The Effect of Platelet-Rich Fibrin and Hyaluronic Acid on Perforation of Nasal Septum.

BACKGROUND: Conservative approaches and surgical methods have been tried for the treatment of nasal septum perforations (NSPs), but a satisfactory method has not yet been determined. OBJECTIVE: Our study aimed to investigate the effect of platelet-rich fibrin (PRF) and hyaluronic acid (HA) in repairing NSPs, which were experimentally created in rabbit septum. METHODS: A total of 36 white New Zealand rabbits were included in the study. Perforations measuring 0.7 × 0.7 cm were created in their nasal septa. No additional intervention was made to the control group, which was the first group. For the second, third, and fourth groups, respectively, HA, PRF, and HA + PRF were used in the NSP region. Macroscopic and histopathological evaluations were performed after 40 days. RESULTS: In the first group, closure was observed in none of the rabbits' NSPs. In the second group, 6 rabbits (66.7%) had full closure in their NSPs. In the third group, the NSP of 6 rabbits (66.7%) was completely closed. In the fourth group, the NSP of 7 rabbits (77.8%) had full closure. CONCLUSION: Statistically significant closure was achieved with PRF and/or HA in rabbits in which NSP was established. These materials can be used to increase the likelihood of perforations closing.

Rhinotillexomania Manifesting as Empty Nose Syndrome.

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.

Rinotilexomanía / Rhinotillexomania

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Nasoseptal Perforation: from Etiology to Treatment.

PURPOSE OF REVIEW: Nasal septum perforation (NSP) is a communication between the two nasal cavities. This review contributes to the better knowledge of NSP causes, diagnosis, and treatment. RECENT FINDINGS: NSP prevalence is about 1%. Clinical presentation may range from absence of symptoms to the presence of bothersome sinonasal symptoms. NSP is more frequently caused by trauma or post-surgery, inflammatory diseases, and abuse substances. Conservative management (nasal irrigation, topical use of antibiotic or lubricant ointments, or placement of prosthesis) is considered the first-line treatment. Symptomatic NSP not improving with local therapies usually requires surgical approach. Selection of the technique for the endoscopic septal repair depends on perforation characteristics and surgeon experience. When NSP is diagnosed, its cause has to be promptly determined. Most of them can be controlled with conservative measures. Surgical/endoscopic approaches are usually needed in refractory cases, and new repair techniques have to be considered.

Case for diagnosis. Palate perforation due to cocaine use

Abstract: We report a 42-year-old cocaine addicted female patient referred for evaluation of hard palate ulceration resulting in oro-sinus communication with difficulties in swallowing and phonation, an rhino-sinusitis. Acrylic and removable silicone prosthesis was prescribed to relieve severe functional disorders. It is essential that the patient permanently abandons cocaine use to perform surgical reconstruction.

Analyses and treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms.

In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery.

Case for diagnosis. Palate perforation due to cocaine use.

We report a 42-year-old cocaine addicted female patient referred for evaluation of hard palate ulceration resulting in oro-sinus communication with difficulties in swallowing and phonation, an rhino-sinusitis. Acrylic and removable silicone prosthesis was prescribed to relieve severe functional disorders. It is essential that the patient permanently abandons cocaine use to perform surgical reconstruction.

The Effect of Nasal Septal Perforation and its Treatment on Objective Sleep and Breathing Parameters.

BACKGROUND Nasal septal perforation (NSP) may alter nasal airflow patterns and physiology. To the best of our knowledge, no studies in the English literature have investigated the effect of NSP and its treatment on polysomnographic parameters. In this study, we aimed to investigate polysomnographic parameters in patients with NSP as well as changes in those parameters after treatment of NSP. MATERIAL AND METHODS Nineteen patients diagnosed with NSP were included in the study. All patients had baseline and post-procedure polysomnographies (PSG) after insertion of silicone septal button for closure of NSP. RESULTS Both median AHI [5.30 (14.40) vs. 2.40 (14.50)] and median supine AHI [10.00 (42.10) vs. 6.60 (37.00)] decreased after correction of the perforation. There was a large reduction in median supine AHI in patients with a perforation size >66 mm2 [10.10 (34.15) vs. 1.60 (28.30)]. CONCLUSIONS We conclude that NSP did not cause any deterioration in objective sleep parameters as determined by PSG, other than a decrease in REM sleep duration and an increase in supine AHI. Correction of NSP did not affect REM duration and supine AHI decreased after treatment.

[Morphological peculiarities and possibilities of the conservative treatment of perforations in the nasal septum].

