Choanal atresia is an uncommon condition with an incidence of 1:5,000-8,000 live births, affecting females more frequently and often associated with other malformations. This case report presents a 42-year-old female patient who was born with bilateral choanal atresia and intervened surgically for the first time at birth. However, the formed orifice was reobstructed a few months afterward, necessitating reoperation in adulthood. The purpose of this case report is to describe bilateral choanal atresia in detail, including its clinical presentation, epidemiology, diagnosis, pathogenesis, and therapeutic approach. It aims to enhance understanding of this rare but significant condition.

The middle nasal turbinate is an important anatomical formation located on the lateral nasal wall. Concha bullosa can be defined as the presence of an air gap inside the turbinate. It is the most common middle nasal turbinate variation. It is often asymptomatic, but can sometimes cause nasal obstruction. In this study, an asymptomatic patient with concha bullosa within concha bullosa in both middle turbinates, which has not been reported before in the literature, is presented. Laryngoscope, 134:3516-3518, 2024.

UNASSIGNED: This report details the unusual presentation of two hidden cavernous hemangiomas in the orbital apex, initially appearing as one tumor. The rarity and diagnostic complexity of this case underscore the need for meticulous surgical exploration and verification in orbital apex tumors.
METHODS: A physical examination of an elderly male with a three-year history of headaches revealed a space-occupying lesion in the left orbital apex. Imaging confirmed a tumor in the extraconical space above the optic nerve. Initial nasal endoscopy removed an orbital apex tumor, pathologically confirmed as a cavernous hemangioma.
UNASSIGNED: Postoperative examination revealed incomplete tumor removal, prompting a second surgery for full excision. This case underscores the diagnostic and management challenges of orbital apex tumors, especially when imaging indicates a single mass. The endoscopic transsphenoidal approach for cavernous hemangiomas in the medial orbital apex, as illustrated in this case, appears promising.
CONCLUSIONS: Clinicians must be aware of the potential for multiple tumors in orbital apex cases, even if imaging does not explicitly reveal them. This case highlights the importance of thorough surgical exploration and illustrates the effectiveness of endoscopic methods in intricate orbital apex surgeries.

BACKGROUND: The workhorse for endonasal reconstruction of skull base defects is the posteriorly-based nasoseptal flap (NSF). Postoperative nasal deformities and decreased olfaction are potential complications of NSF. The reverse septal flap (RSF) minimizes the donor site morbidity of the NSF by covering the exposed cartilage of the anterior septum. Currently, there are minimal data examining its effect on outcomes including nasal dorsum collapse and olfaction.
OBJECTIVE: Our study aims to clarify whether the RSF should be utilized when the option exists.
METHODS: Adult patients undergoing endoscopic endonasal approach (EEA) surgery of the skull base (transsellar/transplanum/transclival approaches) with NSF reconstruction were identified. Data from 2 separate cohorts, one retrospective and one prospective, were collected. Follow-up was at least 6 months. Patients were photographed preoperatively and postoperatively using standard rhinoplastic nasal views. Patients completed the University of Pennsylvania Smell Identification Test (UPSIT) and the 22-item Sino-Nasal Outcome Test (SNOT-22) preoperatively and postoperatively and were also queried regarding subjective changes in nasal appearance and plans for cosmetic surgery following EEA.
RESULTS: There were no statistically significant differences in the change in UPSIT and SNOT-22 scores between patients receiving RSF and other reconstructive groups (either NSF without RSF or no NSF). One of 25 patients who were reconstructed with an NSF with RSF reported a change in nasal appearance; none were considering reconstructive surgery. The proportion of patients reporting changes in appearance was significantly lower in the NSF with RSF group as compared to the NSF without RSF group (P = .012).
CONCLUSIONS: The use of an RSF to limit donor site morbidity of the NSF was shown to significantly decrease the proportion of patients who reported nasal deformities and did not show a significant difference in patient-reported sinonasal outcomes. Given these findings, RSF should be considered whenever an NSF is used for reconstruction.

