Histological Features of the Nasal Passage in Juvenile Japanese White Rabbits

Rabbits are sometimes used for intranasal toxicology studies. We investigated the postnatal development of the nasal passage in juvenile Japanese white rabbits from just after birth to 6-week-old to provide information for conducting intranasal toxicological evaluation using juvenile animals. On postnatal day (PND) 1, the nasal passage consisted of the septum with mostly cartilaginous nasal wall and turbinates. The lining squamous, transitional, respiratory, and olfactory epithelia were already distributed similar to adults and were still underdeveloped. The nasal passage gradually expanded with age, as did the nasal wall, including the turbinates formed by endochondral ossification. The maxilloturbinate elongated, during which it branched complexly. The respiratory epithelium takes the form of columnar epithelium together with a reduction in goblet cells. In addition, the olfactory epithelium had clear cytoplasm in the ethmoturbinate, the olfactory nerve bundles thickened, and Bowman’s gland acini increased in size and number. Other tissues, including the vomeronasal organ, nasal-associated lymphoid tissue, and nasolacrimal duct, also developed histologically with age. This investigation characterized the postnatal histological development of the nasal passage in Japanese white rabbits, providing basic knowledge regarding the histological examination and rationale for appropriate study design of intranasal toxicology studies in juvenile rabbits.

MINIMAL INVASIVE SURGICAL METHODS FOR TREATMENT OF CHRONIC PERFORATED SINUSITIS

The main factors of the odontogenic maxillary sinuses inflammation are perforation of the maxillary sinus bottom during teeth removal, anatomical and physiological features of the maxillary sinus structure when the root or roots are located in the cavity of the maxillary sinus, which is independent of the dental surgeon in any case, a perforation of the maxillary sinus bottom during teeth removal, as well as more complex chronic processes in periodontium, which form resorption of bone tissue within the bottom of the maxillary cavity, and clinical cases with the root penetrating the cavity of the maxillary sinus or the foreign body penetrating the genyantrum. Difficulties appear in the operation of removing the upper jaw teeth, which are located near the bottom of the maxillary cavity or in the genyantrum cavity, and in the presence of inflammation, accompanied by bone resorption. Therefore, in order to prevent complications of perforated sinusitis, there is a need to develop new non-invasive methods of prevention and treatment of perforation of the bottom of the maxillary cavity. One can state with certainty that traditional traumatic surgical interference, such as Caldwell-Luc radical antrostomy, is less frequently used in clinical practice. Nowadays many authors offer less traumatic methods for treating perforations and maxillary sinus fistula. We also offer our options of surgical interference using the domestic bone and plastic material (Kergap), GAP “Biomin”. In the case of the foreign body penetrating the maxillary sinus cavity, under the conduction anesthesia, a mucosal flap from the vestibular side is formed, and, if necessary, another one may be formed from the palatine side. We extend the bone hole to the necessary size so that it is possible to get the foreign body out through it, use a curettage spoon to remove the pathologically altered mucous membrane of the maxillary cavity till a healthy bone, then cover the bone hole with the osteoplastic material and cover it with the mu- cous flap, fix it and suture with the “Vikril 3,0” material. In case of maxillary cavity perforation during teeth removal operation, which roots break through the bottom of the maxillary sinus, which does not depend on the experience and qualifications of the dental sur- geon, the edges of the perforated hole are smoothed with a cutter or bone forceps in such a way that there are no sharp perforation eminences. Be sure to wash the sinus with a warm solution of antiseptic. We cover the bone joint between the maxillary and the oral cavity (with Kergap), GAP Biomin. After that, cover the maim with the cut bone flap and suture with the “Vikril 3.0” material. In more complex clinical cases, such as chronic long-term inflammatory processes without exacerba- tion of pathological processes in the genyantrum sinus of odontogenic origin, when a foreign body pene- trates the maxillary cavity, we decided to modify extreme maxillary sinusotomy using the Caldwall-Luc method, which became the goal of our research. Description of surgical interference: under local anesthesia, we simultaneously carry out an operation for removing the causative tooth and make a trapezoidal incision in the area of the maxillary sinus transi- tional wall. After that, we make a bone hole on the anterior wall of the maxillary sinus, do not sculpt the pathologically altered mucus, remove the foreign body through the bone hole. Antiseptic treatment is carried out during surgical interference. If there is a route between the maxillary sinus and the lower nasal passage, we do not form another one. After applying antiseptic, we put the bone flap onto the place and fixed with non-absorbing sutures, sew the removed tooth well with a pre-closed perforation aperture using osteoplastic material (Kergap), GAP Biomin. After that, we irradiate the surgical wound with a helium-neon laser, which provides a gentler healing period of the wound after surgery. Seams are removed on the 8th-12th day after surgery. The patients were examined both in the short term and in the long-term, after a year or more. No relapses of the oronasal route were found, bone wound healed in the period of 6-8 months, and contrast Rg-scans showed no regression of polyposis and granulation dilatations. In our opinion, this is the result of etiopathological treatment aimed at eliminating the cause. Thus, according to our research treatment and prevention of perforated sinusitis requires etiopathological treatment. The formation of an oronasal route during the causative tooth removal of odontogenic sinusitis re- quires the closure of this route with osteoplastic material (Kergap), GAP Biomin, while suturing the tooth. In the case of a foreign body entering the maxillary cavity, the traditional method opens the maxillary cavity in order to remove the foreign body through the anterior wall of the maxillary sinus and treats it with the solution of antiseptics without making a route with the lower nasal passage. It can be combined with the causative tooth removal and the tight suturing of the mucous flaps, which is less a traumatic surgical interference than the extreme Caldwall-Luc method of sinusotomy. Eliminating the inflammation cause of the maxillary sinus in combination with the osteoplastic closure of the oronasal route with tight suturing is a thorough treatment compared to the traditional technique. The regularities discovered as a result of clinical and X-ray quality assessment of non-invasive surgical methods for the treatment of chronic perforated sinusitis require further long-term studies and evaluation of other factors that influence the success of chronic perforated sinusitis treatment.

