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Int. arch. otorhinolaryngol. (Impr.) ; 22(3): 297-302, July-Sept. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-975589


Abstract Introduction A pneumatized turbinate, also called concha bullosa, is a normal anatomical variant of the paranasal sinus region. Depending on the site of pneumatization, the concha is classified into extensive, bulbous or lamellar type. The middle turbinate concha bullosa has been implicated as a possible etiological factor in chronic sinusitis. Objectives The aim of this study was to investigate the anatomical variations of the concha bullosa, based on paranasal sinus imaging, and its possible association with sinusitis. Methods This prospective descriptive study was performed at the Department of ENT and Head Neck Surgery over a period of one year, from 2016 to 2017. We studied the computed tomography scans of the nose and paranasal sinuses- in axial, coronal and sagittal planes-of patients who had symptoms of nasal obstruction, or headache and features of chronic sinusitis. Results Out of the 202 scans studied, the prevalence of concha bullosa was 31.7%. The concha was bilateral in 35 (54.7%) patients and unilateral in 29 (45.3%) patients. Out of 99 conchae, 54 were on the right side and 45 were on left side. Ipsilateral sinusitiswas found in 40.4% of the sides in the scans of subjectswith concha. There was no statistically significant association between any type of middle turbinate concha with sinusitis, but sinusitis was more predominant with the extensive type of concha (p > 0.05). Conclusion Multiple air cells, mucocele, pyocele and inflammatory mucosal thickenings in the concha are relatively rare. Detailed knowledge of anatomic variations of the concha bullosa is imperative for the radiologists and the operating surgeons.

Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Conchas Nasais/anatomia & histologia , Conchas Nasais/patologia , Sinusite/patologia , Conchas Nasais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Obstrução Nasal/diagnóstico por imagem , Prevalência , Estudos Prospectivos , Cefaleia/diagnóstico por imagem , Mucocele/diagnóstico por imagem
Int. arch. otorhinolaryngol. (Impr.) ; 22(3): 280-283, July-Sept. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-975590


Abstract Introduction Nasal obstruction is a common complaint, and, for some, the middle turbinate resection is still a controversial issue among the surgical options due to the possibility of deleterious effects on olfaction. The University of Pennsylvania smell identification test (UPSIT) is considered the gold standard of smell identification tests, but data about it is still incipient in Brazil. Objective To evaluate if the middle turbinectomy has any repercussion on the sense of olfaction by using the UPSIT as an assessment tool. Methods A prospective study performed between 2013 and 2015 with 27 patients who were treated with middle turbinectomy by the same surgeon and tested with the UPSIT pre- and post-surgery, with a minimum interval of 3 months. Results Twenty-five patients completed the study. The mean age was 27.9 years. There was no statistical correlation betweenmiddle turbinectomy and the UPSIT score, or between gender and the UPSIT score. Conclusion There was no clinical repercussion on olfaction from partial middle turbinectomy.

Humanos , Masculino , Feminino , Adolescente , Adulto , Olfato/fisiologia , Conchas Nasais/cirurgia , Obstrução Nasal/cirurgia , Estudos Prospectivos , Estudos de Coortes , Estudos Longitudinais , Olfatometria
Int. arch. otorhinolaryngol. (Impr.) ; 22(3): 284-290, July-Sept. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-975591


Abstract Introduction Nasal septoplasty is considered the treatment of choice for nasal obstruction due to septal deviation. An ongoing discussion among rhinologists is whether it is reasonable to perform objective measurements of nasal patency pre or postoperatively routinely. Objective The primary aim of this study was to identify the short- and long-term functional benefits for patients undergoing septal surgery, as assessed by acoustic rhinometry (AR). The secondary goal was to evaluate the short- and long-term perception of symptom relief and disease-specific quality of life (QoL) outcomes on the part of the patients. Methods This was a prospective observational study in which AR was utilized for the assessment of nasal patency preoperatively and 1, 6 and 36months after septoplasty. Total 40 patients who underwent septoplasty filled out the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire and the Glasgow Benefit Inventory (GBI) to assess their subjective improvement in nasal obstruction symptoms and the changes in their QoL. Results There were statistically significant improvements in nasal patency, mean postoperative NOSE and GBI scores postoperatively. However, there was no correlation between the mean NOSE and GBI scores and the AR measurements. Furthermore, the GBI scores tended to decrease as the postoperative period increased. Conclusion The present study confirms that septoplasty significantly increases nasal patency and causes a significant subjective improvement in nasal obstruction symptoms. The absence of a statistically significant correlation among the objective measurements, the symptom scores, and the patients' low GBI scores indicates that factors other than the anatomical findings may also contribute to the patients' perception of QoL.

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Rinoplastia/métodos , Obstrução Nasal/cirurgia , Eletrocoagulação/métodos , Septo Nasal/cirurgia , Conchas Nasais/cirurgia , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Satisfação do Paciente , Escala de Resultado de Glasgow , Rinometria Acústica
Artigo em Espanhol | LILACS | ID: biblio-1000273


INTRODUCCIÓN: Las micosis invasivas agudas son infecciones rápidamente progresivas con una alta tasa de morbimortalidad. Se presentan principalmente en pacientes neutropénicos. La neutropenia puede clasificarse en cuantitativa (en neoplasias hematológicas, SIDA, inmunodepresión secundaria a transplantes) o cualitativa (en diabéticos mal controlados). Existen dos formas de presentación: Rinosinusal y extrasinusal. En esta última se describen tres subtipos: Rinoorbitaria (mayor frecuencia), rinocerebral y de partes blandas cervicofaciales. OBJETIVO: Describir dos casos clínicos de pacientes con presentaciones atípicas en las micosis invasivas agudas.

