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Abreu VRLS, Xavier JA. Imaging Nasal Obstruction: An Objective Evaluation for a Subjective Complaint. Facial Plast Surg 2024; 40:294-303. [PMID: 38016660 DOI: 10.1055/a-2218-7060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Nasal obstruction (NO) is a common clinical symptom characterized by a subjective sensation of insufficient airflow through the nasal cavity and may result from various factors, including changes in nasal anatomy, inflammatory conditions, tumoral lesions, and other etiologies. While a thorough medical history and physical examination can often identify its cause, imaging is usually necessary to fully understand the problem. Computed tomography (CT) is the primary imaging modality used to evaluate the nasal cavity and paranasal sinuses, allowing for the identification of potential causes and structural abnormalities. However, when soft tissue characterization is required, magnetic resonance imaging (MRI) is also useful. Understanding the anatomical and pathological basis of NO is crucial for accurate diagnosis and appropriate management. Imaging techniques provide valuable information for identifying the underlying causes of NO and guiding treatment decisions. This article reviews the normal anatomy of the nasal cavity and adjacent paranasal sinuses as well as the several conditions that may affect breathing comfort (tumors, inflammatory diseases, bony and cartilaginous anatomical variants, and "nonobstructive" mucosal thickenings), showing their normal presentation on CT and MRI.
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Affiliation(s)
- Vasco R L S Abreu
- Neuroradiology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João A Xavier
- Neuroradiology Department, Centro Hospitalar Universitário de Santo António, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
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Maubras J, Bonigen S, Kerimian M, Alharbi A, de Gabory L. Functional assessment of septo(rhino)plasty revision surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:127-132. [PMID: 38238185 DOI: 10.1016/j.anorl.2024.01.002] [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: 05/27/2024]
Abstract
INTRODUCTION Functional septo(rhino)plasty incurs a 17-25% rate of revision for persistent symptoms. OBJECTIVES The main study objective was to assess functional results before and after surgical revision. The secondary objective was to describe the shortcomings or excesses of the prior surgeries, with a-posteriori comparison of efficacy for the surgical techniques requiring revision. MATERIAL AND METHODS A single-center retrospective study included functional salvage septo(rhino)plasties. Data comprised epidemiology, intraoperative anatomic abnormalities indicative of prior surgery, operative correction maneuvers, and pre- and post-intervention NOSE and RhinoQoL scores and satisfaction on VAS. RESULTS Eighty-two patients were included. Anatomic abnormalities comprised deviated posterior septum (81.7%) and chondroethmoidal junction (58.5%), valve stenosis (54.9%), and obstructive boney spur or crest (46.3%). Prior surgeries comprised 33 submucosal resections, 29 septorhinoplasties, 14 Cottle septoplasties and 5 Killian procedures. Complete septoplasty was performed in 80% of cases, with associated maneuvers in 15%. All scores showed improvement taking the whole population together (P<10-5), but on subgroup analysis improvement concerned only revision of septorhinoplasty (P<10-4) and of submucosal resection (P<10-3), while 17% of patients showed no change in scores. CONCLUSION Functional nasoseptal salvage surgery enables most patients to recover respiratory comfort, with the exception of a few cases despite a perfectly straight nasal septum.
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Affiliation(s)
- J Maubras
- Service d'ORL et Chirurgie Cervicofaciale, CHU de Bordeaux, Bordeaux, France
| | - S Bonigen
- Service d'ORL et Chirurgie Cervicofaciale, CHU de Bordeaux, Bordeaux, France; Université de Bordeaux, 33000 Bordeaux, France
| | - M Kerimian
- Service d'ORL et Chirurgie Cervicofaciale, CHU de Bordeaux, Bordeaux, France
| | - A Alharbi
- Service d'ORL et Chirurgie Cervicofaciale, CHU de Bordeaux, Bordeaux, France
| | - L de Gabory
- Service d'ORL et Chirurgie Cervicofaciale, CHU de Bordeaux, Bordeaux, France; Université de Bordeaux, 33000 Bordeaux, France.
