B. Lange, C. Mortz, C. Bindslev‐Jensen, A. Kjeldsen
Background : Approximately 1 to 2% of the general population suffers from nonsteroidal anti-inflammatory drugs (NSAID) hypersensitivity. NSAID hypersensitivity is closely associated with concomitant respiratory disease. Exact knowledge of sino-nasal symptoms among patients with NSAID hypersensitivity is important as patients with NSAID hypersensitivity are at risk of having underdiagnosed, undertreated chronic rhinosinusitis with affected QoL. The aim of this study was to estimate the prevalence of chronic rhinosinusitis in patients with NSAID hypersensitivity and to evaluate QoL and the need of ENT intervention. Methodology : Patients with confirmed NSAID hypersensitivity at the Allergy Centre were referred to the Department of Otorhinolaryngology for evaluation by an ENT specialist. All patients completed the Sino Nasal Outcome test 22 (QoL) and underwent nasal endoscopy and smell test. Results : A total of 46 patients with NSAID hypersensitivity participated in ENT evaluation. Chronic rhinosinusitis was diagnosed in 19 patients. The mean Sino Nasal Outcome test 22 score was 39 in patients with chronic rhinosinusitis and 17 in patients without chronic rhinosinusitis. The sense of smell was decreased in patients with chronic rhinosinusitis. Nasal steroid was indicated in 22 patients. Seven patients had former sinus surgery and 10 patients underwent new sinus or nasal surgery. Conclusion : With a prevalence of 41% more than one third of patients with NSAID hypersensitivity have chronic rhinosinusitis with decreased QoL. In patients with sino-nasal problems medical and surgical advice and treatment is important. It is recommended that patients with NSAID hypersensitivity are screened for sino-nasal symptoms and referred for ENT evaluation.
{"title":"Nasal symptoms in patients with NSAID hypersensitivity","authors":"B. Lange, C. Mortz, C. Bindslev‐Jensen, A. Kjeldsen","doi":"10.4193/RHINOL/19.009","DOIUrl":"https://doi.org/10.4193/RHINOL/19.009","url":null,"abstract":"Background : Approximately 1 to 2% of the general population suffers from nonsteroidal anti-inflammatory drugs (NSAID) hypersensitivity. NSAID hypersensitivity is closely associated with concomitant respiratory disease. Exact knowledge of sino-nasal symptoms among patients with NSAID hypersensitivity is important as patients with NSAID hypersensitivity are at risk of having underdiagnosed, undertreated chronic rhinosinusitis with affected QoL. The aim of this study was to estimate the prevalence of chronic rhinosinusitis in patients with NSAID hypersensitivity and to evaluate QoL and the need of ENT intervention. Methodology : Patients with confirmed NSAID hypersensitivity at the Allergy Centre were referred to the Department of Otorhinolaryngology for evaluation by an ENT specialist. All patients completed the Sino Nasal Outcome test 22 (QoL) and underwent nasal endoscopy and smell test. Results : A total of 46 patients with NSAID hypersensitivity participated in ENT evaluation. Chronic rhinosinusitis was diagnosed in 19 patients. The mean Sino Nasal Outcome test 22 score was 39 in patients with chronic rhinosinusitis and 17 in patients without chronic rhinosinusitis. The sense of smell was decreased in patients with chronic rhinosinusitis. Nasal steroid was indicated in 22 patients. Seven patients had former sinus surgery and 10 patients underwent new sinus or nasal surgery. Conclusion : With a prevalence of 41% more than one third of patients with NSAID hypersensitivity have chronic rhinosinusitis with decreased QoL. In patients with sino-nasal problems medical and surgical advice and treatment is important. It is recommended that patients with NSAID hypersensitivity are screened for sino-nasal symptoms and referred for ENT evaluation.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49419776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Lux, R. Douglas, D. Cho, Michael W Taylor, K. Biswas
Chronic rhinosinusitis (CRS) is a morbid condition of the paranasal sinuses which severely impairs patients’ quality of life. CRS represents one of the leading diseases that are responsible for antibiotic prescriptions. However, there is little evidence to support the efficacy of antibiotics in CRS. Due to the highly heterogeneous nature of CRS determining the underlying etiology is challenging. The mucosal microbiome has been hypothesised to play a role in the pathophysiology of CRS. Several attempts to establish a representative model of CRS have been made to help determine the pathogenesis of this condition. This review summarises the current literature on model systems for inflammatory sinus disease. Fourteen different studies are discussed, including mouse, rabbit and sheep as model organisms. A detailed description of the methods for model development and examples for their application are provided. Focus is put on animal models that should be suitable for studying the sinonasal microbiome in CRS. To date, only two studies sought to employ their model for microbiome analysis. Other models are included for which there is currently no microbiome information, however they are of potential use in this regard and we thus discuss their suitability. This review identifies a need for further employment of animal models of CRS for microbiome research. Recently, a rabbit model of CRS featuring several qualities that make it particularly suitable for microbiological research has been described. This model system represents a further advance of translational research in the field of CRS.
