Evaluation of diagnostic accuracy of cone beam computed tomography and multi-detector computed tomography for detection of anatomical variations in rhinoplasty.

BACKGROUND: Different imaging techniques, such as multi-detector computed tomography (MDCT) scan and cone beam computed tomography(CBCT), are used to check the structure of the nose before rhinoplasty. This study aimed to evaluate the accuracy of two imaging techniques, MDCT scan, and CBCT, in diagnosing structural Variations in rhinoplasty for the first time. METHODS: This diagnostic accuracy study was conducted on 64 rhinoplasty candidates who complained of snoring and sleep apnea or had a positive result in the examination with Cottle's maneuver or modified Cottle technique between February 2021 and October 2022 at 15- Khordad Hospital affiliated to Beheshti University of Medical Sciences. Before rhinoplasty, patients were randomly assigned to one of the CT and CBCT techniques with an equal ratio. Scans were assessed for the presence of Nasal septum deviation (NSD), Mucocele, Concha bullosa, and nasal septal spur by two independent radiologists. The findings of the two methods were evaluated with the results during rhinoplasty as the gold standard. RESULTS: NSD was the most common anatomical variation based on both imaging techniques. The accuracy of CBCT for diagnosing Nasal Septum Deviation and Mucocele was 80% and 75%, respectively. The sensitivity, specificity, and accuracy of CBCT in detecting Concha bullosa were 81.3% and 83.3%, respectively. The Kappa coefficient between CBCT and intraoperative findings for diagnosing NSD and Concha Bullosa was 0.76 and 0.73, respectively (p < 0.05). CONCLUSION: CBCT can be considered a suitable method with high accuracy and quality to evaluate the anatomical variations before rhinoplasty.

Factors Affecting the Surgical Outcome in Nasal Septal Perforation Repair.

OBJECTIVE: Nasal septal perforation (NSP) repair is challenging surgery considered in patients with symptomatic NSP intractable to conservative treatments. This study aimed to assess the success rate and identify factors affecting the surgical outcome of NSP by analyzing consecutive series of NSP repairs by a single surgeon. METHODS: We enrolled 84 patients diagnosed with NSP and who underwent surgical repair of NSP by a single surgeon (Y.J.J.) between November 2007 and July 2022. Medical records were retrospectively reviewed regarding variables involving preoperative symptoms, rhinologic history, etiology, surgical techniques, and the outcome of surgery. In addition, features of NSP were objectively evaluated using computed tomography scans. RESULTS: The overall success rate of NSP repair was 64.3% (54 of 84). Nasal obstruction (79.8%), crusting (34.5%), and epistaxis (27.4%) were frequent preoperative symptoms. Iatrogenic injury from previous nasal surgery (70.2%) was the most common cause. The average size of NSP on preoperative CT was 9.53 ± 6.68 mm. Patients with incomplete NSP closure had significantly larger perforations (12.21 ± 7.92 mm) than those with successful closure (8.04 ± 5.41 mm) preoperatively (P = .005). Patients with smoking history (OR = 2.971, 95% CI 1.170-7.548, P = .020) and NSP repair with combined rhinoplasty (OR = 3.811, 95% CI 1.401-10.370, P = .007) were more likely to experience incomplete closure. Patients whose perforations were reinforced with interposition graft were more likely to result in successful repair (OR = 6.752, 95% CI 2.496-18.262, P < .001). The bilaterality of mucosal flap coverage, surgical approach, types of mucosal flap and interposition graft, perforation shape, mucosal thickness around perforation, and distance from the nasal floor were not significantly related to the surgical outcome. CONCLUSIONS: Significant factors affecting the outcome of NSP repair were patient's smoking status, combined rhinoplasty, application of interposition graft, and perforation size.

A Safe Technique for Excising the Perpendicular Plate of the Ethmoid Bone in Patients with Crooked Nose: A Finite Element Analysis.

