Lobular capillary hemangioma of the nasal cavity in child

Although the head and neck is not an uncommon region, the nasal cavity is extremely rare sites for lobular capillary hemangioma (LCH) in children. The authors report a case of an 11-year-old boy with LCH of the nasal cavity presenting with nasal obstruction and epistaxis. To our knowledge, on searching the English literature, only nine cases of hemangioma of nasal cavities have been reported in children since 1985. The authors feel that it should be considered in the differential diagnosis of lesion of the nasal cavity.     

Lobular capillary haemangioma of the middle turbinate

Lobular capillary haemangioma (LCH) is a benign, vascular lesion of unknown origin. It usually affects skin and mucous membranes of the oral cavity. It rarely occurs in the nose. Microtrauma and hormonal factors are considered in the aetiology. The most frequently seen symptoms of nasal LCH are epistaxis and nasal obstruction. LCH can be pedinculated or wide based. Its size ranges from several millimetres to centimetres. LCH cases secondary to postoperative use of nasal packs have been reported. Here we present an LCH which was located on the middle turbinate and occurred after the usage of nasal packing. It is known that the nose is a rare location for LCH but middle turbinate location has not been described so far in the literature. LCH should be considered in the differential diagnosis of all endonasal masses with bleeding.     

Lobular capillary haemangioma of the middle turbinate

Lobular capillary haemangioma (LCH) is a benign, vascular lesion of unknown origin. It usually affects skin and mucous membranes of the oral cavity. It rarely occurs in the nose. Microtrauma and hormonal factors are considered in the aetiology. The most frequently seen symptoms of nasal LCH are epistaxis and nasal obstruction. LCH can be pedinculated or wide based. Its size ranges from several millimetres to centimetres. LCH cases secondary to postoperative use of nasal packs have been reported. Here we present an LCH which was located on the middle turbinate and occurred after the usage of nasal packing. It is known that the nose is a rare location for LCH but middle turbinate location has not been described so far in the literature. LCH should be considered in the differential diagnosis of all endonasal masses with bleeding.     

Lobular capillary hemangiomas: Case report and review of literature of vascular lesions of the nasal cavity

Vascular tumors of the nasal cavity can represent a variety of pathologies. In this case report, we discuss two patients presenting with a large vascular lesion occupying the nasal cavity. Significant bleeding was encountered during the initial attempts for endoscopic surgical resection. One lesion was successfully excised following preoperative embolization while a second following sphenopalatine artery vascular ligation. In both cases, final pathology showed lobular capillary hemangioma (LCH). We present a literature review and discussion of LCH and other vascular tumors that present in the nasal cavity. In addition, we discuss the utility of pre-resection vascular control of these tumors.     

"Bleeding polyp" of the nasal septum: an uncommon lesion in adults

Inflammatory hemangioma of the nasal septum, known as "bleeding polyp," is an uncommon lesion in adults. We report the case of a 20-year-old woman who presented with left nasal hemangioma revealed by unilateral epistaxis and obstruction. The patient had a medical history of septoplasty performed 5 years earlier. This benign tumor can be spontaneous or posttraumatic and occurs in young postpubertal adults or patients over 40 years of age, without a sex preponderance. The site of origin is most frequently the cartilaginous septum. The appearance and clinical signs often mimic malignancy, and a biopsy for histologic confirmation of the diagnosis is crucial. The capillary hemangioma is more frequently observed than the cavernous type. This tumor does not present spontaneous involution, and treatment is based on a surgical excision including the mucosa and the underlying perichondrium, after computed tomographic and/or nuclear magnetic resonance examination.     

Lobular capillary hemangioma of the nasal cavity: A retrospective study on 40 patients

BACKGROUND: Nasal lobular capillary hemangioma (LCH) is a benign lesion of unknown etiology that must be included in the differential diagnosis of vascular lesions. Based on a large cohort of LCH patients, we retrospectively analyzed the clinical presentation, histological and radiological findings, and the treatment strategy. METHODS: Clinical records of 40 patients affected by LCH, treated in a 20-year period at two university hospitals, were reviewed. Data concerning symptoms, possible etiologic factors, endoscopic findings, imaging studies, and treatment were collected. RESULTS: Previous nasal trauma and pregnancy were identified as possible causes in six (15%) and two (5%) patients, respectively. The main symptoms were unilateral epistaxis (95%) and nasal obstruction (35%). Lesions ranged in size from 1 to 8 cm and mainly involved the nasal septum (45%) and the nasal vestibule (17.5%). In the four (10%) patients with a large lesion, radiological evaluation was helpful not only in assessing the extent, but also in suggesting the possible nature of the lesion. All patients underwent endoscopic resection under local (72.5%) or general (27.5%) anesthesia. At mean follow-up time of 53 months, no recurrence has been observed. CONCLUSION: To the best of our knowledge, this is the largest series of patients with nasal LCH. When the mass is considerable in size, differentiation from other hypervascularized lesions may be intriguing. Under these circumstances, information obtained with imaging may sometimes suggest a correct diagnosis without resorting to biopsy. Endoscopic surgery is the treatment of choice even for large lesions, that do not require preoperative embolization.     

