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Objectives: Squamous cell carcinoma of the nasal vestibule (NV‐SCC) is a rare but challenging entity, due to the complex anatomy of the region. Consensus on the best treatment strategy is still lacking, as well as a dedicated staging system. Our aim was to analyze oncological outcomes of surgically treated patients and to investigate possible prognostic factors. Methods: We performed a retrospective multi‐centric observational study including six Academic Hospitals over a 10‐year period, including only patients who underwent upfront surgery for primary NV‐SCC. Patients were staged according to all currently available staging systems. The Kaplan–Meier method was used to compute overall, disease‐free, and disease‐specific survival. Logistic regression models were used to correlate between survival outcomes and clinical and pathological variables. Results: Seventy‐one patients with a median follow‐up of 38 months were included in the study. Partial and total rhinectomy were the most commonly performed procedures, respectively, in 49.3% and 25.4% of cases. Neck dissection was performed on 31% of patients, and 45.1% of them underwent adjuvant radiotherapy. Three years overall, disease‐specific and disease‐free survival were, respectively, 86.5%, 90.3%, and 74.2%. None of the currently available staging systems were able to effectively stratify survival outcomes. Factors predicting lower overall survival on multivariate analysis were age (p = 0.021) and perineural invasion (p = 0.059), whereas disease‐free survival was negatively affected by age (p = 0.033) and lymphovascular invasion (p = 0.019). Conclusion: Currently available staging systems cannot stratify prognosis for patients who underwent surgery for NV‐SCC. Level of Evidence: 4 Laryngoscope, 134:2634–2645, 2024 [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: The columella has many fundamental functions, such as nasal breathing and support of the nasal tip, in addition to the aesthetic role it plays. The columella is one of the most difficult nasal subunits, both from the point of view of disease control and from that of reconstruction. Lesions involving the columella can be difficult to control, and malignancies can spread to the septum, subcutaneous tissues of the lip, and floor of the nasal cavities. Many columella reconstruction methods after resection have been proposed (local nasal flaps, skin grafts, regional flaps, free flaps), depending on the size of the defect, patient's features, surgeon's experience, and patient's aesthetic wishes. Case Report: We present a case of an 82-year-old woman with various comorbidities who had squamous cell carcinoma (G2) originating from the skin of the right side of the columella. The lesion infiltrated the cartilage, arriving to the skin of the columella on the left side and extending to the mucosa of the nasal septum bilaterally. Reconstruction was conducted using a bilateral nasolabial flap, with good functional and aesthetic result. Surgical revision for the autonomization of pedicled flaps was not necessary, nor desired by the patient. Conclusions: The bilateral nasolabial flap is an effective and safe solution for reconstructing the columella, with good support of the tip even without cartilaginous graft. This technique is especially feasible in elderly patients and those with concomitant pathologies, who benefit from rapid healing of the wound. [ABSTRACT FROM AUTHOR]

Sebaceous carcinoma (SC) is a slow-growing but aggressive malignant skin tumour derived from sebaceous glands. SC most commonly occurs in the periocular region, whereas extraocular sites are rare. SC of the nasal dorsum is a rare pathology, and only a few cases are reported worldwide. Here, we report a case of an 80-year-old man who presented with a mass over the nasal dorsum, diagnosed morphologically and immunohistochemically as sebaceous carcinoma. [ABSTRACT FROM AUTHOR]

Sinonasal malignancies make up

CASE SERIES SUMMARY: Nasal planum tumors are rare in cats, with squamous cell carcinoma over-represented. Other skin tumors have been reported in this location and though hemangiosarcoma frequently occurs on the skin of the head, these tumors localized to the nasal planum have not been specifically reported. The objectives of this study were to report the clinical findings and outcomes in cats diagnosed with hemangiosarcoma of the nasal planum. Medical records from four different institutions were reviewed to identify cats with a definitive diagnosis of hemangiosarcoma of the nasal planum. Five cats met the inclusion criteria. One cat was treated with palliative radiation therapy (RT) alone, two cats had lesions removed via an excisional biopsy by the primary care veterinarian and two cats had excisional biopsies performed at a referral institution. All four cats that received surgical treatment were treated with adjuvant strontium-90 therapy. The cat receiving palliative RT alone was lost to follow-up 311 days after treatment. At the time of writing, the survival time for 2/3 cats receiving surgery and strontium-90 was 365 days and 1381 days, respectively. One cat receiving this combination of therapy was lost to follow-up immediately after treatment. One cat developed tumor recurrence and a revision surgery via nasal planectomy and upper lip resection was performed 376 days following the initial surgery. Following revision, palliative RT was pursued. The cat was still alive at the time of writing 618 days after the initial procedure, with no evidence of recurrence. RELEVANCE AND NOVEL INFORMATION: In this case series, surgery was the primary treatment used, but due to the location, only narrow or incomplete surgical margins were possible. RT (strontium-90 and/or palliative) was utilized to decrease the risk of recurrence.