BACKGROUND: Correction of the crooked nose, especially the perpendicular plate of the ethmoid bone, has the potential to cause skull base injury. At present, the safe and effective method for perpendicular plate resection has not been clearly defined through biomechanics. METHOD: CT scan data of 48 patients with crooked nose and deviated nasal septum were divided into C-type, angular deformity-type, and S-type based on the morphology of the 3D model. Different types of finite element models of the nasal bony septum and skull base were established. The osteotomy depth, angle, and force mode of the PPE resection were simulated by assembling different working conditions for the models. The von Mises stress of the anterior cranial fossa was observed. RESULTS: When the osteotomy line length was 0.5 cm, the angle was at 30° to the Frankfurt plane, and 50 N·mm torque was applied, the von Mises stress of the skull base was minimal in the four models, showing 0.049 MPa (C-type), 0.082 MPa (S-type), 0.128 MPa (angular deformity-type), and 0.021 MPa (control model). The maximum von Mises stress values were found at the skull base when the osteotomy line was 1.5 cm, the angle was 50°, and the force was 10 N along the X-axis, showing 0.349 MPa (C-type), 0.698 MPa (S-type), 0.451 MPa (angular deformity-type), and 0.149 MPa (control model). CONCLUSION: The use of smaller resection angle with the Frankfurt plane, conservative resection depth, and torsion force can better reduce the stress value at the skull base and reduce the risk of basicranial fracture. It is a safe and effective technique for perpendicular plate resection of the ethmoid bone in the correction of crooked nose. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The vanishing nasal septum sign: a case of severe fungal sinusitis.

Acute invasive fungal sinusitis (AIFS) is a fungal infection of the nasal cavity and paranasal sinuses with associated invasion of adjacent vessels and soft/hard tissues. It usually occurs in immunocompromised patients and may follow a rapid course of less than four weeks with high mortality rate. We report a 39-year-old male with relapse of acute myelogenous leukemia (AML) who was under evaluation for neutropenic fever. On his sinus CT, there was loss of calcification of his nasal septum when compared to a prior head CT, a sign indicative of an aggressive infectious process. He was diagnosed with AIFS and underwent emergent surgical debridement and systemic antifungal therapy, leading to a positive outcome. The sign described on CT ("Vanishing Nasal Septum" sign) may provide an additional, reliable tool to prospectively identify locally aggressive cases of invasive fungal infections of the nasal cavity at an earlier stage and improve patient outcomes.

Effect of septal extension graft on nasal tip support: A finite element analysis.

BACKGROUND: Septal extension graft (SEG) is an effective method to control the projection, rotation, and shape of the nasal tip. However, the structural mechanics of SEG have not yet been adequately determined. OBJECTIVES: The purpose of this study was to examine the effect of SEG parameters on nasal tip support using finite element analysis. METHODS: A multicomponent nasal model was constructed from a computed tomographic scan. A control model without graft and a total of 15 models with different SEGs were created, regarding the direction, length, width, and piece of SEG. The nasal tip compression was simulated to analyze the von Mises stress, reaction force, and strain energy of the tip structure. RESULTS: The SEG increased the max stress, reaction force, and strain energy of the nasal tip compared to the normal control. The SEG perpendicular to the nasal dorsum resulted in the highest maximum stress, reaction force, and strain energy for the same size of SEG. With the length increasing from 15 × 8 × 1 mm to 25 × 8 × 1 mm, the reaction force remained relatively stable, but the stress on the graft reduced significantly. Adding the width and pieces of the SEG increased the reaction force and strain energy of the tip. CONCLUSION: The placement of SEG can strengthen the nasal tip support. The direction, length, width, and piece of SEG have an impact on the mechanics. LEVEL OF EVIDENCE: Diagnostic, III.

Comparison of the Effects of Spreader Graft Versus Spreader Flap on Nasal Valve Angle in Open Approach Rhinoplasty.

