Ashok K Gupta
ABSTRACT After the introduction of endoscope in 1960s, there have been several major developments made in the sinonasal surgery. Earlier the principle was to remove the entire sinus mucosa but with the advent of endoscope and functional endoscopic sinus surgery, theory of preserving the normal mucosa and opening the natural pathways to sinuses got popularized. In the past decade, rapid advancement has taken place in the field of endoscopic nasal surgery by extending applications from sinuses to skull base, pituitary, suprasellar lesions, optic nerve, cavernous sinus, clivus, and laterally to infratemporal fossa and petrous apex. This evolution is attributed to better understanding of endoscopic anatomy and new surgical techniques.
Anjali Aggarwal, Tulika Gupta, Daisy Sahni, Ashok Gupta
ABSTRACT Introduction: In patients with posterior epistaxis, generally the source of bleeding is branches of sphenopalatine artery (SPA), which enter the nasal cavity through the sphenopalatine foramen (SPF). Cases of intractable massive bleeding may require endonasal endoscopic occlusion of these vessels. Materials and methods: A total of 32 hemisections of formalinfixed cadaveric heads were used. The anatomic variations of SPF, its distance from anatomical landmarks, and angle of elevation of endoscope were studied so as to facilitate accurate localization of the foramen and endoscopic arterial ligation. Results: T he S PF w as g enerally s ingle; h owever, m ultiple exits in the form of accessory foramina were found in 36.75% hemisections. The transition of superior and middle meatuses was the most common location of SPF, followed by the superior meatus, and middle meatus was the least common site. The accessory foramina were commonly present in the superior meatus. Ethmoid crest was distinctly visible in all but two cases. In majority of the cases, the SPF was located within a range of 55 to 65 mm from the anterior nasal spine (ANS); 60 to 70 mm from piriform aperture, 50 to 60 mm from limen nasi, 20.1 to 25 mm vertically above the floor of nasal cavity, and 8 to 15 mm from the inferior turbinate (IT). The angulation of SPF from the floor of nasal cavity was 20 to 30°. Conclusion: Exploration of lateral nasal wall (LNW) up to middle meatus would minimize the risk of missing any arterial branch, and the data of distance from the anatomical references would assist in more precise localization of SPF during endoscopic ligation or cauterization of the branches of the SPA. Keywords: Endoscopy, Posterior epistaxis, Sphenopalatine artery, Sphenopalatine foramen. How to cite this article: Aggarwal A, Gupta T, Sahni D, Gupta A. Anatomicosurgical References for Endoscopic Localization of Sphenopalatine Foramen: A Cadaveric Study. Clin Rhinol An Int J 2016;9(3):109-114. Source of funding: Nil Conflict of interest: None
ABSTRACT Objective: To examine the impact of endoscopic sinus surgery (ESS) on olfactory impairment in patients with chronic rhinosinusitis (CRS) and nasal polyposis over intermediateto long-term follow-up. Study design: Prospective, cohort study. Conducted in a tertiary care center over a period of 2 years (August 2014-July 2016). Materials and methods: A total of 42 patients presenting for ESS were examined preoperatively and at 1st, 3rd, 6th, and 12th week postoperatively. Demographic, comorbidity, and olfactory scores were collected at each point of time. Sniffin Sticks test was used to assess the olfaction of the patients. Results: Olfactory scores in anosmic patients significantly improved after ESS at 3-month follow-up. Only few hyposmic patients improved after surgery and others did not show any change. Among normosmic patients, 80% showed no change after surgery, whereas 20% became hyposmic postoperatively. None of the normosmics became anosmic after surgery. Conclusion: Patients with severe olfactory dysfunction significantly improved after ESS, whereas patients with mild olfactory dysfunction did not. A realistic assessment of effects of ESS on olfaction could be derived. This will help in counseling the patients undergoing ESS in future. Olfactory impairment is an important patient safety and quality-of-life issue for patients with CRS and one that requires continued research. Keywords: Anosmia, Endoscopic sinus surgery, Hyposmia, Sniffin sticks test. How to cite this article: Mohanty S. Effect of Endoscopic Sinus Surgery on Olfaction: A Prospective Analysis. Clin Rhinol An Int J 2016;9(3):115-119. Source of support: Nil Conflict of interest: None
