Unilateral Nasal Cavity Research Articles

Seromucinous Hamartoma of the Sinonasal Cavity.

Benign tumors or malignant neoplasms must be evaluated in patients with unilateral nasal cavity mass lesions. The 3 most prevalent unilateral benign mass lesions in such individuals are nasal polyps (NPs) and inverted papillomas (IPs). Although rare, it should be kept in mind that sinonasal hamartomas can be occasionally diagnosed as well. Among sinonasal hamartomas, respiratory epithelial adenomatoid hamartoma is more prevalent, with seromucinous hamartoma (SMH) being the second most common. Unlike NPs, sinonasal hamartomas are benign tumors with growth potential, which means it should not be undertreated and warrants surgical removal for treatment. However, sinonasal hamartomas do not have local invasion or malignant transformation potential like IPs; hence, it is vital not to overtreat them. Therefore, understanding the histopathology of SMH and thereby establishing proper surgical planning prior to the surgery remains crucial in such cases. Here, we present a successfully treated case of SMH with a distinctive radiographic, gross, and pathological clinical image of SMH.

Penetration of a Wooden Foreign Body into the Zygomaticomaxillary Bone to the Nasal Cavity: Navigation-Guided Successful Treatment.

Penetrations of the nasal cavity through the zygomaticomaxillary bone by wooden foreign bodies have not been reported yet. Wooden foreign bodies, characterized as hypodense signals resembling air bubbles on computed tomography scans, could increase the risk of infection and abscess formation if left untreated. Therefore, any possible attempts to remove it entirely should be made in a timely manner. Also, regarding removal surgery, the complications of the surgery, such as massive bleeding or iatrogenic injury to the adjacent structure, should be considered, especially in the paranasal area. At the construction site, a 67-year-old worker hit his right cheek with a wooden foreign body. A wooden foreign body penetrated the right cheek and extended into the right nasal cavity through the zygomaticomaxillary complex. Using a navigation system, the wooden foreign body was removed from the right zygomaticomaxillary bone to the unilateral nasal cavity, and we cauterized arterial bleeding. After bleeding control, we reconstructed the bony defect with an absorbable mesh with screws. Septal reconstruction was also done, along with debridement and irrigation of the nasal cavity. We conducted a follow-up computed tomography scan a week later and confirmed that the wooden foreign body was successfully removed without any residual ones. The fracture was also reduced successfully.

Analyses on the influence of normal nasal morphological variations on odorant transport to the olfactory cleft

Objective Olfaction requires a combination of sensorineural components and conductive components, but conductive mechanisms have not typically received much attention. This study investigates the role of normal nasal vestibule morphological variations in ten healthy subjects on odorant flux in the olfactory cleft. Materials and methods Computed tomography images were used to create subject-specific nasal models. Each subject’s unilateral nasal cavity was classified according to its nasal vestibule shape as Standard or Notched. Inspiratory airflow simulations were performed at 15 L/min, simulating resting inspiration using computational fluid dynamics modeling. Odorant transport simulations for three odorants (limonene, 2,4-dinitrotoluene, and acetaldehyde) were then performed at concentrations of 200 ppm for limonene and acetaldehyde, and 0.2 ppm for dinitrotoluene. Olfactory cleft odorant flux was computed for each simulation. Results and discussion and conclusion Simulated results showed airflow in the olfactory cleft was greater in the Standard phenotype compared to the Notched phenotype. For Standard, median airflow was greatest in the anterior region (0.5006 L/min) and lowest in the posterior region (0.1009 L/min). Median airflow in Notched was greatest in the medial region (0.3267 L/min) and lowest in the posterior region (0.0756 L/min). Median olfactory odorant flux for acetaldehyde and limonene was greater in Standard (Acetaldehyde: Standard = 140.45 pg/cm2-s; Notched = 122.20 pg/cm2-s. Limonene: Standard = 0.67 pg/cm2-s; Notched = 0.65 pg/cm2-s). Median dinitrotoluene flux was greater in Notched (Standard = 2.86 × 10−4pg/cm2-s; Notched = 4.29 × 10−4 pg/cm2-s). The impact of nasal vestibule morphological variations on odorant flux at the olfactory cleft may have implications on individual differences in olfaction, which should be investigated further.

