Search Results (45)

Understanding the anatomy of the avian nasal cavity and paranasal sinuses is essential for diagnosing respiratory diseases and interpreting imaging findings. However, detailed tomographic descriptions of these structures are scarce in seabirds. This study aimed to provide an anatomical and radiological characterization of the nasal cavity and associated sinuses of the yellow-legged gull (Larus michahellis atlantis). Computed tomography (CT) was performed on eight cadaveric specimens using a 16-slice helical scanner with bone and pulmonary window settings. Anatomical cross-sections of the same heads were subsequently obtained to correlate and validate CT findings. CT imaging clearly delineated major nasal structures, including the rostral, middle, and caudal nasal conchae, the nasal septum, and the infraorbital sinus, as well as their connections to adjacent cranial bones. The integration of CT and anatomical cross-sections provided detailed spatial relationships and accurate visualization of the internal nasal architecture. This study demonstrates the value of CT for examining avian cranial anatomy and provides a morphological reference framework that may aid in diagnosing nasal and sinus pathologies in seabirds. Full article

Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition of the paranasal sinuses. While the burden of CRS on quality of life and respiratory health is well recognized, its potential impact on orbital structures is an area of growing clinical attention. The orbit is separated from the ethmoid and frontal sinuses by only thin bony laminae. Chronic sinus disease can therefore easily extend beyond the sinuses to involve the orbit, leading to ophthalmologic complications that range from eyelid edema changes to severe, sight-threatening emergencies. Traditionally, orbital complications are more commonly associated with acute sinusitis (particularly in children), but contemporary evidence highlights that chronic rhinosinusitis and its sequelae—including mucoceles, chronic infections (bacterial or fungal), and protracted inflammation—can likewise produce significant orbital consequences. This narrative review synthesizes the current literature on the orbital complications of chronic rhinosinusitis, highlighting clinical, relevant anatomical/pathophysiological pathways, preoperative versus postoperative findings, and the therapeutic impact of FESS. Through this review, clinicians in both otolaryngology and ophthalmology can gain an updated understanding of this interdisciplinary topic, guiding prompt recognition and effective management of CRS patients with orbital involvement. Full article

Objective: IgG4-Related Orbital Disease (IgG4-ROD) is an incompletely understood differential of idiopathic orbital inflammatory syndrome (IOIS). Accurate separation guides therapy and prognosis. This retrospective study also profiles its clinical features, therapy needs, and compares them with IOIS. Methodology: Fifty-four patients were biopsied between January 2016 and December 2023, comprising 18 who were diagnosed with IgG4-ROD (4 definite, 14 probable) and 36 with IOIS. Mean follow-up was 21.7 ± 26.2 months for IgG4-ROD versus 7.5 ± 10.3 months for IOIS. Results: Patients with IgG4-ROD were older than those with IOIS (mean 61.8 vs. 49.9 years). Gender distribution was balanced. The lacrimal gland (66.7% vs. 61.6%; p = 0.690) and extra-ocular muscles (55.6% vs. 30.6%; p = 0.076) were frequently involved in both entities, whereas paranasal sinus infiltration was significantly associated with IgG4-ROD (p = 0.003). Common shared symptoms (p > 0.05) included eyelid swelling (83.3% vs. 86.1%), exophthalmos (50% vs. 36.1%), and motility restriction (22.2% vs. 25%). Relative afferent pupillary defect (p = 0.042), chemosis (p = 0.02), and systemic disease (p = 0.005) were more prevalent in IgG4-ROD. During ≥ 6-month follow-up (n = 7), only 28.6% of IgG4-ROD patients achieved sustained remission; Kaplan–Meier analysis yielded a mean time to first event of 926 days. Additional steroid-sparing therapy was required more often in IgG4-ROD than in IOIS (p = 0.002). Conclusion: IgG4-ROD and IOIS share clinical features but differ in key aspects such as associated diseases, therapy requirements, and disease control. Understanding these differences is crucial for targeted diagnostics and individualized treatment strategies. Full article