Purpose: The Nordic countries (27 M) all have comparable, publicly funded healthcare systems, and the management of sinonasal tumours is centralised to the 21 university hospitals. We sought to assess and compare the treatment practice of sinonasal tumours across the Nordic countries. Methods: A web-based questionnaire was sent to all university hospital departments of otorhinolaryngology—head and neck surgery in the Nordic countries. Results: Answers were obtained from all 21 Nordic university hospitals. The endoscopic approach was widely utilised by all, with most (62%) centres reporting 3–4 surgeons performing endoscopic sinonasal tumour surgery. Finland reported the lowest rates of centralisation among university hospitals despite having the highest number of 0.1–1 M catchment population hospitals. Most centres (88%) opted for the endoscopic approach in a patient case warranting medial maxillectomy. In a case of a Kadish C esthesioneuroblastoma, most (52%) of the centres preferred an endoscopic approach. Most centres (62%) reported favouring the endoscopic approach in a case describing a juvenile angiofibroma. Regarding a case describing a sinonasal undifferentiated carcinoma, consensus was tied (38% vs. 38%) between endoscopic resection followed by postoperative (chemo)radiotherapy (RT/CRT) and induction chemotherapy followed by RT/CRT or surgery followed by RT/CRT. Conclusion: Endoscopic approach was widely utilised in the Nordic countries. The case-based replies showed differences in treatment practice, both internationally and nationally. The rate of centralisation among university hospitals remains relatively low, despite the rarity of these tumours. [ABSTRACT FROM AUTHOR]

Introduction: The nose has great aesthetic and functional importance, with a high incidence of malignant lesions. There are several techniques for reconstructing the distal third of the nose, but there is no universal indication; will depend on the characteristics of the injury. Surgical options vary between skin grafts and local, regional, and microsurgical flaps. The objective is to present a series of cases of reconstruction of the distal third of the nose using different surgical techniques, discussing the peculiarities and the results obtained. Method: This is a retrospective study carried out at the Hospital do Servidor Público Estadual de São Paulo (HSPE), evaluating a series of eight patients diagnosed with non-melanoma skin cancer located in the distal third of the nose and who underwent reconstruction by the team of Plastic Surgery. Results: Satisfactory results were obtained for all patients undergoing distal nose reconstruction, using total skin graft techniques (n=1) and local flaps (n=7), such as the bilobed, nasolabial, and dorsal nose flap. nose, paramedian frontal, and nasolabial transposition. Conclusion: Reconstruction of defects in the distal third of the nose is challenging and involves great technical variability. A careful assessment of the patient and the injury must be carried out, risks and benefits assessed and the decision shared with the patient.

PurposeThe FLASH effect is characterized by normal tissue sparing without compromising tumor control. Although demonstrated in various preclinical models, safe translation of FLASH-radiotherapy stands to benefit from larger vertebrate animal models. Based on prior results, we designed a randomized phase III trial to investigate the FLASH effect in cat patients with spontaneous tumors. In parallel, the sparing capacity of FLASH-radiotherapy was studied on mini pigs by using large field irradiation.Experimental designCats with T1-T2, N0 carcinomas of the nasal planum were randomly assigned to two arms of electron irradiation: arm 1 was the standard of care (SoC) and used 10 × 4.8 Gy (90% isodose); arm 2 used 1 × 30 Gy (90% isodose) FLASH. Mini pigs were irradiated using applicators of increasing size and a single surface dose of 31 Gy FLASH.ResultsIn cats, acute side effects were mild and similar in both arms. The trial was prematurely interrupted due to maxillary bone necrosis, which occurred 9 to 15 months after radiotherapy in 3 of 7 cats treated with FLASH-radiotherapy (43%), as compared with 0 of 9 cats treated with SoC. All cats were tumor-free at 1 year in both arms, with one cat progressing later in each arm. In pigs, no acute toxicity was recorded, but severe late skin necrosis occurred in a volume-dependent manner (7-9 months), which later resolved.ConclusionsThe reported outcomes point to the caveats of translating single-high-dose FLASH-radiotherapy and emphasizes the need for caution and further investigations. See related commentary by Maity and Koumenis, p. 3636.

Rhazes, or Abū Bakr Muḥammad ibn Zakariyyā al-Rāzī (854-925 CE), was an Iranian physician, philosopher and chemist. He learned medicine more through the hospital and so-called clinical observations and, therefore, spent more time on his studies; this can be seen in his works and writings. He used the writings of medical predecessors and cited them in his writings. He followed and completed their works and sometimes wrote critiques on their works. In his written medical works, Rhazes has paid special attention to various diseases, notably tumors and cancer. It is noteworthy that over a thousand years ago, a skilled physician presented his explanation and treatment strategies for nasal cancer and tumor status.

Rhazes, or Abū Bakr Muḥammad ibn Zakariyyā al-Rāzī (854-925 CE), was an Iranian physician, philosopher and chemist. He learned medicine more through the hospital and so-called clinical observations and, therefore, spent more time on his studies; this can be seen in his works and writings. He used the writings of medical predecessors and cited them in his writings. He followed and completed their works and sometimes wrote critiques on their works. In his written medical works, Rhazes has paid special attention to various diseases, notably tumors and cancer. It is noteworthy that over a thousand years ago, a skilled physician presented his explanation and treatment strategies for nasal cancer and tumor status. [ABSTRACT FROM AUTHOR]

IntroductionThe short-term adverse events and predictors of morbidity in surgical resection of esthesioneuroblastoma (ENB) are largely unknown, and investigating these variables can help direct planning for at-risk patients.MethodsThe 2005-2017 National Surgical Quality Improvement Program database was queried to identify patients with a diagnosis of ENB undergoing skull base surgery for tumor resection. Information regarding demographics, patient morbidity score, pre-operative and intra-operative data, and post-operative outcomes were extracted. Cox proportional hazard analysis was utilized to assess complication and readmission/reoperation rates.ResultsA total of 95 patients undergoing skull base surgery for resection of ENB were included. Mean age, BMI, operation time, and post-operative length of stay (LOS) of the cohort were 53.6 ± 16.2 years, 29.1 ± 6.5, 392.0 ± 204.6 minutes, and 5.8 ± 4.6 days, respectively. In total, 31 patients (32.6%) experienced at least one 30-day adverse event, which included blood transfusion intra-operatively or within 72 hours from the operation (22.1%), readmission (10.7%), intubation >48 hours (7.4%), reintubation (4.2%), organ or space infection (4.2%), reoperation (4.0%), superficial or deep surgical site infection (2.1%), sepsis (2.1%), pulmonary embolism (1.1%), and myocardial infarction (1.1%). Patients who experienced at least one adverse event had significantly higher operation time (486.8 ± 230.4 vs. 347.5 ± 176.2 minutes, p = 0.002), LOS (9.2 ± 5.6 days vs. 4.2 ± 3.0, p

