[Show abstract][Hide abstract] ABSTRACT: The nasal valve region plays a key role in nasal breathing. In the international literature, a variety of techniques have been described to rectify nasal valve compromise, but based on the present evidence it is impossible to counsel a patient as to which technique is most effective. The aim of this study was to evaluate the results of surgery of the nasal valve through a hemitransfixion incision objectively with nasal endoscopy and rhinomanometry. The study group consisted of 54 males and 15 females with a mean age of 41.8 ± 14.4 years, (range: 21-72 years). After a mean follow-up of 8 ± 4.1 months, nasal endoscopy demonstrated the favourable effects of surgical treatment with a normalization of the nasal valve angles. Only 5 patients showed persistent nasal valve stenosis, and were scheduled for revision surgery. Preoperatively, total decongested inspiratory NARs were 0.245 ± 0.091 Pa/cm3/s and decreased significantly after the operation (p < 0.0005) to 0.154 ± 0.059 Pa/cm3/s. Similarly, preoperatively total decongested expiratory NARs were 0.188 ± 0.068 Pa/cm3/s and decreased significantly after the operation (p < 0.0005) to 0.142 ± 0.059 Pa/cm3/s. Moreover, total dilated inspiratory and expiratory NARs resulted significantly (p < 0.0005) lower than the preoperatively total decongested NARs, with a mean value of 0.120 ± 0.059 Pa/cm3/s and 0.102 ± 0.057 Pa/cm3/s, respectively. Statistical analysis did not reveal any influence of sex and age in rhinomanometric measurements. Hemitransfixion incision allowed a wide access to the whole valve area for inspection and correction of the various components. Rhinomanometry, performed in a decongested condition and after dilation test, was thus a useful diagnostic tool for the preoperative diagnosis of nasal valve obstruction and permitted to assess quantitatively the favourable effect of surgical procedures.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 06/2013; 33(3):196-201. DOI:10.1055/s-0030-1271298 · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Septoplasty in children is still a matter of open discussion, because it is thought that a surgical procedure on a developing structure might produce some adverse effects on normal nasal growth. The goal of this retrospective study is to evaluate the effects of pediatric nasal septum surgery in a long-term follow-up by anthropometry.
Forty-four Italian patients, 25 male patients and 19 female patients, who had undergone septoplasty during childhood using the endonasal approach, were reassessed after a mean follow-up of 12.2 years. Anthropometric recordings were used to identify any growth retardation due to the operation by a comparison with previously published age-specific normative data of North American white subjects. Nasal measurements consisted of five linear parameters, three angular parameters, and three proportional index.
There were no significant differences in any of the measures between the sample and controls (p > 0.1) with regard to gender, with the exception of the nasolabial angle measurement. Indeed, the nasolabial angle of the female patients was significantly reduced compared with controls (p = 0.04), whereas that of the male patients was reduced compared with controls (p = 0.08). This measurement seems to be influenced by the type of operation, because it has been noted that the nasolabial angle of patients treated surgically by extracorporeal septoplasty were significantly lower than those of patients treated surgically by conservative septoplasty.
Pediatric septoplasty may be indicated in selected cases of obstructing nasal septum deformities. The operation, performed via endonasal approach, does not interfere with the normal growing nasal process.
