Septum

A rare case of pleomorphic adenoma of the nasal septum

June 4, 2015     Tejinder Singh Anand, MS, PhD; Gautam Bir Singh, MS; Sunil Garg, MS; Garima Yadav, MBBS; Anita Nangia, MD
article

Pleomorphic adenomas of the nasal cavity differ from those found elsewhere in that they have more myoepithelial cells and little or no stromal component.

A novel method for reconstruction of severe caudal nasal septal deviation: Marionette septoplasty

June 4, 2015     Gurkan Kayabasoglu, MD; Alpen Nacar, MS; Mahmut Sinan Yilmaz, MD; Aytug Altundag, MD; Mehmet Guven, MD
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Abstract

We conducted a retrospective study to compare open and endonasal (closed) approaches to extracorporeal reconstruction of severe caudal septal deviations. From January 1, 2010, through December 31, 2013, 78 patients with severe caudal septal deviation underwent corrective surgery at our hospital. Of this group, 33 patients (mean age: 32 yr) underwent extracorporeal septoplasty via an open approach, and 45 patients (mean age: 35 yr) underwent treatment with a new procedure that we developed: subtotal extracorporeal septoplasty through a closed approach, which we call “marionette septoplasty.” In addition to demographic data, we compiled information on surgical time, the duration of postoperative edema, the degree of postoperative pain, and differences between pre- and postoperative nasal function and tip support in both groups. We found that our marionette septoplasty procedure required significantly less surgical time and resulted in a significantly shorter duration of postoperative edema than did open septoplasty, while there was no statistically significant difference between the two procedures in the degree of pain. Following surgery, nasal function in both groups improved significantly, without any significant difference between the two. Finally, we documented improved tip support in all 78 patients. Our results show that marionette septoplasty produces the same functional results as does open septoplasty while requiring less surgical time and shortening the healing period.

Septic arthritis: A unique complication of nasal septal abscess

March 2, 2015     Steven M. Olsen, MD; Cody A. Koch, MD, PhD; Dale C. Ekbom, MD
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Abstract

Nasal septal abscesses (NSAs) occur between the muco-perichondrium and the nasal septum. They most often arise when an untreated septal hematoma becomes infected. The most commonly reported sequela is a loss of septal cartilage support, which can result in a nasal deformity. Other sequelae include potentially life-threatening conditions such as meningitis, cavernous sinus thrombosis, brain abscess, and subarachnoid empyema. We report the case of a 17-year-old boy who developed an NSA after he had been struck in the face with a basketball. He presented to his primary care physician 5 days after the injury and again the next day, but his condition was not correctly diagnosed. Finally, 7 days after his injury, he presented to an emergency department with more serious symptoms, and he was correctly diagnosed with NSA. He was admitted to the intensive care unit, and he remained hospitalized for 6 days. Among the abscess sequelae he experienced was septic arthritis, which has heretofore not been reported as a complication of NSA. He responded well to appropriate treatment, although he lost a considerable amount of septal cartilage. He was discharged home on intravenous antibiotic therapy, and his condition improved. Reconstruction of the nasal septum will likely need to be pursued in the future.

Primary thyroid-like papillary adenocarcinoma of the nasal septum: A case report

February 2, 2015     Kerem Ozturk, MD; Rasit Midilli, MD; Ali Veral, MD; Yesim Ertan, MD; Bulent Karci, MD
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Abstract

Primary thyroid-like papillary adenocarcinomas are extremely rare neoplasms that generally originate in the nasopharynx. We report the case of a 24-year-old woman who was diagnosed with a thyroid-like papillary adenocarcinoma that originated in the nasal septum. The tumor was surgically removed, and the patient showed no evidence of local recurrence during 4 years of follow-up.

Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery

September 17, 2014     Raman Wadhera, MS; Naushad Zafar, MS; Sat Paul Gulati, MS; Vijay Kalra, MS; Anju Ghai, MD
article

