Objective: To identify the internal nasal valve (INV) and to evaluate its key parameters in the established 3D models of nasal cavity space via Mimics from CT images, in order to provide evidence for quantitative diagnosis of nasal valve compromise. Methods: A total of 32 Han adults without nasal diseases who underwent maxillofacial CT test in Shanghai Ninth People's Hospital from January 2015 to December 2018 were retrospectively recruited, including 16 males and 16 females, with the age ranged from 20 to 80 years (50% age<50 years old). Maxillofacial CT images were used to create 3D model of nasal cavity space. The INV was identified and the following parameters were measured: the angle between the INV and the nasal bone (θ_INV-B), unilateral cross-sectional area of the INV (A_INV-R, A_INV-L), total cross-sectional area of the INV (A_INV), unilateral height of the INV (H_INV-R, H_INV-L), unilateral nasal valve angle (α_INV-R, α_INV-L), and the sum of nasal valve angle (α_INV). The A_INV in our study was compared with the results of the previously adopted planes (Plane_C, perpendicular to the hard palate and Plane_B, plane perpendicular to the nasal bone). The parameters above were compared among genders, age and race groups. SPSS 26 and GraphPad Prism 9 software were used for statistical analysis and mapping of data. Results: The A_INV in our study was (214.87±52.94) mm², which was significantly less than that of Plane_C (254.97±47.80) mm² and Plane_B (226.07±57.36) mm². The measured parameters were as follows: θ_INV-B was (82.07±7.06)°; A_INV-R was (112.66±31.39) mm²; A_INV-L was (102.21±27.14) mm²; A_INV was (214.87±52.94) mm²; H_INV-R was (24.87±4.62) mm; H_INV-L was (24.35±4.86) mm; α_INV-R was (20.48±2.99)°; α_INV-L was (19.65±3.82)°; α_INV was (40.13±6.24)°. The A_INV-R was larger than A_INV-L (t=2.33, P<0.05); The H_INV, A_INV-R, A_INV-L and A_INV of males were more than those of females (t value was 5.77, 3.21, 2.91 and 3.52, respectively, all P<0.01). The A_INV of the young group (<50 years) was larger than that of the old group (t=2.83, P<0.01); The θ_INV-B was different between the Han people and the Caucasian (t=2.92,P<0.01). The α_INV of the Han people was larger than that of Caucasians (Z=-6.92, P<0.01), but the H_INV was smaller (Z=-3.89, P<0.01). Conclusion: The A_INV carried out in 3D models of nasal cavity space is significantly smaller than that obtained by the previous methods of CT evaluation. INV static parameters differ among genders, age and race groups.
Adult ; Female ; Humans ; Male ; Young Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Nasal Cavity/diagnostic imaging* ; Retrospective Studies ; China ; Nose ; Nasal Bone

Nuclear protein of the testis midline carcinoma (NMC) is a rare malignant tumor that is mostly located in the upper trachea,mediastinal midline,and paravertebral midline,and few literature has described the imaging features of NMC in the nasal cavity and paranasal sinuses. In this article we summarize the clinical,radiologic,and pathologic data of one case of pathologically confirmed NMC in the nasal cavity and paranasal sinus by focusing on its CT and magnetic resonance imaging features.
Humans ; Magnetic Resonance Imaging ; Nasal Cavity ; pathology ; Nose Neoplasms ; diagnostic imaging ; Nuclear Proteins ; Paranasal Sinus Neoplasms ; diagnostic imaging ; Paranasal Sinuses ; pathology ; Tomography, X-Ray Computed

OBJECTIVE: This study aims to compare the effects of fast and slow expansion on nasal cavity structure. METHODS: A total of 40 patients were selected and randomly divided into two groups. Cone-beam computer tomography (CBCT) was obtained before and after surgery and used for comparing the changes in nasal structure before and after treatment. RESULTS: Fast expansion had resulted in greater changes in the basilar and nasal bone arch extension structures than slow expansion. No significant difference at maxillary width and nasal parenchyma. CONCLUSIONS Rapid expansion therapy has more beneficial effects on nasal function.
Cephalometry ; Cone-Beam Computed Tomography ; Humans ; Maxilla ; diagnostic imaging ; Nasal Cavity ; Nose ; Palatal Expansion Technique

A 68-year-old Chinese man presented with an eight-month history of pyrexia of unknown origin and chronic sinusitis despite multiple courses of antibiotics. He underwent extensive investigations, including workups for infections, chronic granulomatous diseases and malignancy. Nasal biopsies were performed twice under local anaesthesia, but did not show any evidence of malignancy. Eventually, the patient was diagnosed with natural killer (NK)/T-cell lymphoma, nasal variant, based on histopathological findings from harvested deep tissue obtained via functional endoscopic sinus surgery. This study highlights that, for patients presenting with pyrexia of unknown origin and nasal symptoms, NK/T-cell lymphoma must be considered as a differential diagnosis. Generous amounts of tissue should be harvested under general anaesthesia rather than limited tissue under local anaesthesia, in order to facilitate and ensure a definitive diagnosis.
Aged ; Anti-Bacterial Agents ; chemistry ; Biopsy ; China ; Humans ; Lymphoma, Extranodal NK-T-Cell ; diagnosis ; diagnostic imaging ; pathology ; Male ; Nasal Cavity ; pathology ; Nose Neoplasms ; complications ; diagnosis ; radiotherapy ; Prognosis ; Radiography ; Radiotherapy ; Sinusitis ; complications ; diagnosis ; Treatment Outcome

