Avaliação da Obstrução Nasal em Pacientes Submetidos à Septoplastia com Cirurgia das Conchas Nasais Inferiores Utilizando o Questionário NOSE / Evaluation of Nasal Obstruction in Patients Undergoing Septoplasty with Inferior Nasal Turbinate Surgery Using the NOSE Questionnaire

Introdução: O desvio septal e a hipertrofia das conchas nasais inferiores são as principais causas de obstrução nasal. Uma forma de avaliarmos o grau de obstrução nasal é através do questionário NOSE, o qual é baseado em cinco perguntas com nota de 0 a 04, podendo alcançar 100 pontos. Esse pode ser aplicado no pré-operatório e pós-operatório, servindo para comparação do grau de melhora do paciente em relação à obstrução nasal. Objetivo: O trabalho teve como objetivo aplicar o questionário NOSE para avaliação de grau de satisfação dos pacientes no pós-operatório de cirurgia de septoplastia, associado à técnica cirúrgica das conchas nasais inferiores. Métodos: Os pacientes eletivos para septoplastia e cirurgia das conchas nasais inferiores foram avaliados com o questionário NOSE no pré-operatório e no pós-operatório (07 e 30 dias, 3 e 06 meses e 01 ano). Para análise estatística, foi utilizado o teste de Friedman e de Mann-Whitney. Foram excluídos os pacientes menores de idade e presença de alterações sinusais. Resultados: Um total de 64 pacientes preencheu os critérios de inclusão, sendo excluídos 13 pacientes por perda de seguimento, permanecendo com 51 pacientes. A média de idade foi de 31,33 anos. A maioria dos pacientes era do gênero masculino, 72,5%, e 27,5% do gênero feminino. Houve diferença estatística entre o pré-operatório e o seguimento de 06 meses e 01 ano. Conclusão: O questionário NOSE mostrou que a septoplastia associada à cirurgia das conchas nasais inferiores demonstrou melhora do sintoma de obstrução nasal no pós-operatório, tendo como parâmetro o próprio paciente.

Introduction: Septal deviation and inferior nasal turbinate hypertrophy are the primary causes of nasal obstruction. One way to assess the degree of nasal obstruction is through the NOSE questionnaire, which bases itself on five questions with a score from 0 to 04, and may reach 100 points. Its application can be preoperatively and postoperatively to compare the degree of patient improvement regarding nasal obstruction. Objective: This study aimed to apply the NOSE questionnaire to evaluate the degree of patient satisfaction in the post-operative period of septoplasty associated with the surgical technique of inferior nasal concha. Methods: Elective patients for septoplasty and inferior nasal concha surgery were evaluated with the NOSE questionnaire preoperatively and postoperatively (7 and 30 days, 3 and 6 months, and one year). The Friedman and Mann-Whitney tests were used for statistical analysis. Exclusion of underage patients and the presence of sinus changes. Results: A total of 64 patients met the inclusion criteria, eliminating 13 patients due to loss of follow-up, remaining only 51 cases. The mean age was 31.33 years. Most patients were male, 72.5% and 27.5% were female. There was a statistical difference between the preoperative and the follow-up of 6 months and one year. Conclusion: The NOSE questionnaire showed that septoplasty associated with inferior nasal concha surgery showed improvement of nasal obstruction symptoms postoperatively, using the patient's parameters.

Anomalías congénitas nasales: Estudio retrospectivo y revisión de la literatura / Congenital Anomalies of the Nose: retrospective study and literature review

INTRODUCTION. Congenital malformations occur in 1 in 5,000 to 40,000 live births. They present as a morphological abnormality of the nasal pyramid or as a picture of moderate to severe nasal obstruction. OBJECTIVE. Evaluate the etiology, associated comorbidities, management and mortality of congenital malformations of the nose in neonates and infants. MATERIALS AND METHODS. Cross-sectional retrospective descriptive study, 105 medical records were reviewed, of which 26 corresponded to patients with congenital nasal malformations, at the Carlos Andrade Marín Specialty Hospital in Quito - Ecuador, between January 2009 and May 2022; the tabulation and analysis of data was carried out in the Excel program. The patients were classified according to Losee et al. in 4 types: hypoplasia, hyperplasia, clefts and tumors RESULTS. Nasal anomalies occurred in males in 73.07%, all presented nasal obstruction, the diagnosis was made by flexible nasofibroscopy; in 42.3% of the cases, the evaluation was complemented with computed tomography. The most frequent congenital pathology was stenosis - choanal atresia with 53.8%, followed by craniofacial clefts with 15.39%. In 42.3% of the cases there was an association with genetic syndromes, neurological, ocular and intestinal pathology. 69.23% of the patients received clinical treatment with nasal lavages, nasal corticosteroids and positive pressure by cannula, while 30.77% were resolved surgically, being: 2 unilateral choanal atresia, 1 middle fossa stenosis, 4 cleft lip and palate and 1 encephalocele. Mortality was 7.69% CONCLUSION. Hypoplasias and clefts are the predominant pathologies, flexible nasal nasofibroscopy is the diagnostic test of choice. The clinical treatment was successful in the initial management in 69.23% of cases. Surgery was performed for the repair of facial clefts; being the hypoplasias or masses managed by endoscopic approach.