Nasal septal distortion of endogenous genesis as a manifestation of human morphofunctional asymmetry

By analyzing the data available in the literature and his own findings, the author forwards a hypothesis on the endogenous etiology of nasal septal distortions as a result of human morphofunctional asymmetry. Asymmetries are more pronounced in males and right-handed individuals than in females and left-handed ones. Due to this fact, nasal septal distortions are more common in males and with their convex part deviate to the left nasal cavity. Emphasis is laid on the necessity of using a sparing approach to removing the nasal septal cartilage during surgical interventions.     

Congenital choanal atresia and nasal stenosis

The most common form of nasal obstruction in neonates is soft tissue edema, but congenital bony nasal anomalies are recognized as an important cause of newborn airway obstruction. We reviewed 20 cases of congenital bony nasal abnormalties such as choanal atresia and nasal stenosis referred to National Children's Hospital between 1996 and 2001. Of the 20, 8 involved choanal atresia (6 bilateral and 2 unilateral) and 12 nasal stenosis (5 nasal cavity stenosis, 2 pyriform aperture stenosis and 5 unknown). Six cases of bilateral choanal atresia and 5 of 12 cases of the nasal stenosis presented severe airway distress. Most cases in respiratory distress required immediate surgical enlargement of nasal cavity and stenting with an endotracheal tube for 4 to 8 weeks. Of 12 with nasal stenosis, 5 with mild nasal obstruction were treated with nasal drops and 3 with mild airway distress required no treatment. Five of 7 (71%) with choanal atresia and 1 of 4 with nasal stenosis (25%) required restenosis of the nasal cavity after stent removal. Restenosis occurred more often in choanal atresia than in nasal atresia. Two of 5 with nasal restenosis required stenting for 1 to 2 months again and 1 of those was followed by stenting for more 4 months. Longer stenting did not prevent choanal from restenosis, however, no standard stenting protocol exists for neonates, highlighting the need for further study.     

The importance of rigid nasal endoscopy in the diagnosis and treatment of rhinolithiasis

OBJECTIVES: Rhinolithiasis is the presence of mineralized and calcareous formations located in the nasal cavity. They have rare occurrence and can be easily confused with infection or obstruction of upper airways. If they are undetected for a long time, they may grow large enough to cause of nasal obstruction, mimicking sinusitis. Seven cases of rhinolithiasis were presented, and their diagnosis was made by rigid endoscopic nasal examination. Also computerized tomography scan was used to describe the size and site of the rhinoliths accurately. Our purpose was to determine the role of rigid nasal endoscopy in the diagnosis and the treatment of rhinolithiasis. METHODS: In this study, seven cases of rhinolithiasis, who were diagnosed and treated by rigid nasal endoscopy were presented. RESULTS: Between January 2000 and November 2004, seven cases (four males and three females; age ranged from 8 to 45 years) with rhinolithiasis were diagnosed. The most frequent symptoms were nasal obstruction with purulent rhinorhea, nasal and oral malodor. As complementary examinations, computerized tomography and simple X-ray of paranasal sinuses were used to locate and measure the dimension of calcareous mass, and to reveal possible invasion of the adjacent structures. The removal of rhinolithiasis was done with rigid nasal endoscopy under topical anesthesia in six cases and general anesthesia in one case. CONCLUSION: Rhinolithiasis is a rare condition but must always be suspected in patients with long standing nasal obstruction, nasal and oral malodor, purulent rhinorrhea and chronic headache.     

