Nasal Septal Perforation closure with bacterial cellulose in rabbits

Alloplastic materials can be used together with tissue and structure to close nasal septal perforation.Aimto test cellulose use in the closure of septal perforation in rabbits and to compare fibrosis, inflammation, vascular congestion and graft integrity.Materials and MethodsFifteen rabbits. The rabbits were divided into two groups: Control: Five rabbits and Bionext® and fibrin glue Tissucol®: Ten rabbits. Septal perforations were done in all of them. In the Bionext® group the closure was performed with the placement of cellulose.ResultsTwo rabbits died in the first week. Cellulose group: 2 closures without the cellulose in between the septum membrane and in 4 cases the graft stood in the middle of the perforation locked in place by the edges. No closure in the control group.ConclusionThere was no closure of the perforation of the nasal septum with the graft between the septum membranes. There was no statistically significant difference concerning acute inflammation, vascular congestion and fibrosis between the 2 groups. In cases in which the graft remained in place, there was no change in its integrity. It may be used as a substructure for reepithelization of the perforation edges.     

多材料组合填塞在鼻中隔手术中的应用

目的 评价多材料组合填塞对改善鼻中隔手术填塞期不良反应的影响。方法 回顾性分析105例多材料组合填塞患者(治疗组)与124例常规填塞患者(对照组)的临床资料,观察两组在鼻中隔手术后鼻腔填塞期的患者主观自觉不适症状、并发症及病理生理改变。结果 多材料组合填塞能明显改善或减轻鼻腔填塞期的不良反应。结论 鼻中隔术后进行多材料组合填塞是理想的鼻腔填塞方法。     

鼻内镜手术并发鼻中隔穿孔(附7例报告)

目的 探讨鼻内镜手术后发生鼻中隔穿孔的原因和预防措施。方法 回顾分析鼻内镜术后发生鼻中隔穿孔7例的临床资料。结果 鼻内镜手术前的局部或全身激素的应用,患者的全身疾病,手术时的操作损伤,填塞物的压力过大、时间过长等都可以促使鼻中隔穿孔的发生。结论 鼻内镜手术患者术前应全盘考虑如何处理患者的全身疾病及术前用药,填塞物的选择和压力,局部处理等,以减少鼻中隔穿孔的发生。     

鼻─鼻窦常规手术与内窥镜手术的对照观察

本文以1993年10月～1994年10月一年间所作的47例71侧鼻腔鼻息肉摘除术为鼻息肉摘除组（Ⅰ），以51例Caldwel－Luc和de—Lima手术为鼻窦手术组（Ⅱ），43例73侧内窥镜鼻一鼻窦手术为内窥镜组（Ⅲ），比较分析鼻一鼻窦常规手术与内窥镜手术的疗效，发现Ⅰ－Ⅲ、Ⅱ—Ⅲ组间显效率有显著性差异，并发现Ⅲ组术腔上皮化率高、并发症少的优点。文中强调指出了内窥镜手术中钩突和额隐窝完全切除的重要性。     

鼻中隔矫正术后鼻腔硅胶管填塞的临床观察

目的探讨鼻中隔矫正术后鼻腔填塞硅胶管对术后反应的影响。方法对60例鼻中隔偏曲患者。分为观察组和对照组。手术结束时，观察组30例用硅胶管填塞鼻腔，对照组30例用凡士林纱条填塞鼻腔。观察比较两组患者的术后反应。结果硅胶管鼻腔填塞较凡士林纱条鼻腔填塞的术后不良反应明显减轻。结论硅胶管是鼻中隔矫正术后较为理想的鼻腔填塞物。     

鼻畸形矫正同期鼻中隔偏曲矫正术治疗严重外伤性鼻畸形一例

正鼻畸形分为先天性和后天性,其中外伤所致的鼻畸形以歪鼻、鞍鼻、驼峰鼻多见~([1])。严重鼻畸形患者常伴有严重的鼻中隔偏曲与畸形~([2])。患者除对外形不满意外,通常还会伴有鼻塞、鼻衄、头痛等鼻腔功能障碍症状。这部分患者希望既能矫正鼻畸形又能改善鼻腔通气功能。本课题组开展了大量鼻畸形矫正同期鼻中隔偏曲矫正术。近期本课题组收治了1例严重面部外伤性伴鼻畸形患者,患者1年前因严重车祸伤、面部毁损伤在外院行手术修复治     

