Happy 34th Birthday Nicki Minaj!

“Onika Tanya Maraj (born December 8, 1982), known professionally as Nicki Minaj, is a Trinidadian-born American rapper, singer, and songwriter. Born in Saint James, Trinidad and Tobago and raised in South Jamaica, Queens, New York, Minaj earned public attention after releasing three mixtapes between 2007 and 2009. She has been signed to Young Money Entertainment since 2009.

Minaj’s first and second studio albums, Pink Friday (2010) and Pink Friday: Roman Reloaded (2012), both peaked at number one on the U.S. Billboard 200 and produced the successful singles "Super Bass” and “Starships”, respectively. In 2010, Minaj became the first female solo artist to have seven singles simultaneously charting on the U.S. Billboard Hot 100. Her third studio album, The Pinkprint (2014), was preceded by its second single, “Anaconda”, which peaked at number two on the Hot 100 and is her highest-charting single in the U.S. to date. Minaj made her film debut in the 2012 animated film Ice Age: Continental Drift, followed by supporting roles in The Other Woman (2014) and Barbershop: The Next Cut (2016). In 2013, she was a judge on the twelfth season of American Idol.“

Read more at Wikipedia.com

#theslaymagazine #sheslays #slayday #happybirthday #wikipedia #slaybirthday #famousbirthdays #actress #sagittarius #nickiminaj #melanin #blackgirlsrock #blackgirlmagic #beauty #rapper #singer #songwriter #onika #thepinkprint #iceage #barbershop #americanidol #anaconda @charlynichole

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Jacob van Ruisdael (1629-1682) was a Dutch painter, draughtsman, and etcher. He is generally considered the pre-eminent landscape painter of the Dutch Golden Age, a period of great wealth and cultural achievement when Dutch painting became highly popular. (Wikipedia)

(“The Waterfall” by Jacob van Ruisdael)

Camera 📸

Camera \ˈkam-rə, ˈka-mər-ə\
a device that consists of a lightproofchamber with an aperture fitted with a lensand a shutter through which the image of an object is projected onto a surface for recording (as on film) or for translation intoelectrical impulses (as for televisionbroadcast) •merriam webster•

A camera is an optical instrument for recording or capturing images, which may be stored locally, transmitted to another location, or both. The images may be individual still photographs or sequences of images constituting videos or movies. The camera is a remote sensing device as it senses subjects without physical contact. The word camera comes from camera obscura, which means “dark chamber” and is the Latin name of the original device for projecting an image of external reality onto a flat surface. The modern photographic camera evolved from the camera obscura. The functioning of the camera is very similar to the functioning of the human eye. -Wikipedia

For me, it is the most useful application nowadays because as far as I know that some people have this, and it is the one that they are using whenever they want. The camera in our phone is part of our daily lives, for me it makes my life complete and aside from that through camera you can smile and you can apply your skillls. In this generation all of us took a photo or what we called ‘selfie’.

Camera is all about a moment and specially a source of happiness to others. You can express of your own thoughts by taking a photo.

Camera \ˈkam-rə, ˈka-mər-ə\
a device that consists of a lightproofchamber with an aperture fitted with a lensand a shutter through which the image of an object is projected onto a surface for recording (as on film) or for translation intoelectrical impulses (as for televisionbroadcast) •merriam webster•

A camera is an optical instrument for recording or capturing images, which may be stored locally, transmitted to another location, or both. The images may be individual still photographs or sequences of images constituting videos or movies. The camera is a remote sensing device as it senses subjects without physical contact. The word camera comes from camera obscura, which means “dark chamber” and is the Latin name of the original device for projecting an image of external reality onto a flat surface. The modern photographic camera evolved from the camera obscura. The functioning of the camera is very similar to the functioning of the human eye. -Wikipedia

For me, it is the most useful application nowadays because as far as I know that some people have this, and it is the one that they are using whenever they want. The camera in our phone is part of our daily lives, for me it makes my life complete and aside from that through camera you can smile and you can apply your skillls. In this generation all of us took a photo or what we called ‘selfie’.

Camera is all about a moment and specially a source of happiness to others. You can express of your own thoughts by taking a photo.

en.wikipedia.org
Goatman (Maryland) - Wikipedia
According to urban legend, the Goatman is an axe-wielding half-animal, half-man creature that was once a scientist who worked in the Beltsville Agricultural Research Center. The tale holds that he was experimenting on goats until one experiment backfired, and he was mutated, becoming goat-like himself. He then began attacking cars with an axe, roaming the back roads of Beltsville, Maryland.

cinnamon-starlight  asked:

Do you have a favorite unsolved mystery?? If so can you tell me as much about it as possible and maybe other ones I would be interested in?? Thanks!!

Probably one of my favorite unsolved cases is the Somerton Man mystery.  I’m also really fascinated with the concept of time travelers too. 

Other neat cases: 

https://en.wikipedia.org/wiki/Dyatlov_Pass_incident

https://en.wikipedia.org/wiki/Hinterkaifeck_murders

https://thehairpin.com/a-beekeepers-funeral-when-the-mourners-included-the-bees-9ed728e0d7e#.nu02m1zi2

https://en.wikipedia.org/wiki/Salish_Sea_human_foot_discoveries

The Norwegian Wikipedia article Isak read on Sat translated into English.

Mania is a morbid state of mind with a very high mood level and energy level, usually comes in periods lasting weeks or months. The manic can spend money that he / she has not, buy expensive things and enter into contracts and agreements that are unrealistic. Many initiate a number of projects that are difficult to implement. They feel invincible and uninhibited. Often manic people are irritable by adversity, and sometimes aggressive. Some can be very sexually assertive and active, and acquire many partners (promiscuity). They sleep often a small amount, usually 3-4 hours a day. The person often does not realize that he / she is sick. Mania many times develop into a psychosis, where the sick person completely loses touch with reality. Mania could be a very heavy burden for those affected and their relatives, but also involves the strong positive feelings and experiences. When the manic episode is nearing its end people report remorse and self-criticism, and many go directly into a deep depression.

To begin with, there is often no one but close family who discover that they are about to go into a manic episode, but as the disease progresses it becomes clear to everyone.

An episode of mania is one of the criteria for diagnosis of bipolar I, one of two types of bipolar disorder. Hypomania is a more moderate condition with easily lifted mood, which can be far more difficult to diagnose. Hypomania in combination with episodes of depression qualify for a diagnosis of bipolar II.


Definitely not the most comforting article. I understand why he had essentially given up before Magnus educated him.

Nasal septal perforation in children

Nasal septal perforation in children: Presentation, etiology, and management: The presentation, etiology, and treatment of nasal septal perforation have been described in the adult literature; however, reports in the pediatric population are limited. In this study, we review our experience with pediatric nasal septal perforations with a focus on presentation, pathogenesis, management, and outcomes of surgical repair.




External image






Nasal septum perforation

From Wikipedia, the free encyclopedia





A nasal septum perforation is a medical condition in which the nasal septum, the cartilaginous membrane dividing the nostrils, develops a hole or fissure.

This may be brought on directly, as in the case of nasal piercings, or indirectly, as by long-term topical drug application, including intranasal ethylphenidate, methamphetamine, cocaine, crushed prescription pills, or decongestant nasal sprays, chronic epistaxis and as a complication of nasal surgery like septoplasty or rhinoplasty. Much less common causes for perforated nasal septums include rare granulomatous inflammatory conditions like granulomatosis with polyangiitis. It has been reported as a side effect of anti-angiogenesis drugs like bevacizumab.











Congenital and Acquired Lesions of the Nasal Septum: A Practical …http://ift.tt/2gZeL6t
Μετάφραση αυτής της σελίδαςαπό MP Valencia - ‎2008 - ‎Γίνεται αναφορά σε 45 - ‎Σχετικά άρθρα





Lupus vulgaris leading to perforation of nasal septum in a child Singal …http://ift.tt/2hnLkaS;… - Μετάφραση αυτής της σελίδαςαπό A Singal - ‎2015 - ‎Σχετικά άρθρα




Hematoma of the Nasal Septum | In Brief | Pediatrics in Reviewhttp://ift.tt/2gZcEiU
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[PDF]Nasal Septal Perforation Due to Button Battery - International Journal …http://ift.tt/2hnNHus
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Pediatric nasal septal perforation secondary to magnet misuse: a case …http://ift.tt/2hnKqv7 - Μετάφραση αυτής της σελίδαςαπό C Shermetaro - ‎2007 - ‎Γίνεται αναφορά σε 9 - ‎Σχετικά άρθρα





[Septal perforation in children due to button battery lodged in the nose …http://ift.tt/2hnPsb3 - Μετάφραση αυτής της σελίδαςαπό A Zanetta - ‎2012 - ‎Γίνεται αναφορά σε 4 - ‎Σχετικά άρθρα

