Giant Rhinolith- An Unusual Entity: A Case Report

Rhinolith is defined as a mineralized mass resulting from calcification of an endogenous or exogenous nidus within the nasal cavity. A case of a 25 year old female with a history of unilateral nasal stuffiness and nasal bleed, which was clinically and radiologically diagnosed as rhinolith, is being reported here.

Atresia de coana unilateral: o uso de molde na cirurgia da reestenose / Unilateral choanal atresia: the use of cast in surgery for restenosis

Introdução: A atresia de coana (AC) é a anomalia nasal congênita mais comum. Estima-se a incidência de 1 caso para cada 8000-10000 nascidos vivos. Relato do caso: Paciente feminina, 9 anos, com obstrução nasal em fossa nasal direita (FND) desde o nascimento. Apresentava roncos e apneia em vigência de infecção de via aérea superior. À rinoscopia anterior direita, secreção hialina abundante. À videonasoendoscopia flexível não foi possível visualizar cavum pela FND, observando-se estase de secreção em região posterior; à esquerda cavum livre, sem lesão expansiva. Tomografia de nariz e seios paranasais evidenciou atresia de coana mista à direita. Foi realizada cirurgia para correção da malformação. Após 30 dias, observou-se reestenose do cavum. Na reintervenção, a coana foi ampliada com remoção do osso palatino e do septo posterior, realizada dilatação com balão e posicionado molde de silicone. Realizada aplicação de Mitomicina. A remoção do molde foi feita em bloco cirúrgico após 42 dias, com permeabilidade coanal preservada. Nasofibroendoscopia após 6 meses mostrou fossas nasais pérvias. Discussão: Ainda há controvérsias na literatura quanto à efetividade das diferentes técnicas cirúrgicas e ao uso de stents e de agentes antineoplásicos no pós-operatório. Neste relato, a dilatação com balão pode ter contribuído para o sucesso da cirurgia, porém o molde foi fundamental para evitar a reestenose. Considerações finais: O uso do molde mostrou um excelente resultado nesta reintervenção de correção de atresia de coana. A baixa reação inflamatória e o sucesso do pós-operatório mostraram que esta é uma opção a ser utilizada para evitar a reestenose (AU)

Introduction: Choanal atresia (CA) is the most common congenital nasal anomaly. Its incidence is estimated as 1 case for every 8,000-10,000 live births. Case report: Female patient, 9 years old, with obstruction in the right nasal cavity (RNC) since birth. She presented snoring and apnea in the presence of upper airway infection. At right anterior rhinoscopy, abundant hyaline secretion. Flexible videonasoendoscopy failed to visualize cavum through RNC, with secretion stasis in posterior region; left cavum free, without expansive lesion. Tomography of the nose and paranasal sinuses revealed mixed choanal atresia on the right. Surgery was performed to correct the malformation. Thirty days later, restenosis of the cavum was observed. At reoperation the choana was enlarged with removal of the palatine bone and posterior septum, balloon dilatation was performed and a silicone cast was positioned. Mitomycin application was performed. Removal of the cast was done in surgical ward after 42 days, with preserved choanal permeability. Nasofibroscopy at 6 months postoperatively showed permeable nasal cavities. Discussion: There is still controversy in the literature regarding the effectiveness of different surgical techniques and the use of stents and anti-neoplastic agents in the postoperative period. In this report, balloon dilatation may have contributed to the success of the surgery, but the cast was crucial to avoid restenosis. Final considerations: The use of the cast had an excellent outcome in this re-intervention of choanal atresia correction. The low inflammatory reaction and postoperative success have shown that this is an effective option to be used to avoid restenosis (AU)

Papiloma nasal invertido. Presentación de un caso / Inverted nasal papilloma. Presentation of a case

