Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS). METHODS: We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373). RESULTS: Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group. CONCLUSIONS: This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.

Pleomorphic Adenoma of the Nasal Cavity.

Pleomorphic adenoma (PA) most commonly manifests in the parotid gland, though it occasionally emerges in atypical locations. We present a case involving an 87-year-old female who exhibited chronic left-sided nasal symptoms, leading to the diagnosis of PA in the nasal cavity. This diagnosis was confirmed through rhinoscopy and subsequent pathological examination following the surgical excision of an 8x8 mm mass. The procedure, which included tumor-based cautery, alleviated her symptoms effectively. A follow-up strategy was established to monitor for any signs of recurrence. The patient has shown no signs of recurrence at subsequent three-month follow-up visits, highlighting the success of the intervention. This case underscores the importance of early recognition and intervention in atypical presentations of PA, which is crucial to prevent potential complications and ensure favorable outcomes.

A Rare Case of Fungal Granuloma Confined to the Nasal Septum.

Granulomatous lesions in the nasal sinuses are associated with a variety of diseases, including immune disorders such as sarcoidosis, vasculitis, immunoglobulin G4 (IgG4)-related diseases, malignant lymphomas, and microbial infections. Here, we report a rare case of fungal granuloma that occurred exclusively within the nasal septum. The patient presented to the Department of Surgery with the chief complaint of nasal obstruction associated with nasal septal deviation. A bulge was found below the right nasal septum. Initially, it was diagnosed as mucosal swelling associated with rhinitis, and surgery was performed. A granulomatous lesion with bone destruction was found under the mucosa of the nasal septum, which led to the diagnosis of fungal granulation based on postoperative pathology. Though bacterial and fungal infections of the nasal septum are occasionally observed, this is the first reported instance of a fungal granuloma confined to the nasal septum. Infection within the nasal septum, although rare, should also be considered as a differential diagnosis for morphological abnormalities of the nasal septum.

Mucormycosis in an Immunocompetent Patient Recovering From Dengue Fever.

Mucormycosis is a rare yet aggressive fungal infection. Despite its rarity, India has experienced a surge in cases during the post-COVID-19 era. The high mortality rate associated with this infection necessitates early diagnosis, intervention, and aggressive treatment. Typically, it is observed in immunocompromised patients, where the disease progresses rapidly and leads to unfavorable outcomes. However, occurrences in previously healthy individuals are not uncommon. Dengue has been occasionally associated with mucormycosis in the post-recovery phase. This case report highlights the importance of heightened clinical suspicion and early intervention in patients with recent dengue infections and chronic sinus conditions. It explores potential risk factors, such as dengue-related immune alterations, environmental exposures, and anatomical alterations that may contribute to the development of mucormycosis in otherwise healthy individuals.

Olfaction Preservation and Long-Term Outcomes in Patients with Unilateral Endoscopic Resection of Olfactory Neuroblastoma: A Systematic Review and Institutional Experience.

BACKGROUND: Endoscopic endonasal surgical resection is an effective therapeutic approach for olfactory neuroblastoma (ONB). Unilateral excision of ONBs with limited extension has been reported with the purpose of preserving olfactory function. We aimed to review implications of surgical management, olfactory preservation feasibility, and survival outcomes in patients who underwent endoscopic unilateral resection of ONB. METHODS: A systematic literature review was conducted using the search terms [("Olfactory neuroblastoma") OR ("Esthesioneuroblastoma")] AND [("Unilateral resection") OR ("Olfaction preservation")]. Studies reporting cases of unilateral ONB endoscopic resection with postoperative olfaction assessment were included. Concurrently, records of patients who met inclusion criteria at our institution were reviewed retrospectively. The survival and olfactory outcomes were analyzed in both cohorts. RESULTS: Thirty-three patients were identified in the published literature. Twenty-three (69.7%) reported postoperative olfaction preservation. Olfactory function after surgery did not show an association with Kadish stage (P = 0.128). No evidence of disease was observed at the latest follow-up in this group of patients. Nine patients who met inclusion criteria were identified at our institution. The extent of resection influenced the level of olfaction preservation when cribriform plate and nasal septum resection coexisted (P = 0.05). A single patient at our institution developed recurrence after being lost to follow-up for 22 months. CONCLUSIONS: Olfaction preservation can be achieved in patients who undergo endoscopic unilateral resection and adjuvant radiotherapy. The extent of resection should aim for negative margins, particularly in the midline. Larger studies are required to assess the risk of contralateral microscopic disease, and, hence, close follow-up is advised.

