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Chi X, Wang Y, Yang H, Xing C, Gan J, Yang S, Liu GS, Han SS, Nie C, Gao H. Malignant Peripheral Nerve Sheath Tumor in the Nasal Cavity of a Neonate: A Case Report. EAR, NOSE & THROAT JOURNAL 2023; 102:NP527-NP533. [PMID: 34134529 DOI: 10.1177/01455613211014103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Malignant peripheral nerve sheath tumor (MPNST) is a rare tumor that can develop on the lining of nerves and within the network of nerve fibers in different organs, and it is commonly found in the head and neck, limbs, and trunk. These tumors can occur in patients of any age. They most commonly occur in adults aged 20 to 50 years; however, fewer cases of this tumor in children have been reported. To date, no neonatal case of MPNST in the nasal cavity has been reported. Here, we report the case of a 4-day-old female newborn who presented with a nasal mass that re-enlarged after surgery and was diagnosed as MPNST of the nasal cavity on the basis of pathological results. This is the first report of MPNST in the nasal cavity of a neonate. Differential diagnosis and treatment of nasal masses have been proposed in the related literature.
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Affiliation(s)
- Xiufang Chi
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yue Wang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Haoming Yang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Cheng Xing
- Department of Pathology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jiamin Gan
- Guangdong Women and Children Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shumei Yang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Guo Sheng Liu
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Sha Sha Han
- Department of Pediatrics, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Chuan Nie
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Hongyi Gao
- Department of Pathology, Guangdong Women and Children Hospital, Guangzhou, China
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2
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Tropsek R, Horoi M, Ziereisen F. Congenital Nasal Pyriform Aperture Stenosis in Association With Polymalformative Syndrome of the Midline. Cureus 2023; 15:e45153. [PMID: 37711266 PMCID: PMC10498658 DOI: 10.7759/cureus.45153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/16/2023] Open
Abstract
Congenital nasal pyriform aperture stenosis (CNPAS) is a rare neonatal entity characterized by a reduction in the pyriform orifice of the nasal cavity. Because of its nonspecific clinical presentation as respiratory distress symptoms, it can mimic choanal atresia. Although isolated forms have been described, CNPAS is often associated with other congenital midline malformations. A single median incisor is usually found, with or without other cervical and maxillofacial malformations. The existence of hypothalamic-pituitary axis malformations with endocrine disorders is also possible and, in some cases, a moderate to severe intellectual deficit in association with other brain malformations. Radiological investigation is a central point in the multidisciplinary management of this type of polymalformative syndrome.
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Affiliation(s)
- Robert Tropsek
- Radiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Bruxelles, BEL
| | - Mihaela Horoi
- Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Bruxelles, BEL
| | - France Ziereisen
- Radiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Bruxelles, BEL
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3
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Kotowski M. The Differential Diagnosis of Congenital Developmental Midline Nasal Masses: Histopathological, Clinical, and Radiological Aspects. Diagnostics (Basel) 2023; 13:2796. [PMID: 37685334 PMCID: PMC10486988 DOI: 10.3390/diagnostics13172796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Developmental midline nasal masses including nasal dermoids (NDs), encephaloceles (EPHCs), and nasal glial heterotopias (NGHs) are a consequence of disrupted embryonal developmental processes in the frontonasal region. Surgery is the only method of treatment in order to prevent local and intracranial inflammatory complications as well as distant deformities of the facial skeleton. Due to their rarity, similar location, and clinical and radiological symptoms, meticulous preoperative differential diagnostics is mandatory. The aim of this thorough literature review was to present and discuss all clinical, histopathological, and radiological aspects of NDs, NGHs, and EPHCs that are crucial for their differential diagnosis.
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Affiliation(s)
- Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 60-572 Poznań, Poland
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Srikanthan A, Scott S, Desai V, Reichert L. Neonatal Airway Abnormalities. CHILDREN 2022; 9:children9070944. [PMID: 35883928 PMCID: PMC9322467 DOI: 10.3390/children9070944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 02/03/2023]
Abstract
Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a broad overview of neonatal airway anomalies to arm those caring for these children with a broad differential diagnosis and basic knowledge of how to manage basic and complex presentations.