SV Manjunatha Rao, MM Rajshekar
ABSTRACT Aim: To study surgical outcome in dacryocystorhinostomy (DCR) stent insertion in initial endoscopic DCR and the complications associated with the surgery. Study design: This is a prospective, single-blinded, randomized, controlled trial. Materials and methods: The study was carried in a tertiary level center (period between November 2009 and February 2015). A total of 50 patients with epiphora due to nasolacrimal duct obstruction were divided randomly into two groups - with one group undergoing endoscopic DCR with stent and the other group undergoing endoscopic DCR without stent. The postoperative results were assessed subjectively and objectively after 3 and 6 months and also for complications of the procedure. The results were statistically analyzed by chi-square test. Results: There was significant postoperative improvement across all participants and within both groups. A total of 92% of patients in the stent group and 84% of patients in the without stent group improved. There was no significant difference with respect to complications. Synechiae and secondary hemorrhage were the most common complications in the without stent group and stent group respectively. Conclusion: The present study shows that statistically significant difference in results is not achieved by inserting stents initially. But, whenever there is excessive bleeding during surgery, which masks endoscopic picture, or when bony stoma created is small because of thick bone and poor access, when atrophic sac is present, or when adhesions are expected due to pus in sac, then stenting should be done without hesitancy. Best time to do stenting is when surgeons’ first think of stenting. Regular postoperative follow-up is necessary as any defect like synechia and granulation tissue formation can be dealt with immediately. Keywords: Endoscopic dacryocystorhinostomy, Epiphora, Lacrimal stents. How to cite this article: Rao SVM, Rajshekar MM. Dacryocystorhinostomy Stent Insertion in Initial Endoscopic Dacryocystorhinostomy. Clin Rhinol An Int J 2016;9(3):120-124. Source of support: Nil Conflict of interest: None
Nidhi V Maggon, Ashwani Sethi, Avinash Das
ABSTRACT Introduction: Posttraumatic nasal valve collapse (NVC) is an underdiagnosed cause of nasal obstruction causing significant symptoms and has been treated by various techniques, the results of which have been variable. In our study, alar batten graft (ABG) has been used to strengthen the nasal wall. Techniques: A prospective interventional study was done on 13 patients of posttraumatic NVC using an ABG to reinforce the ala, and results were measured on the basis of standardized nasal obstruction symptom evaluation (NOSE) and nasal obstruction visual analog scale (NO-VAS) scores at 6 months. Results: There was a statistically significant improvement in 12 out of 13 patients, with mean improvement of 25.62 on NOSE and 2.4 on NO-VAS scores. There was a visible improvement in the extent of collapse also. Conclusion: Posttraumatic NVC can be treated effectively using ABG, with significant improvement in standard scores as well as the symptomatology. Keywords: Alar batten graft, Nasal valve collapse, Posttraumatic. How to cite this article: Maggon NV, Sethi A, Das A. Posttraumatic Nasal Valve Collapse: Is Alar Batten Graft the Answer? Clin Rhinol An Int J 2016;9(3):125-129. Source of support: Nil Conflict of interest: None
Rajalaxmi Panigrahi, Sudhir K Acharya
ABSTRACT Allergic rhinitis is an inflammatory, immunoglobulin E (IgE)- mediated disease, characterized by nasal congestion, rhinorrhea, and sneezing with or without nasal itching. It can significantly interfere with patient’s quality of life. The goals of treatment are to provide the patient with symptomatic relief and improve the quality of life with minimal adverse effects. Prevention has been a large focus in the treatment of allergic rhinitis, but few interventions have proven effective. Although dust mite allergies are more common. Keywords: Allergens, Allergic menifestation, Rhinorrhea, Rhinitis. How to cite this article: Panigrahi R, Acharya SK. Recent Trends in Management of Allergic Rhinitis. Clin Rhinol An Int J 2016;9(3):130-136. Source of support: Nil Conflict of interest: None
Anilkumar S Harugop, Ramesh S Mudhol, Shama A Bellad, Priti S Hajare, Dharmishtha R Kaku, Basavaraj Hiremath
