Cases reported "Nasal Obstruction"

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1/18. Endoscopic treatment of sinonasal disease in patients who have had orthognathic surgery.

    Certain skeletofacial patterns may be predisposed to aggravated sinonasal disease postoperatively. These may include, but are not limited to, facial skeletal asymmetries with high septal deviations and those with obstructive nasal respiration and mouth breathing that leads to skeletal growth disturbances such as vertical maxillary hyperplasia and apertognathism. These sinonasal diseases may partly be the result of osteomeatal blockage by pre-existing structures, or synechial shelves and webs blocking normal maxillary antral mucosal flow. The use of nasal antral windows placed anteriorly in the lateral nasal wall at the time of downfracture LeFort (Hosaka window) do not seem to benefit the drainage of the maxillary antrum. This is because physiological flow often bypasses this region. If patients present postoperatively with new sinonasal disease or the aggravation of pre-existing symptoms, evaluation by both endoscopically assisted intranasal and axially and coronal computed tomography (CT) is recommended. Functional endoscopic sinus surgery by the minimally invasive Messerklinger technique, combined with intranasal use of laser-assisted turbinoplasty and soft tissue lysis, have been successfully used for most of these patients. Because the anatomical positioning of the midfacial structure can potentially affect patients with a predisposition to sinonasal physiological disturbances, consideration should be given to preoperative evaluation and discussion of potential consequences.
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2/18. Congenital nasal pyriform aperture stenosis: diagnosis and management of 20 cases.

    The objective of this study was to review the characteristics of congenital nasal pyriform aperture stenosis (CNPAS) in a series of 20 children seen between 1993 and 1996. The diagnosis was made by physical examination and computed tomography scan. A single central maxillary incisor was detected in 12 cases (60%). Three children had morphological abnormalities of the pituitary gland shown on magnetic resonance imaging. One child had an antidiuretic hormone deficiency, and another child had a growth hormone deficiency. Two children had craniosynostoses, 1 of which was Apert's syndrome. All patients underwent operation by a sublabial approach, and 1 was referred for a columellar necrosis after nasal stenting. After surgery, all patients showed improvement, and the nasal stenting was usually removed 1 week after surgery. Follow-up revealed normal breathing. In conclusion, CNPAS was previously considered to be an unusual cause of nasal obstruction in neonates and infants. The number of cases treated recently in our department suggests that this newly recognized entity is more common than expected.
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3/18. Radiographic diagnosis of congenital bony nasal stenosis.

    Congenital bony nasal stenosis (CBNS) is a rare condition that causes respiratory distress in neonates. Between 1986 and 1996, we encountered 13 cases of CBNS. Recently, CT measurements have been used to evaluate the features of this type of stenosis, but no satisfactory investigation of the severity of bony nasal stenosis has been reported. We compared the nasal width (NW), facial width (FW), and interorbital distance (IOD) measured from occipitofrontal (Caldwell's) projections of plain radiographs in nine CBNS patients and nine normal infants. NW was significantly narrower in the CBNS patients than in the controls, and never exceeded the IOD in any of the CBNS patients. This measuring method can be used to diagnose CBNS, because NW in normal subjects of all age groups is always greater than IOD on Caldwell's view. We also investigated one patient radiographically, to determine how NW increased until the age of 4 years. However, there was no significant change in nasal width, although the FW increased significantly. This method seems useful for determining the severity of stenosis, and its simplicity makes it useful for routine investigation of breathing difficulty in neonates and infants. We review and discuss the CT images of CBNS reported in the literature.
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4/18. A simple and reliable method of patient evaluation in the surgical treatment of nasal obstruction.

