Cavernous Hemangioma Involving the Maxilla: A Case Report

Background: Intraosseous vascular lesions are rare, they seldom occur in facial skeleton and maxilla is one of the least reported sites of involvement.Case Presentation: We report a 45-year-old woman with cavernous hemangioma of maxillary bone involving inferior turbinate. It   showed osteolytic expansile nature in imaging. The mass was approached via facial degloving technique. Histologic evaluation revealed vascular lesion in favor of cavernous hemangioma.Conclusion: Intraosseous vascular anomalies are one of the diagnoses of facial skeletal masses not routinely occurring to the mind especially in adults due to their rarity and various presentations. They can mimic other pathologies with regard to symptoms and imaging characteristics. They also should be differentiated from malignancies, though frequently the definite diagnosis will be uncertain until proven histologically

Nasal Valve Area in Iranians, an Imaging Based Study

Background and Aim:The internal nasal valve is the narrowest area of nasal airway bounded by the nasal septum, the caudal edge of upper lateral cartilage and the anterior head of the inferior turbinate. Knowledge about this area is of utmost importance for every nasal surgeon.This study was done to evaluate the internal nasal valve angle and cross sectional area in Iranians.methods:This is a retrospective study done using data from cross sectional imagings available from patients who underwent image guided endoscopic skull base surgery between 2013 and 2017. An image navigation software [Osiri- x: 8.5.2] was used for display of the multidimensional images.Results:Collectively 43 cases (i.e. 86 nasal passages) including 24 males and 19 females in the age range 21 – 74 years (48 ± 13.6) participated in the study.The internal nasal valve angle of naval cavities of the 86 subjects was averaged and the mean value of 17.70º (±3.72) was obtained. Mean value for cross sectional area was of 1.40 cm2(±0.38).There was not a statistically significant difference between males and females in terms of the nasal valve angle and nasal valve cross sectional area.Conclusion: We found some differences between the nasal valve angle and cross sectional area between Iranians and values of Asians / Japanese and Caucasians reported in previous studies. Despite these findings, reaching a conclusion needs further large sample studies in different ethnic groups paying special attention to similar case selection and study design

Hypochondriasis in Patients Seeking Revision Rhinoplasty

AbstractBackground: Revision rhinoplasty is one of the most complicated surgeries. However, there exists a lack of information about the psychological status of the non-traumatic revision rhinoplasty candidates.Purpose: The purpose of the present research is to investigate the frequency of hypochondria among these patients.  Methods: The current study was designed prospectively with 57 patients seeking revision rhinoplasty from June 2015 to July 2016 in two university hospitals. There were 57 candidates of revision rhinoplasty and 47 participants in the control group, from which 33 (32.4%) were male and 69 (67.6%) were female. The control group was selected randomly from patients visiting the otolaryngology clinic who had no previous type of cosmetic surgery. The data were analysed using the software program SPSS, performing a MANOVA test.Results: Among 102 participants in our study, 57 (55.88%) were candidates of revision rhinoplasty with 11 (19.25%) male and 46 (80.70%) female patients.  The average age was 25.56±6.52 years old among the patients. Most of the patients (78.94%) were between the age of 19 and 34. There was a significant difference between the  group seeking revision rhinoplasty and the control group in the total score of hypochondria, appearance-related mind’s preoccupation and fear/worry sub-scale (P<0.0001).Conclusion: Our results indicated a high prevalence of appearance-related mind’s preoccupation, fear/worry and hypochondria among revision rhinoplasty candidates. Our data showed that decision on seeking revision rhinoplasty is a personal opinion, which may not be affected by friends and family.

Sinonasal Findings on Paranasal Computed Tomography in Patients Presenting with Facial Pain

Background: Facial pain is one of the common complaints in otolaryngology. Patients often self-diagnose facial pain as "sinusitis". The sinonasal source of facial pain and headache could be one of the possible etiologies, which needs to be confirmed by nasal endoscopy or CT scan. Aim: This study aimed to detect the frequency of variations and pathological findings in the sinonasal region of patients presenting with facial pain and sinonasal symptoms by PNS CT imaging. Methods: This descriptive study was conducted in a tertiary referral hospital where consecutive patients presenting to the otorhinolaryngology clinic with facial pain and at least one of the sinonasal symptoms, including nasal obstruction, nasal congestion, rhinorrhea, reduction or loss of smell, and postnasal discharge, were included. For evaluation of facial pain, a paranasal sinus CT scan in coronal view was performed and analyzed by an otolaryngologist. Results: A total of 64 patients including 27 males (42%) and 37 females (57.8%) were included. The average age was 35.5±10.5. Most patients experienced bilateral facial pain (78.1%.). The most common location of pain was the forehead (76.6%). Fifteen patients (23.4%) had acute pain (<12 weeks) while 49 (76.6%) experienced chronic pain (>12 weeks). Cold weather was the most common triggering factor in 29 patients (45.3%). The most common sinonasal symptom was posterior nasal discharge (in 42 patients, 65.6%). A minority of patients, 8 (12.5%), had evidence of rhinosinusitis (acute or chronic). Ethmoid sinus was the most frequently involved sinus (9.3%), and sphenoid and frontal sinuses were the least commonly involved. 2 patients (3.1%) had unilateral complete opacification of the maxillary sinus. Conclusion: Sinusitis was not the most common cause of facial pain in the present study, even in the presence of sinonasal symptoms. The definitive diagnosis of facial pain warrants confirmation by complementary imaging before starting therapy

