We report an elderly male patient with frequent episodes of dizziness due to a complete atrioventricular block who underwent temporary pacemaker insertion in a local hospital. After the implantation of a permanent pacemaker and removal of the temporary pacemaker lead, the patient developed sudden neurological symptoms, upon which an acute cerebellar infarction was diagnosed via head CT. We will discuss the adequacy of the periprocedural administration.

Inverted sinonasal papillomas, also referred to as Schneiderian papillomas, are benign tumors originating from the Schneiderian membrane that lines the nasal cavity and paranasal sinuses. They frequently display an endophytic growth pattern, in which the stroma beneath is invaded by epithelial cells. The exact cause of inverted sinonasal papillomas is unknown, but several theories have been offered. The most widely accepted theory states that these tumours arise from the metaplasia of the respiratory epithelium into a stratified squamous epithelium. This metaplastic process is thought to be brought on by irritant exposure, chronic inflammation, or viral infections like the human papillomavirus (HPV). While inverted sinonasal papillomas commonly arise from the paranasal sinuses and lateral walls of the nasal cavity, their occurrence from the nasal septum is relatively rare. Additionally, although inverted sinonasal papillomas are typically benign, they can exhibit locally aggressive behaviour and damage nearby structures. The histopathological examination revealed nuclear atypia, which raises questions about the potential for malignant transformation. We describe a rare case of an inverted sinonasal papilloma that developed from the nasal septum. The tumour spread into the septum\'s anterior cartilaginous region, causing the cartilage to deteriorate and develop mucosal defects. The rarity of an inverted sinonasal papilloma arising from the nasal septum along with its impact on cartilaginous septum is discussed. Careful monitoring and prolonged follow-up are therefore necessary to spot any signs of recurrence or malignant changes.

UNASSIGNED: To report our experience in the use of silicone septal splint for recurrent severe epistaxis in hereditary haemorrhagic telangiectasia patients (HHT).
UNASSIGNED: This is a descriptive analysis carried out at the Otorhinolaryngology Department of Fondazione IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent silicone septal splint positioning after the endoscopic surgical treatment of epistaxis from 2000 to 2022.
UNASSIGNED: Of the 506 patients surgically treated in the period of analysis, 74 patients underwent silicone septal splint positioning and 37 were post-operatively interviewed. With a mean of 2.4 previous surgical treatments and a mean epistaxis severity of 7.38, the majority of patients presented with septal perforation (71.6%). On average, patients maintained the splint in place for 54.5 months, with a good tolerability and a significant reduction in epistaxis severity, need for blood transfusion and improvement of haemoglobin levels.
UNASSIGNED: In HHT patients with recurrent severe epistaxis and with septal perforation, the placement of septal splints offers a useful additional strategy in the management of nosebleeds.
Lamine settali in silicone nel trattamento dell’epistassi ricorrente nei pazienti con HHT: l’esperienza di un centro di riferimento nazionale.
UNASSIGNED: Riportare la nostra esperienza nell’utilizzo delle lamine settali in silicone nel trattamento dell’epistassi ricorrente nei pazienti con teleangectasia emorragica ereditaria (HHT).
UNASSIGNED: Si tratta di uno studio retrospettivo svolto presso la SC di Otorinolaringoiatria della Fondazione IRCCS Policlinico San Matteo, centro di riferimento per la diagnosi e la cura dell’HHT. Sono stati valutati i pazienti con HHT sottoposti dal 2000 al 2022 al posizionamento di lamine settali in silicone nella gestione delle epistassi ricorrenti.
UNASSIGNED: Dei 506 pazienti trattati chirurgicamente, 74 sono stati sottoposti al posizionamento delle lamine e 37 hanno aderito allo studio. Con una media di 2,4 precedenti trattamenti chirurgici ed un valore medio di gravità delle epistassi di 7,38, il 71,6% dei pazienti presentava una perforazione settale. Mediamente, i pazienti hanno mantenuto le lamine in sede per 54 mesi, con una buona tollerabilità e una significativa riduzione della gravità delle epistassi, del numero medio di trasfusioni e un miglioramento nei valori medi di emoglobina.
UNASSIGNED: Nei pazienti HHT con epistassi gravi ricorrenti e con perforazione settale, il posizionamento di lamine di silicone a protezione della mucosa settale rappresenta una valida strategia nel controllo delle epistassi.

