RESUMEN
OBJECTIVE: This case report presents a unique manifestation of Mucocutaneous Leishmaniasis (MCL) in a 56-year-old woman with chronic nasal symptoms. Initially diagnosed with chronic sinusitis and septal perforation, the patient's history of a childhood sandfly bite and subsequent episodes of Leishmaniasis, revealed after nasal surgery, provided crucial information for accurate diagnosis. METHODS: A retrospective review was conducted on this patient's electronic medical record. RESULTS: The patient's life-long struggle with nasal obstruction, congestion, and a septal perforation initially masked the underlying MCL. Sinus surgery and persistent symptoms further complicated the diagnostic process. Only after postoperative complications, including grainy skin texture extending into the nasal passages, did the patient recall the sandfly bite, prompting reevaluation and diagnosis of MCL. The case highlights the challenges of diagnosing MCL due to its varied presentation and potential mimicry of other chronic nasal conditions. It emphasizes the importance of thorough patient history-taking, especially when symptoms are atypical or persistent. Additionally, the report underscores the potential for unexpected postoperative complications in MCL patients and the need for vigilance in recognizing and assessing them. CONCLUSION: This case contributes to the understanding of MCL's diverse clinical presentation and the importance of early diagnosis and multidisciplinary management for prompt intervention and improved outcomes.
Asunto(s)
Leishmaniasis Mucocutánea , Humanos , Femenino , Persona de Mediana Edad , Leishmaniasis Mucocutánea/diagnóstico , Leishmaniasis Mucocutánea/complicaciones , Obstrucción Nasal/etiología , Obstrucción Nasal/diagnóstico , Obstrucción Nasal/cirugía , Perforación del Tabique Nasal/etiología , Perforación del Tabique Nasal/diagnóstico , Sinusitis/diagnóstico , Sinusitis/complicaciones , Mordeduras y Picaduras de Insectos/complicaciones , Mordeduras y Picaduras de Insectos/diagnóstico , Tomografía Computarizada por Rayos X , Enfermedad Crónica , Diagnóstico DiferencialRESUMEN
Nasal septal perforation (NSP) is a complex problem in otorhinolaryngology, which leads to impaired nasal breathing and dryness in the nose. This reduces the patient's quality of life and leads to psychological discomfort. The treatment of nasal septum perforation is selected taking into account the clinical manifestations, perforation parameters and general condition of the patient. Currently, a large number of different surgical methods have been described in order to closing the defect of nasal septum. To date, there is no universally accepted method for closing NSP, which stimulates the search and development of new treatment options. OBJECTIVE: Under experimental conditions, to study a new method for closing nasal septum perforation using a collagen scaffold together with adipose stromal vascular fraction containing multipotent mesenchymal stromal cells. MATERIAL AND METHODS: The experiment was carried out on a model of nasal septum perforation in 24 male rabbits divided into four groups, depending on the construct, implanted into the defect zone: the 1st group was the control group - without the introduction of implantation material; the 2nd group - collagen scaffold without adipose stromal vascular fraction; the 3rd group - collagen scaffold with xenogenic adipose stromal vascular fraction; the 4th group - collagen scaffold with allogeneic adipose stromal vascular fraction with further dynamic evaluation of endoscopic control on day 14, after 1 month, 3 months, and 6 months. At month 6, the animals were removed from the experiment, followed by morphological examination in color with hematoxylin and eosin, as well as safranin and methyl green. RESULTS: As a result of the experiment using adipose stromal vascular fraction of allogeneic and xenogenic origin, closing of perforation of the nasal septum of a rabbit for 3 months of dynamic endoscopic control, as well as according to morphological research, was demonstrated. CONCLUSION: Our study showed that the use of adipose stromal vascular fraction containing not only endothelial cells and pericytes, but also multipotent mesenchymal stromal cells in combination with a collagen scaffold closes the perforation of the nasal septum in a rabbit, without increasing the risk of violations of habitual vital activity.