SPECTRUM OF CT FINDINGS IN CLINICALLY SUSPECTED CASES OF MUCORMYCOSIS – A STUDY AT TERTIARY HEALTH-CARE CENTER (RAJINDRA HOSPITAL PATIALA) DURING SECOND WAVE OF COVID PANDEMIC

Objective: Rhinocereberal mucormycosis is an acute, fulminant, and often lethal opportunistic infection typically affecting diabetic or immunocompromised patients. Early diagnosis is vital in these infections because delay in initiation of the treatment can be life-threatening. Computed tomography (CT) with axial and coronal sections is a highly accurate and non-invasive modality to accurately image sinonasal mycosis. The aim of the study was to describe the imaging findings in suspected cases of mucormycosis on CT. Methods: This study was conducted in Radiodiagnosis Department of Rajindra Hospital, Patiala. The data of 22 patients who were referred for CT with a clinical suspicion of mucormycosis were collected and all these patients were followed up to know about the prognosis of the disease. Results: In our study, there were 54.60% females and 45.40% males. Maximum number of patients (45.45%) belonged to 40–49 year age group. Diabetes mellitus was found to be the most commonly (90.90%) found comorbidity followed by hypertension (36.36%). In our study, involvement of unilateral nasal cavity was observed in 36.36% cases. Among the paranasal sinuses, maxillary and ethmoid sinuses were the most commonly involved in 95.45% and 77.27% cases. Conclusion: Prompt diagnosis and treatment of rhino-orbital mucormycosis are the sine qua non as antifungal drugs and surgical debridement can successfully control the infection and thus reduce the high mortality and morbidity associated with mucormycosis.

Radiography, CT, and MRI Diagnosis of Enzootic Nasal Tumor in Goats Infected With Enzootic Nasal Tumor Virus.

The aim of this study was to describe radiography, computed tomography (CT), and magnetic resonance imaging (MRI) findings of enzootic nasal tumors in goats infected with enzootic nasal tumor viruses. Five of six goats with a mean age of 2 years, showed clinical signs of respiratory disease. Head radiographs showed increased density of the unilateral or bilateral nasal cavity in four goats, and a CT scan showed that the space-occupying lesion of the nasal cavity originated from the ethmoid bone and was enhanced homogeneously postcontrast in all goats. The nasal concha was destroyed and the paranasal sinus mucosa was thickened and filled with fluid in some goats. On MRI, the mass exhibited equal or slightly higher signal intensity on T2 weighted images, equal signal intensity on T1 weighted images, a high signal on fluid-attenuated inversion recovery images and heterogeneous enhancement postcontrast. After dissection, histopathological examination of the mass and virus genome detection of the nasal secretions confirmed that the intranasal mass was a low-grade adenocarcinoma and that the goats were infected with enzootic nasal tumor virus type 2. In conclusion, CT and MRI have high diagnostic values for enzootic nasal tumors because they match the postmortem findings and are more accurate than radiography.

Medidas da aeração nasal e fluxo máximo inspiratório em crianças com respiração oral pré e pós manobras de limpeza e massagem nasal

ABSTRACT This study aimed at investigating the effects of nasal cleansing and massage maneuvers on upper airway patency in mouth-breathing children. This is a case report on eight children, aged 7 to 10 years, with a speech-language-hearing diagnosis of mouth breathing and otorhinolaryngological assessment and clinical diagnosis of rhinitis. Nasal airflow and patency were respectively assessed with the Glatzel mirror and Peak Nasal Inspiratory Flow (PNIF). Then, they were submitted to nasal cleansing and massage maneuvers with a saline solution, followed by reassessment with the Glatzel mirror and PNIF to compare results. The medians of total nasal airflow quantification were significant. Data on unilateral nasal cavity measurement indicated a sharp increase in nasal airflow in each nostril, with statistically significant differences between before and after nasal cleansing and massage maneuvers. The medians of the total PNIF were significant after the cleansing. It is concluded that the nasal airflow increased in PNIF after the cleansing maneuver.