{"title":"Animal models for inflammatory mucosal disease and their potential for studying the microbiome in chronic rhinosinusitis","authors":"C. Lux, R. Douglas, D. Cho, Michael W Taylor, K. Biswas","doi":"10.4193/RHINOL/19.015","DOIUrl":"https://doi.org/10.4193/RHINOL/19.015","url":null,"abstract":"Chronic rhinosinusitis (CRS) is a morbid condition of the paranasal sinuses which severely impairs patients’ quality of life. CRS represents one of the leading diseases that are responsible for antibiotic prescriptions. However, there is little evidence to support the efficacy of antibiotics in CRS. Due to the highly heterogeneous nature of CRS determining the underlying etiology is challenging. The mucosal microbiome has been hypothesised to play a role in the pathophysiology of CRS. Several attempts to establish a representative model of CRS have been made to help determine the pathogenesis of this condition. This review summarises the current literature on model systems for inflammatory sinus disease. Fourteen different studies are discussed, including mouse, rabbit and sheep as model organisms. A detailed description of the methods for model development and examples for their application are provided. Focus is put on animal models that should be suitable for studying the sinonasal microbiome in CRS. To date, only two studies sought to employ their model for microbiome analysis. Other models are included for which there is currently no microbiome information, however they are of potential use in this regard and we thus discuss their suitability. This review identifies a need for further employment of animal models of CRS for microbiome research. Recently, a rabbit model of CRS featuring several qualities that make it particularly suitable for microbiological research has been described. This model system represents a further advance of translational research in the field of CRS.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45849881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. A. Moene, M. Hauge, J. Silvola, G. Bachmann-Harildstad
Background: Posterior epistaxis is often treated with nasal packing by balloon compression or gauzes, and in refractory cases, with ligation of the sphenopalatine artery. These methods are painful, require admission and imply a substantial risk of complications. It has been shown that hot water irrigation is effective to stop bleeding. However, the hot water procedure is associated with patient discomfort, and temperatures over 520C may cause tissue necrosis. The use of nasal balloons filled with hot water may potentially be equally effective and cause less discomfort, but has not yet been studied. The aim of this study was to determine the surface temperature of nasal balloons when filled with hot water. Methodology: An in vitro study was performed to determine surface temperature of Epistat® and Rapid Rhino® nasal balloons when filled with water at different temperatures. Results: There was a strong correlation between inserted water temperature and maximum temperature at Epistat® balloon surface. Maximum surface temperature occurred during the first 30 seconds after water insertion and there was a rapid temperature decline irrespective of inserted water temperature. There was a similar correlation for Rapid Rhino®. However, surface temperatures were in general lower, maintained for a longer period and the peak temperature occurred later. Conclusions: Hot water inflation in nasal balloons seems to be feasible and is unlikely to cause tissue necrosis with inserted water temperatures of 600C or less.
