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Objectives: Eosinophilic chronic rhinosinusitis (ECRS) is an allergic inflammatory disease characterized by chronic inflammation of the sinus mucosa, and sometimes, osteitis. This study aimed to investigate the pattern of osteitis in ECRS and the relationship between bony thickening of the middle turbinate and recurrence of ECRS. Methods: A total of 246 patients with paranasal diseases were included in the study. The patients' data on bone thickening level, mucosal thickening, polyp score, clinical severity, and laboratory data were retrospectively evaluated. Results: In total, 38, 186, and 22 patients had ECRS, non-ECRS (NECRS), and odontogenic sinusitis, respectively. The Lund–Mackey (LM) score and Global Osteitis Scoring Scale (GOSS) scores in patients with ECRS were higher than those in patients with other paranasal diseases. There was a significant positive correlation between the GOSS score and ECRS clinical disease severity. Postoperative recurrence was significantly increased in patients with ECRS associated with bony thickening of the middle turbinate. Conclusion: Both mucosal inflammation and osteitis were more severe in patients with ECRS than in patients with other diseases, and clinical disease severity was correlated with osteitis. Furthermore, the postoperative recurrence rate tended to increase in patients with ECRS who had bony thickening of the middle turbinate. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to determine the clinical characteristics and cephalometric risk factors associated with decreased postoperative olfaction in patients in whom the transplanum and transtuberculum expanded endonasal approach (EEA) was performed. Methods A retrospective cohort of 41 patients treated with the transplanum and transtuberculum EEA was divided into two groups based on the maximum change in the postoperative 22-item Sino-Nasal Outcome Test (SNOT22) olfaction score: prolonged olfactory loss group (n = 5) with a ΔSNOT22 olfaction score of ≥ 4 without a return to baseline and a preserved olfaction group (n = 36) with a ΔSNOT22 olfaction score ≤ 3 with return to baseline on follow-up of at least 3 months. Demographics, operative details, and cephalometric measurements were compared between the two groups. Results There were no differences in terms of the type of surgical approach (transplanum and transtuberculum), resection of turbinates (middle and superior), use of reconstructive flap (nasoseptal flap and reverse flap), or tumor pathology between the two groups. In the prolonged olfactory loss group, there was a smaller angle between the planum and the face of the sella (89.75 ± 9.18 vs. 107.17 ± 16.57 degrees, p = 0.05) and a smaller angle between the anterior nasal spine and the sphenoid sinus face (21.20 ± 2.49 vs. 25.89 ± 4.90 degrees, p = 0.047) compared with the preserved olfaction group. Conclusion Patients with a narrow angle between the planum and the face of the sella or that between the anterior nasal spine and the sphenoid sinus face are at a higher risk of prolonged olfactory dysfunction with the transplanum and transtuberculum approaches. Level of Evidence IV. [ABSTRACT FROM AUTHOR]

Superior repositioning of the maxilla during Le Fort I osteotomy (LFI) may narrow the inferior nasal passage. This retrospective study was performed to investigate morphological changes in the inferior nasal passage following LFI with/without additional procedures performed for nasal ventilation (horseshoe osteotomy or inferior turbinate partial resection). Three groups of patients were compared: those undergoing conventional LFI (Conv, 63 patients), LFI with horseshoe osteotomy (Hs, eight patients), and LFI with inferior turbinate partial resection (Turb, 21 patients). Coronal computed tomography images were used to evaluate the degree of stenosis of the inferior nasal passage. The soft tissue and bony tissue volumes in the inferior turbinate were also calculated three-dimensionally. The rate of obstruction of the inferior nasal passage postoperative was 65.9%, 50%, and 11.9% in the Conv, Hs, and Turb groups, respectively (Fisher's exact test, P < 0.001). Patients in the Turb group had significantly less nasal obstruction regardless of the pitch direction of the maxillary movement or volume of the bone in the inferior turbinate (all P < 0.001). In conclusion, for patients with high superior repositioning and well-developed bony tissue in the inferior turbinate, additional procedures are recommended to maintain the ventilation of the nasal passage postoperatively. [ABSTRACT FROM AUTHOR]

Alzheimer's disease, the most common form of dementia among older adults, slowly destroys memory and thinking skills. In recent years, scientists have made tremendous progress in understanding Alzheimer's disease, still, they do not yet fully understand what causes the disease. This article proposes a novel etiology for Alzheimer's disease. Our hypothesis developed from a review of nuclear medicine scans, in which the authors observed a significant increase in nasal turbinate vasodilation and blood pooling in patients with hypertension, sleep apnea, diabetes and/or obesity, all risk factors for Alzheimer's disease. The authors propose that nasal turbinate vasodilation and resultant blood pooling lead to the obstruction of normal nasal lymphatic clearance of cerebrospinal fluid and its waste products from the brain. The nasal turbinate vasodilation, due to increased parasympathetic activity, occurs alongside the well-established increased sympathetic activity of the cardiovascular system as seen in patients with hypertension. The increased parasympathetic activity is likely due to an autonomic imbalance secondary to the increase in worldwide consumption of highly processed food associated with dysregulation of the glucose regulatory system. The authors' hypothesis offers a novel mechanism and a new paradigm for the etiology of Alzheimer's disease and helps explain the rapid worldwide rise in the disease and other dementias which are expected to double in the next 20 years. This new paradigm provides compelling evidence for the modulation of the parasympathetic nervous system as a novel treatment strategy for Alzheimer's disease and other degenerative brain diseases, specifically targeting nasal turbinate lymphatic flow. [ABSTRACT FROM AUTHOR]

Hamartomas, as non-true tumors, are commonly found in the lungs, digestive tract, and kidneys, and there are few clinical reports on nasal cases. Nasal histiocytosis accompanied by lymphatic lesions is a common feature of nasal hamartoma. Three patients with nasal cavity hamartoma were treated in our department, including 1 male and 2 females, with nasal obstruction or epistaxis. The imaging (computed tomography, magnetic resonance imaging) of 2 patients showed a soft tissue mass in the nasal cavity and no erosion of bone, while in 1 patient, the imaging was inconclusive. The excised material in all patients was found to be a soft mass. The 3 cases showed the same pattern under histological examination, and all 3 patients were diagnosed with nasal cavity respiratory epithelial adenomatoid hamartoma (REAH). Nasal hamartoma is a rare disease with nonspecific clinical manifestations and imaging features and is often misdiagnosed. Only by a better understanding of this disease can the rate of correct clinical diagnosis be improved. [ABSTRACT FROM AUTHOR]

The anteromedial temporal region and the lateral wall of the sphenoid can be the site of an array of pathology including trigeminal schwannoma, encephalocele, cholesterol granuloma of the petrous apex, malignancy, infection, and sellar pathology extending to the lateral cavernous sinus. Approaches to this region are technically challenging and the existing approach requires sacrifice of all of the turbinates including the nasolacrimal duct, which can cause postoperative complications. We describe a novel anatomical landmark between the periorbita and the periosteum of the pterygopalatine fossa (which is located at the inferolateral periorbital periosteal line [ILPPL]). The posterior one-third of the incision line lies between the foramen rotundum and the superior orbital fissure, which is proximal to the maxillary strut. A 1.5-cm incision can divide the orbital and pterygoid contents and lead us to the posterior inferolateral orbital region, anteromedial temporal region, lateral wall of the sphenoid sinus, and lateral wall of the cavernous sinus. A combined multiangled approach to the ILPPL will enable us to preserve all of the turbinates and the septum, and the nasolacrimal duct, allowing for the preservation of the physiological function and pedicled flaps, such as the middle turbinate, inferior turbinate, and septal membrane flap. The ILPPL is a simple, effective, and novel landmark for the minimally invasive approach to the anteromedial temporal fossa. [ABSTRACT FROM AUTHOR]

