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1.
Ann R Coll Surg Engl ; 103(2): e48-e49, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559557

RESUMO

Angiofibroma of the head and neck is classically found in the nasopharynx of an adolescent male. We present a rare case where an angiofibroma was diagnosed in the anterior nasal septum of a 51-year-old woman, the eighth nasal septal angiofibroma reported in a female. This case highlights how an angiofibroma in an older woman has a less vascular behaviour than one in an adolescent male, even though radiological enhancement may suggest that the lesion is highly vascularised. Nasal septal angiofibromas can be managed by biopsy and removed by simple endoscopic resection with minimal haemorrhage. Although very rare, extranasopharyngeal angiofibroma/nasal septal angiofibroma should be included in the differential diagnosis when patients of all ages present with nasal obstruction secondary to a nasal mass, with or without epistaxis.


Assuntos
Angiofibroma/diagnóstico , Obstrução Nasal/etiologia , Neoplasias Nasais/diagnóstico , Angiofibroma/irrigação sanguínea , Angiofibroma/complicações , Angiofibroma/cirurgia , Biópsia , Endoscopia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Obstrução Nasal/cirurgia , Septo Nasal/irrigação sanguínea , Septo Nasal/diagnóstico por imagem , Neoplasias Nasais/irrigação sanguínea , Neoplasias Nasais/complicações , Neoplasias Nasais/cirurgia , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431530

RESUMO

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.


Assuntos
Paralisia Facial/etiologia , Granulomatose com Poliangiite/diagnóstico , Perfuração do Septo Nasal/etiologia , Convulsões/etiologia , Adolescente , Anticorpos Anticitoplasma de Neutrófilos/sangue , Encéfalo/diagnóstico por imagem , Ciclofosfamida/administração & dosagem , Paralisia Facial/sangue , Paralisia Facial/diagnóstico , Paralisia Facial/terapia , Feminino , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/terapia , Humanos , Imagem por Ressonância Magnética , Metilprednisolona/administração & dosagem , Perfuração do Septo Nasal/diagnóstico , Septo Nasal/diagnóstico por imagem , Seios Paranasais/diagnóstico por imagem , Plasmaferese , Pulsoterapia , Convulsões/sangue , Convulsões/diagnóstico , Convulsões/terapia , Tomografia Computadorizada por Raios X
3.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500311

RESUMO

Extracranial manifestation of arteriovenous malformations (AVMs) is uncommon. Nasoseptal AVMs are an even rarer entity. In this case report, we present an interesting and first-of-its-kind case of the development of a left nasoseptal AVM in a 60-year-old man after a fall. This was likely post-traumatic, unlike the usual congenital AVMs described in the literature. The patient was managed conservatively with regular follow-up for the AVM as he was asymptomatic.


Assuntos
Acidentes por Quedas , Malformações Arteriovenosas/diagnóstico por imagem , Osso Etmoide/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Doenças Nasais/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Malformações Arteriovenosas/etiologia , Angiografia por Tomografia Computadorizada , Osso Etmoide/lesões , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Nasais/etiologia , Fraturas Cranianas/complicações
4.
Angle Orthod ; 90(5): 672-679, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378475

RESUMO

OBJECTIVES: To determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS: A retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed. RESULTS: No changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05). CONCLUSIONS: Following RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.


Assuntos
Fenda Labial , Fissura Palatina , Adolescente , Criança , Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Tomografia Computadorizada de Feixe Cônico , Humanos , Maxila/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Técnica de Expansão Palatina , Estudos Retrospectivos
5.
Dental Press J Orthod ; 25(5): 51-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206829

