Válvula nasal: anatomia e fisiologia

A porção anterior das cavidades nasais, da narina à válvula nasal (VN), é a região de maior resistência nasal ao fluxo aerífero, de suma importância para a fisiologia nasal. Na literatura existem terminologias diferentes para se referir às mesmas estruturas anatômicas e, ainda, o mesmo termo se referindo a estruturas anatômicas diferentes. OBJETIVO: Realizamos este trabalho com o objetivo de revisarmos o funcionamento da VN e definirmos com mais clareza estruturas anatômicas da porção anterior das cavidades nasais, principalmente a região da VN. CONCLUSÃO: Existe controvérsia na literatura quanto à nomenclatura das estruturas da VN. Neste trabalho definimos VN como uma estrutura tridimensional compreendida anteriormente pelo ostium internum e posteriormente pelo isthmus nasi.

Rinometria acústica: correlação anatômica dos dois primeiros entalhes encontrados no rinograma

O gráfico obtido pela rinometria acústica em indivíduos adultos, caucasianos, sem alterações nasais, mostra, com clareza, dois entalhes no início do rinograma; porém, na literatura existe controvérsia sobre sua correlação anatômica. OBJETIVO: Realizamos este estudo com o objetivo de obtermos dados que contribuam para a correlação anatômica destes dois entalhes. FORMA DE ESTUDO: Clínico prospectivo. CASUÍSTICA E MÉTODO: Foram analisados os rinogramas de 35 indivíduos em condição basal, após o uso de vasoconstritor tópico nasal e após obliteração da válvula nasal com algodão embebido em vaselina. RESULTADOS: Identificou-se diminuição e aumento, estatisticamente significante, da área de secção transversal apenas do segundo entalhe após obliteração da válvula nasal e após o uso de vasoconstritor tópico nasal, respectivamente. CONCLUSÃO: A análise dos resultados sugeriu que o primeiro entalhe do rinograma se refere à narina e o segundo à válvula nasal como um todo.

Volumes nasais de adultos aferidos por rinometria acústica

A rinometria acústica permite aferir a geometria nasal de forma objetiva e não-invasiva. OBJETIVO: O presente estudo teve por finalidade determinar os volumes de segmentos específicos da cavidade nasal, incluindo a nasofaringe, de adultos sadios por rinometria acústica. Forma de Estudo: Clínico prospectivo. CASUÍSTICA E MÉTODO: Foram analisados 30 voluntários sem evidências de obstrução nasal com idade entre 18 e 30 anos, sendo 14 homens e 16 mulheres. Os volumes foram medidos nos segmentos correspondentes à região da válvula nasal (V1), cornetos (V2) e nasofaringe (V3), antes e após a aplicação tópica de vasoconstritor nasal. RESULTADOS: Os volumes médios aferidos em 60 cavidades, antes da vasoconstrição nasal foram os seguintes: 1,81±0,35cm³ (V1), 4,02±1,41cm³ (V2) e 17,52±4,44cm3 (V3) no grupo masculino, e, 1,58±0,25cm³ (V1), 3,94±1,03cm³ (V2) e 17,80±2,73cm³ (V3) no grupo feminino. As diferenças entre os sexos foram significantes apenas para V1 (p<0,05). Após a vasoconstrição nasal, os volumes de todos os segmentos analisados foram significantemente maiores (p<0,05), sendo as diferenças entre os sexos significantes para V1 e V2. CONCLUSÃO: Os volumes dos três segmentos da cavidade nasal determinados em adultos sem evidências de obstrução nasal podem ser utilizados como valores de referência para outros estudos.

