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Concept: Nose


The evolutionary reasons for variation in nose shape across human populations have been subject to continuing debate. An import function of the nose and nasal cavity is to condition inspired air before it reaches the lower respiratory tract. For this reason, it is thought the observed differences in nose shape among populations are not simply the result of genetic drift, but may be adaptations to climate. To address the question of whether local adaptation to climate is responsible for nose shape divergence across populations, we use Qst-Fst comparisons to show that nares width and alar base width are more differentiated across populations than expected under genetic drift alone. To test whether this differentiation is due to climate adaptation, we compared the spatial distribution of these variables with the global distribution of temperature, absolute humidity, and relative humidity. We find that width of the nares is correlated with temperature and absolute humidity, but not with relative humidity. We conclude that some aspects of nose shape may indeed have been driven by local adaptation to climate. However, we think that this is a simplified explanation of a very complex evolutionary history, which possibly also involved other non-neutral forces such as sexual selection.

Concepts: Natural selection, Precipitation, Respiratory system, Humidity, Relative humidity, Population genetics, Nose, Charles Darwin


Foreign bodies lodged in the nasal cavity are a common problem in children, and their removal can be challenging. The published studies relating to the “mother’s kiss” all take the form of case reports and case series. We sought to assess the efficacy and safety of this technique.

Concepts: Evaluation methods, English language, Nose, German language, Nasal cavity, Case series, Case report


We are flat-faced hominins with an external nose that protrudes from the face. This feature was derived in the genus Homo, along with facial flattening and reorientation to form a high nasal cavity. The nasal passage conditions the inhaled air in terms of temperature and humidity to match the conditions required in the lung, and its anatomical variation is believed to be evolutionarily sensitive to the ambient atmospheric conditions of a given habitat. In this study, we used computational fluid dynamics (CFD) with three-dimensional topology models of the nasal passage under the same simulation conditions, to investigate air-conditioning performance in humans, chimpanzees, and macaques. The CFD simulation showed a horizontal straight flow of inhaled air in chimpanzees and macaques, contrasting with the upward and curved flow in humans. The inhaled air is conditioned poorly in humans compared with nonhuman primates. Virtual modifications to the human external nose topology, in which the nasal vestibule and valve are modified to resemble those of chimpanzees, change the airflow to be horizontal, but have little influence on the air-conditioning performance in humans. These findings suggest that morphological variation of the nasal passage topology was only weakly sensitive to the ambient atmosphere conditions; rather, the high nasal cavity in humans was formed simply by evolutionary facial reorganization in the divergence of Homo from the other hominin lineages, impairing the air-conditioning performance. Even though the inhaled air is not adjusted well within the nasal cavity in humans, it can be fully conditioned subsequently in the pharyngeal cavity, which is lengthened in the flat-faced Homo. Thus, the air-conditioning faculty in the nasal passages was probably impaired in early Homo members, although they have survived successfully under the fluctuating climate of the Plio-Pleistocene, and then they moved “Out of Africa” to explore the more severe climates of Eurasia.

Concepts: Human, Respiratory system, Primate, Humidity, Nose, Computational fluid dynamics, Nasal cavity, Human evolution


This report describes a case of gossypiboma in the septum. A 31-year-old woman presented with nasal obstruction and crusting that started 2 years previously after she underwent rhinoseptoplasty in another private clinic. Physical examination disclosed remaining posterior septal deviation to the left side with septal mucosal erosion on the left side. Under general anesthesia, the septal flap was elevated on the left side of the nasal cavity. A gossypiboma was found around the perpendicular ethmoid plate and between the septal flaps. The perpendicular ethmoid plate was resected and the gossypiboma was removed under endoscopy. Because of severe adhesion between the gossypiboma and the septal mucosa, removal of the gossypiboma resulted in a defect on the left mucoperichondrial flap. Right inferior turbinate mucosa was harvested and grafted on the mucosal defect of the left side. Five months after the operation, the nasal cavity showed a straight septum with a well-healed mucosa without any nasal symptoms. This case is a reminder of the fundamental importance of absolute care at every step of rhinologic surgery.

Concepts: Anesthesia, Mucus, Nose, Nasopalatine nerve


Objectives: Allergic reactions to Prolene are rare. This paper reports a nasal tip abscess which developed in a patient with an adverse skin reaction to Prolene after rhinoplasty. Methods and results: A 26-year-old woman presented with painful, progressive nasal tip swelling and redness. She had undergone septo-rhinoplasty two years previously. She was initially treated with endonasal drainage of the abscess and antibiotics, but a revision rhinoplasty three months later became necessary because of recurrent abscess formation. Intra-operative findings included granulation tissue with pockets of pus and knotted Prolene sutures at the tip-defining points of the lower lateral cartilages. She was patch-tested with Prolene and a cutaneous Prolene suture was placed on her back; an adverse skin reaction was seen for the latter. Conclusion: Use of non-absorbable sutures, such as Prolene, in the subcutaneous layer may be a potential, rare risk factor for adverse skin reactions.