{"title":"In vitro surface temperature of nasal balloons during hot water inflation","authors":"C. A. Moene, M. Hauge, J. Silvola, G. Bachmann-Harildstad","doi":"10.4193/rhinol/19.012","DOIUrl":"https://doi.org/10.4193/rhinol/19.012","url":null,"abstract":"Background: Posterior epistaxis is often treated with nasal packing by balloon compression or gauzes, and in refractory cases, with ligation of the sphenopalatine artery. These methods are painful, require admission and imply a substantial risk of complications. It has been shown that hot water irrigation is effective to stop bleeding. However, the hot water procedure is associated with patient discomfort, and temperatures over 520C may cause tissue necrosis. The use of nasal balloons filled with hot water may potentially be equally effective and cause less discomfort, but has not yet been studied. The aim of this study was to determine the surface temperature of nasal balloons when filled with hot water. Methodology: An in vitro study was performed to determine surface temperature of Epistat® and Rapid Rhino® nasal balloons when filled with water at different temperatures. Results: There was a strong correlation between inserted water temperature and maximum temperature at Epistat® balloon surface. Maximum surface temperature occurred during the first 30 seconds after water insertion and there was a rapid temperature decline irrespective of inserted water temperature. There was a similar correlation for Rapid Rhino®. However, surface temperatures were in general lower, maintained for a longer period and the peak temperature occurred later. Conclusions: Hot water inflation in nasal balloons seems to be feasible and is unlikely to cause tissue necrosis with inserted water temperatures of 600C or less.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43723269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The nasal valve area is the narrowest region of the entire upper airway. Numerous procedures and spreader devices are published to widen the nasal valve or to stabilize it, but the indications are based only on the surgeon’s experience. Methods: In 30 healthy volunteers the deflection of elastic steel elements touching the lower nasal side at its deepest point was precisely measured by means of strain gauges. The deflection was calibrated by standard calibration devices. A special 4-phaserhinomanometer (4RHINO/ Rhinolab/Germany) with a protective face mask allowed simultaneous measurements of the airflow and differential pressure. All signals were recorded simultaneously on both sides. The measurements have been carried out as unilateral measurements according to anterior rhinomanometry. Results: Surprisingly the lateral nasal wall is already moving during quiet breathing. The airflow and its acceleration as well as the pressure difference generating a complete closure of the nose can be determined and has expectedly a high variance between individuals. Conclusions: The elastography confirms the loops in 4-phase-rhinomanometry as symptomatic for the nasal valve elongation and will after developing as medical product allow the systematic quantitative measurement of the influence of the nasal valve on the nasal air stream.
{"title":"Nasal valve elastography: quantitative determination of the mobility of the nasal valve","authors":"L. Akmenkalne, M. Prill, K. Vogt","doi":"10.4193/RHINOL/18.086","DOIUrl":"https://doi.org/10.4193/RHINOL/18.086","url":null,"abstract":"Background: The nasal valve area is the narrowest region of the entire upper airway. Numerous procedures and spreader devices are published to widen the nasal valve or to stabilize it, but the indications are based only on the surgeon’s experience. Methods: In 30 healthy volunteers the deflection of elastic steel elements touching the lower nasal side at its deepest point was precisely measured by means of strain gauges. The deflection was calibrated by standard calibration devices. A special 4-phaserhinomanometer (4RHINO/ Rhinolab/Germany) with a protective face mask allowed simultaneous measurements of the airflow and differential pressure. All signals were recorded simultaneously on both sides. The measurements have been carried out as unilateral measurements according to anterior rhinomanometry. Results: Surprisingly the lateral nasal wall is already moving during quiet breathing. The airflow and its acceleration as well as the pressure difference generating a complete closure of the nose can be determined and has expectedly a high variance between individuals. Conclusions: The elastography confirms the loops in 4-phase-rhinomanometry as symptomatic for the nasal valve elongation and will after developing as medical product allow the systematic quantitative measurement of the influence of the nasal valve on the nasal air stream.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41379092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Thunberg, S. Hugosson, H. Fredlund, Y. Cao, R. Ehricht, S. Monecke, E. Müller, S. Engelmann, B. Söderquist
{"title":"Anti-Staphylococcal humoral immune response in patients with chronic rhinosinusitis","authors":"U. Thunberg, S. Hugosson, H. Fredlund, Y. Cao, R. Ehricht, S. Monecke, E. Müller, S. Engelmann, B. Söderquist","doi":"10.4193/rhinol/19.002","DOIUrl":"https://doi.org/10.4193/rhinol/19.002","url":null,"abstract":"","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44429506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Katle, J. Hatlebakk, R. Omdal, J. Kvaløy, S. Steinsvåg
Background: Gastro-esophageal reflux (GER) may be a contributing factor for some patients with chronic rhinosinusitis (CRS). The aim of the present study was to investigate if Peptest, an immunoassay for pepsin detection, could be used as a biomarker for GER in CRS. Methodology: Peptest was used to analyse 3 saliva and 3 nasal samples for pepsin A in 62 CRS-patients and 62 age and gender matched healthy controls. The results were correlated to 24-hour impedance pH-monitoring and symptom questionnaires. Results: Patients with CRS did not have more abnormal Peptest measures compared to healthy controls, 39 patients and 48 controls, respectively. The presence of abnormal Peptests did not correlate to proximal reflux in CRS-patients. Patients with high GerdQ scores did not have more positive Peptests than those without. Conclusions: These results question the value of Peptest as screening tool for GER in CRS.
