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Rüttgers M, Waldmann M, Vogt K, Ilgner J, Schröder W, Lintermann A. Automated surgery planning for an obstructed nose by combining computational fluid dynamics with reinforcement learning. Comput Biol Med 2024; 173:108383. [PMID: 38555704 DOI: 10.1016/j.compbiomed.2024.108383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/26/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Septoplasty and turbinectomy are among the most common interventions in the field of rhinology. Their constantly debated success rates and the lack of quantitative flow data of the entire nasal airway for planning the surgery necessitate methodological improvement. Thus, physics-based surgery planning is highly desirable. In this work, a novel and accurate method is developed to enhance surgery planning by physical aspects of respiration, i.e., to plan anti-obstructive surgery, for the first time a reinforcement learning algorithm is combined with large-scale computational fluid dynamics simulations. The method is integrated into an automated pipeline based on computed tomography imaging. The proposed surgical intervention is compared to a surgeon's initial plan, or the maximum possible intervention, which allows the quantitative evaluation of the intended surgery. Two criteria are considered: (i) the capability to supply the nasal airway with air expressed by the pressure loss and (ii) the capability to heat incoming air represented by the temperature increase. For a test patient suffering from a deviated septum near the nostrils and a bony spur further downstream, the method recommends surgical interventions exactly at these locations. For equal weights on the two criteria (i) and (ii), the algorithm proposes a slightly weaker correction of the deviated septum at the first location, compared to the surgeon's plan. At the second location, the algorithm proposes to keep the bony spur. For a larger weight on criterion (i), the algorithm tends to widen the nasal passage by removing the bony spur. For a larger weight on criterion (ii), the algorithm's suggestion approaches the pre-surgical state with narrowed channels that favor heat transfer. A second patient is investigated that suffers from enlarged turbinates in the left nasal passage. For equal weights on the two criteria (i) and (ii), the algorithm proposes a nearly complete removal of the inferior turbinate, and a moderate reduction of the middle turbinate. An increased weight on criterion (i) leads to an additional reduction of the middle turbinate, and a larger weight on criterion (ii) yields a solution with only slight reductions of both turbinates, i.e., focusing on a sufficient heat exchange between incoming air and the air-nose interface. The proposed method has the potential to improve the success rates of the aforementioned surgeries and can be extended to further biomedical flows.
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Affiliation(s)
- Mario Rüttgers
- Jülich Supercomputing Centre, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52425 Jülich, Germany; Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany.
| | - Moritz Waldmann
- Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| | - Klaus Vogt
- Faculty of Medicine, Center of Experimental Surgery, University of Latvia, 1586 Riga, Latvia
| | - Justus Ilgner
- Department of Otorhinolaryngology, Head and Neck Surgery, Uniklinik RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Wolfgang Schröder
- Institute of Aerodynamics and Chair of Fluid Mechanics, RWTH Aachen University, Wüllnerstraße 5a, 52062 Aachen, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
| | - Andreas Lintermann
- Jülich Supercomputing Centre, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52425 Jülich, Germany; Jülich Aachen Research Alliance, Center for Simulation and Data Science, 52074 Aachen, Germany
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Cnockaert P, Vecellio L, Dubus JC, Jamar F, Reychler G. A large-volume low-pressure nasal irrigation delivers drug into the nasal cavity? An in vivo study. Drug Deliv Transl Res 2024; 14:1232-1238. [PMID: 37882984 DOI: 10.1007/s13346-023-01455-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Abstract
The nasal administration route emerged as an interesting route in systemic and brain drug delivery, and different modalities of nasal delivery are available. The nasal irrigation is one of them, but there is a lack of studies investigating the distribution of a large-volume irrigation. The main aim of this study was to assess the deposition of radiolabeled saline in the nasal cavities and paranasal sinuses following nasal irrigation by imaging. Five healthy males volunteered to perform large-volume low-pressure nasal irrigation, with a douching device containing 50 mL of radiolabeled isotonic saline. Participants underwent a scintigraphy immediately after. Both the nasal cavities and maxillary sinuses were systematically reached by the solution during nasal irrigation. The sinuses set in a lower position during nasal irrigation showed a tendency to be more irrigated than the sinuses set in a higher position (7.67% vs 22.72%; p = 0.086). Moreover, substantial inter- and intraindividual heterogeneity regarding solution deposition was observed. Large-volume low-pressure nasal irrigation is a good modality to reach the maxillary sinuses as well as the nasal cavities. In order to ensure adequate reaching of both nasal cavities and paranasal sinuses, nasal irrigation should be performed bilaterally.
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Affiliation(s)
- Pierre Cnockaert
- Service de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et Dermatologie, UCLouvain, 1200, Brussels, Belgium
- Faculté des Sciences de la Motricité, UCLouvain, Louvain-La-Neuve, Belgium
| | | | - Jean-Christophe Dubus
- Pneumologie et allergologie pédiatrique, CHU Timone-Enfants, Marseille, France
- Aix-Marseille Université, IRD, AP-HM, MEPHI, IHU Méditerranée-infection, Marseille, France
| | - François Jamar
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et Dermatologie, UCLouvain, 1200, Brussels, Belgium
- Service de Médecine Nucléaire, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Service de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et Dermatologie, UCLouvain, 1200, Brussels, Belgium.
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.
- Haute Ecole Vinci, Secteur Santé, Département de kinésithérapie, Brussels, Belgium.
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Nakamura M, Anzai T, Ishimizu E, Ashikawa K, Inoshita A, Takata Y, Matsumoto F. Intravascular papillary endothelial hyperplasia of the maxillary sinus extending into the contralateral nasal cavity. Eur Arch Otorhinolaryngol 2024; 281:2749-2753. [PMID: 38502360 PMCID: PMC11024052 DOI: 10.1007/s00405-024-08499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Intravascular papillary endothelial hyperplasia (IPEH) predominantly occurs in the subcutaneous and dermal regions and rarely originates from the sinonasal mucosa. CASE PRESENTATION We report on the case of a 58-year-old male patient who presented with progressive bilateral nasal obstruction, left-sided epiphora, and intermittent epistaxis. Computed tomography revealed a soft tissue opacity in the left maxillary sinus with intersinusoidal nasal wall demineralization, extending into the surrounding ethmoid cells and the right nasal cavity through a contralateral deviation of the nasal septum. Contrast-enhanced T1-weighted magnetic resonance imaging further confirmed these findings. The IPEH originating from the maxillary sinus extended into the contralateral nasal cavity, and it was successfully removed using an endoscopic endonasal approach, avoiding overly aggressive treatment. CONCLUSION This case report highlights the diagnostic challenges of IPEH in the sinonasal region and the importance of considering IPEH as a differential diagnosis in patients presenting with nasal obstruction, epiphora, and intermittent epistaxis.
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Affiliation(s)
- Masahiro Nakamura
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Takashi Anzai
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Erina Ishimizu
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Karin Ashikawa
- Department of Human Pathology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Ayako Inoshita
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yusuke Takata
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Ronsivalle V, Leonardi R, Lagravere M, Flores-Mir C, Grippaudo C, Alessandri Bonetti G, Lo Giudice A. Medium-term effects of rapid maxillary expansion on nasal cavity and pharyngeal airway volumes considering age as a factor: A retrospective study. J Dent 2024; 144:104934. [PMID: 38461886 DOI: 10.1016/j.jdent.2024.104934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES The medium-term effects of rapid maxillary expansion (RME) on nasal cavity (NC) and upper airway (UA) dimensions based on chronological age are still unclear. This retrospective study evaluated the medium-term changes occurring in the NC and pharyngeal airways (PA) after RME in two distinct age-based cohorts of patients. METHODS This retrospective study included 48 subjects who underwent RME grouped in two cohorts: a 6-9-year-old group (EEG group: early expansion group - 25 subjects) and an 11-14-year-old group (LEG group: late expansion group - 23 subjects). NC and PA volumes were analyzed from CBCT imaging segmentation before RME (T0) and twelve months after RME (T1). The amount of maxillary expansion (PW) and minimal cross-sectional area (CSmin) were also considered. RESULTS All PAs' volumetric sub-regions, CSmin and PW showed a significant volumetric increment (p < 0.05). Inter-group comparisons showed significant differences (p < 0.05) for nasopharynx and CSmin parameters (p < 0.05), while no significant changes were recorded for the other UA's sub-regions and PW (p > 0.05). According to a deviation analysis, part of the UA increase (more marked for the nasopharynx area) may have occurred due to reduced adenotonsillar tissues, which were larger in the EEG group. CONCLUSIONS Twelve months after treatment, clinicians should not expect changes in the UAs dimensions to be solely related to treatment effects of RME; instead, normal craniofacial growth changes and spontaneous regression of the adenotonsillar tissue could represent the most significant factors influencing UAs changes. CLINICAL SIGNIFICANCE From the clinical perspective, the results of the present study encourage caution when considering the therapeutic effects of RME on airways dimensions.
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Affiliation(s)
- Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Rosalia Leonardi
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Manuel Lagravere
- Orthodontic Graduate Program, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- Orthodontic Graduate Program, University of Alberta, Edmonton, Alberta, Canada
| | - Cristina Grippaudo
- Orthodontic Graduate Program, University of Roma Cattolica - Sacro Cuore
| | | | - Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, University of Catania, Policlinico Universitario "Gaspare Rodolico - San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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Xiao Q, Bates AJ, Doorly DJ. Effects of decongestion on nasal cavity air conditioning efficiency: a CFD cohort study. Sci Rep 2024; 14:8482. [PMID: 38605156 DOI: 10.1038/s41598-024-58758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
Decongestion reduces blood flow in the nasal turbinates, enlarging the airway lumen. Although the enlarged airspace reduces the trans-nasal inspiratory pressure drop, symptoms of nasal obstruction may relate to nasal cavity air-conditioning. Thus, it is necessary to quantify the efficiency of nasal cavity conditioning of the inhaled air. This study quantifies both overall and regional nasal air-conditioning in a cohort of 10 healthy subjects using computational fluid dynamics simulations before and after nasal decongestion. The 3D virtual geometry model was segmented from magnetic resonance images (MRI). Each subject was under two MRI acquisitions before and after the decongestion condition. The effects of decongestion on nasal cavity air conditioning efficiency were modelled at two inspiratory flowrates: 15 and 30 L min-1 to represent restful and light exercise conditions. Results show inhaled air was both heated and humidified up to 90% of alveolar conditions at the posterior septum. The air-conditioning efficiency of the nasal cavity remained nearly constant between nostril and posterior septum but dropped significantly after posterior septum. In summary, nasal cavity decongestion not only reduces inhaled air added heat by 23% and added moisture content by 19%, but also reduces the air-conditioning efficiency by 35% on average.
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Affiliation(s)
- Qiwei Xiao
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alister J Bates
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Denis J Doorly
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, UK, SW7 2AZ.