Objective: To share our experience with nasal reconstruction and to give a standardized algorithm for nasal reconstruction. Study Design: Descriptive cross sectional. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2022. Material & Methods: Data was obtained from patient records after approval from IREB. Patients with multiple co-morbidities and small defects (<1.5cm) were excluded from this study. Defects were classified based on anatomic areas of radix, dorsum, sidewall, alar and lower third nasal defects. Cases were cross tabulated regarding site for the reconstructive options to generate the treatment algorithm. Results: A total of 51 cases were included in the study including 30 (58.8%) male patients. Mean age of patients was 48.12+21.89SD. Skin malignancies were the most common (n=35, 68.6%). Nasal ala was the most common site reconstructed in our study (25.5%) followed by nasal dorsum and sidewalls. Medium size (41.2%) was the most common. In 64.8% (n=33) cases, forehead based flaps were used to reconstruct the nasal defects (Table-I). In 5.9% cases we observed flap congestion. In 19 (37.25%) cases, patients presented with additional soft tissue defects which needed reconstruction (Table-II). Reconstructive options are presented as an algorithm based on the defect site (Figure-1). Conclusion: In this study we shared our experience with the readers regarding reconstruction of the nasal detects. We have formulated an algorithm for reconstruction of these defects that will simplify reconstruction in such cases. [ABSTRACT FROM AUTHOR]

Pleomorphic adenoma is very rare in the sinonasal region, with the most common localization on the nasal septum, followed by lateral nasal wall. In the case presented, a 72-year-old woman was complaining of the right sided nasal obstruction without any other symptoms. The symptom started a year before and increased progressively. Anterior rhinoscopy revealed a mucosa-covered, smooth-surfaced, soft, polypoid, pale, grayish-pink in color mass in the right nasal cavity, approximately 2x2 cm in size. Nasal endoscopy showed the mass to have a broad base on the lateral nasal wall. Computerized tomography scan showed a homogeneous, solid soft tissue mass, 25x18x12 mm in size, which was attached to the lateral nasal wall, behind the nasal vestibule, just in front of the inferior turbinate. Endonasal endoscopic complete tumor excision was performed, during which some spillage of the tumor occurred. Histology diagnosis was pleomorphic adenoma of minor salivary glands. The patient was followed up on regular basis and had no tumor recurrence in the 6th postoperative year. Intranasal pleomorphic adenoma arising from the lateral nasal wall in front of the inferior turbinate is extremely rare, so the presented case is probably the first ever published.

Abstract Objective Respiratory epithelial adenomatoid hamartoma (REAH) is classified as a histopathologic diagnosis and often identified in sinus surgery for chronic rhinosinusitis (CRS). The purpose of this study was to clarify the frequency and predictors of REAH and prognosis of CRS with REAH in CRS cases. Methods In the first study, we histologically reviewed sinonasal polyps and mucosal tissue specimens obtained from patients who underwent endoscopic sinus surgery (ESS) for CRS to reveal how many REAH were involved in ESS cases. We compared REAH and non‐REAH groups in terms of preoperative symptoms and endoscopic, imaging and blood examination findings to elucidate predictors of REAH genesis. In the second study, we compared the data 3 months after surgery such as endoscopic and imaging findings and olfactory test to evaluate prognosis of CRS with REAH. Results The prevalence of REAH was 15.5% of all 304 cases in the first and second studies combined. Higher polyp score in the middle meatus was an independent predictor of the presence of REAH (p = .02). Presence of REAH was significantly associated with the enlargement of olfactory cleft polyps (p

Background: Extranodal NK/T-cell lymphoma, nasal type (ENKL), is an aggressive tumour with poor prognosis. Its early diagnosis may improve the prognosis of patients; however, it is often overlooked in many cases and misdiagnosed as an inflammatory sinus disease during its initial stage. Identifying the clinical characteristics of ENKL may aid otorhinolaryngologists in indicating cases early for a pathologic examination. In this study, we aimed to investigate the clinical characteristics of ENKL compared with that of diffuse large B-cell lymphoma (DLBCL), which is the most common nasal malignant lymphoma. Methods: The backgrounds, clinical symptoms, blood test results, and computed tomography images of patients with nasal/paranasal malignant lymphoma in our hospital between 2012 and 2017 were investigated. The characteristics of ENKL and nasal DLBCL were compared to differentiate them. Results: A total of 27 patients with nasal cavity and/or paranasal sinus lymphoma were included. Extranodal NK/T-cell lymphoma, nasal type, was diagnosed in 10 patients, while DLBCL was diagnosed in 17 patients. The median age of patients with ENKL was significantly lower than that of patients with DLBCL. All patients with ENKL had a unilateral lesion in the nasal cavity, with most located at the inferior turbinate. They also experienced nasal symptoms with significantly higher incidence of nasal obstruction and tendency of bleeding. Conclusion: ENKL was often unilateral and caused nasal obstruction, unlike DLBCL. Those who are younger in age and have sinonasal tumour with unilateral nasal obstruction and bleeding should be considered for early and repeated biopsies at multiple sites, with ENKL taken into consideration. [ABSTRACT FROM AUTHOR]

