Septoplasty in children Cingi, Cemal; Muluk, Nuray Bayar; Ulusoy, Seckin ...
American journal of rhinology & allergy,
2016 Mar-Apr, 2016-03-00, 20160301, Volume:
30, Issue:
2
Journal Article
Peer reviewed
Physicians have long had concerns about the potential harmful effects of pediatric septoplasties on the nasoseptal growth process because septal cartilage is important for the growth and development ...of the face.
In this review article, pediatric septoplasty and its indications are discussed, together with a literature survey. In addition, overviews of development of the nasal skeleton from neonate to adult, nasal growth, and cartilaginous septum are presented. Important issues and comments on pediatric septoplasties are provided.
During septoplasty procedures, elevation of the mucoperichondrium unilaterally or bilaterally does not negatively affect growth of the face. Stabilization of the septum may be easier when mucosal elevation is performed unilaterally. The nasal floor mucosa should not be elevated so to avoid damage to the incisive nerves. Corrections and limited excisions may be done from the cartilaginous septum. Separation of the septal cartilage from the perpendicular plate, especially at the dorsal part, should not be performed because this area is important for the length and height of the nasal septum and nasal dorsum. Incisions or excisions should not be performed through the growing and supporting zones, especially at the sphenoethmoid dorsal zone.
If there are severe breathing problems related to the septal deviation, septoplasty should be performed. In the majority of cases, septal surgery may be conducted in 6-year-old children. However, if necessary, septal surgery may be performed in younger children and even at birth.
Introduction. Innate immunity is the first protection against microorganisms. Nowadays, there is a growing interest in innate immune molecule known as palate, lung, nasal epithelial clone (PLUNC). ...PLUNC is a specific product of the airways, of approximately 25 kDa, encoded by adjacent genes found within a 300 kb region of chromosome 20; these proteins must be detected predominantly in the upper respiratory tract. Materials and Methods. We performed a case-control study to investigate the presence of this protein in nasal tissue of patients affected by chronic rhinosinusitis. 59 patients were enrolled (44 cases, 15 controls). We have examined the correlation between the presence of pathology and the PLUNC proteins positivity. Results. 100% of controls have a +++ rated PLUNC proteins positivity, while cases have a lower percentage of positivity. We used χ2 statistical test to analyze the results of the study and there is a difference statistically significant between cases and controls in PLUNC proteins positivity. Conclusions. These observations suggest that, in response to agents or chemical factors, nasal mucosal epithelium will react and produce PLUNC proteins. So PLUNC proteins have a protective function on upper airways mucosa, as we can see by evaluating the high positivity in control group.
We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal ...rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery.
The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.
Obstructive sleep apnea is a chronic disease characterized by the appearance of apnea or hypopnea episodes during sleep. This condition is associated with several risk factors. Among them, the most ...important is obesity and it is the only potentially curable. The treatment is polimodal and it involves several therapeutic directions. The purpose of this paper is to establish the role of obesity in the etiology of sleep apnea, as well as the role of the weight loss in its management, both through intensive lifestyle interventions and surgical therapy.
Juvenile nasopharyngeal angiofibroma is a rare benign tumour of vascular origin found in adolescent males, originating around the sphenopalatine foramen. Although the exact pathogenesis of the tumour ...is not yet known, natural history and growth patterns can be predicted. JNA progressively involves the nasopharynx, nasal cavity, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and, in severe cases, an orbital or intracranial extension can be seen. Early diagnosis based on clinical examination and imaging is mandatory to ensure the best resectability of the tumour, as small to moderate tumours can be managed exclusively endoscopically. Preoperative angiography can reveal the vascular sources and allow embolization to prevent significant bleeding. We present a brief literature review followed by our case series of endoscopic removal of 7 juvenile nasopharyngeal angiofibromas.
An irreversible disease, cystic fibrosis (CF), is responsible for affecting multiple organ systems containing epithelia. It is well known that the sinonasal disease caused by CF has consequences for ...the incidence of the lower airway exacerbations, as well as affecting the quality of life of those patients. This review provides an update by evaluating the available literature regarding pathogenesis, management and treatment of cystic fibrosis patients. To gain a better view of the disease and obtain a higher life expectancy, further studies are needed.
BACKGROUND. Crista galli is an anatomical structure localized in the midline, that derives from the ethmoid bone, with a compact bone structure, sometimes pneumatized. The connection between the ...pneumatized crista galli and the adjacent paranasal structures is usually performed through an opening similar with a sinusal ostium.
