[Closing of nasal septum perforation using adipose stromal vascular fraction: an experimental study]. / Zakrytie perforatsii peregorodki nosa s primeneniem stromal'no-vaskulyarnoi zhirovoi fraktsii: eksperimental'noe issledovanie.

Nasal septal perforation (NSP) is a complex problem in otorhinolaryngology, which leads to impaired nasal breathing and dryness in the nose. This reduces the patient's quality of life and leads to psychological discomfort. The treatment of nasal septum perforation is selected taking into account the clinical manifestations, perforation parameters and general condition of the patient. Currently, a large number of different surgical methods have been described in order to closing the defect of nasal septum. To date, there is no universally accepted method for closing NSP, which stimulates the search and development of new treatment options. OBJECTIVE: Under experimental conditions, to study a new method for closing nasal septum perforation using a collagen scaffold together with adipose stromal vascular fraction containing multipotent mesenchymal stromal cells. MATERIAL AND METHODS: The experiment was carried out on a model of nasal septum perforation in 24 male rabbits divided into four groups, depending on the construct, implanted into the defect zone: the 1st group was the control group - without the introduction of implantation material; the 2nd group - collagen scaffold without adipose stromal vascular fraction; the 3rd group - collagen scaffold with xenogenic adipose stromal vascular fraction; the 4th group - collagen scaffold with allogeneic adipose stromal vascular fraction with further dynamic evaluation of endoscopic control on day 14, after 1 month, 3 months, and 6 months. At month 6, the animals were removed from the experiment, followed by morphological examination in color with hematoxylin and eosin, as well as safranin and methyl green. RESULTS: As a result of the experiment using adipose stromal vascular fraction of allogeneic and xenogenic origin, closing of perforation of the nasal septum of a rabbit for 3 months of dynamic endoscopic control, as well as according to morphological research, was demonstrated. CONCLUSION: Our study showed that the use of adipose stromal vascular fraction containing not only endothelial cells and pericytes, but also multipotent mesenchymal stromal cells in combination with a collagen scaffold closes the perforation of the nasal septum in a rabbit, without increasing the risk of violations of habitual vital activity.

Nasal Septal Perforation Secondary to Graft-Versus-Host Disease.

Nasal septal perforation is a full-thickness defect of the nasal septum. There are many described etiologies of nasal septal perforation, including trauma, infectious, neoplastic, iatrogenic, and autoimmune. Graft-versus-host disease (GVHD) is a common and potentially life-threatening complication that can occur after an allogenic transplant. GVHD can result in the development of autoantibodies that lead to granulomatous inflammation with necrotizing vasculitis, causing perforation of the nasal septum. In this report, we describe a patient with nasal septal perforation secondary to GVHD and hope to provide novel insights into the association of GVHD and nasal septal perforation.

Repair of Septal Perforations.

Nasal septal perforations have varied etiologies, clinical presentations, and methods of management. Some patients may be asymptomatic, while others may complain of nasal obstruction, crusting, epistaxis, and whistling. Management of nasal septal perforations is guided by the patient's symptoms and characteristics of the perforation. Some lesions can be managed conservatively or with minimally invasive procedures, while others require surgery. Surgical repair of perforations can be challenging and many techniques have been described without a standardized method of management. This article aims to provide a comprehensive review of options for repair of nasal septal perforations.

Innovative Surgical Techniques for Nasal Septal Perforations: Management and Treatment.

PURPOSE OF REVIEW: The aim of this study was to review and describe the main innovative surgical techniques for nasal septal perforation (NSP) repair that have been published in recent years. RECENT FINDINGS: Several techniques for NSP repair have been developed recently. The anterior ethmoidal artery (AEA) flap is a versatile technique for middle-size perforations in different locations. The greater palatine artery (GPA) flap is an excellent option for anterior-most NSPs. The lateral nasal wall flap and the pericranial flap are the most appropriate techniques for large perforations. The advent of these techniques has changed the management and has expanded the therapeutic arsenal to treat all types of NSPs according to the size, location, and osteo-cartilaginous support. However, no technique has been accepted as the gold standard. Extensive knowledge of different techniques is important to individualize the treatment, selecting the most appropriate in each case.

