Clinical Rhinology

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Volume 14, Number 1--3, January-December 2023
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Sanjeev Kumar Singla, Ankush Singla

Evaluation of Surgical Conditions during Elective Endoscopic Sinus Surgery with Total Intravenous Anesthesia and Monitored Anesthesia Care

[Year:2023] [Month:January-December] [Volume:14] [Number:1--3] [Pages:4] [Pages No:1 - 4]

Keywords: Endoscopic sinus surgery, Monitored anesthesia care, Total intravenous anesthesia

   DOI: 10.5005/jp-journals-10013-1384  |  Open Access |  How to cite  | 


Background: The diseases of sinuses are commonly seen in all age groups. Currently, endoscopic sinus surgery (ESS) is commonly performed as a daycare procedure. The anesthetic technique should also be selected on this basis. Keeping these considerations in view, ESS has been performed under total intravenous anesthesia (TIVA) using or monitored anesthesia care (MAC). Materials and methods: This prospective randomized open-level study was conducted in 40 ASA I–II adult patients of either sex, undergoing elective ESS. All the patients were divided into two groups according to the randomized table: Group A: TIVA and group B: local anesthesia and conscious sedation. In group B, patients who did not tolerate the procedure were converted to the TIVA group. Results: The duration of surgical procedure was 69.00 ± 9.63 minutes in group A patients and 55.00 ± 10.34 minutes in group B patients. This result was statistically significant. But in group A, 55% of patients had a score of 2, and 45% had a score of 3. In group B, 90% had a score of 2 and 10% had a score of 3. This was statistically significant (p < 0.05). Conclusion: The time taken for ESS is reduced, the surgical field is better despite of higher mean blood pressure done with MAC care in comparison to TIVA. However, this needs the cooperative patient.



Sunil Richardson, K Prajwal

A Randomized Controlled Trial to Compare the Conformability and Adhesion of Fiberglass Splint Over Plaster of Paris Splint Material in Rhinoplasty

[Year:2023] [Month:January-December] [Volume:14] [Number:1--3] [Pages:3] [Pages No:5 - 7]

Keywords: Fiberglass, Nasal splints, Plaster of Paris, Rhinoplasty

   DOI: 10.5005/jp-journals-10013-1390  |  Open Access |  How to cite  | 


Aim/background: In rhinoplasties, splints are frequently employed to stabilize the nasal bone structure after osteotomies. The most popular splinting techniques used are Plaster of Paris (POP), thermoplastic splints, and aluminum splints. These splints also help to approximate the skin flap to the underlying bone and reduce hematoma formation. The objective of our study is to assess and compare the conformability and adhesion properties of fiberglass splints vs POP splint materials in the context of rhinoplasty. Materials and methods: About 1,000 patients undergoing cosmetic rhinoplasty were randomized into two groups. Group I, POP splint was placed, and group II patients managed fiberglass thermoplastic material. Conclusion: Fiberglass splint material is far simpler to use, more beneficial and takes lesser time to prepare overall than the widely used POP splinting material. Clinical significance: Due to the benefits of fiberglass splint material, the surgeon may be able to avoid long recovery times and obtain the ideal postoperative look.



Pookamala Sathasivam

Endonasal Endoscopic Excision of Sinonasal Malignancies: An Overview

[Year:2023] [Month:January-December] [Volume:14] [Number:1--3] [Pages:7] [Pages No:8 - 14]

Keywords: CSF leak, CSF leak repair, Endoscopic endonasal, Endoscopic excision, Endoscopic nasal surgeries, Endonasal transsphenoidal approach, Sinonasal malignancy, Squamous cell carcinoma

   DOI: 10.5005/jp-journals-10013-1385  |  Open Access |  How to cite  | 


Sinonasal malignancies are relatively an uncommon entity and squamous cell carcinoma is the commonest malignancy. Tumor mainly arises from the mucosa of nasal cavity or maxillary sinus. Primary tumor from the frontal and sphenoid sinuses are very rare. Patients often present with advanced disease, as the initial symptoms of tumor, such as nasal block, nasal bleeding, and nasal discharge mimic those of common nasal pathology such as rhinitis/sinusitis. The ideal treatment for sinonasal malignancy is surgery, followed by postoperative radiotherapy. Traditionally, such tumors were treated with open surgical excision or combined craniofacial resection in the case of skull base involvement. Now in the era of minimally invasive surgery, more and more such tumors are diagnosed early and operated on via a transnasal endoscopic approach. This article will serve as a guide for surgeons planning to operate upon such tumors endoscopically.