RESUMO

INTRODUCTION: Nasal septum deviation (NSD) is the most common structural cause of nasal obstruction, affecting around 65-80% of the adult population. Rapid maxillary expansion (RME) is currently used for treatment of maxillary transverse deficiency, but can also influence nasal cavity geometry. OBJECTIVE: The present study aimed at evaluating the changes in NSD by using Cone-Beam Computed Tomography (CBCT) scans in pre-pubertal patients treated with RME. METHODS: This retrospective exploratory study evaluated 20 pre-pubertal patients (mean age 10 ± 2 years) who were treated for transverse maxillary constriction with RME and presented mild/moderate NSD as an incidental finding. The outcome measures were NSD tortuosity and area. These measures were obtained from transverse and coronal views of records taken before and after RME treatment. Intra-rater reliability was also assessed with intraclass correlation coefficient. RESULTS: NSD was mild in thirteen patients (65%) and moderate in seven (35%). NSD tortuosity index did not significantly change over time (mean difference 0.002 mm/year, 95% CI; p = 0.58). NSD area did not significantly change over time (mean difference 2.103 mm2/year, 95% CI; p = 0.38). Intraclass correlation coefficient was 0.73 (95% CI) for NSD tortuosity and 0.84 (95% CI) for NSD area. CONCLUSIONS: NSD tortuosity and area suggested potential changes in NSD with small clinical relevance in pre-pubertal patients who were treated with RME. Additional studies using CBCT scans in larger samples are required to clarify the role of RME in NSD treatment.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Técnica de Expansão Palatina , Criança , Humanos , Maxila , Cavidade Nasal/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Plast Reconstr Surg ; 146(2): 277-280, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740574

RESUMO

BACKGROUND: Despite the widespread use of the Cottle maneuver as a finding to define nasal valve collapse, no studies have confirmed the association between a positive Cottle maneuver and need for nasal valve repair. This study demonstrates the low construct validity of the Cottle maneuver. METHODS: One hundred healthy volunteer students and employees at Boston Medical Center were recruited for this study. Participants were asked to evaluate their breathing on a 10-point scale, rating their subjective airflow in each nostril while occluding the contralateral nostril, where 0 indicated complete obstruction and 10 indicated complete patency. Following the baseline ratings, participants were asked to rate their breathing once again while examiners preformed the Cottle and modified Cottle maneuvers. RESULTS: Overall, 97 percent of participants reported improved airflow in each nostril following the Cottle maneuver (p < 0.00001); 98 percent reported improved airflow in each nostril following the modified Cottle maneuver (p < 0.00001). CONCLUSIONS: If the clinical consensus regarding the observed improvement in nasal airflow is to be followed, nearly all the participants recruited are experiencing some surgically correctable nasal obstruction. Given the population from which our cohort was collected-students and residents from a medical campus-such a conclusion seems extremely unlikely. We believe the more likely explanation for the high positive test rate is flawed assumptions of the Cottle and modified Cottle maneuvers. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.


Assuntos
Obstrução Nasal/diagnóstico , Septo Nasal/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico , Rinoplastia/efeitos adversos , Adulto , Coleta de Dados , Feminino , Seguimentos , Voluntários Saudáveis , Humanos , Masculino , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Estudos Prospectivos
7.
J Oral Maxillofac Surg ; 78(10): 1833.e1-1833.e9, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32544472

RESUMO

PURPOSE: The role of morphologic characteristics of the nasal cavity in nasal obstruction is not yet sufficiently understood. The aim of this study was to determine which morphometric parameters of the nasal cavity severely impair nasal breathing and when. PATIENTS AND METHODS: In a hospital-based, computed tomography-morphometric cross-sectional study, we evaluated computed tomography coronal scans of patients with known nasal obstruction scheduled to undergo functional nasal surgical procedures (cases) and trauma patients without facial involvement or known nasal obstruction (controls). The primary predictor variable was case versus control. In both groups, we measured and compared the piriform aperture width; nasal floor canting; piriform aperture vertical height, height-width ratio, and total cross-sectional area; height difference between the right and left nasal floors; and nasal septal thickness; as well as age and gender differences. Metric data means, standard deviations, and 95% confidence intervals were calculated and analyzed. RESULTS: The sample was composed of 60 patients evenly divided between cases and controls. Of these, 30 were men. The average age of the cases and controls was 27.4 ± 7.8 years and 38.5 ± 18.6 years, respectively (P < .001). The differences in piriform aperture width were not statistically significant between cases and controls (23.3 ± 1.9 mm and 23.8 ± 1.7 mm, respectively; P > .2). In contrast, we noted statistically significant differences between cases and controls in nasal floor canting (5.4° ± 4.6° and 1.8° ± 1.5°, respectively; P < .001) and height difference between the right and left nasal floors (1.8 ± 1.2 mm and 1.0 ± 0.7 mm, respectively; P = .002). CONCLUSIONS: Nasal floor canting of 3° or greater and a height difference between the right and left nasal floors of 1.5 mm or greater may contribute to the etiology of clinically relevant nasal obstruction. A piriform aperture width of 22 mm or less may be considered narrow. Future studies can determine when and how exactly to surgically address a clinically relevant narrow piriform aperture and nasal floor canting.


