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PubMed2001

[Findings of massive pneumatization of the middle nasal turbinate in a collection of skulls from the 13th-18th centuries].

Ethmoid cells display a considerable variability due to their extensive development. Pneumatization of middle turbinate intermediary one or several ethmoid cells is referred to "concha bullosa", which belongs to the frequent and clinically significant variations of bony nasal cavity. The collection of 309 (176 male and 133 female) adult dry skulls pertaining to the "Broumov Ossuary" (13th-18th centuries) was examined for the presence of concha bullosa. The appearance of the middle turbinate was evaluated by inspection. Only noticeably enlarged middle turbinates were rated as positive finding of concha bullosa. All positive findings of concha bullosa were also verified by their probing; coronal CT examination of the nasal cavity and paranasal sinuses was performed in seven of them. Concha bullosa was diagnosed in 160 skulls (51.77%).

Czech Republic↗
PubMed2002

Early depictions of the nasal turbinates in the 15th century.

Although nasal turbinates had already been described by Hippocrates, it was not until the 15th century that they were depicted. The inferior turbinate was shown for the first time rather true- to nature in the works of the Middle Rhenic Master circa 1450-1460 and Leonardo da Vinci in 1489. The posterior ends of the middle turbinates were depicted on a woodcut by Georg Thomas for Dryander's "Anatomiae ... pars prior" in 1536. These and a few other examples show that some artists were ahead of the medical profession in demonstrating anatomical details in the 15th and 16th century.

Anatomy, Artistic↗
PubMed2002

Early depictions of the nasal turbinates in the 15th century.

Although nasal turbinates had already been described by Hippocrates, it was not until the 15th century that they were depicted. The inferior turbinate was shown for the first time rather true-to nature in the works of the Middle Rhenic Master circa 1450-1460 and Leonardo da Vinci in 1489. The posterior ends of the middle turbinates were depicted on a woodcut by Georg Thomas for Dryander's "Anatomiae ... pars prior" in 1536. These and a few other examples show that some artists were ahead of the medical profession in demonstrating anatomical details in the 15th and 16th century.

History, 15th Century↗
PubMed1999

[Management of middle turbinates in endoscopic sinus surgery].

OBJECTIVE: To explore the relationship between the partial middle turbinectomy and the prognosis. METHODS: Forty patients with nasal polyp and sinusitis were chosen. The partially middle turbinate was removed on one side and preserved on the opposite side. The time of postoperative debridement for nasal cavity, synechia of nasal cavity, and olfactory changes were assessed. RESULTS: The time of postoperative debridement of nasal cavity in patients with partial endonasal middle turbinectomy was shorter than those with preservation of middle turbinate (P < 0.01). There was no synechia in cases with partial middle turbinectomy and 12 cases of synechia in cases with preservation of middle turbinate. There was not difference about olfactory change in both sides. CONCLUSION: The partial middle turbinectomy in the endoscopic sinus surgery may be good for the prognosis of patients.

Adult↗
PubMedDate not supplied

Facial growth after middle turbinate resection: an experimental study in the rabbit.

BACKGROUND: The aim of this study was to determine the effects of total middle turbinate resection on midfacial growth through a morphometric analysis on an animal model. METHODS: Twenty-eight male New Zealand white rabbits were used. The animals were divided into three groups: group 1, elevation and relocation of the nasal bone was performed; group 2, concha resection was performed; group 3, control group with no surgical procedure. The surgery was done at 8-10 weeks of age and the skull of each subject was sampled as they reached maturity. The determined distances then were measured by using landmarks identified on skull. The supplied data were evaluated by using the Mann-Whitney U test. RESULTS: Deviation of the nasal axis to the opposite side of the resected concha and an increase in the width of nasal bone were observed only in group 2. In group 1, an increase of nasal bone length and zygomaticonasal distances was determined in both the operated and the unoperated sides of nasal bones. CONCLUSION: This animal experiment showed that operations on the nasal bone or concha resection affected the midfacial growth in rabbits. The effects of middle turbinate resection to midfacial development should be evaluated by additional studies. We recommend only limited, conservative surgical procedures on the middle turbinate, saving all the vital mucosa, periosteum, and bone.

Animals↗
PubMed2003

Nasal polyps and middle turbinates epithelial cells sensitivity to amphotericin B.

