[A case of rhinofacial entomophthoromycosis in Soudano-Sahelian tropical climate in Burkina Faso]. / Un cas d'entomophthoromycose rhinofaciale en climat tropical soudano-sahélien au Burkina Faso.

We describe a rhinofacial entomophthoramycosis case in a sexagenarian (65 years old) housewife. She was immunocompetent and resident of Burkina Faso. She consulted both the service of dermatology and the service of stomatology of the Teaching Hospital of Bobo-Dioulasso in February 2016 for a diffuse facial tumefaction evolving over six months. This tumefaction was associated with headaches and a left nasal obstruction. Histological examination of the lesion showed an important and polymorphic inflammatory reaction. Also, a filamentous fungus with wide non-septated hyphae and right-angled fungal branching, consistent with mucormycosis was isolated. Mycological diagnosis based on fungal culture with Sabouraud medium without any antibiotic and cyclohexemide after incubation at 27°C and at 30°C was negative. Furthermore, it was not possible to amplify the DNA extracted from biopsy. Antifungal therapy based on the administration of fluconazole per os at 800mg/day was started allowing clinical improvement. This is the first case of a rhinofacial entomophtharomycosis documented in Bobo-Dioulasso. Rhinofacial entomophthoromycosis is largely unknown, even in tropical regions such as Burkina Faso. This lack of knowledge results in a delay in the diagnosis, and subsequently a bad prognosis. It is therefore urgent to improve knowledge on this disease to guide diagnostic steps, prognosis of outcome, and antifungal therapy.

Secondary rhinoplasty fixations with hyaluronic acid.

The management of nasal deformities especially after rhinoplasty is a challenge. Postsurgical edema may last 6-8 months, causing aesthetic irregularities and nose deformities. The aim of this study is to present the correction of minor nose deformities secondary to rhinoplasty using hyaluronic acid subdermal injections. Eleven patients were treated between 2009 and 2011 with subdermal injections of hyaluronic acid (24 mg/mL) with 0.3% lidocaine (Juvederm, Allergan, Pringy-France) at the 1-month follow-up visit. The volume of hyaluronic acid injected varied from 0.4 to 1 mL according to the deformity. Injections were aimed to correct minor surface irregularities and to provide aesthetic symmetry. These patients were followed for at least 12 months postoperatively. Irregularities were aesthetically corrected immediately after hyaluronic acid injections. No complications were reported with the exception of minor swelling that resolved within 1 week. Esthetic correction was achieved in all patients as determined by the surgeon as well as by overall patient's satisfaction. Our 1-year follow-up data suggest that hyaluronic acid absorption is slow enough to provide the necessary time for postsurgical edema resorption. Rhinoplasty is among the most commonly used procedures for aesthetic improvement in men and women. However, achievement of the final outcome may take several months due to the induced postsurgical edema. Subdermal hyaluronic acid injections can provide temporary correction of these nose irregularities. Our data suggest that subdermal hyaluronic acid injections may provide immediate and long-lasting correction of these minor deformities. As a result, the aesthetic outcome is achieved and maintained throughout the postsurgical course of edema decompression.

[The minimally invasive rhinoplasty with hyaluronic acid and botulinum toxin in a 49-year old woman]. / Maloinwazyjna rynoplastyka z uzyciem kwasu hialuronowego i toksyny botulinowej u 49-letniej kobiety.

A significant component of human appearance and a major aspect of one's profile depend on the shape of the nose. This shape can be distorted by a variety of factors. To date, treatment options reported have included surgical procedures. Recently minimally invasive procedures for aesthetic medicine have become widely popular, and facial soft tissue augmentation is one of the most common procedures. This article presents a simple and effective alternative using hyaluronic acid and botulinum toxin in a 49-year old female patient in nasal recontouring. We think it is a very effective technique with immediate results. It can be employed in those cases where patients are reluctant to undergo a surgery, or as a primary indication of the correction of minor nose defects.

Soft tissue augmentation with ArteFill.

ArteFill is a novel, third-generation polymethylmethacrylate (PMMA) injectable filler with unique properties. When compared with predecessor materials, ArteFill demonstrates improved biocompatibility as a result of more uniform PMMA microsphere size and shape. This translates into less adverse events after placement. ArteFill can provide a permanent volume enhancement by stimulation of fibroblasts that encapsulate nonabsorbable microspheres with collagen deposition. Currently, ArteFill is FDA approved for permanent augmentation of moderately deep nasolabial folds. It is also commonly used off-label for augmentation of other skin creases and regional areas of volume deficiency, such as the tear trough-malar and marionette line-prejowl sulcus regions. The key to success with ArteFill is a conservative approach with avoidance of overcorrection. Proper technique includes deep dermal to subcutaneous placement with full correction achieved gradually over several treatments. Complications are mostly limited to nodule formation, which is easily managed in most cases with conservative intervention.

