[Computational fluid dynamics simulations of the airflow in the human nasal cavity]

OBJECTIVE

This study represents an attempt to simulate the complex three-dimensional airflow pattern in the human nasal passageways.

MATERIALS AND METHODS

In the present study the computational Fluid Dynamics (CFD) have been used. The CFD solved numerically the flow governing equations. The CFD demonstrated to be a very efficient tool for researching on nasal flow.

RESULTS

By means of CT scan, an anatomic accurate three-dimensional representation of the human nasal cavity was obtained. Based on this model the influence of the inspiration and at the expiration at the flow pattern has been reviewed. The flow pattern is visualized by the velocity, pressure and turbulence intensity fields.

CONCLUSIONS

The flow patterns show the channel effect of turbinates and the influence of the breathing phase.

[Cartilaginous grafts in rhinoplasty]

We present a revision of 38 cases operated on for augmentation rhinoplasty from 1992 to 2001, using a cartilaginous graft. 83% of our patients were men and 17% were female. The mean age was 31 years old. In 33 rhinoplasties, the graft was placed in the nasal dorsum; in 4 cases it was placed at the nasal tip and in one case reconstruction of the dorsum and the tip was performed. The most frequently used graft was septal cartilage, in 28 cases. Conchae cartilages were used in 3 cases, lower lateral cartilage in 5 cases, rib cartilage in one, and in another case, septal and lower lateral cartilage were used in the same patient. We stabilized the graft fixing it to the skin with a suture which is removed after a week. We did a postoperative follow-up on 25 of the patients. In terms of patient satisfaction, 12% of them felt that their nasal appearance had improved, 76% felt that there had been a great improvement, and 12% did not notice any change. Only one patient had to be reoperated on because of an overprojection of the graft in the nasal dorsum. We conclude that the use of autologous cartilaginous grafts offers important advantages in rhinoplasty; they are easy to be obtained, easy to mould and with a low index of resorption.

[External lateral osteotomy in rhinoplasty for the correction of nasal dorsal deviations]

We present a revision of 45 patients with nasal deviation operated on between 1993 and 2001. Septorhinoplasties were done in all cases using the external lateral nasal osteotomies technique. 67% of our patients were male and 33% were female with a mean age of 25. In all cases a septoplasty was performed. To correct nasal deviation, medial osteotomies through an intercartilaginous approach and external lateral nasal osteotomies were done. We did a postoperative follow-up of 35 patients. In terms of patient satisfaction, 78% of them felt that their nasal appearance had improved after surgery, and 22% felt that they had a great improvement. One case had to be reoperated on because of a traumatic nasal fracture after surgery. We believe this technique offers important advantages, such as: an excellent control of the fracture line, fewer incidences of open roof and lateral step, without causing visible scars.

[Inflammatory pseudotumor of paranasal sinuses]

Inflammatory pseudotumor is a rare benign lesion of unknown etiology which was first described in the lung. In head and neck the areas most commonly involved are the orbit and paranasal sinuses, but they have been also described in the larynx, pterygomaxilar space, tonsils, ears, gingiva and other periodontal tissues. We present a case of a 64 years old male who presented a three months history of right nasal obstruction. Physical examination showed a big nasal tumor arising from the nostril. CT scan shows nasal fossa mass with a normal paranasal sinuses. Histology made the diagnosis of an inflammatory pseudotumor. The lesion was surgically removed trough a midface degloving approach. The patient has no signs of recurrence two years after surgery. Data about diagnosis, treatment and outcome of inflammatory pseudotumors is revised also in this paper.

Botulinum toxin treatment for spasmodic dysphonia: percutaneous versus transoral approach

Spasmodic dysphonia (SD) is at present defined as focal dystonia. Botulinum toxin (BT) injection is the treatment of choice for SD. BT is usually injected by a percutaneous route, but a direct, visually guided transoral approach has also been successful. It is not known whether percutaneous injection is as effective as the transoral approach. This article reviews our experience with both techniques of injection on 29 patients with adductor type SD. Since 1992, we have carried out 48 treatment sessions with the transoral technique and 76 treatment sessions with the percutaneous technique. Two patients did not respond to the percutaneous technique despite several attempts, but they did respond to the transoral approach. Globally, transoral technique was superior to percutaneous technique in terms of effectiveness (48 of 48 responses with transoral technique versus 61 of 76 responses with percutaneous approach, p < 0.01). Dosage of BT, duration, and side effects were similar with both techniques. This article also describes a simple, inexpensive device, composed of materials on hand at every hospital, that facilitates the transoral approach.

