is rarely that occur on the nasal tip and nasal septum at same time and rarely repair of using nasal septum mucosa. The authors treated a child with dermoid cyst in the nasal tip and septum. Only the dermoid cyst at the tip of the nose caused the change of appearance. Dermoid cyst of nasal septum did not cause any clinical symptoms. She underwent excision of the dermoid cyst at the tip of the nose and endoscopic surgery for the dermoid cyst in the nasal septum and used the nasal septum mucosa for repair at the same time. After 6 months of recovery, the appearance of the nasal tip recovered well without obvious scar, the nasal septum area recovered well, and the local stoma was unobstructed without recurrence. The authors found that this kind of nasal septal cyst with no clinical symptoms can achieve good therapeutic effect through endoscopic surgery and repair of using nasal septum mucosa, with less damage, rapid recovery, and good prognosis.

8-iso-prostaglandin E2 induces nasal obstruction via thromboxane receptor in murine model of allergic rhinitis.

Thromboxane receptor (TP) mediates nasal obstruction, a typical symptom of allergic rhinitis. Since it has been reported that several types of eicosanoids, such as non-enzymatic oxidation product of arachidonic acid isoprostane, act as a TP ligand, there is a possibility that some other eicosanoids contribute to the TP-mediated nasal obstruction. The aim of this study is to investigate the mechanisms of TP-mediated nasal obstruction. Intranasal challenges of ovalbumin (OVA) induced nasal obstruction in mice. Pharmacological blockade of TP receptor but not thromboxane A2 synthase inhibited OVA-induced nasal obstruction. Simultaneous analysis of eicosanoids in nasal lavage fluid and the responses in trans-endothelial resistance suggested that 8-iso-prostaglandin E2 (PGE2 ) can be a candidate for TP ligand. Intranasal challenge of 8-iso-PGE2 induced vascular hyperpermeability and nasal obstruction in TP receptor-dependent manner. Wholemount immunostaining of nasal septum mucosa revealed that 8-iso-PGE2 increased plasma leakage accompanied by distention of venous sinusoids. This study shows that 8-iso-PGE2 is a contributor in TP-mediated nasal obstruction in mice.

A Case of Large Septal Perforation Repair Using Inferior Based Contra-Lateral Nasal Floor Flap, a New Surgical Technique for Large Septal Perforation

A nasal septal perforation is a defect of cartilage, bone, or mucosa of nasal septum, which is caused by previous septal surgery, trauma, chemicals, inflammatory disease, or drugs. If conservative managements, such as nasal saline irrigation or ointments, are not effective, surgical treatment can be considered. Various methods for the reconstruction of nasal septal perforation were reported, such as local flaps, free flaps, autografts, allografts, or xenografts. However, there is no standardized method due to low success rate and high recurrence rate, especially in large perforations. The authors report a successful repair case of large anteroinferior nasal septal perforation, using inferior based contralateral nasal floor flap. The authors believe that our method is an effective way to repair large nasal septal perforation and to minimalize donor site morbidity, without using other allografts.

The observation and evaluation of curative effect of nasal mucosa dryness, hemorrhae and erosion

Objective:To observe the curative effects of four kinds of plant extracts nasal spray mixture （myrtle oil, hyaluronic acid, fucoidan, anthocyanin） on 161 patients with nasal mucosa dryness, hemorrhae and erosion. Methods:① Diagnosis: patients with nasal dryness, erosive and hemorrhae nasal septum mucosa confirmed by patients' complaints and nasal endoscopic test; ② Evaluation: the severity of subjective symptoms was evaluated by VAS score method from 0 to 10 points; the degree of mucosal lesions was divided into 0-8 points by nasal endoscopic test. ③ Intranasal Intranasal administration: 2 times per-day with 2 sprays on each side of the nasal cavity, and no less than 6-8 weeks. In the patients which with allergic rhinitis were also given conventional oral administration of montelukast at the same time. ④ Follow up and curative effect evaluation: VAS and nasal endoscopic test scores that before and after treatment was statistically processed; the patients' own how feels the treatment were evaluated; finally, doctor made the final evaluation based on the combined results of subjective and objective evaluation results before and after treatment, the patients' satisfaction with treatment effect. Results:① There were significant differences in VAS scores of 161 patients before and after treatment （P<0.01）.② There were statistically significant differences in nasal endoscopic test scores of 104 patients before and after treatment （P<0.01）. ③ Patients' satisfaction survey showed the satisfied with the compliance, tolerance and treatment effect was 95%. Conclusion:The mixed nasal spray of four plant extracts can effectively improve the dryness, hemorrhae and erosion of nasal mucosal.