INTRODUCCIÓN. Las malformaciones congénitas se presentan en 1 de cada 5.000 a 40.000 nacidos vivos. Se presentan como una anomalía morfológica de la pirámide nasal o como un cuadro de obstrucción nasal moderada a severo. OBJETIVO. Evaluar la etiología, comorbilidades asociadas, manejo y mortalidad de las malformaciones congénitas de nariz en neonatos y lactantes. MATERIALES Y MÉTODOS. Estudio descriptivo retrospectivo transversal, se revisaron 105 historias clínicas de las cuales 26 correspondieron a pacientes con malformaciones congénitas nasales, en el Hospital de Especialidades Carlos Andrade Marín de Quito - Ecuador, entre enero de 2009 a mayo de 2022; la tabulación y análisis de datos se realizó en el programa Excel. Los pacientes fueron clasificados según Losee et al. en 4 tipos: hipoplasia, hiperplasia, hendiduras y tumores. RESULTADOS. Las anomalías nasales se presentaron en el sexo masculino en el 73.07%, el motivo de consulta fue la obstrucción nasal, el diagnóstico se realizó mediante nasofibroscopía flexible; en el 42,3% de los casos se complementó la evaluación con tomografía computarizada. La patología congénita más frecuente fue la estenosis - atresia de coana con un 53,8%, seguida de hendiduras craneofaciales con un 15.39%. En el 42.3% de los casos existió asociación con síndromes genéticos, patología neurológica, ocular e intestinal. El 69,23% de los pacientes recibió tratamiento clínico con lavados nasales, corticoides por vía nasal y presión positiva por cánula, mientras que el 30,77% se resolvió quirúrgicamente, siendo: 2 atresia unilateral de coana, 1 estenosis de fosa media, 4 hendiduras labio palatinas y 1 encefalocele. La mortalidad fue del 7,69%. CONCLUSIÓN: Las hipoplasias y las hendiduras son las patologías que predominaron, la nasofibroscopia flexible nasal es el examen diagnóstico de elección. El tratamiento clínico fue exitoso en el manejo inicial en el 69,23% de casos. La cirugía se realizó para la reparación de hendiduras faciales; siendo las hipoplasias o masas manejadas por abordaje endoscópico.

Paciente con rinofima no clasificable

RESUMEN Introducción: El rinofima es una enfermedad de la cual se han descrito 4 clasificaciones clínicas asociadas a la gravedad de la afectación dérmica. Aun así, existen casos en quienes no son clasificables por ninguna de las alternativas. Objetivo: Mostrar un paciente no clasificable, según las clasificaciones preexistentes del rinofima. Caso clínico: Se presenta un paciente masculino de 68 años de edad, de piel blanca, con diagnóstico de rinofima, que en el examen físico se observa engrosamiento nasal, nodular, asimétrico, con piel normocoloreada, presencia de telangiectasias en toda su superficie y compromiso de más de una subunidad anatómica nasal. Conclusiones: El caso presentado no se puede enmarcar en ninguno de los ítems de las clasificaciones existentes, lo cual muestra la necesidad del diseño de una nueva clasificación del rinofima más exhaustiva e inclusiva para pacientes con este diagnóstico.

ABSTRACT Introduction: Rhinophyma is a disease of which four clinical classifications associated with the severity of dermal involvement have been described. Even so, there are cases in which they are not classifiable by any of the alternatives. Objective: To show an unclassifiable patient, according to the preexisting classifications of rhinophyma. Clinical case: A 68-year-old male patient is presented, with white skin, with a diagnosis of rhinophyma, who in the physical examination shows nasal, nodular, asymmetric thickening, with normal-colored skin, presence of telangiectasias on all its surface and compromise of more than one nasal anatomical subunit. Conclusions: The case presented cannot be framed in any of the items of the existing classifications, which shows the need to design a new, more exhaustive and inclusive rhinophyma classification for patients with this diagnosis.

