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Rhinitis
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Vinay Mehta, Srinivasan Ramanuja, Pramod S Kelkar
The internal ostium is the entrance to the nasal cavity. The turbinates (inferior, middle and superior) are located laterally and lined with pseudostratified columnar respiratory epithelium. They are important in air filtration and air conditioning. The nasal septum, which forms the medial wall of the nasal cavity, divides the nose into two nostrils, and is composed of membranous, cartilaginous and bony components.
The respiratory system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Physical aspects Finally, it is important to ask about any deformity of the nose. Nasal symptoms can be caused by deviation of the nasal septum as a result of previous trauma. The nasal septum can also be affected by Wegener’s granulomatosis, syphilis and leprosy.
Paediatric epistaxis
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
On inspection, look for signs of anaemia (pale conjunctiva, blanched palmar creases, etc.) and possible bleeding disorders (bruising, telangiectasia, bleeding gums). Given that the vast majority of children present with anterior nosebleeds, anterior rhinoscopy is the next step of the exam. Use a headlight and Thudichum’s or Killian nasal speculum with fine Zoellner suction to thoroughly examine the anterior nose, looking for engorged vessels or a possible bleeding point. In very young children, anterior rhinoscopy may be performed using a well-illuminated otoscope (Figure 27.2). If no obvious bleeding point is seen, light agitation of the nasal septum using a cotton tipped swab is appropriate and can reveal occult bleeding points. If no bleeding point or obvious vessel is seen, flexible nasendoscopy (FNE) or rigid endoscopy using an appropriate topical decongestant with local anaesthetic (e.g. co-phenylcaine) is warranted, if tolerated. Endoscopy is also an essential diagnostic procedure in any male presenting with unilateral epistaxis or where JNA is a concern.
A new technique for Asian nasal tip shaping: "twin tower" folding ear cartilage transplantation
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Long Zhang, Jiang-wen Wang, Jun Ding, Xi Zhang, Xi-mei Wang, Zhan-zhao Zhang, Run-ze Yu
The nasal scaffold constructed by ear cartilage is also based on the nasal septum cartilage and maxillary nasal spine. A piece of the ear cartilage is folded cephalad and then stuck on the nasal septum, equivalent to the extended graft of the nasal septum and the support graft of the nasal columella. According to the hardness and length of the nasal septum cartilage, the ear cartilage stent can determine how much the ear cartilage overlaps with the nasal septum cartilage to extend the nasal septum and help shrink a short nose or nasal columella. It can also move back and forth to permit fixing onto the middle or posterior horn of the caudal margin of the nasal septum according to need, and reasonably raise the height of the nasal tip. The two auricular cartilages were folded in half and fixed on the caudal margin of the nasal septum to form two isolated "tower"-shaped cartilages. After suturing the two together, a cartilage scaffold resembling a triangle was formed. We use the prosthesis combined with ear cartilage transplantation instead of autologous tissue. The reason is that the amount of autologous ear cartilage taken out is not enough. If only autologous tissue is used, it is not enough to completely adjust the height of the nasal dorsum.
Frontoethmoidal mucocele presenting with ocular manifestations
Published in Clinical and Experimental Optometry, 2020
Two components within the lesion were noted on T2‐weighted axial magnetic resonance imaging of the head with fat saturation: a hyperintense component anteriorly, nasally, and posteriorly (Figure 4, blue arrows) and a hypointense complement centrally representing trapped fluid, inspissated secretions/haemorrhage or mucosa (Figure 4, red arrow). On coronal T1‐weighted images, the lesion showed a prominent superior hyperintensity (Figure 5, blue arrow) and less prominent inferior hyperintensity (Figure 5, red arrow), consistent with the previously mentioned trapped fluid, inspissated secretions/haemorrhage or mucosa. The surrounding bone appeared intact, without blow‐out fracture or intracranial extension, taking into consideration the enhancement was difficult to appreciate due to underlying T1 hyperintensity within the lesion. The left lobe was normal. There was a deviated nasal septum. The retro‐orbital contents – which includes retro‐orbital fat – extraocular muscles and optic nerve were normal.
Perioperative nasal and paranasal sinus considerations in transsphenoidal surgery for pituitary disease
Published in British Journal of Neurosurgery, 2020
Lisa Caulley, Ravindra Uppaluri, Ian F. Dunn
The nasal septum is a midline bony-cartilaginous structure that divides the nasal passages. Manipulation and resection of the nasal septum may be required to provide additional exposure in the transsphenoidal approach. However, surgeons should preserve normal nasal septum when possible to reduce the risk of structural compromise of the nose or septal perforation.14 Septoplasties for severe nasal septal deviation that obstructs the endonasal corridor are required infrequently, reported in 1.8% of cases.36 A dorsal and caudal septal segment of 1 cm, termed the L-strut, must be maintained to ensure dorsal and tip support for the nose.14 In order to establish binarial exposure of the sphenoid sinus, a posterior septectomy must be performed.32 A posterior septectomy of 15 mm provides surgical exposure equivalent to the mean inter-opticocarotid recess. Additional septectomy beyond 20 mm does not provide significant additional surgical exposure or freedom.32 While many surgeons removing the bony septum entirely, it may be profligate in most cases.