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Wang AJ, Lee CK, Blanch M, Talati PA, Gray ST, Bleier BS, Scangas GA, Holbrook EH, Curry WT. Endoscopic endonasal approach for olfactory groove meningioma resection: Strategies and outcomes in a retrospective case series. J Clin Neurosci 2024; 122:93-102. [PMID: 38492512 DOI: 10.1016/j.jocn.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Though the endoscopic endonasal approach (EEA) is a widely accepted treatment for skull base tumors, the specific use of EEA for olfactory groove meningiomas (OGMs) is debated, with variable outcomes reported in the literature. We review the surgical results of OGM resections for one surgeon including the operative approach, surgical nuances, and outcomes, with a focus on factors relating to patient selection which favor EEA over transcranial approaches. METHODS We retrospectively reviewed thirteen cases of endoscopic endonasal resection of olfactory groove meningiomas. Patient characteristics, clinical characteristics, surgical outcomes, and complications were analyzed. Extent of resection was determined based on volumetric analysis of pre- and postoperative MRI. RESULTS Anatomic characteristics that render a tumor difficult to access fully are lateral extension beyond the mid-orbit and anterior extension to the falx. Simpson Grade I resection was achieved in 11/13 (84.6 %) cases. Mean pre-operative tumor volume was 8.99 cm3 (range 2.19-16.79 cm3), and 92 % of tumors were WHO grade I. We demonstrate 2 cases of smell preservation, possible with small unilateral tumors and tumors that are confined to either the anterior or posterior portion of the cribriform plate. The post-operative CSF leak rate was 7.7 %, without prophylactic lumbar CSF drainage. The mortality rate was 7.7 % (n = 1) after infectious complications following CSF leak. CONCLUSIONS Endoscopic endonasal resection of olfactory groove meningiomas is an effective and safe operative method with outcomes and complication rates comparable to transcranial approaches. Key considerations include careful patient selection and familiarity with technical nuances of endoscopic endonasal approach for this specific tumor type.
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Affiliation(s)
- Amy J Wang
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Christine K Lee
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Max Blanch
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Pratik A Talati
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - George A Scangas
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - Eric H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - William T Curry
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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7
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Guillemin F, Blanchard P, Boisselier P, Brahimi Y, Calugaru V, Coutte A, Gillon P, Graff P, Liem X, Modesto A, Pointreau Y, Racadot S, Sun XS, Bellini R, Pham Dang N, Saroul N, Bourhis J, Thariat J, Biau J, Lapeyre M. [Proposal for the delineation of postoperative primary clinical target volumes in maxillary sinus and nasal cavity cancers]. Cancer Radiother 2024; 28:218-227. [PMID: 38599940 DOI: 10.1016/j.canrad.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/31/2023] [Indexed: 04/12/2024]
Abstract
In this article, we propose a consensus delineation of postoperative clinical target volumes for the primary tumour in maxillary sinus and nasal cavity cancers. These guidelines are developed based on radioanatomy and the natural history of those cancers. They require the fusion of the planning CT with preoperative imaging for accurate positioning of the initial GTV and the combined use of the geometric and anatomical concepts for the delineation of clinical target volume for the primary tumour. This article does not discuss the indications of external radiotherapy (nor concurrent systemic treatment) but focuses on target volumes when there is an indication for radiotherapy.
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Affiliation(s)
- F Guillemin
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - P Blanchard
- Département de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - P Boisselier
- Département de radiothérapie, Institut régional cancer de Montpellier, parc Euromedecine, 208, rue des Apothicaires, 34090 Montpellier, France
| | - Y Brahimi
- Département de radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), 13, rue Albert-Calmette, 67200 Strasbourg, France
| | - V Calugaru
- Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - A Coutte
- Département de radiothérapie, CHU d'Amiens-Picardie, 30, avenue de la Croix-Jourdain, 80054 Amiens cedex 1, France
| | - P Gillon
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Graff
- Département de radiothérapie, institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - X Liem
- Pôle de radiothérapie curiethérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - A Modesto
- Département de radiothérapie, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Y Pointreau
- Département de radiothérapie, institut interrégional de cancérologie (ILC), centre Jean-Bernard, centre de cancérologie de la Sarthe (CCS), 64, rue de Degré, 72000 Le Mans, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - X S Sun
- Département de radiothérapie, hôpital Nord Franche-Comté de Montbéliard, CHRU de Besançon, 1, rue Henri-Becquerel, 25200 Montbéliard, France
| | - R Bellini
- Département de radiodiagnostic, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - N Pham Dang
- Département de chirurgie maxillofaciale, centre hospitalier universitaire Estaing, 63003 Clermont-Ferrand cedex 1, France
| | - N Saroul
- Département de chirurgie ORL, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France
| | - J Bourhis
- Département de radiothérapie, centre hospitalier universitaire vaudois (CHUV), rue du Bugnon 46, 1005 Lausanne, Suisse
| | - J Thariat
- Département de radiothérapie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France.
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Yaprak F, Coban I, Ozer MA, Eraslan C, Govsa F. The Upper Attachment of the Uncinate Process and Anterior Ethmoidal Artery. Ann Otol Rhinol Laryngol 2024; 133:181-189. [PMID: 37608702 DOI: 10.1177/00034894231191311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Variations in the upper attachment of the uncinate process (UP) are important because they can affect frontal sinus drainage and change the morphology. Functional endoscopic sinus surgery (FESS) is the primary technique used to treat chronic medically refractory rhinosinusitis. Uncinectomy is the basis of FESS technique to obtain the best possible result from surgery. The anterior ethmoidal artery (AEA) enters the nasal cavity through the orbital medial wall (lamina papyracea) may also be affected by the upper attachment of the UP. The aim of this study was to investigate a possible link between UP variations and the course of the AEA. MATERIALS AND METHODS This retrospective, computed tomography (CT)-based, anatomic study was conducted on 200 healthy adults (100 females and 100 males) by screening bilateral paranasal sinus images. The upper attachment of the UP was classified in 6 types (1-6) based on the Liu classification. The AEA was divided into 4 types (A-D) based on location: anterior to the frontal sinus (A), between the frontal sinus and the middle nasal turbinate (B), and anterior to the posterior ethmoidal cells (C and D). All the CT images were evaluated simultaneously by 2 anatomists and 1 radiologist. RESULTS Of the total cases (200 right and 200 left side), 48.8% were type 1 UP attachment, 11.0% type 2, 12% type 3, 9% type 4, 18% type 5, and 1.2% type 6. The AEAs were classified as 12.2% type A, 71.8% type B, 15.2% type C, and 0.8% type D. CONCLUSION The course of the AEA through the nasal cavity was observed to shift anteriorly from the ethmoidal bulla to the frontal sinus in patients with UP attached to the lamina papyracea and middle turbinate. Remarkably, the AEA always coursed anterior from the middle nasal turbinate line.
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Affiliation(s)
- Fulya Yaprak
- Department of Anatomy, Faculty of Medicine, Izmir Democracy University, Izmir, Turkey
| | - Istemihan Coban
- Department of Anatomy, Faculty of Medicine, Izmir Democracy University, Izmir, Turkey
| | - Mehmet Asim Ozer
- Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Cenk Eraslan
- Department of Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Govsa
- Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey
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9
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Na Y, Kwon KW, Jang YJ. Impact of nasal septal perforation on the airflow and air-conditioning characteristics of the nasal cavity. Sci Rep 2024; 14:2337. [PMID: 38281976 PMCID: PMC10822863 DOI: 10.1038/s41598-024-52755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024] Open
Abstract
We investigated (1) how nasal septal perforations (NSPs) modify nasal airflow and air-conditioning characteristics and (2) how the modifications of nasal airflow are influenced by the size and location of the NSP. Computed tomography scans of 14 subjects with NSPs were used to generate nasal cavity models. Virtual repair of NSPs was conducted to examine the sole effect of NSPs on airflow. The computational fluid dynamics technique was used to assess geometric and airflow parameters around the NSPs and in the nasopharynx. The net crossover airflow rate, the increased wall shear stress (WSS) and the surface water-vapor flux on the posterior surface of the NSPs were not correlated with the size of the perforation. After the virtual closure of the NSPs, the levels in relative humidity (RH), air temperature (AT) and nasal resistance did not improve significantly both in the choanae and nasopharynx. A geometric parameter associated with turbinate volume, the surface area-to-volume ratio (SAVR), was shown to be an important factor in the determination of the RH and AT, even in the presence of NSPs. The levels of RH and AT in the choanae and nasopharynx were more influenced by SAVR than the size and location of the NSPs.
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Affiliation(s)
- Yang Na
- Department of Mechanical Engineering, Konkuk University, Seoul, 05029, Korea
| | - Kyung Won Kwon
- Department of Otolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Yong Ju Jang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Russel SM, Gosman RE, Gonzalez K, Wright J, Frank-Ito DO. Insights into exercise-induced rhinitis based on nasal aerodynamics induced by airway morphology. Respir Physiol Neurobiol 2024; 319:104171. [PMID: 37813324 PMCID: PMC11037931 DOI: 10.1016/j.resp.2023.104171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/24/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Exercise-induced rhinitis (EIR) is a poorly understood phenomenon that may be related to increased inspiratory airflow. Characterization of the development of EIR is important to understand contributing factors. OBJECTIVE To characterize how different nasal morphologies respond to airflow-related variables during rapid/deep inspiratory conditions. METHODS Subject-specific nasal airways were reconstructed from radiographic images. Unilateral airways were classified as Standard, Notched, or Elongated accord to their distinct nasal vestibule morphology. Computational fluid dynamics simulations were performed at various airflow rates. RESULTS For all simulated flow rates, average resistance at the nasal vestibule, airflow velocity and wall sheer stress were highest in Notched. Average mucosal heat flux was highest in Standard. Notched phenotypes showed lower mean percent increases from 10 L/min to 50 L/min in all computed variables. CONCLUSION Resistance values and airflow velocities depicted a more constricted nasal vestibule in the Notched phenotypes, while perception of nasal mucosal cooling (heat flux) favored the Standard phenotypes. Different nasal phenotypes may predispose to EIR.
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Affiliation(s)
- Sarah M Russel
- University of North Carolina - Chapel Hill, Department of Otolaryngology/Head & Neck Surgery, Chapel Hill, NC, USA; Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA
| | - Raluca E Gosman
- Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA
| | - Katherine Gonzalez
- Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA
| | - Joshua Wright
- Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA
| | - Dennis O Frank-Ito
- Duke University Medical Center, Department of Head and Neck Surgery & Communication Sciences, Durham, NC, USA.
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11
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Valerian Corda J, Shenoy BS, Ahmad KA, Lewis L, K P, Rao A, Zuber M. Comparison of microparticle transport and deposition in nasal cavity of three different age groups. Inhal Toxicol 2024; 36:44-56. [PMID: 38343121 DOI: 10.1080/08958378.2024.2312801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Objective: The nasal cavity effectively captures the particles present in inhaled air, thereby preventing harmful and toxic pollutants from reaching the lungs. This filtering ability of the nasal cavity can be effectively utilized for targeted nasal drug delivery applications. This study aims to understand the particle deposition patterns in three age groups: neonate, infant, and adult.Materials and methods: The CT scans are built using MIMICS 21.0, followed by CATIA V6 to generate a patient-specific airway model. Fluid flow is simulated using ANSYS FLUENT 2021 R2. Spherical monodisperse microparticles ranging from 2 to 60 µm and a density of 1100 kg/m3 are simulated at steady-state and sedentary inspiration conditions.Results: The highest nasal valve depositions for the neonate are 25% for 20 µm, for infants, 10% for 50 µm, 15% for adults, and 15% for 15 µm. At mid nasal region, deposition of 15% for 20 µm is observed for infant and 8% for neonate and adult nasal cavities at a particle size of 10 and 20 µm, respectively. The highest particle deposition at the olfactory region is about 2.7% for the adult nasal cavity for 20 µm, and it is <1% for neonate and infant nasal cavities.Discussion and conclusions: The study of preferred nasal depositions during natural sedentary breathing conditions is utilized to determine the size that allows medication particles to be targeted to specific nose regions.
