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Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants., Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries., Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01).The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04)., Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

Background: As the incidence of new cases of coronavirus disease increased exponentially, the use of viral swabs to collect nasopharyngeal specimens are increasing drastically. Therefore, healthcare workers military staff and uneducated nonprofessional's were ordered to make this swabs. Subsequently case reports reported about basal skull perforation, cerebrospinal fluid fistula and injury due to an incorrect technique., Methods: Search of the literature., Results: Only in 44% of the videos (Youtube) nasal swabs were correctly performed. Due to an false technique biological sampling resulted in false-negative COVID-19 tests., Conclusion: Although professional societies started to report about this unacceptable situation, no publication reported about this health endangerment. In this time of overwhelming information and diversity of opinions, it is necessary to report about this in the hope, all media and TV reports will follow this article to show correctly performed nasal swabs to reduce false-negative COVID-19 tests and injury., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Abstract: Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children's Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

The aim of the study was to determine the role of the stress effect of septoplasty modeling on p53 protein expression in the hippocampus of rats under conditions of sensory olfactory deprivation. Simulation of septoplasty was carried out on 30 sexually mature male rats. A quantitative assessment of the apoptosis of neurons in the pyramidal layer of the hippocampus in the subfields CA1, CA2, CA3, and dentate gyrus (DG) on days 2, 4, and 6 after surgery was carried out. Histological sections were stained by the immunohistochemical method with antibodies to the p53 protein. An increase in the number of p53-positive neurons was noted in all subfields; the maximum increase in the number of apoptotic neurons was noted on day 4 after surgery. The stress effect of modeling septoplasty in rats, accompanied by sensory deprivation of the peripheral part of the olfactory analyzer, provoked the expression of p53 and the initiation of apoptosis mechanisms in various subfields of the hippocampus.

Context: Mercuric chloride (mercury (II) chloride) belongs to inorganic mercury compounds characterized by good water solubility and associated high toxicity. The paper describes an unusual case of intranasal intoxication with corrosive sublimate confused with cocaine by a young male., Case Report: Intranasal administration of corrosive sublimate caused severe local symptoms of chemical burn within the nasal cavity. From the 2nd day the patient developed symptoms of renal dysfunction with transient polyuria and serum retention of nitrogen metabolites. The patient was undergoing chelation therapy with DMPS, N-acetylcysteine and d-penicyllamine. Four procedures of haemodialysis were performed with simultaneous DMPS and N-acetylcysteine treatment. The urine mercury level on the first day of hospitalization was 1989 μg/L, and after 26 days of treatment returned to the physiological level. During treatment renal function was normalized, the patient was discharged in general good condition., Discussion: Mercuric chloride is readily absorbed from the nasal cavity. Its administration may cause intoxication manifested by both chemical burn at the exposure site and systemic symptoms, particularly renal impairment. Even in case of renal dysfunction the use of DMPS seems safe, if haemodialysis is performed at the same time. Simultaneous haemodialysis and chelation therapy may accelerate elimination of mercury from the organism., (Copyright © 2021 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

In this article, the effect of surgical damage to the nasal mucosa in rats under the action of general anesthesia was investigated. The motor activity and heart rate variability (HRV) of rats were studied before and 2 days after the surgery. After surgical exposure, motor activity decreased, the time of fading and grooming increased, VLF increased, and HF decreased. Surgical trauma of the nasal septum in rats at the early postoperative stage promotes a pronounced stress response in the form of a sharp shift in the balance of the autonomic nervous system towards the sympathetic level and causes a decrease in exploratory activity, an anxiety, and a depressive-like state in rats.

Purpose Pharyngeal high-resolution manometry is an emerging practice for diagnosis of swallowing disorders in the upper aerodigestive tract. Advancement of a catheter through the upper esophageal sphincter may introduce safety considerations. There are no published studies of catheter placement complications, side effects, or tolerability. This study examines patient-reported side effects and tolerability of pharyngeal high-resolution manometry. Method Data were collected prospectively from 133 adult patients who underwent pharyngeal high-resolution manometry for the 1st time. Patients rated tolerability specific to "nose" and "throat" using a visual analog scale for 4 procedure time points: catheter passage, during the procedure, catheter removal, and after the procedure. Complications during catheter passage and removal were recorded. A telephone call was placed to the patient within 6 days to survey side effects experienced after the procedure. Results The patient sample was composed of 91 males and 42 females with a mean age of 66 years ( SD = 14.4). Tolerability scores for catheter passage showed no significant difference ( p = .7288) in the nose versus throat. Tolerability for females was significantly less ( p = .0144) than that for males. Participants with the shortest procedure duration showed greatest discomfort in the nose ( p = .0592) and throat ( p = .0286). Complications included gag response (14%), emesis (2%), and epistaxis (< 1%). Side effects included sore throat (16%), nose discomfort (16%), coughing (11 %), nosebleed (4%), and nausea/vomiting (4%). Conclusions High-resolution manometry appears to have high patient tolerability with low incidence of side effects. Rates of complications and side effects are similar to those reported for other transnasal procedures.