CD133, a Progenitor Cell Marker, is Reduced in Nasal Polyposis and Showed Significant Correlations with TGF-β1 and IL-8

Abstract Introduction Combination of chronic inflammation and an altered tissue remodeling process are involved in the development of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP). Studies demonstrated that mesenchymal stem cells expressing the progenitor gene CD133 were involved in a significant reduction of the chronic inflammatory process in the polypoid tissue. Objective To evaluate the levels of CD133 (Prominin-1) in nasal polypoid tissue and its correlation with interleukin-8 (IL-8) and transforming growth factor β1 (TGF-β1). Methods A total of 74 subjects were divided in the following groups: control group (n = 35); chronic rhinosinusitis with nasal polyps nonpresenting comorbid asthma and aspirin intolerance (CRSwNPnonAI) group (n = 27); and chronic rhinosinusitis with nasal polyps presenting comorbid asthma and aspirin intolerance (CRSwNPAI) group (n = 12). Histologic analysis and also evaluation of the concentration of CD133, IL-8, and TGF-β1 by enzyme-linked immunosorbent assay (ELISA) kits were performed in nasal tissue obtained from nasal polypectomy or from middle turbinate tissue. Results Higher eosinophilic infiltration was found in both CRSwNP groups by histologic analysis. Lower levels of TGF-β1 and IL-8 were observed in both CRSwNP groups when compared with the control group, whereas the CD133 levels were significantly reduced only in the CRSwNPnonAI group compared with the control group. Conclusion It was demonstrated that the nasal mucosa presenting polyposis showed a significant reduction of CD133 levels, and also that this reduction was significantly correlated with the reduction of TGF-β1 levels, but not with IL-8 levels. Therefore, these findings may be involved in the altered inflammatory and remodeling processes observed in the nasal polyposis.

Clinical observation on repairing nasal defect with multiple flaps / 中国医师进修杂志

Objective:To summarize the clinical application of multiple flaps in repairing nasal defects.Methods:The clinical data of 32 nasal defect patients underwent flap repair in the Tengzhou Central People′s Hospital from 2017 to 2021 were analyzed retrospectively.Results:The nasal median displacement flap was used in 9 cases, nasofacial groove displacement flap in 10 cases, nasolabial groove flap in 8 cases, nasolabial displacement flap in 2 cases, frontal displacement flap in 2 cases, and free tragus cartilage flap in 1 case. After operation, all flaps survived, blood supply was good, nasal shape and stereoscopic structure returned to normal. There was no tumor recurrence during 6 to 24 months after operation.Conclusions:It is a good choice to use multiple flaps to repair the small defects of nasal parts. And the operation is simple and easy with high success rate.

Retalho interpolado de sulco nasogeniano em único estágio para reconstrução de defeitos nasais e de canto interno da órbita / Single-stage nasolabial interpolation flap for reconstructing defects of the nose and inner corner of the eye

Introdução: Os retalhos interpolados são opções cirúrgicas eficazes para reconstruções de defeitos cutâneos em várias áreas do corpo, inclusive na face. O retalho proposto dispensa cuidados pós-operatórios com o pedículo exposto e pode ser realizado em tempo único. O objetivo é avaliar a utilidade do retalho interpolado de sulco nasogeniano (RISN) em ilha, na reconstrução de segmentos nasais e do canto interno da órbita, bem como discutir refinamentos em seu design e execução. Métodos: Estudo retrospectivo de prontuários de pacientes com defeitos nasais ou de canto interno da órbita, e que foram reparados com retalho interpolado do sulco nasogeniano. Todos os retalhos foram confeccionados de maneira randômica, realizando-se túnel subcutâneo para evitar pedículo exposto e cicatriz que comunicasse a área doadora e o defeito. Resultados: cinco pacientes foram incluídos no estudo, com idade entre 30 e 92 anos. Em todos os casos foi realizada biópsia de congelação intraoperatória que revelou margens livres de doença, orientando a extensão da ressecção. O CBC foi encontrado em 4 pacientes e o CEC em um paciente. Não houve complicações como sangramento pós-operatório ou necrose. Bons resultados funcionais e estéticos foram alcançados em todos os pacientes. Discussão: Vale ressaltar a versatilidade do retalho nasogeniano interpolado, sendo capaz de auxiliar na reconstrução de defeitos extensos não apenas de asa, ponta e columela nasais, mas também de dorso e canto medial do olho. Destaca-se também o aspecto estético mais favorável do pedículo do retalho interpolado em ilha comparado ao de transposição. Conclusão: O RISN interpolado em único estágio é uma opção confiável na reconstrução de segmentos faciais. Apresenta boa vascularização, possibilidade se ser realizado em único tempo e pode ser utilizado para cobertura nos locais onde há poucas opções reconstrutivas disponíveis.

Introduction: Interpolation flaps are effective surgical options for reconstructing skin defects in various areas of the body, including the face. The proposed flap does not require postoperative care with the pedicle exposed and can be performed in a single surgery. The objective is to evaluate the usefulness of the nasolabial interpolation island flap (NIF) for reconstructing nasal segments and the inner corner of the eye, as well as discuss improvements in its design and performance. Methods: In this retrospective study, medical records of patients with nasal defects that were repaired with a nasolabial interpolation flap were reviewed. All flaps were created with a subcutaneous tunnel to avoid pedicle exposure and prevent scar connection with the donor area and the defect. Results: Five patients aged 30­92 years were included. In all cases, intraoperative frozen biopsy revealed disease-free margins, indicating the extent of the resection. Basal cell carcinoma was found in four patients and squamous cell carcinoma in one. There were no complications such as postoperative bleeding or necrosis. Good functional and aesthetic results were achieved. Discussion: The NIF can help in the reconstruction of extensive defects of the nasal ala, tip, columella, and medial dorsum as well as the corner of the eye. We also highlight the more favorable aesthetic aspect of the pedicle in the interpolation island versus transposition flap. Conclusion: The single-stage NIF flap is a reliable option for reconstructing facial segments as it has good vascularization, can be performed in a single surgery, and can be used to cover places where few other reconstructive options are available.