[Nasal septum perforation non-surgical treatment and preparation for plastic closure: literature review and own experience]. / Konservativnoe lechenie perforatsii peregorodki nosa i podgotovka k ikh plasticheskomu zakrytiyu: obzor literatury i sobstvennyi opyt.

Nasal septum perforations complete elimination is possible only with surgical treatment. However, most of perforation symptoms and clinical manifestations can be reduced with conservative treatments, thus improving the patient's quality of life. This article presents a short review of publications and our own clinical examples of nasal septum perforation conservative treatment methods in children and adults. Palliative methods and preparing for surgical closure are described.

Posteroinferior septal defect due to vomeral malformation.

PURPOSE: Vomeral malformation may lead to a posteroinferior septal defect (PISD). It is usually found incidentally, without any characteristic symptoms. The purpose of this study was to evaluate its clinical implications. METHODS: In this study, we included 18 patients with PISD after reviewing paranasal sinus computed tomography scans and medical records of 2655 patients. We evaluated the shape of the hard palate and measured the distances between the anterior nasal spine (A), the posterior end of the hard palate (P), the posterior point of the vomer fused with the palate (V), the lowest margin of the vomer at P (H), and the apex of the V-notch (N). RESULTS: None of the PISD patients had a normal posterior nasal spine (PNS). Six patients lacked a PNS or had a mild depression (type 1 palate), and 12 had a V-notch (type 2 palate). The mean A-P, P-H, and P-V distances were 44.5 mm, 15.3 mm, and 12.4 mm, respectively. The average P-N distance in patients with type 2 palate was 7.3 mm. There were no statistically significant differences between the types of palates in A-P, P-H, or P-V distances. In patients with type 2 palate, there was a significant correlation between P-V and P-N distances (r = 0.664, p = 0.019). CONCLUSIONS: PISD due to vomeral malformations was identified in 0.7% of the cases in this study. None of the subjects had a normal PNS, which suggests that the development of the vomer is closely related to that of the hard palate.

Nasoseptal Perforation: from Etiology to Treatment.

PURPOSE OF REVIEW: Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment. RECENT FINDINGS: NSP prevalence is about 1%. Clinical presentation may range from absence of symptoms to the presence of bothersome sinonasal symptoms. NSP is more frequently caused by trauma or post-surgery, inflammatory diseases, and abuse substances. Conservative management (nasal irrigation, topical use of antibiotic or lubricant ointments, or placement of prosthesis) is considered the first-line treatment. Symptomatic NSP not improving with local therapies usually requires surgical approach. Selection of the technique for the endoscopic septal repair depends on perforation characteristics and surgeon experience. When NSP is diagnosed, its cause has to be promptly determined. Most of them can be controlled with conservative measures. Surgical/endoscopic approaches are usually needed in refractory cases, and new repair techniques have to be considered.

A CFD approach to understand nasoseptal perforations.

INTRODUCTION: Nasoseptal perforations (NSP) are becoming common in the modern world, and can cause a wide variety of symptoms, including a sensation of nasal obstruction, epistaxis, crusting, dryness, headache, nasal pain and a whistling sound. There is an extensive range of surgical treatment techniques, but reported results were rarely statistically significant. The lack of consistent surgical results may be related to the lack of knowledge about the pathophysiology of NSP and how they affect the nasal flow. Computational fluid dynamics (CFD) has proved to be a very useful tool to study nasal function. METHODS: We have used CFD software (the program MECOMLAND® and the Digbody® tool for virtual surgery) to investigate the behaviour of the parameters R-[Formula: see text] based on CFD results, when four subjects underwent virtual surgery to induce a septal perforation: two subjects with healthy noses and two patients suffering from nasal airway obstruction. For each case a CFD study was performed, before and after creating an anterior (close to nostrils) or a posterior (close to choanae) NSP. RESULTS: In all cases analyzed, a posterior septal perforation did not result in a significant volumetric flow rate [Formula: see text] through the perforation between nasal passages. However, for anterior defects only in those nasal cavities considered diseased or unhealthy, high values of [Formula: see text] were found. CONCLUSION: The induced NSP only rendered significant flow alterations in noses with preexisting nasal airway obstruction alterations, whereas in nasal cavities considered as normal the creation of a NSP did not produce significant differences between both sides. We strongly suggest that this finding can explain the variety of symptoms and the number of asymptomatic patients bearing NSP.