INTRODUCTION: Acute invasive mycosis can be a rapidly progressing infection that exhibits high rates of morbidity and mortality. Most commonly occurs in individuals with hematologic malignancies, particularly in patients who have received bone marrow transplantation. Other compromised patient populations at risk are those on chronic steroids, poorly controlled diabetics, patients with AIDS, and those undergoing chemoradiation therapy. Presentation forms can be rinosinusal and extrasinusal, this last one divided into: Rhinorbital, rhinocerebral and soft tissue affectation. OBJECTIVE: Describe two clinical cases of atypical presentation of acute invasive mycosis.

INTRODUÇÃO: Infecções fúngicas invasivas agudas são rapidamente progressivas, com alta taxa de morbidade e mortalidade. Eles ocorrem principalmente em pacientes neutropênicos. A neutropenia pode ser classificada como quantitativa (em neoplasias hematológicas, AIDS, imunossupressão secundária a transplantes) ou qualitativa (em diabéticos pouco controlados). Existem duas formas de apresentação: Rinossinusal e extrasinusal. Neste último, são descritos três subtipos: rino-orbitário (maior freqüência), tecido mole cervicofacial e rinocerebral. OBJETIVO: Descrever dois casos clínicos de pacientes com apresentações atípicas em micoses invasivas agudas e realizar uma revisão bibliográfica da referida patologia.

Humanos , Adolescente , Infecções Fúngicas Invasivas/complicações , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/patologia , Conchas Nasais/patologia , Zigoma , Zigoma/microbiologia , Estudos Retrospectivos , Neutropenia/complicações
Int. arch. otorhinolaryngol. (Impr.) ; 20(2): 166-171, tab, graf
Artigo em Inglês | LILACS | ID: lil-788024


Abstract Introduction Even in the absence of inflammatory disease, facial pain often results from pressure of two opposing nasal mucosa surfaces. Objectives The objective of this study is to assess the efficacy of surgical treatment of contact point headache. Methods Our study enrolled patients with unilateral facial pain and without nasal/ paranasal sinus disease. We confirmed the presence of mucosal contact by nasal endoscopy and by computed tomography. Forty-two subjects with the three most common anatomical variations underwent complete evaluation: 17 with concha bullosa (CB), 11 with septal deviation (SD), and 14 with septal spur (SS). All participants were treated by topical corticosteroid, adrenomimetic, and antihistamine. The patients without improvement were treated surgically. We assessed the severity of pain using a Visual Analogue Score (VAS) before surgical treatment and one, six, twelve, and twenty-four months after. Results The patients with SS had more severe facial pain in comparison with patients with CB (p=0.049) and SD (p=0.000). The subjects with CB had higher degree of facial pain than the ones with SD (p=0.001). After an unsuccessful medical treatment and surgical removal of mucosal contacts, the decrease of headache severity was more intense in patients with CB and SS (p=0.000) than in the patients with SD (p=0.01). Conclusion Our results suggest that topical medications have no effects and that surgical removal of mucosal contacts could be effective in the treatment of contact point headache. The results of surgical treatment were better in cases of facial pain caused by SS and CB, than in those caused by SD.

Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Cefaleia/etiologia , Cefaleia/cirurgia , Septo Nasal , Resultado do Tratamento , Procedimentos Cirúrgicos Otorrinolaringológicos , Medição da Dor , Conchas Nasais
Braz. j. otorhinolaryngol. (Impr.) ; 82(2): 131-139, Mar.-Apr. 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-780983


ABSTRACT INTRODUCTION: Turbinoplasty is a procedure that aims to reduce the size of the inferior turbinate through exuberant bone removal with high mucosal preservation. The procedure is recommended for patients with or without allergic rhinitis and those showing irreversible hypertrophy of inferior turbinates. OBJECTIVE: To evaluate the efficacy of inferior turbinoplasty for obstructive and non-obstructive symptoms in patients with or without allergic rhinitis. METHODS: Prospective study with 57 patients who underwent inferior turbinoplasty. They were evaluated for nasal obstruction, snoring, facial pressure, smell alterations, sneezing, nasal itching and runny nose symptoms, surgery time, and intraoperative bleeding. The last evaluation took place three months after surgery. RESULTS: Thirty-nine patients with allergic rhinitis and 18 without were assessed. Ninety days after surgery, 94.7% of patients showed degrees IV and V of breathing improvement; 89.5% showed moderate or complete improvement in snoring; all patients showed smell improvement (only one showed moderate improvement; all the others had full improvement); 95.5% experienced complete facial pressure improvement; and 89.7% showed moderate to complete improvement in nasal itching and runny nose symptoms, as well as in sneezing. CONCLUSION: The efficacy of inferior turbinoplasty was confirmed not only for obstructive symptoms, but also for non-obstructive symptoms in patients with and without allergic rhinitis.

RESUMO INTRODUÇÃO: A turbinoplastia é procedimento que visa a redução da concha inferior, à custa da remoção óssea exuberante e maior preservação da mucosa. É indicada para pacientes com e sem rinite alérgica, com hipertrofia irreversível das conchas inferiores. OBJETIVO: Avaliar a eficácia da cirurgia de turbinoplastia inferior nos sintomas obstrutivos e não obstrutivos em pacientes com e sem rinite alérgica. MÉTODO: Estudo prospectivo com 57 pacientes submetidos a turbinoplastia inferior. Foram avaliados quanto à obstrução nasal, roncos, pressão facial, alterações no olfato, espirros, prurido nasal e coriza, tempo de cirurgia e sangramento intraoperatório. A última avaliação foi com 3 meses de operação. RESULTADOS: 39 pacientes com rinite alérgica e 18 sem. Com 90 dias de operação, 94,7% dos pacientes apresentaram graus IV e V de melhora na respiração; 89,5% apresentaram melhora moderada ou total dos roncos; todos os pacientes tiveram melhora no olfato (apenas 1 moderada, os demais melhora total); 95,5% obtiveram melhora total da pressão facial e 89,7% obtiveram melhora moderada ou total em prurido nasal, espirros e coriza. CONCLUSÃO: Comprovou-se a eficácia da cirurgia de turbinoplastia inferior não só nos sintomas obstrutivos, mas também nos sintomas não obstrutivos tanto em pacientes com ou sem rinite alérgica.

Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Obstrução Nasal/cirurgia , Rinite Alérgica/cirurgia , Conchas Nasais/cirurgia , Hipertrofia/cirurgia , Estudos Longitudinais , Resultado do Tratamento , Conchas Nasais/patologia
Int. arch. otorhinolaryngol. (Impr.) ; 20(1): 2-5, Jan.-Mar. 2016. tab, ilus
Artigo em Inglês | LILACS | ID: lil-773514


Introduction Numerous surgical methods are used to treat nasal obstruction due to inferior turbinate hypertrophy. The primary goal of the therapy is to maximize the nasal airway for as extended a period of time as possible while minimizing therapeutic complications. Objectives The aim of this study was to assess the effects of radiofrequency thermal ablation (RFTA) and bipolar electrocautery (BEC) on the removal of nasal obstruction in patients with inferior turbinate hypertrophy and on nasal mucociliary clearance (MCC). Patients in both groups were also evaluated in terms of postoperative morbidity. Methods We compared the outcomes of two groups of patients: those treated with RFTA (n = 23) and those who underwent BEC (n = 20). Nasal obstruction was graded using a visual analog scale (VAS) and MCC was measured using a saccharin clearance test. Both measurements were performed before and 2 months after treatment. Results Pre- and postoperative VAS scores showed significant improvement for both groups. However, MCC results did not significantly differ between two groups. Neither edema nor crust formation persisted for more than 1 week in any patients. Conclusion Submucosal cauterization with preservation of the nasal mucosa and periosteum is as effective and safe as RFTA and should be considered when planning inferior turbinate interventions.

Depuração Mucociliar , Obstrução Nasal , Doenças Nasais , Conchas Nasais , Técnicas de Ablação , Eletrocoagulação
Int. j. morphol ; 33(4): 1476-1482, Dec. 2015. ilus
Artigo em Inglês | LILACS | ID: lil-772341


The respiratory epithelium is the first line of contact with the external hazards. Thus it can be damaged and need to be replaced to avoid healing by fibrosis. Tracheal tissue engineering is an alternative promising treatment modality. Mesenchymal stem cell markers are surface proteins, which are responsible for some of these cells unique properties. The objective of this study was to detect the mesenchymal stem cell phenotype among the human nasal respiratory epithelial cells via two immunophenotyping techniques. Respiratory epithelial cells were cultured using co-culture technique, fibroblasts was removed at confluence leaving respiratory epithelial cells, which were passage further to passage 4. Cells were evaluated for mesenchymal stem cell markers that were CD73, CD90, CD105 and the hematopoietic stem cell marker CD45 at passage 1 (P1) and passage 4 (P4) using Flow cytometry and Immunocytochemistry techniques. Respiratory epithelial cells expressed the mesenchymal stem cell markers at P1 and maintain the expression these markers until P4. Using both techniques, to compare the values of mesenchymal stem cell markers expression at P1 to P4 there was no significant difference. This study indicates that respiratory epithelial cells derived from nasal turbinate retain some of mesenchymal stem cells properties even after serial passages. Both methods of Immunophenotyping are comparable.

El epitelio respiratorio es la primera línea de contacto con los peligros externos. Por lo tanto, puede ser dañado y necesita ser reemplazado para evitar uan cicatrización por fibrosis. La ingeniería de tejidos traqueales es una modalidad de tratamiento alternativo prometedora. Los marcadores de células troncales mesenquimales son proteínas de superficie, que son responsables de algunas propiedades únicas de estas células. El objetivo fue detectar el fenotipo de células troncales mesenquimales entre las células epiteliales respiratorias nasales humanas a través de dos técnicas de inmunofenotipaje. Fueron cultivadas las células epiteliales respiratorias utilizando la técnica de co-cultivo; los fibroblastos se eliminaron en la confluencia dejando solo células epiteliales respiratorias, resultantes de los 4 pasajes. Las células fueron evaluadas para encontrar marcadores de células troncales mesenquimales mediante CD73, CD90, CD105 y el marcador de células troncales hematopoyéticas CD45 en el paso 1 (P1) y el paso 4 (P4), usando citometría de flujo y técnicas de inmunocitoquímica. Las células epiteliales respiratorias expresaron los marcadores de células troncales mesenquimales en P1 y mantuvieron la expresión de estos marcadores hasta P4. No hubo diferencias significativas en el uso de ambas técnicas al comparar los valores de los marcadores de células troncales mesenquimales expresadas desde P1 a P4. Este estudio indica que las células epiteliales respiratorias derivadas de la concha nasal retienen algunas de las propiedades de células troncales mesenquimales, incluso después de pases seriados. Ambos métodos de inmunofenotipificación son comparables.