Purpose: The aim of this study was to investigate nasal hygiene in intensive care patients and improve patient care using isotonic saline nasal spray., Material and Methods: In the study group, over a period of tendays saline nasal spray was administered four times daily. Nasal treatment was not given to the control group. Each patient was examined with a flexible nasopharyngoscope before and after the treatment and a nasal culture was taken., Results: In the study group, the secretion score (1- absent; 2- serosal; 3- seropurulent and 4- purulent) mean value improved from 1.9 to 1.4. In the control group, the secretion score mean value had risen from 1.7 to 3.1. At the beginning of the study, there was no difference in secretion scores between the groups, but on the tenth day a statistically significant difference was found., Conclusion: The use of saline nasal spray in this group of intensive care patients was found to be effective in achieving nasal hygiene., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This article reports two clinical cases of the successful treatment of the gunshot wounds in the nasal cavity and paranasal sinuses of the children resulting from the careless use of the pneumatic weapons. Despite the fact that the shots were fired from a close distance, the intracranial structures and the eyeballs remained unaffected. The bullets were localized in the nasal septum of one child and in the frontal recess of the other as is typical of the injuries inflicted to the nose and paranasal sinuses by the shots from the air rifles. Multi-slice spiral computed tomography (MSCT) is known to have a number of important advantages over the roentgenological examination for determining the location of the bullets. Bullets for pneumatic rifles are manufactured in the form of the balls either from lead or copper-coated steel; therefore, they are a priory can not be removed with the use of a magnet.

We present a case report of a traveller injured by a needlefish in the Caribbean. The needlefish leapt from the ocean and struck the traveller's face at high speed, causing a seemingly superficial puncture wound on his nose. Later, it became apparent that multiple fish bones had broken off and lodged in his nasal cavity, very narrowly missing his cribriform plate. Some bones were discharged spontaneously through his nose over the next 3 months, and one required surgical removal. Our report highlights the importance of urgent radiological examination in patients injured by needlefish, even if the external wound appears insignificant., (© International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

The objective of this study was to compare the efficacy and safety of continuous positive airway pressure (CPAP) delivered using nasal masks with binasal prongs. We randomly allocated 72 neonates between 26 and 32 weeks gestation to receive bubble CPAP by either nasal mask (n = 37) or short binasal prongs (n = 35). Primary outcome was mean FiO 2 requirement at 6, 12 and 24 h of CPAP initiation and the area under curve (AUC) of FiO 2 against time during the first 24 h (FiO 2 AUC 0-24 ). Secondary outcomes were the incidence of CPAP failure and nasal trauma. FiO 2 requirement at 6, 12 and 24 h (mean (SD); 25 (5.8) vs. 27.9 (8); 23.8 (4.5) vs. 25.4 (6.8) and 22.6 (6.8) vs. 22.7 (3.3)) as well as FiO 2 AUC 0-24 (584.0 (117.8) vs. 610.6 (123.6)) were similar between the groups. There was no difference in the incidence of CPAP failure (14 vs. 20%; relative risk 0.67; 95% confidence interval 0.24-1.93). Incidence of severe nasal trauma was lower with the use of nasal masks (0 vs. 31%; p < .001)., Conclusions: Nasal masks appear to be as efficacious as binasal prongs in providing CPAP. Masks are associated with lower risk of severe nasal trauma., Trial Registration: CTRI2012/08/002868 What is Known? • Binasal prongs are better than single nasal and nasopharyngeal prongs for delivering continuous positive airway pressure (CPAP) in preventing need for re-intubation. • It is unclear if they are superior to newer generation nasal masks in preterm neonates requiring CPAP. What is New? • Oxygen requirement during the first 24 h of CPAP delivery is comparable with use of nasal masks and binasal prongs. • Use of nasal masks is, however, associated with significantly lower risk of severe grades of nasal injury.

Intrusive luxation may cause complications for the primary tooth and generate adverse sequelae in the permanent successor. Although intrusion is prevalent in the primary dentition, full intrusion is a rare event that requires specialized treatment and a multidisciplinary approach. This article describes the case of a 1-year-old girl who presented with traumatic displacement of the maxillary left central incisor into the nasal cavity. The parents sought treatment 1 month after the child sustained the injury, and the impacted tooth was removed through her left nostril under general anesthesia. Four-year clinical and radiographic follow-up revealed no adverse sequelae.