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Affiliation(s)
- John Valerian Corda
- Department of Aeronautical & Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - B Satish Shenoy
- Department of Aeronautical & Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Kamarul Arifin Ahmad
- Department of Aerospace Engineering, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Leslie Lewis
- Department of Paediatrics, Kasturba Medical College & Hospital, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Prakashini K
- Department of Radio Diagnosis, Kasturba Medical College & Hospital, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
| | - Anoop Rao
- Department of Pediatrics, Neonatology, Stanford University, Palo Alto, CA, USA
| | - Mohammad Zuber
- Department of Aeronautical & Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal-576104, Karnataka, India
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12
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Abstract
Extraskeletal mesenchymal chondrosarcoma (ESMC) originate from the nasal cavity have rarely been reported, especially its imaging features, which makes the preoperative diagnosis difficult. Here, we report the clinical, computed tomography, and magnetic resonance imaging features of a 60-year-old female patient with pathologically confirmed ESMC in the nasal cavity to help provide more reference for diagnosis before operation. Extraskeletal mesenchymal chondrosarcoma in the nasal cavity demonstrates typical imaging features, such as mesh-like enhancement, calcification, hemorrhage, necrosis, cystic degeneration, and so on.
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Affiliation(s)
- Chengru Song
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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13
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Wang Q, Huang H, Li J, Fan W. Intraosseous hemangioma of the nasal cavity. Am J Med Sci 2024; 367:e12-e13. [PMID: 37716596 DOI: 10.1016/j.amjms.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/19/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Qi Wang
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Hai Huang
- Department of Pathology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Wanfeng Fan
- Department of Radiology, Binzhou Medical University Hospital, Binzhou, Shandong, China.
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14
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Bance RRR, Acharya V, Paula C, Panesar J. To X-Ray or Not to X-Ray? Discussing Unknown Nasal Foreign Bodies and Button Batteries. Ear Nose Throat J 2024; 103:NP49-NP52. [PMID: 34338035 DOI: 10.1177/01455613211033123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The emergency of esophageal button batteries is recognized. Foreign bodies in the ear or nose are treated as comparatively nonemergent. We present the case of a child who presented with suspected pen-nib in the nostril to highlight the importance of investigation and intervention in unwitnessed nasal foreign body and review the literature regarding X-rays in these cases. Fifteen papers were identified as per search parameters; 3 papers recommend the use of plain radiographs for nasal foreign bodies. We propose that in unwitnessed pediatric nasal foreign body insertion, a facial X-ray should be considered, especially if suspecting a metallic foreign body.
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Affiliation(s)
- Rujuta R Roplekar Bance
- Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
- University College London Hospital, Cambridge, United Kingdom
| | - Vikas Acharya
- Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
- Northwick Park Hospital, Harrow, United Kingdom
| | - Coyle Paula
- Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
| | - J Panesar
- Luton and Dunstable University Hospital, Luton, Bedfordshire, United Kingdom
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15
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Núñez-Cook S, Vidal-Mugica F, Salinas P. Anatomy and computed tomography of the nasal cavity, nasal conchae, and paranasal sinuses of the endangered Patagonian huemul deer (Hippocamelus bisulcus). Anat Rec (Hoboken) 2024; 307:141-154. [PMID: 37084232 DOI: 10.1002/ar.25230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
This study explores for the first time the shape, volume, and configuration of nasal cavity structures of the endangered Patagonian huemul deer via computed tomography (CT). Three-dimensional (3D) reconstructions derived from data sets obtained from five Patagonian huemul deer skulls were analyzed. Using semiautomatic segmentation, 3D models were created of all the sinus compartments and nasal conchae. Volumetric measurements were taken of seven sinus compartments. The Patagonian huemul deer has a wide, large nasal cavity, with an osseous nasal aperture typical of cervids and a choana with characteristics that differentiate it from the pudu and roe deer. It also has six nasal meatuses and three nasal conchae, with the ventral nasal concha having the greatest volume and surface, which given its extension ensures a greater ability to humidify and heat the air. Further analysis showed the complex system of paranasal sinuses to be characterized by a rostroventral and interconnected group, where communication with the nasal cavity is common through the nasomaxillary opening, and a caudodorsal group that communicates with the nasal cavity through openings in the nasal meatuses. Our study of the endangered Patagonian huemul deer documents an intricate, and in some nasal cavity structures, unique morphological construction which may predispose it to higher rates of sinonasal afflictions due largely to its nasal complex anatomy, thus affecting its high cultural value.
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Affiliation(s)
- Samuel Núñez-Cook
- Laboratory of Animal & Experimental Morphology, Institute of Biology, Faculty of Sciences, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
- MSc Program in Morphological Sciences, Universidad de La Frontera, Temuco, Chile
| | - Fernando Vidal-Mugica
- Departamento de Ciencias Básicas, Facultad de Ciencias, Universidad Santo Tomas, Temuco, Chile
- Fauna Andina, Wildlife Conservation and Management Center, Villarrica, Chile
- IUCN, Deer Specialist Group, Apple Valley, Minnesota, USA
- IUCN, Conservation Planning Specialist Group, Apple Valley, Minnesota, USA
| | - Paulo Salinas
- Laboratory of Animal & Experimental Morphology, Institute of Biology, Faculty of Sciences, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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16
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Cheon HL, Kjelstrup S, Kizilova N, Flekkøy EG, Mason MJ, Folkow LP. Structure-function relationships in the nasal cavity of Arctic and subtropical seals. Biophys J 2023; 122:4686-4698. [PMID: 38101406 PMCID: PMC10754691 DOI: 10.1016/j.bpj.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
The heating and moistening of inhaled air, and the cooling and moisture removal from exhaled air, are crucial for the survival of animals under severe environmental conditions. Arctic mammals have evolved specific adaptive mechanisms to retain warmth and water and restrict heat loss during breathing. Here, the role of the porous turbinates of the nasal cavities of Arctic and subtropical seals is studied with this in mind. Mass and energy balance equations are used to compute the time-dependent temperature and water vapor profiles along the nasal passage. A quasi-1D model based on computed tomography images of seal nasal cavities is used in numerical simulations. Measured cross-sectional areas of the air channel and the perimeters of the computed tomography slices along the nasal cavities of the two seal species are used. The model includes coupled heat and vapor transfer at the air-mucus interface and heat transfer at the interfaces between the tissues and blood vessels. The model, which assumes constant blood flow to the nose, can be used to predict the temperature of the exhaled air as a function of ambient temperature. The energy dissipation (entropy production) in the nasal passages was used to measure the relative importance of structural parameters for heat and water recovery. We found that an increase in perimeter led to significant decreases in the total energy dissipation. This is explained by improved conditions for heat and water transfer with a larger complexity of turbinates. Owing to differences in their nasal cavity morphology, the Arctic seal is expected to be advantaged in these respects relative to the subtropical seal.
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Affiliation(s)
- Hyejeong L Cheon
- PoreLab, Department of Physics, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Signe Kjelstrup
- PoreLab, Department of Chemistry, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
| | - Nataliya Kizilova
- PoreLab, Department of Physics, Norwegian University of Science and Technology, NTNU, Trondheim, Norway; V.N. Karazin Kharkov National University, Kharkov, Ukraine
| | - Eirik G Flekkøy
- PoreLab, Department of Physics, University of Oslo, Oslo, Norway
| | - Matthew J Mason
- Department of Physiology, Development & Neuroscience, University of Cambridge, Cambridge, UK
| | - Lars P Folkow
- Department of Arctic and Marine Biology, UiT - The Arctic University of Norway, Tromsø, Norway
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17
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Lubojacký J, Čábalová L, Mladoňová M, Hránková V, Krejčí T, Mičaník J, Miklošová M, Ličev L, Komínek P, Matoušek P. Transnasal Endoscopic Pituitary Surgery-The Role of a CT Scan in Individual Tailoring of Posterior Septum Size Resection. Tomography 2023; 9:2222-2232. [PMID: 38133076 PMCID: PMC10747678 DOI: 10.3390/tomography9060172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE This study was designed to evaluate the possibility of predicting the minimum size of septal resection for safe tumor extraction in transnasal paraseptal pituitary adenoma resection from preoperative computed tomography scans. METHODS A retrospective CT scan analysis was performed on 20 patients who underwent endoscopic pituitary surgery at the University Hospital in Ostrava. Virtual insertion of the straight instrument into the sphenoid cavity was simulated using a CT scan. The minimum septal resection size was predicted and compared to various diameters in the nasal cavity. The results were then compared with cadaveric dissections, in which septal resections were performed at 1 cm and 2 cm distances from the anterior sphenoid wall. The association between cadaver dissections and CT scan results was studied. RESULTS A total of 20 patients who underwent endoscopic transnasal surgery for pituitary adenoma between the years 2020 and 2021 were enrolled in the study. The mean virtual posterior septal size resection needed to reach the medial edge of the ICA with the straight instrument, without infracturing the nasal septum, was 13.2 mm. In cadavers with a 1 cm posterior septal resection, the medial edge of the ICA was reached with the straight instrument. In 2 cm resections, it was possible to reach beyond the lateral edge of the ICA. CONCLUSION There is no significant correlation between the minimum septal size resection and measured diameters in the nasal cavity. According to our study, a 1 cm resection is sufficient for a non-extended pituitary tumor extraction. More extensive septal resections allow for better maneuverability and overview in the surgical field.
