Cefalea rinogénica causada por mucopiocele en concha bullosa, un origen infrecuente. Reporte de caso / Rhinogenic headache caused by concha bullosa mucopyocele, an unusual origin. Case Report

Introducción: la cefalea rinogénica es secundaria al contacto permanente de la mucosa nasal y puede ser secundario a concha bullosa, si se infecta puede ser mucocele o mucopiocele. Caso clínico: paciente de 34 años con cefalea hemicraneal izquierda, dolor periocular ipsilateral, congestión y rinorrea hialina con cambios en consistencia y coloración del moco. En la tomografía computarizada (TAC) de senos paranasales (SPN) desviación septal derecha por concha bullosa izquierda, ocupación de líquido. Se sospecho mucocele y cefalea rinogénica secundaria, prueba de lidocaína positiva. Se detecto por cultivo, Eikenella corrodens. Manejo con antibiótico y posterior resolución de patología. Conclusiones: debe incluirse en el diagnóstico diferencial de cefalea y concha bullosa, realizarse endoscopia nasal y TAC de SPN. El manejo quirúrgico ha demostrado reducir la intensidad y la frecuencia de la cefalea a corto y largo plazo, y es exitoso si hay test de lidocaína positivo.

Introduction: rhinogenic headache is secondary to permanent contact with the nasal mucosa and may be secondary to concha bullosa, if infected it may be mucocele or mucopiocele. Clinical case: 34-year-old patient with left hemicranial headache, ipsilateral periocular pain, congestion, and hyaline rhinorrhea with changes in consistency and coloration of the mucus. In the computed tomography (CT) of the paranasal sinuses (SPN) right septal deviation due to left concha bullosa, fluid occupation. Mucocele and secondary rhinogenic headache were suspected, lidocaine test positive. Eikenella corrodens was detected by culture. Management with antibiotics and subsequent resolution of pathology. Conclusions: nasal endoscopy and SPN CT should be included in the differential diagnosis of headache and concha bullosa. Surgical management has been shown to reduce headache intensity and frequency in the short and long term, and is successful if there is a positive lidocaine test.

The effect of early radiofrequency turbinate reduction, intranasal steroid, and antihistamine H-1 on persistent allergic rhinitis: a randomized clinical trial

Abstract Objective: We aimed to evaluate the effect of radiofrequency turbinate reduction as an initial treatment on clinical improvement, inflammatory mediators, and remodeling process. Methods: Between July 2018- February 2020, 32 patients with moderate-severe persistent AR were randomly divided into 2 groups. Intervention group received radiofrequency turbinate reduction followed by intranasal steroid and Antihistamine H-1 (AH-1), control group received intranasal steroid and AH-1. Both groups were evaluated for clinical improvement (using visual analogue scale based on total nasal symptoms score, peak nasal inspiratory flow, and turbinate size using imageJ) after 4 and 8 weeks of treatment. Inflammatory mediators (ELISA from nasal secretions was performed to measure ECP, IL-5, and HSP-70) and remodeling markers (nasal biopsy followed by immunohistochemistry examination was performed to evaluate MMP-9, TIMP-1, and PAI-1) were evaluated in week 4. Results: Three patients dropped out of the study, resulting in 16 patients in intervention group and 13 patients in control group. At week 4, clinical response improved significantly in the intervention group compared to control group (Chi-Square test, p<0.05). Compared to control, intervention group experienced a reduction of IL-5 and no significant change in ECP level (Mann Whitney test, p>0.05). Reduction in the ratio of MMP-9/TIMP-1 were significantly higher in intervention group (unpaired t-test, p< 0,05). Meanwhile, increase in HSP-70 in the intervention group was slightly lower than in control group, but the difference with control group was not significant (Mann Whitney test, p>0.05). Conclusion: Early radiofrequency turbinate reduction followed by pharmacotherapy given to persistent moderate-severe AR patients give more improvement only in early clinical symptoms and reduce MMP-9/TIMP-1 ratio, thus it might be suggested as one of the adjuvant therapies for the management of moderate-severe persistent AR. However, further investigation with a larger sample size and longer follow-up period is needed. Level of evidence: 1B.