OBJECTIVE: To observe the CT three-dimensional imaging features of the frontal recess region with advanced three-dimensional reconstruction, and develop the real image of the important anatomical structures around the region to conduct surgery. METHOD: Thirty patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard three-dimensional reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely. RESULT: After the reconstruction, we get the three-dimensional model very close to the true state of the nasal cavity-sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In these patients, the height, width and depth of the agger nasi and frontal sinus were (9.45 ± 3.60)mm, (8.08 ± 3.37)mm, (26.98 ± 6.82)mm and (26.86 ± 9.45)mm, respectively. CONCLUSION This study tried to develop the standardized techniques and measurements from three-dimensional reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The project results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.
Ethmoid Sinus ; diagnostic imaging ; Frontal Sinus ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Nasal Cavity ; Paranasal Sinuses ; diagnostic imaging ; Tomography, Spiral Computed ; methods

In order to evaluate the calculation precision of the pencil beam (PB) algorithm and convolution-superposition(CS) algorithm for the situation with air cavity and small fields, we built a water phantom with an air cavity slab, in which the depth dose (DD) and off-axis ratio (OAR) for field 1cm x 1cm to field 7cm x 7cm were calculated by PB algorithms, CS algorithms and Monte Carlo (MC) simulation. The evaluation of algorithms by MC simulation was achieved by comparisons of DD with the spread penumbras of OAR curve self-defined as the width between isodose lines of 10% and 90%. It was shown that PB algorithm and CS algorithm both overestimated the DD but the degree overestimated by PB algorithm was more serious. The CS algorithm showed a better agreement with the MC simulation for the OARs, which spread to both laterals, while that was not predicted accurately by PB algorithm. It was indicated that PB algorithm and CS algorithm do not have high calculation precision whereas CS algorithms is relatively better for the situation with air cavity and small fields.
Algorithms ; Body Burden ; Computer Simulation ; Nasal Cavity ; diagnostic imaging ; Nasopharyngeal Neoplasms ; radiotherapy ; Nose Neoplasms ; radiotherapy ; Photons ; Radiography ; Radiometry ; methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Sensitivity and Specificity

Bone Cysts, Aneurysmal ; diagnostic imaging ; pathology ; surgery ; Cartilage Diseases ; diagnostic imaging ; pathology ; surgery ; Female ; Hamartoma ; diagnostic imaging ; pathology ; surgery ; Humans ; Infant ; Mesoderm ; diagnostic imaging ; pathology ; surgery ; Nasal Cavity ; diagnostic imaging ; pathology ; surgery ; Neoplasm Recurrence, Local ; Nose Diseases ; diagnostic imaging ; pathology ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo study the clinicopathologic features and differential diagnosis of extranodal Rosai-Dorfman disease (RDD) of the upper respiratory tract.

METHODSThe clinical, pathologic and immunohistochemical features of 10 cases of RDD were evaluated.

RESULTSAmong the 10 cases studied, there were 3 males and 7 females. The age of patients ranged from 20 to 61 years old (mean 38 years). The lesion arose in the nasal cavity (7 cases), nasopharynx (2 cases) or hard palate to trachea (1 case). Most of the patients presented with nasal obstruction, rhinorrhagia or tumor mass in the nasal/nasopharyngeal regions. CT scan often showed the presence of soft tissue lesion without bone destruction. Histologically, extranodal RDD was characterized by light-staining bands alternating with dark-staining bands. The light-staining bands were formed by aggregates of large round or polygonal histiocytes with emperipoiesis. The dark-staining bands were formed by abundant lymphoplasmacytic infiltrates. Immunohistochemical study showed that the histiocytes strongly expressed S-100 protein and partially expressed CD68. Six patients had no recurrence after surgical resection.

CONCLUSIONSExtranodal RDD of the upper respiratory tract is a rare disorder of histiocytic proliferation, which usually involves the nasal cavity and paranasal sinuses. RDD can easily mimic rhinoscleroma, mainly due to the overlapping morphologic appearance. Immunohistochemical study is helpful in the differential diagnosis.