Effect of immune drugs to treat acute viral nasopharyngitis

The task in treating acute nasopharyngitis (ANP) deals with reducing the disease symptoms and the risk of complications. The lack of reliable antiviral drugs makes it important to search for appropriate medicines among other pharmacotherapeutic groups.The study involves a comparative analysis of the efficiency and estimates potential: the recombinant interferon α2b and the compound containing fungal β-D-glucans used in treat ANPThe studies involved patients with ANP from 18 to 55 years old. As many as 152 people were examined including the following: 38 were practically healthy people (group 1); and 114 patients wuth ANP: 38 people (group 2) was subject to a standard therapy (vasoconstrictor nasal drops, nasal cavity irrigation using 0.1% Miramistine solution, gargling using the Furacilin solution); forty people (group 3) were administered application of intranasal interferon α2b of 105 IU, it was delivered with a spray into each nasal passage twice a day; 36 people (group 4) were administered an immunotropic drug containing β-D-glucans orally twice a day. The duration of drug administration lasted 7 days. Polymerase chain reaction (PCR) was used to identify the ANP etiological factor. Concentrations of cytokines IL-1β, IL-1ra were estimated using enzyme immunoassay (ELISA) technique. Clinical efficiency was assessed through score approach. The following symptoms were taken into account: general malaise, sore throat, character of nasal discharge, and the difficulty of nasal breathing. The results of the study were analyzed using parametric and nonparametric statistical methods. In 60.0% the nasal secretions of patients revealed RV. The distribution of cytokine concentrations in nasal secretions in group 1 indicated that the concentration of IL-1β was in the range of 20.0-25.0 pg/ml, and the concentration of IL-1ra was about 1250.0-2500.0 pg/ml. Developing ANP stimulated an increase in IL-1β concentration up to 30.0-70.0 pg/ml in nasal secretions of patients without affecting IL-1ra concentrations. On day 7 of treatment, the cytokine concentrations among the patients treated using the immunotropic drugs were the same as in the group of healthy individuals. There were no significant changes in cytokine production on day 7 in the group of patients undergoing the standard treatment. Application of proposed immunobiological medicines to ANP does not result in overproduction of proinflammatory cytokine IL-1β in nasal secretion. This confirms that these drugs are promising in the treating strategy including reduction of the risk of developing complications.

Optimization of Local Anesthesia during Radical Maxillary Sinusotomy in Dental Patients