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Affiliation(s)
- Jakub Lubojacký
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Lenka Čábalová
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Michaela Mladoňová
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Viktória Hránková
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
- Department of Anatomy, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Tomáš Krejčí
- Department of Neurosurgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Jakub Mičaník
- Department of Radiodiagnostics, Ostrava University Hospital, 70800 Ostrava, Czech Republic;
| | - Maria Miklošová
- Department of Anatomy, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Lačezar Ličev
- Faculty of Electrical Engineering and Computer Science, VŠB Technical University Ostrava, 70800 Ostrava, Czech Republic;
| | - Pavel Komínek
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
| | - Petr Matoušek
- Department of Otorhinolaryngology and Head and Neck Surgery, Ostrava University Hospital, 70800 Ostrava, Czech Republic
- Department of Craniofacial Sciences, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic
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18
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Shih MC, Edwards TS, Snyder J, Germroth M, Nguyen SA, Schlosser RJ. Impact of Nasal Cavity CT Opacification Upon Sinonasal Quality of Life. Ann Otol Rhinol Laryngol 2023; 132:1590-1599. [PMID: 37246346 DOI: 10.1177/00034894231176329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Current methods of quantifying inflammation in chronic rhinosinusitis (CRS) on computed tomography (CT) imaging focus on opacification of the paranasal sinuses and show limited correlation with patient-reported outcome measures. OBJECTIVE This study aimed to determine if quantifying CT opacification of the nasal cavity correlated with Sino-Nasal Outcomes Test scores (SNOT-22). METHODS Thirty patients with CRS were enrolled. Lund-Mackay and SNOT-22 scores were measured. Nasal cavity regions of interest (ROIs) were measured by 2 independent raters using ImageJ at 3 points on coronal CT scans: anteriorly at the lacrimal duct, at the approximate midpoint demarcated by the posterior aspect of the globe, and posteriorly at the transition from the hard to soft palate. Superior and inferior regions were defined based upon the root of the inferior turbinate. Percent opacification was calculated for each ROI. Analyses were conducted bilaterally and for the side with greater opacification (worse side). RESULTS Interrater reliability was strong for all ROIs. Lund-Mackay scores correlated with nasal blockage only (r = .495, P = .01) and did not correlate with nasal cavity ROI opacification. Inferior nasal cavity opacification for worse-sided anterior ROI and middle ROI correlated with SNOT-22 scores for nasal blockage (anterior r = .41, P = .03) (middle r = .42, P = .023) and runny nose (anterior r = .44, P = .02) (middle r = .38, P = .04). Posterior ROIs did not correlate with SNOT-22. CONCLUSIONS Traditional CT scoring of sinus opacification does not correlate well with nasal cavity opacification or SNOT-22. Inferior nasal cavity inflammation provides unique correlations with SNOT-22 nasal questions and may guide targeted interventions in these regions.
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Affiliation(s)
- Michael C Shih
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas S Edwards
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jacob Snyder
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew Germroth
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rodney J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Kitagawa S, Habu M, Tsurushima H, Ohtani T, Sakamoto K, Yoshiga D, Yoshioka I, Tominaga K. Horseshoe osteotomy maintains the nasal cavity and function after superior repositioning. J Craniomaxillofac Surg 2023; 51:746-754. [PMID: 37816658 DOI: 10.1016/j.jcms.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/14/2023] [Indexed: 10/12/2023] Open
Abstract
The aim of this prospective cohort study was to compare changes in nasal cavity and function between Le Fort I with and without horseshoe osteotomy after superior repositioning of the maxilla. The patients were divided into 2 groups, a Le Fort I alone (LF alone) group and a combination Le Fort I and horseshoe osteotomy (HS) group. The nasal cavity volume was measured using 3-dimensional computed tomographic images, and nasal resistance was assessed by anterior active mask rhinomanometry. The HS group consisted of 17 patients, and the LF alone group consisted of 15 patients. The magnitude of change in nasal cavity volume was significantly smaller in the HS group than in the LF alone group (p < 0.001), even though the mean amount of superior maxillary movement was considerably larger in the HS group than in the LF alone group (p < 0.001). Mean nasal resistance was significantly smaller postoperatively than preoperatively in the HS group (p < 0.05). Furthermore, the change in nasal resistance was smaller in the HS group than in the LF alone group (p < 0.001). Within the limitations of this study, it seems that horseshoe osteotomy is useful for maintaining the nasal cavity and function after superior repositioning of the maxilla.
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Affiliation(s)
- Shota Kitagawa
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Manabu Habu
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Hiroki Tsurushima
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Taishi Ohtani
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Kikuo Sakamoto
- Sakamoto Clinic, Otolaryngology Head and Neck Surgery, Japan.
| | - Daigo Yoshiga
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Izumi Yoshioka
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Japan.
| | - Kazuhiro Tominaga
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Japan.
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Krishnan R, Annasamy RK, Vasanthi V, Muthiah B. Radiologic-Pathologic correlation of Pindborg tumor of maxilla with extension to maxillary sinus, nasal cavity, and infraorbital margin: A case report. Oral Oncol 2023; 147:106588. [PMID: 37890306 DOI: 10.1016/j.oraloncology.2023.106588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Calcifying epithelial odontogenic tumor is a benign epithelial odontogenic tumor thought to originate from the stratum intermedium. Clear cell type, Langerhans cell/non-calcified type, and cystic/microcystic are the three recently recognized histological subtypes of CEOT in the 5th edition of the World Health Organization Classification of Head and Neck Tumors. Almost 350-400 cases of CEOT have been reported in literature, accounting for less than 1% of the reported cases of odontogenic tumors. We are reporting a case of Pindborg tumor of the maxilla with extension to the maxillary sinus, nasal cavity, and infraorbital margin, with an emphasis on radiographic and histopathologic presentation.
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Affiliation(s)
- Rajkumar Krishnan
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Ramesh Kumar Annasamy
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - V Vasanthi
- Department of Oral Pathology and Microbiology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India.
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21
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Roy S, Mehta A, Muraleedharan M, Virk RS. Sinonasal schwannoma masquerading as an IgG4-related nasal mass. BMJ Case Rep 2023; 16:e255135. [PMID: 37973538 PMCID: PMC10660653 DOI: 10.1136/bcr-2023-255135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
An elderly (8th decade) diabetic patient presented with insidious, painless protrusion of the right eye for 1 month, associated with nasal congestion. Past history included healed serous chorioretinopathy in the right eye (>30 years back) and recently diagnosed (1 year prior) autoimmune IgG4-related pancreatitis for which he was on long-term corticosteroids. On nasal endoscopic examination, a well circumscribed mass was found in the right nasal cavity.Keeping in mind the systemic diagnosis, the sinonasal mass was suspected to be a IgG4-related disease. An endoscopic biopsy was performed and revealed a surprise diagnosis of grade 1 nasal schwannoma.
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Affiliation(s)
- Shrimoyee Roy
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditi Mehta
- Grewal Eye Institute, Chandigarh, Chandigarh, India
| | - Manjul Muraleedharan
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh Virk
- Otorhinolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Humbert M, Bastit V, Perreard M, Roussel LM, Senol MK, Hitier M, Patron V. Review of olfactory cleft roof anatomy. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:289-295. [PMID: 37926654 DOI: 10.1016/j.anorl.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Progress in skull-base endoscopic surgery has improved our knowledge of olfactory cleft (OC) anatomy. This article presents a review of current knowledge concerning the OC roof: descriptive anatomy, radiological exploration, and endoscopic observation. The OC is a narrow area in the most superior part of the nasal cavity. Its roof is the thinnest structure separating the nasal cavities from the brain; it comprises three superimposed tissues: nasal mucosa, ethmoid cribriform plate (ECP), and dura mater. The ECP comprises the anterior ECP containing the ethmoidal slit (ES) medially and the cribroethmoidal foramen (CEF) laterally; and the posterior ECP, comprising the olfactory foramina. The OC roof is bordered anteriorly by the nasal bone roof, laterally by the lateral ethmoid masses, and posteriorly by the jugum and anterior wall of the sphenoid sinuses. Imaging is crucial for analyzing this wall, providing precise detailed information on conformation and anatomic relations with adjacent structures such as the anterior ethmoidal artery. Understanding OC roof anatomy and correct interpretation of imaging are essential for safety in present-day functional endoscopic sinus surgery and anterior skull-base oncologic surgery.
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Affiliation(s)
- M Humbert
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France.
| | - V Bastit
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France
| | - M Perreard
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm 1086 ANTICIPE, université de Normandie, Normand, Caen, France
| | - L M Roussel
- Service d'ORL, CLCC Henri-Becquerel, 76038 Rouen, France
| | - M K Senol
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France
| | - M Hitier
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; Inserm COMETE, Université de Normandie, Caen, France
| | - V Patron
- Service d'ORL et de chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France; EA 7451 BioConnecT, Université de Normandie, UNICAEN, Caen, France
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Khandwala K, Alam MM, Ashfaq Z, Hilal K. Olfactory schwannoma masquerading as esthesioneuroblastoma. BMJ Case Rep 2023; 16:e257847. [PMID: 37852667 PMCID: PMC10603402 DOI: 10.1136/bcr-2023-257847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Affiliation(s)
| | | | - Zoonish Ashfaq
- Pathology & Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Kiran Hilal
- Radiology, The Aga Khan University, Karachi, Sindh, Pakistan
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Guo XJ, Ma LM, Xia T, Li XH. High-grade neuroendocrine carcinoma of the nasal cavity combined with respiratory epithelial papilloma: A rare case report. Asian J Surg 2023; 46:4530-4531. [PMID: 37173251 DOI: 10.1016/j.asjsur.2023.04.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Xiang-Jun Guo
- Department of Pathology, The Third People's Hospital of Zigong, Sichuan Province, China
| | - Li-Mei Ma
- Department of Pathology, The Third People's Hospital of Zigong, Sichuan Province, China
| | - Tian Xia
- Department of Pathology, Affiliated Hospital of Southwest Medical University, Sichuan Province, China
| | - Xiao-Hong Li
- Department of Pathology, The First People's Hospital of Zigong, Sichuan Province, China.
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Teixeira R, Massaro C, Garib D. Comparison of nasal cavity changes between the expander with differential opening and the fan-type expander: a secondary data analysis from an RCT. Clin Oral Investig 2023; 27:5999-6006. [PMID: 37620440 DOI: 10.1007/s00784-023-05213-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The aim of this study was to compare the nasal cavity skeletal changes between the expander with differential opening (EDO) and the fan-type expander (FE). METHODS This study was a secondary analysis of a previous randomized clinical trial. Forty-eight patients with posterior crossbite were randomly allocated into two study groups. Twenty-four patients (11 male, 13 female) with a mean initial age of 7.6 ± 0.9 years were treated with rapid maxillary expansion (RME) using the EDO. Twenty-four patients (10 male, 14 female) with a mean initial age of 7.8 ± 0.9 years were treated with the FE. Cone-beam computed tomography (CBCT) was performed before treatment and 1 to 6 months after the active phase of RME. Using frontal CBCT slices passing at the level of maxillary permanent first molars and maxillary deciduous canines, the width of the nasal cavity was measured in the lower, middle and upper thirds. Nasal cavity height was also evaluated in both slices. Intergroup comparisons of interphase changes were performed using t or Mann-Whitney tests (P < 0.05). RESULTS The two groups were similar regarding baseline data. EDO showed a greater transverse increase in the lower third of the nasal cavity in both canine (P = 0.007) and molar regions (P < 0.001). No intergroup difference was observed for changes in middle and upper widths and height of the nasal cavity. CONCLUSIONS Both expanders are effective in promoting an increase of the nasal cavity skeletal dimensions. The expander with differential opening produced a greater transverse increase in the lower third of the nasal cavity compared to the fan-type expander, both at the anterior and posterior regions of the maxilla. CLINICAL RELEVANCE EDO might be more beneficial to pediatric patients with oral breathing and obstructive sleep apnea compared to FE.
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Affiliation(s)
- Rodrigo Teixeira
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-901, Brazil.