Surgical treatment of vidianneurectomy and selective vidianneurectomy in 60 cases of refractory allergic rhinitis / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the effect of vidian neurectomy and selective vidian neurectomy in the treatment of moderate and severe persistent allergic rhinitis (AR). Methods: A total of 60 patients with moderate-to-severe persistent AR treated in Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine from June 2018 to June 2020 were selected, including 28 males and 32 females. A total of 40 cases in the observation group were subjected to vidianneurectomy, while, 20 cases in the control group underwent selective vidianneurectomy. Patients in the two groups were followed up at 6 months, 1 year, and 2 years, respectively, and evaluated according to AR diagnostic and efficacy assessment criteria. Four symptoms of sneezing, clear runny nose, nasal congestion, and nasal itching were scored as efficacy indices before and at 6 months, 1 year, and 2 years after surgery. The regression of the lower turbinate swelling after surgery was assessed by nasal endoscopy or sinus CT. Postoperative tear secretion was followed up in both groups, and patients with dry eyes were counted in combination with ocular symptoms. SPSS 19.0 software was used to statistically analyze the data before and after the surgery and between the two groups. Results: The preoperative, 6-month, 1-year, and 2-year postoperative inferior turbinate signs were (2.73±0.45), (1.20±0.41), (1.25±0.49) and (1.30±0.56) points in the observation group and (2.75±0.44), (1.45±0.69), (1.75±0.72) and (1.90±0.85) points in the control group, respectively, with a statistically significant difference in the between-subjects effect test between the two groups (F=8.28, P<0.05), indicating a more durable surgical effect in the observation group. The total effective rate at 2 years after surgery was 95.0% (38/40) in the observation group and 50% (10/20) in the control group. The difference between the two groups by Fisher's exact test was statistically significant. No dry eye patient was found in either group at a 1.5-year postoperative follow-up. Conclusion: Both vidianneurectomy and selective vidianneurectomy have good recent treatment effects, vidianneurectomy has better long-term curative effects than selective vidianneurectomy.

Clinical analysis of the treatment of maxillary odontogenic cyst by nasal endoscope fenestration through nasal base / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the feasibility and clinical effect of the surgical approach and method of transnasal fenestration under nasal endoscope for the treatment of maxillary odontogenic cyst. Methods:The clinical data of 23 cases with maxillary odontogenic cysts treated by nasal endoscopy through nasal fenestration were retrospectively analyzed. All cases underwent nasal endoscopy and CT examination before the operation. The mucosal membrane of the parietal wall of the cyst was excised through fenestration of the nasal base. The cyst fluid was removed by decompression, and the bony opening of the nasal base was trimmed and enlarged to the edge of the cyst. The intraoperative and postoperative effects were observed. Results:All cases were well exposed under the direct vision of nasal endoscope. The top wall of the cyst was removed to maximize the communication between the cyst cavity and the nasal floor. There were no complications such as nasolacrimal duct injury, turbinate atrophy, necrosis, and facial numbness. All patients were followed up for 6-12 months, and the clinical symptoms gradually disappeared after surgery. The inferior turbinate was in good shape, the cyst cavity was smooth, the cyst wall was determined, and no cyst recurrence was observed. Conclusion:The treatment of odontogenic cyst of maxilla under nasal endoscope through nasal fenestration is convenient. It has less trauma, fewer complications and a satisfactory curative effect, which is worthy of clinical promotion.

Incidental finding of bullous concha by cone beam computed tomography / Hallazgo incidental de concha bullosa por tomografía computarizada de haz cónico

Abstract This study aimed to describe the imaging aspects of a concha bullosa discovered incidentally by means of cone-beam computed tomography (CBCT) imaging. A female patient underwent a CBCT exam, and a bilateral extensive pneumatization of the middle concha was verified, presenting a larger dimension of the right side and a deviated septum. The patient reported nasal obstruction and loss of smell. The CBCT for covering the maxillofacial region allowed the discovery of this incidental finding, allowing the patient to be referred for appropriate treatment.