Improvement in Pulmonary Function Tests After Septoplasty: A Longitudinal Study.

Introduction The relationship between the nasal and pulmonary systems is rooted in the shared anatomy and physiology of the upper and lower respiratory tracts. Our study objective was to assess the improvement in pulmonary function tests (PFTs) after septoplasty in patients with a deviated nasal septum (DNS). Methods A longitudinal study was conducted at a tertiary care center from October 1, 2022, to March 31, 2024. Patients aged 18-55 years with chronic nasal obstruction due to an isolated DNS were included in the study. Patients under 18 or over 55 years of age, those undergoing combined nasal surgeries, and those with comorbidities such as hypertension, diabetes, chronic smoking, chronic obstructive pulmonary disease, bronchial asthma, turbinate hypertrophy, chronic sinusitis, or nasal polyposis were excluded. Pre-operative assessments included detailed ear, nose, and throat examinations, routine blood investigations, X-rays of the chest and paranasal sinuses (Waters' view), PFTs (spirometry), the Sino-Nasal Outcome Test-22 (SNOT22) questionnaire, and the six-minute walk test (6MWT). Post-operative assessments included repeated spirometry, a 6MWT at three weeks post-surgery, and the SNOT22 questionnaire for subjective symptom assessment. Results Participants included 30 males and 30 females, with a mean age of 35.6 ± 8.2 years. Significant improvements (p < 0.05) were observed in PFT parameters (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow), exercise capacity (6MWT distance), and symptom severity (SNOT22 scores) post-septoplasty. High levels of patient satisfaction and notable improvements in quality of life were reported. The average hospital stay was 2.5 days. Conclusion Septoplasty in patients with DNS significantly improves pulmonary function, exercise capacity, and symptom severity, with high patient satisfaction and minimal complications.

Innovative Repair Method for Septal Perforation Repair: The Fascia Lata and Platelet-Rich Plasma Fusion Technique.

BACKGROUND: Nasal septal perforation (NSP) is a structural flaw that affects the mucosa, cartilage, and bone of the nasal septum, often stemming from septoplasty as the most frequent cause. The natural healing of a perforated septum is uncommon; on the contrary, it tends to deteriorate progressively. Various surgical methods have been outlined for the repair of NSP. In this research, the authors introduce an innovative approach utilizing fascia lata graft with PRP for the restoration of NSP across diverse sizes. METHODS: The researchers conducted a retrospective analysis involving 25 patients who underwent repair for nasal septal perforation (NSP) from January 2021 to January 2023. Grafts were obtained, and the perforation was addressed using an open rhinoplasty technique, followed by the insertion and suturing of the graft. RESULTS: The mean size of the septal perforations was 17 mm horizontally and 18 mm vertically. The mean follow-up period was 12 months. Complete closure of NSP was achieved in 23 out of 25 patients (92%). Among the cases, 17 were male (68%), and the age ranged from 25 to 45 years with a mean of 38.7. Eight cases (32%) were smokers. At 12 months postoperatively, three large-sized NSPs were closed successfully, while two medium-sized NSPs did not achieve closure due to smoking. CONCLUSION: The Fascia Lata and Platelet-Rich plasma fusion technique for the closure of nasal septal perforations is a secure and dependable method, demonstrating a notable success rate. This approach should be regarded as a viable option for individuals dealing with nasal septal perforation. LEVEL OF EVIDENCE V: 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 .

Nasal Septum Deviation in Patients with Acute Invasive Fungal Rhinosinusitis in a Tertiary Care Hospital: A Cross-Sectional Study.