Concepts: Collagen, Allergy, Skin, Tissue, Term, Nose, Surgical suture, Dermis


OBJECTIVES/HYPOTHESIS: Immunoglobulin (Ig)G4-related disease is a systemic syndrome, characterized by sclerosing lesions that mainly affect the exocrine tissue. Although some patients with IgG4-related disease complain of nasal symptoms, there are few reports concerning the nasal manifestations of this disease. We investigated the clinical and pathological features of the nasal manifestations of IgG4-related disease. STUDY DESIGN: Retrospective review in a tertiary referral hospital. METHODS: Twenty-three consecutive patients with IgG4-related disease, six allergic rhinitis (AR) patients, and eight healthy subjects (HS) were evaluated. Nasal symptoms, local findings of the nasal cavity, and laboratory data were examined. Mucosal tissues from the inferior turbinate were obtained from all subjects before treatment. The level of IgG4-positive plasma cells and other infiltrating cells, and the number of nasal glands in the nasal subjects were compared among the three groups. RESULTS: Ten (43.4%) of 23 cases had some nasal symptoms, such as nasal obstruction and nasal crusting. Thirteen cases (56.5%) had numerous IgG4-positive plasma cell infiltration in the nasal mucosa. IgG4-positive plasma cells, CD3, and CD4 were significantly higher in the IgG4-related disease group than in the HS and AR groups, whereas the number of nasal glands in the IgG4-related disease group was significantly lower than in the HS and AR groups. CONCLUSIONS: The inflammatory lesions associated with IgG4-related disease exist on the nasal membrane. Thus, the nasal manifestations of IgG4-related disease were thought to be different from AR.

Concepts: Protein, Mucous membrane, Secretion, Allergy, Mucus, Nose, Somatic hypermutation, Tertiary referral hospital


The purpose of this study was to directly compare the pharmacokinetic (PK) profile of 22-mg sumatriptan powder delivered intranasally with a novel Breath Powered™ device (11 mg in each nostril) vs a 20-mg sumatriptan liquid nasal spray, a 100-mg oral tablet, and a 6-mg subcutaneous injection.

Concepts: Pharmacology, Pharmacokinetics, Nose, Dosage forms, Subcutaneous injection, Nasal administration, Nasal spray


Abstract Preoperative, accurate measurement of spatial parameters of the external nose could be essential in the postoperative assessment of rhinoplasty. The aim of the study was to analyse the relevance of three-dimensional (3D) imaging in aesthetic evaluation after operation, to provide a standardised algorithm of nasal shape measurements, which will enable the development of software for assessing the nose before and after rhinoplasty, to perform analysis of spatial changes of both its shape and asymmetry by the new protocol of measurements. Fifty-four patients were examined preoperatively and 6 months postoperatively. The following nasal parameters were determined: rates of proportion, angles, and spatial parameters. After the operation, statistically significant differences were observed in all parameters. In conclusion, a 3D scanner can be used as a tool to assess the results of rhinoplasty. This protocol of measurements describes spatial changes of the nose shape resulting from the operation.

Concepts: Evaluation, Statistical significance, Evaluation methods, Assessment, Psychometrics, Nose, Educational evaluation, Human nose


Empty nose syndrome (ENS) is a rare, late complication of turbinate surgery. The most common clinical symptoms are paradoxical nasal obstruction, nasal dryness and crusting, and a persistent feeling of dyspnea. Little is known about the pathogenesis of ENS, though it is speculated that anatomical changes leading to alterations in local environment, disruption of mucosal cooling, and disruption of neurosensory mechanisms are strongly implicated. The diagnosis is clinical, though often difficult to make due to the poor correlation between subjective and objective findings. Medical therapies include mucosal humidification, irrigations, and emollients. Surgical therapy should be reserved for refractory cases and may involve turbinate reconstruction, most commonly using implantable biomaterials. Ultimately, prevention of this feared complication through turbinate-sparing techniques is essential.

Concepts: Medicine, Therapy, Physician, Mucus, Nose, Nasal cavity, Medical error, Empty nose syndrome


Several alternatives can be used for nasal dorsum augmentation. We report the use of crushed diced cartilage embedded in an autologous fibrin matrix. This construct is placed on the nasal dorsum and is gently molded according to the characteristics of each patient. Rhinoplasty and nasal dorsum augmentation were performed in 45 patients with Mestizo characteristics after a complete medical history and development of a surgical plan. A crushed diced cartilage autologous graft and an autologous fibrin matrix from peripheral blood processed using the Choukroun method was used. Pre- and postoperative photographs were taken at short- and long-term follow-up. Two separate variables were evaluated: reabsorption and irregularities. Three plastic surgeons evaluated the results, using a Likert scale: the first variable was considered very excellent in 88.9%, very good in 6.7%, good in 4.4% with no poor or very poor results. In the second variable, results were excellent in 88.9%, very good in 4.4%, good in 3.4%, and poor in 3.3% with no very poor results. Our patients carry a volume with an aesthetically pleasing contour and form with no changes over a mean follow-up period of 4 years. Long-term effectiveness continues to be the main topic of discussion; however, this method can be considered an alternative not only to augment but also to smoothen irregularities of the nasal dorsum. We used a simple method with good and stable long-term clinical results.

Concepts: Hospital, Surgery, English-language films, Plastic surgery, Nose, Likert scale, Augment