OBJECTIVE: This study aimed to compare the spreader graft and flap techniques, which are used in nasal valve surgery, based on measurements of nasal valve angles using computed tomography. MATERIAL AND METHOD: In this retrospective study, all patients' right and left internal nasal valve angles were measured from coronal computed tomography images taken preoperatively and in the third postoperative month. A paired t-test and independent t-test were used to compare continuous numerical variables. RESULTS: There were 52 patients with 104 valves in the spreader flap group and 54 patients with 108 valves in the spreader graft group, with a mean age of 27.76 ± 8.16 years. The angles were found to be statistically significantly higher in the postoperative period (p<0.001) in all patients. While the angles did not differ significantly between the flap and graft groups in the preoperative period, they were significantly higher in the flap group in the postoperative period (p<0.001). DISCUSSION: It is essential to preserve nasal valve function in rhinoplasty. The findings show that a spreader flap is superior to a spreader graft, although both techniques increase internal nasal valve function. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effect of Trans-Sutural Distraction Osteogenesis on Nasal Bone, Nasal Septum, and Nasal Airway in the Treatment for Midfacial Hypoplasia in Growing Patients.

The purposes of this study were to analyze the effect of trans-sutural distraction osteogenesis (TSDO) on nasal bone, nasal septum, and nasal airway in the treatment of midfacial hypoplasia. A total of 29 growing patients with midfacial hypoplasia who underwent TSDO by a single surgeon were enrolled. The 3-dimensional measurement of nasal bone and nasal septum changes was performed using computed tomography (CT) images obtained preoperatively (T0) and postoperatively (T1). One patient was selected to establish 3-dimensional finite element models to simulate the characteristics of nasal airflow field before and after traction. After traction, the nasal bone moved forward significantly ( P <0.01). The septal deviation angle was lower than that before traction (14.43±4.70 versus 16.86 ±4.59 degrees) ( P <0.01). The length of the anterior and posterior margin of the vomer increased by 21.4% ( P <0.01) and 27.6% ( P <0.01), respectively, after TSDO. The length of the posterior margin of the perpendicular plate of ethmoid increased ( P <0.05). The length of the posterior inferior and the posterior superior margin of the nasal septum cartilage increased ( P <0.01) after traction. The cross-sectional area of nasal airway on the deviated side of nasal septum increased by 23.0% after traction ( P <0.05). The analysis of nasal airflow field showed that the pressure and velocity of nasal airflow and the nasal resistance decreased. In conclusion, TSDO can promote the growth of the midface, especially nasal septum, and increase the nasal space. Furthermore, TSDO is conductive to improve nasal septum deviation and decrease nasal airway resistance.

Closed reduction of nasoseptal fractures: key concepts for predictable results.

Nasal complex injuries are the most common facial fracture encountered in the trauma population. Multiple surgical techniques for treatment of these fractures have been described with varying results. The goal of this study was to review the efficacy of closed reduction of nasal and septal fractures using a technique based upon several key concepts. We reviewed the records of patients who had undergone isolated nasal and/or septal fractures with closed reduction at our institution between January 2013 and November 2021. Inclusion criteria consisted of preoperative CT imaging, surgical treatment within fourteen days of initial injury, and follow up of at least one year. All patients were treated under general or deep sedation. The same surgical technique was applied with closed reduction of the septum and nasal bones with internal and external postoperative splints. Of the 232 records initially reviewed, 103 met inclusion criteria. Four patients had undergone revision septorhinoplasty (3.9%). Mean (range) follow up was 2.7 (1-8.2) years. Three patients had undergone revision nasal repair due to persistent airflow obstruction with complete resolution of symptoms after revision. The other patient received multiple revisions at another institution as a result of their dissatisfaction with cosmesis without improvement. Closed reduction of nasal and septal fractures can be a highly successful procedure and yield predictable results, limiting the need for post-traumatic open septorhinoplastic surgery. Five critical concepts of nasal fracture repair can help surgeons achieve predictable functional and cosmetic results: selection, timing, anaesthesia, reduction, and support.

Nasal Bifidity: An Unusual Pediatric Congenital Anomaly and Review of the Literature.

