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Background: Choanal atresia is a congenital obstruction of the posterior nasal aperture. Endoscopic endonasal surgery has led to successful choanal atresia repair. This paper describes our surgical technique using septal mucosal flaps without the need for stenting. Methods: This study comprised a multicentre retrospective review of patient notes. A cross-over septal technique is described, whereby bilateral vertical mucosal incisions are made at the posterior third of the septum, and the atretic plate and posterior vomer are removed. One flap is pedicled superiorly and rotated over the bare skull base and sphenoid bone; the contralateral flap is pedicled inferiorly to cover the exposed vomer remnant and hard palate. Results: There were 12 patients from 2013 to 2020, aged 0.07–50 years, with a male to female ratio of 1:5. Ten patients had unilateral and two had bilateral choanal atresia. Nine patients had bony choanal atresia, with the remainder mixed. Conclusion: The cross-over technique for choanal atresia has low morbidity and 100 per cent success in our series. The use of mucoperiosteal flaps to cover exposed bone and minimal instrumentation to the lateral nasal wall reduce post-operative stenosis. [ABSTRACT FROM AUTHOR]

Objectives: To compare the outcomes of endoscopic repair of bilateral congenital choanal atresia using a flap technique without stenting versus endoscopic repair using stenting without a flap. Methods: A prospective randomised controlled study was conducted, comprising 72 patients with bilateral congenital choanal atresia. The patients were randomised into two groups. Group A (42 patients) underwent endoscopic repair using a mirrored L-shaped flap without stenting, and group B (30 patients) underwent endoscopic repair using stenting without a flap. Results: At a mean follow-up period of 18.2 months, endoscopic assessment revealed a patent posterior choana in 81 per cent and 83.33 per cent of patients in group A and group B respectively. Choanal stenosis occurred in 21.40 per cent and 33.33 per cent of patients in group A and group B respectively. Granulation tissue was observed in 28.6 per cent and 53.3 per cent of patients in group A and group B respectively. Conclusion: The endoscopic approach utilising a flap without stenting is safe and effective, with a high success rate. [ABSTRACT FROM AUTHOR]

Objective:We report the use of triamcinolone injections to correct severe nasal deformity due to sarcoidosis, as an alternative to formal surgical rhinoplasty.Case report:A 30-year-old woman with a long-standing history of sarcoidosis presented to a tertiary referral rhinology clinic complaining of breathing difficulty and nasal deformity. Flexible nasoendoscopy revealed red nasal plaques typical of nasal sarcoidosis, together with significant widening of the nasal bridge. Triamcinolone, a long-acting corticosteroid, was injected both intralesionally and subcutaneously over the nasal dorsum, at zero, three and eight months, resulting in long-lasting improvement of the nasal shape.Conclusion:Sarcoidosis is a non-caseating, granulomatous, epithelioid inflammation. Otorhinolaryngological manifestations occur in approximately 10 per cent of patients; however, there is little published experience of nasal reconstruction in such patients. We describe a quick, simple and relatively cost-effective technique, with little or no co-morbidity, with which to improve the aesthetic and symptomatic outcomes of nasal sarcoidosis. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of excision of nasal dermoids through a closed rhinoplasty incision. This is the first description of the use of this approach for excision of superficial nasal dermoids. Methods: Three boys aged five, nine and 12 years presented with midline nasal dermoids with minimal cutaneous involvement. Magnetic resonance imaging demonstrated distinct, cystic, superficial nasal masses. The cysts were excised through a closed rhinoplasty approach. In each case, completeness of extirpation was judged by histopathological examination of the excised specimen. Aesthetic outcome was recorded photographically. Results: All three patients' cysts were completely excised, with excellent cosmetic results. Conclusions: The closed rhinoplasty incision is another approach in the surgeon's armamentarium for excision of small, superficial nasal dermoid cysts. In well selected cases, this approach gives optimal cosmetic results, provides adequate exposure with minimal dissection, and allows total extirpation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate current concerns about transnasal endoscopic repair of bilateral congenital choanal atresia, regarding technical difficulties, prognostic factors and important controversies. Patients and methods: Ten infants with bilateral congenital choanal atresia, aged from 3 to 27 days (mean, 11.2 days) were included. All cases underwent transnasal endoscopic repair and were clinically and endoscopically monitored. Results: Of the seven patients treated with stenting, five remained patent and two required minor debridement (with complete patency thereafter). Of the three patients treated without stenting, one remained patent and two required minor debridement (with patency thereafter). Conclusions: Transnasal endoscopic repair of bilateral congenital choanal atresia is a safe and successful technique. The use of powered instrumentation in neonatal patients requires experience and a correctly sized drill. Stenting with an appropriate nasal tube for a suitable period is favoured, especially in hospitalised patients. [ABSTRACT FROM AUTHOR]