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Jankowski R, Favier V, Saroul N, Lecanu JB, Nguyen DT, de Gabory L, Verillaud B, Rumeau C, Gallet P, Béquignon E, Vandersteen C, Patron V. Critical review of diagnosis in rhinology and its therapeutical implications. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:271-278. [PMID: 37838600 DOI: 10.1016/j.anorl.2023.10.006] [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: 10/16/2023]
Abstract
Diagnosis in rhinology is currently based on the concept of inflammation (chronic rhinosinusitis [CRS]) or the clinical concept of chronic nasal dysfunction (CND). The complementarity between these two approaches can be discussed by a critical review of the literature structured by the analysis of the fundamental and diagnostic bases and the therapeutic implications linked to each. The concept of CRS is based on the anatomical continuity of the nasal and sinus respiratory mucosa and molecular biology data, seeking to analyze the mechanisms of chronic inflammation and to identify proteins and biomarkers involved in the different supposed endotypes of chronic inflammation of this mucosa. The concept of CND seeks to analyze medical, instrumental or surgical diagnostic and therapeutic strategies, taking account of both inflammatory and non-inflammatory causes impacting the anatomy or physiology of each of the three noses (olfactory, respiratory and sinus) that make up the mid-face sinonasal organ of evolution-development (Evo-Devo) theory. Thus, the concept of CRS offers an endotypic approach, based on biological characterization of mucosal inflammation, while the concept of CND offers a compartmentalized phenotypic and pathophysiological approach to sinonasal diseases. The joint contribution of these two concepts in characterizing nasal functional pathology could in future improve the medical service provided to patients.
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Affiliation(s)
- R Jankowski
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France.
| | - V Favier
- Département ORL, CCF et CMF, hôpital Gui-de-Chauliac, CHU de Montpellier, université Montpellier, Montpellier, France
| | - N Saroul
- Équipe ASMS, service d'oto-rhino-laryngologie et chirurgie cervico-faciale, INRAE, UNH, CHU de Clermont-Ferrand, université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - J-B Lecanu
- Service ORL & chirurgie cervico-faciale, institut Arthur-Vernes, Paris, France
| | - D T Nguyen
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - L de Gabory
- Service d'ORL, de chirurgie cervico-faciale et pédiatrique, centre F-X Michelet, hôpital Pellegrin, CHU, université de Bordeaux, Bordeaux, France
| | - B Verillaud
- Service d'ORL, hôpital Lariboisière, AP-HP, Inserm U1131, université Paris Cité, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C Rumeau
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - P Gallet
- Service ORL & chirurgie cervico-faciale, hôpital de Brabois, université de Lorraine, CHRU, Nancy, France
| | - E Béquignon
- Service Orl & chirurgie cervico-faciale, hôpital Henri-Mondor, CHIC Créteil, Créteil, France
| | - C Vandersteen
- Centre hospitalier universitaire, institut universitaire de la face et du cou, université Côte d'Azur, 31, avenue de Valombrose, Alpes-Maritimes, 06100 Nice, France
| | - V Patron
- Service ORL & chirurgie cervico-faciale, CHU de Caen Normandie, Caen, France
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Houdu J, Jankowski R, Renkes R, Nguyen-Thi PL, Gallet P, Nguyen DT. Minimal clinically important differences on the DyNaChron questionnaire after surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:261-266. [PMID: 37838601 DOI: 10.1016/j.anorl.2023.10.010] [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: 10/16/2023]
Abstract
OBJECTIVES To determine minimal clinically important differences (MCIDs) for the DyNaChron chronic rhinosinusitis quality-of-life questionnaire. INTRODUCTION MCIDs are the smallest changes in a quality-of-life score that are of clinical relevance for the patient. They allow treatment benefit to be estimated. MCIDs have not previously been determined for DyNaChron. MATERIAL AND METHODS A single-center retrospective study analyzed DyNaChron questionnaires filled out between June 2016 and December 2021 by all patients consulting for chronic nasal dysfunction. Five hundred and thirteen of the 2390 patients were operated on for nasal polyposis (NP; n=282) or septo(rhino)plasty+inferior turbinoplasty (SPIT; n=231). Standard error of measurement was used to determine MCIDs. RESULTS MCID for DyNaChron global score was 60 in NP and 58 in SPIT. MCIDs per symptom domain in NP and SPIT respectively were: 15 and 13 for nasal obstruction, 21 and 21 for anterior rhinorrhea, 20 and 19 for posterior rhinorrhea, and 17 and 17 for olfaction. In agreement with global MCID, 257 NPs (91%) and 149 SPITs (65%) showed clinical improvement. CONCLUSION MCID helps assess response to treatment. In the DyNaChron questionnaire, MCIDs enable global and symptom-specific assessment of chronic nasal dysfunction and its impact on quality of life in a single patient or in groups.
