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The eruption of a canine tooth into the nasal cavity constitutes one topographic form of dental ectopy. We report a case and discuss the diagnostic aspects and diverse pathogenic theories proposed. This unusual situation should be suspected in patients with nasal obstruction and unilateral fetid purulent rhinorrhea.
Foreign objects frequently have been reported in the nasal structures, often these foreign bodies are occasionally inhaled by children or they are often inserted in nasal cavities after various accidents. Frequently, the presence of foreign bodies in the nose represents an emergency, particularly for pediatric patients where the incidence is high. The report in this article described an unusual nasal foreign body in an adult discovered incidentally during a cranial radiography. This report is an unusual case of facial asymmetry caused by a foreign nasal body in adult, which is destitute of complications, connected to long-term presence of the intranasal button. The finding was accidental; moreover the patient was an adult and did not present a clear symptomatology. Through careful clinical and fibroscopy exam, valuating also the site of the foreign body, it is necessary an intranasal surgery treatment. The results of the treatment is connected to a combined use of different branches of learning with the aim of obtaining positive results from both a clinical and legal point of view.
BACKGROUND: This study was conducted to determine whether the paranasal extension of a primary non-Hodgkin's lymphoma (NHL) of the nasal cavity has any deleterious effect on patient outcome. METHODS: One hundred and seventy-five patients with previously untreated nasal NHL were reviewed. There were 2 with low grade, 107 with intermediate grade, 17 with high grade, and 49 with unclassifiable lymphomas. In 48 cases the immunophenotype was available and 46 were T-cell lymphoma. According to the Ann Arbor system, there were 133 patients with Stage IE, 28 with Stage IIE, 4 with Stage IIIE, and 10 with Stage IVE lymphomas. Stage IE was subdivided into limited Stage IE (i.e., confined to the nasal cavity [67 patients]) or extensive Stage IE (i.e., presenting with extension beyond the nasal cavity [66 patients]). For patients with limited Stage IE disease the treatment of choice was radiotherapy with or without chemotherapy. In patients with extensive Stage IE disease, treatment was comprised of a combination of chemotherapy and radiotherapy or radiotherapy alone. For patients with a more advanced stage of disease (IIE-IVE), chemotherapy was an integral part of the treatment and was completed by irradiation, especially for patients with Stage IIE disease. RESULTS: The actuarial overall survival (OS) and disease free survival (DFS) rates at 5 years for the whole group were 65% and 57%, respectively. The 5-year OS and DFS rates were influenced by stage, with a gradual decrease from 75% and 68% for Stage IE disease to 35% and 28% for Stage IIE disease, and 31% and 19% for Stage IIIE/IVE disease. Patients with limited Stage IE disease survived significantly longer (90% 5-year OS) compared with those with extensive Stage IE disease (57% 5-year OS; P < 0.001). For 67 patients with limited Stage IE disease, the 5-year OS was 89% with radiotherapy alone and 92% with radiotherapy and chemotherapy, whereas for 66 patients with extensive Stage IE disease, the 5-year OS was 54% with radiotherapy and 58% with combined modality therapy or chemotherapy (P > 0.05). CONCLUSIONS: The prognosis of patients with primary NHL of the nasal cavity is stage dependent. In this large cohort of Stage IE patients, it was demonstrated that the paranasal local extension was a significant prognostic factor associated with poorer treatment outcome. The authors believe that Ann Arbor Stage IE should be subclassified further into limited and extensive Stage IE. The addition of chemotherapy did not appear to modify significantly the survival of patients with either limited or extensive Stage IE disease. The extranodal progression observed in patients with extensive Stage IE and Stage IIE-IVE disease clearly illustrates the need for improvement of systemic treatment.
The experience with 40 consecutive cases of cancer of the nasal cavity seen over a period of 15 years is presented. Males outnumbered females in a ratio or 5 to 3. Age ranged from 35 to 88 years, and the median age was 67 years. Epidermoid carcinoma accounted for 78% of the cases. Smoking from early age was a noticeable habit among these patients. The median length of smoking history was 51 years. Most lesions were diagnosed in an advanced stage of the disease, 58% of the cases being T3 lesions. Regional lymph nodes metastases were infrequent; only 12% of the patients presented nodes on admission; another 5% developed metastatic nodes during the follow-up period. An overall 5-year survival of 56% was obtained. The survival of cases with T1N0 lesions was 91%. Radiation therapy was the treatment of choice employed in 85% of the cases. A 5-year survival of 50% was obtained in these patients. Irradiation offers an additional means of salvaging recurrences after surgery. The special characteristics of tumors of the nasal cavity merit the evaluation of such lesions separately from tumors of the paranasal sinuses.