Survey anatomy and histological observation of the nasal cavity of Tupaia belangeri chinensis (Tupaiidae, Scandentia, Mammalia)

This study aimed to provide researchers with an atlas of the survey anatomy, histology, and imaging of the nasal cavity of Tupaia belangeri chinensis. Seven T. b. chinensis adult males were euthanized and scanned using micro-computed tomography (CT). The nose was separated, and tissue sections were made on the coronal and axial planes to observe the survey anatomy and histological and imaging characteristics of the nose. T. b. chinensis contains one maxilloturbinal and three ethmoturbinals, one nasoturbinal, one interturbinal, two frontoturbinals, and one lamina semicircularis in the unilateral nasal cavity. Other identified structures were the ostiomeatal complex, vomeronasal organ, superior nasal vault, maxillary sinus, and frontal recess. The drainage pathways of the sinuses and nasal airflow in T. b. chinensis were confirmed. The vault epithelium consisted of the squamous epithelium, respiratory epithelium, transitional epithelium, and olfactory epithelium. Micro-CT confirmed our findings of the coronal tissue sections. The nasal cavity anatomy of T. b. chinensis is similar to that of some strepsirrhine primates. However, the airflow and olfactory function are quite different from that of humans. Our gross and histological atlas of the nasal septum, turbinals, maxillary sinus, and frontal recess provides a reference for researchers to use T. b. chinensis for nasal cavity functional research.

Role of nasal vestibule morphological variations on olfactory airflow dynamics

BackgroundThe conductive mechanisms of olfaction are typically given little priority in the evaluation of olfactory function. The objective of this study is to investigate the role of nasal vestibule morphological variations on airflow volume at the olfactory recess in healthy subjects. MethodsAnatomically realistic three-dimensional nasal airway models were constructed from computed tomography scans in five subjects. Each individual's unilateral nasal cavity (10 total) was classified according to the shape of their nasal vestibule: Standard, Notched, or Elongated. Nasal airflow simulations were performed using computational fluid dynamics modeling at two inspiratory flow rates (15 L/min and 30 L/min) to reflect resting and moderate breathing rates. Olfactory airflow volume and cross-sectional flow resistance were computed. FindingsAverage olfactory airflow volumes (and percent airflow in olfactory) were: 0.25 L/min to 0.64 L/min (3.0%–7.7%; 15 L/min simulations) and 0.53 L/min to 1.30 L/min (3.2%–7.8%; 30 L/min simulations) for Standard; 0.13 L/min – 0.47 L/min (2.0%–6.8%; 15 L/min simulations) and 0.06 L/min – 0.82 L/min (1.7%–6.1%; 30 L/min simulations) for Notched; and 0.07 L/min – 0.39 L/min (1.2%–5.4%; 15 L/min simulations) and 0.30 L/min – 0.99 L/min (2.1%–6.7%; 30 L/min simulations) for Elongated. On average, relative difference in olfactory resistance between left and right sides was 141.5% for patients with different unilateral phenotypes and 82.2% for patients with identical unilateral phenotype. InterpretationOlfactory cleft airflow volume was highest in the Standard nasal vestibule phenotype, followed by Notched phenotype for 15 L/min simulations and Elongated phenotype for 30 L/min simulations. Further, intra-patient variation in olfactory cleft airflow resistance differs greatly for patients with different unilateral phenotypes compared to patients with identical unilateral phenotype.

Evaluation of narrow band imaging for diagnosis of unilateral nasal lesions.

This study aimed to investigate the effect of narrow band imaging (NBI) examination on differentiating diagnosis between benign and malignant neoplasms involving nasal cavity. A retrospective study was conducted to analyse cases from January 2018 to December 2019 at a single centre. A total of 188 consecutive patients who were newly diagnosed with lesions in unilateral nasal cavity underwent complete examination with white light endoscopy (WLE) and NBI endoscopy. Biopsy specimens were harvested from the target lesions and sent to the pathologist for definite diagnosis. Participants with a history of congenital malformation, trauma and surgery in nasal cavity were excluded from the study. Endoscopic diagnosis was assessed using sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV, respectively). In identifying benign and malignant lesions of nasal cavity, NBI had a significant higher sensitivity (92.7% vs 70.7%, P=.020) and NPV (98% vs 92.3%, P=.032) than WLE, but there were no significant differences between NBI and WLE in specificity (98.6% vs 97.3%, P=.684), accuracy (97.3% vs 91.5%, P=.416) and PPV (95% vs 87.9%, P=.400). NBI as an emerging technique can improve the diagnostic accuracy by distinguishing benign and malignant lesions in nasal cavity and remains a promising and helpful adjunct to the endoscopy techniques.