RSNA Education Exhibits

Congenital and Acquired Lesions of the Nasal Septum: A Practical Guide for Differential DiagnosisMaría P. Valencia, MD, and Mauricio Castillo, MD
1From the Department of Radiology, Hospital Universitario San Vicente de Paúl, Universidad de Antioquia, Medellín, Colombia (M.P.V.); and Neuroradiology Section, Department of Radiology, University of North Carolina, CB 7510, UNC-CH, 101 Manning Dr, Chapel Hill, NC 27599-7510 (M.C.). Presented as an education exhibit at the 2006 RSNA Annual Meeting. Received March 19, 2007; revision requested May 10 and received June 28; accepted July 18. All authors have no financial relationships to disclose.Address correspondence to M.C. (e-mail: castillo@med.unc.edu).DOI: http://ift.tt/2hnLY8y
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LEARNING OBJECTIVES FOR TEST 5Section:ChooseChooseTop of pageAbstractLEARNING OBJECTIVES FOR T… <<IntroductionEmbryologic DevelopmentCategories of Nasal Septa…SummaryReferencesprevnextAfter reading this article and taking the test, the reader will be able to:•. Describe lesions that are caused by abnormal embryologic development of the nasal septum.•. Recognize the imaging appearances of the most common lesions that affect the nasal septum.•. Formulate a differential diagnosis for nasal septal masses in children and adults.IntroductionSection:ChooseChooseTop of pageAbstractLEARNING OBJECTIVES FOR T…Introduction <<Embryologic DevelopmentCategories of Nasal Septa…SummaryReferencesprevnextNasal septal lesions are relatively common. Although most manifest with symptoms of nasal destruction, some are incidentally found. The purpose of this article is to review the spectrum of nasal septal lesions. The category of congenital lesions includes the rare developmental midline nasal masses in children (1). Such anomalies may be understood by studying their anatomy and embryologic development. Potential intracranial extension or connection, if present, has implications for treatment and prognosis. In patients with this type of lesion, magnetic resonance (MR) imaging is essential to characterize and map the lesions. High-resolution computed tomography (CT) may be helpful in older children, but a lack of ossification at the base of the skull in very young children may simulate defects.Acquired septal lesions may appear either as erosive changes or as masses and may be due to inflammatory or neoplastic processes. Because their imaging features often are nonspecific, the diagnosis usually is based also on the clinical history and histopathologic findings. The most common symptoms produced by such lesions include nasal obstruction, nasal discharge, epistaxis, facial swelling, and pain. If a physical examination confirms the presence of a mass, both MR imaging and CT may be used to characterize the finding.The article provides a practical guide for differential diagnosis of the wide range of entities that may involve the nasal septum. Although blunt trauma to the nose and generalized facial trauma are common causes of nasal septal abnormalities, those lesions are not described here because the findings vary according to the specific event and because the cause is readily identified from the physical examination and medical history.Embryologic DevelopmentSection:ChooseChooseTop of pageAbstractLEARNING OBJECTIVES FOR T…IntroductionEmbryologic Development <<Categories of Nasal Septa…SummaryReferencesprevnextNasal SeptumDevelopment of the nose and the nasal cavities occurs between 3 and 10 weeks of gestation (2,3). The nasomedial processes fuse in the midline with the frontal prominence, and the result is the formation of the frontonasal process, which gives origin to the columella, philtrum, upper lip, nasal bones, cartilaginous nasal capsule, and midline superior alveolar ridge (2). The nasal placodes, which are local thickenings of surface ectoderm, develop laterally during the 5th gestational week. They deepen gradually into pits that eventually form the nostrils. The primitive nasal cavities are separated from the buccal cavity by the rudimentary palatal shelves and from the oropharynx by the buccopharyngeal membrane (4). Deeper within the face, fusion of the maxillary and frontal processes forms the rudimentary palatal shelves at 6 weeks of gestation. By the 9th week, the cartilaginous nasal septum, which results from the persistence of neural crest cells between the nasal cavities, directly overlies the buccal cavity (4). The palatal shelves migrate medially, and the septum migrates inferiorly (Fig 1). By the 10th week, the palatal shelves and the inferior septum fuse to form the secondary palate (2,5). The primary palate is triangular in shape and is located anterior to the shelves and posterior to the central incisors. At this point, the posterior nasal cavities are separated from the buccal cavity by the bucconasal membrane. Cellular apoptosis causes the disappearance of these membranes and the resultant configuration and patency of the posterior choanae.Frontonasal RegionThe nasofrontal fontanelle, or fonticulus frontalis, temporarily separates the nasal and frontal bones (Fig 2a). Simultaneously, the transient prenasal space separates the nasal bones and the underlying cartilaginous nasal capsule (6). A diverticulum of dura mater extends from the anterior cranial fossa through a foramen into the prenasal space. This diverticulum briefly contacts the skin at the tip of the nose before retracting back into the cranium. The nasal and frontal bones fuse, obliterating the fonticulus frontalis and forming the frontonasal suture (Fig 2b). The prenasal space becomes smaller with growth of the adjacent bone structures and eventually is reduced to a small blind canal (the foramen cecum of frontal bone) anterior to the crista galli. Finally, the foramen cecum is filled by fibrous tissue.Categories of Nasal Septal LesionsSection:ChooseChooseTop of pageAbstractLEARNING OBJECTIVES FOR T…IntroductionEmbryologic DevelopmentCategories of Nasal Septa… <<SummaryReferencesprevnextNasal septal lesions may be categorized as congenital or acquired. The latter category is significantly more common than the former.Congenital LesionsDevelopmental midline nasal masses in children are rare, with a reported annual incidence of one in every 20,000–40,000 live births (6–8). They result from a failure of embryologic separation of neuroectodermal and ectodermal tissues during the development of the nose and frontobasal region. Many such lesions may include an intracranial extension or connection. Their differential diagnosis includes abscesses, hemangiomas, fibromas, lipomas, granulomas, and mucoceles.Neuroimaging is essential to characterize these lesions and to determine their exact location and the presence or absence of intracranial extension (1). Potential complications of these lesions include Mollaret meningitis (benign recurrent aseptic meningitis) as well as infectious meningitis, abscess, osteomyelitis, cavernous sinus thrombosis, seizures, and periorbital cellulitis.Sincipital Encephaloceles.—Brain tissue that is trapped in the nose during embryologic development usually results in either a type of sincipital encephalocele or a nasal glioma. Sincipital encephaloceles are more common in Asia and Latin America, whereas occipital encephaloceles are more common in North America. By convention, the name of the structure that forms the roof of the encephalocele precedes the name of the structure that forms its floor. When a sincipital encephalocele extends through the foramen cecum into the ethmoid sinuses and nose, it is called a nasoethmoidal encephalocele, whereas one that protrudes anteriorly between the nasal and frontal bones is called a frontonasal encephalocele (Fig 3). Naso-orbital encephaloceles are the least common type of sincipital encephalocele.Encephaloceles contain brain tissue of varied signal intensities at MR imaging (hyperintensity on T2-weighted images may reflect gliosis) as well as spaces that are filled with cerebrospinal fluid. The nasal septum may appear deformed or truncated anteriorly by the encephalocele, especially if the lesion is large. Tissues harbored in encephaloceles are nonfunctional and may be resected with no adverse consequences. Encephaloceles have a direct connection to the intracranial cavity, and this connection must be obliterated to avoid potential future meningitis and abscess formation. The neurodevelopmental outcome depends on the state of the brain and the size of the encephalocele; larger lesions generally are accompanied by more numerous intracranial anomalies and incur a worse prognosis.Nasal Gliomas.—A nasal glioma, like an encephalocele, consists of disorganized (hamartomatous) trapped brain tissue; however, unlike encephaloceles, nasal gliomas usually have no connection to the intracranial brain. These lesions, unlike intracranial gliomas, contain non-neoplastic glial tissue. For this reason, the term nasal glioma is not accurate; nasal brain heterotopia or nasally trapped brain might be a better term.Intranasal gliomas are analogous to nasoethmoidal encephaloceles in that they occur when detached brain tissue remains in the prenasal space (Fig 4a). Intranasal gliomas are covered by the skin and thus are not directly visible (Fig 4b, 4c). In patients with a lesion of this type, the foramen cecum may be deeper than normal, and the crista galli may be small or bifid. In the presence of a large lesion, the anterior border of the nasal septum may be deformed. Extranasal gliomas (60%) are slightly more common than intranasal gliomas (40%).An extranasal glioma represents brain tissue that was trapped over the bridge of the nose during closure of the fonticulus frontalis (Fig 5a). Although these lesions also are covered by skin, they are visible as masses in the frontonasal region. Both types of nasal gliomas are generally disconnected from the brain and grow very little or none at all. Occasionally (1%–15%), they remain connected to the brain via a thin stalk, and their growth may reflect that of intracranial structures.Nasal gliomas have intermediate signal intensity on T1-weighted images, may show some contrast enhancement, and have high signal intensity on T2-weighted images as a result of gliosis (Fig 5b). MR imaging with contrast material occasionally depicts a tract that extends from the nasal glioma to the frontobasal region. The nasal septum remains intact in the presence of most of these lesions but may appear truncated anteriorly with large nasal gliomas. Coronal CT images may show an intact anterior cranial fossa or the presence of a wide foramen cecum, which is suggestive of an intracranial communication. The crista galli may be normal, but if it is widened or bifid, intracranial extension is likely.Teratomas, Dermoids, and Epidermoids.—Incomplete regression of the embryonic frontonasal diverticula with trapping of nonglial tissue may result in the formation of teratomas, dermoids, or epidermoids (Fig 6a). Teratomas contain ectoderm, mesoderm, and endoderm, whereas epidermoids and dermoids are composed exclusively of ectoderm. Dermoids contain epidermis, subcutaneous tissue, and annexa (hair follicles, sebaceous glands, and sweat glands), whereas epidermoids contain only epidermis (6). On CT and MR images, teratomas usually appear as large masses with a complex appearance. The most mature ones include fat and bone, whereas immature teratomas have a nonspecific appearance. The tumors typically are very large at presentation. Oronasal teratomas, although rare, are second in frequency to those found in the lower neck (near the thyroid gland) and are more common than those found in the orbits.Congenital dermoids are benign developmental anomalies rather than true neoplasms (8). Those arising in the head and neck comprise approximately 7% of all dermoids. More than 50% of head and neck dermoids are found in the periorbital region; 25%, in the oral cavity; and 13%, in the nasal cavities (9). Dermoids are slightly more common in males, whereas epidermoids have equal prevalence in both sexes.A dermoid may manifest clinically as a nasal pit, a fistula, or an area of fluctuant swelling that may be located anywhere from the glabella to the nasal tip (8). Their most common location is the lower third of the bridge of the nose. Hair protruding from the cyst or sinus tract is typical of a nasal dermoid but is found in less than 50% of patients. Paller et al suggested that patients with a sinus ostium had a higher risk (44%) of intracranial involvement than those with isolated cysts (10%) (10). Wardinsky et al reported in 1991 a 41% rate of associated craniofacial malformations in patients with nasal dermoids (11). Failure to recognize and promptly treat dermoids and epidermoids may lead to progressive enlargement of the lesions and to skeletal distortion or to recurrent infections that may progress to meningitis, brain abscess, thrombosis of the cavernous sinus, periorbital cellulitis, or a combination of these (8).Unlike intracranial dermoids, which usually have high T1 signal intensity due to the presence of fat, extracranial dermoids have a variable and often nonspecific appearance (Fig 6b). If they are or previously were infected, they may show internal contrast enhancement. The anterior border of the nasal septum appears irregular or truncated, and the mass is covered by skin. Occasionally, a dermoid becomes infected, resulting in an abscess in the nasal septum (see the section titled “Nasal Septal Abscess”). Normal fat within the crista galli or nasal septum should not be mistaken for a dermoid or epidermoid. MR imaging should be used as a primary tool in the imaging work-up of developmental nasal midline masses.Choanal Atresia and Stenosis.