Congenital defects of the vomer

Six cases of congenital defect of the vomer, a rare nasal anomaly, are reported. All 6 patients visited Kobe University Hospital with other complaints, and the anomaly was incidentally detected. In all cases, the nasal septum showed a defect at the posteroinferior portion that appeared to coincide with the location of the vomer. None of the patients had a past history of nasal trauma, nasal surgery, drug abuse, or infectious disease. This anomaly may be attributable to an embryological disorder based on an immature ossification center of the vomer.     

Congenital vomeral bone defect in two thalassemia trait cases

The nasal septum is composed of a perpendicular plate of ethmoid bone, quadrilateral septal cartilage, membraneous septum, crest of palatine and maxillary bone and vomer. Defects of the nasal septum may be due to a variety of causes such as trauma, infection, inhalant irritants and neoplasia. To our knowledge, up until now, congenital defect of the vomer has been presented in six cases without any nasal symptoms. We present two cases of congenital defect of vomer with thalassemia trait, the patients complaining of nasal obstruction.     

Congenital vomeral bone defect: report of two cases and a review of the literature

Nasal septum perforations or defects can have a variety of causes. Defects of the septum tend to occur in the antero-inferior region. We report two cases of congenital vomeral defect of the septum detected during nasal endoscopy. Neither of the patients in this report had any nasal surgery, trauma, infectious disease, or drug abuse. Our findings suggest that a developmental abnormality of the vomer during the prenatal period resulted in congenital defects of the vomer. Congenital defects of the nasal septum should be added to the etiology of septal perforation and defect.     

Congenital vomeral bone defect: report of two cases and a review of the literature

Nasal septum perforations or defects can have a variety of causes. Defects of the septum tend to occur in the antero-inferior region. We report two cases of congenital vomeral defect of the septum detected during nasal endoscopy. Neither of the patients in this report had any nasal surgery, trauma, infectious disease, or drug abuse. Our findings suggest that a developmental abnormality of the vomer during the prenatal period resulted in congenital defects of the vomer. Congenital defects of the nasal septum should be added to the etiology of septal perforation and defect.     

Paradoxical giant inferior concha

Anatomic variations of the middle and superior conchae are common, but inferior concha anomalies are rare. These anomalies have included pneumatization, agenesis, and duplication. We describe what we believe is the first reported case of a paradoxical curvature of the bony part of the inferior concha. The patient was a 13-year-old girl. The development of a huge inferior concha blocked the left nasal cavity and deviated the nasal septum to the contralateral side, resulting in bilateral obstruction. The patient was successfully treated with surgery.     

Nasal septal abscess and palatine process of the maxilla abscess complicating acute rhinosinusitis in a 12-year old boy

We report a case of nasal septal abscess and palatine process of the maxilla abscess secondary to acute rhinosinusitis in an 12-year-old boy. Rare complication of acute sinusitis is the nasal septum abscess; even rarer is the abscess of the palatine process of the maxilla, which our patient presented. Nasal septum abscess is an reservoir of suppurative secretion between cartilage or bone of the septum and their periostium or perichondrium. Nasal septum abscess is most often bilateral, causing nasal cavities obstruction. Other symptoms are: nasal pain, fever, headache, nasal tenderness, bad general feeling. Spontaneous abscesses of nasal septum are rare and occur due to acute ethmoid or sphenoid sinusitis and inflammations originating from teeth. Patophysiology of nasal septum abscess depends on its etiology. The isolated acute sphenoid sinusitis may lead to occurrence of nasal septum abscess by spreading of inflammatory changes under periostium along the anterior surface of sphenoid bone and damaging the periostium of vomer and perpendicular lamina of ethmoid bone into subperichondrial space of quadrangular cartilage. Inflammation of inferior wall of sphenoid sinus located over fornix of nasopharynx might have lead to appearance of the palatine process of the maxilla abscess. We consider this mechanism of abscess creation occurred in our patient. Another possible mechanism comprehends spreading of inflammatory process through bone fissures, congenital bone malformations of due to thrombophlebitis. Recommended procedure in cases of confirmed nasal septum abscess is surgical decompression from semitransverse incision of the column and abscess drainage. Aspiration and bacteriological culture allow for exact establishment of proper antibiotic treatment. Antibiotic therapy should be conducted for 2-3 weeks according to bacterial sensitivity to chemotherapeutics. In reexamination of our boy's nasal septum cavity of abscess was assessed and a small cartilage defect was noted. Necrotic changes in nasal septum cartilages arise due to ischemia and compression by residual pathological contents between perichondrium and cartilage. Proper recognition and surgical and preservative treatment lead to total recovery. In our boy, control examinations after 2 and 6 months confirmed recovery without recurrence and later complications.     

