[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.

[Nasal mucosa recovery after endoscopic surgery using the plasma radiofrequency ablation at low temperature for treatment of nasal inverted papilloma]

OBJECTIVE

To assess the therapeutic effect and study the role of nasal mucosa epithelization after endoscopic surgery using the plasma radiofrequency ablation at low temperature in patients with nasal inverted papilloma.

METHOD

The clinical data of 104 patients with nasal inverted papilloma underwent endoscopic surgery u sing the plasma radiofrequency ablation at low temperature from July, 2008 to July, 2012 were analyzed,and the recovery of mucosa was observed under nasal endoscope.

RESULT

The mucosa recovery extent showed a decreasing trend from mucosa pattern degree I to III, where the difference was statistically significant by chi-square test between groups (P < 0.05). The average epithelialization time was 2.7 months. It showed a significantly decreasing trend among average epithelialization time of different degrees of mucosa (P < 0.05). The nasal mucosa of most patients completed epithelialization 2.9 months after surgery.

CONCLUSION

It is safe and effective to treat nasal inverted papilloma with plasma radiofrequency ablation at low temperature. The patients should be followed up with regular reexamination for at least three months after surgery.

[Efficacy and safety of heated humidified high-flow nasal cannula for prevention of extubation failure in neonates]

OBJECTIVE

To assess the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) ventilation compared with nasal continuous positive airway pressure (NCPAP) on prevention of extubation failure in the NICUs.

METHOD

A prospective randomized, controlled un-blinded study was conducted in 12 tertiary hospitals in Hebei Province from December 1, 2012 to May 31, 2013. Neonates were eligible for this study if they were admitted to the participating NICUs within 7 days of postnatal age, and needed noninvasive respiratory support after a period of mechanical ventilation with an endotracheal tube. Infants were randomly assigned to either HHHFNC or NCPAP group. The primary outcome measures included: the incidence of extubation failure, bronchopulmonary dysplasia and the mortality before discharge.

RESULT

Among the 255 cases included, 128 were in the HHHFNC group, and 127 were in the NCPAP group. There was no significant difference in gestational age, birth weight, and age at randomization, and male/female ratio between the two groups (P > 0.05). There were no significant differences between groups for days on ventilation, noninvasive respiratory support, oxygen requirement, hospital stay and time to full oral feedings (P > 0.05). The overall mortality of the studied population was 10.6% (27/255) . The occurrence of extubation failure within 7 days was 9.4% whereas 29.0% in very low birth weight infants. There was no significant difference in the extubation failure for HHHFNC (12/128, 9.4%) versus NCPAP (12/127, 9.4%) (P > 0.05), or in mortality for HHHFNC (12/128, 9.4%) versus NCPAP (15/127, 11.8%) (P > 0.05). No significant difference was found between the study groups in the occurrence of bronchopulmonary dysplasia (BPD) and most of severe adverse outcomes analyzed, including air leak syndrome and nasal trauma. The occurrence of abdominal distention during treatment was higher in NCPAP than HHHFNC group (12.6% vs. 5.5%, P < 0.05).

CONCLUSION

Among infants ≤ 7 d of postnatal age, HHHFNC appears to have efficacy and safety similar to those of NCPAP group when applied immediately post-extubation to prevent extubation failure. Despite concerns on unmonitored pressure delivery during HHHFNC support, no increase of the occurrence of BPD, air leak syndrome or mortality was found.

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.

[Clinical analysis of 49 cases of esthesioneuroblastoma]

OBJECTIVE

To investigate the optimal treatment and prognostic factors of esthesioneuroblastoma (ENB).

METHOD

Forty-nine cases of ENB, received therapies in Chinese people liberation army general hospital from October 2004 to June 2013, were reviewed retrospectively. The therapeutical strategies and prognostic factors were analyzed using the Kaplan-Meier method. Efficacy of different therapeutical strategies was compared.

RESULT

The 5-year overall survival (OS) in the group was 63.8%. The 5-year OS of Kadish stage A, B, C were 90.0%, 77.1%, 32.6%, respectively, with significant difference (χ(2) = 7.379, P = 0.03). The 5-year OS of the patients treated by surgery and radiotherapy, chemoradiotherapy, surgery with chemoradiotherapy were 68.6%, 0, 92.3%, respectively, with significant difference (χ(2) = 8.140, P = 0.02). The 5-year OS of the patients with transnasal endoscopic resection (or combined with transcranial resection) and lateral rhinotomy ( or combined with transcranial resection) were 63.7%, 50.0%, respectively, which had no significant difference (χ(2) = 3.818, P = 0.05).

CONCLUSIONS

ENB has a relatively good prognosis in head and neck malignancies, the prognosis is associated with clinical stages and treatment approaches. Transnasal endoscopic surgery based multimodality is the preferable choice.

Transnasal endoscopy is preferred by transoral endoscopy experienced patients

BACKGROUND & AIMS

Both unsedated transoral endoscopy (TOE) and sedated TOE have some drawbacks in clinical practice. Unsedated transnasal endoscopy (TNE) has been suggested as an alternative to both methods. This study aimed to determine the advantages of TNE in patients who have previously undergone unsedated conventional TOE.

METHODS

Patients who had received an unsedated TOE in the last 12 months and were scheduled for a second upper endoscopy were included. They were randomized to undergo either unsedated TOE, using a standard endoscope, or unsedated TNE, using an ultrathin endoscope. Post-procedure, patients were asked to complete a questionnaire to assess pain, discomfort and acceptability of the procedure, and to compare the current procedure with their previous unsedated TOE. Endoscope insertion rate, procedure duration, and side-effects were recorded.

