[Clinical analysis of orbital apex syndrome caused by sinus diseases]

OBJECTIVE

To investigate the clinical characters and therapeutic methods of orbital apex syndrome caused by sinus diseases.

METHOD

Six cases of orbital apex syndrome originated from sinus diseases were retrospective analyzed in our hospital from August 2003 to February 2009. Different therapeutic methods were taken according to different causes of disease.

RESULT

Four cases of sinus infection,one cases of sphenoethmoidal mucocele, one cases of sinus squamous cell carcinoma. The results of patients with orbital apex syndrome included cure and effectiveness in 2 cases respectively, death from myocardial infarction in one case, and one case is still following up.

CONCLUSION

Orbital apex syndrome originated from sinus diseases was rare, which was mainly caused by sinus infection. The key point is the correct etiology diagnosis in early phase. Treatment with endoscopic sinus surgery early is a good effective method for orbital apex syndrome caused by sinus diseases, in the same time with enough dosage of antibiotic and glucocorticoid therapy intravenously.

[The role of active rhinomanometry in the surgical treatment of nasal deformation with concomitant endonasal pathology]

This work was designed to substantiate the necessity of application of active rhinomanometry in rhinoplastic surgery bearing in mind that evaluation of the efficiency of surgical treatment requires the use of such objective methods as the rhinomanometric technique. The authors maintain that it may be helpful not only for the purpose of clinical research but also in practical otorhinolaryngological surgery providing an opportunity to collect objective information for the development of indications for the choice and extent of surgical intervention and the assessment of its outcome. Moreover, under present-day conditions, rhinomanometric measurements may be included in the legal basis on which the results of surgery are estimated if appropriate. The method under consideration serves as a diagnostic standard generally accepted worldwide.

Congenital nasal pyriform aperture stenosis: clinical and radiologic findings and treatment

Congenital nasal pyriform aperture stenosis (CNPAS) is an unusual cause of airway obstruction in the newborn and infants. Immediate recognition and therapy are essential for this potentially life-threatening circumstance. CNPAS should be considered in the differential diagnosis of any infant with episodic apnea, cyclical cyanosis, and feeding difficulty. Computerized tomographic (CT) measurements and imaging features enable accurate diagnosis of this abnormality. In this report we demonstrated CT examination findings of CNPAS in a neonate.

Frontal mucocoele secondary to nasal polyposis: an unusual complication

The incidence of mucocoeles associated with a non-surgically treated nasal polyposis is rare. We report a rare case of nasal polyposis with asymptomatic frontal mucocoeles in a 28-year-old Malay man who presented with bilateral nasal obstruction with anosmia. Physical examination revealed bilateral grade III nasal polyps causing obstruction. Computed tomography revealed paranasal polyposis with a large polyp extending and expanding the posterior table of the frontal sinus causing erosion and thinning of its wall. Marsupialisation of the mucocoele and nasal polypectomy were done. Endoscopic sinus surgery and marsupialisation should be the treatment of choice for asymptomatic frontal mucocoele.

Rhinolithiasis: the importance of flat panel detector-based cone beam computed tomography in diagnosis and treatment

Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity. A nidus may be endogenous or exogenous. Rhinoliths are uncommon and often an asymptomatic condition diagnosed accidentally during a routine examination; but sometimes they may cause complications such as unilateral nasal obstruction, fetid rhinorrhea, or epistaxis. This article describes a case of rhinolith involving a 21-year-old female. The flat panel detector-based cone beam computed tomography (FPD-CBCT) findings, differential diagnosis, and treatment in a case of rhinolith are presented.

[Analysis of the causes of pediatric rhino-source diseases]

OBJECTIVE

To analyze clinical features of pediatric rhino-source diseases for reducing missed diagnosis and misdiagnosis.

METHOD

Data of 3588 children with rhino-source diseases seen from April 2005 to May 2006 were retrospectively analyzed in this study in order to disclose the relationship of etiological factor, clinical features and diagnosis.

RESULT

Among all these cases, 2090 complained of nasal discomfort including nasal obstruction, discharge, rhinalgia and epistaxis. However 1498 cases (41.76%) did not, of whom 470 cases had snoring and apnea, 332 cases of otalgia and otorrhea, 145 cases had chronic cough, 138 had headache and 92 had lower respiratory infection.