Background: Nasal septal perforation is a structural or anatomical defect in the septum. The present study focused on the effects of septal perforation on nasal airflow and nasal patency, investigated using a computer simulation model. Methods: The effect of nasal septal perforation size on nasal airflow pattern was analysed using computer-generated, three-dimensional nasal models reconstructed using data from magnetic resonance imaging scans of a healthy human subject. Computer-based simulations using computational fluid dynamics were then conducted to determine nasal airflow patterns. Results: The maximum velocity and wall shear stress were found always to occur in the downstream region of the septal perforation, and could potentially cause bleeding in that region, as previously reported. During the breathing process, there was flow exchange and flow reversal through the septal perforation, from the higher flow rate to the lower flow rate nostril side, especially for moderate and larger sized perforations. Conclusion: In the breathing process of patients with septal perforations, there is airflow exchange from the higher flow rate to the lower flow rate nostril side, especially for moderate and large sized perforations. For relatively small septal perforations, the amount of cross-flow is negligible. This cross-flow may cause the whistling sound typically experienced by patients. [ABSTRACT FROM AUTHOR]

AbstractNasal obstruction is one of the most common complaints in the otolaryngology clinic. It can be a complex problem and may be multifactorial. Nasal valve dysfunction can be a cause of nasal obstruction, particularly in patients who have undergone previous reduction rhinoplasty. The exact site of the nasal valve is contentious and is frequently subdivided into the internal and external nasal valves. Accurate assessment is crucial for correct diagnosis and management planning. Various surgical and non-surgical techniques for addressing the problem of nasal valve collapse have been described in the literature. The choice of technique will depend on the causative pathology, availability of graft material, surgical experience and patient preference. [ABSTRACT FROM AUTHOR]

Aim: To assess the results of reconstruction of composite defects involving the nose which extend to involve the cheeks, eyelids or upper lip. Study design: Retrospective observational study. Material: Sixteen patients with defects of the nose extending to the adjoining cheek, upper lip or eyelid. Method: A combination of flaps and grafts were needed to reconstruct these defects so that the aesthetic subunits were replaced and joined at their junctions wherever possible. Results: Where the defect required three or four flaps, there was some unpredictable cicatrisation at their junction that resulted in some asymmetry. This problem primarily occurred at the alar base, and was compounded if there was tissue loss of the premaxilla or maxilla. Conclusion: If a defect that involves the nose, cheek and upper lip is repaired with a combination of cheek advancement, nasolabial, paramedian forehead and/or septal flaps, there can be unpredictable cicatrisation at their junction, particularly at the alar base. In these circumstances, we recommend replacing the nasal and other defects with a slightly more generous amount of tissue than would be taken to repair a similar, but solitary, defect. It is important to replace any loss of the facial skeleton, in order to provide support for overlying flaps. [ABSTRACT FROM AUTHOR]