Preoperative Misdiagnosis of Malignant Mucosal Melanoma of the Nasal Septum by MRI.

Malignant sinonasal mucosal melanoma is a rare and aggressive neoplasm. As it shows nonspecific clinical symptoms, magnetic resonance imaging (MRI) is the most effective diagnostic tool. Before a mass is histopathologically confirmed, MRI is regarded as the optimal differential diagnostic procedure, especially in patients who present with a unilateral sinonasal cavity mass. However, we recently treated a patient who showed atypical MRI findings, resulting in a preoperative misdiagnosis of a vascular tumor. By pathologic examination, the patient was confirmed to have a malignant mucosal melanoma that originated from the nasal septum. This case demonstrates that unilateral nasal cavity masses that present with nonspecific symptoms, such as epistaxis, should be evaluated for possible malignant neoplasms, even if the mass has benign-looking characteristics in preoperative endoscopic findings and MRI images.

Effects of olfactory deprivation on action potential and ankyrin-G expression in glutamatergic neurons in the barrel cortex of mice

To investigate effect of upregulated touch sensation induced by olfactory deprivation on action potentials and ankyrin-G expression in the glutamatergic neurons in the barrel cortex of mice. Chloroform (40 μL) was dropped into the unilateral nasal cavity to induce olfactory deprivation in 40 C57 mice (12 days old), whose glutamatergic neurons were genetically labeled with yellow fluorescent protein (YFP). Behavioral experiments were carried out to assess the effects of olfactory deprivation on whisker tactile of the mice. The action potentials of the glutamatergic neurons in the barrel cortex on the side with or without chloroform treatment (olfactory deprivation group and control group, respectively) were recorded by patch-clamp electrophysiological recording, and ankyrin-G expression in the proximal axonal segment of the neurons was detected with immunohistochemistry. Compared with those on the control side, the inter-spike intervals of the barrel glutamatergic neurons were significantly decreased and the absolute refractory periods were significantly shortened on the side with olfactory deprivation (P < 0.01); the expression of ankyrin-G was also significantly increased in the proximal axonal segment of the glutamatergic neurons in the barrel cortex on the side with olfactory deprivation (P < 0.01). Olfaction deprivation induces up-regulation of touch sensation in mice possibly as a result of functional enhancement of the glutamatergic neurons and increased ankyrin-G expression in the barrel cortex.

Value of PET/CT in the prognosis of extranodal NK/T cell lymphoma

Objective: To explore the value of Positron-Emission Tomography/Computed Tomography (PET/CT) in the prognosis of extranodal NK/T cell lymphoma. Methods: The patients of NK/T cell lymphoma diagnosed from January 2007 to July 2016 in Department of Pathology of Beijing Tongren Hospital were enrolled in this study. Seventy-two in-hospital patients were examined on the invasion of adjecent tissue or organ by PET/CT. The PET/CT results were analyzed retrospectively. Kaplan-Meier method was used to analyze the prognostic value of the positive results by PET/CT on overall survival (OS). Results: There were 54 males and 18 females with median age of 44.5 years (13-75 years). According to Ann Arbor staging system, there were 16 cases (22.2%) in stage Ⅰ, 29 cases (40.3%) in stage Ⅱ, 6 cases (8.3%) in stage Ⅲ and 21 cases (29.2%) in stage Ⅳ. According to the IPI scoring system, there were 34 cases (47.2%) in the low risk group (0-1 point), 21 cases (29.2%) in the low-middle risk group (2 points), 16 cases (22.2%) in the middle-high risk group (3 points), and 1 case (1.4%) in the high risk group (4-5 points) . The median follow-up time was 29.2 months (1-118 months). The disease occured in unilateral nasal cavity in 26 cases (36.1%), bilateral nasal cavities in 36 cases (50.0%), nasopharynx, oropharynx and pharynx in 10 cases (13.9%). The tumors of 51 cases involved the surrounding tissue, including nasal wings in 29 cases (40.3%), nasal sinus in 29 cases (40.3%), maxillofacial soft tissue in 18 cases (25.0%), orbital in 12 cases (16.7%), maxilla and skull base in 8 cases (11.1%), eyelid in 6 cases (8.3%), brain tissue in 3 cases (4.2%), eyeball in 2 cases (2.8%). In addition, cervical and inguinal lymphadenopathy were found in 54 cases (75.0%) . Splenomegaly and hepatomegaly were found in 10 cases (13.9%) and 2 cases (2.8%), respectively. Survival analysis showed that the clinical stage and IPI were significantly associated the clinical prognosis (P=0.000, 0.001, respectively). Involvement of the maxillofacial soft tissue, eyelid, orbital, maxilla and skull base and brain tissue were significantly related to reduced the overall survival time (P=0.006, 0.000, 0.024, 0.001 and 0.015, respectively). Involvement of palate or tonsil, the nosewingand nasal sinus did not show significant shorter overall survival (P=0.091, 0.063, and 0.139, respectively). Cox regression multivariate analysis showed maxilla and skull base involvement was independent adverse prognostic factor (P=0.047). Conclusions: The PET/CT examination can accurately detect the extent of adjacent and distant tissues of tumor involvement of NK/T cell lymphoma by showing the tumor structure and metabolic status, thus has important value in the clinical staging and prognosis predication.