This is a retrospective study exploring the demographics and the role of nasal septum deviation in acute invasive fungal rhinosinusitis (AIFS); and if this deviation contributes to the laterality predilection of this opportunistic infection. Fifty-six craniofacial CT scans were evaluated by two radiologists blinded to the clinical data and outcome for laterality of the disease; and nasal septal deviation (NSD). NSD was graded based on the measured septal angle of deviation into mild, moderate, and severe and furtherly classified into one of seven types based on Mladina's classification. High prevalence of remarkable nasal septum deviation existed in our population with AIFS, with type 7 Mldina NSD represented the most prevalent in this population. We found no significant statistical relation between the side of deviation and the initial side of the fungal disease. We recommend screening for early manifestations of AIFS in similar debilitated patients; with high degrees of nasal septum deviation for considering it as an anatomical risk factor.

A Comparative Study of Outcomes of Submucosal Diathermy Versus Inferior Turbinoplasty in Patients With Deviated Nasal Septum With Inferior Turbinate Hypertrophy.

Introduction Nasal obstruction due to deviated nasal septum (DNS) and inferior turbinate hypertrophy (ITH) is a common problem necessitating surgical intervention. Submucosal diathermy (SMD) and inferior turbinoplasty (IT) are two commonly performed procedures aimed at improving nasal patency. Methods A prospective comparative study was conducted on 56 patients with DNS and inferior turbinate hypertrophy, divided into SMD and inferior turbinoplasty groups. Preoperative and postoperative assessments included symptom assessment using the 22-item Sinonasal Outcome Test (SNOT-22) questionnaire. Results Both procedures led to significant improvements in nasal symptoms and quality of life. Inferior turbinoplasty showed slightly better outcomes in symptom improvement compared to submucosal diathermy. Conclusions Inferior turbinoplasty appears to offer slightly better outcomes in improving nasal symptoms compared to SMD in patients with DNS and inferior turbinate hypertrophy. However, both procedures are effective and safe options for surgical management. Individualized treatment decisions should consider patient preferences and surgeon expertise.

Using Cone Beam Computed Tomography For Appropriate Nostril Selection in Nasotracheal Intubation.

OBJECTIVES: Nasotracheal intubation is a standard blind procedure associated with various complications. The selection of the appropriate nostril is crucial to preventing most of these complications. The present study aimed to evaluate the predictive ability of CBCT images to select the correct nostril for nasotracheal intubation. METHODS: The study encompassed 60 patients who underwent maxillofacial surgery with nasotracheal intubation under general anesthesia. While the anesthetist made the appropriate nostril selection clinically according to a simple occlusion test and spatula test, the radiologist made the selection after analyzing various CBCT findings such as the angle and direction of nasal septum deviation (NSD), minimum bone distance along the intubation path, and the presence of inferior turbinate hypertrophy. The appropriateness of these choices made blindly at different times was evaluated using descriptive statistics, chi-squared test, and independent samples t-test. RESULTS: The study found that 83.3% of the suggested nostril intubations were successful. We also observed that intubation duration was longer when inferior turbinate hypertrophy was present (p = 0.031). However, there was no statistical relationship between the presence of epistaxis and septal deviation (p = 0.395). Nonetheless, in 64.3% of cases with epistaxis, the intubated nostril and the septum deviation direction were the same. CONCLUSIONS: Pre-operative evaluations using CBCT can aid anesthetists for septum deviation and turbinate hypertrophy, as both can impact intubation success rates and duration.

Fungal Abscess of Anterior Nasal Septum Complicating Maxillary Sinus Fungal Ball Rhinosinusitis Caused by Aspergillus flavus: Case Report and Review of Literature.

Anterior nasal septum abscess is not a rare clinical disease entity. In terms of the etiologies of the disease, bacteria are obviously more common than fungi. Fungal culture and pathological examination are essential for diagnosis of a fungal abscess of the anterior nasal septum and the basis of prescription of antifungal agents. We report a 57-year-old male patient who came to our outpatient clinic due to refractory nasal congestion for 3 weeks despite receiving treatments by a local medical doctor. Radical surgery with postoperative adjuvant radiotherapy for the right buccal cancer was carried out 14 years ago. The patient has diabetes mellitus and the blood sugar level has been well controlled by oral hypoglycemic agents over the past several years. Computed tomography revealed an abscess in the anterior septum along with rhinosinusitis. Incision and drainage of the nasal septum abscess and functional endoscopic sinus surgery were carried out. Fungal culture and pathological examination confirmed a fungal abscess in the anterior nasal septum and fungal ball rhinosinusitis. Antibiotics and an antifungal agent were given, and the postoperative course was uneventful. A dialectical argument was made regarding the causal relationship between the fungal abscess of the anterior nasal septum and maxillary fungal ball sinusitis. A literature review of the previous case reports was carried out to elucidate the immune status of patients of this disease. In order to reach a rapid establishment of a fungal abscess of the anterior nasal septum, clinicians should keep this disease in mind and remain vigilant. An immuno-compromised status is more commonly found in patients with fungal abscess of the anterior nasal septum and is another important characteristic of this disease. Prompt diagnosis and effective treatment are equally important in patients with lower immune status of this kind, and the latter is based on the former.