Nasal septal lipoma in a child: Pai syndrome or not?

Lipoma is the most common soft tissue mass in adults but it is uncommon in children. Nasal septal lipoma is an even more rare entity. In this report, a 12-year-old girl was presented with congenital nasal septal lipoma. She had permanent partial nasal obstruction on her right side and disfigurement of her right upper lip. CT scan revealed a lipoma-like mass in the septum plus an additional incidental finding of an intracranial lipoma. Further workup with MRI demonstrated corpus callosum agenesis with interhemispheric lipoma. To remove the mass, septoplasty, nasal lipoma excision and nasal vestibule V-Y advancement flap were performed. To close the lip a rotational advancement flap was required. Our case seemed to be a variety of Pai syndrome. We recommend imaging of the central nervous system in newborns with congenital lipomas located in the craniofacial midline to rule out the Pai syndrome.     

Post-traumatic haematoma and abscess in the nasal septa of children

Septal haematoma following nasal trauma is a complication that, if not diagnosed and treated early, may evolve into a nasal septal abscess. We present the case of a 10-year-old male who suffered nasal trauma with fracture and an undiagnosed septal haematoma that evolved into a septal abscess. During drainage of the abscess, necrosis of the quadrangular cartilage was noted. The patient later presented collapse of the nasal dorsum and deviation of the nasal septum. This sequela was corrected by means of an osteochondral costal graft. In the presence of any nasal trauma, it is important to explore the nasal septum correctly to discard the presence of a haematoma which, if not drained early, may evolve into an abscess due to compression of the quadrangular cartilage, leading to its necrosis in a few days and later collapse of the nasal dorsum as the child grows.     

Nasal septal abscess: a case report

INTRODUCTION: The nasal septum abscess is a rare and serious infection because of the complications which can be generated. The authors report a new case of nasal septum abscess to probably from dental origin. OBSERVATION: A 47 year old man consulted for bilateral nasal obstruction and rhinorrhea for 3 days with an infectious context. The clinical examination as well as the CT scan demonstrated a septal abscess. The patient had a surgical drainage associated with a triple antibiotherapy with favourable evolution at the end of 10 days. The etiologic investigation is in favour of a dental etiology. CONCLUSION: It is about a rare and serious infectious pathology of the nasal septum. We point out its various etiologies, its management, while insisting on the preventive treatment of this affection.     

鼻内镜下三线减张鼻中隔矫正术

目的探讨鼻内镜下三线减张鼻中隔矫正的手术技巧及其疗效观察。方法回顾性分析156例鼻中隔偏曲患者,全部行鼻内镜下三线减张鼻中隔矫正术,将鼻中隔方形软骨尾端、鼻中隔软骨与筛骨垂直板结合处、鼻中隔软骨下端与犁骨、上颌骨鼻嵴与腭骨鼻嵴结合处分离,并将在此形成的三条受力线及核心受力区切除条形软骨和骨质,解除导致鼻中隔偏曲的应力,从而达到矫正鼻中隔的效果。结果术后随访3～24个月,156例中,治愈134例,好转22例。结论鼻内镜下三线减张鼻中隔矫正术安全可靠,效果满意,最大限度保留了鼻中隔正常组织结构,具有创伤小,并发症少等优点,符合鼻中隔偏曲产生的生物力学规律,将手术上升到微创水平。     

Chondrosarcoma of the nasal septum

Chondrosarcoma of the head and neck region are relatively uncommon, arising rarely in the naval septum. The reported cases of nasal septal chondrosarcomas are extensive lesions with involvement of paranasal sinuses, orbit or skull base at the lime of diagnosis. Those limited to the nasal cavity is extremely rare and to date there has been one case report in English language literature. We present a case of chondrosarcoma of the nasal septum with involvement of the nasal cavity alone and no evidence of bony erosion. Initial multiple biopsies showed mature chondromatous areas with no atypia. The patient had wide excision of the tumour. The final biopsy of the excised specimen revealed foci of well-differentiated chondrosarcoma. Wide surgical excision with adequate margins should be considered as the treatment of choice in lesion of nasal septum even if initial biopsies are negative for malignancy. Hence this case report.     

