Tumor nasal de músculo liso de comportamiento maligno incierto: informe de un caso / Nasal smooth muscle tumor of uncertain malignant potential: A case report

Los tumores de músculo liso que no pueden ser clasificados según su histología como leiomiomas o leiomiosarcomas se denominan tumores de músculo liso de comportamiento maligno incierto. La localización nasal de estos tumores es muy infrecuente y la extensión adecuada de la cirugía para tratar estas neoplasias no está bien definida. Se describe el caso clínico de una adolescente de 16 años, que consultó por padecer un tumor de aspecto vascular en la cavidad nasal derecha y que fue tratada con éxito mediante cirugía intranasal. El diagnóstico histológico fue tumor de músculo liso de comportamiento maligno incierto. Por la rareza de estas neoplasias, su infrecuente localización nasal y la falta de evidencia que soporte cuál debe ser la extensión de la cirugía, es relevante la descripción y discusión del caso clínico.

Smooth muscle tumors that cannot be histologically classified as leiomyomas or leiomyosarcomas are defined as smooth muscle tumors of uncertain malignant potential. The location of these tumors in the nose is very rare, and the appropriate surgical extent to manage these neoplasms has not been adequately defined. Here we describe the case of a 16-year-old female adolescent who consulted due to a vascular-like tumor in the right nasal cavity who was successfully treated with intranasal surgery. The histological diagnosis was smooth muscle tumor of uncertain malignant potential. Given that these neoplasms are rare, the uncommon location in the nose, and the lack of evidence indicating the extent of surgery, it is relevant to describe and discuss this clinical case.

Rinosporidiosis humana de cavidad nasal en Argentina / Human rhinosporidiosis of the nasal cavity in Argentina

Resumen La rinosporidiosis es una enfermedad infecciosa causada por el patógeno protista acuático Rhinosporidium seeberi que habita en agua dulce de lagos o lagunas y el suelo. Es sumamente infrecuente, siendo endémica en India y Sri Lanka, aunque se han visto casos en países de Europa, África y Sudamérica. Predomina en jóvenes de sexo masculino y afecta tanto a humanos como animales. Se caracteriza por la formación de pólipos ro jizos uni o bilaterales, principalmente en cavidad nasal. Los síntomas de presentación en la vía aérea incluyen obstrucción, epistaxis, rinorrea y sensación de cuerpo extraño. Reportamos el caso de un varón de 22 años nativo de Argentina que se presentó a la consulta por insuficiencia ventilatoria nasal, rinorrea y epistaxis. La rinoscopía exhibió una formación polipoide que surgía del tabique septal y ocupaba toda la fosa nasal derecha. Microscópicamente el pólipo estaba revestido por epite lio de tipo respiratorio y pavimentoso y a nivel estromal evidenciaba proceso inflamatorio crónico granulomatoso con presencia de abundantes estructuras quísticas de pared gruesa de entre 100 y 500 μm (esporangios), que contenían en su interior abundantes endosporas. Las técnicas de ácido peryódico de Schiff y Grocott resalta ron dichas estructuras. Dado los antecedentes clínico-epidemiológicos y el cuadro morfológico se arribó al diagnóstico de rinosporidiosis.

Abstract Rhinosporidiosis is an infectious pathology caused by the aquatic protist pathogen Rhinosporidium seeberi that in habits the fresh water of lakes or lagoons and in the soil. It is extremely rare, being endemic in India and Sri Lanka, al though cases have been seen in countries in Europe, Africa and South America. It predominates in young males and affects both humans and animals. It is characterized by the formation of uni- or bilateral reddish polyps, mainly in the nasal cavity. Presenting airway symptoms include obstruc tion, epistaxis, rhinorrhea and foreign body sensation. We report the case of a 22-year-old man from Argentina who presented with nasal ventilatory insufficiency, rhinorrhea and epistaxis. Rhinoscopy revealed a polypoid formation arising from the septal septum and occupying the entire right nostril. Microscopically, the polyp was covered by respiratory and squamous epithelium, and at the stromal level it evidenced a granulomatous chronic inflammatory process with the presence of abundant thick-walled cystic structures between 100 and 500 μm (sporangia), which contained abundant endospores inside. The periodic acid Schiff and Grocott techniques highlighted these structures. Given the clinical-epidemiological background and the morphological picture, the diagnosis of rhinosporidiosis was reached.