CONCLUSION

A high percentage of children who suffered from pediatric rhino-source disease did not develop nasal symptoms. Pediatric rhino-source disease should be considered for patients in whom the therapeutic effect is unexpectedly poor.

Three spontaneous occurrences of nasal septal abscess in patients with chronic asymptomatic HIV-the need for early intervention and reconstruction

We identified 3 patients with chronic, asymptomatic HIV who presented between 2001 and 2005 with spontaneous nasal septal abscesses in the absence of previous trauma, nasal surgery, sinusitis, infection, or immunodeficiency. A MEDLINE search revealed no other cases of spontaneous isolated nasal septal abscesses. Each of our patients presented to the emergency department with complaints of fever and headaches; 2 of them also had nasal obstruction, nasal and lip swelling, and pain. Clinical examinations and imaging studies revealed isolated anterior nasal septal abscesses. In each case, incision and drainage was performed immediately, and antibiotics started. One patient had an early loss of septal cartilage and nasal support, which developed into a crooked and saddle-nose deformity requiring reconstruction 7 months later. Staphylococcus aureus was identified in all 3 cases. To the best of our knowledge, these are the only 3 cases of spontaneous isolated nasal septal abscess reported in the literature. We discuss the importance of early diagnosis and intervention, as well as reconstructive techniques.

[Diagnostic values of the clinical characteristics of chronic cough]

OBJECTIVE

To evaluate whether the clinical characteristics of chronic cough were helpful in determining its specific causes.

METHODS

Patients with chronic cough were evaluated by a validated systematic diagnostic protocol. The patients with identified single cause were divided into 4 groups accordingly: cough-variant asthma (CVA), upper airway cough syndrome (UACS) or post-nasal drip syndrome (PNDS), eosinophilic bronchitis (EB), gastroesophageal reflux related cough (GERC), and the characteristics of the timing, character, onset and associated manifestations of chronic cough in different causes were compared.

RESULTS

A total of 196 patients met the inclusion criteria, including 55 with EB, 45 with UACS, 50 with CVA and 46 with GERC. No significant difference was found in age, gender and course among EB, UACS, CVA and GERC. The incidence of nocturnal cough in CVA was 26.0% (13/44), significantly higher than in EB (9.1% (5/55), chi2 = 5.272, P<0.05), UACS (2.2% (1/45), chi2 = 10.657, P<0.01) and GERC (0% (0/46), chi2 = 13.833, P<0.01). The specificity of nocturnal cough for CVA was 95.9%. The sensitivity and specificity of cough associated with meals in GERC was 52.2% (24/46) and 83.3%, and regurgitation associated symptom in GERC were 69.6% (32/46) and 80.0%, which were significantly higher than other groups. The incidence of postnasal drip, rhinitis associated symptom and case history of nasal diseases in UACS were 66.7% (30/45), 88.9% (40/45) and 82.2% (37/45), and the specificity of them were 89.4%, 65.6% and 63.6% respectively.

CONCLUSION

The timing character and some associated symptoms of chronic cough are useful in predicting a single cause.

Bilateral nasolabial cysts: a case report

The nasolabial cyst is one of the rarer soft tissue cysts, and presents beneath the alae of the nose. There have been few reports of an association between nasolabial cysts and dacryocystitis (an infection of the nasolacrimal sac). This case report describes a female who presented with bilateral nasolabial cysts and longstanding symptoms of epiphora (watery eye).

Patient reported outcome measures in rhinology

Patient rated outcome measures (PROMs) are increasingly being used to supplement clinical measures of disease in order to assess how disease and medical intervention impacts on quality of life. As the primary aim of treatment for most rhinological conditions is to improve quality of life they have particular relevance in our sub-specialty. Some PROMs have been developed for particular conditions or treatments (disease-specific measures) while others were developed to be used in all patient groups or healthy individuals (generic measures). There are an increasing number of both disease-specific and global measures available for use in rhinological conditions, and they are reviewed. Both factors limiting wide scale adoption of PROMs into routine practice, and limitations of PROMs are also discussed.