Congenital nasal anomalies are rare, with an estimated incidence of 1/20,000 to 40,000 live births. Hyperplasia and duplication anomalies are the most uncommon, comprising about 1% of reported cases. The authors present the case of a 6-year-old girl who presented to our institution with an isolated congenital bifid nasal septum. Parents reported a visibly abnormal nose since birth, and it had been continuously monitored by the parents and pediatrician. She demonstrated no history of difficulty breathing or other nasal concerns and was otherwise growing and developing normally. On physical examination, she was breathing comfortably through her bilateral nasal airways. Her nasal examination revealed a widened mid-vault with deep dorsal grooving and a bifid tip. Magnetic resonance imaging demonstrated an isolated bifid nasal septum without other facial malformation or intracranial extension. She underwent an open septorhinoplasty. Intraoperatively, the authors identified an anomalous dorsal nasal bone extension with a resultant bifidity in the body and caudal portions of the septum. Ostectomy and cartilaginous repositioning allowed for an autogenous reconstruction without the need for grafting. She subsequently recovered well without postoperative complications and continues to have improved nasal appearance with maintenance of function. A review of recent literatures revealed 2 other cases that are similar in presentation. The authors proposed that embryologically there might have been a change in expression of bone morphogenetic protein in the frontonasal area leading to caudal extension of the nasal bone. This in turn interferes with the fusion of nasal septum resulting in the bifid septum and dual dome morphology.

Efficacy of Nostril Supportive Splint Treatment for Nasal Septum Deformities after Le Fort I Osteotomy.

This retrospective study aimed to evaluate the efficacy of support splint treatment for deformities and deviations of the nasal septum after Le Fort I osteotomy (LFI). Patients were divided into two groups: the retainer group wore a nasal support splint immediately after LFI for 7 days, and the no retainer group did not wear a nasal support splint. Evaluation was performed by measuring the ratio of the difference between the left and right sides of the nasal cavity area (ratio of nasal cavity) and the angle of the nasal septum using three computed tomography frontal images (anterior, middle, and posterior) before and one year postoperatively. Sixty patients were included and divided into two groups, the retainer and no retainer group (n=30 each). Regarding the ratio of nasal cavity on middle images at one year postoperatively, the retainer and no retainer groups differed significantly (0.79±0.13 and 0.67±0.24, respectively; P =0.012). The angle of the nasal septum on anterior images at one year postoperatively was 164.8±11.7° in the retainer group and 156.9±13.5° in the no retainer group, showing a significant difference ( P =0.019). This study suggests that support splint treatment after LFI is effective in preventing post-LFI nasal septal deformation or deviation.

A Case of Cavernous Hemangioma on the Lateral Wall of the Inferior Nasal Meatus.

Hemangiomas, which originate in the sinonasal area, are not common among the various types of tumors from the head and neck region. Mechanisms for the formation of the tumor are yet to be discovered, and a few factors such as trauma, infection, oncogene, and some hormones are considered to take a role in the occurrence and growth of the tumor. Hemangiomas are classified for their histologic features as cavernous, capillary, and mixed types. There are a few reported cases of cavernous hemangiomas of the maxillary sinus, ethmoid sinus, middle and inferior nasal turbinate, and nasal septum. However, a case of cavernous hemangioma from the inferior nasal meatus, on the lateral wall to be precise, has never been reported. The authors are the first to report a case of a 69-year-old female patient who had cavernous hemangioma which was originated from the lateral wall of the inferior nasal meatus and successfully managed.

Evolution of Radiographic Changes of a Vascularized Pedicled Nasoseptal Flap after Endonasal Endoscopic Skull Base Surgery.