ABSTRACT Isolated sphenoid sinusitis is a rare entity. Due to noncharacteristic primary manifestations, most of the patients present with ophthalmic complications, most commonly proptosis and diplopia. We report here the case series of two patients who presented with diplopia, blurred vision, and headache. Diagnosis of isolated abducens nerve palsy secondary to isolated sphenoid sinus disease was made, and both the patients underwent endoscopic sinus surgery (ESS). We hereby propose that prompt diagnosis and treatment of isolated sphenoidal sinusitis is very important, and abducens nerve (CN6) palsy could be attributed to the disease condition as both the patients’ condition improved after surgery. Keywords: Abducens nerve palsy, Case series, Endoscopic sinus surgery, Sphenoid sinus. How to cite this article: Harugop AS, Mudhol RS, Bellad SA, Hajare PS, Kaku DR, Hiremath B. Isolated Abducens Nerve Palsy Secondary to Isolated Sphenoid Sinus Disease: Case Series. Clin Rhinol An Int J 2016;9(3):137-140. Source of support: Nil Conflict of interest: None
Mohammad W El-Anwar, Ahmed I Ali
ABSTRACT Introduction: Concha bullosa is the most common anatomic variation of osteomeatal complex region that is generally seen in the middle turbinate (MT). Materials and methods: A 25-year-old male presented with headache and nasal obstruction. Computed tomography (CT) scan documented right paradoxical MT. The right MT also showed aerated concha bullosa with narrow right osteomeatal area. Routine preoperative laboratory tests were within normal limits. Results: This case of concha bullosa in paradoxically bent MT was reported, described, and could be safely managed endoscopically. Patient was symptom free up to date without any complication, recurrence, or other pathology. Conclusion: Computed tomography may easily identify such uncommon anatomic variations of the osteomeatal region. This directs the surgeon attention to these variations as a cause of headache and osteomeatal area obstruction. Keywords: Concha bullosa, Middle turbinate, Osteomeatal area. How to cite this article: El-Anwar MW, Ali AI. Concha Bullosa in Paradoxical Middle Turbinate: A New Variation. Clin Rhinol An Int J 2016;9(3):141-142. Source of support: Nil Conflict of interest: None
MK Rajasekar, Malarvizhi R Sankar
ABSTRACT Cerebrospinal fluid (CSF) rhinorrhea is common in traumatic penetrating nasal injuries. In the pediatric age group, we often encounter self-inflicted foreign body injuries of blunt type, which rarely leads to any complications. We came across a case of CSF rhinorrhea due to self-inflicted penetrating nasal injury, after 7 years of initial injury. In this case, the sharp end of a screw nail had injured the fovea ethmoidalis and caused a meningoencephalocele on removal, which had been asymptomatic until 4 years ago, when the patient came with CSF rhinorrhea. Miraculously, there were no complications in the period before presentation and after surgical correction. Keywords: Cerebrospinal fluid rhinorrhea, Endonasal approach, Pediatric trauma, Screw nail trauma How to cite this article: Rajasekar MK, Sankar MR. A Rare Case of Pediatric Self-inflicted Meningoencephalocele. Clin Rhinol An Int J 2016;9(3):143-145. Source of support: Nil Conflict of interest: None
Apoorva K Pandey, Aparna Bhardwaj, Tripti Maithani, Sonam Rathi
ABSTRACT Pleomorphic adenomas occurring in the nasal cavity are rarely encountered; nevertheless, there is abundance of minor seromucinous glands in that region. Most cases present with a painless, slowly progressing unilateral nasal obstruction, a nasal mass, and epistaxis. Herewith, we present an unusual case of pleomorphic adenoma arising from the lateral wall of the right nasal cavity in a 41-year-old male who complained of right nasal obstruction with no history of epistaxis. Rigid nasal endoscopy revealed a swelling continuous with right inferior concha. Computed tomography showed a well-defined, soft tissue mass in the right nasal cavity. The lesion was completely excised endoscopically. Histopathology confirmed a pleomorphic adenoma consisting of epithelial and mesenchymal elements. Wide exposure is crucial for complete excision with negative margins to achieve positive outcome and to prevent recurrence. Keywords: Endoscopic excision, Lateral nasal wall, Pleomorphic adenoma. How to cite this article: Pandey AK, Bhardwaj A, Maithani T, Rathi S. Pleomorphic Adenoma of the Lateral Nasal Wall: An Unusual Entity. Clin Rhinol An Int J 2016;9(3):146-148. Source of support: Nil Conflict of interest: None