The transport and deposition of nanoparticles, i.e., dp = 1-2 nm, or equivalent vapors, in the human nasal cavities is of interest to engineers, scientists, air-pollution regulators, and healthcare officials alike. Tiny ultrafine particles, i.e., dp < or = 5 nm, are of special interest because they are most rapidly absorbed and hence have an elevated toxic or therapeutic impact when compared to larger particles. Assuming transient laminar 3-D incompressible flow in a representative human nasal cavity, the cyclic airflow pattern as well as local and overall nanoparticle depositions were computationally simulated and analyzed. The focus was on transient effects during inhalation/exhalation as compared to the steady-state assumption typically invoked. Then, an equation for a matching steady-state inhalation flow rate was developed that generates the same deposition results as cyclic inhalation. Of special interest is the olfactory region where the narrow channel surfaces receive only about one-half of a percent of the inhaled nanoparticles because the airflow bypasses these recesses located in the superior-most portions in the geometrically complex nasal cavities.
Stepped-tube models with a constriction in the anterior section were used to evaluate the effects that nasal valve passage area and nasal cavity shape have on acoustic rhinometry (AR) measurements. The AR-determined cross-sectional areas beyond a constriction of small passage area were consistently underestimated, and the corresponding area-distance curves showed pronounced oscillations. Also, the AR technique did not accurately reproduce abrupt changes in passage area. The results suggest that, regardless of the particular shape of the nasal cavity model, AR does not provide reliable information about cross-sectional areas posterior to a severe constriction. The experimental results are discussed in terms of theoretically calculated acoustic input impedance for the models studied, the physical limitations of AR, and assumptions made in AR algorithms. The study demonstrated that energy losses and sound wave attenuation due to air viscosity do not significantly affect AR measurements. It was also shown that passage area beyond a severe constriction is underestimated because the barrier created by the constriction reflects most of the incident sound power. The results also indicate that the oscillations in area-distance curves are due to low-frequency acoustic resonances in the nasal cavity model.
Chemical irritation in the human nasal cavity is poorly documented. In this field, an important issue concerns the differential responses produced by successive stimulation. Repeated identical chemical irritant stimuli can produce increases or decreases in responses (two phenomena known as self-sensitization or self-desensitization). In the same way, different molecules can interact and produce cross-sensitization or cross-desensitization. The aim of this study was to contribute to this question using two specific molecules, acetic acid (AA) and allyl isothiocyanate (AIC). As the self-sensitization and -desensitization for AIC is known, a first experiment in the present work investigated the response, acute effects and time course of sensitization or desensitization to acetic acid. A second experiment tested the responses of acetic acid after a previous stimulation with allyl isothiocyanate (mustard oil) and inversely with a short inter-stimulus interval (ISI of 45 s). A third experiment similar to the second used a long inter-stimulus interval (ISI of 3 min 30). Twelve healthy subjects participated in the study using psychophysical (intensity ratings) and psychophysiological (skin conductance response) measurements. Firstly, the results showed that repeated nasal stimulation with acetic acid produced a self-desensitization whatever the ISI. Secondly, the results showed a cross-desensitization of allyl isothiocyanate by previous acetic acid stimulation. In contrast, previous stimulation with allyl isothiocyanate had no effect on the following acetic acid response. These findings confirm that trigeminal sensitization and desensitization in the nasal cavity do not follow the same processes in relation to molecules used.
Seventeen patients were operated suffering from unilateral inverted papilloma of the nasal cavities, in one male associated with malignancy. We investigated these patients pre- and post-operatively by clinical examination, video-endoscopy, acoustic rhinometry, and computed tomography (CT). The aim was to find out which technique delivers reliable information about tumour recurrence in follow-up. By these controls three recurrences could be detected in a period of two-years' follow-up. Our results showed that the combination of CT, video-endoscopy and histological examination of biopsies is reliable to detect recurrence of inverted papilloma. To study the possibilities of detecting tumour recurrence by means of acoustic rhinometry, investigations on models of nasal cavities with various shape, size and location of tumour masses were undertaken. A comparison between the results of the model study and the acoustic rhinometric measurements in patients showed that growth of tumour masses can be detected by this method in an early phase under constant conditions such as nasal models. In patients, however, it is not easy to evaluate the absolute size and site of the growing tumour masses, because there are several factors which lead to false-positive interpretations, such as localized inflammations of the mucosa, crusting and nasal secretion and especially the movements of the soft palate. We conclude from our results that acoustic rhinometry does not deliver more information than obtained by video-endoscopy and CT to detect tumour recurrence in the nasal cavity.
