Malignant lymphoma of nasal septum is uncommon. It presents a problem in diagnosis to both otorhinolaryngologist and pathologist. This case report is about one such patient in whom the local disease has been controlled with the treatment of radiotherapy alone. However it is suggested that combined treatment of radiotherapy and cytotoxic therapy might improve the survival rate.
The prevalence of nasal septal deformity and its relationship with the different types and difficulty of delivery were studied in a randomised group of newborns at the Maternity Hospital Kuala Lumpur between 1st November 1989 to 31st January 1990. Out of a total of 674 noses examined using the otoscope, 147 (21.8%) were found to have nasal septal deformity. There was no significant difference in the prevalence of nasal septal deformity in the different types of delivery. There was also no significant increase in the prevalence of nasal septal deformity with increasing degree of difficulty of the delivery. Therefore, we cannot then attribute parturition pressures or birth trauma as the etiology of these congenital nasal septal deformity. Nevertheless a policy of routine screening in view of early correction is advocated to decrease the morbidity associated with this deformity in newborns and children.
The transseptal transsphenoidal hypophysectomy has become a relatively frequent procedure in recent years. We performed 20 such procedures between January 1984 and December 1987 for various pituitary disorders. Significant complications such as CSF rhinorrhea, meningitis, diabetes insipidus, haemorrhage and septal perforation are discussed. The mortality rate for the series was 5%. In analysing the data, we feel that this technique of hypophysectomy is a safe procedure.
Fourteen patients who presented to the University Hospital of Kuala Lumpur between June 1981 and June 1991 were reviewed retrospectively. Nasal septal abscesses are uncommon and therefore there are limited reports in the medical literature. Early diagnosis and immediate therapy is mandatory to avoid cosmetic nasal deformity or intracranial infection. Two out of the fourteen patients developed saddle nose deformity and septal perforation because of delay in treatment, the cases were misdiagnosed by non-otolaryngologist as turbinates swelling. The leading cause of nasal septal abscess was non-surgical trauma which accounted for about 85.7%. The commonest pathogenic organism isolated from the pus of nasal septal abscess was Staphylococcus aureus.
A case of chondrosarcoma of the nasal septum is presented with the result of treatment. The patient was admitted for a growth in the nose of four years' duration. Fine needle aspiration for cytological examination was suggestive of squamous cell carcinoma. She was treated with lateral rhinotomy and wide excision followed by septorhinoplasty. Histological examination showed that the lesion was chondrosarcoma. The patient remained free of disease 26 months after surgery.
Septal perforation from intranasal cocaine abuse is well recognised. We present a case of progressive septal as well as palatal perforation. Progression from septal perforation to palatal perforation occurred after cessation of intranasal cocaine abuse. This patient had a weakly positive cytoplasmic antineutrophilic cytoplasmic antibody (C-ANCA) but no histologic evidence of Wegener's Granulomatosis. The differential diagnosis for septal and palatal perforation is reviewed. This case represents the fifth reported case of palatal perforation secondary to cocaine abuse in the literature, and the second associated with positive C-ANCA.