American Journal of Rhinology and Allergy 01/2011; 25(1):e7-12. DOI:10.2500/ajra.2011.25.3536 · 1.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The term extranasopharyngeal angiofibroma has been applied to vascular, fibrous nodules occurring outside the nasopharynx. The maxillary sinus is the most common site involved, while the nasal septum represents an extremely rare localization. Computerized tomography scan and magnetic resonance imaging are used to determine the tumour site and its extension. Surgical excision of the mass is the treatment of choice, and recurrence is rare. Typically, clinical characteristics of extranasopharyngeal angiofibromas do not conform with that of nasopharyngeal angiofibromas and, for this reason, these tumours must be regarded as a separate entity. Due to these different features, extranasopharyngeal angiofibromas can present a diagnostic challenge and a meticulous evaluation with a high index of suspicion is essential in establishing the correct diagnosis and treatment. We report the case of a 57-year-old female with a 1-year history of a slowly progressing right nasal obstruction due to the presence of a whitish mass adhering to the posterior nasal septum. The patient was succesfully treated surgically. Histopathological findings were compatible with a diagnosis of angiofibroma. Extranasopharyngeal angiofibroma must be taken into consideration in the differential diagnosis of nasal vascular tumours and nasal septum should be regarded as a potential, though exceptional, localization of these neoplasms.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 01/2009; 28(6):312-4. · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: First described in 1973 by Alfi et al,(1) the 9p deletion syndrome is a well-recognized (although rare) clinical entity reported in slightly more than 100 cases to date. The head and neck are always involved, typically manifesting long philtrum, microstomia, short, appearing neck, trigonocephaly, epicanthal folds, anteverted nares, midlace hypoplasia, upslanting palpebral fissures, and posteriorly angulated and poorly formed ears. Other phenotypical characteristics include hypotonia, widely spaced nipples, mental retardation, square hyperconvex nails, dolichomesophalangy, and an excess of whorls on the fingers.(2) Furthermore, ambiguous genitalia and male-to-female primary sex reversal have been reported inpatients with a normal Y chromosome and a terminal 9p deletion.(3,4)
Archives of Otolaryngology - Head and Neck Surgery 11/2007; 133(10):1054-6. DOI:10.1001/archotol.133.10.1054 · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report our experience in nasal septum perforation surgery using the endonasal approach. The role of rhinomanometry and nasal endoscopy in the management of septal perforation repair is also discussed.
We reviewed a sample of 30 patients with septal perforation. Patients underwent preoperative and postoperative nasal endoscopy and rhinomanometry. They were all treated using the Cottle technique with the backward extraction-reposition of nasal septum and inverted sliding flap suture technique.
Closure rate for small-sized and middle-sized perforations was 94% and 75%, respectively. It was 86.6% if calculated for all patients. Preoperative nasal resistances was normal in patients with isolated septum perforation, and high in patients with associated septum deformity or hypertrophic turbinates.
The Cottle technique is a viable procedure for the closure of small- and middle-sized perforations. Endoscopy and rhinomanometry help provide a correct and complete understanding of this nasal alteration.
Otolaryngology Head and Neck Surgery 01/2007; 135(6):922-7. DOI:10.1016/j.otohns.2006.04.017 · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rapid maxillary expansion is an orthodontic procedure that is commonly used to widen the maxilla. It is generally admitted that this technique is effective to correct palate narrowing, whereas there has not been agreement on the effect of this procedure in nasal parameters. The availability of a reliable and objective technique to assess the geometry of nasal cavities, such as acoustic rhinometry, stimulated the present investigation.
Twenty-seven children, undergoing rapid maxillary expansion, were evaluated by rhinomanometry and acoustic rhinometry. Postero-anterior radiographs were taken in 15 patients for cephalometric measurements. Examinations were performed before expansion treatment and after 12 month follow-up and compared to the measurements obtained from an untreated control group.
With regard to rhinomanometry, we recorded a significant reduction in nasal airway resistance (NAR) after the orthodontic procedure only in decongestion. Using acoustic rhinometry, we found a significant increase in total minimum cross-sectional areas (TMCA) and total nasal volume (TNV) after the expansion both in basal and decongested conditions. Also, nasal cavity width and interzygomatic distance had a significant mean increase after the treatment. Comparison of measures between the control group and the treated group showed that the increase in TMCA and TNV, as well as the decrease in NAR, were significantly greater in the treated group in both basal and decongested conditions.
We demonstrated that rapid maxillary expansion is an effective procedure in widening nasal cavities with respect to an untreated control group and that the reported improvement in nasal breathing after palatal expansion, is a consequence of an increase in nasal size.
American Journal of Rhinology 07/2006; 20(4):385-93. DOI:10.2500/ajr.2006.20.2881 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate geometric changes of nasal cavities in children undergoing rapid maxillary expansion and to assess the effect of this procedure on nasal airway size by means of acoustic rhinometry.
We recruited 14 mouth-breather children (mean age 8.2 years) presenting constricted maxillary arches and scheduled for rapid maxillary expansion in the orthodontics department of our hospital. Clinical history did not reveal any allergic diseases and ENT examination was completely normal with a well-aligned nasal septum. Nasal measurements were obtained using acoustic rhinometry, which was performed before the expansion treatment and after 1-year follow-up. A postero-anterior radiograph of the skull was also performed in all patients for cephalometric analysis before and 3 months after the treatment.
