Postoperative pneumocranium after endoscopic transnasal optic canal decompression

Dear Editor,We present the first time,a case of a patient developed cerebrospinal fluid(CSF)leak and pneumocranium following optic canal decompression(OCD).INTRODUCTION Indirect traumatic optic neuropathy(ITON)impairs visual functions and quality of life.Endoscopic transnasal optic canal decompression(ETOCD)is one of the standard treatment strategies for the ITON.During the ETOCD,the optic nerve sheath are usually incised for sufficient decompression of optic nerve after removal of optic canal,which is associated with complications like CSF leakage,ophthalmic artery injury,and optic nerve injury[1].Generally,the mild CSF leak is common and can heal spontaneously using conventional treatment,the severe CSF leak requires surgical repair[2].

Treatment of primary nasal tuberculosis with anti-tumor necrosis factor immunotherapy:A case report

BACKGROUND Primary nasal tuberculosis(TB)is a rare form of extrapulmonary TB,particularly in patients receiving anti-tumor necrosis factor(TNF)immunotherapy.As a result,its diagnosis remains challenging.CASE SUMMARY A 58-year-old male patient presented to the ear,nose,and throat department with right-sided nasal obstruction and bloody discharge for 1 month.He was diagnosed with psoriatic arthritis and received anti-TNF immunotherapy for 3 years prior to presentation.Biopsy findings revealed chronic granulomatous inammation and a few acid-fast bacilli,suggestive of primary nasal TB.He was referred to our TB management department for treatment with oral anti-TB agents.After 9 months,the nasal lesions had disappeared.No recurrence was noted during follow-up.CONCLUSION The diagnosis of primary nasal TB should be considered in patients receiving TNF antagonists who exhibit thickening and crusting of the nasal septum mucosa or inferior turbinate,particularly when pathological findings suggest granulomatous inflammation.

Nasal Dermoid Cyst with Sinus Tract Intranasal Bone: A Case Report

Dermoid cysts are benign tumors originating from germ cells, which can form in various locations, including the nasal area in rare cases. They are of unknown exact etiology, but it is suggested that it is due to abnormal tissue migration during early embryonic development. Nasal dermoid cysts albeit rare, can present in various forms such as sinuses, fistulas, or intracranially extending tracts. They can be asymptomatic and incidentally discovered or present with a visible external mass or sinus that is either painful, infected or cosmetically concerning. If nasal dermoid cysts with an intra-nasal bone sinus tract are left untreated, they can lead to life-threatening complications. This report describes the case of a 6-year-old girl with a nasal dermoid cyst connected to a superficial punctum by an intra-nasal tract. She had undergone surgical excision of a nasal swelling previously diagnosed as a dermoid cyst. One year later, she returned to our clinic with a recurrence of the nasal swelling. Imaging tests revealed a nasal dermoid cyst with a tract extending to the nasal tip, without intracranial expansion. The cyst, along with the entire tract, was successfully removed surgically, and the postoperative follow-up indicated no complications. Histopathology confirmed the diagnosis of a dermoid cyst. This case underscores the significance of considering the dermoid tract in nasal cyst cases and the necessity of its complete removal to prevent recurrence.

Intranasal administration of carbamazepine-loaded carboxymethyl chitosan nanoparticles for drug delivery to the brain

Epilepsy is considered as a common and diverse set of chronic neurological disorders and its symptoms can be controlled by antiepileptic drugs(AEDs). The presence of p-glycoprotein and multi-drug resistance transporters in the blood-brain barrier could prevent the entry of AEDs into the brain, causing drug resistant epilepsy. To overcome this problem, we propose using carboxymethyl chitosan nanoparticles as a carrier to deliver carbamazepine(CBZ) intranasally with the purpose to bypass the blood-brain barrier thus to enhance the brain drug concentration and the treatment efficacy. Results so far indicate that the developed CBZNPs have small particle size(218.76 ± 2.41 nm) with high drug loading(around 35%) and high entrapment efficiency(around 80%). The in vitro release profiles of CBZ from the NPs are in accordance with the Korsmeyer-peppas model. The in vivo results show that both encapsulation of CBZ in nanoparticles and the nasal route determined the enhancement of the drug bioavailability and brain targeting characteristics.