BACKGROUND AND PURPOSE: There is active research involving the radiographic appearance of the skull base following reconstruction. The purpose of this study was to describe the radiographic appearance of the vascularized pedicle nasoseptal flap after endoscopic skull base surgery across time. MATERIALS AND METHODS: We performed chart and imaging review of all patients with intraoperative nasoseptal flap placement during endoscopic skull base surgery at a tertiary academic skull base surgery program between July 2018 and March 2021. All patients underwent immediate and delayed (>3 months) postoperative MR imaging. Primary outcome variables included flap and pedicle enhancement, flap thickness, and flap adherence to the skull base. RESULTS: Sixty-eight patients were included. Flap (P = .003) enhancement significantly increased with time. Mean nasoseptal flap thickness on immediate and delayed postoperative scans was 3.8 and 3.9 mm, respectively (P = .181). The nasoseptal flap adhered entirely to the skull base in 37 (54.4%) and 67 (98.5%) patients on immediate and delayed imaging, respectively (P < .001). CONCLUSIONS: Our findings demonstrate heterogeneity of the nasoseptal flap appearance after skull base reconstruction. While it is important for surgeons and radiologists to evaluate variations in flap appearance, the absence of enhancement and lack of adherence to the skull base on immediate postoperative imaging do not appear to predict reconstructive success and healing, with many flaps "self-adjusting" with time.

Significance of nasal septal deviation among patients with antrochoanal polyp.

OBJECTIVE: This study aimed to examine the association between nasal septal deviation and antrochoanal polyp. METHODS: This was a retrospective review of medical records and imaging of patients who underwent endoscopic sino-nasal surgery for antrochoanal polyp. RESULTS: Forty-eight patients operated on for antrochoanal polyp between 2009 and 2019 were eligible for the study. The median age was 32 years, and 52.1 per cent were male. Antrochoanal polyp was diagnosed equally in the right and left nasal cavities. Septal deviation was present in 77 per cent of such cases. In 44 per cent of septal deviation cases, the antrochoanal polyp was ipsilateral to the deviation, which was not statistically significant. The type of deviation according to the Mladina classification was not correlated with the laterality of septal deviation and antrochoanal polyp. CONCLUSION: The laterality of the septal deviation was not found to be correlated with that of the antrochoanal polyp. Therefore, performing routine septoplasty during antrochoanal polyp surgery is unnecessary unless the deviation interferes with the complete extraction of the polyp.

Otolaryngologists' radiological assessment of nasal septum deviation symptomatology.

OBJECTIVES: Nasal Septal Deviation (NSD) is one of the most common causes of nasal obstruction. This study aims to further examine the clinical utility of imaging assessment in the workup and management of symptomatic nasal septal deviation, across all levels of medical training. STUDY DESIGN: Cross-sectional survey. METHODS: CT scans of 10 confirmed NSD patients and 36 healthy controls (HC) were mixed and emailed through anonymous REDCap surveys to otolaryngologists in the US. The HC had no reported sinonasal obstruction symptoms-NOSE (NSD: 62.2 ± 12.5; HC: 5.69 ± 5.99, p < 0.05); SNOT-22 (NSD: 31.4 ± 14.5; HC: 9.72 ± 10.76, p < 0.05). The images consisted of a coronal slice at each subject's most deviated location. Participants were instructed to choose the patients suspected to present with symptoms of sinonasal obstruction. RESULTS: 88 otolaryngologists responded to the survey. 18 were excluded due to incomplete responses. On average, they identified 64.2 ± 29.8% of symptomatic NSD subjects correctly, but misidentified 54.6 ± 34.6% of HC as symptomatic. Their decisions were strongly correlated to degree of NSD (r = 0.69, p < 0.05). There exists a significant degree of NSD among HC (38.7 ± 17.2%), which does not significantly differ from symptomatic subjects (51.0 + 18.7%, p = 0.09). Residents and fellows performed similarly, with responses correlated between levels of training (r = 0.84-0.96, p < 0.05). CONCLUSIONS: The incorporation of a substantial number of otolaryngologists, large patient sample, and blind mixing with HC gives us greater insight to the relative contribution of the extent of septal deviation to symptoms of nasal obstruction. Although NSD is a common factor contributing to nasal obstruction, the results of this study suggest that it is difficult to reliably infer obstructive symptoms based on degree of NSD on CT. LEVEL OF EVIDENCE: Three.

