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Inferior turbinoplasty: patient selection, technique, and long-term consequences.

When conservative medical management of symptomatically enlarged inferior turbinates is ineffective, the obstructing tissue may be reduced by an intramucosal or extramucosal destructive procedure (such as electrocautery, cryotherapy, or laser vaporization), or by conservative surgical resection. In the latter instance, enlarged conchal bones may be removed by the technique of turbinate submucous resection, while diffuse stromal hypertrophy necessitates partial resection of the inferior turbinates. A number of techniques of inferior turbinate surgery have been described. I have used the procedure of "inferior turbinoplasty" with increasing frequency for more than 9 years. Three to five years after such surgery, a detailed followup of 40 patients revealed none of the once-feared sequelae of turbinate resection, such as bleeding, crusting, foul nasal discharge, or bothersome postnasal drainage. Histologic examination of turbinates almost 5 years after turbinoplasty revealed fibrosis and scarring, with a marked decrease in mucous gland population, and normal mucosa. To obtain the best possible functional result inferior turbinate surgery is a necessary adjunct to most septal surgery. If conservatively done, it does not impair normal turbinate function. It must be stressed, however, that if the underlying cause of the turbinate hypertrophy is not addressed, recurrent obstruction can and probably will occur.

Adolescent↗

Developmental toxicity study of inhaled acrylic acid in New Zealand White rabbits.

In range-finding and definitive developmental toxicity studies, timed pregnant New Zealand White rabbits were exposed to acrylic acid (CAS No. 79-10-7) vapour for 13 consecutive days during pregnancy. In the range-finding study, eight pregnant does/group were exposed to 30, 60, 125 or 250 ppm acrylic acid vapour on gestation days (gd) 10-22 of pregnancy. Monitors of toxicity included body weight measurements, daily food consumption measurements and clinical observations. Three of the eight does/group were killed on the day following the last exposure (gd 23), and the remaining does were killed and autopsied on gd 29. At autopsy, special attention was given to gross observation of maternal nasal turbinates, and nasal turbinates from all does were evaluated histologically. No evaluation of foetuses was performed in the range-finding study. In the definitive study, 16 does/group were exposed to concentrations of 25, 75 or 225 ppm acrylic acid vapour from gd 6 to 18, the major period of organogenesis. Monitors of maternal toxicity included clinical observations and measurements of body weight and daily food consumption measurements. Does were killed and autopsied on gd 29. Maternal liver and kidney weights were measured and external, visceral and skeletal evaluations of foetuses were conducted. Maternal nasal turbinates were not evaluated histologically in the definitive study. Effects in does from both studies included consistent concentration-related reductions in food consumption and body weight gains throughout the exposure period at concentrations of acrylic acid vapour above 60 ppm. Characteristic clinical signs of sensory irritation, including perinasal and perioral wetness and severe nasal congestion, were noted in does from both studies at or above vapour concentrations of 75 ppm. Gross observation of nasal turbinates immediately following exposures in the range-finding study indicated colour changes in the nasal turbinates of does in the 60 and 250 ppm groups. Colour changes in the nasal turbinates were noted in one doe from the 250 ppm exposure group killed on gd 29. Pertinent autopsy findings in the does from the definitive study included ulceration of the nasal turbinates of a single doe in the 225 ppm group. Histological evaluation of turbinates from does killed the day following exposures in the range-finding study revealed lesions in the nasal epithelium in all acrylic acid-exposed groups. The severity of the lesions was concentration related. Microscopic evaluation of turbinates from does killed on gd 29 showed the presence of nasal lesions in the 60, 125 and 250 ppm groups. However, the nasal tissues had recovered considerably during the post-exposure interval. Despite the severe effects on the nasal mucosa of does in both studies, there was no evidence of developmental toxicity including teratogenicity at any exposure concentration used in the definitive study.

Abnormalities, Drug-Induced↗

NTP Toxicology and Carcinogenesis Studies of Propylene Oxide (CAS no. 75-56-9) in F344/N Rats and B6C3F1 Mice (Inhalation Studies).