RESULTS

Each group included 50 patients. With the exception of nasal pain, the tolerability and acceptance were significantly greater in the unsedated TNE group. Significantly more TNE patients (82%) found the current endoscopic procedure to be better than their previous TOE when compared with patients who had received a second TOE (12%). A repeat procedure was significantly more acceptable for TNE patients when compared to the TOE group (68% vs.16%). The duration of endoscopy was significantly shorter in TOE than in TNE (p<0.05). Endoscope insertion failed in 4% and mild epistaxis was observed in 4% of TNE patients.

CONCLUSION

Unsedated TNE was better tolerated in endoscopy experienced patients when compared with unsedated TOE. The majority of patients found TNE more acceptable and preferable to TOE, suggesting that TNE should become a more common practice in clinics when applicable.

Localized acne induced by radiation therapy

The appearance of localized acne or comedo reaction during or shortly after radiotherapy is an unusual adverse event, but one that is probably underestimated. It can manifest as an inflammatory (papules, pustules, nodules), comedonal (open and closed comedones, Favre-Racouchot-like syndrome), or mixed presentation. We report two new cases of radiation-induced acne with different clinical aspects and discuss the main known features of this adverse event.

Endonasal endoscopic transsphenoidal pituitary surgery: early experience and outcome in paediatric Cushing's disease

BACKGROUND

Selective adenomectomy remains the first-line treatment for Cushing's disease (CD), until recently by microscopic transsphenoidal pituitary surgery. Endonasal transsphenoidal endoscopic surgery (ETES) is emerging as a novel, less invasive treatment for pituitary adenomas and has become the optimal surgical approach.

OBJECTIVE

There are no published series for the treatment of paediatric CD by ETES, and we report our centre's preliminary results.

DESIGN

Retrospective analysis.

PATIENTS

Six paediatric patients (median age 15·8 years; range 11·7-17·0 years) fulfilled standard diagnostic criteria for CD. Preoperatively, no abnormality was identified on pituitary MR scanning in 3 (50%) patients, one had a macroadenoma. Bilateral petrosal sinus sampling demonstrated central ACTH secretion (IPS/P ACTH ratio ≥3·0, post-CRH) in 3/6 (50%) patients. The same neurosurgeon and endoscopic nasal surgeon undertook all the operations.

OUTCOME MEASURES

Therapeutic outcome and rate of complications.

RESULTS

Clinical recovery and biochemical 'cure' were achieved in 5 (83%) patients, and a corticotroph adenoma was confirmed histologically in all cured cases. One case developed post-operative CSF leak requiring lumbar drain insertion and patching. At a mean interval of 4·7 years (0·1-10·8 years) post-operatively, cured patients have shown no recurrence. One patient, with a large diffuse adenoma requiring more extensive surgery, has panhypopituitarism, and another patient has GH and gonadotrophin deficiencies.

CONCLUSIONS

Our experience shows that ETES for removing corticotroph adenomas in children, in most cases not visualized on MRI, is minimally invasive and gave excellent post-operative recovery/results. In skilled hands, this technique provides an alternative to conventional transsphenoidal microscopic surgery in managing paediatric CD.

Impairment of secondary peristalsis in Barrett’s esophagus by transnasal endoscopy-based testing

AIM: To investigate dysfunctions in esophageal peristalsis and sensation in patients with Barrett’s esophagus following acid infusion using endoscopy-based testing.

METHODS: First, physiological saline was infused into the esophagus of five healthy subjects, at a rate of 10 mL/min for 10 min, followed by infusion of HCl. Esophageal contractions were analyzed to determine whether the contractions observed by endoscopy and ultrasonography corresponded to the esophageal peristaltic waves diagnosed by manometry. Next, using nasal endoscopy, esophageal sensations and contractions were investigated in patients with, as well as controls without, Barrett’s esophagus using the same infusion protocol.

RESULTS: All except one of the propulsive contractions identified endoscopically were recorded as secondary peristaltic waves by manometry. Patients with long segment Barrett’s esophagus (LSBE) tended to have a shorter lag time than the control group, although the difference did not reach statistical significance (88 ± 54 s vs 162 ± 150 s respectively, P = 0.14). Furthermore, patients with LSBE had significantly fewer secondary contractions following the infusion of both saline and HCl than did either the control group or patients with short segment Barrett’s esophagus (4.1 ± 1.2 vs 8.0 ± 2.8, P < 0.001 and 7.3 ± 3.2, P < 0.01, respectively, following saline infusion; 5.3 ± 1.2 vs 8.4 ± 2.4 and 8.1 ± 2.9 respectively, P < 0.01 for both, following infusion of HCl).

CONCLUSION: Using nasal endoscopy and a simple acid-perfusion study, we were able to demonstrate disorders in secondary peristalsis in patients with LSBE.

[Absorbable shanching satin rb-bFGF prepreg sheet and expansion hemostatic sponge together to cure epistaxis with blood disease]

OBJECTIVE

This study investigated the effects and Numerical Rating Pain Scale (NRS) of using absorbable shanching satin rb-bFGF prepreg sheet and expansion hemostatic sponge together nasal packing in the control of epistaxis with blood disease, and compared it with traditional vaseline gauze.

