Benign Salivary Gland Tumour Presenting as Unilateral Nasal Mass: Case Report of Pleomorphic Adenoma of Nasal Septum

Introduction: Unilateral nasal mass can be benign or malignant. Very rarely we will find benign salivary gland tumor in nasal cavity. Pleomorphic adenoma is still the most common pathological variety either in major or minor salivary gland tumors. In the nasal cavity, even though most of the accessory salivary glands are present in the lateral wall of nose, nasal septum remains the most common site of origin. Case Report: A 40-year-old female presented with right-sided nasal obstruction and epistaxis. CT scan of Nose and Paranasal sinuses found a lesion involving the anterior third of the right nasal cavity. The patient underwent complete surgical resection of the tumor via an endonasal approach. Histological examination found a mixed cellular component (epithelial and myoepithelial) and mesenchymatous tissue with chondromyxoid stroma, enabling diagnosis of a typical pleomorphic adenoma. Conclusion: Pleomorphic adenoma is the most common salivary gland tumor but rare to find in the nasal cavity with only few cases reported in the literature. Although benign, the risk of local recurrence, malignant transformation and metastasis requires close long-term follow-up.

Nasal septal foreign body as a complication of dental root canal therapy: A case report

BACKGROUND Currently,there have been no reports on foreign bodies found in the nasal septum after dental root canal therapy.Herein,we present an unusual case of a foreign body found in the nasal septum,which occurred after dental root canal therapy and two unsuccessful surgeries.CASE SUMMARY A 55-year-old man was referred to our department due to slight nasal discomfort that persisted for about 1 wk.Before consulting our department,the patient visited three different hospitals/clinics and underwent two surgeries that were not successful in removing a foreign body completely.A computed tomography scan was performed to detect the shift of the foreign body from dental root to the nasal septum,which resulted in the healing of oral inflammation and nasal septum discomfort.An endoscopic foreign body extraction surgery(3rd removal surgery)was then successfully performed,using a needle as the reference.No nasal reconstruction was required after the operation.Postoperative healing was uneventful.CONCLUSION Medical healthcare professionals should consider past medical history when dealing with foreign body cases.During septal foreign body extraction surgery,a needle could be used as a helpful reference.

“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect

BACKGROUND At present,neuroendoscopy technology has made rapid development,and great progress has been made in the operation of lesions in the saddle area of the skull base.However,the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications,which may lead to poor prognosis.AIM To investigate the method of in situ bone flap combined with nasal septum mucosal flap for reconstruction of enlarged skull base defect by endonasal sphenoidal approach and to discuss its application effect.METHODS Clinical data of 24 patients undergoing transnasal sphenoidal endoscopic approach in the Department of Neurosurgery,Affiliated 2 Hospital of Nantong University from January 2019 to December 2022 were retrospectively analyzed.All patients underwent multi-layer reconstruction of skull base using in situ bone flap combined with nasal septum mucosa flap.The incidence of intraoperative and postoperative cerebrospinal fluid leakage and intracranial infection were analyzed,and the application effect and technical key points of in situ bone flap combined with nasal septum mucosa flap for skull base bone reconstruction were analyzed.RESULTS There were 5 cases of high flow cerebrospinal fluid(CSF)leakage and 7 cases of low flow CSF leakage.Postoperative cerebrospinal fluid leakage occurred in 2 patients(8.3%)and intracranial infection in 2 patients(8.3%),which were cured after strict bed rest,continuous drainage of lumbar cistern combined with antibiotic treatment,and no secondary surgical repair was required.The patients were followed up for 8 to 36 months after the operation,and no delayed cerebrospinal fluid leakage or intracranial infection occurred during the follow-up.Computed tomography reconstruction of skull base showed satisfactory reconstruction after surgery.CONCLUSION The use of in situ bone flap combined with vascular pedicled mucous flap to reconstruction of skull base defect after endonasal sphenoidal approach under neuroendoscopy has a lower incidence of cerebrospinal fluid leakage and lower complications,which has certain advantages and is worthy of clinical promotion.