The objective of the present work was to enhance the effectiveness of the conservative treatment of perforations in the nasal septum (PNS) with the use of the newly developed method that includes septal splinting with the possibility of the long-term targeted medicamental treatment of the affected nasal septum tissue taking into consideration its morphological characteristics. The study included a total of 67 patients presenting with perforations in the nasal septum. The authors distinguished the following four types of septal perforations: non-inflamed (n=4; 6%), subatrophic (n=9; 13.4%), erosive-ulcerative (n=12; 17.9%), and mixed (n=42; 62.7%) ones. Twenty six patients were given conservative treatment by means of the original method including preventive splintage of the nasal septum with the use of silicone splints one of which had a slot-type conduit designed for manipulations. The inclusion of physiotherapeutic procedures in the protocol of the treatment of the perforated nasal septum was substantiated. It is concluded that the proposed original method for the conservative treatment of perforations in the nasal septum has advantages over the traditional approaches for the same purpose; it ensures complete (100%) regeneration of the affected mucous membrane of the nasal septum and a four-fold increase in the duration of remission of the disease.

Marine collagen scaffolds for nasal cartilage repair: prevention of nasal septal perforations in a new orthotopic rat model using tissue engineering techniques.

Autologous grafts are frequently needed for nasal septum reconstruction. Because they are only available in limited amounts, there is a need for new cartilage replacement strategies. Tissue engineering based on the use of autologous chondrocytes and resorbable matrices might be a suitable option. So far, an optimal material for nasal septum reconstruction has not been identified. The aim of our study was to provide the first evaluation of marine collagen for use in nasal cartilage repair. First, we studied the suitability of marine collagen as a cartilage replacement matrix in the context of in vitro three dimensional cultures by analyzing cell migration, cytotoxicity, and extracellular matrix formation using human and rat nasal septal chondrocytes. Second, we worked toward developing a suitable orthotopic animal model for nasal septum repair, while simultaneously evaluating the biocompatibility of marine collagen. Seeded and unseeded scaffolds were transplanted into nasal septum defects in an orthotopic rat model for 1, 4, and 12 weeks. Explanted scaffolds were histologically and immunohistochemically evaluated. Scaffolds did not induce any cytotoxic reactions in vitro. Chondrocytes were able to adhere to marine collagen and produce cartilaginous matrix proteins, such as collagen type II. Treating septal cartilage defects in vivo with seeded and unseeded scaffolds led to a significant reduction in the number of nasal septum perforations compared to no replacement. In summary, we demonstrated that marine collagen matrices provide excellent properties for cartilage tissue engineering. Marine collagen scaffolds are able to prevent septal perforations in an autologous, orthotopic rat model. This newly described experimental surgical procedure is a suitable way to evaluate new scaffold materials for their applicability in the context of nasal cartilage repair.

Rhinotillexomania: a rare cause of medial orbital wall erosion.

The authors report a rare case of medial orbital wall erosion with an orbital inflammatory mass and resultant lacrimal obstruction secondary to rhinotillexomania. A 67-year-old male with known history of compulsive nose picking (rhinotillexomania) sought treatment for complaints of watering in his OD. Examination revealed a blocked right inferior canaliculus. Nasal endoscopy showed a large nasal septal defect with multiple areas of crusting and bleeding. Hematologic investigations were normal. CT scan confirmed a large nasal septal and right medial orbital wall defect with an adjacent soft tissue mass in the medial orbit. Investigations ruled out systemic pathology. Histologic examination of medial orbital mass, sinus, and nasal mucosa revealed a reactive inflammatory infiltrate with surface Gram-positive cocci. The authors hypothesized that the patient had enlarged an existing nasal septal defect due to repetitive nose picking resulting in recurrent infection and inflammation of sinuses, leading to erosion of his medial orbital wall.

[Experience with individual obturators to treat nasal septum perforation]. / Erfahrungen mit individuellen Obturatoren zur Behandlung von Septumperforationen.

BACKGROUND: Individual septal buttons have gained more attention during the last years. However, experiences in patients being treated by an individual septal button are limited. Therefore, further evaluation of this treatment option is needed. MATERIAL AND METHODS: Records of 64 patients being treated by an individual septal button were evaluated retrospectively. As the silicon prints of the septum perforation were available size of the septal perforation were measured. Telephone interview were used to ask the patients about their general judgement and eff ect of the septal button on their different complaints. RESULTS: Septumplasty in 42 patients and a trauma in 10 patients had been documented prior to treatment. In 7 patients Wegner's granulomatosis had been proven by serological and histopathological analysis. Digital manipulation and nasal drop abuses were judged to be the reason of the septal perforation in 2 patients each. In one patient the etiology remained unknown. Size of the septal perforation ranged from 7.4 to 807 mm(2). Using visual analog scale 42 patients reported to be highly satisfied. A statistically significant improvement was reported for all symptoms. Respiratory noise and nasal obstruction were improved best followed by nasal bleeding, pain and crust formation. CONCLUSION: Treatment of septal perforations with individual septal buttons should be considered in treating septal perforations. Nasal obstruction and nasal bleeding were found to be improved best by this treatment option.