—Choanal atresia and stenosis are discussed here because the posterior nasal septum is generally involved and deformed. Theories proposed to explain the embryogenesis of choanal atresia include persistence of the buccopharyngeal membrane and the oronasal membrane, as well as the mesodermal flow theory, in which a misdirection of neural crest cell migration, secondary to local factors, is implicated (12,13).Superiorly, the stomodeum is separated from the ectoderm (which forms the cranium and brain) by a mesodermal plate. The failure of this mesodermal plate to resorb produces bony choanal atresia. In the most severe form of this condition, the hard palate and vomer are fused with the ventral clivus, and the nasopharynx is very small (nasopharyngeal atresia) (5). In another form, membranous choanal atresia results from the failure of the buccopharyngeal membrane to perforate. In more than 90% of cases of choanal atresia, the abnormality is partly or completely osseous; pure membranous atresia is rare.Choanal atresia occurs in one of 8000 live births and is commonly (>75%) associated with syndromes and systemic anomalies. Approximately two-thirds of cases are bilateral. Affected newborns experience respiratory distress because they are obligatory nasal breathers, and it is not possible to insert a nasogastric tube more than a few centimeters into the nose. However, in cases of membranous atresia, forceful insertion of a nasogastric tube may perforate the membranes, thus resolving the problem.The imaging method of choice for suspected choanal anomalies is CT, which is performed with the gantry angled 5° cephalad to a line perpendicular to the hard palate (3). Image data acquired in sequential 1.5-mm sections must be processed with a high-resolution bone filter to clearly depict the partially ossified or unossified structures. Normal choanal orifices measure more than 0.37 cm in children younger than 2 years. The width of the posterior and inferior parts of the vomer is normally less than 0.34 cm in patients younger than 8 years (Fig 7). The nasal septum also may be bowed or deviated. Membranous atresia is usually treated with endoscopic perforation, but osseous atresia requires trans-palatine resection of the thick vomer (3,14).Vomeronasal Organ Enlargement.—The vomeronasal organ is a special sensory organ that plays a role in chemical communications in both animals and humans (15,16). This membranous structure, also referred to as the Jacobson organ, is located bilaterally at the base of the anterior nasal septum in most mammals. In animals, it has an important function in the detection of pheromones and is implicated in sexual activity and fertility cycles. Whether it has a similar function in humans is uncertain.The human vomeronasal organ probably functions only during fetal development, when it contributes to the migration of neurosecretory cells containing luteinizing hormone-releasing factor to their proper sites in the brain (eg, the hypothalamus). However, the remnant of the vomeronasal organ in humans may persist until birth and sometimes even after. In adults, it appears as an atrophic diverticulum in the nasal septal mucosa. The organ is not generally visible on MR images.Abolmaali et al conducted the first investigation of the vomeronasal duct by using imaging (17). The median length of the organ was found to be 7 mm, and there was wide variation in its shape. In babies, a persistent vomeronasal organ has been reported (18). However, in these reports, its nature was always assumed and not pathologically proved. The organ is depicted on radiologic images as a thickening of the mucosa in the anterior and inferior parts of the nasal septum, and it shows peripheral enhancement at contrast material–enhanced CT (Fig 8). The peripheral enhancement may be due to normal mucosa that covers the vomeronasal organ. In neonates, evidence of nasal obstruction and lack of response to local vasoconstrictors may be indicative of the persistence of the vomeronasal organ. The size of a persistent vomeronasal organ is expected to decrease as the child grows, and these symptoms eventually should disappear.Acquired LesionsMost patients with an acquired nasal septal lesion experience symptoms of nasal obstruction and discharge, which are easily attributed to rhinosinusitis. Epistaxis and facial swelling also may occur. With disease progression, facial pain and destruction of the nasal septum may ensue. At physical examination, the most typical finding is nasal septal perforation, which may or may not be associated with a soft-tissue mass (19) (Table).Indications for the use of CT to evaluate acquired nasal septal lesions include the detection of intralesional calcifications and cartilage, determination of the type of pathologic process (destructive vs expansile bone involvement) and the location of lesions (nasal cavities, sinuses, orbits, and cranium), and identification of any adenopathy. Indications for MR imaging include the delineation of the lesion boundaries and any intracranial extension; differentiation between a tumor and postobstructive sinusitis; and identification of adenopathy. Contrast-enhanced MR imaging helps differentiate a highly vascular mass from a minimally vascular or avascular mass, and findings of lesion vascularity may lead to a change in the management strategy with regard to preoperative embolization. In addition, contrast-enhanced MR imaging can help identify intracranial dural and perineural extension of the tumor. Differentiation of a mucocele (which has a thin rim of mucosal enhancement) from a neoplasm (solid enhancement) is also aided by the administration of contrast material (19).Trauma from Rhinotillexomania.—The term rhinotillexomania refers to chronic nose picking. Chronic self-mutilation with resultant loss of body parts occurs most often in schizophrenic and severely obsessive-compulsive patients (20). However, rhinotillexomania is a common and generally benign habit in adolescents and adults and only rarely leads to significant self-injury. Injuries that may result from rhinotillexomania include nasal septal perforation and epistaxis, which may recur as a result of repetitive trauma. The imaging findings may include perforation or absence of the nasal septum, particularly its anterior and inferior aspect (Fig 9). Generally, septal perforation is due to chronic inflammation and relative ischemia induced by trauma, and there is no associated soft-tissue mass. The differential diagnosis includes previous trauma from other causes, such as surgery; Wegener granulomatosis; sarcoidosis; and, most commonly, cocaine abuse. In nonindustrialized countries, it might also include syphilis and leprosy (19).Cocaine-induced Nasal Septal Destruction.—Cocaine causes damage to tissues in the nasal area, lungs, cardiac conduction system, and brain (21). Nasal septal perforation, alone or accompanied by a hard palate defect, is recognized as a local complication of nasal cocaine abuse. The prevalence of cocaine-induced sinonasal complications was 4.8% in one patient series (22). The pathogenesis of nasal septal destruction by cocaine lies in the combined interaction of chemical irritation, ischemic necrosis from intense vasoconstriction of small blood vessels, and direct trauma from auto-instrumentation. The nasal mucosa becomes atrophic, chronically irritated, and necrotic, leading to nasal septal perforation, which may be followed by superinfection (23). Epistaxis, crust formation, ischemia, and perforation of the nasal septum may occur with chronic (>3 months) intranasal cocaine use. Significant structural damage to the nasal cavity may follow, with disintegration of the nasal cartilages and loss of the structural integrity of the nasal cavity (Fig 10). Chronic osteolytic sinusitis may occur, with resultant erosion into the adjacent orbits (24). Destructive lesions caused by cocaine toxicity may mimic lesions resulting from (limited) Wegener granulomatosis. A recent report indicates that the reaction of antineutrophil cytoplasmic antibodies to human neutrophil elastase may be used as a diagnostic marker for cocaine-induced destructive lesions in the nasal and palatal area and that this finding can help distinguish patients with cocaine-induced midline destructive lesions from those with Wegener granulomatosis (25). A possible pathogenetic mechanism for cocaine-induced lesions in the nasal septal region may be the repetitive local vasoconstrictive effects of the inhaled drug on the nasal mucosa. Subsequent damage to the mucosa leads to infiltration by Staphylococcus aureus and the formation of antineutrophil cytoplasmic antibodies. Necrosis commonly ensues when the direct toxic effects of cocaine are combined with infection, infiltration, and inflammation (24,25).Wegener Granulomatosis.—The combination of necrotizing granulomatous lesions of the upper and lower respiratory tracts, generalized necrotizing vasculitis of arteries and veins, and glomerulonephritis is called Wegener granulomatosis. The disease may affect the eyes, skin, joints, muscles, and cardiac system as well as the paranasal sinuses, lungs, and kidneys. It commonly involves the nervous system (22%–54% of patients), usually taking the form of peripheral or cranial neuropathy, which is thought to result from small-vessel vasculitis (26).Advanced Wegener granulomatosis may lead to destructive lesions of the hard palate, sinonasal-oral fistulas, or complete nasal septal destruction (Fig 11). The premaxillary soft tissues, retroantral fat, pterygopalatine fossa, infratemporal fossa, and orbits are commonly involved. Sarcoidosis may have a similar appearance. When a destructive mass in the nasal septum extends into the orbits, Wegener granulomatosis should be considered in the differential diagnosis. Intracranial involvement also may result, usually in the anterior cranial fossa, owing to the spread of the disease through the cribriform plate (19). As the disease becomes chronic, the walls of the residual paranasal sinuses (particularly the maxillary sinuses) become markedly thickened while the sinus volume is gradually reduced, and the nasal septum may completely disappear.Reparative Giant Cell Granuloma.—Reparative giant cell granuloma is most frequently seen in the mandible and maxilla, but it also may involve the paranasal sinuses and nasal septum, the orbit, and the cranial vault, as well as the small bones of the hands and feet and the long tubular bones. According to the most commonly accepted theory, the lesion originates as a reactive response to intraosseous hemorrhage secondary to either trauma or chronic inflammation.Reparative giant cell granulomas that arise in the midline maxilla may extend superiorly into the nasal cavity and involve the nasal septum. Such lesions typically occur before the age of 30 and are slightly more prevalent among female patients than among males.Imaging manifestations in lesions of this kind are nonspecific (27). At CT, reparative giant cell granulomas appear as heterogeneous soft-tissue masses with occasional hemorrhagic or cystic foci. The lesions also may be aggressive, eroding or destroying the nasal septum, ethmoid and sphenoid bones, clivus, and cribriform plate, and extending intracranially (Fig 12). At MR imaging, the lesions have a heterogeneous appearance on T1- and T2-weighted images, with expansile remodeling and enhancement of their soft-tissue components. After contrast material administration, enhancement is markedly inhomogeneous (27).Nasal Septal Abscess.—A nasal septal abscess is defined as a collection of purulent material located between the cartilaginous or bony septum and the mucoperichondrium or mucoperiosteum. Most adult patients with nasal septal abscesses have a history of accidental or iatrogenic trauma or a suppressed immune status. Spontaneous septal abscesses are rare but may be caused by acute ethmoiditis, sphenoiditis, or dental infection. Several proposed mechanisms for the development of a nasal septal abscess include direct extension from sinusitis, infection of a septal hematoma or underlying dermoid or epidermoid, infection of dental origin, and septic thrombophlebitis with spread from the orbits or cavernous sinuses (28) (Fig 13). An infected underlying mass (generally a dermoid or epidermoid) is the usual cause of nasal septal abscesses in neonates, and nasal obstruction is the most common symptom at presentation. Other symptoms include throbbing pain in the nose, general malaise, fever, headache, and tenderness over the nasal area. Nasal septal abscesses are more common in males. Staphylococcus aureus is the most common organism cultured.Streptococcus pneumoniae, Streptococcus milleri, Streptococcus viridans, Staphylococcus epidermis, Haemophilus influenzae, and various anaerobic bacteria also have been cultured in material extracted from nasal septal abscesses. Fungi and other unusual microorganisms also may be responsible for nasal septal abscesses in immunocompromised patients and newborns (Fig 14).Drainage and immediate reconstruction of the nasal septum are effective treatments (29). Delayed management of a nasal septal abscess may result in ischemia due to a compromised vascular supply to septal cartilage, with resultant necrosis and saddle-shaped deformity of the nose. Other potential complications of nasal septal abscesses include sepsis, bacteremia, meningitis, and maxillary hypoplasia (30,31).TumorsClinical manifestations suggestive of a sinonasal malignancy include chronic sinusitis that is unresponsive to antibiotic treatment, recurrent nasal symptoms, and unilateral nasal symptoms. MR imaging may help differentiate malignant neoplasms from inflammatory sinusitis, since most malignant sinonasal tumors have low to intermediate signal intensity on T2-weighted images, whereas inflammatory lesions (including postobstructive sinusitis) have high signal intensity on T2-weighted images. On gadolinium-enhanced MR images, tumors usually enhance less than mucosa.Sinus neoplasms usually display a mostly solid enhancement. Most tumors have heterogeneous signal intensity, whereas inflammatory masses usually have homogeneous signal intensity. MR imaging also allows precise demonstration of tumor boundaries, including information about intracranial extension, which is important for surgical planning. CT is useful in characterizing the extent and nature of bone involvement by a nasal mass.Squamous Cell Carcinoma.