We report an unusual case of giant cell reparative granuloma (GCRG) arising in the nasal cavity of a 7-year-old girl. GCRG is an uncommon benign lesion that is most commonly found in the mandible and maxilla. The MR imaging and CT findings of this lesion, as well as GCRGs in other craniofacial bones and extragnathic sites, will be reviewed. Although rare, the imaging characteristics of GCRGs should be recognized, and this entity should be suggested when the clinical information, CT, and MR features suggest a fibrous-osseous lesion in the nasal cavity.
Squamous cell carcinoma of the canine nasal cavity and frontal sinus was diagnosed in eight cases between May 1988 and April 1994. The most common presenting complaints were nasal discharge, including epistaxis; sneezing; and facial deformity or exophthalmos. Metastasis was not identified in any case, but bone lysis and invasion into tissues outside the nasal cavity were noted in five cases. Computed tomograms were performed in five cases and were more useful than radiographs in determining the extent of neoplastic involvement. Euthanasia was performed within one week of diagnosis in three cases at the owner's request; one case died at home within one month; and the remaining four cases were euthanized within eight months due to progressive clinical signs. The mean survival time in these eight cases was three months, with a range of zero weeks to eight months.
It is generally accepted that pheromones act by stimulating of the dendritic receptors of the olfactory neurones massed in the olfactory epithelium. This study was designed to ascertain whether it is possible for the boar pheromone androstenol (5alpha-androst-16-en-3-ol) to be transported from the nasal cavity of anaesthetized gilts to the brain and hypophysis via local transfer from the blood in the perihypophyseal vascular complex. The experiment was performed on days 18-21 of the porcine oestrous cycle (crossbred gilts, n = 6). Tritiated androstenol (3H-A; total amount 10(8) d.p.m. (758 ng)) was applied for 1 min onto the respiratory part of the nasal mucosa, 4-6 cm from the opening of the nares. Arterial blood samples from the aorta and from the carotid rete were collected every 2 min during the 60 min period following administration of the steroid. Total radioactive venous effluent from the head was removed and an adequate volume of homologous blood was transfused into the heart through the carotid external vein. At the end of the experiment gilts were killed and tissue samples of the hypophysis and some brain structures were collected to measure radioactivity. In addition, corresponding control tissues were collected from three untreated gilts and from three heads of gilts 60 min after 3H-A was applied post mortem into the nasal cavity. The concentration of 3H-A was significantly higher (P < 0.0001) in the arterial blood of the carotid rete than that of aorta. The mean rate of 3H-A counter current transfer from venous to arterial blood in the perihypophyseal vascular complex, expressed as the ratio of the 3H-A concentration in arterial blood of the carotid rete to the 3H-A concentration in blood sampled simultaneously from the aorta, was 1.96 +/- 0.1. The concentration of 3H-A in plasma from the venous effluent from the head ranged from 1.3 to 1.8 pg x ml(-1). During the 60 min period of the experiment, 0.68% of the total applied dose of 3H-A was resorbed from the nasal cavity into the venous blood. Moreover, we found that 3H-A was present in the olfactory bulb (P <0.01), amygdala, septum, hypothalamus, adenohypophysis, neurohypophysis (P > 0.05) and perihypophyseal vascular complex (P < 0.01). These results demonstrate that, in anaesthetized gilts, the boar pheromone androstenol may be resorbed from the nasal mucosa, transferred in the perihypophyseal vascular complex into arterial blood supplying the brain and hypophysis, and then arrested in the hypophysis and certain brain structures. We suggest that in addition to the standard neural pathway for signalling pheromones, another pathway exists whereby androstenol, as a priming pheromone, may be resorbed from the nasal cavity into the bloodstream and then pass locally from the perihypophyseal vascular complex into the arterial blood supplying the brain and hypophysis, thus avoiding the first passage metabolism in the liver.
Therapeutic effects of topically applied steroids is closely related to the deposition of sprayed particles. To clarify deposition in the nasal cavity, model experiments were undertaken using the gas and powder sprays. Deposits on the moistened filter paper which covered the surface of a nose model were assessed by absorbance of the extracts. The influence of the shape and the effect of continuous suction from the posterior outlet were also studied. When the nasal cavity was kept straight without any abnormal protrusions, the gas spray deposited more than 90% of particles. The amount was significantly lowered in the model of a concave septum with hypertrophic turbinates. The powder spray deposited approximately 75% of the original dose. This amount was more than 90% of actually sprayed particles because some loss was inevitable in spraying the powder. In general, the shape of the cavity more affected the deposition of the gas spray than the powder spray. This difference was probably due to the spray angle and to the size and speed of the aerosol particles. It was concluded that the powder spray was preferable to the gas spray with regard to the deposition in the nasal cavity.