Introduction: Functional endoscopic sinus surgery is commonly performed to treat paranasal sinus diseases, often necessitating nasal packing to control bleeding and aid healing. However, current materials can cause discomfort or lack adequate antibacterial properties. This study aimed to develop a biodegradable, biocompatible nasal packing material by combining polyvinyl alcohol (PVA) and carbon dots (CDs), and to evaluate its antibacterial activity and tissue compatibility. Materials and Methods: Electrospun nanofiber membranes were fabricated using PVA and biomass-derived CDs. Antibacterial efficacy of nasal packing variants (PVA, PVA-chitosan [CS], PVA-CS-CDs-1 mL, and PVA-CS-CDs-2 mL) was assessed using the Kirby–Bauer disk diffusion method against Escherichia coli, Salmonella spp., and Staphylococcus aureus. The in vivo biocompatibility was evaluated via histological analysis following implantation into the nasal cavity of mice. Results: All materials demonstrated antibacterial activity, with PVA-CS-CDs-2 mL showing the largest inhibition zones. Histological examination revealed minimal epithelial damage and no inflammation, with PVA-CS-CDs-2 mL yielding the most favorable tissue response. Conclusion: The PVA-CS-CDs composite demonstrates potential as a biocompatible, antibacterial nasal packing material. Further studies are warranted to validate its long-term clinical utility. Full article

Particulate matter (PM) is a major environmental pollutant implicated in various respiratory diseases. However, its impact on the upper respiratory tract, particularly the nasal and paranasal sinus mucosa, remains poorly understood. This study aimed to investigate the acute inflammatory effects of PM exposure on the sinonasal mucosa and evaluate the natural recovery process in a controlled rat model. Ten-week-old male Sprague Dawley rats were exposed to incense-derived PM in a custom-designed exposure chamber for 2 h daily for seven consecutive days. Rats were sacrificed at 3, 7, and 14 days post-exposure. Histopathologic changes were assessed using hematoxylin and eosin and Alcian blue staining, and mucosal gene expression of inflammatory cytokines including interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and IL-5 and MUC5AC was quantified using real-time reverse transcription polymerase chain reaction. PM exposure induced significant histological alterations, including epithelial thickening, inflammatory cell infiltration, and goblet cell hyperplasia, which peaked at 7 days post-exposure. Expression levels of TNF-α and IFN-γ were significantly elevated at 7 days compared to controls. The sinonasal mucosa in the 14-day post-exposure groups exhibited a remarkable decrease in goblet cell numbers, and IL-1β and TNF-α expression. Short-term exposure to high concentrations of PM resulted in acute inflammatory changes in the sinonasal mucosa of rats, including epithelial thickening and goblet cell hyperplasia. These changes were partially resolved after exposure ended, indicating that PM-induced sinonasal inflammation may be at least partially reversible. Full article

Background: Cholesteatoma, characterized by the abnormal growth of keratinizing squamous epithelium in ectopic locations, most commonly arises in the middle ear. Its occurrence in the sinonasal tract is rare and presents significant diagnostic and management challenges. These lesions can lead to severe complications like bone erosion, intracranial involvement, and orbital spread. This narrative review aims to summarize the current knowledge on cholesteatomas in these regions, focusing on epidemiology, pathophysiology, diagnosis, and treatment. Methods: A comprehensive review of the English literature was conducted, focusing on reported cases of cholesteatomas in the nasal cavity and paranasal sinuses. This review examines key aspects, including epidemiological data, imaging findings, surgical strategies, and postoperative outcomes. The role of diagnostic tools, particularly computed tomography and diffusion-weighted magnetic resonance imaging, in distinguishing cholesteatomas from other sinonasal lesions is also discussed. Results: As of March 2025, 51 cases of paranasal sinus cholesteatoma were reported. The frontal sinus is the most commonly affected site, followed by the maxillary, ethmoid, and sphenoid sinuses. Diagnosis is often delayed due to nonspecific symptoms, such as nasal congestion and recurrent infections. Surgical excision is the primary treatment, with endoscopic techniques being favored for their minimally invasive nature. Recurrence remains a major concern, and although very rare, cases of squamous cell carcinoma have also been observed in association with cholesteatoma. Conclusions: Nasal and paranasal sinus cholesteatomas require early recognition and intervention to prevent complications. Advances in imaging and surgery have improved outcomes; however, further research is needed to refine therapies and understand disease mechanisms. Full article