Mucormycosis is an angioinvasive disease caused by fungi of the order Mucorales. In this article, three case reports of rhinocerebral mucormycosis developing after COVID-19 infection in a diabetic patient are presented. Early diagnosis and treatment of those high morbidity conditions are vital to better outcomes. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to compare the applicability of classic lateral lamellectomy versus submucosal conchoplasty techniques in managing concha bullosa during and after functional endoscopic sinus surgery. Methods: The study randomly divided 56 patients with bilateral concha bullosa into two groups. One group of patients underwent the submucosal conchoplasty technique and the other group underwent the lateral lamellectomy technique. The study compared the intra-operative findings, including the time required for each technique, the amount of intra-operative bleeding and the post-operative endoscopic outcome of the middle meatus and middle turbinate stability. Results: Submucosal conchoplasty was significantly more time-consuming than the lateral lamellectomy technique (p = 0.001*). The difference in the intra-operative amount of bleeding was (p = 0.086*). The lateral lamellectomy group showed a higher rate of synechia formation in the middle meatus (p = 0.012*). Conclusion: Submucosal conchoplasty is a valid technique for managing concha bullosa with better post-operative endoscopic outcomes. [ABSTRACT FROM AUTHOR]

Objective: Nasal septoplasty is one of the most performed procedures within ENT. Nasal obstruction secondary to a deviated nasal septum is the primary indication for functional septoplasty. Since the coronavirus disease 2019 pandemic, waiting lists have increased and are now long. This study assessed patients on the waiting list for septoplasty and/or inferior turbinate reduction surgery using the Nasal Obstruction Symptom Evaluation instrument. Method: Patients on our waiting list for septoplasty and/or inferior turbinate reduction surgery were reviewed using a validated patient-reported outcome measure tool to assess symptom severity. Results: Eighty-six out of a total of 88 patients (98 per cent) had Nasal Obstruction Symptom Evaluation scores of 30 or more. In addition, 78 (89 per cent) and 50 (57 per cent) patients were classified as having 'severe' or 'extreme' nasal obstruction, respectively. Two patients scored less than 30 and were classified as having non-significant nasal obstruction. Conclusion: The Nasal Obstruction Symptom Evaluation instrument is a quick and easy way to validate septoplasty waiting lists. In this study, two patients were identified who no longer required surgery. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is closely associated with the development and chronicity of temporomandibular disorder (TMD). Given the intricate pathophysiology of both OSA and TMD, comprehensive diagnostic approaches are crucial. This study aimed to develop an automatic prediction model utilizing multimodal data to diagnose OSA among TMD patients. We collected a range of multimodal data, including clinical characteristics, portable polysomnography, X-ray, and MRI data, from 55 TMD patients who reported sleep problems. This data was then analyzed using advanced machine learning techniques. Three-dimensional VGG16 and logistic regression models were used to identify significant predictors. Approximately 53% (29 out of 55) of TMD patients had OSA. Performance accuracy was evaluated using logistic regression, multilayer perceptron, and area under the curve (AUC) scores. OSA prediction accuracy in TMD patients was 80.00–91.43%. When MRI data were added to the algorithm, the AUC score increased to 1.00, indicating excellent capability. Only the obstructive apnea index was statistically significant in predicting OSA in TMD patients, with a threshold of 4.25 events/h. The learned features of the convolutional neural network were visualized as a heatmap using a gradient-weighted class activation mapping algorithm, revealing that it focuses on differential anatomical parameters depending on the absence or presence of OSA. In OSA-positive cases, the nasopharynx, oropharynx, uvula, larynx, epiglottis, and brain region were recognized, whereas in OSA-negative cases, the tongue, nose, nasal turbinate, and hyoid bone were recognized. Prediction accuracy and heat map analyses support the plausibility and usefulness of this artificial intelligence-based OSA diagnosis and prediction model in TMD patients, providing a deeper understanding of regions distinguishing between OSA and non-OSA. [ABSTRACT FROM AUTHOR]

This article reports on the discovery of a complete male skull of the marsh deer in Uruguay, marking the southernmost limit of its range. The skull was found in the departments of Canelones and Maldonado and was estimated to be around 294 years old through radiocarbon dating. Genetic analysis revealed significant genetic diversity and past population dynamics of marsh deer in the region. These findings highlight the need for habitat restoration and future rewilding strategies to protect this species. [Extracted from the article]

Background: The aim of this study was to evaluate the effects of nasal septum deviation and inferior turbinate hypertrophy on nasal obstruction by utilizing the Nose Obstruction Symptom Evaluation (NOSE) values and paranasal sinus computed tomography (PSCT) findings for correct preoperative evaluation. Methods: Ninety-six patients (57 males and 39 females) aged between 18 and 54 years (mean age, 30.3 ± 9.7 years) participated in this study. Among them, 56 patients underwent septoplasty combined with inferior turbinate outfracture, while 40 patients underwent septoplasty alone. Preoperative nasal examinations were performed on all patients. The direction, location, nasal septum deviation classification, and inferior turbinate hypertrophy size classification were carefully evaluated and compared with the NOSE survey results. PSCT of 56 patients were evaluated and classified by calculating the coronal location of septum deviation, the axial location of septum deviation, the coronal angle of septum deviation, and the axial angle of septum deviation. Results: A positive correlation was found between the coronal location of the septal deviation and the preoperative NOSE 2, and the NOSE total, and the difference of postoperative and preoperative NOSE (p = 0.032, p = 0.007, p = 0.021, respectively). There was a statistically significant relationship between the coronal location of the septal deviation classification and the NOSE preoperative total values (p = 0.26). A negative statistically significant correlation was found between inferior turbinate hypertrophy and preoperative NOSE 5 values (p = 0.029). Conclusion: We conclude that the combination of PSCT and the NOSE scale is helpful in determining the severity of nasal obstruction prior to surgery. Specifically, we found that nasal septum deviations located in the anterior and coronal planes have a greater impact on nasal obstruction compared to deviations in the axial plane. Inferior turbinate fracture does not provide more benefit than septoplasty alone in treating patients' nasal obstruction. These findings emphasize the importance of a comprehensive approach in addressing nasal obstruction for optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Functional endoscopic sinus surgery (FESS) is a crucial additional procedure employed in the management of chronic rhinosinusitis (CRS). It has mostly overtaken the external methods for managing CRS that do not respond to medicinal treatment. Over the years, several instruments have been created to eliminate anatomical obstructions and restore proper function in the sinus drainage pathways. The purpose of this work was to reflect on various anatomical findings after primary functional endoscopic sinus surgery and their relationship with sinus surgery revision. Methods: This is a prospective cohort study conducted on 40 participants with CRS. The Sino-Nasal Outcome Test version 22 (SNOT-22) was utilized as a measure of results and was filled out by participants both prior to and following their operation (at the 6-month and 12-month intervals). Results: There were multiple anatomical findings encountered in CRS persistence and subsequent need for revision FESS; the most common was incomplete ethmoidectomy (both anterior and posterior) 62.5% (N = 25), and the least common was misplaced antrostomy and partial or full resection of the middle turbinate 7.5% (N = 3). Preoperative total SNOT-22 scoring ranged from 42 to 86 with mean 58.83 ± 12.08, while 6-month postoperative scoring ranged from 10 to 32 with mean 21.48 ± 5.12, and 12-month postoperative scoring ranged from 15 to 37 with mean 28.83 ± 5.52. There was significant improvement (P = 0.001). The ages of patients range between 18 and 62 years. Conclusions: Several common anatomical findings are often found during revision surgeries by analysis of CT scans and endoscopic examination of participants who underwent revision FESS for recurrent or persistent CRS, and this often shows persisting anatomical features or incompletely excised cells that correspond to persistent symptoms and signs of CRS, and the most common was incomplete ethmoidectomy. Also, there was significant improvement regarding outcome measure SNOT-22, 6-month and 12-month period postoperative as contrasted with preoperative scoring. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to retrospectively assess the effect of Radiofrequency Volumetric Tissue Reduction (RFVTR) on hypertrophic turbinates and clinical outcome in brachycephalic dogs when included in multi-level surgery (MLS). Study design: Clinical retrospective multicenter study. Animals: 132 client-owned brachycephalic dogs. Methods: 132 brachycephalic dogs with high-grade Brachycephalic Obstructive Airway Ayndrome (BOAS) and hypertrophic turbinates were treated with RFVTR as part of MLS of the upper airways. Intranasal obstruction was evaluated by computer tomography (CT) and antero-/retrograde rhinoscopy before and 6 months after RFVTR. The clinical records, the CT images and the rhinoscopy videos were reviewed and clinical evolution was evaluated using a standardized questionnaire. The data was scored semi-quantitatively. Results: In this study, 132 patients were included for a follow-up period of 120 weeks. RFVTR resulted in minor complications, including serous nasal discharge within the first postoperative week in all dogs, and intermittent nasal congestion between 3–8 weeks after treatment in 24.3% of the patients. Rhinoscopy and CT follow-ups were available for 33 patients. Six months after treatment intranasal airspace was increased (p = 0.002) and the presence and overall amount of mucosal contact points was reduced (p = 0.039). Conclusion: MLS with RFVTR led to a significant reduction in turbinate volume at the 6-month follow-up examination and significant clinical improvement over a long-term period of 120 weeks. This suggests the viability of RFVTR as a turbinate-preserving treatment for intranasal obstruction in dogs with BOAS. Clinical significance: RFVTR is a minimally invasive turbinoplasty technique for intranasal obstruction in dogs with BOAS and can be included in MLS without increasing complication rates. [ABSTRACT FROM AUTHOR]