Objective:To report a unique case of unilateral blindness secondary to transnasal endoscopic surgery and stenting for right choanal atresia.Case report:A 24-year-old man was referred with right eye blindness and acute headache, occurring immediately after transnasal endoscopic surgical repair of unilateral right choanal atresia with placement of an endonasal stent. Maxillo-facial computed tomography with three-dimensional reconstruction showed the endonasal stent entering the right nostril, passing through the lamina papyracea into the orbit and running anterior to the optic foramen towards the superior orbital fissure. Despite stent removal and medical treatment (ceftriaxone and dexamethasone), permanent right eye blindness secondary to an irreversible lesion of the optic nerve was diagnosed. At three-month follow up, an uncommon, complete fibrous obliteration of the right nasal fossa was noticed.Conclusion:To the best of our knowledge, this is the only published report of unilateral blindness following transnasal endoscopic stenting for right choanal atresia. Causes of this complication, and ways of avoiding it, are discussed. [ABSTRACT FROM PUBLISHER]

Background: Arrhinia is defined as the partial or complete absence of the nasal structures. It is a defect of embryonal origin and can be seen in association with other craniofacial anomalies, central nervous system anomalies, absence of paranasal sinuses, and other palatal and ocular abnormalities. Very few patients with arrhinia have been reported so far in the history of modern medicine., Case Report: This study reports an adult patient with congenital partial arrhinia and reviews the literature along with the embryological basis of such a rare disease., Conclusion: Arrhinia is a medical condition with scarce documentation in the literature. This article presents the clinical as well as radiological features of this rare entity.

Introduction:We report the first published description of transoral use of the transnasal flexible laryngoesophagoscope during surgical correction of choanal atresia.Case report:A four-month-old boy was referred to the ear, nose and throat department by his general practitioner with a two-week history of left-sided, watery, green, nasal discharge. A diagnosis of choanal atresia was made. The child underwent successful surgical correction which incorporated transoral use of a transnasal flexible laryngoesophagoscope.Discussion:When used transorally, the transnasal flexible laryngoesophagoscope's ability to provide omnidirectional visualisation together with high definition picture clarity significantly improves the operative field of view. This endoscope's incorporated suction and insufflation functions and its facility to pass extra instruments via the endoscope port are of particular advantage for this type of procedure. [ABSTRACT FROM PUBLISHER]

Objective:We describe a case of bilateral congenital choanal atresia in the oldest patient reported with this condition in the recent English language literature.Method:Case report and a review of the relevant English language literature, presenting the embryopathogenesis, diagnostic methods and treatment options for this condition.Results:A 53-year-old woman having difficulty with nasal breathing, and with a continuous nasal discharge, was admitted to our clinic. Bilateral congenital choanal atresia was diagnosed by endoscopic examination and paranasal sinus computed tomography. Surgical treatment used an endoscopic transnasal approach. The follow-up examination a year later revealed adequate choanal openings bilaterally.Conclusion:To our knowledge, this is the oldest patient with bilateral congenital choanal atresia to be reported in the recent literature. This condition is rarely encountered in adulthood but should be considered as a possible differential diagnosis of persistent nasal obstruction. [ABSTRACT FROM PUBLISHER]

Objective: We present the first report of agenesis of the middle nasal turbinate. Method: We present a case report and briefly discuss the world literature. Results: A 57-year-old man presenting with sinonasal symptoms was evaluated clinically and radiologically. Agenesis of the patient's left middle turbinate was detected. Coronal computed tomography images showed a septal spur replacing the absent left middle turbinate. Conclusion: The lateral nasal wall has complex anatomy, and several anatomical variations have been reported. The most common anatomical variation of the middle nasal turbinate is concha bullosa. Unilateral agenesis of the middle nasal turbinate has not previously been reported; the presented patient represents the first reported case. [ABSTRACT FROM AUTHOR]

Proboscis lateralis is one of the rare craniofacial congenital anomalies which presents as an obvious deformity of the nose. It tends to occur in male offspring of consanguineous marriages. This is a report of computerized tomography of this rare anomaly. In proboscis lateralis, the nasal cavity on one side is completely normal, while on the affected side it is replaced by a trunk-like process attached to the medial portion of the orbital roof. This anomaly occurs sporadically as an isolated defect or in association with other anomalies. It is usually associated with developmental failure of the paranasal sinuses and the nasolacrimal duct.