Chronic or Recurrent Invasive Fungal Sinusitis after COVID-19 Infection

Background: During the COVID-19 epidemic, we have witnessed numerous manifestations and complications after contracting this disease. One of these complications in patients with COVID-19 is the increased risk of invasive fungal infections due to the suppression of the immune system caused by the disease or due to the use of suppressive drugs such as corticosteroids. Case presentation: Here we report three cases of invasive fungal sinusitis after contracting COVID-19 with recurrence after primary treatment and the measures taken for these patients. Discussion: Invasive fungal sinusitis with involvement of orbit or brain is a known complication in COVID-19 patients especially in diabetics. Recurrence of manifestations of fungal infection after primary treatment and hospital discharge may be related to uncontrolled underlying disease and residual fungal infection especially in necrotic soft tissue or bone. Conclusion: Early diagnosis and management with antifungal drugs and surgical debridement and also close follow up after discharge from hospital is essential for treatment and achieving higher survival in patients with invasive fungal sinusitis

Olfactory and gustatory manifestations in hospitalized patients with COVID-19

Background: Pulmonary involvement is the main clinical and imaging feature of the novel corona virus disease (COVID-19). However, some patients present with upper airway symptoms. Aim: In this study, we report upper respiratory manifestations, specifically focusing on smell and taste disorders in COVID-19. Methods: We performed this cross-sectional prospective study in patients admitted to Masih Daneshvari Hospital, a tertiary referral center in Tehran, Iran, with severe COVID-19 as documented by the polymerase chain reaction assay. Results: We included 268 hospitalized patients, 183 (68.3%) men and 85 (31.7%) women. The average age was 52.8±16.4. The sinonasal symptoms included nasal obstruction (44 [16.4%]), rhinorrhea (31 [11.5%]), sneeze (33 [12.3%]), headache (77 [28.6%]), facial pain (12 [4.5%]), associated with hypogeusia (65 [24.2%]) and olfactory dysfunction (90 [33.5%]). In 35 (38.9%) patients with olfactory symptoms, change in the smell was the sole initial manifestation of COVID-19. On logistic regression, the relationship between the olfactory symptoms and headache (p=0.002), nasal obstruction (p=0.0001) and sneeze (p=0.018) were statistically significant. Conclusion: We report a considerable prevalence of olfactory and gustatory symptoms in hospitalized patients with COVID-19. Not infrequently, these symptoms were the sole initial presenting symptoms in the course COVID-19. During the current pandemic, we suggest that presence of these symptoms should mandate expedited screening for COVID-19, isolation and close monitoring of the patients for evolution of the clinical course

Evaluating Patients with Olfactory Dysfunction after COVID-19 Infection by Questionnaire of Olfactory Disorders-Negative Statements

Background: The number of patients with COVID-19-induced olfactory dysfunction has consistently increased since the onset of the pandemic. Since a considerable proportion of these patients have olfactory dysfunction for a relatively long period of time, their quality of life (QOL) may considerably be impacted as a result. Aim: The aim of the present study was to investigate the adverse effects of olfactory dysfunction on QOL in patients with COVID-19-induced hyposmia or anosmia. Methods: The data were obtained via self-reported online questionnaire in individuals who met the inclusion criteria. The questionnaire included demographics, olfactory status and Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS). Results: Among1531 participants, 1072 individuals met the inclusion criteria, with 588 (54.85%) having hyposmia and 484 (45.15%) anosmia. Average age was 35.7 in the hyposmic group and 34.5 in the anosmic group. Concurrent hypogeusia/ageusia was reported in 398 (67.7%) of cases with hyposmia and in 346 (71.5%) of participants with anosmia. Lack of enjoyment of eating food was the most negative effect in both hyposmic and anosmic groups, followed by annoyance when eating food and a continuous awareness of the olfactory problem. The mean QOD-NS score was 20.5±10.2 in the hyposmic group and 23.3±10.4 in the anosmic group, demonstrating significant adverse impact on QOL. Conclusion: Persistent olfactory dysfunction in patients with COVID-19 has adverse effects on QOL. Early diagnosis and treatment of olfactory dysfunction may be crucial in limiting the adverse impact on QOL by psychological and nutritional support and olfactory rehabilitation