We observed a satisfactory increment in the transverse dimension of the maxilla in all patients but one who manifested a relapse after 4 months from the treatment and required a second procedure. Similarly, acoustic rhinometric measurements and cephalometric tracings showed a statistically significant increase respectively in decongested total nasal volumes (p=0.047) and in binasal cavity width (p=0.001). However, only eight children switched their respiration from oral to nasal breathing mode.
Rapid maxillary expansion is an effective method for increasing the width of narrow maxillary vault and it is also associated with a significant increment in nasal volumes and in the transverse diameter of the maxilla. With regard to breathing posture, the role of this procedure still remains debatable. To date this is the first study aimed at analysing the effects of rapid maxillary expansion on nasal dimensions by means of acoustic rhinometry.
International Journal of Pediatric Otorhinolaryngology 02/2006; 70(1):27-34. DOI:10.1016/j.ijporl.2005.05.004 · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Systemic lupus erythematosus is a disease of unknown cause that manifests with tissue and cellular alterations due to the deposition of antibodies and pathogenic immune complexes. The disease can be associated with anticardiolipin antibody syndrome, a disorder of recurrent vascular thrombosis and thrombocytopenia associated with a persistent anticardiolipin test positivity. In this report, we describe the case of a young woman affected by lupus erythematosus and positive for anticardiolipin antibodies who was brought to our observation for a sudden sensorineural hearing loss in the right ear. The patient was successfully treated with osmotic therapy and, 13 months after the initial symptom, is now in good clinical condition with no recurrence of the hearing loss and normal bilateral hearing. Together with a critical review of the pertinent literature, this rare clinical case led us to formulate some original comments.
The Annals of otology, rhinology, and laryngology 04/2005; 114(3):214-8. DOI:10.1177/000348940511400308 · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The nasal valve represents the main region of nasal respiratory resistance; therefore, even small deformities in this area can result in breathing disorders. A total of 93 patients (55 male, 38 female, mean age 37 years, range 16-52) suffering from nasal respiratory impairment due to valvular stenosis were recruited to study nasal function by means of rhinomanometry and acoustic rhinometry. Examinations were made in basal conditions, after decongestion and using the Ognibene internal dilator. Of these patients, 75 underwent surgery for functional correction of valvular stenosis and were observed at follow-up 3 months later, to analyse the surgical outcome. A review of the data concerning acoustic rhinometry has proven that, on the basis of post-operative tests, Minimal Cross-sectional Area values almost match pre-operative findings, carried out with nasal dilator. The aim of the present study is to demonstrate that acoustic rhinometry, associated with rhinomanometry and carried out with the aid of Ognibene internal dilator, is a valid tool for the diagnosis of nasal valvular stenosis and can also be usefully employed in post-operative follow-up.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 09/2004; 24(4):193-8. · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors present the results of a long-term follow-up after an immediate reduction of nasal septum luxation in newborn infants.
Forty-nine children, who underwent a treatment for septal dislocation within 48 hours after birth, were reexamined in 2002 at a mean age of 13.2 years (range, 10-17 years). The examination was performed through inspection of the nasal pyramid, anterior rhinoscopy, nasal endoscopy, rhinomanometry, and acoustic rhinometry.
Anatomic and functional findings showed satisfactory results for all children affected by septal dislocation. Three patients presenting irreplaceable septal-pyramidal deformity had no spontaneous reduction at 7-, 10-, and 11-year follow-ups and thus required surgical intervention.
Considering the simplicity and the safety of the reduction maneuver, the importance of early detection and treatment of neonatal septal dislocations is stressed. This is the longest follow-up study reported in international literature to date.
American Journal of Rhinology 01/2004; 18(1):47-51. · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. Isolated sarcoidosis of palatine tonsils in the absence of other systemic localizations is very rare, and only a few cases have been described in literature. We report a case of a 69-year-old woman presenting an asymptomatic unilateral enlargement of palatine tonsils. The pathologic report of the tonsillectomy specimen revealed the presence of noncaseating granulomatous lesions compatible with sarcoidosis. The research of acid-fast bacilli on the biopsy material using the Ziehl-Neelsen stain was negative, and no cultural growth was documented. Further investigations confirmed the diagnosis and excluded other systemic localizations of the disease. In our experience, asymmetric tonsils caused by sarcoid disease should be taken into consideration for the differential diagnosis in tonsillar enlargement. With this report, we underline the possibility of an isolated localization of sarcoidosis in palatine tonsils manifested as asymmetric enlargement, and we point out the value of histopathologic examination after tonsillectomy in selected cases. Once sarcoid lesions are found in tonsillar specimens, further investigations are mandatory to confirm the diagnosis, to detect an eventual multisystemic disease, and to exclude a possible association with malignancy.
