Posterior Choanae Research Articles

Cemento-ossifying fibroma: an extensive fibro-osseous lesion involving paranasal sinuses

Cemento-ossifying fibroma (COF) is a fibro-osseous lesion arising from cells of the periodontal ligament. This tumor typically occurs in individuals during their third and fourth decades of life, with a predilection for women. COF primarily affects the maxillofacial region, most commonly the mandible. Its localization in the paranasal sinuses and skull base is unusual. However, we present a rare case of COF involving the right paranasal areas of the maxillofacial region in an 18-year-old female. Computed tomography (CT) revealed an expansile lesion measuring 52.45×32×74.29 mm involving the right maxillary sinus, expanding into both the anterior and posterior choanae. The patient underwent endoscopic sinus surgery (ESS) with preservation of adjoining vascular structures. Clinical, radiographic, and histologic features are presented, and differential diagnosis is discussed.

Bilateral Choanal Atresia in 24 Years Old Woman: A Case Report.

Choanal atresia is a congenital anomaly characterized by an absence of the nasal choanae due to Failure to recanalize the nasal fossae during embryogenesis. Instances involving unilateral Choanal atresia may go unidentified for extended periods. Bilateral choanal atresia presenting in adulthood is an infrequent occurrence. A case of bilateral choanal atresia in a female 24-year-old presenting to our otolaryngology department's out clinics with long-standing nasal obstruction, mouth breathing, and anosmia. She underwent endoscopic choanoplasty to reestablish patency of the posterior choana. Follow-up after one month revealed patent posterior choana. Bilateral choanal atresia requires early surgical intervention in infants for survival. Adult presentations are rare. Nasal endoscopy and CT help determine the surgical approach. Endoscopic trans-nasal Chonaolplasty is typically the standard treatment.

A Radiological Study on the Location of Sphenopalatine Foramen in Koreans

Background and Objectives Endoscopic ligation or cauterization of the sphenopalatine artery (SPA) is used to treat intractable bleeding. Acquisition of intranasal anatomical landmarks can be helpful for locating the sphenopalatine foramen (SPF). The purpose of this study is to evaluate the clinical usefulness of endoscopy by selecting the radioanatomical landmarks for the location of the SPF.Subjects and Method Sinus CT was performed on a total of 271 people, and a study was conducted on bilateral 542 sides. In this study, seven landmarks included third lamella, posterior choana, posterior fontanelle, maxillary line, anterior head of middle turbinate, nasal floor, and bony attached part of inferior turbinate. The distances from the seven landmarks to SPF were measured, respectively. Additionally, the distance from the anterior nasal spine to SPF and the angle between the nasal floor and SPF were measured.Results The horizontal position of SPF was located at the middle point between the posterior choana and the third lamella, and the vertical position was around 13-14 mm upward from the bony attached part of the inferior turbinate. For the performed middle meatal antrostomy, the distance from the posterior fontanelle to SPF was around 12-13 mm behind. The average distance from the anterior nasal spine to SPF was 46.47 mm, and the angle between the nasal floor and the SPF was 29.76°.Conclusion The four landmarks, namely the posterior choana, third lamella, bony attached part of the inferior turbinate, and posterior fontanelle can be useful for locating SPF.

Congenital atresia of posterior nares: Diagnosis and treatment at Hilla, Iraq

Abstract Background: Atresia of posterior nares (choana) is a congenital condition in which the posterior nares fail to develop either bilaterally or unilaterally. Objectives: The aim of this article is to show different methods of diagnosis and surgical procedures used for management in our department. Materials and Methods: In this study, 21 patients were included. It is a retrospective study form. The confirmation of the diagnosis is by failure of 6–8-F tube catheter to pass; CT scan of posterior choana shows the type and thickening of atretic plate (cartilage or bone), and endoscopic examination confirms it. Results: Female patients were 15, whereas male patients were 6. Age range was from 1 day to 25 years. All of the patients were within the pediatric age group except one adult patient. Unilateral cases were found in 14 patients, while 7 patients had bilateral atresia. Bilateral atresia was presented within early day life (1–3 days). They were five females and two males. The unilateral cases diagnose at a later life period (4–25 years). There were 4 males and 10 females. Proved by CT scan, mixed bony and membranous atresia were in 18 patients, bony atresia was in 3 patients, and there was no pure membranous atresia. Thirteen of the unilateral cases involved right side, while only one case had left-side atresia (7.6%). Three cases of bilateral atresia had other congenital anomalies (14%). Ten patients were treated by nonendoscopic (transnasal) surgical approach (five of them had bilateral and unilateral atresia, respectively). Endoscopic trans-septal approach was done in two patients, both had bilateral atresia. Nine patients were treated by transnasal endoscopic method. Stent was used in 13 patients postoperatively for 4–6 weeks. Two patients required revision surgery for restenosis. Conclusion: Endoscopic transnasal approach is the proper way in the surgical treatment of atresia because it is more accurate, under surgeon vision, less invasive with less morbidity in spite of longer time to perform.