BACKGROUND: Extranodal NK/T-cell lymphoma, nasal type (ENKL), is an aggressive tumour with poor prognosis. Its early diagnosis may improve the prognosis of patients; however, it is often overlooked in many cases and misdiagnosed as an inflammatory sinus disease during its initial stage. Identifying the clinical characteristics of ENKL may aid otorhinolaryngologists in indicating cases early for a pathologic examination. In this study, we aimed to investigate the clinical characteristics of ENKL compared with that of diffuse large B-cell lymphoma (DLBCL), which is the most common nasal malignant lymphoma. METHODS: The backgrounds, clinical symptoms, blood test results, and computed tomography images of patients with nasal/paranasal malignant lymphoma in our hospital between 2012 and 2017 were investigated. The characteristics of ENKL and nasal DLBCL were compared to differentiate them. RESULTS: A total of 27 patients with nasal cavity and/or paranasal sinus lymphoma were included. Extranodal NK/T-cell lymphoma, nasal type, was diagnosed in 10 patients, while DLBCL was diagnosed in 17 patients. The median age of patients with ENKL was significantly lower than that of patients with DLBCL. All patients with ENKL had a unilateral lesion in the nasal cavity, with most located at the inferior turbinate. They also experienced nasal symptoms with significantly higher incidence of nasal obstruction and tendency of bleeding. CONCLUSION: ENKL was often unilateral and caused nasal obstruction, unlike DLBCL. Those who are younger in age and have sinonasal tumour with unilateral nasal obstruction and bleeding should be considered for early and repeated biopsies at multiple sites, with ENKL taken into consideration. [ABSTRACT FROM AUTHOR]

BackgroundEsthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, represents up to 3% of all sinonasal neoplasms. Hyams histologic grading is a promising tool in predicting metastases and establishing prognoses for this complex tumor.MethodsA systematic literature search was performed in the PubMed, Ovid MEDLINE, and Cochrane databases. ENB patients with Hyams I-II or III-IV were categorized as low-grade Hyams (LGH) or high-grade Hyams (HGH), respectively. Binary and continuous random-effects models were applied to calculate odds ratios (ORs) for the incidences of neck and distal metastases as well as for 5- and 10-year overall survival rates.ResultsOf the 57 screened articles published from 1993 to 2018, 16 (525 patients) and 21 (563 patients) provided data for tumor metastases and overall survival rates, respectively. Neck metastasis was observed in 18.2% of HGH vs 7.9% of LGH patients. Distant metastasis was noted in 20.7% of HGH vs 8.9% of LGH patients. LGH patients had 5- and 10-year overall survival rates of 81.2% and 64.0%, respectively, as compared with 60.9% and 40.6%, respectively, for HGH patients. In comparing HGHs vs LGHs, the collective ORs for neck and distant metastases were 2.08 (95% confidence interval [CI], 1.09-3.99; p = 0.03) and 2.37 (95% CI, 1.07-5.26; p = 0.03), respectively. Moreover, in comparing LGHs vs HGHs, collective ORs for 5- and 10-year overall survival rates were 3.39 (95% CI, 2.09-5.49; p < 0.001) and 3.03 (95% CI, 1.82-5.06; p < 0.001), respectively.ConclusionHGH ENBs, compared with LGH ENBs, are more likely to metastasize to neck or distal targets and to have lower overall survival rates.

BACKGROUND: Fibrous dysplasia belongs to a group of neoplasms known as benign fibro-osseous lesions (osteoma, ossifying fibroma and fibrous dysplasia), which share similar histopathological properties, having as main characteristic the replacement of normal bone by tissue composed of collagen fibers, fibroblasts and a variable amount of mineralized tissue. There's a low incidence of polyostotic fibrous dysplasia affecting the nasal cavity. CLINICAL CASE: A 44-year-old female patient presented with left nasal obstruction, vertigo and one-year history of left frontoparietal headache. Computed tomography showed lesions with a ground-glass appearance at the level of the frontal, parietal, ethmoid, sphenoid, and left temporal bones. Patient underwent surgery, through a functional endoscopic surgery of the nose and paranasal sinuses in order to improve her nasal function, obtaining a good post-surgical evolution. The diagnosis of fibrous dysplasia was confirmed by histopathological study of the material obtained at surgery. CONCLUSIONS: Fibrous dysplasia with nasal presentation is very rare. In this case, the endoscopic treatment obtained a good result in terms of improvement in the nasal symptoms of the treated patient. [ABSTRACT FROM AUTHOR]

Objective: The presentation of unilateral nasal polyps traditionally necessitates histological evaluation for a neoplasm. This study sought to determine the rates of significant pathology in patients presenting with benign-appearing unilateral nasal polyps, to inform practice. Method: All patients who underwent nasal polypectomy for benign-appearing unilateral nasal polyps over a 13-year period were included. Results: A total of 77 patients were included. On histology, 60 cases (77.9 per cent) were found to be inflammatory polyps. Thirteen cases were neoplastic, of which 11 (14.3 per cent) were benign and 2 (2.6 per cent) were malignant neoplasms. The following significant pathologies were found: Schneiderian papillomas, in 10 cases (13.0 per cent); neurofibroma, in 1 case (1.3 per cent); adenoid cystic carcinoma, in 1 case (1.3 per cent); and malignant melanoma, in 1 case (1.3 per cent). Conclusion: Our data support routine histological assessment for all unilateral nasal polyps. Malignancy is rare (2.6 per cent) in patients presenting with benign-appearing unilateral nasal polyps. In elderly, unfit patients with minimal symptoms, initial conservative management may be reasonable. [ABSTRACT FROM AUTHOR]

