1/6. 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.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/6. Complications of intranasal prescription narcotic abuse.The abuse of drugs via an intranasal route is an increasingly prevalent pattern of behavior. In the past year, a number of patients received care at our institution for complications resulting from the previously unreported phenomenon of intranasal prescription narcotic abuse. This report describes the clinical manifestations of this form of drug abuse in 5 patients. Their symptoms consisted of nasal and/or facial pain, nasal obstruction, and chronic foul-smelling drainage. Common physical findings were nasal septal perforation; erosion of the lateral nasal walls, nasopharynx, and soft palate; and mucopurulent exudate on affected nasal surfaces. In addition, 2 of the 5 patients had invasive fungal rhinosinusitis, which appears to be a complication unique to intranasal narcotic abuse.- - - - - - - - - - ranking = 0.056646682804226keywords = physical (Clic here for more details about this article) |
3/6. 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.- - - - - - - - - - ranking = 0.056646682804226keywords = physical (Clic here for more details about this article) |
4/6. Anterior nasal stenosis secondary to accessory nasal bones.choanal atresia may result from a posterior or anterior obstruction of the airway. Treatment is predicated on an accurate identification of the underlying pathological condition by means of physical examination, fluoroscopy, and computed tomographic scan. Expeditious surgical management after appropriate diagnosis appears to result in effective relief of the obstruction.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/6. Nasal hamartoma: case report and review of the literature.Nasal masses in the pediatric population present with nasal obstruction, epistaxis and chronic rhinorrhea. We report on a 6-year-old boy with long-standing nasal obstruction. A large left nasal mass was evident on physical examination and CT scan. Techniques of functional endoscopic sinus surgery were used to resect the mass, which, on pathologic examination, proved to be a hamartoma. Hamartomas are non-neoplastic malformations, or inborn errors of tissue development. They are characterized by an abnormal mixture of tissues indigenous to that area of the body. review of the literature revealed 5 previously reported cases of nasal hamartomas, only 2 of these in children. Our case is unique in that the hamartoma arose from the ethmoid and maxillary sinuses; previously reported cases arose from the septum and vestibule. This is the first reported case treated using a functional endoscopic sinus surgery approach.- - - - - - - - - - ranking = 0.056646682804226keywords = physical (Clic here for more details about this article) |
6/6. Acquired nasopharyngeal stenosis: a warning and review.OBJECTIVES: To present and discuss the clinical presentation and treatment planning in children with acquired nasopharyngeal stenosis (NPS) following tonsillectomy and adenoidectomy. DESIGN: Case series. SETTING: Tertiary care center. patients AND OTHER PARTICIPANTS: Nine children identified over 2 years (1995-1996) with newly diagnosed NPS were evaluated. Seven of these children underwent adenoidectomy using a potassium titanyl phosphate laser technique at a neighboring facility. These children were aged 15.6 to 62.1 months at the time of original surgery, and all presented with nasal obstruction and mouth breathing beginning within 10 weeks after surgery. In addition, 5 had newly documented obstructive sleep apnea. RESULTS: Of the 9 children, 1 required a tracheotomy. After undergoing an adenoidectomy, chronic rhinosinusitis developed and aggressive medical treatment failed in 4 children. time from symptom onset to diagnosis of NPS ranged from 2 to 34 months. The diagnosis of NPS depends on obtaining a thorough medical history and conducting a physical examination that includes nasopharyngoscopy. Most children underwent a computed tomographic scan prior to repair. The scarring encountered in these patients involved the soft palate and the posterior pharyngeal wall and/or choanae bilaterally. Five children had no identifiable eustachian tube opening into the nasopharynx, and all 5 children had chronic otitis media with effusion or persistent otorrhea. CONCLUSIONS: Nasopharyngeal stenosis following adenoidectomy and/or tonsillectomy is difficult to correct. Multiple surgeries may be required to relieve the obstruction. Standard operative techniques using the lateral pharyngeal flap and transpalatal or endoscopic intranasal approaches were adapted to the clinical situation. Prolonged use of nasal stents is mandatory to produce a nasopharyngeal opening. Adjunctive treatment may include pressure equalization tubes. However, the best treatment remains prevention.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |