A gated recurrent unit model based on ultrasound images of dynamic tongue movement for determining the severity of obstructive sleep apnea.

Obstructive sleep apnea (OSA) presents as a respiratory disorder characterized by recurrent upper pharyngeal airway collapse during sleep. Dynamic tongue movement (DTM) analysis emerges as a promising avenue for elucidating the pathophysiological underpinnings of OSA, thereby facilitating its diagnosis. Recent endeavors have utilized artificial intelligence techniques to categorize OSA severity leveraging electrocardiography and blood oxygen saturation data. Nonetheless, the integration of ultrasound (US) imaging of the tongue remains largely untapped in the development of machine learning models aimed at determining the severity of OSA. This study endeavors to bridge this gap by capturing US images of DTM dynamics during wakefulness, encompassing transitions from normal breathing (NB) to the performance of the Müller maneuver (MM) in a cohort of 53 patients. Leveraging the modified optical flow method (MOFM), the trajectories of patients' DTM were tracked, facililtating the extraction of 27 parameters vital for model training. These parameters encompassed nine-point lateral movement, nine-point axial movement, and nine-point total displacement of the tongue, resulting in a dataset of 186,030 samples. The gated recurrent unit (GRU) method, renowned for its efficacy in motion tracking, was employed for model development in this study. Validation of the developed model was conducted via stratified k-fold cross-validation (SCV). The systems' overall performance in classifying OSA severity, as quantified by mean accuracy (MA), yielded a value of 43.49%. This pilot investigation marks an exploratory endeavor into the utilization of artificial intelligence for the classification of OSA severity based on US images and dynamic movement patterns. This novel model holds potential to assist clinicians in categorizing OSA severity and guiding the selection of pertinent treatment modalities tailored to the individual needs of patients afflicted with OSA.

Early detection of nasopharyngeal carcinoma through machine-learning-driven prediction model in a population-based healthcare record database.

OBJECTIVE: Early diagnosis and treatment of nasopharyngeal carcinoma (NPC) are vital for a better prognosis. Still, because of obscure anatomical sites and insidious symptoms, nearly 80% of patients with NPC are diagnosed at a late stage. This study aimed to validate a machine learning (ML) model utilizing symptom-related diagnoses and procedures in medical records to predict nasopharyngeal carcinoma (NPC) occurrence and reduce the prediagnostic period. MATERIALS AND METHODS: Data from a population-based health insurance database (2001-2008) were analyzed, comparing adults with and without newly diagnosed NPC. Medical records from 90 to 360 days before diagnosis were examined. Five ML algorithms (Light Gradient Boosting Machine [LGB], eXtreme Gradient Boosting [XGB], Multivariate Adaptive Regression Splines [MARS], Random Forest [RF], and Logistics Regression [LG]) were evaluated for optimal early NPC detection. We further use a real-world data of 1 million individuals randomly selected for testing the final model. Model performance was assessed using AUROC. Shapley values identified significant contributing variables. RESULTS: LGB showed maximum predictive power using 14 features and 90 days before diagnosis. The LGB models achieved AUROC, specificity, and sensitivity were 0.83, 0.81, and 0.64 for the test dataset, respectively. The LGB-driven NPC predictive tool effectively differentiated patients into high-risk and low-risk groups (hazard ratio: 5.85; 95% CI: 4.75-7.21). The model-layering effect is valid. CONCLUSIONS: ML approaches using electronic medical records accurately predicted NPC occurrence. The risk prediction model serves as a low-cost digital screening tool, offering rapid medical decision support to shorten prediagnostic periods. Timely referral is crucial for high-risk patients identified by the model.

Risk of Migraine after Traumatic Brain Injury and Effects of Injury Management Levels and Treatment Modalities: A Nationwide Population-Based Cohort Study in Taiwan.