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Affiliation(s)
| | - Samantha Scott
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
| | - Vilok Desai
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
| | - Lara Reichert
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
- Correspondence:
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CONGENITAL INFERIOR TURBINATE HYPERTROPHY: AN OVERLOOKED ENTITY IN NEWBORNS AND REVIEW OF LITERATURE. The Journal of Laryngology & Otology 2021; 136:181-184. [PMID: 34649637 DOI: 10.1017/s0022215121002905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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6
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Galluzzi F, Garavello W, Dalfino G, Castelnuovo P, Turri-Zanoni M. Congenital bony nasal cavity stenosis: A review of current trends in diagnosis and treatment. Int J Pediatr Otorhinolaryngol 2021; 144:110670. [PMID: 33706014 DOI: 10.1016/j.ijporl.2021.110670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/31/2021] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
Congenital bony nasal cavity stenosis is caused by alterations of the normal embryological development of the nasal cavity. Depending on the site of the obstruction, the most important types of stenosis are: choanal atresia and stenosis, congenital nasal pyriform aperture stenosis, congenital midnasal stenosis, arhinia and nasal septum deviation. Although they are uncommon, they could be potentially life-threatening conditions that require early diagnosis and proper treatment. In case of neonatal nasal obstruction, appropriate differential diagnosis with other causes, such as rhinitis and sinonasal masses, are performed by nasal endoscopy and radiological exams. Treatment strategy consisting of medical nasal therapies and endoscopic or open nasal surgery should be tailored according to the types and the degree of the stenosis. When indicated, endoscopic endonasal approach is considered the most effective technique in neonates warranting minimal surgical invasiveness and maximum effect. In order to promote the management of these rare yet clinically relevant neonatal nasal breath disorders, we review the current trends in diagnosis and treatment of congenital bony nasal cavity stenosis.
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Affiliation(s)
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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7
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Alvo A, Villarroel G, Sedano C. Neonatal nasal obstruction. Eur Arch Otorhinolaryngol 2021; 278:3605-3611. [PMID: 33388986 DOI: 10.1007/s00405-020-06546-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Congenital nasal obstruction can be a significant cause of respiratory distress in the newborn, given that they are considered to be obligate nasal breathers. Several different causes have been described, which can be broadly classified as anatomical/malformative, non-tumoral masses and cysts, benign and malignant neoplasia, inflammatory/infectious, traumatic/iatrogenic, and miscellaneous. The purpose of this review is to provide updated and useful clinical information for teams involved in neonatal care, especially in a hospital setting. METHODS A review of the available literature was performed. Studies were sourced from PubMed with searching of relevant headings and sub-headings and cross-referencing. RESULTS The most common etiology is inflammatory, which can have different precipitating factors or be idiopathic, a condition known as neonatal rhinitis. On the other hand, some less frequent but nonetheless relevant conditions causing severe nasal obstruction include choanal atresia, midnasal stenosis, and pyriform aperture stenosis. Some cystic lesions, such as dacryocystoceles with intranasal mucocele, can also produce significant obstruction. Diagnosis usually requires a nasal endoscopy and in some cases imaging such as computed tomography. Management includes different medical and surgical strategies and will greatly depend on the etiology and the severity of symptoms. CONCLUSION Congenital nasal obstruction can be a significant cause of respiratory distress in the newborn. The wide spectrum of differential diagnoses requires a thorough knowledge of nasal anatomy, physiology, and pathology; as well as different management strategies.
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Affiliation(s)
- Andrés Alvo
- Otorhinolaryngology Unit, Hospital de Niños Roberto del Río, Santiago, Chile. .,Clínica Alemana de Santiago, Santiago, Chile. .,Department of Otorhinolaryngology. Hospital Clínico, Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile.
| | | | - Cecilia Sedano
- Otorhinolaryngology Unit, Hospital de Niños Roberto del Río, Santiago, Chile
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8
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Wegman SJ, McKnight L. Case 2: Recurrent Respiratory Distress in a Newborn. Pediatr Rev 2020; 41:297-299. [PMID: 32482693 DOI: 10.1542/pir.2018-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Lucas McKnight
- The Ohio State University, Columbus, OH.,Nationwide Children's Hospital, Columbus, OH
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9
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Sahin Onder S, Sahin-Yilmaz A, Gergin Tinay O, Unsal B. Congenital midnasal stenosis: Conservative management. Int J Pediatr Otorhinolaryngol 2020; 132:109939. [PMID: 32065878 DOI: 10.1016/j.ijporl.2020.109939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Congenital midnasal stenosis (MNS) is an extremely rare disease which may be life threatening, and shows difficulty in diagnosis and management. This case series summarizes superiority of using intranasal mometasone furoate spray (IMS) and continuous positive airway pressure (CPAP) to treat nasal obstruction in neonates with MNS. METHODS This study reviewed six consecutive cases of MNS. RESULTS Three patients were treated with IMS and CPAP. Two patients were treated with endoscopic balloon dilatation without stenting, followed by IMS and CPAP due to persisting nasal obstruction after the operation. One patient was treated with endoscopic balloon dilatation without stenting alone. CONCLUSION This study is the first to review the use of CPAP and IMS as an effective therapy for some patients with MNS. It suggests that conservative management with CPAP and IMS may be an alternative therapeutic option to surgery.