Assuntos
Obstrução Nasal , Adulto , Estudos Transversais , Face , Humanos , Masculino , Cavidade Nasal/diagnóstico por imagem , Obstrução Nasal/diagnóstico por imagem , Obstrução Nasal/etiologia , Septo Nasal/diagnóstico por imagem , Adulto Jovem
8.
Saudi Med J ; 41(6): 635-639, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518931

RESUMO

OBJECTIVES: To demonstrate the correction of overhanging alar with the vestibular triangular excision technique using preoperative and postoperative photographs.   Methods: This descriptive retrospective study was conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Fifty patients who underwent open rhinoplasty with the vestibular triangular excision technique were retrospectively assessed. Preoperative and postoperative photographs were examined to evaluate the alar-columellar relationship. Patients included had undergone either primary or revision rhinoplasties between January 2013 and March 2018 and had a thick hanging alar with a grade IV Gunter's rating for alar-columellar discrepancies. Patient outcomes and satisfaction were subjectively assessed using the rhinoplasty outcome evaluation (ROE) scale and visual analog scale (VAS) by independent analysis of the right lateral, left lateral, and frontal view photographs by 2 rhinoplasty surgeons, both preoperatively and 1-year postoperatively. Statistical significance was calculated by Wilcoxon signed-rank tests.  Results: Patients' ages ranged from 18 to 37 years (mean, 26.34). The study included 22 men (44%) and 28 women (56%). Mean preoperative and postoperative ROE scores were 10.12 and 19.3 and VAS scores 5.14 and 7.94. P-values for preoperative and postoperative comparison of both ROE and VAS were statistically significant (p=0.001).  Conclusion: Caring of alar soft tissue during rhinoplasty is important to correct overhanging alar to improve nasal appearance and patient satisfaction. The sail excision technique is reliable and simple and provides good patient satisfaction.


Assuntos
Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Satisfação do Paciente , Rinoplastia/métodos , Adolescente , Adulto , Estética , Feminino , Humanos , Masculino , Septo Nasal/diagnóstico por imagem , Deformidades Adquiridas Nasais/diagnóstico por imagem , Avaliação de Resultados da Assistência ao Paciente , Fotografação , Estudos Retrospectivos , Arábia Saudita , Escala Visual Analógica , Adulto Jovem
9.
Braz. j. otorhinolaryngol. (Impr.) ; 86(3): 343-350, May-June 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1132596

RESUMO

Abstract Introduction: Nasal obstruction is one of the most frequent otolaryngologic complaints; and the collapse of the internal nasal valve is one the main causes of the nasal air flow obstruction. Objective: We aimed to evaluate internal nasal valve by using reformatted CT-scans pre- and post- rhinoplasty at 3 months and to assess its correlation to symptomatic improvement of nasal obstruction using the NOSE scale. Methods: A prospective observational study was conducted between March 2017-May 2018 in a tertiary care otorhinolaryngology center. We included patients suffering from nasal obstruction secondary to internal nasal angle collapse and nasal deformity. Patients with sinusitis, nasal polyposis, and nasal masses were excluded. Results: Twenty consecutive patients underwent rhinoplasty, with a mean age (22.2 ± 2.8), with majority of males (n = 14; 70%). There was no significant correlation between pre- and post- CT-scans of the internal nasal valve angle/area and NOSE scores. A high significant difference was detected between mean pre- and post- NOSE scores (p < 0.0001), which was absent in CT-scan results. Conclusion: Reformatted CT-scans measurements of internal nasal valve area and angle were not of value. NOSE scores pre- and post- rhinoplasty had a significant value to determine degree of obstructive symptom improvement.