Objective: Respiratory epithelial adenomatoid hamartoma (REAH) is classified as a histopathologic diagnosis and often identified in sinus surgery for chronic rhinosinusitis (CRS). The purpose of this study was to clarify the frequency and predictors of REAH and prognosis of CRS with REAH in CRS cases. Methods: In the first study, we histologically reviewed sinonasal polyps and mucosal tissue specimens obtained from patients who underwent endoscopic sinus surgery (ESS) for CRS to reveal how many REAH were involved in ESS cases. We compared REAH and non‐REAH groups in terms of preoperative symptoms and endoscopic, imaging and blood examination findings to elucidate predictors of REAH genesis. In the second study, we compared the data 3 months after surgery such as endoscopic and imaging findings and olfactory test to evaluate prognosis of CRS with REAH. Results: The prevalence of REAH was 15.5% of all 304 cases in the first and second studies combined. Higher polyp score in the middle meatus was an independent predictor of the presence of REAH (p =.02). Presence of REAH was significantly associated with the enlargement of olfactory cleft polyps (p <.01), increasing postoperative scores of standard olfactory tests (p =.03), and decline of ratio of improvement (p <.01) measured using T&T olfactometry. Conclusions: Higher polyp score in the middle meatus is an independent predictor of REAH. Olfactory function is difficult to recover after surgery in REAH patients because it is associated with recurrent polyps in the olfactory cleft. [ABSTRACT FROM AUTHOR]

The sinonasal inverted papilloma is a benign tumor located in the sinuses lining the nasal cavity. It is a very rare tumor, representing approximately 4% of all sinonasal tumors. The incidence of sinonasal inverted papilloma is higher in males than females and is most commonly diagnosed in the 5th decade of life. Four separate cases of sinonasal pathology involving inverted papillomas are presented in this case series. The first clinical case presents a 68-year-old man with persistent nasal symptoms, who was found to have a sinonasal papilloma, which was successfully removed surgically. In the second case, a 61-year-old woman needed multiple procedures for a comprehensive surgical approach due to her inverted papilloma. Despite postoperative complications, the patient showed improvement at later follow-up appointments. In the third case, a 65-year-old man who had an inverted nasal papilloma previously needed surgery to remove and clear the tumor after developing acute sinusitis and rhinosinusitis symptoms. Last but not least, a 57-year-old male presented with nasal blockage and purulent discharge. Polyps were observed during the examination. The initial biopsy indicated the presence of chronic inflammatory polyps. However, during the operation, a first sample biopsy revealed an inflammatory polyp, but due to the appearance of the mass, the surgeon became suspicious and decided to take another biopsy. The second biopsy confirmed the presence of an inverted nasal papilloma. All things considered, these cases demonstrate clinical variability, difficulties in diagnosing, and effective management techniques related to inverted and sinonasal papillomas. The aim of this case series is to emphasize the importance of proper history taking, physical examination, and use of diagnostic tools to distinctly diagnose inverted nasal papilloma as its symptoms are similar to rhinosinusitis, especially chronic rhinosinusitis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Committee in King Hamad University Hospital issued approval Exempt. All patients admitted at King Hamad University Hospital consented before their admission for possible participation in case reports or research. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Buali et al.)

In the German Ordinance on Occupational Diseases (BKV), there are currently 82 occupational diseases listed, of which 18 partially or completely fall within the field of ENT medicine due to the associated health disorders. Noise-induced hearing loss is usually the focus of attention for the ENT specialist, but it has long since ceased to be the only occupational disease. In order to help uncover possible causalities between occupational noxious substances and diseases, it is important that physicians report their own observations and new scientific findings regarding suspected cases to the German Social Accident Insurance, especially in situations where cancer may be linked to occupational influences., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

ABSTRACT Basal cell carcinoma is the most common type among skin cancers. It occurs in basal cells and is primarily caused by sun exposure. It mainly affects elderly people, mainly man, in exposed areas of the body and is diagnosed through biopsy. The choice of treatment depends on the type, size, location and depth of penetration, the patient’s age, health conditions and potential aesthetic outcome. The present study aims to evidence, through a case report, the aesthetic and functional importance of the cutaneous transplant technique in cases of tissue loss in the face region by Basal cell carcinoma. A 56-year-old female patient, leukoderma, attended the Maxillofacial Surgery and Traumatology service of the Federal University of Pernambuco, complaining of asymmetry in the nasal dorsum region, with differentiated staining and raised edges. In anamnesis time she reported having suffered sun exposure for long periods. The patient underwent an incisional biopsy and subsequently, with a diagnosis of basal cell carcinoma, a resection of the lesion followed by skin autografting. Good acceptances of the skin flap as well as excellent aesthetic result were attained. The autogenous grafts use has shown satisfactory aesthetic results for remaining coverage after the lesion excision.

ABSTRACT Introduction: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. Methods: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). Results: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. Conclusions: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.

Introduction. The reconstruction of columella defects is still regarded as a challenging procedure due to the very specific anatomy of the columella and limited local and regional flap options. Furthermore, the texture and color of columella tissue pose difficulties in choosing the right method of reconstruction. Case report. The report presents a patient who underwent reconstruction of a complex columella defect using a Schmid-Meyer flap. Schmid-Meyer flap represents a tubular flap with an internal supraciliary pedicle which allows the transposition of the temporal skin with the addition of ear cartilage on the tip of the nose or the ala nasi. The integration of the flap was complete. During the five-year follow-up period, the cosmetic and functional results were satisfying. Conclusion. Schmid-Meyer flap may be one of the best options for the reconstruction of complex defects of the columella.