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Affiliation(s)
- Serap Sahin Onder
- Umraniye Research and Education Hospital, Department of Otolaryngology, Turkey.
| | - Asli Sahin-Yilmaz
- Umraniye Research and Education Hospital, Department of Otolaryngology, Turkey
| | - Ozgul Gergin Tinay
- Umraniye Research and Education Hospital, Department of Otolaryngology, Turkey
| | - Busra Unsal
- Umraniye Research and Education Hospital, Department of Otolaryngology, Turkey
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10
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Gupta P, Tripathi T, Singh N, Bhutiani N, Rai P, Gopal R. A review of genetics of nasal development and morphological variation. J Family Med Prim Care 2020; 9:1825-1833. [PMID: 32670926 PMCID: PMC7346930 DOI: 10.4103/jfmpc.jfmpc_1265_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
The nose is central in the determination of facial esthetics. The variations in its structural characteristics greatly influence the ultimate dentoskeletal positioning at the end of an orthodontic therapy. A careful insight into its developmental etiology will greatly aid the health care professional in identifying patient's real concern about the facial appearance. This in turn will aid in the fabrication of a better treatment plan regarding the end placement goals for the teeth and jaws in all the three dimensions of space. However, this important structure is often missed as a part of the diagnostic and treatment planning regime owing to the lack of meticulous understanding of its developmental etiology by the orthodontists. The development of the nose in the embryo occurs in pre skeletal and skeletal phases by a well-coordinated and regulated interaction of multiple signaling cascades with the crucial importance of each factor in the entire mechanism. The five key factors, which control frontonasal development are sonic hedgehog (SHH), fibroblast growth factors (FGF), transforming growth factor β (TGFβ), wingless (WNT) proteins, and bone morphogenetic protein (BMP). The recent evidence suggests the association of various nasal dimensions and their related syndromes with multiple genes. The revelation of nasal genetic makeup in totality will aid in ascertaining the direction of growth, which will govern our orthodontic treatment results and will also act as a harbinger for potential genetic editing and tissue engineering. This article describes at length the morphological and genetic aspect of nasal growth and development in light of the gender and racial variability along with the emphasis on the importance of knowing these nasal features with regard to diagnosis and treatment planning in orthodontics.
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Affiliation(s)
- Prateek Gupta
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah ZafarMarg, New Delhi, India
| | - Tulika Tripathi
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah ZafarMarg, New Delhi, India
| | - Navneet Singh
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah ZafarMarg, New Delhi, India
| | - Neha Bhutiani
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah ZafarMarg, New Delhi, India
| | - Priyank Rai
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah ZafarMarg, New Delhi, India
| | - Ram Gopal
- Department of Orthodontics and Dentofacial Orthopaedics, Maulana Azad Institute of Dental Sciences, Bahadur Shah ZafarMarg, New Delhi, India
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11
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Inthavong K, Das P, Singh N, Sznitman J. In silico approaches to respiratory nasal flows: A review. J Biomech 2019; 97:109434. [PMID: 31711609 DOI: 10.1016/j.jbiomech.2019.109434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/15/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
The engineering discipline of in silico fluid dynamics delivers quantitative information on airflow behaviour in the nasal regions with unprecedented detail, often beyond the reach of traditional experiments. The ability to provide visualisation and analysis of flow properties such as velocity and pressure fields, as well as wall shear stress, dynamically during the respiratory cycle may give significant insight to clinicians. Yet, there remains ongoing challenges to advance the state-of-the-art further, including for example the lack of comprehensive CFD modelling on varied cohorts of patients. The present article embodies a review of previous and current in silico approaches to simulating nasal airflows. The review discusses specific modelling techniques required to accommodate physiologically- and clinically-relevant findings. It also provides a critical summary of the reported results in the literature followed by an outlook on the challenges and topics anticipated to drive research into the future.
