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International Journal of Environmental... Mar 2021Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of... (Review)
Review
Surgical treatment of the inferior turbinates is required for hypertrophic inferior turbinates refractory to medical treatments. The main goal of surgical reduction of the inferior turbinate is to relieve the obstruction while preserving the function of the turbinate. There have been a variety of surgical techniques described and performed over the years. Irrespective of the techniques and technologies employed, the surgical techniques are classified into two types, the mucosal-sparing and non-mucosal-sparing, based on the preservation of the medial mucosa of the inferior turbinates. Although effective in relieving nasal block, the non-mucosal-sparing techniques have been associated with postoperative complications such as excessive bleeding, crusting, pain, and prolonged recovery period. These complications are avoided in the mucosal-sparing approach, rendering it the preferred option. Although widely performed, there is significant confusion and detachment between current practices and their basic objectives. This conflict may be explained by misperception over the myriad of available surgical techniques and misconception of the rationale in performing the turbinate reduction. A comprehensive review of each surgical intervention is crucial to better define each procedure and improve understanding of the principle and mechanism involved.
Topics: Catheter Ablation; Humans; Hypertrophy; Nasal Obstruction; Treatment Outcome; Turbinates
PubMed: 33810309
DOI: 10.3390/ijerph18073441 -
Ear, Nose, & Throat Journal Feb 2021A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in... (Review)
Review
OBJECTIVES
A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in mind, this article aims to summarize the most recent literature concerning laser application in rhinology.
METHODS
A literature search from 2000 to 2020 using the PubMed database was employed. Keywords used included "laser," "rhinology," "endonasal endoscopic surgery," "hereditary haemorrhagic telangiectasia," "rhinitis," "refractory rhinitis," "Inferior turbinate hypertrophy," "dacryocystorhinostomy," "septoplasty," "cartilage reshaping" and "choanal atresia." The most up to date studies published for each rhinology condition that could potentially be treated with laser surgery was included.
RESULTS
Rhinological conditions appropriate for laser applications are discussed. We identified articles related to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies and their limitations.
CONCLUSIONS
There is currently no one-size-fits-all laser and therefore being up to date on the latest clinical application results can help the clinician decide which are the best treatments to offer their patients.
Topics: Humans; Laser Therapy; Nasal Surgical Procedures; Nose Diseases; Otolaryngology; Treatment Outcome
PubMed: 32703032
DOI: 10.1177/0145561320940115 -
Cureus Oct 2021Inferior concha bullosa is a rare disease that has been related to sinonasal symptoms. This study aimed to determine the characteristics of concha bullosa in the... (Review)
Review
Inferior concha bullosa is a rare disease that has been related to sinonasal symptoms. This study aimed to determine the characteristics of concha bullosa in the inferior turbinate and assess its common clinical manifestations, computed tomography findings, and the surgical techniques used to treat the condition. We conducted a search of the PubMed database, using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis, for articles published until May 2021 using the following terms: "inferior turbinate and concha bullosa"; "inferior turbinate and pneumatization"; and in combination with other terms such as "concha bullosa release and concha bullosa excision", among others. We found 12 papers that met our inclusion criteria. The main presenting symptom was a nasal obstruction in 13 patients (100%), followed by headache in 10 patients (77%). The site of inferior concha bullosa was bilateral in six cases and left-sided in five cases. Computed tomography was conducted in all cases in this review. The type of intervention performed was medical, surgical, and both in 23%, 54%, and 23% of the cases. Despite multimodal surgical approaches and medical treatment, all the outcomes were good and no compactions were noted. All cases also had good prognoses.
PubMed: 34868747
DOI: 10.7759/cureus.19089 -
Ear, Nose, & Throat Journal Mar 2022Eosinophilic chronic rhinosinusitis (ECRS) is an allergic inflammatory disease characterized by chronic inflammation of the sinus mucosa, and sometimes, osteitis. This...
OBJECTIVES
Eosinophilic chronic rhinosinusitis (ECRS) is an allergic inflammatory disease characterized by chronic inflammation of the sinus mucosa, and sometimes, osteitis. This study aimed to investigate the pattern of osteitis in ECRS and the relationship between bony thickening of the middle turbinate and recurrence of ECRS.