Nasal chondrogenic tumors: Case reports of primary chondroma and recurrence of atypical cartilaginous tumor (chondrosarcoma grade I) with review of the Literature

Nasal chondromas and nasal atypical cartilaginous tumors (or chondrosarcoma grade 1) are very rare chondrogenic tumors. Approximately 150 cases of nasal chondroma and fewer than 50 cases of nasal atypical cartilaginous tumors have been described. We reported a case with nasal chondroma in the right ethmoid area and a case with a nasal atypical cartilaginous tumor of the anterior septum. No chondroma recurrence was noted for 17 years after endoscopic resection. Recurrence was noted for the nasal atypical cartilaginous tumor 36 months after wide surgical excision via midfacial degloving. Revision surgery was performed again via midfacial degloving. Recurrences of nasal chondroma and atypical cartilaginous tumors are extremely rare. The current data indicate adequate surgical excision, in some cases even radical, as the most important parameter to avoid recurrence. For inoperable recurrent cases of atypical cartilaginous tumors, observation may be followed.

A Systematic Literature Study of the Sinus Septi Nasi, Crista Galli and Other Minor Pneumatizations / Estudio Bibliográfico Sistemático del Seno Septi Nasi, Crista Galli y Otras Neumatizaciones Menores

SUMMARY: Variations in the paranasal sinuses and pneumatizations originating from these structures are clinically important for surgical procedures to be performed in the nose and nasal cavity regions. No systematic review examining the sinus septi nasi, crista galli and other minor pneumatizations was found in the literature review. This study aimed to review the papers in the literature including the sinus septi nasi, crista galli and other minor pneumatizations and standardize the mean incidence, distribution by sex, age and origin of these structures. Furthermore, it was aimed to examine the height, length, and width values of sinus septi nasi and crista galli pneumatizations, determine the measurement intervals and measurement values, and standardize them. The studies involving these pneumatizations were reviewed from various databases. After being evaluated according to the inclusion and exclusion criteria, 35 articles between the years 1991-2021 were reviewed. Based on the data obtained from these articles, we examined the incidence of sinus septi nasi, crista galli, and other minor pneumatizations. Middle nasal turbinate pneumatization had the highest incidence among all these pneumatizations. Uncinate process pneumatization had the lowest incidence. Considering the distribution by sex, no difference was found. Upon examining the age range, there were people aged between 1-95 years, and the mean age range was 33.05-41.48. The length, width and height values of crista galli and sinus septi nasi could not be standardized due to the insufficient number of studies and variable data in the literature. We believe that our study will contribute to similar future studies in larger populations with the clinical procedures to be performed in and around the nasal cavity.

Las variaciones en los senos paranasales y las neumatizaciones que se originan en estas estructuras son clínicamente importantes para los procedimientos quirúrgicos que se realizan en las regiones de la nariz y la cavidad nasal. En la revisión de la literatura no se encontró ninguna revisión sistemática que examinara el seno septi nasi, la crista galli y otras neumatizaciones menores. Este estudio tuvo como objetivo revisar los trabajos en la literatura que incluyen el seno septi nasi, la crista galli y otras neumatizaciones menores y estandarizar la incidencia media, la distribución por sexo, edad y origen de estas estructuras. Además, tuvo como objetivo examinar los valores de altura, longitud y ancho de las neumatizaciones del seno septi nasi y crista galli, determinar los intervalos de medición y los valores de medición, y estandarizarlos. Los estudios relacionados con estas neumatizaciones se revisaron a partir de varias bases de datos. Luego de ser evaluados según los criterios de inclusión y exclusión, se revisaron 35 artículos entre los años 1991-2021. Sobre la base de los datos obtenidos de estos artículos, examinamos la incidencia de septi nasi nasi, crista galli y otras neumatizaciones menores. La neumatización de la concha nasal media tuvo la mayor incidencia entre todas estas neumatizaciones. La neumatización del proceso uncinado tuvo la menor incidencia. Considerando la distribución por sexo, no se encontró diferencia. Al examinar el rango de edad, había personas con edades entre 1 y 95 años, y el rango de edad promedio fue de 33,05 a 41,48. Los valores de longitud, ancho y altura de crista galli y seno septi nasi no pudieron estandarizarse debido a la cantidad insuficiente de estudios y datos variables en la literatura. Creemos que nuestro estudio contribuirá a futuras investigaciones similares en poblaciones más grandes con los procedimientos clínicos que se realizarán en y alrededor de la cavidad nasal.

Asociación entre las variantes anatómicas del complejo osteomeatal y patología inflamatoria sinusal: estudio de casos y controles / Association between anatomical variants of the osteomeatal complex and inflammatory sinus pathology: case-control study