Asunto(s)
Tejido Adiposo , Modelos Animales de Enfermedad , Perforación del Tabique Nasal , Animales , Conejos , Perforación del Tabique Nasal/cirugía , Perforación del Tabique Nasal/etiología , Tejido Adiposo/trasplante , Andamios del Tejido , Masculino , Trasplante de Células Madre Mesenquimatosas/métodos , Tabique Nasal/cirugía , Resultado del Tratamiento , ColágenoRESUMEN
OBJECTIVE: Nasal septal perforation (NSP) repair is challenging surgery considered in patients with symptomatic NSP intractable to conservative treatments. This study aimed to assess the success rate and identify factors affecting the surgical outcome of NSP by analyzing consecutive series of NSP repairs by a single surgeon. METHODS: We enrolled 84 patients diagnosed with NSP and who underwent surgical repair of NSP by a single surgeon (Y.J.J.) between November 2007 and July 2022. Medical records were retrospectively reviewed regarding variables involving preoperative symptoms, rhinologic history, etiology, surgical techniques, and the outcome of surgery. In addition, features of NSP were objectively evaluated using computed tomography scans. RESULTS: The overall success rate of NSP repair was 64.3% (54 of 84). Nasal obstruction (79.8%), crusting (34.5%), and epistaxis (27.4%) were frequent preoperative symptoms. Iatrogenic injury from previous nasal surgery (70.2%) was the most common cause. The average size of NSP on preoperative CT was 9.53 ± 6.68 mm. Patients with incomplete NSP closure had significantly larger perforations (12.21 ± 7.92 mm) than those with successful closure (8.04 ± 5.41 mm) preoperatively (P = .005). Patients with smoking history (OR = 2.971, 95% CI 1.170-7.548, P = .020) and NSP repair with combined rhinoplasty (OR = 3.811, 95% CI 1.401-10.370, P = .007) were more likely to experience incomplete closure. Patients whose perforations were reinforced with interposition graft were more likely to result in successful repair (OR = 6.752, 95% CI 2.496-18.262, P < .001). The bilaterality of mucosal flap coverage, surgical approach, types of mucosal flap and interposition graft, perforation shape, mucosal thickness around perforation, and distance from the nasal floor were not significantly related to the surgical outcome. CONCLUSIONS: Significant factors affecting the outcome of NSP repair were patient's smoking status, combined rhinoplasty, application of interposition graft, and perforation size.
Asunto(s)
Perforación del Tabique Nasal , Rinoplastia , Humanos , Perforación del Tabique Nasal/cirugía , Perforación del Tabique Nasal/etiología , Estudios Retrospectivos , Rinoplastia/métodos , Tabique Nasal/diagnóstico por imagen , Tabique Nasal/cirugía , Resultado del TratamientoRESUMEN
Mycobacterium chelonae, a rapidly growing mycobacterium found in the natural environment, is known to cause localized lesions in the skin, soft tissue, and bone through traumatic inoculation, but widespread lesions are uncommon. We herein report an immunocompromised 79-year-old man suspected of having polyangiitis granulomatosis due to weight loss, epistaxis, and nasal crusts with impending septal perforation who was subsequently diagnosed with mucocutaneous and bone disease caused by widespread M. chelonae infection. Given these findings, clinicians should be aware of the tendency to develop unusual widespread lesions in immunocompromised patients, which can present a clinical picture similar to systemic vasculitides, such as granulomatosis with polyangiitis.
Asunto(s)
Granulomatosis con Poliangitis , Infecciones por Mycobacterium no Tuberculosas , Mycobacterium chelonae , Perforación del Tabique Nasal , Masculino , Humanos , Anciano , Granulomatosis con Poliangitis/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/microbiología , Perforación del Tabique Nasal/diagnóstico , Perforación del Tabique Nasal/etiología , Diagnóstico DiferencialRESUMEN
Sinonasal lymphoma is a rare clinical entity. Three main subtypes exhibit different clinical patterns and treatment outcomes. We report the first case of a B-cell lymphoma in a patient without any previous history of nasal surgery, trauma or drug use, who presented to our center with a nasal septal perforation. Laryngoscope, 133:2871-2873, 2023.
Asunto(s)
Linfoma de Células B , Linfoma , Perforación del Tabique Nasal , Neoplasias de los Senos Paranasales , Humanos , Perforación del Tabique Nasal/diagnóstico , Perforación del Tabique Nasal/etiología , Linfoma de Células B/complicaciones , Linfoma de Células B/diagnóstico , Linfoma de Células B/patología , Neoplasias de los Senos Paranasales/patología , Linfoma/patología , Resultado del TratamientoRESUMEN
Nasal septal perforation is a full-thickness defect of the nasal septum. There are many described etiologies of nasal septal perforation, including trauma, infectious, neoplastic, iatrogenic, and autoimmune. Graft-versus-host disease (GVHD) is a common and potentially life-threatening complication that can occur after an allogenic transplant. GVHD can result in the development of autoantibodies that lead to granulomatous inflammation with necrotizing vasculitis, causing perforation of the nasal septum. In this report, we describe a patient with nasal septal perforation secondary to GVHD and hope to provide novel insights into the association of GVHD and nasal septal perforation.
Asunto(s)
Enfermedad Injerto contra Huésped , Perforación del Tabique Nasal , Humanos , Perforación del Tabique Nasal/etiología , Tabique Nasal/cirugía , Enfermedad Injerto contra Huésped/complicacionesRESUMEN
OBJECTIVES: Surgical repair of nasal septal perforations (NSPs) is technically challenging. Advantages associated with endoscopic NSP repair (ENSPR) include enhanced visualization and its minimally invasive nature. Purely endoscopic techniques have successful outcomes with low morbidity. This study provides a review of clinical features, surgical techniques, and outcomes in patients who underwent ENSPR. METHODS: A systematic review was conducted using PubMed/MEDLINE, Cochrane library, and Embase databases. Manual bibliography search produced additional articles. Studies reporting purely endoscopic approaches for NSP repair were included. Patient demographics, NSP size, etiology, repair strategy, incidence of closure, and follow-up were analyzed. RESULTS: A total of 329 cases from 20 studies were included. The mean age was 37.2 years (range, 12.3-51 years) and 55.0% were male. Common etiologies were iatrogenic (n = 180, 60.0%), trauma (n = 66, 22.0%), and idiopathic (n = 36, 12.0%). The mean NSP size was 17.1 mm (range, 4-23). Repair techniques included unilateral random pattern flaps (n = 205, 62.3%), interposition grafts (n = 137, 41.6%), and unilateral axial pedicled local flaps (n = 81, 24.6%). 222 patients (67.5%) underwent a 2-layered repair, while 70 (21.3%) and 37 (11.2%) patients underwent single and 3-layered repairs, respectively. Successful closure was achieved in 296 patients (90.0%). When stratified by layers of repair, 65 single-layered (92.9%), 196 2-layered (88.3%), and 34 3-layered repairs (91.9%) were successful at a mean follow-up of 16.3 months (range, 3-31 months). CONCLUSIONS: ENSPR generally achieves NSP closure with high rates of success among varying types of repairs. Further studies may determine how clinical factors and surgical methods impact the likelihood of obtaining successful closure.
Asunto(s)
Perforación del Tabique Nasal , Rinoplastia , Humanos , Masculino , Adulto , Femenino , Perforación del Tabique Nasal/cirugía , Perforación del Tabique Nasal/etiología , Colgajos Quirúrgicos , Rinoplastia/métodos , Endoscopía/efectos adversos , Bases de Datos Factuales , Tabique Nasal/cirugíaRESUMEN
Nasal septal perforations have varied etiologies, clinical presentations, and methods of management. Some patients may be asymptomatic, while others may complain of nasal obstruction, crusting, epistaxis, and whistling. Management of nasal septal perforations is guided by the patient's symptoms and characteristics of the perforation. Some lesions can be managed conservatively or with minimally invasive procedures, while others require surgery. Surgical repair of perforations can be challenging and many techniques have been described without a standardized method of management. This article aims to provide a comprehensive review of options for repair of nasal septal perforations.
Asunto(s)
Obstrucción Nasal , Perforación del Tabique Nasal , Humanos , Perforación del Tabique Nasal/etiología , Perforación del Tabique Nasal/cirugía , Estudios Retrospectivos , Obstrucción Nasal/etiología , Tabique Nasal/cirugíaRESUMEN
Nasal septum perforations complete elimination is possible only with surgical treatment. However, most of perforation symptoms and clinical manifestations can be reduced with conservative treatments, thus improving the patient's quality of life. This article presents a short review of publications and our own clinical examples of nasal septum perforation conservative treatment methods in children and adults. Palliative methods and preparing for surgical closure are described.
