Remifentanil Target Controlled Infusion for conscious sedation in a pregnant woman: safety and efficacy

Background: Every year 2% of pregnant women undergo non-obstetric surgical interventions worldwide. According to the American College of Obstetricians and Gynaecologists Committee on Obstetric Practice, pregnant women should never be denied the most appropriate surgical treatment regardless of the trimester of pregnancy.However, additional attention should be paid during the first trimester since there is the highest risk of inducing teratogenic mutations; similarly, during the third trimester, due to the possibility of preterm birth and low weight of the new-born great care should be paid.Case presentation: We present the case of a 36-year-old woman during her 21st week of pregnancy, with a normal-sized foetus according to the gestational age on ultrasound exam and with no additional risk factors. The patient referred an increasing nasal obstruction associated with rhinorrhoea of the left nasal cavity. She also reported episodes of sleep apnoea and hyposmia.The patient received a detailed otolaryngological examination which allowed to identify a mass within the left nasal cavity. The subsequent nasal endoscopy confirmed a greyish polypoid mass lesion with a multinodular surface occupying the entire left nasal fossa. The lesion totally obliterated the left maxillary sinus resulting in obstruction of the anterior osteo-meatal unit and ethmoidal sinusitis She was referred for functional endoscopic sinus surgery (FESS) using analgosedation with Remifentanil Target Controlled Infusion.Discussion and conclusions: To the very best of our knowledge this is the first case described in English literature about the use of analgosedation with Remifentanil Target Controlled Infusion for otolaryngology surgery, specifically in FESS. It could be an interesting option to avoid the use of inhaled anaesthetics that could induce foetal damage, especially during the first months of pregnancy. Furthermore, patient intubation is not necessary, avoiding cases of difficult intubation or any trauma to the airways. An adequate informed consent and the appropriate compliance are elements of paramount importance in tailoring the anaesthetic strategy for pregnant women who need non-obstetric surgical management.

A Case of Schwannoma in Subfrontal Area and Nasal Cavity

Schwannoma is a benign solitary neoplasm emerging from the Schwann cells of the peripheral, cranial and autonomic nerves. Approximately 25 to 45% of schwannomas occur in the head and neck region. However, schwannoma in the subfrontal area, nasal cavity or paranasal sinus is very rare and accounts for only 4% of these neoplasms. We experienced a case of schwannoma in the subfrontal area and left nasal cavity in a 74-year-old man who complained of recurrent rhinorrhea. We report this unusual case of schwannoma with a review of the literature.

Invasive pulmonary and sino-orbital mucor mycosis in patient with SARS-Cov-2 infection with diabetic ketoacidosis

Patients with Severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) are susceptible for developing fungal infection due to uncontrolled diabetes or immunosuppression. A 46 years male presented with diabetic ketoacidosis, respiratory failure with peri orbital blackish discoloration with SARS-Cov-2 positive report. Computed tomography (CT) chest was suggestive of perihilar ground glass opacity and multiple thick-walled cavities. Left nasal cavity scrapings revealed hyaline aseptate hyphae and growth of Rhizopus arrhizus. Patient was initially managed conservatively with liposomal amphotericin B but later underwent orbital exenteration and finally succumbed. We want to emphasize higher mortality and aggressive management of mucor mycosis when it occurs with SARS-Cov-2 as a concurrent illness.

Mucocele of a giant inferior turbinate concha bullosa mimics a nasal mass: case report

Background The concha bullosa is a pneumatized nasal turbinate commonly middle turbinate but that of the inferior turbinate is an uncommon entity. A giant inferior conchal pneumatization with mucocele formation is not reported in the literature till now. Case presentation A 17-year-old female patient presented with bilateral severe nasal obstruction. Anterior rhinoscopy and endoscopic examination revealed a giant mass which filled the left nasal cavity completely, pushing the septum to the contralateral side. The paranasal sinus CT showed a mass in the left nasal cavity ballooning the whole nasal cavity with compression of the nasal septum to the right side. MRI was done and the lesion was hyperintense in T2 MRI sequences and hypointense in T1 sequences consistent with a cystic lesion. The patient was consented and prepared for endoscopic resection under general anesthesia. The lesion was completely separated from the nasal septum and the orbit but attached to the lateral nasal wall at the site of origin of the inferior turbinate. Conchoplasty was done and patient follow-up for 9 years is excellent with complete disappearance of all patient symptoms. Conclusions Concha bullosa of the inferior turbinate should be considered in the differential diagnosis of nasal tumors, nasal cystic lesions, and preoperative evaluation of endoscopic sinus surgery. Also, a systematic approach for dealing with nasal lesions with thorough examination and radiological review will be of great value in decision-making. The anatomy of the paranasal should be thoroughly examined prior to endoscopic sinus surgery to develop treatment strategies and to prevent possible complications.