Principles of magnetic resonance imaging and its value in diagnosis of sinonasal disease / 中华耳鼻咽喉头颈外科杂志

Magnetic resonance imaging is commonly used in clinical work for its high resolution for soft tissue, and without radiation or interaction of bone interference. For ENT physicians, to read MRI accurately and retrieve more information from it would help the clinical work a lot. This review introduces the principles of MRI, the anatomy, the inflammatory disease, benign tumors and malignancies of the nasonasal tract.

Rinofima: análise da técnica cirúrgica por em Shave Excision / Rhinophyma: analysis of the shave excision technique

INTRODUÇÃO: Rinofima é uma condição estigmatizante para o indivíduo portador. Descrita desde a época de Hipócrates, a doença, popularmente conhecida como nariz de alcoólatra ou elefantíase nasal, é responsável por gerar uma enorme deformidade no nariz. Oriunda de um processo de hiperplasia e hipertrofia das glândulas sebáceas da região cutânea nasal, associadas à fibrose e dilatação dos vasos sanguíneos e tecido conjuntivo locais. O tratamento cirúrgico é considerado o procedimento de escolha para melhoria estética. MÉTODOS: Estudo retrospectivo baseado na análise dos resultados de 11 pacientes, sendo dez homens e uma mulher, submetidos a tratamento do rinofima entre janeiro de 2010 e janeiro de 2016 no serviço de Cirurgia Plástica do Hospital Universitário da Universidade Federal de Juiz de Fora e Clínica Plastic Center. RESULTADOS: Dos 11 pacientes operados, um homem de 72 anos apresentou carcinoma basocelular invasor expansivo com margens cirúrgicas comprometidas após análise anatomopatológica da peça cirúrgica, obtendo resultado anatomopatológico de margens livres após reoperação. Outros três pacientes apresentaram hipercromia na região de intervenção durante o pós-operatório imediato, mas obtiveram resultados satisfatórios 6 meses após procedimento. CONCLUSÕES: Apesar dos avanços tecnológicos atuais, a retirada da lesão com bisturi frio e aplicação dos curativos pós-operatórios ainda demonstram ser altamente eficazes quando associadas, proporcionando excelentes resultados estéticos, com baixos índices de complicação e altos índices de satisfação dos pacientes, que em sua maioria obtiveram melhora da qualidade de vida após o procedimento.

INTRODUCTION: The rhinophyma is an extremely stigmatizing condition for a patient. The first descriptions of this disease dates back to the time of Hippocrates, which was popular known as alcoholic nose or nasal elephantiasis is responsible for generating a huge deformity in the nose. This deformity derives from a process of hyperplasia and hypertrophy of the sebaceous glands in nasal skin associated with fibrosis and dilated local blood vessels and connective tissue. Surgery is considered the treatment of choice for aesthetic improvement of the injury. METHODS: This was a retrospective study based on analysis of results from 11 patients (10 men and 1 woman) who underwent treatment for rhinophyma between January 2010 to January 2016 at the Plastic Surgery Service of the Teaching Hospital of Federal University of Juiz de Fora and Clinical Plastic Center. RESULTS: Of 11 patients who underwent surgery, a 72-year-old man had basal expansive invasive carcinoma with positive surgical margins after pathological examination of the surgical specimen, however, the patient had pathological free margins after reoperation. Other 3 patients had hypercromy in the intervention region during the immediate postoperative. CONCLUSION: Despite technological advances, the removal of the injury with a cold scalpel technique and the use of postoperative dressings are highly efficient, when combined, provide excellent aesthetic results with low complication rates and high rates of patients' satisfaction, whom mostly had improvement in quality of life after the procedure.

Tratamento combinado para o rinofima / Combined treatment for rhinophyma

O rinofima tende a determinar importantes alterações nasais, com prejuízos estéticos e funcionais, especialmente nos casos mais avançados. Apesar das diversas técnicas já descritas, a busca do tratamento ideal persiste. Dois pacientes com rinofima foram submetidos à excisão tangencial associada à eletrocoagulação, com posterior tratamento cosmético intenso. A técnica descrita se mostrou eficaz, segura, com excelente resultado estético e sem recidivas ao longo do período avaliado. Essa proposta de tratamento combinado configura-se como excelente alternativa para o tratamento do rinofima, devido a sua simplicidade técnica e seus bons resultados em longo prazo.