HYPOTHESIS: Intranasal application of the antimycotic agent amphotericin B (AmphoB) has been proposed as an effective treatment of chronic rhinosinusitis (CRS) with polyps. AmphoB is a sterol-binding agent known to modify cell membrane structure. The cytotoxic effects of AmphoB were studied on primary human nasal epithelial cells in vitro. METHODS: Human epithelial cells were isolated from nasal polyps and middle turbinates of patients suffering from CRS, and grown on collagen-coated polycarbonate filters with an air liquid-interface. After 15 days of culture, cells were exposed apically to 50 microM AmphoB during 4 h daily for 5 days. Some cells were treated during 4 weeks. The bioelectric properties of cells were then studied in Ussing chambers. Integrity of the cell monolayers was assessed by measurement of the transepithelial resistance (R) and immunofluorescent localization of the tight junction protein occludin. RESULTS: Disruption of the epithelial monolayer integrity was observed in all of the nasal polyps cell cultures, as demonstrated by a 60% drop in R. Immunofluorescence microscopy showed significant loss in cell number and disruption in the distribution of occludin. Turbinate cell cultures elicited no change in R and expression of occludin after AmphoB treatment. However, the transepithelial potential, the basal short-circuit current and the amiloride-sensitive current were reduced by 70%. CONCLUSIONS: AmphoB was cytotoxic for nasal polyp epithelial cells with disruption of the epithelium integrity and loss of tight junctions. In contrast, integrity of turbinate epithelial cells was conserved despite alterations in transepithelial ion transport. These observations may explain the beneficial effect of intranasal application of AmphoB on CRS observed in clinical trials.

Amphotericin B↗
PubMed2004

Histologic evaluation of nasal epithelium of the middle turbinate in untreated OSAS patients and during nCPAP therapy.

OSAS-patients complain about nasal disorders. Irritation of the nasal mucosa often leads to termination of nCPAP treatment. The aim of this study is to evaluate whether symptoms are related to histologic changes of the nasal mucosa of the head of the middle turbinate in OSAS-patients. Semi-thin sections of epon-embedded middle turbinate biopsy samples from 35 male patients (age 51-75 yr) with OSAS were compared with those of 10 healthy men (age 51-75 yr). In untreated OSAS-patients atrophic epithelium is common whereas ciliated epithelial types are rare. After short-time nCPAP therapy (mean 581h) patches of ciliated epithelium and squamous metaplasia reappear. Short-term nCPAP leads to a partially restoration of the mucosal architecture. During long-time nCPAP therapy (mean 6.737h) squamous metaplasia with conspicuous intraepithelial connective tissue papillae predominates whereas pseudostratified ciliated epithelium is missing. Dense round cell infiltrates in the lamina propria are frequently found. Rhinitic symptoms in OSAS-patients are correlated with marked histological changes of the respiratory epithelium of the head of the middle turbinate. Histological changes in untreated OSAS differ from those of patients during nCPAP-treatment.

Aged↗
PubMed2005

[Argon plasma coagulation (APC) for interior turbinates reduction].

Authors analyze results of argon plasma coagulation (APC) for interior turbinates reduction in patients with chronic nasal obstruction treated ineffectively with nasal drops. Rhinomanometric parameters, clearance of saccharine test results and cytological examinations were statistically analyzed in 70 patients with bilateral hypertrophy of turbinates treated in ENT Department of Medical University of Silesia in Katowice in years 2000-2001. Control group consists of 30 patients without breathing problems. The obtained results confirmed high effectiveness of APC for interior turbinates reduction. Only patients with first degree in T/S (turbinate/septum) nasal septum deviation were enrolled in both groups.

Adult↗
PubMed2004

Pyocele of the middle turbinate: a case report.

Mucoceles are uncommon and the majority of cases occur in the frontoethmoidal complex. The accumulation of mucous secretion and eventual secondary infection may result in the formation of a pyocele of the middle turbinate, which is exceptionally rare. This case report presents a patient with a large pyocele of the middle turbinate invading the orbit. A 48-year-old woman presented with a three-week history of nasal obstruction, slight rhinorrhea, and headache. There was an external swelling of the nasal pyramid just near the medial canthus and right exophthalmos with bulging of the medial canthus of the ipsilateral eye. A computed tomography scan revealed a rounded, expansive lesion of soft tissue density. There was a thin compact bone at the margin. Under general anesthesia, resection of the lateral and inferior walls of the middle turbinate was performed. The large cystic mass was filled with pus. Exophthalmos and bulging of the medial canthus immediately disappeared. Histologic examination showed the mucocele wall with a ciliary respiratory epithelium.

Diagnosis, Differential↗
PubMedDate not supplied

Radiofrequency for inferior turbinate hypertrophy: could its long-term effect be predicted with a preoperative topical vasoconstrictor drop test?