Propylene oxide is a volatile, colorless liquid used as an intermediate in the production of polyether polyols, polyurethane foams, and unsaturated polyester resins and also as a fumigant for sterilizing a variety of materials ranging from plastic medical instruments to foodstuffs. In the United States, propylene oxide is registered as a fumigant for packaged dried prunes and glacé fruits such as candied cherries and as an insecticidal and fungicidal fumigant for bulk quantities of cocoa, gums, and processed spices. The 2-year carcinogenesis studies of propylene oxide (greater than 99.9% pure) were conducted by exposing groups of 50 F344/N rats and 50 B6C3F1 mice of each sex to air containing propylene oxide at concentrations of 0 (chamber control), 200, or 400 ppm for 6 hours per day, 5 days per week, for 103 weeks. The survival of rats exposed to propylene oxide was comparable with that of the controls; terminal body weights were lower than those of the controls for high dose males (8%) and high dose females (6%). Survival of exposed male and female mice decreased relative to that of the controls (male: control, 42/50; low dose, 34/50; high dose, 29/50; female: 38/50; 29/50; 10/50), but the difference was significant only for animals in the high dose groups. High dose female mice had a mean terminal body weight 22% below that of the controls. The respiratory epithelium of the nasal turbinates was one of the primary tissues affected in male and female rats; exposure-related increases occurred in the incidences of suppurative inflammation, epithelial hyperplasia, and squamous metaplasia. Papillary adenomas, involving the respiratory epithelium and underlying submucosal glands of the nasal turbinates, were observed in three female rats and two male rats exposed to propylene oxide at 400 ppm. The incidence of adenomas in females was significant by the trend tests. The proportions of high dose female rats with C-cell adenomas and with C-cell carcinomas of the thyroid gland were increased, but only the combined incidence of these tumors was significant (2/45; 2/35; 7/37). These tumors were not considered to be related to exposure to propylene oxide because there was no other evidence for C-cells' being a target tissue and because there was no increase in C-cell hyperplasia. The combined incidences of female rats with endometrial stromal polyps and endometrial stromal sarcomas of the uterus were significantly increased in the dosed groups (3/49; 12/50; 10/47). However, the occurrence of these lesions in the dosed groups was similar to the average (306/1,502, 20%) seen in untreated controls in NTP carcinogenesis studies, and hence this increase was not regarded as being related to exposure to propylene oxide. The respiratory epithelium of the nasal turbinates was also one of the primary tissues affected in male and female mice; exposure-related increases occurred in the incidences of inflammation, and squamous metaplasia was observed in one low dose male and two high dose female mice. One squamous cell carcinoma and one papilloma occurred in the nasal cavity of different high dose male mice, and two high dose female mice had adenocarcinomas of the nasal cavity. The endothelial cells of the submucosal vascular plexus in the nasal turbinates also appeared to be a major site affected in high dose male mice. Three high dose male and three high dose female mice had a saccular dilation (classified as angiectasis) of submucosal turbinate vessels. Further, hemangiomas were seen in the nasal cavity of 5/50 high dose male mice and 3/50 high dose female mice, and hemangiosarcomas were found in the nasal cavity of 5/50 high dose male mice and 2/50 high dose female mice. The increased incidences of hemangiomas in males and females and of hemangiosarcomas in males were statistically significant. Vascular tumors were not present in the nasal turbinates of any low dose or control mice. Under the conditions of these studies, there was some evidence of carcinogenicity for F344/N rats, as indicated by increased incidences of papillary adenomasncreased incidences of papillary adenomas of the nasal turbinates in male and female rats exposed to propylene oxide at 400 ppm. For male and female B6C3F1 mice, there was clear evidence of carcinogenicity, as indicated by increased incidences of hemangiomas or hemangiosarcomas of the nasal turbinates at 400 ppm. In the respiratory epithelium of the nasal turbinates, propylene oxide also caused suppurative inflammation, hyperplasia, and squamous metaplasia in rats and inflammation in mice.