Medical rhinoplasty with hyaluronic acid and botulinum toxin A: a very simple and quite effective technique.

OBJECTIVE: The management of nasal deformities, and in particular those with "plunging" tip, has always been a typical area of interest in surgery. In the author's experience many of these problems can be successfully approached with a new medical technique, which consists of using only hyaluronic acid for the correction of nasal angles and botulinum toxin for patients with hyperactivity of the depressor septi nasi muscle. The present study aims to illustrate this new technique and evaluates safety and results. MATERIALS AND METHODS: Ninety-five patients were treated between January 2006 and July 2007. The average age of the patients was 42.7 years. In 45% of the cases, botulinum toxin was employed. In all of the cases, the treatment was conducted with hyaluronic acid (24 mg/mL), the same substance used for face rejuvenation. The amount varied from 0.6 to 1.4 mL. RESULTS: Results were evaluated using a definitive graduated score calculated by patient's and doctor's satisfaction score (range, 1-10) and by photographs' score at time 0, after 30 days, and after 180 days. It ranged from 8 to 10 (average of 9.1). No significant side effects were reported. CONCLUSION: The medical rhinoplasty for a "plunging" nose is a simple and very effective technique with immediate results. It can be used in those cases where patients are reluctant to undergo surgery, or as primary indication in the correction of minor nose defects. Results are satisfactory and no side effects have been reported so far. Results will last for a long time.

Lepra nasal: impacto de la multiterapia en la morfología y la fisiología nasal / Nasal leprosy: impact of multitherapy in the morphology and physiology of the nose

Introducción: El protocolo de terapia combinada ha permitido que los enfermos de lepra tratados según esta estrategia alcancen una curación sin secuelas neurotróficas ni deformidades. Objetivos: Determinar el impacto de la multiterapia en el desarrollo de las alteraciones del esqueleto óseo cartilaginoso y en la función respiratoria nasal. Pacientes y método: Estudiamos a 84 sujetos: 38 pacientes tratados con monoterapia, 22 pacientes tratados con multiterapia y 24 sujetos control. Exploramos la morfología nasal mediante rinoscopia anterior y la función respiratoria nasal mediante rinomanometría anterior activa. En el análisis estadístico se ha utilizado el test ANOVA de un factor. Resultados: En el grupo de monoterapia observamos una reabsorción osteocartilaginosa de las estructuras nasales y un aumento de las resistencias nasales. Los pacientes que recibieron multiterapia no presentaron cambios morfológicos significativos y la función respiratoria nasal se mantuvo dentro de la normalidad. Conclusiones: La terapia combinada es eficaz porque previene la aparición de deformidades nasales y la insuficiencia respiratoria nasal

Introduction: The multi-drug therapy protocol has allowed leprosy patients following this strategy to achieve complete recovery without developing neurotrophic sequelae or deformities. Objectives: To assess the impact of multi-drug therapy on the development of nasal deformities and nasal airway patency. Patients and method: In an overall group of 84 patients studied, 38 were treated with a therapy based on a single drug and 22 were treated with multi-drug while 24 subjects formed a control group. Nose morphology was determined by anterior rhinoscopy. Nasal patency and flow resistances were measured by anterior rhinomanometry. The results were compared by using the Anova test for a single variable. Results: The nasal structures in the group with therapy based on a single drug underwent resorption of bone and cartilage in the structures of the nose and increased flow resistance. In the group receiving the multi-drug protocol, there were no significant morphological alterations and nasal patency and flow resistance remained within normal levels. Conclusions: The multi-drug therapy is effective in preventing the development of nasal deformities and maintains normal nasal airflow

Mucocutaneous entomophthoramycosis acquired by conjunctival inoculation of the fungus.

Entomophthoramycoses are classified into subcutaneous, mucocutaneous, and primary visceral forms. The mucocutaneous form, also known as rhinoentomophthoramycosis, involves the mucosa and subcutaneous tissues of the nose and is caused by Conidiobolus coronatus (Entomophthora coronata). In this report, we describe the first case of mucocutaneous entomophthoramycosis acquired by introduction of the fungus through the conjunctival mucosa as a consequence of trauma involving contamination with soil. The patient was a 37-year-old man with no other complaints. The lesion was tumoral and extended into the ethmoidal and maxillary sinuses. The histopathologic appearance of the lesion was characteristic of this infection with a granulomatous process rich in eosinophils and with hyphae surrounded by an eosinophilic, periodic acid-Schiff stain-positive halo (Splendore-Hoeppli phenomenon). To the best of our knowledge, this case constitutes the first report of mucocutaneous entomophthoramycosis acquired by ocular contamination.