    We have developed a simple method of evaluating nasal obstruction both before and after corrective surgery. With our system, patients self-rate their nasal patency on a 10-point visual analog scale under different conditions. After a baseline self-assessment, patients rate their breathing while the examiner lifts the lower lateral nasal cartilage with an ear curette and again during lifting of the upper lateral cartilage. Separate assessments during cartilage support are made before and after the patient has received nasal decongestion therapy. The results of these manipulations help identify the specific structural abnormality and its anatomic site, thereby serving as a reliable aid to planning surgery (i.e., open septorhinoplasty, turbinoplasty, external valve surgery with alar batten grafts, and/or internal valve surgery with spreader grafts with or without composite skin/cartilage grafts). We tested our method in preoperative evaluation and surgical planning on 19 patients with nasal obstructions. Our method was just as useful in making postoperative assessments, and it allowed us to judge the effectiveness of specific procedures in restoring nasal patency. Of the 19 patients, 18 (94.7%) reported that their nasal breathing had improved following surgery.
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5/18. Foetal warfarin syndrome--a complex airway problem. Case report and review of the literature.

    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.
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6/18. Blocked nose and snoring in a 6-year-old boy.

    nasal obstruction, mouth-breathing, snoring and deafness are common symptoms seen in children presenting to the otorhinolaryngology clinic. The aetiopathologies are frequently due to adenotonsillar hypertrophy and otitis media with effusion. Rarely however, nasal obstruction and snoring may be associated with more sinister pathology. We report a case of a child with nasopharyngeal B-cell Non-Hodgkin's lymphoma whose initial symptoms were of nasal obstruction and snoring.
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7/18. Resolution of nocturnal enuresis in snoring children after treatment with nasal budesonide.

    nocturnal enuresis has been associated with obstructive sleep apnea-hypopnea and may resolve after adenotonsillectomy. Nasal corticosteroids have improved symptoms and polysomnography findings in children with snoring. Two children with primary nocturnal enuresis, chronic nasal obstruction, and loud snoring underwent polysomnography. The apnea-hypopnea index was 4.9 and 7.3 episodes/hr, and the oxygen desaturation of hemoglobin index was 4.6 and 5.2 episodes/hr. After administration of budesonide, the frequency of snoring decreased, the polysomnography findings improved, and the enuresis resolved completely. Six months after treatment, both children were still dry at night. Administration of nasal corticosteroids is associated with resolution of enuresis in children with mild obstructive sleep-disordered breathing.
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8/18. Apertura pyriformis stenosis in the newborn.

    Apertura pyriformis stenosis in the newborn. Respiratory distress in the newborn can have a variety of aetiologies, the best known of which are cardiac and pulmonary diseases. Major nasal airway obstruction is probably often overlooked when acute desaturation of the neonate requires reanimation procedures, although it is well established that the baby is an obligate nose breather at birth. Nasal airway stenosis or atresia could account for a number of unexplained deaths in the delivery room. In the differential diagnosis of major nasal airway obstruction in the newborn, choanal atresia is by far the most common aetiology. However, a few cases of pyriform aperture stenosis have been reported. One child presenting this pathology was recently treated at the Brussels University Children's Hospital. Unexpectedly, the baby survived until 3 months without any medical support but had severe feeding problems. The diagnosis was confirmed by naso-sinusal CT scan. Surgery was performed at 4 months through an unusual endonasal approach which seems to be less traumatic than the classical sublabial approach. The post-operative course was satisfactory. The 9-month-old patient does not now show residual breathing problems. The presentation will focus on this unusual case.
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9/18. Surgical correction of the snout suffocation syndrome.

    Two nursing home patients with difficulty breathing because of occlusion of the mouth and nares by an involuntary snout reflex-like mannerism have previously been described. In both cases advanced dementia, edentia, and a downward-angled nasal base were present. life-threatening hypoxia occurred intermittently in one case, and after becoming severe, was corrected by the surgical procedure described.
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10/18. Obligate mouth breathing during exercise. Nasal and laryngeal sarcoidosis.

    A young black man presented with simultaneous nasal and laryngeal sarcoidosis, each uncommon entities. Despite severe upper airway obstruction and emergent tracheostomy, there was an uncharacteristic rapid response to oral steroids alone. The patient's predominant initial complaint of early mouth breathing during routine army physical training demonstrates a symptom complex and an alternate mechanism of dyspnea to consider in sarcoidosis.
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