Beyond the Blockage: Unveiling Diagnosis and Management of Choanal Atresia-A Case Series.

Choanal atresia is a rare congenital disorder characterised by anatomical closure of the posterior choana in the nasal cavity due to failed recanalization during foetal development. The main aim of our study is to focus on our experience with choanal atresia and its management. In this study, we are discussing the prospective study of 12 cases of choanal atresia that came to a tertiary hospital from July 2017 to July 2022. All 12 choanal atresia cases underwent thorough evaluation, including history, blood investigations, nasal endoscopy, and CT scanning. Intra-nasal endoscopic choanoplasty with stenting was performed on all patients, followed by a 2-year follow-up, except for one case that missed follow-up after 6months. All 12 cases were female, with their ages varying from newborn to 4months old. In our study, 75% were unilateral and 25% were bilateral cases from newborn to 4months old. The right was more prevalent in unilateral choanal atresia. The mixed type was the most commonly observed. The most common symptom was difficulty breathing and a running nose. All cases achieved an adequate patent airway. No intraoperative complications were noted in any case. All cases of choanal atresia can be diagnosed by a cold spatula test, failure to pass an intra-nasal catheter, and a CT scan is confirmatory. Surgical correction with endoscopic intranasal choanoplasty and stenting has less morbidity, a high success rate, and a lower recurrence rate.

Practical Tips for Surgical Management of Bilateral Choanal Atresia.

Choanal atresia refers to congenital blockage of posterior choana of nose by the presence of a bony or membranous soft tissue. It causes respiratory distress innewborn which requires emergency surgical intervention. Various surgical methods areavailable for correction of choanal atresia and endoscopic approach is the commonlyused one. However there is risk of re-stenosis after surgery. This article focuses onsurgical refinements to improve the surgical outcome.It is a retrospective study done on eight newborns with bilateral congenital choanalatresia. Data included gestational age, any ante-natal issues, breathing activity at birth, diagnostic tests for choanal atresia and Head to Foot examination findings. Initialdiagnostic work up included CT scan of paranasal sinus and Echocardiography to ruleout associated cardiac anomalies. All the newborns were treated initially in NICU withventilator support and then taken up for endoscopic correction of atresia. After surgery, newborns were successfully weaned off from ventilator.Among the 8 newborns, there were 5 males and 3 females and their gestational agewas full term. (except in one). Initial presentation included respiratory distress on day 1of life with difficulty in inserting feeding tube through the nose. Imaging showedbilateral atresia in 7 newborns and unilateral atresia in one newborn. 5 of themunderwent atresia surgery using endoscopic approach. One newborn required revisionsurgery. Remaining newborns remained symptom free during the follow up period.Currently endoscopic approach remains a safer method for correction of choanalatresia with very minimal chance of re-stenosis. Surgical refinements like adequatewidening of neo-choana and usage of mucosal flaps to cover the raw area has beenfound to improve the surgical outcome.

Antrochoanal polyp in pediatric age. A purpose of a clinical case

The antrochoanal polyp is a rare entity in the pediatric age; represents 4-6% of all nasal polyps in the general population, defined as a single, benign mass originating in the sinus maxilla, grows toward the posterior choana and may extend to the nasopharynx. Diagnosis is established by clinical findings and imaging studies; in particular, tomography. Most of the patients have a lesion visible on anterior rhinoscopy, as well as obstructive nasal symptomatology. During the early stages of development of a nasal polyp, when its size is still small, it is possible to make it disappear with corticosteroid treatment. The Surgical treatment remains the most effective and consists of surgical removal with Caldwell-Luc approach (antrostomy) or endoscopic. The objective of our work is to describe the diagnosis, therapeutic management, review the bibliography as well as the possible Differential diagnoses of a case of antrochoanal Killiam polyp.