Background: Chronic rhinosinusitis (CRS) affects 5.5–28% of the population and is primarily an inflammatory disease, with microbiota potentially playing a key role. Understanding microbial pathogens and resistance patterns is crucial for effective management. This study aimed to evaluate the incidence of Gram-negative rods in CRS in adults as a part of a prospective microbiological study. Methods: Over one year, paranasal sinus mucosa samples from CRS patients and nasal concha samples from controls were analyzed. Cultivable bacterial flora was assessed using culture-based methods. Biofilm formation was evaluated via a microtiter-plate assay, and antibiotic susceptibility was tested using the disk diffusion method. Results: Tissue samples from 74 CRS patients and 47 controls yielded 198 bacterial strains. Gram-positive cocci dominated, while Gram-negative rods accounted for 17.6%, with Escherichia coli, Klebsiella oxytoca, and Citrobacter spp. being most common. All Gram-negative rods formed biofilms in vitro. They were susceptible to cefotaxime, aztreonam, ciprofloxacin, and meropenem but showed varying sensitivity to ampicillin (20–67%), tigecycline (40–57%), and amoxicillin/clavulanic acid (73–83%). Conclusions: The result of this study underlines that treatment of CRS should be based on the result of drug susceptibility testing of the isolated microorganism. Full article

Objectives: In this retrospective study, we performed a volumetric analysis of paranasal cavity pneumatization in a population of adult patients with cystic fibrosis compared to healthy controls, providing parcel evaluation of each sinus, and analyzing the prevalence of major anatomical sinonasal variants in the two groups. Methods: We compared paranasal sinus volumes of 89 adult patients with cystic fibrosis and 144 healthy controls who underwent paranasal sinus computed tomography. Volumes were segmented and extracted on tomographic images using the freely available software MRIcron 2019, then compared using a t-test; the z-score test was used to determine whether the two groups differ significantly in terms of major anatomical variants prevalence. Results: Overall sinus volumes in patients with cystic fibrosis patients differ significantly as compared to the healthy population (p < 0.00001). Furthermore, with the only exception of ethmoid sinus pneumatization, which was similar in both populations, all the other sinuses were statistically different. No significant difference emerged concerning anatomical variants’ prevalence. Conclusions: Our results further stress the impact of cystic fibrosis on sinus structure in adult patients, better revealing the consequences of the disease on upper airways and in optimizing the management of patients with sinonasal manifestations. Full article

The adoption of automated machine learning (AutoML) in dentistry is transforming clinical practices by enabling clinicians to harness machine learning (ML) models without requiring extensive technical expertise. This narrative review aims to explore the impact of autoML in dental applications. A comprehensive search of PubMed, Scopus, and Google Scholar was conducted without time and language restrictions. Inclusion criteria focused on studies evaluating autoML applications and performance for dental tasks. Exclusion criteria included non-dental studies, single-case reports, and conference abstracts. This review highlights multiple promising applications of autoML in dentistry. Diagnostic tasks showed high accuracy, such as 95.4% precision in dental implant classification and 92% accuracy in paranasal sinus disease detection. Predictive tasks also demonstrated promise, including 84% accuracy for ICU admissions due to dental infections and 93.9% accuracy in orthodontic extraction predictions. AutoML frameworks like Google Vertex AI and H2O AutoML emerged as key tools for these applications. AutoML shows great promise in transforming dentistry by facilitating data-driven decision-making and improving patient care quality through accessible, automated solutions. Future advancements should focus on enhancing model interpretability, developing large and annotated datasets, and creating pipelines tailored to dental tasks. Educating clinicians on autoML and integrating domain-specific knowledge into automated platforms could further bridge the gap between complex ML technology and practical dental applications. Full article