Intracorporeal Septorhinoplasty: Technique and Outcome.

OBJECTIVE: Septal deformities usually associated with functional and aesthetic nasal consequences. Multiple techniques were described to correct these deformities. Using less invasive and at the same time competent technique with loge standing results is important. This study aimed to assess intracorporeal correction for septal deviation with assessment of its competence in managing deferent degrees of deviation and to show concomitant patient-dependant internal valve manipulation used. METHODS: Intracorporeal correction of septal deviation was used in 35 patients which was performed at plastic surgery departments of Menoufia University Hospital and Mawada Privet Hospital, Egypt. The study was carried out between July 2014 and July 2017. RESULTS: Thirty-five patients with variable types of septal deformities, 16 of them were females and 19 were males, were included in the study. Age of patients was between 18 and 55 years (mean 24.9, standard deviation 7.9). Etiology was found as follows: 15 (about 43%) posttraumatic septal deviation, 8 (about 23%) patients had postcleft septal deviation, and the remaining 12 had idiopathic septal deviation. Spreader graft was in 22 (about 63%) patients. Septal hematoma followed by septal perforation occurred in 1 patient (2.8%), while dorsal irregularities were found in 3 (8.4%) patients. Recurrent septal deviation occurred in 2 (5.6%) patients. Concerning functional outcome, no residual nasal obstruction was found in all patients with negative Cottle sign postoperative. CONCLUSION: Intracorporeal correction of septal deformities in open rhinoplasty technique is still found to be effective and less invasive option even with sever septal deviation.

Correcting the Cleft Lip Nose Deformity: The Graft Number 1 for the Columella.

BACKGROUND: The nose deformity associated with cleft lip is difficult to solve in the primary and secondary surgery. In an adult patient, many techniques are used including mobilization, suspension, fixation and trimming the alar cartilages, septoplasty, nasal bones osteotomies, and dorsal bone and cartilage resection. Different types of cartilage grafts are commonly used. METHODS: A septal cartilage graft was used in 75 adult patients with mild to severe cleft lip deformities. Based on the golden ratio proportions of the columella that can be observed in the lateral view, a septal cartilage graft with a number 1 shape was created and inserted between the medial cruras in 75 patients, with unilateral or bilateral cleft lip, between 2007 and 2014. Complementary surgery was done in the nose of all the patients. A retrospective, observational, and descriptive study was made with presurgical and postsurgical photographs, throughout a 6-month follow-up period. RESULTS: Excellent cosmetic and functional results were seen, especially in the lateral view. There was 1 septal perforation reported. The patients were satisfied with the aesthetic results. CONCLUSION: The graft number 1 works in the reality; it has proven to be a stable support to the affected cartilage, projects a nice nasal tip, and is a lasting solution for adults.

[Granulomatosis with polyangiitis associated with the cytoplasmic antineutrophil antibodies]. / Granulematoz s poliangiitom, assotsiirovannyi s antineitrofil'nymi tsitoplazmaticheskimi antitelami.

The objective of the present work was to analyze the clinical case of granulomatosis with polyangiitis associated with the presence of cytoplasmic antineutrophil antibodies. We considered the medical records of the patient presenting with this condition. It was shown that systemic vasculitis had a polymorphic clinical picture; its diagnostics and treatment encountered serious difficulties. It is concluded that the development of progressive perforation of the nasal septum and destructive changes in the intranasal and adjacent structures after the endonasal surgical intervention implies the necessity of the detailed analysis of the clinical and laboratory observations with the subsequent counselling by a rheumatologist and oncologist for the clarification of the diagnosis and the choice of adequate therapy.

[The clinical observation of NK/T-cell lymphoma of the nasal type]. / Klinicheskoe nabliudenie NK/T-kletochnoi limfomy nazal'nogo tipa.

The objective of the present work was to present the results of the clinical analysis of the patient presenting with natural killer (NK)/T-cell lymphoma of the nasal type. We undertook the analysis of the medical documentation concerning the case of interest. It was shown that the development of progressive perforation of the nasal septum and the pronounced destructive changes in the intranasal and adjacent structures following the endonasal surgical interventions made necessary differential diagnostics between the condition under consideration and certain latent disorders (such as Wegener's granulomatosis, leprosy, syphilis, leishmaniasis, dirofilariasis tuberculosis, etc.). The study has demonstrated that the negative results of the analysis imply the necessity of special attention to the possibility of development of oncological diseases including hematological disorders (e.g. NK/T-cell lymphoma) and the repeat careful follow-up examination of the patients by the experienced experts.