The editorial discusses Johann Gottfried Zinn (1727-1759) and his anatomical treatise of 1755, focusing on the lacrimal system. Zinn's treatise, 'Descriptio Anatomica Oculi humani iconibus illustrata,' was a comprehensive study of ocular anatomy, with a chapter dedicated to the lacrimal system. Zinn's observations on the lacrimal gland, canaliculi, lacrimal sac, and nasal duct opening were groundbreaking for his time and continue to hold value in understanding lacrimal drainage disorders. [Extracted from the article]

The nasal cavity of living mammals is a unique structural complex among tetrapods, acquired along a series of major morphological transformations that occurred mainly during the Mesozoic Era, within the Synapsida clade. Particularly, non-mammaliaform cynodonts document several morphological changes in the skull, during the Triassic Period, that represent the first steps of the mammalian bauplan. We here explore the nasal cavity of five cynodont taxa, namely Thrinaxodon, Chiniquodon, Prozostrodon, Riograndia, and Brasilodon, in order to discuss the main changes within this skull region. We did not identify ossified turbinals in the nasal cavity of these taxa and if present, as non-ossified structures, they would not necessarily be associated with temperature control or the development of endothermy. We do, however, notice a complexification of the cartilage anchoring structures that divide the nasal cavity and separate it from the brain region in these forerunners of mammals. [ABSTRACT FROM AUTHOR]

Objective: To explore whether the different phases of the nasal cycle have a significant effect on nasal temperature, the nasal mucosal clearance rate, and levels of nasal nitric oxide (nNO) and to investigate the correlation between these nasal conditions. Methods: The study participants were divided into 2 groups: the control group and the rhinitis group. The participants' nasal temperature, cilia clearance rate, and nNO levels were measured during different phases of the nasal cycle (the congestion phase and decongestion phase) in the control group and before and after undergoing inferior turbinate ablation in the rhinitis group. Results: The temperature of the nasal cavity in the control group was significantly higher in the congestion phase than in the decongestion phase (P =.0025), while in the rhinitis group, the temperature of the nasal cavity decreased significantly after inferior turbinate ablation (P =.001). In the control group, the nasal mucosa clearance time was significantly shorter in the congestion phase than in the decongestion phase (P =.001), and in the rhinitis group, the clearance time of the nasal mucosa was significantly shortened after the operation (P =.0025). In the control group, the levels of nNO were significantly higher in the congestion phase than in the decongestion phase (P =.025), while in the rhinitis group, nNO levels decreased significantly after the operation (P =.005). Conclusion: The function of the nasal cavity changes in different phases of the nasal cycle. Therefore, when evaluating the impact of various factors on nasal function, factors associated with the nasal cycle should also be considered. Inferior turbinate plasma ablation can improve the ciliary function of the nasal mucosa, reduce the temperature of the nasal cavity, and reduce nNO levels. [ABSTRACT FROM AUTHOR]

Background: Nasal obstruction, triggered by allergic rhinitis, often does not resolve with allergen-specific immunotherapy (AIT) alone, thus inferior turbinate reduction surgery (ITR) may be required. This study aims to investigate the impact of combined treatment on nasal obstruction, as evidence is currently limited. Methodology/Principal: A retrospective cohort study of perennial allergic rhinitis patients experiencing nasal obstruction and undergoing ≥12 months AIT was conducted. Two groups were derived, those undergoing AIT—with or without an ITR. Patient reported nasal obstruction (evaluated with questionnaires) and nasal airway function (Nasal Peak Inspiratory Flow [NPIF] and Nasal Airflow Resistance [NAR]) were monitored. The change from baseline to 12 months post-treatment in each group were compared. Results: A total of 118 patients (33.71 ± 14.43 years, 41.5% female) were recruited, 72% had AIT and 28% AIT&ITR. At baseline, the AIT&ITR group had a higher level of nasal obstruction (>moderate%; 63.6% vs 52.9%, P =.048). Post treatment, AIT&ITR group reported greater reduction in nasal obstruction (>1 category change: 75.8% vs 48.2%, P =.002). Similarly, the AIT&ITR group had greater improvement in nasal function by NPIF (−13.9 ± 110.3 L/minute vs −3.4 ± 78.1 L/minute, P =.049) and NAR (−0.120 ± 0.342 Pa/cm³/second vs −0.093 ± 0.224 Pa/cm³/second, P =.050). Conclusions: Allergic rhinitis patients, with moderate to severe nasal obstruction, who undergo combined AIT&ITR have greater relief of nasal obstruction and improved airflow analysis compared to AIT alone. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article discussing the delivery of drugs to the lower nasal space (LNS) and upper nasal space (UNS) and their potential benefits. It provides a list of various nasal delivery systems, including OptiNose's Xhance and Onzetra Xsail, which are approved for specific conditions. Other devices mentioned include Satsuma's STS101, AeroPump, PharmaSystems' Metered Nasal Dispenser, MeadWestvaco/Silgan's Mistette MkII Pump, Nemera's SP270+, SipNose, Teleflex's Mucosal Atomisation Device, BD's Accuspray, and Aptar's BiVax and LuerVax. The summary also mentions the target delivery areas and any limitations or issues associated with each device. This document is a valuable resource for library patrons researching nasal delivery systems. [Extracted from the article]

Pasteurella multocida, a zoonotic pathogen that produces a 146-kDa modular toxin (PMT), causes progressive atrophic rhinitis with severe turbinate bone degradation in pigs. However, its mechanism of cytotoxicity remains unclear. In this study, we expressed PMT, purified it in a prokaryotic expression system, and found that it killed PK15 cells. The host factor CXCL8 was significantly upregulated among the differentially expressed genes in a transcriptome sequencing analysis and qPCR verification. We constructed a CXCL8-knockout cell line with a CRISPR/Cas9 system and found that CXCL8 knockout significantly increased resistance to PMT-induced cell apoptosis. CXCL8 knockout impaired the cleavage efficiency of apoptosis-related proteins, including Caspase3, Caspase8, and PARP1, as demonstrated with Western blot. In conclusion, these findings establish that CXCL8 facilitates PMT-induced PK15 cell death, which involves apoptotic pathways; this observation documents that CXCL8 plays a key role in PMT-induced PK15 cell death. [ABSTRACT FROM AUTHOR]