Traumatic brain injury (TBI) causes several long-term disabilities, particularly headaches. An association between TBI and subsequent migraine has been reported. However, few longitudinal studies have explained the link between migraine and TBI. Moreover, the modifying effects of treatment remain unknown. This retrospective cohort study used records from Taiwan's Longitudinal Health Insurance Database 2005 to evaluate the risk of migraine among patients with TBI and to determine the effects of different treatment modalities. Initially, 187,906 patients, aged ≥ 18 years, who were diagnosed as TBI in 2000, were identified. In total, 151,098 patients with TBI and 604,394 patients without TBI were matched at a 1:4 ratio according to baseline variables during the same observation period. At the end of follow-up, 541 (0.36%) and 1491 (0.23%) patients in the TBI and non-TBI groups, respectively, developed migraine. The TBI group exhibited a higher risk of migraine than the non-TBI group (adjusted HR: 1.484). Major trauma (Injury Severity Score, ISS ≥ 16) was associated with a higher migraine risk than minor trauma (ISS < 16) (adjusted HR: 1.670). However, migraine risk did not differ significantly after surgery or occupational/physical therapy. These findings highlight the importance of long-term follow-up after TBI onset and the need to investigate the underlying pathophysiological link between TBI and subsequent migraine.

Effects of Different Voice Rest on Vocal Function After Microlaryngeal Surgery: A Systematic Review and Meta-Analysis.

OBJECTIVES: To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short-duration (voice rest for <7 days) or long-duration (≥7 days) voice rest. STUDY DESIGN: Systematic review and meta-analysis. METHODS: The PubMed, Embase, and Cochrane Library databases were systematically searched for articles published before March 1, 2021. Randomized controlled trials (RCTs) that measured the voice outcomes of patients after different durations and extents of postoperative voice restriction were included in the meta-analysis. RESULTS: Four RCTs comprising 112 patients were included in the quantitative meta-analysis. Compared with the long-duration voice rest group, the short-duration group exhibited comparable VHI scores (mean difference [MD], -7.01; 95% CI, -16.12 to 2.09; p = 0.13), maximum phonation time (MD, -2.58; 95% CI, -5.42 to 0.26; p = 0.07), and acoustic variables of jitter (MD, -1.25; 95% CI, -3.43 to 0.94; p = 0.26) and shimmer (MD, -0.79; 95% CI, -2.08 to 0.51; p = 0.24). Subgroup analysis for benign pathology and cold instruments studies demonstrated significantly better VHI scores (MD, -14.45; 95% CI, -26.19 to -2.72; p = 0.02 and MD, -15.98; 95% CI, -28.52 to -3.44; p = 0.01, respectively) in the short-duration group. CONCLUSIONS: The limited evidence does not demonstrate benefit in voice outcomes from long-duration voice rest and suggests potential unfavorable effects on compliance and quality of life, providing a rationale for short-duration voice rest after microlaryngeal surgery. More studies are required to determine the optimal duration and extent of postoperative voice rest. LEVEL OF EVIDENCE: 1 Laryngoscope, 133:154-161, 2023.

Increased Risk of Injury in Ménière's Disease and Effects of Treatment: Population-Based Retrospective Cohort Study.

OBJECTIVE: To investigate the risk of injury in patients with Ménière's disease (MD) and the effects of treatment. STUDY DESIGN: Population-based retrospective cohort study. SETTING: Data were collected from the Longitudinal Health Insurance Database 2005, containing the information of 2 million randomly selected individuals in Taiwan. METHODS: We enrolled 90,481 patients with newly diagnosed MD between 2000 and 2017 and 361,924 matched individuals without MD. The study outcomes were diagnoses of all-cause injuries. The Kaplan-Meier method was used to determine the cumulative incidence rates of injury in the MD and non-MD cohorts, and a log-rank test was used to analyze the differences between the cohorts. Cox proportional hazards models were used to calculate the 18-year hazard ratios of each cohort. RESULTS: A total of 80,151 patients were diagnosed with injuries during the follow-up period: 24,031 and 56,120 from the MD and non-MD cohorts, respectively. The adjusted hazard ratio (aHR) was 2.19 (95% CI, 2.16-2.35) after adjusting for demographic characteristics and comorbidities. Subgroup analysis revealed that MD was associated with an increased incidence of unintentional and intentional injuries (aHR, 2.24 [95% CI, 2.21-2.41] and 2.05 [95% CI, 2.01-2.19], respectively). Treatment with diuretics, antivertigo medications, or surgery did not reduce the risk of injury (aHR, 0.98 [95% CI, 0.59-1.54], 0.94 [95% CI, 0.58-1.50], and 0.99 [95% CI, 0.61-1.54]). CONCLUSION: MD is independently associated with an increased risk of injuries. Medical or surgical treatment for MD does not reduce the risk of injury in patients with MD. Physicians should counsel patients with MD regarding preventive measures for avoiding subsequent injuries.

