RESUMO
The nasal cavity of living mammals is a unique structural complex among tetrapods, acquired along a series of major morphological transformations that occurred mainly during the Mesozoic Era, within the Synapsida clade. Particularly, non-mammaliaform cynodonts document several morphological changes in the skull, during the Triassic Period, that represent the first steps of the mammalian bauplan. We here explore the nasal cavity of five cynodont taxa, namely Thrinaxodon, Chiniquodon, Prozostrodon, Riograndia, and Brasilodon, in order to discuss the main changes within this skull region. We did not identify ossified turbinals in the nasal cavity of these taxa and if present, as non-ossified structures, they would not necessarily be associated with temperature control or the development of endothermy. We do, however, notice a complexification of the cartilage anchoring structures that divide the nasal cavity and separate it from the brain region in these forerunners of mammals.
Assuntos
Fósseis , Mamíferos , Crânio , Conchas Nasais , Microtomografia por Raio-X , Animais , Mamíferos/anatomia & histologia , Fósseis/anatomia & histologia , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , América do Sul , Conchas Nasais/anatomia & histologia , Conchas Nasais/diagnóstico por imagem , Evolução Biológica , Cavidade Nasal/anatomia & histologia , Cavidade Nasal/diagnóstico por imagem , FilogeniaRESUMO
INTRODUCTION: The middle turbinate and ethmoid roof are intranasal structures and may have many anatomical variations. These structures, which serve as anatomical markers during functional sinus surgery, are important for preventing complications and performing a proper surgery. Knowledge of anatomical variations will increase surgical success and reduce complications. OBJECTIVE: We aimed to investigate the presence of asymmetry in the ethmoidal roof and anatomical variation in patients with and without concha bullosa. METHODS: In this study, the files of patients who underwent paranasal computed tomography between 2012 and 2018 were analyzed retrospectively. The patients were divided into two groups, as patients with and without concha bullosa. Differences between the two groups in terms of age, gender, septum deviation, ethmoid artery dehiscence, ethmoid roof asymmetry were examined. RESULTS: The 369 patients included in our study were divided into two groups; those with concha bullosa and those without concha bullosa. The mean age of the patients with concha bullosa was 36.1⯱â¯13.4 (min-max: 12-74) and the mean age of patients without concha bullosa was 37.5⯱â¯14.3 (min-max: 10-81). The ethmoid roof depths were compared between the two groups and a significant difference was observed (pâ¯<â¯0.001). The ethmoid roof depth was higher in the group with concha bullosa (pâ¯<â¯0.001). CONCLUSION: The results of our study indicate that the ethmoidal roof tends to be higher in patients with middle concha bullosa.
Assuntos
Doenças Nasais , Seios Paranasais , Humanos , Septo Nasal/diagnóstico por imagem , Estudos Retrospectivos , Conchas Nasais/diagnóstico por imagemRESUMO
INTRODUCTION: Although many surgical techniques exist to manage obstructive concha bullosa, there continues to be a drive to find the least invasive technique with the fewest complications and best results. OBJECTIVES: The purpose of this study is to describe and assess the short- and long-term efficacy of a modified crushing technique for concha bullosa management. METHODS: Patients who met inclusion criteria underwent a detailed nasal examination and cone beam computed tomography imaging prior to and after septoplasty with crushing surgery for obstructive concha bullosa. Patients were divided into short- and long-term groups based on their followup period such that the short-term group had a mean followup of 15.14 months (range 6-22 months) and the long-term group had a mean followup of 56.66 (range 29-80) months. RESULTS: Twenty-four cases of obstructive concha bullosa were included in this study with 13 short-term and 11 long-term follow-ups. All patients showed a significantly decreased postoperative CB size (pâ¯<â¯0.001). There was no correlation between age and postoperative CB change in area (pâ¯=â¯0.39) and no significant difference in the amount of postoperative CB area reduction between the short-term and long-term groups (pâ¯=â¯0.35). No patients experienced bleeding, synechia, conchal destruction, or olfactory dysfunction on followup evaluations. CONCLUSIONS: Our modified crushing technique is a simple, effective, and lasting treatment option for concha bullosa. From our experience, there have been no complications and no instances of concha bullosa reformation during the follow-up period.
Assuntos
Doenças Nasais , Conchas Nasais , Humanos , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/cirurgia , Tomografia Computadorizada por Raios X , Doenças Nasais/cirurgia , Tomografia Computadorizada de Feixe Cônico , ComputadoresRESUMO
Abstract Introduction: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. Objective: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. Methods: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. Results: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. Conclusion: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.