Journal Article↗

Comparison of the effects of radiofrequency tissue ablation, CO2 laser ablation, and partial turbinectomy applications on nasal mucociliary functions.

OBJECTIVES: One of the major causes of chronic nasal airway obstruction is disease of the inferior turbinate. However, there is no agreement on how to deal with this problem. Comparison was made of the nasal functions after treatment by radiofrequency tissue ablation, laser ablation, and partial turbinectomy using subjective symptom scores and objective tests. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: The study was conducted on three groups of 45 adult volunteer patients with symptoms and signs of nasal obstruction and stuffiness related to enlarged turbinates. In group A, laser ablation was applied to the inferior turbinate on one side and partial turbinectomy to the inferior turbinate on the other side. In group B, radiofrequency tissue ablation was applied to the inferior turbinate on one side and partial turbinectomy to the inferior turbinate on the other side. In group C, patients who were not treated by any surgical techniques were the control subjects. Clinical examinations, visual analogue scales, rhinomanometry, and isotopic study of nasal mucociliary transport time were used to assess treatment outcomes. RESULTS: At 12 weeks after surgery, the nasal mucociliary transport time results were compared in the same patients. The average time was 25.60 minutes on the side where laser ablation was applied and 11.40 minutes on the side where partial turbinectomy (PT) was applied. In the patients on whom radiofrequency tissue ablation and partial turbinectomy were applied, the average nasal mucociliary transport time was 10.33 minutes on the radiofrequency tissue ablation side, whereas it was 11.33 minutes on the partial turbinectomy side. Rhinomanometric measurements demonstrated a significant decrease in nasal resistances at 12 weeks in both sides in groups A and B. CONCLUSIONS: In the study it was demonstrated that radiofrequency tissue ablation to the turbinate is effective in improving nasal obstruction objectively and in preserving nasal mucociliary function. Laser ablation of the turbinate is effective in improving the nasal obstruction; however, it disturbs the mucociliary function significantly. With the partial turbinectomy technique, results obtained were similar to the results with the radiofrequency tissue ablation technique.

Adult↗

The permeation of nalmefene hydrochloride across different regions of ovine nasal mucosa.

The permeability of nalmefene hydrochloride (NH) across different regions of ovine nasal mucosa was investigated in vitro. Five different regions of ovine nasal mucosa (superior turbinate mucosa, middle turbinate mucosa, inferior turbinate mucosa, posterior septum mucosa, and anterior septum mucosa) were studied. The results showed that the permeability coefficients of NH through different regions of nasal mucosa were different, and the suitable regions for the absorption of NH were the middle turbinate mucosa, the posterior septum mucosa and the superior turbinate. At the same time, the middle turbinate mucosa was the largest region among the five regions, thus it was the main absorption region for NH. The high uniformity of the middle turbinate mucosa also made it the most suitable model for the permeation of NH in vitro.

Animals↗

Pneumatization of the concha inferior as a cause of nasal obstruction.

Chronic nasal obstruction is a common disorder. Hypertrophy of the inferior turbinates is responsible for nasal obstruction more frequently than it is commonly thought. A pneumatized inferior turbinate has recently been described as a cause for nasal obstruction and only two cases have been reported until now. Inferior nasal turbinate develops by endochondral ossification of components of the mesethmoid and ectethmoid. The chondral framework of the inferior turbinate consists of a double lamella and two separate ossification centers that develop between the fifth and seventh month of fetal life. The separate ossification centers meet by the eighth fetal month. During ossification, the inferior turbinate detaches from the ectethmoid and becomes an independent bony structure. During that time the epithelium may misinvaginate into double lamellas and such double lamellas formed by the inferior turbinate may become persistent. A patient was referred to our clinic with headaches and nasal obstruction. A CT scan was performed which showed that the right lower concha was pneumatized. The headache of the patient disappeared after partial resection of the lower and middle turbinate.