BACKGROUND: Our purpose was to evaluate whether postoperative improvement by radiofrequency (RF) volumetric tissue reduction (RFVTR) correlated with a preoperative topical vasoconstrictor drop test (TVDT) in subjects with chronic nasal obstruction secondary to inferior turbinate hypertrophy (ITH). METHODS: This study was a prospective and unblinded clinical trial. We included 22 subjects suffering from chronic nasal obstruction secondary to ITH. TVDT was performed on all subjects before the operation, and RF energy was delivered to three different sites of each turbinate. Nasal obstruction was evaluated by visual analog score (VAS) preoperatively, after TVDT, and 1, 2, 4, 6, 8, 12, and 24t weeks after surgery. Success rates of RFVTR and gain ratios of RFVTR and TVDT were calculated. RESULTS: Significant improvements were observed in success ratios by RFVTR between the 2nd and 12th weeks. Postoperative VAS values reached to VAS value achieved by TVDT at the 8th week. Correlation analysis revealed that postoperative VAS values found at the 2nd to 24th weeks correlated positively with VAS values achieved by TVDT (r = 0.47 and p < 0.03 at the 2nd week; r = 0.65 and p = 0.001 at the 24th week) but not with preoperative VAS values. Similar positive correlations also were found between gain ratios of TVDT and RFVTR from the 4th to 24th weeks. CONCLUSION: This study showed that success by RFVTR in ITH could be predicted by preoperative TVDT. Improvement by RFVTR depends on how much the patient's turbinates respond to TVDT, but not how much he/she complains of nasal obstruction.

Administration, Topical↗
PubMed2006

Choanal polyp originating from the inferior turbinate presenting as nasal polyposis.

Although choanal polyps frequently arise from the maxillary sinus, a choanal polyp originating from the inferior turbinate is a rare entity. A 14-year-old girl who had a history of bilateral nasal obstruction with snoring, mouth breathing and nasal discharge for 10 years was presented. On endoscopic examination, a polypoid mass completely obliterated the right nasal cavity. The left choana was also totally occluded by the polypoid mass. Endoscopic polypectomy was performed and it was observed that the polyp originated from the right inferior turbinate. Choanal polyps arising from the inferior turbinate should be kept in mind in the differential diagnosis of unilateral nasal polypoid masses.

Adolescent↗
PubMed1991

The secondary middle turbinate.

During functional endoscopic sinus surgery, the ethmoidal infundibulum and bulla are accessed through the middle meatus. This paper describes a secondary middle turbinate which arises from the lateral wall of the middle meatus, posterosuperior to the infundibulum and points superiorly within the meatus. A secondary middle turbinate was identified bilaterally in 6 out of 400 coronal CT scans of the nasal cavity and paranasal sinuses. The secondary middle turbinate did not obstruct the osteomeatal complex in any of our patients.

Congenital Abnormalities↗
PubMed1991

[Sinusitis of the middle turbinate. Descriptive study and treatment].

The middle turbinate inflammatory disease is a well a clinical as a radiological reality which is often unknown because of the rich sinusal surrounding diseases. This pathology represents less than 2% of the total sinusal pathologies we meet daily, and it always occurs on a concha bullosa: the middle turbinate becomes a real sinusal cavity with its own diseases. The new methods of diagnosis, nasal endoscopy and CT scanning, let identifie this turbinal own pathology better than ever. The authors emphasize a surgical treatment.

Adult↗
PubMed1986

Turbinate atrophy in gnotobiotic pigs intranasally inoculated with protein toxin isolated from type D Pasteurella multocida.

Three doses (75 micrograms, 25 micrograms, and 25 micrograms) of purified toxin isolated from a toxigenic strain of type D Pasteurella multocida were given (by atomizer) into the right nasal cavities of each of 10 gnotobiotic pigs on the 21st, 24th, and 27th days of age, respectively. Inoculated pigs (usually 2) and 1 noninoculated control pig each were necropsied on 3, 6, 9, 12, and 15 days after inoculations were given. Severe bilateral atrophy of turbinates occurred in all toxin challenge-exposed pigs. Atrophy was more severe in the inoculated nasal cavity than that in the noninoculated side in 2 of the 10 pigs. Microscopic changes in turbinates of toxin challenge-exposed pigs were more severe in pigs killed at later dates. Dominant changes included degeneration and necrosis of osteoblasts, markedly accelerated osteoclastic osteolysis, replacement of the osseous core by a highly cellular mesenchymal stroma, and multifocal atrophy of submucosal glands. Seemingly, a protein toxin isolated from toxigenic type D strains of P multocida produced rapid atrophy of turbinates and may be a contributing factor in development of clinical progressive atrophic rhinitis in swine.