Asunto(s)
Perforación del Tabique Nasal , Adulto , Niño , Tratamiento Conservador , Humanos , Perforación del Tabique Nasal/diagnóstico , Perforación del Tabique Nasal/etiología , Perforación del Tabique Nasal/cirugía , Tabique Nasal/cirugía , Plásticos , Calidad de VidaRESUMEN
The usefulness of nasal irrigation for chronic rhinosinusitis is recognized, and it is widely used as a topical treatment after endoscopic sinus surgery (ESS). Generally, there are few complications due to nasal irrigation, and it is recognized as a highly safe treatment. There are no reports of nasal septal perforation due to nasal irrigation. The objective of this study was to describe three cases of nasal septal perforation occurring during self-nasal irrigation after ESS. Case patient 1 was a 38-year-old woman who was admitted to our hospital with a complaint of nasal obstruction. Based on a diagnosis of chronic rhinosinusitis and allergic rhinitis, we performed bilateral ESS and bilateral inferior turbinectomy. At discharge, we instructed the patient in how to perform self-nasal irrigation twice a day at home. At the time of the third visit after discharge, a black crust had adhered to the bilateral anterior nasal septum. Crust formation continued at the same site, and nasal septal perforation was seen two and a half months after the operation. The other two cases showed similar courses. Postoperative nasal irrigation can cause nasal septal perforation. We need to educate patients on proper nasal irrigation and regularly check the nasal septum.
Asunto(s)
Perforación del Tabique Nasal , Rinitis , Sinusitis , Adulto , Femenino , Humanos , Lavado Nasal (Proceso) , Perforación del Tabique Nasal/etiología , Perforación del Tabique Nasal/cirugía , Tabique Nasal/cirugía , Rinitis/terapia , Sinusitis/cirugíaRESUMEN
PURPOSE OF REVIEW: The aim of this study was to review and describe the main innovative surgical techniques for nasal septal perforation (NSP) repair that have been published in recent years. RECENT FINDINGS: Several techniques for NSP repair have been developed recently. The anterior ethmoidal artery (AEA) flap is a versatile technique for middle-size perforations in different locations. The greater palatine artery (GPA) flap is an excellent option for anterior-most NSPs. The lateral nasal wall flap and the pericranial flap are the most appropriate techniques for large perforations. The advent of these techniques has changed the management and has expanded the therapeutic arsenal to treat all types of NSPs according to the size, location, and osteo-cartilaginous support. However, no technique has been accepted as the gold standard. Extensive knowledge of different techniques is important to individualize the treatment, selecting the most appropriate in each case.
Asunto(s)
Perforación del Tabique Nasal , Endoscopía , Humanos , Perforación del Tabique Nasal/etiología , Perforación del Tabique Nasal/cirugía , Nariz , Colgajos QuirúrgicosRESUMEN
OBJECTIVE: This study reviews a cohort of patients in whom septal perforation repair was performed concurrently with endoscopic sinus surgery. We present an endonasal perforation repair technique using bilateral mucosal flaps with an autogenous interposition graft. Intraoperative and postoperative management of the combined surgical patient is discussed and perforation closure outcomes are reported. STUDY DESIGN: Case series. SETTING: Tertiary care center. METHODS: In this institutional review board-approved retrospective chart review, adult patients who underwent concurrent bilateral mucosal flap septal perforation repair and endoscopic sinus surgery from March 1992 to March 2020 were identified. Data on demographics, clinical presentations, perforation size, surgical techniques, and outcomes were extracted and analyzed for patients with a minimum of 3 months of follow-up. RESULTS: Fifty-six patients met study inclusion criteria. Nasal obstruction/congestion was the most frequent symptom reported (80.4%), followed by crusting and epistaxis. Mean perforation size measured at the time of surgery was 14.7 (range, 3-41) mm in length by 9.3 (range, 2-23) mm in height. Temporalis fascia was the most frequent (57.9%) interposition graft material used. Complete perforation closure at the time of the last follow-up was noted in 51 (91.1%) patients. Only 1 failure was noted in the last 48 attempted repairs. CONCLUSION: Patients with a perforated septum may have coexistent chronic sinusitis. The feasibility of attempting concurrent sinus surgery and perforation repair has been questioned. Our review demonstrates a high perforation closure rate when a bilateral mucosal flap procedure is performed after sinus surgery is performed at the same setting.