American Journal of Otolaryngology 05/2003; 24(3):187-90. DOI:10.1016/S0196-0709(03)00006-1 · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In nasal surgery some surgical steps are done without the aid of direct vision. In these situations, surgeons must use their experience and judgment. I have adapted techniques used in endoscopic sinus surgery to perform some of the surgical steps of functional and aesthetic rhinoplasty. Between September 1999 and February 2000, 11 patients underwent endoscopic-assisted septorhinoplasty, and 18 patients underwent traditional closed rhinoplasty. The following parameters were compared: surgical bleeding, postoperative edema and ecchymosis, dorsum irregularity, and operative time for each technique. The following steps were clearly visualized with the endoscope: raising the periosteum from the nasal bone, resecting the nasal hump, and rasping the nasal bones. The use of endoscopic instruments does not change the surgical steps required. Rather, it allows direct vision of steps previously not viewable.
Archives of Facial Plastic Surgery 07/2002; 4(3):190-3. DOI:10.1001/archfaci.4.3.190 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: SUMMARY The term extranasopharyngeal angiofi broma has been applied to vascular, fi brous nodules occurring outside the nasopharynx. The maxillary sinus is the most common site involved, while the nasal septum represents an extremely rare localization. Com- puterized tomography scan and magnetic resonance imaging are used to determine the tumour site and its extension. Surgical excision of the mass is the treatment of choice, and recurrence is rare. Typically, clinical characteristics of extranasopharyngeal angiofi bromas do not conform with that of nasopharyngeal angiofi bromas and, for this reason, these tumours must be regarded as a separate entity. Due to these different features, extranasopharyngeal angiofi bromas can present a diagnostic challenge and a meticulous evaluation with a high index of suspicion is essential in establishing the correct diagnosis and treatment. We report the case of a 57-year-old female with a 1-year history of a slowly progressing right nasal obstruction due to the presence of a whitish mass adhering to the posterior nasal septum. The patient was succesfully treated surgically. Histopathological fi nd- ings were compatible with a diagnosis of angiofi broma. Extranasopharyngeal angiofi broma must be taken into consideration in the differential diagnosis of nasal vascular tumours and nasal septum should be regarded as a potential, though exceptional, localization of these neoplasms. Con il termine angiofi broma extrarinofaringeo si intende denominare una lesione di tipo fi brovascolare che origina al di fuori del cavo rinofaringeo. Il seno mascellare è la sede più comunemente interessata, mentre il setto nasale rappresenta una loca- lizzazione estremamente rara di questa neoplasia. La tomografi a computerizzata e la risonanza magnetica sono le indagini utilizzate per determinare la sede e l'estensione di queste neoformazioni. Tipicamente, le caratteristiche cliniche dell'angiofi - broma extrarinofaringeo non rispecchiano quelle dell'angiofi broma a origine rinofaringea e, per tale motivo, questa lesione deve essere considerata una entità a sé stante. A causa di queste differenti caratteristiche, la neoplasia può rappresentare una sfi da in termini diagnostici; pertanto, una valutazione metodica della lesione è essenziale ai fi ni di un corretto inquadramento diagnostico e terapeutico. Riportiamo il caso di una paziente, di 57 anni, con una storia clinica di ostruzione respiratoria nasa- le, insorta gradualmente nel corso dell'ultimo anno a causa di una massa biancastra aderente al setto nasale posteriormente. La paziente è stata trattata chirurgicamente con successo. Il riscontro istopatologico è risultato compatibile con la diagnosi di angiofi broma. L'angiofi broma extrarinofaringeo deve essere preso in considerazione nella diagnosi differenziale dei tumori vascolari del naso e il setto nasale deve essere ritenuto una localizzazione possibile, seppur rara, di queste neoplasie. PAROLE CHIAVE: NasoTumori benigniSetto nasaleAngiofi bromaAngiofi broma extrarinofaringeo