{"title":"Nasal and salivary pepsin as a biomarker for gastroesophageal reflux in chronic rhinosinusitis","authors":"E. Katle, J. Hatlebakk, R. Omdal, J. Kvaløy, S. Steinsvåg","doi":"10.4193/RHINOL/19.003","DOIUrl":"https://doi.org/10.4193/RHINOL/19.003","url":null,"abstract":"Background: Gastro-esophageal reflux (GER) may be a contributing factor for some patients with chronic rhinosinusitis (CRS). The aim of the present study was to investigate if Peptest, an immunoassay for pepsin detection, could be used as a biomarker for GER in CRS. Methodology: Peptest was used to analyse 3 saliva and 3 nasal samples for pepsin A in 62 CRS-patients and 62 age and gender matched healthy controls. The results were correlated to 24-hour impedance pH-monitoring and symptom questionnaires. Results: Patients with CRS did not have more abnormal Peptest measures compared to healthy controls, 39 patients and 48 controls, respectively. The presence of abnormal Peptests did not correlate to proximal reflux in CRS-patients. Patients with high GerdQ scores did not have more positive Peptests than those without. Conclusions: These results question the value of Peptest as screening tool for GER in CRS.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44160332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Zinreich, H. Stammberger, W. Bolger, M. Solaiyappan, M. Ishii
Objective: Our objective is to show how the use of Computer Tomography (CT) multiplanar displays (MPR) and 3D Stereoscopic Imaging (3DSI), can provide precise anatomical landmarks to identify the location of the Anterior Ethmoid Artery (AEA) during endoscopic sinus surgery (FESS). Materials and Methods: The study comprised 48 patients, representing 96 nasal cavity/sinus sides. The anterior ethmoid foramen was the landmark that defined the entry of the AEA into the ethmoid on CT MPR and 3DSI, and anatomic relationships closely related to to the AEA were recorded. Results: The anterior ethmoidal foramen (AEF) was associated with the bulla lamella (BL) in 46.9% of cases, and the basal lamella of the middle turbinate (BLMT) in 31.6%. In 7.1% of cases, the AEF was associated with both lamellae. Similarly, at the AES, the AEF was associated with the BL and BLMT in 72.5% and 46.9% of cases, respectively. In 29.6%, the AEA was associated with both lamellae. In 48%, the AEF and AES were at or in the bone of the ethmoidal roof/ skull base. In 48%, the AEA, the AEF, and the AES were in the same coronal plane, indicating a straight horizontal course across the ethmoid. In the remaining samples, the AES was anterior to the AEF, indicating an oblique course of the AEA. Conclusion: This study demonstrates that 3DSI imaging provides improved localization of the AEA, and establishes recognizable anatomic landmarks for endoscopically guided surgery, thus, preventing inadvertent complications.
