Outfracture of the inferior turbinates during superior repositioning Le Fort I osteotomy with cone-beam computed tomographic analysis of the volume of the nasal cavity

We have investigated the volumes of the nasal cavities of 35 patients treated with superior repositioning Le Fort I osteotomy by analysing cone-beam computed tomography (CT) data with a 3-dimensional reconstruction program to correlate changes in the volume of the nasal cavity that were associated with the maxillary superior repositioning and the role of outfracture of the inferior turbinates. The patients were treated at the Pusan National Dental Hospital during the 14-month period January 2011-March 2012.. The patients were divided into two groups, the first of which consisted of 20 patients who had superior repositioning of 4mm or more with a mean superior movement of 5.2mm and outfracture of the inferior turbinates (outfracture group). The second group consisted of 15 patients who also had more than 4mm impaction with a mean superior movement of 5.0mm and for whom outfracture was not done (no outfracture group). Nasal symptoms were investigated preoperatively and 6 months postoperatively using the Nasal Obstruction Symptom Evaluation (NOSE) scale, and 3-dimensional volumetric analysis was made using cone-beam CT data to assess changes in nasal volume. There were significant differences between the groups in volumetric changes (V1-V2) (p=0.001) but no significant differences between the sexes. The volume of the nasal cavity in the outfracture group decreased by 20% after superior repositioning, but that in the no outfracture group decreased by 33%. Among the 20 patients in the outfracture group not one complained of nasal symptoms postoperatively. We conclude that outfracture of the inferior turbinates should be considered when the amount of superior movement of maxilla is more than 4mm.

Biomechanical characterisation of the human nasal cartilages; implications for tissue engineering

Nasal reconstruction is currently performed using autologous grafts provides but is limited by donor site morbidity, tissue availability and potentially graft failure. Additionally, current alternative alloplastic materials are limited by their high extrusion and infection rates. Matching mechanical properties of synthetic materials to the native tissue they are replacing has shown to be important in the biocompatibility of implants. To date the mechanical properties of the human nasal cartilages has not been studied in depth to be able to create tissue-engineered replacements with similar mechanical properties to native tissue. The young's modulus was characterized in compression on fresh-frozen human cadaveric septal, alar, and lateral cartilage. Due to the functional differences experienced by the various aspects of the septal cartilage, 16 regions were evaluated with an average elastic modulus of 2.72 ± 0.63 MPa. Furthermore, the posterior septum was found to be significantly stiffer than the anterior septum (p < 0.01). The medial and lateral alar cartilages were tested at four points with an elastic modulus ranging from 2.09 ± 0.81 MPa, with no significant difference between the cartilages (p < 0.78). The lateral cartilage was tested once in all cadavers with an average elastic modulus of 0.98 ± 0.29 MPa. In conclusion, this study provides new information on the compressive mechanical properties of the human nasal cartilage, allowing surgeons to have a better understanding of the difference between the mechanical properties of the individual nasal cartilages. This study has provided a reference, by which tissue-engineered should be developed for effective cartilage replacements for nasal reconstruction.

An overview of common diseases of the nasal cavity and paranasal sinuses

Diseases of the nasal cavity and paranasal sinuses are a common complaint amongst the general population and service personnel. Chronic rhinosinusitis, with or without nasal polyps, and nasal deformity leading to airway obstruction are some of the commonest ear, nose and throat (ENT) conditions encountered. However, hidden within this generally benign group of conditions are some potentially lethal problems that clinicians need to be able to recognise. This article aims to provide an overview of common conditions affecting the nose and paranasal sinuses, including fractured nasal bones, acute rhinosinusitis and its complications, and chronic rhinosinusitis. Epistaxis and sinonasal malignancies are largely outside the scope of this paper. Background information on pathogenesis will be described, along with guidance on diagnosis and management with particular stress on emergency pre-hospital treatment and indications for referral to an ENT specialist.

[Nasal endoscope negative pressure cleaning and sinupret drops to treat radiation nasosinusitis]

OBJECTIVE

To observe the effect of nasal endoscope negative pressure cleaning and sinupret drops to treat radiation nasosinusitis (RNS).

METHOD

One hundred and fifty-three patients with nasopharyngeal carcinoma were randomly divided into treatment group A, B, C . Group A using nasal endoscope negative pressure cleaning and sinupret drops, group B using nasal endoscope negative pressure cleaning and normal saline spray washing, group C using saline nasal irrigation through nasal catheter. All patients with sinusitis condition were evaluated at the end of radiotherapy, three months and six months after radiotherapy.

RESULT

Comparison between groups, three periods of RNS incidence, moderate to severe RNS incidence are A < B < C. Six months after radiotherapy, group A compared with group C, there are significant difference (P < 0.01), group A and group C compared with group B respectively, the difference was statistically significant (P < 0.05).

CONCLUSION

Nasal endoscope negative pressure cleaning and sinupret drops can significantly reduce the long-term incidence of RNS, especially obviously reduce the incidence of moderate to severe RNS,which is a practical and effective method to treat RNS.

[Clinical efficacy of heated humidified high-flow nasal cannula in preventing extubation failure in neonates: a Meta analysis]

OBJECTIVE

To evaluate the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) in preventing extubation failure in neonates.

METHODS

A literature search was performed using PubMed, Cochrane Library, FMRS, and CNKI to collect the randomized controlled trials (RCTs) and quasi-RCTs which compared the clinical efficacy of HHHFNC and nasal continuous positive airway pressure (NCPAP) in preventing extubation failure in neonates. The identified studies were finally selected after full-text search and quality assessment and then subjected to a Meta analysis using RevMan 5.3.

RESULTS

Five eligible trials involving 1040 neonates were included in the Meta analysis. The Meta analysis showed that there was no significant difference in treatment failure rate between the HHHFNC and the NCPAP groups. The HHHFNC group had significantly lower incidence rates of nasal trauma (OR=0.49, 95% CI: 0.34-0.71, P=0.0001) and pneumothorax (OR=0.27, 95% CI: 0.07-0.97, P=0.04) than the NCPAP group, but there were no significant differences in the duration to reach full oral feedings and the incidence rates of serious adverse events or other complications between the two groups, such as in-hospital mortality, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity.

CONCLUSIONS

HHHFNC is safe and effective in preventing extubation failure in neonates.

Endoscopic surgery for malignant sinonasal tumours: an eighteen year experience

INTRODUCTION

Curative resection of malignant tumours of the skull base is increasingly undertaken endoscopically. Hitherto the diverse histology, rarity and long natural history have made it difficult to accrue statistically robust cohorts for comparison with conventional craniofacial resection. It is now possible to make such a comparison in a large personal cohort.

METHOD

Data on all cases of sinonasal malignancy undergoing endoscopic resection with curative intent over an eighteen year period were collected prospectively and analysed for survival and prognostic factors.