The present study provides an accurate simulation of velocity and temperature distributions of inhalation thermal injury in a human upper airway, including vestibule, nasal cavity, paranasal sinuses, nasopharynx, oropharynx, larynx, and upper part of main bronchus. To this end, a series of CT scan images, taken from an adult woman, was used to construct a three dimensional model. The airway walls temperature was adjusted according to existing in vivo temperature measurements. Also, in order to cover all breathing activities, five different breathing flow rates (10, 15, 20, 30, and 40 l/min) and different ambient air temperatures (100, 200, 300, 400, and 500 °C) were studied. Different flow regimes, including laminar, transitional, and turbulence were considered and the simulations were validated using reliable experimental data. The results show that nostrils, vestibule, and nasal cavity are damaged more than other part of airway. Finally, In order to obtain the heat flux through the walls, correlations for Nusselt number for each individual parts of airway (vestibule, main upper airway, nasopharynx etc.,) are proposed., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: To compare the outcomes of preterm infants with respiratory distress initiated on either Heated Humidified High Flow Nasal Cannula or Nasal Continuous Positive Airway Pressure as a primary mode of respiratory support., Study Design: Prospective observational cohort study., Setting: Tertiary care level III neonatal intensive care unit., Participants: 88 preterm infants between 28 to 34 weeks of gestation with mild to moderate respiratory distress within 6 hours of birth., Intervention: Eligible infants were treated either with Heated Humidified High Flow Nasal Cannula (n=46) or Nasal Continuous Positive Airway Pressure (n=42)., Primary Outcome: Need for mechanical ventilation within 72 hrs of initiating support., Results: Baseline demographic characteristics were comparable between the two groups. There was no difference in the requirement of mechanical ventilation between Heated Humidified High Flow Nasal Cannula (19.5%) and Nasal Continuous Positive Airway Pressure (26.2%) groups [RD-0.74 (95% CI 0.34-1.62; P =0.46)]. Moderate or severe nasal trauma occurred less frequently with Heated Humidified High Flow Nasal Cannula (10.9%) in comparison to Nasal Continuous Positive Airway Pressure (40.5%) (P= 0.004)., Conclusions: Heated Humidified High Flow Nasal Cannula was comparable to Nasal Continuous Positive Airway Pressure as a primary respiratory support for preterm infants with respiratory distress, with lesser incidence of nasal trauma.

Penetrating cervical lesions caused by a foreign body are rare events. The neck is a complex and delicate body region, given the important vascular structures it holds. The most frequent fatal complications often involve vascular injuries, and as a consequence, the mortality rate increases by approximately 50%. Civilian patients are mainly victims of violence or motor vehicle accidents and rural accidents involving neck are not very common. When a cervical lesion is because of a wooden foreign body, infectious risk increases for its organic peculiarity. The authors report a rural nonfatal cervical lesion in a civilian, and its management.

Objectives: To provide an epidemiological framework of symptoms related to Foreign Body (FB) injuries due to Button Battery (BB)., Methods: Data on BB ingestion/inhalation have been obtained from the ButtonBatteryDB. The ButtonBatteryDB is a database collecting information on BB injuries in children (0-18 years of age). Data on 348 BB injures have been derived from the Registry of Foreign Body Injuries "Susy Safe" (269 cases) and from published scientific literature reporting case reports of FB injuries (79 cases)., Results: Most of injured children were male and BBs were found more often in the mouth/esophagus/stomach (ICD935) and in the nose (ICD932). Analyzing symptoms related to BB located in the esophagus/mouth/stomach, we found that children had higher probability of experiencing dysphagia (30.19%, 95% C.I. 17.83-42.55), fever and cough (26.42%, 95% C.I. 14.55-38.28), compared to the other symptoms. Referring to the probability that symptoms occurred simultaneously, fever and cough are more likely (3.72%, 95% C.I. 1.0-6-43) to jointly showing up in children with BB in mouth/esophagus/stomach (ICD935), followed by fever and dysphagia (2.66%, 95% C.I. 0.36-4.96) and by fever and irritability/crying, fever and drooling, dysphagia and irritability/crying (2.13% C.I. 0.00-4.19, 95% C.I.), Conclusions: These findings provide new insight in clinical presentation of BB injuries: the identification of unique patterns of symptoms related to BB injuries is useful to perform an early diagnosis (and to guarantee a prompt medical reaction), also when the injury is un-witnessed., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Children with a button battery impaction present with nonspecific symptoms that may account for a delay in medical care. We conducted a retrospective study of the clinical presentation, management, and complications associated with button battery ingestion in the pediatric aerodigestive tract and to evaluate the associated long-term morbidity. We reviewed the medical records of 23 patients who were treated for button battery impaction at our tertiary care children's hospital from Jan. 1, 2000, through July 31, 2013. This population was made up of 14 boys and 9 girls, aged 7 days to 12 years (mean: 4 yr). Patients were divided into three groups based on the site of impaction; there were 9 impactions in the esophagus and 7 each in the nasal cavity and stomach. We compiled information on the type and size of each battery, the duration of the impaction, presenting symptoms, treatment, and outcomes. The mean duration of battery impaction was 40.6, 30.7, and 21.0 hours in the esophagus, nasal cavity, and stomach, respectively. We were able to identify the specific type of battery in 13 cases; 11 of these cases (85%) involved a 3-V 20-mm lithium ion battery, including all cases of esophageal impaction in which the type of battery was identified. The most common presenting signs and symptoms were vomiting (n = 7 [30%]), difficulty feeding (n = 5 [22%]), cough (n = 5), and bloody nasal discharge (n = 5); none of the presenting signs and symptoms predicted the severity of the injury or the outcome. The median length of hospital stay was far greater in the esophageal group (12 days) than in the nasal and stomach groups (1 day each; p = 0.006). Battery impaction in the esophagus for more than 15 hours was associated with a significantly longer postoperative hospital stay than impaction for less than 15 hours (p = 0.04). Esophageal complications included strictures (n = 5), perforation (n = 3), and tracheoesophageal fistula formation (n = 2). Clinicians should consider battery impaction in the upper aerodigestive tract as an emergency that can lead to significant long-term morbidity, and therefore immediate surgical intervention is required.