Adult↗

Management of severe cicatricial entropion using shared mucosal grafts.

OBJECTIVE: To retrospectively analyze our experience using nasal turbinate and hard palate mucosal grafts as shared buttress grafts between the upper and lower eyelid for reconstruction in severe cicatricial entropion. SURGICAL TECHNIQUES: A horizontal tarsectomy is performed in the upper and lower eyelid approximately 2 mm posterior to the gray line. The distal tarsal segments are then dissected and rotated 180 degrees. A graft of nasal turbinate mucosa or hard palate mucosa measuring 1.5 x 3 cm is harvested. The graft is sutured to the cut edge of tarsus in the upper and lower eyelid. The rotated distal tarsal segment is stabilized against the graft using 5 mattress sutures. After 3 weeks, the graft is split by sharp dissection between the upper and lower eyelids. METHODS: The medical records of 12 consecutive patients, representing 15 shared buttress grafts, were reviewed. There were 5 hard palate and 10 nasal turbinate mucosal grafts placed. Follow-up ranged from 2 months to 7 years. RESULTS: The amount of corneal stipple, as well as subjective patient comfort, improved after eyelid margin reconstruction in 12 of the 15 eyes. One patient's visual acuity improved by more than 2 lines after surgery. There were no cases of failure of graft survival and no complications directly related to the shared graft technique. Recurrent entropion and trichiasis were noted in 3 eyelids more than a year after graft placement, reflecting ongoing cicatrization in these eyelids. Hard palate mucosal grafts were irritating to the corneal surface, requiring removal of the epithelium using a diamond burr and bandage contact lens wear. Nasal turbinate mucosal grafts were better tolerated by the corneal surface and had the added benefit of mucous production. CONCLUSIONS: Eyelid reconstruction using nasal turbinate and hard palate mucosal tissues as a shared buttress graft is a viable treatment option for patients with severe cicatricial entropion. Resolution of trichiasis and mechanical corneal abrasion was noted in 13 (86%) of 15 patients with no specific complications related to the technique. The shared buttress technique successfully autostents the healing eyelid margins, makes good use of the large turbinate mucosal graft, and minimizes trips to the operating room. When the mechanical requirements of eyelid margin reconstruction do not require the sturdiness of hard palate mucosa, nasal turbinate mucosa is a preferable graft tissue because it is better tolerated by the corneal surface and produces mucous.

Adult↗

Nasal polyposis: immunohistochemistry and bioelectrical findings (a hypothesis for the development of nasal polyps).

Nasal polyps and turbinates were obtained from individuals undergoing surgery for symptomatic nasal obstruction caused by nonatopic rhinosinusitis or allergic rhinosinusitis. One part of the tissue from each patient was fixed in neutral buffered formalin and prepared for study by histochemical and immunohistochemical methods. Monoclonal antibodies were used to identify macrophages, lymphocytes, and plasma cells. In most cases (12 of 16, 75%) the remainder of the polyp and turbinate samples was treated with protease to achieve disaggregation of the epithelial cells. Those cells were cultured on permeable collagen matrix supports. Transepithelial potential difference and resistance were measured daily. At the time of maximal transepithelial potential difference, the epithelial cells were mounted in modified. Ussing chambers and exposed to a sodium-positive channel blocker (amiloride hydrochloride) and to selected chloride-negative channel agonists (isoproterenol bitartrate and adenosine triphosphate). Middle turbinates and polyps were found to have more macrophages, lymphocytes, plasma cells, HLA-DR-positive cells, and eosinophils than the inferior turbinates. Epithelial cells obtained from polyps exhibited higher transepithelial potential differences and equivalent short-circuit currents than turbinate cell cultures. The responses to amiloride, isoproterenol, and adenosine triphosphate were also greater for polyp than for turbinate cultures. A theory for the pathogenesis of nasal polyps is proposed. Local release of inflammatory mediators could cause sodium absorption and chloride permeability to be higher in polyps than in turbinate epithelia. Increased sodium absorption is consistent with the hypothesis that epithelial fluid absorption contributes to the development of nasal polyps and is a result of the increased recruitment of inflammatory cells, which are present in nasal polyps.