Resumo Introdução: A obstrução nasal é uma das queixas otorrinolaringológicas mais comuns, e o colapso ou obstrução da válvula nasal interna é a principal causa da obstrução das vias aéreas nasais. Objetivo: Objetivamos avaliar a válvula nasal interna pré, e 3 meses pós-rinoplastia utilizandotomografias computadorizadas reformatadas e avaliar sua correlação com a melhora do sintoma obstrutivo utilizando a escala NOSE, do Inglês Nasal Obstruction Symptom Evaluation. Método: Um estudo observacional prospectivo foi realizado entre março de 2017 e maio de 2018 em um centro de otorrinolaringologia de atenção terciária. Foram incluídos pacientes que apresentavam obstrução nasal secundário a colapso da valva nasal interna e deformidade nasal. Pacientes com sinusite, polipose nasal e tumores nasais foram excluídos. Resultados: Vinte pacientes consecutivos, a maioria do sexo masculino (n = 14; 70%) com média de idade de 22,2 ± 2,8 anos, foram submetidos a rinoplastia eincluídos no estudo. Não houve correlação significante entre as avaliações tomográficas pré / pós cirúrgicas do ângulo/área da valva nasal interna e os escores NOSE. Foi detectada uma diferençã altamente significante entre os escores médios da escala NOSE entre o pré e pós-operatório (p < 0,0001), mas não nos resultados da avaliação por tomografia computadorizada. Conclusão: As medidas reformatadas de tomografias computadorizadas da área e ângulo da valva nasal interna pré e pós cirúrgicas não tiveram valor. Entretanto, os escores da escala NOSE pré e pós-rinoplastia mostraram uma diferença significante ao determinar o grau de melhora do sintoma obstrutivo.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Rinoplastia/métodos , Tomografia Computadorizada por Raios X , Obstrução Nasal/diagnóstico por imagem , Estudos Prospectivos , Septo Nasal/diagnóstico por imagem
10.
J Laryngol Otol ; 134(4): 332-337, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32238199

RESUMO

OBJECTIVE: To evaluate the colour values of nasal mucosa for the purpose of presenting an objective parameter of allergic rhinitis. METHODS: Seventy-three patients with allergic rhinitis (allergy group) and 73 normal healthy individuals (control group) were included in the study. Endoscopic examinations were conducted, and endoscopic photographs of the septum and both inferior turbinates were taken. The Adobe Photoshop Elements 7.0 software program was used to measure the numerical values of red-green-blue (RGB) colour components in the endoscopic photographs of nasal mucosa. RESULTS: The G and B values were significantly higher in the allergy group compared to the control group (both p < 0.05). Cumulative R, G and B values of all measurement points were significantly higher in the allergy group compared to the control group (p < 0.05). CONCLUSION: Nasal mucosa discolouration can be measured objectively with RGB analysis to aid the diagnosis of allergic rhinitis.


Assuntos
Cor/normas , Endoscopia/métodos , Mucosa Nasal/anatomia & histologia , Fotografação/instrumentação , Rinite Alérgica/diagnóstico , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Septo Nasal/diagnóstico por imagem , Rinite Alérgica/epidemiologia , Rinite Alérgica/patologia , Sensibilidade e Especificidade , Software , Conchas Nasais/diagnóstico por imagem
11.
J Laryngol Otol ; 134(4): 323-327, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32241312

RESUMO

OBJECTIVE: The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates. METHOD: Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient. RESULTS: A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04). CONCLUSION: The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.


Assuntos
Obstrução Nasal/patologia , Septo Nasal/diagnóstico por imagem , Rinite/patologia , Conchas Nasais/diagnóstico por imagem , Adulto , Idoso , Austrália/epidemiologia , Feminino , Humanos , Hipertrofia , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Obstrução Nasal/terapia , Septo Nasal/patologia , Seios Paranasais/diagnóstico por imagem , Osso Petroso/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Conchas Nasais/patologia
12.
Braz. j. otorhinolaryngol. (Impr.) ; 86(2): 242-246, March-Apr. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1132568

