In patients with posterior epistaxis, generally the source of bleeding is branches of sphenopalatine artery (SPA), which enter the nasal cavity through the sphenopalatine foramen (SPF). Cases of intractable massive bleeding may require endonasal endoscopic occlusion of these vessels.

A total of 32 hemisections of formalinfixed cadaveric heads were used. The anatomic variations of SPF, its distance from anatomical landmarks, and angle of elevation of endoscope were studied so as to facilitate accurate localization of the foramen and endoscopic arterial ligation.

The SPF was generally single; however, multiple exits in the form of accessory foramina were found in 36.75% hemisections. The transition of superior and middle meatuses was the most common location of SPF, followed by the superior meatus, and middle meatus was the least common site. The accessory foramina were commonly present in the superior meatus. Ethmoid crest was distinctly visible in all but two cases. In majority of the cases, the SPF was located within a range of 55 to 65 mm from the anterior nasal spine (ANS); 60 to 70 mm from piriform aperture, 50 to 60 mm from limen nasi, 20.1 to 25 mm vertically above the floor of nasal cavity, and 8 to 15 mm from the inferior turbinate (IT). The angulation of SPF from the floor of nasal cavity was 20 to 30°.

Exploration of lateral nasal wall (LNW) up to middle meatus would minimize the risk of missing any arterial branch, and the data of distance from the anatomical references would assist in more precise localization of SPF during endoscopic ligation or cauterization of the branches of the SPA.

Aggarwal A, Gupta T, Sahni D, Gupta A. Anatomicosurgical References for Endoscopic Localization of Sphenopalatine Foramen: A Cadaveric Study. Clin Rhinol An Int J 2016;9(3):109-114.

To examine the impact of endoscopic sinus surgery (ESS) on olfactory impairment in patients with chronic rhinosinusitis (CRS) and nasal polyposis over intermediate- to long-term follow-up.

Prospective, cohort study. Conducted in a tertiary care center over a period of 2 years (August 2014-July 2016).

A total of 42 patients presenting for ESS were examined preoperatively and at 1st, 3rd, 6th, and 12th week postoperatively. Demographic, comorbidity, and olfactory scores were collected at each point of time. Sniffin Sticks test was used to assess the olfaction of the patients.

Olfactory scores in anosmic patients significantly improved after ESS at 3-month follow-up. Only few hyposmic patients improved after surgery and others did not show any change. Among normosmic patients, 80% showed no change after surgery, whereas 20% became hyposmic postoperatively. None of the normosmics became anosmic after surgery.

Patients with severe olfactory dysfunction significantly improved after ESS, whereas patients with mild olfactory dysfunction did not. A realistic assessment of effects of ESS on olfaction could be derived. This will help in counseling the patients undergoing ESS in future. Olfactory impairment is an important patient safety and quality-of-life issue for patients with CRS and one that requires continued research.

Mohanty S. Effect of Endoscopic Sinus Surgery on Olfaction: A Prospective Analysis. Clin Rhinol An Int J 2016;9(3):115-119.

To study surgical outcome in dacryocystorhinostomy (DCR) stent insertion in initial endoscopic DCR and the complications associated with the surgery.

This is a prospective, single-blinded, randomized, controlled trial.

The study was carried in a tertiary level center (period between November 2009 and February 2015). A total of 50 patients with epiphora due to nasolacrimal duct obstruction were divided randomly into two groups – with one group undergoing endoscopic DCR with stent and the other group undergoing endoscopic DCR without stent. The postoperative results were assessed subjectively and objectively after 3 and 6 months and also for complications of the procedure. The results were statistically analyzed by chi-square test.

There was significant postoperative improvement across all participants and within both groups. A total of 92% of patients in the stent group and 84% of patients in the without stent group improved. There was no significant difference with respect to complications. Synechiae and secondary hemorrhage were the most common complications in the without stent group and stent group respectively.

The present study shows that statistically significant difference in results is not achieved by inserting stents initially. But, whenever there is excessive bleeding during surgery, which masks endoscopic picture, or when bony stoma created is small because of thick bone and poor access, when atrophic sac is present, or when adhesions are expected due to pus in sac, then stenting should be done without hesitancy. Best time to do stenting is when surgeons’ first think of stenting. Regular postoperative follow-up is necessary as any defect like synechia and granulation tissue formation can be dealt with immediately.

Rao SVM, Rajshekar MM. Dacryocystorhinostomy Stent Insertion in Initial Endoscopic Dacryocystorhinostomy. Clin Rhinol An Int J 2016;9(3):120-124.