Implementing an entrustable professional activities programmatic assessments for nurse practitioner training in emergency care: A pilot study.

BACKGROUND: Entrustable professional activities (EPAs), as new methods used to operationalize competency-based education, are gaining acceptance in medical professions. However, no EPA-based framework exists to evaluate emergency care nurse practitioners' competencies in clinical practice. OBJECTIVES: To develop, implement, and evaluate an EPA-based framework for emergency care nurse practitioners. DESIGN: Prospective observational study. SETTING: An accredited nurse practitioner training program in the emergency department of a University-affiliated Hospital. PARTICIPANTS: Eight novice nurse practitioners and eighteen clinical instructors. METHODS: A working group of academic educators, nurse practitioner leaders, and clinical instructors developed a set of EPAs using a participatory design method. We scheduled weekly ad hoc evaluations for the nurse practitioners in emergency care, and we collected several observations from multiple assessors for analysis. RESULTS: Four nested EPAs were developed that adopted a 1-5 supervision-entrustment scale to measure performance. The results of the 20-month assessments illustrated that the average scores of EPA1, which measured the assessment and management of patients with acute medical presentations in the emergency department, differed significantly but were not positively correlated with the nurse practitioners' increasing subspecialty and department seniority levels (Kruskal-Wallis test P = .011 and 0.006, respectively). In addition, the most time required for the nurse practitioners to achieve a stable level 5 entrustability score for all EPAs for at least 3 consecutive months was 18 months. Clinical instructors noted that recognizing limits is a skill that is essential for a nurse practitioner to earn clinical instructors' trust. CONCLUSIONS: Entrustability scores may not correlate with nurse practitioners' increasing seniority, and patient care requires the longest training time (18 months) for emergency care nurse practitioners to achieve autonomy. Program directors should adjust the supervision-entrustment level expected at various stages of training according to the complexity of individual EPAs. An EPA-based assessment framework in a nurse practitioner training program may assist in overseeing the development of competencies for emergency care nurse practitioners.

Association between Dysphagia and Frailty in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Increasing bodies of epidemiological evidence indicate potential associations between dysphagia and the risk of frailty in older adults. We hypothesized that older adults with symptoms of dysphagia might have a higher prevalence of frailty or prefrailty than those without dysphagia. METHODS: We systematically searched the PubMed, Embase, and Cochrane Library databases for relevant studies published through 20 April 2022. Cross-sectional and longitudinal studies that examined the associations between dysphagia and the existence of frailty or prefrailty in community-dwelling, facility-dwelling, or hospitalized adults aged 50 years or older were synthesized. The Newcastle-Ottawa Scale was used to evaluate study quality. RESULTS: The meta-analysis comprised 12 cohorts, including 5,503,543 non-frailty participants and 735,303 cases of frailty or prefrailty. Random-effect meta-analysis demonstrated a significant association between dysphagia and the risk of frailty and prefrailty (OR, 3.24; 95% CI, 2.51-4.20). In addition, we observed consistent results across the subgroups and heterogeneity assessments. CONCLUSIONS: We propose including dysphagia assessment as a critical factor in the cumulative deficit model for identifying frailty in older adults. Understanding dysphagia and the potential role of nutritional supplements in older adults may lead to improved strategies for preventing, delaying, or mitigating frailty.

Kikuchi-Fujimoto Disease Associated With Mycoplasma Pneumoniae Infection.

Kikuchi-Fujimoto disease (KFD) is a self-limited disease that is more common in young Asian women. Typical presentations included fever and cervical lymphadenopathy. The etiology of KFD is unknown, and diagnosis is based mainly on lymph node biopsy. KFD has been reported to be associated with Mycoplasma pneumoniae infection. However, the role of antibiotic treatment is unclear. We reported 2 cases of KFD associated with Mycoplasma pneumoniae infection and were successfully treated with a macrolide.

Factors Associated With Hearing Outcomes After Stapedotomy in Taiwanese Patients With Clinical Otosclerosis.