Safety of intranasal corticosteroids.

BACKGROUND: Concurrent use of intranasal corticosteroids (INCSs) and inhaled corticosteroids (ICSs) is indicated for patients who are comorbid for asthma and allergic rhinitis. Clinicians need to know the data regarding INCS safety for their patients with asthma. OBJECTIVE: To discuss INCS safety data for the use of INCSs in patients with asthma and allergic rhinitis. METHODS: INCS safety studies were selected for their relevance to the discussion. RESULTS: To date, most studies regarding INCS safety are performed in patients with allergic rhinitis. These studies reveal no evidence of increased risk of nasal atrophy, and only isolated cases of septal perforation have been reported. Evidence of hypothalamic-pituitary-adrenal axis suppression is inconsistent and not clinically significant. Early growth studies indicated that beclomethasone dipropionate but not other INCSs have systemic effects on growth; however, newer, larger, and better designed studies are detecting small but significant growth effects in other INCSs. INCSs do not increase the risk of cataracts or glaucoma, although there are anecdotal data on transient elevated intraocular pressure. Data on concurrent use of INCSs and ICSs are limited, but these limited data reveal no evidence of systemic effects on the hypothalamic-pituitary-adrenal axis. CONCLUSION: More studies of concurrent therapy are needed because concurrent use of ICSs and INCSs is common in practice. Clinicians might want to consider monitoring whether there are risk factors, such as a family history of glaucoma.

Optimal time for intranasal splint removal after septoplasty: a prospective clinical study.

To investigate the effect of intranasal splint removal time on patient comfort and possible complications after septoplasty. One hundred and nine patients who had septoplasty operations were included in this study. The patients were divided into three groups. In the 1st group (n = 36), splints were removed on the 3rd day after septoplasty; in the 2nd group (n = 36), splints were removed on the 5th day; and in the 3rd group (n = 37), splints were removed on the 7th day. Pain and nasal fullness were evaluated with visual analog scale. Synechia, perforation, hematoma, infection and hemorrhage were recorded after the removal of the splints (postoperative 1, 8 and 24 weeks). For the 1st, 2nd, and 3rd groups, respectively, pain score was 1.96, 2.67, and 2.67; and nasal fullness score was 6.23, 6.04, and 5.48. Nasal synechia was detected in two patients in the 1st group and in one patient in the 2nd group. Early hemorrhage was detected in two patients in the 1st group and one patient in the 3rd group. Infection, septal perforation and hematoma were detected in three patients in the 1st group. There was no difference in hemorrhage, hematoma, synechia and perforation rates between the three groups. There are various opinions in the literature about the ideal removal time of intranasal tampons after septoplasty, but there is no consensus on this topic. Our study shows that removal time of intranasal splints has no effect on patient comfort or possible complications.

Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure.

The aim of this study was to determine whether infiltration of local anesthetics with adrenaline improved septoplasty procedure when compared to normal saline. Eight-two patients undergoing septoplasty were randomized into two groups. In group 1, septal mucoperichondrium was infiltrated with lidocaine with adrenaline, and normal saline was used in group 2. Presence of intra-operative septal mucosal injuries, the amount of bleeding, arterial blood pressure, operation time as well as the quality of the surgical field and the convenience of finding the correct surgical plane as determined by the surgeon using a 5-point scale were compared between two groups. There were no significant differences for the amount of blood loss, mean arterial pressure, operation time, or scores for convenience of finding the correct surgical plane between the two groups. There was no significant difference for intra-operative simple (P = 0.631) and total (simple+severe) (P = 0.649) septal mucoperichondrial injuries between groups 1 and 2, either. However, severe mucoperichondrial injury rate was higher in the patients infiltrated with lidocaine and adrenaline (P = 0.026), and the quality of the surgical field was worse in the patients injected with normal saline (P = 0.0179). Infiltration of septal mucoperichondrium with lidocaine and adrenaline instead of normal saline was not advantageous in terms of objective parameters tested, including bleeding amount and duration of surgery as well as the of the total mucosal injury rate in septoplasty procedure.