Acoustic rhinometry (AR) evaluates the geometry of the nasal cavity by measuring the minimum cross-sectional area (MCA) and nasal volume (V) by means of acoustic reflection. Understanding the normal and pathologic conditions of the internal nasal cavity using AR is important in the diagnosis of structural abnormalities in patients. The aim of this study was to investigate the normal range of AR parameters in healthy volunteers from three ethnic groups in Singapore: Chinese, Malay and Indian. We also attempted to evaluate the role of these measurements in the documentation of structural abnormalities in the nose. A total of 189 Singaporeans, aged > or = 18 years, were recruited from a nationwide survey study. They comprised 83 Chinese, 35 Malays and 71 Indians. Eighty-nine subjects had a rhinoscopically normal nose (Group 1), 77 had significant septal deviation (Group 2) and 23 had inferior turbinate hypertrophy (Group 3). AR was performed to measure the MCA at the anterior 1-5 cm from the nostril and the volume (V) between points at the nostril and 5 cm into the nose. A mean MCA (mMCA; equal to (L + R)/2) and a total volume (Vt; equal to L + R) were then calculated for each subject, where L and R refer to the measurements made for the left and right nostrils, respectively. The results showed that there was no statistically significant difference in mMCA (p = 0.80) and Vt (p = 0.60) among the three ethnic subgroups of Group 1. Statistically significant differences were found only between Groups 1 and 3 (p < 0.001 for both mMCA and Vt) and between Groups 2 and 3 (p = 0.001 for mMCA and p = 0.013 for Vt). Although there was no significant difference between Groups 1 and 2, significant differences in MCA (p = 0.001) and V (p = 0.040) were found between the narrower sides (smaller volume) and the wider sides in Group 2, indicating volume compensation between the nasal cavities. In conclusion, our study demonstrates that there is no significant difference in the normal range of AR measurements among Chinese, Malay and Indian ethnic groups. AR is able to determine the structural abnormality of the internal nasal cavity caused by septal deviation and inferior turbinate hypertrophy.
Nasal obstruction is a subjective complaint in patients with nasal disease. The ability to quantitate the nasal ventilation dysfunction would be useful for making the appropriate choice of nasal disease management. This cross-sectional study comprised of 200 adult subjects. They underwent assessment of relevant symptoms, nasal examination and investigations before undergoing active anterior rhinomanometry (AAR) assessment. A group of 88 normal subjects and 112 patients with nasal disease were included. The mean total nasal air resistance (NAR) was significantly higher in patients with nasal disease (0.33 Pa/cm(3)/s) as compared to normal subjects (0.24 Pa/cm(3)/s). There was no significant difference in total NAR between patients with symptoms of nasal obstruction and those without the symptoms (p = 0.42). It is concluded that AAR is a sensitive but not a specific tool for the detection of abnormalities in NAR and it failed to relate to the symptom of nasal obstruction.
We have previously formulated an optimized human chondrocytes growth medium based on 2% fetal bovine serum supplementation. For clinical usage, the animal serum must be replaced by patient own serum. We investigated the effects of human serum concentration for human nasal septum chondrocytes monolayer culture and cartilage reconstruction. Human serum demonstrated a dose dependent manner in promoting chondrocytes growth and cartilage engineering.
This study was to investigate the effects of insulin-transferrin-selenium (ITS) on the proliferation and quantitative gene expression of adult human nasal septum chondrocytes in monolayer culture expansion and the formation of tissue engineered hyaline cartilage. Effects of ITS on human nasal septum chondrocytes monolayer culture expansion and gene expression were evaluated in various culture media either added with 2% fetal bovine serum (FBS) or 1 ng/mL basic fibroblast growth factor plus 1 ng/mL transforming growth factor or both serum and growth factors supplementation in comparison with medium added with 10%FBS. Chondrocytes cultured in medium added with 2% fetal bovine serum and growth factors either supplemented with or without ITS were then mixed with pluronic F-127 hydrogel for in vivo tissue engineered cartilage formation in nude mice model. Engineered tissues were removed after 8 weeks of implantation and evaluated with histological staining, immunohistochemistry, transmission electron microscopy and quantitative gene expression analysis. ITS promoted human chondrocytes proliferation and reduced chondrocytes dedifferentiation in media supplemented with serum and growth factors. ITS with 2% FBS and growth factors provided 15-fold increased in chondrocytes number by the end of the culture period compared to the standard culture medium used in chondrocytes culture (medium added with 10% FBS). Engineered tissue resulted from ITS supplementation demonstrated higher quality of cartilage formation. In conclusion, our study has demonstrated the benefits of ITS supplementation in human chondrocytes monolayer culture and tissue engineering cartilage formation.