{"title":"Advanced CT imaging demonstrating the bulla lamella and the basal lamella of the middle turbinate as endoscopic landmarks for the anterior ethmoid artery","authors":"S. Zinreich, H. Stammberger, W. Bolger, M. Solaiyappan, M. Ishii","doi":"10.4193/RHINOL/18.082","DOIUrl":"https://doi.org/10.4193/RHINOL/18.082","url":null,"abstract":"Objective: Our objective is to show how the use of Computer Tomography (CT) multiplanar displays (MPR) and 3D Stereoscopic Imaging (3DSI), can provide precise anatomical landmarks to identify the location of the Anterior Ethmoid Artery (AEA) during endoscopic sinus surgery (FESS). Materials and Methods: The study comprised 48 patients, representing 96 nasal cavity/sinus sides. The anterior ethmoid foramen was the landmark that defined the entry of the AEA into the ethmoid on CT MPR and 3DSI, and anatomic relationships closely related to to the AEA were recorded. Results: The anterior ethmoidal foramen (AEF) was associated with the bulla lamella (BL) in 46.9% of cases, and the basal lamella of the middle turbinate (BLMT) in 31.6%. In 7.1% of cases, the AEF was associated with both lamellae. Similarly, at the AES, the AEF was associated with the BL and BLMT in 72.5% and 46.9% of cases, respectively. In 29.6%, the AEA was associated with both lamellae. In 48%, the AEF and AES were at or in the bone of the ethmoidal roof/ skull base. In 48%, the AEA, the AEF, and the AES were in the same coronal plane, indicating a straight horizontal course across the ethmoid. In the remaining samples, the AES was anterior to the AEF, indicating an oblique course of the AEA. Conclusion: This study demonstrates that 3DSI imaging provides improved localization of the AEA, and establishes recognizable anatomic landmarks for endoscopically guided surgery, thus, preventing inadvertent complications.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46697032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cameron P Worden, Carly A. Clark, A. Senior, R. Schlosser, A. Kimple, B. Senior
Background The microdebrider has become nearly universal in the treatment of sinonasal pathology; however, recent case reports have demonstrated the potential for major ophthalmic complications. The goal of this study was twofold: 1) determine the anatomical proximity of ophthalmic structures to the paranasal sinuses, and 2) assess the timeframe at which ophthalmic injury may occur with the use of a microdebrider during FESS utilizing a cadaveric model. Methodology/Principal Computed tomography scans from 50 patients were accessed retrospectively. The distances between the lamina papyracea (LP) and orbital structures were determined at varying depths. Seven cadavers (14 sides) were studied using three microdebrider systems operated by otolaryngology residents. Following removal of a window of LP, the time from activation of the microdebrider on the periorbita until transection of the medial rectus (MR), optic nerve (ON), and to aspiration of the globe were measured. Results The mean distance between the LP and MR at the level of the anterior aspect of the anterior ethmoid and basal lamella were 3.59 ±1.2mm and 1.5 ±0.8mm, respectively. The mean distance between the LP and ON at the level of the basal lamella was 8.1 ±2.1mm. Mean transection times for the MR and ON were 13.4 ± 7.3 seconds and 37.3 ± 9.2 seconds, respectively, with minimum times of 4 seconds and 26 seconds. Conclusions The proximity of orbital structures to the paranasal sinuses and the rapidity of ophthalmic damage following violation of the periorbita reaffirms the need for cautious use of the microdebrider during FESS.
{"title":"Modeling Microdebrider-Mediated Ophthalmic Damage: A Word of Caution in Endoscopic Sinus Surgery.","authors":"Cameron P Worden, Carly A. Clark, A. Senior, R. Schlosser, A. Kimple, B. Senior","doi":"10.4193/RHINOL/19.004","DOIUrl":"https://doi.org/10.4193/RHINOL/19.004","url":null,"abstract":"Background\u0000The microdebrider has become nearly universal in the treatment of sinonasal pathology; however, recent case reports have demonstrated the potential for major ophthalmic complications. The goal of this study was twofold: 1) determine the anatomical proximity of ophthalmic structures to the paranasal sinuses, and 2) assess the timeframe at which ophthalmic injury may occur with the use of a microdebrider during FESS utilizing a cadaveric model.\u0000\u0000\u0000Methodology/Principal\u0000Computed tomography scans from 50 patients were accessed retrospectively. The distances between the lamina papyracea (LP) and orbital structures were determined at varying depths. Seven cadavers (14 sides) were studied using three microdebrider systems operated by otolaryngology residents. Following removal of a window of LP, the time from activation of the microdebrider on the periorbita until transection of the medial rectus (MR), optic nerve (ON), and to aspiration of the globe were measured.\u0000\u0000\u0000Results\u0000The mean distance between the LP and MR at the level of the anterior aspect of the anterior ethmoid and basal lamella were 3.59 ±1.2mm and 1.5 ±0.8mm, respectively. The mean distance between the LP and ON at the level of the basal lamella was 8.1 ±2.1mm. Mean transection times for the MR and ON were 13.4 ± 7.3 seconds and 37.3 ± 9.2 seconds, respectively, with minimum times of 4 seconds and 26 seconds.\u0000\u0000\u0000Conclusions\u0000The proximity of orbital structures to the paranasal sinuses and the rapidity of ophthalmic damage following violation of the periorbita reaffirms the need for cautious use of the microdebrider during FESS.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":"2 1","pages":"44-49"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41646427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Santamaría-Gadea, G. Santos, I. Cobeta, S. Dominguez-Carames, F. Mariño‐Sánchez
Background: Nasal dermoid sinus cysts (NDSC) are infrequent congenital midline lesions. Complete removal is the treatment of choice. When there is intracranial involvement, the traditional surgical approach requires a bicoronal flap and frontal craniotomy. Case report: A 17-year-old male presented with a midline nasal dorsum mass. The radiological exams revealed a cystic lesion within nasal dorsum with intracranial extension through a patent foramen caecum into a bifid crista galli. Total macroscopic resection was performed through an endoscopic-assisted open rhinoplasty approach. The patient remains asymptomatic and free of recurrence after 20 months follow-up. Conclusion: This case demonstrates the feasibility of an endoscopic-assisted open rhinoplasty approach for successful resection of NDSC, avoiding a frontal craniotomy and the significant morbidity associated herewith.