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Affiliation(s)
| | - Prashant Das
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | - Narinder Singh
- Dept of Otolaryngology, Head & Neck Surgery, Westmead Hospital Clinical School, Faculty of Medicine, University of Sydney, Australia
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
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12
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Abstract
Congenital nasal deformities can cause nasal obstruction with early respiratory distress. Choanal atresia is characterized by no communication between the nasal cavity and nasopharynx. Pyriform aperture stenosis involves more anterior nasal obstruction with limited intranasal space. Nasal masses such as encephaloceles, gliomas, and dermoids are thought to be related through a skull base defect in utero. Imaging with computed tomography and MRI are helpful in distinguishing lesions and identifying intracranial communication. Nasolacrimal duct cysts can get infected and cause obstruction. Nasal septal deviation can be corrected at bedside if detected early. Evaluation and treatment are discussed with all these entities.
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Affiliation(s)
- Roy Rajan
- Department of Surgery, Lehigh Valley Health Network, 1210 South Cedar Crest Boulevard, Suite 1100, Allentown, PA 18103, USA.
| | - David Eric Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Room 6161B, Baltimore, MD 21287, USA
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13
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Bronshtein M, Leibovitz Z, Laham G, Egenburg S, Wolman I, Bardin R. Early Transient Prenatal Ultrasound Features of Choanal Atresia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2439-2444. [PMID: 29480518 DOI: 10.1002/jum.14586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 06/08/2023]
Abstract
We present a case series of early second-trimester prenatal ultrasound (US) features in 4 fetuses with a confirmed diagnosis of choanal atresia. The clinical characteristics and outcomes evaluated included prenatal US findings, genetic analyses, postmortem autopsies (2 cases), and computed tomographic findings. A transient large nasal cavity was detected by US in all 4 fetuses. This finding disappeared a few weeks later. Three cases were unilateral choanal atresia, and 1 was bilateral. Transient enlargement of the nasal cavity in early pregnancy appears to be a US sign of choanal atresia.
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Affiliation(s)
- Moshe Bronshtein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
| | - Zvi Leibovitz
- Department of Obstetrics and Gynecology, Bnai Zion Medical Center, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gaby Laham
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sandro Egenburg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
| | - Igal Wolman
- Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bardin
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Abstract
A number of textbooks, review articles, and case reports highlight the potential comorbidity of choanal atresia in craniosynostosis patients. However, the lack of a precise definition of choanal atresia within the current craniosynostosis literature and widely varying methods of detection and diagnosis have produced uncertainty regarding the true coincidence of these conditions. The authors review the anatomy and embryologic basis of the human choanae, provide an overview of choanal atresia, and analyze the available literature that links choanal atresia and craniosynostosis. Review of over 50 case reports that describe patients diagnosed with both conditions reveals inconsistent descriptions of choanal atresia and limited use of definitive diagnostic methodologies. The authors further present preliminary analysis of three-dimensional medical head computed tomographic scans of children diagnosed with craniosynostosis syndromes (e.g., Apert, Pfeiffer, Muenke, and Crouzon) and typically developing children and, although finding no evidence of choanal atresia, report the potentially reduced nasal airway volumes in children diagnosed with Apert and Pfeiffer syndromes. A recent study of the Fgfr2c Crouzon/Pfeiffer syndrome mouse model similarly found a significant reduction in nasal airway volumes in littermates carrying this FGFR2 mutation relative to unaffected littermates, without detection of choanal atresia. The significant correlation between specific craniosynostosis syndromes and reduced nasal airway volume in mouse models for craniosynostosis and human pediatric patients indicates comorbidity of choanal and nasopharyngeal dysmorphologies and craniosynostosis conditions. Genetic, developmental, and epidemiologic sources of these interactions are areas particularly worthy of further research.