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Affiliation(s)
- J Houdu
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - R Jankowski
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - R Renkes
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P-L Nguyen-Thi
- Unité d'évaluation médicale, unité de méthodologie, data management et statistique - UMDS, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P Gallet
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - D-T Nguyen
- Service d'ORL et chirurgie cervico-faciale, CHRU de Nancy, hôpitaux de Brabois, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Barron M, Nguyen DT, Rumeau C, Jankowski R. Chronic respiratory rhinitis: Toward endoscopic diagnosis of nasal allergy? An observational study. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139:177-183. [DOI: 10.1016/j.anorl.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bartier S, Coste A, Béquignon E. Biotherapy and treatment of adult primary chronic rhinosinusitis with nasal polyps: Cellular and molecular bases. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:355-362. [PMID: 33358657 DOI: 10.1016/j.anorl.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The present article reviews the molecular and cellular mechanisms involved in the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwCRSwNP) and underlying the action mechanisms of biotherapies. Biotherapy uses substances naturally produced by the organism or their specific antagonists targeting a proinflammatory mechanism. CRSwCRSwNP is a form of chronic rhinosinusitis (CRS), which is classically subdivided in to 2 types according to the presence of polyps. In recent years, the concept of endotypes emerged, with a more exhaustive definition of the types of CRS according to inflammatory mechanism, with a view to developing personalized treatments. CRSwNP pathophysiology is poorly understood. Polyps arise from a primary epithelial lesion in a context of chronic local inflammation, mainly type 2 in Europe, implicating eosinophils, IgE, Th2 cytokines (IL-4/IL-13, IL-5) and T and B cells. Biotherapy seems promising in CRSwNP. The present review details the various pathophysiological pathways underlying the action mechanisms of biotherapies, and the various published studies, assessing efficacy and mode of action in the treatment of CRSwNP.
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Affiliation(s)
- S Bartier
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Henri Mondor, 94000 Créteil, France; Université Paris-Est Créteil (UPEC), Faculté de Médecine, 94000 Créteil, France; INSERM U955, 94000 Créteil, France; CNRS, ERL 7240, 94000 Créteil, France.
| | - A Coste
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Henri Mondor, 94000 Créteil, France; Université Paris-Est Créteil (UPEC), Faculté de Médecine, 94000 Créteil, France; INSERM U955, 94000 Créteil, France; CNRS, ERL 7240, 94000 Créteil, France
| | - E Béquignon
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Henri Mondor, 94000 Créteil, France; Université Paris-Est Créteil (UPEC), Faculté de Médecine, 94000 Créteil, France; INSERM U955, 94000 Créteil, France; CNRS, ERL 7240, 94000 Créteil, France
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Karakuş MF, Özcan KM, Özcan M, Karakurt SE, Çetin MA, Çolak M, Eravcı FC, Yüksel Y, Titiz A, Ünal A. Does the Change in the Indications of Endoscopic Sinonasal Surgery Continue? Data between 1994-2018. Turk Arch Otorhinolaryngol 2020; 58:5-9. [PMID: 32313888 DOI: 10.5152/tao.2020.4828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/30/2019] [Indexed: 11/22/2022] Open
Abstract
Objective Endoscopic sinonasal surgery (ESS) has changing over the years in parallel with the developments in endoscopy devices, video-imaging techniques, and surgical instruments. In the present study we investigated whether the indications of patients who underwent surgery over a period of 25 years have accommodated to these changes. Methods We retrospectively evaluated 1173 patients who underwent surgery in our clinic from 1994 through 2007, and 954 patients who underwent surgery from 2008 through 2018. The patients were divided into three groups as follows: chronic rhinosinusitis with polyps (CRSwNP), chronic rhinosinusitis without polyps (CRSsNP), and others. The changes in the indications during the first 14 years and the following 11 years were compared, and the results were statistically evaluated. Results A significant decrease was observed in the number of patients who underwent surgery following the diagnosis of CRSsNP (p<0.001). In addition, a statistically significant increase was found in CRSwNP (p<0.001) and other (p<0.001) indications. Conclusion When ESS indications identified in our clinic were reviewed, it was observed that the increasing trend in CRSwNP rate in the first 14 years continued, there was a significant increase in non-CRS indications in the last 11 years, and there has been an increase in patients with fungal sinusitis, especially in this group.