Treatment methods of obstructive sleep apnea (OSA) in children with adenoid hypertrophy and contraindications for adenectomy

Obstructive sleep apnea (OSA) is a common problem in pediatric population, most frequently caused by the adenoid hypertrophy. Improper sleep pattern leads to an inadequate night rest and therefore influences daytime behavior. The easiest method of treatment in such cases is adenectomy, which means the excision of the adenoid (so called „third tonsil”). Obviously, it should be performed only after an objective confirmation of the etiology in the fiberoscopy. Children with defects in the palatine, like „overt” and „occult” submucous cleft palate, cleft palate or after palatine reconstructions, stand for an exceptional group of patients. On one hand, all the reconstructive surgeries increase the risk of an obstructive sleep apnea in such children, while on the other hand palatal defects are a classic contraindication for adenectomy. Adenectomy is contraindicated due to an increased risk of velopharyngeal insufficiency, which impairs the act of swallowing and speech. When aggravated symptoms are observed, after specialist phoniatrics consultation, a partial adenectomy should be considered. This procedure means partial excision of the adenoid, where only the superior part of the adenoid, responsible for the blockage of the airflow through posterior choanae, is excised, and at the same time the inferior part is left, providing contact between the adenoid and the soft palate (what is responsible for the preservation of veloadenoidal closure).

ANTROCHOANAL POLYP OF MAXILLARY SINUS IN ADULT – A CASE REPORT

ABSTRACT Antrochoanal polyp also called Killian Polyp is an inflammatory polyp, which arises from within the maxillary sinus, and prolapses in to the nasal cavity through the accessory ostium of the maxillary sinus. This polyp grows backwards towards the posterior choana. It is a unilateral benign lesion common in children and rare among adults. Antrochoanal polyps are diagnosed clinically with diagnostic nasal endoscopy and CT scan of paranasal sinus helps in analyzing the extent of lesion and in ruling out other differential diagnosis of a unilateral nasal mass. The gold standard modality of treatment is functional endoscopic sinus surgery with complete removal of the polyp by dissecting out all the attachments of the polyp from within the maxillary sinus and widening of the obstructed ostium. The typical histological features are characterized by presence of cystic component, infiltration of inflammatory cells and edema. The choanal portion shows presence of fibrosis and squamous metaplasia . This is a case report of an adult patient with antrochoanal polyp. Key words-Antrochoanal polyp, Unilateral, Adult.

Demographic profile of subjects currently undergoing middle meatus antrostomy for maxillary sinusitis, in a tertiary care centre of Punjab: analysis of 64 subjects

Background: The demographic profile of patients with Maxillary sinusitis undergoing surgical intervention in the state of Punjab was analyzed. The emphasis was on the age, gender and clinical presentation in this prospective study. Methods: In this prospective study 64 patients with maxillary sinusitis, were randomly selected from the Rhinology clinics of Oto-rhino-laryngology services, Dayanand Medical College and Hospital, Ludhiana in a period of one and a half years (June 2008 to December 2009). All patients were taken up for Functional endoscopic sinus surgery with middle meatus antrostomy.Results: Only 7 (10.94%) patients, with maxillary sinusitis were in the pediatric age group. 40(62.5%) were males and 24 (37.5%) females. Males outnumbered females in the ratio of 1.67:1. Clinical findings were nasal polyp in 33 (51.56%), middle meatus discharge in 10 (15.63%) and septal deviation was seen in 36 (56.25%) patients. Polypoidal mass was seen in the posterior choana in 24 (37.5%) patients followed by discharge inferior to the Eustachian tube orifice in 7 (10.94%). Recurrence of polypoidal change or frank polyposis occurred in 7 patients (10.94%). Post nasal drip persisted in 15/49 cases, while 54 (84.38%) were completely relieved of their symptoms. Recurrence was noticed more commonly in the region of ethmoid air cells.Conclusions: Patients with maxillary sinusitis were seen in the broad age range from 11 to 66 years with a male predominance. Nasal blockage rather than cheek ache was the primary complaint followed by polyp in the middle meatus and post nasal drip inferior to the Eustachian tube.