Lymphomas of the nasal cavity and paranasal sinuses (NPS) are rare. Knowledge on sinonasal B‐cell lymphoma (SNBCL) primarily comes from case series or single‐center studies on small cohorts. We sought to determine the subtype distribution, clinical characteristics, disease behavior, and prognosis on a nationwide scale, with an emphasis on prognostic factors for the most common sinonasal lymphoma, primary sinonasal diffuse large B‐cell lymphoma (PSDLBCL). We collated all data from medical records and national databases on patients registered with SNBCL from 1980 through 2018 in the national pathology registry and collected all tissue samples for validation of diagnosis. We included 205 patients and found 10 different subtypes of lymphoma. Diffuse large B‐cell lymphoma (DLBCL) was the predominant subtype (80%). The incidence of SNBCL was 0.14/100,000 person‐years. The five‐year progression‐free survival (PFS) and overall survival rates for PSDLBCL were 50% and 56%, respectively. For PSDLBCL, Rituximab showed a statistically significant effect (Hazard Ratio 0.22, p < 0.001), whereas consolidative radiotherapy combined with immunochemotherapy was of limited value (PFS, p = 0.93). When treatment failure occurred, DLBCL showed a distinct pattern of recurrence/dissemination to the NPS, skin, breast, central nervous system (CNS), and/or testis. Collectively, DLBCL comprised a clear majority of SNBCLs, although nine other subtypes were represented. Data showed that immunochemotherapy increased survival for PSDLBCL and that the addition of radiotherapy did not benefit patients. Furthermore, treatment failure for sinonasal DLBCL showed a possible common pathogenesis with primary extranodal lymphomas of specific locations (e.g., CNS, skin, breast, and testis). [ABSTRACT FROM AUTHOR]

Surgical defects located within 5 mm of the nasal alar margin are at risk for alar elevation or collapse of the external nasal valve during wound healing. To reduce the chance of such complications, free cartilage grafts may be used as part of the reconstruction. However, if the defect is large enough so that the free cartilage graft does not fill most of the defect, wound contraction can still lead to alar displacement. In these situations, skin may need to be recruited from either the forehead or cheek in the form of an interpolation flap to cover both the free cartilage graft and the residual cutaneous defect. Typically, such reconstructions require multiple procedures at separate time periods and pose prolonged wound care and an inconvenience to the patient. We describe a case of a 94-year-old male who desired an aesthetic reconstruction of a large nasal alar defect that required only a single operative visit. To simplify the repair into a one-stage procedure, a tunneled cheek interpolation flap was performed over a free cartilage graft. J Drugs Dermatol. 2017;16(3):288-290..

Congenital face tumors are frequently referred to the pediatric plastic surgeon. Most of them are benign lesions, but they are striking because of their localization. The nasal midline masses are especially important because they may have intracranial connections, they can cause airway obstruction and because the delay in correct diagnosis and treatment may cause long term sequelae. We will focus on the diagnosis and treatment of nasal glial heterotopia regarding a two-year-old patient. [ABSTRACT FROM AUTHOR]

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The reconstruction of deep surgical defects of the nasal tip and wing of the nose often presents a challenge to the surgeon. In these cases, full-thickness skin grafting is widely used, but it often results in sinking or graft depression. We present a surgical technique that is easy to perform and reproducible; nonetheless still very little diffused in Brazil: the “Drumhead” graft. This method performs the grafting of a rigid plastic suspension together with the full-thickness skin graft. Thus, this technique constitutes another tool for the dermatological surgeon to prevent irregularities of undesirable contours, graft depression, and nasal vestibule collapse.

Osteoma cutis is a rare tumor characterized by the presence of bone tissue in the dermis and/ or hypodermis. We describe the case of a patient diagnosed with osteoma cutis on the scalp for approximately ten years with progressive growth and local alopecia area. The patient underwent surgical excision of the lesion using the rotation flap "S" italic technique to reconstruct the area aiming at the best possible aesthetic result.

Keratoacanthoma (KA), although frequent in clinical practice, is a tumor that raises questions. The most intriguing aspect is associated with its position on the border between malignancy and benignity. The approach to the tumor, as well as its classification, is controversial. When defining the conduct, it is essential to consider the potential for transformation into squamous cell carcinoma. Thus, surgical excision is the therapy of choice, whenever possible. Some cases require additional attention, such as associated immunosuppression. In this article, we report a case of giant KA in a patient with acquired immunodeficiency syndrome treated with Mohs micrographic surgery.

Introduction: the reconstruction of skin defects in the distal part of the nose is always a challenge. The dorsal nasal flap, initially described by Gillies, was unveiled when Rieger, in 1967, described the use of a modified rotation flap that used the redundant skin of the glabella to repair full-thickness defects of the lower half of the nose of equal or greater size of 2 cm, allowing reconstruction in a single surgical time. Methods: A retrospective study was carried out, selecting patients who had basal cell carcinoma, in the middle and/or lower third of the nose, who were treated at the Plastic Surgery outpatient clinic of the Plastic Surgery Service Prof. Dr. Oswaldo de Castro, in the period from 2017 to 2019. Results: The total number of patients was six, with ages ranging from 64 to 95 years, with an average of 80.67 years. Five of these patients were male, with only one female. There were no complications during or after the procedures. Also, there were no cases of infection, bleeding, hematoma, dehiscence, or necrosis of the flap. Conclusion: the Rieger flap is a good option for cases of reconstruction of defects located in the lower half of the nose; it is performed in a single moment, is easy to perform, and has a high level of patient satisfaction. It provides an adequate result aesthetics of the reconstructed area, in texture and color, through the use of specific tissues for the nasal covering.

The present clinical report describes the fabrication of an implant-retained prosthesis with bar and clip retention for a patient with total rhinectomy due to basal cell carcinoma (BCC). The nasal prosthesis was retained on the face by a reverse Y-shaped bar with horizontal and vertical extensions, resulting in favorable retention and function.