Rhinophyma tends to determine important nasal changes, with aesthetic and functional impairment, especially in more advanced cases. Despite the various techniques already described, the search for the ideal treatment persists. Two patients with rhinophyma underwent tangential excision associated with electrocoagulation, with subsequent intensive cosmetic treatment. The described technique is effective, safe, with excellent aesthetic results and no recurrences during the study period. This proposed combined treatment appears as a great alternative for the treatment of rhinophyma due to its technical simplicity and its good long-term results.

Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment / Rinossinusite crônica e polipose nasossinusal na fibrose cística: atualização sobre diagnóstico e tratamento

Although cystic fibrosis (CF) is an irreversible genetic disease, advances in treatment have increased the life expectancy of CF patients. Upper airway involvement, which is mainly due to pathological changes in the paranasal sinuses, is prevalent in CF patients, although many are only mildly symptomatic (with few symptoms). The objective of this literature review was to discuss the pathophysiology and current therapeutic management of chronic rhinosinusitis (CRS) in CF patients. The review was based on current evidence, which was classified in accordance with the Oxford Centre for Evidence-Based Medicine criteria. When symptomatic, CRS with nasal polyps can affect quality of life and can lead to pulmonary exacerbations, given that the paranasal sinuses can be colonized with pathogenic bacteria, especially Pseudomonas aeruginosa. Infection with P. aeruginosa plays a crucial role in morbidity and mortality after lung transplantation in CF patients. Although clinical treatment of the upper airways is recommended as initial management, this recommendation is often extrapolated from studies of CRS in the general population. When sinonasal disease is refractory to noninvasive therapy, surgery is indicated. Further studies are needed in order to gain a better understanding of upper airway involvement and improve the management of CRS in CF patients, with the objective of preserving lung function and avoiding unnecessary invasive procedures.

A fibrose cística (FC) é uma doença genética irreversível, mas os avanços no tratamento têm aumentado a expectativa de vida dos pacientes. O acometimento das vias aéreas superiores, principalmente por alterações patológicas dos seios paranasais, é prevalente nesses pacientes, embora muitos apresentem poucos sintomas. O objetivo desta revisão é discutir a fisiopatologia e o manejo terapêutico atual da rinossinusite crônica (RSC) na FC. A revisão fundamentou-se nas evidências mais recentes, classificadas em conformidade com os critérios do Oxford Centre for Evidence-Based Medicine. Quando sintomática, a RSC com pólipos nasais pode afetar a qualidade de vida e as exacerbações pulmonares, já que os seios paranasais podem ser colonizados por bactérias patogênicas, principalmente a Pseudomonas aeruginosa. Essa bactéria tem papel crucial na morbidade e mortalidade após o transplante pulmonar em pacientes com FC. Embora o tratamento clínico das vias aéreas superiores seja indicado no manejo inicial, a indicação é muitas vezes extrapolada de estudos sobre RSC na população geral. A cirurgia é a alternativa quando o quadro nasossinusal é refratário à terapia não invasiva. Mais estudos são necessários para compreender melhor o acometimento das vias aéreas superiores e melhorar o manejo da RSC na FC, a fim de preservar a função pulmonar e evitar procedimentos invasivos desnecessários.

Manejo y evaluación de la epistaxis en pediatría / Treatment and evaluation of epistaxis in children

Introducción: El niño que sangra por la nariz produce en sus padres y cuidadores gran angustia. Las causas son múltiples y en la gran mayoría de los casos se trata de un padecimiento corto, auto limitado y que no repite. Objetivo: Identificar claramente cuándo realizar una valoración hematológica completa, ungüentos o cauterización según el caso y qué materiales se deben usar en epistaxis severas. Diseño: Revisión narrativa de la literatura. Materiales y métodos: Se realizó una búsqueda en bases de datos virtuales y búsqueda manual de información con el fin de encontrar la blibliografía pertinente para describir el estado del arte en el manejo y la evaluación de la epistaxis en niños a través de una revisión narrativa de la literatura. Resultados: Las fuentes bibliográficas halladas, se depuraron según impacto, población objeto y tiempo de publicación hasta obtener los artículos de revisión, reportes de caso y libros, de los cuales se sintetizó la información contenida en la revisión. Conclusiones: El enfoque del tratamiento depende de la presencia o no de sangrado activo, de la severidad del mismo, su localización y además de las enfermedades intercurrentes. Los episodios de sangrado nasal recurrentes moderados de localización anterior, con varices septales identificadas, incluso en un paciente con comorbilidades de base, pueden ser eficazmente tratadas con la combinación de cauterización con nitrato de plata y crema antiséptica tópica dos veces al día durante 4 semanas.