Resumo Introdução: Embora o nariz e os pulmões sejam órgãos separados, numerosos estudos relataram que todo o sistema respiratório pode ser considerado como uma única unidade anatômica e funcional. As vias aéreas superiores e inferiores afetam uma à outra diretamente ou através de mecanismos reflexos. Objetivo: Avaliar os efeitos da ablação por radiofrequência em conchas nasais inferiores com hipertrofia persistente sobre a função nasal e pulmonar. Método: Foram incluídos neste estudo 27 pacientes com hipertrofia persistente bilateral de conchas inferiores sem desvio septal. Todos os pacientes foram avaliados com rinoscopia anterior, endoscopia nasal, rinometria acústica, escala visual analógica e espirometria sensível ao fluxo no dia anterior e quatro meses após o procedimento de ablação por radiofrequência. Resultados: As medidas pós-ablação demonstraram que a ablação das conchas nasais inferiores resultou em um aumento da área transversal média e do volume do nariz, bem como do volume expiratório forçado em um segundo, da capacidade vital forçada e do fluxo expiratório máximo dos pacientes. Essas diferenças entre os resultados pré e pós-ablação foram estatisticamente significantes. Os escores da escala visual analógica pós-ablação foram menores quando comparados com os escores pré-ablação e essa diferença também foi estatisticamente significante. Conclusão: O alargamento da passagem nasal após a redução do tamanho das conchas nasais inferiores teve efeito favorável nos testes de função pulmonar.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Sistema Respiratório/fisiopatologia , Conchas Nasais/fisiopatologia , Hiperostose/cirurgia , Obstrução Nasal/cirurgia , Obstrução Nasal/fisiopatologia , Ablação por Radiofrequência/métodos , Tamanho do Órgão , Período Pós-Operatório , Valores de Referência , Conchas Nasais/cirurgia , Conchas Nasais/patologia , Conchas Nasais/diagnóstico por imagem , Hiperostose/fisiopatologia , Obstrução Nasal/diagnóstico por imagem , Pico do Fluxo Expiratório , Capacidade Vital , Volume Expiratório Forçado , Estudos Prospectivos , Resultado do Tratamento , Estatísticas não Paramétricas , Rinometria Acústica , Endoscopia/métodos , Escala Visual AnalógicaRESUMO
INTRODUCTION: Although the nose and lungs are separate organs, numerous studies have reported that the entire respiratory system can be considered as a single anatomical and functional unit. The upper and lower airways affect each other either directly or through reflex mechanisms. OBJECTIVE: In this study, we aimed to evaluate the effects of the radiofrequency ablation of persistent inferior turbinate hypertrophy on nasal and pulmonary function. METHODS: Twenty-seven patients with bilateral persistent inferior turbinate hypertrophy without septal deviation were included in this study. All of the patients were evaluated using anterior rhinoscopy, nasal endoscopy, acoustic rhinometry, a visual analogue scale, and flow-sensitive spirometry on the day before and 4 months after the radiofrequency ablation procedure. RESULTS: The post-ablation measurements revealed that the inferior turbinate ablation caused an increase in the mean cross-sectional area and volume of the nose, as well as in the forced expiratory volume in 1s, forced vital capacity, and peak expiratory flow of the patients. These differences between the pre- and post-ablation results were statistically significant. The post-ablation visual analogue scale scores were lower when compared with the pre-ablation scores, and this difference was also statistically significant. CONCLUSION: This study demonstrated that the widening of the nasal passage after the reduction of the inferior turbinate size had a favorable effect on the pulmonary function tests.
