Purpose The aim of the study was to investigate whether olfactory fluctuations (OF) are pronounced in patients with sinonasal olfactory dysfunction (OD). - Methods The retrospective investigation included patients aged 18 years or older, who consulted a tertiary referral center for olfactory loss. Patients with normal smell function were excluded. Patients answered a structured questionnaire about their olfactory symptoms, with specific questions related to the presence of OF and its average frequency, amplitude, duration, time since most recent OF, and associated symptoms of self-reported OF. Patients also underwent clinical evaluation including a structured medical history and physical examination including nasal endoscopy. In addition, we assessed orthonasal olfactory function using Sniffin’ Sticks, and gustatory function using “taste sprays”. - Results Participants included 131 men and 205 women (n = 336), aged 18 to 86 years (mean 50, SD 16). Patient-reported fluctuations occurred most frequently in sinonasal (38%), idiopathic (29%), and postviral (29%) OD. Amplitude of OF was highest in postviral OD (p = 0.009). Average frequency, duration, and the time since the most recent fluctuation were not significantly different between groups (all p’s > 0.42). Odor discrimination (p = 0.002) and identification (p = 0.017) scores were higher among those individuals with OF. - Conclusion Amplitude of OF may help distinguish postviral from other causes of OD, especially in patients presenting with equivocal symptoms of sinonasal disease.

Introduction Advanced Kadish stage esthesioneuroblastoma requires more extensive resections and aggressive adjuvant therapy to obtain adequate disease-free control, which can lead to higher complication rates. We describe the case of a patient with Kadish D esthesioneuroblastoma who underwent multiple surgeries for infectious, neurologic, and wound complications, highlighting potential preventative and salvage techniques. Case Presentation A 61-year-old man who presented with a large left-sided esthesioneuroblastoma, extending into the orbit, frontal lobe, and parapharyngeal nodes. He underwent margin-free endoscopic-assisted craniofacial resection with adjuvant craniofacial and cervical radiotherapy and concomitant chemotherapy. He then returned with breakdown of his skull base reconstruction and subsequent frontal infections and ultimately received 10 surgical procedures with surgeries for infection-related issues including craniectomy and abscess evacuation. He also had surgeries for skull base reconstruction and CSF leak, repaired with vascularized and free autologous grafts and flaps, synthetic tissues, and CSF diversion. Discussion Extensive, high Kadish stage tumors necessitate radical surgical resection, radiation, and chemotherapy, which can lead to complications. Ultimately, there are several options available to surgeons, and although precautions should be taken whenever possible, risk of wound breakdown, leak, or infection should not preclude radical surgical resection and aggressive adjuvant therapies in the treatment of esthesioneuroblastoma.

Introdução: As afecções nasais e sinonasais em cães possuem causas variadas, e algumas vezes cursam com sinusites, sendo raros os casos que não há doença nasal pré-existente. O diagnóstico presuntivo é baseado nas manifestações clínicas como secreção nasal uni ou bilateral anormais, esternutações, esternutações reversas paroxísticas, respiração estertorosa, engasgos, halitose, epistaxes, rinorragia, tosse, distrição respiratória, dor e deformação facial. Para concluir o diagnóstico, são indicados exames de imagem, rinoscopia, culturas, citologia e histopatológico. Objetivo: O presente estudo observacional teve como objetivo avaliar a contribuição ao diagnóstico das afecções da cavidade nasal e seios paranasais de cães, da radiografia, tomografia computadorizada e rinoscopia, realizando-se a comparação dos métodos diagnósticos mediante ao escore comparativo idealizado para este fim. Materiais e métodos: Foram utilizados 20 cães atendidos do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, com manifestações clínicas compatíveis com afecção nasal e submetidos a exame radiográfico, tomográfico e rinoscópico. A biópsia foi realizada, em 18 cães, por meio da rinoscopia, nos casos em que visibilizou-se proliferação tecidual, úlcera ou alteração na mucosa nasal sendo encaminhadas para estudo histológico. Resultados: Foram observados resultados estatisticamente significativos, baseados pelo escore, a radiografia em conjunto com a tomografia computadorizada, a rinoscopia associada à tomografia computadorizada e, também, a rinoscopia isoladamente, como métodos diagnósticos mais específicos na diferenciação de lesão maligna. A rinoscopia demonstrou como vantagem a visibilização direta diferenciando a presença ou não de inflamação ou proliferação tecidual, alteração anatômica, corpo estranho e placa fúngica. Conclusão: Os resultados do presente estudo indicam que embora possuam especifidade diferentes a utilização da radiografia, tomografia computadorizada e rinoscopia se complementaram como métodos diagnósticos nas afecções nasais e sinonasais dos cães avaliados. Nos casos de proliferação tecidual o estudo histológico demonstrou ser mais útil para conclusão diagnóstica em comparação aos exames de imagem e a rinoscopia. / Introduction: The nasal and sinus disorders in dogs have various causes, and sometimes go with sinusitis that there is no pre-existing nasal disease. The presumptive diagnosis is based on clinical manifestations as nasal discharge, sneezing, reverse sneezing, gagging, stertor, halitosis, epistaxis, cough, open-mouth breathing, pain and facial deformation. To complete the diagnosis, image examinations, rhinoscopy, cultures, cytology and histopathological fidings. Objectives: This observational study aimed to evaluate the contribution to the diagnosis of disorders of the nasal cavity and paranasal in dogs, radiography, computed tomography and rhinoscopy, performing comparison of diagnostic methods through the comparative score conceived for this purpose. Materials and methods: This study used 20 dogs of Veterinary Hospital of the Faculty of Veterinary Medicine and Zootechny of the University of São Paulo, with clinical signs compatible with nasal disorder and undergone radiographic examination, computed tomography and rhinoscopy. The biopsy was performed on 18 dogs through rhinoscopy, where is tissue proliferation, ulcer or change in the nasal mucosa histology study being forwarded to. Results: Significant results were observed by the score with radiography, computed tomography, rhinoscopy associated with computed tomography, and also, separately, as rhinoscopy diagnostic methods more specific differentiation of malignant lesion. The rhinoscopy demonstrated how advantage to visualize directly differentiating presence or not of inflammation or tissue proliferation, alteration, foreign body and fungal plaques. Conclusion: The results of this study indicate that although having different specific utilization, radiography, computed tomography and rhinoscopy as diagnostic methods arranged in nasal disorders of dogs and evaluated. In cases of tissue proliferation, histological study proved most useful in final diagnostic compared to the image exams and rhinoscopy.

Orientador: Júlio Carlos Canola / Banca: Fabrício Singaretti de Oliveira / Banca: Márcia Rita Fernandes Machado / Resumo: Doenças sinonasais são comuns em pequenos animais, todavia o diagnóstico definitivo é difícil de ser estabelecido pela similaridade dos sinais clínicos das enfermidades que acometem a cavidade nasal e os seios paranasais, além da limitação dos métodos de diagnóstico. A imagem adquirida com a radiografia apresenta sobreposição de estruturas anatômicas. A tomografia computadorizada (TC) permite o estudo do corpo em planos, onde as estruturas internas podem ser visibilizadas diretamente. Estudos em que foram comparadas as imagens radiográficas e de TC da cabeça de gatos, em sua maioria, confrontaram dados de tomografias arquivadas com achados radiográficos de exames feitos em grupos distintos de animais. Com este estudo objetivou-se descrever os achados radiográficos e tomográficos de imagens obtidas da cabeça de um grupo de dez gatos mestiços, adultos, com sinais clínicos crônicos de rinite e sinusite. As alterações visibilizadas nas imagens radiográficas e de TC foram aumento de opacidade dos seios frontais e da cavidade nasal e envolvimento de estruturas extra sinonasais. Foram observados ainda nas imagens de TC desvio do septo nasal e destruição de turbinados nasais e de ossos da face. O reduzido comprimento facial do gato, associado à sobreposição de tecidos que ocorre nas radiografias de cabeça, limitam a avaliação da cavidade nasal, seios frontais e bulas timpânicas. Entretanto, o conhecimento anatomoradiográfico da cabeça permite identificar a maioria das alterações encontradas no exame de TC. / Abstract: Sinonasal diseases are common in small animals, however is difficult to establish a definitive diagnosis due clinical signals are similar in different diseases of nasal cavity and paranasal sinuses and the diagnostic methods are limited. The image acquired with the radiographic presents overlapping of anatomical structures. Computed tomography (CT) is a technique that allows the study of the body in slices, generating images without overlapping of anatomical structures. Studies have compared radiographic and CT images of feline head, however radiographic and CT images were acquire to different groups of animals. The aim of this study was to describe the aspects of radiographic and tomographic images acquired to the head of a group of ten adults mixed-breed mixed-breed cats, with chronic signals of rhinitis and sinusitis. The findings in radiographic and CT images in this study were opacification of frontal sinuses and nasal cavity, and extrasinonasal involvement. In CT, were observed nasal septal deviation, turbinate destruction and nasal bony changes. The small facial length of the cat, associated with tissue superimposition that commonly occurs in head radiographs, restrict nasal cavity, frontal sinus and timpanic bullae evaluation. However, the anatomoradiographic knowledge of the head allows the identification of most alterations found at CT examination. / Mestre

Sinonasal and dental diseases can be a serious disorder in horses due to the persistence of the former and the common extension of the latter to the supporting bones of the skull. The diagnosis of equine sinonasal and dental disease can be challenging due to the complexity of these and adjacent anatomical structures, and therefore the use of advanced imaging, including computed tomography (CT) has greatly increased recently. A major aim of this study was to improve the morphological characterization of the sinuses and cheek teeth in normal horses of different ages. These studies defined the volumes of the 7 different sinus compartments; showed that the volume of the different compartments increase with age; that in contrast to accepted findings, the Triadan 09 alveoli is located in the caudal maxillary sinus (CMS) in 13% of the youngest group and the Triadan 10 alveoli is fully within the rostral maxillary sinus (RMS) in 53% of cases. The infraorbital canal was found to be susceptible to apical infection-related damage in horses < 2 years of age (< 2 y.o.) due to the intimate relationship of this canal and the medial aspect of the maxillary cheek teeth alveoli. The mean positions of the clinical crowns and apices of the maxillary Triadan 11s were 2.48 cm (adjusted 5.2% of head height) and 2.83 cm (adjusted 6.2% of head height) more rostral, respectively in horses >16 y.o. compared to horses < 6 y.o., consistent with rostral dental drift. Measurements of dental drift could provide further objective radiographic guidelines on ageing horses by dental imaging and also help our understanding of the aetiopathogenesis of cheek teeth diastemata. This study also found that the reserve crown length decreased from a mean of 4.7 cm (adjusted 19.7% of head height) in the youngest (< 6y.o.) group of horses to a mean of 2.9 cm (adjusted 10.5% of head height) in the oldest group (>15y.o.), with the 06s and 09s having the shortest reserve crowns. These data are useful reference information for clinicians and radiologists in the diagnosis and treatment of equine sinonasal and dental disease. Morphological characterization of the ventral and dorsal conchal bullae in horses of different age using CT described the age-related difference in sizes of these structures (smaller in younger horses). In the ventral conchal bulla, this reduction in volume was probably related to protrusion of the large dental alveoli in young horses into the nasal cavity and bulla. Bullae linear measurements and volumes were also associated with head size. The anatomical position of both bullae was associated with specific maxillary cheek teeth, thus increasing the diagnostic value of conventional radiography in the investigation of bulla disease and providing landmarks for the surgical treatment of this disorder. Skull shape analyzed with the use of Procrustes statistical analysis showed landmark variability between different age groups and in particular, high landmark variability between young (< 5y.o.) and old (>16y.o.) horses and less landmark variability between adult (6-15y.o.) and old horses. Future studies could investigate changes in the equine skull in relation to genotype to characterize breed-related diseases affecting teeth and sinonasal compartments. In the second part of the study, 32 infected maxillary cheek teeth extracted from clinical cases were evaluated grossly and histologically and these pathological results were compared to the pre-extraction radiographic and CT imaging findings. This study showed a high sensitivity (97%) of CT in detecting changes in teeth affected by apical infection. In the third part