Introducción: las variantes anatómicas nasosinusales pueden ser una causa frecuente de infecciones crónicas, y resulta importante identificarlas en la práctica diaria. Objetivo: determinar la asociación entre las variantes anatómicas del complejo osteomeatal (COM) y el desarrollo de patologías inflamatorias nasosinusales. Materiales y métodos: estudio de casos y controles, muestra de 226 pacientes identificando las variantes anatómicas del COM en la tomografía computada (TAC) de senos paranasales (SPN) y su correlación clínica. Resultados: el 51,9 % presentaron hallazgos imagenológicos indicativos de patología inflamatoria nasosinusal y el 19,8 % reportaron sintomatología sugestiva de sinusitis en la historia clínica. Los SPN más afectados fueron: maxilares (46,9 %) y etmoidales (23 %). Las variantes anatómicas más frecuentes fueron las celdillas de Agger Nasi (50,2 %) y la desviación septal (46,2 %). Se encontró como variable estadísticamente significativa la inserción lateral de la apófisis unciforme (p = 0,015) más frecuente del lado izquierdo (p = 0.018, odds ratio [OR] = 4,078, intervalo de confianza [IC] 95 % = 1,3-12,6). Discusión: Se confirmó la incidencia de las variantes anatómicas más frecuentes en la literatura, sin embargo, no se correlacionan con los hallazgos clínicos para la serie de pacientes estudiada en comparación con otros estudios. Existe una alta relación entre la inserción lateral de apófisis unciforme y hallazgos de rinosinusitis escasamente documentados en la literatura médica. Conclusión: se requieren más estudios sobre modelos predictivos en muestras poblacionales mayores y protocolos de lectura TAC enfocados sobre diferentes variantes anatómicas de la apófisis unciforme.

Introduction: Sinonasal anatomical variants can be a frequent cause of chronic in- fections, so it is important to identify them in daily practice. Objective: To determine the association between the anatomical variants of the osteomeatal complex (OCM) and the development of sinonasal inflammatory pathologies. Materials and methods: Case-control study, a sample of 226 patients is analyzed identifying the anatomical variants of OCM in computed tomography of the paranasal sinuses and their clinical correlation. Results: 51.9% presented imaging findings indicative of sinonasal in- flammatory disease, 19.8% reported symptoms suggestive of sinusitis in the clinical history. The most affected paranasal sinuses were: maxillary (46.9%) and ethmoid (23%). The most frequent anatomical variants were Agger Nasi cells (50.2%) and septal deviation (46.2%). The lateral insertion of the uncinate process (p=0.015) was a statistically significant variable, more frequent on the left side (p=0.018, odds ratio [OR]=4.078, 95% confidence interval [CI]=1.3-12.6). Discussion: The incidence of the most frequent anatomical variants in the literature was confirmed, however not correlated with the clinical findings for the series of patients studied in comparison with other studies. There is a high relationship between the lateral insertion of the uncinate process and rhinosinusitis findings that are scarcely documented in the medical literature. Conclusion: More studies are required on predictive models in larger population samples and tomographic reading protocols focused on different anatomical variants of the uncinate process

Schwannoma in the nasal cavity: A benign nerve sheath tumor at an odd location

Schwannomas are neurogenic tumors arising from the Schwann cells present in the neural sheath of the myelinated nerves. These are benign tumors that can arise anywhere in the body. Schwannomas are rarely seen in the nose and paranasal sinuses representing <4% of all head-and-neck schwannomas. Surgical excision is the treatment of choice in these cases. Nasal polyps are common nasal cavity lesions which are usually inflammatory polyps. Schwannoma of the nasal cavity usually presented with headache, unilateral nasal obstruction due to mass obliterating the nasal cavity, and epistaxis. Here, we report the case of a 47-year-old female who presented with a mass in the left nasal cavity causing the nasal blockage.

Clinical characteristics of nasal respiratory epithelial adenomatoid hamartoma / 临床耳鼻咽喉头颈外科杂志

〓 Objectives: To analyze the pathological and clinical features of nasal respiratory epithelial adenomatoid hamartoma（REAH）, and summarize the diagnostic points, to improve the experience of diagnosis and treatment. Methods:The clinical data of 16 patients with REAH were analyzed retrospectively. The clinical manifestations, pathological features, imaging features, surgical treatment and prognosis were summarized. Results:16 cases of REAH were studied, 10 cases（62.50%） were associated with sinusitis, 1 case（6.25%） was associated with inverted papilloma, 1 case（6.25%） was associated with hemangioma. 5 cases（31.25%） had a history of nasal sinus surgery, including 1 case with 3 times of nasal sinus surgery, 1 case with 2 times of nasal sinus surgery, 3 cases with 1 time of nasal sinus surgery; 10 cases（62.50%） occurred in the bilateral olfactory cleft, 2 cases（12.50%） in the unilateral olfactory cleft, 3 cases（18.75%） in the unilateral middle turbinate, 1 case（6.25%） in the nasopharynx. All 16 patients were pathologically diagnosed as REAH. In the patients with lesions located in bilateral olfactory fissures, symmetrical widening of olfactory fissures and lateral displacement of middle turbinate were observed on preoperative sinus CT. The average width of bilateral olfactory fissures was （9.9±2.70） mm. The ratio of wide to narrow olfactory cleft was 1.21 ± 0.19. There was no significant difference in Lund-Mackay score between the two sides（P>0.05）. All patients underwent surgery under general anesthesia and nasal endoscopy. The follow-up period ranged from 1 to 66 months, and no recurrence occurred. Conclusion:Preoperative diagnosis of REAH is facilitated by the combination of clinical manifestations and endoscopic and imaging features. Endoscopic complete resection can achieve a good therapeutic effect.

