[How to blow the nose--an aerodynamic study of the nose blowing (author's transl)].
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Adolescent↗
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[Inverted papilloma of the nose. Apropos of a case associating polyps and an inverted papilloma of the nose].
In this article is presented a case report of a 59 years old woman with a medical history of recurrent nasal polyps (from 20 years ago). This woman presented an inverted papilloma in the middle meatus of the lateral wall of the nasal cavity simultaneously with the nasal polyps, and she was faced with surgical intranasal removal. The patient, two years later, presented again nasal polyps, but without any indication of the recurrence of the inverted papilloma. It is noticed the value of the local surgical removal of the inverted papilloma in patients who do not present extensive tumors.
Female↗
Invasive aspergillosis in acute leukemia: correlation with nose cultures and antibiotic use.
Aspergillosis in cancer patients is a problem. Because not all patients can undergo invasive procedures, we sought other methods for diagnosis. We reviewed the data from all patients with acute nonlymphocytic leukemia treated at our center during a 3-year period. Of 125 patients, 18 had invasive aspergillosis (cases). Eleven patients had nose cultures growing Aspergillus flavus or A. fumigatus; 10 of these 11 had aspergillosis, whereas only eight of 114 without such nose cultures had invasive disease (P less than 0.000001). Thus, A. flavus on nose culture appears "predictive" for aspergillosis. Absence of such a culture does not preclude infection. Of 125 patients, 61 had sterile nose culture(s) and 14 of the 18 cases had such a sterile nose culture. Only four of the 64 patients without sterile nose cultures developed aspergillosis (P less than 0.008), suggesting a relation between sterile nose culture and aspergillosis. Carbenicillin was used for a longer period among cases and patients with predictive nose cultures than among patients without aspergillosis. These data may help identify patients at risk of aspergillosis and help determine antifungal therapy when invasive procedures are contraindicated.
Acute Disease↗
The universal nose of early childhood: nature's aid in understanding the supratip deformity and its correction.
The noses of the babies of the world are strikingly similar despite race. Overresected noses have the same characteristics as babies' noses for exactly the same reason: in both cases the nasal skin is relatively unsupported by its underlying skeleton. Teaching rhinoplasty is a most difficult task, but nature offers valuable help in understanding the delicate balance between nasal skeleton and skin sleeve. Nature transforms the "universal nose of early childhood" into an adult nose by gradually augmenting the nasal skeleton, thus showing us the way to correct the iatrogenically overreduced nose.
Adolescent↗
The histopathology of lepromatous leprosy in the nose.
On the basis of clinical, histological and bacteriological assessments, 31 patients in Central India were selected and classified as having active but early lepromatous leprosy and 4 patients as having early borderline leprosy. From the nose of each patient an average of 4 biopsies were taken from particular sites of the septum and turbinates either by punch biopsy or dissection with a scalpel. The nasal tissues from all the lepromatous patients contained many acid-fast bacilli; no bacilli or abnormalities were seen in nasal tissues from the borderline patients. The histopathology of these highly bacilliferous tissues is described. Bacilli were universally seen in macrophages, but they were also seen in blood monocytes and polymorphs, fibroblasts, squamous and pseudo-columnar epithelium, keratin, peri- and endo-neurial cells of tiny nerve bundles, erectile tissue, vascular plain muscle, perivascular histiocytes and frequently and abundantly in the cytoplasm of endothelial lining cells of lymphatics and of small blood vessels and free within the lumina of these vessels. Five basic mechanisms of escape of bacilli from the submucosa on to the surface, and thus into the external environment, are described. Secondary infection, in the presence of an expansile lepromatous infiltrate, together with simple trauma to the surface epithelium, are the main factors in the discharge of bacilli. These histopathological observations are consistent with the findings from other recent studies on the nose in leprosy regarding (1) the large numbers of morphologically intact and viable Myco. leprae excreted in the nasal mucus of lepromatous patients; (2) the clinical changes observed in the nose of such patients, and (3) the similar nasal involvement and excretion of Myco. leprae from the nose of mice inoculated with leprosy bacilli of human origin. Of particular interest was the frequency and intensity of bacilli within the endothelial lining cells of small blood and lymph vessels and the presence of bacilli free within the lumina of these vessels or within monocytes and polymorphs. The possible dynamic significance of these observations in the pathogenesis of leprosy is discussed. The significance of all these observations in relation to (1) the spread of leprosy; (2) local factors in the nose which might favour the growth of Myco. leprae, and (3) the nose as a portal of entry, are discussed.