of the study, 30 cheek teeth assessed as being abnormal based on oral, radiographic and CT examinations were extracted along with their alveoli from 27 cadaver heads. Gross and histological examination findings from these teeth and alveoli were compared to the pre-extraction imaging findings, again showed high sensitivity (96.4%) of CT in diagnosing cheek teeth apical infection. Additionally, CT showed a high correlation with histology in detecting dental infection related alveolar bone changes including alveolar bone lysis, sclerosis and bone thickening. This aspect of the study was also the second largest pathological study of equine apical infection published to date and thus has also improved our understanding of the pathogenesis of this disorder. In conclusion, CT was shown to be an excellent imaging modality for improving the morphological characterization of the sinuses and teeth in normal horses of different ages, and thus also improving the value of this modality in diagnosis and treatment of disease affecting sinonasal and dental structures. This study also objectively showed the high sensitivity of CT in detecting cheek teeth apical infection in horses as compared to radiography, including by assessment of alveolar bone changes. Overall, the results of this project improve morphological knowledge of the equine skull and teeth and will have direct clinical benefits by improving the diagnosis and thus the treatment of equine sinonasal and dental disease.

Made available in DSpace on 2014-06-11T19:23:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-07-25Bitstream added on 2014-06-13T18:51:09Z : No. of bitstreams: 1 zanatta_r_me_jabo.pdf: 1763368 bytes, checksum: 178126ce040eb604169af1e6c9213ec7 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Doenças sinonasais são comuns em pequenos animais, todavia o diagnóstico definitivo é difícil de ser estabelecido pela similaridade dos sinais clínicos das enfermidades que acometem a cavidade nasal e os seios paranasais, além da limitação dos métodos de diagnóstico. A imagem adquirida com a radiografia apresenta sobreposição de estruturas anatômicas. A tomografia computadorizada (TC) permite o estudo do corpo em planos, onde as estruturas internas podem ser visibilizadas diretamente. Estudos em que foram comparadas as imagens radiográficas e de TC da cabeça de gatos, em sua maioria, confrontaram dados de tomografias arquivadas com achados radiográficos de exames feitos em grupos distintos de animais. Com este estudo objetivou-se descrever os achados radiográficos e tomográficos de imagens obtidas da cabeça de um grupo de dez gatos mestiços, adultos, com sinais clínicos crônicos de rinite e sinusite. As alterações visibilizadas nas imagens radiográficas e de TC foram aumento de opacidade dos seios frontais e da cavidade nasal e envolvimento de estruturas extra sinonasais. Foram observados ainda nas imagens de TC desvio do septo nasal e destruição de turbinados nasais e de ossos da face. O reduzido comprimento facial do gato, associado à sobreposição de tecidos que ocorre nas radiografias de cabeça, limitam a avaliação da cavidade nasal, seios frontais e bulas timpânicas. Entretanto, o conhecimento anatomoradiográfico da cabeça permite identificar a maioria das alterações encontradas no exame de TC. / Sinonasal diseases are common in small animals, however is difficult to establish a definitive diagnosis due clinical signals are similar in different diseases of nasal cavity and paranasal sinuses and the diagnostic methods are limited. The image acquired with the radiographic presents overlapping of anatomical structures. Computed tomography (CT) is a technique that allows the study of the body in slices, generating images without overlapping of anatomical structures. Studies have compared radiographic and CT images of feline head, however radiographic and CT images were acquire to different groups of animals. The aim of this study was to describe the aspects of radiographic and tomographic images acquired to the head of a group of ten adults mixed-breed mixed-breed cats, with chronic signals of rhinitis and sinusitis. The findings in radiographic and CT images in this study were opacification of frontal sinuses and nasal cavity, and extrasinonasal involvement. In CT, were observed nasal septal deviation, turbinate destruction and nasal bony changes. The small facial length of the cat, associated with tissue superimposition that commonly occurs in head radiographs, restrict nasal cavity, frontal sinus and timpanic bullae evaluation. However, the anatomoradiographic knowledge of the head allows the identification of most alterations found at CT examination.