The standard multi-dose nasal spray pump features an integrated actuator and nozzle, which inevitably causes a retraction of the nozzle tip during application. The retraction stroke is around 5.5 mm and drastically reduces the nozzle's insertion depth, which further affects the initial nasal spray deposition and subsequent translocation, potentially increasing drug wastes and dosimetry variability. To address this issue, we designed a new spray pump that separated the nozzle from the actuator and connected them with a flexible tube, thereby eliminating nozzle retraction during application. The objective of this study is to test the new device's performance in comparison to the conventional nasal pump in terms of spray generation, plume development, and dosimetry distribution. For both devices, the spray droplet size distribution was measured using a laser diffraction particle analyzer. Plume development was recorded with a high-definition camera. Nasal dosimetry was characterized in two transparent nasal cavity casts (normal and decongested) under two breathing conditions (breath-holding and constant inhalation). The nasal formulation was a 0.25% w/v methyl cellulose aqueous solution with a fluorescent dye. For each test case, the temporospatial spray translocation in the nasal cavity was recorded, and the final delivered doses were quantified in five nasal regions. The results indicate minor differences in droplet size distribution between the two devices. The nasal plume from the new device presents a narrower plume angle. The head orientation, the depth at which the nozzle is inserted into the nostril, and the administration angle play crucial roles in determining the initial deposition of nasal sprays as well as the subsequent translocation of the liquid film/droplets. Quantitative measurements of deposition distributions in the nasal models were augmented with visualization recordings to evaluate the delivery enhancements introduced by the new device. With an extension tube, the modified device produced a lower spray output and delivered lower doses in the front, middle, and back turbinate than the conventional nasal pump. However, sprays from the new device were observed to penetrate deeper into the nasal passages, predominantly through the middle-upper meatus. This resulted in consistently enhanced dosing in the middle-upper turbinate regions while at the cost of higher drug loss to the pharynx. [ABSTRACT FROM AUTHOR]

Decongestion reduces blood flow in the nasal turbinates, enlarging the airway lumen. Although the enlarged airspace reduces the trans-nasal inspiratory pressure drop, symptoms of nasal obstruction may relate to nasal cavity air-conditioning. Thus, it is necessary to quantify the efficiency of nasal cavity conditioning of the inhaled air. This study quantifies both overall and regional nasal air-conditioning in a cohort of 10 healthy subjects using computational fluid dynamics simulations before and after nasal decongestion. The 3D virtual geometry model was segmented from magnetic resonance images (MRI). Each subject was under two MRI acquisitions before and after the decongestion condition. The effects of decongestion on nasal cavity air conditioning efficiency were modelled at two inspiratory flowrates: 15 and 30 L min−1 to represent restful and light exercise conditions. Results show inhaled air was both heated and humidified up to 90% of alveolar conditions at the posterior septum. The air-conditioning efficiency of the nasal cavity remained nearly constant between nostril and posterior septum but dropped significantly after posterior septum. In summary, nasal cavity decongestion not only reduces inhaled air added heat by 23% and added moisture content by 19%, but also reduces the air-conditioning efficiency by 35% on average. [ABSTRACT FROM AUTHOR]

Abstract Expression of serotonergic (5HT) receptors in patients with chronic rhinosinusitis with nasal polyposis and in normal nasal mucosa: a case-control study. Background Chronic rhinosinusitis with nasal polyposis is one of the challenging conditions regarding treatment and management. Many recent studies introduced new modalities for treatment like targeted immunomodulating drugs rather than antihistamines, local and systemic steroids, and endoscopic sinus surgery. Understanding the pathology behind the disease by studying its immunologic pathways and substances that take part in the inflammatory process can help in the introduction of new treatment options that can improve outcomes and decrease the costs of treatment. Objective The aim of our study is to demonstrate the presence of 5-HT receptors in nasal polyps and inferior turbinate mucosa in patients with chronic rhinosinusitis with nasal polyposis and then compare this expression of 5-HT receptors with inferior turbinate mucosa of the normal control group. Methods A case-control study was conducted on 80 patients. Specimens from nasal polypi and turbinate mucosa of patients with chronic rhinosinusitis (cases) and specimens from normal turbinate mucosa (controls) were stained with serotonin receptor Immunohistochemical staining by automated immunostainer in the pathology department laboratory in Ain Shams University Hospital with ratio 1:200–400 as recommended by the manufacturing company. Then, compared as regards stain distribution and intensity of mucosal lining, glands, and blood vessels. Results There was a significant difference between polyp cases and controls as regards lining epithelium and mucosal gland stain distribution and stain intensity. Also significant difference between the polyp cases and controls as regards blood vessel strain distribution. However, no significant difference was found as regards blood vessel stain intensity. There was a significant difference between turbinate cases and controls as regards lining epithelium stain distribution, and stain intensity. There was no significant difference between turbinate cases and controls as regards gland stain distribution. However, a significant difference was found between turbinate and controls as regards gland stain intensity. There was a significant difference between turbinate cases and controls as regards blood vessel stain distribution; however, no significant difference was present as regards stain intensity. There was no significant difference between polyp and turbinate cases as regards lining epithelium and blood vessel stain distribution and stain intensity. There was no significant difference between polyp and turbinate cases as regards gland stain distribution; however, a highly significant difference between polyp and turbinate cases as regards gland stain intensity. Conclusion Serotonin receptors are highly expressed in patients with chronic rhinosinusitis with nasal polyposis in both turbinate and polypoidal tissues which proves that serotonin has a strong role in the formation and growth of nasal polypi and allergic reactions. Hence serotonin modulating drugs can be studied as a new therapy for chronic rhinosinusitis with nasal polyposis. [ABSTRACT FROM AUTHOR]

Background: The endoscopic modified Lothrop procedure (EMLP) has become a frequently utilized procedure in rhinologic surgery. One of the most serious complications of the procedure is cerebrospinal fluid leak, which may occur due to lack of recognition of the anterior skull base in the region of the first olfactory filum (FOF), or direct injury to the FOF itself. Objectives: To evaluate the position of the head of the middle turbinate (MT) relative to the FOF, which is an important landmark in the EMLP. Methods: A series of previously obtained patient computed tomography scans of the sinus were reviewed. A reproducible process was implemented to obtain the measurements. First, the FOF was identified on an axial series. Using a localization feature of the radiographic software, this anteroposterior (AP) position could be visualized in a coronal plane. Subsequently, the MT was viewed in a sagittal plane, where a measurement between the head of the MT and the AP position of the FOF could be performed. Results: The AP distance between the head of the MT and the FOF was measured in 92 patients. The head of the MT was either at or anterior to the FOF in all measured subjects. The mean anterior distance of the head of the MT to FOF was 3.6 mm (±2.4 mm) on the right, and 3.8 mm (±2.2 mm) on the left. The range in AP distance was 0 to 12 mm. There was no significant difference in AP distance between the head of the MT and FOF based on gender (P =.413) or diagnosis (P =.254). Conclusions: In our study, the head of the MT was reliably at or anterior to the FOF in all subjects, suggesting its utility as a fixed landmark in endoscopic sinus surgery, particularly in the EMLP. Level of Evidence: N/A. [ABSTRACT FROM AUTHOR]

