phenylephrine-hydrochloride and Cartilage-Diseases

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

Topics: Calcinosis; Cartilage Diseases; Female; Humans; Infant; Male; Nasal Obstruction; Nose; Pregnancy; Prenatal Exposure Delayed Effects; Warfarin

In our study, we showed that the septal extension graft (SEG) technique, which we applied for nasal projection in rhinoplasty surgery, increases the tension of the lateral cartilage (LC) and alar structures. We also demonstrated that nasal congestion could be treated by applying this technique in patients with nasal obstruction due to bilateral dynamic alar collapse.. This study was conducted retrospectively on 23 patients with nasal obstruction due to alar collapse. Bilateral dynamic nasal collapse and (+) Cottle test was present in all patients. Nasal lateral wall tissue was also found flaccid on nasal palpation and collapsed to the extent of obstruction on deep inspiration. Standard septal extension graft (SEG) and tongue-in-groove techniques were applied to all patients.. Septal cartilage was used for SEG in all patients. No complaints of nasal obstruction on deep inspiration were noted by the patients at six months postoperative follow-up, and Cottle tests were negative. The patients' mean respiratory score was 152 postoperatively, compared to 66.5 preoperatively. This difference was statistically significant using the Wilcoxon signed ranks test (p<0.001). In evaluating postoperative cosmetic appearance due to nasal tip projection (NTP) and cephalic rotation changes, 16 men and four women reported that it was better, while two men felt that there was no change. One woman reported that her cosmetic appearance was worse than before; a revision surgery was performed for her at seven months postoperatively.. This method is effective for patients with bilateral nasal collapse and thick-short columella. With the applied surgery, the caudal edge of the LC diverges from the septum, alar region tension and resistance increase, the columella increases in length, nasal projection increases, and the vestibule cross-sectional area is enlarged. In this way, a significant increase in nasal vestibular volume was obtained.

Topics: Cartilage; Cartilage Diseases; Female; Humans; Male; Nasal Obstruction; Nasal Septum; Nose; Retrospective Studies; Rhinoplasty

Nasal biopsy is the essential method for differentiating and diagnosing granulomatosis with polyangiitis (GPA) in patients with chronic rhinosinusitis. Nevertheless, in the real clinical settings, there are several cases unable for nasal biopsy. Hence, in this study, we investigated initial clinical manifestations and laboratory factors which could be helpful for diagnosing GPA in cases unable for nasal biopsy performance. We retrospectively reviewed the medical records of 45 patients with GPA. Twenty-five patients exhibited chronic rhinosinusitis, among which 16 patients underwent nasal biopsy. We applied the 2007 European Medicines Agency algorithm for the classification of GPA, the 2012 Chapel Hill Consensus Conferences Nomenclature of Vasculitis and the 2017 American College of Rheumatology/European League Against Rheumatism provisional classification criteria for GPA to them for reclassifying GPA. Among six patients without granuloma on nasal biopsy, three patients with only antineutrophil cytoplasmic antibody (ANCA) and chronic rhinosinusitis could be classified as GPA due to proteinase 3 (PR3)-ANCA (or cytoplasmic (C)-ANCA) positivity. Among nine patients without nasal biopsy, three patients with only chronic rhinosinusitis could be classified as GPA due to GPA-specific lung lesions. When we excluded an item of granuloma in ten GPA patients with granuloma on nasal biopsy, four patients without ANCAs could be classified as GPA due to GPA-specific lung lesions and cartilaginous involvement. In conclusion, PR3-ANCA (or C-ANCA) positivity, GPA-specific lung lesions and cartilaginous involvement could help physicians in charge make a final diagnosis of GPA in cases unable for nasal biopsy.

Topics: Adolescent; Adult; Aged; Antibodies, Antineutrophil Cytoplasmic; Biopsy; Cartilage Diseases; Child; Female; Granulomatosis with Polyangiitis; Humans; Lung Diseases; Male; Middle Aged; Myeloblastin; Nose; Retrospective Studies; Rhinitis; Sinusitis; Young Adult