The Effects of Nasal Septal Deviation on Anterior Skull Base Parameters.

Introduction Functional endoscopic sinus surgery and endoscopic skull base surgery are frequently performed surgeries today. Nasal septal deviation is a common finding and can affect the surgical area. Therefore, it is important to examine the effect of this deviation on other anatomical structures. Objective The aim of the present study was to determine whether there is a relationship between the degree of nasal septal deviation and anterior skull base structures using computed tomography (CT). Methods A total of 312 patients (aged 18 to 65 years old) whose paranasal sinus CT images were available were included in the study. Measurements were obtained on images retrieved from Picture Archiving and Communication System (PACS) and Horos image archive systems in the bone window in the coronal and axial plane. Results The mean age of 312 patients was 33.00 years old (standard deviation [SD] 11.22 years). The presence of septal deviation was not associated with changes in olfactory fossa (OF) depths, Keros degrees, and the angle between the lateral lamella and the cribriform lamella. However, OF depths and Keros degrees on the deviated side of the septum were found to change at a significant level ( p < 0.05). No significant association was observed between the degree of septal deviation and cribriform lamella-lateral lamella angle. Conclusion The study showed significantly increased OF depth and Keros degree on the deviated side of the nasal septum. Performing CT scans before endoscopic sinus surgery and endoscopic skull base surgery is important to increase the chances of a successful surgical outcome and to reduce complications.

[Clinical analysis of resection and dura skull base reconstruction of cranionasal communication tumor in 31 cases].

Objective:To explore the methods of resection, dura and skull base repair and reconstruction of cranionasal communication tumor. Methods:Data of 31 patients with cranionasal communication tumor who underwent dura and skull base reconstruction after tumor resection from 2018 to 2022 were collected. Follow-up lasted for 3 to 41 months. Results:A total of 31 patients were enrolled, including 20 males and 11 females. The ages ranged from 19 to 74 years, with a median age of 57 years old. There were 17 benign lesions（one case of hemangioma, one case of Rathke cyst, one case of squamous papilloma, one case of craniopharyngioma, two cases of meningocele, two cases of varus papilloma, two cases of meningioma of grade Ⅰ, three cases of schwannoma, four cases of pituitary tumor） and 14 malignant lesions（one case of osteosarcoma, one case of poorly differentiated carcinoma, two cases of varus papilloma malignancy, two cases of olfactory neuroblastoma, two cases of adenocarcinoma, two cases of adenoid cystic carcinoma, four cases of squamous cell carcinoma） . Sixteen cases underwent nasal endoscopy combined with craniofacial incision and 15 cases underwent nasal endoscopy surgery alone. Complete resection of the mass and dura and skull base reconstruction were performed in all 31 patients, and free graft repair was performed in 8 cases（fascia lata in 5 cases and nasal mucosa in 3 cases）. Twenty-three cases were repaired with pedicled flaps（septal mucosal flap alone in 11 cases, septal mucosal flap combined with free graft in 6 cases, and cap aponeurosis combined with free graft in 6 cases）. Eight out of 31 patients underwent skull base bone repair. Postoperative cerebral hemorrhage occurred in 1 case, cerebrospinal fluid leakage in 1 case, intracranial infection in 2 cases. All patients were successfully treated without severe sequelae. Cerebrospinal fluid leakage and intracranial infection occurred in one patient after radiotherapy, who recovered after conservative treatment. All 17 patients with benign lesions survived. Thirteen out of 14 patients with malignant lesions received radiotherapy after surgery, nine survived without recurrence, five cases recurred, of which 2 survived with tumor, one underwent reoperation and 2 died. Conclusion:Cranionasal communication tumors are high-risk diseases of anterior and middle skull base, and various surgical repair methods could be selected after complete resection of the tumor. Successful reconstruction and multidisciplinary cooperation are crucial for treatment outcome.