Adenosine Triphosphate↗

Intranasal anatomy of the nasolacrimal sac in endoscopic dacryocystorhinostomy.

Intranasal surface anatomy is fundamental to the technique of endoscopic dacryocystorhinostomy. In the current literature the lacrimal sac is described as being situated anterior to the anterior end of the middle turbinate with between 0% and 20% of the sac above the insertion of the middle turbinate on the lateral nasal wall (the axilla of the middle turbinate). The aim of this study was to use CT dacryocystograms (DCGs) and CT scans to establish the relationship of the lacrimal sac to the lateral nasal wall. Forty-seven individual lacrimal sacs were measured in relation to the common canaliculus, and 76 were measured in relation to the insertion of the middle turbinate. Measurements taken from the long axis of the sac showed the mean height of the sac above the middle turbinate insertion was 8.8 mm (SD = 0.2, 95% CI = 1.3) and below it was 4.1 mm (SD = 2.3, 95% CI = 1.1). The average measurement of the sac above the com-mon canaliculus on CT DCGs was 5.3 mm (SD = 1.7, 95% CI = 0.56), whereas the average measurement below the common canaliculus was 7.7 mm (SD = 2, 95% CI = 1.3) (n = 47 CT DCGs). The findings in this study show that a major portion of the sac is locat-ed above the insertion of the anterior end of the middle turbinate and, in addition, that a significant part of the sac lies above the entry point of the common canaliculus. Knowledge of these findings can ensure that the sac is adequately exposed during dacryocystorhinostomy by removal of sufficient bone and mucosa above the anterior insertion of the middle turbinate.

Adult↗

Water flow in high-speed handpieces.

OBJECTIVES: This study measured the water flow commonly used in high-speed handpieces to evaluate the water flow's influence on temperature generation. Different flow speeds were evaluated between turbines that had different numbers of cooling apertures. METHOD AND MATERIALS: Two water samples were collected from each high-speed handpiece at private practices and at the School of Dentistry at São José dos Campos. The first sample was collected at the customary flow and the second was collected with the terminal opened for maximum flow. The two samples were collected into weighed glass receptacles after 15 seconds of turbine operation. The glass receptacles were reweighed and the difference between weights was recorded to calculate the water flow in mL/min and for further statistical analysis. RESULTS: The average water flow for 137 samples was 29.48 mL/min. The flow speeds obtained were 42.38 mL/min for turbines with one coolant aperture; 34.31 mL/min for turbines with two coolant apertures; and 30.44 mL/min for turbines with three coolant apertures. There were statistical differences between turbines with one and three coolant apertures (Tukey-Kramer multiple comparisons test with P < .05). CONCLUSION: Turbine handpieces with one cooling aperture distributed more water for the burs than high-speed handpieces with more than one aperture.

Body Temperature↗

Lymphocytes and nonlymphoid cells in human nasal polyps.

Immunohistochemical stainings were performed on polyp specimens of 48 patients and on mucosal biopsy specimens of the middle and inferior turbinates of 23 and 28 patients, respectively. Significantly more CD8+ (suppressor/cytotoxic) than CD4+ (helper/inducer) cells were found in the polyps. The number of CD2+, CD4+, and CD8+ lymphocytes in nasal polyps were very similar to the number in the macroscopically unaffected mucosa of the middle turbinates, whereas scores in the inferior turbinates were lower. In healthy subjects, the differences were smaller. CD22+ B cells were detected in varying numbers in the polyps in more or less organized clusters. Significantly more HLA-DR+ cells were found in polyps and middle turbinates than in the inferior turbinates. Eosinophils were found in moderate to large numbers in polyps of 77% of the patients. Mast cells and plasma cells were detected in moderate numbers, whereas neutrophils were found in 35% of the patients. In the middle and inferior turbinates varying but small numbers of eosinophils, mast cells, plasma cells, and neutrophils were found. In considering these findings, the role of chronic inflammation with T cell-dependent disturbances is discussed with regard to the pathogenesis of nasal polyps.