Clinical and histopathological findings of a rare sinonasal glomangiopericytoma

ABSTRACT Glomangiopericytoma is a rare vascular neoplasm of the nasal cavity and paranasal sinuses that occurs during the sixth or seventh decade of life. It is categorized as a borderline tumor with low malignant potential and classified as a distinct entity of sinonasal tumors with perivascular myoid phenotype by the World Health Organization (WHO). We report the case of a 50-year-old woman with nasal obstruction and severe epistaxis. The nasal sinuses computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a 3.1 cm soft tissue mass occupying the upper part of the left nasal cavity invading the left paranasal sinuses and nasal septum, and the left eye medial rectus muscle. A total mass resection was performed by nasal endoscopy. The histological and immunohistochemical examination yielded the diagnosis of glomangiopericytoma. This case report aims to contribute to the knowledge of nasal neoplasms. The need for more data on this entity is the main obstacle to developing standardized treatment guidelines.

Influence des facteurs épidémio-cliniques dans le résultat fonctionnel de la septoplastie: étude de 250 cas / Epidemiological and clinical predictive factors of success in septoplasty: Study of 250 patients

to describe the epidemiological and clinical aspects, to evaluate the surgical result and to identify the prognostic factors for the success of septoplasty. Methods: It was a retrospective study including 250 patients operated on for a septoplasty collected over a 6-yearperiod. The evaluation of our results was made using 2 tools: NOSE scale and the visual satisfaction scale. Results: In our series, there was a male predominance with a sex ratio of 1.4. The mean age of the patients was 32.7 years. The medical history was dominated by allergic rhinitis in 38.4% of cases. Nasal trauma was noted in 45.2% of cases. A subjective quantification of respiratory discomfort by the NOSE score made it possible to divide them into 3 groups:Group 1: Severe ON: 65.2% of cases; Group 2: Moderate ON: 31.6% of cases; Group 3: Mild ON: 3.2% of cases. Our analytical study of the epidemiological and clinical factors that may influence the functional results showed that: Severe or moderate overall discomfort, severe ON (NOSE scale> 50) or moderate (NOSE scale between 26 and 50), DS classified zone I, II, III according to the Cottle classification, a quasi-obstructive deviation were considered as a predictor of the success of septoplasty. Conclusion: Several factors can influence the results of a septoplasty that must be considered before any surgical indication.

Clinical characteristics and factors influencing the prognosis of patients with mucosal melanoma / 肿瘤研究与临床

Objective:To investigate clinical characteristics and factors influencing the prognosis of patients with mucosal melanoma.Methods:The clinical data of 49 patients with mucosal melanoma in Fujian Cancer Hospital from March 2012 to March 2022 were retrospectively analyzed, and their clinical characteristics and prognostic influencing factors were observed. Kaplan‐Meier method was used for survival analysis and Cox proportional risk model was used to analyze the prognostic influencing factors.Results:Female accounted for 61.2% (30/49) of all 49 patients with mucosal melanoma and the median age was 56 years (42-79 years). The most frequent primary tumor sites occurred in head and neck (42.9%, 21/49), followed by the reproductive system (32.7%, 16/49). At the time of initial diagnosis, 81.6% (40/49) of patients had no distant metastasis and 79.6% (39/49) of patients had normal levels of peripheral blood lactate dehydrogenase. The median overall survival time of 49 patients with mucosal melanoma was 39.5 months (95% CI 23.1-55.9 months). The median overall survival time of patients without distant metastasis at the time of initial diagnosis was significantly longer than that of patients with distant metastasis [46.5 months (95% CI 31.6-61.4 months) vs. 19.2 months (95% CI 0-42.2 months, P = 0.025]. There were no statistically significant differences in median overall survival time of patients with different gender, age at the time of initial diagnosis, primary tumor site, and the level of lactate dehydrogenase in peripheral blood at the time of initial diagnosis (all P > 0.05). The presence of distant metastasis at the time of initial diagnosis was an independent risk factor for the prognosis of patients with mucosal melanoma ( HR = 0.379, 95% CI 0.157-0.918, P = 0.032). Conclusions:Mucosal melanoma is more common in female. The most frequent primary tumor sites occur in head and neck. At the time of initial diagnosis, most patients have non‐distant metastasis and the normal level of peripheral blood lactate dehydrogenase. At the time of initial diagnosis, whether there is distant metastasis is an independent influencing factor for the prognosis of patients with mucosal melanoma.