Preparation, characterization and in vivo evaluation of alginate-coated chitosan and trimethylchitosan nanoparticles loaded with PR8 influenza virus for nasal immunization

For efficient mucosal vaccine delivery, nanoparticulate antigens are better taken by microfold cells in the nasal associated lymphoid tissue and also dendritic cells. Nanoparticles based on polymers such as chitosan(CHT) and its water soluble derivative, trimethylchitosan(TMC), could be successfully used as carrier/adjuvant for this purpose. Sodium alginate, a negatively charged biopolymer, could modify the immunostimulatory properties of CHT and TMC NPs and increase their stability. Sodium alginate(ALG)-coated chitosan(CHT)and trimethylchitosan(TMC) nanoparticles(NPs) loaded with inactivated PR8 influenza virus were successfully prepared by direct coating of the virus with CHT or TMC polymers to evaluate their immunoadjuvant potential after nasal immunization. After nasal immunizations in BALB/c mice, PR8-CHT formulation elicited higher IgG2 a and Ig G1 antibody titers compared with PR8-TMC. ALG coating of this formulation(PR8-CHT-ALG) significantly decreased the antibody titers and a less immune response was induced than PR8-TMC-ALG formulation. PR8-TMC-ALG formulation showed significantly higher Ig G2 a/Ig G1 ratio, as criteria for Th1-type immune response, compared with PR8-CHT-ALG and PR8 virus alone. Altogether, the PR8-TMC-ALG formulation could be considered as an efficient intranasal antigen delivery system for nasal vaccines.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Diagnostic errors of nasal fractures in the emergency department:A monocentric retrospective study

Nasal bone fracture is one of the most common face bone injuries and the third most frequent of all body fractures.[1]Clinical examination is considered to be the gold standard to confirm the diagnosis of a nasal fracture.However,diagnosis may be challenging in case of haematoma and oedema of adjacent tissues,this leading to the use of X-rays to confirm or infirm the hypothesis.[2]Radiographic explorations for midface traumas can also be indicated for forensic purposes.[3]

Efficacy and Safety of Nasal Administration of “Na-no-L-DOPA” Based on PLGA Nanoparticles

Inclusion of L-DOPA, the standard Parkinson’s disease medication, into polymeric particles (PLGA) results in optimization the drug metabolism and increasing its bioavailability, significantly increases of physical endurance, better coordination and lower anxiety in Wistar rats, when chronically administered nasally.

Enhancement of intranasalmucosal immunization of mucosal vaccines by ultrasonic treatment

The pathogens of most infectious diseases invade the host through mucosal sites,and immunization with mucosal vaccines is the best means of combating these infectious diseases.Oral delivery and nasal delivery are the most common methods of mucosal vaccination.However,the delivery process is inefficient,and mucosal vaccination is ineffective because the vaccine formulation is easily and rapidly removed and has difficulty in crossing the mucosal surface.In this paper,we investigated whether the mucosal immune response could be enhanced by ultrasound facilitation of nasal mucosal delivery of vaccine preparations.For this purpose,we used manganese dioxide(MnO2)as the vaccine carrier/adjuvant,coated with chitosan oligosaccharide(COS)to enhance mucosal adsorption,and further physically adsorbed model antigen ovalbumin(OVA)to construct a nanoparticulate vaccine formulation MnO2@COS@OVA.Ultrasound treatment was found to promote antigen delivery and recruitment of dendritic cells(DCs)and macrophages as well as T-cell infiltration in nasal mucosal tissues through nasal mucosal immunization studies.With ultrasound assistance,MnO2@COS@OVA particles promoted the maturation of DCs in vitro and in vivo and promoted the production of effector memory T cells in vivo and cytokine secretion by splenocytes in vitro.In particular,ultrasound treatment significantly increased the levels of secretory IgA antibodies in the nasal mucosa and genital tract mucosa of experimental mice.In addition,the experimental data showed that the MnO2@COS@OVA particles had good biocompatibility and caused no significant damage to the nasal mucosal and vital organ tissue.These data suggest that ultrasound treatment can promote the induction of efficient immune responses to mucosal vaccines and provide new ideas for the opening and clinical translation of mucosal vaccines.