Animals↗
PubMed1985

Inferior turbinate fracture in the treatment of congenital nasolacrimal duct obstruction and congenital nasolacrimal duct anomaly.

A group of 52 pediatric patients with lacrimal obstruction were considered to be high risk since they had been previously probed (27 patients) or were older (average age 23 months). At the time of probe and irrigation, a small, straight hemostat was placed into the nose to grasp the inferior turbinate and rotate it a full 90 degrees inward. All cases of congenital nasolacrimal duct obstruction (49) resolved following this maneuver. A small muscle hook with the tip directed upward was placed underneath the inferior turbinate to identify three patients with congenital nasolacrimal duct anomaly (absence or atresia of the nasolacrimal duct) who would not have benefitted from further probings and responded to dacryocystorhinostomy. Even though the results of our uncontrolled surgical trial cannot be compared to other treatment methods, the data suggest that even very difficult cases of congenital nasolacrimal duct obstruction will respond to a simple turbinate fracture with a hemostat without the necessity of complicated tubes or stents. A small muscle hook can be used to identify those rare cases of congenital nasolacrimal duct anomaly who may require specialized procedures such as dacryocystorhinostomy or inferior turbinectomy.

Child, Preschool↗
PubMed1985

[8 years' laser surgery of the inferior turbinates in vasomotor rhinopathy in the form of laser strip carbonization].

Between 1976 and 1984 more than 2000 patients with nasal obstruction due to vasomotor rhinitis were treated with the argon laser. The inferior turbinate was treated by laser-strip carbonisation over an area 3 to 5 cm long, 2 mm wide and 1 to 3 mm deep, surrounded by a 2 mm broad coagulation zone. 700 patients were invited to attend follow up and 411 turned up. The observation period was up to 5 years. 80% of the patients obtained a significantly improved or completely free nasal breathing. This result could be improved by 6% by further surgery. Advantages of the laser-strip carbonisation of the inferior turbinate are that it is a bloodless procedure which can be carried out accurately under vision, without nasal packing and it can be performed under local anesthesia without pain. Disadvantages are a longer healing period and temporary crust formation as in conchotomy, the high technical effort and cost of the laser. The end result after laser-strip carbonisation on the inferior turbinates was achieved after 1 1/2 to 2 years.

Humans↗
PubMed1983

[Osteomyelitis of the turbinates and its significance in chronic sinusitis].

We described the treatment of hyperplasia of the turbinate by sub-mucous resection of the inferior turbinate in 1981. The conchal bones removed were examined, and a histological study is now presented. In most cases we found a nonbacterial inflammation of the bone marrow of the inferior turbinate. The bearing of this and other changes in the bone marrow on the increase in size of the bone causing reduced ventilation of the nose and the paranasal sinuses, leading to sinusitis are discussed.

Chronic Disease↗
PubMed1996

Agreement among veterinarians evaluating gross lesions of lungs, livers, and nasal turbinates of pigs.

OBJECTIVE: To evaluate agreement between trained veterinarians and a reference inspector when recording gross lesions of lungs, livers, and nasal turbinates of pigs. DESIGN: Prospective study. SAMPLE POPULATION: 10 veterinarians in workshop 1 and 11 veterinarians in workshop 2. PROCEDURE: Analysis of data obtained from 2 workshops in which veterinarians evaluated fresh tissues (30 lungs and 30 livers) and 100 slides of nasal turbinates previously evaluated by the reference inspector. Veterinarians independently recorded observations of gross lesions. Agreement was evaluated by percentage agreement, kappa or weighted kappa, and sensitivity and specificity, where relevant. RESULTS: Agreement between veterinarians and the reference inspector was excellent for detecting consolidation of lung lobes typical of enzootic pneumonia (kappa = 0.81 and 0.87 for workshops 1 and 2, respectively) and white spots on livers (kappa = 0.76 and 0.78). Estimates of the extent of consolidation as a proportion of lung volume also agreed closely with reference values. Agreement was closer for veterinarians who had undergone repeated training and evaluation. Agreement was good for detecting nasal turbinate atrophy (weighted kappa = 0.63 and 0.68) and was poorest for detecting lesions of pleuritis (kappa = 0.39 and 0.44). CLINICAL IMPLICATIONS: For most of the lesions evaluated, acceptable levels of agreement with reference scores were achieved after training of veterinarians to use standardized methods to record gross lesions. Standardization of veterinarians' recordings of gross lesions should improve the reliability and usefulness of data collected by inspection of slaughtered pigs.

Abattoirs↗