Resumen Este estudio tuvo como objetivo describir los aspectos imaginológicos de una concha bullosa hallada incidentalmente por medio de imágenes de tomografía computarizada de haz cónico (TCHC). Una paciente de sexo femenino fue sometida a examen de TCHC y se verificó una neumatización extensa bilateral de la concha media, presentando una mayor dimensión del lado derecho, asi como desvío del tabique. El paciente refirió obstrucción nasal y pérdida del olfato. La TCHC de la región maxilofacial permitió localizar este hallazgo incidental, permitiendo derivar al paciente para el tratamiento adecuado.

Nasosinusal Endoscopic Anatomy and Physiology

The present article focuses on the analysis of the nasal cavity's anatomy succinctly and descriptively. This essay was carried out through a bibliographic review, directed to the detailed anatomy of the nasal cavity, and the structures that form its sinuses. We have identified the need formore studies directed to the related anatomical area so that the improved knowledge of this region ensures a nasoendoscopic treatment with better effectiveness and no complications.

Early clinical outcomes of ınferior turbinate radiofrequency and lateralization combined with septoplasty / Resultados clínicos iniciais da utilização de radiofrequência e lateralização das conchas nasais inferiores combinadas à septoplastia

Abstract Introduction: Mechanical obstruction is the most common form of nasal obstruction. Among the types of mechanical obstructions, septum deviation and inferior turbinate hypertrophy are the most prevalent. Objective: This study evaluated the early clinical outcomes of inferior turbinate radiofrequency and inferior turbinate lateralization combined with septoplasty in the treatment of nasal obstruction symptoms. Methods: The research retrospectively evaluated data from 33 patients (24 male, nine female) undergoing septoplasty and inferior turbinate radiofrequency (RF group) and 32 patients (24 male, eight female) treated with septoplasty and inferior turbinate lateralization (LAT group), who were admitted, with complaints of nasal obstruction, to the University of Health Sciences, Department of Otorhinolaryngology, between January 1, 2017 and January 1, 2018. The patients' preoperative and 6-month postoperative symptoms were evaluated via the Nasal Obstruction Symptom Evaluation, the NOSE scale. Results: The mean preoperative NOSE scores were 10.3 ± 4.2 in the RF group and 10.9 ± 4.9 in the LAT group, and the mean six-month postoperative scores were 1.09 ± 1.3 in the RF group and 1.2 ± 1.3 in the LAT group. There was no significant difference in NOSE scores between the two groups (p > 0.05). Conclusion: The data obtained in this study show that both methods result in similar outcomes in terms of relieving nasal obstruction symptoms in patients requiring inferior turbinate intervention. Therefore, the researchers believe that, in each case, the intervention method should be selected at the discretion of the patient and surgeon(s).

Resumo Introdução: A obstrução mecânica é a forma mais comum de obstrução nasal. Entre os tipos de obstruções mecânicas, o desvio do septo e a hipertrofia de conchas inferiores são os mais prevalentes. Objetivo: Avaliar os resultados clínicos iniciais da aplicação de radiofrequência nas conchas inferiores e a lateralização delas combinada com septoplastia no tratamento dos sintomas de obstrução nasal. Método: O estudo avaliou retrospectivamente dados de 33 pacientes (24 homens, nove mulheres) que foram submetidos a septoplastia e aplicação de radiofrequência no concha inferior (grupo RF) e 32 pacientes (24 homens, oito mulheres) submetidos a septoplastia e lateralização de concha inferior (grupo LAT), que foram admitidos com queixas de obstrução nasal na University of Health Sciences, Departamento de Otorrinolaringologia, entre 1° de janeiro de 2017 e 1° de janeiro de 2018. Os sintomas pré-operatórios e pós-operatórios de 6 meses dos pacientes foram avaliados pela escala NOSE, do inglês Nasal Obstruction Symptom Evaluation. Resultados: Os escores médios pré-operatórios da escala NOSE foram 10,3 ± 4,2 no grupo RF e 10,9 ± 4,9 no grupo LAT e os escores médios pós-operatórios de seis meses foram 1,09 ± 1,3 no grupo RF e 1,2 ± 1,3 no grupo LAT. Não houve diferença significante nos escores da escala NOSE entre os dois grupos (p > 0,05). Conclusão: Os dados obtidos neste estudo mostram que ambos os métodos têm resultados semelhantes em termos de alívio dos sintomas de obstrução nasal em pacientes que necessitam de intervenção nas conchas inferiores. Portanto, os pesquisadores acreditam que, em cada caso, o método de intervenção deve ser selecionado a critério do paciente e do cirurgião.