{"title":"Resection of intracranial nasal dermoid sinus cyst by endoscopic-assisted open rhinoplasty approach","authors":"A. Santamaría-Gadea, G. Santos, I. Cobeta, S. Dominguez-Carames, F. Mariño‐Sánchez","doi":"10.4193/RHINOL/19.005","DOIUrl":"https://doi.org/10.4193/RHINOL/19.005","url":null,"abstract":"Background: Nasal dermoid sinus cysts (NDSC) are infrequent congenital midline lesions. Complete removal is the treatment of choice. When there is intracranial involvement, the traditional surgical approach requires a bicoronal flap and frontal craniotomy. Case report: A 17-year-old male presented with a midline nasal dorsum mass. The radiological exams revealed a cystic lesion within nasal dorsum with intracranial extension through a patent foramen caecum into a bifid crista galli. Total macroscopic resection was performed through an endoscopic-assisted open rhinoplasty approach. The patient remains asymptomatic and free of recurrence after 20 months follow-up. Conclusion: This case demonstrates the feasibility of an endoscopic-assisted open rhinoplasty approach for successful resection of NDSC, avoiding a frontal craniotomy and the significant morbidity associated herewith.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41616637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Common cocaine cutting agent Levamisole is known to cause agranulocytosis. However, a lesser known public health issue is levamisole-induced granulomatosis with polyangiitis. This case series explores this link. Methods and Results: A three case-series report with findings confirmed through clinical history, examination, biopsy and urine toxicology screens. Conclusions: Our case-series highlights a possible link between levamisole and extensive necrosis of the nasal cavity; caused by polyangiitis with granuloma formation and secondary vasculitis. A high degree of suspicion is needed if young patients present with ANCA positive vasculitis, or in patients with cocaine use, if there is a disproportionate destruction of tissuesparticularly the lateral wall of the nose. If diagnosed and treated early, this can be lifesaving.
{"title":"Cocaine contaminant Levamisole-induced polyangiitis and necrosis of the nasal cavity – a Scottish case series","authors":"D. Andrew, R. Scott, A. Kochman, N. Balaji","doi":"10.4193/rhinol/18.069","DOIUrl":"https://doi.org/10.4193/rhinol/18.069","url":null,"abstract":"Background: Common cocaine cutting agent Levamisole is known to cause agranulocytosis. However, a lesser known public health issue is levamisole-induced granulomatosis with polyangiitis. This case series explores this link. Methods and Results: A three case-series report with findings confirmed through clinical history, examination, biopsy and urine toxicology screens. Conclusions: Our case-series highlights a possible link between levamisole and extensive necrosis of the nasal cavity; caused by polyangiitis with granuloma formation and secondary vasculitis. A high degree of suspicion is needed if young patients present with ANCA positive vasculitis, or in patients with cocaine use, if there is a disproportionate destruction of tissuesparticularly the lateral wall of the nose. If diagnosed and treated early, this can be lifesaving.","PeriodicalId":74737,"journal":{"name":"Rhinology online","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44710712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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