Objectives: Posterior nasal nerve (PNN) ablation is a minimally invasive treatment option for patients with chronic rhinitis. Recent evidence shows that parasympathetic innervation of the nasal cavity is more extensive and there are many fibers posterior to the lateral attachment of the middle turbinate. We describe a modified ablative technique that targets the extensive innervation of the posterior nasal nerves. Methods: Description of the technique and retrospective cohort analysis. In addition to the traditional radiofrequency and cryoablation targets, three additional treatment sites posterior to the middle turbinate were targeted using radiofrequency ablation, as well as one focused treatment posteroinferior to the middle turbinate attachment using cryotherapy ablation. The primary outcome collected was a 30% improvement in overall rhinitis symptoms. Results: Forty‐five patients received treatment and completed 3‐month follow‐up using the modified technique for radiofrequency and cryotherapy PNN ablation. Previously, our institution documented a 64.5% responder rate at 3 months. After introducing the modified technique, the response rate at 3 months significantly improved (64.5% vs. 91.1%, p =.004). Conclusions: This report suggests improved efficacy with implementation of the modified technique for in‐office PNN ablation. Given the extensive nature of the post‐ganglionic parasympathetic fibers of the nasal cavity which often emerge posterior to the middle turbinate attachment, a modified technique to target these branches should be considered. Prospective randomized studies comparing this modified technique to the traditional technique are needed. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Background. Nasal sprays are widely used in treating nasal and sinus diseases; however, there are very few studies on the drug delivery efficiency of nasal sprays. In this study, the drug delivery efficiency of three different nasal spray devices was evaluated in vitro using a 3D printed cast model of nasal cavity. Methods. Three nasal spray devices with different nozzles and angles of administration were used in the 3D model of the nasal cavity and paranasal sinuses. The spraying area (SA), maximal spraying distance (MSD), and spraying distribution scores on the nasal septum and lateral nasal wall were recorded. Results. Different nasal spray devices have their own characteristics, including volume of each spray, SA, and plume angle. The SA of the three nozzles on the nasal septum increased with an increasing angle of administration. When the angle of administration was 50°, each nozzle reached the maximal SA. There was no statistically significant difference in MSD among the three nozzles at the three angles. The total scores for each nozzle using the three different spraying angles were as follows: nozzle A, 40° > 30° > 50°; nozzle B, 30° > 40° > 50°; and nozzle C, 30° > 40° > 50°. The total scores for different nozzles using the same angle were statistically significantly different and the scores for nozzle C were the highest. Nozzle C had the minimum plume angle. None of the three nozzles could effectively delivered drugs into the middle meatus at any angle in this model. Conclusions. The design of the nozzle affects drug delivery efficiency of nasal spray devices. The ideal angle of administration is 50°. The nozzle with smaller plume angle has higher drug delivery efficiency. Current nasal spray devices can easily deliver drugs to most areas of the nasal cavity, such as the turbinate, nasal septum, olfactory fissure, and nasopharynx, but not the middle meatus. These findings are meaningful for nozzle selection and device improvements. [ABSTRACT FROM AUTHOR]

Background: Hypertrophy of inferior turbinate (IT) may arise from soft tissue and/or bony enlargement and is most related to inflammatory rhinitis. We aimed to study and compare the histopathological changes in the IT mucosa, submucosa, and bone in chronic rhinosinusitis with (CRSwNP) and without nasal polyps (CRSsNP). Methods: The specimens of the IT in patients who underwent endoscopic sinus surgery and inferior turbinoplasty (ITplasty) were included and studied under the microscope in the high-power field. The changes in the mucosa, submucosa, and bone were studied, graded accordingly, and compared between the 2 groups. Results: In the mucosa, there was no significant difference in the polymorphonuclear neutrophils (PMN) and lymphocytic counts; however, the eosinophilic count in the mucosa was significantly higher in CRSwNP (P = .001). There was no significant difference in basement membrane thickness or subepithelial oedema. However, the lymphocyte count was higher in CRSsNP (P = .003), and the eosinophilic count was higher in CRSwNP (P = .001). The bone did not show inflammation. The significant osteitic changes in the bone were periosteal thickening with osteoblastic activity (P = .016). Conclusion: The mucosa and submucosa had a significant change in CRSwNP related to the eosinophilic infiltrates. In the submucosa, the lymphocyte count was significantly higher in CRSsNP. The osteitic changes seen were limited to periosteal thickening with minimal osteoblastic activity in both groups, but were significantly higher in CRSsNP. Hence, we can resect only the effected mucosa and spare bone during ITplasty in cases of CRSwNP, and IT bone may be partly resected in CRSsNP patients [ABSTRACT FROM AUTHOR]

Empty nose syndrome (ENS) is a rare complication following nasal surgery, particularly surgery of the turbinates, with limited effectiveness of its treatments. A synthesis without meta-analysis (SWiM) was carried out to assess treatments and their reported effectiveness. In August 2022, a literature search was conducted on PubMed, Google Scholar, Cochrane Database, Science Direct, and Embase. Article selection, eligibility assessment, and risk of bias evaluation of each article were performed independently by each author and then compared. A synthesis without meta-analysis was then conducted on the selected studies. Forty-three articles were selected from 445 potential references, encompassing 586 patients. The quality of publications on ENS was generally poor or critical. Reported treatments for ENS, attributed to a combination of endonasal aerodynamic changes, impaired intranasal trigeminal function, and psychological factors, primarily consisted of intranasal topical instillations, lower meatus filling, stem cell therapy, and psychological/psychiatric management. However, all reported case series were subject to significant biases. As it was not feasible to address the question, “How effective are the treatments for ENS?” this synthesis aimed to answer, “Is there evidence of effectiveness of ENS treatments?” Possible treatments encompassed medical, surgical, psychological, and respiratory interventions. Nevertheless, the available data with limited bias were insufficient to provide precise recommendations for their indications. Future research employing robust methodological approaches is essential to assess treatment effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the presence and severity of inferior turbinate hypertrophy (ITH) in patients with hypertrophic scars (HTS). Methods: This case-control study was conducted with patients diagnosed with HTS during dermatologic examination and a control group without HTS. An otolaryngologist evaluated the presence and severity of inferior turbinate hypertrophy by anterior rhinoscopy. Results: ITH was more common in patients with HTS compared to the control group (64%, and 34%, respectively) (p=0.014). In the HTS group, 48% of patients had grade 2, and 16% had grade 3 ITH; in the control group, 24% had grade 2, and 10% had grade 3 ITH (p=0.046). Also, ITH was higher in patients who complained of pruritus or pain (83%, and 80%, respectively) in the HTS than in asymptomatic HTS patients (p=0.020). Conclusion: A higher number of patients with HTS had ITH compared to the control group, especially those who reported pruritus or pain associated with scar. Given the limited understanding of the full pathogenesis and treatment of HTS and ITH, their association potentially provides new insights into these related conditions. [ABSTRACT FROM AUTHOR]

Objectives: To determine pre-operative cleft volume and evaluate cleft´s impact on surrounding anatomical structures in children and adolescents with orofacial clefts using cone bean computed tomography (CBCT) imaging. Methods: The present retrospective study retrieved CBCT examinations of 68 patients from a previous study. The examinations had been exposed either before (n = 53) or after (n = 15) alveolar bone grafting. Pre-operative volume of cleft was determined, and type and location were evaluated. Morphological changes on the adjacent anatomical structures, including the incisive foramen, the nasal septum and floor, and the inferior turbinate, were assessed. Results: Mean bilateral cleft volume was 0.76 cm3, while mean unilateral cleft volume was 1.08 cm3; the difference was significant (p < 0.001). Variation in cleft volume, however, was large. The incisive foramen was not visible in the majority of cases with bilateral clefts (71%); the difference was significant (p = 0.001). In cases with unilateral clefts, the nasal septum in 87% was curved towards the cleft or graft side. Also, the mean size of the widest part of the inferior turbinate was 8.8 mm on the cleft or graft side and 10.4 mm on the non-cleft side. The difference was significant (p < 0.001). Conclusions: When required, CBCT is a feasible method for quantitatively illustrating alveolar clefts and their impact on the morphological development of surrounding structures. Variation in cleft volume was large. [ABSTRACT FROM AUTHOR]