UNASSIGNED: To determine whether septal perforations have an effect on nasal swell body (NSB) size.
UNASSIGNED: Retrospective cohort study.
UNASSIGNED: Two tertiary academic medical centers.
UNASSIGNED: Computed tomography maxillofacial scans of 126 patients with septal perforation and 140 control patients from November 2010 to December 2020 were evaluated. Perforation etiology was determined. Measurements included perforation length and height and swell body width, height, and length. Swell body volume was calculated.
UNASSIGNED: The width and volume of the NSB are significantly smaller in perforation patients when compared to controls. The swell body is significantly smaller and thinner in perforations exceeding 14 mm in height compared to small perforations. Perforation etiology groupings into prior septal surgery, septal trauma, septal inflammatory, and mucosal vasoconstriction categories all demonstrated decreased swell body volume and width compared to controls. Inflammatory etiology had the greatest decrease in swell body size. The hemi-swell body on the contralateral side of a septal deviation is significantly thicker than the ipsilateral side.
UNASSIGNED: The NSB is smaller in patients with septal perforation regardless of perforation size or etiology.

暂无摘要。

Eosinophilic angiocentric fibrosis (EAF) is a rare, but benign, tumefactive lesion of the head and neck regions. It was initially discovered in 1983 but has recently been connected to the spectrum of immunoglobulin G4-related disease (IgG4-RD). It commonly presents with symptoms of nasal obstruction, structural deformities of the external nose, and involvement of the nasal septum and lateral nasal wall. Our patient presented with a saddle nose deformity, a septal perforation, and palatal fistulas. Laboratory testing for EAF is often negative for the presence of antinuclear cytoplasmic antibodies (ANCA). A definitive diagnosis of EAF can be made through histopathological analysis of the lesion. The appearance of \"onion-skin\" fibrosis with perivascular infiltration of primary eosinophils is pathognomonic for EAF. While there is a presence of ulceration tissue, EAF does not have any histological signs of necrosis. EAF is a very uncommon etiology of nasal obstructive symptoms; therefore, it is necessary to rule out more conventional pathologies. Even though it appears as a malignant process, it has an excellent prognosis. The common treatment modalities for an active lesion of EAF involve either surgical resection of margins alone or a combination of corticosteroids and resection. Rituximab has also shown benefits in the management of IgG4-RD as a corticosteroid-sparing treatment. Rituximab was chosen for treatment in our patient because surgical resection was not possible due to the absence of an active lesion. In this article, we provide a brief review of EAF and provide a unique case of EAF presenting with oronasal palatal fistulas.

Epistaxis is one of the most common emergencies. Topical agents such as silver nitrate, is known to be a strong oxidizing agent and have been widely used, especially in recurrent and refractory cases. The extent of depth of coagulative necrosis is dependent on time of exposure and concentration. 2 mm wide bar of nasal septum from 30 patients was taken and AgNO3 was applied for 10, 20, 40 s. H&E staining was then performed to see depth of penetration and intensity of stain deposits. It was observed that with increase time of application, depth of penetration and density of deposits were increased for both 75% and 100% concentration of solution. Distribution in depth of penetration was significant when 75% concentration was applied for more than 20 s. But when 100% concentration was used, similar findings were found even after 10 s in young age group. Our study shows that when silver nitrate is used for chemical cauterization in different concentrations and for different times, their penetration is different. Moreover, the depth of penetration depends more on the time of contact than concentration of silver nitrate. We would recommend using 75% solution for use with a contact time not more than 20 s in adults and 10 s in children.