The impact of trauma of the mucous membrane of the nasal septum in rats on behavioral responses and changes in the balance of the autonomic nervous system (pilot study)

The nasal cavity surgery are usually traumatic surgery. Septoplasty leads to reactive inflammation, edema and hypoxemia. In the present study, we study the response of the autonomic nervous system (ANS), its role in changing behavioral reactions, as well as possible mechanisms of impairment of cognitive and adaptive reactions in rats after trauma to the nasal septum mucosa. The nasal septum mucosa was scarified in 10 adult mongrel male rats. The day before surgery and 2 days after surgery animals were tested in the square-shaped “open field” (OF) and electrocardiogram (ECG) in 1 hour before OF. ANS condition was analyzed by the high-frequency component of the heart rate (HF) and the low-frequency component of the heart rate (LF). The correlation of HF & LF with rat behavior in the open field before and after surgery was performed. Simulation of septoplasty in rats provokes a powerful stress response in the form of a sharp imbalance of ANS towards its PNS on the 2 postoperative day. Changes in behavioral and research reactions of rats in OF are manifested in a decrease in research activity, a display of uneasiness, depression-like state, as well as anxiety.

In vivo and in vitro observation of nasal ciliary motion in a guinea pig model.

Cilia play an important role in the airway defense mechanism. So far, studies on ciliary function have mainly been based on in vitro methods. Images of in vivo ciliary motion are very difficult to capture. In this study, we describe a novel approach to observe and analyze nasal ciliary motion in living animals with comparison to in vitro observation. Such images of ciliary motion from living animals have not been reported to date. The result of the study indicates that in vivo ciliary physiological function differs from ex vivo and in vitro conditions in many ways, such as the stability over time and response to temperature variation. This is a good foundation for further in vivo analysis of airway ciliary physiological function in animals as well as humans.

Evaluation of Surgical Freedom for One-and-a-Half Nostril, Mononostril, and Binostril Endoscopic Endonasal Transsphenoidal Approaches.

Objective This article determines which of the one-and-a-half nostril, mononostril, and binostril endoscopic endonasal transsphenoidal approaches provide a superior manipulation during surgery. Methods The three approaches were orderly performed on 10 silicon-injected cadaveric heads to quantitatively assess surgical freedom and attack angle for sella. Measurements were determined with a standardized method under neuronavigation system using data of computed tomography. Results The one-and-a-half nostril endoscopic transsphenoidal approach (OETA) offered superior exposed area than that of the mononostril approach (META), and similar to that of the binostril approach (BETA). For surgical freedom at anatomic targets, the OETA showed greater surgical flexibility at pituitary center, the right medial optic carotid recess (R-mOCR), the left mOCR, the medial intersection of the right cavernous internal carotid artery, and extension line of upper margin of the clivus (R-mICC) than those of the META, and similar to those of the BETA. For sagittal angle of attack to the R-mOCR, R-mICC, and L-mOCR, the OETA can provide better angular freedom for surgeon than that of the META, and similar to that of the BETA. The OETA had the same axial attack to the pituitary center with the BETA. The OETA and the META had limited surgical freedom at L-mICC, and both inferior to the BETA. Conclusion The OETA has similar exposed area, surgical freedom, and attack angle for most anatomic targets to the BETA without resecting contralateral nasal septal mucosa, and obviously superior to the META.

Tissue engineering of a tympanic membrane graft using decellularized nasal septal mucosa seeded with tragus chondrocytes: a morphological In vitro study

Objective: Tympanic membrane (TM) perforations require surgical repair with graft constituents. Tissue engineering which used cells, scaffold materials, and bioactive molecules facilitates an opportunity in otology for the synthesis of an ideal TM graft having proper mechanical possessions and high acoustic properties. The purpose of this study was to analyze the efficacy and feasibility of decellularized nasal septal mucosa (DNSM) seeded with tragus chondrocytes for in vitro regeneration of a TM graft material. Methods: A NSM scaffold constructed with decellularization was seeded with flow cytometry-characterized tragus chondrocytes. Cells were grown on NSM scaffold to produce an “artificial TM graft” (ATMG). Sections of untreated NSM (UNSM), DNSM, and ATMG were compared by histological examinations and immunohistochemistry analysis (i.e., total oxidant status [TOS] assay, cytokeratin K15 expression, Bcl-2, and tumour necrosis factor-alpha TNF-α). Results: Histological analysis of DNSM seeded with chondrocytes indicated a healthy tissue formation suggesting that a cytocompatible ATMG was produced artificially. When compared with UNSM and DNSM, low TOS level, high cytokeratin K15 expression, high Bcl-2, and acceptable TNF-α levels in ATMG samples indicated the presence of healthy chondrocytes and their proper integration to the scaffold with low risk of apoptosis. Conclusion: This study is a prospective investigation for ATMG engineering based on the patient's own tragal chondrocytes seeded over DNSM scaffold, the employed biological niche. The aim of supplementing an ATMG to the armamentarium of graft alternatives will lead to a significant potential for surgical convenience in otology.