El papiloma invertido es un tumor infrecuente que ha recibido múltiples interpretaciones histológicas. Es localizado, agresivo, recidivante y potencialmente maligno. De etiología oscura, aún cuando la teoría por virus papiloma humano es la más firmemente aceptada; microscópicamente tiene la característica de invaginarse en el corion, respetando la membrana basal. Este tumor se maligniza, generalmente, por esta causa se comporta con una gran agresividad provocando una gran destrucción por desplazamiento de las estructuras. Se presentó un caso de papiloma invertido en estadio 2, según la clasificación de Krause, analizando las manifestaciones clínicas y hallazgos radiológicos. El síntoma más frecuente es la obstrucción nasal unilateral. El método diagnóstico en este caso se basó en la tomografía axial computarizada de senos perinatales y en la biopsia, las cuales permitió conocer la extensión del tumor y su naturaleza. Se programó la intervención y se realizó una rinotomía lateral con exéresis total del tumor. La modalidad de tratamiento dependerá de la localización y extensión de la enfermedad, aunque el tratamiento quirúrgico radical es el factor más importante en la prevención de la invasión intracraneal.

The inverted nasal papilloma is an infrequent tumor that has several histological interpretations. It is localized, aggressive, recidivist and potentially malignant. Its etiology is not clear, although the most accepted theory is the one of being caused by the human papilloma virus; microscopically it has the characteristic of invaginating the corium without affecting the basal membrane. This tumor becomes malignant in general, and for this cause it behaves with a great aggressiveness, causing a great destruction by structure displacement. We present a case of an inverted papilloma in stage 2, according to Krauss classification, analyzing the clinical manifestations and radiologic findings. The most frequent symptom is the unilateral nasal obstruction. The diagnostic method in this case was based on the computerized axial tomography of the perinasal sinuses and the biopsy, allowing knowing the tumor extension and nature. We programmed the surgical intervention and carried out the lateral rhinotomy with the total tumor extirpation. The treatment modality will depend on the disease location and extension, though the radical surgical treatment is the most important factor to prevent the intracranial invasion.

Obstrucción nasal unilateral en niños: Síndrome de Pai / Unilateral nasal obstruction in children: Pai syndrome

La obstrucción unilateral de las fosas nasales en niños es causada principalmente por la introducción de cuerpos extraños, se manifiesta con rinorrea y olor fétido. Con menor frecuencia, puede ser de origen traumático, neoplásico, malformativo congénito o iatrogénico. Los síntomas de una masa intranasal congénita pueden manifestarse desde el nacimiento, o pasar desapercibidos y ser un hallazgo en un examen pediátrico de rutina. La evaluación del paciente debe incluir estudios por imágenes para orientar al diagnóstico y descartar una extensión intracraneal. Un síndrome asociado al tumor nasal congénito debe sospecharse cuando existen otras anomalías. El síndrome de Pai es un trastorno genético raro. Sus manifestaciones son craneofaciales y su marcador principal es el pólipo nasal congénito. Presentamos un paciente con insuficiencia ventilatoria nasal unilateral secundaria a un lipoma nasal congénito, junto a anomalías craneofaciales del síndrome de Pai. La obstrucción nasal fue resuelta quirúrgicamente en forma exitosa.

Unilateral obstruction of the nasal cavity in children is mainly caused by the introduction of foreign bodies further stated with rhinorrhea and fetid odor. Less commonly, it can be traumatic, neoplastic, due to congenital malformation or iatrogenic. Symptoms of congenital intranasal mass may present at birth, or go unnoticed and be a finding in a routine pediatric examination. Patient evaluation should include imaging studies to guide the diagnosis and rule out intracranial extension. A syndrome associated with congenital nasal tumor should be suspected when other abnormalities are present. Pai syndrome is a rare genetic disorder. Its manifestations are craniofacial being congenital nasal polyp his main marker. We present a patient with unilateral nasal respiratory failure secondary to congenital nasal lipoma, with craniofacial anomalies belonging to Pai syndrome. Nasal obstruction was successfully surgically resolved.