Successful management of primary atrophic rhinitis by turbinate reconstruction using autologous costal cartilage.

Initial management of primary atrophic rhinitis is conservative, with nasal ointments, saline irrigation, and antibiotics prescribed to relieve symptoms. However, in cases that show no improvement, a surgical approach is considered. Recently, many studies have reported successful surgical outcomes using various nasal implants. However, no study has reported implantation of autologous costal cartilage in PAR patients. We report here the case of a 63-year-old woman diagnosed with PAR that was intractable to medical therapy. Under general anesthesia, bilateral inferior turbinate reconstruction with autologous costal cartilage was successfully performed without any complications. One month after surgery, her symptoms improved dramatically. At the 2-year follow-up, her Sinonasal Outcome Test 25 (SNOT-25) score was 6, down from an initial score of 108. Her OMU CT showed improved sinonasal mucosal thickness and disappearance of thick mucosal secretion compared with preoperative CT image. Although this is a single case experience, it is suggested that turbinate reconstruction using autologous costal cartilage can serve as promising surgical modality for management of atrophic rhinitis.

Regeneration of toxigenic Pasteurella multocida induced severe turbinate atrophy in pigs detected by computed tomography.

BACKGROUND: Atrophic rhinitis is a widely prevalent infectious disease of swine caused by Bordetella bronchiseptica and Pasteurella multocida. The course of the disease is considered to be different depending on the principal aetiological agents distinguishing B. bronchiseptica induced non-progressive and toxigenic P. multocida produced progressive forms. In order to compare the pathological events of the two forms of the disease, the development of nasal lesions has longitudinally been studied in pigs infected by either B. bronchiseptica alone or B. bronchiseptica and toxigenic P. multocida together using computed tomography to visualise the nasal structures. RESULTS: B. bronchiseptica infection alone caused moderately severe nasal turbinate atrophy and these lesions completely regenerated by the time of slaughter. Unexpectedly, complete regeneration of the bony structures of the nasal cavity was also observed in pigs infected by B. bronchiseptica and toxigenic P. multocida together in spite of seeing severe turbinate atrophy in most of the infected animals around the age of six weeks. CONCLUSIONS: B. bronchiseptica mono-infection has been confirmed to cause only mild to moderate and transient lesions, at least in high health status pigs. Even severe turbinate atrophy induced by B. bronchiseptica and toxigenic P. multocida combined infection is able to be reorganised to their normal anatomical structure. Computed tomography has further been verified to be a useful tool to examine the pathological events of atrophic rhinitis in a longitudinal manner.

Pneumocephalus: a rare complication of nasal myiasis.

Infestation of ear, nose, and throat by maggots, the larvae of the fly (genus Chrysomyia) [J Laryngol Otol 1976:393-399], is termed "myiasis." Prevalent in tropical countries, atrophic rhinitis is the most common predisposing factor for this condition. The maggots burrow into delicate membranes and feed on underlying structures, causing considerable destruction of tissues, resulting in complications such as extensive erosion of the nose, face, and orbit, with rarely meningitis and death as a result of intracranial involvement [J Laryngol Otol 1989;103:489-491]. We report a rare complication of pneumocephalus after atrophic rhinitis with nasal myiasis.

Turbinate atrophy evaluation in pigs by computed tomography.

Computed tomography (CT), a non-invasive visualisation technique was applied for imaging the bony structures of the nasal cavity of pigs, and compared to the traditional scoring system of turbinate atrophy in swine. Twenty-three 27-week-old pigs representing various stages of turbinate atrophy were used. Nasal structures were visually scored on CT scans and transversal cuts of the noses at the level of the first upper premolar teeth using the same scoring system in both cases. A tissue/air area ratio was also determined based on density differences. A highly significant correlation was found between visual scoring of CT images and transversal cuts of pig noses (r = 0.98, p < 0.0001) as well as between visual scoring of CT images and tissue/air area ratio determination (r = -0.82, p < 0.0001).

Diagnosis of atrophic rhinitis in a Simmental heifer by computed tomography.

Atrophic rhinitis was diagnosed in a 10-month-old heifer with the assistance of computed tomography. The aetiology of the condition in cattle is uncertain and the clinical disease may be overlooked owing to the lack of signs such as the shortening or deformity of the snout observed in pigs.

Computed axial tomography of the porcine nasal cavity and a morphometric comparison of the nasal turbinates with other visualization techniques.