Assuntos
Hiperostose/cirurgia , Obstrução Nasal/fisiopatologia , Obstrução Nasal/cirurgia , Ablação por Radiofrequência/métodos , Sistema Respiratório/fisiopatologia , Conchas Nasais/fisiopatologia , Conchas Nasais/cirurgia , Adulto , Endoscopia/métodos , Feminino , Volume Expiratório Forçado , Humanos , Hiperostose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/diagnóstico por imagem , Tamanho do Órgão , Pico do Fluxo Expiratório , Período Pós-Operatório , Estudos Prospectivos , Valores de Referência , Rinometria Acústica , Estatísticas não Paramétricas , Resultado do Tratamento , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/patologia , Escala Visual Analógica , Capacidade Vital , Adulto JovemAssuntos
Humanos , Masculino , Adolescente , Conchas Nasais/diagnóstico por imagem , Doenças Nasais/patologia , Doenças Nasais/diagnóstico por imagem , Seio Maxilar/patologia , Seio Maxilar/diagnóstico por imagem , Conchas Nasais/cirurgia , Conchas Nasais/patologia , Tomografia Computadorizada por Raios X , Doenças Nasais/cirurgia , Resultado do Tratamento , Cirurgia Endoscópica por Orifício Natural , Seio Maxilar/cirurgiaRESUMO
Abstract Introduction A pneumatized turbinate, also called concha bullosa, is a normal anatomical variant of the paranasal sinus region. Depending on the site of pneumatization, the concha is classified into extensive, bulbous or lamellar type. The middle turbinate concha bullosa has been implicated as a possible etiological factor in chronic sinusitis. Objectives The aim of this study was to investigate the anatomical variations of the concha bullosa, based on paranasal sinus imaging, and its possible association with sinusitis. Methods This prospective descriptive study was performed at the Department of ENT and Head Neck Surgery over a period of one year, from 2016 to 2017. We studied the computed tomography scans of the nose and paranasal sinuses- in axial, coronal and sagittal planes-of patients who had symptoms of nasal obstruction, or headache and features of chronic sinusitis. Results Out of the 202 scans studied, the prevalence of concha bullosa was 31.7%. The concha was bilateral in 35 (54.7%) patients and unilateral in 29 (45.3%) patients. Out of 99 conchae, 54 were on the right side and 45 were on left side. Ipsilateral sinusitiswas found in 40.4% of the sides in the scans of subjectswith concha. There was no statistically significant association between any type of middle turbinate concha with sinusitis, but sinusitis was more predominant with the extensive type of concha (p > 0.05). Conclusion Multiple air cells, mucocele, pyocele and inflammatory mucosal thickenings in the concha are relatively rare. Detailed knowledge of anatomic variations of the concha bullosa is imperative for the radiologists and the operating surgeons.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Conchas Nasais/anatomia & histologia , Conchas Nasais/patologia , Sinusite/patologia , Conchas Nasais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Obstrução Nasal/diagnóstico por imagem , Prevalência , Estudos Prospectivos , Cefaleia/diagnóstico por imagem , Mucocele/diagnóstico por imagemAssuntos
Seio Maxilar/diagnóstico por imagem , Seio Maxilar/patologia , Doenças Nasais/diagnóstico por imagem , Doenças Nasais/patologia , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/patologia , Adolescente , Humanos , Masculino , Seio Maxilar/cirurgia , Cirurgia Endoscópica por Orifício Natural , Doenças Nasais/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Conchas Nasais/cirurgiaRESUMO
Abstract Introduction: Topical therapies are the best postoperative treatment option for chronic rhinosinusitis, especially those with high volume and pressure, such as the squeeze bottles. However, they are not an available option in Brazil, where irrigation syringes are used. Objective: To investigate the efficacy of topical sinonasal therapy with syringe and the influence of the middle turbinate on this process Methods: Intervention study in training models (S.I.M.O.N.T.). After standard dissection, three interventions were performed (Nasal Spray 4 puffs, 60-mL syringe and 240-mL Squeeze Bottle) with normal and Sutured Middle Turbinate. Images of each sinus were captured after the interventions, totalizing 144 images. The images were classified by 10 evaluators according to the amount of residual volume from zero to 3, with zero and 1 being considered poor penetration and 2 and 3, good penetration. The 1440 evaluations were used in this study. Results: Considering all middle turbinate situations, the amount of good penetrations were 8.1% for Spray; 68.3% for Syringe, and 78.3% for Squeeze (p < 0.0001). Considering all types of interventions, the Normal Middle Turbinate group had 48.2% of good penetrations and the Sutured Middle Turbinate, 55% (p = 0.01). Considering only the Sutured Middle Turbinates, there was no difference between the interventions with Syringe and Squeeze (76.3% vs. 80.4%; p = 0.27). Conclusion: Topical therapy of irrigation with a 60-mL syringe was more effective than that with nasal spray. The status of the middle turbinate proved to be fundamental and influenced topical therapy. Irrigation with syringe was as effective as the squeeze bottle when the middle turbinate was sutured to the nasal septum.
