Nasal Vestibulum Research Articles

Reconstruction of columella and nasal vestibuli by bilateral nasolabial flaps - A case report.

Introduction and importanceThe nose is a common location for non-melanoma skin cancers. Resection of such cancers can result in large, multilayer defects that are challenging to reconstruct. The surgical approach is determined by multiple factors and the main goal is to obtain a satisfactory functional and aesthetic result. We present a case of reconstruction of the nasal vestibuli and columella by two transnasal nasolabial flaps.Presentation of caseA 66-year-old male underwent resection of a large squamous cell carcinoma in the right nasal vestibulum that extended through the columella into the left vestibulum. The resection resulted in a multilayer defect including the floor and roof of the right vestibulum, the entire columella, part of the septum cartilage and floor of the left vestibulum. The defect was reconstructed in two stages by bilateral nasolabial flaps, that were brought into the nasal cavity through incisions on the side of the nose and were used to line the vestibuli and sutured to each other medially to form the neocolumella. No complications or surgical site infections were observed.Clinical discussionTransnasal nasolabial flaps can be used for larger columellar defects. The length of the flaps in our case provided enough tissue to reconstruct the columella as well as the entire vestibular linings.ConclusionWe describe a successful reconstruction of the nasal vestibuli and columella with two transnasal nasolabial flaps, which provided an acceptable aesthetic and functional result.

Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation

BackgroundHerpes zoster, also known as shingles, results from reactivation of the varicella-zoster virus. It commonly presents with burning pain and vesicular lesions with unilateral distribution and affects the thoracic and cervical sites in up to 60 and 20% of cases, respectively. The branches of the trigeminal nerves are affected in up to 20% of cases. Multidermatomal involvement of the trigeminal nerves has been only anecdotally described in immunocompetent subjects.Case presentationA 71-year-old previously healthy male presented with grouped vesicular and impetiginized lesions with crusts on the left half of the face of two-weeks duration. The lesions first developed on the left nasal tip and progressively worsened with unilateral appearance of vesicular lesions on the left forehead, face, ala nasi, nasal vestibulum and columella, as well as on the left side of hard and soft palate. The affected edematous erythematous areas corresponded to the distribution of the left ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve, including the infraorbital and nasopalatine nerves of the maxillary branch responsible for the oral cavity involvement. Viral DNA amplification by polymerase chain reaction confirmed the presence of Varicella zoster virus. The patient was started on oral valaciclovir with rapid recovery.ConclusionsAmong immunocompetent patients, herpes zoster is considered a self-limited localized infection. Our observation provides a rare but paradigmatic example of herpes zoster with involvement of both the ophthalmic and maxillary divisions of the trigeminal nerve in an immunocompetent patient. Immunocompetence status and age-specific screening should be warranted in case of atypical involvement and according to the patient’s history, while treatment with antiviral drugs should be rapidily initiated in patients at risk.

EP-1792: Nasal function after exclusive brachytherapy for primary SCCs of the nasal vestibulum

EP-1792: Nasal function after exclusive brachytherapy for primary SCCs of the nasal vestibulum

Nasal Vestibular Furunculosis Presenting as the Rudolph Sign.

Nasal furunculosis is a deep infection of hair follicle within the nasal vestibule. In this report, the authors presented a 49-year-old woman with 4-day history of focal red area and tender swelling on the tip of her nose. On physical examination, together with a swelling at nasal vestibulum, erythema, and edema on the skin of nasal tip were observed, which is called the Rudolph Sign. The patient was treated with intranasal topical mupirocin and oral sodium fusidate. Because nasal furunculosis may lead to serious complications such as ophthalmic vein thrombosis and cavernous sinus thrombosis, early diagnosis and effective treatment is essential.