Chronic rhinosinusitis (CRS) is a common inflammatory disease of the paranasal sinuses with a yet unknown etiology. As studies continue to elucidate the disease’s heterogeneity inflammatory profile and presentation, there is a growing interest in the influence of the nasal microbiome on disease pathogenesis and chronicity. The sinus microbiota appear dominated by the Staphylococcus and Corynebacterium genera; known upper airway pathogens, such as Haemophilus influenza, are present in the upper airways of healthy individuals, though at relatively lower abundances than in CRS patients. Viral culprits may induce an unhindered local immune response that contributes to the recurrence and chronicity of inverted papillomas—benign mucosal lesions with the propensity for local destruction and malignant transformation that can be found in patients with a history of nasal infection. The persistence of inverted papillomas warrants investigation into their pathogenesis and how they may contribute to a nasal landscape promoting the chronicity of CRS. Further investigation is needed to uncover the interplay between resident microbiota and viral, fungal, and immunological influence. Discerning between ‘healthy’ and ‘diseased’ sinonasal microbiomes and ‘keystone’ species could shed light on CRS etiology and provide the opportunity for CRS treatment tailored to an individual’s microbiome. This review aims to explore the interrelation of microbial residents in the pathogenesis and chronicity of the diseased sinonasal environment. Full article

Background/Objectives: Periostin’s role in the pathogenesis of inflammatory diseases, particularly in the nose and paranasal sinuses, is an area of growing interest. This study aims to evaluate the expression of periostin in mucoceles, inverted papillomas, choanopolyps and retention cysts. Methods: Tissue samples collected during functional endoscopic sinus surgery (FESS) were analyzed for POSTN gene mRNA expression using qPCR. Periostin protein levels were measured via ELISA and Western Blot. Serum periostin levels were also assessed through ELISA in both patients (n = 54) and controls (n = 12). Results: A total of 66 participants were recruited, including 18 with inverted papillomas, 10 with mucoceles, 10 with choanopolyps, 16 with retention cysts and 12 controls. There were no significant alternations between tissue and serum samples of inverted papilloma compared to the control group. Choanopolyp tissues exhibited elevated POSTN protein expression, though POSTN mRNA and serum levels remained unchanged. In mucoceles, periostin levels were significantly elevated in both tissues and serum. Retention cyst tissues demonstrated an increase in POSTN mRNA and protein expression, whereas serum periostin levels remained consistent with those observed in the control group. Conclusions: The findings suggest that periostin may play a role in the pathophysiology of benign non-neoplastic lesions of the nose and paranasal sinuses such as mucoceles, retention cysts and choanopolyps, highlighting a need for more investigation in this subject. Full article

Chronic rhinosinusitis (CRS) is a complex inflammatory condition affecting the nasal and paranasal sinus mucosa. Gastroesophageal reflux disease (GERD) has been implicated as a potential exacerbating factor in CRS, but the specific endoscopic features of nasopharyngeal pathology in this context remain poorly understood. Background and Objectives: Chronic rhinosinusitis is a multifactorial disease with various underlying etiologies, including inflammation, anatomical factors, and environmental triggers. While gastroesophageal reflux disease has been suggested as a potential contributor to chronic rhinosinusitis, the specific endoscopic features indicative of nasopharyngeal pathology in CRS patients with GERD symptoms have not been clearly elucidated. Our aim is to identify specific endoscopic features of nasopharyngeal pathology in patients with CRS associated with GERD symptoms and to propose a method for assessing the influence of gastroesophageal reflux disease on the mucosal layer of the nose and nasopharynx. Materials and Methods: We conducted a cross-sectional observational study involving 521 adult patients presenting with symptoms suggestive of CRS. From this cohort, 95 patients with the highest scores on the Reflux Symptom Index (RSI) and Reflux Symptom Score-12 (RSS-12) questionnaires were selected as the main group. Endoscopic examinations were performed to assess the nasal and nasopharyngeal mucosa. Results: Our study revealed significant alterations in the nasopharyngeal mucosa of patients with CRS associated with GERD symptoms. Increased vascularity of the nasopharyngeal mucosa was observed in 91 patients (95.7%), while hypertrophy was noted in 83 patients (87.4%). Mucus was present in the nasopharynx of 77 patients (81.1%), exhibiting varying characteristics of color and consistency. Asymmetric hypertrophy of the oropharyngeal mucosa was noted in 62 patients (65.3%). Conclusions: We propose a method for assessing the influence of gastroesophageal reflux disease on the mucosal layer of the nose and nasopharynx, which may aid in diagnostic and management decisions. Further research is warranted to explore the potential impact of GERD symptoms on the course and severity of CRS exacerbations. Full article