Humanos , Biomarcadores/metabolismo , Células Epiteliais/citologia , Mucosa Nasal/citologia , Conchas Nasais/citologia , Técnicas de Cultura de Células , Citometria de Fluxo , Imuno-Histoquímica , Células-Tronco Mesenquimais/citologia , Fenótipo , Engenharia Tecidual
Rev. otorrinolaringol. cir. cabeza cuello ; 75(1): 55-60, abr. 2015. ilus
Artigo em Espanhol | LILACS | ID: lil-745620


El síndrome de nariz vacía es una enfermedad de reciente descripción, que no tiene una definición clínica clara. Se puede originar como complicación de la cirugía de resección de cornetes, en especial del inferior. La fisiopatología no está del todo definida, pero es probable que posterior a la resección de cornetes se altere la permeabilidad nasal, interfiriendo con los mecanismos neurosensitivos y con las funciones de los cornetes. Su síntoma principal, es la obstrucción nasal paradójica. El diagnóstico es clínico, basado en los síntomas con los hallazgos de una cavidad nasal amplia posterior a la cirugía nasal. El tratamiento es difícil por lo subjetivo de los síntomas, prefiriendo en un comienzo el tratamiento médico y reservando la cirugía para casos más severos. Lo más importante es la prevención, realizando cirugías lo más conservadora posibles de la anatomía de la cavidad nasal.

The Empty Nose Syndrome is a recently described disease, which has no clear clinical definition. It is a rare complication of turbinate surgery especially in the inferior turbinectomy. The pathophysiology is unclear, but after turbinectomy the nasal patency could be affected and this can interfere with neurosensory mechanisms and functions of the turbinates. The most common symptom is the paradoxical nasal obstruction. The diagnosis is clinical, based on symptoms with the discovery of a wide nasal cavity after nasal surgery. Treatment is difficult because of the subjective symptoms, initially preferring medical treatment and surgery is reserved for more severe cases. Most important is the prevention, being as conservative as possible with the nasal cavity.

Humanos , Obstrução Nasal/diagnóstico , Obstrução Nasal/etiologia , Obstrução Nasal/terapia , Doença Iatrogênica , Obstrução Nasal/fisiopatologia , Síndrome , Conchas Nasais/cirurgia
Braz. dent. sci ; 18(2): 38-43, 2015. ilus, tab
Artigo em Inglês | LILACS, BBO - Odontologia | ID: lil-766807


Objetivo: Este estudo teve com objetivo analisar a prevalência do desvio do septo nasal e da presença de concha nasal média bolhosa e estudar a possível relação entre estes por meio de imagens por tomografia computadorizada de feixes cônicos (TCFC). Material e Métodos: Foram selecionados 118 exames de TCFC de arquivo, previamente adquiridos por indicações diversas para odontologia. Todos os exames foram realizados em tomógrafo i-CAT Next Generation (imaging Sciences International, Hatfield, PA, EUA) com o mesmo protocolo, tendo o FOV (Field of View) abrangendo o terço médio e inferior da face. Todas as imagens foram avaliadas no software especifico do sistema por 01 avaliador devidamente treinado. O desvio de septo nasal, a concha nasal média bolhosa e demais dados foram tabulados e realizada a análise descritiva dos mesmos. O teste de McNemar foi aplicado para se estudar a possível relação entre os mesmos. Resultados: Os resultados indicaram que, nos casos em que não ocorria o desvio de septo nasal, 73,5% destes não apresentaram e 26,5% destes apresentaram a concha média bolhosa. Considerando-se apenas os casos que apresentaram o desvio de septo nasal para um dos lados, a proporção que não apresentou a concha média bolhosa para o mesmo lado foi de 77,1% e a que apresentou também a concha média bolhosa para o mesmo lado foi de 22,9%. Conclusão: Concluiu-se que não houve relação (p = 0,568) entre a presença das duas variáveis analisadas na pesquisa – desvio de septo nasal e presença de concha média bolhosa.

Objective: This study aimed to analyze the prevalence of nasal septum deviation and the presence of middle nasal concha bullosa, as well as to study the possible relationship between these findings by means of cone-beam computed tomography (CBCT) images. Material and Methods: One hundred and eighteen CBCT exams were selected from a file previously acquired for diverse reasons in dentistry. All images were obtained with CT i-CAT Next Generation (Imaging Sciences International, Hatfield, PA, USA) with the same protocol, and the field of view (FOV) covered the middle and lower third of the face. All images were evaluated in the specific software system by one trained evaluator. The deviated septum, nasal concha bullosa, and other data were tabulated and a descriptive analysis was performed. The McNemar test was used to study the possible relationship between them. Results: The results indicated that, in cases without nasal septum deviation, 26.5% and 73.5% were associated or not to the presence of middle concha bullosa, respectively. Considering patients with nasal septum deviation on one side only, the proportions of 22.9% and 77.1% were associated or not to middle concha bullosa in the same direction, respectively. Conclusion: Thus, it was concluded there was no relationship (p = 0.568) between nasal septum deviation and the presence of middle concha bullosa.

Humanos , Tomografia Computadorizada de Feixe Cônico , Cavidade Nasal , Septo Nasal/anormalidades , Conchas Nasais
Repert. med. cir ; 24(4): 294-297, 2015. Fotos
Artigo em Espanhol | LILACS | ID: lil-795730


Los mucoceles del seno esfenoidal representan de 1 a 2% de todos los de los senos paranasales. Se han reportado 140 casos de los cuales 95% ocurrieron en adultos, siendo un paciente de 11 años el más joven informado. El objetivo es presentar nuestra experiencia en una paciente de siete años de edad con un mucocele del seno esfenoidal. Los signos y síntomas consistieron en cefalea y rinorrea purulenta escasa. El diagnóstico se realizó mediante TAC y RMN de senos paranasales, así como por los hallazgos histopatológicos. El tratamiento consistió en abordaje endoscópico. El diagnóstico precoz es importante para evitar déficit neurológico permanente o alteraciones visuales y nerviosas por vecindad. Se analizó la etiología, manifestaciones y tratamiento de los mucoceles esfenoidales y se revisa la literatura médica disponible...