RESULTS

There were 140 cases, 68 men and 72 women, aged 20-92 years (mean 63 yrs). Follow-up ranged from 6-184 months (mean 60 months). Eighteen different histopathologies were represented with olfactory neuroblastoma (36), malignant melanoma (33) and adenocarcinoma (19) being the commonest. Additional radiotherapy was given in 95 cases and chemotherapy in 49. Overall survival is 84% at 5 years and 69% at 10 years. Overall disease-free survival was 77% at 5 years and 56% at ten. Overall and disease-free survival at 5 (and 10) years is, respectively, 97% and 90% for olfactory neuroblastoma, 79% and 68% for adenocarcinoma and 56% and 39% for malignant melanoma.

CONCLUSION

These results show that endoscopic resection is an alternative to conventional craniofacial resection in selected cases.

Pedicled lateral nasal wall flap for the reconstruction of the nasal septum perforation. A radio-anatomical study

INTRODUCTION

The aim of this radio-anatomical study is to ensure that the potential donor area of the pedicled lateral nasal wall flap (PLNW) is adequate to reconstruct nasal perforation.

MATERIAL AND METHODS

Analysis was conducted on 40 de-identified CT angiographies. The area and length of the PLNW, the septum, and the nasal floor were measured. In a cadaver study, 20 hemi-cranial sagittal sections were also analyzed. The anterior-posterior length of the PLNW flap and the distance between the sphenopalatine foramen and piriform aperture were measured. A clinical study with endoscopic closure of a large perforation was conducted in three patients.

RESULTS

The CT angiographies demonstrated an average PLNW area of 10.80±1.13 cm2 and a nasal floor area of 3.78±0.58 cm2. The septal area (22.54±21.32 cm2) was significantly larger than the total PLNW flap area (14.59±1.21 cm2). The average length of the flap was 5.58±0.39 cm, while the septum was 6.66±0.42 cm; therefore the PLNW flap is insufficient to reconstruct the entire septum. The cadaver study showed that the length of the PLNW flap was 5.28±0.40 cm. These results demonstrate that measurements obtained from CT scans are reliable data and similar to those found in the radiological study. Complete closure was achieved in all three patients.

CONCLUSION

The PLNW flap does not render enough tissue to reconstruct a total septal perforation; however, up to 84% of the septum could be repaired with a PLNW. The potential donor area obtained by CT scan and clinical practice support the approachability of PLNW to repair large septal perforation.

Computed tomography as an aid to planning intubation in the difficult airway

Patients having oral and maxillofacial operations often require nasal intubation, but limited mouth opening and unfavourable nasal anatomy can make it difficult. We aimed to find out whether there is an association between the prediction of difficult nasal intubation on computed tomography (CT) and actual problems. We retrospectively reviewed the imaging and anaesthetic records of 77 patients who had replacement of the temporomandibular joint (TMJ) as these patients often have limited mouth opening and have had a preoperative CT. There was a positive correlation between a radiographically-assessed difficult nostril and difficulty of intubation (p<0.001). The positive predictive value was 71.4%. As a consequence, our radiologists now routinely report on the nasal cavity in these patients, and their report and the scan are then reviewed by the anaesthetist before intubation. Our results suggest that review of the CT before planned nasal intubation should be part of routine practice.

Extramedullary plasmacytoma associated with an ectopic tooth in the nasal cavity

Extramedullary plasmacytoma and tooth eruption into the nasal cavity are both rare events. We report a case of plasmacytoma associated with an ectopic tooth. To the best of our knowledge, such a case has not been previously reported in the literature. A 63-year-old woman presented for evaluation of an 8-month history of a bloody nasal discharge from the posterior naris. Nasal endoscopy detected a slight eminence approximately 0.5 cm in diameter in the right nasal floor. Computed tomography demonstrated a tooth-like, high-attenuation shadow. A biopsy identified chronic inflammation of the mucosa and tissue. A diagnosis of an ectopic tooth in the right nasal cavity was initially considered. The mass and the tooth-like neoplasm were removed via nasal endoscopy. Immunohistochemistry of the excised mucosa showed strong positivity for kappa light chains, positivity for leukocyte common antigen and CD138, and negativity for lambda light chains, epithelial membrane antigen, CD1, and HMB-45. The final diagnosis was an extramedullary plasmacytoma in the right nasal cavity associated with an ectopic tooth. No bone metastasis was observed. Definitive radiotherapy was performed after the operation. During 40 months of follow-up, the patient exhibited no evidence of local recurrence or metastasis. The diagnosis in this case was made difficult by the nonspecific clinical manifestations, the presence of the ectopic tooth, and incorrect interpretation of preoperative histopathology. Physicians should maintain a clinical suspicion for the possibility that an ectopic tooth might be associated with a tumor.

High-flow nasal cannula use in a paediatric intensive care unit over 3 years

OBJECTIVE

High-flow nasal cannula (HFNC) therapy is increasingly used in paediatric intensive care unit (PICU) patients, despite a paucity of studies. We describe its use over the 3 years since its implementation in our tertiary intensive care unit.

DESIGN

The clinical database was used to identify PICU patients on HFNC therapy from 2011 to 2013. Patients were assessed for risk factors, underlying diagnosis, viral test results and cardiorespiratory parameters before and after HFNC therapy.

RESULTS

Fifty-four children were included with a median age of 3.5 months (interquartile range [IQR], 1-10 months) and 59% were females. The commonest diagnosis was bronchiolitis (79%). HFNC therapy was successful in 78% of patients and failed for 12 (seven patients went on to CPAP treatment and five were intubated). The median time to HFNC therapy failure was 5.5 hours (IQR, 3.6-9 hours), with 75% of patients experiencing therapy failure by 8.25 hours. The failure rate was 50% in children with a primary diagnosis of congenital heart disease. There was a statistically significant difference between the mean respiratory rate at 1 hour in the success and failure groups (P = 0.037), despite similar respiratory rates at onset. HFNC therapy failure was associated with a longer PICU LOS (P = 0.04).

CONCLUSION

HFNC therapy was successful in most patients. Most failures occurred within 8.25 hours. Use of HFNC for heart disease was associated with a high therapy failure rate (50%).

Endoscopic endonasal transsellar approach for laterally extended pituitary adenomas: volumetric analysis of cavernous sinus invasion

PURPOSE

The authors conducted a statistical analysis of surgical results of the endoscopic endonasal transsellar approach to provide quantitative indices for selection of the approach in the treatment of laterally extended pituitary adenomas.

METHODS

Surgical results of 25 patients with laterally extended pituitary adenomas of Knosp grade 3 or 4 were retrospectively analyzed. The removal rate was evaluated by the volumetric change of the lateral tumor compartment.