Fractures of the midface and internal orbit occur isolated or in combination with other injuries. Frequently, the patients are first seen in emergency rooms responsible for the coordination of initial diagnostic procedures, followed by the transfer to specialties for further treatment. It is, therefore, important for all physicians treating facial trauma patients to understand the basic principles of injuries to the midface. Thus, this article aims to describe the anatomy and the current classification systems in use, the related clinical symptoms, and the essential diagnostic measures to obtain precise information about the injury pattern., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Postoperative nasal mucosa healing is a highly complex and organized process, and the success rates of endoscopic sinus surgery and septoplasty surgeries are closely associated with the postoperative wound healing processes. In this experimental study, the authors' aim was to use histopathologic examination to investigate the effects of N-Acetylcysteine (NAC) on the wound healing of rat nasal mucosa after mechanical trauma. Twenty-one Sprague-Dawley rats were randomly divided into 3 groups: the nontreated group (N = 7), the control saline group (N = 7), and the NAC group (N = 7). No treatment was given to the nontreated group for 15 days. The control saline group received intraperitoneal injection of saline (2.5  mL/kg, intraperitoneal) for 15 days and the NAC group was intraperitoneally injected with NAC at a dose of 300  mg/kg/day for 15 days. At the beginning of the study, unilateral mechanical nasal trauma was induced with an interdental brush inserted through the right nostril in all rats. Samples were stained using hematoxylin and eosin solution, and were examined by a pathologist using a light microscope. The severity of inflammation was milder in the NAC group compared with that in the nontreated and saline groups (P < 0.05). The subepithelial thickness index was lower in the experimental group (P < 0.05). Goblet cell loss was reduced in the experimental group compared with the nontreated and saline groups (P < 0.05). NAC decreases inflammation and goblet cell loss. Therefore, NAC has potential beneficial effects on the wound healing of nasal mucosa in rats.

Background: Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a "cut-as-you-go" technique. We compared these methods with a newer technique utilizing computed tomography (CT)-guided imaging., Methods: Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded., Results: Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%)., Conclusions: A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.