Sphenoid sinus mucoceles represent only 1 to 2% of all paranasal mucoceles. Only 140 cases have been reported so far, 95% in adults and an 11-year-old child is the youngest patient reported. Our objective is to describe our experience in a 7-year-old girl with a sphenoid sinus mucocele. Signs and symptoms consisted of headache and mild purulent rhinorrhea. Paranasal sinus CT and MR imaging, as well, as the histopathologic findings allowed the diagnosis. Patient was treated by endoscopic approach. Because of close proximity with vital structures early diagnosis is essential to prevent permanent neurologic deficit, such as, visual or nerve impairment. Etiology, manifestations and treatment of sphenoid sinus mucoceles and relevant medical literature were reviewed...

Criança , Seios Paranasais , Seio Esfenoidal , Mucocele , Conchas Nasais
Gac. méd. espirit ; 16(2): 105-117, Mayo.-ago. 2014.
Artigo em Espanhol | LILACS | ID: lil-719176


Fundamento: la reducción quirúrgica del cornete inferior es la conducta de elección en pacientes con rinitis crónica hipertrófica no infecciosa que no responden al tratamiento farmacológico; aunque existen otras técnicas quirúrgicas para ello, todavía son insuficientes las evidencias que soportan su eficacia. Objetivo: describir las características clínicas y los resultados posquirúrgicos en pacientes con rinitis crónica hipertrófica no infecciosa tratados mediante turbinoplastia inferior endoscópica . Metodología: estudio descriptivo de serie de casos en pacientes mayores de 15 años con rinitis crónica hipertrófica no infecciosa tratados mediante turbinoplastia inferior endoscópica en el Centro Nacional Cirugía Mínimo Acceso, entre el 1 de mayo de 2010 al 30 de junio de 2012. Los pacientes se siguieron por 6 meses. Resultados: se incluyeron 36 pacientes, el 63,9 % eran masculinos; el 69,4 % presentó rinitis alérgica. Predominó la obstrucción nasal asociada a rinorrea, prurito y cefalea ( 44,4 %), así como la hipertrofia grado II (58,3 %). Después de la cirugía todos los pacientes mejoraron y solo el 8,3 % presentó complicaciones. Conclusiones: se obtuvieron resultados favorables con el uso de la turbinoplastia inferior endoscópica , fundamentalmente por el alivio de los síntomas y por la escasa presentación de complicaciones.

Background: the surgical reduction of the inferior turbinate is the treatment of choice for patients with non-infectious chronic hypertrophic rhinitis unresponsive to drug treatment; although there are other surgical techniques for this condition, evidence supporting its effectiveness is still insufficient. Objective: to describe the clinical characteristics and postoperative outcomes in patients with non-infectious chronic hypertrophic rhinitis treated by inferior endoscopic turbinoplasty . Methodology: descriptive case series study of patients over 15 years with non-infectious chronic hypertrophic rhinitis treated by inferior endoscopic turbinoplasty in the Minimum Access National Surgery Center from May 1, 2010 to June 30, 2012. The p atients were followed for 6 months. Results: 36 patients were included , 63.9% were male ; 69.4 % had allergic rhinitis. N asal obstruction associated with rhinorrhea , pruritus and headache ( 44.4 %) and grade II hypertrophy ( 58.3 %) predominated . After surgery all patients improved and only 8.3 % had complications . Conclusions : with the use of endoscopic inferior turbinoplasty favorable results were obtained , mainly due to the relief of symptoms and the limited development of complications.

Humanos , Conchas Nasais/anormalidades , Conchas Nasais/cirurgia , Epidemiologia Descritiva
Int. arch. otorhinolaryngol. (Impr.) ; 18(4): 403-405, 2014. graf
Artigo em Inglês | LILACS | ID: lil-727682


Introduction: The extranasopharyngeal angiofibroma is histologically similar to juvenile nasopharyngeal angiofibroma, differing from the latterin clinical and epidemiologic characteristics. Objectives We present a case of extranasopharyngeal angiofibroma originating in the inferior turbinate. Resumed Report The patient was a girl, 8 years and 6 months of age, who had constant bilateral nasal obstruction and recurrent epistaxis for 6 months, worse on the right side, with hyposmia and snoring. Nasal endoscopy showed a reddish lesion, smooth, friable, and nonulcerated. Computed tomography showed a lesion with soft tissue density in the right nasal cavity. We used an endoscopic approach and found the lesion inserted in the right inferior turbinate. We did a subperiosteal dissection and excision with a partial turbinectomy with a resection margin of 0.5 cm. Histopathology reported it to be an extranasopharyngeal angiofibroma. Conclusion Although rare, extranasopharyngeal angiofibroma should be considered in the diagnosis of vascular tumors of the head and neck...

Humanos , Feminino , Criança , Diagnóstico Diferencial , Neoplasias Nasais , Conchas Nasais , Angiofibroma , Cavidade Nasal/lesões
Int. arch. otorhinolaryngol. (Impr.) ; 17(2): 131-138, Apr.-June 2013. ilus, tab
Artigo em Inglês | LILACS | ID: lil-670350


INTRODUCTION: Olfactory neuroepithelium (ON) biopsy has several therapeutic applications for both disorders of olfaction and neurodegenerative diseases. Successful collection of ON is still anything but routine due to a dearth of studies on the distribution of ON in the superior and middle turbinates. AIM: To determine the location in which ON is most likely to be present in endoscopically removed cadaver superior and middle turbinates as well as the influences of gender, age, and naris side on the presence of ON and the extent to which it is present. METHODS: We conducted a prospective anatomical study. The superior and middle turbinates on both sides endoscopically removed from 25 fresh cadavers (less than 12 h post-mortem). The turbinates were halved into anterior and posterior segments for a total of 200 specimens, which were analyzed after hematoxylin and eosin and immunohistochemical staining. Hematoxylin and eosin-stained slides were subjected to blind examination by 3 independent pathologists, and the presence of ON was graded on a 5-point scale from 0 to 4. Kappa measurement was used to determine the agreement between pairs of observers. RESULTS: ON was present in 82.9% of superior turbinate samples and in 17.1% of middle turbinate samples. Immunohistochemistry detected ON in superior turbinates only by S-100 staining and only in 15 fragments. Gender, age, and naris side had no statistically significant effects on the presence of ON. CONCLUSION: When biopsying ON, the posterior portion of the superior turbinate should be targeted whenever possible because it has the highest concentration of ON among the nasal structures.