Tamoghna Jana, Moushumi Sengupta, Saumik Das, Asok K Saha, Subhasis Saha
ABSTRACT Retinoblastoma is the most common intraocular tumor of childhood. These tumors, though they respond to treatment, are prone to develop secondary malignancy, recurrence, and metastasis, which may present as sinonasal mass. We are presenting a rare case of metastatic retinoblastoma of sinonasal region in a 3-year-old male child. The mode of presentation and management of the case is presented along with a review of the literature. Keywords: Metastatic, Retinoblastoma, Sinonasal. How to cite this article: Jana T, Sengupta M, Das S, Saha AK, Saha S. An Unusual ENT Presentation of Retinoblastoma: A Diagnostic Dilemma. Clin Rhinol An Int J 2016;9(3):149-152. Source of support: Nil Conflict of interest: None
Satyawati Mohindra, Ashok K Gupta
ABSTRACT Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with the nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral congenital choanal atresia (BCCA), because this is a life-threatening situation in newborns as they are obligate nose breathers. This article reports on an 18-month-old female child, with delayed presentation of bilateral choanal atresia, treated successfully endoscopically and stent placement postoperatively. Case report: The patient is an 18-month-old female child, born full term, by cesarean section (for cephalopelvic disproportion) with birth weight 3,750 gm to a 30-year-old primigravida. There were no immediate prenatal or postnatal medical or surgical problems in the mother. The child cried immediately after birth, there was no postnatal respiratory distress, cyanosis, or any major hospital admission. On examination, microcephaly (head circumference 46 cm below 2 standard deviation of the mean), hypertelorism, ani-Mongolian slanted eyes, left side cleft lip with high arched palate with malocclusion were observed. She presented late with c/o nasal discharge and mild breathing difficulty on breastfeeding. The catheter test revealed the diagnosis of BCCA. Noncontrast computed tomography (CT) scan nose was done, which showed nonposterior choana blocked with bony plates on both the sides (Fig. 1). The paranasal sinuses, orbit, and anterior nasal cavities were within normal limits. Transnasal endoscopic repair was done under general anesthesia. Endoscopy revealed a bony atresia (Fig. 2), which was drilled out keeping the direction medially and inferiorly. Feeding tubes were fashioned as stents and placed for a period of 6 weeks. There were no postoperative complications. The patient was referred to pediatric surgery for other problems. Endoscopy confirmed bilateral patency at 12 weeks postoperatively. Keywords: Congenital choanal atresia, Stent, Transnasal endoscopic repair. How to cite this article: Mohindra S, Gupta AK. Bilateral Complete Congenital Choanal Atresia in an 18-month-old Female Child with Rare Clinical Presentation: Transnasal Endoscopic Repair with Stent. Clin Rhinol An Int J 2016;9(3):153-154. Source of support: Nil Conflict of interest: None
Ashok K Gupta
Natasha Choudhury, Joe Marais
Abstract Silent sinus syndrome (SSS) is a rare and interesting clinical condition that is associated with spontaneous, painless, unilateral enophthalmos and hypoglobus resulting from downward bowing of the orbital floor, in the absence of any symptomatic sinonasal disease. It generally affects younger patients between the third and fifth decades of life. The pathogenesis of silent sinus syndrome is based on chronic maxillary sinus obstruction, related to occlusion of the maxillary infundibulum which results in a hypoventilated sinus and negative pressures. Endoscopic sinus surgery to create a wide maxillary antrostomy with or without orbital floor reconstruction is considered the gold standard treatment of choice. Keywords: Silent sinus syndrome, imploding antrum syndrome, chronic maxillary atelactasia, enophthalmos, hypoglobus.
Chandrashekharayya SH, SS Suligavi, Sachin Chougule, SS Doddamani
Abstract Rhinosporidiosis is a rare chronic granulomatous disease caused by rhinosporidium seeberi. Nasal rhinosporidiosis presents with nasal mass, nasal obstruction and epistaxis. In this study, we present our experience in 17 patients of rhinosporidiosis. Diagnosis was made on clinicopathological features. Different clinical presentations, management by surgical, combined with medical line of treatment are discussed with review of literature Keywords: Nasal rhinosporidiosis, endoscopic excision, dapsone.