Paranasal sinus pathologies, particularly those affecting the maxillary sinuses, pose significant challenges in diagnosis and treatment due to the complex anatomical structures and diverse disease manifestations. The aim of this study is to investigate the use of deep learning techniques, particularly generative adversarial networks (GANs), in combination with convolutional neural networks (CNNs), for the classification of sinus pathologies in medical imaging data. The dataset is composed of images obtained through computed tomography (CT) scans, covering cases classified into “Moderate”, “Severe”, and “Normal” classes. The lightweight GAN is applied to augment a dataset by creating synthetic images, which are then used to train and test the ResNet-50 and ResNeXt-50 models. The model performance is optimized using random search to perform hyperparameter tuning, and the evaluation is conducted extensively for various metrics like accuracy, precision, recall, and the F1-score. The results demonstrate the effectiveness of the proposed approach in accurately classifying sinus pathologies, with the ResNeXt-50 model achieving superior performance with accuracy: 91.154, precision: 0.917, recall: 0.912, and F1-score: 0.913 compared to ResNet-50. This study highlights the potential of GAN-based data augmentation and deep learning techniques in enhancing the diagnosis of maxillary sinus diseases. Full article

This study aimed to present the treatment patterns and outcomes for adenoid cystic carcinoma (ACC) arising in the nasal cavity and paranasal sinus. Sixty-one sinonasal ACC patients were retrospectively reviewed: 31 (50.8%) underwent surgery followed by postoperative radiation therapy (S+PORT), and 30 (49.2%) received definitive radiation therapy (D(C)RT). T4 disease was significantly more frequent in the D(C)RT group (25.8% vs. 80.0%, p < 0.001), where all T4b disease patients underwent D(C)RT. The 5-year local failure-free survival (LFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival were 61.8% versus 37.8% (p = 0.003), 64.8% versus 38.1% (p = 0.036), 52.6% versus 19.3% (p = 0.010), and 93.2% versus 73.4% (p = 0.001) in the S+PORT and D(C)RT groups, respectively. The absolute differences in 5-year rates of LFFS, DMFS, and PFS between the two groups were smaller in the T3–4 subgroup. The univariate analysis showed that T4b disease, neurologic symptoms, longest diameter of tumor, radiological evidence of nerve involvement, and undergoing D(C)RT were associated with worse clinical outcomes, but the significance disappeared in the multivariate analysis, except for in the case of radiological evidence of nerve involvement. In conclusion, most patients with extensive disease underwent upfront D(C)RT and generally exhibited inferior clinical outcomes when compared to those with less extensive disease and who underwent S+PORT. Full article

Different inflammatory endotypes reflect the heterogeneity of chronic rhinosinusitis with nasal polyps’ (CRSwNPs) clinical presentation. This retrospective study aimed to analyze the distribution of polyps in nasal cavities and paranasal sinuses to establish a possible association between CRSwNP endotypes, prognosis, and polyps’ extension. This study included 449 adult patients who underwent endoscopic sinus surgery for CRSwNPs between 2009 and 2022. Patients were categorized based on the number of paranasal sinuses involved by polyps. Statistical analyses, including Cox regression, were performed to identify associations between demographic, clinical, and histopathological factors and disease recurrence. CRSwNP patients were stratified into four groups based on the extent of polyp involvement. Asthma and acetylsalicylic acid (ASA) sensitivity were associated with more sinuses involved (p-values = 0.0003 and 0.0037, respectively). Blood eosinophil counts increased with the number of sinuses affected (p-value < 0.0001). The distribution of eosinophilic and non-eosinophilic histotypes varied significantly among these groups (p-value < 0.0001). The risk of CRSwNP recurrence was higher in patients with asthma, higher basophil percentages, and eosinophilic histotype (p-value 0.0104, 0.0001, 0.0118, and 0.0104, respectively). This study suggests a positive association between the number of paranasal sinuses involved by polyps and the severity of CRSwNPs, particularly in patients with eosinophilic histotype, asthma, and ASA sensitivity. Full article