The nasal vestibulum is the optimal sampling site for MRSA screening in hospitalised horses

The increased incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in equine hospitals highlights the need for infection control protocols based on optimal patient screening. In horses, the deep ventral meatus of the nasal cavity is the principal site sampled to detect MRSA. However, in humans, the anterior nares are the preferred sampling site. The objective of this study was to determine the optimal sampling location in the nasal chambers for MRSA in horses by comparing the results obtained from three different locations (the vestibulum, diverticulum and ventral meatus) in 240 hospitalised animals. Antimicrobial susceptibility testing and epidemiological typing were conducted on representative subsets of the isolates obtained.Compared to the more invasive ventral meatus sampling (relative sensitivity 68.9%; isolation rate 37.9%), vestibulum (RS 81.1%; IR 44.6%, P=0.13) and diverticulum (RS 52.3%; IR 28.8%, P=0.03) sampling were more or less sensitive, respectively. In total, 132 horses (55%) were MRSA positive with the vast majority (98.5%) carrying genotyped isolates of the livestock-associated (LA)-MRSA clonal complex (CC) 398, and only a minority (1.5%) CC8. Of the 22 MLST typed isolates, five belonged to a novel ST2197 (t011, CC398). Although 93.9% of the isolates were multi-resistant (to β-lactam, tetracycline, trimethoprim, and gentamicin), <5% were resistant to virtually all antimicrobials commonly used in equine medicine. The study findings indicate that detection of MRSA in horses may be enhanced by replacing the traditional deep sampling of the ventral nasal meatus by the less invasive approach of sampling the nasal vestibulum.

Humidification of Inspired Oxygen Is Increased With Pre-nasal Cannula, Compared to Intranasal Cannula

Oxygen therapy is usually combined with a humidification device, to prevent mucosal dryness. Depending on the cannula design, oxygen can be administered pre- or intra-nasally (administration of oxygen in front of the nasal ostia vs cannula system inside the nasal vestibulum). The impact of cannula design on intra-nasal humidity, however, has not been investigated to date. First, to develop a system, that samples air from the nasal cavity and analyzes the humidity of these samples. Second, to investigate nasal humidity during pre-nasal and intra-nasal oxygen application, with and without humidification. We first developed and validated a sampling and analysis system to measure humidity from air samples. By means of this system we measured inspiratory air samples from 12 subjects who received nasal oxygen with an intra-nasal and pre-nasal cannula at different flows, with and without humidification. The sampling and analysis system showed good correlation to a standard hygrometer within the tested humidity range (r = 0.99, P < .001). In our subjects intranasal humidity dropped significantly, from 40.3 ± 8.7% to 35.3 ± 5.8%, 32 ± 5.6%, and 29.0 ± 6.8% at flows of 1, 2, and 3 L, respectively, when oxygen was given intra-nasally without humidification (P = .001, P < .001, and P < .001, respectively). We observed no significant change in airway humidity when oxygen was given pre-nasally without humidification. With the addition of humidification we observed no significant change in humidity at any flow, and independent of pre- or intranasal oxygen administration. Pre-nasal administration of dry oxygen achieves levels of intranasal humidity similar to those achieved by intranasal administration in combination with a bubble through humidifier. Pre-nasal oxygen simplifies application and may reduce therapy cost.

Laser light combined with a photosensitizer may eliminate methicillin-resistant strains of Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital acquired infection throughout the world especially in wound and burn infections, pneumonia, septicaemia and endocarditis. We describe the effect of a HeNe laser in combination with a TBO dye on the viability of MRSA. A total of 34 isolates of S. aureus were obtained from 100 patients suffering from burns or wounds and from the nasal vestibulum of medical and nonmedical staff as carriers; eight isolates were methicillin-resistant. The isolates were exposed for 5, 10 and 15 min to a HeNe laser at a wavelength of 632.8 nm and 7.5 mW output power in the presence of 50 microg/ml toluidune blue O photosensitizer. The viable count was substantially decreased as determined by the plate count method for the three exposure times, with 100% killing with the 15-min exposure time. No significant effect was observed on MRSA isolates exposed to the laser alone. So MRSA was completely eradicated following 15 min exposure to a 632.8-nm HeNe laser in the presence of 50 microg/ml toluidune blue O photosensitizer under in vitro conditions.