A preliminary survey showed half of the participating Royal Netherlands Air Force (RNLAF) F-16 fighter pilots to have nasal integument and osteocartilagenous disorders related to wearing in-flight oxygen masks.. To make an inventory of these disorders and possible associated factors.. All RNLAF F-16 pilots were requested to fill out a semi-structured questionnaire for a cross-sectional survey. Additionally, one squadron in The Netherlands and pilots in operational theater were asked to participate in a prospective study that required filling out a pain score after each flight. Pilot- and flight-related variables on all participants were collected from the RNLAF database. A linear mixed model was built to identify associated factors with the post-flight pain score.. The response rate to the survey was 83%. Ninety of the 108 participants (88%, 6 missing) reported tenderness, irritation, pain, erythema, skin lesions, callous skin, or swelling of nasal bridge integument or architecture. Seventy-two participants (71%, 6 missing) reported their symptoms to be troublesome after a mean of 6±3 out of 10 flights (0;10, 54 missing). Sixty-six pilots participated in scoring post-flight pain. Pain scores were significantly higher if a participant had ≥3 nasal disorders, after longer than average flights, after flying abroad, and after flying with night vision goggles (respectively +2.7 points, p = 0.003; +0.2 points, p = 0.027; +1.8 points, p = 0.001; +1.2 points p = 0.005). Longer than average NVG flights and more than average NVG hours per annum decreased painscores (respectively -0.8 points, p = 0.017; -0.04 points, p = 0.005).. The majority of the RNLAF F-16 fighter pilot community has nasal disorders in the contact area of the oxygen mask, including pain. Six pilot- or flight-related characteristics influence the experienced level of pain.

Topics: Adult; Aircraft; Cartilage Diseases; Cross-Sectional Studies; Erythema; Humans; Masks; Middle Aged; Military Personnel; Nose; Occupational Diseases; Oxygen; Pain; Prospective Studies; Risk Factors; Surveys and Questionnaires; Young Adult

Keutel syndrome is a rare autosomal recessive disorder, characterized by brachytelephalangia (short, broad distal phalanges), midfacial hypoplasia, abnormal cartilage calcifications, peripheral pulmonary stenosis and hearing loss. Binder profile is a well known maxillonasal dysplasia composed of midfacial hypoplasia with absence of anterior nasal spine and facial dysmophism (short nose, flat nasal bridge, perialar flatness, convex upper lip). Here we report a Keutel syndrome presenting with Binder phenotype, abnormal calcifications, hearing loss and respiratory insufficiency in the newborn period. Keutel syndrome should be considered in the differential diagnosis of children with tracheobronchial calcifications, midfacial hypoplasia and stippled epiphysis.

Topics: Abnormalities, Multiple; Calcinosis; Cartilage Diseases; Chondrodysplasia Punctata; Diagnosis, Differential; Fatal Outcome; Hand Deformities, Congenital; Humans; Infant, Newborn; Maxilla; Maxillofacial Abnormalities; Nose; Pulmonary Valve Stenosis

AIM of the study is to identify histological and histochemical peculiarities of nasal septum cartilage reconstruction in patient with different remoteness of trauma.. Patients of both sexes at the age of 16-39 years have been operated on. Depending on remoteness of the period from the trauma, witch caused the deformation, till the surgery, the materials was divided into 2 group: I group (36 patients) 1-5 years from the trauma to the surgery, II group (23 patient) 10-20 years from the trauma to the surgery. Bioptats of the nasal septum cartilage were fixed in Carnoy mixture. Paraffin sections were stained with hematoxilin and eozin, after Van Ghison on collagen fibrils, toluidine blue on acid glycoaminglicans (GAG) and Brashe reaction on RNA.. Thus, the histological and histochemical investigation of nasal septum cartilage, received in rhinoplasty, has revealed dystrophic changes in cartilage. Basing on the analysis of the material, we can conclude that the degree of expression of these changes depends on three factors: - localization of examined area of the nasal septum (bioptat); - the period of time the deformation exist; - the degree of septum curvature. The structure of cartilage bioptates in the patients with relatively short (1-5 years) duration of traumatic deformation differs from the normal hyaline cartilage by moderate dystrophic changes of some chondrocytes (20-25% of all the cells) in the central zone of the cartilage as well as by irregular distribution of acid GAG in cartilage matrix. Cartilage tissue dystrophic changes are still more pronounced in the patients with a longer period of nose deformation including nasal septum curvature. This fact indicates that these changes are connected with deformation duration rather than with etiology of the process. The analysis of material also enable to find the dependence of cartilage dystrophic changes on the degree of nasal septum deformation: at the 3rd degree of curvature, chondropathy is more pronounced than at the 1st-2nd degree.

Topics: Adolescent; Adult; Biopsy; Cartilage Diseases; Female; Histocytochemistry; Histological Techniques; Humans; Male; Nasal Septum; Nose; Nose Deformities, Acquired; Rhinoplasty; Time Factors

Foley's catheter is used for post-nasal packing in severe epistaxis. Various methods have been described for securing the catheter in position, all of which can be associated with patient discomfort, risk of alar necrosis or unsightliness. We describe a new method to secure the Foley's catheter without these problems. The ribbon gauze used for anterior nasal packing is tied over the catheter in multiple knots to secure it in place. This has been successfully tried on over 50 patients.