Abstract

We conducted a prospective, comparative, interventional study to evaluate the role of intranasal septal splints and to compare the results of this type of support with those of conventional nasal packing. Our study population was made up of 60 patients, aged 18 to 50 years, who had undergone septoplasty for the treatment of a symptomatic deviation of the nasal septum at our tertiary care referral hospital. These patients were randomly divided into two groups according to the type of nasal support they would receive: 30 patients (25 men and 5 women, mean age: 23.3 yr) received bilateral intranasal septal splints and the other 30 (26 men and 4 women, mean age: 22.4 yr) underwent anterior nasal packing. Outcomes parameters included postoperative pain and a number of other variables. At 24 and 48 hours postoperatively, the splint group had significantly lower mean pain scores (p < 0.05). At 48 hours, the splint group experienced significantly fewer instances of nasal bleeding (p < 0.01), swelling over the face and nose (p < 0.01), watering of the eyes (p < 0.01), nasal discharge (p = 0.028), nasal obstruction (p < 0.001), and feeding difficulty (p = 0.028). Likewise, mean pain scores during splint or pack removal were significantly lower in the splint group (p < 0.01). At the 6-week follow-up, only 2 patients (6.7%) in the splint group exhibited a residual deformity, compared with 8 patients (26.7%) in the packing group (p = 0.038). Finally, no patient in the splint group had an intranasal adhesion at follow-up, while 4 (13.3%) in the packing group did (p < 0.05). We conclude that intranasal septal splints result in less postoperative pain without increasing postoperative complications, and thus they can be used as an effective alternative to nasal packing after septoplasty.

Rhinosporidiosis: An unusual presentation

July 13, 2014     Borlingegowda Viswanatha, MS, DLO, PhD
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Abstract

Rhinosporidiosis is a chronic granulomatous disease that primarily affects the mucous membranes of the nose and nasopharynx. It is caused by Rhinosporidium seeberi. Clinically it presents as a reddish, bleeding, polypoid mass with a characteristic strawberry-like appearance on its surface, which is caused by the presence of mature sporangia. In the case described here, a 35-year-old man presented with a 6-month history of a slowly growing polypoid mass in his left nasal cavity. The surface of the mass was smooth, pale, and covered with nasal mucosa. It was attached to the nasal septum. Fine-needle aspiration cytology was suggestive of a parasitic cyst. The mass was excised with the use of local anesthesia. Histopathologic examination of the resected specimen revealed rhinosporidiosis. Prior to this diagnosis, the patient had not exhibited most of the typical clinical features that are suggestive of rhinosporidiosis. In the case of a nasal mass, a diagnosis of rhinosporidiosis is important to establish prior to any surgery because bleeding during and after surgery is usually profuse and can be life-threatening. The site of the excised mass should be cauterized to prevent recurrence.

Schwannoma of the nasal septum: An unusual finding

March 18, 2014     Shruti Dhingra, MS, DNB; Jaimanti Bakshi, MS, DNB; Satyawati Mohindra, MS, DNB
article

Abstract

Schwannomas of the nasal cavity are rare benign tumors, and those that arise from the nasal septum are even rarer. When they do occur, they usually become symptomatic early because of the close confines of the nasal cavity. We describe a case of nasal septal schwannoma that was noteworthy in that the patient-a 28-year-old woman-waited 8 months after the onset of symptoms to seek medical care. Her symptoms included complete right-sided nasal obstruction, occasional epistaxis, and hemifacial pain. The tumor was completely removed via an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.

Glomangioma of the nasal septum: A case report and review

April 17, 2013     Magdalena Chirila, MD, PhD; Liliana Rogojan, MD
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Abstract

Glomangioma is a painful, blue-red tumor that appears as a solitary encapsulated nodular mass, almost always on the skin. The first case of nasal glomangioma was reported in 1965. Since then, only 31 other cases have been reported in the literature. We present a new case of glomangioma of the nasal septum in a 61-year-old woman. The tumor was removed via an intranasal endoscopic excision. No recurrence was found at 3 years of follow-up. Our challenge was to distinguish the glomangioma from a true hemangiopericytoma and a paraganglioma.

Fungal sinusitis with a nasal septal perforation

January 24, 2013     Jae Hoon Lee, MD; Ha Min Jeong, MD
article

Nasal septal perforations or defects have a variety of causes, including previous septal surgery, infection, collagen vascular disease, granulomatous disease, the use of irritant inhalants, and neoplasia; the most common of these is previous septal surgery.

Endoscopic view of iatrogenic nasal septal perforations

December 31, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

While many surgically created nasal septal perforations are asymptomatic, others can create long-term problems.

Endoscopic view of compensatory hypertrophy of the middle turbinate

June 4, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

Compensatory hypertrophy of the middle turbinate can occur when a patient's nasal septum is markedly deflected to one side, enlarging the airway and hence giving the middle turbinate an unusually large space in which to expand.

Temporary blindness and ophthalmoplegia due to local anesthetic infiltration of the nasal septum

June 4, 2012     Devrim Bektas, MD; Neslihan Kul, MD; Nurettin Akyol, MD; Ahmet Ural, MD; Refik Caylan, MD
article

Abstract

We report the case of a 35-year-old man who developed blindness and ophthalmoplegia during local anesthetic infiltration of the nasal septum. The complications were temporary, and the patient had full recovery without treatment. The vascular anatomy of the area and possible pathogenic mechanisms are discussed, with some suggestions on the prevention of this complication.

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