Turbinates surgery: when and how to perform it / Cirurgia dos cornetos: quando e como realizá-la

In our practice, turbinates became in the last 10 years an important and often used procedure for three basic purposes: (a) for improving nasal patency in chronic nasal obstruction; (b) for improving sinuses ventilation and drainage in chronic or relapsing sinusitis; (c) for relieving rhinogenic craniofacial pains and some neurovascular headhaches. For nasal patency are the important the size of the head and tail of lower turbinates. The tail deserves special attention in children less than five/seven years old and nose blocking not relieved by topic decongestion. The middle turbinate volume and shape plays a minor role in nasal patency but it can be outstanding in determining anterior sinuses ventilation and drainage problems as well as in rhinogeniuc pain and neurovascualr headhaches triggered by abnormnal contacts in middle meatus. Turninates reduction of volume and change in position or shape accomplished through; (a) partial resection (splitting, trimming, localized resection), submucous fractures and/or repositioning (lateralization) of the bony framework; (b) trimming of adequate amount of mucous lining. Reduction of turbinates response to congestive stimuli is achieved through (a) pos-operative submucous cicatrical fibrosis (mainly when submucous comminuted fractures are done); (b) reduction of nerves supply to concomitant avulsion with the mucosal lining resected (mainly from the tail) and - in selected cases - (c) specific submucous coagulation of sphenopalatine glanglion and sphenoplalatine artery nasal branches. Turbinates submucous coagulation is an eventual and complementary procedure for additional improvement of previous surgical results

Computerized rhinomanometry: on the normal limits of nasal resistance / Rinomanometria computadorizada: sobre os limites normais da resistência nasal

A randomized sample of 100 adults (200 nasal fossae), both sexs, with subjective unilateral or bilateral complaints of nose obstruction and no previous, nose surgeries, was studied. After decongestion, the patency of each nasal was registered according three different evaluations: (a) by the patient himself, (b) by the examiner (inspection, rhinoscopy, endoscopy) and (c) by unilateral anterior active computerized rhinomanometry (Mercury rhinomanometer RN-6) at the reference pressure of 150 Pa. The site and grade of the anatomic abnormalities found in each nasal fossa were also registered. For evaluations (a) and (b), four grades of nasal fossa patency (NFP) were considered: normal (A), slightly abnormal (B), moderately abnormal (C) or severely abnormal (D). Rhinomanometric data (RMD) were distributed in five categories: Group I - RMD of NFP considered normal both by the examiner and the patient; Group II - RMD of NFP considered normal by the examiner but abnormal by the patient; Group III - RMD of NFP considered normal by the patient but abnormal by the examiner; Group IV - RMD of NFP considered slightly abnormal by the examiner and abnormal by the patient; Group V - RMD of NFP considered moderate or severely abnormal by the examiner and abnormal by the patient. The mean inspiratory unilateral resistance in Pa/sec/ccs was 0,33 ñ 0,10 for Group I, 0,39 ñ 0,10 for Group II and 0,52 ñ 0,12 for Group III. The findings of Groups I, II, III and the ones of the Groups IV and V were compared and their clinical implications discussed

The routine use of nasal topic vasoconstrictor for computerized tomography of nasal & paranasal cavities

The use of a long lasting nasal topic vasoconstrictor (NTVC) 15 minutes before CT-scans of nasal & paranasal cavities (N&PC) would be higbly advisable in order to avoid that normal or pathological transitory engorgement of the nasal mucosa can be interpreted as permanent or semipermanent changes in it, or toavoid that such transitory changes could obliterate the vision or importantanatomic or pathologic details, mostly in the middle meatus - a "K" area for interpretation of anterior sinuses inflamatory diseases. From a group of 10 patients who had CT-scans taken before and after the use of NTVC two cases ilustrates it quite well. The presence of swollen tissues not retracted by NTVC would indicate their permanent or semipermanent change. In evaluating nasal lumen patency, CT-scans after the use of NTVC - coronal or semicoronal sectionstaken for studying N&PC - can provide interesting and realistic correlations with rhinomanometric data from noses also decongested. The purpose of thisshort communication was to reiterate the advantage of NTVC use in N&PC CT-scans

Endoscopia naso-sinusal: parte II / Nose and sinuses endoscopy: part II

Os autores apresentam uma visåo geral da entidade e modo de emprego da endoscopia nasal e sinusal. O trabalho está dividido em duas partes: Parte I - Instrumental básico, endoscopia nasal (técnica), endoscopia sinusal (técnica). Parte II - Indicaçöes da endoscopia nasal, indicaçöes da endoscopia sinusal

Endoscopia naso-sinusal: parte I / Nose and sinuses endoscopy: part I

Os autores apresentam uma visäo geral da utilidade e modo de emprego da endoscopia nasal e sinusal. O trabalho está dividido em duas partes: Parte I - Instrumento básico, endoscopia nasal (técnica). Parte II - Indicaçöes da endoscopia nasal, indicaçöes da endoscopia sinusal

On the incidence of septal deformities according to Mladian's classification and some correlated aspects

Foi estudada uma amostra aleatória de 110 pacientes masculinos e 92 femininos, adultos, portadores de enfermidades do ouvido, nariz ou garganta, com ou sem obstruçäo nasal. Foram analisadas: a incidência dos diversos tipos de deformidades do septo nasal (DSN) de acordo com a classificaçäo de Mladina (CM); a correlaçäo entre DSN/CM e o sintoma subjetivo de obstruçäo nasal (SSON); a correlaçäo DSN/CM e o sexo dos pacientes; a correlaçäo DSN/CM e fossa nasal predominantemente afetada. As seguintes afirmativas säo estatisticamente significativas - considerando o total da amostra, predominam as DSN/CM tipos 2, 3 e 5: qualquer tipo de DSN/CM pode coexistir com ou sem SSON; o SSON predomina nas DSN/CM tipos 2 e 6; a ausência de SSON predomina largamente nas DSN/CM tipo 1; a DSN/CM tipo 2 predomina claramente na populaçäo masculina; a fossa nasal esquerda é mais afetada pela DSN/CM do que a direita. As DSN/CM tipo 2 envolve a área da válvula, por isso sua relaçäo positiva marcante com SSON é previsível. A correlaçäo entre DSN/CM tipo 2 e trauma explicaria sua predominância na populaçäo masculina. A DSN/CM Tipo 1 - näo perturbando a válvula nasal, por definiçäo - dificilmente será responsável por SSON

Frontal sinus surgery: the south american contribution

In a study on the history of the frontal sinus surgery - prepared for a Round-Table on "The History of Rhinology" (XIII Congress of the European Rhinologic Society, London, 1990) - the authorrs point out the important South American contributions

Puncture in the canine fossa: technique and pros and cons.

The authors describe in detail the technique they are employing for puncturing the canine fossa, for irrigation, sinuscopy and/or register of the antral pressures. Two trocars are introduced, one developed and the other modified by one of the authors (N.P.) A morbid entity named "glue-sinus" is commented. The pros and cons of the technique are discussed concluding that puncture in the canine fossa is a valid procedure and even more advantageous than the one in the nasal inferior meatus.

Incision in the gingival margin for approaching the maxillary sinus: a comment after an eight years experience.

After an eight years experience performing an incision in the free border of the gum (the Neumann's incision) to approach the maxillary sinus - the first written communication had been six years before (Rev. Brasil. Oto-Rino-Laring., 40:398, 1974) - the authors describe the details of the technique justifying also their enthusiasm for its almost exclusive use now a days.