Septum

Endoscopic view of a Haller cell draining into the maxillary sinus

January 1, 2011     Dewey A. Christmas, MD, Joseph P. Mirante, MD, FACS, and Eiji Yanagisawa, MD, FACS
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Cerebrospinal fluid rhinorrhea complicating septoplasty: A novel mechanism of injury

January 1, 2010     Annabelle C. Leong, MRCS, Toral Patel, MBBS, Faizal Rehman, MS, Manuel Oyarzabal, FRCS (ORL), and Paul Gluckman, FRCS (ORL)
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Abstract

Cerebrospinal fluid (CSF) rhinorrhea after a septoplasty procedure is very rare and potentially life-threatening. We present a case of iatrogenic postseptoplasty CSF rhinorrhea. To the best of our knowledge, only 2 other cases of CSF rhinorrhea complicating septoplasty have previously been reported. However, neither resolved in the manner that our case did, when spontaneous cessation of CSF rhinorrhea unexpectedly occurred upon removal of intranasal splints. We discuss the clinical importance of anatomic variations and potential causative mechanisms of CSF rhinorrhea during septoplasty. Our experience with this case suggests a mechanism of injury to the cribiform plate during septoplasty that has not been described previously.

An asymptomatic schwannoma of the nasal septum: Report of a unique case

December 1, 2009     Fabio Pagella, MD, Georgios Giourgos, MD, Elina Matti, MD, and Andrea Colombo, MD
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Abstract

Schwannomas of the nasal septum are extremely rare, and therefore their diagnosis and treatment can pose certain challenges. We describe the case of an incidentally discovered schwannoma of the nasal septum that was unique in that the lesion was completely asymptomatic. In view of our finding, we believe that routine examinations of both nasal fossae should be considered during routine diagnostic laryngeal flexible endoscopy.

Extranasopharyngeal angiofibroma of the nasal septum: A case report

October 31, 2009     Satyawati Mohindra, MS, DNB, Gogia Grover, MS, and Amanjit Kaur Bal, MD, DNB
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Abstract

Angiofibroma arising outside the nasopharynx is unusual. The nasal septum is an extremely rare site for the origin of angiofibroma, and to date only 6 such cases previously have been reported in the literature. We report here a case of a 22-year-old man with a vascular mass arising from his nasal septum. The histopathology report was consistent with angiofibroma. We also review other cases in the literature of angiofibroma arising from the nasal septum and discuss a theory of the likely origin of angiofibroma.

Three spontaneous occurrences of nasal septal abscess in patients with chronic asymptomatic HIV-the need for early intervention and reconstruction

July 31, 2009     Henry D. Sandel IV, MD and Steven P. Davison, MD, DDS
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Abstract

We identified 3 patients with chronic, asymptomatic HIV who presented between 2001 and 2005 with spontaneous nasal septal abscesses in the absence of previous trauma, nasal surgery, sinusitis, infection, or immunodeficiency. A MEDLINE search revealed no other cases of spontaneous isolated nasal septal abscesses. Each of our patients presented to the emergency department with complaints of fever and headaches; 2 of them also had nasal obstruction, nasal and lip swelling, and pain. Clinical examinations and imaging studies revealed isolated anterior nasal septal abscesses. In each case, incision and drainage was performed immediately, and antibiotics started. One patient had an early loss of septal cartilage and nasal support, which developed into a crooked and saddle-nose deformity requiring reconstruction 7 months later. Staphylococcus aureus was identified in all 3 cases. To the best of our knowledge, these are the only 3 cases of spontaneous isolated nasal septal abscess reported in the literature. We discuss the importance of early diagnosis and intervention, as well as reconstructive techniques.

The nasal septum: An osteometric study of 16 cadaver specimens

July 31, 2009     Latha Venkatraya Prabhu, MBBS, MS, Anu Vinod Ranade, MSc, PhD, Rajalakshmi Rai, MSc, Mangala M. Pai, MBBS, MD, Arunachalam Kumar, MBBS, MS, Prakash Sinha, MBBS, MD, and Soubhagya Ranjan Nayak, MSc
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Abstract

Studies of the shape, dimensions, and other morphologic characteristics of the nasal septum are scant in the literature. We conducted a study of 16 male cadavers to measure six osseous components of the nasal septum and to calculate the proportional contribution that each made to the total septal bone surface area. We found a wide range of inter-specimen variations in both categories. It is our hope that a better understanding of nasoseptal anatomy will improve surgical technique.

