What are malformations of the nose and paranasal sinuses?
The nose serves to cleanse, moisten and warm the inhaled air. The inside of the nose is called the nasal cavity. The paranasal sinuses are air-containing cavities lined with mucous membrane that are connected to the nasal cavity. A total of four paranasal sinuses are distinguished:
- the maxillary sinus next to the nose
- the frontal sinus above the nose
- the sphenoid sinus behind the nose
- the ethmoid bone behind the nose between the eyes
Various diseases and malformations can affect the shape and function of the nose and paranasal sinuses. They can exist from birth or be acquired in the course of life. Overall, however, malformations of the nose are relatively rare and are usually associated with other syndromes. A common malformation of the nose is, for example, choanal atresia (bony closure of the rear nasal opening).
Treatment depends on the extent of the functional impairment and the associated psychological stress.
Malformations of the nose and paranasal sinuses: Causes
There are many different causes that can lead to malformations of the nose and paranasal sinuses and can cause different symptoms. A basic distinction can be made between congenital and acquired causes.
Congenital causes
- Choanal atresia: Choanal atresia is when a bony obstruction has formed between the posterior nasal opening and the pharynx. It is the most common congenital malformation of the nose, but is rare in the population as a whole. Choanal atresia can occur either unilaterally or bilaterally. Unilateral choanal atresia can remain undetected for years and is usually only treated in infancy. Bilateral choanal atresia, on the other hand, must be operated on immediately after birth, as the affected babies can only breathe through their mouths.
- Cleft lip and palate: Cleft lip and palate is a common congenital malformation of the mouth. The extent to which cleft lip and palate also affects the nose varies: the malformation can range from a slight indentation of the tip of the nose to a complete cleft of the nose.
- Congenital nasal fistulas (dermoids): Nasal fistulas and cysts are rare congenital malformations. A fistula is a small connecting duct under the skin that can contain a variety of tissues (such as hair and glands). Nasal fistulas usually appear as small protrusions in the area of the bridge of the nose.
- Curved nasal septum: Although a curved nasal septum can also be the result of an accident, in many cases it is hereditary. This condition, technically known as deviated septum, is quite common, but only rarely leads to symptoms such as restricted nasal breathing.
- Hemangiomas (blood sponges): A hemangioma is a benign tumor caused by the proliferation and new formation of blood vessels. In principle, such hemangiomas can occur anywhere where there are blood vessels – however, they rarely occur on the nose.
Acquired causes
- Rhinophyma (bulbous nose): Experts refer to a bulbous deformation of the nose caused by rosacea as rhinophyma. The reason for the deformation is the thickening of the outer skin of the nose and the enlargement of the sebaceous glands.
- Chronic sinusitis (inflammation of the paranasal sinuses): The most common disease of the paranasal sinus system is chronic inflammation (chronic sinusitis). Inflammation of the paranasal sinuses is usually caused by a viral infection or other pathogens. Common symptoms are headaches, fatigue and difficulty breathing through the nose. Certain anatomical features, such as a curved nasal septum or enlarged turbinates, can promote the development of the condition.
- Injuries and fractures: The nasal bone fracture and the zygomatic bone fracture are among the most common bony injuries to the facial skull. They usually occur as a result of a blow or a fall, for example during sport. A distinction can be made between displaced and non-displaced fractures. In the case of a dislocated fracture, the pieces of bone are displaced against each other and usually have to be repositioned surgically.
Malformations of the nose and paranasal sinuses: Rhinologic diagnostics
A careful rhinological examination of the nose and paranasal sinuses is the basic prerequisite for choosing the right treatment method. It is not only the cause of the disease or malformation that is decisive, but also the resulting symptoms. Typical diagnostic procedures include:
- Nasal endoscopy
- Rhinomanometry
- Neuroradiological examinations
Nasal endoscopy (rhinoscopy)
Rhinoscopy is a routine examination performed by an ear, nose and throat specialist. It is used at almost every visit to the doctor to clarify diseases or disorders in the area of the inside of the nose.
Depending on which area of the nose we want to examine more closely, different procedures are used: anterior, middle and posterior rhinoscopy.
- For anterior rhinoscopy, we use a nasal speculum – a type of metal forceps with a funnel at the end. This allows us to view the entire nasal cavity and the anterior nasal passages.
- We use a so-called nasal endoscope for mid-nasal endoscopy. This consists of either a rigid or a flexible tube, at the end of which a light source and a small camera are attached.
- A posterior rhinoscopy is performed using a tongue depressor and an angled nasopharyngeal mirror. We use it to diagnose enlarged tonsils, purulent secretions, adenoids and thickened posterior tonsil ends.
Rhinomanometry
Rhinomanometry is a procedure for measuring the airflow from the nose. For this examination, we insert two funnels into both nostrils, whereby only one of the two funnels is permeable to air. The patient is then given a breathing mask and breathes in through the mouth and out through the nose a few times. The funnels are then changed so that we can gain information about the patency of the two nasal passages.
Neuroradiological examinations
Imaging procedures can show the nasal cavity and any changes in it. The following methods are used to examine bones and tissue around the nose:
Malformations of the nose and paranasal sinuses: Treatment
Nowadays, malformations of the nose and paranasal sinuses can usually be treated endoscopically thanks to modern technology. Larger skin incisions on the face or head are no longer necessary. Depending on the cause, very different surgical procedures are used – for example:
- Straightening of the nasal septum (septoplasty) and/or surgery on the paranasal sinuses
- Reconstruction of the nasal septum for defects
- Aesthetic-functional rhinoplasty (septoplasty and rhinoplasty)
- Reduction of the turbinates (e.g. radiofrequency therapy of the turbinates)
- Anterior skull base operations
- Surgery on the eye socket and tear ducts
- Minimally invasive tumor removal in the area of the nose and sinuses
- Surgery for congenital malformations (e.g. choanal atresia or cleft lip and palate)
- Dacryoplasty for nasal problems that affect the tear ducts