POLYPOID NASAL MASSES;

Objectives: The purpose of this study is firstly to signify the occurrence ofunusual nasal polypoid masses by analyzing their histopathological spectrum and to be on thelookout for them. Secondly to highlight the fact that nasal polypoid masses should not be takenlightly as they may be representing an underlying grave pathological process meriting urgentmedical advice. Study Design: Retrospective/observational study. Setting: Charsada TeachingHospital affiliated with Jinnah Medical College Peshawar. Period: March 2010 to March 2015.Methods: In this study, all the surgical pathology cases with clinical diagnosis of nasal polypswith no suspicion for malignancy were retrieved from archives of Charsada Teaching Hospitalaffiliated with Jinnah Medical College Peshawar. The slides and diagnoses of all the retrievedcases were reviewed. The number of cases for each diagnostic category were recorded andanalyzed according to the non-neoplastic, neoplastic and their subcategories. Results: Thereview of cases from March 2010- March 2015 showed that most of the polypoid masses werenon-neoplastic, while only few were neoplastic. Of all the non-neoplastic masses, inflammatory/allergic polyps were much more common followed bypolyps with fungal infections andeosinophilic angiocentric fibrosis. Amongst the neoplastic masses, benign tumors were morecommon than the malignant. The benign masses comprised of hemangioma, angiofibroma,inverted papilloma and schwannoma. The malignant nasal masses constituted one case eachof polypoid extraskeletal Ewings sacoma, plasmacytoma, non-Hodgkin lymphoma and renalcell carcinoma. Conclusions: Awareness about the occurrence of the usual and unusualentities in the nasal cavities needs to be increased. Important diagnostic categories requiringurgent management include polyps with invasive fungal infection, inverted papilloma and allmalignant cases. Therefore, all unilateral nasal cavity masses with frequent epistaxis, pain orbone erosions should be submitted for histopathological examination.

English

Objectives: The purpose of this study is firstly to signify the occurrence ofunusual nasal polypoid masses by analyzing their histopathological spectrum and to be on thelookout for them. Secondly to highlight the fact that nasal polypoid masses should not be takenlightly as they may be representing an underlying grave pathological process meriting urgentmedical advice. Study Design: Retrospective/observational study. Setting: Charsada TeachingHospital affiliated with Jinnah Medical College Peshawar. Period: March 2010 to March 2015.Methods: In this study, all the surgical pathology cases with clinical diagnosis of nasal polypswith no suspicion for malignancy were retrieved from archives of Charsada Teaching Hospitalaffiliated with Jinnah Medical College Peshawar. The slides and diagnoses of all the retrievedcases were reviewed. The number of cases for each diagnostic category were recorded andanalyzed according to the non-neoplastic, neoplastic and their subcategories. Results: Thereview of cases from March 2010- March 2015 showed that most of the polypoid masses werenon-neoplastic, while only few were neoplastic. Of all the non-neoplastic masses, inflammatory/allergic polyps were much more common followed bypolyps with fungal infections andeosinophilic angiocentric fibrosis. Amongst the neoplastic masses, benign tumors were morecommon than the malignant. The benign masses comprised of hemangioma, angiofibroma,inverted papilloma and schwannoma. The malignant nasal masses constituted one case eachof polypoid extraskeletal Ewings sacoma, plasmacytoma, non-Hodgkin lymphoma and renalcell carcinoma. Conclusions: Awareness about the occurrence of the usual and unusualentities in the nasal cavities needs to be increased. Important diagnostic categories requiringurgent management include polyps with invasive fungal infection, inverted papilloma and allmalignant cases. Therefore, all unilateral nasal cavity masses with frequent epistaxis, pain orbone erosions should be submitted for histopathological examination.