—The most common primary malignant tumor of the nose is squamous cell carcinoma. This type of tumor occurs more frequently in male patients. Nickel workers are particularly susceptible to squamous cell carcinomas of the sinonasal cavity. The maxillary sinuses and the nasal cavity are the most common sites of origin. Irregular destruction or nonvisualization of adjacent bone is common in squamous cell carcinoma. At MR imaging, most squamous cell carcinomas have hypointense signal on T2-weighted images and show heterogeneous solid enhancement, as opposed to the uniform homogeneous peripheral rim of enhancement that represents the normal sinus mucosa surrounding nonenhancing nasal secretions. However, other tumors (eg, benign inverting papillomas, neoplastic lymphomas) may have similar imaging characteristics. An important radiographic finding for malignancies is bone destruction, which is best depicted at CT. This finding was observed at the initial radiographic evaluation in approximately 80% of cases of sinonasal squamous cell carcinoma (32) (Fig 15).The differential diagnosis includes other types of carcinoma (eg, adenocarcinoma, mucoepidermoid carcinoma, and adenoid cystic carcinoma), lymphoma, chloroma, melanoma, metastasis, plasmacytoma, malignant fibrous histiocytoma, various sarcomas, esthesioneuroblastoma, and aggressive fungal infections (Figs 16, 17).Esthesioneuroblastoma.—Olfactory neuroblastomas, also referred to as esthesioneuroblastomas, originate from olfactory epithelium in the upper part of the nasal cavities. These rare tumors are usually found in young men, with a secondary peak occurrence in those aged 50–60 years. Common symptoms at presentation include hyposmia, anosmia, nasal congestion, facial pain, epistaxis, headache, and personality changes if the frontal lobes are affected. Orbital extension may cause exophthalmos, ophthalmoplegia, visual loss, or a combination thereof. On CT and MR images, the lesion is often centered near the cribriform plate. CT is useful for defining bone destruction, whereas MR imaging best delineates soft-tissue extension. The use of both modalities is critical for discriminating between postobstructive secretions and tumor tissue, as well as for defining intraorbital and intracranial extension. Characteristic imaging features include origin from olfactory epithelium high in the nasal vault and moderate enhancement. The tumor may extend toward the interior and erode the nasal septum (Fig 18). It may be homogeneous or may contain areas of inhomogeneity. On T1-weighted MR images, these tumors have signal intensity lower than that of brain parenchyma; on T2-weighted images, they may have signal that is isointense to or higher than that of the brain. Important associated imaging characteristics include cysts along the superior tumor margin, especially within the anterior cranial fossa (7,32).Pindborg Tumor.—Tumors of odontogenic origin occasionally involve the central maxilla and extend into the nasal septum. This group of lesions includes ameloblastoma and various types of cysts, as well as calcifying epithelial odontogenic tumor, a benign neoplasm also known as Pindborg tumor. This neoplasm was first described as a distinct histopathologic entity in 1958 by Jens J. Pindborg, a Danish oral pathologist. It occurs rarely and accounts for only 0.17%–1.8% of all odontogenic tumors. Both sexes are equally affected, and the lesion usually manifests between the ages of 20 and 60 years. Most patients are asymptomatic at the time of diagnosis. Two-thirds of calcifying epithelial odontogenic tumors arise in the mandible; the remaining one-third arise in the maxilla and may extend into the nasal septum. The tumors in most cases are centrally located, mainly in the premolar and molar regions of the mandible. Those that arise in the central maxilla may extend into the nasal septum and, by virtue of their mass effect, may displace and remodel it. The most common imaging feature of calcifying epithelial odontogenic tumors is that of perichondral lucencies. Other features, including a mixed lucent-opaque lesion not associated with an un-erupted tooth, a “driven snow” appearance, and a solid opacity, have been observed in a few patients. The MR imaging appearance of the lesion is indistinguishable from that of other sinus tumors. Calcifying epithelial odontogenic tumors have predominantly low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Heterogeneous contrast enhancement within a mass is a common finding. In most patients, intralesional calcifications are present, and CT may show diffuse highly attenuating foci (33) (Fig 19). Osteomas, another type of calcifying lesion, may have a distinctly different appearance (Fig 20). In addition, fibrous dysplasia may involve the nasal septum, but, because its imaging appearance is fairly typical, it is not described in this article.Neuroendocrine Tumors.—Neuroendocrine neoplasms may have an epithelial or neural origin. True neuroendocrine tumors are derived from neurons and associated structures, such as the paraganglia of the peripheral nervous system. The term neuroendocrine carcinomaencompasses a spectrum of malignant epithelial neuroendocrine neoplasms that ranges from atypical or well-differentiated to high-grade neoplasms. Neuroendocrine carcinomas are classified into three subtypes: typical carcinoid tumor (well-differentiated neuroendocrine carcinoma), atypical carcinoid tumor (moderately differentiated neuroendocrine carcinoma), and small cell carcinoma (poorly differentiated neuroendocrine carcinoma).Nasal septal neuroendocrine carcinomas have no distinctive CT or MR imaging characteristics; images obtained with both modalities depict an expansile lesion with erosion of the nasal septum and surrounding bone (34) (Fig 21).Sarcomas.—Rhabdomyosarcoma is the most common soft-tissue sarcoma, not only in children under 15 years of age but also in adolescents and young adults. The head and neck, especially the orbit, are the most frequent sites of childhood rhabdomyosarcoma. In adults, the ethmoid sinuses are the most common site of origin of head and neck rhabdomyosarcomas. Tumors in this parameningeal site are associated with a particularly poor prognosis because of the likelihood of intracranial extension. Rhabdomyosarcomas are classified into four histologic types: embryonal, botryoid, alveolar, and pleomorphic. The embryonal type is the most common and accounts for 70%–80% of all rhabdomyosarcomas. It affects mainly but not exclusively children (newborn through age 15 years) and occurs predominantly in the head and neck, the genitourinary tract, and the retroperitoneum. The botryoid type is a variant of the embryonal type. Alveolar rhabdomyosarcoma is less frequent and accounts for 10%–20% of all rhabdomyosarcomas, chiefly affecting those between the ages of 10 and 25 years. Pleomorphic rhabdomyosarcoma, which primarily affects the large muscles of the extremities, is the least common type. It may occur at any age, but it occurs most frequently in adults, with a peak prevalence in those older than 45 years.CT images of head and neck rhabdomyosarcomas show poorly defined, inhomogeneous soft-tissue masses destroying adjacent bone. On images obtained after the intravenous injection of contrast material, the mass enhances to the same degree as muscle. Necrosis, hemorrhage, and calcification are uncommon findings. The most commonly reported MR imaging appearance of rhabdomyosarcoma in the head and neck is that of a homogeneous mass with signal that is isointense or minimally hyperintense in relation to that of muscle on T1-weighted images and hyperintense in relation to those of muscle and fat on T2-weighted images, and with internal enhancement of the tumor on contrast-enhanced MR images (35). Rhabdomyosarcomas may erode the nasal septum and are indistinguishable from other sarcomas at imaging (Fig 22).Tumors of Neural Origin.—Schwannomas are slightly less common than neurofibromas, but, like the latter, constitute about 5% of all benign soft-tissue tumors. Schwannomas have a true capsule composed of epineurium, which allows their successful surgical resection. In contrast, neurofibromas arise from the nerve fascicle, are centrally located, are rarely encapsulated, and cannot be separated from the involved nerve.The MR imaging appearance of schwannoma is that of a mass with signal isointense to that of skeletal muscle on T1-weighted images and with increased, slightly heterogeneous signal intensity on T2-weighted images (Fig 23). Unfortunately, these patterns of signal intensity are not specific to neural tumors, nor do they allow differentiation between benign and malignant nerve sheath tumors. The target sign is characterized by low signal intensity centrally and high signal intensity peripherally on T2-weighted images, reflecting central fibrous components and peripheral myxomatous elements seen at pathologic analysis. In addition, after contrast material administration, the central part of the schwannoma may enhance less than its periphery. The term fascicular signrefers to the appearance in neurogenic tumors of fascicular bundles like those in normal nerves (36).Tumors of Vascular Origin.—Angiofibroma is a relatively uncommon, histologically benign, locally invasive tumor that usually occurs in adolescent boys. In the general population, it accounts for approximately 0.5% of all neoplasms of the head and neck. Two constant features seen in angiofibromas are (a) a mass in the posterior nasal cavity and pterygopalatine fossa and (b) the erosion of bone posterior to the sphenopalatine foramen and extending to the upper medial pterygoid plate (37). The tumors also arise occasionally in the nasal septum. Characteristics of angiofibroma on CT and MR images include anterior bowing of the posterior wall of the maxillary antrum; enlargement of the pterygopalatine fossa with bone erosion posterior to the sphenopalatine foramen, extending toward the medial pterygoid plate; intense enhancement on contrast-enhanced images; blood supply by the ipsilateral internal maxillary artery; and small ascending pharyngeal artery branches. Despite preoperative embolization and surgery, early recurrences have been reported, especially in cases in which there was involvement of the skull base (7,37). Angiofibromas that arise in the nasal septum have similar features but appear as well-defined masses (Fig 24).Hemangioma is another common nasal septal lesion of vascular origin. Hemangiomas are divided into two histologic types, capillary and cavernous, depending on the dominant vessel size at microscopy. Most nasal hemangiomas arise from the nasal septum or vestibule and are of the capillary type. Only a few arise from the lateral wall of the nose, and these are usually cavernous. In the paranasal sinuses, hemangiomas are even rarer (Fig 25). These lesions arise in the vestibule or the nasal septum, usually in the most anterior part of the septum, the region called the Little area or Kiesselbach triangle (38). The peak age at symptom onset is the 5th decade of life, which supports the contention that these are acquired lesions and not congenital hamartomatous malformations (39). At MR imaging, peripheral areas of low signal intensity are visible in the mass on T2-weighted images, findings suggestive of the deposition of hemosiderin and, thus, of a hemangioma. The differential diagnosis includes pyogenic granuloma, hemangiopericytoma, and granuloma gravidarum (pyogenic granuloma of pregnancy). At CT, benign bone changes usually are seen; however, hemangiomas also may cause substantial bone erosion, which may make them indistinguishable from true malignant tumors. Angiography is warranted if there is any suspicion about the nature of a vascular tumor, not only to enable an accurate diagnosis but also to facilitate treatment with transarterial embolization so as to avoid the risk of hemorrhage due to surgical intervention (40).SummarySection:ChooseChooseTop of pageAbstractLEARNING OBJECTIVES FOR T…IntroductionEmbryologic DevelopmentCategories of Nasal Septa…Summary <<ReferencesprevnextWe have described imaging findings and differential diagnoses of many lesions that may arise in or involve the nasal septum. Congenital nasal septal anomalies are rare but tend to have fairly typical imaging features, which, when considered alongside the imaging appearance of the normal anatomy, help determine the correct diagnosis in most instances. By contrast, many acquired lesions have nonspecific imaging features, and their diagnosis therefore must be based also on the patient’s age and the histologic findings. The most important contribution made by the radiologist in such cases may be mapping of the lesion location and extent.Section:ChooseChooseTop of pageAbstractLEARNING OBJECTIVES FOR T…IntroductionEmbryologic DevelopmentCategories of Nasal Septa…Summary <<Referencesprevnext
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Causes of Common Acquired Lesions of the Nasal SeptumCauses of Common Acquired Lesions of the Nasal Septum