[Peculiarities of surgical technique for the treatment of rhinogenic abscesses of the frontal cerebral lobe]

Peculiar features of the clinical picture of rhinogenic abscesses of the frontal cerebral lobe (RAFCL) were studied for the purpose of optimization of medical and diagnostic measures intended for the early detection of this severe disease. Causes and pathways of infection penetrating in the cranial cavity and possibilities of RAFCL diagnosis were thoroughly analysed in 4 patients with the help of computerized tomography (CT), in 1 patients by brain ultrasound study (BUS) during osteoplastic trepanation (OPT), and in 9 patients using neurologic diagnostic tools. A total of 14 patients were given treatment for RAFCL; one of them died. The study has demonstrated the possibility to use BUS in situations where CT is unfeasible. The method proposed by V.I. Morokhoev [9] was employed that comprises an algorithm for the search, opening, and drainage of RAFCL along with adequate combined therapy by means of simultaneous catheterization of the temporal artery at the site of RAFCL localization. Opening of RAFCL through the frontal sinus was shown to be less traumatic than OPT indications for which are currently limited. It is emphasized that the mechanism of cooperation between otorhinolaryngologists and neurosurgeons in this country needs to be further improved.

A case of rhino-orbital cerebral mucormycosis with diabetic keto-acidosis

A 60-year-old lady was admitted in the hospital with the complaints of burning sensation during micturition and abdominal pain. She was diagnosed to have moderate hydronephrosis with left lower 1/3rd ureteric calculus for which ureteroscopy and lithotripsy were done. Her pre-operative random blood sugar was normal. On the 7th postoperative day the patient developed diabetic keto-acidosis which was followed by an acute onset of right sided peri-orbital oedema, proptosis and facial pain. Subsequently she developed diminished vision and lower motor neurone type of Ill, IV and VI cranial nerves paralysis on right side, disorientation and minimal left sided hemiparesis. ENT examination revealed black eschar nasal turbinates, nasal septum and palate and a provisional diagnosis of rhino-orbital cerebral mucormycosis was made. Extensive debridement was done for the patient and the specimen culture showed growth of mucor species. Patient was started on intravenous amphotericin-B and she started improving dramatically. This case of rhino-orbital cerebral mucormycosis with diabetic keto-acidois is presented here for its rarity.

Supernumerary nostrils together with oesophageal atresia and patent ductus arteriosus

Supernumerary nostril is an extremely rare congenital anomaly. It can be unilateral or bilateral and it sometimes occurs in association with other congenital abnormalities. We describe a newborn infant with bilateral supernumerary nostrils together with oesophageal atresia and patent ductus arteriosus, an association that has not been reported previously in the literature.

Clinical features of epistaxis in dogs: a retrospective study of 35 cases (1999-2002)

Epistaxis was retrospectively evaluated in 35 dogs. Systemic disease was diagnosed in seven dogs and intranasal disease in 29. Nineteen dogs with intranasal disease had neoplasia. Dogs with neoplasia were older (mean 10.0 years) than dogs with nonneoplastic intranasal disease (mean 5.6 years). Signs persisting for >1 month occurred more often in dogs with intranasal than systemic disease. Unilateral epistaxis did not distinguish intranasal from systemic disease. Only dogs with intranasal disease had facial deformity, decreased airflow, or regional sub-mandibular lymphadenopathy. Dogs with systemic disease had a lower packed cell volume (mean 31.8%) than dogs with intranasal disease (mean 42.7%).

Bone reconstruction of the maxillary alveolus for subsequent insertion of a dental implant in patients with cleft lip and palate

Bone grafting of maxillary alveolus cleft defect followed by insertion of dental implant may be a good alternative to conventional prosthetic treatment. The principle is the formation of stable alveolar crest with a sufficient three-dimensional volume. The problems are lack and quality of mucoperiosteum for the reconstruction of shell and bone gap characteristics for bone graft intake. The procedure was carried out by a single surgeon (MD) in 45 patients between 29 August 2001 and 30 June 2006, with an 86.7% success rate. The success was defined as completed process with dental implant insertion and its loading by a prosthetic suprastructure without a failure for at least 15 months from that last step. The success rate mainly depends on 1) good alveolar arch flow of maxilla segments in both horizontal and vertical planes; 2) the height of osseous poles of at least 12 mm and onlay augmentation of built-up section does not work; 3) adequate volume of cancellous bone graft, 3.7 cm on average. On the basis of histologic verification and clinical findings, the bone graft is matured enough to ensure a primary stability of a fixture in 12.5 weeks after reconstruction. Early load may prevent bone resorption. Prediction of complications are as follows: 1) graft resorption increases according to gap size and low possibility of revascularization; 2) a higher number of complications are linked to presence of oronasal fistula and to scarring of soft tissues; 3) because of more gracile skeleton and female metabolism, the risk is higher in women.