Topics: Acute Disease; Cartilage Diseases; Catheterization; Epistaxis; Hemostasis, Surgical; Humans; Necrosis; Nose

We have introduced a method of securing a Foley's catheter in the nose, in the management of posterior epistaxis. Our method has the advantage of securing the catheter in situ, while maintaining traction on the balloon in the posterior nasal space and preventing nasal alar cartilage necrosis.

Topics: Cartilage; Cartilage Diseases; Catheterization; Epistaxis; Equipment Design; Humans; Necrosis; Nose

To describe and document the development of tumoral proliferation of cartilage in 4 patients after nasal surgery, a complication that, to our knowledge, has not been reported before.. Similar postoperative nasal masses were excised from 4 patients who underwent rhinoplasty. Histopathologic evaluation was carried out to identify the nature of the lesions and to provide a basis for rational management of similar lesions subsequently encountered.. Academic tertiary referral center.. Four healthy patients (3 women and 1 man) ranging in age from 21 to 49 years. Two of the patients underwent routine rhinoplasty with resection of cephalic margins of alar cartilages, and 2 underwent augmentation procedures with implantation of auricular cartilage.. Discrete firm masses were excised from each patient's nose approximately 1 year after the most recent rhinoplastic procedure was performed. Histological evaluation was carried out on each specimen.. All 4 masses were found to consist of tumefactive proliferation of cartilage. Clonal proliferation and mild nuclear atypia were observed.. After rhinoplasty, progressive asymmetrical fullness in or adjacent to cartilaginous structures or graft material should suggest the possibility of tumefactive proliferation of cartilage and should be evaluated with surgical exploration. All areas of thickened cartilage should be excised completely, with immediate auricular cartilage reconstruction of resulting anatomical defects. Perichondrium should be completely removed from auricular cartilage implants in the nose, and mechanical injury to the graft should be minimized. We strongly caution against morsellizing dorsal cartilage implants for nasal reconstruction.

Topics: Adult; Cartilage Diseases; Female; Humans; Male; Middle Aged; Nose; Rhinoplasty

An auricular or nasal chondritis or a saddle nose deformity are the initial manifestation in half of cases of relapsing polychondritis; the other initial manifestations are various and less evocative; polyarthritis, laryngo-tracheal symptoms, episcleritis which delay the diagnosis. From 15 cases of relapsing polychondritis, the diagnosis time from the first symptom are studied; this one is long, about 3 years and 6 months (from 3 months to 17 years) in 13/15 of the cases even if the first manifestation is typical (external chondritis). In two cases only, the diagnosis was established after the first attack. This late of diagnosis had socioeconomical impact and exposed to severe complications like tracheal chondritis.

Topics: Adult; Aged; Cartilage Diseases; Diagnostic Errors; Ear Cartilage; Female; Humans; Laryngeal Diseases; Male; Middle Aged; Nose; Polychondritis, Relapsing; Retrospective Studies; Time Factors; Trachea

To evaluate the clinical characteristics and treatment outcome of hematoma and abscess of the nasal septum (HANS) in children.. Retrospective case series.. Pediatric tertiary care facility.. Consecutive series of 20 children (age, 2 months to 15 years; mean age, 7 years) who were admitted to the hospital for treatment of HANS after nasal trauma during an 18-year period.. In addition to receiving antibiotics, all patients underwent general anesthetic for incision and evacuation of the collection of blood and pus together with nasal packing.. All patients had a history of nasal trauma. The HANS was a consequence of child abuse (2 patients younger than 2 years), minor nasal trauma (14 patients aged 1 to 10 years), and sports injury (4 patients older than 10 years). The diagnosis was made 1 to 14 days (mean, 5.9 days) after the episode of trauma. Nasal obstruction was the most common symptom found and was present in all but 1 patient. Pain, rhinorrhea, and fever occurred in 50%, 35%, and 25% of patients, respectively. Nasal fracture was present in 3 children. Abscess was found at surgery in 12 patients and was universally associated with septal cartilage destruction. Hematoma was present in 8 patients and associated with cartilage destruction in 2 patients. Organisms cultured were Staphylococcus aureus, Streptococcus pneumoniae, and group A beta-hemolytic streptococcus and were obtained from all 12 patients with septal abscess and from 1 patient with septal hematoma. Corrective nasal surgery has been performed in 5 patients, 4 of whom had a history of septal abscess.. The diagnosis of HANS must be considered in all children who have acute onset of nasal obstruction and a history of recent nasal trauma to minimize the risk of nasal deformity and prevent the development of septic complications.