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-901, Brazil
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, São Paulo, 17012-901, Brazil
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Laaß M, Kaestner A. Nasal turbinates of the dicynodont Kawingasaurus fossilis and the possible impact of the fossorial habitat on the evolution of endothermy. J Morphol 2023; 284:e21621. [PMID: 37585231 DOI: 10.1002/jmor.21621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
The nasal region of the fossorial anomodont Kawingasaurus fossilis was virtually reconstructed from neutron-computed tomographic data and compared with the terrestrial species Pristerodon mackayi and other nonmammalian synapsids. The tomography of the Kawingasaurus skull reveals a pattern of maxillo-, naso-, fronto- and ethmoturbinal ridges that strongly resemble the mammalian condition. On both sides of the nasal cavity, remains of scrolled maxilloturbinals were preserved that were still partially articulated with maxilloturbinal ridges. Furthermore, possible remains of the lamina semicircularis as well as fronto- or ethmoturbinals were found. In Kawingasaurus, the maxilloturbinal ridges were longer and stronger than in Pristerodon. Except for the nasoturbinal ridges, no other ridges in the olfactory region and no remains of turbinates were recognized. This supports the hypothesis that naso-, fronto-, ethmo- and maxilloturbinals were a plesiomorphic feature of synapsids, but due to their cartilaginous nature in most taxa were, in almost all cases, not preserved. The well-developed maxilloturbinals in Kawingasaurus were probably an adaptation to hypoxia-induced hyperventilation in the fossorial habitat, maintaining the high oxygen demands of Kawingasaurus' large brain. The surface area of the respiratory turbinates in Kawingasaurus falls into the mammalian range, which suggests that they functioned as a countercurrent exchange system for thermoregulation and conditioning of the respiratory airflow. Our results suggest that the environmental conditions of the fossorial habitat led to specific sensory adaptations, accompanied by a pulse in brain evolution and of endothermy in cistecephalids, ~50 million years before the origin of endothermy in the mammalian stem line. This supports the Nocturnal Bottleneck Theory, in that we found evidence for a similar evolutionary scenario in cistecephalids as proposed for early mammals.
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Affiliation(s)
- Michael Laaß
- Fakultät für Geowissenschaften, Geotechnik und Bergbau, TU Bergakademie Freiberg, Freiberg, Germany
- FRM II and Physics E21, Technische Universität München, Garching, Germany
| | - Anders Kaestner
- Laboratory for Neutron Scattering and Imaging, Paul Scherrer Institute, Villigen PSI, Switzerland
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Yeom HG, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC, Kim JE. Nasal cavity perforation by implant fixtures: case series with emphasis on panoramic imaging of nasal cavity extending posteriorly. Head Face Med 2023; 19:37. [PMID: 37608398 PMCID: PMC10463305 DOI: 10.1186/s13005-023-00384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023] Open
Abstract
The nasal cavity is an important landmark when considering implant insertion into the anterior region of the maxillary arch. The perforation of implants into the nasal cavity may cause complications, such as implant migration, inflammation, or changes in nasal airflow; thus, precise assessment of the nasal cavity is mandatory.Three cases of nasal cavity perforation by dental implants are presented, including one case of implant fixture migration into the nasal cavity. On panoramic radiographs of the patients, the following common features were observed: the horizontal radiopaque line of the hard palate was observed to be inferior to or similar to that of the antral floor and the bone between the lateral wall of the nasal cavity and the medial wall of the maxillary sinus was emphasized in a triangular shape.When the maxillary sinus is small and alveolar bone resorption is severe, panoramic evaluation may cause overestimation of the available residual bone, particularly in the maxillary canine/premolar region. Therefore, the residual bone should be reevaluated three-dimensionally to measure the exact bony shape and volume.
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Affiliation(s)
- Han-Gyeol Yeom
- Department of Oral and Maxillofacial Radiology and Wonkwang Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.
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Park TH. Penetration of a Wooden Foreign Body into the Zygomaticomaxillary Bone to the Nasal Cavity: Navigation-Guided Successful Treatment. J Craniofac Surg 2023; 34:e403-e404. [PMID: 37062855 DOI: 10.1097/scs.0000000000009338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 04/18/2023] Open
Abstract
Penetrations of the nasal cavity through the zygomaticomaxillary bone by wooden foreign bodies have not been reported yet. Wooden foreign bodies, characterized as hypodense signals resembling air bubbles on computed tomography scans, could increase the risk of infection and abscess formation if left untreated. Therefore, any possible attempts to remove it entirely should be made in a timely manner. Also, regarding removal surgery, the complications of the surgery, such as massive bleeding or iatrogenic injury to the adjacent structure, should be considered, especially in the paranasal area. At the construction site, a 67-year-old worker hit his right cheek with a wooden foreign body. A wooden foreign body penetrated the right cheek and extended into the right nasal cavity through the zygomaticomaxillary complex. Using a navigation system, the wooden foreign body was removed from the right zygomaticomaxillary bone to the unilateral nasal cavity, and we cauterized arterial bleeding. After bleeding control, we reconstructed the bony defect with an absorbable mesh with screws. Septal reconstruction was also done, along with debridement and irrigation of the nasal cavity. We conducted a follow-up computed tomography scan a week later and confirmed that the wooden foreign body was successfully removed without any residual ones. The fracture was also reduced successfully.
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Affiliation(s)
- Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
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29
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McAvoy M, Satyanarayan Shenoy V, Miller C, Feroze A, Moe KS, Sekhar LN. Operative Technique and Complication Management in a Case of Giant Esthesioneuroblastoma Resected by a Combined Transcranial and Endonasal Endoscopic Approach: Technical Case Report. Oper Neurosurg (Hagerstown) 2023; 24:e449-e453. [PMID: 36804514 DOI: 10.1227/ons.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/06/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Esthesioneuroblastoma (ENB) is a rare anterior skull base tumor derived from olfactory epithelium. There are very few operative videos in the literature demonstrating the surgical resection techniques for giant ENB because of their rarity and complexity. In this technical report, we demonstrate the microsurgical resection of a very large and complex high-grade ENB, initially deemed unresectable, through a bifrontal craniotomy and extended subfrontal approach combined with an endonasal endoscopic approach. CLINICAL PRESENTATION A 34-year-old woman presented with headaches, nasal congestion, and bloody nasal drainage. MRI showed a large nasal cavity mass with extension into the anterior cranial fossa and bifrontal lobes. There was significant bifrontal edema causing headaches and abutting the optic nerves. Initial management with surgical resection was offered to the patient for local tumor control and to preserve her vision. A combined bifrontal craniotomy and endonasal transsphenoidal approach was used for resecting this giant tumor. After achieving gross total resection, we reconstructed the anterior skull base in layers. She developed several postoperative complications which were appropriately managed. CONCLUSION We demonstrate the surgical resection of a giant ENB through a combined transcranial and endonasal endoscopic approach. We discuss the several postoperative complications in this complex case and the lessons learned.
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Affiliation(s)
- Malia McAvoy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Varadaraya Satyanarayan Shenoy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Innovation Commercialization, Co-Motion, University of Washington, Seattle, Washington, USA
| | - Charles Miller
- Department of Neurosurgery, Walter Reed National Military Medical Center, Washington, District of Columbia, USA
| | - Abdullah Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Kris S Moe
- Department of Otolaryngology, University of Washington, Seattle, Washington, USA
| | - Laligam N Sekhar
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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30
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Tretiakow D, Tesch K, Markiet K, Przewoźny T, Kusiak A, Cichońska D, Skorek A. Numerical analysis of the ostiomeatal complex aeration using the CFD method. Sci Rep 2023; 13:3980. [PMID: 36894608 PMCID: PMC9998384 DOI: 10.1038/s41598-023-31166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
We aimed to analyse ostiomeatal complex (OMC) aeration using the computational fluid dynamics (CFD) method of simulation based on human craniofacial computed tomography (CT) scans. The analysis was based on CT images of 2 patients: one with normal nose anatomy and one with nasal septal deviation (NSD). The Reynolds-Average Simulation approach and turbulence model based on linear eddy viscosity supplemented with the two-equation k-[Formula: see text] SST model were used for the CFD simulation. As a result, we found differences in airflow velocity through the ostiomeatal complex in patients with a normal nose and those with NSD. In a patient with NSD, the flow is turbulent in contrast to the normal nose (laminar flow). A faster (more intensive) airflow through the OMC was observed in the wider nasal cavity of the patient with NSD than on the narrower side. In addition, we want to emphasise the higher speed of airflow through the apex uncinate process area towards the ostiomeatal complex during exhalation, which, in the presence of secretions in the nose, predisposes to its easier penetration into the sinuses of the anterior group.
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Affiliation(s)
- Dmitry Tretiakow
- Department of Otolaryngology, Medical University of Gdansk, Gdańsk, Poland.
| | - Krzysztof Tesch
- Faculty of Mechanical Engineering and Ship Technology, Gdansk University of Technology, Gdańsk, Poland
| | - Karolina Markiet
- II Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
| | - Tomasz Przewoźny
- Department of Otolaryngology, Medical University of Gdansk, Gdańsk, Poland
| | - Aida Kusiak
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, Gdańsk, Poland
| | - Dominika Cichońska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdansk, Gdańsk, Poland
| | - Andrzej Skorek
- Department of Otolaryngology, Medical University of Gdansk, Gdańsk, Poland
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31
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Hu H, Hu X, Hu G, Li D, Cai J. Diagnosis and management of extramedullary plasmacytoma in nasal cavity: Clinical experience and literature review. Medicine (Baltimore) 2023; 102:e32647. [PMID: 36637932 PMCID: PMC9839280 DOI: 10.1097/md.0000000000032647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Nasal extramedullary plasmacytoma (EMP) is a rare plasma cell tumor that occurs in the soft tissue of the nasal cavity, and its imaging characteristics are still unclear. The purpose of this study was to investigate the clinical features, imaging findings, treatment, survival analysis, and prognosis of nasal EMP, and to provide a systematic review of the patients we treated and the published literature. A 45-year-old female patient who presented with epistaxis with nasal obstruction was recommended for magnetic resonance imaging to assess the nature of the lesion. On magnetic resonance imaging, abnormal signal shadow can be seen in the right nasal cavity. Diffusion weighted imaging showed signal of the lesion was significantly limited, presenting high signal, with a low apparent dispersion coefficient, and the lesion was significantly enhanced on contrast-enhanced scan. Combined with the clinical manifestations of the patient, who was initially considered to have a hemangioma. She underwent endoscopic nasal surgery under general anesthesia to remove the mass, and the final pathology confirmed it was EMP. However, the final pathology confirmed EMP. Five months later, the patient came to our hospital for follow-up and underwent fluorine-18-fluorodeoxyglucose/positron emission tomography/computed tomography scan, which showed no recurrence of the lesion and no transformation of multiple myeloma. The nasal EMP imaging findings were mostly soft tissue masses with uniform density or signal, which were significantly enhanced by enhancement scan, high signal on diffusion weighted imaging and low signal on apparent dispersion coefficient. Immunohistochemical staining for CD38, CD138, and CD79a was positive in most of the cases evaluated, while CD20 and CD10 were negative. The absence of dilated features, infiltrative features and the presence of significant contrast enhancement may be relatively specific imaging findings of nasal EMP. The prognosis of nasal EMP is good, and recurrence, metastasis, and transformation into multiple myeloma are rare. Because the lesions are sensitive to radiotherapy, surgical resection combined with radiotherapy is a more effective treatment.
