Necrotic lesions in the nasal cavity are induced by a variety of diseases that cause necrosis of the mucosa, bone, and cartilage in the nasal cavity, and Wegener's granulomatosis and sinonasal natural killer cell or T-cell lymphoma must be included in the differential diagnosis. Necrotic lesions induced by cocaine inhalation, on the other hand, are very rare in Japan, and cocaine inhalation also needs to be included in the differential diagnosis. We report the case of a 33-year-old male who complained of nasal pain and necrosis in the nasal cavity. Although we initially suspected Wegener's granulomatosis based on the endoscopic findings and results of laboratory tests, especially based on a slight elevation of the PR3-ANCA value, we did not detect any giant cell granulomas or necrotizing vasculitis, which are histological characteristics of Wegener's granulomatosis in repeatedly biopsyed specimens. Systemic steroid therapy was started based on suspicion of localized Wegener's granulomatosis, but was ineffective. Two months after the start of treatment, the patient failed to return for follow up. He was later arrested for the illegal possession of cocaine, and we realized that the necrotic lesions were caused by cocaine inhalation. Necrosis induced by cocaine inhalation should be included the differential diagnosis of necrotic nasal lesions.
Advances in nasal endoscopy have broadened the indications of endoscopic surgery to nose-related areas, and it has recently become more common to treat diseases in related fields such as neurosurgery or ophthalmology, endoscopically. In this report we describe endoscopic bath plug closure and endoscopic dacryocystorhinostomy as means of treating cerebrospinal fluid leaks and nasolacrimal duct obstruction, respectively. In the bath plug closure procedure, fat tissue tied with sutures is packed into the dural perforation, and is then drawn back with adequate tension to achieve complete closure. In the endoscopic dacryocystorhinostomy procedure, the lacrimal sac with surrounding bone is opened endoscopically in nasal cavity, and a silicone tube is then inserted and mitomycin-C is applied in and around the lacrimal sac. These procedures are less traumatic than conventional procedures. To optimize the results, it is fairly important and advisable to discuss the case and cooperate with neurosurgeons and ophthalmologists before and during the operation, in addition to having sufficient anatomical and physiological knowledge of diseases in related fields.
The radicular cyst is the most common form of odontogenic cyst. We report on the first case of a large radicular cyst, successfully and radically treated with endoscopic sinus surgery (ESS). The most important points in the surgery for radicular cysts are complete removal of the cyst and treatment of the causative tooth. To meet these criteria, the cyst wall was totally extirpated via the inferior meatal approach and the canine fossa approach. After removal of the cyst wall, the root of the causative tooth was resected with a diamond cutting instrument. This approach has been widely adopted for the surgery of maxillary sinus disease, and is therefore a simple technique for oto-rhino-laryngologists. The ESS technique is very useful in cases of a large radicular cyst extending to the maxillary sinus because it is less invasive for the patient than a conventional approach.
Examination of intranasal surface structures was performed with narrow band imaging (NBI) using white light in patients with allergic rhinitis and patients with vasomotor rhinitis. At the surface of the nasal mucosa, rather deep capillaries were visualized with a reticulate pattern. It is difficult to differentiate NBI findings in the nasal mucosa during an attack-free phase in allergic rhinitis and those in non-allergic rhinitis. During an allergy attack of the nasal obstruction type, rather deep capillaries in the inferior turbinate are visualized as being partially dilated, along with interstitial edema. The rather deep capillaries in the inferior turbinate are sparsely visualized during an allergy attack of the rhinorreheal type. The rather deep capillaries are seen mottled during an attack-free phase in vasomotor rhinitis, during which, the NBI demonstrates contracted capillary nets and dilated cavernous sinus blood vessels. The axon reflex is likely to be exaggerated during an attack of vasomotor rhinitis. Intranasal examination with NBI is of value for differentiation between allergic rhinitis and vasomotor rhinitis during an attack
The eye socket lies anatomically adjacent to the paranasal sinuses, meaning that inflammatory disease of the sinuses can easily cause orbital complications. From January 2007 to April 2008, we observed seven such cases. By category, we observed 4 cases of acute paranasal sinusitis, 1 postoperative maxillary cyst, 1 orbital fracture, and 1 malignant lymphoma. Impaired ocular movement was observed in all cases and 2 patients experienced complications associated with visual disturbance. Each patient was appropriately treated and improvement was observed in visual acuity and ocular movement, except in one patient with malignant lymphoma. Treatment was initially conservative; surgical treatment was included only if no improvement was seen in disturbances in visual perception. Since visual organ dysfunctions could become irreversible depending on treatment, prompt and competent determination of the treatment policy based on diagnostic imaging and sequential evaluation of visual function is important.