Adolescent↗

Effect of SO2 exposure on nasal mucociliary clearance in intact chickens.

The time required for mucociliary clearance from the chicken nasal turbinate and from the maxillary sinus was investigated in individual animals by using a newly designed plastic holder for the experimental animals. Determined in this way were: 1) the effect of SO2 exposure on sinus and turbinate clearance time, 2) the effect of the nerve blocking drugs atropine, scopolamine, reserpine, and propranolol on turbinate clearance time, and 3) the effect of these nerve blockers on clearance rates in chickens exposed to SO2. Turbinate mucociliary clearance was measured at 5 intervals per day, during 1 to 7 hr after exposure, for 7 consecutive days. Sinus clearance time was measured twice daily 1 to 4 hr after exposure. Turbinate clearance time in birds exposed to 6 ppm, and sinus clearance time in birds exposed to 40 ppm intermittently for 2 consecutive days both increased strikingly as a direct effect of SO2 exposure. However, continuous exposure to 6 ppm of SO2 during 16 hr per day for 7 consecutive days produced double peaks of increased turbinate clearance time with intervening recovery periods, suggesting an intranasal mucociliary homeostatic response. In individual animals, 26 of 35 animals (75%) exposed to 5 ppm, and 5 of 10 animals (50%) exposed to 20 ppm continuously during 16 hr per day for 7 consecutive days showed the same patterns. Reserpine and propranolol, which are sympatholytic agents, produced decelerated intranasal transport rates. Atropine and scopolamine, which are parasympatholytic agents, did not affect clearance rates. These nerve blockers, however, blocked the biphasic recovery pattern due to SO2 exposure. This blocking effect was statistically significant for atropine and reserpine 1 hr after injection.

Animals↗

A comparison of nasopharyngeal endoscopy and lateral cephalometric radiography in the diagnosis of nasopharyngeal airway obstruction.

Two auxiliary methods of diagnosing nasopharyngeal airway obstruction were compared. Cephalometric radiography and nasopharyngeal videoendoscopy were evaluated for efficacy in terms of reproducibility and validity. Thirty orthodontic patients (7 to 12 years of age) seeking otorhinolaryngologic treatment for mouth breathing, or mouth and nose breathing, had nasopharyngeal endoscopy and radiographic examinations performed on the same day. Two otorhinolaryngologists analyzed the results. Nasopharyngeal endoscopy was more reliable in identifying all the obstructive nasopharyngeal processes. Endoscopy obtained kappa index scores of almost perfect agreement for diagnosis of posterior nasal septum deviation, of substantial agreement for anterior nasal septum deviation and lower turbinate hypertrophy, and of moderate agreement for middle turbinate hypertrophy. Lateral cephalometric radiography obtained scores of perfect agreement for imaging hypertrophy of the middle turbinate, of almost perfect agreement for imaging hypertrophy of the posterior portion of the inferior turbinate, and of substantial agreement for imaging hypertrophy of the inferior turbinate. Radiographic diagnoses of hypertrophy of the middle and lower turbinates exhibited high sensitivity and low specificity when compared with diagnoses by nasopharyngeal endoscopy.

Cephalometry↗

Experimentally induced changes in nasalucous secretory systems and their effect on virus infection in chickens. II. Effects on adsorption of Newcastle disease virus.