The treatment of frontal sinus fractures is still a matter of research in neurosurgical and craniofacial surgery. The present study aimed to determine new criteria regarding surgical or observational treatment, especially concerning the fracture dislocation. Clinical information on 164 consecutive patients with fractures of the frontal sinus, treated at the Department of Craniomaxillofacial Surgery of the Medical University of Innsbruck from 2006 to 2010, have been evaluated. 23 female (14%) and 141 male (86%) patients suffered mainly from traffic (31.7%) and sports accidents (28.0%), followed by work accidents (20.1%), violence (3.7%) and accidents at home (3.1%). 51.8% presented an isolated fracture of the anterior wall, 47.6% both anterior and posterior wall fracture, 0.6% an isolated posterior wall fracture. Injury of the nasofrontal duct was found in 29.2%, CSF liquorrhoea in 15.9%. In total, 44.5% of the patients underwent surgical therapy, 55.5% were treated conservatively by observation. Treatment decision depended significantly on concomitant injuries of the nasofrontal duct and the presence of rhinoliquorrhoea as well as on the fracture dislocation. A new classification of frontal sinus fractures depending on their maximum dislocation is proposed. In addition, a treatment algorithm considering displacement, liquorrhoea and injury of the nasofrontal duct is presented., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Injury to the nasofrontal outflow tract is important in the treatment of fractures of the frontal sinus. In 2008 preoperative computed tomographic (CT) criteria or signs of such injuries were proposed and stated to be reliable. The aim of this study was to evaluate the validity of these criteria by comparing the radiological evidence with the operative findings. Thirty-nine patients for whom the data from preoperative CT could be compared with operative findings were eligible for the study, all but 4 of whom had at least one indicator of injury to the outflow tract. Patients whose tracts were found to be obstructed at operation had at least 2 preoperative CT signs of obstruction of the tract. If the outflow tract was obstructed all 3 criteria were significantly more likely to be present than if it was intact (p=0.02). Two criteria or fewer did not correlate significantly with obstruction. Fractures were managed by reconstruction (n=18), obliteration (n=11), or cranialisation (n=10). This study is the first to our knowledge to examine the correlation between preoperative CT criteria and operative findings, and there was a significant difference in the number of criteria present depending on whether the outflow tract was intact or injured. Our findings allow for more accurate planning of management of fractures of the frontal sinus., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: In Japan we currently use absorption properties for facial fractures. OSTEOTRANS MX(®) (Takiron co., ltd, Japan) is an absorption device, which is called Super FIXSORB MX(®) in Japan. This absorbable osteosynthetic device constitutes unsintered hydroxyapatite particles/poly l-lactide (u-HA/PLLA) composites. This study focuses on reporting clinical cases of using OSTEOTRANS MX(®)., Materials and Methods: Seventeen patients (16 men and 1 woman) aged 10-80 years (mean: 39.9 years, SD: ±20.7) with 86 fracture sites were treated. In all cases we used 1.0 mm plates and 5 mm or 7 mm screws. The postoperative observation period was 6-60 months (mean: 21.8 months, SD: ±14.5)., Results: The fracture site recovered in all cases. Complications included one bone excess on the forehead and one foreign-body reaction on the frontozygomatic suture, but the fracture sites were recovered and had no problems. In the case with the longest observation time 60 months, the plate was almost fully absorbed. However, in other cases the plate was not fully absorbed because of a shorter observation time., Conclusion: OSTEOTRANS MX(®) is a useful device because of its suitable intensity, thinness, radiopaque, and few complications. A longer observation time is required for a plate to be absorbed completely., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

An implant that had penetrated the nasal cavity of a 53-year-old woman was removed after 10 months. The implant had a resorbable blast media surface and an external connection. Histomorphometric evaluation showed that the mean bone-implant contact ratio was 88.08%, and excellent osseointegration was observed. The mean bone fill between threads was 78.46%.

The presence of shrapnel or a bullet lying in the medial orbital and retrobulbar area is rare. A review of the literature revealed only a few reports. Recently eye/orbital penetrating trauma has increased dramatically, mainly due to IEDs or conventional weaponry in civilian and military casualties. Our experience in the management of these types of injuries prompted this report. Practical techniques for correctly determining the location of retained projectiles in the orbit are described. Surgical techniques for treatment are presented, based on safe and successful practices used in the missile retrievals. Six shrapnel and three bullet injuries, mostly in the medial orbital region, were removed without increasing morbidity and with limited orbital tissue injury., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Injuries to the nose and perinasal region are common. Although the nasal fractures are commonly recognized and properly addressed, injuries to adjacent structures such as the orbit, medial canthus, and midface skeleton can be missed or misdiagnosed, leading to improper primary treatment and subsequent secondary deformities. In this discussion, three common injuries will be discussed, including nasomaxillary fractures, limited naso-orbital-ethmoid fractures, and severe central facial injuries with naso-orbital-ethmoid fractures. For instructional purposes, a case example of inadequate primary diagnosis and subsequent delayed or secondary management will be followed by a case example of proper initial diagnosis and proper primary management., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Here, a case has been reported of a road traffic accident with multiple glass pieces arranged in an unusual pattern in the left maxillary sinus, ethmoid sinus, nasopharynx and medial side of the orbit, as seen in the radiographs. Combined surgical approach through the existing wound and endoscopic surgery was successfully used to remove nearly all the glass pieces.

The inhalation of sulfur mustard (SM) causes substantial deposition in the nasal region. However, specific injury has not been characterized. 2-chloroethyl ethyl sulfide (CEES) is an SM analogue used to model injury and screen potential therapeutics. After the inhalation of CEES, damage to the olfactory epithelium (OE) was extensive. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling-positive cells were present by 4 hours, and maximal at 18-72 hours. Cleaved caspase 3 immunohistochemistry (IHC) was maximal at 18 hours after the inhalation of 5% CEES. Olfactory marker protein (OMP)-positive olfactory neurons were markedly decreased at 18 hours. IHC-positive cells for 3-nitrotyrosine (3-NT) within epithelium were elevated by 8 hours, waning by 18 hours, and absent by 72 hours. AEOL 10150, a catalytic manganoporphyrin antioxidant, administered both subcutaneously (5 mg/kg) and intranasally (50 μM, "combined treatment"), decreased OE injury. CEES-induced increases in markers of cell death were decreased by combined treatment involving AEOL 10150. CEES-induced changes in OMP and 3-NT immunostaining were markedly improved by combined treatment involving AEOL 10150. The selective inducible nitric oxide synthase inhibitor 1400W (5 mg/kg, subcutaneous), administered 1 hour after inhalation and thereafter every 4 hours (five doses), also reduced OE damage with improved OMP and 3-NT staining. Taken together, these data indicate that reactive oxygen and nitrogen species are important mediators in CEES-induced nasal injury.