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Figure 1a.  Diagrams show normal development of the nasal cavities. Black-and-white areas indicate the turbinate anlagen. n = nasal cavity, o = oral cavity, p = palatal shelves, s = septum, t = tongue. (a) At 9 weeks of gestation, the cartilaginous nasal septum directly overlies the buccal cavity. (b) A few days later, the inferior nasal cavity widens and the palatal shelves assume a more horizontal orientation. ©Close to the 10th gestational week, the palatal shelves begin to approach each other, the primitive turbinates start to take shape, and the nasal septum begins to descend. (d) At the end of the 10th week, the palatal shelves fuse at the midline to form the secondary palate, which fuses superiorly with the nasal septum. The oral and nasal cavities now are separated, and the turbinates are almost fully formed.

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Figure 1b.  Diagrams show normal development of the nasal cavities. Black-and-white areas indicate the turbinate anlagen. n = nasal cavity, o = oral cavity, p = palatal shelves, s = septum, t = tongue. (a) At 9 weeks of gestation, the cartilaginous nasal septum directly overlies the buccal cavity. (b) A few days later, the inferior nasal cavity widens and the palatal shelves assume a more horizontal orientation. ©Close to the 10th gestational week, the palatal shelves begin to approach each other, the primitive turbinates start to take shape, and the nasal septum begins to descend. (d) At the end of the 10th week, the palatal shelves fuse at the midline to form the secondary palate, which fuses superiorly with the nasal septum. The oral and nasal cavities now are separated, and the turbinates are almost fully formed.

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Figure 1c.  Diagrams show normal development of the nasal cavities. Black-and-white areas indicate the turbinate anlagen. n = nasal cavity, o = oral cavity, p = palatal shelves, s = septum, t = tongue. (a) At 9 weeks of gestation, the cartilaginous nasal septum directly overlies the buccal cavity. (b) A few days later, the inferior nasal cavity widens and the palatal shelves assume a more horizontal orientation. © Close to the 10th gestational week, the palatal shelves begin to approach each other, the primitive turbinates start to take shape, and the nasal septum begins to descend. (d) At the end of the 10th week, the palatal shelves fuse at the midline to form the secondary palate, which fuses superiorly with the nasal septum. The oral and nasal cavities now are separated, and the turbinates are almost fully formed.

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Figure 1d.  Diagrams show normal development of the nasal cavities. Black-and-white areas indicate the turbinate anlagen. n = nasal cavity, o = oral cavity, p = palatal shelves, s = septum, t = tongue. (a) At 9 weeks of gestation, the cartilaginous nasal septum directly overlies the buccal cavity. (b) A few days later, the inferior nasal cavity widens and the palatal shelves assume a more horizontal orientation. © Close to the 10th gestational week, the palatal shelves begin to approach each other, the primitive turbinates start to take shape, and the nasal septum begins to descend. (d) At the end of the 10th week, the palatal shelves fuse at the midline to form the secondary palate, which fuses superiorly with the nasal septum. The oral and nasal cavities now are separated, and the turbinates are almost fully formed.

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Figure 2a.  Diagrams show normal development of the frontonasal region. (a) Early in gestation, the frontal bone (superior arrow) is separated from the nasal bone (inferior arrow) by a small fontanelle or fonticulus frontalis (F). A small remnant of the prenasal space remains anterior and inferior to the intracranial foramen cecum ©. Beneath these structures lies the cartilaginous nasal septum (S) or capsule. (b) With continued growth, the frontal and nasal bones fuse, creating the frontonasal suture between them. The foramen cecum (arrowhead) becomes shallower, and the crista galli (*) forms. The septum (S) grows anteriorly and fuses with the nasal bones, obliterating the prenasal space.

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Figure 2b.  Diagrams show normal development of the frontonasal region. (a) Early in gestation, the frontal bone (superior arrow) is separated from the nasal bone (inferior arrow) by a small fontanelle or fonticulus frontalis (F). A small remnant of the prenasal space remains anterior and inferior to the intracranial foramen cecum ©. Beneath these structures lies the cartilaginous nasal septum (S) or capsule. (b) With continued growth, the frontal and nasal bones fuse, creating the frontonasal suture between them. The foramen cecum (arrowhead) becomes shallower, and the crista galli (*) forms. The septum (S) grows anteriorly and fuses with the nasal bones, obliterating the prenasal space.

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Figure 3a.  Frontonasal encephaloceles. (a) Diagram shows the formation of a nasoethmoidal encephalocele (E) as a result of failed obliteration of the prenasal space during gestation. The roof of the encephalocele is composed of the frontal and nasal bones (arrows), and its floor is the cartilaginous capsule, which also will form part of the ethmoid sinuses. (b) Midsagittal unenhanced T1-weighted MR image shows a nasoethmoidal encephalocele (E) under the nasal bone, superior to a deformed nasal septum (arrow). A stalk (*) connects the encephalocele with the intracranial brain.

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Figure 3b.  Frontonasal encephaloceles. (a) Diagram shows the formation of a nasoethmoidal encephalocele (E) as a result of failed obliteration of the prenasal space during gestation. The roof of the encephalocele is composed of the frontal and nasal bones (arrows), and its floor is the cartilaginous capsule, which also will form part of the ethmoid sinuses. (b) Midsagittal unenhanced T1-weighted MR image shows a nasoethmoidal encephalocele (E) under the nasal bone, superior to a deformed nasal septum (arrow). A stalk (*) connects the encephalocele with the intracranial brain.

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Figure 4a.  Intranasal glioma (heterotopia). (a) Diagram shows an intranasal glioma, a lesion composed of brain tissue (G) that became trapped in the prenasal space and disconnected from the intracranial contents during normal closure of the frontal and nasal bones (arrows). The foramen cecum may be deep, and the crista galli may be small or bifid. In large lesions of this type, the anterior part of the nasal septum (S) may be hypoplastic. (b) Midsagittal reformatted CT image shows an intranasal glioma (G), a large foramen cecum (arrow), and a well-formed crista galli (*). © Coronal T2-weighted MR image shows an intranasal lesion (arrow) that has caused rightward deviation of the superior part of the nasal septum.

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Figure 4b.  Intranasal glioma (heterotopia). (a) Diagram shows an intranasal glioma, a lesion composed of brain tissue (G) that became trapped in the prenasal space and disconnected from the intracranial contents during normal closure of the frontal and nasal bones (arrows). The foramen cecum may be deep, and the crista galli may be small or bifid. In large lesions of this type, the anterior part of the nasal septum (S) may be hypoplastic. (b) Midsagittal reformatted CT image shows an intranasal glioma (G), a large foramen cecum (arrow), and a well-formed crista galli (*). © Coronal T2-weighted MR image shows an intranasal lesion (arrow) that has caused rightward deviation of the superior part of the nasal septum.

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Figure 4c.  Intranasal glioma (heterotopia). (a) Diagram shows an intranasal glioma, a lesion composed of brain tissue (G) that became trapped in the prenasal space and disconnected from the intracranial contents during normal closure of the frontal and nasal bones (arrows). The foramen cecum may be deep, and the crista galli may be small or bifid. In large lesions of this type, the anterior part of the nasal septum (S) may be hypoplastic. (b) Midsagittal reformatted CT image shows an intranasal glioma (G), a large foramen cecum (arrow), and a well-formed crista galli (*). © Coronal T2-weighted MR image shows an intranasal lesion (arrow) that has caused rightward deviation of the superior part of the nasal septum.

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Figure 5a.  Extranasal glioma (heterotopia). (a) Diagram shows an extranasal lesion that formed when brain tissue herniated through the fonticulus frontalis. After the frontal (F) and nasal (N) bones fused, the herniated brain tissue (arrow) was trapped over the dorsum of the nose and disconnected from the intracranial brain. (b)Axial unenhanced T1-weighted image shows an extranasal lesion (arrow) with signal intensity similar to that of the intracranial brain.

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Figure 5b.  Extranasal glioma (heterotopia). (a) Diagram shows an extranasal lesion that formed when brain tissue herniated through the fonticulus frontalis. After the frontal (F) and nasal (N) bones fused, the herniated brain tissue (arrow) was trapped over the dorsum of the nose and disconnected from the intracranial brain. (b) Axial unenhanced T1-weighted image shows an extranasal lesion (arrow) with signal intensity similar to that of the intracranial brain.