Ashok K Gupta, Rijuneeta
Abstract Ninety-eight cases of nasolacrimal duct obstruction including 6 bilateral cases were included in the study done at Postgraduate Institute of Medical Research, Chandigarh. All the cases had been divided into three groups with Group I including cases in which 12 endoscopic dacryocystorhinostomy (DCR) with dilatation and probing and stent insertion were performed. In Group II, 23 Endo DCR performed with intraoperative dilatation and probing but no stent insertion. Group III included 69 cases of Endo DCR without dilatation and probing and no stent insertion. Overall success rate was found to be 94.3% with Group III cases having a success rate of 97.1% and was found statistically significant on comparing with that of Group II (p value: 0.03). Keywords: Endoscopic dacryocystorhinostomy, probing, outcome.
Hemant Chopra, Kapil Dua, Neha Chopra, Vikrant Mittal
Abstract Objective: Comparison of clinical and histopathological diagnosis of nasal masses. Material and methods: A prospective randomized study conducted over a three years period on 100 patients of nasal mass selected from the inpatient department of Otorhinolaryngology, Dayanand Medical College and Hospital, Ludhiana. Results: A variety of pathological condition (ranging from benign lesions to malignant tumors) can present as nasal mass. The results show that the final diagnosis can be established only on histopathology. Conclusion: It is concluded that for proper evaluation of a nasal mass, clinical and histopathological evaluation should be done conjointly in all the patients. Histopathology always gives a confirmatory diagnosis. Although rare, unexpected clinically relevant findings may be identified during routine histologic examination of nasal mass specimens. Keywords: Nasal mass, clinical findings, histopathology.
Ishwar Singh, Amar Sherstha, Dej Gautam, Ojasvini
Abstract Chronic rhinosinusitis and nasal polyposis is more common in the age group of 18 to 25 years. Urban population and housewives are more commonly affected. Common complains were headache and nasal blockage in 80% and 76.6% cases respectively. Polyps were common clinical finding in one third of cases. Subjective complete relief was seen in 83.3% of cases after FESS. Eight cases had minor postoperative complications Keywords: Chronic rhinosinusitis, nasal polyps, FESS.
Rupender K Ranga, Jyoti Yadav, Jagat Singh
Abstract Allergic rhinitis in children is not an uncommon disease in India. Our objective was to evaluate the effect of allergic rhinitis on nasal mucociliary clearance. The nasal mucociliary clearance time (NMC) was studied using Andersen’s saccharin method in fifty controls and fifty age and sex matched patients of allergic rhinitis. The nasal mucociliary clearance time in healthy controls was found to be 5.11 ± 1.51 minutes. A significant impairment (p < 0.01) in nasal mucociliary clearance time of 12.46 ± 3.74 minutes was observed in children suffering with allergic rhinitis, signifying that allergic rhinitis may predispose to sinusitis and pulmonary diseases. Keywords: Allergic rhinitis, nasal mucociliary clearance, children.
Gopika Kalsotra, Ashok K Gupta
Abstract Skull base chondrosarcomas are rare and account for approximately 0.15% of all intracranial tumors. Management of these tumors is challenging because of their potential to recur, and their proximity to vital structures such as major vessels and cranial nerves. We describe five patients with chondrosarcoma of the skull base who were managed at our institute between January 2002 and December 2009. Keywords: Chondrosarcoma, skull base, endoscopic, craniotomy.
Abstract Background: Ossifying fibroma is an uncommon tumor of the craniofacial skeleton presenting in several variant histopathological subtypes. Ossifying fibroma is a benign fibro-osseous lesion that commonly involves the maxilla.1 Ossifying fibromas occur predominantly in women, frequently during the 3rd and 4th decades of life.1 The overlapping clinical and histopathological features of these subtypes have led to diagnostic dilemma and confusion.1 Complete excision of this tumor has become a necessity since it is notorious for recurrence.1 Aims: To study and compare the clinical profiles of various types of ossifying fibroma and also the surgical approaches to the tumor. To discuss the diagnostic difficulties and controversies associated with the tumor. Setting: Medical college referral hospital. Design: Case reports of 4 patients presenting to our medical college OPD. Methods: Planned surgical excision based on criteria. Results: Four cases of different types of ossifying fibroma were successfully treated by various surgical approaches. 42 papers related to diagnostic and treatment aspects of ossifying fibroma were studied. Conclusion: The diagnostic dilemma of ossifying fibroma can be overcome with a combination of clinical, radiological and pathological criteria. Complete surgical excision of the tumor is possible when surgery is based on preplanned criteria. Combination of 2 or more surgical approaches may be necessary in many cases in order to ensure complete clearance and prevent recurrence of the tumor. Keywords: Ossifying fibroma fibrous dysplasia, lateral maxillectomy.