Chondrosarcoma of the nasal septum

January 1, 2009     Akram Rahal, MD, FRCSC, Joseph R. Durio, PA-C, and Michael L. Hinni, MD
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Abstract

Chondrosarcoma of the nasal septum is a rarely encountered malignancy. When it does occur, early diagnosis is difficult because patients generally present with common, nonspecific sinonasal complaints. We describe a case of chondrosarcoma of the nasal septum in a 38-year-old Hispanic man. The lesion was discovered on computed tomography during a workup for symptoms of chronic sinus disease. The tumor was removed in its entirety and identified as a low-grade lesion that required no further treatment. The patient remained disease-free 4 years postoperatively. We review the diagnosis of this neoplasm and its treatment and follow-up.

Nasoseptal chondrosarcoma resection requiring anterior fossa floor repair: A case report

December 1, 2008     Samuel Spear, MD, John Iskandar, MD, Derek Seaquist, MD, and Douglas Sorensen, MD
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Abstract

We present a case in which a 23-year-old male patient diagnosed with nasoseptal chondrosarcoma with anterior cranial fossa extension underwent combined surgical approaches to optimize complete resection of the tumor. Surgery was followed by a 6-month course of proton-beam radiation therapy. Extensive tumors of this type with significant intracranial extension require surgical repair of the anterior fossa floor. We employed a repair technique not previously associated with the resection of these tumors, using a split-calvaria osteoplastic rotational flap. This method provided structural integrity while avoiding the risks associated with the use of free bone grafts and metallic meshes.

Nasal packing after septoplasty: A randomized comparison of packing versus no packing in 88 patients

October 31, 2008     Mohammad Sohail Awan, FCPS and Moghira Iqbal, MBBS
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Abstract

The once-common practice of packing the nose after septoplasty was based on a desire to prevent postoperative complications such as bleeding, septal hematoma, and adhesion formation. However, it was since found that not only is nasal packing ineffective in this regard, it can actually cause these complications. Although the consensus in the world literature is that packing should be avoided, to the best of our knowledge, no truly randomized study has been undertaken in Southwest Asia upon which to justify this recommendation here. Therefore, we conducted a prospective randomized comparison of the incidence of a variety of postoperative signs and symptoms in 88 patients, 15 years of age and older, who did (n = 44) and did not (n = 44) undergo nasal packing following septoplasty. We found that the patients who underwent packing experienced significantly more postoperative pain, headache, epiphora, dysphagia, and sleep disturbance on the night of surgery. Oral and nasal examinations 7 days postoperatively revealed no significant difference between the two groups in the incidence of bleeding, septal hematoma, adhesion formation, and local infection. Finally, the packing group reported a moderate to high level of pain during removal of the packing. Our findings confirm that nasal packing after septoplasty is not only unnecessary, it is actually a source of patient discomfort and other signs and symptoms.

Rhinolithiasis with a nasal polyp: A case report

March 1, 2008     Ibrahim Ozcan, MD, K. Murat Ozcan, MD, Serdar Ensari, MD, and Huseyin Dere, MD
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Abstract

Rhinoliths are uncommon mineralized masses that form as a result of calcification of an endogenous or exogenous nidus. The most common manifestations of rhinolithiasis are unilateral nasal discharge, nasal obstruction, and facial pain. The diagnosis is made by nasal endoscopy and computed tomography. The differential diagnosis includes chronic inflammation, osteomyelitis, benign tumors (e.g., calcified nasal polyps, ossifying fibromas, osteomas, and chondromas), and malignant tumors (e.g., osteosarcomas, chondrosarcomas, and squamous cell carcinomas). Rhinoliths may cause rhinosinusitis, erosion of the nasal septum and medial wall of the maxillary sinus, and perforations of the palate. To the best of our knowledge, the occurrence of a nasal polyp associated with rhinolithiasis has not been previously reported in the English-language literature. In this article, we describe such a case.

Neurosarcoidosis presenting as complicated sinusitis: A case report and review

February 1, 2008     Lt. Matthew T. Brigger, MD, Maj. Ian K. McLeod, MD, and Cdr. Martin P. Sorensen, MD
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Abstract

Sarcoidosis is a systemic granulomatous disease with widely variable clinical characteristics, including numerous head and neck manifestations. We describe the case of a 49-year-old man who presented to the emergency department with symptoms consistent with complicated sinusitis. He was ultimately found to have an atypical case of neurosarcoidosis. This case illustrates the varied multisystem presentation of sarcoidosis and the diagnostic considerations that are merited.

Pediatric nasal septal perforation secondary to magnet misuse: A case report

October 31, 2007     Carl Shermetaro, DO, FAOCO and Melissa Charnesky, DO
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Abstract

We describe the case of a 7-year-old girl who had placed magnetic earrings bilaterally on her nasal ala. However, the two backing magnets that had been placed inside the nasal cavity became attached to each other rather than to the outer jewelry, compressing the nasal septum. Several weeks later, the septum became perforated. The patient was treated conservatively with mupirocin ointment, oral amoxicillin, and nasal saline. Subsequent examinations revealed no enlargement of the perforation, and the patient was followed conservatively with saline nasal spray.

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