Biopsy↗
External skin excision in the sebaceous nose and supratip deformity.
Some sebaceous noses cannot be properly reduced in size because of redundant skin. After standard rhinoplasty some noses develop a supratip deformity that recurs even after subcutaneous removal of the scar tissue. These noses can be corrected only by wedge-shaped skin excision. Most patients much prefer a pleasantly shaped nose, even at the cost of a midline scar on the nose. Most surgeons are hesitant to add scars to the face. However, the vast experience with wounds following accidents, tumor excisions, or corrections of malformations has shown that generally scar formation on the nose is inconspicuous. Nineteen patients were treated successfully by skin excision at the time of primary rhinoplasty or by a second operation.
Adult↗
Deposition of aerosol particles in the human nose.
About 2000 breathing experiments were performed, involving four breathing manoeuvres, four volunteers, a wide range of particle diameters and various breathing patterns. Monodisperse droplets of bis(2-ethylhexyl) sebacate served as aerosol particles. The deposition of particles in the nose was calculated from total deposition of particles in the whole respiratory tract for mouth, nose, mouth-nose and nose-mouth breathing. This method allowed the determination of nasal deposition and nasal efficiency for inspiration and expiration. Total deposition was determined from measurements of the particle concentration and the respiratory volume flow rate. Considerable scatter of nasal deposition in the four subjects was found. At a constant tidal volume it rose rapidly with increasing flow rate. The nasal efficiences were found to be independent of tidal volume. For inspiration as well as expiration the nasal passages removed particles very efficiently by inertial impaction. However, inspiratory and expiratory nasal efficiences were different. The scatter of individual inspiratory efficiency could be considerably reduced by employing a mathematical relationship to describe inspiratory nasal efficiency which makes use of the pressure difference across the nose and nasopharynx during nose breathing.
Aerosols↗
The anatomy of the nose. External support.
The anatomy of the nose is poorly defined, even in standard anatomical texts. Wide disagreement exists regarding the interdigitation of the supporting cartilages, the articulation of these cartilages with the nasal bones, and the contribution of each of these cartilages to the support of the external nose. An understanding of this nasal anatomy is essential to the facial plastic surgeon. The authors describe the fundamental anatomical structure of the adult nose based on gross and microscopical observations and serial sections in 31 cadaveric noses. Tables of cartilage measurements and variation, plus appropriate drawings define the anatomy encountered. Structural variations are common and can be predicted by external appearance in selected cases. To discuss relationships of importance in the surgical alteration of the nose in rhinoplasty, anatomical findings are compared to descriptions in the surgical and anatomical literature. Preservation of essential support and physiological function is stressed.
Adult↗
The Oriental nose: an anatomical basis for surgery.
Fifteen Oriental noses were examined macrosurgically and microscopically. Five soft tissue layers overlying the osseocartilaginous framework are identified: the skin, the subcutaneous areolar plane, the vascular-fibromuscular layer, the deep areolar plane and perichondrium/periosteum. Two natural planes of dissection are represented by these areolar planes which separate the nose into an overlying skin envelope, a vascular-fibromuscular layer and an underlying osseocartilaginous framework. The cartilaginous framework provides projection, support and shape to the dorsum and tip of the nose but not to the alar lobule as this is devoid of cartilage. As there is no cartilage in the Alar lobule, the term 'Alar Cartilage' is misleading and the term 'Tip Cartilage' is introduced to replace it. The skin of the nose is specialised and has the ability to retain its shape even after dissection. This is due to an arrangement of elastin fibres in the upper dermis and the subcutaneous areolar plane which confers elasticity to the skin especially in the region of the Alar lobule which is a skin and fibromuscular sandwich. The vascular fibromuscular layer is like a sheet draping the osseocartilaginous framework. The main arteries of the nose lie on this layer. Injection studies of the blood supply reveal many arterial variations but always a distinct alar artery, columellar artery and alar plexus that have not been previously named. The alar groove is a junction between the alar lobule which is soft tissue alone and the tip which is soft tissue, supported by cartilage. The alar groove lies over the lateral edge of the tip cartilage and here there is muscular attachment to the fibromuscular layer.