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Biópsia , Mucosa Olfatória/fisiopatologia , Conchas Nasais , Cadáver , Corantes , Transtornos do Olfato
Int. j. morphol ; 31(2): 438-443, jun. 2013. ilus
Artigo em Inglês | LILACS | ID: lil-687081


The objective of this study was to evaluate the relationship between variations of the lateral wall of the nasal cavity and septal deviation (SD). Coronal and axial paranasal sinus CT images of 115 individuals (65 females, 50 males) were reviewed and the presence of pneumatisation and hypertrophy of the conchae was evaluated. Pneumatisation of the concha was classified as lamellar concha bullosa (LCB), bulbous concha bullosa (BCB), or extensive concha bullosa (ECB). If bulbous and extensive conchae and hypertrophic conchae were bilateral the side on which it was greatest was accepted as the dominant concha. The relationship between these variations and nasal septum deviation was also taken into account. Eighty-six (74.8 percent) of the 115 subjects had SD. Of these, 20 were not affected by the size of the middle nasal concha (MNC) or inferior nasal concha (INC). Thirty-four cases had dominant MNC, 20 had dominant INC, and 11 had both dominant MNC and dominant INC, and all of which had SD towards the opposite side. In one case there was SD towards the side in which the MNC was dominant. Our data indicate that coexistence of pneumatisation or hypertrophy of the conchae and SD was more common in adults compared to the results of similar studies conducted with a wide range of age groups, including children. Thus the presence of SD together with a large concha increases with age. A prospective study, which will include infants, will elucidate the relationship between conchae and SD.

El objetivo del estudio fue evaluar la relación existente entre las variaciones de la pared lateral de la cavidad nasal y la desviación septal. Se revisaron los senos paranasales en imágenes de TC de 115 individuos (65 mujeres, 50 varones) coronales y axiales y se evaluó en ellas la presencia de neumatización e hipertrofia de los conchas nasales. La neumatización de la concha fue clasificada como concha laminar bulosa (CLB), concha bulbosa bulosa (CBB), o concha extensa bulosa (ECB). Conchas nasales bulbosa y extensa y conchas hipertróficas eran bilaterales siendo el lado en que esta era más grande como la concha dominante. También se tuvo en consideración la relación entre estas variacio nes y la desviación del tabique nasal. Ochenta y seis (74,8 por ciento) de los 115 sujetos tenían desviación septal. De éstos, 20 no se vieron afectados por el tamaño de la concha nasal media (CNM) o concha nasal inferior (CNI). Treinta y cuatro de los casos tenía CNM dominante, 20 tenían CNI dominante, y 11 tenían tanto CNM dominante y CNI dominante, todos los cuales tenían desviación septal hacia el lado opuesto. En un caso hubo desviación septal hacia el lado en el que el CNM era dominante. Nuestros datos indican que la coexistencia de neumatización o hipertrofia de conchas nasales y la desviación septal es más común en adultos en comparación con los resultados de estudios similares realizados con una amplia gama de grupos etarios, incluidos los niños. Así, la presencia de desviación septal, junto con una gran concha aumenta con la edad. Un estudio prospectivo, que incluirá los bebés, aclarará la relación entre concha nasal y desviación septal.

Humanos , Masculino , Feminino , Cavidade Nasal/anatomia & histologia , Cavidade Nasal , Conchas Nasais/anatomia & histologia , Conchas Nasais , Seios Paranasais/anatomia & histologia , Seios Paranasais , Tomografia Computadorizada por Raios X , Septo Nasal/anatomia & histologia , Septo Nasal
Radiol. bras ; 45(6): 351-352, out.-dez. 2012. ilus
Artigo em Português | LILACS | ID: lil-660797


A concha nasal média secundária é uma rara variação anatômica na cavidade nasal, descrita pela primeira vez por Khanobthamchai et al. como uma estrutura óssea revestida por partes moles originária da parede lateral do meato médio. Na maioria dos casos relatados na literatura ocorre bilateralmente, sem complicações associadas. Neste artigo descrevemos um caso encontrado em nosso serviço, com tal variação anatômica incomum.

Secondary middle turbinate is an anatomical variant rarely observed in the nasal cavity, firstly described by Khanobthamchai et al. as a bone structure originating from the lateral nasal wall and covered by soft tissue. In most cases reported in the literature, this variant is bilateral, occurring without associated complications. In the present report, the authors describe the case of patient of their institution with such anatomical variation.

