Prognostic Value of Polypoid Changes of the Middle Turbinate in Relapsed Nasal Polypi after FESS: A Prospective Cohort Study

Abstract Introduction Despite the high level of patient satisfaction with functional endoscopic sinus surgery (FESS) and the clinical improvement, polyp recurrence is observed in 23% to 87% of patients and requires reoperation. Objective To assess the prognostic value of polypoid changes of the middle turbinate (PCMT) in relapse of paranasal sinus polyps in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) after FESS and the effect of partial middle turbinectomy (PMT) on the outcome of surgery. Methods We conducted a prospective clinical study on 60 patients with CRSwNP with and without PCMT. The patients were allocated into three groups: group I included twenty patients without PCMT; group II, twenty patients with PCMT; and group III included twenty patients with PCMT submitted to PMT. The patients were evaluated endoscopically according to the Lund-Kennedy endoscopic scoring system, radiologically according to the Lund-Mackay scoring system, and symptomatically through the 22-item Sinonasal Outcome Test (SNOT-22). Results The total postoperative Lund-Kennedy score differed significantly among the 3 groups (p < 0.001), with a group II presenting a significantly higher total score compared to groups I and III. The Preoperative SNOT-22 score differed significantly among the three groups (p = 0.013), with group II presenting a significantly higher score compared to group I. There was a significant association involving the 3 groups and relapse at 12 months (p = 0.029); relapse was higher in group II (50.0%) than in groups I (20%) and III (15.0%). Conclusion There was a significant association between PCMT and the relapse of nasal polyps. Also, nasal polyposis recurred at a lower rate in the group submitted to middle turbinate resection compared to the group in whom it was preserved.

Expression of mesenchymal stem cell phenotype in human nasal respiratory epithelial cells / Expresión del fenotipo de células troncales mesenquimales en células epiteliales nasales humanas

The respiratory epithelium is the first line of contact with the external hazards. Thus it can be damaged and need to be replaced to avoid healing by fibrosis. Tracheal tissue engineering is an alternative promising treatment modality. Mesenchymal stem cell markers are surface proteins, which are responsible for some of these cells unique properties. The objective of this study was to detect the mesenchymal stem cell phenotype among the human nasal respiratory epithelial cells via two immunophenotyping techniques. Respiratory epithelial cells were cultured using co-culture technique, fibroblasts was removed at confluence leaving respiratory epithelial cells, which were passage further to passage 4. Cells were evaluated for mesenchymal stem cell markers that were CD73, CD90, CD105 and the hematopoietic stem cell marker CD45 at passage 1 (P1) and passage 4 (P4) using Flow cytometry and Immunocytochemistry techniques. Respiratory epithelial cells expressed the mesenchymal stem cell markers at P1 and maintain the expression these markers until P4. Using both techniques, to compare the values of mesenchymal stem cell markers expression at P1 to P4 there was no significant difference. This study indicates that respiratory epithelial cells derived from nasal turbinate retain some of mesenchymal stem cells properties even after serial passages. Both methods of Immunophenotyping are comparable.

El epitelio respiratorio es la primera línea de contacto con los peligros externos. Por lo tanto, puede ser dañado y necesita ser reemplazado para evitar uan cicatrización por fibrosis. La ingeniería de tejidos traqueales es una modalidad de tratamiento alternativo prometedora. Los marcadores de células troncales mesenquimales son proteínas de superficie, que son responsables de algunas propiedades únicas de estas células. El objetivo fue detectar el fenotipo de células troncales mesenquimales entre las células epiteliales respiratorias nasales humanas a través de dos técnicas de inmunofenotipaje. Fueron cultivadas las células epiteliales respiratorias utilizando la técnica de co-cultivo; los fibroblastos se eliminaron en la confluencia dejando solo células epiteliales respiratorias, resultantes de los 4 pasajes. Las células fueron evaluadas para encontrar marcadores de células troncales mesenquimales mediante CD73, CD90, CD105 y el marcador de células troncales hematopoyéticas CD45 en el paso 1 (P1) y el paso 4 (P4), usando citometría de flujo y técnicas de inmunocitoquímica. Las células epiteliales respiratorias expresaron los marcadores de células troncales mesenquimales en P1 y mantuvieron la expresión de estos marcadores hasta P4. No hubo diferencias significativas en el uso de ambas técnicas al comparar los valores de los marcadores de células troncales mesenquimales expresadas desde P1 a P4. Este estudio indica que las células epiteliales respiratorias derivadas de la concha nasal retienen algunas de las propiedades de células troncales mesenquimales, incluso después de pases seriados. Ambos métodos de inmunofenotipificación son comparables.

Inferior turbinate osteoma: a case report.

Osteoma is the most common benign tumor of the paranasal sinuses. Turbinate osteomas are very rare and only five middle turbinate, two inferior turbinate and one superior turbinate osteoma cases have been reported. We present a rare case of osteoma of the left inferior turbinate in a patient presented with unilateral nasal obstruction that was removed endoscopically and conduct a literature review on turbinate osteomas arising from differen t turbinates.