Evaluation of Nasal Conditions on Sleep: Integrating Wearable Tech in Surgical Outcomes.

Objective: The primary objective of this study was to explore and identify the impacts of nasal septum deviation and turbinate hypertrophy on respiratory function, sleep quality, and overall well-being. Additionally, the study aimed to establish the therapeutic efficacy of surgical intervention and comprehensively analyse the additional advantages of wearable sleep trackers when combined with established diagnostic techniques. Methods: A prospective cohort of 150 participants (75 with nasal septum deviation and 75 with turbinate hypertrophy) underwent surgical intervention. The NOSE scale, PSQI, SF-36, and wearable sleep tracker data were employed for pre- and post-surgical evaluations. Objective measurements, such as nasal airflow and acoustic rhinometry, were also used. Multivariate regression was utilised to identify potential predictors of post-surgical outcomes. Results: The cohort had a mean age of 41 years with evenly balanced gender distribution. Both conditions showed post-surgical improvements in respiratory function, sleep quality, and quality-of-life. Wearable sleep tracker data provided insights into REM sleep duration and interruptions during sleep. The results indicated significant disturbances in sleep patterns in individuals with nasal septum deviation before undergoing surgery. Duration of the nasal condition was found to be a significant factor in predicting outcomes. Conclusion: Nasal septum deviation and turbinate hypertrophy had a significant impact on sleep patterns, overall well-being, and respiratory function. Surgical interventions provided significant relief, and wearable sleep tracker integration provides deeper insights into sleep disorders. The study highlights the importance of early intervention and the benefit of modern technologies in clinical evaluations. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04524-y.

Pleomorphic Adenoma in the Nasal Cavity: Case Report and Review of Literature.

Pleomorphic adenoma (PA) represents the most frequently occurring benign tumor within both major and minor salivary glands. However, in rare instances, nasal PA is an epithelial-derived borderline tumor, often originating from the nasal septum. Diagnosis usually relies on histopathological analysis. Under general anesthesia, these rare nasal tumors can be completely resected via endoscopic surgery. This article reports a case of PA originating from the nasal septum in a 49-year-old patient presenting with nasal congestion, along with a brief review of the current literature. The diagnostic nasal endoscopic examination showed a pink neoplastic mass in the left nasal cavity. Subsequent radiologic examination demonstrated a soft tissue mass in the anterior part of the nasal septum. After complete resection under nasal endoscopy, histopathological examination confirmed it as PA. Fortunately, no related complications occurred perioperatively and postoperatively. After surgery, performing a thorough examination with nasal endoscopy and scheduling regular follow-ups are crucial steps to prevent local recurrence.

Determination of safety margin of nasal septum osteotomy for sphenoid sinus in cleft lip and palate patients.

BACKGROUND: Nasal septum osteotomy is used for separating the nasal septum and maxilla during a Le Fort I osteotomy. If this osteotomy is applied too high or is tilted into the nasal cavity, the sphenoid sinus and various adjacent vital structures may be damaged, and serious bleeding, neurological complications, blindness or even death may occur. The aim of this study is to determine the safety margin of the nasal septum osteotomy for sphenoid sinus during the Le Fort I surgery in cleft lip and palate (CLP) patients. METHODS: Twenty cleft lip and palate (the CLP group) and 20 healthy individuals (the control group) were included in this study. Three values (two lines and an angle) were measured by cone beam computed tomography (CBCT). The first line is the line passing through the junction of the spina nasalis anterior point and the lower point of the perpendicular lamina of the palatine bone. The undersired line is the line passing through the junction of the spina nasalis anterior point and the lower anterior border of the base of the sphenoid sinus. The osteotomy angle is the angle between these two lines. RESULTS: In the control group; a surgical line of 44.11-61.14 mm (mean 51.91 ± 4.32), an undesired line of 52.48-69.58 mm (mean 59.14 ± 5.08) and an angle of 18.22-27.270 (mean 22.66 ± 2.55) were found, while in the CLP group, a surgical line of 34.53-51.16 mm (mean 43.38 ± 4.79), an undesired line of 46.86-61.35 mm (mean 55.02 ± 3.24) and an angle of 17.60-28.810 (mean 22.60 ± 2.81) were found. CONCLUSIONS: Although the angle to the sphenoid sinus was not significantly affected by CLP, careful planning and consideration of these anatomical differences are crucial to prevent complications and ensure the safety of Le Fort I surgery in CLP patients. Further research with larger sample sizes and subgroup analysis of unilateral and bilateral CLP cases is needed to improve our understanding of these anatomical variations and improve surgical approaches to individuals with CLP undergoing orthognathic procedures.