RESULTS

The transsellar approach was used exclusively in all cases. Gross total removal of the lateral tumor compartment was achieved in 14 (56.0%). Factors affecting the tumor removal through the transsellar approach were lateral tumor volume (p = 0.006), maximal distance to the cavernous sinus outer wall (p = 0.004) and history of previous surgery (p = 0.017). The cut-off values for the lateral tumor volume and maximal distance to the cavernous sinus outer wall predicting the gross total removal were 0.479 ml and 8.1 mm, respectively. The surgical complications of the transsellar approach included each case of anterior lobe function insufficiency and liquorrhea.

CONCLUSIONS

The transsellar approach is adequate for removal of lateral tumor compartment in the majority of cases with laterally extended pituitary adenomas. The tumor compartments dorsal and ventral to the horizontal portion of the intracavernous carotid artery are amenable to the removal. But for removal of the tumor compartment lateral to the carotid siphon requires additional use of the parasellar approach.

[Application of endoscopic nasal lateral wall dissection in lesions of the maxillary sinus]

OBJECTIVE

To investigate the application of endoscopic nasal lateral wall dissection in lesions of the maxillary sinus.

METHOD

Ten hospitalized patients with the maxillary sinus lesions were treated with the endoscopic nasal lateral wall dissection.

RESULT

All 10 patients were unilateral invasion. Among them, 7 cases were inverted papilloma, 2 cases were recurrent antrochoanal polyps, 1 case was sinusal tooth. The tumors and antrochoanal polyps originated from the every part of the maxillary sinus wall during operation, especially from the anterior and media wall. During 10-62 months follow-up,epithelization of nasal occured and the shape of inferior turbinate was well. All of them had no epiphora.

CONCLUSION

Endoscopic nasal lateral wall dissection can remain the function of nasal lacrimal duct and nasal cavity,and may provide a new minimally invasive approach for complete resection of lesions of nasal cavity and the maxillary sinus.

Endoscopic transnasal resection of Eustachian-tube dermoid in a new-born infant

INTRODUCTION

Dermoids of the Eustachian tube are rare benign developmental tumours that typically occur in female children. General consensus of classification and nomenclature has still not been reached. The treatment of choice consists of a radical surgical excision. Several approaches have been described and few cases are reported in literature. A gross total resection is now safely achievable through an endoscopic mini-invasive approach.

MATERIALS AND METHODS

We have reported a case of dermoid pedicled in the left Eustachian tube and resected with a pure endoscopic transnasal approach. A review of the literature was performed.

CASE STUDY

The aim of this paper is to present the first case of pure endoscopic transnasal resection in a 4-day-old infant as emergency treatment of Eustachian tube dermoid presenting an acute respiratory failure at birth.

CONCLUSION

The endoscopic transnasal resection is a safe and feasible technique in selected dermoids of the Eustachian tube, when the middle ear is not involved. This approach could be used also in new-born children, decreasing the morbidity of the classic surgical treatment and avoiding the risk of craniofacial alterations.

Effect analysis of nasotracheal suction mechanical ventilation treatment of cerebral ischemic stroke induced by sleep apnea

OBJECTIVE

To investigate the difference between the clinical effects of nasotracheal suction (NTS) mechanical ventilation and noninvasive positive pressure ventilation (CPAP) treatment of cerebral ischemic stroke (IS) induced by sleep apnea.

PATIENTS AND METHODS

Fifty-three patients diagnosed with cerebral IS caused by sleep apnea from February 2013 to February 2014 were selected for this study from our hospital. After the approval of the hospital's Ethics Committee and patients' signed consent, the patients were randomly divided into a test group (n=29 cases) and a control group (n=24 cases). All patients were given conventional treatment for stroke. The control group received the noninvasive ventilator application with CPAP model. The test group was treated with nasal endotracheal suction of mechanical ventilation treatment. Using the NIHSS scale and Barthel index, we compared the status of the nervous system on admission and after seven days stroke recovery treatment of the two groups. Through the comparison of apnea-hypopnea index (AHI), oxygen desaturation index (ODI), LSaO2 and MSaO2 of the two groups on the seventh day, we compared the efficacy of the obstructive sleep apnea-hypopnea syndrome (OSAHS).

RESULTS

The NIHSS score and Barthel index score of mild, moderate and severe were compared on the OSAHS patients at admission, and the difference was not statistically significant (p > 0.05). After treatment, all patients showed lower NIHSS score and increased Barthel scores, and the difference had statistical significance (p < 0.05). For the mild OSAHS patients, we compared the NIHSS score and Barthel index score of the test and control group, and the difference was not statistically significant (p > 0.05). For the moderate and severe OSAHS patients, the NIHSS score of the test group decreased significantly. However, the Barthel index scores increased significantly, and the difference had statistical significance (p > 0.05). The AHI, LSaO2, MSaO2, and ODI index of the two groups of patients were compared with the treatment, and the differences were not statistically significant (p > 0.05). After treatment, the AHI and the ODI index of the two groups decreased, LSaO2 and MSaO2 index increased, and AHI and ODI index of the test group decreased more than that of the control group. However, the LSaO2 and the MSaO2 index increased, and the difference had statistical significance (p > 0.05). The total effective rate of patients of the test group was higher than that of the control group, but no effectiveness and overall mortality was lower than the control group. The difference was statistically significant (p > 0.05).

CONCLUSIONS

Compared with noninvasive ventilator therapy, nasotracheal suction mechanical ventilation and noninvasive positive pressure ventilation treatment of cerebral IS induced by sleep apnea can naturally improve the prognosis of nervous system recovery, and improve the respiratory ventilation function. This may be a better treatment option for moderate and severe sleep apnea patients that is worthy of clinical application.

Customized individual applicators for endocavitary brachytherapy in patients with cancers of the nasal cavity, sinonasal region and nasopharynx

Brachytherapy has become an established therapeutic regimen for primary, persistent, recurrent and metastatic tumour disease in the head and neck region. This study presents the authors' preliminary experience with intracavitary brachytherapy by means of an individual silicone applicator in the treatment of patients with nasal, sinonasal, orbital and nasopharyngeal cancer. Between January 2001 and January 2013, twenty patients with cancer of the nasal cavity, the paranasal sinuses and nasopharynx underwent surgery and intracavitary brachytherapy with the aid of an individually manufactured silicone applicator in the Department of Otolaryngology, Head and Neck Surgery and in the Department of Radiotherapy and Radiooncology at the Saarland University Medical Center of Homburg, Germany. The tumour was localized in the nasal cavity/paranasal sinuses (15) affecting the orbit twice and the nasopharynx (5). There were 14 patients with squamous cell carcinoma, 2 patients with mixed tumours and one patient with adenocarcinoma, adenoid cystic carcinoma, mucosal melanoma or plasmocytoma. The majority of the patients presented with advanced disease (T3 or T4 tumours). In 18/20 patients, brachytherapy was performed as a boost technique, in the remaining two solely because of a previous radiation series. All surgical interventions were performed endonasally. Three to six weeks after surgery, a cast of the nasal cavity was created under general anaesthesia. Subsequently, an individual brachytherapy silicon applicator with two to four plastic tubes was manufactured. The radiation therapy was applied using the Ir-192 high-dose-rate-afterloading method (total dose 10-20 Gy) in two to five sessions, additionally in 18/20 patients a percutaneous radiotherapy with a total dose of 30-60 Gy was applied. After a mean duration of follow-up of 2 years, 7/20 patients experienced a local progression, 5/19 a regional recurrence in the neck nodes and 4/19 distant metastases. The 2-year survival was 57.3 %. No serious complications were reported. The silicone applicator was well tolerated by all patients. Because of the complexity of the sinonasal anatomy with the finding of mainly advanced tumours, the presented individual silicone brachytherapy applicator has proven to be useful and meaningful for endocavitary brachytherapy of malignancies of the nasal cavities, paranasal sinuses and nasopharynx.