Humanos , Feminino , Pessoa de Meia-Idade , Conchas Nasais/anatomia & histologia , Conchas Nasais/anormalidades , Cavidade Nasal , Obstrução Nasal , Cefaleia , Tomografia Computadorizada por Raios X
Actas odontol ; 9(2): 14-26, dic. 2012.
Artigo em Espanhol | LILACS | ID: lil-706322


La imagenología convencional es una reproducción bidimensional de una realidad anatómica tridimensional. En una radiografía convencionalse superponen imágenes radiopacas y radiolúcidas, para cuya interpretación se debe conocer en detalle la anatomía descriptivay en especial la anatomía topográfica tridimensional. De esta superposición pueden surgir imágenes que no se correspondan conelementos anatómicos ni patológicos, son las llamadas imágenes fantasmas, que pueden inducir a importantes errores de diagnóstico.Por el contrario, como las Tomografías computo asistidas (TC) y las Resonancias magnéticas nucleares (RMN) son cortes tomográficosde espesores variables y regulables, las superposiciones no se producen.En las Telerradiografías norma lateral (TRG -NL) convencionales, debido a las superposiciones se encuentra, en muchas de ellas, un árearadiopaca esferoidal que se investigó a los efectos de saber, si correspondía a un elemento anatómico, a una patología o a una imagenfantasma. Se procedió a estudiar las apófisis pterigoides, las apófisis coronoides y los cornetes inferiores, efectuando mediciones de laaltura, del ancho y del espesor de estos elementos. Sobre ellos y en un hemicráneo seco, se realizó la Técnica con alambre de cobre yen cada etapa se tomaron TRG-NL experimentales. Así mismo, se realizó una revisión bibliográfica sobre la anatomía, fisiología y patologíadel cornete inferior, llegándose a la conclusión de que el área radiopaca estudiada corresponde a la superposición bilateral de lasapófisis coronoides, de las apófisis pterigoides junto con la apófisis piramidal del palatino, de la tuberosidad del maxilar, ocasionalmentedel germen del 3er molar y de la cola del cornete inferior. A esta imagen, se le llamó área radiopaca mandíbulo-ptérigo-turbinal. De todos los elementos involucrados en la conformación de esta área se debe jerarquizar el cornete inferior y especialmente su cola...

The conventional imaging is a two-dimensional reproduction of three-dimensional anatomical reality. In a conventional X-ray images are superimposed radiopaque and radiolucent, to whose interpretation must know in detail the descriptive anatomy and especially three dimensional topographical anatomy. This overlap may arise images that do not correspond with anatomical and pathological elements, are called ghost images, which can induce significant diagnostic errors. On the contrary, such as computing assisted CT (CT) and nuclear magnetic resonances (NMR) tomographic slices thicknesses are variable and adjustable, overlaps do not occur. In lateral cephalometric standard (TRG-NL) conventional, due to overlap is found, in many of them, an area radiopaque spheroidal investigate the effects of knowing if corresponded to an anatomical element, to a pathology or a ghost image. We proceeded to study the pterygoid process, the coronoid process and inferior turbinates, taking measurements of the height, width and thickness of these elements.On them and on a dry hemicráneo, was performed technology with copper wire and at each stage were taken experimental TRG-NL.Likewise, a literature review of the anatomy, physiology and pathology of the inferior turbinate, and concluded that the radiopaque area studied corresponds to the superposition of bilateral coronoid process of the pterygoid with the pyramidal process of the palatine , the maxillary tuberosity, occasionally 3rd molar germ and tail of the inferior turbinate. This picture, was called " radiopaque area mandibulo-pterygo-turbinate ". Of all the elements involved in forming this area should prioritize the inferior turbinate and particularly its tail by the variability in shape and density, due to the presence of lymphoid follicles and arteriovenous plexus.

Humanos , Cavidade Nasal/anatomia & histologia , Cavidade Nasal , Conchas Nasais/anatomia & histologia , Conchas Nasais/fisiologia , Telerradiologia , Hipertrofia/etiologia , Hipertrofia
Rev. otorrinolaringol. cir. cabeza cuello ; 72(3): 278-281, dic. 2012. ilus
Artigo em Espanhol | LILACS | ID: lil-676834


La cefalea es uno de los motivos de consulta más frecuentes en medicina y se clasifica como primaria en cefaleas tensionales o migrañas y secundaria a tumores, infecciones u otras causas. Dentro del grupo de cefaleas o algias faciales secundarias se plantea la existencia del cuadro clínico de cefalea rinogénica generada por puntos de contacto de la mucosa de la cavidad nasal. En este artículo se presenta un caso de una paciente que posterior al fracaso del tratamiento farmacológico para migraña, consultó por algia facial persistente. Al realizar un examen clínico y con tomografía computarizada de las cavidades perinasales, se diagnosticó una cefalea rinogénica por contacto de mucosa secundaria a una displasia fibrosa del cornete medio. La resección quirúrgica del punto de contacto a través de una turbinectomía media realizada por cirugía endoscópica nasal abolió totalmente el dolor facial. Este caso recalca la utilidad y necesidad del estudio de las cavidades perinasales en aquellos pacientes que presentan cefalea o algia facial.

Headache is one of the most frequent symptoms in medicine that can be classified as primary, like tensional headache and migraine or secondary as in tumors, infections, or other causes. Rhinogenic headache is proposed as a clinical entity secondary to mucosal contact points within the nasal cavity. In this article we present a case of a patient that after a pharmacological treatment failure for migraine, consulted for sustained facial pain. After clinical examination and a paranasal sinus computed tomography, a rhinogenic headache secondary to middle turbinate fibrous dysplasia was diagnosed. Endoscopic surgical extirpation of contact mucosal points by a medial turbinectomy produced complete abolition of facial pain. This case illustrates the need and utility of studying paranasal sinus in those patients with headache or facial pain.