Introduction: Children who bleed from their nose, worry highly to their parents and carers. The causes are many and for most cases it is a short, self-limited and not repeated illness. Objective: Clearly identify when to perform a complete hematologic assessment, ointments or cauterization and what materials should be used in severe epistaxis. Design: Narrative review of the literature. Materials and methods: A search can be performed in virtual databases and manual search for information to find relevant information to describe the state of the art in the management and evaluation of epistaxis in children through a narrative review of the literature. Results: The bibliographical sources found, were refined by impact, target population and publication time until review articles, case reports and books, of which the information contained in the review were synthesized. Conclusions: The treatment approach depends on the presence or absence of active bleeding, its severity, location and intercurrent diseases. Recurrent episodes of moderate anterior nasal bleeding, with septal varices identified, even in a patient with comorbidities base, can be effectively be treated with the combination of silver nitrate cauterization and topical antiseptic cream twice daily for 4 weeks.

Removing Nasal Packing in Epistaxis: What to Do in the Case of an Undeflatable Foley Catheter Balloon

Introduction: Undeflatable Foley catheter balloons adapted for use as nasal packing in epistaxis represent a possible complication. Case Reports:  We report on three cases in which Foley catheter balloons adapted for use as posterior nasal packing in epistaxis failed to deflate. In one patient, deflation was achieved by simply using the fingertips to massage the segment of the catheter collapsed by the fixation device. In the second case, the Foley balloon was removed by the oral route after sectioning the catheter. In the third patient, the Foley catheter was successfully deflated after sectioning. Discussion: The probable causes of the undeflatable balloons in these cases were a blockage or lumen collapse of the balloon or a malfunction in the valve system. Although no definitive method has been established for dealing with this complication, the options proposed are the following: manipulation to restore the permeability of the segment of the catheter collapsed by the fixation device, if this is the case; sectioning the catheter or inserting a stiletto catheter; bursting the balloon; or removing it by the oral route. The latter option is apparently the most appropriate for the otolaryngologist in cases unrelated to simple collapse caused by the fixation device...

Retrospective Study of a Series of Choanal Atresia Patients

Introduction: Although it has been more than 250 years since the first description of choanal atresia (CA), there are still doubts about this abnormality. The differences between unilateral and bilateral forms are seldom discussed. Objectives: Aggregate data from patients diagnosed with CA, grouping patients with unilateral and bilateral forms. Methods: Retrospective study. Results  Eighteen patients were included: 12 (66.6%) presented bilateral atresia, of which 77.8% were mixed bony-membranous type and 22.2% were pure bony type. From the 12 patients with bilateral atresia, 10 presented related malformations, 3 of whom had CHARGE syndrome (coloboma, heart defects, choanal atresia, retardation of growth and development, genitourinary problems, ear abnormalities). From the remaining 6 patients with unilateral atresia, only 2 showed malformations, 1 renal and 1 cardiac. All patients with unilateral atresia needed only 1 surgical procedure, and patients with the bilateral form needed a median of 2.85 interventions (p = 0.003). The median age of surgical procedure in the unilateral group was 6 years, ranging from 6 months to 18 years, and in the bilateral group was 25 days, ranging from 6 days to 6 years (p = 0.003). The median interval between diagnosis and surgery was 9 months in the unilateral group, ranging from 1 month to 18 years, and in the bilateral group was 1 day, ranging from 1 day to 2 months (p = 0.001). Discussion and Conclusions:  Success rates with the endoscopic approach vary from 62 to 100%. Nonetheless, most of these reports present results without considering the number of compromised sides. In our opinion, unilateral and bilateral cases involve distinct patients (taking into account the related malformations), have diverging clinical presentations, and show discrepant restenosis rates and therefore could be considered in different groups of analysis...

Two Cases of Angioleiomyoma in the Nasal Cavity

Leiomyoma is a benign tumor arising from smooth muscle cells. They are commonly found in the uterus, skin, and gastrointestinal tract. However, it is rare in the head and neck area. Especially, only 3% of leiomyomas in the head and neck area occur in the nasal cavity. Rhinologists need to know leiomyoma as a differential diagnosis of the tumors in the nasal cavity. Herein we present two cases of angioleiomyoma in the nasal cavity and review the literature.

Two Cases of Angioleiomyoma in the Nasal Cavity

Leiomyoma is a benign tumor arising from smooth muscle cells. They are commonly found in the uterus, skin, and gastrointestinal tract. However, it is rare in the head and neck area. Especially, only 3% of leiomyomas in the head and neck area occur in the nasal cavity. Rhinologists need to know leiomyoma as a differential diagnosis of the tumors in the nasal cavity. Herein we present two cases of angioleiomyoma in the nasal cavity and review the literature.

An unusual case of nasopalatine cyst in Brazilian population / Um caso incomum de cisto nasopalatino na população brasileira

The nasopalatine duct cyst (NPDC) is the most common non-odontogenic cyst typically found in middle-aged Caucasian female in Brazil, however the present report describes a case in a 35 year-old black male. NPDC are usually asymptomatic and are discovered incidentally during routine radiological examination. A cone-beam computed tomography (CBCT) is a valuable tool to localize a cyst within the nasopalatine canal. CBCT enables analysis of the dimension of the NPDC, analysis of the involvement of neighboring anatomical structures and assists in treatment planning. The authors at this case highlight the importance of clinical examination with an unbiased view of age, gender and ethnicity.