Objective: Surgery is frequently used to treat inferior turbinate hypertrophy, and post-surgical bleeding is the most common complication. This study aims to evaluate the whole turbinate in terms of the vascular structures histologifically from the anterior to posterior and to determine regional diferences and, if any, clinical implications. Methods: Eight fresh-frozen cadavers were examined macroscopically. Thirteen selected turbinates were divided into 7 right and 6 left inferior turbinates. Ten randomized sections were obtained from each one-third section. On a light microscope, these sections were counted along the entire section with the artery and vein structures at high magnification. In the calculation of arterial cross-sectional area, vessel diameters were measured in the transverse plane and grouped as anterior, middle, and posterior. Results: In the anterior one-third, the mean value for arterial sections was 33.25, and the mean value for venous sections was 308. In the middle one-third, the mean values for arterial sections were 56.13, and the mean values for the venous sections were 663.63. In the posterior one-third, the mean values for arterial sections were 35.63, and the mean values for venous sections were 445.88. Statistical analysis with one-way ANOVA showed that the difference between the regions for venous structures was P = .202, and for arterial structures was P = .449. Conclusion: According to the outcomes of our study, contrary to what was previously known about surgical techniques applied to inferior turbinate hypertrophies, bleeding can occur, whichever part of the turbinate is operated on. [ABSTRACT FROM AUTHOR]

This article discusses the abnormal pneumatization of the middle nasal turbinate, known as concha bullosa, which can cause changes in airflow and congestion of the nasal mucosa. The article provides an overview of concha bullosa, including its classification, diagnosis, and management. The etiology of concha bullosa is still debated, with some attributing it to congenital defects and others suggesting traumatic factors. Diagnosis is typically done through clinical examination and imaging tests, and treatment options include medication and surgery. The article is a valuable resource for researchers and clinicians interested in this topic. Additionally, the document provides a list of research articles related to otolaryngology and head and neck surgery, covering topics such as chronic nasal obstruction, paranasal sinus osteomas, and the treatment of chronic rhinosinusitis. These articles aim to contribute to the understanding and improvement of diagnosis and treatment in this field. [Extracted from the article]

Background: Nasal airway stenosis may lie anterior and/or posterior to the piriform aperture. We intended to compare the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction. Methods: Segmented computed tomography cross-sectional areas of the nasal airway anterior (CT-CSAant) and posterior to the piriform aperture (at the level of the head of the inferior turbinate; CT-CSApost) were compared between patients with nasal obstruction (cases) and trauma controls. CT-CSA were approximately perpendicular to the direction of the nasal airflow. Anterior to the piriform aperture, they were tilted about 30o, 60o and 90o to the nasal floor. Posterior to the piriform aperture, they were tilted about 50o, 80o and 100o to the nasal floor. In cases, we examined the Pearson's correlation of active anterior rhinomanometry with CT-CSAant and CT-CSApost. Results: Narrow and bilateral CT-CSApost were similarly large between 56 cases and 56 controls (all p > 0.2). On the contrary, narrow and bilateral CT-CSAant were significantly smaller in cases than in controls (all p < 0.001). The ratio of the size of CT-CSAant−30 to that of CT-CSApost−80 was significantly lower in cases (median: 0.84; lower to upper quartile: 0.55–1.13) than in controls (1.0; 0.88–1.16; Mann-Whitney U test; p = 0.006). Bilateral CT-CSAant correlated significantly with total inspiratory flow (all p < 0.026) in contrast to bilateral CT-CSApost (all p > 0.056). Conclusions: The nasal airway anterior to the piriform aperture was smaller in patients with nasal obstruction due to skeletal nasal stenosis than that in controls. On the contrary, the nasal airway posterior to the piriform aperture was similarly large between patients with and without nasal obstruction. Furthermore, in patients with nasal obstruction, the anterior nasal airway was narrower compared to that located posterior to it. On the contrary, control patients' anterior nasal airway was as large as the posterior one. [ABSTRACT FROM AUTHOR]

Background: The inferior turbinate is located in the inferior part of the nose, and contribute to the nasal valve formation. Inferior turbinate hypertrophy causes chronic nasal obstruction. Aim: We aimed to assess the effectiveness of coblation-assisted reduction of the inferior turbinate hypertrophy using a specially designed coblator probe. Additionally, this study aimed to compare this technique with traditional surgical partial turbinectomy as the control arm and follow up with patients to identify potential complications. Methods: This study involved 40 patients with nasal obstruction, those patients attended the Otorhinolaryngology Department of Al Azhar University Hospital in Assiut and diagnosed with enlarged inferior turbinate that did not respond to medical treatment. Also, Pre- and post-operative CT scanning was performed to objectively evaluate the improvement. Results: Coblation group has more advantages over the traditional group like less operative time, less intraoperative blood loss, less post-op pain, less post-op nasal crusts, early return to daily activity (P value < 0.001). Significant decrease in postoperative nasal obstruction among partial inferior turbinectomy group in comparison with coblation group (P value < 0.001). Conclusion: Coblation assisted inferior turbinate reduction of the hypertrophied inferior turbinate is the technique of less complications (i.e. post-operative pain, bleeding, and nasal crust), which are commonly encountered with traditional methods. Traditional method is a bit better in patient self-satisfaction after surgery and relieving post-operative nasal obstruction. [ABSTRACT FROM AUTHOR]

During the Omicron wave, previous variants such as BA.2, BA.4, and BA.5 were replaced by newer variants with additional mutations in the spike protein. These variants, BA.4.6, BQ.1.1, and XBB, have spread in different countries with different degrees of success. Here, we evaluated the replicative ability and pathogenicity of BA.4.6, BQ1.1, and XBB clinical isolates in male Syrian hamsters. Although we found no substantial differences in weight change among hamsters infected with these Omicron subvariants, the replicative ability of BQ.1.1 and XBB in lung tissue was higher than that of BA.4.6 and BA.5. Of note, BQ.1.1 was lethal in both male and female transgenic human ACE2 hamsters. In competition assays, XBB replicated better than BQ.1.1 in the nasal turbinate tissues of female hamsters previously infected with Omicron BA.2. These results suggest that newer Omicron subvariants in the XBB family are still evolving and should be closely monitored. Omicron variants BQ.1.1 and XBB increased pathogenicity in wild-type hamsters, with BQ.1.1 showing higher mortality in human ACE2 transgenic hamsters compared to earlier Omicron variants.. [ABSTRACT FROM AUTHOR]

Empty nose syndrome (ENS) is a rare entity in patients who undergo sinonasal surgery due to over-resection of the turbinate. This syndrome leads to debilitating symptoms that include dry nose, painful nasal breathing, paradoxical nasal obstruction, crusting, and sleep disorder. The goal of surgical treatment is to reestablish the volume of the turbinates to rehabilitate the nasal resistance. Endonasal microplasty with cartilage implants on the lateral wall of the nasal cavity is useful for creating the neoturbinate. Here, we present 2 cases that describe the management of empty nose syndrome by endonasal microplasty using platelet-rich fibrin (PRF) scaffolds embedded with a diced cartilage graft. The integration of the PRF scaffolds with diced cartilage efficiently facilitated the reestablishment of the neoturbinate. This autologous biomaterial is suitable for the treatment of ENS. [ABSTRACT FROM AUTHOR]