The role of RUNX1 in the apoptosis of epithelial cells in nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the expression of Runt-related transcription factor 1 (RUNX1) in nasal polyps (NPs) tissues and the potential role on apoptosis of primary human nasal epithelial cells (pHNECs) in NPs. Methods: The expression level of RUNX1 in NPs tissues was determined by Western blot (WB) and immunohistochemical staining (IHC). In vitro, TNF-α (20 ng/ml) was used to stimulate pHNECs to establish the apoptosis injury model. Hoechst staining was performed to observe pHNECs apoptosis by kit. Subsequently, quantitative real-time PCR (qRT-PCR) and WB were utilized to detect the expression of apoptosis-related proteins B-cell lymphoma-2 (BCL-2), BCL2-associated X (BAX) and cysteinyl aspartate specific proteinase-3 (Caspase-3) to assess the level of apoptosis. The plasmid of sh-RUNX1-6 was transfected into the pHNECs apoptosis model, then the effect of RUNX1 silence on apoptosis was evaluated by WB and flow cytometry. Statistical analysis was performed by the SPSS 19.0 and GraphPad Prism5 software. Results: The expression of RUNX1 in NPs tissue was significantly higher than that in inferior turbinates, and the difference was statistically significant (0.274±0.042 vs 0.110±0.027, t=9.675, P<0.05). Compared with the inferior turbinates, BAX and Caspase-3 expressions were increased whereas BCL-2 was decreased in NPs, and the differences were statistically significant (BAX 0.346±0.032 vs 0.302±0.037, Caspase-3 0.228±0.061 vs 0.158±0.065, BCL-2 0.090±0.047 vs 0.276±0.057, t value was 2.680, 2.361 and 7.575, respectively, all P<0.05). The expression levels of RUNX1 and apoptosis in pHNECs increased in a time-dependent manner after TNF-α exposure (P<0.05). Plasmid of sh-RUNX1-6 transfected silenced the expression of RUNX1 in pHNECs treated by TNF-α. After silencing RUNX1 in pHNECs apoptosis model, the protein levels of BAX and Caspase-3 were decreased, while the expression of BCL-2 was increased, the rate of apoptosis was decreased (P<0.05). Conclusions: RUNX1 is increased in NPs. Silencing RUNX1 can inhibit the apoptosis and reduce cell inflammatory damage of pHNECs induced by TNF-α.

Rinoplastía y rinoseptoplastía funcional: mejorando la función nasal más allá de la cirugía del tabique y los cornetes nasales / Functional rhinoplasty and septorhinoplasty: improving nasal function beyond septal and turbinate surgery

Resumen La obstrucción nasal es una de las causas más frecuentes de consulta otorrinolaringológica general. Diversas estructuras juegan un rol en la mantención de una adecuada función respiratoria nasal, incluyendo el tabique, los cornetes, las paredes laterales y las alas nasales. La cirugía del tabique y de los cornetes inferiores son los procedimientos más comúnmente realizados y aunque son efectivos en un gran porcentaje de los casos, en ocasiones se deben intervenir otras estructuras nasales para corregir adecuadamente la obstrucción. La cirugía con fines primariamente funcionales de las válvulas nasales externa e interna, de la punta y/o de la pirámide ósea se ha denominado "rinoplastía funcional". Dada la importancia de estas estructuras para la recuperación de una adecuada permeabilidad nasal estática y dinámica, el diagnóstico y manejo quirúrgico de estas condiciones debe ser de dominio del otorrinolaringólogo.