Nasal reconstruction using 20 mg/ml cross-linked hyaluronic acid.

According to American Society for Aesthetic Plastic Surgery (ASAPS), 200,924 people had rhinoplasties in 2005. Patients typically have surgical rhinoplasty to correct unsightly noses resulting from trauma, surgery, or heredity. Several alternatives presently exist for patients considering surgical rhinoplasty. These include injections of botulinum toxins to correct the shape of the nasal tip and the use of various fillers to correct contour and profile defects. This article presents a simple and effective alternative using hyaluronic acid for some patients requiring nasal recontouring. The procedure offers patients the opportunity to avoid the risks and expense associated with surgical correction.

[Entomophthoramycosis (zygomycosis) caused by Conidiobolus coronatus in Mato Grosso (Brazil): case report]. / Entomoftoromicose (zigomicose) causada por Conidiobolus coronatus em Mato Grosso (Brasil): relato de caso.

Zygomycosis is a subcutaneous mycosis caused by soil fungi, such as Conidiobolus coronatus. In general, the main clinical manifestation is a chronic rhinofacial tumor. We report the first case of zygomycosis (entomophthoramycosis) caused by Conidiobolus coronatus, occurring in Mato Grosso, West Brazil.

Entomoftoromicose (zigomicose) causada por Conidiobolus coronatus em Mato Grosso (Brasil): relato de caso / Entomophthoramycosis (zygomycosis) caused by Conidiobolus coronatus in Mato Grosso (Brazil): case report

Zigomicoses são micoses subcutâneas causadas por fungos do solo, que geralmente manifestam-se como uma infiltração granulomatosa crônica da submucosa nasal, estendendo-se para o tecido subcutâneo e pele da face. Descreve-se aqui o primeiro caso de zigomicose nasofacial causada pelo Conidiobolus coronatus, ocorrendo em Mato Grosso, Brasil.

Entomophthoramycosis by Conidiobolus coronatus. Report of a case successfully treated with the combination of itraconazole and fluconazole.

Rhinoentomophthoramycosis caused by Conidiobolus coronatus in a 61-year old woman was unsuccessfully treated during 8 years with all the antifungals available in the Brazilian market, including potassium iodide for 1 month, sulfamethoxazole plus trimethoprim for 2 months, amphotericin B, total dose of 1130 mg, cetoconazole, 400 mg/day for 6 months, fluconazole, 200 mg/day, for at least 2 months and, itraconazole, 400 mg/day for 2 months, followed by 200 mg/day for 4 more months. Complete clinical and mycological cure was achieved using itraconazol 400 mg/day in association with fluconazol 200 mg/day during 24 months. After cure she was submitted to plastic surgery to repair her facial deformation. Today she remains clinically and mycologically cured after 59/60 months (5 years!) without any specific antifungal. We thus suggest the use of the combination of itraconazole and fluconazole as an additional option for the treatment of this mycosis.

Rhinophycomycosis.

Rhinophycomycosis, a subcutaneous fungal infection, is less uncommon than many other frequently cited granulomatous lesions of the paranasal sinuses. Four illustrative cases are presented with their characteristic clinical, radiological and histopathological features. The initial origin of the swelling was always in the region of the nasal vestibule and ala. The therapeutic response to potassium iodide, ketaconazole and fluconazole was dramatic and sustained.

New approach to curb the transmission of leprosy

O efeito do tratamento local do nariz de paciente do tipo lepromatoso com diferentes formulaçöes de rifampicina em gotas ou "sprays" nasais, foi investigado em um grande número de pacientes. As preparaçöes foram ou aspergidas ou instiladas dentro das narinas depois de sua limpeza por jato com soluçäo salina normal a 37-C. Observou-se que 10 mg/ml de rifampicina eram eficazes na reduçäo do BI e do MI a zero no nariz em sete dias na maioria dos pacientes. Näo foi visto efeito desagradável em qualquer dos paciente. Sugere-se que "sprays"/gotas nasais possam prevenir a transmissäo da hanseníase, uma vez que o nariz é reconhecido ser uma importante porta de saida de M. leprae. Além disso a deformidade nasal pde ser prevenida quando a rifampicina "sprays"/gotas é usada täo logo o diagnóstico é feito. Acredita-se que o tratamento local juntamente com a terapia sistêmica contribuiriam muito no controle da transmissäo da hanseníase

[Relapsing polychondritis. An infrequent cartilage disease]. / Policondritis recidivante. Cartilagopatia infrecuente.

Report of a case affecting a middle-age woman, 48, involving the E.N.T. area only. The AA comment on the features of the disease and report on the good results with medical treatment (prednisolone, indomethacin and dapsone).