Adult ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Histiocytic Sarcoma ; metabolism ; pathology ; Histiocytosis, Langerhans-Cell ; metabolism ; pathology ; Histiocytosis, Sinus ; diagnostic imaging ; metabolism ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Nasopharyngeal Diseases ; diagnostic imaging ; metabolism ; pathology ; surgery ; Neoplasms, Muscle Tissue ; metabolism ; pathology ; Nose Diseases ; diagnostic imaging ; metabolism ; pathology ; surgery ; S100 Proteins ; metabolism ; Tomography, X-Ray Computed ; Young Adult

Disclosures: The author signed a disclosure that there are no financial or other (including personal) relationships, intellectual passion, political or religious beliefs, and institutional affiliations that might lead to a conflict of interest.Olfactory neuroblastomas (esthesioneuroblastomas, ONB) are rare malignant neoplasms that arise from sensory neuroepithelial (neuroectodermal) olfactory cells found in the superior nasal concha and the cribriform plate of the ethmoid sinus. ONBs comprise approximately 5% of sinonasal tract malignancies, affect both genders equally and primarily involve the middle aged adult group (range 3 – 79 years). The most common presenting symptoms are unilateral nasal obstruction, epistaxis and a fairly slow-growing mass high in the nasal cavity or ethmoid region. Anosmia is also characteristic. A classic, though advanced, radiologic presentation is that of a “dumbbell-shaped” mass on either side of the cribriform plate, with an expansion into the nasal vault and an opposite expansion into the intracranial cavity. 1, 2, 3We present here two illustrative cases. The first is a 67 year old male who has had three recurrences of a left nasal mass over a span of 24 years. The initial occurrence was treated with excision and radiotherapy, while subsequent recurrences were treated with excision alone. The material shown herein is from the latest recurrence. All previous slides were not available for review. The second case is a 52 year old male who presented with a 6 month history of a right nasal cavity mass that on initial consult already extended into the maxillary, ethmoid, sphenoid, and bilateral frontal sinuses, penetrated the cribriform sinus, and involved the right frontal lobe of the brain. A craniofacial resection was performed.The typical case is best described as a “malignant small round cell tumor” arranged in rounded lobules in a vascularized stroma (Fig. 1). This general architecture is found irrespective of the grade of the tumor. The cells are neuroendocrine in appearance, with uniform, small round nuclei that have “salt-and-pepper” nuclear chromatin (Fig. 2) and scanty cytoplasm. Tumors are graded according to the Hyams’ grading system. Grades 1 – 2 tumors have nil to few mitoses, minimal nuclear pleomorphism, absent necrosis and presence of Homer-Wright pseudorosettes (Fig. 3), while Grades 3 – 4 tumors have brisk mitoses, prominent nuclear pleomorphism, frequent necrosis and predominance of Flexner-Wintersteiner true rosettes (Fig. 4, 5). The first case is an example of a Grade 2 ONB, while the second shows a Grade 4 morphology. Immunohistochemistry typically shows diffuse positivity for the neuroendocrine markers neuron-specific enolase, chromogranin and synaptophysin (Fig. 6), and negative reactions for cytokeratins, desmin and CD99. The latter three stains are significant in that the differential diagnoses include Sinonasal Undifferentiated Carcinomas (SNUC), Rhabdomyosarcomas and Primitive Neuroectodermal Tumors/Ewing Sarcomas (PNET/ES) in which these stains are expected to be positive, respectively.1, 3, 4 Other differential diagnosis include a Non-Hodgkin Lymphoma and a Mucosal Malignant Melanoma for which a Leukocyte Common Antigen (LCA) and melanoma markers (e.g. HMB-45 or Melan-A) may be performed. The two cases were however sufficiently distinct as to rule out these two entities on morphologic grounds.Prognosis is stage- (90% 5-year survival rate for early-stage versus 40% for advanced-stage cases), and grade-dependent (80% for low-grade versus 40% for high-grade cases). Recurrence occurs in approximately 30% of cases, usually within two years. The long-term recurrences seen in the first case is compatible with its low-grade morphology. In contrast, the shorter history and high stage (Kadish stage C)4 at presentation of the second case are both compatible with its high-grade morphology. Metastases develop in about 20% of cases and usually involve the lymph nodes, lungs and bone. Complete surgical excision with post-operative radiotherapy is the mainstay of treatment. 1,2
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Esthesioneuroblastoma, Olfactory ; Neoplasms ; Signs And Symptoms ; Nasal Obstruction ; Epistaxis ; Nasal Cavity ; Ethmoid Sinus ; Diagnostic Imaging ; Radiotherapy

The present study reports a case of inverted papilloma of the nasal cavity and infiltrating into the maxillary sinus. Inverted papilloma is an uncommon and locally aggressive benign tumor of the sinonasal region. The patient, 51- year-old male, presented with unilateral nasal obstruction and periodic swelling on the palate without pain. Enhanced CT scan revealed a heterogeneously enhancing solid mass in the nasal cavity and infiltrating into the right maxillary sinus, as well as an incidental, secondarily infected residual cyst in the periapical area of the right maxillary canine. The sinonasal mass was revealed as an inverted papilloma on histopathologic examination.
Diagnostic Imaging ; Humans ; Male ; Maxillary Sinus ; Nasal Cavity ; Nasal Obstruction ; Palate ; Papilloma, Inverted