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Figure 6a.  Dermoid of the prenasal space. (a) Diagram shows the formation of the lesion. After the primitive diverticulum in the prenasal space touches the skin of the tip of the nose, as it regresses intracranially, it may drag ectodermal elements back with it, creating a tract between the nasal bone and the septum. Cells trapped in this tract may proliferate, producing a dermoid (blue circle), an epidermoid, or, rarely, a teratoma. These lesions may arise at any point along this tract. (b) Midsagittal T2-weighted MR image shows dermoids in the prenasal space (arrowhead) and in the region of the foramen cecum (arrow).

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Figure 6b.  Dermoid of the prenasal space. (a) Diagram shows the formation of the lesion. After the primitive diverticulum in the prenasal space touches the skin of the tip of the nose, as it regresses intracranially, it may drag ectodermal elements back with it, creating a tract between the nasal bone and the septum. Cells trapped in this tract may proliferate, producing a dermoid (blue circle), an epidermoid, or, rarely, a teratoma. These lesions may arise at any point along this tract. (b) Midsagittal T2-weighted MR image shows dermoids in the prenasal space (arrowhead) and in the region of the foramen cecum (arrow).

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Figure 7a.  Osseous choanal atresia. (a) Axial CT image shows right-sided atresia, with an accumulation of secretions in the nasal cavity on the right side. Note the lateral displacement of the vomer and the thin bone plate in the narrowed right posterior choana. (b) Axial CT image in another patient shows a marked thickening of the posterior vomer (straight arrow), which is fused with the anterior surface of the clivus; the absence of both posterior choanae; and a persistent craniopharyngeal canal (curved arrow). Because the nasopharynx was very small in this patient, this anomaly was categorized as bucconasopharyngeal atresia.

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Figure 7b.  Osseous choanal atresia. (a) Axial CT image shows right-sided atresia, with an accumulation of secretions in the nasal cavity on the right side. Note the lateral displacement of the vomer and the thin bone plate in the narrowed right posterior choana. (b) Axial CT image in another patient shows a marked thickening of the posterior vomer (straight arrow), which is fused with the anterior surface of the clivus; the absence of both posterior choanae; and a persistent craniopharyngeal canal (curved arrow). Because the nasopharynx was very small in this patient, this anomaly was categorized as bucconasopharyngeal atresia.

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Figure 8.  Enlarged vomeronasal organ. Coronal CT image shows a prominent anterior nasal septum (VN) and a patent foramen cecum, findings thought to be incidental in this infant with troubled nasal breathing. The presumptive diagnosis was an enlarged vomeronasal organ. The abnormality resolved spontaneously as the patient grew. (Reprinted, with permission, from reference 15).

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Figure 9.  Rhinotillexomania. Axial CT image shows the absence of the anterior and inferior areas of the nasal septum (*) and the inferior turbinates in a patient with a chronic habit of picking his nose.

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Figure 10.  Cocaine abuse. Axial CT image shows erosion of the nasal septum (*) and turbinates. The nasal mucosa is atrophic, but the maxillary sinuses have a normal appearance, with the exception of polypoid mucosal thickening in the left-sided sinus.

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Figure 11a.  Wegener granulomatosis. (a) Coronal CT image shows the absence of the midline nasal structures and the medial wall of the maxillary sinuses. The bones surrounding the cavity have a thickened, ground-glass appearance typical of the late stages of this disease. (b) Axial contrast-enhanced T1-weighted MR image also shows the absence of the midline nasal structures and patchy enhancement of the surrounding abnormal bone. © Axial CT image in another patient shows a midline intranasal mass (*) that has eroded the septum. The maxillary sinuses are small, and their lateral and anterior walls have a thickened, ground-glass appearance.

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Figure 11b.  Wegener granulomatosis. (a) Coronal CT image shows the absence of the midline nasal structures and the medial wall of the maxillary sinuses. The bones surrounding the cavity have a thickened, ground-glass appearance typical of the late stages of this disease. (b) Axial contrast-enhanced T1-weighted MR image also shows the absence of the midline nasal structures and patchy enhancement of the surrounding abnormal bone. © Axial CT image in another patient shows a midline intranasal mass (*) that has eroded the septum. The maxillary sinuses are small, and their lateral and anterior walls have a thickened, ground-glass appearance.

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Figure 11c.  Wegener granulomatosis. (a) Coronal CT image shows the absence of the midline nasal structures and the medial wall of the maxillary sinuses. The bones surrounding the cavity have a thickened, ground-glass appearance typical of the late stages of this disease. (b) Axial contrast-enhanced T1-weighted MR image also shows the absence of the midline nasal structures and patchy enhancement of the surrounding abnormal bone. © Axial CT image in another patient shows a midline intranasal mass (*) that has eroded the septum. The maxillary sinuses are small, and their lateral and anterior walls have a thickened, ground-glass appearance.

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Figure 12a.  Reparative granuloma. (a) Coronal CT image shows a large mass in the midline nasal cavity with erosion of the hard palate and destruction of the midline structures, including the septum. There is polypoid mucosal thickening in both maxillary sinuses. (b) Axial CT image shows the mass eroding the nasal septum (*). A tiny remnant of the vomer is visible posterior to the septum.

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Figure 12b.  Reparative granuloma. (a) Coronal CT image shows a large mass in the midline nasal cavity with erosion of the hard palate and destruction of the midline structures, including the septum. There is polypoid mucosal thickening in both maxillary sinuses. (b) Axial CT image shows the mass eroding the nasal septum (*). A tiny remnant of the vomer is visible posterior to the septum.

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Figure 13a.  Nasal septal abscess due to an infected dermoid in a 1-year-old boy. (a) Coronal contrast-enhanced T1-weighted MR image shows a large hypointense and nonenhancing lesion (arrow) in the nasal septum. (b) Axial T2-weighted MR image shows hyperintense signal in the lesion, which has expanded the septum. Postobstructive infected secretions are visible in the left maxillary sinus. ©Diffusion-weighted MR image in the same patient shows signal hyperintensity of the septal lesion (arrow) and contents of the left maxillary sinus. At surgery, an infected nasal septal dermoid was found, and the maxillary sinus contained pus.

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Figure 13b.  Nasal septal abscess due to an infected dermoid in a 1-year-old boy. (a) Coronal contrast-enhanced T1-weighted MR image shows a large hypointense and nonenhancing lesion (arrow) in the nasal septum. (b) Axial T2-weighted MR image shows hyperintense signal in the lesion, which has expanded the septum. Postobstructive infected secretions are visible in the left maxillary sinus. ©Diffusion-weighted MR image in the same patient shows signal hyperintensity of the septal lesion (arrow) and contents of the left maxillary sinus. At surgery, an infected nasal septal dermoid was found, and the maxillary sinus contained pus.

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Figure 13c.  Nasal septal abscess due to an infected dermoid in a 1-year-old boy. (a) Coronal contrast-enhanced T1-weighted MR image shows a large hypointense and nonenhancing lesion (arrow) in the nasal septum. (b) Axial T2-weighted MR image shows hyperintense signal in the lesion, which has expanded the septum. Postobstructive infected secretions are visible in the left maxillary sinus. ©Diffusion-weighted MR image in the same patient shows signal hyperintensity of the septal lesion (arrow) and contents of the left maxillary sinus. At surgery, an infected nasal septal dermoid was found, and the maxillary sinus contained pus.

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Figure 14.  Nasal septal fungal abscess in a newborn with immunodeficiency due to nuclear factor-κB essential modulator syndrome. Axial contrast-enhanced T1-weighted fat-suppressed image shows a nonenhancing hypointense abscess (arrow) in the anterior part of the septum. The abscess was caused by Paecilomyces.

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Figure 15a.  Poorly differentiated squamous cell carcinoma. (a) Axial contrast-enhanced T1-weighted fat-suppressed MR image shows a large midline nasal cavity mass. The mass (arrows) has destroyed the intranasal structures, expanded the nasal cavity, and projects posteriorly into the nasopharynx. (b) Axial T2-weighted MR image shows a complex internal appearance of the lesion, with multiple cysts, striations, and overall low signal intensity. The mass protrudes via the nares. The maxillary sinuses contain high-signal-intensity postobstructive secretions (arrows).

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Figure 15b.  Poorly differentiated squamous cell carcinoma. (a) Axial contrast-enhanced T1-weighted fat-suppressed MR image shows a large midline nasal cavity mass. The mass (arrows) has destroyed the intranasal structures, expanded the nasal cavity, and projects posteriorly into the nasopharynx. (b) Axial T2-weighted MR image shows a complex internal appearance of the lesion, with multiple cysts, striations, and overall low signal intensity. The mass protrudes via the nares. The maxillary sinuses contain high-signal-intensity postobstructive secretions (arrows).

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Figure 16a.  Adenocarcinoma and adenoid cystic carcinoma. (a) Axial CT image shows an aggressive mass (adenocarcinoma) that has destroyed the superior part of the nasal septum (*) as well as the ethmoid and sphenoid sinuses and that extends into the left orbit. (b) Axial contrast-enhanced T1-weighted MR image in a different patient shows a mass (arrows) that enhances mostly peripherally but retains low signal intensity centrally. No perineural spread was present. The mass was subsequently diagnosed as an adenoid cystic carcinoma.

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Figure 16b.  Adenocarcinoma and adenoid cystic carcinoma. (a) Axial CT image shows an aggressive mass (adenocarcinoma) that has destroyed the superior part of the nasal septum (*) as well as the ethmoid and sphenoid sinuses and that extends into the left orbit. (b) Axial contrast-enhanced T1-weighted MR image in a different patient shows a mass (arrows) that enhances mostly peripherally but retains low signal intensity centrally. No perineural spread was present. The mass was subsequently diagnosed as an adenoid cystic carcinoma.

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Figure 17.  Intranasal primary melanoma. Axial contrast-enhanced T1-weighted fat-suppressed MR image shows a mass in the left nasal cavity. The nasal septum is thinned and bowed rightward by the mass, which arose from the left inferior turbinate.

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Figure 18.  Esthesioneuroblastoma. Coronal T2-weighted MR image shows a mass with slight signal hyperintensity in the midline superior part of the nasal cavity. The mass protrudes downward, eroding the nasal septum and the cribriform plates, and extends into the cranium (arrow). Postobstructive secretions are visible in the ethmoid sinuses (E).

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Figure 19.  Pindborg tumor. Axial CT image shows a large soft-tissue mass that has destroyed the midline nasal structures and extends from the nasopharynx to the adjacent base of the skull, the left maxillary sinus, and the retroantral region. The mass, which contains calcifications, also has invaded the right maxillary sinus (arrow).