Kliniğimizde tanı almış benign ve malign nazal patolojili olguların retrospektif olarak değerlendirilmesi

Objectives Primary tumors of nasal cavity are classified as benign and malignant or epithelial and non-epithelial tumors. Nasal cavity tumors among the factors that play a role in the etiology of prolonged contact with wood dust, cigarette and tobacco use habits can be considered. Malignant tumors in these locations, the first signs of clinical findings are nonspecific, often are confused with inflammatory diseases, so diagnosis is delayed to take. The aim of these study benign and malignant pathology of the nasal cavity, septum, vestibulum and concha symptoms, clinical findings and treatment approaches review with the literature. Material and Method During 10 years period (from January 1989 to January 2009), the 102 (%60.0) of men and 68 (%40) of women in total 170 patients that were operated because of the nasal patalogies in Cumhuriyet University Faculty of Medicine department of otorhinolaryngology was included in this study. All of the patients age, gender, lesion location, the first clinical complaints, symptoms of the emergence time and duration; physical examination findings, treatment, recurrence and histopathological diagnosis, follow-up period, recurrence and their surgical recovery of the properties recorded as statistically were analyzed. Findings ENT examination of these cases in this study lesions were located in the 18 (10.6%) nasal septum, 142 (% 83.5) nasal cavity, 5 (2.9%) turbinate and 5 (2.9%) originate in vestibuli. Histopathologically diagnosis of patient were done with 168 (98.8%) of the cases by surgical excision and 2 (1.2%) of the cases by incisional biopsy. Results ENT physicians are encountered many benign and malignant pathologies in the nasal region that clinical symptoms mimic inflammatory pathologies. Delay in the diagnosis of malignant pathology significantly worse prognosis. Therefore, treatment-resistant patients, and this should always be very close clinical follow-up could be kept in mind in the diagnostic pathology of the malignant purpose perhaps repeating insistently biopsiler be made.

Investigation of Pharyngeal Swallowing Function Using High‐Resolution Manometry

This study aimed to demonstrate the feasibility of a novel high-resolution manometry system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. Prospective study. Thirty-three asymptomatic adult Japanese controls were studied. A solid-state high-resolution manometry assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 mL of water) pressures at velopharynx, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distances from the nostril to the above-mentioned points of pressure measurement were also measured. The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point in men were 141.1 +/- 73.5 (mm Hg, mean +/- standard deviation) and 162.7 +/- 94.9, 175.3 +/- 59.7 and 182.9 +/- 83.6, 172.7 +/- 73.8 and 236.1 +/- 78.9, and 10.0 +/- 1.3 (cm) and 10.1 +/- 1.4, 14.1 +/- 1.5 and 14.4 +/- 1.3, 17.9 +/- 1.7 and 18.0 +/- 1.4, respectively. Those in women were 118.9 +/- 38.0 (mm Hg) and 124.7 +/- 43.4, 165.9 +/- 41.5 and 167.3 +/- 65.0, 149.2 +/- 68.7 and 243.7 +/- 87.4, and 9.5 +/- 1.2 (cm) and 9.4 +/- 1.2, 13.0 +/- 1.5 and 12.8 +/- 1.4, 15.8 +/- 1.5 and 16.0 +/- 1.3, respectively. The maximum value of resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure and the distance from the nostril to the mid-point of the width of the resting UES pressure in men and in women were 70.2 +/- 30.0 mm Hg, 4.0 +/- 0.7 cm, 19.1 +/- 1.3 cm, and 61.8 +/- 26.7 mm Hg, 3.6 +/- 0.6 cm, 17.0 +/- 1.2 cm, respectively. The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to the future clinical and investigative studies.