Chickens 3 wk old, inoculated intranasally with a mesogenic (moderately virulent) strain of Newcastle disease virus, developed necrotic lesions of the mucous acini, predominantly of the middle turbinates. The infection subsequently spread to involve much of the rest of the mucosa, including mucous and ciliated epithelial cells, and other acini. The early phase of adsorption of a virulent strain of the virus to the middle turbinates of chicks 5-21 days of age was studied by giving a standard inoculum intranasally to unanesthetized animals. Variation in amounts adsorbed by individual chickens was large, but was minimized by making measurements on pools of turbinates from three chicks at intervals of 1, 3, and 5 hr after exposure of the excised turbinates to antibody, by washing, and by trypsinization. The virus released from the cells into the trypsin was designated as adherent virus, and the infectious virus in the cells after destruction of the cells by water grinding, as cell virus. Paralysis of ciliary action by cocaine increased the number of infected cells in the turbinates about 10-fold at all three time intervals. Pilocarpine injection before virus inoculation caused a large increase in the amount of infected cells 1 hr after virus administration, but was followed by a sharp drop in infected cells by 3 or 5 hr. Pilocarpine given after the virus decreased the number of infected cells and changed the relationship of infected cells to adherent virus. Exposure of chicks to sustained or severe cold caused a similar but less marked effect. The drop in infected cells was restored to control values if chicks were returned to brooder temperatures. The marked drop of infected cells produced by pilocarpine and cold in living chicks, and in cultures of chicken trachea (previous study), is consonant with the idea that virus has been adsorbed on mucus granules in the mucous cells of the turbinates and then has been reexcreted, as unincorporated virus, into the moving mucous sheet. A series of accessory data support this interpretation.

Adsorption↗

Surgical anatomy of the natural ostium of the sphenoid sinus.

OBJECTIVES: This study was undertaken to measure the distance and the angle between the anterior part of nasal cavity and the natural ostium of the sphenoid sinus. The anatomical location of the natural ostium according to the direction of surgeon's operating view toward the anterior wall of the sphenoid sinus was also analyzed. STUDY DESIGN: This study used careful cadaver dissection under a surgical microscope. METHODS: One hundred sagittally sectioned adult cadaveric heads were used. We measured the distances and angles for identifying the natural ostium of the sphenoid sinus using several reference points such as the limen nasi, the sill, and the posteroinferior end of the superior turbinate. In addition, we tried to identify whether the location of the natural ostium is medial or lateral to the posterior end of the superior turbinate. RESULTS: The natural ostium of the sphenoid sinus was located at an angle of 35.9 degrees with a distance of 56.5 mm from limen nasi and at an angle of 34.3 degrees with a distance of 62.7 mm from nasal sill. It was located approximately 1 cm above the posteroinferior end of the superior turbinate and at a medial aspect to the posterior end of the superior turbinate in 83% of specimens. CONCLUSIONS: We speculate that the posteroinferior end of the superior turbinate is the best landmark for identifying the natural ostium of the sphenoid sinus. Furthermore, the natural ostium should ideally be searched from a superior and medial aspect in relation to the posteroinferior end of the superior turbinate.

Adult↗

Partial inferior turbinectomy using the microdébrider.

BACKGROUND: A microdébrider was selected to accomplish partial inferior turbinectomy, allowing for controlled and rapid removal of hypertrophic soft tissue while preserving the general turbinate form. OBJECTIVE: To assess the clinical outcome, healing, and any adverse consequences from the microdébrider partial turbinectomy procedure. SETTING: A public hospital in north-central Israel. DESIGN: A nonrandomized prospective study of 35 adults who were referred for nasal airway surgery, including turbinectomy. METHODS: All patients underwent bilateral inferior turbinate reduction with the microdébrider, with removal of mucosa from the medial and inferior portions of the inferior turbinates. Detailed follow-up was accomplished at 4 or more months postoperatively, including a visual analogue scale questionnaire and videoendoscopy. For seven patients, pre- and postoperative mucosal biopsies were available to evaluate healing and epithelial regeneration. RESULTS: Nasal endoscopy showed well-healed turbinate membranes and preservation of the turbinate form, with widening of the inferomedial nasal airway space. Subjective nasal patency improved after surgery, p < .01, and the subjective sense of smell was improved, p < .01, without associated crusting, pain, irritation, sneezing, or dryness. Postoperative biopsies showed subepithelial fibrosis and regenerated epithelium, generally of respiratory differentiation. CONCLUSION: Inferior turbinate reduction can be accomplished efficiently with the microdébrider device, without undue side effects. SIGNIFICANCE: Further experience and long-term follow-up with this technique are warranted.