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Figure 20.  Osteomas in Ollier syndrome. Axial CT image shows multiple osteomas (arrows) in the vomer, posterior choanae, maxillary sinuses, and right vertical mandible ramus.

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Figure 21.  Neuroendocrine carcinoma. Coronal CT image shows a mass with a nonspecific appearance in the superior midline nasal cavity. The mass has eroded the nasal septum (*), cribriform plates (arrow), and medial orbital walls and extends into the left orbit (M).

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Figure 22a.  Sarcomas. (a) Midsagittal contrast-enhanced T1-weighted MR image in an adult patient with a midline nasal rhabdomyosarcoma shows erosion of the floor of the anterior cranial fossa and intracranial tumor extension (*). (b) Axial contrast-enhanced CT image in a patient with a midline maxillary osteosarcoma shows erosion of the anterior nasal septum (*) by the mass, which extends into the left maxillary sinus (M). Despite the histologic diagnosis, the mass contains no calcifications and has a nonspecific appearance. © Axial CT image in a patient with a nasal septal chondrosarcoma shows expansion of the vomer (arrows) and extension of the mass into the left maxillary sinus and through the left anterior pyriform aperture. Faint whorls of calcification inside the mass are suggestive of the diagnosis.

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Figure 22b.  Sarcomas. (a) Midsagittal contrast-enhanced T1-weighted MR image in an adult patient with a midline nasal rhabdomyosarcoma shows erosion of the floor of the anterior cranial fossa and intracranial tumor extension (*). (b) Axial contrast-enhanced CT image in a patient with a midline maxillary osteosarcoma shows erosion of the anterior nasal septum (*) by the mass, which extends into the left maxillary sinus (M). Despite the histologic diagnosis, the mass contains no calcifications and has a nonspecific appearance. © Axial CT image in a patient with a nasal septal chondrosarcoma shows expansion of the vomer (arrows) and extension of the mass into the left maxillary sinus and through the left anterior pyriform aperture. Faint whorls of calcification inside the mass are suggestive of the diagnosis.

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Figure 22c.  Sarcomas. (a) Midsagittal contrast-enhanced T1-weighted MR image in an adult patient with a midline nasal rhabdomyosarcoma shows erosion of the floor of the anterior cranial fossa and intracranial tumor extension (*). (b) Axial contrast-enhanced CT image in a patient with a midline maxillary osteosarcoma shows erosion of the anterior nasal septum (*) by the mass, which extends into the left maxillary sinus (M). Despite the histologic diagnosis, the mass contains no calcifications and has a nonspecific appearance. © Axial CT image in a patient with a nasal septal chondrosarcoma shows expansion of the vomer (arrows) and extension of the mass into the left maxillary sinus and through the left anterior pyriform aperture. Faint whorls of calcification inside the mass are suggestive of the diagnosis.

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Figure 23.  Schwannoma. Axial T2-weighted MR image shows a mass (M) with mixed signal intensity centered in the nasal septum. The mass contains some cystic regions with high signal intensity similar to that of the postobstructive secretions (arrows) in the superior recess of the left maxillary sinus and in the left-sided sphenoid sinus.

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Figure 24.  Angiofibroma in the anterior part of the nasal septum in a 5-year-old boy. Axial contrast-enhanced T1-weighted fat-suppressed image shows significant enhancement of the mass (arrow).

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Figure 25.  Hemangioma. Coronal contrast-enhanced T1-weighted fat-suppressed MR image shows enhancement of the mass, which has high signal intensity. The use of contrast material was helpful in this case for determining the extent of the lesion on both sides (black arrows) of the anterior nasal septum (white arrow). The lesion extent was not well depicted on the unenhanced images.

Open in Image ViewerReferencesSection:ChooseChooseTop of pageAbstractLEARNING OBJECTIVES FOR T…IntroductionEmbryologic DevelopmentCategories of Nasal Septa…SummaryReferences <<prev1.HuismanTA, Schneider JF, Kellenberger CJ, Martin-Fiori E, Willi UV, Holzmann D. Developmental nasal midline masses in children: neuroradiological evaluation. Eur Radiol2004; 14(2): 243–249. CrossRef, Medline2.LeeKJ. Embryology of clefts and pouches. In: Essential otolaryngology: head and neck surgery. 3rd ed. New York, NY: Medical Examination Publishing, 1983; 304–306.3.CastilloM. Congenital abnormalities of the nose: CT and MR findings. AJR Am J Roentgenol1994; 162: 1211–1217. CrossRef,Medline4.NishimuraY. Embryological study of nasal cavity development in human embryos with reference to congenital nostril atresia.Acta Anat (Basel)1993; 147: 140–144. CrossRef, Medline5.AlbernazVS, Castillo M, Mukherji SK, Ihmeidan IH. Congenital arhinia. AJNR Am J Neuroradiol1996; 17: 1312–1314. Medline6.LoweLH, Booth TN, Joglar JM, Rollins NK. Midface anomalies in children. RadioGraphics2000; 20: 907–922. Link7.AllberySM, Chaljub G, Cho NL, Rassekh CH, John SD, Guinto FC. MR imaging of nasal masses. RadioGraphics1995; 15:1311–1327. Link8.BilkayU, Gundogan H, Ozek C, et al. Nasal dermoid sinus cysts and the role of open rhinoplasty. Ann Plast Surg2001; 47(1): 8–14. CrossRef, Medline9.KolliasSS, Ball WS, Prenger EC, Myers CM. Dermoids of the eustachian tube: CT and MR findings with histologic correlation.AJNR Am J Neuroradiol1995; 16: 663–668. Medline10.PallerAS, Pensler JM, Tomita T. Nasal midline masses in infants and children: dermoids, encephaloceles and gliomas. Arch Dermatol1991; 127: 362–366. CrossRef, Medline11.WardinskyTD, Pagon RA, Kropp RJ, et al. Nasal dermoid sinus cysts: association with intracranial extension and multiple malformations. Cleft Palate Craniofac J1991; 28: 87–95. CrossRef, Medline12.HengererAS, Strome M. Choanal atresia: a new embryologic theory and its influence on surgical management.Laryngoscope1982; 92: 913–921. Medline13.AmirR, Dunham ME. Bilateral choanal atresia associated with nasal dermoid cyst and sinus: a case report and review of the literature. Int J Pediatr Otorhinolaryngol2001; 58: 81–85. CrossRef, Medline14.BlackCM, Dungan D, Fram E, et al. Potential pitfalls in the work-up and diagnosis of choanal atresia. AJNR Am J Neuroradiol1998; 19: 326–329. Medline15.ZoselAE, Smith MM, Smith TL, Castillo M. Enlarged vomeronasal organ in a child: imaging findings. Clin Imaging2004; 28:356–359. CrossRef, Medline16.SmithTD, Siegel MI, Mooney MP, Burdi AR, Burrows AM, Todhunter JS. Prenatal growth of the human vomeronasal organ. Anat Rec1997; 248: 447–455. CrossRef, Medline17.AbolmaaliND, Kuhnau D, Knecht M, Kohler K, Huttenbrink KB, Hummel T. Imaging of the human vomeronasal organ. Chem Senses2001; 26: 35–39. CrossRef, Medline18.MeredithM. Human vomeronasal organ function: a critical review of best and worst cases. Chem Senses2001; 26: 433–445.CrossRef, Medline19.BorgesA, Fink J, Villablanca P, Eversole R, Lufkin R. Midline destructive lesions of the sinonasal tract: simplified terminology based on histopathologic criteria. AJNR Am J Neuroradiol2000; 21: 331–336. Medline20.CarusoRD, Sherry RG, Rosenbaum AE, Joy SE, Chang JK, Sanford DM. Self-induced ethmoidectomy from rhinotillexomania.AJNR Am J Neuroradiol1997; 18: 1949–1950. Medline21.VolkowND. Cocaine abuse and addiction. National Institute on Drug Abuse. Research report. NIH November 2004. Publication number 99–4342.22.MessingerE. Narcotic septal perforations due to drug addictions. JAMA1962; 179: 964–965. CrossRef, Medline23.GuptaA, Hawrych A, Wilson WR. Cocaine-induced sinonasal destruction. Otolaryngol Head Neck Surg2001; 124: 480.CrossRef, Medline24.BrownE, Prager J, Lee HY, Ramsey RG. CNS complications of cocaine abuse: prevalence, pathophysiology, and neuroradiology. AJR Am J Roentgenol1992; 159: 137–147. CrossRef, Medline25.SimsekS, de Vries XH, Jol JA, et al. Sino-nasal bony and cartilaginous destruction associated with cocaine abuse, S. aureus and antineutrophil cytoplasmic antibodies. Neth J Med2006; 64: 248–251. Medline26.ProvenzaleJM, Allen NB. Wegener granulomatosis: CT and MR findings. AJNR Am J Neuroradiol1996; 17: 785–792. Medline27.MorrisJM, Lane JI, Witte RJ, Thompson DM. Giant cell reparative granuloma of the nasal cavity. AJNR Am J Neuroradiol2004; 25: 1263–1265. Medline28.SantiagoR, Villalonga P, Maggioni A. Nasal septal abscess: a case report. J Int Pediatr1999; 14: 229–231.29.DispenzaC, Saraniti F, Dispenza F, Caramanna C, Salzano FA. Management of nasal septal abscess in childhoood: our experience. Int J Pediatr Otorhinolaryngol2004; 68: 1417–1421. CrossRef, Medline30.SinghM, Singh R, Sonsale AP. Tubercular septal abscess. Bombay Hospital J2004; 46: 676.31.DornbuschHJ, Buzina W, Summerbell RC, et al. Fusarium verticillioide abscess of the nasal septum in an immunosuppressed child: case report and identification of the morphologically atypical fungal strain. J Clin Microbiol2005; 43: 1998–2001.CrossRef, Medline32.DasS, Kirsch CF. Imaging of bumps and lumps in the nose: a review of sinonasal tumours. Cancer Imaging2005; 5: 167–177.CrossRef, Medline33.ChingAS, Pak MW, Kew J, Metrewely C. CT and MR imaging appearances of an extraosseous calcifying epithelial odontogenic tumor (Pindborg tumor). AJNR Am J Neuroradiol2000; 21: 343–345. Medline34.KanamallaUS, Kesava PP, McGuff HS. Imaging of nonlaryngeal neuroendocrine carcinoma. AJNR Am J Neuroradiol2000; 21:775–778. Medline35.LeeJH, Lee MS, Lee BH, et al. Rhabdomyosarcoma of the head and neck in adults: MR and CT findings. AJNR Am J Neuroradiol1996; 17: 1923–1928. Medline36.BeamanFD, Kransdorf MJ, Menke DM. Schwannoma: radiologic-pathologic correlation. RadioGraphics2004; 24: 1477–1481.Link37.SeoCS, Han MH, Chang KH, Yeon KM. Angiofibroma confined to the pterygoid muscle region: CT and MR demonstration. AJNR Am J Neuroradiol1996; 17: 374–376. Medline38.OsbornDA. Hemangiomas of the nose. J Laryngol Otol1959; 73: 174–179. CrossRef, Medline39.DillonWP, Som PM, Rosenau W. Hemangiomas of the nasal vault: MR and CT features. Radiology1991; 180: 761–765. Link40.KimHJ, Kim JH, Kim JH, Hwang EG. Bone erosion caused by sinonasal cavernous hemangioma: CT findings in two patients.AJNR Am J Neuroradiol1995; 16: 1176–1178. Medline