A Rare Cause of Facial Cellulitis

Facial cellulite are infections of the cellulo-adipose tissues of the human face. Head and neck cellulitis is today one of the most serious ENT emergencies, which is very life-threatening and requires immediate multidisciplinary care. Diabetes mellitus is one of the most common predisposing factors. They are serious conditions because of the rapidity with which they tend to spread. They perform an extensive necrotizing condition, developing from a banal, pharyngeal or dental infection, and spreading along the aponeurotic partitions of the face and neck. The etiologies are diverse and come mainly from dental infections. Nasosinus infections can be the cause especially on immunocompromised patients. The diagnosis is mainly clinical. The treatment is medico-surgical and must start as soon as the diagnosis is made to avoid complications. We report a case of an abscess of the nasal septum responsible for facial cellulitis in 45-year-old diabetic patient. Her diabetes was irregularly followed. The septal abscess spread over a few days to the tissues of the face. He was received in a picture of impaired general condition with significant facial oedema. He received rapid and appropriate medical and surgical car. He progressed well under treatment after 15 days.

婴幼儿鼻中隔毛息肉2例

毛息肉是一种罕见的口咽或鼻咽部的先天畸形,是局部组织发育异常所致,一般由中胚层(纤维脂肪组织、软骨或肌肉)和外胚层(角化层状鳞状上皮和皮肤附件)构成,生长于婴幼儿咽后壁的中线或近中线处。文献报道毛息肉多发生于鼻咽部,而发生在鼻中隔的较为罕见。其性质是畸胎瘤还是发育异常,尚有争议。现将河北省儿童医院耳鼻咽喉科治疗的鼻中隔毛息肉2例报道如下。

Management of Sphenoidal Sinus Lesions by Septal-assisted Approach: Surgical Skills and Advantages

Summary： The aim of this study was to develop a less invasive trans-septal approach for the endo- scopic management of sphenoid sinus lesions. We performed a septal-assisted surgical procedure for endoscopic sphenoidectomy in 38 patients with isolated or combined sphenoidal sinus lesions, including fungal balls, mucoceles, purulent cystic sphenoidal sinusitis, etc. The posterior portion of the nasal sep- turn became flexible after removal of the vomer and the sphenoidal rostrum. The superior portion of the common meatus was expanded to accommodate the endoscope after the septum was repositioned con- tra-laterally. The lesions were individually managed through the enlarged ostiums while damage to the mucosa of the front sphenoidal wall was avoided. All the procedures were completed successfully without intraoperative complications, and the bony ostiums were identified easily and enlarged accu- rately. During the follow-up period of 16 weeks to 2 years, no re-atresia or restenosis was observed. The recurrence rate was 0. No postoperative complications were recorded. All the responses from the pa- tients were satisfactory. It was concluded that endoscopic sphenoidectomy assisted by trans-septal ap- proach is a feasible, safe, effective and minimally invasive approach for selected cases with unilateral or bilateral lesions in the sphenoid sinuses.

双瓣叠加法修复鼻中隔大穿孔1例

1 临床资料患者,女,30岁,因鼻内镜术后鼻中隔穿孔1年收治入院。患者于10年前无明显诱因下出现流脓涕,色黄质稠,伴鼻塞,间断口服药物(具体不详)治疗,症状未见明显改善。1年前于外院就诊,诊断:慢性鼻窦炎不伴鼻息肉,行鼻内镜手术,术后门诊随访期间再次出现流黄脓涕,伴头晕、闷胀等不适,并出现涕中带血。经鼻内镜检查发现鼻中隔穿孔,予外用药物(具体不详)涂抹穿孔处治疗,但穿孔未缩小反而逐渐增大,否认梅毒、结核等病史。

Repair of Full-Thickness Defects of the Lower Eyelid

The defect after an enlarged resection of lower eyelid tumor was reconstructed by transplantation of a mucosaCartilage composite graft from the nasal septum and a mucosa graft from the oral cavity for inner part of the eyelid. A pedicled skin flap from the adjacent region was rotated to cover the defect. The results in 4 patients were all satisfactory. The keypoint of the operation is the selection and design of an ideal pedicled skin flap.