In order to prepare and apply the polyvinyl alcohol/drug-loaded chitosan microspheres composite wound dressing, we first prepared chitosan microspheres by emulsion cross-linking method, and then added chitosan microspheres into the reactants during the acetalization of polyvinyl alcohol and formaldehyde. We further studied the morphology, water absorption, swelling degree, mechanical properties and in vitro release of the sponge with different amount of chitosan microspheres. The results showed that polyvinyl alcohol/drug-loaded chitosan composite sponge has porous structure with connectionism. Increasing the amount of chitosan microspheres would make the apertures smaller, so that the water absorption and the swelling of sponge decreased, but the tensile strength and compressive strength increased. With the increase of the amount of chitosan microspheres, the drug absorption of cefradine and the release rate increase, and the release time become longer. With the results of toxicity grade of 0 to 1, this type of composite sponge is non-toxic and meets the requirement of biocompatibility. The observation of rabbit nasal cavity after surgical operation suggested that polyvinyl acetal sponge modified with the chitosan has antiphlogistic, hemostatic and non-adherent characteristic, and can promote the healing and recovering of the nasalmucosa. After using this composite material, best growing surroundings for patients' granulation tissue were provided. Exposed bone and tendon were covered well with granulation tissue.

The purpose of this study was to explore the conservative management for an unusual case of transnasal intracranial injury. A 3-year-old female child presenting with transnasal injuries after a domestic accident whereby she apparently fell while holding a large pair of scissors, which then penetrated her left nasal cavity, piercing her nasal cavity, ethmoid sinus, and skull base. The scissors were removed from her nasal cavity. The patient had scant cerebrospinal rhinorrhea and no other additional neurologic deficits noted at the time, as well as no long-term developmental deficits. This report highlights the occurrence of this rare condition. The role of radiologic studies such as computed tomographic scans and plain films in diagnosis and management of this case is affirmed. The strategy of minimally invasive treatment of this injury can be a reasonable treatment option., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Disturbed nasal breathing in the children always was a topical socio-medical problem and has remained such up to now. The objective of the present investigation was to estimate the potential of modern endoscopic techniques for diagnostics of disturbed nasal breathing in the premature infants and to develop therapeutic measures aimed at the prevention of destructive changes in the nose during therapy with the use of continuous positive airway pressure (CPAP). The study included 43 children ranging in the age from 1 month to 2 years (24 boys and 19 girls). All the newborn babies were transferred to the department of resuscitation and intensive therapy for the urgent treatment including respiratory support with the use of the CPAP technique. The endoscopic surveillance made it possible to exactly determine the causes responsible for the disturbances of nasal breathing in the children who survived the critical conditions, to estimate the anatomical and functional conditions of the nasopharyngeal structures, and to develop therapeutic and preventive measures to protect the nose from further destructive changes.

We report the case of a deliberate application of cyanoacrylate adhesive (commonly called "superglue") to the nose of a 9-year-old boy during a fight. The glue was successfully removed under general anesthesia without causing trauma to the nasal mucosa. To the best of our knowledge, only 1 other case of cyanoacrylate injury to the nasal cavity has been published in the literature. We also provide an algorithm to guide clinicians in the future management of this unusual circumstance.

Nasotracheal tube induced nasal ala pressure sores or necrosis during prolonged nasotracheal intubation have been reported, and it is a serious but preventable complication. Here we introduce a modified nasotracheal tube to prevent this complication. This modified nasotracheal tube is composed of two parts, an oral endotracheal tube and a proximal part of a preformed nasotracheal tube, which are linked by a connector. The use of this modified nasotracheal tube can prevent nasal ala pressure sores during prolonged nasotracheal intubation.

The authors describe rare clinical observations of patients suffering transnasal injuries to the base of the skull. Based on their own experience, they propose practical recommendations for the management of such cases.

Objective: Repair of a cerebrospinal fluid (CSF) leak after transsphenoidal surgery (TSS) is usually accomplished using various graft materials. These methods are effective in most, but not all, cases., Methods: Since 2006, we have been directly suturing the sellar floor dura in patients with an intraoperative CSF leak. Fat and/or fascial grafts were utilized only when a major CSF leak developed. The incidence of postoperative CSF rhinorrhea was compared before and after the suture., Results: Postoperative CSF rhinorrhea developed in 3.7% (7 out of 188) of cases before 2005, but never since the dural suture was introduced (0 out of 136, 0%; P = 0.0229). Although watertight closure was not achieved in some cases, narrowing the dural defect and supporting the intrasellar graft was attained in every case. Surgical time was approximately 30 min longer in patients who underwent dural suture (148 +/- 42 min) than those who did not (119 +/- 37 min; P = 0.0001)., Conclusion: Direct suturing of the sellar dura is a simple, safe, and reliable surgical technique for repairing CSF leaks after TSS. Using this procedure, more than 70% of patients with an intraoperative CSF leak can avoid autologous tissue grafts.