Eosinophilic Mucin Rhinosinusitis in Iranian Patients Undergoing Endoscopic Sinus Surgery

Introduction:  Eosinophilic mucin rhinosinusitis is a type of chronic rhinosinusitis (CRS). Diagnosis and treatment of this condition play a significant role in reducing the patients’ clinical symptoms. This type of rhinosinusitis has a higher relapse rate, compared to the other types. This disease is more resistant to treatment and more dependent on corticosteroid therapy, compared to the other types of rhinosinusitis. Regarding this, the present study was designed to evaluate the frequency of eosinophilic mucin rhinosinusitis in patients undergoing sinus surgery in a tertiary referral center and examine some clinical and laboratory characteristics regarding this type of rhinosinusitis.   Materials and Methods: This cross-sectional observational study was performed on patients over the age of 16 years, who were diagnosed with CRS in the otolaryngology clinic of a referral tertiary-level hospital, and were candidates for endoscopic sinus surgery. Based on the detection of eosinophilic mucin, the subjects were divided into two groups of eosinophilic mucin and non-eosinophilic mucin rhinosinusitis (controls). The groups were compared in terms of sino-nasal outcome test (SNOT-22) scores, Lund-Mackay staging scores, osteitis status, immunoglobulin E (IgE) level, and eosinophilia.   Results: In this study, 46 subjects participated, 29 (63%) cases of whom had eosinophilic mucin. The SNOT-22 score and serum IgE level were significantly higher in the eosinophilic mucin group, compared to those in the control group. Osteitis and Lund-Mackay scores were also higher in the eosinophilic mucin group than those in the control group; however, this difference was not statistically significant.    Conclusion: Patients with eosinophilic mucin rhinosinusitis showed a more severe clinical involvement. Seemingly, the Iranian patients have a lower and higher frequency of eosinophilic mucin rhinosinusitis, compared to the patients from the Western countries and East Asia, respectively

Histopathologic Findings of Olfactory Mucosa in COVID-19 Patients

Background: Olfactory manifestations are common findings during the course of COVID-19, while exact physiopathology is not known Aim: We review histological changes of the nasal olfactory mucosa in COVID-19 non-survivors who died in the ICU. Methods: Sampling was done within 1 hour of death under direct vision. Specimens were taken medial to the middle turbinate in the cribriform area and embedded in paraffin blocks and stained by haematoxylin and eosin. Results: The most frequent histologic finding was the infiltration of inflammatory cells mostly comprised of lymphocytes. Inflammatory infiltration of mucosa was seen in all 11 patients with ulceration in 9 cases and neuritis in 3 cases.  Conclusion: Inflammatory infiltration of olfactory mucosa may be associated with smell manifestations. Further histological studies will clarify the role of the nasal mucosa in the physiopathology of COVID-19 especially olfactory involvement

Comparing the Effect of Oral Clonidine and Tranexamic Acid on Bleeding and Surgical Field Quality during Functional Endoscopic Sinus Surgery

Introduction: Bleeding during functional endoscopic sinus surgery (FESS) is an important issue for both anesthesiologists and surgeons as it can affect the safety and efficiency of the procedure. We compared the efficacy of tranexamic acid (TXA) and clonidine in reducing blood loss and improving surgical field visualization during FESS.   Materials and Methods: In a double-blind, randomized, clinical trial, 52 patients, American Society of Anesthesiologists (ASA) physical status 1–2, aged 13–75 years, suffering from rhinosinusitis with or without polyposis, and who were candidates for FESS, were enrolled. The first group received intravenous TXA 15 mg/kg diluted in 100 ml normal saline, administered during 10-min infusion after induction. In the second group, 0.2 mg oral clonidine was given 1 to 1.5 hours before surgery. Duration of surgery, hemoglobin level, heart rate, blood pressure, and quality of surgical field based on Boezzart's scale and surgeon satisfaction based on Likert's scale were recorded in both groups.   Results: In total, 52 patients, 27 (51.9%) males and 25 (48.07%) females were studied. Twenty-two (42.3%) and 30 (57.7%) were in the TXA and clonidine groups, respectively. The mean pre- and post-surgical hemoglobin level showed no meaningful difference between the two groups. The same result was obtained for blood pressure and heart rate at different time points (P>0.05). Mean anesthesia time (P=0.859), mean surgical time (P=0.880), surgeon's satisfaction of the surgical field (P=0.757) and surgical field quality at different time points revealed no significant difference between the two groups.   Conclusion: Premedication with oral clonidine and intravenous TXA has the same effect on bleeding during FESS, surgical field visualization, and surgeon satisfaction