Abstract Nasal obstruction is one of the most frequent complaints in general otorhinolaryngology practice. Different structures have a role in maintaining an adequate nasal breathing function, including the septum, turbinates, lateral sidewalls and nasal alae. Surgery of the nasal septum and inferior turbinates are the most commonly performed procedures and, although effective in most cases, occasionally other nasal structures must be intervened to correctly address the sites of obstruction. The term "functional rhinoplasty" has been coined for surgery of the external and internal nasal valves, nasal tip and/or bony pyramid, with primarily functional objectives. Given the importance of these structures for restoring an adequate static and dynamic nasal patency, diagnosis and management of these conditions must be dominion of the otorhinolaryngologist.

Changes in substance P levels of inferior turbinate in patients with mucosal contact headache / Alterações nos níveis da substância P da concha inferior de pacientes com cefaleiapor ponto de contato da mucosa

Abstract Introduction Mucosal contact headache is a referred pain that arises from contact between the nasal septum and the lateral nasal wall. Evidence supports the role of substance P in a contact headache such that release of substance P from sensory nerve endings causes inflammation and allergy. Objectives This study aimed to determine possible differences in substance P levels in inferior turbinate hypertrophy creating a contact headache. Methods 28 patients who had contact headaches (study group) and 16 volunteers with no complaints were included in the study. Substance P levels in the inferior turbinate tissue samples were quantified using a commercially available substance P EIA kit. Results In the study group average substance P levels were 2.65 ± 0.27 pg/mg tissue (range: 0.61-5.44) and in the control group it was 1.77 ± 0.27 pg/mg tissue (range: 0.11-4.35). The difference was statistically significant between the two groups (p = 0.0215). Average preoperative headache group visual analog scale scores was 5.93 ± 0.38 (2-9) and the turbinate volume was 6.56 ± 0.35 cm3 (3.50-10.30). The control group turbinate volume was 4.71 ± 0.39 cm3 (2.50-7.70). We found a correlation between the visual analog scale scores and substance P levels such that substance P levels were higher in visual analog scale scores above 5 (p = 0.001). Conclusion This study demonstrates the relationship between intranasal contact headaches and increased mucosal substance P levels. We also found that there is no correlation with substance P levels and volume of the inferior turbinate.

Resumo Introdução A cefaleia por ponto de contato da mucosa é uma dor direcionada que surge do contato entre o septo nasal e a parede nasal lateral. Evidências corroboram o papel da substância P na cefaleia de contato, de tal forma que a liberação da mesma a partir de terminações nervosas sensoriais possa causar inflamação e alergia. Objetivo Determinar possíveis diferenças nos níveis da substância P na hipertrofia de conchas inferiores em relação à cefaleia de contato. Método Foram incluídos no estudo 28 pacientes que apresentaram cefaleia por ponto de contato (Grupo Estudo) e 16 voluntários sem queixas. Os níveis de substância P nas amostras de tecido da concha inferior foram quantificados com um kit substância P EIA, comercialmente disponível. Resultados No grupo do estudo, os níveis médios de substância P foram 2,65 ± 0,27 pg/mg de tecido (variação: 0,61-5,44) e no grupo controle foram de 1,77 ± 0,27 pg/mg de tecido (variação: 0,11-4,35) e a diferença foi estatisticamente significante entre os dois grupos (p = 0,0215). O escore médio da escala visual analógica do grupo de cefaleia pré-operatória foi de 5,93 ± 0,38 (2-9) e o volume das conchas foi de 6,56 ± 0,35 cm3 (3,50-10,30). O volume da concha do grupo controle foi de 4,71 ± 0,39 cm3 (2,50 ± 7,70). Encontramos uma correlação entre o escore da escala visual analógica e os níveis de substância P, de modo que os níveis de substância P foram maiores nos escores da escala visual analógica acima de 5 (p = 0,001). Conclusão Este estudo demonstra a relação entre cefaleias por contato intranasais e níveis aumentados de substância P nas mucosas. Também observamos que não há correlação com os níveis de substância P e o volume da concha inferior.