Correlation of nasal obstruction with nasal cross-sectional area measured by computed tomography in patients with nasal septal deviation

Objectives: The objective of the present study was to investigate the relationship between the subjective sensation of nasal obstruction and the corresponding cross-sectional area for nasal airflow in patients with a deviated septum. Methods: Seventy-one patients with a diagnosis of unilateral nasal obstruction due to a deviated nasal septum were evaluated by preoperative computed tomography. Anterior anatomic characteristics (the internal nasal valve angle and the cross-sectional areas at the external nasal valve, the head of the inferior turbinate, and the head of the middle turbinate) and posterior anatomic factors (the cross-sectional areas at the openings of the frontal sinus, maxillary sinus, and end of the nasal septum) were examined. Associations between the computed tomography measurements and the subjective severity of nasal obstruction were analyzed with a visual analog scale (VAS). Results: Anterior and posterior anatomic characteristics were associated with the subjective severity of nasal obstruction. Anterior anatomic factors were related to the VAS scores of patients with anterior septal deviation, and posterior anatomic factors were related to the VAS scores of patients with posterior septal deviation. Conclusions: This study indicated that the anterior and posterior parts of the nasal cavity are both related to nasal obstruction. In some patients, the posterior part of the nasal cavity was more important than other locations in causing nasal obstruction.     

鼻腔鼻窦转移性肾透明细胞癌一例报道并文献综述

目的 探讨鼻腔鼻窦转移性肾透明细胞癌的临床特点及诊疗方法.方法 回顾性分析1例肾透明细胞癌转移至鼻腔鼻窦患者病历资料,并检索1993～2020年间国内外发表的相关文献,包括本例共有64篇文献76例患者纳入研究,总结其临床表现、诊断、治疗方法及预后.结果 76例中男61例,女15例.症状出现较多者为鼻出血58例、鼻塞25...     

鼻内窥镜下射频热凝治疗鼻腔血管瘤

目的：探讨鼻内窥镜下射频热凝治疗鼻腔血管瘤的优越性。方法：将鼻内窥镜与射频联合应用治疗鼻腕血管瘤患者１５例。结果：１５例均一次成功摘除血管瘤,术中出血少,无并发症发生,随访０．５￣４年无复发。结论：鼻内窥镜下射频热凝治疗鼻腔血管瘤,具有视野清晰、出血少、手术安全彻底、患者痛苦少及不遗留面部瘢痕等优点。     

Head and neck manifestations of langerhan's cell histiocytosis in children: A 46-year experience

ObjectiveLangerhan's cell histiocytosis (LCH) is an uncommon disease characterized by abnormal proliferation of polyclonal Langerhan's cells, most commonly presenting with head and neck manifestations. This is a report of a series of patients with LCH at St. Jude Children's Research Hospital over a 46-year period. The purpose was to examine the head and neck presentations of LCH, their treatments and outcomes, and to compare with other previously reported series.MethodsThis was a retrospective study of all patients with a diagnosis of LCH who presented to St. Jude Children's Research Hospital, Memphis, TN between 1962 and 2008. Patients who presented with an initial diagnosis of LCH but were later determined to not fit the diagnostic criteria were excluded from the study. IRB approval was obtained and a chart review was conducted to collect data regarding demographics, tumor site(s) and manifestations, pathology, treatment, surgical procedures, and outcomes. This data was compiled and compared to previously published results.ResultsEighty-eight cases of LCH with at least one head and neck manifestation were diagnosed during the period studied. There were 54 males and 34 females, with an average age of onset of 4.1 years. The most common lesions were those involving the skull (44.3%) and cervical lymph nodes (40.9%). The most common treatment was chemotherapy (80%) and corticosteroids (64%), with vinblastine being the most common chemotherapeutic agent. Surgical intervention occurred in 39% of cases. Total mortality due to LCH was 9.1%. The results were found to generally concur with other previously published studies.ConclusionThis study represents the largest series of head and neck manifestations of LCH reported to date. Although LCH is a rare disease, it often mimics other common head and neck pathologies and therefore requires a high index of suspicion. Biopsy is required for definitive diagnosis and the mainstay of treatment is chemotherapy.     

Do angiomas of the nasal septum exist?

Juvenile nasopharyngeal angiofibromas (JNA) by definition originate in the nasopharynx. Vascular tumors arising in the nasal cavity can easily be mistaken for JNA, when the correct diagnosis is hemangioma or angiofibromatous polyp. We present a case that illustrates this problem, an 11-year-old boy with a unilateral anterior nasal cavity mass associated with recurrent epistaxis. At surgery, the mass was found to arise from the anterior nasal septum and was removed easily with minimal bleeding. The initial pathologic interpretation was JNA. After extensive review of the specimen, however, the diagnosis of hemangioma was made. Similar tumors have been reported as being JNA that have been simple to remove with minimal blood loss. JNA is associated with more severe blood loss, is more difficult to expose surgically and has a higher risk of recurrence than other nasal tumors. Therefore, JNA needs to be distinguished from anterior nasal cavity masses.     