Background: Postoperative wound healing of the nasal mucosa is a highly organized process. However, this process still has not been fully understood. The present study aimed to establish a wound healing model in a rat and describe histomorphological changes of the nasal mucosa after mechanical injury., Methods: Unilateral wound in the nasal cavity was induced using the brushing technique in 4-week-old, Sprague-Dawley rats. Experimental rats were divided into five groups (n = 7 for each group). Animals were killed 1 hour and 2, 5, 14, and 28 days after injury. The histological sections were examined for inflammatory cell infiltration, goblet, and ciliated cell formation in hematoxylin and eosin staining. The subepithelial and epithelial thicknesses were measured and expressed as the subepithelial thickness index (STI) and epithelial thickness index (ETI). Fibrosis was evaluated by subepithelial fibrosis index (SFI) in Masson's trichrome-stained sections., Results: Respiratory epithelial discontinuity and hemorrhage were observed 1 hour after injury. On day 2, edematous subepithelium and infiltration of neutrophils could be found on the injured site. Day 5 was characterized by the infiltration of monocytes and granulation tissue. SFI and ETI values increased significantly at day 14. Goblet cells and ciliated cells began to regenerate from day 14 and restored to near normal at day 28., Conclusion: Using mechanical injury, the wound healing model of the nasal mucosa was established in a rat. The regeneration of respiratory mucosa was completed on day 28 after injury.

Between January 2004 and June 2007 we conducted a retrospective analysis to assess post-operative complications related to endoscopic pituitary surgery in a series of 150 patients. Patients were treated with an endoscopic endonasal transsphenoidal approach to the sellar region for removal of pathological sellar and suprasellar lesions. We analysed the complications in groups according to the anatomical structures of the approach and the functional systems of the pituitary gland (anterior and posterior endocrine systems), and compared them to a large historical series using the traditional microsurgical transsphenoidal approach. Overall, we observed a decreased incidence of complications with respect to the surgical trauma, the functionality of the pituitary gland and post-operative patient comfort. We believe that the reduction of the complication rate observed in this study was mainly due to the wide structural overview offered by the endoscope as well as the anatomically direct, and therefore minimally invasive, character of the procedure. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Furthermore, close cooperation between a multidisciplinary team consisting of endocrinologists, neurosurgeons, ear, nose and throat surgeons, radiologists, and radiation oncologists is of utmost importance.

Many articles have detailed local accidents and complications in dental implant treatment. Comparisons of the data they report are not always easy because different criteria have been followed in the various classifications and there is confusion between the terms accident and complication. The aim of this paper is to propose a classification that considers the timing of the events and makes a distinction between the two terms. Accidents are events that occur during surgery, and complications are any pathologic conditions that appear postoperatively. The proper diagnostic procedures and surgical techniques for their prevention and treatment are also described.

Introduction: Needlefish penetrating injuries have become a worldwide problem, inflicting critical morbidities and even mortalities. This is the first published case of needlefish injury in the Mediterranean basin., Case Report: A 29 year old man was admitted to Meir Medical Centre in Israel with a penetrating facial wound caused by elongated needlefish jaws. The severity of the wound contrasted greatly with the expected injury from collision with a fish inflicting a small penetration lesion. The rigid jaws penetrated the maxilla transversely and obliquely from the left canine-fossae, through the nasal cavity, and to the right maxillary sinus, with its tip reaching the right medial-inferior orbital wall. The needlefish jaws were completely removed using a combined endoscopic and external approach. The course of surgery and hospitalization was uneventful and the patient was discharged with no complications., Conclusions: Fish inflicted critical facial injuries might be dangerously underestimated prima facie. The impact might be energetic enough to penetrate deep facial and vital cranial structures, hence thorough examination and imaging are recommended. Needlefish species are now common in the tropical and subtropical regions of all oceans and therefore this phenomenon is of interest to worldwide trauma medical providers, fishermen, divers, and also to marine-biologists.

Epistaxis is a frequent finding in patients with facial trauma. Herein, we report an unusual presentation of pediatric naso-orbital-ethmoid (NOE) fracture with epistaxis as the only initial symptom. The course of the patient's condition was later complicated by meningitis, related in part to the delay in diagnosis. A 3-year-old girl with preexisting upper respiratory symptoms was involved in a traffic accident, sustaining blunt trauma to the right side of her face. During the initial examination, only right-sided epistaxis was noted. Five days later, she developed febrile convulsion and was admitted to the intensive care unit with other signs of meningitis such as mental status change and neck stiffness. Her craniofacial computed tomographic scan showed a right-sided NOE fracture with minimal displacement and without dura tear. The cerebrospinal fluid culture grew Streptococcus pneumoniae, which may be due to ascending infection as a result of cribriform plate fracture. Intravenous antibiotic therapy was initiated with good response, and she was discharged from the hospital after 2 weeks. The presence of epistaxis and periorbital bruise, together with other symptoms and signs, helps in the identification of NOE and cribriform plate fracture. A high index of suspicion with repetitive computed tomographic scans is necessary to achieve correct early diagnosis. Parental antibiotic therapy is indicated if ascending cerebrospinal fluid infection develops.