Pankaj Gupta, Usha Singh, Ashok K Gupta, Sandeep Bansal, Narinder Kumar, Kusum Joshi
Abstract The orbit is involved in 10% of all lymphomas. Paranasal sinuses and nose are other sites for extranodal lymphoma that are involved in upto 2.6 to 6.7% of lymphomas involving head and neck region and are second most common presentation of extranodal lymphoma. In nearly 22.5% of patients, sinonasal lymphoma and orbital lymphoma may coexist. The present report describes such patient with first presentation to an ophthalmologist with an attempt to review the present literature of coexistent orbital and paranasal sinuses lymphoma. Keywords: Proptosis, paranasal sinuses, orbit, lymphoma.
Surinder K Singhal, Charanjit Singh, Rajeev Kumar, Harsh Mohan
Abstract Capillary hemangioma of the maxillary sinus is a rare entity. It commonly presents as a sinonasal mass with nasal obstruction, intermittent epistaxis and occasionally as a cheek swelling. Computed tomography and angiography assist in making a correct diagnosis. Biopsy is not usually recommended as it can cause profuse bleeding and may yield false results. Selective arterial embolization followed by surgical resection forms the mainstay of treatment. Keywords: Hemangiomas, maxillary sinus.
P Mishra, Anjani Sharma, Mohnish Grover
Abstract Meningiomas arise from arachnoid cells. They can occur at intracranial or extracranial sites. Extracranial meningiomas are very rare tumors. They may arise from nasal cavity, paranasal sinuses, middle ear, and subcutaneous tissues. The ectopic meningiomas of paranasal sinuses do not have any communication with intracranial meninges. They usually occurs in young males. Imaging studies shows no bone erosion or intracranial extension. Primary surgical excision is the treatment of choice. The present case is reported due to its rarity and presentation at an unusual age. Keywords: Ectopic meningioma, meningioma of paranasal sinus, paranasal sinus tumor.
Vipin Arora, Nitin M Nagarkar, Arjun Dass, Anil Dash, Ravinder Kaur
Abstract Aspergillosis of paranasal sinuses is a rare infection with invasion of surrounding soft tissues, orbit and anterior cranial base. Eighteen years old immunocompetent man presented with gross facial swelling, proptosis and unilateral blindness. Histopathology was reported as invasive aspergillosis. The patient was given systemic antifungal therapy in the form of liposomal amphotericin B. He died of cerebral infarction by fungal embolism. Aspergillus fumigatus was the causative organism. Keywords: Invasive aspergillosis, intracranial aspergillosis, cavernous sinus thrombosis.
Saurabh Varshney, SS Bist, RK Singh, Nitin Gupta, Sanjeev Bhagat
Abstract Sneezing is usually the physiologic response to nasal irritation but intractable paroxysmal sneezing is very uncommon. Various causative factors have been identified in the literature; these include psychologic problems, cervical lymphadenitis, epilepsy, and allergy. Majority of cases of intractable sneezing are reported among adolescents and are psychogenic in origin. We report one young lady with intractable paroxysmal sneezing in whom the removal of psychogenic stressors resulted in complete remission. The sneezing was continuous but did not occur while talking or sleeping, and did not respond to antihistamines, steroids and bronchodilators. The authors discuss the patients’ treatment and outcomes and the pathophysiology of intractable paroxysmal sneezing. Keywords: Sneezing, intractable.
Bulbul Gupta, Sridevi, Ishwar Singh
Abstract Rhinolithiasis is an uncommon condition but attract attention because they can be confused with both benign and malignant nasal tumors. We report a case of incidental finding of a rhinolith for a patient being taken up for septoplasty. Keywords: Rhinolith, rhinolithiasis, calcification.
Arjun Dass, Hitesh Verma, Surinder Singhal, Meenakshi G Bansal
Abstract Neurofibroma is a tumor of neuronal origin. Solitary neurofibroma of maxillary sinus is exceedingly rare tumor. Keywords: Neurofibroma, maxillary sinus, malignant peripheral nerve sheath tumor (MPNST).
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