Choanal Atresia Repair With Stents and Flaps: A Systematic Review Article.

BackgroundChoanal Atresia is an obliteration by an atretic plate of the posterior choanae due to a failure of the bucconasal membrane to rupture. The insertion of stents post choanal atresia repair is familiar. Still, there are limited studies in the literature that specify the time to remove it, the best materials, and the effectiveness of each kind.ObjectiveOur study aims to compare different types of choanal atresia stents and flaps and the outcome of different kinds of stents and flaps that use post-operatively. Also, to assess the risk of restenosis post-operatively with varying types of Stent and flaps.MethodsA systematic review via databases for different types of stents and flaps used in choanal atresia, including 31 studies with precise technique, variety of stents, restenosis rates, and risk factors (unilaterality, the component of the atretic plate). And about 10 different approaches to flaps reconstruction were mentioned.ResultsAccording to the data, we observed a successful rate of choanal atresia repair by using the ordinary ETT post-operatively ranged from 28 to 94.2%, which could be explained due to many factors. Post-operative Instructions on care and suctioning provided a good impact. Other types of stents found in case series like steroid eluting stents, Nelaton catheters, Silastic stents, or modified ETT have a promising future during 26 to 39 weeks follow-up. Still, they need further studies with randomization and more data. Flaps with different approaches and techniques showed promising results and fewer complication rates with or without stents, also now have been used in practice providing suitable alternatives for stents.ConclusionThe original types of choanal atresia stents were shown to have a wide variety of results, while innovative materials of stents showed promising results, however, in relatively small case studies. Flaps were now used in practice giving other choices for stents with fewer complications, better healing, and new choana formation.

Endoscopic Management of a Large Tornwaldt Cyst: A Case Report

ABSTRACT
 Objective: To report successful marsupialization of a large Tornwaldt cyst using combined transnasal and transoral endoscopic surgery in a 7-year-old girl who presented with nasal obstruction.
 Methods:Design: Case ReportSetting: Tertiary Government Training HospitalPatient: One
 Result: A 7-year-old girl presented with an 11-month history of recurrent yellowish nasal discharge gradually associated with nasal obstruction. Examination revealed a large, well encapsulated, broad-based cystic mass in the nasopharynx immediately adjacent to the posterior choanae, continuing posterior to the soft palate (pushing the uvula anteriorly) and extending inferiorly to the epiglottic area. Computerized Tomography (CT) demonstrated a well-circumscribed, midline hypodense mass with fluid attenuation obstructing the nasopharyngeal area extending inferiorly to the oropharyngeal area. Endoscopic marsupialization via transnasal and transoral approach was successful, and a respiratory epithelium-lined cyst consistent with a Tornwaldt cyst was confirmed by histopathologic examination
 Conclusion: Combined transnasal and transoral endoscopic marsupialization is possible a for a large symptomatic Tornwaldt cyst in a pediatric patient with relatively smaller and complex nasal cavities.

Difficult laryngoscopy and intubation using thyromental distance during: Operative assessment of patients

The airway begins functionally at the nares. The septum divides the nasal cavity into two narrow cavities. The nasal cavity extends from the external nares to the posterior choanae, where it becomes continuous with the nasopharynx. Vertically it extends from the palate to the cribriform plate. Each half has a floor, roof, a lateral wall and a medial septum wall. The lateral wall is uneven because of the three bony projection known as conchae. 300 consecutive (apparently normal) American Society of Anaesthesiologist grade 1 &2 adult patients undergoing elective surgical procedures under general anaesthesia with endotracheal intubation at Medical college and teaching Hospital were the subjects in this study. Thyromental distance<6cm was considered as predictor of difficult intubation. There were 16 cases out of 300 patients (5.3%) belong to thyromental distance less than 6cms.