The purpose of the study was to give a clinical evaluation of the effectiveness of endonasal blockade of the nasopalatine nerve in different ways during radical maxillary sinusotomy in dental patients. Materials and methods. Clinical observations were performed in 50 patients diagnosed with chronic odontogenic maxillary sinusitis. Radical maxillary sinusotomy was performed under local potentiated anesthesia. All patients underwent anesthesia on the maxilla according to classical methods. Patients, depending on the methods of endonasal blockade of the nasopalatine nerve, were divided into two clinical groups: the main (24 people) and the comparison group (26 people). Patients of the main group underwent endonasal blockade of the nasopalatine nerve at the site of its branch from the pterygopalatine ganglion. In patients of the comparison group, the blockade of this nerve was performed before its entry into the incisal canal. The effectiveness of anesthesia was evaluated for clinical and autonomic manifestations of pain stress. Results and discussion. During the removal of polyps and pathological granulations from the mucous membrane of the maxillary sinus in patients of the main group there was no pain, no emotional-motor and autonomic manifestations of pain stress, which confirmed the effectiveness of the endonasal method of anesthesia of the nasopalatine nerve. In patients of the comparison group during similar surgical manipulations the full effect of local anesthesia was achieved in 50.0% of cases (χ2 – 8.065, р = 0.005). These were patients who had hypopneumatized or moderately pneumatized types of maxillary sinuses. The rest of the patients during the operation had emotional – motor and autonomic manifestations of pain stress during the removal of pathologically altered mucous membrane located on the medial wall of the maxillary sinus. Conclusion. Complete anesthesia of the mucous membrane, maxillary sinus, regardless of the degree of its pneumatization is achieved during the usage of endonasal blockade of the nasopalatine nerve at the site of its branch from the pterygopalatine ganglion during radical maxillary sinusotomy in dental patients. Anesthesia of the nasopalatine nerve in the lower nasal passage, before its entry into the incisal canal, allows painless surgery only in patients with hypopneumatized maxillary sinuses and in most patients with moderate pneumatization

Myoepithelial Carcinoma ex Pleomorphic Adenoma: Rare Case Report with Clinicopathologic and Immunohistochemical Features

Introduction/Objective Myoepithelial carcinoma is identified by nearly exclusive myoepithelial differentiation and evidence of malignancy. It may arise de novo or in preexisting benign tumors including pleomorphic adenoma and benign myoepithelioma. It occurs most commonly in the parotid gland followed by submandibular glands, minor salivary glands, and occasionally in the sublingual gland. Nasopharyngeal origin has been rarely reported. Methods/Case Report An afebrile 19-year-old female presented to the emergency department with persistent facial pressure, otalgia (right side greater than left side), rhinorrhea, and several episodes of epistaxis. One month before, she has been treated with Amoxicillin for three days with no relief, where Augmentin started for her for five days. About four days prior presentation, she was placed on Prednisone and Cefdinir. Over the next several days, she began having throat pain with difficulty swallowing. Routine blood work revealed a leukocytosis of 14.2 with normal differentiation. CT of the neck showed a large soft tissue mass centered at the right nasopharynx. Flexible nasal endoscopy performed bilaterally to reveal the nasopharynx is entirely obstructed with a lobulated mass filling the nasopharynx. On the right side, it extends into the posterior nasal passage filling the sphenoethmoid recess and the posterior floor of the nasal passage. Outpatient biopsy from nasopharynx mass is also performed. Results (if a Case Study enter NA) Mass biopsy reveals a mucinous and chondromyxoid background with mixed epithelial and myoepithelial differentiation. The is squamous metaplasia of myoepithelial cells and prominent mitotic activity and apoptotic activity. Immunohistochemistry was positive for CK5/6, calponin, BCL2, SMA, BerEp4, Sox10, and a proliferative index up to 40%. Based on this information Myoepithelial Carcinoma ex-pleomorphic adenoma of the nasopharynx is the diagnosis. Conclusion Carcinoma ex pleomorphic adenoma is usually a high-grade malignancy. It occurs most commonly in the parotid gland, followed by submandibular glands, minor salivary glands, and occasionally in the sublingual gland. Our case is one of the few cases of myoepithelial carcinoma arising in nasopharyngeal pleomorphic adenoma.

Comparison of nostril sizes of newborn infants with outer diameter of endotracheal tubes

Background Recommendations for endotracheal tube (ETT) size usually refer to the inner diameter (ID). Outer diameters (OD), however, vary greatly between manufacturers, which in some brands might cause difficulties in passing the ETT through the nostrils if choosing the nasal route for intubation. Even though the nostrils are dilatable by an ETT, it might be difficult to pass an ETT through the posterior naris (narrowest point of the nasal passage), if the OD is bigger than the nostrils. Therefore, nostril size may provide some guidance for the appropriate ETT size preventing unsuccessful intubation attempts. This study therefore compares nostril sizes of newborn infants with ODs of ETTs from several manufacturers. Methods This is a subgroup analysis of a prospective observational study, performed in a single tertiary perinatal centre in Germany. The diameter of the nostril of infants born between 34 and 41 weeks´ gestation was measured in 3D images using 3dMDvultus software and compared to the OD of ETT from five different manufacturers. Results Comparisons of nostril sizes with ODs of different ETTs were made for 99 infants with a mean (SD) birthweight of 3058g (559) [range: 1850-4100g]. Mean (SD) nostril size was 5.3mm (0.6). The OD of the 3.5mm ETT of different manufacturers ranged from 4.8-5.3mm and was thus larger than the nostril size of 20-46% of late preterm or term infants. Some OD of a 3.0mm ETT were even bigger than the OD of a 3.5mm ETT (e.g. the 3.0mm ETT from Rüsch® has an OD of 5.0mm while the 3.5mm ETT from Portex® has an OD of 4.8mm). Conclusions Clinicians should be aware of the OD of ETTs to reduce unsuccessful intubation attempts caused by ETT sizes not fitting the nasal cavity. Generated data may help to adapt recommendations in future. Trial registration Subgroup analysis of the “Fitting of Commonly Available Face Masks for Late Preterm and Term Infants (CAFF)”-study: NCT03369028, www.ClinicalTrials.gov, December 11, 2017.

