April 17, 2013 Eun Sun Jung, MD, PhD; Suk-Woo Yang, MD, PhD; Ji-Hong Kim, MD; Soo Whan Kim, MD, PhD
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Abstract
Sinonasal type hemangiopericytomas are very rare tumors, and are often called glomangiopericytoma. They are believed to be derived from perivascular modified smooth muscle cells. Their origin is similar to glomus tumors but some distinct differences exist. Glomangiopericytomas are indolent tumors and overall survival rates are higher after complete surgical excision. Recurrence rates are as high as 30%. We present a case of glomangiopericytoma which involves the orbital wall, noteworthy because such bone-dissolving glomangiopericytomas are extremely rare.
March 24, 2013 Mark E. Fons, DO; David Poetker, MD; Paul E. Wakely Jr., MD
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Abstract
Oncocytomas arising in the nasal cavity are quite rare. These entities more commonly occur in the major salivary glands, minor salivary glands, respiratory seromucinous glands, and endocrine organs. Very few cases of oncocytoma in the nasal cavity have been reported, with only 5 diagnosed as malignant. This article describes a case involving an 81-year-old man with a nasal oncocytoma that was completely resected with an endoscopic medial maxillectomy. The diagnostic rationale is discussed, along with a review of the literature.
February 25, 2013 Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
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The empty nose syndrome usually is defined by excessive loss of normal nasal tissue and loss of anatomic landmarks, which results in a widely patent airway with excessive crusting (ozena) and easy nasal bleeding and dryness of the nasal mucosa. Functional endoscopic sinus surgery for chronic sinus disease has diminished the possibility of the difficult empty nose.
December 31, 2012 Shafik N. Wassef, MD; Payal Kapur, MBBS, MD; Samuel L. Barnett, MD; Larry L. Myers, MD, FACS
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Abstract
Sinonasal teratocarcinosarcoma (SNTCS) is an extremely rare malignancy of the paranasal sinuses that possesses the histopathologic features of both teratomas and carcinosarcomas. We report the case of a 58-year-old white man who presented with a 1-year history of a gradually enlarging left-sided nasal mass. The patient had previously undergone endoscopic sinus surgery at another facility, and the final pathologic specimen was reported as an SNTCS with positive margins. He was then referred to our institution, where he underwent a craniofacial resection combined with endoscopic intranasal resection. Postoperatively, he received combined chemotherapy and irradiation. At 48 months of follow-up, he was alive without evidence of disease.
June 4, 2012 Roshan K. Verma, MS, DNB, MNAMS; Jaimanti Bakshi, MS, DNB; Naresh K. Panda, MS, MNAMS, FRCS
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Abstract
Nasal bleeding is a common disorder in children that is frequently caused by irritation in the Kiesselbach plexus (also known as Little’s area). Other common underlying causes include local inflammatory diseases of the nose, infections, vascular malformations, and trauma. We report here a rare case of an ectopic tooth in the nasal cavity as the cause of recurrent epistaxis in a 3.5-year-old child. The clinical presentation, investigations, and management are discussed.
February 18, 2012 Raewyn G. Campbell, BMed(Hons), BApplSci(Physio)
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Abstract
Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after trans-sphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. She underwent septoplasty and unilateral ESS, which included frontal recess clearance and sphenoidotomy. However, during surgery, severe generalized bleeding was encountered. The bleeding was arrested only after anterior and posterior nasal packing. After two attempts to remove the packing failed, angiography was obtained. It revealed an SPA pseudoaneurysm, which was immediately and successfully embolized. SPA pseudoaneurysm is a rare but significant complication of ESS, and it should be considered in patients with posterior epistaxis after ESS or prolonged posterior nasal packing. The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication.
February 18, 2012 David J. Howe, FRCS ORL-HNS, SpR ENT; Umar Wazir, MBBS, MRCS, MSc; Derek W. Skinner, FRCS Eng(Otol)
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Abstract
Epistaxis is a common emergency seen by the otolaryngologist. A minority of cases require surgical intervention. Multiple surgical procedures have been tried in the past, including endoscopic ligation of the sphenopalatine artery (ELSPA), which is considered an effective surgical modality in the management of epistaxis. This study examines the outcome of 33 ELSPA procedures over a 5-year period. Three of 4 cases that were not controlled with ELSPA were successfully managed with subsequent anterior ethmoidal ligation. Failed ELSPA procedures may represent an incorrect choice of procedure rather than a failure of the procedure. High-resolution computed tomography can identify the position of the anterior ethmoidal artery; it may be possible to infer vulnerability to hemorrhage from this artery and hence target procedure selection.
January 25, 2012 Salina Husain, MBBS, MSurg ORL-HNS and S.H. Primurharsa, MD, MSurg ORL-HNS
October 26, 2011 Senol Polat, MD, Hasan Murat Tanyeri, MD, and Selcuk Bilgi, MD
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Abstract
Inferior turbinate reduction by radiofrequency ablation (RFA) has been recommended as an easy and safe option for the treatment of patients with inferior turbinate hypertrophy. Complications of this type of excision are generally acceptable. We describe a case of RFA turbinate reduction that resulted in an unusual complication: the formation of an arteriovenous hemangioma.
September 20, 2011 Doug Massick, MD and Agnes Hurtuk, MD
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Abstract
We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients. Our study group consisted of 74 patients-43 men and 31 women (mean age: 64.4 yr)-who had been seen in our department over an 18-month period and whose bleeding had originated in the anterior portion of the nasal vault. Most patients had been experiencing epistaxis for at least 6 months. Patients were given the saline nasal gel and taught to gently apply it to the mucosa of the anterior nasal vault with a cotton-tipped applicator at the first sign of recurrent bleeding. Patients were then followed up periodically over the next 3 months. Among the 74 patients, 69 (93.2%) had experienced a cessation of their epistaxis at 3 months. The results of our study suggest that this simple, painless technique has considerable value as a treatment option in this cohort of patients.
July 13, 2011 Sandeep Lerra, MS (ENT), Tanvir Nazir, MS (ENT), Sajjad Mir Qadri, MS (ENT), and Masod Kirmani, MS (ENT)
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Abstract
Primary tuberculosis of the nose is very rare. We report a case of a 35-year-old woman who presented with bilateral nasal obstruction and epistaxis of 3 months' duration but who was otherwise healthy. She was diagnosed with primary nasal septal tuberculosis and was treated with antituberculosis DOTS (directly observed treatment, short course) therapy for 6 months with complete recovery. Given the resurgence of tuberculosis in recent times, it is important that clinicians remain aware of this rare and treatable clinical entity.
March 1, 2010 Nicole L. Bryan, MD and Melissa A.M. Hertler, MD
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Abstract
While nasal packs are effective in controlling epistaxis, some potential complications are associated with this procedure that physicians should be aware of and take measures to avoid. We report the case of an 80-year-old man who developed cerebrospinal fluid rhinorrhea several hours after he had undergone placement of nasal packing in an emergency department. He was eventually transferred to our facility, where he required a prolonged hospital stay to correct the complication. We also review the literature on various complications of nasal packing, and we emphasize the importance of carefulness when performing intranasal manipulation.