Topics: Abscess; Adolescent; Cartilage Diseases; Child; Child, Preschool; Drainage; Female; Hematoma; Humans; Infant; Male; Nasal Septum; Nose; Retrospective Studies

Relapsing poly(peri)chondritis (RP) is a connective tissue disorder characterized by recurrent inflammatory episodes of cartilaginous structures and the involvement of special sense organs. The diagnostic criteria of McAdam 1976 include at least three of the following criteria: a) bilateral auricular chondritis, b) nonerosive sero-negative inflammatory polyarthritis, c) nasal chondritis, d) ocular inflammation, e) respiratory tract chondritis, f) audiovestibular chondritis. A cartilage biopsy according to these criteria is not mandatory. Nevertheless, unclear cases still remain as there is a broad spectrum of differential diagnosis. In these individuals it is important to obtain a biopsy from the affected cartilage. Although up to 89% develop auricular inflammation, only few electron microscope studies are performed on cartilage specimens. The purpose of this study is to report on a patient with a history of recurrent swelling of both ears, where the diagnosis could only be established by ear biopsy which was studied by light and electron microscopy. Differential diagnosis is discussed and a review of the literature is given.

Topics: Biopsy; Cartilage Diseases; Diagnosis, Differential; Ear Cartilage; Humans; Inflammation; Male; Middle Aged; Nose; Polychondritis, Relapsing

The typical nose deformity after cleft-lip repair still represents great challenge for the plastic surgeon in this field. Many methods have been designed in attempts to correct the deformity, either during primary closure of the lip or as a secondary procedure when growth of the nose is complete. In this paper the author's own technique of secondary rhinoseptoplasty in cleft-lip patients is presented. The different cartilaginous and osseous structures are approached through a transcolumellar incision and the skin of the nose completely reflected upwards. This so-called "open sky view" gives a total perspective on the entire pathology of the cleft-lip nose deformity and makes it possible to correct it accordingly. Emphasis is put on some important surgical manoeuvers. Recent results are presented and the pros and cons of this procedure discussed.

Topics: Adult; Cartilage Diseases; Cleft Lip; Female; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Rhinoplasty

A case of relapsing polychondritis with atrophic lesions in nose and ears and conjunctivitis is presented. The patient was treated with dapsone during 18 months with remission of the acute breaks.

Topics: Atrophy; Basal Ganglia; Calcinosis; Cartilage Diseases; Conjunctiva; Dapsone; Ear, External; Female; Humans; Middle Aged; Nose; Recurrence

The existence of a cartilaginous facial structure, the mesethmoid, has been demonstrated in the newborn human infant. This structure is the peri- and post-natal tissue developed from the embryonic cartilaginous nasal capsules. Unrecognized during facial development, the cartilaginous mesethmoid, partly because of its multidirectional growth, is responsible for frontonasomaxillary osteomembranous centrofacial morphogenesis. Practical aspects are discussed, and studies to determine the post-natal structures derived from the mesethmoid are in progress.

Topics: Cartilage; Cartilage Diseases; Cleft Palate; Ethmoid Bone; Facial Muscles; Humans; Infant, Newborn; Maxillofacial Development; Morphogenesis; Nose

Topics: Achondroplasia; Bone and Bones; Cartilage Diseases; Cleft Palate; Diagnosis, Differential; Dwarfism; Eye Abnormalities; Female; Humans; Infant, Newborn; Karyotyping; Limb Deformities, Congenital; Nose; Ossification, Heterotopic; Radiography

Topics: Aorta, Thoracic; Aortic Valve Insufficiency; Cartilage Diseases; Ear; Humans; Male; Middle Aged; Nose; Polychondritis, Relapsing; Urethritis

Topics: Adult; Audiometry; Calcinosis; Cardiac Catheterization; Cartilage Diseases; Child; Child, Preschool; Chromosome Aberrations; Chromosome Disorders; Congenital Abnormalities; Female; Fingers; Hearing Disorders; Heart Function Tests; Humans; Labyrinth Diseases; Male; Nose; Pedigree; Pulmonary Valve Stenosis

Topics: Bronchi; Cartilage Diseases; Female; Humans; Inflammation; Middle Aged; Nose; Tomography; Trachea

Collapse of the nasal alae against the septum brings about a serious obstruction to the airway. Collapse may be overlooked on routine examination because the speculum may prevent it. In most cases alar collapse can be corrected by a simple surgical procedure, herein described, which can be readily done at the same time as operation on the caudal portion of the septum.

Topics: Cartilage; Cartilage Diseases; Humans; Male; Nasal Surgical Procedures; Nose; Nose Diseases; Rhinoplasty