The role of the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) Omicron BA.1 Spike (S) on disease pathogenesis was investigated. For this, we generated recombinant viruses harboring the S D614G mutation (rWA1-D614G) and the Omicron BA.1 S gene (rWA1-Omi-S) in the backbone of the ancestral SARSCoV-2 WA1 strain genome. The recombinant viruses were characterized in vitro and in vivo. Viral entry, cell-cell fusion, plaque size, and the replication kinetics of the rWA1-Omi-S virus were markedly impaired when compared to the rWA1-D614G virus, demonstrating a lower fusogenicity and ability to spread cell-to-cell of rWA1-Omi-S. To assess the contribution of the Omicron BA.1 S protein to SARS-CoV-2 pathogenesis, the pathogenicity of rWA1-D614G and rWA1-Omi-S viruses was compared in a feline model. While the rWA1-D614G-inoculated cats were lethargic and showed increased body temperatures on days 2 and 3 post-infection (pi), rWA1-Omi-S-inoculated cats remained subclinical and gained weight throughout the 14-day experimental period. Animals inoculated with rWA1-D614G presented higher infectious virus shedding in nasal secretions, when compared to rWA1-Omi-S-inoculated animals. In addition, tissue replication of the rWA1-Omi-S was markedly reduced compared to the rWA1-D614G, as evidenced by lower viral load in tissues on days 3 and 5 pi. Histologic examination of the nasal turbinate and lungs revealed intense inflammatory infiltration in rWA1-D614Ginoculated animals, whereas rWA1-Omi-S-inoculated cats presented only mild to modest inflammation. Together, these results demonstrate that the S protein is a major virulence determinant for SARS-CoV-2 playing a major role for the attenuated phenotype of the Omicron virus. [ABSTRACT FROM AUTHOR]

Objective: Determine the effects of differential maxillary expansion on nasal width in patients with unilateral cleft lip and alveolus with or without cleft of the secondary palate (UCLA ± P). Design: Retrospective radiographic study. Setting: Institutional. Participants: Forty patients with UCLA ± P who had alveolar bone grafting (ABG) between 2015 and 2020 and available preexpansion and postexpansion cone beam computed tomography (CBCT) scans. Twenty patients with UCLA ± P who underwent ABG without expansion were included as controls. Main Outcome Measure: Percent change in width at the nasal pyriform, inferior turbinates, and alar base on cleft and noncleft sides. Results: The study included 40 patients (24 males, mean age 9.6 years) and 20 controls (10 males, mean age 10.1 years). After maxillary expansion, there was an increase in width on the cleft and noncleft sides compared to nonexpanded controls at nasal pyriform (10.9% cleft side, P ≤ 0.001 and 4.3% noncleft side, P ≤.001), inferior turbinate (8.7%, P ≤.001 and 4.5%, P =.01), and alar base (6.7%, P = <.001 and 0.8% P =.54). The increase in width was greater on the cleft side than the noncleft side at the nasal pyriform (7.1%, P ≤.001), inferior turbinate (4.3%, P ≤.001), and alar base (7.0%, P ≤ 0.001) in the expansion group. There was good to excellent intra-rater and inter-rater agreement for measurements. Conclusion: Patients with UCLA ± P who undergo differential maxillary expansion before ABG exhibit greater nasal widening on the cleft side. [ABSTRACT FROM AUTHOR]

Background: When medical therapy fails to control maxillary sinus (MS) disease, surgery is required. There are many advanced MS endoscopic approaches, each one with its anatomical limitations and possible complications. This study aimed to review the outcomes of three endoscopic approaches to the MS (middle meatal antrostomy approach (MMAA), prelacrimal recess approach (PLRA), and canine fossa approach (CFA)) to manage benign MS lesions. Methods: Sixty-three patients with diseased MS require surgery. Endoscopic MS approaches used include MMAA, PLRA, and CFA. Each approach was used in 21 patients. The outcome of each approach was measured regarding lesion accessibility and clearance, complications (intraoperative or postoperative), and recurrence. Results: The maxillary sinus posterior wall was accessible in all approaches. Other walls and different recesses were also accessible in the case of PLRA and CFA with statistically significant difference between the three approaches. There was no significant difference between patients operated by PLRA and CFA regarding accessibility to different walls and recesses of the MS. Endoscopic and radiological recurrence were found in three (15%) patients who were operated by MMAA. There was no evidence of recurrence in patients operated by the other approaches. Complications like crustations, fascial pain, fascial welling, and fascial hypoesthesia occurred in a few patients. Conclusion: By using a suitable endoscopic approach, the different walls and recesses of the MS were completely accessible, so benign MS lesions that required open surgical approaches can be managed endoscopically while preserving the sinus structure and function. [ABSTRACT FROM AUTHOR]

Since the beginning of the COVID-19 pandemic, there has been a significant need to develop antivirals and vaccines to combat the disease. In this work, we developed llama-derived nanobodies (Nbs) directed against the receptor binding domain (RBD) and other domains of the Spike (S) protein of SARS-CoV-2. Most of the Nbs with neutralizing properties were directed to RBD and were able to block S-2P/ACE2 interaction. Three neutralizing Nbs recognized the N-terminal domain (NTD) of the S-2P protein. Intranasal administration of Nbs induced protection ranging from 40% to 80% after challenge with the WA1/2020 strain in k18-hACE2 transgenic mice. Interestingly, protection was associated with a significant reduction in virus replication in nasal turbinates and a reduction in virus load in the brain. Employing pseudovirus neutralization assays, we identified Nbs with neutralizing capacity against the Alpha, Beta, Delta, and Omicron variants, including a Nb capable of neutralizing all variants tested. Furthermore, cocktails of different Nbs performed better than individual Nbs at neutralizing two Omicron variants (B.1.529 and BA.2). Altogether, the data suggest the potential of SARS-CoV-2 specific Nbs for intranasal treatment of COVID-19 encephalitis. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 41-year-old man who presented with symptoms of mild dysarthria and ataxic gait, which were found to be caused by complete clival resorption and associated pontine pneumatosis due to prolonged cocaine use. The patient underwent surgical repair of the defect using a combined open and endoscopic approach, with reconstruction using a pericranial flap. The surgery was successful, and at a one-year follow-up, there was reduced inflammation. The article concludes that combined endoscopic-open clival reconstruction is a viable option for cases of complete clival destruction caused by substance use. [Extracted from the article]

This article, titled "Outcomes of the Middle Turbinate Swing Technique during the Expanded Endonasal Approach (EEA): A Tertiary Center Experience," explores the use of the middle turbinate (MT) swing technique in skull base surgery. The MT swing technique involves detaching the posterior and lateral attachments of the middle turbinate to allow it to swing laterally into the maxillary sinus, providing better access to the skull base. The study analyzed surgeries performed between January 2021 and August 2023, finding that the MT swing technique did not compromise skull base exposure or tumor resection and had low rates of complications. The authors suggest that further research is needed to investigate the long-term benefits of preserving the middle turbinate during skull base surgery. [Extracted from the article]

Morphometric studies of 3D micro CT‐scanned images can provide insights into the evolution of the brain and sensory structures but such data are still scarce for the most diverse mammalian order of rodents. From reviewed and new data, we tested for convergence to extreme aridity and high elevation in the sensory and brain morphology of rodents, from morphometric data from micro‐CT X‐ray scans of 174 crania of 16 species of three distantly related African murid (soft‐furred mice, Praomyini, laminate‐toothed rats, Otomyini, and gerbils, Gerbillinae) clades and one North American cricetid (deer mice and white‐footed mice, Peromyscus) clade. Recent studies demonstrated convergent evolution acting on the oval window area of the cochlea (enlarged in extremely arid‐adapted species of Otomyini and Gerbillinae) and on endocranial volume (reduced in high elevation taxa of Otomyini and Peromyscus). However, contrary to our predictions, we did not find evidence of convergence in brain structure to aridity, or in the olfactory/respiratory system (turbinate bones) to high elevation. Brain structure differed, particularly in the petrosal lobules of the cerebellum and the olfactory bulbs, between Otomyini and Gerbillinae, with extreme arid‐adapted species in each clade being highly divergent (not convergent) from other species in the same clade. We observed greater "packing" of the maxillary turbinate bones, which have important respiratory functions, in Peromyscus mice from high and low elevations compared to the high‐elevation African Praomyini, but more complex patterns within Peromyscus, probably related to trade‐offs in respiratory physiology and heat exchange in the nasal epithelium associated with high‐elevation adaptation. [ABSTRACT FROM AUTHOR]