METHOD

Ninety-six blood disease patient with epistaxis were enrolled between January 2009 and February 2011, they were divided into two groups at random, and differently treated with absorbable shanching satin rb-bFGF prepreg sheet and the vaseline gauze nasal packing for haemostasis. Then haemostasis efficacy,the hemorrhage rate after nasal packing removed and host response, such as nasal pain and headache, which evaluated pain degrees against NRS, were all observed.

RESULT

There was no significant difference between the two groups of the haemostatic effect. But the hemorrhage rate of treatment group was obviously lower than that of the control group after paching,in addition, host responses, such as nasal pain and headache, remarkably better than the control group, the difference had statistical significance.

CONCLUSION

It is indicate that absorbable shanching satin rb-bFGF prepreg sheet presents reliable hemostasis effect, good biocompatibility and compliance; the pain and headache caused by packing are superior to vaseline gauze. Moreover, this method avoids the direct touch of vaseline gauze with nasal mucosal wound, and reduce hemorrhage after packing. Absorbable shanching satin rb-bFGF prepreg sheet and expansion hemostatic sponge together is better to select the nasal packing material for blood disease patient with epistaxis.

Positive distending pressure produced by heated, humidified high flow nasal cannula as compared to nasal continuous positive airway pressure in premature infants

OBJECTIVE

our objective is to assess the positive distending pressure generated by high flow nasal cannula and nasal continuous positive airway pressure by measuring the end esophageal pressure in premature infants.

STUDY DESIGN

This is a pilot, non-randomized, open label, uncontrolled, crossover assignment study that included neonates born with a birth weight of 1750 grams or less and receiving nCPAP ventilatory support for 24 hrs or more and requiring FiO2 21-50% on nCPAP. Each infant was started on nCPAP at 4, 6 and 8 cm H2O then on three levels of HHHFNC, 4 L/min, 6 L/min and 8 L/min with 4 hours interval on each flow level. Esophageal pressure (EP), apnea of prematurity, FiO2 requirements and bradycardia were recorded during the different levels of CPAP and HHHFNC use.

RESULTS

The study showed that there were no complications observed during the study such as pneumothorax. It showed that EP created by the three different levels of HHHFNC were slightly higher than that EPs created by the three different levels of nCPAP, but statistically not significant. There was no significant change in the FiO2 requirements during the study. There was a trend towards the improvement of oxygen saturation in HHHFNC at different levels and it was statistically significant when 8 L/min was used (P 0.0214). The rates of bradycardia and apnea in nCPAP and HHHFNC were low and statistically were not significant, however the episodes of bradycardia were less in HHHFNC and they were statistically significant at the level of 6 L/min.

CONCLUSIONS

HHHFNC in premature infants was well-tolerated with no adverse side effects such as pneumothorax, desaturation, apnea and bradycardia. The study also showed that HHHFNC was able to deliver distending pressure equal to nCPAP. Moreover, we have observed a significant improvement in oxygen saturation when higher levels of HHHFNC was used, most probably due to the improvement of infant comfort which is a noticeable feature of HHHFNC.

Neurological symptoms of leptomeningeal carcinomatosis as the primary manifestation of an adenocarcinoma of the nasal cavity and sinus: a case report and literature review

Carcinomas of the nose and paranasal sinuses are rare solid head and neck tumours. With an incidence of 1-1.5/100,000 per year, they account for only 3% of all malignancies in the head and neck region. Sinonasal carcinomas are often adenocarcinomas. Hardwood dust is one possible triggering agent, although the latency period may extend to decades. Central nervous system complications arising from solid tumours of the head can be explained in terms of the close anatomical relationship between the two areas. However, leptomeningeal spread is rare. To our knowledge, this is the first report demonstrating cranial nerve deficits due to a leptomeningeal carcinomatosis as the primary manifestation of an adenocarcinoma of the paranasal sinus and the nasal cavity.

Recurrent chondro-osseous respiratory epithelial adenomatoid hamartoma of the nasal cavity in a child

Chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH) is an extremely rare type of hamartoma. To the best of our knowledge, only 1 case has been previously reported. A 7-year-old girl presented with a case of COREAH of the bilateral nasal cavities. Polypous masses in both nasal cavities were resected endoscopically, and they were histologically diagnosed as COREAH. A large polypous mass recurred 1 year postsurgically on the right side only. A second endoscopic surgery was performed, and the lesion was confirmed to be recurrent COREAH. Hamartoma of the nasal cavity is rare and is generally considered to be self-limiting. This case suggests that nasal hamartomas may have neoplastic characteristics, and therefore require complete resection.

Primary amelanotic melanoma of the nasal cavity: a case report

Primary mucosal malignant melanomas of the nose are rare, accounting for only 0.3 to 2% of all cases of malignant melanoma and about 4% of all head and neck melanomas. The amelanotic variant of mucosal malignant melanoma is even more rare, and the prognosis is poor. This variant usually arises in locations in which it is not noticeable, and therefore it is usually diagnosed at an advanced clinical stage when symptoms eventually manifest. We report a case of locally advanced amelanotic melanoma of the nasal cavity in a 55-year-old woman who presented with complaints of nasal obstruction and intermittent bleeding on the right side of the nose for 3 months and a gradually progressive diffuse swelling over the right periorbital and maxillary areas for 2 months with associated pain for 15 days. She was diagnosed with amelanotic melanoma on the basis of clinical, radiologic, and pathologic findings. In view of her advanced disease, she declined surgery and was treated with chemoradiotherapy, and she experienced a significant alleviation of her symptoms.