RESUMO

Abstract Introduction: Chronic upper airway obstruction due to marked nasal septal deviation may cause chronic hypoxia. It may change the balance of the sympathetic-parasympathetic system and may affect blood flow in the choroid. Objective: To assess choroidal thickness measurements of patients with marked nasal septal deviation. Methods: The patients who had nasal obstruction symptoms diagnosed with marked nasal septal deviation by anterior rhinoscopy and nasal endoscopy and scheduled for septoplasty were included in the study. The control group consisted of age, sex and body mass index-matched healthy individuals. The choroidal measurements at the central fovea and 1000 µm away from the fovea in the nasal and temporal regions were performed using enhanced depth imaging optical coherence tomography. Results: In the study group, 52 eyes of 26 patients with a mean age of 26.34 ± 8.14 years were examined. In the control group, 52 eyes of 28 healthy individuals with a mean age of 26.69 ± 7.84 years were examined. There was no statistically significant difference in terms of choroidal thickness measurements between the groups (p > 0.05). Conclusion: Our results suggest that marked nasal septal deviation may not lead to significant hypoxia and sympathetic activation, resulting in deterioration of the choroidal blood flow and consequent choroidal thickening.


Resumo Introdução: A obstrução crônica das vias aéreas superiores devido a acentuado desvio do septo nasal pode causar hipóxia crônica. Pode alterar o equilíbrio do sistema simpático-parassimpático e afetar o fluxo sanguíneo na coroide. Objetivo: Avaliar as medidas da espessura da coroide em pacientes com acentuado desvio de septo nasal. Método: Foram incluídos no estudo pacientes que apresentavam sintomas de obstrução nasal, com diagnóstico de acentuado desvio de septo realizado por rinoscopia anterior e endoscopia nasal, e com septoplastia programada. O grupo controle consistiu de indivíduos saudáveis pareados por idade, sexo e índice de massa corporal. As medidas da coroide na fóvea central e a 1.000 µm da fóvea nas regiões nasal e temporal foram feitas com tomografia de coerência óptica com imagem de profundidade melhorada. Resultados: No grupo de pacientes, 52 olhos de 26 pacientes com média de 26,34 ± 8,14 anos foram examinados. No grupo controle, 52 olhos de 28 indivíduos saudáveis com média de 26,69 ± 7,84 anos foram examinados. Não houve diferença estatisticamente significante em termos de medidas da espessura da coroide entre os grupos (p > 0,05). Conclusão: Nossos resultados sugerem que desvios do septo nasal acentuados podem não levar à hipóxia significativa e ativação simpática, resultar na deterioração do fluxo sanguíneo coroidal e consequente espessamento da coroide.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Corioide/patologia , Septo Nasal/anormalidades , Estudos de Casos e Controles , Estudos Prospectivos , Corioide/diagnóstico por imagem , Tomografia de Coerência Óptica , Hipertrofia/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem
13.
Int J Comput Assist Radiol Surg ; 15(4): 725-735, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32078099

RESUMO

PURPOSE: A deviated nasal septum is the most common etiology for nasal airway obstruction (NAO), and septoplasty is the most common surgical procedure performed by ear-nose-throat surgeons in adults. However, quantitative criteria are rarely adopted to select patients for surgery, which may explain why up to 50% of patients report persistent or recurrent symptoms of nasal obstruction postoperatively. This study reports a systematic virtual surgery method to identify patients who may benefit from septoplasty. METHODS: One patient with symptoms of NAO due to a septal deviation was selected to illustrate the virtual surgery concept. Virtual septoplasty was implemented in three steps: (1) determining if septal geometry is abnormal preoperatively, (2) virtually correcting the deviation while preserving the anatomical shape of the septum, and (3) estimating the post-surgical improvement in airflow using computational fluid dynamics. Anatomical and functional changes predicted by the virtual surgery method were compared to a standard septoplasty performed independently from the computational analysis. RESULTS: A benchmark healthy nasal septum geometry was obtained by averaging the septum dimensions of 47 healthy individuals. A comparison of the nasal septum geometry in the NAO patient with the benchmark geometry identified the precise locations where septal deviation and thickness exceeded the healthy range. Good agreement was found between the virtual surgery predictions and the actual surgical outcomes for both airspace minimal cross-sectional area (0.05 cm2 pre-surgery, 0.54 cm2 virtual surgery, 0.50 cm2 actual surgery) and nasal resistance (0.91 Pa.s/ml pre-surgery, 0.08 Pa.s/ml virtual surgery, 0.08 Pa.s/ml actual surgery). CONCLUSIONS: Previous virtual surgery methods for NAO were based on manual edits and subjective criteria. The virtual septoplasty method proposed in this study is objective and has the potential to be fully automated. Future implementation of this method in virtual surgery planning software has the potential to improve septoplasty outcomes.