This study investigated the intricate dynamics of intranasal spray deposition within nasal models, considering variations in head orientation and stages of the nasal cycle. Employing controlled delivery conditions, we compared the deposition patterns of saline nasal sprays in models representing congestion (N1), normal (N0), and decongestion (P1, P2) during one nasal cycle. The results highlighted the impact of the nasal cycle on spray distribution, with congestion leading to confined deposition and decongestion allowing for broader dispersion of spray droplets and increased sedimentation towards the posterior turbinate. In particular, the progressive nasal dilation from N1 to P2 decreased the spray deposition in the middle turbinate. The head angle, in conjunction with the nasal cycle, significantly influenced the nasal spray deposition distribution, affecting targeted drug delivery within the nasal cavity. Despite controlled parameters, a notable variance in deposition was observed, emphasizing the complex interplay of gravity, flow shear, nasal cycle, and nasal morphology. The magnitude of variance increased as the head tilt angle increased backward from upright to 22.5° to 45° due to increasing gravity and liquid film destabilization, especially under decongestion conditions (P1, P2). This study's findings underscore the importance of considering both natural physiological variations and head orientation in optimizing intranasal drug delivery. [ABSTRACT FROM AUTHOR]

The study is dedicated to investigating the influence of anatomical peculiarities of the ethmoid sinus and identifying predictors of isolated fungal sphenoiditis development. The introduction highlights the multifactorial nature of the involvement of paranasal sinuses and the relevance of establishing patterns of fungal sphenoiditis development. The methods include a retrospective analysis of 76 patients with isolated sphenoiditis requiring surgical treatment. All participants underwent thorough pre-hospital examination, including computed tomography, endoscopic examination, and in some cases, magnetic resonance imaging. The results show that fungal involvement was observed in 12%, and all subjects exhibited an increased distance from the posterior wall of the middle nasal turbinate to the sphenoid sinus ostium (identified as a prognostic pattern of fungal ball development). Among the complaints, there was a statistically significant difference in "nasal congestion," which was more common in fungal infections, and a gender association, as sphenoiditis predominantly affected women. The findings can be utilized for developing effective prevention and treatment methods for this condition. The conclusions emphasize the importance of studying the anatomical parameters of the ethmoid sinus to enhance the diagnosis and treatment of fungal sphenoiditis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the prevalence and correlation of Concha Bullosa (CB) and Nasal Septal Deviation (NSD) with maxillary sinus Mucosal Thickening (MT) using Cone-Beam Computed Tomography (CBCT). Methods: This descriptive, cross-sectional study was conducted on CBCT scans of 228 females and 157 males (mean age of 44.82±15.10 years) retrieved from the archives of the Radiology Department of Shahid Beheshti Dental School. The images were evaluated by one oral and maxillofacial radiologist for presence/absence of NSD, CB, and maxillary sinus MT, and their correlations. Statistical analyses were performed by independent t-test, Chi-square test, and binomial test (alpha=0.05). Results: The prevalence of CB, NSD, and MT was 61.6, 80, and 70.6%, respectively. NSD (p=0.131) and CB (p=0.211) had no significant correlation with MT. However, CB and NSD were significantly correlated (p=0.006). NSD had a significant correlation with contralateral presence of CB as well (p=0.000). The prevalence of CB was significantly higher in females (p<0.05), while the prevalence of NSD and MT was significantly higher in males (p<0.05). Conclusion: The present study revealed no significant correlation between CB and NSD with maxillary sinus MT. Thus, in absence of clinical symptoms, patients with CB or NSD should not be necessarily referred for treatment of sinus abnormalities. However, considering the significant correlation of CB and NSD, in case of presence of one entity, the other one should be suspected. [ABSTRACT FROM AUTHOR]

This article presents a study on concha bullosa, an anatomical variant of the nasal turbinates. The study analyzed CT scans and found that concha bullosa was present in over half of the patients. A new classification system based on the morphological types of concha bullosa was proposed. The study also discussed the relationship between concha bullosa and rhinosinusitis, as well as the therapeutic management options. The document also includes a list of references covering various topics related to oral health, sinus conditions, and medical imaging. [Extracted from the article]

Extraskeletal Ewing sarcoma (EES) is a relatively rare primary tumor of the soft tissues predominantly affecting men in the second and third decades of life. They are a less common form of the cancerous growth known as an Ewing sarcoma, which occurs in bones or soft tissue such as cartilage. Head and neck ESS can require intervention including endoscopic sinus surgery, septoplasty, inferior turbinectomy, and left internal nasal valve repairs with septal cartilage This is a case report on an unusual presentation of ESS in the sinonasal region. [ABSTRACT FROM AUTHOR]

Purpose: To determine the optimum angle for placement of Lester Jones lacrimal bypass tube using fixed radiological markers on CT scan head with axial and coronal cuts, as well as analysing the anatomical variation and range of angulation between individuals within our local population. Methods: A retrospective radiological study conducted on a randomly selected sample of 384 adult patients in a UK Teaching Hospital. The angle between the medial canthus and the middle turbinate was measured on CT scans of the head using fixed radiological anatomical landmarks and analysed using the IMPAX software. Patients with orbital or nasal fractures, as well as those with history of surgical procedures involving the facial bones, were excluded. The accuracy of our measurements was validated using three dimensional (3D) CT head reconstruction technology. Results: Analysis of the results showed a range of angulation between 28–45 degrees, with a mean angle of 36.99 ± 4.78 SD. There was no significant correlation found when comparing the different age groups using the One Way ANOVA test. Furthermore, a non-significant correlation was found between males and females when their mean angles were compared using the independent t-test. Conclusion: Our study showed that the ideal angle for insertion of Lester Jones tube would be between 30–45 degrees, with a mean of 37 degrees. No significant correlation was found between the age of the patient and the ideal angle of insertion of Lester Jones tube. Moreover, no significant difference was found in the angle measurements between males and females. [ABSTRACT FROM AUTHOR]

Hyaluronic acid-binding protein (HABP4) plays important roles in regulating cell cycle and apoptosis. However, its functions in regulating cell apoptosis remain unclear. To reveal the effects of HABP4 on cell proliferation, cell cycle and apoptosis, the HABP4 sequence was cloned, and we investigated the gain and loss functions of HABP4 in goat turbinate bone cells. Our results showed that a 1,496-bp HABP4 sequence was cloned successfully. The interference effect of siRNA1 on HABP4 was the strongest, reducing its mRNA expression level by 83%, decreasing the cells in the G0/G1 and S phases of the cell cycle and inhibiting cell growth and apoptosis. The overexpression of HABP4 produced contrasting results. Furthermore, an HABP4 knockdown caused the up-regulated expression of genes associated with apoptosis, including Bcl-2 and BCL2L11, but the down-regulation of Caspase3, Caspase7, Bax, PARP1, SOCS2 and P53 mRNA levels. Additionally, HABP4 overexpression significantly up-regulated the expression levels of Bax, Caspase3, Caspase7, BCL2L11, P53, SOCS2 and PARP1. However, the expression of Bcl-2 was down-regulated. These data provide an important foundation for further in-depth studies of HABP4 functions. [ABSTRACT FROM AUTHOR]