Áreas seccionais nasais de adultos sadios aferidas por rinometria acústica

A rinometria acústica tem sido utilizada como teste específico da permeabilidade nasal. OBJETIVO: O propósito do presente estudo foi determinar valores de referência de áreas de secção transversa da cavidade nasal de adultos sadios pela técnica rinométrica. DESENHO: Estudo clínico prospectivo. CASUÍSTICA E MÉTODO: Trinta voluntários sem evidências de obstrução nasal com idade entre 18 e 30 anos (14 homens e 16 mulheres) foram avaliados antes e após a aplicação tópica de vasoconstritor nasal. As áreas de secção transversa foram medidas nos três entalhes do rinograma correspondentes à válvula nasal (AST1), região anterior (AST2) e região posterior (AST3) das conchas nasais inferior e média. RESULTADOS: Os valores médios (±DP) das áreas aferidas em 60 cavidades antes da vasoconstrição nasal foram os seguintes: 0,54±0,13cm2 (AST1), 0,98±0,31cm2 (AST2) e 1,42±0,44cm2 (AST3). Após a vasoconstrição, os valores médios dos três segmentos analisados foram significantemente maiores (p<0,05). Não foram constatadas diferenças significantes entre os sexos. CONCLUSÃO: As áreas seccionais nasais de adultos obtidas para adultos podem ser usadas para fins de controle no estudo de pacientes com obstrução nasal, em complementação aos volumes nasais relatados anteriormente por nosso grupo.

Pituitary Macroadenoma Presenting As A Nasal Tumor: Case Report.

Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass. The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases. Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present.

Facial Changes After Early Treatment Of Unilateral Coronal Synostosis Question The Necessity Of Primary Nasal Osteotomy.

The premature fusion of unilateral coronal suture can cause a significant asymmetry of the craniofacial skeleton, with an oblique deviation of the cranial base that negatively impacts soft tissue facial symmetry. The purpose of this study was to assess facial symmetry obtained in patients with unilateral coronal synostosis (UCS) surgically treated by 2 different techniques. We hypothesized that nasal deviation should not be addressed in a primary surgical correction of UCS. Consecutive UCS patients were enrolled in a prospective study and randomly divided into 2 groups. In group 1, the patients underwent total frontal reconstruction and transferring of onlay bone grafts to the recessive superior orbital rim (n = 7), and in group 2, the patients underwent total frontal reconstruction and unilateral fronto-orbital advancement (n = 5). Computerized photogrammetric analysis measured vertical and horizontal axis of the nose and the orbital globe in the preoperative and postoperative periods. Intragroup and intergroup comparisons were performed. Intragroup preoperative and postoperative comparisons showed a significant (all P < 0.05) reduction of the nasal axis and the orbital-globe axis in the postoperative period in the 2 groups. Intergroup comparisons showed no significant difference (all P > 0.05). Facial symmetry was achieved in the patients with UCS who underwent surgery regardless of surgical approach evaluated here. Our data showed a significant improvement in nasal and orbital-globe deviation, leading us to question the necessity of primary nasal correction in these patients.

Nasal Potential Difference In Cystic Fibrosis Considering Severe Cftr Mutations.

The gold standard for diagnosing cystic fibrosis (CF) is a sweat chloride value above 60 mEq/L. However, this historical and important tool has limitations; other techniques should be studied, including the nasal potential difference (NPD) test. CFTR gene sequencing can identify CFTR mutations, but this method is time-consuming and too expensive to be used in all CF centers. The present study compared CF patients with two classes I-III CFTR mutations (10 patients) (G1), CF patients with classes IV-VI CFTR mutations (five patients) (G2), and 21 healthy subjects (G3). The CF patients and healthy subjects also underwent the NPD test. A statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, χ(2), and Fisher's exact tests, α = 0.05. No differences were observed between the CF patients and healthy controls for the PDMax, Δamiloride, and Δchloride + free + amiloride markers from the NPD test. For the finger value, a difference between G2 and G3 was described. The Wilschanski index values were different between G1 and G3. In conclusion, our data showed that NPD is useful for CF diagnosis when classes I-III CFTR mutations are screened. However, if classes IV-VI are considered, the NPD test showed an overlap in values with healthy subjects.