The nasal region is a frequent site of keratinocyte carcinomas. Its peculiar anatomy, contour, and three-dimensionality make surgical repair challenging. Eventually, in situations of greater complexity, a single technique may not be sufficient to restore the original anatomy, requiring the association of methods. This article describes a strategy for reconstructing a full-thickness alar defect, including the nasal margin, based on the combination of a nasolabial transposition flap with a hinge flap. It is a safe procedure, dependent on the mobilization of local tissue and performed in a single surgical procedure.

Aims: Sinonasal teratocarcinosarcomas (SNTCS) are rare sinonasal malignancies, the incidence of which is less than 1% of all tumors. There is limited data available on SNTCS's, often as case reports and small case series. The management of SNTCS is complicated because of its location, locally aggressive biology, difficulty in achieving complete resection, and limited data on chemotherapy in these malignancies. This audit was performed to understand the role of neoadjuvant chemotherapy (NACT) in SNTCS's, its ability to downstage the disease, achieve complete resection, and impact on long-term survival outcomes., Methods: This was a retrospective analysis of a prospectively maintained database approved by the Institutional Ethics Committee (IEC). The baseline characteristics, the extent of tumor, Kadish stage, NACT regimen, and adverse events were extracted from the Electronic Medical Records and the patient's case file. Patients with baseline extensive/inoperable disease were referred for NACT from the multidisciplinary joint clinic followed by response assessment (RECIST v1.1). Patients underwent skull-base surgery if respectable post-completion of NACT, however, if deemed unresectable were treated with non-surgical modalities or palliative therapies., Results: The data of 27 patients were evaluated from the year 2015-2022. The median age was 42 years (IQR:30-56) and 85.2% (n = 23) were males. The ECOG-PS was 0-1 in 88.8% (n = 24) patients. All 27 patients received NACT in view of extensive disease at presentation. 74.1% (n = 20) patients received Cisplatin-Etoposide and 25.9% (n = 7) received other chemotherapy regimens. The median number of chemotherapy cycles was 2(IQR:2-3). 96.3% patients (n = 26) completed the planned NACT cycles. 70.4% (n = 19) patients achieved a partial response in post-NACT imaging. 77.8% (n = 18) underwent surgery, 18.5% (n = 5) received CTRT, and 7.4% (n = 2) received definitive-RT alone. The median PFS and OS of the cohort was 19months (95%CI:12.0-25.6) and 23months (95%CI:5.94-40.06) respectively., Conclusion: NACT is safe, feasible, and effective with significant response rates, leading to effective downstaging, resectability and improved survival in patients with locally advanced SNTCS's., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Nasal sebaceous carcinoma is an extremely rare cutaneous malignancy. We present the case of an 86-year-old female who had a skin nodule with surface telangiectasia on the right ala of the nose. The lesion had been removed and has been reconstructed with an advancement rotational flap with a minimal residual defect. Upon histopathological examination, the lesion was diagnosed with sebaceous carcinoma. The patient was followed up because of the high rate of recurrence as well as metastatic potential. No recurrence occurred during 4 years of follow-up, and the patient was unwilling to reconstruct the remaining alar defect. We present a rare skin cancer case that could be encountered during the head and neck examination by oral and maxillofacial surgeons. By reporting this case, we aimed to raise the awareness and familiarize clinicians with these less common lesions. [ABSTRACT FROM AUTHOR]

Two cases of a large fungal ball of the paranasal sinuses and nasal cavity are presented and its removal via an endoscopic approach is detailed. The clinical symptoms of the fungal body of the paranasal sinuses are not specific. With one-sided localization and large sizes of fungal bodies, they must be differentiated from neoplasms. The most informative non-invasive diagnostic method is computed tomography. We are presenting two cases of giant fungal bodies of the paranasal sinuses and identified specific CT signs.

ObjectiveTo characterise the relationship between lacrimal gland dose and ocular toxicity among patients treated by intensity-modulated radiotherapy (IMRT) for sinonasal tumours.Methods40 patients with cancers involving the nasal cavity and paranasal sinuses were treated with IMRT to a median dose of 66.0 Gy. Toxicity was scored using the Radiation Therapy Oncology Group morbidity criteria based on conjunctivitis, corneal ulceration and keratitis. The paired lacrimal glands were contoured as organs at risk, and the mean dose, maximum dose, V10, V20 and V30 were determined. Statistical analysis was performed using logistic regression and the Akaike information criterion (AIC).ResultsThe maximum and mean dose to the ipsilateral lacrimal gland were 19.2 Gy (range, 1.4-75.4 Gy) and 14.5 Gy (range, 11.1-67.8 Gy), respectively. The mean V10, V20 and V30 values were 50%, 25% and 17%, respectively. The incidence of acute and late Grade 3+ toxicities was 23% and 19%, respectively. Based on logistic regression and AIC, the maximum dose to the ipsilateral lacrimal gland was identified as a more significant predictor of acute toxicity (AIC, 53.89) and late toxicity (AIC, 32.94) than the mean dose (AIC, 56.13 and 33.83, respectively). The V20 was identified as the most significant predictor of late toxicity (AIC, 26.81).ConclusionA dose-response relationship between maximum dose to the lacrimal gland and ocular toxicity was established. Our data suggesting a threshold relationship may be useful in establishing dosimetric guidelines for IMRT planning that may decrease the risk of acute and late lacrimal toxicities in the future.Advances in knowledgeA threshold relationship between radiation dose to the lacrimal gland and ocular toxicity was demonstrated, which may aid in treatment planning and reducing the morbidity of radiotherapy for sinonasal tumours.