Assessment of adenoid size in children by fibreoptic examination

In order to investigate the relationship between the size of the adenoid and upper respiratory symptoms in children, fibreoptic examination of the nasal cavity and nasopharynx was performed in 817 children. The size of the adenoid was classified into three categories according to the distance between the vomer and the adenoid tissue. There was a significant relation between the size of the adenoid and the complaints of nasal obstruction (P < 0.001) and of snoring (P < 0.001), but not with the presence of purulent sinusitis. In the whole population, the size of the adenoid correlated well with the results of tympanometry (P < 0.001), but this does not hold in all age groups. This study has confirmed adenoid hypertrophy as a common aetiological factor in children with the complaints of nasal obstruction and snoring. The enlargement of the adenoid only partially explains the occurrence of otitis media with effusion. The introduction of the flexible fibrescope in the examination of the nasal cavity and nasopharynx in children is of great clinical value, especially in the selection of children for adenoidectomy. It is a minor invasive examination well tolerated by most children, giving more information than a lateral skull radiograph and avoiding unnecessary radiation.     

Lobular capillary haemangioma of the nasal vestibule: a rare entity

The authors report a case of an 8-year-old boy with lobular capillary haemangioma (LCH) of the nasal vestibule presenting with nasal blockage, nasal discharge and epistaxis. LCH of the nasal vestibule is rarely reported in the English literature, and the authors feel that it should be considered in the differential diagnosis of lesion of the nasal vestibule. Unnecessary investigations could be avoided if its diagnosis is considered, especially in children.     

Hemangioma of the nasal cavity: a clinicopathologic study

Objective: The purpose of this study was determining the optimal surgical approach and preoperative examination for a hemangioma of the nasal cavity. We performed to summarize the indications of endoscopic surgery and its postoperative course. Methods: Eight patients with a history of epistaxis found to have an intranasal hemangioma were studied. Radiological study, postoperative course examination after the endoscopic surgery, and histological study were performed on these cases. Results: Preoperative computed tomography (CT) scan and MR image together with postoperative histological studies demonstrated characteristic figures of epithelioid hemangioma. Radiological studies were necessary to examine the extension of the tumor. The capillary type usually arose from the nasal septum while the cavernous type was seen in the lateral nasal wall. The postoperative course of the patient was uneventful, and no recurrence was found after endoscopic surgery in all cases. Conclusion: Radiological study was proven effective for the pre-surgical diagnosis. The hemangioma strictly pertaining to the nasal cavity can be completely treated by the endoscopic transnasal surgery. We suggest that the method inflict least stress on the patient and thus considered optimal.     

Langerhans' cell histiocytosis: report of a case with temporal localization

The authors report a case of Langerhans' cell histiocytosis (LCH) with temporal localization and rapidly evolving initial clinical presentation in a 12-year-old boy. This disease of currently unknown etiology is actually considered a proliferative entity of cells with phenotypic characteristics of normal Langerhans' cells. An immunoregulation defect leading to abnormal maturation and migration of Langerhans' cells might be the basis for LCH. According to the Hystiocyte Society diagnostic criteria, ATPase, S 100 and D-mannoxidase positivity in addition to typical hystopathologic findings are sufficient for diagnosis of LCH. Head and neck localization of LCH occurs in about 70% of cases; males are more frequently affected than females, age at presentation varies from a few months to 15 years. Presenting features, initial diagnostic evaluation, differential diagnosis and treatment protocol of a unifocal monosystemic temporal bone localization of LCH are presented.     

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.     

Passive smoking, allergic rhinitis and nasal obstruction in children

Allergic rhinitis is a common cause of nasal obstruction in childhood. This prospective study looked at the effect of passive smoking on nasal obstruction in children with and without allergic rhinitis. Eighty-one children took part. Each child was asked to score his or her degree of nasal obstruction on a visual analogue scale. Exposure to passive smoking was determined subjectively using a parental questionnaire, and objectively by measuring the urinary cotinine/creatinine ratio. Results were tabulated using Microsoft Excel and analysed with SPSS statistical software. Nasal obstruction was significantly worse in children with a positive history of allergic rhinitis (p < 0.05). There was also a trend towards a higher nasal obstruction score in children without allergic rhinitis exposed to passive smoking compared to those who were not so exposed. As would be expected, nasal obstruction is worse in children with allergic rhinitis than in those without. Passive smoking tends to increase the symptom of nasal obstruction in children without allergic rhinitis.