Assuntos
Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Rinoplastia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Prognóstico , Software , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
14.
Int J Oral Maxillofac Surg ; 49(10): 1260-1263, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32088131

RESUMO

Endoscopic approaches for septal perforation closure have achieved a certain popularity. Many of the flaps described provide unilateral closure of the perforation. Thus, complete restoration of the normal multilayer septal anatomy is still challenging, particularly in children. This article presents a modified technique for endoscopic bilateral surgical repair of nasal septal perforations. A novel cross-septal returned flap was performed in nine patients with nasal septal perforations. The mean size of the perforation was 17.7mm in the sagittal axis and 16.9mm in the vertical axis. All patients were followed up for a minimum of 12 months (range 12-31 months). There was only one case of residual septal perforation during the follow-up period, but with a significant decrease in the severity of symptoms. The results of the surgical technique presented show its high efficacy. We believe that the best indication for this technique is non-epithelized perforation edges that cannot be used as a reliable bridge for the preparation of any cross-over flaps. Use of the cross-septal returned flap allows the complete bilateral repair of nasal septal perforations to be achieved.


Assuntos
Perfuração do Septo Nasal , Criança , Progressão da Doença , Endoscopia , Humanos , Perfuração do Septo Nasal/diagnóstico por imagem , Perfuração do Septo Nasal/cirurgia , Septo Nasal/diagnóstico por imagem , Septo Nasal/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento
15.
J Craniofac Surg ; 31(3): e285-e288, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32068734

RESUMO

OBJECTIVE: To investigate the impact of the presence and the severity of the nasal septal deviation (NSD) on the paranasal pneumatization. METHODS: Initially, the deviated and contralateral sides was compared to evaluate the impact of the presence of NSD on pneumatization. Then, NSD classification groups were categorized according to the severity of deviation degree; 1: mild (<9°), 2: moderate (9°-15°), and 3: severe (>15°). Pneumatization of all paranasal sinuses, osteomeatal complex (OMC), frontoethmoid recess (FER) and variant structures were compared according to the NSD classification groups separately both for the deviated and the contralateral sides. RESULTS: Although there was no statistically significant difference in pneumatization of the paranasal sinuses between the deviated and contralateral sides, a significant difference was observed in OMC and FER diameters. In the deviated side, there was statistically significant difference in ethmoid sinus volume, in FER and OMC diameters between NSD classification groups. In the contralateral side, FER and OMC diameters were found to be significantly different between group 1 and group 2 and between group 1 and group 3, respectively (P = 0.04 and 0.06, respectively). Both the presence and severity of the NSD did not statistically significant influence the pneumatization of variant structures, air cells and vital structures. CONCLUSION: The severity of NSD effects the ethmoid sinus volume. The relationship of FER and OMC with NSD is evident, however this may not always be in a proportional pattern. The paranasal pneumatization did not affect Keros type, bone integrity of carotid canal and optic canal.


Assuntos
Septo Nasal/diagnóstico por imagem , Deformidades Adquiridas Nasais/diagnóstico por imagem , Adolescente , Adulto , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
J Craniofac Surg ; 31(3): 813-815, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049913