Asunto(s)
Endoscopía/métodos , Perforación del Tabique Nasal/cirugía , Rinoplastia/métodos , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perforación del Tabique Nasal/diagnóstico por imagen , Perforación del Tabique Nasal/etiología , Colgajos Quirúrgicos , Resultado del TratamientoRESUMEN
Granulomatosis with polyangiitis (GPA) is a necrotising vasculitis of unknown cause that has several systemic manifestations. The disease is characterised by the classical triad involving acute inflammation of the upper and lower respiratory tracts with renal involvement. However, the disease pathology can involve the central nervous system. This case report presents a case of GPA with facial nerve palsy as the first manifestation of the disease, which has been rarely reported in the medical literature.
Asunto(s)
Parálisis Facial/etiología , Granulomatosis con Poliangitis/diagnóstico , Perforación del Tabique Nasal/etiología , Convulsiones/etiología , Adolescente , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Encéfalo/diagnóstico por imagen , Ciclofosfamida/administración & dosificación , Parálisis Facial/sangre , Parálisis Facial/diagnóstico , Parálisis Facial/terapia , Femenino , Granulomatosis con Poliangitis/sangre , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/terapia , Humanos , Imagen por Resonancia Magnética , Metilprednisolona/administración & dosificación , Perforación del Tabique Nasal/diagnóstico , Tabique Nasal/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Plasmaféresis , Quimioterapia por Pulso , Convulsiones/sangre , Convulsiones/diagnóstico , Convulsiones/terapia , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES/HYPOTHESIS: To evaluate the outcomes of endonasal repair of septal perforations utilizing opposing bilateral rotational flaps and a periosteum interposition graft. METHODS: Retrospective review of a single surgeon, tertiary referral center experience of patients who underwent septal perforation repair. Patient demographics, etiology of perforation, closure rate, and complication data were obtained. Patients screening positively for cocaine use or anti-neutrophil cytoplasmic antibodies (ANCA) were not offered repair. RESULTS: A total of 104 patients were included, 65 male and 39 female with mean age of 45.4 years. Etiology of perforations included prior surgery in 45, trauma in 15, and unknown in 44, and the average perforation size in each etiologic group were 1.35 cm, 1.25 cm, and 1.30 cm, respectively. The greatest dimension of perforations repaired ranged from 0.5 cm to 1.5 cm. The overall success rate was 87.5% at 6 month follow-up. Successful closure was achieved in 95.6%, 86.7%, and 79.5%, respectively (χ2 = 5.264, P = .0218). CONCLUSION: Our described technique is a reliable endonasal approach with predictable outcomes in septal perforations up to 1.5 cm in size. Having an unknown etiology of septal perforation may be a risk factor for failure. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1497-1500, 2021.
Asunto(s)
Apófisis Mastoides/trasplante , Perforación del Tabique Nasal/cirugía , Periostio/trasplante , Rinoplastia/métodos , Colgajos Quirúrgicos/trasplante , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Perforación del Tabique Nasal/etiología , Tabique Nasal/patología , Tabique Nasal/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Rinoplastia/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Cocaine use is associated with multiple complications, some of which can mimic systemic diseases, especially Antineutrophil Cytoplasmic Antibody (ANCA) associated vasculitis. We report a case of Cocaine Induced Midline Destructive Lesions (CIMDL) for which a diagnosis of granulomatosis with polyangiitis (GPA) was discussed. CASE REPORT: A 42-year-old male, cocaine consumer, was admitted in our department for a centrofacial destructive process. He had no extra ear, nose and throat (ENT) involvement. ANCA were positive with a perinuclear fluorescence pattern and an anti-Proteinase 3 specificity. Regarding this unusual immunologic pattern and in the absence of histological argument for a GPA, a diagnosis of CIMDL was made. CONCLUSION: CIMDL is a centrofacial destructive process due to intranasal cocaine use. It is frequently associated with the presence of p-ANCA with both anti-HNE and anti-PR3 specificity.
Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Granulomatosis con Poliangitis/etiología , Perforación del Tabique Nasal/etiología , Adulto , Anticuerpos Anticitoplasma de Neutrófilos/efectos adversos , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Trastornos Relacionados con Cocaína/diagnóstico , Diagnóstico Diferencial , Granuloma Letal de la Línea Media/diagnóstico , Granuloma Letal de la Línea Media/etiología , Granulomatosis con Poliangitis/diagnóstico , Humanos , Masculino , Perforación del Tabique Nasal/diagnósticoRESUMEN
An 88-year-old man with mutilating mucosal leishmaniasis (ML) involving septal perforation, with granulomas in the pharynx and larynx, was treated with oral miltefosine, 50 mg three times/day for 28 days. Miltefosine, an antineoplastic agent, is considered an alternative option for the treatment of ML, showing efficacies of 75-92% in Bolivia, Brazil, and Argentina. The patient denied having previous cutaneous (CL) leishmaniasis, and no CL lesions were recognized by physical examination. Parasites obtained from mucosal lesions were identified by cytochrome b gene sequencing as Leishmania guyanensis. Clinical cure was observed 2 months posttreatment, and no evidence of reactivation was observed in the 3-year follow-up. Adverse effects such as nausea, loss of appetite, and epigastric pain were experienced during treatment with miltefosine. There is a need for improved access to miltefosine in leishmaniasis-endemic areas of Latin America and a greater awareness of ML and its treatment among physicians working in endemic countries.
Asunto(s)
Antiprotozoarios/uso terapéutico , Leishmaniasis Mucocutánea/tratamiento farmacológico , Enfermedades Nasales/tratamiento farmacológico , Enfermedades Faríngeas/tratamiento farmacológico , Fosforilcolina/análogos & derivados , Anciano de 80 o más Años , Citocromos b/genética , Disfonía/etiología , Humanos , Leishmania guyanensis/genética , Leishmania guyanensis/aislamiento & purificación , Masculino , Perforación del Tabique Nasal/etiología , Enfermedades Nasales/complicaciones , Enfermedades Nasales/patología , Enfermedades Faríngeas/complicaciones , Enfermedades Faríngeas/patología , Fosforilcolina/uso terapéutico , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: To highlight a severe case of rhinotillexomania (compulsive nasal picking) and its potential to manifest as empty nose syndrome (ENS). METHODS: A single case report with the presentation and management of a patient with severe rhinotillexomania who presented with chronic obstructive symptoms. We review the current literature on rhinotillexomania and ENS. RESULTS: This patient's manifestations mimic the obstructive symptoms of ENS, despite widely patent nasal passages. CONCLUSION: This is the first report of rhinotillexomania manifesting with features of ENS.
Asunto(s)
Conducta Compulsiva/complicaciones , Perforación del Tabique Nasal/etiología , Anciano , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Budesonida/uso terapéutico , Endoscopía , Humanos , Humidificadores , Masculino , Mupirocina/uso terapéutico , Obstrucción Nasal , Perforación del Tabique Nasal/diagnóstico , Perforación del Tabique Nasal/terapia , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/etiología , Enfermedades Nasales/terapia , Síndrome , Irrigación Terapéutica , Tomografía Computarizada por Rayos XRESUMEN
Iatrogenic septal perforation is a complication of nasal surgery. Small or posterior perforations cause few symptoms, and need only conservative treatment. Larger and anterior perforations contribute to nasal airflow disturbances and external nasal deformities. When considering surgical candidacy, one should consider the severity of symptoms, location and size of the perforation, and need for revsional rhinoplasty. We repair perforations using intranasal mucosal advancement flaps augmented by an interposition connective tissue graft. Septal perforation repairs are tedious and technically challenging. We review key points to minimize unintended perforation formation following nasal surgery.
Asunto(s)
Perforación del Tabique Nasal/prevención & control , Perforación del Tabique Nasal/cirugía , Rinoplastia/métodos , Humanos , Mucosa Nasal/cirugía , Perforación del Tabique Nasal/etiología , Perforación del Tabique Nasal/patología , Selección de Paciente , Colgajos Quirúrgicos , Evaluación de SíntomasRESUMEN
A 44-year-old female with rheumatoid arthritis treated with methotrexate (MTX) and tocilizumab (TCZ) was admitted to our hospital with nasal pain. Nasal fiberscopy revealed septum perforation, while a membrane biopsy indicated granuloma and fibrinoid necrosis of the small artery. The patient was treated with prednisolone 30 mg/day after discontinuation of MTX and TCZ. Inguinal lymph node biopsy revealed diffuse infiltrations of atypical T-cells and Epstein-Barr virus-positive B cells. The patient was diagnosed with peripheral T-cell lymphoma due to MTX-associated lymphoproliferative disorder (MTX-LPD). We herein describe the case of a patient with nasal septum perforation due to MTX-LPD mimicking granulomatosis with polyangiitis.