Impact of the Location of Nasal Septal Deviation on the Nasal Airflow and Air Conditioning Characteristics.

The location of nasal septal deviation (NSD) directly impacts nasal physiology. The objective is to examine, using computational fluid dynamics (CFD), the difference in the airflow and air conditioning characteristics according to the location of NSD. Twenty patients with septal deviation were divided into two: 10 caudal septal deviation (CSD) and 10 posterior septal deviation (PSD). Physiological variables were compared and numerical models for nasal cavity were created with CT scans. Cases with CSD had distinctive features including restricted airflow partition, larger nasal resistance, and decreased surface heat flux in the more obstructed side (MOS), and lower humidity and air temperature in the lesser obstructed side (LOS). Physiological differences were observed according to the location of septal deviation, CSD cases exhibit significantly more asymmetric airflow characteristics and air conditioning capacity between LOS and MOS.

A Modified Technique in Rhinoplasty: A Septal Extension Graft Complex Using Septal Cartilage, Ethmoid Bone, and Auricular Cartilage.

BACKGROUND: Due to the small and weak septal cartilage of Asians, it is a challenge to obtain ideal tip projection and nose lengthening in this population by performing septal extension grafts with only septal cartilage. OBJECTIVES: The aim of this study was to introduce a septal extension graft complex incorporating nasal septal cartilage, the perpendicular plate of the ethmoid bone, and bilateral auricular cartilage, and to examine its effectiveness in terms of morphological and mechanical support. METHODS: Septal cartilage was harvested under an endoscope according to standard techniques. Two pieces of the perpendicular plate of the ethmoid bone, placed on either side of the "L" strut, served as 2 spreader grafts. A double layer of auricular cartilage was fixed as columellar strut grafts. Three-dimensional facial scanning was used to examine the change of 3 parameters. Nasal tip resistance was evaluated by a digital Newton meter. RESULTS: In total, 25 patients were followed up postoperatively for a mean of 25.9 months. The analysis showed significant differences in both contour parameters and nasal resistance: nasal length (mean [standard deviation], 41.4 [4.0] vs 46.2 [3.4] mm, P < 0.05) and nasal tip projection (21.3 [3.2] vs 24.4 [2.7] mm, P < 0.05) appeared to increase postoperatively, whereas nasolabial angle (117.6° [5.9°] vs 109.5° [5.3°], P < 0.05) showed a significant decrease after surgery. The resistance of the nasal tip also increased significantly (P < 0.05) at displacements of 1, 2, and 3 mm. All patients were satisfied with the aesthetic results, and no serious complications occurred. CONCLUSIONS: This kind of modified septal extension graft technique can effectively adjust nasal morphology for short-nose East Asians.

The incidence of concha bullosa: a retrospective radiologic study.

AIM: This study was conducted to discuss the incidence, directions, and types of concha bullosa using studies in the literature. MATERIALS AND METHODS: The images of patients who presented to the ENT clinic with different ENT symptoms in the last 7 years and had paranasal sinus tomography were analyzed retrospectively. RESULTS: The study consisted of a total of 3133 patients, including 1534 females (48.96%) and 1599 males (51.03%). The age range of the cases was between 12 and 85 years, and the mean age was 57.25 years. Middle concha bullosa was detected in 1402 (44.74%) of the cases. Of these cases, it was determined that 320 (22.82%) had right, 311 (22.18%) had left, and 771 (54.99%) had bilateral middle concha bullosa. Of middle types of concha bullosa, lamellar type concha bullosa was detected in 575 (41.01%) patients, bulbous type in 363 (25.89%), and extensive type in 464 (33.09%). Of the cases with lamellar type middle concha bullosa, it was found that 130 (22.60%) had right side, 105 (18.26%) had left side, and 340 (59.13%) had bilateral lamellar type middle concha bullosa. Of the cases that were determined to have bulbous type middle concha bullosa, 97 (26.72%) had right side, 99 (27.27%) had left side, and 167 (46.00%) had bilateral bulbous type middle concha bullosa. Of the cases that were determined to have extensive type middle concha bullosa, 93 (20.04%) had right side, 107 (23.06%) had left side, and 264 (56.89%) had bilateral extensive type middle concha bullosa. The incidence of superior concha bullosa was determined in 487 (15.54%) of 3133 cases. Of these, bilateral superior concha bullosa was detected in 332 (68.17%) cases and unilateral in 155 (31.82%) cases. CONCLUSIONS: Our study has the largest case series among studies investigating the incidence of concha bullosa. The incidence of concha bullosa appears to be common in the community. Additional studies may be useful to determine whether its high incidence is associated with other sinus pathologies and the extent of its effect on other rhinological complaints.