Ocular masquerade syndrome associated with extranodal nasal natural killer/T-cell lymphoma: case report

A 33-year-old woman complained of unilateral eyelid edema and blurred vision. Initial ophthalmic examination disclosed anterior chamber reaction with keratic precipitates on the cornea, without posterior abnormalities. Anterior uveitis was treated. Despite that, patient showed rapidly progressive unilateral vision loss with optic nerve swelling. Systemic workup was inconclusive, as well as cranial magnetic resonance imaging and cerebrospinal fluid examination. Based on the hypothesis of optic neuritis, intravenous methylprednisolone pulse was performed with no success. During the following days, the patient presented pericardial effusion and cardiac tamponade, progressing to death. Necropsy was performed and diagnosis of extranodal natural killers/T-cell lymphoma, nasal type with ocular involvement was confirmed by immunohistochemistry.

Derivação ventriculoperitoneal com válvula no tratamento da hidrocefalia infantil

From December-1965 to November-1969, 95 hydrocephalic infants have been operated upon using ventriculoperitoneal shunt with valve (88 cases with a Spitz-Holter valve, 6 cases with a Hakim valve and one case with a Pudenz-Heyer valve). Up to the present time (December, 1970) a total of 54 children are alive with a compensated hydrocephalus and 9 patients died, being impossible to follow-up the 32 remaining cases. The use of the ventriculoperitoneal shunt has eliminated all cardiovascular-pulmonary complications and reduced the number for surgical revisions. Besides, infections involving the draining system are less severe and more easily controlled than those occurring in the ventriculoatrial shunts. After analysis of the surgical techniques as well as complications and results the following conclusions are stated: 1) the use of a valve in the ventriculoperitoneal shunt difficults the oclusion of the peritoneal end of the draining system; 2) good results can be expected without reoperations in about 42,35% of hydrocephalus cases treated by ventriculoperitoneal shunt with valve; 3) ventriculoperitoneal shunts with valve showed better results when compared to ventriculoatrial shunts. This statement is made comparing two groups of hydrocephalic infants submitted to surgery at the same Service and in the same conditions, with the same follow-up period; 4) the cases presented permit to state that at present time the ventriculoperitoneal shunt with valve is the most suitable surgical procedure for hydrocephalus.

Angioleiomioma de cavidade nasal: relato de um caso e revisão de literatura

Leiomioma de cavidade nasal e seios paranasais é raro. Ele constitui menos de 1% de todos os leiomiomas do corpo humano. Isto se deve à escassez de células musculares no nariz. Estas neoplasias podem ser classificadas em três grupos: leiomioma, angiomioma e leiomioma epitelióide. Somente 15 casos de angiomioma foram encontrados na literatura. O tratamento de escolha é a excisão cirúrgica. Um novo caso e a revisão da literatura são apresentados.

Rhinometric evaluation of nasal cavity geometry and its relation to the upper arch transverse distance

The objective of this study was to evaluate children's respiratory patterns in the mixed dentition, by means of acoustic rhinometry, and its relation to the upper arch width development. Fifty patients were examined, 25 females and 25 males with mean age of eight years and seven months. All of them were submitted to acoustic rhinometry and upper and lower arch impressions to obtain plaster models. The upper arch analysis was accomplished by measuring the interdental transverse distance of the upper teeth, deciduous canines (measurement 1), deciduous first molars (measurement 2), deciduous second molars (measurement 3) and the first molars (measurement 4). The results showed that an increased left nasal cavity area in females means an increased interdental distance of the deciduous first molars and deciduous second molars and an increased interdental distance of the deciduous canines, deciduous first and second molars in males. It was concluded that there is a correlation between the nasal cavity area and the upper arch transverse distance in the anterior and mid maxillary regions for both genders.