Efficacy of Yupingfeng granule combined with cetirizine in the treatment of allergic rhinitis and its effects on serum inflammatory factor level / 中国基层医药

Objective:To investigate the efficacy of Yupingfeng granule combined with cetirizine in the treatment of allergic rhinitis and its effects on serum inflammatory factor level. Methods:A total of 162 patients with allergic rhinitis admitted to Zhejiang Provincial Hospital of Chinese Medicine from January 2021 to March 2022 were included in this prospective controlled study. They were randomly divided into a control group and an observation group ( n = 81/group). The control group was treated with cetirizine and the observation group was treated with Yupingfeng granule combined with cetirizine. All patients were treated for 4 weeks. Clinical efficacy was compared between the two groups after 4 weeks of treatment. Main symptom score, nasal function indexes (total nasal airway resistance, nasal minimal cross-sectional area, and 0-5 cm nasal cavity volume), levels of inflammatory factors (interleukin-4, interleukin-6, and interleukin-10), and Rhinoconjunctivitis Quality of Life Questionnaire scores were compared between the two groups before and after 4 weeks of treatment. Results:Total response rate in the observation group was significantly higher than that in the control group [92.59% (75/81) vs. 79.01% (64/81), χ2 = 6.13, P < 0.05]. After 4 weeks of treatment, the scores of nasal congestion, nasal itching, and sneezing in the observation group were (0.63 ± 0.20) points, (0.70 ± 0.21) points, and (0.54 ± 0.17) points, which were significantly lower than (1.07 ± 0.23) points, (1.08 ± 0.24) points, and (0.89 ± 0.22) points in the control group ( t = 12.99, 10.72, 11.33, all P < 0.05). After 4 weeks of treatment, total nasal airway resistance in the observation group was significantly lower than that in the control group [(0.17 ± 0.05) kPa·s -1·L -1vs. (0.26 ± 0.06) kPa·s -1·L -1, t = 10.37, P < 0.05]. Nasal minimal cross-sectional area and 0-5 cm nasal cavity volume in the observation group were (0.94 ± 0.17) cm 2 and (9.74 ± 0.89) cm 3, respectively, which were significantly higher than (0.76 ± 0.10) cm 2 and (8.43 ± 0.78) cm 3 in the control group ( t = 8.21, 9.96, both P < 0.05). After 4 weeks of treatment, serum levels of interleukin-4 and interleukin-6 in the observation group were (67.79 ± 9.94) ng/L and (6.74 ± 1.42) ng/L, respectively, which were significantly lower than (104.31 ± 14.45) ng/L and (10.29 ± 2.56) ng/L in the control group ( t = 18.74, 10.91, both P < 0.05). Serum level of interleukin-10 in the observation group was significantly higher than that in the control group [(17.97 ± 2.54) ng/L vs. (12.48 ± 2.46) ng/L, t = 13.97, P < 0.05]. After 4 weeks of treatment, Rhinoconjunctivitis Quality of Life Questionnaire score in the observation group was significantly lower than that in the control group [(27.43 ± 8.82) points vs. (38.95 ± 7.76) points, t = 8.82, P < 0.05). Conclusion:Yupingfeng granule combined with cetirizine is highly effective on allergic rhinitis. The combined therapy can reduce clinical symptoms and inflammatory reactions, improve nasal function, and thereby improve quality of life.

Efecto de la expansión ósea maxilar en la vía aérea nasofaríngea: Una revisión bibliográfica / Effect of the maxillary bone expansion on the nasopharyngeal airway. A bibliographic review

Introducción: Uno de los tratamientos indicados para la deficiencia maxilar transversal es la expansión maxilar rápida (REM). El presente artículo trata sobre la terapia REM y muestra, a partir de una revisión bibliográfica, los diversos beneficios que esta puede brindar al paciente y los cambios que puede generar en su anatomía. Objetivos: Abordar el efecto de la terapia REM sobre la vía aérea nasofaríngea. También describir, en base a evidencia científica, los cambios que produce en la morfología y resistencia sobre la vía aérea faríngea. Esto mediante distintos métodos de estudios disponibles actualmente. Materiales y métodos: Se realizó una búsqueda bibliográfica en las bases de datos: PubMed, Clinicalkey y Epistemonikos. Se seleccionaron trabajos publicados en los últimos 8 años en adelante. De un universo total de 77 publicaciones, fueron seleccionados 12 estudios para esta revisión. Se excluyeron estudios en los cuales se realizaban acciones clínicas que escapan al tratamiento ortopédico. También se excluyeron tratamientos realizados para mejorar la vía aérea, basados en el tratamiento ortopédico del crecimiento mandibular. Resultados: En los estudios realizados mediante radiografías cefalométricas se obtuvo un aumento significativo (p <0.05) en el espacio de la vía aérea nasofaríngea, en particular en las medidas AD2 y AD-PtV, después del tratamiento ortodóncico. Por otro lado, AD1 también aumentó, pero no significativamente (p> 0.05). Conclusión: La terapia REM, en pacientes en crecimiento, logra separar la sutura palatina media aumentando el tamaño del piso de las fosas nasales y el volumen en el territorio nasofaríngeo. Se necesitan estudios con un tamaño de muestra mayor y un seguimiento a largo plazo para establecer el éxito de esta terapia.