Cone beam computed tomography assessment of the maxillary incisive canal and foramen: considerations of anatomical variations when placing immediate implants

INTRODUCTION

The maxillary incisive canal connects the roof of the oral cavity with the floor of nasal cavity and has the incisive and nasal foramina respectively at its two opposite ends. Its close proximity with the anterior incisors affects one's ability to place immediate implants in ideal position.

OBJECTIVE

To avoid causing complication, variations in their dimensions were studied.

MATERIAL AND METHODS

Images of ninety Mongoloids patients examined with i-CAT Cone Beam Computed Tomography were included. The sizes of the nasopalatine foramen, the incisive canal and foramen, and anterior maxillary bone thickness were measured. The direction and course of the canals were assessed.

RESULTS

The mean labiopalatal and mesiodistal measurements of the incisive foramen were 2.80 mm and 3.49 mm respectively, while the labiopalatal width of the nasal foramen was 6.06 mm. The incisive canal was 16.33 mm long and 3.85 mm wide. The anterior maxillary bone has an average thickness of 7.63 mm. The dimensions of the incisive foramen and incisive canal, and anterior maxillary bone thickness demonstrated gender differences with males showing greater values. The anterior maxillary bone thickness was affected by age but this difference was not observed in canal dimensions. The majority of subjects have a funnel shape-like incisive canal with the broader opening located at its superior. They seem to have a longer slanted-curve canal with one channel at its middle portion and a narrower incisive foramen opening than those reported elsewhere.

CONCLUSIONS

This study found that gender is an important factor that affected the characteristics of the IC and the amount of bone anterior to it. Male generally had bigger IC and thicker anterior bone. In addition, the anterior maxillary bone thickness was affected by aging, where it becomes thinner with increased age even though the subjects were fully dentate.

A Novel Guide-Wire Technique for Repositioning a Nasobiliary Catheter from Mouth to Nostril without Using a Nelaton Tube

OBJECTIVE

We aimed to assess the usefulness of a novel guide-wire technique for repositioning without the use of a Nelaton tube and to compare this to the conventional technique.

SUBJECTS AND METHODS

A total of 50 patients who underwent endoscopic nasobiliary drainage (ENBD) at the Yachiyo Medical Center, Chiba, Japan, were enrolled into the study. The patients were randomly divided into 2 groups according to the use of a novel guide-wire technique (n = 28) or the conventional technique (n = 22). The ENBD catheters were repositioned from the mouth to the nose. The primary end point was the procedural time from the insertion of the Nelaton tube or guide wire into the nostril until the ENBD catheter had been repositioned in the nose. The secondary end point was the success rate of the procedure.

RESULTS

The mean procedure time of our technique (120.8 s) was shorter than the traditional technique (131.9 s), but this difference was not statistically significant (p = 0.56). Our technique did not involve the use of the Nelaton tube, and so could save the cost of USD 1.17 per patient. The novel technique did not require the removal of the mouthpiece with a laryngoscope or the use of a Nelaton tube, and no postural change was necessary. A single operator performed the novel procedure unassisted. No adverse events were observed relating to either the novel or the traditional technique.

CONCLUSIONS

The novel guide-wire technique for repositioning ENBD catheters was effective and is recommended for use.

[Clinical analysis of 14 cases with nasal respiratory enithelial adenomatoid hamartom]

OBJECTIVE

To describe and analyze the clinical features of nasal respiratory epithelial adenomatoid hamartom and improve the levels of diagnosis and treatment.

METHOD

Fourteen cases of nasal respiratory epithelial adenomatoid hamartom confirmed by pathology were collected and analyzed.

RESULT

In 14 cases, primary complaint of Hyposmia(or Anosmia)and nasal obstruction were occured in 13 and 11 cases respectively. Four cases had past history of endoscopic sinus surgery because of the diagnosis of nasal polyps. Polypoid neoplasms could be seen in the bilateral olfactory clefts. Sinus CT showed soft tissue shadows in bilateral nasal cavity and mucous membrane thickening in different sinus. Endoscopic sinus surgery were utilized to eliminate focus in all cases. All cases weren t recurred after 2-20 months' following-up visitings.

CONCLUSION

Nasal respiratory epithelial adenomatoid hamartom is so rare that clinical and pathological doctors have limited knowledge of it. It has its own characteristics from the clinical symptoms, signs to sinus CT although they are nonspecific. So we should improve the understanding about it to avoid misdiagnosis or missed diagnosis.

[Bilateral nasal vestibular cyst 1 case]

Patients with bilateral nasal vestibule area swelling of 1 week, no obvious pain and symptoms of nasal congestion, bilateral nasal vestibule area was highly uplifted, nostril was significantly smaller, both sides existed a palpable 2. 0 cm × 2. 2 cm and 2. 0 cm × 2. 0 cm cystic mass. Ultrasound showed both sides of the nasal bonehad cystic lesions. Sinus CT showed local quasicircular soft tissue shadow at the bottom of bilateral piriform aperture. The postoperative pathology report: the cystiform tissue is covered with squamous epithelium, infiltration of inflammatory cells could be seen and is consistent with the diagnosis of bilateral nasalvestibular cyst.

Long-term oncological outcome after endoscopic surgery for olfactory esthesioneuroblastoma

CONCLUSIONS

Endoscopic techniques seem to be safe approaches for the treatment of esthesioneuroblastomas (ENBs). However, they are intended for selected patients and require extensive experience in base of the skull surgery.

OBJECTIVES

ENB is a rare tumor of the nasal cavity. The craniofacial approaches remain the gold standard of treatment in multiple centers. Endoscopic endonasal approaches were progressively developed. The main objective of this work was to study the overall survival and recurrence-free period for patients with ENB who underwent endoscopic resection.

METHODS

We performed a retrospective study from 1996 to 2014, reviewing the patients treated by endonasal endoscopic surgery for ENB.