Sinonasal Tissue Remodelling during Chronic Rhinosinusitis

The purpose of this review is to summarise contemporary knowledge of sinonasal tissue remodelling during chronic rhinosinusitis (CRS), a chronic disease involving long-term inflammation of the paranasal sinuses and nasal passage. The concept of tissue remodelling has significant clinical relevance because of its potential to cause irreversibility in chronic airway tissues. Recent studies have indicated that early surgical treatment of CRS may improve clinical outcome. Tissue remodelling has been described in the literature extensively with no consensus on how remodelling is defined. This review describes various factors implicated in establishing remodelling in sinonasal tissues with a special mention of asthma as a comorbid condition. Some of the main histological features of remodelling include basement membrane thickening and collagen modulation. This may be an avenue of research with regard to targeted therapy against remodelling in CRS.

Supernumerary tooth in nasopalatine canal: a rare cause of septal cartilage collapse

Mesiodens is the most common type of supernumerary tooth, located between the maxillary central incisors in close relation to the nasopalatine canal. A 20-year-old man presented with right-sided nasal blockage, nasal discharge and collapsed nose without history of trauma. Imaging revealed a calcified mass in the inferior meatus extending into dilated nasopalatine canal. Endoscopic removal of the mass revealed tuberculate appearance of an incompletely developed tooth, consistent with mesiodens. Based on the history of septal cartilage collapse with right-sided mucopurulent discharge, endoscopic findings of the right inferior turbinate being adherent to the septal cartilage and the underlying mesiodens, we believe that the patient developed a septal abscess secondary to infection in nasal mucosa surrounding the mesiodens causing collapse of septal cartilage. While a tooth or tooth-like mass causing nasal passage air-flow obstruction is uncommon, we believe that this is the first reported case of mesiodens presenting with septal cartilage collapse.

The Prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) Nasal Passage among Medical and Non-Medical Students at Al-Jouf University

This study aimed to compare the occurrence of potentially nasal Staphylococcus aureus (S. aureus) of both female medical students and non-medical students at Al-Jouf University and its resistance & sensitivity of methicillin antibiotic. A cross-sectional study was conducted on 30 females’ volunteers. Students including 15 medical students and 15 non-medical students. Specimens were taken from the subjects by a sterile moistened swab, which inserted into each nostril in turn, to a depth of approximately 1 cm, and rotated five times. Then the specimens were subjected to bacteriological examination, isolated S. aureus were subjected for further identification by biochemical tests. Then methicillin antibiotic test sensitivity and resistant were performed on isolates. We found that S. aureus in both samples medical and non-medical with 60% ,and methicillin resistant S. aureus in each samples medical and non-medical with 66.7% as Statistical analysis demonstrated.

Non-Fourier bioheat model for bone grinding with application to skull base neurosurgery

Bone grinding is used to remove the skull bone and access tumors through the nasal passage during cranial base neurosurgery. The generated heat of the spherical diamond tool propagates and could damage the nerves or coagulate the arteries blood. Little is known about the non-Fourier behavior of heat propagation during bone grinding. Therefore, this study develops an analytical model of the hyperbolic Pennes bioheat transfer equation (HPBTE) to calculate the three-dimensional temperature and necrosis in the grinding region. In vitro experimental investigations were carried out, and the contact zone temperature was measured using an infrared thermography system to validate the proposed thermal model. The results demonstrate that the HPBTE provides more reliable temperature evaluation and thermal damage than Fourier or parabolic heat transfer equation (PHTE). Due to the low thermal diffusivity of the bone, the lower grinding feed rate leads to higher temperature amplitude and a smaller radius of the affected zone in the surface and depth of the bone. Also, the intensity of bone necrosis decreases with the increase of the feed rate, and the shape of the damage zone becomes stretched. This analytical model can assess the potential risk of the surgery before clinical trials. Also, it could be used for comparing the different operating conditions to minimize bone necrosis and improve the control process in neurosurgeries.