BACKGROUND: Mucosal melanomas of the nasal cavity and paranasal sinuses are rare and do poorly. METHODS: Seventeen patients treated from 1981 to 1993 at a single referral center were retrospectively reviewed. RESULTS: Thirteen patients underwent surgical resection, with seven receiving postoperative radiotherapy. Eight had microscopically negative margins. The actuarial 2-year and 5-year survivals for this group of 13 were 67% (8 of 12) and 20% (2 of 10). The local recurrence rate was 85% (11 of 13) and distant metastases occurred in 31% (4 of 13) patients. In the absence of metastatic disease, resection of recurrent tumor correlated with disease-free intervals ranging from 3 months to 40 months. CONCLUSIONS: Those who received postoperative radiotherapy appeared to have done better with increased disease-free intervals and prolonged survival. Negative surgical margins were not predictive of a more favorable outcome. Surgical resection followed by postoperative radiotherapy is appropriate and resection of recurrent tumor should be considered.
We report a 65-year-old male with a hamartoma in the left nasal cavity. A mass was found in the left nasal cavity and was diagnosed as a benign tumor on the basis of preoperative findings. Left lateral rhinotomy was performed to completely remove it and the lesion was found to have arisen from the inferior turbinate. The pathological diagnosis was respiratory epithelial adenomatoid hamartoma. We discuss the pathological features of this disease.
OBJECTIVE: To evaluate the treatment modalities and the prognostic factors of nasal cavity carcinoma. METHODS: A retrospective study was done on 60 nasal cavity carcinoma patients treated from 1985 to 1992. Thirty-four patients received radiotherapy alone and 26 patients received surgery plus radiotherapy. Kaplan-Meier method was used to evaluate the survival, Log-rank test to assess the difference between these two groups and Cox proportional hazard model by multivariate analysis. RESULTS: The overall 5- and 10-year survival rates were 55.9% and 36.9% respectively. The 5- and 10-year survival rates were 79.0% and 57.9% in patients with early lesions (stage I, II) and 44.1% and 26.0% in patients with advanced lesions (stage III, IV) (P = 0.005). There was no significant difference in the survival rate between radiotherapy alone and radiotherapy plus surgery (P = 0.33). Patients with squamous cell carcinoma had obviously poorer survival rate than patients with adenocarcinoma (P = 0.04). Patients with positive nodes had a lower survival rate compared with negative node patients (P = 0.09). CONCLUSION: Histological type and clinical stage, but not method of treatment or neck node metastasis, are the important prognostic factors.
We report two solitary fibrous tumors of the nasal cavity and paranasal sinuses that were histologically and immunohistochemically virtually identical to solitary fibrous tumors (fibrous mesotheliomas) of the pleura. One tumor arose in a 48-year-old woman and the other in a 45-year-old woman. Both patients presented with nasal symptoms, and both patients are alive without evidence of disease 6 months and 1 year after excision. The tumors had a disorganized or "patternless" arrangement of spindle cells in a collagenous background and prominent vascular channels of varying size. Immunoperoxidase stains on paraffin sections showed staining of the cells for vimentin only; there was no staining for keratin, S-100 protein, desmin, and actin. Both cases presented some degree of diagnostic difficulty and had to be distinguished from other spindle cell tumors of the nasal cavity and paranasal sinuses, such as hemangiopericytoma, angiofibroma, and fibrous histiocytoma.
We describe a case of small cell carcinoma arising in the nasal cavity using combined chemotherapy with irinotecan (CPT-11)/cisplatin followed by surgical salvage which successfully avoided a radical operation. In a follow-up no local recurrence was observed over 3 years after the operation. Ours is the first report of the use of combined irinotecan (CPT-11)/cisplatin chemotherapy in small cell carcinoma of the nasal cavity.
Fourteen patients suffering from inverted papilloma of the nasal cavity and sinus were operated by the intranasal endoscopic approach. The period of follow-up were 24-60 months. Only one case had recurrence after three months and was then cured by a combined treatment of external nasal approach and radiotherapy. The other 13 cases had no recurrence in the follow up period. The intranasal endoscopic surgical technique was proved a better method for treating inverted papilloma of nasal cavity and sinus even when the lesions had affected the posterior ethmoid and spenoidal sinuses. It seems that this approrch would be a new way for removing inverted papilloma completely and the major advantage of which is an incision of the face can be avoided, while the curative rate might be the same or even better than that of the external approach.