Comparison of visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) score in evaluation of post septoplasty patients

Objective:To compare and correlate the efficacy of the NOSE score&the VAS score in determining the symptomatic benefit in patients undergoing septoplasty.Materials and methods:Eighty patients with deviated nasal septum undergoing septoplasty were included in the study.NOSE score&VAS score(out of 100)was documented before and after surgery.Results were correlated and compared statistically.Results:In the NOSE score,the most bothersome symptom was trouble breathing through the nose(85.83);followed by Nasal obstruction or blockage(82.50).Wilcoxon test showed significant improvement with NOSE score and VAS score in all patients at 1 month and 3 months.Spearman’s coefficient showed a positive correlation between the two,though the score improvement and patient satisfaction rate was significantly high with NOSE score.Conclusions:NOSE score and the VAS score both provide effective framework for evaluating treatment responses after septoplasty.However,the NOSE score showed higher improvement and better patient satisfaction rate when used to measure of nasal obstruction as compared to the VAS score.

Healing of the nasal septal mucosa in an experimental rabbit model of mucosal injury

Objective:The aim of this study was to investigate the regeneration process of the nasal mucosa after a surgically created mucosal defect in the rabbit nasal septum,and to evaluate the effects of different interventions.Methods:A 7 mm-diameter circular mucosal defect was made in the septum of forty New Zealand white rabbits.The rabbits were divided into four groups (ten rabbits in each group) according to the type of intervention;no treatment (control),silastic sheet (SS),hyaluronic acid (HA),and silastic sheet and hyaluronic acid (SS + HA) group.The diameter of the defect,mucosal thickness,epithelial thickness,and ciliated cell count were evaluated every week for five weeks.Results:The average diameter of the defect in the control group were 5.1,3.65,1.2,0.75,and 0.05 mm at postoperative 1,2,3,4,and 5 weeks.In the SS group,the diameter decreased to 4.35,2.1,0.35,0.15,and 0 mm at postoperative 1,2,3,4,and 5 weeks,respectively,in which the mean diameter of the postoperative week 2 was significantly smaller compared to control (3.65 mm vs.2.1 mm,P =0.039).For the HA group and SS + HA group,the diameter of the defect did not show a significant difference from the control group during the five weeks.The mucosal thickness,epithelial thickness,and ciliated cell count of the regenerated mucosa were not significantly different among the groups.Conclusion:The regeneration process of the nasal septal mucosa was identified using a novel rabbit model.Mucosal regeneration can be accelerated by applying silastic sheets.

Septoplasty alone is not suitable for most structural nasal obstructions

Septoplasty is widely used in the treatment of structural nasal obstructions,and it also has a good effect and a high degree of postoperative satisfaction.However,there a large number of structures demonstrate abnormalities related to structural nasal obstruction,including the external nose,maxilla,nasal cavity and paranasal sinus.Nasal septum deviation is only one signs of structural nasal obstruction and does not represent all possible structural abnormalities of the nasal cavity and its surrounding structure.Septoplasty is only performed to correct deviations of the nasal septum,which in many cases is obviously insufficient in restoring the symmetry of the nasal structure.Therefore,septoplasty alone is not suitable for the treatment of most structural nasal obstructions.Nasal ventilation expansion surgery,which typically covers more abnormal structural correction procedures than septoplasty,should be used when describing the treatment of structural nasal obstruction.

Total nasal septal reconstruction using costal cartilage in difficult cases of secondary septoplasty

Rhinoplasty and septal reconstruction often require the use of cartilage grafts.Complete nasal septal reconstruction may be required in very specific situations like difficult secondary septoplasty or severely deformed post traumatic noses.Usually in these cases the septal cartilage or bone is insufficient for septal reconstruction.The authors hereby describe a new technique of complete septal reconstruction by using the 7th rib(costal)cartilage combined with author’s ingenious technique to prevent warping.