RESUMO

BACKGROUND: Alveolar clefts give rise to many aesthetic and functional problems among affected patients. Therefore, surgical adjustments of the bony defective anomalies are important. The authors performed secondary bone grafts and analyzed the effects particularly on the nasal septum and maxillary area (midface). METHODS: The patients who had alveolar bone grafts were retrospectively reviewed with pre/postoperative 3-dimensional computed tomography; the measurements included distances between the anterior nasal spine (ANS) and the vertical midline, angles between the nasal septum and the transverse line, and angles between the floor of the pyriform aperture and the transverse line. RESULTS: A total number of 23 patients were finally included in the study. The mean age of the patients was 9.7 ±â€Š1.95 years (range, 7-14 years). The mean distance between the ANS and the vertical midline was 5.3 ±â€Š4.70 mm/4.9 ±â€Š4.15 mm pre/postoperatively, showing the mean paired difference of 0.4 ±â€Š0.89 mm (P < 0.05). The mean angles between the nasal septum and the transverse line and between the floor of the pyriform aperture and the transverse line were 64.5 ±â€Š14.69°/65.9 ±â€Š13.73° and 21.7 ±â€Š8.94°/11.5 ±â€Š7.03° pre/postoperatively, showing the mean paired differences of -1.4 ±â€Š2.78° and 10.1 ±â€Š8.20°, respectively (both P < 0.05). CONCLUSION: The results suggest that secondary alveolar bone grafting has expanded effects on the adjacent midfacial structures.


Assuntos
Fissura Palatina/diagnóstico por imagem , Maxila/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Adolescente , Enxerto de Osso Alveolar , Transplante Ósseo , Criança , Fissura Palatina/cirurgia , Feminino , Humanos , Masculino , Maxila/cirurgia , Septo Nasal/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
17.
Niger J Clin Pract ; 23(2): 240-245, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32031100

RESUMO

Aims: Le Fort I (LI) osteotomy has been used for the correction of dento-facial deformities of the midface. The aim of this study was to determine the effects of advancement and impaction of the maxilla with LI osteotomy on the nasal cavity and septum. Patients and Methods: In this study, 40 adult patients, 23 females and 17 males (mean age 20.52 ± 4.4 years), who underwent single-piece LI advancement and impaction surgery combined with a bilateral sagittal split osteotomy (BSSO) were included. Posterior-anterior (PA) and lateral cephalometric radiographs taken before surgery (T0) and at least three months after surgery (T1) were evaluated. The superior and anterior movements of maxilla, changes of the nasal cavity, nasal septum and maxillo-mandibular parameter were measured on the cephalometric radiographs. Treatment changes were statistically analyzed using paired sample t-test, and Pearson correlation analysis was applied for the determination of the relationship between variables. Results: There was no statistically significant change in the deviation parameters (P > 0,05). However, a statistically significant decrease was found for left and right nasal cavity heights after LI osteotomy (P < 0.05). Furthermore, no significant correlation was found between septal deviation angle and extent of maxillary movement (P > 0.05). Positive correlation was found between nasal cavity width and amount of maxillary impaction. (P < 0.05). Conclusion: The influence of maxillary impaction with LI osteotomy on nasal septum deviation was not found significant but maxillary impaction with LI osteotomy significantly increased the nasal cavity width.


Assuntos
Mandíbula/cirurgia , Maxila/cirurgia , Septo Nasal/diagnóstico por imagem , Deformidades Adquiridas Nasais/etiologia , Cirurgia Ortognática/métodos , Osteotomia de Le Fort/métodos , Complicações Pós-Operatórias , Adolescente , Feminino , Humanos , Masculino , Cavidade Nasal , Septo Nasal/cirurgia , Osteotomia de Le Fort/efeitos adversos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
18.
J Craniofac Surg ; 31(3): 801-803, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31934966

RESUMO

INTRODUCTION: Endoscopic sinus surgeries (ESS) are frequently used in the treatment of optic nerve decompression, other intracranial lesions and sinonasal pathologies. The olfactory fossa can be localized on different levels in relation to the anterior cranial fossa. The aim of the present study was to evaluate the depth and width of the olfactory fossa (OF) in relation to nasal septum deviation (NSD). METHODS: A total of 225 patient (141 female and 84 male, age range between 15 to 56 years) of cone beam computed tomography (CBCT) data was used in this study. NSD, OF width, OF depth were measured. OF depth which was grouped according to the Keros classification as Type I, II, and III was calculated. All measurements were performed bilaterally except for NSD. RESULTS: In the right and left OF depth were found Keros Type I 32 (14.2%) and 30 (13.3%), Keros Type II 171 (76%) and 167 (74.2%), and Keros Type III 22 (9.8%) and 28 (12.4%) respectively. There was no statistically significant found between OF depth and NSD (P > 0.05). The mean angle of the NSD in men and women were 4.36 ±â€Š4.69 in women 4.11 ±â€Š4.36, respectively. The mean width of the right OF was 2.50 ±â€Š0.64 mm and 2.58 ±â€Š0.72 mm for the left side and there was no statistically significant association between OF width - NSD and OF width - OF depth (P > 0.05). CONCLUSION: The anatomy of the OF should be well established before surgical intervention increase of the length of the lateral lamella is also increases the risk of developing complications such as cerebral damage, hemorrhage, and cerebrospinal fluid fistula during endoscopic sinus surgery. Although there is no significant difference between OF measurement and NSD, with three-dimensional imaging detailed research is required before endoscopic sinus surgical operations.