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Affiliation(s)
- Hongyu Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guomei Hu
- Department of Pathology, The First People’s Hospital of Zunyi City, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dandan Li
- Department of Obstetrics, Zunyi Hospital of Traditional Chinese Medicine, Zunyi, China
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- * Correspondence: Jiong Cai, Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi 563003, China (e-mail: )
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32
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Tsarapkin GY, Polyaeva MY, Gorovaya EV, Kishinevskii AE, Shvedov NV, Kurilenkova AG, Kudinova AA. [Assessment of the structural features of the hard palate in endonasal surgery]. Vestn Otorinolaringol 2023; 88:58-62. [PMID: 37970771 DOI: 10.17116/otorino20238805158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Data on the features of the anatomical structure of the hard palate are little described in the scientific literature, and therefore are not taken into account when planning surgical treatment. One of the intraoperative complications during intervention on the lower part of the nasal septum is perforation of the bottom of the nasal cavity, which can develop during a christotomy. This complication mainly depends on the features of the anatomical structure of the hard palate. OBJECTIVE To study the anatomical structure of the hard palate from the point of view of rhinosurgery, using vector analysis of multispiral computed tomography (MSCT), and to establish anatomical features that should be taken into account when performing surgical interventions on the nasal septum. MATERIAL AND METHODS 107 patients (30 men, 77 women) were examined without congenital cleft palate and surgical interventions on the structures of the nasal cavity and hard palate. All patients underwent MSCT of the nose and paranasal sinuses (PNS) followed by multiplanar image reconstruction. The key point relative to which the measurements were carried out was the posterior wall of the incisor canal from the side of the nasal cavity. The line corresponding to the bottom of the nasal cavity was chosen as the main vector. In the work, measurements of the thickness of the hard palate (THP) at the level of the palatal suture and the width of the palatal suture (WPS) were carried out. RESULTS Statistical analysis of the obtained results showed that the THP is 1.74 mm [min 0.28; max 6.46], the WPS is 0.9 mm [min 0.2; max 2.51] (conditional norm). In 19 patients (17.8%), the THP was 0.82 mm, in 2 patients (1.9%) - 0.2 mm. In 3 patients (2.8%), the WPS was equal to 2.5 mm. CONCLUSION Thus, the data obtained by us indicate that the surgical anatomy of the hard palate is characterized by significant variability, while in some patients the THP can be reduced by 8.8 times, and the WPS increased by 2.7 times compared to normal values. Such anatomical features of the structure of the hard palate should be taken into account when planning septoplasty, since this contingent of patients has an increased risk of developing iatrogenic perforation of the nasal floor during surgical intervention on the lower floor of the nasal septum.
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Affiliation(s)
- G Yu Tsarapkin
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology Moscow Department of Healthcare, Moscow, Russia
| | - M Yu Polyaeva
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology Moscow Department of Healthcare, Moscow, Russia
| | - E V Gorovaya
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology Moscow Department of Healthcare, Moscow, Russia
| | - A E Kishinevskii
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology Moscow Department of Healthcare, Moscow, Russia
| | - N V Shvedov
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology Moscow Department of Healthcare, Moscow, Russia
| | - A G Kurilenkova
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology Moscow Department of Healthcare, Moscow, Russia
| | - A A Kudinova
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology Moscow Department of Healthcare, Moscow, Russia
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33
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Zakharova ML, Pavlov PV, Nasirov RA, Krasnogorskaya OL, Mitrofanova AM, Chernogaeva EA. [Mature teratoma of the pharynx and nasal cavity in a newborn: a case report]. Vestn Otorinolaringol 2023; 88:107-110. [PMID: 38153902 DOI: 10.17116/otorino202388061107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
We present to your attention a case of mature teratoma of the pharynx and nasal cavity in a newborn, which caused severe obstruction of the upper respiratory tract and required emergency action. The article describes the diagnostic algorithm, the choice of optimal treatment tactics, which allowed rehabilitate the child in infancy.
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Affiliation(s)
- M L Zakharova
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - P V Pavlov
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - R A Nasirov
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - O L Krasnogorskaya
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - A M Mitrofanova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - E A Chernogaeva
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
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34
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Salati H, Khamooshi M, Fletcher DF, Inthavong K. Computational investigation of nasal surface coverage from squeeze bottle and Neti Pot saline irrigation flow. Comput Methods Programs Biomed 2022; 227:107223. [PMID: 36370595 DOI: 10.1016/j.cmpb.2022.107223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Nasal saline irrigation is a common therapy for inflammatory nasal and paranasal disease or for managing post nasal and sinus surgery recovery. Two common irrigation devices include the netipot and squeeze bottles, where anecdotally, these devices alleviate congestion, facial pain, and pressure. However, a quantitative evaluation of these devices' performance and the fluid dynamics responsible for the irrigation distribution through the nose is lacking. This study tracked the liquid surface coverage and wall shear stresses during nasal saline irrigation produced from a Neti Pot and squeeze bottle. METHODS This study used transient computational fluid dynamics (CFD) simulations to investigate the saline irrigation flow field in a subject-specific sinonasal model. The computational nasal cavity model was constructed from a high-resolution computed tomography scan (CT). The irrigation procedure applied a head position tilted at 90° forward using an 80 ml squeeze bottle and 120 ml Neti Pot. RESULTS The results from a single sinonasal model demonstrated that the Neti Pot irrigation was more effective in delivering saline solution to the nasal cavity on the contralateral side of irrigation due to typically larger volumes but at the expense of reduced flow and shearing rates, as the flow entered under gravitational forces. The squeeze bottle irrigation provided greater surface coverage on the side of irrigation. CONCLUSIONS The results from the single patient model, demonstrated the Neti Pot increased surface coverage in the paranasal sinuses. Reducing the jet diameter may aid the direct targeting of a specific region at the side of irrigation by preventing the impingement of the jet to the nasal passage surface and redirection of the flow. Evaluating this performance across a wider cohort of patients can strengthen the findings.
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Affiliation(s)
- Hana Salati
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, VIC 3083, Australia
| | - Mehrdad Khamooshi
- Cardio-Respiratory Engineering and Technology Laboratory (CREATElab), Department of Mechanical and Aerospace Engineering, Monash University, VIC 3004, Australia
| | - David F Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, NSW 2006, Australia
| | - Kiao Inthavong
- Mechanical & Automotive Engineering, School of Engineering, RMIT University, Bundoora, VIC 3083, Australia.
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Li K, Iwasaki T, Quo S, Leary EB, Li C, Guilleminault C. [Nasomaxillary Expansion by Endoscopically-Assisted Surgical Expansion (EASE): An airway centric approach]. Orthod Fr 2022; 93:267-282. [PMID: 36217586 DOI: 10.1684/orthodfr.2022.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the skeletal, dental and airway changes with endoscopically assisted surgical expansion (EASE) to widen the nasomaxillary complex for the treatment of sleep apnea in adults. METHODS One hundred and five consecutive patients underwent EASE. Cone beam computed tomography (CBCT) was conducted preoperatively and within four weeks after the completion of the expansion process. Computational fluid dynamic (CFD) analysis was performed on 20 randomly selected patients to assess airway flow changes. RESULTS One hundred patients (67 males) with the mean age of 35.0±13.5 years (17-64 years) had completed pre- and post-expansion imaging. Ninety-six patients (96%) had successful expansion defined as separation of the midpalatal suture at least 1 mm from anterior nasal spine (ANS) to posterior nasal spine (PNS). The nasal cavity expansion was 3.12±1.11 mm at ANS, 3.64±1.06 mm at first molar and 2.39±1.15 mm at PNS. The zygoma expansion was 2.17±1.11 mm. The ratio of dental expansion to skeletal expansion was 1.23:1 (3.83 mm:3.12 mm) at canine and 1.31:1 (4.77 mm:3.64 mm) at first molar. CFD airway simulation showed a dynamic change following expansion throughout the airway. The mean negative pressure improved in the nasal airway (from -395.5±721.0 to -32.7±19.2 Pa), nasopharyngal airway (from -394.2±719.4 to -33.6±18.5 Pa), oropharyngeal airway (from -405.9±710.8 to -39.4±19.3 Pa) and hypopharyngeal airway (from -422.6±704.9 to -55.1±33.7 Pa). The mean airflow velocity within the nasal airway decreased from 18.8±15.9 to 7.6±2.0 m/s and the oropharyngeal airway decreased from 4.2±2.9 to 3.2±1.2 m/s. The velocity did not change significantly in the nasopharyngeal and hypopharyngeal regions. CONCLUSIONS EASE results in expansion of the midpalatal suture from the ANS to PNS with a nearly pure skeletal movement of minimal dental effect. The expansion of the nasomaxillary complex resulted in the widening of the nasal sidewall throughout the nasal cavity. The improved air flow dynamics was demonstrated by CFD simulation.
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Affiliation(s)
- Kasey Li
- Sleep Apnea Surgery Center, 1900 University Avenue, Suite 105, East Palo Alto, CA, États-Unis
| | - Tomonori Iwasaki
- Médecine du développement, Cours de recherche sur la santé, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japon
| | - Stacey Quo
- School of Dentistry, University of California San Francisco, 707 Parnassus Ave, San Francisco, CA 94143, États-Unis
| | - Eileen B Leary
- Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, 3165 Porter Dr, Palo Alto, CA 94304, États-Unis
| | - Connor Li
- Sleep Apnea Surgery Center, 1900 University Avenue, Suite 105, East Palo Alto, CA, États-Unis
| | - Christian Guilleminault
- Décédé. Sleep Medicine Division, Stanford University School of Medicine, Stanford, 3165 Porter Dr, Palo Alto, CA 94304, États-Unis
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Sicard RM, Shah R, Frank-Ito DO. Analyses on the influence of normal nasal morphological variations on odorant transport to the olfactory cleft. Inhal Toxicol 2022; 34:350-358. [PMID: 36045580 PMCID: PMC9799026 DOI: 10.1080/08958378.2022.2115175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/07/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Olfaction requires a combination of sensorineural components and conductive components, but conductive mechanisms have not typically received much attention. This study investigates the role of normal nasal vestibule morphological variations in ten healthy subjects on odorant flux in the olfactory cleft. MATERIALS AND METHODS Computed tomography images were used to create subject-specific nasal models. Each subject's unilateral nasal cavity was classified according to its nasal vestibule shape as Standard or Notched. Inspiratory airflow simulations were performed at 15 L/min, simulating resting inspiration using computational fluid dynamics modeling. Odorant transport simulations for three odorants (limonene, 2,4-dinitrotoluene, and acetaldehyde) were then performed at concentrations of 200 ppm for limonene and acetaldehyde, and 0.2 ppm for dinitrotoluene. Olfactory cleft odorant flux was computed for each simulation. RESULTS AND DISCUSSION AND CONCLUSION Simulated results showed airflow in the olfactory cleft was greater in the Standard phenotype compared to the Notched phenotype. For Standard, median airflow was greatest in the anterior region (0.5006 L/min) and lowest in the posterior region (0.1009 L/min). Median airflow in Notched was greatest in the medial region (0.3267 L/min) and lowest in the posterior region (0.0756 L/min). Median olfactory odorant flux for acetaldehyde and limonene was greater in Standard (Acetaldehyde: Standard = 140.45 pg/cm2-s; Notched = 122.20 pg/cm2-s. Limonene: Standard = 0.67 pg/cm2-s; Notched = 0.65 pg/cm2-s). Median dinitrotoluene flux was greater in Notched (Standard = 2.86 × 10-4pg/cm2-s; Notched = 4.29 × 10-4 pg/cm2-s). The impact of nasal vestibule morphological variations on odorant flux at the olfactory cleft may have implications on individual differences in olfaction, which should be investigated further.