Introduction: One of the treatments indicated for transverse maxillary deficiency is rapid maxillary expansion (REM). This article deals with REM therapy and shows, based on a bibliographic review, the various benefits that it can generate for the patient and the changes in their anatomy. Objectives: To elucidate the effect of REM therapy on the nasopharyngeal airway. Also expose, based on scientific evidence, the changes that it produces in the morphology and resistance on the pharyngeal airway. This through different study methods currently available. Materials and methods: A bibliographic search was carried out in the databases: PubMed, Clinicalkey and Epistemonikos. From a total universe of 77 publications, 12 studies were selected for this review. Results: In the studies carried out using cephalometric radiographs, a significant increase (p < 0.05) in the nasopharyngeal airway space was obtained, particularly in the AD2 and AD-PtV measurements, after orthodontic treatment. On the other hand, AD1 also increased, but not significantly (p > 0.05). Conclusion: REM therapy, in growing patients, manages to separate the middle palatal suture by increasing the size of the floor of the nostrils and the volume in the nasopharyngeal territory. Studies with a larger sample size and long-term follow-up are needed to establish the success of this therapy.

Angiosarcoma de cavidad nasal: reporte de caso y revisión de literatura

Los tumores malignos de cavidad nasal y cavidades paranasales son poco frecuentes y sus síntomas de presentación suelen ser unilaterales e inespecíficos; éstos incluyen: epistaxis, rinorrea y obstrucción nasal. Encontramos una amplia variedad histológica de tumores, entre ellos tenemos el angiosarcoma nasal, que es considerado una rareza y el diagnóstico definitivo lo da la confirmación anatomopatológica complementado con estudios inmunohistoquímicos. Su modalidad de tratamiento incluye múltiples opciones, pero la cirugía radical temprana con márgenes negativos asociado a radioterapia adyuvante, ofrece el mejor pronóstico. Se presenta a un paciente adulto masculino con un angiosarcoma nasal izquierdo que fue detectado de forma precoz y se manejó con cirugía radical y radioterapia.

Malignant tumors of the nasal cavity and paranasal cavities are rare, while presenting symptoms are usually unilateral and nonspecific like, epistaxis, rhinorrhea, and nasal obstruction. There are many histological varieties of tumors, among them we have nasal angiosarcoma, which is considered a rarity pathology. The definitive diagnosis is given by biopsy confirmation complemented with immunohistochemical studies. Its treatment modality includes multiple options, but early radical surgery with negative margins associated with adjuvant radiotherapy offers the best prognosis. We present a male adult patient with a left nasal angiosarcoma that was detected early and managed with radical surgery and radiotherapy.

Leech infestation: Our experience at Government Medical College, Rajouri

Leech invasion into a bodily cavity or orifice is known as hirudiniasis. This article’s objective is to explain an uncommon cause of epistaxis brought on by a leech infestation in the nasal cavity, nasopharynx, or oropharynx in the hilly Rajouri district of Jammu and Kashmir, as well as how to manage it. This retrospective case series consisted of seven cases. All the cases present with unilateral epistaxis. Anterior rhinoscopy with or without endoscope reveal smooth, grayish-black mobile leech inside nasal cavity, nasopharynx, or oropharynx which was removed by suction or forcep.

The efficacy of function?preservation in treating paranasal sinus and nasal cavity neoplasms

Background: Craniofacial resection (CFR) has been regarded as the gold standard for paranasal sinus and nasal cavity (PNSNC) neoplasms. The improvement of surgical procedures has been ongoing in recent years. We analyzed the clinical curative effects of the function-preservation therapy that was mainly using nasal endoscopic surgery along with appropriate radiotherapy and chemotherapy as applicable. Methods: We performed a retrospective analysis of factors that influence the survival time of the 28 patients with PNSNC neoplasms who underwent nasal endoscopic surgery. All patients with tumor lesions underwent a complete resection in en bloc or piecemeal resection. Five cases did not undergo radiotherapy or chemotherapy; the remaining 23 patients had multimodality therapy. Results: The median follow-up time was 41.5 (range = 14–97) months. The overall 3-year survival rate was 78.57% for T3 cancer and 50% for those with T4. T classification (P = 0.031) and multimodality therapy (P = 0.038) were independent prognostic factors for postoperative 3-year survival rate of patients with PNSNC neoplasms. Conclusion: Function-preservation therapy based on the minimally invasive endoscopic resection (MIER) with appropriate adjuvant therapy not only prolonged the overall survival time but also provided an opportunity to preserve organ function at the same time, which helped to improve the patients’ quality of life

Anatomical Variations of the Sinonasal Area and Their Clinical Impact on Sinus Pathology: A Systematic Review