Resumo Introdução: Terapias tópicas são a melhor opção de tratamento pós-operatório da rinossinusite crônica, principalmente com alto volume e pressão, como os squeeze bottles. Porém, não são opções disponíveis na realidade brasileira, na qual frequentemente são usados seringas para a irrigação. Objetivo: Averiguar a eficácia da terapia tópica nasossinusal com seringa e a influência da concha média nesse processo. Método: Estudo de intervenção em modelos de treinamento (S.I.M.O.N.T.). Após dissecção padronizada, três intervenções foram feitas (spray nasal 4 puffs, seringa de 60 mL e squeeze bottle de 240 mL) com a concha média normal e suturada. Foram capturadas imagens de cada seio após as intervenções, totalizando 144 imagens. As imagens foram classificadas por 10 avaliadores de acordo com a quantidade de volume residual de zero a 3, sendo zero e 1 considerados penetração ruim e 2 e 3, penetração boa. As 1.440 avaliações foram utilizadas neste estudo. Resultados: Considerando todas as situações de concha média, a quantidade de penetrações boas foi de 8,1% para spray; 68,3% para seringa e 78,3% para squeeze (p < 0,0001). Considerando todos os tipos de intervenção, a concha média normal obteve 48,2% de penetrações boas e a concha média suturada, 55% (p = 0,01). Considerando apenas concha média suturada, não houve diferença entre as intervenções seringa e squeeze (76,3% vs. 80,4%; p = 0,27). Conclusão: A terapia tópica de irrigação com seringa de 60 mL foi mais eficaz do que com spray nasal. O status da concha média mostrou-se fundamental e influenciou a terapia tópica. A irrigação com seringa foi tão eficaz quanto a com squeeze bottle quando a concha média foi suturada ao septo nasal.
Assuntos
Humanos , Seios Paranasais/diagnóstico por imagem , Sinusite/terapia , Seringas , Rinite/terapia , Conchas Nasais/cirurgia , Conchas Nasais/diagnóstico por imagem , Brasil , Doença Crônica , Endoscopia , Irrigação Terapêutica/instrumentaçãoRESUMO
Abstract Introduction: Crooked or deviated nose is a deviation of the nose from the straight vertical position of the face. Extensive pneumatization of the middle turbinate, also called concha bullosa or bullous middle turbinate (BMT) is known to be one of the possible etiologic factors in nasal obstruction, recurrent sinusitis, and headache. There is no study concerning a link between BMT and crooked nose. Objective: To investigate the association between crooked nose and the presence of a BMT. Methods: A total of 199 patients who underwent open septorhinoplasty were retrospectively analyzed. Preoperative paranasal Computerized Tomography (CT) findings, preoperative photodocumentation, and anterior rhinoscopic examination findings were documented. Of the 199 patients, 169 were found to meet the criteria and were included in the study. CT scans were examined to note the presence of BMT, inferior turbinate hypertrophy, and septum deviation (SD). SDs and crooked noses were classified. Results: Ninety-four of 169 patients (56%) presented a crooked nose deformity and seventy-five of 169 patients (44%) presented a straight nose. While 49 (52%) crooked nose patients had a bulbous and extensive BMT, 20 patients with straight nose (26.6%) had a BMT. A statistically significant relationship was found between the presence of crooked nose and BMT, regardless of the side of the disease (p = 0.011). Conclusion: This study revealed a link between crooked nose and BMT.
Resumo Introdução: O nariz torto ou o nariz com desvio é um nariz com um desvio da posição vertical reta da face. A pneumatização extensa da concha média, também chamada de concha bolhosa ou concha média bolhosa (CMB), é conhecida por ser um dos possíveis fatores etiológicos da obstrução nasal, sinusite recorrente e cefaleia. Não há estudo relativo a uma associação entre CMB e nariz torto. Objetivo: Investigar a associação entre o nariz torto e a presença de CMB. Método: Foram analisados retrospectivamente 199 pacientes que se submeteram a septorrinoplastia aberta. Achados pré-operatórios paranasais à tomografia computadorizada (TC), fotodocumentação pré-operatória e exame rinoscópico anterior foram registrados. Dos 199 pacientes, observou-se que 169 atendiam aos critérios e foram incluídos no estudo. As TC foram examinadas para observar a presença de CMB, hipertrofia de conchas inferiores e desvio de septo (DS). Os DS e narizes tortos foram então classificados. Resultados: Dos 169 pacientes, 94 (56%) apresentavam uma deformidade de nariz e 75 (44%) apresentavam nariz reto. Enquanto 49 (52%) pacientes com nariz torto tinham CMB extensa, 20 pacientes com nariz reto (26,6%) tinham CMB. Uma relação estatisticamente significativa foi encontrada entre a presença de nariz torto e CMB, independentemente do lado da doença (p = 0,011). Conclusão: Este estudo revelou uma relação entre o nariz torto e CMB.