OBJECTIVE: To examine the clinical factors associated with the effectiveness of stapedotomy in improving hearing sensitivity in Taiwanese patients with otosclerosis. METHODS: In this retrospective study, we reviewed the medical records of 31 patients (36 ears) with otosclerosis undergoing stapedotomy performed by a single surgeon. Preoperative and postoperative hearing results were analyzed to identify factors associated with hearing outcomes after stapedotomy in the Taiwanese population with clinical otosclerosis. RESULTS: Compared with preoperative pure tone averages (PTAs), stapedotomy significantly improved postoperative air conduction (AC) thresholds (P < .0001), bone conduction (BC) thresholds (P = .025), and air-bone gaps (ABGs; P < .0001). Postoperative closure of ABGs less than 10 or 20 dB was achieved in 16 (44.4%) and 33 (91.7%) of 36 surgical ears. Improvement in postoperative AC thresholds and ABGs and the size of preoperative ABGs were significantly correlated (r = .650, P < .001 and r = .745, P < .001, respectively). Gender-stratified analysis indicated a stronger correlation between improvement in postoperative AC thresholds and preoperative ABGs in male patients than in female patients (r = .893, P < .001 and r = .476, P = .014, respectively), and in postoperative and preoperative ABGs (r = .933, P < .001 and r = .626, P < .001, respectively). With the more stringent criteria for surgical success, factors including age (≤50 years), type (conductive, BC ≤25 dB), and degree (PTA ≤55 dB) of preoperative hearing loss led to more favorable outcomes. CONCLUSIONS: We reported evidence supporting a potential gender difference on hearing outcomes after stapedotomy in Taiwanese patients with otosclerosis. Age, type, and degree of preoperative hearing loss may affect the surgical success rate.

Prevalence and patterns of tongue deformation in obstructive sleep apnea: A whole-night simultaneous ultrasonographic and polysomnographic study.

Tongue deformation during whole-night natural sleep in adult patients with obstructive sleep apnea has not been well evaluated. Through simultaneous ultrasonography and polysomnography during whole-night sleep, we examined the prevalence and patterns of tongue depth changes and their relationship with the severity of obstructive sleep apnea. Sixty consecutive eligible adults presenting with symptoms suggesting obstructive sleep apnea were enrolled. We observed that 88.4% (38/43) of patients with obstructive sleep apnea exhibited a significant increase in the maximum ultrasonographic tongue depth when hypopnea or apnea occurred during sleep. A mixed-model analysis of variance demonstrated that compared with patients with primary snoring or mild obstructive sleep apnea, those with moderate to severe obstructive sleep apnea have significantly greater maximum ultrasonographic tongue depth during respiratory events (p = .0047). We identified three different ultrasonographic patterns of tongue deformation, namely en bloc, tongue body and tongue base. Approximately 82% (27/33) of patients with moderate to severe obstructive sleep apnea demonstrated an en bloc tongue deformation. By contrast, 70% (19/27) of primary snorers or patients with mild obstructive sleep apnea showed a tongue body obstruction. Recognizing the prevalence and patterns of tongue deformation during sleep may provide insights into pathogenesis and treatment decisions in patients with obstructive sleep apnea. Future studies are warranted to verify the treatment results of various tongue procedures by using this approach.

Ultrasound Shear-Wave Elastography of the Tongue in Adults with Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a chronic breathing disorder characterized by intermittent sleep state-dependent upper airway (UA) collapse. The tongue comprises the primary UA dilator muscle and plays an essential role in the pathogenesis of OSA. We examined whether tongue stiffness measurement using ultrasound (US) shear wave elastography (SWE) is useful for predicting the existence of OSA. Forty-six participants (20 healthy controls and 26 patients with OSA) underwent transcutaneous submental SWE using a US system. Quantification with a shear modulus of 0-200 kPa was recorded during normal breathing and Müller's maneuver (MM). Polysomnography was used as the reference standard. Mid-sagittal tongue stiffness was significantly higher in awake patients with OSA than in controls during normal breathing and the MM (p < 0.0001). The posterior third of the tongue in patients with OSA had the highest value of shear modulus during the MM (p < 0.001). With cut-offs of 27.6 and 35.2 kPa for the whole tongue and posterior third during the MM, respectively, the sensitivity obtained was 69.2% and 76.9%, and the specificity was 85% and 95%, respectively, for detecting OSA. The corresponding areas under the receiver operating characteristic curve were 0.82 and 0.88, respectively. US SWE may have the potential for non-invasive tongue stiffness measurement in OSA.