Treatment and management of congenital as well as post-traumatic trachea stenosis remains a challenge in pediatric surgery. The aim of this study was to reconstruct a trachea with human nasal septum chondrocytes by using the combination of biodegradable hydrogel and non-biodegradable high-density polyethylene (HDP) as the internal predetermined shape scaffold.
In this case series, the senior author details his series of patients who had undergone open septorhinoplasty for functional and/or aesthetic purposes in the Otorhinolaryngology Department at the Hospital Universiti Kebangsaan Malaysia (HUKM), Kuala Lumpur between January 2003 and September 2005. There were 23 patients, consisting of 15 men and 8 women from different Malaysian ethnic groups. Discussion on open septorhinoplasty with regards to operative technique, grafts and implants is presented from an otorhinolaryngologist's point of view.
The objectives of this study were to determine the optimum concentration of basic fibroblast growth factor (bFGF) in foetal bovine serum (FBS) or human serum (HS) supplemented medium for adult human nasal septum chondrocyte culture and to evaluate the potential of cartilage regeneration.
Chondrosarcoma of the nasal septum is an extremely rare malignant tumor. It accounts for only 10% to 20% of primary bone tumors, with approximately 10% found in the head and neck. A case is presented here to illustrate its presentation, evaluation and surgical treatment.
A pregnant lady in her third trimester presented with a rapidly growing right-sided nasal mass associated with epistaxis and nasal obstruction for two months. Examination showed a non tender, protruding mass completely occluding her right nostril. Wide surgical excision was done under local anaesthesia. Histopathology revealed capillary haemangioma. In a gravid patient with a rapidly growing intranasal lesion, capillary haemangioma should be considered as a differential diagnosis. Due to the rapidity of growth, presentation with epistaxis and its macroscopic appearance which often mimics malignancy; histologic confirmation is crucial.
Chronic rhinosinusitis (CRS) remains a prevalent disease and a major cause of morbidity for many patients and functional endoscopic sinus surgery (FESS) is the gold standard for the treatment of CRS. Many factors contribute to the development of CRS, among others nasal anatomic variation. The authors aim to study the association of concha bullosa and deviated nasal septum with CRS patients requiring FESS amongst the diversified multiethnic Malaysian race. The records of 137 patients with CRS who had undergone FESS between March 2002 and October 2006 at the Department of Otorhinolaryngology, Head and Neck Surgery of the Hospital Universiti Kebangsaan Malaysia (HUKM), Kuala Lumpur were retrospectively reviewed. The data revealed that deviated nasal septum (DNS) and concha bullosa (CB) were the two commonest anatomical variations in the nasal cavity. In this study, CB was statistically significant amongst the females and in the Chinese and Indian ethnic groups. DNS is also prevalent but has no significant statistical relationship with sex, age, ethnic group in the local context. CB and DNS are coincidental variations and this study disprove that DNS is associated with CB in its development and pathogenesis of CRS. The mere presence of both these conditions also does not predispose the patients to CRS in the adjacent paranasal sinuses.
The advent of endoscopes has revolutionized rhinology and the traditional headlight based surgeries have largely been replaced by endoscopes. Septoplasty for deviated nasal septum or Sluder's neuralgia have been conventionally performed with the aid of headlight. This can be technically challenging as visualization of the nasal cavity, particularly the posterior portion is rather limited as the procedure is performed via the nostrils. In addition, with headlights for illumination, teaching this procedure can be difficult as only the surgeon who is wearing the headlights has direct vision of the surgical field.Endoscopic septoplasty is an accepted alternative to traditional headlight approach to septoplasty. This approach provides a direct-targeted route to the anatomic deformity, improved visualization, and magnification of the surgical field. Our experience in endoscopic septoplasty is highlighted in this paper, excluding septoplasties performed as part of exposure to the sinuses. We use the open book method that to best of our knowledge has not been described in literature before.
The complexities of the anatomy of the nose and paranasal sinuses, as well as its variations may create technical difficulties during surgery. The significance of these anatomical variations in pathogenesis of rhinosinusitis, which is the commonest disease in the region, is still unclear.