Endoscopic removal of a nasal septum chondrosarcoma

We describe an alternative, endoscopical technique for the surgical removal of a rare chondrosarcoma on the nasal septum. The technique requires a resection of the whole tumour within margins in healthy osteocartilaginous nasal septum under endoscopic guidance and includes bilateral middle turbinectomy and ethmoidectomy. We present the case of a 57-year-old woman with a well-differentiated chondrosarcoma (Grade I) of the nasal septum. Endoscopical surgery resulted without any cosmetic deformity problems, and the functional result was favourable. No recurrence was evidenced after a follow-up of 3 years. The main advantages of this technique are the excellent functional and cosmetic results without any surgical reconstructive techniques. This approach may provide a minimally invasive method to remove well-differentiated, low-grade (Grade I) and size limited malignant cartilaginous tumours of the nasal septum.     

Various aspects of endonasal corrective surgery

This paper discusses the results of 649 rhinoseptoplastic and 139 rhinoconchoplastic operations performed according to modified methods of Killian and Cottle. The surgical intervention led to the following complications: 1) deformation of the nasal septum in the vestibule area (11 patients); 2) perforation of the nasal septum of atrophic origin (15 patients); 3) saddle-like deformation of external nose (7 patients); 4) vibration of the nasal septum which occurred in most patients after total resection of the cartilage and vomer. The author elaborated methods of plastic operations of: the vestibule of the nose in order to prevent its postoperative deformation, the vomerine zone in order to preserve intraosseous vessels in the foramen incisivum area, the ridge of the nose in order to avoid the saddle-like nose, and implantation of the zigzag cartilage graft in order to prevent vibration of the nasal septum. Analysis of the rhinoconchoplastic operations allowed the author to propose medial positioning of the nasal concha in the case of hypotrophic rhinitis and implantation of autocartilage into the nasal concha in order to enlarge it in the case of hypotrophy.     

A schwannoma in the nasal septum

Schwannomas of the sinonasal tract are very rare neoplasms. We present the case of a schwannoma developing in the nasal septum. The patient was a 51-year-old woman with the complaint of unilateral nasal obstruction. We completely removed this tumor by an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.     

Ectopic tonsillar tissue in the nasal septum

A rare case of hypertrophied lymphoid tissue in the nasal septum considered to be an ectopic tonsil was reported. The patient was a 53-year-old male, and a polypoid mass attached to the septal wall by a stalk was removed. Histological examination showed that the tumour was an ectopic hyperplastic tonsil presenting in the nasal septum. The pathogenesis of this tumour was not clear, but it was considered as hyperplasia or a new formation of primary or secondary lymphoid follicles. This is the first case report of such a rare condition.     

Intranasal glomangioma

Glomangioma is a benign tumour of the glomus body. It is a relatively rare tumour in the head and neck region and even rarer in the nasal cavity. We present the 13th documented case of an intranasal glomangioma. A 56-year-old woman presented with a lesion on the nasal septum associated with intermittent nasal pain and epistaxis. Local surgical excision was not only diagnostic but therapeutic as it effected a cure. Intranasal glomangioma has no well-defined presenting features but must be borne in mind as a possible rare cause of nasal pain and epistaxis. We also briefly review the clinical presentation, histology and management of such a rare tumour.     

Restoration of the impacted nasal pyramid using a Kirschner wire

One of the most challenging types of nasal fracture is when the nasal pyramid, comprising of the upper and lower lateral cartilages and septum including the vomer, is fractured, impacted and has rotated into the face. This paper describes a technique to elevate the nasal complex and hold it forwards using a Kirschner wire.     

三维CT辅助下三线减张鼻中隔矫正术疗效观察

目的探讨三维CT辅助鼻内镜下三线减张鼻中隔矫正的手术技巧及其疗效观察。方法回顾性分析78例鼻中隔偏曲患者,全部行鼻内镜下三线减张鼻中隔矫正术,术前采用三维CT重建技术对鼻中隔偏曲部位进行评估,术中选择性地将鼻中隔方形软骨尾端、鼻中隔软骨与筛骨垂直板结合处、鼻中隔软骨下端与犁骨、上颌骨鼻嵴与腭骨鼻嵴结合处等部位形成的三条张力线分离,将应力区软骨和骨质按照事先设计方案进行切除,消除导致鼻中隔偏曲的应力,从而达到矫正鼻中隔的效果。结果所有患者术后均随访3个月以上,其中治愈57例,好转21例。结论鼻内镜下三线减张鼻中隔矫正术安全可靠,效果满意,最大限度保留了鼻中隔正常组织结构。术前利用三维CT重建技术对手术方式进行具有设计,具有手术精细,并发症少等优点,值得临床推广。