Abstract # 1788 Propagation of endotoxin-induced nasal mucosal inflammation to the olfactory bulb along the olfactory neural pathway

Impaired sense of smell is a common symptom of various neurological and psychiatric diseases. However, how olfactory dysfunction is associated with these disorders remains unknown. Since nasopharynx is an entry site for environmental agents, we hypothesized that nasal mucosal inflammation initiated by environmental toxin is transmitted to the brain via the olfactory neural pathway and contributes to neurodegeneration. Adult male mice received multiple injections with 10 μL of lipopolysaccharide (LPS) (1 mg/mL) into the unilateral nasal cavity every other day. Mice were fixed at 1, 3, 7, 14 and 21 days after the first injection and subjected to immunohistological analyses. Intranasal LPS induced neutrophils and monocytes infiltration into the lateral part of the olfactory epithelium (OE) from Day 1. Some monocytes but not neutrophils released IL-1 beta. Olfactory sensory neurons were gradually damaged time-dependently. In addition, neutrophil infiltration into the olfactory nerve layer and the glomerular layer (GL) as well as activation of microglia and astrocytes were evident in the lateral part of the olfactory bulb (OB). At Day 21, immunoreactivity for tyrosine hydroxylase around the GL and that for a synaptic marker in the external plexiform were reduced in the LPS injected side. These results indicate that LPS-induced olfactory epithelial inflammation is transmitted to the OB along the olfactory neural pathway. Neuroinflammation in other brain regions are being studied.

A computational analysis of nasal vestibule morphologic variabilities on nasal function

Although advances in computational modeling have led to increased understanding of nasal airflow, not much is known about the effects of normal sinonasal anatomic variabilities on nasal function. In this study, three distinct variations in the human nasal vestibule airspace that have not been previously described were identified. Computational fluid dynamics modeling of nasal airflow profile in each identified variation of nasal vestibule phenotype was conducted to assess the role of these phenotypes on nasal physiology. Three-dimensional reconstructions of the nasal geometry in sixteen subjects with normal radiographic sinonasal images were created and each respective unilateral nasal cavity was classified as Notched, Standard, or Elongated phenotype based nasal vestibule morphology. Steady state, laminar and incompressible flow simulations were performed in the nasal geometries under physiological, pressure-driven conditions with constant inspiratory pressure. Results showed that at localized regions of the unilateral nasal cavity, average resistance was significantly different among nasal vestibule phenotypes. However, global comparison from nostril to choana showed that average resistance was not significantly different across phenotypes; suggesting that with normal anatomic variations, the nose has a natural compensatory mechanism that modulates localized airflow in order to achieve a desired amount of global airflow.

Grafting the Nasal Cavity with 100% Anorganic Bovine Bone: A Clinical and Histomorphometric Pilot Report

The aim of the present study was to evaluate bone formation and survival rates for implants after nasal cavity grafting using exclusively anorganic bovine bone (ABB) by means of clinical, radiographic, and histologic/histomorphometric examinations. Twelve subjects with edentulous atrophic maxillae were screened for the study; four required bilateral and eight required unilateral nasal cavity grafting. A full-thickness flap was raised to determine the position for the nasal window between the anterior wall of the sinus and the lateral wall of the piriform aperture. A window, 5 to 6 mm wide and 10 to 13 mm high, was created. The window was infractured into the nasal cavity to allow the ABB to be pushed inside and was then covered with a collagen membrane. Cone beam computed tomography (CBCT) was performed before grafting (during screening), after grafting, and 6 months later. Eight months after grafting, from the 16 sites grafted, biopsy cores were taken from three patients using a 2.5-mm trephine and processed to evaluate the percentages of new bone, marrow space, and residual ABB. One screw-form implant was placed in each grafted site and loaded after 3 months. After at least 6 months of loading, the fixed prostheses were removed and all implants placed in grafted areas were tested for mobility. The 6-month CBCTs clearly showed the radiopaque material inside the nasal cavity. The histomorphometric measurements showed 33.34% new bone, 30.30% marrow space, and 36.52% remaining ABB. All implants were osseointegrated and free of pain, infection, and mobility. All implants remained stable at a mean of 13 months after loading (range, 6 to 24 months). The clinical, radiographic, and histomorphometric results showed that nasal cavity grafting with ABB can be an excellent alternative in patients with extensively atrophic maxillae.