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Affiliation(s)
- Ryan M. Sicard
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Reanna Shah
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dennis O. Frank-Ito
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
- Computational Biology & Bioinformatics PhD Program, Duke University, Durham, NC, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
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Pollaers K, Herbert E, Giblett N, Thompson A, Vijayasekaran S, Herbert H. Re-thinking congenital piriform aperture stenosis: Modern imaging demonstrates narrowing of the full nasal cavity length. Int J Pediatr Otorhinolaryngol 2022; 158:111184. [PMID: 35594793 DOI: 10.1016/j.ijporl.2022.111184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Measure the width of the nasal cavity in cases of piriform aperture stenosis using computerised tomography scans. METHODS Retrospective study performed at a paediatric tertiary referral centre in Australia. Comparison nasal cavity widths (measured on computerised tomography scans in the axial plane) at the piriform aperture, choana and points 25, 50 and 75% along the length of nasal cavity, between cases with piriform aperture stenosis and controls. RESULTS In cases of piriform aperture stenosis the piriform aperture along with the nasal cavity is statistically significantly narrower than controls, measured at 25, 50 and 75% along the distance between the piriform aperture and the choana. CONCLUSION This modern imaging review has illustrated the need for a change in the treatment paradigm for neonates with this condition, suggesting the need for further investigation of techniques that treat narrowing beyond the aperture.
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Affiliation(s)
| | - Emma Herbert
- University of Western Australia, 35 Stirling Hwy, Crawley, WA, Australia
| | - Neil Giblett
- The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, United Kingdom
| | - Andrew Thompson
- Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, Australia
| | | | - Hayley Herbert
- Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, Australia
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Zare F, Aalaei E, Zare F, Faramarzi M, Kamali R. Targeted drug delivery to the inferior meatus cavity of the nasal airway using a nasal spray device with angled tip. Comput Methods Programs Biomed 2022; 221:106864. [PMID: 35580527 DOI: 10.1016/j.cmpb.2022.106864] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/09/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Nowadays, by advancement in computational tools, Computational Fluid and Particle Dynamics (CFPD) technique can be used more than ever. The main aim of this study is using a nasal spray device with angled tip to deliver drug particles to the inferior meatus cavity for treatment purposes. In the present study, the drug delivery to the lower regions of the nasal cavity will be improved that has been considered less in the literature. METHODS For this purpose, a spray with an angled tip was used, and the deposition of sprayed particles was compared with a spray with a straight tip. Based on the objectives presented above, a realistic model of the nasal route, including facial geometry, and paranasal sinuses obtained from a series of Computed tomography (CT) scan images, as well as the geometry of a nasal spray with two types of tip were developed. RESULTS It is observed that by using the spray with the straight tip, particles were mainly deposited in the middle and superior regions of the nasal cavity and no particles entered the inferior meatus airway. The results proved that the spray with the angled tip improved the regional deposition percentage in the inferior meatus cavity up to 2.4% of the total sprayed particles and 1 mg drug mass delivered to this region. The majority of these particles had a diameter between 15-55 µm and that could be considered by spray designers to produce more compatible sprays with the targeted region. Also, most particles were deposited near the inferior meatus cavity and so there is a strong chance to be absorbed and delivered to this region. CONCLUSION The deposition pattern and particle size contour due to the spray with the angled tip can give sight to the designers and producers of nasal sprays to build more efficient types for better targeted drug delivery purposes. With this spray type, deposited particles were observed in the inferior meatus that never happened with the straight type. Also, the angled tip of the nasal spray shows the benefit of the ease of use for the user.
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Affiliation(s)
- Farhad Zare
- School of Mechanical Engineering, Shiraz University, Shiraz, Iran
| | - Ehsan Aalaei
- School of Mechanical Engineering, Shiraz University, Shiraz, Iran.
| | - Farzad Zare
- Aliebne-Abitaleb School of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran
| | - Mohammad Faramarzi
- Department of Otolaryngology-Head & Neck Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Reza Kamali
- School of Mechanical Engineering, Shiraz University, Shiraz, Iran.
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Yang X, Ou L, Xu D, Chen Y, Liu H. Increased 68Ga-FAPI Activity in Chondrosarcoma of Nasal Cavity. Clin Nucl Med 2022; 47:425-426. [PMID: 35025783 DOI: 10.1097/rlu.0000000000004023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chondrosarcoma is a rare entity tumor, which mainly appears in long bones and pelvic bones, but rarely in nasal cavity. Herein, we report the 68Ga-FAPI PET/CT findings in a 54-year-old man with chondrosarcoma of nasal cavity.
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Affiliation(s)
| | | | - Duo Xu
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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Narang A, Aggarwal V, Jain R, Maheshwari C, Ramesh A, Singh G. Nasoethmoidal Schwannoma as a Mimicar of Esthesioneuroblastoma: A Case Report and Literature Review. Neurol India 2022; 70:784-787. [PMID: 35532661 DOI: 10.4103/0028-3886.344679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Nasoethmoidal schwannomas are rare lesions and their presentation with intracranial extension is even rarer. Here, a patient presenting with rhinorrhea, epistaxis, and proptosis of left eye was diagnosed with giant nasoethmoidal schwannoma extending to frontal lobe and orbit, which was managed with bifrontal craniotomy with endoscopic transnasal gross total excision. This being predominantly a benign lesion has good prognosis if total excision is achieved.
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Affiliation(s)
- Amit Narang
- Department of Neurosurgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Varun Aggarwal
- Department of Neurosurgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Rahul Jain
- Department of General Surgery, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Chandni Maheshwari
- Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Athira Ramesh
- Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Gurbax Singh
- Department of Otorhinolaryngology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Mureșan AN, Rusu MC, Rădoi PM, Toader C. Patterns of Pneumatization of the Posterior Nasal Roof. Tomography 2022; 8:316-328. [PMID: 35202191 PMCID: PMC8880248 DOI: 10.3390/tomography8010026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/15/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: For good surgical performance, sound knowledge of anatomy is required. Although the ethmoid air cells and sphenoid sinuses are subject to a high degree of variation, their possible extensions above the nasal fossa at the posterior end of the cribriform plate of the ethmoid bone (CPEB) were seemingly overlooked. (2) Methods: We retrospectively studied 162 case files from 55 male and 107 female cases, with ages varying from 42 to 80, which were scanned using Cone Beam Computed Tomography. (3) Results: In 56.17% of cases, an unpneumatized CPEB (type I) was found. Nasal roof recesses of ethmoidal origin (type II) were found at the posterior end of the CPEB in 20.37% of cases. Different types of sphenoidal pneumatizations of the posterior end of the CPEB (type III) were found in 22.83% of the cases. Onodi cells projected nasal roof recesses (type IV) in only 10 cases. In all types, nasal roof recesses were found either above the CPEB or within/underneath it. Moreover, such nasal roof recesses were found to be either unilateral, extended contralaterally, or bilateral. (4) Conclusions: As such recesses of the posterior CPEB, previously overlooked, belong to the posterior rhinobase, they should be carefully documented preoperatively to avoid unwanted surgical damage to the olfactory bulb or CSF fistula.
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Affiliation(s)
- Alexandru Nicolae Mureșan
- Division of Anatomy, Department 1, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania;
- Research Department, “Dr. Carol Davila” Central Military Emergency Hospital, RO-010825 Bucharest, Romania
| | - Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania;
- Correspondence: (M.C.R.); (P.M.R.)
| | - Petrinel Mugurel Rădoi
- Division of Neurosurgery, Department 6—Clinical Neurosciences, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania;
- Clinic of Neurosurgery, “Dr. Bagdasar-Arseni” Emergency Clinical Hospital, RO-041915 Bucharest, Romania
- Correspondence: (M.C.R.); (P.M.R.)
| | - Corneliu Toader
- Division of Neurosurgery, Department 6—Clinical Neurosciences, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania;
- Clinic of Neurosurgery, “Dr. Bagdasar-Arseni” Emergency Clinical Hospital, RO-041915 Bucharest, Romania
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Corda JV, Shenoy BS, Ahmad KA, Lewis L, K P, Khader SMA, Zuber M. Nasal airflow comparison in neonates, infant and adult nasal cavities using computational fluid dynamics. Comput Methods Programs Biomed 2022; 214:106538. [PMID: 34848078 DOI: 10.1016/j.cmpb.2021.106538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Neonates are preferential nasal breathers up to 3 months of age. The nasal anatomy in neonates and infants is at developing stages whereas the adult nasal cavities are fully grown which implies that the study of airflow dynamics in the neonates and infants are significant. In the present study, the nasal airways of the neonate, infant and adult are anatomically compared and their airflow patterns are investigated. METHODS Computational Fluid Dynamics (CFD) approach is used to simulate the airflow in a neonate, an infant and an adult in sedentary breathing conditions. The healthy CT scans are segmented using MIMICS 21.0 (Materialise, Ann arbor, MI). The patient-specific 3D airway models are analyzed for low Reynolds number flow using ANSYS FLUENT 2020 R2. The applicability of the Grid Convergence Index (GCI) for polyhedral mesh adopted in this work is also verified. RESULTS This study shows that the inferior meatus of neonates accounted for only 15% of the total airflow. This was in contrast to the infants and adults who experienced 49 and 31% of airflow at the inferior meatus region. Superior meatus experienced 25% of total flow which is more than normal for the neonate. The highest velocity of 1.8, 2.6 and 3.7 m/s was observed at the nasal valve region for neonates, infants and adults, respectively. The anterior portion of the nasal cavity experienced maximum wall shear stress with average values of 0.48, 0.25 and 0.58 Pa for the neonates, infants and adults. CONCLUSIONS The neonates have an underdeveloped nasal cavity which significantly affects their airway distribution. The absence of inferior meatus in the neonates has limited the flow through the inferior regions and resulted in uneven flow distribution.
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Affiliation(s)
- John Valerian Corda
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - B Satish Shenoy
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - Kamarul Arifin Ahmad
- Department of Aerospace Engineering, Universiti Putra Malaysia, Jalan Universiti 1 Serdang, Seri Kembangan, Selangor 43400, Malaysia
| | - Leslie Lewis
- Department of Paediatrics, Kasturba Medical College and Hospital, Manipal 576104, India
| | - Prakashini K
- Department of Radio Diagnosis, Kasturba Medical College and Hospital, Manipal 576104, India
| | - S M Abdul Khader
- Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - Mohammad Zuber
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India.