Hipertrofia de cornetes inferiores: revisión sobre técnicas quirúrgicas actuales / Inferior turbinate hypertrophy: review of current surgical techniques

La obstrucción nasal es un motivo de consulta habitual en otorrinolaringología, siendo una de las causas más frecuentes la hipertrofia de cornete inferior, la que se puede manejar con cirugía cuando falla el tratamiento médico. En las últimas décadas se han desarrollado múltiples técnicas quirúrgicas y tecnología asociada, sin embargo, no hay un consenso establecido sobre cuál es la mejor opción para el manejo de esta patología. Se realizó revisión bibliográfica, se enuncian los métodos quirúrgicos disponibles, teniendo en cuenta beneficios, complicaciones probables y resultados de cada uno. La cirugía de cornete inferior tiene resultados favorables en pacientes con cornetes hipertróficos que no responden a manejo médico. Hasta la fecha la turbinoplastía con microdebridador ha mostrado superioridad en cuanto a resultados a largo plazo y menor tasa de complicaciones. La evidencia disponible hasta la fecha carece de homogeneidad en cuanto a métodos de selección de pacientes, medición de resultados y tiempo de seguimiento, por lo que se necesitan a futuro estudios prospectivos controlados para reevaluar los métodos descritos.

Nasal obstruction is a common complaint, one of the most frequent causes being inferior turbinate hypertrophy, which can be managed with surgery when medical treatment fails. In the last decades, multiple surgical techniques and associated technology have been developed, however, there is no established consensus on what is the best option for the management of this pathology. Literature review, the available surgical methods are stated, taking into account benefits, probable complications and results of each technique. The surgery of inferior turbinate has favorable results in patients with hypertrophic turbinates that do not respond to medical management. To date, microdebrider turbinoplasty has shown superiority in terms of long-term results and lower complication rates. The evidence available to date lacks homogeneity in terms of patient selection methods, measurement of results and follow-up time, so prospective controlled studies are needed in the future to reassess the described methods.

Radiologic study of the nasal septal swell body and its relationship to septal deviation

Objective@#To compare the radiographic features of the nasal septal swell body (NSB) with the laterality of nasal septal deviation and investigate whether there is a correlation between the severity of the septal deviation and difference in NSB size.@*Methods@#Design: Retrospective Observational Study. Setting: Tertiary Private University Hospital. Participants: 30 paranasal sinus computerized tomography scans from January to October 2017.@*Results@#A septal deviation was present in 60% of the subjects. In 78% of cases with septal deviation, the NSB was noted to be significantly larger on the side opposite the nasal septal deviation (p < .05). @*Conclusion@#The correlation between the severity of the septal deviation and difference in NSB size had a value of (r = 0.37) therefore, no positive correlation was established. Subjects with almost symmetric NSB measurements tend to have no septal deviation. On the other hand, the NSB is more prominent contralateral to a septal deviation.

The diagnostic usefulness and correlation of nasal eosinophil count and percentage in children with rhinitis

PURPOSE: Allergic rhinitis is the most common atopic disease and the most common chronic disease of children. Eosinophil count and percentage in nasal smear are useful for differential diagnosis of allergic rhinitis. The aim of this study is to investigate the correlation between nasal eosinophil count and percentage.METHODS: Between January 2017 and August 2018, 221 children patients with a clinical history of rhinitis were tested at the outpatient respiratory and allergy unit of the Department of Pediatrics, School of Medicine, The Catholic University of Korea. Nasal secretion was collected by swabbing a children's nasal inferior turbinate 3–4 times with a cotton swab and then placed on to a glass slide. Later, the smear was stained by Giemsa stain.RESULTS: This is the first study to assess the comparison of nasal eosinophil count and percent. There is a positive correlation between nasal eosinophil count and percent Y=1.02 X+2.82 (Y=Eosinophil count, X=Eosinophil percentage). To determine the usefulness of nasal eosinophil count and percentage in the diagnosis of allergic rhinitis, we analyzed receiver operating characteristic curves. The cutoff value of the nasal eosinophil count was 6.5/high-power field, and that of the nasal eosinophil ratio was 3% for the diagnosis of allergic rhinitis.CONCLUSION: In patients with suspected rhinitis, one of the values of nasal eosinophil count or percentage can be used in clinical practice.

Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients / Efeitos da turbinoplastia versus fratura lateral e cauterização bipolar no volume da concha inferior hipertrófica compensatória em pacientes submetidos a septoplastia

Abstract Introduction: The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. Objective: In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. Methods: This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0 ± 12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. Results: The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p = 0.004). In both groups the lower turbinate volumes were significantly decreased (p = 0.002, p < 0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p = 0.033). Conclusion: Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization.

Resumo Introdução: A causa mais comum de falha da septoplastia é a hipertrofia das conchas inferiores não tratada adequadamente. Diversas técnicas foram descritas até o momento: turbinectomia total ou parcial, ressecção da submucosa (cirúrgica ou com microdebridador) e a fratura lateral. Objetivo: Neste estudo, comparamos os volumes pré e pós-operatório da concha inferior com hipertrofia compensatória com o uso de tomografia computadorizada entre pacientes submetidos a septoplastia e turbinoplastia ou fratura lateral com cauterização bipolar. Método: Este estudo retrospectivo incluiu 66 pacientes (37 homens e 29 mulheres) internados em nosso serviço de otorrinolaringologia entre 2010 e 2017 por obstrução nasal e submetidos à cirurgia por desvio de septo nasal. Os pacientes submetidos à turbinoplastia devido à hiperplasia compensatória da concha inferior formaram o grupo turbinoplastia; aqueles submetidos à fratura lateral e cauterização bipolar foram separados, formaram o grupo fratura lateral. Os volumes compensatórios da concha inferior de todos os pacientes que participaram do estudo (idade média de 34,0 ± 12,4 anos, faixa de 17 a 61 anos) foram avaliados por tomografia computadorizada dos seios paranasais nos planos axial e coronal no pré-operatório e aos dois meses do pós-operatório. Resultados: As dimensões transversais e longitudinais do grupo turbinoplastia no pós-operatório foram significantemente menores do que as do grupo de fratura lateral (p = 0,004). Em ambos os grupos, os volumes da concha inferior diminuíram significantemente (p = 0,002, p < 0,001, respectivamente). O volume pós-operatório da concha do lado do desvio aumentou significantemente no grupo turbinoplastia (p = 0,033). Conclusão: Tanto a turbinoplastia como a fratura lateral são técnicas efetivas de redução de volume. No entanto, a turbinoplastia causa maior redução do volume da concha inferior do que a fratura lateral com cauterização bipolar.

Does the reduction of inferior turbinate affect lower airway functions? / A redução da concha nasal inferior afeta as funções das vias aéreas inferiores?

Abstract Introduction: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. Objective: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. Methods: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. Results: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. Conclusion: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.

Resumo Introdução: Embora o nariz e os pulmões sejam órgãos separados, numerosos estudos relataram que todo o sistema respiratório pode ser considerado como uma única unidade anatômica e funcional. As vias aéreas superiores e inferiores afetam uma à outra diretamente ou através de mecanismos reflexos. Objetivo: Avaliar os efeitos da ablação por radiofrequência em conchas nasais inferiores com hipertrofia persistente sobre a função nasal e pulmonar. Método: Foram incluídos neste estudo 27 pacientes com hipertrofia persistente bilateral de conchas inferiores sem desvio septal. Todos os pacientes foram avaliados com rinoscopia anterior, endoscopia nasal, rinometria acústica, escala visual analógica e espirometria sensível ao fluxo no dia anterior e quatro meses após o procedimento de ablação por radiofrequência. Resultados: As medidas pós-ablação demonstraram que a ablação das conchas nasais inferiores resultou em um aumento da área transversal média e do volume do nariz, bem como do volume expiratório forçado em um segundo, da capacidade vital forçada e do fluxo expiratório máximo dos pacientes. Essas diferenças entre os resultados pré e pós-ablação foram estatisticamente significantes. Os escores da escala visual analógica pós-ablação foram menores quando comparados com os escores pré-ablação e essa diferença também foi estatisticamente significante. Conclusão: O alargamento da passagem nasal após a redução do tamanho das conchas nasais inferiores teve efeito favorável nos testes de função pulmonar.