An Esthesioneuroblastoma Mimicking a Fibro‐osseous Lesion

Objective: 1) Present the unique radiology and pathology of a coarsely calcified pediatric esthesioneuroblastoma (ONB) that was incorrectly suggested preoperatively to be a fibro-osseous tumor. 2) Review the clinical presentation, radiographical and pathological findings, treatment, and prognosis of ONBs. Method: The PubMed database was searched from 1958 to 2011, limited to the English language, using keywords esthesioneuroblastoma, radiology, and calcification. Results: Esthesioneuroblastomas present with nasal obstruction, pain, hyposmia and epistaxis. Imaging shows a destructive, soft tissue mass without calcifications. Treatment includes surgery, radiation and chemotherapy. Ten year survival is significantly decreased in Hyams high-grade pathological tumors. We present a 12 year-old female with Kadish C and Dulguerov-Calcaterra T3N0M0 esthesioneuroblastoma that on CT and MRI revealed a coarsely calcified 3.8 × 3.5 × 4.1 cm mass involving the right nasal vault and paranasal sinuses. Due to the extensive calcifications, it was incorrectly suggested preoperatively to be a fibro-osseous lesion. She underwent endoscopic-assisted resection with postoperative radiation and is disease-free 9 months post-treatment. Conclusion: Our case highlights a unique radiographic presentation of esthesioneuroblastoma and emphasizes that this uncommon neuroectodermal malignant tumor always be in the differential for unilateral nasal cavity lesions. Optimal treatment requires a multidisciplinary approach and long-term clinical surveillance is essential.

Computed tomography and pathological findings of five nasal neurilemmomas

ObjectivesNeurilemmomas are benign tumors deriving from Schwann cells of the nerve sheath. They occur in all parts of the body. The highest incidence of neurilemmoma is in the head and neck region (38–45%), but involvement of the nose and paranasal sinus is quite rare, with only sporadic cases having been reported in the world literature. Fewer than 4% of these tumors involve the nasal cavity and paranasal sinuses. We describe the clinical, pathologic, and computed tomography (CT) features of five nasal neurilemmomas.MethodologyCT features of five patients with nasal schwannoma proved by operation and pathology were investigated.ResultsSchwannomas tend to be solitary and are usually well-circumscribed tumors with an oval, round or fusiform shape in the unilateral nasal cavity. The lesions usually have a mottled central lucency with peripheral intensification on contrast-enhanced CT scans. The heterogeneous appearance is related to areas of increased vascularity with adjacent non-enhancing cystic or necrotic regions.ConclusionsSchwannoma should be considered in the differential of unusual nasal masses. Certain clinical and CT patterns may be of use in the differential diagnosis.

The role of Nervus Intermedius in side specific nasal responses

Nervus intermedius (NI) dysfunction is common in patients who have had vestibular schwannoma (VS) surgery. Such patients have a unilateral parasympathetic-denervated nasal cavity. A number of side-specific nasal reflexes have been demonstrated in normal individuals, including hand cold-water immersion. It is not understood whether these reflexes have parasympathetic or sympathic efferent pathways. We aimed to evaluate the side specific nasal reflex to cold-water immersion in post-operative VS patients with NI dysfunction, in order to determine the nature of the efferent pathway of these reflexes. Side specific responses to cold-water immersion were tested by acoustic rhinometry in 10 normal individuals and 18 patients with NI dysfunction (proven by Schirmer s test) after VS surgery. A consistent pattern of ipsilateral congestion and contralateral decongestion after the cold-water immersion was seen in normal individuals (p smaller than 0.001). We found no consistent response in VS patients both ipsilateral and contralateral to the side of NI dysfunction. We confirm the consistent side-specific nasal reflexes to cold-water hand immersion in normal individuals. This is disturbed in patients with NI dysfunction. We have also shown unexpectantly that the contralateral side-specific reflex is disturbed in these patients. These data suggest that the reflex is parasympathetic and crosses the midline.