RESULTS

Eight patients benefited from endoscopic surgical resection. According to the Kadish classification, one patient was stage A, three patients were stage B, and four patients were stage C. According to the Dulguerov classification, one patient was stage T1, five patients were stage T2, and two were stage T4. Reconstruction of the base of the skull was performed in three patients. No postoperative complications were noted. The mean follow-up period was 95 months. The 5-year overall survival was 87.5% and the 5-year recurrence-free survival was 75%. To date, there have been no local recurrences but two patients had lymph node recurrences. Seven patients are disease-free and one is deceased.

[Application of nasopore and budesonide suspension on tamping after endoscopic sinus surgery]

OBJECTIVE

To investigate the clinical effect of nasal packing of pulmicort respules combined withnasopore after endoscopic sinus surgery.

METHOD

A total of 30 CRSwNP and CRSsNP patients with bilateral functional endoscopic sinus surgery and finished following up visit were randomly choosed, conventionally select the left nasal cavity as the experimental group, the right nasal cavity as the control group. Experimental group to pack the nasal cavity with pulmicort respules union nasopore after surgery and control group to pack the nasal cavity with only nasopore after surgery. The differences were observed in patients with subjective symptoms and recovery of mucosa of operative cavity between the two groups after two weeks, one month and three months.

RESULT

(1) The postoperative VAS symptoms score about nasal obstruction, nasal secretion, headache, dizziness and distending pain after two weeks,one month and three months in the experiment group were significantly better than those in the control group(P<0.05). (2) The postoperative Lund-Kennedy endoscopic mucosa morphology score after two weeks, one month and three months in the experiment group were significantly better than those in the control group(P<0.05); (3) After three months, the experiment group had 28 cases with clinic symptoms cured(93. 3%), Total effective rate was 96. 6%; The control group had 22 cases with clinic symptoms cured (73. 3%), total effective rate was 93. 3%. The cure rate of the experiment group was significantly higher than the control group(P<0.05), but there was no statistic difference between the two groups in the total effective rate (P>0.05).

CONCLUSION

The application of nasal packing of pulmicort respules combined with nasopore after functional endoscopic sinus surgery can effectively relieve postoperative uncomfortable symptoms, promote recovery of mucosa of perative cavity, which deserves clinical promotion.

[Analysis of six cases concerning clinical features of rhinolith]

To analyze six cases concerning clinical features, the treatment process and curative effect of Rhinolith. The six patients had unilateral nasal obstruction, three of them were accompanied with purulent nasal discharge, two had blood with them, one patient had repeated hemorrhage of nasal cavity and two patients had developed headache. By using endoscopic, four irregular stones which are yellow, gray and brown were found in the middle and back end. Because of the severe nasal septum deviation and inferior turbinate polypoid, the stone could not be seen clearly but could be touched by aspirator. In sinus CT examination of 6 cases, it showed incomplete irregular shapes and had high density unilateral nasal cavity in the posterior segment. 4 patients had nasal deviation, 3 patients had ipsilateral sinusitis. 4 patients removed their stone by using endoscopy, 2 patients took the stone away after correction of nasal septum. Pathologic diagnosis: rhinolith. Two patients also had exogenous foreign matters which were considered as pseudo nasal stones.

[The management of sinonasal inverted papilloma by endoscopic surgery: an analysis of 54 cases]

OBJECTIVE

The study is to evaluate our results of patients with sinonasal inverted papilloma (SIP) undergoing endoscopic sinus surgery and to investigate the recurrence relative factors of SIP.

METHOD

A retrospec- tive analysis was performed of medical records for 54 cases SIP treated with endoscopic resection. Compared to pre operation imaging evaluation and intraoperative observation, efficacy assessments included endoscopy during follow-up after operation and combined with CT examination results.

RESULT

The incidence of 54 cases with ethmoid sinus, part of the lateral wall of the nasal cavity was higher. The recurrence rate was higher in the cases invaded front and/or inferior wall of maxillary sinus, frontal recess. There was no case with middle turbinate. Canceration with the same time accounted for 1.85%.

CONCLUSION

Misdiagnosis as polyps, the lesion sites of tumour, involving the frontal recess, front and inferior wall of maxillary sinus are the risk factors of recurrence. The preoperative accurate judgment of the primary tumor site and surgical resection completly are the most effective means of preventing recurrence. Postoperative endoscopy examination combined with CT examination is an effective means for the evaluation of recurrence.

[Pedicle flap of nasal septum-basis nasi and temporal muscucofascial flap to repair nasoseptal perforation]

OBJECTIVE

To explore curative effect with pedicle flap of nasal septum-basis nasi and temporal muscucofascial flap to repair nasal septal perforation.

METHOD

Dissecting mucoperichondrium and mucoperioseptum around the perforation and taking dowm and out xia-ward to the floor of nasal cavity to make a inferior extremity pedicle flap. Then,the flap was tumbled and sutured onto raw surface of contralateral side through perforation. Reapplicating autoallergic temporal musculofascial flap to repair another side perforation.

RESULT

Repairing perforation Sin twelve cases were sucessfully healed in endoscope.

CONCLUSION

The pedicle flap of nasal septum-basis nasi and temporal muscucofascial flap is easy to acquire and no rejection. The flap has good blood supplying, high survival rate and provides adequate transplantating materail to repair comparatively large perforation.

[By nasal cavity approach resection of bigger pleomorphic adenoma in left skull base with nasal endoscope]

A 46-year-old female patient presented to our hospital with history of pharyngeal discomfort for 6 months. Physical examination showed that she had facial asymmetry, loss of the left nasolabial fold, rightward de- viation of uvula, swelling of the left soft palate. Magnetic resonance imaging revealed a bigger neoplasm in left pa- rapharyngeal space which invaded into left lateral skull base. The left internal carotid artery, vein and the styloid process was jostled backward. The primary clinical diagnosis is pleomorphic adenoma of the parapharyngeal space.

[Anatomy and imaging study of a new upper-agger nasi pathway of frontal sinus surgery]

OBJECTIVE

To investigate the new surgical pathway of endoscopic frontal sinus surgery for frontal sinus lesions through the upper-agger nasi approach.

METHOD

The computed tomography (CT) scans from 32 patients were collected and subjected to three-dimensional reconstruction by Mimics. The distance in sagittal planes from anterior ethmoid artery to midpoint of axilla and to skull base attachment at anterior middle turbinate was measured. The distance in coronal planes between the perpendicular plate of middle turbinate and the orbital lamina was also detected as well as the height of agger nasi. Three-dimensional structures of the frontal sinus and its surrounding cells was reconstructed by Sinuses Trachea I software. We integrated the CT scans and the above data for simulating surgical operation on cadaveric heads.