Posttraumatic nasal valve collapse (NVC) is an underdiagnosed cause of nasal obstruction causing significant symptoms and has been treated by various techniques, the results of which have been variable. In our study, alar batten graft (ABG) has been used to strengthen the nasal wall.

A prospective interventional study was done on 13 patients of posttraumatic NVC using an ABG to reinforce the ala, and results were measured on the basis of standardized nasal obstruction symptom evaluation (NOSE) and nasal obstruction visual analog scale (NO-VAS) scores at 6 months.

There was a statistically significant improvement in 12 out of 13 patients, with mean improvement of 25.62 on NOSE and 2.4 on NO-VAS scores. There was a visible improvement in the extent of collapse also.

Posttraumatic NVC can be treated effectively using ABG, with significant improvement in standard scores as well as the symptomatology.

Maggon NV, Sethi A, Das A. Posttraumatic Nasal Valve Collapse: Is Alar Batten Graft the Answer? Clin Rhinol An Int J 2016;9(3):125-129.

Panigrahi R, Acharya SK. Recent Trends in Management of Allergic Rhinitis. Clin Rhinol An Int J 2016;9(3):130-136.

Harugop AS, Mudhol RS, Bellad SA, Hajare PS, Kaku DR, Hiremath B. Isolated Abducens Nerve Palsy Secondary to Isolated Sphenoid Sinus Disease: Case Series. Clin Rhinol An Int J 2016;9(3):137-140.

Concha bullosa is the most common anatomic variation of osteomeatal complex region that is generally seen in the middle turbinate (MT).

A 25-year-old male presented with headache and nasal obstruction. Computed tomography (CT) scan documented right paradoxical MT. The right MT also showed aerated concha bullosa with narrow right osteomeatal area. Routine preoperative laboratory tests were within normal limits.

This case of concha bullosa in paradoxically bent MT was reported, described, and could be safely managed endoscopically. Patient was symptom free up to date without any complication, recurrence, or other pathology.

Computed tomography may easily identify such uncommon anatomic variations of the osteomeatal region. This directs the surgeon attention to these variations as a cause of headache and osteomeatal area obstruction.

El-Anwar MW, Ali AI. Concha Bullosa in Paradoxical Middle Turbinate: A New Variation. Clin Rhinol An Int J 2016;9(3):141-142.

Rajasekar MK, Sankar MR. A Rare Case of Pediatric Self-inflicted Meningoencephalocele. Clin Rhinol An Int J 2016;9(3):143-145.

Pandey AK, Bhardwaj A, Maithani T, Rathi S. Pleomorphic Adenoma of the Lateral Nasal Wall: An Unusual Entity. Clin Rhinol An Int J 2016;9(3):146-148.

Jana T, Sengupta M, Das S, Saha AK, Saha S. An Unusual ENT Presentation of Retinoblastoma: A Diagnostic Dilemma. Clin Rhinol An Int J 2016;9(3):149-152.

The patient is an 18-month-old female child, born full term, by cesarean section (for cephalopelvic disproportion) with birth weight 3,750 gm to a 30-year-old primigravida. There were no immediate prenatal or postnatal medical or surgical problems in the mother. The child cried immediately after birth, there was no postnatal respiratory distress, cyanosis, or any major hospital admission. On examination, microcephaly (head circumference 46 cm below 2 standard deviation of the mean), hypertelorism, ani-Mongolian slanted eyes, left side cleft lip with high arched palate with malocclusion were observed. She presented late with c/o nasal discharge and mild breathing difficulty on breastfeeding. The catheter test revealed the diagnosis of BCCA. Noncontrast computed tomography (CT) scan nose was done, which showed nonposterior choana blocked with bony plates on both the sides (Fig. 1). The paranasal sinuses, orbit, and anterior nasal cavities were within normal limits. Transnasal endoscopic repair was done under general anesthesia. Endoscopy revealed a bony atresia (Fig. 2), which was drilled out keeping the direction medially and inferiorly. Feeding tubes were fashioned as stents and placed for a period of 6 weeks. There were no postoperative complications. The patient was referred to pediatric surgery for other problems. Endoscopy confirmed bilateral patency at 12 weeks postoperatively.

Mohindra S, Gupta AK. Bilateral Complete Congenital Choanal Atresia in an 18-month-old Female Child with Rare Clinical Presentation: Transnasal Endoscopic Repair with Stent. Clin Rhinol An Int J 2016;9(3):153-154.