Veerasigamani Narendrakumar, Vinod Felix

Endoscopic Endonasal Orbital Transposition, for Closure of Lateral Frontal Sinus CSF Rhinorrhea: A Case Report

[Year:2023] [Month:January-December] [Volume:14] [Number:1--3] [Pages:5] [Pages No:15 - 19]

Keywords: Case report, Cerebrospinal fluid rhinorrhea, Endonasal, Endoscopic, Frontal sinus, Orbital transposition

   DOI: 10.5005/jp-journals-10013-1391  |  Open Access |  How to cite  | 


Cerebrospinal fluid (CSF) rhinorrhea is due to communication between the subarachnoid space and the sinonasal cavity. Cerebrospinal fluid rhinorrhea is treated with immense care to avoid serious complications which can cause high mortality. Various techniques are available for CSF rhinorrhea in which the endoscopic endonasal approach is used widely as it has less morbidity. Treating CSF rhinorrhea in far lateral frontal sinus leaks is a challenging task endoscopically, which can be done with orbital transposition. We report a series of 3 cases of lateral frontal sinus CSF rhinorrhea and they are successfully treated by endoscopic endonasal with orbital transposition.



KG Somashekara, Apurva A Jarandikar, Lakshmi Shantharam, Hemalatha Mahantappa

A Rare Case of Tuberous Xanthoma of Nose: A Case Report

[Year:2023] [Month:January-December] [Volume:14] [Number:1--3] [Pages:3] [Pages No:20 - 22]

Keywords: Benign fibrous histiocytoma, Case report, Deformed nose, Nasal septum, Nose, Open rhinoplasty, Paranasal sinus

   DOI: 10.5005/jp-journals-10013-1389  |  Open Access |  How to cite  | 


Xanthomas are localized lipid deposits in organs that may manifest as papules, plaques, or nodules on skin. There are many variants of xanthomas, and tuberous xanthoma is one of the xanthomas. They are very rare in head and neck region and xanthoma of the nose has been reported only once before. Xanthomas elsewhere are excised mainly for diagnostic purpose, whereas our patient wanted excision for better cosmetic appearance of the nose. We are presenting this case for its rarity and for concerns in management with review of literature. Facial xanthoma management requires excision for diagnosis and cosmesis. However, management of underlying lipid disorder is also very essential.



Nitya Subramanian, Anil Kumar, Neha Sood, WVBS Ramalingam

Primary Tuberculosis of the Ethmoids Mimicking Tolosa Hunt Syndrome: A Case Report

[Year:2023] [Month:January-December] [Volume:14] [Number:1--3] [Pages:2] [Pages No:23 - 24]

Keywords: Case report, Tuberculosis, Paranasal sinuses, Tolosa Hunt syndrome

   DOI: 10.5005/jp-journals-10013-1388  |  Open Access |  How to cite  | 


Incidence of primary sinonasal tuberculosis (TB) is only 1.8% of all cases of tuberculosis and among them the involvement of ethmoidal sinuses is very rare. The most common clinical presentation of sinonasal TB is that of persisting rhinosinusitis, resistant to usual treatment. We report a case of primary tuberculosis of the ethmoids and the orbit which presented with symptoms mimicking Tolosa Hunt syndrome (THS). Through this case we wish to highlight this rare clinical presentation of paranasal sinus tuberculosis and the subsequent management of this patient.