RESULT

(1) Skull base attachment at anterior middle turbinate located at the anterior or posterior of aperture of frontal sinus. (2) The mean distance between anterior ethmoid artery and midpoint of axilla was (22.23 ± 2.78) mm on the left side and (22.30 ± 2.80) mm on right. The mean distance between anterior ethmoid artery and skull base attachment at anterior middle turbinate was (15.31 ± 2.82) mm on left and (15.39 ± 3.53) mm on right. The distance between perpendicular plate of middle turbinate and orbital lamina was (7.61 ± 1.34) mm on left and (7.80 ± 1.40) mm on right side. The height of the agger nasi was (8.33 ± 2.14) mm on left and (8.00 ± 2.57) mm on right. There was no statistical difference in the above data between left and right side (P > 0.05). (3) The visible three-dimensional structure showed that skull base attachment at the anterior middle turbinate was closely adjoined the aperture of frontal sinus, the space between sub-outer side of the attachment and orbital lamina, above the agger nasi cell or the upper area of the agger nasi cell was solely cell structures.

CONCLUSION

Endoscopic frontal sinus surgery for frontal sinus lesions through the upper-agger nasi approach was practicable to solitary frontal sinus lesions and to solve the complex frontal sinus or frontal recess lesions by flexible operation according to the feature of the lesions.

Recovery from SIADH-associated osteoporosis: a case report

INTRODUCTION

Recent studies show an association between hyponatremia and osteoporosis. We have previously reported a case of severe male osteoporosis due to chronic syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Here, we provide a follow-up on this case after cure of the condition that further supports the causal relationship.

THE CASE

A 38-year-old man had been diagnosed with severe osteoporosis most likely due to chronic SIADH. The SIADH was believed to be idiopathic. A magnetic resonance imaging scan, however, revealed a tumor in the sinus, and biopsies showed an esthesioneuroblastoma, immunohistochemically positive for antidiuretic hormone (ADH). After the tumor was removed, ADH and sodium levels normalized. A dual-energy x-ray absorptiometry scan performed 7 months after the patient's last surgery showed a significant spontaneous improvement in bone mineral density in the lumbar vertebrae.

CONCLUSION

This case provides evidence for a causal relationship between SIADH and chronic hyponatremia and impaired bone metabolism that can lead to severe secondary osteoporosis. The effect on bone metabolism is at least partially reversible.

[Three-dimensional reconstruction and visualization of the fronto-ethmoidal cells based on CT images]

OBJECTIVE

Based on contiguous axial computed tomography (CT) images of the frontal sinus, a three-dimensional (3D) visualization and reconstruction of fronto-ethmoidal cells was performed using Intage Realia (version 2011) software to generate a model to accurately understand the anatomical structure of fronto-ethmoidal cells.

METHOD

Retrospective analyses of nose CT scan data of 50 patients without sinusitis were performed. Using Digital Imaging and Communications in Medicine (DICOM) images of sinus axial CT scans, the 3D visualization and reconstruction of the sinus was performed using the Achilles tendon and nasal passage modes in Intage Realia (version 2011) software on personal computers. Two segmentations were performed on the reconstructed sinus, and the structures of the agger nasi, frontal cells, and supraorbital cells and the relative locations of the frontal sinus drainage pathway and cells were observed.

RESULT

The 3D visualization of the fronto-ethmoidal cells and frontal sinus drainage pathway was successful, allowing accurate observation of the anatomical characteristics of the fronto-ethmoidal cells.

CONCLUSION

The 3D visualization of fronto-ethmoidal cells can be reconstructed based on contiguous axial CT images of the sinus, allowing an accurate understanding of the anatomical structure of fronto-ethmoidal cells and is well prepared for frontal sinus surgeries.

[One case of pleomorphic adenoma originates from inferior nasal turbinate]

Pleomorphic adenoma (PA) is the most common benign tumor of the salivary glands. Originating from the nasal cavity is very rare. This paper reports one case of pleomorphic adenoma of the inferior nasal turbinate to analyze the clinic characteristic of this disease. Although these tumors are rarely seen in everyday practice, one should consider this possibility as an uncommon aetiology when confronted with an intranasal mass.

[Sinonasal teratocarcinosarcoma: clinicopathologic study and analysis]

OBJECTIVE

To study the clinicopathologic features, immunophenotype, diagnosis and differential diagnosis of Sinonasal teratocarcinosarcoma (SNTCS).

METHOD

The clinical findings, morphologic features and immunohistochemical markers in one case of SNTCS were studied, and the relevant literatures were reviewed.

RESULT

The Tumor tissue is composed of three layers, with mature and immature squamous epithelium nests, neural epithelial cells and olfactory neuroblastoma-like cells derived of ectoderm; Sarcomatoid components and bone tissue derived of mesoderm; The glandular and tubular structures part of which is adenocarcinoma and respiratory epithelium derived of endoderm; The fetal clear cell squamous epithelium is typical. In addition, diffuse large cytoplasm-with high light and cytoplasm with dark light has no obviously boundery. Immunohistochemical staining showed immune markers of different germ layers corresponding, squamous epithelium, glandular epithelium and respiratory epithelium were positive for CK and EMA, neural epithelial cells and olfactory neuroblastoma-like cells were positive for S-100, NSE and Syn, sarcomatoid area was positive for Vim, light dye area was positive for Vim, CD99 and CK, dark area was positive for NSE and GFAP.

CONCLUSION

SNTCS is a rare malignant tumor with the features of teratoma and carcinosarcoma, its histopathological and immunohistochemical features were typical, should be more drawn and sliced to avoid misdiagnosis and missed diagnosis.

[The influence of hypothermia plasma radiofrequency ablation on synechia nasal after nasopharyngeal carcinoma radiotherapy]

OBJECTIVE

To observe the effect of hypothermia plasma radiofrequency ablation to the adhesion of nasal cavity after radiotherapy of nasopharyngeal carcinoma.

METHOD

The subjective score combined with nasal ventilation function test were used to reflect the degree of patients with nasal adhesion.

RESULT

There is a significant improvement in subjective feeling after treatment. Nasal cavity volume began to increase and nasal expiratory resistance decrease obviously 3M later.

CONCLUSION

Hypothermia plasma radiofrequency ablation technology can improve the nasal cavity adhesion in patients with nasopharyngeal carcinoma after radiotherapy, and also the patients quality of life.

[Angle of titanium clip next turbinate resection without filling in the clinical observation]

OBJECTIVE

To observe the self-developed horn type of titanium clamp used for inferior turbinate resection from filling effect.

METHOD

Choose the cases of inferior turbinate resection of 152 cases randomly selected 92 cases (group) in 2-4 angle type titanium clip head-tail closed wound middle turbinate, and therefore more than nasal passages in the surgical wound, just as in the nasal passages above micro tamponade, bare breathing zone, keep the ventilation, 1- 3 days to take out the angle titanium clamp; 60 cases (control group) with vaseline oil gauze or postoperative Merocel hemostatic sponge tamponade nasal bleeding. Observation of 1-3 days after nasal ventilation, headache, nasal bleeding, dry mouth, tolerance is painful, aural fullness tinnitus, a total of 7 indicators of sleep.

RESULT

The team outside the there was no difference in blood loss and the control group, the rest of the indicators is better than the control group.