To assess the clinical outcome of endoscopic septoturbinal surgeries in patients with rhinogenic contact point headache. Retrospective audit of medical records. Retrospective audit of medical records of patients having undergone endoscopic surgical management for contact point headache between a period of May 2017 to May 2018 were included in the study. Patients who underwent functional endoscopic sinus surgery were excluded from the study. Pre operative pain score were compared with post operative pain score at interval of 1 month for 3 months consequently and at 1 year interval using Visual Analog scale (VAS). The difference between preoperative (mean 6.82) and post operative VAS pain scores after 1 month (mean 3.36), 2 months (mean 4.50), 3 months (mean 5.48), 1 year (mean 5.01) was statistically significant (p < 0.001). Contact point headache is an important clinical entity that might be missed during evaluation and management of refractory headache. Surgical management under endoscopic guidance can help to ensure removal of mucosal contact point and aid in the treatment of refractory headache as noted in our study.

OBJECTIVE: Dacryocystorhinostomy (DCR) is indicated for the treatment of nasolacrimal obstruction with some authors suggesting the use of a silicone tube (stent) to maintain rhinostomy patency a long time. This study aims at comparing the results of endoscopic-DCR (En-DCR) with and without silicone stenting.
METHODS: A randomized prospective study was conducted from January 2013 to January 2018, following patients for up to 72 months. Sixty outbound patients suffering from chronic epiphora for primary acquired nasolacrimal duct obstruction were simply randomized and assigned to En-DCR with \"silicone stent tube\" (SST) or \"no silicone stent tube\" (NSST) group. Data about the results of the two procedures were collected using Munk\' and Ali\' assessments. The results were statistically compared to evaluate the differences.
RESULTS: 30 patients were in the SST group and 30 in NSST. In the SST group, the tube remained in place for 3-6 months (4.1 ± 1.2 months). The follow-up period was 12-72 months (48.3 ± 6.2 months). Success rates (Junk and Javed Ali assessments) were, respectively, 97% in SST and 90% NSST group, with no statistical difference (Student\'s test). On a long-term follow-up, SST patients had an increased risk of re-stenosis by 14 months.
CONCLUSIONS: Our results showed there were not benefit in using tube, in the opposite it increased risk of re-stenosis. Despite preliminary results, our data confirmed comparing the two methods that silicone tube should not be used.

OBJECTIVE: Bilateral endoscopic nasal surgery is usually associated with pain and sleep disturbance. The aim of this study was to evaluate the effects of dexmedetomidine-soaked nasal packing on analgesia and improvement of sleep quality in patients undergoing this surgery.
METHODS: Eighty patients were enrolled and randomly allocated into 4 groups. At the end of surgery, dexmedetomidine-soaked nasal packings were applied to three groups with a dosage of 1 μg kg-1 (D1), 2μg kg-1 (D2), 4 μg kg-1 (D4) and normal saline-soaked nasal packing (NS) was applied to a fourth group. The primary outcome was postoperative pain scores using a visual analog scale (VAS) recorded at six time points: before the surgery (T1); 2 h (T2), 8 h (T3), 24 h (T4), 48 h (T5) after surgery; and at the moment of nasal packing removal (T6). Secondary outcomes were postoperative sleep status evaluated by the Pittsburgh sleep quality index (PSQI) and subjective sleep quality value (SSQV). Factors affecting sleep, hemodynamic changes, and adverse events were also recorded.
RESULTS: Compared with the NS group, dexmedetomidine-soaked nasal packing significantly relieved postoperative pain and improved sleep quality. The effect was similar between D2 and D4, which was greater than in D1. However, D2 was associated with fewer adverse events.
CONCLUSIONS: Dexmedetomidine-soaked nasal packing not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing bilateral endoscopic nasal surgery. Taking effect and adverse events into consideration, a dosage of 2μg kg-1 may be optimal.
BACKGROUND: www.chictr.org.cn/index.aspx (ChiCTR1900025692) Retrospectively registered 5 September 2019.