Inferior turbinate outfracture for successful nasotracheal intubation in a patient undergoing maxillofacial surgery: case report

An enlarged inferior turbinate is a predisposing factor for difficult nasotracheal intubation. We describe a case of successful nasotracheal intubation by induced outfracture of the inferior turbinate during maxillofacial surgery, and discuss the importance of adequate airway evaluation and anesthetic management for successful nasal intubation.

Anesthesia for elective bilateral sagittal slip osteotomy of the mandible and genioplasty in a young man with Klippel-Feil syndrome, Sprengel deformity, and mandibular prognathism

Klippel-Feil syndrome is characterized by congenital fusion of two or more cervical vertebrae, a low hair line at the back of the head, restricted neck mobility, and other congenital anomalies. We report a 16-year-old young man with Klippel-Feil syndrome, Sprengel deformity of the right scapula, thoracic kyphoscoliosis, and mandibular prognathism with an anterior open bite. He was treated with orthodontic treatment and maxillofacial surgery. An anticipated difficult airway due to a short neck with restricted neck movements and extrinsic restrictive lung disease due to severe thoracic kyphoscoliosis increased his anesthesia risk. Due to his deviated nasal septum and contralateral inferior turbinate hypertrophy, we chose awake fiber optic orotracheal intubation followed by submental intubation. Considering the cervical vertebral fusion, he was carefully positioned during surgery to avoid potential spinal injury. He recovered well and his postoperative course was uneventful.

Concha bullosa, nasal septal deviation, and their impacts on maxillary sinus volume among Emirati people: A cone-beam computed tomography study

PURPOSE: To determine the prevalence of concha bullosa (CB) and nasal septal deviation (NSD) and their impact on maxillary sinus volume (MSV). MATERIALS AND METHODS: Cone-beam computed tomographic (CBCT) images of 106 Emirati people were used in this study. The direction and angle of septal deviation were calculated. The presence of CB, which could be unilateral, contralateral, or bilateral in relation to the direction of NSD, was also recorded. MSV was measured using reconstructed Digital Imaging and Communication in Medicine images on Dolphin 3D imaging software version 11.8 premium (Dolphin Imaging, Chatsworth, CA, USA). P values<0.05 were considered to indicate statistical significance. RESULTS: CB was detected in 37.7% of the sample; 20.7% of the sample showed single unilateral CB and 16.6% had single bilateral CB. NSD was seen in 74.5% of the sample. In the participants with CB, 45.5% showed mild deviation, 34.4% showed moderate deviation, and only 12.5% showed severe septal deviation. CB, but not NSD, was associated with significantly higher MSV on the affected side (P=0.001). CONCLUSION: Although NSD was observed in more than two-thirds of the sample and CB was present in more than one-third of the sample, only CB had a significant impact on MSV.

Prelacrimal Recess Approach for Maxillary Sinus Inverted Papilloma: Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various surgical approaches have been employed for the complete resection of inverted papilloma (IP) of the nose and paranasal sinus. Sacrificing the inferior turbinate (IT) and nasolacrimal duct (NLD) is often unavoidable due to the anatomy of maxillary sinus. However, the prelacrimal recess approach (PLRA) provides a wider entrance to the maxillary sinus without the ablation of NLD and IT. We present seven cases of IP successfully treated by the PLRA. SUBJECTS AND METHOD: We collected data from seven different cases involving patients who underwent resection of IP by means of the PLRA from 2016 to 2017. If the lesion could not be removed first via middle meatal antrostomy (MMA), then PLRA was attempted. The surgical specimens were all confirmed to be IP. RESULTS: Preoperative imaging studies demonstrated that the lesions of IP were located mainly in the maxillary sinus. All of the seven patients had unilateral lesions and all tumors were completely resected via PLRA. The follow-up ranged from 3 to 24 months, during which no recurrence or complications were observed in any of the seven patients. CONCLUSION: PLRA provides an adequate operation field without unfavorable scars. It allows the preservation of sinus structure and function. PLRA is feasible and can be used for the diffuse maxillary sinus IP.