Adult↗

In vivo localization of Staphylococcus aureus in nasal tissues of healthy and influenza A virus-infected ferrets.

An in vivo ferret model was used to study the association of Staphylococcus aureus with specific tissues of the nasal cavity in both control and influenza A virus-infected animals. Ferrets were inoculated intranasally with various doses of influenza A3/Hong Kong/1/68 virus. On Days 2, 5, 9 and 14, four or five virus-inoculated and two uninoculated controls were challenged intranasally with a 1-ml volume of radiolabeled S. aureus (3 mg dry wt), a clinical isolate of low passage history. Ferrets were allowed to clear the staphylococci in vivo for 60 to 90 min before sacrifice. The animals were anesthetized, exsanguinated, and decapitated, and the lower jaw was removed. The nasal fossae were exposed by dissection and turbinates from the left nasal fossa were used for virus isolation. The median septum and tissues from the right nasal fossa, which included vestibule and anterior and posterior turbinates, were harvested and processed for radioassay. The percentage of recoverable staphylococci from virus-infected ferrets (Days 2 and 5) was greater than or equal to 10-fold higher compared with controls and animals infected with suboptimal doses of virus; greater than or equal to 76% of the recoverable staphylococci, whether from controls or virus-infected animals, was associated with the anterior turbinates. Histologic examination of the anterior turbinates from virus-infected ferrets, particularly on Days 2 and 5 postexposure to virus, showed that the staphylococci were adhering to desquamating respiratory epithelial cells. In contrast, the anterior turbinates from control ferrets uninoculated with virus and posterior turbinates from both control and virus-infected animals showed no evidence of bacteria adhering to host cells; instead, the staphylococci were found in association with the mucus gel layer of respiratory mucosa. Examination of vestibular tissue showed staphylococci in association with cells of the stratum granulosum in both virus-infected and control animals. Results of this study suggest that the early events of S. aureus interaction with different sites of ferret nasal tissues are effected by different mechanisms, and that the interaction is significantly enhanced by virus-infection.

Animals↗

Concentration, distribution and expression of interleukin-5 in human nasal polyp tissues.

OBJECTIVES: To study the concentration, distribution and expression of IL-5 in nasal polyp tissues and explore its significance in micro-environment differentiation of eosinophil accumulation. METHODS: The concentration and expression of IL-5 in nasal polyp tissues of 40 patients were determined by ELISA and immunohistochemistry and inferior turbinate mucosa from patients with nasal polyps and healthy volunteers were used as control. RESULTS: IL-5 concentration in polyp tissues was significantly higher than that in turbinate mucosa (P < 0.05). There was no significant difference in the turbinate mucosae between patients with nasal polyps and healthy volunteers (P > 0.05). IL-5 concentrations in polyp tissues were markedly higher in patients with allergic rhinitis compared with those without (P < 0.05). IL-5 concentrations had no correlation with age and sex (P > 0.05). 80.1% of the eosinophils were positive for IL-5 and 90.9% of IL-5 positive cells were eosinophils. Only 3.7% of lymphocytes and neutrophils were positive for IL-5; IL-5 was not detectable in epithelial cells. IL-5 expression in eosinophils of polyp tissues was remarkably stronger than that of the turbinate mucosa (P < 0.05); there was no significant difference in the the turbinate mucosae between patients with nasal polyps and healthy volunteers (P > 0.05). IL-5 expression of eosinophils in polyp tissue was significantly stronger in patients with allergic rhinitis compared with those without (P < 0.05). There was no significant difference in IL-5 expression in lymphocytes and neutrophils between polyp tissues and turbinate nasal mucosa (both P > 0.05). CONCLUSION: IL-5 is the key cytokine in eosinophilic pathologic mechanisms in nasal polyp tissues.

Adult↗