Dynamic tongue area measurements in ultrasound images for adults with obstructive sleep apnea.

Obstructive sleep apnea is a chronic breathing disorder where the recursive collapse of the upper airway causes cessation of airflow during sleep. Quantitative assessments of dynamic tongue motion may provide a better understanding of the mechanism of obstructive sleep apnea. Tongue area changes, in submental ultrasound images recorded during wakefulness from normal breathing by the Müller manoeuvre, were tracked using the modified optical flow-based method. The results demonstrated that patients with obstructive sleep apnea had a larger mid-sagittal tongue area compared to the control group (during normal breathing, p = .004, during the Müller manoeuvre p = .005, and differences between normal breathing and the Müller manoeuvre, p = .01). Tongue area measurements were significantly different in patients with varying severity of OSA during normal breathing and during the Müller manoeuvre, and had differences between normal breathing and the Müller manoeuvre (p = .005, p = .008 and p = .03, respectively). Patients with moderate or severe obstructive sleep apnea exhibited minimal movement of the tongue. In contrast, normal controls and patients with mild obstructive sleep apnea demonstrated bidirectional tongue motions during a transition from normal breathing to the Müller manoeuvre in wakefulness. Identifying different patterns of deformation and displacement of the tongue may have potential in evaluating the presence and the pathogenesis of OSA.

Factors associated with changing indications for adenotonsillectomy: A population-based longitudinal study.

OBJECTIVE: Adenotonsillectomy (AT) is one of the most common surgical procedures performed in children and adults. We aim to assess the factors associated with changes in the incidence of and indications for AT using population-level data. STUDY DESIGN: This retrospective cohort study investigated patients who underwent AT between 1997 and 2010 by using data from the Taiwan National Health Insurance Research Database. We examined surgical rates and indications by the calendar year as well as age, sex, hospital level, and insured residence areas for the correlating factors. RESULTS: The average annual incidence rate of AT was 14.7 per 100,000 individuals during 1997-2010. Pediatric (<18 years) patients represented 48.2% of the total AT population. More than 99% of the patients underwent the AT procedures as an inpatient intervention. Longitudinal data demonstrated an increasing trend in the pediatric AT rates from 1997 (4.3/100,000) to 2010 (5.7/100,000) (p = 0.029). In the adult subgroup, a decreasing prevalence of infectious indications (p = 0.014) coincided with an increasing neoplastic indications (p = 0.001). In the pediatric subgroup, the prevalence of obstructive indications increased (p = 0.002). The logistic regression analyses indicated that the significant factors associated with the changing surgical indications for AT were the age in the adult subgroup and hospital level in the pediatric subgroup. CONCLUSIONS: This study revealed a low AT rate in Taiwan than that in other countries. Pediatric AT incidence increased during 1997-2010. Although a rising prevalence of obstructive and neoplastic indications was noted, infection remained the most common indications for AT. Age in the adult subgroup and hospital level in the pediatric subgroup were factors associated with the changing indications for AT.

Tracking Dynamic Tongue Motion in Ultrasound Images for Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA), a breathing disorder characterized by repetitive collapse of the pharyngeal airway during sleep, can cause intermittent hypoxemia and frequent arousal. The evaluation of dynamic tongue motion not only provides the biomechanics and pathophysiology for OSA diagnosis, but also helps doctors to determine treatment strategies for these patients with OSA. The purpose of this study was to develop and verify a dedicated tracking algorithm, called the modified optical flow (OF)-based method, for monitoring the dynamic motion of the tongue base in ultrasound image sequences derived from controls and patients with OSA. The performance of the proposed method was verified by phantom and synthetic data. A common tracking method, the normalized cross-correlation method, was included for comparison. The efficacy of the algorithms was evaluated by calculating the estimated displacement error. All results indicated that the modified OF-based method exhibited higher accuracy in verification experiments. In the human subject experiment, all participants performed the Müller maneuver (MM) to simulate the contour changes of the tongue base with a negative pharyngeal airway pressure in sleep apnea. Ultrasound image sequences of the tongue were obtained during 10 s of a transition from normal breathing to the MM, and these were measured using the modified OF-based method. The results indicated that the displacement of the tongue base during the MM was larger in the controls than in the patients with OSA (p < 0.05); the calculated areas of the tongue in the controls and patients with OSA were 24.9 ± 3.0 and 27.6 ± 3.3 cm2, respectively, during normal breathing (p < 0.05), and 24.7 ± 3.6 and 27.3 ± 3.8 cm2, respectively, at the end of the MM. The percentage changes in the tongue area were 2.2% and 1.3% in the controls and patients with OSA, respectively. We found that quantitative assessment of tongue motion by ultrasound imaging is suitable for evaluating pharyngeal airway behavior in OSA patients with minimal invasiveness and easy accessibility.

Implementation of a Wearable Ultrasound Device for the Overnight Monitoring of Tongue Base Deformation during Obstructive Sleep Apnea Events.

Obstructive sleep apnea (OSA) is a breathing disorder characterized by the repeated collapse of the pharyngeal airway during sleep. Previous studies have reported that tongue base deformation may be a major contributing factor. However, overnight monitoring of tongue motion in patients with OSA has previously been impracticable. We developed a wearable ultrasound device for prolonged recording during natural sleep of the changes in tongue base thickness (TBT) in patients with OSA. The maximum TBT was fed into a polysomnography system so that physiologic signals and TBT data were simultaneously monitored. Subject trials revealed that TBT increased significantly during snoring, hypopnea and apnea events during natural sleep in patients with OSA. Moreover, the data revealed that the location of the maximum TBT during normal breathing was significantly different compared with the location during obstructive respiratory events, which implies a posterior or inferior displacement of the tongue base during sleep apnea.

Simultaneous recording of ultrasound and polysomnography during natural sleep in patients with obstructive sleep apnea: a pilot study.

Tongue base deformation may play a critical role in the phenomenon of obstructive sleep apnea, but polysomnography provides limited information regarding the effect of tongue motion during natural sleep. We reported on preliminary results of combining a novel ultrasound system and polysomnography for simultaneous recordings during natural sleep in volunteers and patients with obstructive sleep apnea. All participants underwent time-synchronized polysomnography and submental transcutaneous ultrasound examinations. The wearable ultrasound device detected the air-mucosal interface of the tongue surface and automatically determined the maximum tongue base thickness in real time. All participants reported no sensation of heat, no sign of skin allergy, and an average of mild disturbance after the ultrasound recordings. In the individual patient with obstructive sleep apnea, we demonstrated a significant difference (P < 0.001) between the ultrasonic tongue base thickness measured during eupnea and that measured during snoring, hypopnea and apnea. The ultrasonic tongue base thickness increased and remained before the occurrence of obstructive apnea. On average, increased tongue base thicknesses of 2.5 (4.1%), 6.0 (9.8%) and 7.7 mm (12.5%) are associated with snoring, hypopnea and apnea, respectively. Our present data demonstrate that simultaneous examination of ultrasonic tongue base thickness and polysomnography is feasible for prolonged recording during natural sleep. The proposed method also enables the detection of significant differences in ultrasonic tongue base thickness between eupnea and obstructive respiratory events evaluated using polysomnography. This novel technique can be used to generate hypotheses for subsequent investigations of the underlying mechanisms and individualized combined therapy for obstructive sleep apnea. CLINICAL TRIAL REGISTRATION: This study has been registered at the Chinese Clinical Trial Registry website with the registration number of ChiCTR-DDT-13003313. The date of registration was 13 July 2013.

Pedunculated carcinoma ex pleomorphic adenoma of the nasal cavity: A unique case report.

BACKGROUND: A carcinoma ex pleomorphic adenoma (CXPA) is an epithelial malignancy arising in or from a benign pleomorphic salivary adenoma. The parotid gland is the most common location of CXPAs. Minor salivary gland CXPAs of the nasal cavity are exceedingly rare, with only 6 documented in the literature. METHODS AND RESULT: We present a 7th case: an unusual pedunculated intranasal CXPA, which had a favorable outcome after a wide endoscopic excision and the longest follow-up period reported to date. The clinical features, immunohistochemical characteristics, treatment choices, and disease outcomes of the intranasal CXPAs reported in previous studies are also reviewed. CONCLUSION: This case demonstrates the importance of considering the possibility of CXPA in the differential diagnosis of minor salivary gland malignancies in the nasal cavity.