International Archives of Otorhinolaryngology

Print version ISSN 1809-9777
On-line version ISSN 1809-4864

Int. Arch. Otorhinolaryngol. vol.18 no.1 São Paulo http://ift.tt/2h6Ebwy;ORIGINAL ARTICLESDemystifying Septoplasty in ChildrenMariane Barreto Brandão Martins1  , Rosa Grazielle de Lima1  , Francis Vinícius Fontes de Lima1  , Valéria Maria Prado Barreto2  , Arlete Cristina Granizo Santos3  , Ronaldo Carvalho Santos Júnior1Department of Otorhinolaryngology, University Hospital, Faculty of medicine, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil2Department of Otolaryngology, Universidade Fedreral de Sergipe, São Cristóvão, SE, Brazil3Department of Otolaryngology, University Hospital of Universidade Federal de Sergipe, São Cristóvão, SE, Brazil4Department of Otolaryngology, Universidade de São Paulo, São Paulo, SP, Brazil; University Hospital of Universidade Federal de Sergipe, São Cristóvão, SE, BrazilABSTRACTIntroduction Septum deviation in children may alter the early physiologic process of breathing, causing obligatory oral breathing and consequently changing craniofacial development and even intellect. Because of these consequences, septoplasty should be performed as early as possible.Materials and Methods The retrospective study reviewed the results of septoplasty in 40 children under 12 years old who had follow-up after surgery for a maximum period of 7 years. The research was submitted to the ethics committee and approved with protocol number 10331912.0.0000.0058.Results Forty patients underwent septoplasty, 39 (97.5%) had cauterization of inferior turbinate and associated procedure, 20 (50%) had adenotonsillectomy, and 17 (42.5%) had adenoidectomy.Conclusion Nasal septum deviation should be corrected early to provide the harmonious growth of the face and to enable normal development of the child, without the occurrence of nasal deformity.Key words: nasal septum; face; growth and developmentINTRODUCTIONSeptoplasty in adults is a well-established surgery, but in children it is still a matter of controversy. Some authors contraindicate surgery before 17 to 18 years of age, because they think that early surgical intervention would influence the normal growth of the nose; others indicate surgery based on the explanation that the sooner septal deviation of a child is corrected, the greater chance of developing normal breath and therefore a suitable facial growth.1 2 The surgery has undergone technical changes since its introduction to minimize trauma to the nasal structure, thus reducing the possible postoperative complications.1 This study aims to present the experience of the Department of Otolaryngology, University Hospital, in the surgical treatment of children with nasal septum deviation and debunk the concept that septoplasty should only be performed after 17 to 18 years of age.MATERIALS AND METHODSThis longitudinal cohort study had a sample of 40 patients, 24 (60%) boys and 16 (40%) girls, aged 4 to 12 years, with a mean age of 9 years, in the period from January 2005 to March 2012 (Table 1). Patients underwent septoplasty and associated procedures such as adenoidectomy, tonsillectomy, and cauterization of inferior turbinate, when indicated, in the same surgery. These were assessed clinically and through nasal endoscopy in the postoperative period at 10, 30, and 60 days, and annually thereafter, with the longest follow-up of 7 years.Table 1 Patient characteristics (n = 40) n (%)Sex
Female
Male
Age at surgery (y)
4
5
6
7
8
9
10
11
16 (40%)
24 (60%)

3 (7.5%)
1 (2.5%)
5 (12.5%)
1 (2.5%)
4 (10%)
5 (12.5%)
5 (12.5%)
10 (25%)126 (15%)Surgical Technique
  • With the patient under general anesthesia, asepsis and antisepsis procedures are performed.
  • Initially, a topically sterile cotton ball soaked in adrenaline concentration of 1:2,000 is placed in both nostrils with the aim of promoting vasoconstriction. After this, epinephrine solution is infiltrated at a concentration of 1:80,000 in the septal mucosa of both nostrils.
  • A septal incision is performed on the left side, held at the mucocutaneous transition at nasal vestibule.
  • The septal mucosa is detached in subperichondrial and subperiosteal bilaterally after transfixation of the quadrangular cartilage.
  • Detachment is extended to the nasal floor bilaterally to facilitate the removal of possible cartilaginous and bony deviations.
  • Cartilaginous and bony deviations are excised conservatively to preserve the growth of the septal cartilage, thereby avoiding abnormalities in nasal growth.
  • Hemostasis is reviewed.
  • The initial incision is sutured.
  • Splints and nasal packing are not used at the end of surgery.
  • All steps are performed with the endoscope at 0 degrees.
RESULTSForty patients underwent septoplasty; 39 (97.5%) of them had associated inferior turbinate cauterization procedure, 20 (50%) patients had adenotonsillectomy, and 17 (42.5%) adenoidectomy (Table 2).Table 2 List of associated procedures n (%)Septoplasty40 (100%)Adenoidectomy17 (42.5%)Adenotonsillectomy20 (50%)Cauterization of nasal inferior turbinates39 (97.5%)There were no intraoperative complications in any of the operated cases. All patients were evaluated by performing nasal dressings in 10, 30, and 60 days, observing possible adhesions and recurrence of the deviation, septal perforation, infection, and nasal deformity. After this period, annual follow-up was done with the maximum of 7 years.None of the aforementioned complications were recorded during this monitoring period.DISCUSSIONThere is controversy in the literature about the consequences of septoplasty for septal deviation in children, and some studies have shown that when done early the procedure brought benefits in the short and long term.2 A study conducted with 80 patients aged between 4 and 14 years old who underwent septoplasty (65 patients), rhinoplasty (11 patients), and rhinoplasty (4 patients) showed postoperative complications in only 13 of these patients (not specifying the surgery performed); the authors concluded that the benefits brought by these surgeries outweigh the occurrence of these minimal complications.2 Dispenza et al3 stated that more important than the age of indication for the procedure is the degree of nasal obstruction, placing it as an absolute indication, because nasal obstruction during infancy disrupts the normal development of the angle of the skull base and consequently the maxillofacial growth and may cause malocclusion and jaw protrusion with bone deformities, confirmed even with anthropometric measurements. Others4 5 6 7 also claimed that delay defect correction can bring negative effect on organ systems that play a role in somatic and psychic development of the child including voice changes and sleep disturbances, but speculated that in some situations monitoring should be done for real indication for surgical treatment. A study performed with 44 patients aged between 8 and 12 years old who underwent septal surgery (reconstructive rhinoplasty) showed efficacy in relation to nasal obstruction and demonstrated that surgery when performed conservatively does not harm the facial growth or promote nasal deformities.8 In our study, all 40 patients were younger than 12 years old and underwent septoplasty surgery early, avoiding development of deformities resulting from mouth breathing. None of our patients had facial deformity at the first visit and none had nasal deformity after surgery (maximum follow-up of 7 years).Septoplasty can be performed safely without affecting the nasal and facial development in appropriately selected patients, and delaying the procedure may cause asymmetry and craniofacial anomalies.9 10 There are caveats, however, that surgery can negatively influence the growth of the nasal dorsum when done by an external approach and that before considering pediatric nasal septum surgery, a thorough clinical examination should be performed for a correct diagnosis and appropriate surgical indication.9Research that showed convincingly that septoplasty in children causes nasal deformity could not be found in the literature. Some studies even questioned the possibility of the occurrence of these deformities; however, most studies, like ours, showed that early surgery when indicated is beneficial.Thus, the studies found in the literature,1 2 3 4 5 6 7 8 9 10 whether anthropometric or clinical trials, corroborated our findings that septoplasty in children allows appropriate craniofacial growth and development, prevents abnormalities in somatic and psychic component of the patient, as well as demystifies the concept that septoplasty should only be performed after the age of 17 to 18 years old.CONCLUSIONThe nasal septum deviation should be corrected early to provide a harmonious craniofacial growth and appropriate child development, without the occurrence of nasal deformity.REFERENCES1 Patrocíno JA. Septoplastia em crianças. Rev Bras Otorrinolaringol (Engl Ed) 1999;65(4):302-306 [ Links ]2 Maniglia JV, Molina FD, Maniglia LP, et al. Rinosseptoplastia em crianças. Rev Bras Otorrinolaringol (Engl Ed) 2002;68(3):320-323 [ Links ]3 Dispenza F, Saraniti C, Sciandra D, Kulamarva G, Dispenza C. Management of naso-septal deformity in childhood: long-term results. Auris Nasus Larynx 2009;36(6):665-670 [ Links ]4 Verwoerd CDA, Verwoerd-Verhoef HL. [Rhinosurgery in children: developmental and surgical aspects of the growing nose]. Laryngorhinootologie 2010;89(1, Suppl 1):S46-S71 [ Links ]5 Verwoerd CDA, Verwoerd-Verhoef HL. Rhinosurgery in children: basic concepts. Facial Plast Surg 2007;23(4):219-230 [ Links ]6 Cupero TM, Middleton CE, Silva AB. Effects of functional septoplasty on the facial growth of ferrets. Arch Otolaryngol Head Neck Surg 2001;127(11):1367-1369 [ Links ]7 Christophel JJ, Gross CW. Pediatric septoplasty. Otolaryngol Clin North Am 2009;42(2):287-294, ix [ Links ]8 Ortiz-Monasterio F, Olmedo A. Corrective rhinoplasty before puberty: a long-term follow-up. Plast Reconstr Surg 1981;68(3): 381-391 [ Links ]9 Lawrence R. Pediatric septoplasy: a review of the literature. Int J Pediatr Otorhinolaryngol 2012;76(8):1078-1081 [ Links ]10 D'Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial growth in children with nasal septum deviation: a cephalometric comparative study. Int J Pediatr Otorhinolaryngol 2010;74(10):1180-1183 [ Links ]



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