内镜下切除鼻咽部肿瘤入路及体会

目的 介绍内镜下经鼻中隔切除鼻咽部肿瘤的方法,探讨此手术方法的优缺点、适应范围和手术注意事项.方法 10例鼻咽部肿瘤患者分别为鼻咽癌放疗后残留3例、海绵状血管瘤2例、良性混合瘤2例、恶性混合瘤1例、腺样囊性癌1例和脊索瘤1例.所有病例均行内镜下鼻中隔后下段1/4切除,手术者和助手经双侧鼻腔径路协作完成肿瘤切除.结果 所有病例的鼻咽肿瘤均一次性全切,无严重手术并发症和后遗症.4例良性肿瘤随访6～18个月无复发,中位随访时间13.8个月;6例恶性肿瘤随访1～4年,中位随访时间2.6年,5例无瘤生存,1例鼻咽癌患者术后1年疑似复发,进一步观察6个月病变无进展.结论 鼻中隔后下段1/4切除后,内镜下能观察整个鼻咽腔及其中的肿瘤,并有利于手术者和助手协调配合完成手术,是一种切除鼻咽部局限性肿瘤较好的手术方法.

Abstract：

Objective To explre the techniques, advantages and disadvantages, indications and cautions of a surgical approach for the resection of nasopharyngeal tumor. Methods Ten cases with nasopharyngeal tumors were recruited in this study, of them, 3 cases with residual nasopharyngeal carcinoma after chemoradiotherapy, 2 cases with cavernous angioma, 2 cases with benign mixed tumor, 1 malignant mixed tumor, 1 adenoid cystic carcinoma, and 1 chordoma. All patients underwent endoscopic resection of posteroinferior quarter part of nasal septum, and then the removal of nasopharyngeal tumors through bilateral transnasal approach. Results Total resection of the tumor was achieved for all cases without severe surgical complications. All cases with benign tumors, with following-up of 6 -18 months, showed no recurrence. Of 6 cases with malignant tumors, with following-up of 12 -48 months, 5 cases showed no recurrence, and 1 case was suspected to relapse one year postoperatively, but not with any lesion enlargement after another 6 month follow-up. Conclusions Posteroinferior quarter part of nasal septectomy is preferred for endoscopic resection of nasopharyngeal tumors because it can provide a panoramic view on nasopharyngeal cavity and tumors, thus, facilitating the removal of nasopharyngeal tumors.     

Learning Curve of Septoplasty with Radiofrequency Volume Reduction of the Inferior Turbinate

Objectives

Since few studies on surgical training and learning curves have been performed, majority of inexperienced surgeons are anxious about performing operations. We aimed to access the results and learning curve of septoplasty with radiofrequency volume reduction (RFVR) of the inferior turbinate.

Methods

We included 270 patients who underwent septoplasty with RFVR of the inferior turbinate by 6 inexperienced surgeons between January 2009 and July 2011. We analyzed success score, cases of revision, cases of complication, operation time, and acoustic rhinometry.

Results

Success score was relatively high and every surgeon had few cases of revision and complication. No significant difference was found in success score, revision, complication case, or acoustic rhinometry values between early cases and later cases. Operation time decreased according to increase in experience. However, there was no significant difference in the operation time after more than 30 cases.

Conclusion

We can conclude that 30 cases are needed to develop mature surgical skills for septoplasty with RFVR of the inferior turbinate and that training surgeons do not need to be anxious about performing this operation in the unskilled state.     

Nasal septal abscess in children: from diagnosis to management and prevention

Background

Nasal septal abscess (NSA) is an uncommon condition. It is a collection of pus in the space between the nasal septum and its overlying mucoperichondrium and/or mucoperiosteum. If left untreated, there are risks of intracranial complications, facial deformity, and delayed facial growth. There is no universally agreed consensus on the treatment of this condition. This study reviews evidence in the literature to determine its etiology, presentation, investigation, management options, and outcome.

Method

A structured review of the PubMed, EMBASE and the Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews) was undertaken, using the MeSH terms: nasal septum, nasal cartilage, trauma, hematoma, abscess, reconstructive surgery, rhinoplasty, pediatric, and children.

Results

A total of 159 citations from 1920 to date were reviewed regarding nasal septal abscess, of which 81 articles were identified to be relevant to this review. No randomized controlled trials or systematic reviews were found in the Cochrane Collaboration database, PubMed or EMBASE. NSA is more common in children and in male. Nasal trauma and untreated septal hematoma are the leading cause. Staphylococcus aureus is isolated in up 70% of the cases. Clinically, nasal septal swelling, pain and tenderness, with purulent discharge are mostly evident. The immediate management of NSA is incision and drainage and antibiotic therapy. Recent studies suggest early septal reconstruction in children in order to prevent immediate and late facial deformity and nasal dysfunction. Autologous cartilage is the implant material of choice.