Introdução: As afecções nasais e sinonasais em cães possuem causas variadas, e algumas vezes cursam com sinusites, sendo raros os casos que não há doença nasal pré-existente. O diagnóstico presuntivo é baseado nas manifestações clínicas como secreção nasal uni ou bilateral anormais, esternutações, esternutações reversas paroxísticas, respiração estertorosa, engasgos, halitose, epistaxes, rinorragia, tosse, distrição respiratória, dor e deformação facial. Para concluir o diagnóstico, são indicados exames de imagem, rinoscopia, culturas, citologia e histopatológico. Objetivo: O presente estudo observacional teve como objetivo avaliar a contribuição ao diagnóstico das afecções da cavidade nasal e seios paranasais de cães, da radiografia, tomografia computadorizada e rinoscopia, realizando-se a comparação dos métodos diagnósticos mediante ao escore comparativo idealizado para este fim. Materiais e métodos: Foram utilizados 20 cães atendidos do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, com manifestações clínicas compatíveis com afecção nasal e submetidos a exame radiográfico, tomográfico e rinoscópico. A biópsia foi realizada, em 18 cães, por meio da rinoscopia, nos casos em que visibilizou-se proliferação tecidual, úlcera ou alteração na mucosa nasal sendo encaminhadas para estudo histológico. Resultados: Foram observados resultados estatisticamente significativos, baseados pelo escore, a radiografia em conjunto com a tomografia computadorizada, a rinoscopia associada à tomografia computadorizada e, também, a rinoscopia isoladamente, como métodos diagnósticos mais específicos na diferenciação de lesão maligna. A rinoscopia demonstrou como vantagem a visibilização direta diferenciando a presença ou não de inflamação ou proliferação tecidual, alteração anatômica, corpo estranho e placa fúngica. Conclusão: Os resultados do presente estudo indicam que embora possuam especifidade diferentes a utilização da radiografia, tomografia computadorizada e rinoscopia se complementaram como métodos diagnósticos nas afecções nasais e sinonasais dos cães avaliados. Nos casos de proliferação tecidual o estudo histológico demonstrou ser mais útil para conclusão diagnóstica em comparação aos exames de imagem e a rinoscopia. / Introduction: The nasal and sinus disorders in dogs have various causes, and sometimes go with sinusitis that there is no pre-existing nasal disease. The presumptive diagnosis is based on clinical manifestations as nasal discharge, sneezing, reverse sneezing, gagging, stertor, halitosis, epistaxis, cough, open-mouth breathing, pain and facial deformation. To complete the diagnosis, image examinations, rhinoscopy, cultures, cytology and histopathological fidings. Objectives: This observational study aimed to evaluate the contribution to the diagnosis of disorders of the nasal cavity and paranasal in dogs, radiography, computed tomography and rhinoscopy, performing comparison of diagnostic methods through the comparative score conceived for this purpose. Materials and methods: This study used 20 dogs of Veterinary Hospital of the Faculty of Veterinary Medicine and Zootechny of the University of São Paulo, with clinical signs compatible with nasal disorder and undergone radiographic examination, computed tomography and rhinoscopy. The biopsy was performed on 18 dogs through rhinoscopy, where is tissue proliferation, ulcer or change in the nasal mucosa histology study being forwarded to. Results: Significant results were observed by the score with radiography, computed tomography, rhinoscopy associated with computed tomography, and also, separately, as rhinoscopy diagnostic methods more specific differentiation of malignant lesion. The rhinoscopy demonstrated how advantage to visualize directly differentiating presence or not of inflammation or tissue proliferation, alteration, foreign body and fungal plaques. Conclusion: The results of this study indicate that although having different specific utilization, radiography, computed tomography and rhinoscopy as diagnostic methods arranged in nasal disorders of dogs and evaluated. In cases of tissue proliferation, histological study proved most useful in final diagnostic compared to the image exams and rhinoscopy.