[Adduction spastic dysphonia: clinical and treatment]

Adduction spastic dystonia (SD) is currently considered a focal dystonia involving laryngeal muscles. SD is one of the most poorly known focal dystonias. We reviewed our experience with twentynine patients with adduction SD and compared the clinical and epidemiologic variables with the other focal dystonias studied at our institution in the last five years (132 patients). Mean age of patients (47.2 +/- 13 years), sex, clinical course in years (5.7 +/- 5) and presence of circadian fluctuations did not differ significantly from those observed in patients with other focal dystonias. Likewise, there were no significant differences regarding the presence of a family history of dystonia, essential tremor, or stuttering. Our results confirm the similarity of the clinical and epidemiologic data of SD with the other focal dystonias. All patients with SD were treated with a local injection of botulinum toxin. A total of 108 treatments were performed, 41 with a visually guided transoral technique and 67 with a percutaneous technique. The transoral technique was effective in all cases (41/41) but not all treatments with the percutaneous technique were effective (53/67). Three patients required the shift to the transoral procedure to achieve enough symptomatic alleviation.

[Pharyngeal chordoma]

Chordoma is a neoplasm arising from embryonal notochord remnants. It is infrequent and rarely located at the cervical level. The diagnosis is histological and immunohistochemical tests are required to differentiate it from other neoplasms. We report a case of pharyngeal chordoma treated with a transmandibular approach. The diagnosis, treatment, and prognosis of these tumors are reviewed.

[Laryngeal dystonia. Comparison of transcutaneous and transoral injection of botulinum toxin]

Spasmodic dysphonia is a focal dystonia that effects the proximal muscles (adduction dystonia) or dilatory (abduction dystonia) of the larynx. Botulinum toxin (BTX), generally delivered by percutaneous injection, is the treatment of choice. Recently, use has been made of a transoral route of delivery, with BTX injected through a curved device with visual control. It remains to be determined which route is better. Percutaneous injection is simple and well-tolerated, but the transoral route is theoretically more effective. We assessed the efficacy of both techniques in 19 patients with adduction dystonia, conducting 55 treatment sessions by percutaneous injection and 20 by transoral injection. All the transoral treatments were effective (20/20, 100%), but only 81% (45-155) of the percutaneous treatments were (p < 0.05). Two patients who had doubtful responses after percutaneous delivery improved considerably when the transoral approach was used. In spite of its greater complexity, the transoral approach is probably more effective than the percutaneous route. We describe a curved device for transoral injection that is composed of simple elements available at any health center.

[Acoustic rhinometry in a normal population]

Acoustic rhinometry is a new method for objectively studying the geometry of the nasal cavity which is based on sound-wave reflection. One hundred normal subjects were studied by acoustic rhinometry under baseline conditions and after decongestion of the nasal mucosa. The minimum cross-section, area distance from this point to the nostril, nasal cavity volumen, and variations in these parameters after decongestion gave useful information about the state of the nasal cavity under normal conditions.

[Acute pharyngo-tonsillitis. Penicillin, yes or no?]

Acute tonsillitis and acute pharyngitis show a high incidence in the healthy population. Recent microbiological studies have demonstrated changes in the frequency with which different microorganisms promote such infections. This fac, together with the variations in sensibility or resistance of germs to the diverse therapeutic agents, have led to the conclusion that penicillin must not be considered as the solo drug of choice in these infections.

[ORL manifestations of Wegener's disease]

Wegener's disease is characterized by necrotizing granulomatous vasculitis. The localized form involves the upper and lower respiratory tract, in the generalized form, the kidneys are also involved. In this paper, three cases of Wegener granulomatosis with otorhinolaryngological symptoms are reported. Frequently the presentation of this disease occurs in the ears, nose and throat, we think that the knowledge of this granulomatosis by the otorhinolaryngologist is necessary.

[A severe rhinological mycosis: mucormycosis. A report of 3 cases]

Mucormycosis is a fungal infection, the most frequent form begins in the nose and the paranasal sinus and can rich the brain. It is a fulminant and often fatal disease, not well known by many specialists. The authors present three cases with positive cultures, histology and postmortem studies, drawing attention to the importance of its prompt diagnosis and aggressive treatment.