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Preet K, Verma N, Chander B. Angiectatic sinonasal polyp: Treading on a false trail. INDIAN J PATHOL MICR 2022; 65:217-218. [PMID: 35075004 DOI: 10.4103/ijpm.ijpm_915_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Kamal Preet
- Department of Pathology, Shri Lal Bahadur Shastri Government Medical College, Mandi at Ner Chowk, Himachal Pradesh, India
| | - Naina Verma
- Department of Otorhinolaryngology, Shri Lal Bahadur Shastri Government Medical College, Mandi at Ner Chowk, Himachal Pradesh, India
| | - Bal Chander
- Department of Pathology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
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Mehta S, Gandhi V, Vich ML, Allareddy V, Tadinada A, Yadav S. Long-term assessment of conventional and mini-screw-assisted rapid palatal expansion on the nasal cavity. Angle Orthod 2021; 92:315-323. [PMID: 34964860 DOI: 10.2319/021221-122.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To evaluate the long-term effects of mini-screw-assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls on the nasal cavity with cone-beam computed tomography (CBCT). MATERIALS AND METHODS A total of 180 CBCT scans that were part of a previous randomized trial were evaluated retrospectively for 60 patients at pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were randomly assigned into 3 groups: MARPE, RPE, and controls (time period T1 to T3; MARPE: 2 years 8 months; RPE: 2 years 9 months; control: 2 years 7 months). Nasal height, nasal length, nasion-ANS height, ANS-PNS length, pyriform height, and nasal septal deviation angle were measured. The changes in alar width, alar base width, anterior nasal cavity width, posterior nasal cavity width, maxillary intermolar width, and maxillary intercanine width were also evaluated. RESULTS The alar base width, posterior nasal cavity width, anterior nasal cavity width, maxillary intercanine width, and maxillary intermolar width significantly increased (P < .05), and the nasal septal deviation angle significantly decreased (P < .05) in both the MARPE and RPE groups as compared with controls in the short term. In the long term, the nasal septal deviation angle was significantly decreased (P < .05) in the MARPE and RPE groups as compared with controls, and the posterior nasal cavity width was significantly increased (P < .05) in the MARPE group compared with the RPE group and controls. CONCLUSIONS MARPE and RPE led to a significant increase in the nasal cavity and alar base width compared with controls in the short term. In the long term, a significant increase was observed only in the posterior nasal cavity width with MARPE. Both MARPE and RPE led to a minimal decrease in nasal septal deviation angle in comparison with controls.
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Turri-Zanoni M, Gravante G, Dalfino G, Antognoni P, Locatelli D, Battaglia P, Castelnuovo P. Ectopic Primary Olfactory Neuroblastoma: Case Series and Literature Review. World Neurosurg 2021; 158:e645-e653. [PMID: 34785363 DOI: 10.1016/j.wneu.2021.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Olfactory neuroblastoma (ONB) is a rare malignant tumor arising in the upper nasal cleft. Rarely, ONB may originate in ectopic sites and the impact of this on prognosis and treatment strategies continues to be debated. METHODS A retrospective analysis was undertaken of patients with ectopic ONB treated between 2000 and 2020 in a tertiary-care referral center for skull base tumors. Three patients were included in this analysis: a 37-year-old woman with ONB arising from the bulla ethmoidalis; a 28-year-old man with inappropriate secretion of antidiuretic hormone caused by a maxillary sinus ONB; and a 41-year-old man with lacrimal sac ONB. Preoperative workup, surgical approach, adjuvant treatments and postoperative surveillance were analyzed. Relevant literature published between 2000 and January 2021 was fully reviewed to investigate oncologic outcomes and delineate the standard of care for such rare tumors. RESULTS All patients were treated via endoscopic endonasal resection with radical intent, followed by adjuvant treatments when required. No recurrences of disease were observed after a mean follow-up time of 32 months (range, 12-60 months). Data emerging from the literature suggest that a multidisciplinary treatment approach, including free-margins surgical resection followed by adjuvant radiotherapy or radiochemotherapy, is recommended. Olfactory bulb and dura preservation should be attempted whenever feasible. CONCLUSIONS Endoscopic endonasal surgery should be preferred, when possible, to achieve complete excision to minimize patients' morbidity. The ectopic site of origin affects prognosis and should be considered when selecting the appropriate multimodal treatment strategy.
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Affiliation(s)
- Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giacomo Gravante
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Bates NS, Massoud TF. Ambiguous "olfactory" terms for anatomic spaces adjacent to the cribriform plate: A publication database analysis and quest for uniformity. Clin Anat 2021; 34:1186-1195. [PMID: 34370888 DOI: 10.1002/ca.23771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/27/2021] [Accepted: 07/24/2021] [Indexed: 11/06/2022]
Abstract
A precise nomenclature and terminology is the foundation of communication in Anatomy and related biomedical sciences. The olfactory bulbs and nerves lie above and below the cribriform plate (CP), respectively. Hence, many anatomical landmarks in this region have names adopting the term "olfactory" as qualifiers. Ambiguous use of these "olfactory" terms exists, with some potential repercussions on patient treatments. We performed a publication database analysis to determine the frequency of misuse of names for seven anatomical "olfactory" spaces close to the CP and nasal cavity. We searched PubMed® publications having the keyword "olfactory" in their title or abstract, plus one of seven other keywords: "groove", "fossa", "recess", "cleft", "vestibule", "sulcus", and "cistern". We reviewed all abstracts for accuracy of these terms relative to accepted norms or customary definitions. By February 2020, we found all these keywords in 1255 articles. For the terms olfactory "groove" and "fossa", the number of relevant articles (and percentage of those inaccurately using these terms) were 374 (1.1%), and 49 (8.2%), respectively. All 52 abstracts containing "olfactory" and "vestibule" were irrelevant, relating to the "nasal vestibule" and olfactory function, instead of "olfactory vestibule". Overall, terms used to describe "olfactory" spaces near the CP are seldom ambiguous or inaccurate, but the terms olfactory "groove" and "fossa" are occasionally misused, We propose several new "olfactory" terms for inclusion in the Terminologia Anatomica, and stress the need for uniform nomenclature leading to greater consistency and accuracy in clinical use of anatomical terms containing the word "olfactory" as a descriptor.
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Affiliation(s)
- Nicholas S Bates
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Guinto-Nishimura GY, Caballero-Delgado S, Eguiluz-Meléndez AG, Ortega-Porcayo LA, Valencia-Ramos C, Aragon-Arreola JF, Portocarrero-Ortiz L, Sangrador-Deitos MV, Gómez-Amador JL. Combined Endoscopic Transsphenoidal and Tubular Retractor-Assisted Transventricular Approach for Giant Pituitary Adenomas. World Neurosurg 2021; 155:e761-e769. [PMID: 34500097 DOI: 10.1016/j.wneu.2021.08.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical resection remains the standard treatment for most giant pituitary adenomas (GPAs). The selected surgical approach for these complex lesions depends mainly on their extension. Single approaches may be limited in some cases presenting with invasion into multiple compartments, thereby limiting extent of resection. METHODS We report a series of patients with GPA operated on through a combined approach involving an endoscopic endonasal transsphenoidal approach and a tubular retractor-assisted transventricular approach, describing the technique, its indications, limitations, and outcomes. Baseline and postoperative clinical, functional, and morphologic variables were documented up until each patient's last follow-up visit. RESULTS Five patients harboring tumors extending into the third and lateral ventricles were included. Mean extent of resection was 94.6%. Mean follow-up was 39.4 months. One patient presented with a growth hormone-secreting GPA, who achieved remission after repeat resection during follow-up. There were no intraoperative complications, and 1 patient required reoperation for cerebrospinal fluid leak repair. One patient received adjuvant radiotherapy, and 3 patients remained stable requiring no additional treatment. All patients maintained an adequate postoperative functional status. CONCLUSIONS The combined approach herein described may be a safe and effective option for some patients with GPAs extending into the third and lateral ventricles. An adequate patient selection is mandatory to exploit the benefits of each individual approach.
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Affiliation(s)
| | - Silvia Caballero-Delgado
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Aldo G Eguiluz-Meléndez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Luis A Ortega-Porcayo
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Jorge F Aragon-Arreola
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Lesly Portocarrero-Ortiz
- Neuroendocrinology Service, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Juan L Gómez-Amador
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
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Sahr S, Dietrich A, Oechtering G. Evaluating malformations of the lacrimal drainage system in brachycephalic dog breeds: A comparative computed tomography analysis. PLoS One 2021; 16:e0257020. [PMID: 34492067 PMCID: PMC8423249 DOI: 10.1371/journal.pone.0257020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to investigate and compare the anatomical features of the nasolacrimal drainage system (NDS) in three brachycephalic dog breeds with those of normocephalic dogs, taking into account how the NDS was related to the malformed brachycephalic head. ANIMALS Fifty-one brachycephalic dogs were examined, comprising 23 Pugs, 18 French Bulldogs, and 10 English Bulldogs. Six normocephalic dogs of different breeds served as a comparison. METHODS Computed tomographic dacryocystography was performed. Parameters such as length, angulation, and gradient were determined. Crossing of the nasolacrimal duct (NLD) beneath the maxillary canine root, as well as the incidence of an accessory opening, were also analyzed. RESULTS AND CONCLUSIONS In all three brachycephalic breeds, the NDS was grossly malformed. We regard this as a further consequence of exaggerated breeding for a short head conformation. While the length of the NLD was substantially reduced by 41 to 57 percent in brachycephalic dogs, their lacrimal canaliculi were two to three times as long as those of normocephalic dogs. Varying parts of the nasolacrimal drainage system followed an inverse direction in short-headed dogs, giving the entire nasolacrimal apparatus an anomalous U- or V-shaped appearance. The NLD exhibited a three to five times steeper alignment in brachycephalic dogs than in normocephalic ones. Obviously, this strong slope did not cause clinical symptoms only because there was an aberrant outflow pathway. The brachycephalic dogs consistently exhibited an accessory opening, through which most of fluid escaped into the posterior nasal cavity instead of through the common route into the nasal vestibule via the nasolacrimal ostia.
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Affiliation(s)
- Sabine Sahr
- Small Animal Department, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - André Dietrich
- Department of Computer Science, Technische Universität Bergakademie Freiberg, Freiberg, Germany
| | - Gerhard Oechtering
- Small Animal Department, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
- * E-mail:
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Shimohonji W, Morisako H, Ohata H, Valenzuela JC, Sakaeyama Y, Goto T. Osaka Sliding Knot Seals Dural Defect Simply in Extended Endoscopic Endonasal Approach. World Neurosurg 2021; 155:144-149. [PMID: 34419659 DOI: 10.1016/j.wneu.2021.08.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022]
Abstract
An extended endoscopic endonasal approach (EEA) has become standard for parasellar and midline skull base lesions. However, postoperative leakage of cerebrospinal fluid (CSF) can result from dural defects after lesion removal. We present a simple and effective technique, the Osaka sliding knot, to prevent CSF leakage. Between November 2018 and March 2021, a total of 41 patients underwent reconstruction of skull base defects with intraoperative high-flow CSF leaks after extended EEA by using this closure technique, of whom only 1 patient experienced postoperative CSF leakage. This technically simple and efficient method seals the dural defect to prevent CSF leakage after surgeries using an extended EEA.
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Affiliation(s)
- Wataru Shimohonji
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Hiroki Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Yuki Sakaeyama
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takeo Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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