An operation is described for correction of unilateral cleft lip nasal deformity which has had considerable uniformity of success and is applicable to both mild and severe degrees of deformity. Our proposed repair technique is performed through an external rhinoplasty approach and depends on repositioning of the displaced and deformed cartilages together with the reinforcement of the structural support of the nose by using multiple cartilage grafts. This surgical technique was used in 18 consecutive adult patients with unilateral cleft lip nasal deformity and yielded consistently good long-term functional and cosmetic results.

Premature cartilaginous calcification and nasal hypoplasia following first trimester exposure to warfarin are known as the Foetal Warfarin Syndrome (FWS). There are over 40 cases reported in the literature, many of which describe breathing and feeding difficulties in the first few months of life. We report a case where a child had had difficulties breathing and feeding in the first months of life. These had been attributed to nasal hypoplasia. After proper ENT assessment the child benefitted from adenoidectomy. ENT surgeons should be aware of the syndrome as more women of child bearing age are taking warfarin following cardiac surgery and treatment of thromboembolic disease. ENT surgeons may be asked to review these children who often present with airway and feeding problems which have been attributed to nasal hypoplasia.

Fraser Syndrome is a rare autosomal recessive disorder (Gupta and Saxena, 1962; Smith, 1982). The most consistent feature is cryptophthalmos (hidden eye), but frequently abnormalities of the ears (meatal stenosis, dysplastic pinna), nose (hypoplastic notched nares, choanal stenosis or atresia), and larynx (glottic web, subglottic stenosis), as well as numerous other anomalies are encountered. We present four cases that have been treated at the Hospital for Sick Children in the last ten years, and describe the various ENT anomalies characteristic of this syndrome.

Despite the complex embryological development of the nose and surrounding structures, significant developmental nasal anomalies are rare. We therefore present our experience in the management of such anomalies (excluding choanal atresia) over the past 10 years. Fifty cases were surgically treated; two nasopharyngeal cysts, four hairy polyps, two meningoencephalocoeles, seven gliomata, 20 dermoids, two capillary haemangiomata, four fibromas, one fibromyxyoma, one mucocoele, one granuloma, one lipoma, two nasal aplasias, two nasal clefts and one nasal web. All cases presented with nasal obstruction and/or as a nasal mass. Computerized tomography and magnetic resonance imaging aided diagnosis determining the extent of intracranial involvement. Various surgical techniques were used ranging from simple excision to the lateral rhinotomy and Goodman's external rhinoplasty approach. Only five patients (10 per cent) suffered complications; two CSF leaks and three recurrences, all treated successfully.

A very rare abnormality is reported of congenital absence of the right half of the nose in combination with microphthalmia, coloboma, epiphora and median cleft of the alveolus.

The instruments for and problems of hump removal are discussed. The author describes his technique of lateral and medial osteotomies and stresses the importance of double or triple osteotomies with a special chisel.

Aspects of rhinoplasty aesthetics as applied to the common nasal deformities have been presented with some comments on present day ethical considerations of this surgery. Airway obstruction due to vestibular narrowing with some alternatives for management are discussed.

Three cases of mid-line dorsal nasal sinuses are reported, together with their mode of surgical management. The embryologic origin of this malformation is discussed, relating their presence to a double fronto-nasal process instead of one.

Two cases of congenital mid-line sinus of the nose are presented. The etiology of the condition with emphasis on its embryology and treatment are discussed. A reversed 'u' incision in each nostril gives a wider exposure and is more acceptable cosmetically.

Three rare cases of congenital anomalies (mid-line nasal proboscis, subintegumental mid-line cleft lip and congenital palatoglossal synechia) are presented with their management. The embryological considerations of these cases are discussed.

Anomalies of the nose, larynx and oral cavity are described in two patients with cryptophthalmos. A teratogen acting at the time of lid fold formation is probably responsible for the ocular and systemic involvement which are primarily ectodermal defects with some mesodermal involvement.