A case report: bilateral choanal atresia in a nine-year-old female child

Choanal atresia is a rare congenital malformation of the nasal cavity characterized by obliteration of posterior choanae. It can be unilateral or bilateral. Bilateral choanal atresia is one of the life-threatening conditions and survival up to adulthood is rare A 9-year-old female presented to our department with complaints of a bilateral nasal block, nasal discharge, snoring, anosmia, and mouth breathing. Diagnostic nasal endoscopy and computerized tomography of the nose and paranasal sinuses revealed bilateral choanal atresia. Transnasal endoscopic choanoplasty was performed and discharged on postoperative day 7. Postoperative follow up on two weeks showed significant improvement in symptoms and endoscopy revealed bilateral patent posterior choanae. The child with bilateral choanal atresia surviving up to nine years of age is rare. In contrast to unilateral choanal atresia, bilateral choanal atresia is a diagnostic and therapeutic emergency. Diagnostic nasal endoscopy and computerized tomography help in planning surgery. Minimally invasive endoscopic choanoplasty has replaced the transpalatal approach.

Schwannoma Arising in Nasopharynx: A Case Report and Literature Review.

Schwannoma in paranasal sinus has been known as a rare tumor in this origin. This study reports on primary schwannoma arising in the nasopharynx, which is an uncommon location. A 36-year-old female presented with nasal obstruction for one month. Physical examination revealed a nasopharyngeal mass totally occluding bilateral posterior choanae and extended downward to the oropharynx. Magnetic resonance image showed heterogeneous enhancing mass at the nasopharynx extending inferiorly to the oropharynx. The tumor was excised via endoscopic combined trans-nasal/trans-oral approach under general anesthesia. The pathologic diagnosis was consistent with schwannoma. The tumor was successfully excised with en-block resection and the patient was discharged the next day after the operation, without any postoperative complications. There was no tumor recurrence at 12-months follow-up. Schwannoma primarily arising in the nasopharynx is uncommon. Minimally-invasive surgery via the endoscopic approach can be applied for tumor removal with fewer complications and reduced risk of morbidity.

The Anatomy of the Nasal Cavity of The Donkey (A Model for Electronic Learning Modules)

Growing number of students, increasing costs of education, demand for quality education and limited facilities (tools are the most common education challenges for the Egyptian higher education). To perform this work, resected heads of five donkeys (3-5 years old) were grossly studied using variable anatomical techniques and the obtained data were used for developing a theoretical and practical interactive and electronic learning (E-Learning) module focusing on the anatomy of the nasal cavity of the donkey. Media, electronic tools, computer programs and authoring apps were usedas aiding tools for development of a web-based module for teaching and learning veterinary anatomy that enables students to learn anywhere and at any time. The present work revealed that, each nostril is divided by the alar cartilage into a dorsal false nostril (leads to a blind diverticulum in the Naso-incisive notch) and a ventral, true nostril (leads to the nasal cavity proper). The nostrils and nasal cavities of the donkey were supported by group of nasal cartilages (nasal septum, alar cartilages, dorsal lateral cartilages, ventral lateral cartilages and medial accessory cartilages). The nasal cavity as a respiratory passage extended from the nostrils rostrally to the cribriform plate caudally. It continued with the nasopharynx caudally through the posterior nares or choanae. Structurally, the nasal cavity possesses nasal conchae (dorsal, middle, ventral and ethmoidal conchae), folds (straight, alar and basal folds) and meatuses (dorsal, middle, ventral and common nasal meatuses). The present study concluded that: The nasal cavities of the donkey are not completely identical to that of the horse. •Although e-learning provides several benefits the online education has not solved the problem of practicing soft skills. •High percentage of the students (80-90%) were satisfied with the various elements of the e-learning evaluation survey, though they agreed about the presence of technical problems regarding the internet connection and facilities.

Unusual presentation of a unilateral choanal atresia in an adult: a case report

&lt;p class="abstract"&gt;Choanal atresia is an uncommon congenital abnormality of nasal airway characterised by the complete obliteration of choana. Unilateral choanal atresia is more common as compared to bilateral choanal atresia. A case of unilateral nasal obstruction in an adult which was initially diagnosed as chronic rhinosinusitis and was posted for endoscopic sinus surgery at a secondary referral hospital. Increased nasal bleeding during the surgery led to the surgeon abandoning the procedure and was referred to Mysore Medical College and Research Institute. On detailed evaluation, unilateral choanal atresia of right sided was noted. It was subsequently managed by endoscopic recanalization of the posterior choana. This case of unilateral choanal atresia in an adult is being reported here for the rarity of its presentation. A high level of clinical suspicion is necessary to diagnose such cases and to prevent avoidable complications during routine endoscopic surgeries. Resection of posterior part of nasal septum to create uni-choana negates the need for stenting post-operatively.&lt;/p&gt;

