xRead - Nasal Obstruction (September 2024) Full Articles

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166

KUANetal.

TABLE XVII.B.1 (Continued)

Clinical endpoint

Study

Year LOE Study design Study groups

Conclusions

Denket al. 876

1. The midline approach provides excellent visualization and an aesthetically acceptable scar 2. Early surgical intervention (usually between 2 and 2.5 years of age) is reasonable

1. Efficacy of

2002 4

Retrospective case series

Patients with nasal

midline open surgical approach hemangioma and feasibility of surgery

hemangiomas who underwent open surgical resection ( n = 11)

2. Ageof

Dillon et al. 821

1991

4

Retrospective case series

Patients with sinonasal hemangiomas (all

Diagnostic utility ofCT/MR imaging for hemangiomas

1. Imaging demonstrates well-circumscribed and

LCHs)who underwent diagnostic imaging and resection (unknown type) ( n = 8)

intensively enhancing lesions 2. CT showed bony remodeling MR was helpful to distinguish lesions from surrounding mucus secretions

Abbreviations: CH, cavernous hemangioma; CT, computed tomography; LCH, lobular capillary hemangioma; IT, inferior turbinate; LNW, lateral nasal wall.

time. 844 The endothelial cells are flattened and mitotically quiescent, surrounded by scant and often disorganized smooth muscle cells. 845 VMs of the nasal cavity are very rare. Interpretation of the literature is additionally challenging due to long standing confusion around the proper nomenclature of vascular anomalies. The International Society for the Study of Vascular Malformations classification system has become the standard in the field but is not universally used. 840 Published literature on nasal VM is restricted to case reports. Only three cases of VM involving the sinuses or nasopharynx have been reported. 843,846,847 Diag nostic imaging can include contrast-enhanced CT and MRI, as well as consideration of angiography. Reported treatments include medical therapies (targeted therapies and/or anticoagulation), laser, sclerotherapy, surgery, or a combination of these modalities. 845,848 In one case, hor monal therapy (progesterone) was felt to be contributing to VM development and was therefore discontinued. 846 4 Paragangliomas Paragangliomas of the sinonasal cavity occur at an inci dence of 1 in 100,000, representing only 0.6% of all tumors within the head and neck. 849 It is classified as a neuroen docrine tumor, though it is included in this section given its well-described vascularity and strategies needed for mit igating blood loss during resection. The average age of presentation is 45 years with most lesions occurring in women, typically in the fifth to seventh decades. 849–851 In a systematic review by Nguyen et al. of 45 studies incor porating 54 patients with sinonasal paraganglioma and a

for consideration of EEAs, but at present individualized care with consideration of the patient, disease, as well as the surgeon’s experience and familiarity with endoscopic and endovascular procedures needs to be considered. Although well described for intracranial AVM, Gamma Knife radiosurgery has not been reported for those within the sinuses and extracranial skull base. Risk of recurrence for sinonasal AVM is not known, but data from soft tissue AVM within the head and neck regions suggest recurrence rates could be as high as 80%. 826 3 Venous malformations Venous malformations (VMs) are developmental errors in venous morphogenesis that arise in utero, but may not become clinically evident until later in life. 835 They result from somatic mutations in PIK3CA or TEK/TIE2 . 836–838 The incidence is estimated to be 1:10,000. 839 VMs are slow flow malformations that tend to grow with the patient and may expand abruptly with trauma or hormonal changes. 835 Clinically these manifest with blue skin discoloration or as a soft subcutaneous mass that is compressible and enlarges with increased venous pressure. 840 The slow flow within the malformation can result in thrombosis, phleboliths, and sometimes localized intravascular coagu lopathy (LIC), which can decompensate into disseminated intravascular coagulopathy (DIC). 841 Depending on their extent, these can be focal, multifocal, or diffuse. 842 Approx imately 40% of VMs occur in the head and neck and are commonly associated with muscles or involve the mucosal lining. 843 Histologically, they are composed of aberrant thin-walled veins that exhibit progressive ectasia over