BACKGROUND: Nasal septal perforations can be managed with a septal button prosthesis. While they do not restore the physiological function of the septal mucosa, they are able to improve laminar nasal airflow. With the development of septal buttons sized specifically to perforations, accurate measurement of perforations has become more important for patient satisfaction and comfort. This task can be difficult to accomplish in the clinical setting. In this study, 2 new instruments developed to measure septal perforations were evaluated for accuracy and ease of use.
METHODS: Two types of measuring devices (\"sizers\") were created via 3D printing. One type included six serial, progressively sized instruments (serial sizers) and the other included two instruments with several size gradations (graded sizers). Septal perforations of varying sizes were surgically created in five fresh-frozen cadaver heads. Using a headlight and nasal speculum, 15 otolaryngology trainees and consultants were asked to measure the perforations (length × height) via four different methods: \"eyeball\" estimation, a ruler, the serial sizers, and the graded sizers. They were also asked to evaluate the methods themselves. An accurate measurement was defined as ± 1 mm of the true measurement. A combination of Chi-square analysis and ANOVA was used to assess the accuracy and ease of use of the four methods.
RESULTS: Chi-square analysis showed that the sizers were more accurate than the two traditional methods (eyeball and ruler) for measuring perforation length (73% vs. 44%, p = 4.8 × 10-7) and height (71% vs. 50%, p = 0.0003). ANOVA showed that the eyeball method overestimated perforation length significantly more than the other three methods (p = 0.002), and was also significantly less accurate than the other three methods (p < 0.001). Chi-square analysis did not show any correlation between participant training experience and measurement accuracy for any of the three methods. Participant comments and scores demonstrated a clear preference for the two sizers over the traditional methods.
CONCLUSIONS: The two novel sizers studied here were significantly more accurate and easier to use than traditional methods for measuring nasal septal perforations. With broader implementation and study of these devices, there is potential to improve patient care surrounding septal perforations.

BACKGROUND: Concha bullosa is a usual anatomical variation of the nose and paranasal sinuses that can compromise their anatomy and function and cause such symptoms as headache, rhinosinusitis, and nasal congestion. Septal perforation is the defect of the septum that brings nasal cavities in communication and is usually caused by trauma. No septal perforation has been reported due to concha bullosa.
METHODS: The case of this report was a 15-year-old female who presented with long-term nasal obstruction due to a huge concha bullosa in her right nasal cavity which perforated nasal septum. She lacked a history of any nasal septum surgery, drug abuse, cocaine, or long-term nasal spray. Endoscopic surgery was performed and our patient\'s symptoms rapidly diminished after the surgery. Negative results were obtained for tuberculosis, Wegener\'s granulomatosis disease, and malignancy.
CONCLUSIONS: We believe that the concha bullosa presented in this case might have caused chondrocyte apoptosis due to mechanical pressure and led to septal perforation. Although uncommon, providers should be aware of the possibility of septal perforation in cases with concha bullosa when planning to perform surgery on patients with similar pathology.

OBJECTIVE: Reductive rhinoplasty is generally intended as a facial plastic procedure aiming for functional and aesthetic outcomes in patients affected by nasal dysmorphism and/or obstruction. However, when applied to different pathologies of the nasal pyramid it holds great potentialities, beyond the solo cosmetic and functional objectives.
METHODS: We retrospectively analyzed preoperative conditions, surgical charts, and postoperative results of patients who underwent reductive rhinoplasty for different nasal diseases at our Institution.
RESULTS: Principles and techniques of reductive rhinoplasty were described in the different possible applications to the treatment of nasal disease, from nasal septal perforation to benign and malignant diseases of the nose.
CONCLUSIONS: Reductive rhinoplasty showed to play a crucial role in the curative purpose of different nasal diseases, representing a versatile tool in the expert hand of rhinoplasty surgeons who approach them.
METHODS: N/A.