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Affiliation(s)
- Mehmet Fatih Karakuş
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Kürşat Murat Özcan
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Müge Özcan
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Süleyman Emre Karakurt
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Çetin
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Mustafa Çolak
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Fakih Cihat Eravcı
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Yeşim Yüksel
- Department of Otorhinolaryngology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Ali Titiz
- Clinic of Otorhinolaryngology, Acıbadem Ankara Hospital, Ankara, Turkey
| | - Adnan Ünal
- Department of Otorhinolaryngology, University of Health Sciences Ankara Numune Training and Research Hospital, Ankara, Turkey
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Migueres N, de Blay F, Braun JJ. Complex rhinobronchial dystrophy and immunodeficiency: Chance association or exceptional congenital syndrome? Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:135-137. [PMID: 31734144 DOI: 10.1016/j.anorl.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION We report a case of an exceptional syndromic association of apparently congenital rhinobronchial dystrophy associated with congenital anosmia and common variable immunodeficiency in a twelve-year-old girl. CASE SUMMARY This young girl, born in 2000, consulted for the first time in 2012 for recurrent respiratory tract infections, refractory to all forms of treatment, starting in early childhood, associated with congenital anosmia and severe atrophic rhinitis as well as common variable immunodeficiency. The laboratory work-up essentially revealed IgG4 deficiency and imaging demonstrated bronchiectasis (lingula), multiple tracheobronchial diverticula, atrophic rhinitis and congenital anosmia with agenesis of the olfactory bulbs and sulci. DISCUSSION After eliminating a number of differential diagnoses, we were left with the problem of the aetiology, the possible links between these various symptoms and the genetic basis for this apparently congenital complex rhinobronchial disease associated with common variable immunodeficiency. Do these various symptoms correspond to a chance association or an exceptional congenital syndrome that has not yet been identified in the literature? CONCLUSION A review of the clinical and genetic literature did not enable us to propose a single diagnosis for these symptoms or this complex syndrome.
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Affiliation(s)
- N Migueres
- Service de pneumologie, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - F de Blay
- Service de pneumologie, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 3072, Fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg, France
| | - J J Braun
- Service de pneumologie, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Service ORL-CCF, hôpital de Hautepierre, hôpitaux universitaire de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Jankowski R, Nguyen DT, Gallet P, Rumeau C. Olfactory cleft dilatation. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:437-441. [PMID: 29934261 DOI: 10.1016/j.anorl.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The surgical technique of olfactory cleft dilatation consists in transmucosal lateral fracture-dislocation of the lateral wall of each olfactory cleft (i.e., of the turbinate wall of the ethmoid, composed, from anterior to posterior, of the middle, superior and supreme turbinates), in order to get access to the recess hosting the human olfactory mucosa and to the roof of the olfactory cleft (i.e., cribriform plate), with minimal trauma to the mucosa. Olfactory cleft dilatation is indicated for dysosmia secondary to constitutional stenosis of the olfactory clefts due to abnormal development of the ethmoid. Constitutional stenosis of the olfactory clefts should be differentiated from inflammatory obstruction and other diseases of the olfactory clefts, and especially from respiratory epithelial adenomatoid hamartoma, which enlarges the olfactory clefts and must be treated by resection. The technique of olfactory cleft dilatation is illustrated by three surgical cases. There was clear improvement in dysosmia in all three cases, without any complications. The place of constitutional olfactory cleft stenosis needs still to be defined in both diagnosis and treatment of dysosmia.
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Affiliation(s)
- R Jankowski
- Service ORL et chirurgie cervico-faciale, université de Lorraine, centre hospitalier régional universitaire de Nancy, 54500 Vandoeuvre-les-Nancy, France.
| | - D T Nguyen
- Service ORL et chirurgie cervico-faciale, université de Lorraine, centre hospitalier régional universitaire de Nancy, 54500 Vandoeuvre-les-Nancy, France
| | - P Gallet
- Service ORL et chirurgie cervico-faciale, université de Lorraine, centre hospitalier régional universitaire de Nancy, 54500 Vandoeuvre-les-Nancy, France
| | - C Rumeau
- Service ORL et chirurgie cervico-faciale, université de Lorraine, centre hospitalier régional universitaire de Nancy, 54500 Vandoeuvre-les-Nancy, France
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