A non-invasive imaging modality, computed tomography (CT), was used to visualize changes in nasal turbinates of anesthetized pigs over a 12-week observation period (pigs were 14 wk of age at study week 0). Normal, non-infected pigs were compared to pigs with mild challenge-induced atrophic rhinitis (AR) in order to detect subtle differences in morphology. To determine feasibility for time course studies in future experiments, morphometric quantitation at the level of the 2nd premolar (turbinate area ratio or TAR) in cross-section CT images at multiple timepoints was done. Additionally, at study termination, the TAR determined from CT images, magnetic resonance imaging (MRI), and wet tissue (WT), were compared to each other and to the standard subjective measure, visual scoring. There were no statistically significant differences between the control and AR groups at CT imaging dates of 0, 3, 6, 9, or 12 wk (P = 0.182). However, a statistically significant decrease in TAR measurements over time (P = 0.015) was observed in both groups, with lower mean values observed on Weeks 3 and 6 before rebounding to baseline values at study termination. At Week 12 (termination of the study), the TAR measurements derived from CT, MRI, and WT were not statistically different from one another (P = 0.220) and the treatment group-by-method interaction was not significant (P = 0.800). This provided evidence of equivalency of the techniques. Mean values for normal and infected groups were not significantly different based on either TAR imaging methods (P = 0.552) or visual scores (P = 0.088). Thus, the current study demonstrated that CT was an acceptable alternative imaging modality which could be used for quantitation of turbinate changes in snouts of live pigs to provide data comparable to tissue taken at necropsy. Computed tomographic imaging would allow non-invasive tracking of disease or treatment responses within individual animals over time. Morphometric analysis of the TAR was equivalent between the CT, MRI, and WT specimens.

Radiological and endoscopic study of the maxillary sinus in primary atrophic rhinitis.

The maxillary sinuses of 40 patients suffering from primary atrophic rhinitis (ozaena) were studied radiologically, antroscopically and histopathologically. Sixty per cent of the patients showed thick bony walls and a small cavity of the maxillary sinus on X-ray and on antroscopy. On the other hand, 25 per cent of the cases revealed signs of infection including mucopurulent secretion on antroscopy associated with corresponding histopathological changes. It is concluded that poor pneumatization of the antrum plays a more important role in the pathogenesis of ozaena than infection.

Computed tomographic findings in atrophic rhinitis.

Computed tomography (CT) has been used increasingly in the assessment of patients with symptoms of sinonasal disease since the introduction of functional endoscopic surgery for the treatment of chronic sinusitis. The association of sinusitis and atrophic rhinitis will inevitably lead to more frequent imaging of patients with atrophic rhinitis. Correct interpretation of the CT appearances of atrophic rhinitis is important as misinterpretation may have serious implications during sinus surgery. These appearances have not been described previously. We describe and discuss the CT findings in three patients with clinical evidence of atrophic rhinitis.

Distribution of atrophy in the nasal ventral conchae of piglets infected experimentally with Bordetella bronchiseptica.

The distribution and extent of atrophy caused by Bordetella bronchiseptica in the nasal ventral conchae were investigated by intranasally infecting piglets at day 4 of life. Experimental and control piglets were killed at one, two, three, four, five and six weeks of age. Serial transverse 80 microns thick nondecalcified sections were cut throughout the entire length of the nasal ventral conchae, and microradiographed. It was observed that the distribution and extent of atrophy was not uniform along the ventral conchae. The articular and transverse laminae as well as the connecting zone were not atrophied, except at their rostral extremity. The entire dorsal scroll was atrophied. This atrophy was moderate, except at the rostral and caudal extremities of the dorsal scroll, where its size was less than half that of the controls. The ventral scroll was less atrophied than the dorsal scroll, although a marked atrophy was present at its rostral extremity. From these observations, it is suggested that two transverse sections should be made through the nose of pigs in order to establish a diagnosis of atrophic rhinitis at slaughter: one section at the level of the first-second premolar tooth and one more rostral section, at the level of the canine tooth.

Diagnosis of atrophic rhinitis by computerised tomography: a preliminary report.

Computerised tomography, used as a diagnostic tool for atrophic rhinitis in pigs, facilitated the macroscopic grading of the nasal structures in live pigs of any age. The results of sequential scans in normal and affected pigs are described; transient atrophy of the ventral conchae was observed in one pig.

[Use of radiography in the diagnosis of atrophic rhinitis (author's transl)]. / De waarde van het röntgenologisch onderzoek voor de diagnostiek van atrofische rhinitis.

In 126 gilts of the Netherlands Landrace breed and eighty-one gilts of the Large Yorkshire breed, slaughtered when they had attained a weight of 100 kg., radiography of the nasal cavities was carried out, followed by post-mortem studies of these cavities. Macrocopic examination of the transverse section at the level of the first premolar tooth showed that the incidence of atrophy as well as of hypertrophy of the turbinate bones was higher in pigs of the Large Yorkshire breed than it was in those of the Landrace breed. The ventral coils of the ventral conchae were most commonly affected in the two breeds. When the X-rays were assessed using the system suggested by Done (3), a discrepancy between the X-rays and the post-mortem findings was observed in a large number of cases. Possible causes of this discrepancy are discussed. The results do not warrant the development of a radiographic technique which can be used in field conditions in the Netherlands to examine the nasal cavities in establishing a diagnosis of atrophic rhinitis.