S118 – Study of Pharyngeal Swallowing by High-resolution Manometry

Objectives This study aimed to demonstrate the feasibility of a novel high-resolution manometry (HRM) system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. Methods 33 asymptomatic adult Japanese controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 ml of water) pressures at velo, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distance from the nostril to the above-mentioned points of pressure were also measured. Results The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point were 132.3±61.3 (mmHg, mean ± standard deviation), and 146.5±77.5, 171.6±52.0, and 176.3±74.4, 163.5±70.6, and 239.3±80.1, and 9.8±1.2 (cm), and 9.8±1.3, 13.6±1.6, and 13.7±1.5, 17.0±1.9 and 17.1±1.6, respectively. The maximum value of the resting USE pressure, the length of the part in the cervical esophagus showing the resting USE pressure, and the distance from the nostril to the mid-point of the length of the resting UES pressure were 66.6±28.1 mmHg, 3.8±0.7 cm, and 18.2±1.6 cm, respectively. Conclusions The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to future clinical and investigative studies.

A nose that roars: anatomical specializations and behavioural features of rutting male saiga

The involvement of the unique saiga nose in vocal production has been neglected so far. Rutting male saigas produce loud nasal roars. Prior to roaring, they tense and extend their noses in a highly stereotypic manner. This change of nose configuration includes dorsal folding and convex curving of the nasal vestibulum and is maintained until the roar ends. Red and fallow deer males that orally roar achieve a temporary increase of vocal tract length (vtl) by larynx retraction. Saiga males attain a similar effect by pulling their flexible nasal vestibulum rostrally, allowing for a temporary elongation of the nasal vocal tract by about 20%. Decrease of formant frequencies and formant dispersion, as acoustic effects of an increase of vtl, are assumed to convey important information on the quality of a dominant male to conspecifics, e.g. on body size and fighting ability. Nasal roaring in saiga may equally serve to deter rival males and to attract females. Anatomical constraints might have set a limit to the rostral pulling of the nasal vestibulum. It seems likely that the sexual dimorphism of the saiga nose was induced by sexual selection. Adult males of many mammalian species, after sniffing or licking female urine or genital secretions, raise their head and strongly retract their upper lip and small nasal vestibulum while inhalating orally. This flehmen behaviour is assumed to promote transport of non-volatile substances via the incisive ducts into the vomeronasal organs for pheromone detection. The flehmen aspect in saiga involves the extensive flexible walls of the greatly enlarged nasal vestibulum and is characterized by a distinctly concave configuration of the nose region, the reverse of that observed in nasal roaring. A step-by-step model for the gradual evolution of the saiga nose is presented here.

Obustronne przerzuty do węzłów chłonnych szyi z niepewnego ogniska pierwotnego w przedsionku nosa

A squamous cell carcinoma of the nasal vestibulum is rare variant of skin cancer and constitutes only 7% of malignant tumors of the nasal cavity. Authors presents a case of neck lymph node metastases from primary site (nose vestibulum) which was completly surgical excision 3 months before. When another primary site of cancer were non confirmed selective neck dissection and adjuvant radiotherapy was performed.

Medical treatment of nasal squamous papilloma with imiquimod cream.

Warts are common lesions. The prevalence and incidence of squamous papilloma of the nasal vestibulum are not known, and it is not certain how often human papilloma viruses are involved. Numerous medical or surgical treatment modalities have been reported in the literature with variable, sometimes unsatisfactory results. Imiquimod cream is a topically applied immunomodulator. It is used for warts and other skin tumours on different locations of the body. We report results of six patients treated with imiquimod five per cent cream for nasal squamous papilloma.

Monitoring of drug resistant Staphylococcus aureus in People's Democratic Republic of Lao.

Drug susceptibility of Staphylococcus aureus has been examined in the past 9 years to monitor the appearance of drug resistant strains especially methicillin resistant S. aureus (MRSA). The pattern of drug susceptibility has been relatively constant, but S. aureus is gradually becoming resistant to ampicillin. One MRSA was isolated in 1996 from the nasal vestibulum of a non-infected patient at Mahosot Hospital but not isolated thereafter. In 2001, 2 strains of MRSA which belonged to different clones were first isolated from the infection foci of patients. One was isolated from Setthathirath Hospital, where many Japanese staff have been dispatched since 2000. Careful monitoring and epidemiological studies of MRSA are recommended.