Nitya Goddanti, Sudarshan Loka Reddy, Mounika Reddy Yalaka, Swetha Chevula, Trinath Yama

Natural Killer/T-cell Lymphoma of Nose—A Diagnostic Dilemma and Its Clinical Impact: A Case Report

[Year:2023] [Month:January-December] [Volume:14] [Number:1--3] [Pages:4] [Pages No:25 - 28]

Keywords: Case report, Lymphoma, Nasal midline swelling, Sinonasal malignancy

   DOI: 10.5005/jp-journals-10013-1386  |  Open Access |  How to cite  | 


Aim: To study the clinical course, investigatory findings, and the need for timely diagnosis of extranodal natural killer/T-cell lymphoma, nasal type (ENKTL-NT) and to understand the diagnostic difficulties and treatment options. Background: Extranodal natural killer/T-cell lymphoma, also known as “Stewart's Granuloma,” is a rare non-Hodgkin's lymphoma originating in the nasal cavity. It mostly arises from the malignant transformation of cytotoxic T cells. It is characterized by aggressive and rapidly progressing necrotic lesions involving the mid face, principally the nose and palate. It is a diagnosis made by the exclusion of other infective and granulomatous mid-facial lesions. Case description: A 35-year-old male presented with bilateral nasal obstruction for 20 days, left cheek swelling for 2 days, associated with progressive left-eye swelling and nasal regurgitation of fluids. Local examination showed extensive nasal crusting, and septal and palatal perforation. No clinical improvement was seen with empirical antibiotics and antifungals. Immunohistochemistry (IHC) was positive for cluster of differentiation (CD) 3 and 56, which led to a diagnosis of ENKTL-NT, and chemotherapy was started. However, he succumbed to coronavirus disease-2019 (COVID-19) disease during the course of treatment. Conclusion: Extranodal natural killer/T-cell lymphoma, nasal type is an aggressive form of non-Hodgkin's lymphoma with a clinical picture masquerading as acute invasive fungal sinusitis, mid-face granulomatous lesions, etc. This leads to delayed diagnosis, which in turn affects morbidity and mortality. Therefore, a timely and precise diagnosis with aggressive treatment is a must. Clinical significance: Extranodal natural killer/T-cell lymphoma, nasal type, is rare with rapid and aggressive local tissue necrosis and progression. Its refractory behavior to our initial treatment regimens raised suspicions. In the current challenging times, trying to decrease misdiagnosis is of paramount importance. Through this case report, we aim to alert fellow practitioners to keep this entity in the differential diagnosis of such an aggressive clinical picture with a short history.



Sunil Kaniyar Chakrapani, Princy Maria Suvaries, Rizwaan Nasser, Saloni Mittal, Harsha Kottiyat

Endoscopic Removal of Orbito-maxillary Foreign Body: A Case Report

[Year:2023] [Month:January-December] [Volume:14] [Number:1--3] [Pages:3] [Pages No:29 - 31]

Keywords: Case report, Orbito-maxillary foreign body, Transnasal endoscopic approach

   DOI: 10.5005/jp-journals-10013-1387  |  Open Access |  How to cite  | 


Introduction: Foreign body piercing orbital floor and entering maxillary antrum is a rare scenario, and has to be managed in a meticulous fashion to avoid further complications. Transnasal endoscopic surgery is one of the methods for gaining access to both orbit as well as the maxillary antrum through a single approach. Case description: We report a case of a 40-year-old female with history of assault to the right eye using a pen. There was a J-shaped sutured wound present over medial aspect of the right eye with upper eyelid edema and a swelling medial to the right medial canthus. Computed tomography scan showed the presence of well-defined cylindrical structure measuring 46 × 9 mm noted in extraconal compartment inferomedial to right eyeball penetrating to floor of the orbit and reaching till posterior wall of right maxillary sinus. Patient was managed using transnasal endoscopic approach under general anesthesia. The postoperative period was uneventful, with complete resolution of complaints. Conclusion: A detailed history with relevant radiological imaging plays an important role in diagnosis of orbito-maxillary foreign bodies (FB) and also for planning the management. Approach to these FB varies based on their composition, size, and location. Therefore, proper surgical planning is important and will result in a good outcome with minimal complications.


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