[Familial nasal bottom supernumerary tooth dentigerous cyst: report of 1 case and review of literatures]

Nasal supernumerary teeth and additional dental cyst is a common disease in Department of ENT and Department of Stomatology. In reported diseases, patients with a variety of additional teeth appeared in differ ent parts have varied clinical manifestations. Because of no obvious early symptoms, it is more difficult to diagnose, but CT examination in corresponding site can make it easy to diagnose the maxillary sinus and dentigerous cyst diagnosis. Operation is an effective method to cure the disease. Operation is simple, but the defect and tooth cavity after operation is one unavoidable problem for ENT doctor. In relevant literature it can be seen that the disease has a genetic tendency.

[Correlation of VEGF expression with microvessel and microlymphatic density in sinonasal squamous cell carcinoma]

OBJECTIVE

To study the expression of VEGF in sinonasal squamous cell carcinoma and its correlations with microvessel density (MVD), microlymphatic vessel density (MLVD).

METHOD

The expression of VEGF, MVD and MLVD in 41 cases of sinonasal squamous cell carcinoma were detected by immunohistochemical technique.

RESULT

In the sinonasal squamous cell carcinoma, the positive rate of VEGF was 82.9% (34/41). The over expression of VEGF was related with tumor invasion, histological grading and lymphatic metastasis (P < 0.05). The MVD of cases with positive VEGF expression was significantly higher than those without VEGF expression (P < 0.05), but was not statistical difference in MLVD (P > 0.05).

CONCLUSION

VEGF may participate in the metastasis of sinonasal squamous cell carcinoma through promoting vascularization in the tumors, but not promoting MLVD.

[Effect of nasal cavity expansion surgery on chronic nasal obstructive diseases on the blood supply of the cerebral arterial system]

OBJECTIVE

To investigate the effect of nasal cavity expansion surgery on the abnormal blood supply of the cerebral arterial system.

METHODS

Fifty-nine inpatients with abnormal blood supply of cerebral arterial system confirmed by transcranial doppler (TCD) and chronic nasal obstructive diseases were included in this study. All patients accepted nasal cavity expansion surgery and were followed-up with TCD every month after operation until TCD became normal, or up to seven months even if the TCD was still abnormal. SPSS 17.0 software was used to analyze the data.

RESULTS

In all 59 patients, there were 164 TCD-abnormal cerebral arteries. Among them, 37 patients(62.71%) with abnormal TCD arteries became normal within 1 to 7 months after operation, 8 patients (13.56 %) got better, but 14 patients (23.73 %) did not improve.

CONCLUSIONS

Abnormal blood flow of some cerebral arteries was possibly induced by increasing the activation of sympathetic nervous system around the vertebral arterial system, caused by chronic nasal obstruction. Nasal dilatancy surgery can improve the blood supplement of the cerebral arterial system.

[Clinical analysis of 20 patients with primary non-Hodgkin's lymphoma of nasal cavity and nasopharynx]

OBJECTIVE

To evaluate the treatment policy for non-Hodgkin's lymphoma of the nasal cavity and nasopharynx.

METHOD

Twenty patients with pathologically confirmed non-Hodgkin's lymphoma of nasal cavity and nasopharynx,treated from Jan. 2006 to Oct. 2010, were retrospectively reviewed.

RESULT

The 3-year overall survival and complete response rates for all patients were 78% and 47% respectively. The 3-year overall survival rates for patients treated with chemotherapy and patients treated with chemotherapy plus radiotherapy were 75% and 82% respectively. The estimates of complete response for patients receiving chemotherapy alone and for patients receiving chemotherapy plus radiotherapy were 37% and 55%, respectively. The 3-year overall survival rates for patients who achieved complete response and patients who did not were 89% and 70%, respectively. The 3-year overall survival rates for patients in stage IE and stage II E were 92% and 57%, respectively.

CONCLUSION

There was no significant difference between chemotherapy alone and chemotherapy plus radiotherapy for the treatment of non-Hodgkin's lymphoma of the nasal cavity and nasopharynx. The 3-year overall survival rate for patients in stage IE was much higher than in stage II E. Early treatment is very important to improve the survival rate of the patients.

[A case of oncocytic papilloma in nasal ethmoid sinus]

The incidence of oncocytic papilloma of nasal ethmoid sinus is very low. In order to improve the understanding of the disease for clinicians,we report one case of oncocytic papilloma in nasal ethmoid sinus. The case performs mainly congestion of the left nasal cavity, running pus nose and hyposmia. Nasal endoscopy found new creature in the meatus,and CT indicates soft tissue shadow in the left superior nasal passages,ethmoid sinus involved. Tumor is resected completely. There is no recurrence after five years follow-up.

Pediatric endonasal endoscopic dacryocystorhinostomy

OBJECTIVE

Nasolacrimal duct obstruction is a relatively common problem among children. Although spontaneous resolution is possible and various conservative treatment options are available, dacryocystorhinostomy is recommended for persistent epiphora. The aim of this study was to report our experience of performing 83 procedures of pediatric endoscopic dacryocystorhinostomy.

METHODS

This retrospective study included 71 children who underwent endonasal endoscopic dacryocystorhinostomy between 2000 and 2011. Thirteen of these children had bilateral procedures. The diagnosis of nasolacrimal duct obstruction was based on the presence of eye discharge, the patient's history obtained from his or her parents and the results of testing the patency of the nasolacrimal canal by irrigating the lacrimal sac. The procedure was considered to be successful if the patient's eye discharge was completely resolved and the dacryocystorhinostomy ostium was patent at end of the postoperative first year.