Nasal Septal Angiofibroma.

Juvenile nasopharyngeal angiofibroma is a benign vascular tumor seen predominantly in adolescent males in the second decade of life. Extranasopharyngeal angiofibroma includes vascular fibrous masses that occur outside the nasopharynx. The diagnosis of an angiofibroma is based on the clinical presentation and imaging, with biopsies being avoided to avoid excessive bleeding. Computed tomography scan is considered sufficient for the diagnosis of extranasopharyngeal angiofibroma as it clearly delineates and identifies the tumor.

A highly specific recurrent pleomorphic adenoma of the nasal septum.

A 90-year-old woman presented with the sudden onset of visual loss. She previously underwent surgery to treat a right septal pleomorphic adenoma (PA) at 77 years old. She initially presented to our hospital with severe nasal obstruction at 83 years old. A large tumor occupied the bilateral nasal cavities and, thus, surgery was performed using midfacial degloving and an endoscopic endonasal combined approach. A 60×45×43 mm tumor was completely removed; however, a small area of the tumor capsule was damaged. Six years after surgery, PA recurred in the posterior midline portion of the nasal cavity. Imaging examinations revealed a 48×42×45 mm mass, which compressed the bilateral optic canal, thereby causing severe visual loss. The recurrent tumor was endoscopically removed, and vision recovered after surgery. The lack of malignant transformation was pathologically confirmed throughout this period. The present case had several highly specific features: she was very elderly, the tumor was very large, and visual dysfunction was caused by nasal PA. We described surgical procedures in detail and considered the specific findings of the present case. En bloc resection with a sufficient margin was considered to be important in the present case because recurrence may be caused by incomplete excision.

Morphometric analysis of sphenopalatine foramen on computed tomography images with clinical significance.

PURPOSE: This study aimed to investigate the effect of anatomical variations in the sphenopalatine foramen and the lateral nasal wall on sphenopalatine foramen-related morphometric measurements. METHODS: Paranasal sinus multidetector computed tomography records of 153 patients were evaluated. Morphometric measurements were made between the fixed bony landmarks and the sphenopalatine foramen. Number, shape, localization variations of the sphenopalatine foramen, concha bullosa, and septum deviation were noted and the results were compared with respect to sex, age, and laterality. RESULTS: No significant difference was detected with respect to laterality, whereas most of the measured distances were higher in males than females. There was a significant difference between the obtained morphometric data according to age groups. In our study, 91.2% single, 7.8% double, and 1% triple sphenopalatine foramen were detected and the most common irregularly shaped (37.3%). The location of sphenopalatine foramen was reported as the most common type II. Septum deviation types have no potential influence on the location of the foramen, but most of the measured parameters were found to be significantly smaller in the presence of concha bullosa, whereas the angle was found to be higher. CONCLUSION: This study revealed a significant relationship between the morphometric measurements of the sphenopalatine foramen and concha bullosa, while septum deviation types did not affect these results. For a safer and more effective surgery with prevention of iatrogenic complications, a surgeon should be aware of this correlation, especially in endoscopic transnasal approaches.