Nasal Maggot Infection in a Patient With Nasal Non-Hodgkin’s Lymphoma

We describe a case of nasal non-Hodgkin’s lymphoma in a 79-year-old Chinese patient accompany with nasal myiasis. The first 2 biopsies in this case were false negative. Subsequently, nasal maggots developed in this patient. After removing all maggots under nasal endoscopy, the patient continued to have recurrent fever and was transferred to a higher hospital for further treatment, in which he received a third biopsy. Unfortunately, several hours after the biopsy, the patient died for severe nasal bleeding. The final biopsy result indicated the neoplasm of the left nasal cavity was non-Hodgkin’s lymphoma. This case illustrates the importance of repeated biopsies for nasal non-Hodgkin’s lymphoma if necessary. Nasal myiasis is a secondary disease of nasal non-Hodgkin’s lymphoma in this case.

Frontal Sinus Schwannoma: Case Report and Literature Review

Whilst schwannomas are mostly developed in the head neck area, the sinonasal involvement is extremely rare, especially those of the frontal sinus. We report a patient with sinonasal schwannoma, invading both frontal sinuses, anterior cranial fossa, the left anterior ethmoidal sinus, and the left nasal cavity. Radiologic imaging showed an isodensed, T2 isointense, T1 hypointense, with heterogeneous enhanced postcontrast mass with bone destruction. The patient underwent resection of the tumor via two approaches, external one and endonasal one. The histological diagnosis was consistent with a schwannoma. The follow-up was marked by the presence of diplopia without any signs of meningitis or cerebrospinal fluid rhinorrhoea.

Case report of a large rhinolith cast – A frequently missed diagnosis

Background: Rhinoliths are calcified or mineralized concretions that are deposited around a nucleus and are usually unilateral. They are rare with an estimated incidence of 1:10000 of all ENT outpatient cases. This may be an underestimation as many cases remain asymptomatic since the process may take years to develop. Case Report: We report a case of unilateral nasal obstruction since childhood in an adult male where the diagnosis remained obscured until thorough assessment was done. According to the anterior rhinoscopic and nasoendoscopic examination, there was an irregular bony mass occupying the left nasal cavity from the floor to the middle meatus. The diagnosis of rhinolith was confirmed by nasoendoscopy and non-contrast CT (NCCT) scan, and it was removed piecemeal from the nose. Conclusion: This case underlines the importance of a detailed clinical and endoscopic examination of the nose in adult cases with unilateral nasal obstruction. It also highlights the potential for misdiagnosis of such cases at the hands of general practitioners or physicians and the importance of early referral to an otolaryngologist in case of treatment failure by established protocols.

Large Rhinolith Mimicking Atypical Odontogenic Pain: Case Report and Brief Review of the Literature

Rhinoliths are rare calcified entities in the nasal fossa, frequently originating around a nidus near the midway point in the inferior meatus, where the passage is the narrowest. They can be clinically asymptomatic and undetected for years. In this study, we present a rare case of large rhinolith mimicking atypical odontogenic pain in a 40-year-old Caucasian female in the left nasal cavity. The lesion was detected in the CBCT and removed uneventfully.

LINKING CHRONIC OTITIS MEDIA AND NASAL OBSTRUCTION: A CFD APPROACH

ABSTRACT OBJECTIVES: To investigate a possible relationship between altered nasal flow and chronic otitis media (COM) using computational fluid dynamics (CFD). DESIGN: Retrospective cohort sample of CT scans from patients with COM and controls without COM to compare the results of various nasal airflow parameters determined by CFD between a group of patients with COM (N=60) and a control group of subjects without any evidence of ear disease (N=81). MAIN OUTCOME MEASURES: The CT were subjected to various procedures to carry out CFD studies, determining the resistance to nasal flow, the proportion of flow through the right and left nasal cavity, and two nondimentional estimators. The results of CFD studies between patients with COM and controls were compared. RESULTS AND CONCLUSIONS: Whereas only 12.3% of the controls had CFD alteration (10 out of 81), 43.3% of the patients suffering COM displayed alterations of our nondimentional parameters (26 out of 60). According to our results, the incidence of alterations in nasal airflow by studying with CFD is significantly higher in patients with COM than in controls IMPLICATIONS: To our knowledge, this is the first paper linking nasal cavity and COM using a CFD approach. Our results support the hypothesis that nasal flow alterations could be implicated in the etiopathogenesis of the COM.