Multifocal tuberculosis of the nose and lymph nodes without pulmonary involvement: a case report

Tuberculosis of the nose is very rare. When it does occur, it almost always arises secondary to primary pulmonary tuberculosis. Nasal tuberculosis is most common in women older than 20 years. We report the case of a 16-year-old girl who presented with epistaxis, fever, submental swelling, and enlargement of multiple cervical and axillary lymph nodes. The patient was diagnosed with tuberculous granuloma of the nose and tuberculous lymphadenopathy. She was successfully treated with a 6-month regimen of standard antituberculous therapy.

[A clinical study on obstructive sleep apnea hypopnea syndrome treating by nasal operation]

OBJECTIVE

To study the treatment of OSAHS with nasal diseases by nasal operation.

METHOD

Ninety four cases of OSAHS with nasal diseases were analyzed. The patients were operated on nasal cavity to improve ventilation included Septectomy, CPS for inferior turbinate and FESS. The patients were examined by PSG at 2 months and 1 year after operation. All patients were followed up one year.

RESULT

Among 94 cases, 19 cases had efficient result after nasal operation and had no recurrence one year after operation. The efficient rate was 20. 21% (19/94). These patients were mild degree and I type. The other 75 cases had invalid result.

CONCLUSION

The patients of OSAHS with nasal diseases, especially mild degree and I type one should be undertaken nasal operation.

The role of accompanying sinonasal abnormalities in the outcome of endonasal dacryocystorhinostomy

BACKGROUND

Acquired nasolacrimal duct obstruction may occur simultaneously and possibly as a consequence of sinonasal disease, because the nasolacrimal system is anatomically related to important nasal and sinus structures.

METHODS

Thirty-seven patients with nasolacrimal canal obstruction (42 eyes) were evaluated with paranasal sinus computerized tomography (CT) to determine the presence of sinonasal abnormalities if any. All of the patients underwent endoscopic dacryocystorhinostomy (end-DCR) and accompanying sinonasal pathology was treated also in the same session.

RESULTS

Paranasal sinus CT examinations revealed one or more sinonasal abnormalities in 26 (73.3%) patients. The postoperative success rate of end-DCR procedure in patients with sinonasal abnormalities was 82.8%, whereas this figure increased to 92.3% in patients without additional sinonasal disease. However, additional rhinological surgery did not affect the success rate of end-DCR procedure significantly (p = 0.640).

CONCLUSION

These data establish a positive correlation between sinonasal abnormalities and the presence of nasolacrimal outflow obstruction, but the additional rhinological surgery does not significantly affect the results of the end-DCR procedure.

Inflammatory Obstruction of the Olfactory Clefts and Olfactory Loss in Humans: A New Syndrome?

The first step in the olfactory perception is the activation by odorants of sensory neurones in the olfactory epithelium. In humans, this sensory epithelium is located at 2 narrow passages, the olfactory clefts, at the upper part of the nasal cavities. Little is known about the physiology of these clefts. We examined, in 34 patients, the impact of obstructed clefts upon detection and postlearning identification of 5 odorants. The location and extension of the obstructions were assessed using endoscopy, CT scans, and MRI. The inflammatory obstruction was usually bilateral, extending anteroposteriorly, and confined to the clefts, with no sign of obstruction or any inflammatory disease in the rest of the nasal cavities and sinuses. When tested with 5 odorants, these patients showed greatly impaired olfaction compared with a group of 73 normosmic subjects. The majority of these 34 patients had sensory deficits equivalent to that found in another group of 41 congenital anosmic patients, where inspection with MRI indicated the lack of olfactory bulbs. This study demonstrates that the olfactory clefts, in human, function as an entity that is different from other regions of the nasal cavity and is the target for local inflammatory events that are apparently not responding to corticoid and antibiotic treatments.