CONCLUSION

The angle of titanium clamp used in inferior turbinate resection from stuffing, patients get better comfort, avoid drawn yarn of pain, improve the quality of perioperative patients with life.

[Computed tomographic images analysis of frontal recess anatomy based on three-dimension reconstruction]

OBJECTIVE

To observe the CT three-dimensional imaging features of the frontal recess region with advanced three-dimensional reconstruction, and develop the real image of the important anatomical structures around the region to conduct surgery.

METHOD

Thirty patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard three-dimensional reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely.

RESULT

After the reconstruction, we get the three-dimensional model very close to the true state of the nasal cavity-sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In these patients, the height, width and depth of the agger nasi and frontal sinus were (9.45 ± 3.60)mm, (8.08 ± 3.37)mm, (26.98 ± 6.82)mm and (26.86 ± 9.45)mm, respectively.

CONCLUSION

This study tried to develop the standardized techniques and measurements from three-dimensional reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The project results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.

[Clinical analysis and literature review of primary melanoma in nasal cavity and sinus--report of 9 cases]

OBJECTIVE

To analyze and summarize clinical characteristic, treatment scheme and survival rate of primary melanom in nasal cavity and sinus.

METHOD

We retrospectively analyzed the 9 patients with primary melanom in nasal cavity and sinus who in data proceed were treated and reviewed the related literature.

RESULT

Among the 9 patients, the clinical main symptoms are rhinostegnosis of lateral nasal and intermittent nasal bleeding. Pathologic examination is mainly characterized by tumor cells abnormity and cytoplasm containing pigment or without pigment, and main diagnosis basis is some or all of the positive for HMB45, S-100, melan-A. The survival rate are 88.9% (8/9) of 1-year, 66.7% (6/9) of 3-year and 33.3% (3/9) of 5-year.

CONCLUSION

The incidence of primary melanom in nasal cavity and sinusis is not frequent in clinic and confirmed by immunohistochemical. The extensive radical excision of focus and combine adjuvant radiotherapy postoperative may improve the survival rate of patients.

[Sinonasal undifferentiated carcinoma: 2 cases report]

Sinonasal undifferentiated carcinoma happens rarely, the clinical manifestations of the disease lacked specificity, with nasal obstruction and blood mainly in a unilateral nasal cavity. Two casas were reviewed, one case of tumor located in the middle of inferior turbinate; 1 in the bottom wall of the anterior nasal cavity. The tumor appeared dark red and unsmooth surface. Sinus CT scan showed occupying shadow and significant bone de struction. Complete resection of the lesion was performed. The pathology of neoplasm showed small-medium sized oval nuclei, high nucleus to cytoplasm ratio, and active mitosis. The pathological diagnosis was undifferentiated carcinoma. Comprehensive treatment of postoperative radiotherapy and chemotherapy were given distant metastasis still happened. One survived in 2 years of follow-up, 1 patient died in 18 months.

[Laser-assisted outpatient septal spur surgery for contact point pain]

OBJECTIVE

To investigate the efficacy outcomes of laser assisted outpatient septal spur surgery for contact point pain in a carefully selected group of patients.

METHOD

This investigation included 32 patients who were selected for laser-assisted septal spur surgery in an outpatient surgical suite. All had endoscopically visible spur contact as well as nansal CT scans. Patients of sinusitis were excluded. The area of the contact point was treated with decongestant and lidocaine. If the headache completely disappeared or diminished by more than 50% in intensity, subjects were considered candidates for surgery. Headache characteristics were assessed preoperatively and at follow-up (30 months after surgery) using a standardized questionare.

RESULT

Nine cases (28.1%) were free from pain at the last follow-up; 19 cases (59.4%) had their headache scores improved after surgery; four cases (12.5%) had a less than 25% reduction in their headache score. No septal perforation, hematoma, was reported.

CONCLUSION

For selected patients with contact point headaches, septoplasty may be useful. The positive dicaine test may indicate better effect of operation. Laser-assisted outpatient septal spur surgery for contact point pain shows good results in short-term effect, and has less complications, but long-term follow-up is required to assess its real effect.

Respiratory mechanics during NCPAP and HHHFNC at equal distending pressures

OBJECTIVE

To compare the effect of heated, humidified, high-flow nasal cannula (HHHFNC) and nasal continuous positive airways pressure (NCPAP) on lung function and mechanics in preterm infants with respiratory distress syndrome (RDS) at the same level of retropharyngeal pressure (Prp).

DESIGN

Randomised crossover trial.

SETTING

Neonatal intensive care unit, Ospedale Maggiore Policlinico, Milan, Italy.

PATIENTS

20 preterm infants (gestational age: 31±1 wks) with mild-moderate RDS requiring non-invasive respiratory support within 96 h after birth.

INTERVENTIONS

Infants were exposed to a randomised sequence of NCPAP and HHHFNC at different settings (2, 4 and 6 cmH₂O for NCPAP and 2, 4, 6 L/min for HHHFNC) to enable comparison at the same level of Prp.

MAIN OUTCOME MEASURES

Tidal volume by respiratory inductance plethysmography, pleural pressure estimated by oesophageal pressure, and gas exchange were evaluated at each setting and used to compute breathing pattern parameters, lung mechanics and work of breathing (WOB).

RESULTS

A poor linear regression between flow and Prp was found during HHHFNC (Prp=0.3+0.7*flow; r²=0.37). Only in 15 out of 20 infants it was possible to compare HHHFNC and NCPAP at a Prp of 2 and 4 cmH₂O. No statistically significant differences were found in breathing pattern, gas exchange, lung mechanics and total WOB. Resistive WOB in the upper airways was slightly but significantly higher during HHHFNC (0.65 (0.49;1.09) vs 1.57 (0.85;2.09) cmH₂O median (IQR)).

CONCLUSIONS

Despite differing mechanisms for generating positive airway pressure, when compared at the same Prp, NCPAP and HHHFNC provide similar effects on all the outcomes explored.

[Transnasal endoscopic choanal plasty for repairing congenital choanal atresia]

OBJECTIVE

To observe the effect of transnasal endoscopic choanal plasty for repairing congenital choanal atresia.

METHOD

A retrospective analysis of 15 patients with choanal atresia in Beijing Children's Hospital from January 2006 to September 2012 was made. All the 15 patients accepted electronic nasopharyngoscope examination and CT scanning of the paranasl sinus. The age was between 4 years old and 6 years old. Seven of them were male and 8 were female. Six cases were unilateral atresia, 9 were bilateral atresia. Ten cases (16 sides) were membranous atresia, 2 cases (4 sides) were mixed type atresia and 3 cases (4 sides) were bony atresia. All the patients accepted transnasal endoscopic choanal plasty. A tube was placed in order to support the enlarged nostrils. The nasal tube should be retained for 3 months and kept patency by routine care. Three months after operation, the tube could be removed. The patients were told to do physiological saline nasal irrigation and receive regular review by transnasal endoscopy.