Humanos , Feminino , Adulto , Conchas Nasais/patologia , Displasia Fibrosa Óssea/cirurgia , Displasia Fibrosa Óssea/complicações , Cefaleia/etiologia , Conchas Nasais/cirurgia , Dor Facial/etiologia , Tomografia Computadorizada por Raios X , Displasia Fibrosa Óssea/diagnóstico por imagem
Braz. j. otorhinolaryngol. (Impr.) ; 78(4): 42-47, jul.-ago. 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-646769


O conhecimento anatomocirúrgico da artéria esfenopalatina (AEP) e de seus ramos é de fundamental importância para o sucesso no tratamento endoscópico da epistaxe posterior. Contudo, essa complexa variação anatômica da irrigação da cavidade nasal ainda é um desafio cirúrgico. OBJETIVO: Descrever a anatomia endoscópica da AEP em cadáveres humanos. CASUÍSTICA E MÉTODOS: Estudo de coorte histórica com corte transversal de abril de 2010 a agosto de 2011. Foi descrita a presença da crista etmoidal da lâmina perpendicular do osso palatino, a localização do forame esfenopalatino principal (FEP) e acessório (FEA) e quantificados os ramos que emergem dos forames. RESULTADOS: Foram analisadas 56 fossas nasais. A crista etmoidal estava presente em 96% dos casos e na maioria das vezes anterior ao FEP. O FEP se localizava na transição do meato médio para o meato superior em todos os casos. O FEA estava presente em 12 casos. Foi mais prevalente a presença de um único tronco arterial bilateral na emergência do FEP (43%). Em outros casos, observaram-se três (n = 8) e dois (n = 5) troncos arteriais, emergindo do FEP bilateralmente. Observou-se que na maioria dos casos um único tronco se emergia do FEA. CONCLUSÕES: A anatomia da artéria esfenopalatina é bastante variável. O conhecimento das possíveis variações anatômicas implica no sucesso do tratamento da epistaxe grave.

Knowledge on the anatomy of the sphenopalatine artery (SPA) and its branches is fundamental for the success of the endoscopic treatment of posterior epistaxis. However, the complex anatomical variations seen in the irrigation of the nasal cavity poses a significant surgical challenge. OBJECTIVE: This paper aims to describe the endoscopic anatomy of the SPA in human cadavers. MATERIALS AND METHODS: This is a contemporary cross-sectional cohort study carried out between April 2010 and August 2011. The presence of the ethmoidal crest on the lamina perpendicular to the palatine bone and the location of the principal sphenopalatine foramen (PSF) and the accessory sphenopalatine foramen (ASF) were analyzed in 28 cadavers, and the branches emerging from the foramens were counted. RESULTS: Fifty-six nasal fossae were analyzed. The ethmoidal crest was present in 96% of the cases and was located anteriorly to the PSF in most cases. The PSF was located in the transition area between the middle and the superior meatus in all cases. The ASF was seen in 12 cases. Most nasal fossae (n = 12) presented a single bilateral arterial trunk emerging from the PSF. In other cases, three (n = 8) or two (n = 5) arterial trunks emerged bilaterally from the PSF. In most cases, the SPA emerged as a single trunk from the ASP. CONCLUSIONS: The anatomy of the SPA is highly variable. The success of the treatment for severe epistaxis relies heavily on adequate knowledge of the possible anatomical variations of the sphenopalatine artery.

Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Epistaxe/cirurgia , Cavidade Nasal/irrigação sanguínea , Conchas Nasais/irrigação sanguínea , Artérias/anatomia & histologia , Cadáver
Braz. j. otorhinolaryngol. (Impr.) ; 77(5): 577-583, Sept.-Oct. 2011. ilus, tab
Artigo em Inglês | LILACS | ID: lil-601854


Most studies show that objective measures to quantify and determine surgical success in the treatment of nasal obstruction do not correlate with subjective improvement as reported by patients. AIM: To evaluate the subjective improvement of nasal symptoms in patients undergoing septoplasty with or without turbinectomy. MATERIALS AND METHODS: A prospective study. We evaluated 72 septoplasty patients with or without partial inferior turbinectomy; the patients answered a questionnaire preoperatively and on the 60th day after surgery. RESULTS: Septoplasty was done associated with bilateral partial inferior turbinectomy in 83.3 percent of patients; it was unilateral in 9.7 percent; there was no need for turbinate reduction in 6.9 percent. An improvement of all symptoms was observed after surgery. Nasal obstruction had improved in 68 patients (94.4 percent) by the 60th postoperative day. The average nasal obstruction score in patients with and without allergic symptoms was similar before surgery and on the 60th postoperative day. Older patients had milder preoperative allergic symptoms. CONCLUSIONS: Nasal symptoms in patients undergoing septoplasty, with or without turbinectomy, improved. Patients with and without allergic symptoms showed a similar improvement of nasal obstruction on the 60th postoperative day.

A maioria dos estudos mostra que medidas objetivas para quantificar e determinar o sucesso das cirurgias para a obstrução nasal não têm correlação com a melhora subjetiva relatada pelo paciente. OBJETIVO: Avaliar a melhora dos sintomas nasais nos pacientes submetidos à septoplastia, com ou sem turbinectomia. MATERIAL E MÉTODO: Estudo prospectivo. Foram avaliados 72 pacientes submetidos à septoplastia, com ou sem turbinectomia inferior parcial, que responderam ao questionário no préoperatório até o 60º dia de pós-operatório (PO). RESULTADOS: Foi realizada septoplastia associada à turbinectomia inferior parcial bilateral em 83,3 por cento dos pacientes, unilateral em 9,7 por cento e não houve necessidade de redução das conchas nasais em 6,9 por cento. Foi observada melhora para todos os sintomas no pós-operatório. Sessenta e oito (94,4 por cento) pacientes apresentaram melhora da obstrução nasal no 60º PO. A média da nota da obstrução nasal entre os pacientes com e sem sintomas alérgicos foi semelhante no pré-operatório e no 60º PO. Os pacientes mais velhos apresentaram menor intensidade dos sintomas alérgicos no pré-operatório. CONCLUSÕES: Os pacientes submetidos à septoplastia, com ou sem turbinectomia, evoluem com melhora de todos os sintomas nasais. Os pacientes com e sem sintomas alérgicos apresentam melhora da obstrução nasal de forma semelhante no 60º PO.

Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Conchas Nasais/cirurgia , Procedimentos Cirúrgicos Nasais/métodos , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento