xRead - Nasal Obstruction (September 2024) Full Articles

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KUANetal.

TABLE XVII.B.2 Evidence surrounding sinonasal paraganglioma.

Clinical endpoint

Study

Year LOE Study design Study groups

Conclusion

Nguyen et al. 852

Optimal management includes total resection with clear margins and long-term follow-up

1. Recurrence 2. Metastasis 3. OS

2019 2

Systematic review

45 studies including patients with sinonasal paraganglioma ( n = 54) Patients with benign or malignant sinonasal paraganglioma ( n = 6)

Papaspyrou et al. 862

2013 4

Retrospective case series

1. Locoregional spread 2. Metastasis

1. Lesions can be malignant with rapid local and distant spread despite resection 2. Malignancy diagnosed on clinical behavior

Abbreviation: OS, overall survival.

C Nasal glial heterotopia Nasal glial heterotopias, formerly termed gliomas, are the least common CMNMs, with only a few hundred cumula tive cases reported in the literature. 879,886–888 Development of these lesions is similar to that of nasal dermoids. 880 They arise from ectopic rests of neural glial tissue sequestered in the nasal soft tissue following obliteration of their embry ologic connection to the subarachnoid space. 888 Nasal gliomas may present as noncompressible masses that may appear red or with a bluish hue. Nearly 10%–30% of these lesions may have a persistent dural connection traversing the foramen cecum. 888 However, unlike menin goencephaloceles, they do not have subarachnoid commu nications and are not filled with CSF. On CT imaging, gliomas appear isodense to brain parenchyma. However, MRI is the preferred modality of evaluation, and these lesions are typically T1 hypointense and nonenhancing. 879 D Meningoencephaloceles Nasal midline congenital meningoencephaloceles are extensions of the brain parenchyma (encephaloceles) or meninges (meningoceles) through a skull base defect caused by abnormal persistent patency of fonticulus frontalis and foramen cecum. 879 This allows for commu nication with the subarachnoid space; therefore, menin goencephaloceles may be filled with CSF and present with CSF rhinorrhea. Their incidence is estimated to be around 1 in 35,000 births. 889,890 They typically present at birth as bluish, compressible masses along the nasal dorsum/glabella, which may also enlarge with Valsalva or crying (positive Furstenberg’s sign). 880 Appropriate workup, including MRI, is very important in assessing the degree of intracranial involvement and other associated intracranial pathologies, most commonly hydrocephalus

involve the nasal dorsum, have a fistulous tract, or extend into the intracranial space. Therefore, prompt diagnosis and appropriate workup of CMNMs are critical to ensure complete resection and to avoid intracranial complications. 877 B Dermoid and epidermoid cysts Nasal dermoid and epidermoid cysts are the most com mon congenital midline nasal masses and account for up to 61% of all CMNM cases. 40 Embryologically, they arise from a retained connection between the dural divertic ulum and ectodermal tissue. 879 Clinically, patients may present with a cyst, sinus, fistula, or a firm, nonpulsatile mass located between the columella and glabella. 883 These lesions do not transilluminate and are negative for the Furstenberg test (pressure on the ipsilateral jugular vein to elicit swelling or pulsation of the lesion). Compared to epi dermoids, which consist of ectoderm/skin elements only, nasal dermoids are composed of ectodermal and mesoder mal tissue and may contain hair follicles and sweat glands. Most are detected early in life, with a mean age at the time of diagnosis of 2–3 years, but a number of cases in young adults have been reported in the literature. 881 There appears to be a male predominance across the literature and a likely familial inheritance in some cases. 883,884 Most recent large retrospective studies show that approximately 25%–35% of patients demonstrate evidence of intracranial extension. 883,885 Therefore, both MRI and CT imaging are usually obtained as part of the workup, although some authors favor the use of MRI as sole and primary imaging tool. 877 Given the potential of intracranial extension and delayed diagnosis due to subtle physical exam findings, up to 36% of patients may present with significant com plications (meningitis, osteomyelitis, cellulitis/abscess), highlighting the need for timely surgical excision. 885