Abstract Introduction Anatomical variations of the nasal cavity and of the paranasal sinuses are frequently encountered and play an important role in dysfunctional drainage of sinuses. However, it is not clear in the literature whether they predispose to sinus pathology. Objectives The aim of the present review is to summarize the understanding of the association between anatomical variations of the sinonasal area and sinus pathology. Data Synthesis The present review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performedathorough research on PubMed from October2004 until May 2020 byusing the search terms paranasal sinus anatomical variations and sinus disease, sinusitis, and mucosal disease. Thirty studies were eligible and were included in the analysis. Overall, the studies encompassed a total of 6,999 patients included in the present review. In many studies, it has been statistically established that certain anatomical variations increase the risk of sinus disease. On the other hand, the rest of the collected studies failed to show any statistically significant correlation between anatomical variants and sinus pathology. Conclusion The present study highlights the possible correlation between some anatomical variations of the sinonasal area and pathologies of the paranasal sinuses. Careful assessment and computed tomography (CT) in patients with chronic rhinosinusitis is needed, especially in those undergoing endoscopic surgery, to identify and treat anatomical variations in the paranasal sinuses that may be correlated with rhinosinusitis. Due to contradictory results in the literature, further research is needed to elucidate the effects of anatomical variants of the sinonasal area.

Sarcoma de Ewing extraesquelético en cavidad nasal y senos paranasales, reporte de caso / Extra-skeletal Ewing sarcoma in the nasal cavity and paranasal sinus, case report

El sarcoma de ewing es un tumor maligno de rápido crecimiento, con prevalencia de 1-5 casos por cada 1.000.000 habitantes, su forma extraesquelética en la cavidad sinonasal o senos paranasales es inusual. Objetivo: describir la localización atípica de esta neoplasia y la importancia de lograr un diagnóstico oportuno. Paciente femenina, con una masa en la cavidad nasal derecha de dos meses de evolución, cefalea y epistaxis. Con asimetría en región orbitaria derecha y deformidad del tabique nasal, senos paranasales con sintomas de obstrucción. La tomografía reveló una masa que invade senos paranasales. La biopsia mostró un sarcoma de Ewing. Se confirmó con CD99. La paciente recibió quimioterapia y plan de resección quirúrgica, pero falleció. El diagnóstico y tratamiento oportuno del sarcoma de ewing en cavidad sinonasal debe apoyarse con examenes tomográficos, histopatológicos, inmunohistoquímicos y de ser posible citogenéticos para llegar al diagnóstico definitivo en etapas tempranas del tumor

Ewing's sarcoma is a rapidly growing malignant tumor, with a prevalence of 1-5 cases per 1,000,000 inhabitants, its extraskeletal shape in the sinonasal cavity or paranasal sinuses is unusual. Objective: to describe the atypical location of this neoplasm and the importance of achieving a timely diagnosis. Female patient, with a mass in the right nasal cavity of two months of evolution, headache and epistaxis. With asymmetry in the right orbital region and deformity of the nasal septum, paranasal sinuses with symptoms of obstruction. Tomography revealed a mass that invades the paranasal sinuses. The biopsy showed Ewing's sarcoma. It was confirmed with CD99. The patient received chemotherapy and a surgical resection plan, however she died. The timely diagnosis and treatment of Ewing's sarcoma in the sinonasal cavity should not be based solely on clinical evaluation, it requires a tomographic, histopathological, immunohistochemical and, if possible, cytogenetic examination to reach a definitive diagnosis in the early stages of the tumor.

How obesity affects nasal function in obstructive sleep apnea: anatomic and volumetric parameters / Como a obesidade afeta a função nasal na apneia obstrutiva do sono: parâmetros anatômicos e volumétricos,

Abstract Introduction Obstructive sleep apnea is a consequence of upper airway collapse. Any obstructive sector in the upper airway can contribute to pharyngeal collapse. Obesity and obesity-related disorders play an important role in obstructive sleep apnea and its relationship with increased upper airway resistance. Objective This study was designed to evaluate the relationship between obesity and properties of the nasal cavity in patients with obstructive sleep apnea. Methods The study was conducted retrospectively by review of medical records of adult patients. The nasal obstruction symptom evaluation, NOSE instrument, was used to measure nasal obstruction. Sleep breathing disorders were evaluated by polysomnography exams. Nasal volume was obtained by computed tomography scans and volumetric reconstruction of nasal airway. Nasal anatomic alterations were assessed by nasal endoscopy. Results Analysis of 83 patient records, among whom 54 were male and 29 females, found the mean body mass index of 28.69 kg/m2. Obese and non-obese groups were determined by using cut-off 30 kg/m2. In the comparison between groups, the obese group had a positive and significant correlation with apnea/hypopnea index (p= 0.02), NOSE instrument (p= 0.033) and inferior turbinate hypertrophy (p= 0.036), with odds ratio 1.983 (95% IC 1.048 − 3.753). nasal septum deviation (p= 0.126) and nasal airway volume evaluation (p= 0.177) showed no significant results. Conclusion Obesity was significantly correlated with subjective nasal obstruction, NOSE scale, and inferior turbinate hypertrophy in patients with obstructive sleep apnea. There was no correlation with the nasal volume evaluation. Level of Evidence 3b - Individual case-control study.