Conclusion

Nasal septal abscess is a serious condition that necessitates urgent surgical management in order to prevent potential life threatening complications. In the growing child, early reconstruction of destructed septal cartilage is essential for normal development of the midface (nose and maxilla).     

鼻内镜下鼻中隔成形联合鼻骨复位术一期治疗鼻骨骨折伴鼻中隔偏曲

目的 探讨鼻内镜下行鼻中隔成形联合鼻骨复位术一期治疗鼻骨骨折伴鼻中隔偏曲的可行性、必要性及手术要点.方法 回顾性分析经鼻内镜下行鼻中隔成形联合鼻骨复位术治疗56例鼻骨骨折伴鼻中隔偏曲的诊疗情况,对手术方式、效果、并发症等进行分析.结果 56例患者鼻部外观满意,鼻腔通气畅,嗅觉良好,1例鼻中隔前端穿孔,经放置软骨支撑愈合.术后无鼻中隔脓肿、血肿,随访半年也无外鼻塌陷等并发症.结论 鼻骨骨折伴鼻中隔偏曲可在鼻内镜下同期行鼻中隔成形联合鼻骨复位术,同期手术具有直视下操作,复位精确,切口灵活,微创、并发症少等优点,同时具有卫生经济学意义,但要知情告知并征得患者同意。     

鼻内镜下同种异体鼻中隔软骨移植术治疗鼻中隔穿孔

目的探讨鼻内镜下同种异体鼻中隔软骨移植术在鼻中隔穿孔修补中的疗效。方法收集2003—2011年采用夹层法治疗16例鼻中隔穿孔患者,在鼻内镜下行同种异体鼻中隔软骨移植术,术后定期鼻腔清洁和换药。结果15例穿孔I期愈合,1例Ⅱ期愈合,随访1—3年,无穿孔复发及不良反应,有效率100％。结论鼻内镜下同种异体鼻中隔软骨移植术在鼻中隔穿孔修补中疗效显著,具有较好的实用性。     

Respiratory Epithelial Adenomatoid Hamartoma Originating from Nasal Septum

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign lesion in nasal cavity. We report two cases of REAH of the nasal cavity arising from nasal septum. The etiology of REAH is unknown although inflammation may induce gland proliferation observed in hamartomas. One of our cases was associated with nasal polyposis. REAH is a self-limiting disease, so it is important to differentiate REAH from other pathologic process, including inverted papilloma and low-grade adenocarcinoma. The treatment of choice is complete excision through a conservative approach.     

Role of Vascular Reflex in Nasal Mucosal Swelling in Nasal Allergy

Objective: In patients with nasal allergy, antigen challenge on the unilateral nasal mucosa results in nasal secretion not only in the ipsilateral but also in the contralateral nasal cavities that can be inhibited almost completely by premedication with atropine sulfate. The present study was performed to elucidate if centrally mediated vascular reflex induced by antigen challenge plays a role in nasal mucosal swelling in subjects with nasal allergy. Methods: Variations of mucosal swelling and mucosal blood flow in the ipsilateral and the contralateral nasal cavities after unilateral antigen challenge were evaluated by acoustic rhinometry and laser Doppler flowmetry in 20 patients with perennial nasal allergy. Results: Unilateral antigen challenge caused ipsilateral and contralateral nasal mucosal swelling in 17 and 13 patients, respectively. Incidence of contralateral nasal mucosal swelling after unilateral antigen challenge was significantly higher compared with that after control disc challenge (P < .001). In 10 patients in whom unilateral antigen challenge caused bilateral nasal mucosal swelling, significant swelling of the nasal mucosa lasted for more than 30 minutes in the ipsilateral nasal cavity after antigen challenge compared with only 15 minutes in the contralateral nasal cavity. Peak values of contralateral mucosal swelling were 45.3% of those of ipsilateral nasal mucosa. Conclusions: Centrally mediated vascular reflex is partially involved in the onset of nasal mucosal swelling observed after antigen challenge in subjects with nasal allergy. However, nasal mucosal swelling that persists and proceeds even 20 minutes after antigen challenge is caused by the direct effects of chemical mediators on the nasal vasculature.