RESULTS

Eighty-three dacrycystorhinostomy procedures were performed in 71 children. There were 35 (49.3%) male and 36 (50.7%) female patients. The age of the patients ranged between 11 months and 14 years, with a mean of 8.9 years. The mean follow-up period was 27.1 months (range of 14-84 months). The overall success rate for primary endoscopic dacryocystorhinostomy was 92.7%. No major complications were encountered in any of the surgical procedures.

CONCLUSION

Pediatric endonasal endoscopic dacryocystorhinostomy is a safe and effective procedure to correct nasolacrimal system obstruction in cases that are unresponsive to conservative treatments. It has a high success rate and a low incidence of complications.

A study to determine the benefits of bilateral versus unilateral nasal packing with Rapid Rhino ® packs

There is little evidence to suggest that bilateral nasal packing increases intra-nasal pressures compared to a single pack (or is well tolerated) for uncontrolled unilateral epistaxis, but it is often performed and justified on those grounds. 15 volunteers were recruited according to strict criteria. Rapid Rhino(®) 5.5 cm anterior packs were inserted bilaterally following topical nasal preparation with co-phenylcaine. The first pack was inflated to a pre-determined pressure. The contralateral pack was inflated to match, and any intra-nasal pressure change on the first side was measured. The subject's level of discomfort was scored on a visual analogue scale. This procedure was repeated at incremental pressures. Higher ipsilateral intra-nasal pressures are achieved when additional contralateral nasal packs are inflated. This change in ipsilateral intra-nasal pressure is greater at higher total inflation pressures. At higher pressures, the subjects reported lower mean pain scores when bilateral packs were used compared to unilateral. This effect was only statistically significant at intra-nasal pressures of 140 mmHg and above (Wilcoxon Signed-Rank test, p < 0.02). It is possible to increase the ipsilateral nasal cavity pressure by inserting a contralateral nasal pack. Although this extra pressure may be enough to tamponade further venous bleeding without significantly increasing a subject's discomfort, the high levels of pack pressure required, make this unlikely to be of significant use in the clinical setting.

Incidental finding of foreign bodies during nasal intubation in a mentally challenged patient

Nasal foreign bodies are frequently encountered among children and mentally challenged patients. They are often asymptomatic and may remain undetected for years. We are presenting a case of an incidental finding of foreign bodies during nasal intubation in a mentally challenged patient.

[Unilateral nasal cavity and paranasal sinus neoplasm in adolescent]

The clinical data of two adolescents with unilateral nasal cavity neoplasm were analyzed. Both were male, one was 14-year-old and the other was 17. Both were complained of unilateral nasal obstruction and nasal discharge; The course of disease of the former was one month ,and that of the latter was three month; both were found neoformation in unilateral nasal cavity in medical examination. Occupying lesion in unilateral nasal cavity and sinus were demonstrated in CT scan of two cases. Endoscopy surgery were operated in both cases, incisal opening in labiogingival groove was added in the latter. Pathology of the former was capillary hemangioma and the latter was rhabdomyosarcoma. No findings indicating recurrence has been observed in two cases under 6 months follow-up. Recognition at nasal cavity and paranasal sinus neoplasm in adolescent is essential so that proper management can be initiated.

[Relationship between inferior turbinate outfracture and the improvement of nasal ventilatory function]

OBJECTIVE

To discuss the relationship between structural change in nasal cavity and the change of nasal ventilatory function after outfracture of the inferior turbinate.

METHODS

The inferior turbinate outfracture surgery was performed on 50 chronic hypertrophic rhinitis patients who suffered inferior turbinate hypertrophy according to endoscopy and CT scan. Preoperative and postoperative nasal endoscopy was carried out on all patients, by which the distance from the inferior turbinate front mucous membrane to nasal septum (DTNS) was measured. In addition, CT was used to measure the minimal distance between the inside edges of the bilateral inferior turbinate soft tissue (MDTT) and the minimal distance between the bilateral inferior turbinate bones (MDTB) at the central layer of coronal sectional infundibulum; the minimal distance between the inferior turbinate at asial nasal limen (NLDT); inferior turbinate thickness (ITT). In this way, the change in the structure of nasal cavity was evaluated. Acoustic rhinometry and rhinomanometry were utilized to evaluate the ventilatory function of the nasal cavity objectively. Visual analogue scale (VAS) was applied to evaluate the severity of preoperative and postoperative nasal obstruction subjectively. The test data were used to perform match t-test; Spearman rank correlation was adopted to evaluate the relationship between patients' bilateral VAS and nasal inspiratory effective resistance (IER),nasal expiratory effective resistance (EER) and DTNS. The relationship between the total resistance of nasal inspiratory phase as well as the total resistance of nasal expiratory phase and MDTT and MDTB was analyzed. SPSS 20.0 software was used to analyze the data.

RESULTS

The preoperative data showed that rightward DTNS was (0.12 ± 0.07) cm, leftward DTNS was (0.10 ± 0.07) cm and MDTT was (0.70 ± 0.13) cm, and postoperative data showed that rightward DTNS was (0.47 ± 0.27) cm, leftward DTNS was (0.43 ± 0.15) cm, and MDTT was (1.05 ± 0.15) cm. Significant differences existed in rightward DTNS, leftward DTNS and MDTT between pre-and post operative data (t values were -8.827, -8.590, -17.525, all P < 0.05). According to the preoperative and postoperative comparison, the difference in MDTB, NLDT, rightward ITT, leftward ITT, IER, EER, 0-5 cm nasal cavity volume (0-5 cm NCV), nasal minimal cross-sectional area (NMCA), rightward VAS and leftward VAS had statistical significance (t values were -23.562, -8.374, 8.693, 6.684, 12.021, 14.510, -6.074, -2.285, 14.042 and 9.925, respectively, all P < 0.05). Patients' bilateral VAS grades had a positive relationship with IER and EER (left side: r values were 0.541 and 0.660, respectively,right side: r values were 0.940 and 0.688, respectively, all P < 0.05). Additionally, patients' VAS had a negative relationship with DTNS (r value was -0.861, P < 0.05). Besides,the total resistance of nasal inspiratory phase had a negative relationship with both MDTT and MDTB (r values were -0.565 and -0.546,respectively, all P < 0.05). The total resistance of nasal expiratory phase had a negative relationship with both MDTT and MDTB (r values were -0.562 and -0.546, all P <0.05).