Objectives: Ethmoidal arteries (EAs) can be responsible for severe bleeding. Clinical features of EA bleeding are rather extensive because it can occur within the nasal cavity or in orbital spaces. Furthermore, surgical management of EA bleeding is challenging., Study Design: Retrospective evaluation., Method of Study: Five clinical patients with severe bleeding from EAs and/or epistaxis refractory to sphenopalatine artery closure were included in this work. Careful anatomic dissection of the orbitoethmoidal region was performed in 3 fresh injected heads., Results: Ethmoidal artery management is not uniform because it depends on the rapidity and severity of the bleeding and the chambers within which it happens. Trauma-related bleeding usually requires a lateral canthotomy, whereas in intraoperative bleeding, efforts should be made to directly coagulate the bleeding vessel, even within the orbital fat. Spontaneous epistaxis refractory to sphenopalatine artery closure is to be addressed externally, preferably under endoscopic vision., Conclusions: Ethmoidal artery management differs according to the clinical situation. Elective surgery is advisable for spontaneous epistaxis, whereas emergency treatment, ranging from intraorbital coagulation of the bleeding vessel to lateral canthotomy (when the patient is in a sight-threatening condition), is necessary when the bleeding occurs within orbital spaces. A treatment management algorithm is useful in cases of severe and refractory EA bleeding.

The effects of an incorporated button battery as a nasal foreign body with regard to the endonasal structures are serious. The following case report will illustrate this on the case of a 4?-year old boy. The acute treatment consisted of the removal of the battery and the debridement of the necroses. Already these measures required considerable medical expenditure. Reconstructive measures which may be needed in the future, will also require a lot of resources. Button batteries as incorporated nasal foreign bodies can lead to severe damage to the endonasal mucoperichondrium. It can lead to necrosis of the nasal septum cartilage and to consecutive nasal septum perforation. Based on these experiences and a review of literature, the conclusions should be drawn that an incorporated button battery should be considered as an ENT emergency case and the immediate removal of the foreign body should be striven for.

Background: Frontal sinus fractures peculiarity is that a wrong treatment not only could it encompass functional or aesthetical problems but also more dangerous complications: the proximity of the frontal bone to the brain, on a side, and to the nasolacrimal duct, on the other side, and therefore to the nasal cavity, lead the traumatisms occurring within this region to be at high risk of infections., Materials and Methods: We report our experience on 132 cases of frontal sinus fracture treated from 1989 to 2005 and to present the surgical techniques performed as well as to compare the complications they reported over time to the International Literature data. 101 patients (76.5%) were treated in order to reduce and contain the isolated fractures involving the frontal sinus anterior wall, the patients presenting associated fractures of the frontal sinus anterior and posterior wall were 28 (21.2%), while the cases reporting isolated fractures of the nasolacrimal duct were 3., Results: Our patients underwent follow-ups from 1 to 16 years long. We subdivided the complications found in our group into infectious and functional so that the incidence of the complications related to the sites and the treatment performed according to the specific case could be better assessed. In conclusion, the infectious and functional complications found were treated with a multidisciplinary study considering the approach to the craniofacial traumatized person is subordinated to the co-existence of general and neurological conditions requiring for their resolution different approaches and times.

Objectives: Problems encountered in the removal of a temporary anchorage device, such as the Orthosystems implant, specially designed for orthodontic anchorage purposes after insertion at the palatal side of the maxilla, are presented and discussed., Material and Methods: The removal of these osseo-integrated implants was originally described to be executed by means of bone cutting around the implant with a trephine explanation burr. However, situations can be encountered in which the orthodontic tooth movement resulted in close contact between the implant and neighbouring teeth or the nasal cavity., Results: Trephine burr bone cutting around the implant can thereby lead to damage of the adjacent tooth with subsequent endodontic problems or perforation of the nasal cavity. In these cases, simple untightening by counterclockwise torque or if unsuccessful, removal of the transmucosal part of the fixture allowing creeping mucosal covering of the implant, should be considered. Furthermore, generation of CT-scan images performed after completion of active orthodontic therapy, with retraction of the upper anterior teeth, seems to be justified and indicated for planning the appropriate removal procedure., Conclusion: Retrospectively, the use of the longer version of the Orthosystems implant (6 mm in length) seems to be obsolete when para-median locations are chosen. Three cases are presented to illustrate these problems.