Endoscopic transnasal optic canal decompression for pediatric traumatic optic neuropathy with no light perception

Dear Editor,We reported the results of endoscopic transnasal optic canal decompression(ETOCD)procedure in 3 pediatric cases(9 to 12y,mean age 10.3y)of traumatic optic neuropathy(TON)with no light perception suffering from road traffic accident.TON is a rare but serious complication secondary to ocular or head trauma,resulting in partial or complete visual loss.In China,the incidence of road traffic accident induced TON is on the rise.The rate of incidence has been reported about 0.5% to 5% in closed head trauma cases[1].

Nasal implants for drug delivery:Advancements and applications

Nasal implants have emerged as a pioneering technology for nasal drug delivery systems.These are breakthrough options made of biocompatible materials that are temporarily inserted into the nasal passages for both functional and cosmetic purposes.Drug-eluting nasal implants are beneficial for improving patient compliance,reducing the need for repeated drug administration,and achieving controlled release of therapeutic agents.This article offers a comprehensive insight into nasal implants and their applications,and addresses a patent perspective in the same context.Important considerations for clinically approved implants,such as Propel,Sinuva,Sinu-Foam,and Relieva Stratus,have also been discussed.

Nasal sill reconstruction with the Abbe flap after skin cancer resection:A case report

Local flaps are widely known as the best option for partial nasal reconstructions depending on donor tissue laxity,vascularization,and defect shape and size.The nasolabial flap is used more often in the nasal sill.For larger defects,greater tissue mobilization with larger scars or free flaps is required.Historically,the Abbe flap has been used for lip reconstruction in patients with cleft lip deformities.It allows less retraction than other local flaps or skin grafts in patients with large defect sizes and great defect depths.This study reported on the application of the Abbe flap for nasal sill reconstruction on a 71-year-old female patient with nasal sill basal cell carcinoma who had undergone resection surgery with a posterior lip switch operation with satisfactory results.The application of the Abbe flap could be considered in patients with multiple previous surgeries and at risk for necrosis.

Nasal valve angle or nasal valve groove:Which is more suitable to describe a normal anatomic structure?

The size of the nasal valve angle is often used to assess nasal ventilation.A larger angle of the nasal valve is believed to be more conducive for ventilation,and a small angle is considered unfavorable.However,in more than 30 years of clinical practice,we have experienced that some patients with a normal nasal valve angle have relatively severe subjective or objective nasal ventilation obstruction.By studying the computed tomography data of these patients,we found that the tips of their nasal valves were at a sharp angle,while those of healthy individuals were in an arc shape.A sharp angle at the tip of the nasal valve,therefore,is a risk factor for obstructed nasal ventilation.Herein,we propose that the term“nasal valve groove”may be a more appropriate descriptor for the normal internal nasal valve anatomy,and we hope that more rhinoplasty surgeons will pay attention to how the shape of the tip affects nasal ventilation.

Effectiveness of out-fracture of the inferior turbinate with reduction nasal bone fracture

BACKGROUND The nasal bone,being the most protruding bone in the center of the facial bones,is particularly susceptible to damage.Nasal bone fractures can often result in secondary deformation and dysfunction of the nose,including septal fractures.Studies on functional or intra-nasal complications have been rarely reported after nasal bone fracture reduction.AIM To evaluate the severity of nasal obstruction and its improvement following nasal bone fracture reduction using inferior turbinoplasty.METHODS We conducted a retrospective review of data from 50 patients with symptomatic nasal obstruction between January to December 2010.All patients underwent preoperative Computed tomography evaluation,and symptom changes and nasal cavity volume were analyzed using a visual analog scale and acoustic rhinometry before and after surgery.Closed reduction and out-fracture of both inferior turbinates performed by the same surgeon.Treatment outcomes were assessed by comparing changes in the nasal airway volume measured using acoustic rhinometry before and after surgery.The minimal cross-sectional area(MCA)was also analyzed based on the Stranc classification.RESULTS Before reduction,the mean MCA for all cases was 0.59±0.06 cm^(2),which represented an 11%decrease compared to the average size of a Korean adult(0.65±0.03 cm^(2)).The MCA for frontal impact was 0.60±0.02 cm^(2) and for lateral impact,it was 0.58±0.03 cm^(2).After reduction via inferior turbinoplasty,the MCA improved to 0.64±0.04 cm^(2).CONCLUSION This study suggests that turbinoplasty is helpful in addressing nasal obstruction.Out-fracture of the inferior turbinate is an effective and durable technique that can be easily performed to enlarge the nasal airway with minimal morbidity.