Abstract: Advancement flaps are important reconstructive options after skin cancer removal on the nose. Donor areas vary according to defect location and size. The objective of this article is to illustrate the versatility of advancement flaps in nasal reconstruction. Five patients were selected. All cases were treated with Mohs' micrographic surgery prior to reconstruction to ensure that 100% of the surgical margins were free of cancer. Advancement flaps can be used to repair a wide variety of surgical defects on the nose with good matching of skin color, texture, and thickness. With careful planning, resulting scars can be camouflaged in natural boundary lines, leading to good functional and cosmetic outcomes.

Objectives: This study aimed to investigate the effect of narrow band imaging (NBI) examination on differentiating diagnosis between benign and malignant neoplasms involving nasal cavity. Design, Setting, Participants: A retrospective study was conducted to analyse cases from January 2018 to December 2019 at a single centre. A total of 188 consecutive patients who were newly diagnosed with lesions in unilateral nasal cavity underwent complete examination with white light endoscopy (WLE) and NBI endoscopy. Biopsy specimens were harvested from the target lesions and sent to the pathologist for definite diagnosis. Participants with a history of congenital malformation, trauma and surgery in nasal cavity were excluded from the study. Main outcome measures: Endoscopic diagnosis was assessed using sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV, respectively). Results: In identifying benign and malignant lesions of nasal cavity, NBI had a significant higher sensitivity (92.7% vs 70.7%, P =.020) and NPV (98% vs 92.3%, P =.032) than WLE, but there were no significant differences between NBI and WLE in specificity (98.6% vs 97.3%, P =.684), accuracy (97.3% vs 91.5%, P =.416) and PPV (95% vs 87.9%, P =.400). Conclusion: NBI as an emerging technique can improve the diagnostic accuracy by distinguishing benign and malignant lesions in nasal cavity and remains a promising and helpful adjunct to the endoscopy techniques. [ABSTRACT FROM AUTHOR]

BackgroundSinonasal papillomas are benign epithelial neoplasms arising from Schneiderian mucosa. The three subtypes, exophytic, oncocytic, and inverted (inverted papilloma [IP]), should be distinguished from one another histopathologically. This study (1) highlights the histopathological and clinical differences between the Schneiderian papilloma subtypes and (2) identifies clinical features that potentially predict papilloma subtypes.MethodsA retrospective review was performed of patients with Schneiderian papillomas over an 11-year period.ResultsSeventy patients with sinonasal papillomas who underwent sinus surgery were identified. There were 50 (71%) male and 20 (29%) female subjects diagnosed at an average age of 53 years (range, 13-80 years). Exophytic (n = 25), oncocytic (n = 9), and IP (n = 37) were identified. IP was associated with transformation into squamous cell carcinoma in three (8%) cases and dysplasia in three (8%) cases. Neither oncocytic nor exophytic subtypes were associated with dysplasia or malignancy. On multivariate analysis of potential predictors of papilloma subtype, history of chronic rhinosinusitis (CRS) and location of papilloma were significantly associated with papilloma subtype. Using classification and regression tree model, papilloma subtypes can be predicted based on presence or absence of CRS and papilloma location with nominal 82.4% accuracy.ConclusionThe inverted and exophytic type are the most common sinonasal papillomas, with the inverted type having an 8% rate of malignant transformation in this study. In contrast, the oncocytic type was not associated with dysplasia or malignancy in our series despite reports in the literature indicating malignant potential. History of CRS and papilloma location can provide clues to the histological subtype, which is important for surgical planning and patient counseling.

Esthesioneuroblastoma (EN) is a rare sinonasal tumor with varied aggressiveness and potential for intracranial invasion. EN is staged anatomically with radiographic evaluation using the Kadish staging system (stages A, B, and C) and histologically by using Hyam's criteria (grades 1-4). Here we show that despite radiographic evidence of aggressive features, the prognosis of patients with Kadish stage C EN is best predicted by tumor histology using Hyam's criteria. We retrospectively analyzed patients with EN with Kadish stage C who were evaluated and treated at our institution between 1995 and 2009. Clinical information was collected using patient medical records, imaging, and review of pathological specimens. Twenty patients with Kadish stage C EN were identified with mean age of 51 years (31-70 years) with a median follow-up of 41.4 months (1.3-175 months). Upon pathological review, 44.4% of patients had low-grade (1/2) and 55.6% had high-grade (3/4) histology. About 37.5% of patients with low-grade EN had undergone gross total resection (GTR) and the remaining 62.5% had GTR and adjuvant radiation, whereas 50% of patients with high-grade ER had undergone GTR, 20% had undergone GTR and adjuvant radiation, and 30% had been treated with a subtotal resection (STR) and adjuvant radiation. The 5-year and 10-year survival in patients with low-grade EN was 86% in comparison to 56% and 28% with high-grade EN, respectively. In patients with low-grade EN, the 2-year progression free survival (PFS) was 86% and the 5-year PFS was 65% in comparison to 73% and 49% in patients with high-grade EN, respectively. The patient's tumor histology (Hyam's criteria) appeared to be the best way of predicting the prognosis and for selecting patients for adjuvant radiotherapy.

Adenoid cystic carcinoma (ADCC) is a malignant tumor of salivary gland origin. ADCC of sinonasal tract is rare. We present a rare and unresectable case of sinonasal ADCC with intracranial extension in an 83-year-old man with the chief complaint of nasal congestion. Invasion to the maxillary sinus, nasopharynx, anterior cranial fossa, sella turcica and extension to cavernous sinus, dura mater and infratemporal fossa were evident on MRI and CT scan. The patient was treated only by palliative radiotherapy, but unfortunately, he died 3 months after the initial diagnosis. [ABSTRACT FROM AUTHOR]