Anthropometry↗
[Preserved human cartilage grafts and autogenous viable transplants for nose and middle ear (author's transl)].
57% of the preserved human cartilage chips being implanted in the nose lead to a remarkable up to a complete resorption. 94% of the patients have nevertheless a sufficiently or well working function of the nose; besides that they are as well satisfied with the shape of their nose. The most important reason for the resorption are mechanical factors; this has been shown by comparing the load of implanted tissue on the columella and on the dorsum of the nose. We can't exclude the possibility of late immunologic reaction. Comparing these results with those of the middle ear by missing any mechanical load, we registered nevertheless a remarkable loss of the volume of the cartilage. This is an intense indication for an immunologic reaction, especially because there is a more intense vascularisation in the middle ear and a strong activity of fibroblasts based on the mesenchymal potency of middle ear mucosa. It's only in the middle ear that preserved cartilage can be substituted by connective tissue, viable cartilage or viable bone.
Cartilage↗
The value of the nose width as an esthetic guide in prosthodontics.
A radiographic method was used to measure the interalar and interalar-fold widths of the nose on 80 men and women. These distances were compared to the subjects' intercanine distances as measure on artificial stone casts. In 56 of the subjects, the width of the skeletal nasal aperture was measured and compared to the intercanine distance. From the results of this study, the following conclusions can be drawn. 1. There was no significant relationship between the intercanine distance and the interalar width of the nose in the 80 men and women who served as subjects in this study. 2. There was no significant relationship between the intercanine distance and the interalar-fold width of the nose in the 80 men and women in this study. 3. The presence or absence of a significant relationship between the intercanine distance and the width of the skeletal nasal aperture was not demonstrated conclusively in this study. 4. The results of this study show that the width of the nose would not be a reliable guide for selecting or arranging artificial anterior teeth, provided one concurs that they should be the same size and shape and occupy the same position as their natural predecessors.
Adult↗
Nose morphology in individuals with Angle Class I, Class II or Class III occlusions.
The intention of this work was to describe the nose morphology in individuals with different craniofacial patterns which dentally were characterized by Angle Class I, Class II div. 1, and Class III occlusions. The material comprised male adults (age 20--30 years), and the results are based on measurements on tracings of lateral cephalograms. Generally, the inclination of the nose in relation to the nasion-sella-line was similar in all groups, and so was the nose length as well. The depth of the nose, when related to the hard and soft tissue facial planes was, however, significantly different, apparently due to the different sagittal position of the chin.
Adolescent↗
Cancer of the nose: ablation and repair.
Cancer of the nose is very common and lesions seen by reconstructive surgeons are often recurrent and extensive. Surgical removal of cancer of the nasal skin can usually be accomplished under local anesthesia, and in most instances frozen section histologic examination should be used to confirm the adequacy of excision. The location and three dimensional extent of the tumor will dictate the choices of repair or reconstruction as well as the timing thereof. Very small lesions can be excised with primary closure; other well circumscribed tumors can be excised and the defect closed with an appropriate nasal flap. In our experience most nasal skin cancers have been managed by excision and full-thickness skin grafting. We have found the skin of the neck and that of the preauricular region to provide the best skin cover except in the upper third of the nose where upper eyelid skin provides excellent coverage. We have used composite grafts from the ear to replace up to two-thirds of an alar rim. Nasolabial, cheek, and midline forehead flaps are useful in a variety of instances, but usually when less than one-half of the nose has been excised. We have been pleased, in most instances, with the Converse scalping flap for near total, subtotal, and extensive three-dimensional lower nasal defects. (Transverse superficial temporal artery pedicle flaps can be successfully used to reconstruct large nasal defects with adjacent cheek loss.) We have rarely used distant flaps. Regardless of what regional pedicle flap has been transferred to the nose, subsequent revisions of a relatively minor nature will nearly always enhance the result. Patients who have undergone extended total nasectomies are probably best managed with a prosthesis, as prognosis is often guarded and flap reconstruction may be quite unsatisfactory. In our experience, defects in lining and support can usually be repaired with local nasal tissue.
