Cryosurgery of the inferior nasal turbinates

Forty-seven patients with irreversible nasal obstruction due to inferior turbinate hypertrophy were treated by cryosurgery, the short and medium term results having been clinically evaluated. Permanent good results in nasal breathing were achieved in 83% of the patients. Failures are mostly related to turbinates hypertrophy due to nasal allergy. The combination of cryosurgery and nasal septoplasty, in cases of hypertrophy associated with deformities of nasal septum, gives an excellent result. Cryosurgery of hypertrophic nasal turbinates is a simple, safe, and reliable procedure to improve nasal breathing in cases of nasal turbinate hypertrophy.     

History of endonasal microsurgery of lacrimal system

The history and development of surgical treatment of lacrimal system from rhinological point of view was presented. The lacrimal drainage system has provoked great deal of investigation throughout history, because ophtalmologists couldn't attain persistent and permeable drainage between the lacrimal and the nose. The change came, when first Italian rhinologist Toti described external dacryocystorhinostomy (DCR), and later West performed endonasal DCR. The use of microscope and endoscope in rhinosurgery caused the significant progress also in lacrimal surgery. The development of endonasal microsurgery enabled to introduce other non invasive procedure, such as endoscopic laser dacryocystorhinostomy or transcanalicular dacryo-cystorhinostomy (endo-canalicular DCR). One of the newest method in the treatment of complete and partial obstruction of lacrimal drainage system is also baloon dacryocystoplasty.     

Density of mucous glands in the normal adult nasal turbinates

On 13 normal inferior and middle turbinates the mucous membrane was freed, stained by the PAS-alcian blue whole-mount method, and the mean density of glandular orifices was determined by counting in 4 mm2 fields. The median density fell in both turbinates in the anteroposterior direction, being in the inferior turbinate 8.2 glands/mm2 anteriorly, 7.9 in the middle, and 7.1 glands/mm2 posteriorly. In the middle turbinate it was 8.4 glands/mm2 anteriorly, 8.1 in the middle, and 7.3 glands/mm2 posteriorly. There were no significant differences in median density between the medial and lateral wall or between the superior and inferior half of the inferior or middle turbinate as a whole. The median total number of glands in the inferior turbinate was 9,200 with a very wide interindividual range of 6,100-12,700. In the middle turbinate the median count was 6,700 glands and the range 4,400-11,500. The pathology of the mucous glands of the nose is discussed.     

Density of mucous glands in the normal adult nasal turbinates

Summary On 13 normal inferior and middle turbinates the mucous membrane was freed, stained by the PAS-alcian blue whole-mount method, and the mean density of glandular orifices was determined by counting in 4 mm² fields. The median density fell in both turbinates in the anteroposterior direction, being in the inferior turbinate 8.2 glands/mm² anteriorly, 7.9 in the middle, and 7.1 glands/mm² posteriorly. In the middle turbinate it was 8.4 glands/mm² anteriorly, 8.1 in the middle, and 7.3 glands/mm² posteriorly. There were no significant differences in median density between the medial and lateral wall or between the superior and inferior half of the inferior or middle turbinate as a whole. The median total number of glands in the inferior turbinate was 9,200 with a very wide interindividual range of 6,100–12,700. In the middle turbinate the median count was 6,700 glands and the range 4,400–11,500. The pathology of the mucous glands of the nose is discussed.     

Early depictions of the nasal turbinates in the 15th century

Although nasal turbinates had already been described by Hippocrates, it was not until the 15th century that they were depicted. The inferior turbinate was shown for the first time rather true- to nature in the works of the Middle Rhenic Master circa 1450-1460 and Leonardo da Vinci in 1489. The posterior ends of the middle turbinates were depicted on a woodcut by Georg Thomas for Dryander's "Anatomiae ... pars prior" in 1536. These and a few other examples show that some artists were ahead of the medical profession in demonstrating anatomical details in the 15th and 16th century.     

Early depictions of the nasal turbinates in the 15th century

Although nasal turbinates had already been described by Hippocrates, it was not until the 15th century that they were depicted. The inferior turbinate was shown for the first time rather true-to nature in the works of the Middle Rhenic Master circa 1450-1460 and Leonardo da Vinci in 1489. The posterior ends of the middle turbinates were depicted on a woodcut by Georg Thomas for Dryander's "Anatomiae ... pars prior" in 1536. These and a few other examples show that some artists were ahead of the medical profession in demonstrating anatomical details in the 15th and 16th century.     

Argon plasma coagulation in the treatment of nonallergic hypertrophic inferior nasal turbinates

PURPOSE: Various surgical procedures have been recently proposed for the treatment of hypertrophic inferior nasal turbinates as a result of the advances made in medical technology and growing public demand for minimally invasive therapies. The aim of this study was to evaluate the safety and efficacy of the argon plasma coagulation technique for inferior turbinate reduction in a homogeneous series of patients with nonallergic inferior turbinate hypertrophy.Material and methods: Twenty symptomatic patients underwent argon plasma coagulation surgical treatment under local anesthesia and were clinically followed up after 1 month and then every 3 months (anterior rhinoscopy and nasal endoscopy). Diagnostic evaluations using active anterior rhinomanometry were made after 3 and 12 months. RESULTS: All of the patients reported a postoperative improvement in nasal swelling and patency. No postoperative complications were observed. Rhinomanometry after 12 months showed a reduction in mean total resistance from the pretreatment level of 1.06 Pa s/cm(3) to 0.49 Pa s/cm(3). There was also a statistically significant reduction in nasal resistance for each of the investigated conditions (inspiration and expiration in orthostatism and clinostatism). CONCLUSIONS: Argon plasma coagulation is a safe and efficacious procedure for the minimally invasive treatment of inferior turbinate hypertrophy, which can be performed under local anesthesia in an outpatient setting with little discomfort for the patient.     

Mast cell distribution and morphology in human nasal turbinates following decalcification

Whole inferior nasal turbinates were used to evaluate six different fixatives followed by decalcification. H and E staining was used to assess general fixation and toluidine blue and thionin to stain mast cells metachromatically. We show that neutral buffered formalin or paraformaldehyde give the best overall fixation. Very long times (six days) are needed in TB to show maximum mast cell numbers; these numbers are never as high, nor the cells as densely stained as those in undecalcified controls. The difference in number between the two supports the hypothesis that there is more than one subset of mast cells in nasal mucosa. The more superficial mast cells have a smaller size and may be dendritic, with relatively few granules which stain faintly. Those in deeper situations are often larger, ovoid, very granular and intensely stained.     

Microscopic endonasal surgery of nasal and paranasal cavities

Objective

To present the experience of our department on microscopic surgery of the nose and sinuses and compare our results with those of other standard approaches. Furthermore we attempt to specify the main indications for the use of the method.

Methods

During the period between January 1990 and December 2002, the prementioned technique was performed in a total of 250 patients. The preoperative evaluation, surgical technique and postoperative management of all patients are described in detail.

Results

Most common diagnoses included nasal polyps and chronic rhinosinusitis. The average age of patients was 42 years. Males accounted for 48%. No major postoperative complications were noted. Minor complications such as epistaxis and midfacial pain were observed in 24% of cases. While the majority of patients reported severe symptomatology preoperatively, 91% reported substantial improvement of their clinical condition within 3 months after surgery.

Conclusion

Microscopic surgery is a technique which can be used alternatively to traditional procedures. It provides an excellent, clear, stereoscopic vision and allows the surgeon to work bimanually. Complications are rare and easily controlled. Our experience favors the use of microscopic technique compared to common endoscopic approaches, especially in cases of nasal polyps and chronic rhinosinusitis.