MATERIAL AND METHODS. We performed a retrospective clinical study about the incidence of the pneumatization of crista galli in 196 patients with chronic sinusitis. We evaluated the degree of pneumatization and the drainage pathways of crista galli, trying to correlate the radiological findings with the symptomatology of the patients with crista galli “sinusitis”.
RESULTS. Pneumatization of crista galli was found in 30.1% of cases. From 59 patients with chronic rhinosinusitis and pneumatized crista galli, 66.4% had no opacification, 23.7% various degrees of opacification and 11.9% showed complete opacification. The presence of an opening of the pneumatized crista galli into surrounding air-cells was found in 16.98% of the patients. Headache was encountered in 76.2% of the patients with CRS and pneumatized crista galli sinusitis.
CONCLUSION. When analyzing a CT scan of a patient with CRS, we should also take into consideration the pneumatization of crista galli, which has a high variability. Most of the patients included in our study had also a certain degree of opacification of the pneumatized crista galli. Headache had a higher incidence in patients with crista galli inflammation than in CRS patients who showed no pneumatization or opacification of the crista galli (76.2% versus 60.5% in “simple” CRS patients).
Sleep apnea is a pathology with an ever-increasing spread, the causes being the most diverse. In this study we focus on sleep breathing disorders caused by nasal obstruction and also by soft palate ...and uvula anatomical changes. The right treatment recommended in this pathology according to the American Academy Sleep Medicine (AASM) is non-invasive ventilation – positive airway pressure (CPAP). A substantial percentage of patients with obstructive sleep apnea seek alternatives to CPAP and the solution for this can be upper airway surgery.
The attempt to demonstrate the viability of upper respiratory tract surgery as an alternative to CPAP treatment, demonstrating objectives by pre- and postoperative polysomnographic control.
Aggregating the data from all 54 patients with nasal obstruction and pharyngeal modifications, we observed a decrease in AHI from 20.406/h to 15.86/h, representing 32.36%, an improvement in sleep architecture and especially REM sleep from 41.5 minutes initially to 67.8 minutes (increased value with 63.37 percent).
The benefits of nasopharyngeal repermeabilization surgery are represented by decreasing the severity of respiratory events and, second to this, lowering the number of arousals. By reducing the number of arousals, one will obtain a better percentage regarding the deep sleep phase - REM, having a beneficial effect on reducing the daytime sleepiness – which is a major symptom that patients are present.
Signal void, or the absence of signal on MRI sequences, in the sinonasal region may be encountered in fungal rhinosinusitis cases with the aspect of a pseudo-pneumatized sinus, leading to diagnostic ...errors.
We present the case of a 75-year-old woman referred to our clinic for complete and persistent right-sided nasal obstruction. The patient was evaluated using sinus CT and contrast-enhanced head MRI. Opacification of the right maxillary, ethmoid and frontal sinuses as well as of the right nasal fossa were seen on CT, with maxillary sinus expansion and osseous erosion. The MRI showed T2 signal void in the maxillary sinus with extension to the nasal fossa, creating the appearance of a pseudo-pneumatized sinus, and hyperintense signal in the ipsilateral anterior ethmoid and frontal sinuses. The patient underwent endoscopic sinus surgery. The dual imaging evaluation of the patient aided the preoperative differential diagnosis and choosing the surgical approach.
Malignancies of the upper aerodigestive tract are high morbidity bearing and life-threatening diseases, which require thorough care from diagnostic suspicion and confirmation to surgical and/or ...oncologic treatment and rehabilitation. Difficulties in managing head and neck cancers arise from delays in diagnosis and treatment caused by either patient-related factors or healthcare system-related factors. Tumor origin and stage determine whether surgical excision is feasible, the approach required for safe excision, the extent of functional and aesthetic sacrifice required to attain oncologic safety and the need for reconstructive surgery. A thorough and systematic preoperative risk versus benefits assessment to select potential surgical candidates and give realistic outcomes is important from both a medical and a legal point of view. Because tumors in the head and neck region frequently involve more than one system and sensory organ, potential loss of function from either the disease course, surgical or nonsurgical treatment should be taken into account form a quality of life perspective. Effective management of head and neck cancer patients requires the cooperation and combined effort of a multidisciplinary team of surgeons, physicians and other workers over a long period of time which, in the absence of a specialised head and neck cancer centre and guidelines, can lead to increased morbidity and mortality, and patient dissatisfaction.
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