O cisto do ducto nasopalatino (CDNP) é o mais comum dos cistos não-odontogênicos geralmente encontrado em mulheres brancas de meia idade no Brasil, embora o presente relato descreva um caso em um homem negro de 35 anos de idade. Os CDNP são usualmente assintomáticos e são descobertos acidentalmente durante o exame radiográfico de rotina. A tomografia computadorizada por feixe cônico(TCFC) é uma ferramenta válida para localizar o cisto dentro do canal nasopalatino. A TCFC permite análise da dimensão do CDNP, análise do envolvimento das estruturas anatômicas vizinhas e auxilia no planejamento do tratamento. Os autores neste caso alertam para a importância do exame clinico, com uma visão embasada na idade, gênero e grupo étnico.

Rinofima: opções cirúrgicas utilizadas no serviço de cirurgia plástica do Hospital Agamenon Magalhães: PE / Rhinophyma: surgical options used at the service of plastic surgery of Hospital Agamenon Magalhães: PE

Introdução: A rinofima é uma inflamação crônica dos tecidos do nariz com acometimento decor, textura e vascularização, apresentando crescimento exofítico irregular e telangiectasias.Objetivo: Levantar dados epidemiológicos de pacientes portadores de rinofima e avaliar osresultados dos diversos tratamentos para esta patologia realizados no Serviço de CirurgiaPlástica do Hospital Agamenon Magalhães (HAM), Recife, PE, Brasil, comparando-os comos tratamentos descritos na literatura. Método: Estudo retrospectivo, baseado na análise deprontuários de 28 pacientes submetidos a tratamento do rinofima, entre março de 2002 emarço de 2010. Resultados: A média de idade dos pacientes foi 50,1 anos, sendo 72,72%do sexo masculino e 17,28% do sexo feminino. O tratamento mais utilizado foi associaçãode decorticação/ dermoabrasão e eletrocoagulação, em 96% dos casos. Foram observadas asseguintes complicações: 1 caso de hipopigmentação, 2 de hiperpigmentação e 1 de cicatrizinestética. Em 3 casos, houve necessidade de mais de uma cirurgia para complementação dotratamento. Nenhum caso de câncer foi verificado nas peças cirúrgicas. O grau de satisfaçãodos pacientes foi de 100%. Conclusões: A rinofima é uma doença que possui tratamentosimples e eficaz, com excelentes resultados cosméticos.

Introduction: Rhinophyma is a chronic inflammation of the nose with involvement of color,texture and vascularization, with irregular exophytic growth and telangiectasia. Objective:To analyze epidemiological data of patients with rhinophyma and evaluate the results ofvarious treatments for this disease at the Service of Plastic Surgery of Hospital Agamenon Magalhães, Recife, PE, Brasil, comparing them with the treatments described in the literature.Methods: A retrospective study using analysis of medical records of 28 patients undergoing treatment of rhinophyma, between March 2002 and March 2010. Results: The average patient age was 50.1 years, with 72.72% male and 17.28% female. The most common treatment was an association of decortication/ dermabrasion and electrocoagulation,in 96% of cases. Complications observed: one case of hypopigmentation, two cases of hyperpigmentation and one case of unsightly scar. In three cases, there was need for more surgery to completion of treatment. No cancer was found on surgical specimens. The degree of patient satisfaction was 100%. Conclusion: Rhinophyma is a disease that has simple and effective treatment with excellent cosmetic results.

Análise retrospectiva de cirurgias rinossinusais em um hospital escola / Sinus retrospective analysis of surgeries in a hospital school

Introdução: A otorrinolaringologia é uma especialidade médica que abrange 4,4% do total de médicos paulistas, tendo uma variedade de procedimentos cirúrgicos distribuídos entre faringe, nariz, ouvido e laringe. O conhecimento do perfil de um serviço de referência em otorrinolaringologia permite a sua melhor organização, dimensionamento do volume do atendimento e das cirurgias realizadas, proporcionando uma melhor formação ao aluno e ao médico residente. Objetivo: Descrever o perfil das cirurgias nasossinusais e dos pacientes submetidos a elas no departamento de otorrinolaringologia e cirurgia de cabeça e pescoço de um hospital escola. Método: Foi realizado estudo de coorte histórico com corte transversal retrospectivo, com revisão de 872 prontuários de pacientes submetidos a cirurgias rinossinusais entre janeiro de 2006 e dezembro de 2008. Utilizado questionário próprio, buscando sexo, idade, diagnóstico cirúrgico e cirurgia realizada. Resultados: Do total de 872 pacientes analisados, 45,4% eram sexo feminino e 54,6% sexo masculino, variando em uma faixa etária 4 a 80 anos (média de 29,8 anos). Os principais diagnósticos cirúrgicos foram: desvio septo nasal(n=457), deformidade nasal pós-trauma (n=287), hipertrofia de conchas nasais (n=153), polipose rinossinusal(n=73), rinossinusite crônica(n=32). Entre os procedimentos cirúrgicos mais frequentemente realizadas, estão: septoplastia (n=388), rinosseptoplastia (n=215), FESS (n=131), cauterização intra-turbinal(n=114), rinoplastia reparadora(n=73), turbinectomia(n=43), turbinoplastia (n=55). Ressalta-se que os pacientes podem ter recebido mais de um diagnóstico cirúrgico e realizado mais de uma cirurgia, dependendo da indicação. Conclusão: Apresenta-se o volume e a diversidade de cirurgias rinossinusais realizadas em nosso serviço, contribuindo com a escassa produção científica sobre esse tipo de casuística...