Background: The contribution of the nasal and paranasal cavities to the vocal tract resonator properties is unclear. Here we investigate these resonance phenomena of the sinonasal tract in isolation in a cadaver and compare the results with those gained in a simplified brass tube model. Methods: The resonance characteristics were measured as the response to sine sweep excitation from an earphone. In the brass model the earphone was placed at the closed end and in the cadaver in the epipharynx. The response was picked up by a microphone placed at the open end of the model and at the nostrils, respectively. A shunting cavity with varied volumes was connected to the model and the effects on the response curve were determined. In the cadaver, different conditions with blocked and unblocked middle meatus and sphenoidal ostium were tested. Additionally, infundibulotomy was performed allowing direct access to and selective occlusion of the maxillary ostium. Results: In both the brass model and the cadaver, a baseline condition with no cavities included produced response curves with clear resonance peaks separated by valleys. Marked dips occurred when shunting cavities were attached to the model. The frequencies of these dips decreased with increasing shunting volume. In the cadaver, a marked dip was observed after removing the unilateral occlusion of the middle meatus and the sphenoidal ostium. Another marked dip was detected at low frequency after removal of the occlusion of the maxillary ostium following infundibulotomy. Conclusion: Combining measurements on a simplified nasal model with measurements in a cadaveric sinonasal tract seems a promising method for shedding light on the acoustic properties of the nasal resonator.

Background: Despite clinical importance and frequent occurrence of sinus disease, little is known about the size of paranasal sinuses and their communication in ponies and small horses. To examine the shape and volume of the paranasal sinuses and evaluate the sinonasal communication, three-dimensional (3D) reconstructions of computed tomography (CT) datasets of 12 healthy adult Shetland ponies were performed and analysed. Linear measurements of head length and width were taken. Using semi-automatic segmentation, 3D-models of all sinus compartments were created. Volumetric measurement of the seven sinus compartments were conducted and statistical analysis was performed. Sinus volumes were compared between the left and right sinuses and the relation to age and head size was evaluated. Results: Structure and shape of the paranasal sinus system in Shetland ponies was similar to that of large horses. All seven sinus compartments on each side of the head were identified (rostral maxillary sinus, ventral conchal sinus, caudal maxillary sinus, dorsal conchal sinus, middle conchal sinus, frontal sinus, sphenopalatine sinus). The existence of a bilateral cranial and a caudal system formed by a maxillary septum was visible in all 12 individuals. The volumetric sizes of the left and right sinuses did not differ significantly (p > 0.05). A positive correlation between the size of the paranasal sinuses and the head length was shown. A relation between sinus volumes and age could not be proved in adult ponies aged > six years. Communication between single sinus compartments was identified. Furthermore, communication with the nasal cavity over the nasomaxillary aperture (Apertura nasomaxillaris) and a common sinonasal channel (Canalis sinunasalis communis) as well as its splitting up into a rostral and a caudolateral channel could be seen. Examination of the sinonasal communication was challenging and only a descriptive evaluation was possible. Conclusions: Our findings concerning the size, shape and volumetric dimensions of Shetland pony CT images could help improve CT interpretation of abnormal clinical cases as well as aiding clinicians to develop and select appropriate instruments for medical inspection and treatments.