CONCLUSION

The inferior turbinate outfracture surgery was an ideal surgical method by which nasal cavity could be broadened and nasal ventilatory function improved.

Oncocytoma of the nasal cavity: A case report

Oncocytomas arising in the nasal cavity are quite rare. These entities more commonly occur in the major salivary glands, minor salivary glands, respiratory seromucinous glands, and endocrine organs. Very few cases of oncocytoma in the nasal cavity have been reported, with only 5 diagnosed as malignant. This article describes a case involving an 81-year-old man with a nasal oncocytoma that was completely resected with an endoscopic medial maxillectomy. The diagnostic rationale is discussed, along with a review of the literature.

[A case report of muscular lipoma in nasal vestibular]

A 53-year-old woman presented with a gradually growing mass on the right nostril.

PHYSICAL EXAMINATION

a size of 2.0 cm x 2.0 cm x 1.5 cm, smooth and movable mass was on the right side of lateral ala nasi. In surgery, a taupe neoplasm was found in the nasal vestibular area and some faint yellow adipose tissues were found in the neoplasm. The tumor showed indiscernible boundaries and invaded ipsilateral facial vein and infraorbital nerve. Postoperative pathologic findings were consistent with muscular lipoma. The diagnosis mainly relied on the postoperative pathological findings.

[A case of nasal malignant peripheral nerve sheath tumor]

The 52-year-old female patient complained of persistent and progressive obstruction in left nasal cavity for more than 1 years. A grey, hard and smooth tumor with telangiectasia, were seen plugged in left post-nostrils and nasopharynx. CT scanning showed a tumor in the left nasal cavity. Post-operational pathologic diagnosis was peripheral nerve sheath tumors of nasal cavity.

[A case of an unexpected difficult nasal intubation, caused by hypertrophied lingual tonsil]

We experienced a case of unexpected difficult nasal intubation due to lingual tonsil hyperplasia. A 43-year-old man was scheduled for pharyngoplasty because of sleep apnea syndrome. After induction of general anesthesia, Macintosh laryngoscopy failed to expose his glottis by two experienced anesthesiologists. We also found that the view of his larynx by fiberoptic bronchoscope (FOB) was poor, and nasal intubation guided by FOB was difficult. Finally, we made an oral intubation with Macintosh laryngoscopy under a gum elastic bougie guide. Ventilation and oxygenation were maintained throughout the procedure. A FOB guided intubation under general anesthesia is often difficult, because identification of glottis is interfered by deviated pharyngeal tissue and epiglottis, which are affected by the use of muscle relaxants. At present, a selective relaxant binding agent, sugammadex, is available in anesthesia, to reverse the effect of non-depolarizing muscle relaxant and to restore spontaneous breathing in this situation.

A comparison of two nasal continuous positive airway pressure interfaces--a randomized crossover study

BACKGROUND

In spite of widespread use of nasal CPAP there are comparatively few studies to guide the choice of nasal prongs.

OBJECTIVES

To determine whether the Fisher & Paykel Healthcare (FPH) neonatal continuous positive airway pressure (CPAP) interface was effective in providing bubble CPAP when compared to the Hudson prong interface.

METHODS

The study was a randomized cross-over study of twenty newborn infants 500 g or more requiring CPAP for respiratory support at birth. Infants were randomized to either the Fisher & Paykel Healthcare or Hudson CPAP interface for twenty four hours. Crossover between interfaces occurred after subsequent twenty four hour periods. The primary outcome was the provision of desired CPAP pressures, defined as provision of CPAP within ± one cm H2O of set pressure.

RESULTS

The percentage time CPAP was within ± one cm H2O of set pressure was 66.5% for the Hudson and 71.8% for the FPH interface (p = 0.66). Oxygen saturations for the Hudson interface were in target range for a median of 97.8% of the time, and, with the FPH interface, for a median of 98.2% of the time (p = 0.76). Clinically significant differences in primary or secondary outcomes between the two groups were not detected.

CONCLUSIONS

The nasal CPAP interfaces studied were equally effective in achieving desired bubble CPAP pressures and target saturations.

Dynamic growth and deposition of hygroscopic aerosols in the nasal airway of a 5-year-old child

Hygroscopic growth within the human respiratory tract can be significant, which may notably alter the behavior and fate of the inhaled aerosols. The objective of this study is to evaluate the hygroscopic effects upon the transport and deposition of nasally inhaled fine-regime aerosols in children. A physiologically realistic nasal-laryngeal airway model was developed based on magnetic resonance imaging of a 5-year-old boy. Temperature and relative humidity field were simulated using the low Reynolds number k - ε turbulence model and chemical specie transport model under a spectrum of four thermo-humidity conditions. Particle growth and transport were simulated using a well validated Lagrangian tracking model coupled with a user-defined hygroscopic growth module. The subsequent aerosol depositions for the four inhalation scenarios were evaluated on a multiscale basis such as total, subregional, and cellular-level depositions. Results of this study show that a supersaturated humid environment is possible in the nasal turbinate region and can lead to significant condensation growth (d / d(0)  > 10) of nasally inhaled aerosols. Depositions in the nasal airway can also be greatly enhanced by condensation growth with appropriate inhalation temperature and humidity. For subsaturated and mild inhalation conditions, the hygroscopic effects were found to be nonsignificant for total depositions, while exerting a large impact upon localized depositions.