UNASSIGNED: Nasal septal abscess is a rare disorder in pediatric patients and is mostly diagnosed as a complication of trauma or secondary to dental or sinonasal infection.
UNASSIGNED: A 10-year-old girl presented with acute nasal obstruction, otalgia, and headache. Medical history was negative; physical examination and anterior rhinoscopy did not reveal signs of acute rhinosinusitis or septal abscess.
UNASSIGNED: A thorough nasal endoscopy was performed to rule out a posterior nasal infection, revealing a bilateral posterior septal bulging, in the absence of purulent discharge. CT scan and contrast-enhanced MRI were performed, confirming the diagnosis of a spontaneous posterior septal abscess. Trans-nasal endoscopic-assisted drainage was conducted under general anesthesia. Haemophilus influenzae was detected on culture.
UNASSIGNED: Although rare, nasal septal abscess in the pediatric age is typically anterior and secondary to local trauma or infection. Accurate medical history and anterior rhinoscopy are usually sufficient to make the diagnosis. In cases where the clinical presentation is consistent with a nasal septal abscess, with no history of recent local trauma or infection, or signs of anterior septal bulging, nasal endoscopy should be performed to rule out spontaneous posterior septal abscess. Delay in diagnosis and treatment could potentially cause the rapid onset of life-threatening complications, including intracranial abscess, meningitis, and cavernous sinus thrombosis.

UNASSIGNED: If the respiratory nasal mucosa is damaged and the mucosa does not heal properly during nasal or paranasal sinus surgery, a revision surgery may be required. The aim of this study is to investigate the effects of oral propolis application on mucosal wound healing following endoscopic nasal surgery in a rabbit model.
UNASSIGNED: Twenty four New Zealand rabbits were randomly divided into three groups, namely the experimental group (EG), the control group (CG), and the negative control group (NCG). Mucosal resection was applied with 3-mm punch forceps in the bilateral ventral nasal concha in the experimental and control groups. 75 mg/kg/day propolis was added to the diet of the rabbits in the EG for 14 days. The CG continued with the standard diet postoperatively. In the NCG, no surgical intervention was made, and no dietary support was given. On postoperative day 14 all rabbits were sacrificed and left nasal specimens were examined histopathologically, hydroxyproline levels were measured in right nasal specimens.
UNASSIGNED: There were no statistically significant differences in hydroxyproline level, epithelial and subepithelial thickness, ciliary and goblet cell count, subepithelial fibrosis and collagen density between EG and CG. Neutrophil count was statistically significantly lower in EG, compared to CG (p=0.019, Tamhane test).
UNASSIGNED: Although there are many studies that show the positive effects of propolis on wound healing, such effect was not observed in this study. This study is deemed to constitute a unique experimental study that can be a resource for future similar studies to be performed with higher numbers of subjects and higher dosage of propolis.

OBJECTIVE: to describe the results of the treatment of invasive fungal sinusitis with nasal endoscopic surgery in an immunocompromised paediatric oncological population.
METHODS: retrospective study of all patients diagnosed with invasive fungal sinusitis operated in the National Paediatric Oncology Unit between 2012 and 2016. Data taken from their medical history included: epidemiological characteristics, oncological diagnosis, haematological data, symptoms, tomographic studies, surgical interventions, results of pathology and cultures, medications received, complications, evolution and survival.
RESULTS: 18 patients were identified, 7 male and 11 female. The average age was 12 years, 13 had a diagnosis of acute lymphocytic leukemia and 5 of acute myeloid leukemia. Seventeen patients presented severe neutropenia at the time of diagnosis. The most frequently identified aetiological agent was Aspergillus in 13 patients. In 16 patients (89%) the disease was controlled with nasal endoscopic surgery. Ten patients died due to unrelated causes throughout the study.
CONCLUSIONS: Invasive fungal sinusitis should be considered a medical emergency due to its high mortality. The diagnosis is based on a high index of suspicion in patients with predisposing factors (leukaemia, neutropenia, persistent fever, nasogastric tube) and endoscopic nasal evaluation. Antifungal medical treatment and aggressive nasal endoscopic surgery is indicated regardless of the patient\'s condition to reduce the fungal burden and associated high mortality. The treatment must be provided by a multidisciplinary team that includes paediatrics, haemato-oncology, infectology and otorhinolaryngology.