Pleomorphic Adenoma of the Nasal Vestibule – A Rare Case

Pleomorphic adenomas arising in the nasal cavity are extremely uncommon, despite the large numbers of minor mucous and serous glands in the region. We present a rare case of a pleomorphic adenoma arising from the right nasal vestibule in a 65-year-old man complained of right nasal obstruction for 6 months. Anterior rhinoscopy showed a reddish, firm, polypoid mass in right nasal cavity which is free from the nasal septum and from the inferior tubinate but it was attached to the nasal vestibule. Flexible nasal endoscopy showed no extension of the mass towards the posterior choana or nasopharynx. The mass was completely excised from the nasal vestibule through intranasal approach and sent for histology which confirmed a pleomorphic adenoma with a predominant stromal component. The main treatment modality is surgical resection with histological clear margins. Recurrences and evolution to malignancy are not frequent, but long tern follow-up is recommended. In our case, the patient demonstrated satisfactory cosmetic results with no evidence of recurrence.&#x0D; Bangladesh J Otorhinolaryngol; April 2017; 23(1): 88-91

A new stereospondylomorph, Korkonterpeton kalnense gen. et sp. nov., from lower Permian of the Czech Krkonoše Piedmont Basin and a redescription of Intasuchus silvicola from the lower Permian of Russia (Temnospondyli, Amphibia)

A new temnospondyl, Korkonterpeton kalnense gen. et sp. nov., is described on the basis of an almost complete specimen from the lover Permian Prosečné Formation of the Czech Krkonoše Piedmont Basin. The exceptional preservation of the holotype allows a detailed description of the cranial and postcranial characters: Korkonterpeton kalnense gen. et sp. nov. is characterized by the presence of vomerine fangs located anteriorly to the posterior choana, much longer than wide tabulars – as long as the supratemporals, a deeply concave posterior margin of the skull table, extraordinarily elongated exoccipitals, anteriorly widened pterygoids and a parasphenoid cultriform process swollen at its mid-length. In order to clarify the relationship between this new taxon and Intasuchus silvicola Konzhukova, 1956 from the lower Permian (late Kungurian) of the Russian Inta Basin, the latter is also redescribed here: Intasuchus silvicola exhibits a lacrimal entering the septomaxilla, a widened jugal, a posterolaterally widened interpterygoid vacuity, a subtemporal window elongated anteriorly up to the anterior orbital region, an elongated basipterygoid ramus which is as long as the orbit width, a vomer with a parachoanal tooth row, and an ectopterygoid of about the same length as the palatine. The description of Korkonterpeton kalnense gen. et sp. nov. and the revision of Intasuchus silvicola complete our knowledge on the origin and evolution of early stereospondylomorph temnospondyls during the lower Permian.

Endonasal anatomy of the olfactory neural network: Surgical implications.

Define the anatomic distribution of the olfactory filaments within specific mucosal regions of the nasal cavity. Cadaveric study. Seventeen cadaveric specimens (34 sides) were dissected to study the anatomical distribution and density of olfactory fila within different regions of the nasal cavity. Olfactory fila were dissected retrogradely to their point of entry into the anterior cranial fossa through the cribriform plate. Anatomic relationships among various components of the olfactory system and their corresponding arterial supply were determined subjectively. The highest density of olfactory fila was found at the mucosa of the ethmoid roof and superior turbinates. Olfactory fila were found at regions not previously considered to be part of the olfactory system: lateral wall of the nose, ethmoidal bullae, and between the os sphenoidale and arc of the posterior choana. Furthermore, at the septum, 20% of the olfactory fila crossed contralaterally before exiting the nose. The anterior ethmoidal arteries were the primary blood supply to the olfactory epithelium. This study suggests that olfactory filaments extend beyond previously established boundaries. These findings may have clinical implications regarding oncologic resections and could serve as the foundation for the development of techniques that better preserve olfactory function. NA Laryngoscope, 2473-2477, 2018.