Introduction: The ENT is a medical specialty that covers 4.4% of all doctors in São Paulo, with a variety of surgical procedures distributed between pharynx, nose, ear and larynx. Knowing the profile of a reference service in otolaryngology allows for a better organization, scaling the volume of care and surgeries, providing better training to the student and resident physician. Objective: To describe the profile of sinonasal surgery and patients to them in the department of otolaryngology and head and neck surgery at a teaching hospital. Method: We conducted a cohort study of cross-sectional retrospective study with review of 872 charts of patients undergoing surgery Sinus between January 2006 and December 2008. Used questionnaires, seeking sex, age, surgical diagnosis and surgery. Results: Of 872 patients studied, 45.4% were female and 54.6% male, ranging in an age group 40-80 years (mean 29.8 years). The main surgical diagnoses were: nasal septum deviation (n=457), nasal deformity after trauma (n=287), enlarged turbinates (n=153), rhinosinusal polyposis (n=73), chronic sinusitis (n=32). Among the most frequently performed surgical procedures include: septoplasty (n=388), rhinoplasty (n=215), FESS (n=131), intra-turbinal cauterization (n=114), reconstructive rhinoplasty (n=73), turbinectomy (n=43), turbinoplasty (n=55). It is emphasized that patients may have received more than one surgical diagnosis and realized more than one surgery, depending on the alert. Conclusion: We present the volume and diversity of Sinus surgeries performed in our department, contributing to the scarce scientific literature on this type of case...

Prevalence of Otolaryngologic Diseases in South Korea: Data from the Korea National Health and Nutrition Examination Survey 2008

OBJECTIVES: The aims of this study were to evaluate the prevalence of otolaryngologic diseases in Korea. METHODS: We obtained data from the 2008 Korea National Health and Nutrition Examination Surveys (KNHANES), which were cross-sectional surveys of the civilian, non-institutionalized population of South Korea (n=4,930). A field survey team that included an otolaryngologist, nurses, and interviewers moved with a mobile examination unit and performed otolaryngologic interviews and physical examinations. RESULTS: The prevalence of subjective hearing loss, tinnitus, preauricular fistua, tympanic membrane perforation, and cholesteatoma were 11.97%, 20.27%, 2.08%, 1.60%, and 1.18%, respectively. Dizziness and vestibular dysfunction were common among Korean adults, since 23.33% of the participants reported symptoms of dizziness or imbalance, and the prevalence of vestibular dysfunction was 3.86%. The prevalence of nasal diseases was relatively high, as the prevalence of allergic rhinitis, chronic rhinosinusitis, and a deviated nasal septum were 28.01%, 7.12%, and 42.94%, respectively. Subjective dysphonia was found in 6.60% of the participants, and the prevalence of subjective dysphonia increased with age. CONCLUSION: This is the first nation-wide epidemiologic study to assess the prevalence of otolaryngologic diseases by both the Korean Otolaryngologic Society and the Ministry of Health and Welfare. Considering the high prevalence of otolaryngologic diseases in Korea, the results call for additional studies to better prevent and manage otolaryngologic diseases.

Analysis of Acupoints for Treating Nasal Conditions in Acupuncture Verses / 针灸推拿医学（英文版）

Objective:To explore the rule of acupoints for treating nasal conditions in acupuncture verses.Method:The 20 acupuncture verses were selected to build a database,and data.were retrieved from the database with the key word of nose,and comprehensive analysis was done basing on the search results.Results:In acupuncture verses,there were 12 verses referring to treatment of nasal conditions,including 22 acupoints prescription,in which 8 were repeated,involving 12 acupoints and 5 meridians.The major diseases included nasal bleeding,nasal polypus,rhinorrhoea and nasal obstruction.Conclusion:The characteristics of treating nasal conditions in acupuncture verses included selecting acupoint along meridian,selecting acupoint from the local area and selecting acupoints from yang meridian.Shangxing(GV 23),Yingxiang(LI 20)and Hegu(LI 4)can be the basic acupoints for treating nasal conditions.