Evaluation of osteomeatal complex by cone-beam computed tomography in patients with maxillary sinus pathology and nasal septum deviation.

BACKGROUND: This study aimed to determine if there is a relationship between the presence of maxillary sinus pathology, nasal septum deviation and various lengths of the osteomeatal complex. METHODS: A total of 223 CBCT images were included in the study. The lengths of the osteomeatal complex (maxillary sinus ostium width, infundibulum length, maxillary sinus ostium height) were analyzed. The presence of maxillary sinus pathology, nasal septum deviation, age, sex, right-left, septum deviation level, and the relationship between pathology level and all variables were evaluated. RESULTS: The average maxillary sinus ostium width, ostium height and infundibulum length were 3.06 ± 0.70 mm, 30.10 ± 5.43 mm and 8.82 ± 1.86 mm, respectively. Ostium width was significantly higher in the healthy group than in the groups evaluated in the presence of deviation and pathology. A significant difference was found in infundibulum length only between the healthy condition and the condition evaluated in the presence of deviation. No significant difference was observed between the groups in terms of ostium height. In all groups, ostium height and infundibulum length were significantly higher in men than in women. The age group with the highest average ostium height was found in the 35-44 age group (p < 0.001). CONCLUSION: Identifying normal and abnormal conditions in the osteomeatal complex area is important for diagnosing the cause of a patient's complaint, guiding the surgical procedures to be performed, and preventing possible complications that may arise during surgical procedures.

A Large Asymptomatic Polyp Originating From the Nasal Septum: A Case Report.

A neoplasm was found in the left nasal cavity of a 45-year-old woman during electronic laryngoscopy for reflux pharyngitis. She reported experiencing an occasional slight headache in the left parietal region for 1 to 2 years, which she considered a migraine. Electronic laryngoscopy showed a gray, soft, smooth neoplasm in the left nasal meatus, located near the olfactory region blocking the olfactory clef and compressing the left middle turbinate. The neoplasm was resected at endonasal endoscopic surgery. Histological assessments indicated chronic mucus inflammation and cyst formation. This is a rare case because the polyp was large but asymptomatic and originated from nasal septum.

Congenital choanal atresia where the atretic wall thickened while waiting for an elective surgery.

INTRODUCTION AND IMPORTANCE: Although bilateral congenital choanal atresia (CCA) requires early intervention to open closure walls for safe breathing, it is desirable to be withheld until an infant acquires surgical and anesthetic tolerance. Here we introduce an infant of CCA whose closure wall had thickened during a waiting period for an elective surgery. CASE PRESENTATION: The choana of the patient could not be identified by intranasal fiberscopy and the bilateral CCA was found by CT scan on day 17 after birth. Since he could breathe orally without distress, surgery was withheld until he acquires the tolerance. At nine weeks old, however, CT image detected thickening of the closure wall. At 10 weeks old, he underwent scheduled surgery in which the bilateral closure walls were removed together with attached posterior part of the nasal septum under endoscopic endonasal approach. The patient became able to breath nasally and the choana remained open without restenosis at 3 years after surgery. CLINICAL DISCUSSION: This is the first CCA case reporting closure walls thickened during a waiting period for an elective surgery. Although waiting for surgery was systemically safer by growth, the surgery became more invasive to prevention from restenosis. CONCLUSIONS: This case suggests that we must decide appropriate timing of surgery in an infant, considering dilemma between systemic safety ensuring and lesion aggravation by waiting for surgery.