RESULT

The patients were followed up for 1 year postoperatively by electronic nasopharyngoscope examination. There was no failure case in all the 15 patients. The total effective rate was 100%.

CONCLUSION

Transnasal endoscopic choanal plasty had better efficacy and safety in the treatment of congenital choanal atresia.

[Juvenile xanthogranuloma of the nasal vestibule: one case report]

To Study Juvenile xanthogranuloma (JXG) in the nasal cavity, raise the level of diagnosis and treatment for this disease. We reported a case with JXG and reviewed the literatures. JXG in nasal vestibule is ex tremely rare. Only three cases were reported before. After surgical removal,no recurrence was found over a 10-month follow-up. Clinical manifestations and imaging examination is nonspecific for JXG, and the diagnosis of the disease relies on pathological examination. Surgical resection is an effective treatment method.

Are high flow nasal cannulae noisier than bubble CPAP for preterm infants?

BACKGROUND

Noise exposure in the neonatal intensive care unit is believed to be a risk factor for hearing loss in preterm neonates. Continuous positive airway pressure (CPAP) devices exceed recommended noise levels. High flow nasal cannulae (HFNC) are an increasingly popular alternative to CPAP for treating preterm infants, but there are no in vivo studies assessing noise production by HFNC.

OBJECTIVE

To study whether HFNC are noisier than bubble CPAP (BCPAP) for preterm infants.

METHODS

An observational study of preterm infants receiving HFNC or BCPAP. Noise levels within the external auditory meatus (EAM) were measured using a microphone probe tube connected to a calibrated digital dosimeter. Noise was measured across a range of frequencies and reported as decibels A-weighted (dBA).

RESULTS

A total of 21 HFNC and 13 BCPAP noise measurements were performed in 21 infants. HFNC gas flows were 2-5 L/min, and BCPAP gas flows were 6-10 L/min with set pressures of 5-7 cm of water. There was no evidence of a difference in average noise levels measured at the EAM: mean difference (95% CI) of -1.6 (-4.0 to 0.9) dBA for HFNC compared to BCPAP. At low frequency (500 Hz), HFNC was mean (95% CI) 3.0 (0.3 to 5.7) dBA quieter than BCPAP. Noise increased with increasing BCPAP gas flow (p=0.007), but not with increasing set pressure. There was a trend to noise increasing with increasing HFNC gas flows.

CONCLUSIONS

At the gas flows studied, HFNC are not noisier than BCPAP for preterm infants.

Results of endoscopic endonasal dacrocystorhinostomy

OBJECTIVES

To analyse the results of Endonasal Endoscopic Dacrocystorhinostomy regarding complications and success rate.

METHODS

The prospective quasi-experimental study was conducted at the Departments of Otolaryngology and Ophthalmology of Islamic International Medical College Teaching Hospital, Rawalpindi, from August 2008 to July 2012. Patients presenting with epiphora and diagnosed with chronic nasolacrimal duct obstruction were included in the study. Endonasal Endoscopic Dacrocystorhinostomy was performed under general anaesthesia. Patients were followed up for at least 6 months after the removal of dacrocystorhinostomy tube. Complications during and after the procedure were recorded.

RESULTS

Of the 31 patients in the study, 27 (87%) were females and 4 (13%) were males with an overall mean age of 45.7 +/- 13.4 years (range: 21-70). The duration of symptoms ranged between 6 months and 13 years (Mean: 4.1 +/- 3.2). Average duration of endoscopic dacrocystorhinostomy was 40 +/- 17.5 minutes (range: 25-70). The tube was removed 6 months after operation in 27 (87%) patients and after 3 months in 4 (13%). Complications encountered were peroperative haemorrhage in 4 (13%), ecchymosis in 2 (6%), nasal adhesions in 3 (9.6%), granulations at osteotomy site in 1 (3.2%), retrograde tube displacement in 3 (9.6%) and symblepheron in 1 (3.2%) patient. Of the total, 26 (84%) patients were symptom-free 6 months after the removal of the tube. Two (6.4%) patients underwent revision surgery and were symptom-free 6 months after the removal of the tube. Overall success rate of the procedure was 28 (90%).

CONCLUSIONS

Endonasal Endoscopic Dacryocystorhinostomy is an effective procedure with high success rate and minimal complications.

[Clinical features of sinonasal inverted papilloma with recurrence and malignant transformation]

OBJECTIVE

To investigate the clinical characteristics, treatment and the effectiveness of sinonasal inverting papilloma with recurrence and malignant transformation.

METHOD

Retrospective comparative analysis of sinonasal inverting papilloma with recurrence and malignant transformation treated from Jan. 2008 to Oct. 2012 in our hospital.

RESULT

All the 24 patients with recurrence had the history of sinonasal surgery. Among them, 17 patients recurred once,6 recurred twice and 1 recurred three times. The recurrence time was from 1 month to 14 years after operation. Four patients relapsed within half year after 5 months to 4 years follow-up and the recurrence ratio was 16.7% (4/24). All the 4 patients with recurrence had an operation once again and one of them was given chemoradiotherapy after surgery whose pathological results showed canceration. There was no recurrence among the all of 24 patients followed up until now. Among 5 patients with malignant transformation, 3 patients of them were given radiochemotherapy after surgery. Except 1 patient died of extensive recurrence, 1 received other operation after relapsed twice and 1 lost follow up,all the others were alive without recurrence during 10 months to 4 years.

CONCLUSION

The surgical treatment with completely and positively is the firse choice and an effective management for sinonasal inverting papilloma. To the patients with recurrence on many times and malignant tumors, post-operative radiation or chemotherapy should be considered when needed.

[Clinical analysis of sinonasal hemangiopericytoma]

OBJECTIVE

To investigate the clinical features, therapeutic methods and therapeutic effects of sinonasal hemangiopericytoma.

METHODS

Clinical data of 6 patients with sinonasal hemangiopericytoma, diagnosed by pathology and immunohistochemistry between January 1990 and December 2012 were analyzed retrospectively. There were 4 males and 2 females, with a median age of 58 years. Clinical manifestation included epistaxis and nasal obstruction. These patients were operated on by nasal endoscopic surgery or endoscope-assisted surgery, of which 2 cases of tumor located in the nasal cavity underwent nasal endoscopic surgery and 4 cases of tumor located in the nasal cavity and sinuses underwent endoscope-assisted surgery.

RESULTS

All the patients were followed up for a period of 6 months to 7 years after operation. Two cases recurred and 4 cases didn't recurred. One case recurred 6 months after operation and underwent second operation, with no recurrence by further one year follow-up. Another case recurred 17 months after operation and underwent second operation, with recurrence by further 9 months follow-up. This patient lived with tumor over two years.

CONCLUSIONS

Hemangiopericytomas are rarely found in the sinonasal cavity. Nasal endoscopic or endoscope-assisted surgery provides satisfactory effect.