METHODS
A total of 246 patients with paranasal diseases were included in the study. The patients' data on bone thickening level, mucosal thickening, polyp score, clinical severity, and laboratory data were retrospectively evaluated.
RESULTS
In total, 38, 186, and 22 patients had ECRS, non-ECRS (NECRS), and odontogenic sinusitis, respectively. The Lund-Mackey (LM) score and Global Osteitis Scoring Scale (GOSS) scores in patients with ECRS were higher than those in patients with other paranasal diseases. There was a significant positive correlation between the GOSS score and ECRS clinical disease severity. Postoperative recurrence was significantly increased in patients with ECRS associated with bony thickening of the middle turbinate.
CONCLUSION
Both mucosal inflammation and osteitis were more severe in patients with ECRS than in patients with other diseases, and clinical disease severity was correlated with osteitis. Furthermore, the postoperative recurrence rate tended to increase in patients with ECRS who had bony thickening of the middle turbinate.
PubMed: 35353655
DOI: 10.1177/01455613221083793 -
Allergy & Rhinology (Providence, R.I.) 2019Localized amyloidosis involving the nasal mucosa is rare, with only 38 published cases reported to date. We report a case of amyloidosis localized to the sinonasal...
Localized amyloidosis involving the nasal mucosa is rare, with only 38 published cases reported to date. We report a case of amyloidosis localized to the sinonasal tract. A 61-year-old man presented with a 1-year history of left-sided nasal obstruction. Endoscopic examination and computed tomography revealed the presence of a nasal mass originating from the left inferior turbinate. The patient subsequently underwent an examination under anesthesia and an excision biopsy of the nasal mass. Histology confirmed amyloidosis with no immunospecific stains. Systemic amyloidosis testing was negative, leading to a diagnosis of localized sinonasal amyloidosis of nonamyloid A (AA) subtype. To our knowledge, this is the second reported case of non-AA subtype of the sinonasal tract. The patient was managed conservatively and is currently under close follow-up.
PubMed: 31321117
DOI: 10.1177/2152656719860821 -
Journal of Inflammation Research 2024The purpose of this study was to analyze the nasal lymphatic system in order to uncover novel factors that might be involved in pathogenesis of chronic rhinosinusitis...
PURPOSE
The purpose of this study was to analyze the nasal lymphatic system in order to uncover novel factors that might be involved in pathogenesis of chronic rhinosinusitis (CRS) with (CRSwNP) and without nasal polyps (CRSsNP).
PATIENTS AND METHODS
Lymphatic vessels (LVs) and macrophages were localized and counted in the inferior and middle turbinate, the uncinate process and the ethmoid of CRSwNP and CRSsNP patients, the NP and the inferior turbinate of controls (n≥6 per group). Lysates of the same tissue types (n=7 per group) were analyzed for lymphatic vessel endothelial receptor 1 (LYVE-1), for matrix metalloproteinase 14 (MMP-14) and for Hyaluronic acid (HA) using ELISA. HA was localized in sections of CRSwNP NP, CRSsNP ethmoid and control inferior turbinate (n=6 per group). The results of HA levels were correlated to the number of macrophages in tissues. The nasal secretions of CRSwNP (n=28), CRSsNP (n=30), and control (n=30) patients were analyzed for LYVE-1 and HA using ELISA.
RESULTS
The number of LVs was significantly lower in tissues of both CRS groups compared to the control. In the tissue lysates, LYVE-1 expression differed significantly between the CRSwNP tissues with a particularly high level in the NP. MMP-14 was significantly overexpressed in CRSwNP uncinate process. There were no significant differences in tissue HA expression. In the mucus LYVE-1 was significantly underexpressed in CRSsNP compared to CRSwNP and control, while HA was significantly underexpressed in both CRS groups. In the NP, HA and macrophages were accumulated particularly below the epithelium. Tissue levels of HA revealed a significant positive correlation with the number of macrophages.
CONCLUSION
CRS might be associated with an insufficient clearing of the nasal mucosa through the lymphatics. The accumulation of HA and macrophages might promote inflammation, fluid retention, and polyp formation. These results may provide novel CRS-associated factors.
PubMed: 38348276
DOI: 10.2147/JIR.S436450