Effect of Temporal Fascia and Pedicle Inferior Turbinate Mucosal Flap on Repair of Large Nasal Septal Perforation via Endoscopic Surgery.

BACKGROUND: The repair of large nasal septal perforations (NSPs) is one of the most challenging procedures in nasal surgery. The aim of this prospective clinical study was to determine the efficacy of using a pedicle inferior turbinate mucosal flap combined with temporal fascia to repair a large NSP. METHOD: Between January 2008 and December 2015, 17 consecutive patients with large NSPs underwent septal perforation repair via an endoscopic approach using a pedicle inferior turbinate mucosal flap combined with temporal fascia. RESULTS: Complete closure of the perforation was achieved in all patients. CONCLUSION: The pedicle inferior turbinate mucosal flap combined with the temporal fascia technique can easily solve this challenging problem, and the current data from this prospective study suggest that this technique shows promising results.

Causes and Prevention of Secondary Obstruction.

Secondary nasal obstruction occurs when surgery fails to improve a patient's nasal obstruction symptoms. This may occur from failure to recognize a problem preoperatively or failure to address mucocutaneous medical ailments. Secondary obstruction may even occur despite perfect execution of the operative plan. In this article, we discuss the etiology, intraoperative pitfalls, and surgical correction of secondary obstruction after primary rhinoplasty. When managing postrhinoplasty secondary obstruction, care must be taken to correct the cause of obstruction without creating new problems.

Multiple mucocutaneous ulcers associated with cocaine-induced midline destructive lesions.

Cocaine-induced midline destructive lesions (CIMDL) occur in a small subset of cocaine users, who clinically present with inflammation and necrosis of facial midline structures such as the palate, nasal septum, turbinates, and sinuses. We present a patient with CIMDL occurring concomitantly with ulcers on the cheek and upper trunk. Multiple biopsy specimens from the cutaneous and mucosal lesions consistently showed a dense dermal/submucosal infiltrate of neutrophils and plasma cells, without vasculitis or thrombosis. The ulcers resolved following cessation of cocaine use.

Repair of nasal septal perforation using middle turbinate flap (monopedicled superiory based bone included conchal flap): a new unilateral middle turbinate mucosal flap technique.

UNLABELLED: The purpose of this study is to present a new approach for treatment of nasal septal perforation using middle turbinate flap. A consecutive study with follow-up of 31 patients with nasal septal perforation treated using middle turbinate flap. All patients underwent an endoscopic repair of nasal septal perforation using middle turbinate flap. All patients were followed for 18-24 months. Complete closure of the perforation was achieved in 29 of the 31 patients. Complete failure of the repair was observed in two patients. All patients showed nasal crusting in varying degrees for a period of 2-4 weeks. None of the patients showed nasal obstruction or atrophic rhinitis symptoms (stuffy nose, purulent postnasal drip, nasal crusting, epistaxis and anosmia) in postoperative follow-up. This technique provides a new method with many advantages compared to other techniques for closure of septal perforations. LEVEL OF EVIDENCE: IV.

Button battery intake as foreign body in Chinese children: review of case reports and the literature.

OBJECTIVES: Button batteries have been recognized as one of the dangerous foreign bodies to children for more than 30 years, but few related studies have been published to give more concern in China. METHODS: We reported 6 cases of button battery intake as foreign body in children. The Chinese literature on button battery as foreign body in children was reviewed. RESULTS: The interval between the accidental ingestion and battery removal ranged from 6 hours to 3 days. Two patients had no sequela, 3 patients had tracheoesophageal fistulas, and 1 patient had nasal septal perforation. Twenty-eight articles about button battery as foreign body in children were obtained by Chinese-language literature searches including 25 case reports, 2 health education articles, and 1 imaging article. In total, 172 cases of button battery intake as foreign body in children were identified, 23 and 10 of the 159 cases involving nasal button battery lodgment developed nasal septal perforation and nasal adhesion, respectively. Tracheoesophageal fistula was identified in 4 of the 12 ingestion cases. One case of button battery intake was in external auditory canal. CONCLUSIONS: A small number of children with button battery as foreign body were reported in China, which is 1 of the biggest countries with large population of children.