Photographic assessment of nasal morphology following rapid maxillary expansion in children

OBJECTIVE: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. MATERIAL AND METHODS: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. RESULTS: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. CONCLUSIONS: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

Obstrução nasal por granuloma fúngico em eqüino: relato de caso

Um eqüino de nove anos de idade apresentou ausência de ar expirado e secreção serossanguinolenta na narina direita, associado a ruído respiratório. Os exames endoscópico e radiológico mostraram uma formação de aproximadamente seis centímetros de diâmetro recoberta por mucosa amarelada, que obstruía a cavidade nasal direita e insinuava-se para a cavidade nasal esquerda. Tal massa foi ressecada por meio de sinusotomia frontal direita. O exame histológico e a cultura revelaram lesão granulomatosa causada por fungos. O tratamento pós-operatório compreendeu associação de antibiótico e antiinflamatório, assim como de lavagens com água destilada e chá de camomila.

Collagen V-induced nasal tolerance downregulates pulmonary collagen mRNA gene and TGF-beta expression in experimental systemic sclerosis

Background: The purpose of this study was to evaluate collagen deposition, mRNA collagen synthesis and TGFbeta expression in the lung tissue in an experimental model of scleroderma after collagen V-induced nasal tolerance. Methods: Female New Zealand rabbits (N = 12) were immunized with 1 mg/ml of collagen V in Freund's adjuvant (IM). After 150 days, six immunized animals were tolerated by nasal administration of collagen V ( 25 mu g/day) (IM-TOL) daily for 60 days. The collagen content was determined by morphometry, and mRNA expressions of types I, III and V collagen were determined by Real-time PCR. The TGF-beta expression was evaluated by immunostaining and quantified by point counting methods. To statistic analysis ANOVA with Bonferroni test were employed for multiple comparison when appropriate and the level of significance was determined to be p < 0.05. Results: IM-TOL, when compared to IM, showed significant reduction in total collagen content around the vessels (0.371 +/- 0.118 vs. 0.874 +/- 0.282, p < 0.001), bronchioles (0.294 +/- 0.139 vs. 0.646 +/- 0.172, p < 0.001) and in the septal interstitium (0.027 +/- 0.014 vs. 0.067 +/- 0.039, p = 0.026). The lung tissue of IM-TOL, when compared to IM, showed decreased immunostaining of types I, III and V collagen, reduced mRNA expression of types I (0.10 +/- 0.07 vs. 1.0 +/- 0.528, p = 0.002) and V (1.12 +/- 0.42 vs. 4.74 +/- 2.25, p = 0.009) collagen, in addition to decreased TGF-beta expression ( p < 0.0001). Conclusions: Collagen V-induced nasal tolerance in the experimental model of SSc regulated the pulmonary remodeling process, inhibiting collagen deposition and collagen I and V mRNA synthesis. Additionally, it decreased TGF-beta expression, suggesting a promising therapeutic option for scleroderma treatment.

Evaluation of children nasal geometry, employing accoustic rhinometry

The area above the nasal cavity plays a role in respiratory physiology. Aim: To analyze, during a period of growth, a possible change in the minimum cross sectional area (MCA) and nasal volume of the anterior nasal cavity. Materials and Methods: We evaluated 29 children (14 boys and 15 girls) with a mean age of 7.81 years at first examination (M1) and 11.27 years in the second examination (M2), without symptoms of nasal obstruction. The interval between examinations was 36-48 months. Children were subjected to the examination of acoustic rhinometry in which we recorded the minimum cross-sectional areas, volumes and their correlations with gender. Study design: Cohort. Results: The mean cross-sectional area of the nasal cavity of MCA for girls was 0.30 +/- 0.09 cm2 (M1) and 0.30 +/- 0.14 cm2 (M2), while for boys was 0.24 +/- 0.12 cm2 (M1) and 0.32 +/- 0.10 cm2 (M2). The mean values of the total volumes found for the whole sample were 2.17 +/- 0.23 cm3 (MCA1-M1), 2.56 +/- 0.27 cm3 (MCA1-M2), 4.24 +/- 1.17 cm3 (MCA2-M2) and 4.63 +/- 1.10 cm3 (MCA2-M2). Conclusion: There was no significant change in the minimum cross sectional area of the anterior nasal cavity. There was no significant difference between genders for both MCA and for the volume. There was a significant increase in MCA1.