Nasolabial perforator flap for nasal defects

Nasal defects can be reconstructed with a nasolabial perforator flap,resulting in good aesthetic outcomes based on the facial subunit principle,owing to the combined advantages of the traditional nasolabial flap and the perforator flap.However,the localization of perforators makes the clinical application of a nasolabial perforator flap difficult.This review aims to provide a comprehensive summary of the nasolabial perforator flap from anatomical,methodological,and clinical application aspects,intending to provide plastic surgeons with a reference on conducting nasal reconstruction with a nasolabial perforator flap.

Nasal Dermoid Cyst: A Case Report

Nasal dermoid sinus cysts (NDSCs) are rare neoplasms in the median line of the nasofrontal area. Unlike other dermoid cysts, a NDSC can manifest as a cyst, sinus, or fistula, and may extend intracranially. Nasal dermoid cysts usually present at birth and are commonly diagnosed by 3 years of age. An incidentally detected nasal dermoid cyst in an adult patient is extremely rare. In this case, a 23-year-old female with a history of intermittent serous thick discharge from a pit in the nasal columella since early childhood. Examination of the nasal cavity showed mild septal deviation to the left side, dorsal hump, wide nasal bone, a small pit-sinus at the columella, over projected nose, and wide bulbous down rotated nasal tip. The findings were suggesting nasal dermoid cyst, so a magnetic resonance imaging (MRI) was done for the patient to confirm the diagnosis. The MRI findings showed that there are 3 small cysts at the nasal septum anteriorly with a small fistula connecting the anterior inferior 2 cysts with no involvement to the intracranial cerebrospinal fluid (CSF) space. During the surgery, an open rhinoplasty approach was used. The trans-columellar incision was made around the fistula, and the tract was identified using a lacrimal probe and methylene blue. The dissection around the tract was continued until the sac was identified in the area of the membranous septum, and it was removed and sent for histopathology. The surgery then continued in a regular full rhinoplasty fashion. In conclusion, dermoid cyst of the nasal septum is a rare congenital lesion, especially in adults. After a thorough history taking and physical examination, a preoperative high-resolution axial and coronal CT and/or MRI is essential for diagnostic and operative planning. The treatment of choice for nasal dermoid cysts is complete surgical excision with clear margins. Surgical strategies usually depend on the location and extent of the lesion. Recurrence is uncommon and often easily managed.

Novel Intranasal Mask Provides Potent Protection against Viral Aerosols

Researchers from the Institute of Process Engineering(IPE)of the Chinese Academy of Sciences have developed a novel intranasal mask to protect the respiratory tract from viral aerosols.It showed satisfactory protection in multiple models,including a mouse model,a digital human nasal model,and a human respiratory tract model.

Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

筛泡径路黏膜间隙追踪法在鼻内镜额窦开放术中的应用

目的应用黏膜延续性的特点,探讨黏膜间隙追踪法在临床中的应用。方法回顾性分析2021年1月~2023年1月间32例行黏膜间隙追踪法额窦开放术患者的临床资料,分析和记录术中情况以及随访观察恢复情况。结果黏膜间隙追踪法额窦开放手术时间短,手术并发症少。术后随访6个月以上,临床症状逐步消失,病变未复发。结论黏膜间隙追踪法可以将复杂关系的额隐窝手术简单化,提高手术安全性和手术效率。

高锰酸钾致鼻腔腐蚀伤1例

1临床资料患儿,女,2岁9个月,就诊3h前意外将“高锰酸钾消毒片(0.2 g/片)”塞入左侧鼻腔,出现哭闹不止,鼻部疼痛症状,立即就诊当地医院,前鼻镜检查未见异物,于2022-10-22转入我院。前鼻镜检查双侧未见异物,左侧鼻腔可见黄褐色分泌物流出,行电子鼻咽镜检查见左侧鼻腔后端黑褐色分泌物堵塞,充分吸引清理后见后端鼻中隔黏膜、鼻底黏膜及下鼻甲黏膜成黑色腐蚀状,急诊以“鼻腔腐蚀伤”收治入院。