Resumo Introdução A apneia obstrutiva do sono é consequência do colapso das vias aéreas superiores Qualquer região de obstrução nas vias aéreas superiores pode contribuir para o colapso da faringe. A obesidade e os distúrbios relacionados à obesidade desempenham um papel importante na apneia obstrutiva do sono e sua relação com o aumento da resistência das vias aéreas superiores. Objetivo Avaliar a relação entre a obesidade e as propriedades da cavidade nasal em pacientes com apneia obstrutiva do sono. Método O estudo foi feito retrospectivamente através da revisão de prontuários médicos de pacientes adultos. O instrumento de avaliação NOSE, do inglês nasal obstruction symptom evaluation, foi usado para avaliar a obstrução nasal. Os distúrbios respiratórios do sono foram avaliados através de exames polissonográficos. O volume nasal foi obtido por tomografia computadorizada e a reconstrução volumétrica das vias aéreas nasais. As alterações anatômicas nasais foram avaliadas por endoscopia nasal. Resultados A análise dos prontuários de 83 pacientes, entre os quais 54 eram do sexo masculino e 29 do feminino, encontrou um índice de massa corporal médio de 28,69 kg/m2. Os grupos obeso e não obeso foram determinados com o ponto de corte de 30 kg/m2. Na comparação entre os grupos, o grupo obeso apresentou correlação positiva e significante com o índice de apneia/hipopneia (p = 0,02), instrumento NOSE (p = 0,033) e hipertrofia da concha inferior (p = 0,036), com uma odds ratio de 1,983 (IC95%: 1,048 a 3,753). A avaliação do desvio do septo nasal (p = 0,126) e do volume das vias aéreas nasais (p = 0,177) não mostrou resultados significantes. Conclusão A obesidade correlacionou-se significantemente com a obstrução nasal subjetiva pela escala NOSE e hipertrofia de concha inferior em pacientes com apneia obstrutiva do sono. Não houve correlação com a avaliação do volume nasal. Nível de evidência 3b. Estudo de caso-controle individual.

Correlation and comparative evaluation of nasal index and nasal cavity volume in nasal and mouth breathers A preliminary cone-beam computed tomographic study

Introduction: Mouth breathing is one of the most deleterious oral habits with a prevalence of 4%–6% among children. Due to the wide range of comorbidities associated with mouth breathing, early diagnosis and prompt treatment is indispensable. At present, there are very few objective methods available for the diagnosis of mouth breathing. The present study was planned to evaluate a possible correlation between nasal index (NI) and nasal cavity volume (NCV) among nasal and mouth breathers (MB). In addition, the average NCV of nasal and MB was also computed. The foresight of this research was to establish the significance of NI as an objective diagnostic tool for mouth breathing. Methods: This cross-sectional study was conducted among 8–11-year-old children. The NI was determined using a digital Vernier caliper and NCV was calculated using dolphin imagingsoftware. Results: There was a significant difference in NCV and nasal width (NW) in both groups, but no difference was seen in nasal height and NI. There was no statistically significant correlation between NCV and other parameters in both groups. Conclusion: The present study was a baseline analysis in this line. Even though this study did not reveal any significant correlation between both parameters, future studies are recommended to explore a plausible correlation.

Larva de Attagenus na cavidade nasal em um paciente com complicações após o uso de preenchimento de ácido hialurônico / Attagenus larva in the sinus cavity in a patient with complications after the use of hyaluronic acid filler

Uma ampla variedade de preenchimentos dérmicos está agora disponível para uso na indústria da beleza. Apresentamos o caso de uma mulher de 33 anos com complicações após injeção de ácido hialurônico por um não médico. Duas semanas após a injeção, dor nos seios da face bilateral, febre e sensação de queimação ocorreram na área da bochecha. Ela foi submetida a um diagnóstico detalhado revelando larva de Attagenus nos seios paranasais. Apesar do tratamento, os sintomas continuaram presentes, sendo administrada hialuronidase na região infraorbital com remissão completa

A wide range of dermal fillers is now available for use in the beauty industry. We present a case of a 33-year-old woman with complications after hyaluronic acid injection by a non-medical practitioner. Two weeks after the injection, bilateral sinus pain, fever, and burning sensation occurred in the cheek area. She underwent a detailed diagnosis revealing Attagenus larva in the paranasal sinus. Despite treatment, the symptoms remained. Thus, hyaluronidase was administered in the infraorbital area, obtaining a full remission.