Basal Cell Carcinoma↗
Microlipoinjection for the elevation of depressed full-thickness skin grafts on the nose.
BACKGROUND: Full-thickness skin grafts on the dorsum of the nose may heal depressed and might benefit from elevation. Microlipoinjection has been used to elevate depressed tissue; however, the long-term persistence of the augmentation is questioned. OBJECTIVE: To determine whether microlipoinjection beneath depressed full-thickness grafts on the dorsum of the nose can provide effective and persistent graft elevation. METHODS: Microlipoinjection was performed at one to three sessions under depressed full-thickness skin grafts on the nose of four patients. Their appearance was assessed clinically and photographically for the amount of correction at their last postmicrolipoinjection visit. RESULTS: All four patients had clinically significant elevation of their full-thickness skin graft. In the two patients followed for over 3 years, significant augmentation persisted. CONCLUSION: Microlipoinjection can provide cosmetically useful soft tissue augmentation under depressed full-thickness skin grafts; this augmentation can persist.
Adipose Tissue↗
Infections of the ears, nose, and throat in children with primary immunodeficiencies.
Children who suffer from primary immunodeficiencies have long been thought to be subject to infections of the ears, nose, and throat due to unusual or resistant organisms. A retrospective chart review was undertaken at Children's Hospital of Pittsburgh from 1979 to 1989 to determine the types and frequency of infections of the ears, nose, and throat, and the bacteriologic findings from cultures of the sinuses, ears, and head and neck abscesses, when obtained. Seventy-five patients were identified with primary immunodeficiencies, and 80% suffered from infections of the ears, nose, and throat. Cultures obtained from 33% of the group showed the majority of the organisms commonly seen in ear and sinus infections. We conclude from this study that children with primary immunodeficiencies who require hospitalization frequently have an infection of the ears, nose, and throat, and that the infection is usually caused by community acquired bacteria. Empiric treatment may therefore be directed to common organisms causing these infections.
Aspergillosis↗
Fractured-nose reduction under local anaesthesia. Is it acceptable to the patient?
This article examines patients' acceptance of fractured-nose reduction under local anaesthesia, both objectively and subjectively. At each stage of the reduction the level of the discomfort, the patients' experiences were recorded. The success rate of complete reduction of the nasal fracture was found to be 71% and this was similar to that obtained in other studies that have used general anaesthesia. An overall level of discomfort for the procedure in terms a layman can understand was obtained by comparing the manipulation with that of having a tooth filled at the dentist. Sixty-three percent of the patients said that the nasal fracture reduction was no worse or the same as a dental filling. Our study showed that 96% of patients would be willing to undergo the same local anaesthetic procedure if they fractured their nose a second time. We conclude that it is possible to reduce the majority of fractured noses adequately with little inconvenience to the patient under local anaesthesia, and so we recommend that this procedure should be considered in the first-line treatment of the displaced fractured nose.
Adolescent↗
Septorhinoplasty of the traumatically deformed nose.
The author has reviewed the 69 patients upon whom he has performed septorhinoplasty in treatment of posttraumatic deformities. These have been followed over a 12-year period; however, only the 59 followed over one year have been studied. In analyzing the deformities, it was noted that three characteristics occur alone or in combination: excessive width, depression, and twisting. The wide nose was best treated by removal of medial tissue, full mobilization of the nasal bones, and postoperative compression exercises. The depressed nose was built forward by onlay grafts, the first choice being septal cartilage. Finally, the twisted nose was treated by freeing the nasal components, straightening the bone and cartilage, and replacing them in their anatomical positions. Not infrequently all three problems were treated in one operative session.
Adolescent↗
Reconstructive surgery of the injured nose.
A method of reconstructing healed injuries of the nose in the adult and young growing child is presented. The actual surgical technique is relatively simple and may be acquired easily during the period of residency or in many of the excellent postgraduate courses that are presented. Emphasis should be placed on restoration of function and form. A basic understanding of septal anatomy and physiology provides a good foundation in the treatment of this organ. Appreciation of the fundamental inter-relationships of the bone pyramid and the cartilaginous vault and lobule provides the foundation of proper treatment of the external nose. When both elements of the nose require attention, combined septal and rhinoplastic techniques should produce the best result.
Adolescent↗