Middle Turbinate Osteoma

Osteoma is the most common benign tumor of the paranasal sinuses. Turbinate osteomas are very rare and only four middle turbinate, one superior turbinate and one inferior turbinate osteoma cases have been reported. We present a rare case of osteoma of the left middle turbinate in a patient presented with unilateral nasal obstruction and epiphora that was removed endoscopically, and conduct a literature review on turbinate osteomas arising from different turbinates, their symptoms and management.

A Case of Mucoepidermoid Carcinoma on Inferior Turbinate in Nasal Cavity / 대한이비인후과학회지

Malignant carcinoma involving the sinonasal cavity is a rare tumor that is usually diagnosed as squamous cell carcinoma. Mucoepidermoid carcinoma is relative common, originating from the salivary glands of the oral cavity, pharynx and lacrimal glands. But mucoepidermoid carcinoma of nasal cavity, paranasal sinuses and respiratory tract is very rare. In particular, 38 cases of mucoepidermoid carcinoma occurring in the primary sinonasal tract were reported in the English literature, but only one case of mucoepidermoid carcinoma arising from the nasal cavity has been previous reported to date in the Korean literature. Recently, we experienced a 51-year-old man presenting with progressive nasal obstruction and recurrent epistaxis. He was diagnosed as mucoepidermoid carcinoma extending into the inferior turbinate in the nasal cavity and it was excised with nasal endoscope. We present the clinical characteristics and therapeutic methods of this case with a review of the literature.

Morphometry of the Korean Nasal Turbinates / 체질인류학회지

Recently, with the increasing interests in the endoscopic nasal surgery, it is essential for practitioners to have detailed knowledges of the anatomical structures for the successful surgery. This study was undertaken to provide morphological information of the nasal turbinates as anatomical reference during endoscopic nasal surgery. A total of 43 adult cadaver heads were bisected midsagitally and evaluated morphometrically. The results were as follows: The highest nasal turbinatee were observed in 66.7% of the case. After removal of the mucosa, the distances from the akanthion to the anterior end of superior, middle, inferior nasal turbinate were 46.75 mm, 38.23 mm, 18.51 mm respectively. The distances from the akanthion to the posterior end of superior, middle, inferior nasal turbinate were 55.11 mm, 54.72 mm, 50.26 mm respectively. The lengths of the superior, middle, inferior nasal turbinate were 22.20 mm, 40.14 mm, 40.97 mm respectively. The detailed measurements of the nasal turbinates performed in this study may provide useful anatomical landmarks for the endonasal endoscopic surgery.

Management of Severe Cicatricial Entropion Using Shared Nasal Turbinate Mucosal Graft

PURPOSE: Nasal turbinate mucosal graft provides an appropriate sturdiness and smooth mucosal surface and has added benefit of mucus production. We report one case of correction of severe upper and lower cicatricial entropion with shared nasal turbinate mucosal graft procedure. METHODS: A 40-year-old male patient who had past medical history of Stevens-Johnson syndrome in his early twenties had severe upper and lower cicatricial entropion and trichiasis irritating the cornea. We corrected the severe upper and lower entropion simultaneously with shared inferior nasal turbinate mucosal graft. RESULTS: A successful correction of severe upper and lower cicatricial entropion and improvement of dry eye symptom by plentiful mucus secretion were achieved and there was no recurrence during the followup of 14 months. CONCLUSIONS: We report a case of good anatomical, functional and cosmetic results achieved by shared nasal turbinate mucosal graft procedure in the correction of severe upper and lower cicatricial entropion which cannot be corrected successfully with other conventional methods.

High-resolution CT appearance of pneumatization of the inferior turbinate / 中华放射学杂志

Objective To study the HRCT features of pneumatized inferior turbinate and to evaluate their diagnostic value.Methods Twelve cases of pneumatized inferior turbinates demonstrated by HRCT were retrospectively analyzed.Results Coronal HRCT could demonstrate pneumatization of the inferior turbinate clearly and directly.Unilateral pneumatization was found in 11 cases and bilateral in one case. According to the location of pneumatization,pneumatized inferior turbinates were classified into three types : bulbous,lamellar,and extensive types.Five of 12 cases were bulbous,5 were lamellar and 2 were extensive type.On coronal HRCT scans,bulbous type showed nodular shape in one case,oval and ellipse shape in 2 cases each,respectively.Lamellar pneumatization appeared as curved stripe-like shape in 4 cases communicating with the maxillary sinus and ellipse shape in one case.Extensive type was found in 2 cases, curled lamella-like shape was found in 1 case communicating with the maxillary sinus and ellipse shape in another case.In 5 cases with maxillary sinus communication,axial HRCT revealed a defect on the medial wall of the maxillary sinus.In such a condition,the maxillary process of palatine bone and maxillary bone attached to the lower turbinate separately.Conclusion HRCT was an optimal imaging modality for the diagnosis of pneumatization of the inferior turbinate and may help the clinicians to differentiate from other causes of the inferior turbinate hypertrophy.