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15
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Patel VA, Carr MM. Congenital nasal obstruction in infants: A retrospective study and literature review. Int J Pediatr Otorhinolaryngol 2017; 99:78-84. [PMID: 28688570 DOI: 10.1016/j.ijporl.2017.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/27/2017] [Accepted: 05/27/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify etiologies of congenital nasal obstruction and describe clinical practice patterns in the evaluation, diagnosis, and treatment of symptomatic infants. METHODS An electronic chart review from 1/1/2006-10/1/2016 for all patients with a diagnosis of nasal obstruction within the first six months of life using ICD-9 and 10 codes 478.19 and J34.89. RESULTS A total of 34 patients were evaluated by the Division of Otolaryngology for this chief complaint. 38% of neonates were born premature and 32% were admitted to the NICU at birth, with a female-to-male ratio of 1:1.4. Presenting signs and symptoms included: stertor (44%), cyanosis (24%), stridor (24%), retractions (21%), rhinorrhea (21%), apnea (12%), and epistaxis (8%). 47% of patients received ancillary radiographic imaging (CT or MRI). Diagnoses observed include: midnasal stenosis (38%), pyriform aperture stenosis (21%), choanal stenosis (12%), dacryocystocele (6%), microrhinia (6%), septal deviation (6%), nasopharyngeal reflux (3%), nasopharyngeal teratoma (3%), neonatal rhinitis (3%), and pharyngeal wall collapse (3%). 71% of patients were noted to have bilateral nasal obstruction. 41% of infants were found to have an associated ear, nose, and throat anomaly. 15% of patients required surgical intervention. The mean time-to-resolution was 240 days. CONCLUSION Congenital nasal obstruction has a broad differential diagnosis: the timing, onset, and laterality of symptoms can provide insights into the source of upper airway compromise. Most infants improve through conservative management (i.e. suctioning, humidification) and medical therapies (i.e. intranasal drops, nasal sprays).
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Affiliation(s)
- Vijay A Patel
- The Pennsylvania State University, College of Medicine, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, Hershey, PA, USA
| | - Michele M Carr
- The Pennsylvania State University, College of Medicine, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, Hershey, PA, USA.
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16
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Wagner MW, Haileselassie B, Kannan S, Chen C, Poretti A, Tunkel DE, Huisman TAGM. Oropharyngeal dermoid cyst in an infant with intermittent airway obstruction. A case report. Neuroradiol J 2014; 27:627-31. [PMID: 25260210 DOI: 10.15274/nrj-2014-10085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/10/2014] [Indexed: 11/12/2022] Open
Abstract
Dermoid cysts are benign epithelial inclusions and cystic lesions that may occur in several locations including the oropharynx. We describe the case of a two-month-old baby girl who presented with progressive respiratory distress, hypoxemia, and feeding difficulties because of an oropharyngeal dermoid cyst. The child had an airway work-up that included laryngoscopy. However, the mass remained undetected. This is most likely explained by the mobile nature of the lesion, prolapsing into the high nasopharynx in supine position. In our patient, magnetic resonance imaging (MRI), initially performed to rule out brainstem pathology, revealed an oropharyngeal dermoid cyst. This case shows the potential role of neuroimaging in the diagnostic work-up of a young child presenting with respiratory distress by excluding a central nervous system lesion and diagnosing an "unexpected" nasopharyngeal mass lesion. In addition, MRI allowed exclusion of skull base lesions of neural origin such as an anterior meningoencephalocele or heterotopic neuroglial tissue which would be managed differently from pharyngeal masses.
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Affiliation(s)
- Matthias W Wagner
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA -
| | - Bereketeab Haileselassie
- Division of Anesthesiology and Critical Care Medicine, Department of Anesthesiology, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Sujatha Kannan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Cynthia Chen
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine; Baltimore, MD, USA
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Moreno-Calero C, Benítez-Segura I, Ramis LF, Ferré CG, Busto JR, Balliu-Badia PR. Dacryocystocele: a rare cause of neonatal respiratory distress. J Matern Fetal Neonatal Med 2013; 27:750-2. [DOI: 10.3109/14767058.2013.823395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Krugman SD, Bhagtani HR. Parental perception of the effectiveness of treatments for infant nasal congestion. Clin Pediatr (Phila) 2013; 52:762-4. [PMID: 22399567 DOI: 10.1177/0009922812439461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Scott D Krugman
- Department of Pediatrics, Franklin Square Hospital Center, Baltimore, MD 21237, USA.
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Abstract
Nasal obstruction is a serious clinical scenario in the newborn infant with a large differential diagnosis. This article reviews the etiologies of nasal obstruction to aid the pediatrician in prompt evaluation, diagnosis, and treatment.
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Affiliation(s)
- Sharon H Gnagi
- Department of Otolaryngology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
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