Assuntos
Septo Nasal/diagnóstico por imagem , Deformidades Adquiridas Nasais/diagnóstico por imagem , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico , Fossa Craniana Anterior/diagnóstico por imagem , Fossa Craniana Anterior/cirurgia , Endoscopia , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Adulto Jovem
19.
J Craniofac Surg ; 31(3): 778-781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895848

RESUMO

Nasal septal body is a thickened mucosal area of nasal septum with an unknown certain role. In this study, the authors aimed to investigate the association between the area, length, and width of the nasal septal body with inferior turbinate hypertrophy (ITH) and allergic rhinitis (AR). A total of 106 patients with ITH (54 with AR and 52 without AR), and 49 patients without ITH and AR (control group) were included in this study. Using axial and coronal paranasal computed tomography scans, the area, length, and width of nasal septal body were measured, and the mean values between the groups were compared. Mean area, length, and width of nasal septal body significantly differed among 3 groups (P < 0.001). Septal body area was significantly greater in ITH with AR group, compared to ITH without AR group (P < 0.001) and the control group (P < 0.001). Also, it was significantly greater in ITH without AR group compared to the control group (P < 0.001). Septal body width was significantly greater in ITH with AR group, compared to ITH without AR group (P < 0.001) and the control group (P < 0.001). Also, it was significantly greater in ITH without AR group compared to the control group (P < 0.001). Patients with ITH had a greater nasal septal body area, length, and width, compared to the patients without. Moreover, AR had an additional increasing effect on the area and width of the nasal septal body.


Assuntos
Septo Nasal/diagnóstico por imagem , Doenças dos Seios Paranasais/diagnóstico por imagem , Rinite Alérgica/diagnóstico por imagem , Conchas Nasais/diagnóstico por imagem , Adolescente , Adulto , Tamanho Corporal , Feminino , Humanos , Hipertrofia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto Jovem
20.
J Craniofac Surg ; 31(3): 782-786, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895849

RESUMO

OBJECTIVES: This study aimed to investigate the relationship between nasal septal deviation and paranasal abnormalities in the etiology of primary acquired nasolacrimal duct obstruction (PANDO). METHODS: A total of 37 (8 men, 29 women) patients (48 eyes with PANDO) between the ages 20 and 77 years (mean age, 52.8 ±â€Š13.1 years) were included in the study. In the axial sections of paranasal sinus computed tomography, the transverse diameters at the most upper part and the most distal part of the nasolacrimal canal were separately measured. In addition, the relationships between PANDO and nasal septal deviation, inferior turbinate hypertrophy, agger nasi cells, paradoxical middle turbinate, concha bullosa, and the angle between the bony inferior turbinate and medial wall of the maxillary sinus were investigated. RESULTS: A statistically significant relationship was found between PANDO and the axial location of septal deviation classification, axial angle of septal deviation classification, paradoxical middle turbinate, angle between the bony inferior turbinate and medial wall of the maxillary sinus and inferior meatus measure. CONCLUSION: The authors concluded that the location and angle of the nasal septal deviation in the axial plane, width of the angle between the bony inferior turbinate and medial wall of the maxillary sinus, inferior meatus measure, and paradoxical middle turbinate may be effective factors in the etiology of PANDO.


Assuntos
Obstrução dos Ductos Lacrimais/etiologia , Septo Nasal/diagnóstico por imagem , Ducto Nasolacrimal/diagnóstico por imagem , Deformidades Adquiridas Nasais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Deformidades Adquiridas Nasais/complicações , Tomografia Computadorizada por Raios X , Adulto Jovem
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