A simple home test to differentiate habitual from pathological mouth breathing.

BACKGROUND: Mouth breathing (MB) is defined as breathing through the mouth alone or the mouth and the nose for more than six months. Unfortunately, after managing its mechanical causes, MB may continue due to habit, obscuring the results of surgical correction of nasal breathing and misleading to unnecessary or aggressive maneuvers. OBJECTIVE: to develop and evaluate a new test to define children of habitual MB. MATERIALS AND METHODS: Design: a prospective observational study conducted from May 2022 to February 2023. SETTING: multicenter; outpatient university clinics and a private ENT center. PARTICIPANTS: 577 children aged 2-12 years and complaining of MB during sleep (±daytime) for ≥6 months were assessed for eligibility, 340 were excluded due to a lack of inclusion criteria, 29 declined or discontinued participation, and 208 were enrolled. Of these, 180 gave reliable data. THE TEST: After about 1 h of the child's sleep, the parent applies one warmed hand to close the child's open mouth recording his awakeness time (AT) for a maximum of 3 min for three nights. On the next visit, the child's examination started for obstruction causes, including endoscopy, and the test results were collected. MAIN OUTCOME AND MEASURES: The AT was compared to examination results aiming to find a significant diagnostic relation. Children with no abnormality in the clinical and endoscopic examination were considered habitual mouth breathers. RESULTS: Among 94 males and 86 females aged 2-12 years, MB duration ranged from 6 to 42 months, with a mean of 15.9. The home test results were presented by the mean AT in seconds. The awakeness time (AT) could discriminate patients' abnormalities at a cut-off level of <133 s, with 98.5% sensitivity and 89.7% specificity. Results <133 s are considered positive. Positive results mean the presence of a cause of obstruction. Negative results suggest no reason could be detected by endoscope or clinical examination. True positive children were 120 (66.7%), and 12 (6.7%) were false positive. True negative children were 43 (23.9%), and 5 (2.8%) were false negative. CONCLUSIONS: Test results ≥133 s are associated with habitual MB. We recommend the test for the initial assessment of night MB.

Endoscopic Endonasal Removal of Stray Bullets in the Fossa Pterygopalatine in Innocent Young Bystanders of Conflicts in Somalia in a Period of Six Months.

ABSTRACT: In Somalia, which is located in the horn of Africa, a fragile and insecure state structure allowed the strengthening of terrorist groups provoking armed conflicts. Stray bullet injuries can be defined as an accidental bullet wound caused by an anonymous attacker and are usually associated with celebratory gunfire or urban violence. The anatomy of the pterygopalatine fossa (PPF) is complex and penetrating foreign body injuries pose even a greater challenge for the surgeon to operate in this area. Endoscopic approaches facilitate the removal of foreign bodies from the paranasal sinuses, orbital cavity, and aerodigestive system, minimizing potential risks. This study presents a series of removal of stray bullets found in the PPF, as a result of urban violence in Somalia in a period of 6 months. Patient demographics, foreign body origin, treatment modalities, and surgery details were evaluated and assessed. All patients were male and aged 16, 2, and 24 years, respectively. The surgeries were quite straightforward with surgery times recorded as 25, 44, and 22 minutes, respectively. The endoscopic endonasal approach proved to provide safe and sufficient access for removal. Surprisingly, even the foreign body in the PPF of a 2-year-old patient could be removed with an endoscopic endonasal approach and did not require an external approach. The management of foreign body removal in the PPF is challenging due to the potential risks of iatrogenic vascular and nervous tissue injury. The endoscopic endonasal approach for removal proved efficient in 3 cases regardless of age and anatomical dimensions.

Chondromyxoid Fibroma of the Mastoid: A Rare Entity with Comprehensive Literature Review.

Chondromyxoid fibroma (CMF) is the least commonly occurring bone tumor of cartilaginous origin. It is usually situated in the metaphysis of long bones of the lower limbs. Localization of the tumor in the skull is extremely rare. The definitive diagnosis is challenging and depends on radiological and histological examinations. To the best of our knowledge, only 14 cases of CMF involving the temporal bone have been reported to date, 7 of which were within the mastoid. The most common clinical symptom is headache; however, these symptoms vary greatly according to site, size, and extension of the lesion. Surgical removal is the treatment of choice. A literature review of the diagnostic challenges, histological difficulties in differential diagnosis, imaging, clinical features, and recommended modalities of treatment have been discussed in the present case.Chondromyxoid fibroma (CMF) is the least commonly occurring bone tumor of cartilaginous origin. It is usually situated in the metaphysis of long bones of the lower limbs. Localization of the tumor in the skull is extremely rare. The definitive diagnosis is challenging and depends on radiological and histological examinations. To the best of our knowledge, only 14 cases of CMF involving the temporal bone have been reported to date, 7 of which were within the mastoid. The most common clinical symptom is headache; however, these symptoms vary greatly according to site, size, and extension of the lesion. Surgical removal is the treatment of choice. A literature review of the diagnostic challenges, histological difficulties in differential diagnosis, imaging, clinical features, and recommended modalities of treatment have been discussed in the present case.