Anteriorly based pedicled flaps for skull base reconstruction

The expansion of endoscopic skull base surgery has resulted in the creation of large defects that must be repaired to ensure separation of the cranial vault from the nasal cavity. The workhorse of anterior skull base reconstruction remains the nasoseptal or Hadad-Bassagasteguy flap. Despite its success, the nasoseptal flap is limited in its ability to reach extremely anterior defects including those involving the frontal break, posterior frontal table, and anterior cribiform plate. Alternative approaches utilizing anteriorly pedicled flaps have been described which exploit the vascular supply to the anterior septum and lateral nasal wall. The diminutive nature of the anterior septal blood supply has led to the elaboration of a bipedicled anterior septal flap which is capable of reliable reconstruction of both the frontal beak as well as posterior frontal table defects. Similarly anteriorly based inferior turbinate flaps pedicled largely on anterior ethmoid arborizations have been used successfully to reconstruct anterior defects. In light of the limitations of the nasoseptal flap, the addition of anteriorly pedicled flaps to the clinical armamentarium offers the opportunity to provide vascularized mucosal coverage of virtually any region of the skull base which can be reached endoscopically.

[The application of no nasal packing after functional endoscopic sinus surgery in type I and type II chronic sinusitis]

OBJECTIVE

The subjective sensation of the patients and the treatment effect were compared prospectively between the no nasal packing group and the common nasal packing group.

METHOD

The patients were divided into no nasal packing group and nasal packing group matched for the type of chronic sinusitis. All patients received operation of functional endoscopic sinus surgery. The patients of no nasal packing group were given thoroughly bleeding control without nasal packing, while the patients of nasal packing group received nasal packing with sponge after hemostatic seaweed covering of wound. The nasal stents in nasal packing group were removed two days after operation, and the other treatments were all identical in the two groups. The clinical symptoms and treatment effect were compared between the two groups using visual analog scale. The levels of headache, rhinalgia, nasal obstruction, bleeding and nasal secretions volume at different time points, such as 1 day, 2 days and 3 days after operation, were evaluated and compared, as well as the recovering of operative region, such as crustal, secretion, reaction film, mucosal edema, vesicle and blockage of the sinus ostium.

RESULT

At the 1st day after operation, the degrees of headache, rhinalgia and nasal obstruction in the no nasal packing group were milder than the nasal packing group, and the differences have statistical significance. Two days after operation, the degrees of headache, rhinalgia and nasal obstruction, as well as the volume of bleeding and nasal secretions in the no nasal packing group were milder and lower than the nasal packing group, and the differences have statistical significance. Three days after operation, the differences of the indexes above were not statistically significant. The scores of total bleeding volume during the 3 days after operation showed no statistically significant difference between the two groups. Thirty-four patients were cured in no nasal packing group with the average epithelialization time of (10.7 +/- 2.6) weeks. Thirty-two patients were cured in nasal packing group with the average epithelialization time of (10.6 +/- 2.9) weeks. The difference of average epithelialization time between the two groups was not statistically significant.

CONCLUSION

No nasal packing could relieve the discomfort caused by nasal packing and avoid the rebleeding and pain when removing the nasal stents. No nasal packing has obvious superiority than common nasal packing, and is effective in the treatment of depression. It is be appropriate for type I and type II chronic sinusitis patients without systemic disease with limited economic conditions.

Nasal tip angiolipoma: the "Pinocchio" nasal deformity

Angiolipoma is a rare, benign variant of lipoma; its distinctive feature is its prominent vascularity. It presents as a subcutaneous nodule of white adipose tissue; pain, which may be exacerbated by pressure, is the chief symptom. The anatomic distribution predominantly involves the trunk and extremities. Because of the rarity of this condition in otorhinolaryngology, our understanding of its diagnosis, treatment, and follow-up is limited. Microscopically, two different histopathologic forms of angiolipomas exist: circumscribed and infiltrating. The diagnosis of angiolipoma can be aided by ultrasound, computed tomography, or magnetic resonance imaging. Surgical excision remains the treatment of choice. Sites of previously reported otolaryngologic cases include the cheek, palate, mandible, nasal septum, and cervical area. We describe what we believe to be the second case of a nasal tip angiolipoma in a 78-year-old woman complaining of progressive aesthetic deformity.

Recent advances in interfaces for non-invasive ventilation: from bench studies to practical issues

The interface is the defining element of non-invasive ventilation (NIV). Nowadays different types of interfaces, which differ in terms of shape, mechanical properties and comfort, are available, and their choice and fitting is a key element of NIV success. In the last decade, larger masks covering the entire face and specifically designed helmets have been developed for delivering NIV, theoretically improving comfort and patient tolerance. Recent studies have shown that, despite marked heterogeneity in mask internal volume and compliance, the dynamic dead space and, above all, the clinical efficacy of different masks is on average very similar. Thus, with the exception of the nasal mask and the mouthpiece, a variety of interfaces for NIV can be used in the acute care setting. However, prevention and monitoring of interfaces related side-effects and evaluation of patient tolerance are crucial to avoid NIV failure. To optimize effectiveness and costs, an interface strategy for NIV in acute respiratory failure could be convenient in clinical practice.