Soft tissue conjunctivo-rhinostomy.

To evaluate the results of implantation of a tubular prosthesis between the medial palpebral canthus and the nasal fossa, through the soft tissues of the face, in cases of irrecuperable damage of the lacrimal canaliculi. Fifty eyes with canalicular destruction were operated, placing a silicone and Pyrex tubular prosthesis between the lacrimal caruncle and the nasal vestibulum, running almost vertically through the soft tissues of the face, without osteal perforation. Lacrimal flow was restored in 47 cases. There were three cases of dislocation of the prosthesis, three infections and five papillomata. Vertical conjunctivo-rhinostomy without osteal perforation is an easy and efficient solution for irrecuperable occluded canaliculi.

Atopic dermatitis: from the genes to skin lesions.

Atopic dermatitis: from the genes to skin lesions.

Preoperative bacterial colonization and its influence on postoperative wound infections in plastic surgery

During two separate periods a total of 654 patients were included in a clinical study relating preoperative bacterial colonization to occurrence of postoperative wound infection in plastic surgery. During the second period one half of the patients were randomized to receive prophylactic azithromycin. Bacteriological samples were collected from the nasal vestibulum during both periods, and additionally from the surgical field during the second period. All patients had preoperative chlorhexidine bathing. The bacteriological findings were categorized as either normal flora or potentially pathogenic bacteria, and as either having no growth. Surgical wounds were divided into four contamination classes. Postoperative follow-up was 30 days, and assessment of wound infection was based on a graded scale. We did not find any statistically significant relation between preoperative bacterial colonization and postoperative wound infection, regardless of place of sample collection, method of bacterial classification, class of contamination or use of prophylactic azithromycin.

Collapse of the nasal alae and instruments for treating this condition, especially with the Feldbausch nasal dilator. Pictures from the history of otorhinolaryngology, presented by instruments from the collection of the German Museum of Medical History in Ingolstadt

Although the anatomy of the nasal muscles and the active movement of the nasal alae brought about by them, were already known in ancient times (Galenos), it was only at the end of the 19th century that the collapse of the nasal alae was recognized as a passive mechanism obstructing the inspiratory air passages. Since surgical methods for treating this condition were not available at that time, various small gadgets to be introduced into the nasal vestibulum were invented for stabilising the alae. Among these, Feldbausch's nasal dilator was the best known. It was in use up to the middle of this century, but then became completely obsolete. The history of this chapter of rhinology is related primarily by means of literal quotations of the phrases with which the authors presented their devices and praised their virtues.

鼻腔血管外皮腫例

A 52-year-old male complained of left nasal obstruction and frequent nasal bleeding. The first operation performed was intranasal resection of a tumor. Eight years later, a recurrent tumor was found in the nasal vestibulum. An enhanced CT scan revealed low density area with marked contrast. There was no sign of invasion into the maxillary sinus or of bone absorption. Wide surgical excision was performed through a lateral rhinotomy approach. The patient has been followed for 2 years with no evidence of recurrence.

A Case of a Foreign Body in the Maxillary Sinus

The authors reported a case of a foreign body in the left maxillary sinus. An 8-year-old girl with swelling of the left cheek visited Mie University Hospital on December 19, 1979. Fifteen days earlier, the patient had received an accidental injury which was the puncture of the nasal vestibulum by a bit of dry grass on the playground. After removal of a small piece of dry grass, treatment was given with antibiotics for two weeks but her condition did not improve.Probe operation of the maxillary sinus with a labiogingival incision was carried out three days later. A stick of dry grass, which was 6cm in length and 8mm in diameter, was found in the maxillary sinus with a large defect in the upper part of the fossa canina. It was thought that the stick of dry grass was stuck in the anterior wall of the maxillary sinus, having entered from the nasal vestibulum through the buccal soft tissue. The shape of the grass was presumably that of a tall golden rod.