[Influence of nasal septal deviation on incidence of bilateral sinusitis]

OBJECTIVE

To investigate the influence of nasal septal deviation on the incidence of bilateral sinusitis.

METHOD

Two thousand and seventy-four cases of nasal septal deviation with chronic sinusitis available from January 2006 to March 2012 were reviewed retrospectively.

RESULT

Of these 2074 cases, 1 687 (81.3%) patients had sinusitis in narrow side and 1582 (76.3%) in wide side, the difference was statistically significant (P < 0.01) and the relative risk value in narrow side (1.4) was higher than wide side (0.7) associated with the incidence of sinusitis. There was significant difference (P < 0.05) between the two group counting datas analyzed by rank sum test, and the mean rank order in narrow side was 1656.396, significantly greater than wide side (1 612.184). The incidence of sinusitis in men was 50.6% (1049/2074), in women was 49.4% (1025/2074), and there was no significant difference between them. Deviating leftward was 1148 cases (55.4%), deviating rightward was 926 cases (44.6%), and the difference was statistically significant (P < 0.05). Anatomic variations in narrow side and wide side were uncinate process hypertrophy (7.0%, 27.0%), middle turbinate hypertrophy (7.8%,38.0%), ethmoidal bulla hypertrophy (26.2%, 39.0%), paradoxical middle turbinate (5.4%, 15.5%), hypertrophic inferior turbinate (52.9%, 67.0%) and mucosa pachynsis (0.5%, 2.8%), respectively.

CONCLUSION

Sinusitis incidence in narrow side is higher than wide side. There is no significant difference between the incidence of sinusitis in men and women. The majority of nasal septum deviate leftward. Higher incidence of sinusitis in wide side is the result of compensatory mechanism. Only septoplasty may not restore the normal venting function in nasal cavity. Hypertrophic inferior turbinate are closely correlated with sinusitis.

Impact of early radiological response evaluation on radiotherapeutic outcomes in the patients with nasal cavity and paranasal sinus malignancies

We analyzed the correlation between primary tumor response within 6 months after radiation therapy (RT) including proton beam therapy (PBT) and progression free survival rate (PFS) in patients with nasal cavity and paranasal sinus malignancies to clarify the impact of early radiological evaluation of treatment response on prognosis. Sixty-five patients treated between January 1998 and December 2008, and whose follow-up duration was more than 2 years were included. The Response Evaluation Criteria in Solid Tumors (version 1.1) was used for the evaluation of treatment. Median age was 59 years (range 21-83 years). Olfactory neuroblastoma (n = 20, 30%) and squamous cell carcinoma (n = 15, 23%) were the major pathological tumor types. The median follow-up duration was 51.6 months. Radiological response evaluation within 6 months after treatment demonstrated that 15% of the patients achieved complete response (CR), and 3-year progression free survival rates of all patients was 49.2%. The 3-year PFS rates according to response for the treatment were 55.6% in the patients with CR and 46.4% in those with non-CR, respectively (P = 0.643). However, the 3-year PFS rates were 80.% in the patients with CR and 10.% in those with non-CR (P = 0.051) in the patients with squamous cell carcinoma (SCC) histology. Radiological response evaluation within 6 months did not have a significant impact on prognosis when analysis included all histology, although early radiological response within 6 months after RT had a borderline significant impact on treatment outcomes for the patients with nasal and paranasal SCC.

Antiallergic effect of KOB03, a polyherbal medicine, on mast cell-mediated allergic responses in ovalbumin-induced allergic rhinitis mouse and human mast cells

ETHNOPHARMACOLOGICAL RELEVANCE

KOB03 is a polyherbal medicine consisting of five different herbs and has commonly been used for the treatment of various allergic diseases. However, its precise anti-allergic effect and mechanism remain unknown.

AIM OF THE STUDY

The aim of this study was to investigate the effect of KOB03 on allergic responses through the regulation of mast-cell mediated allergic inflammation.

MATERIALS AND METHODS

To determine the effect of KOB03 on mast cell-mediated allergic reactions, we investigated the parameter changes of in vivo models such as compound 48/80-induced systemic anaphylaxis and ovalbumin (OVA)-induced allergic rhinitis, and the release of allergic inflammatory mediators such as histamine, immunoglobulin (Ig) E, and inflammatory cytokines via the MAPKs and NF-kappaB pathways.

RESULTS

The oral administration of KOB03 at doses of 100 and 200mg/kg inhibited histamine release and mortality in compound 48/80-induced anaphylactic rats. KOB03 also improved rhinitis symptoms, inhibited the histopathological changes of nasal mucosa, and decreased the serum levels of histamine, OVA-specific IgE and TNF-α in OVA-induced allergic rhinitis in mice. In vitro, KOB03 suppressed compound 48/80-induced histamine release by blocking mast cell degranulation. In addition, KOB03 inhibited the production of inflammatory cytokines such as TNF-α, IL-1β, IL-6 and IL-8 in PMA/A23187-stimulated HMC-1 mast cells by suppressing their gene expression and blocking the ERK1/2 and p38 MAPK and NF-κB pathways.

CONCLUSIONS

These results suggest that KOB03 has an anti-allergic effect by modulating mast cell-mediated allergic responses in allergic rhinitis.