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class="elsevierStyleTextfn">Original article</span>" "titulo" => "Mometasone furoate intranasal spray is effective in reducing symptoms and adenoid size in children and adolescents with adenoid hypertrophy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "147" "paginaFinal" => "153" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El aerosol nasal de mometasona furoato es efectivo para reducir los síntomas y el tamaño de las adenoides en niños y adolescentes con hipertrofia adenoidea" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1029 "Ancho" => 1500 "Tamanyo" => 74827 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Grade 4 adenoid is when it is in contact with the torus tubarius, vomer and soft palate.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Muhammad Hazim Abdul Ghafar, Hazama Mohamed, Nik Mohd Yunus Mohammad, Zahiruddin Wan Mohammad, Teti Madiadipoera, De Yun Wang, Baharudin Abdullah" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Muhammad Hazim Abdul" "apellidos" => "Ghafar" ] 1 => array:2 [ "nombre" => "Hazama" "apellidos" => "Mohamed" ] 2 => array:2 [ "nombre" => "Nik Mohd Yunus" "apellidos" => "Mohammad" ] 3 => array:2 [ "nombre" => "Zahiruddin Wan" "apellidos" => "Mohammad" ] 4 => array:2 [ "nombre" => "Teti" "apellidos" => "Madiadipoera" ] 5 => array:2 [ "nombre" => "De Yun" "apellidos" => "Wang" ] 6 => array:2 [ "nombre" => "Baharudin" "apellidos" => "Abdullah" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217357352030034X" "doi" => "10.1016/j.otoeng.2019.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357352030034X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651919301050?idApp=UINPBA00004N" "url" => "/00016519/0000007100000003/v1_202005042318/S0001651919301050/v1_202005042318/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Congenital nasal pyriform aperture stenosis: Diagnosis, management and technical considerations" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "154" "paginaFinal" => "159" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gilberto E. Marrugo Pardo, Juan S. Parra Charris, Andrés E. Parra Charris, Daniel F. Villa Zuluaga" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Gilberto E." "apellidos" => "Marrugo Pardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Juan S." "apellidos" => "Parra Charris" "email" => array:1 [ 0 => "jusparrach@unal.edu.co" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Andrés E." "apellidos" => "Parra Charris" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Daniel F." "apellidos" => "Villa Zuluaga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Otorhinolaryngology, Fundación Hospital de la Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad de la Sabana, Bogotá, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universidad Nacional de Colombia, Bogotá, Colombia" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estenosis de la apertura piriforme nasal: diagnóstico, tratamiento y consideraciones técnicas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 625 "Ancho" => 850 "Tamanyo" => 55046 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sublabial approach. Submucosal dissection of the nasal processes of the maxillary bones, carefully without damaging the nasal mucosa.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite being a rare cause of nasal obstruction in neonates, congenital nasal pyriform aperture (PA) stenosis (CNPAS) takes relevance in clinical practice because of its clinical presentation of respiratory distress, the confirmed prevalence of other associated genetic syndromes such as solitary median maxillary central incisor or other midline anomalies in 65% of cases,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1,2</span></a> dysphagia, endocrinologic pathologies such as hyphotalamo-pituitary axis abnormalities that could lead to hypopituitarism in 43% of the cases.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Incidence is about 1 in 25,000 births and it seems to appear more in females.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4–6</span></a> Respiratory distress could become life-threatening due to the preferential nasal breathing neonates have until 3–6 months of age.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The pyriform aperture is the most anterior and the narrowest part of superior airway, consequently, even little changes in its diameter are sufficient to increase the airway flow resistance, causing respiratory consequences.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> The main actual theory that explains the obstruction is a possible disrupted interaction between nasal placode and the nasal processes that form the nasal maxilla and help establish the internal nasal aperture at the PA in the fifth to sixth week of development.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">3,9</span></a> The consequence is a bone overgrowth in the nasal processes of the maxillary bones (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The diagnosis must be suspected through physical examination and confirmed with nasal endoscopy and CT sections in which nasal pyriform aperture must measure<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>11.0<span class="elsevierStyleHsp" style=""></span>mm at the axial level of the inferior meatus in full-term neonates with a triangular shaped palate and dental anomalies<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Fundación Hospital de la Misericordia is a children's hospital, referral center in Bogotá, Colombia. This is a review of all the patients that received surgical treatment for CNPAS between 2010 and 2017. Patient demographics, radiological characteristics, coexisting anomalies, management and outcome were reviewed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis was made based con clinical features associated with pediatric fibroscope findings and confirmed with craniofacial CT – scan. The measurement was made using a standardized ruler function on the institution's radiographic software at the portion of the PA that corresponded to the axial level of the inferior meatus, a diameter of less than 11.0<span class="elsevierStyleHsp" style=""></span>mm confirmed the diagnosis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Medical treatment with nasopharyngeal or oropharyngeal airway (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), nasal saline, low dosing topical steroids and feeding support was given to all the patients during two weeks with close monitoring by a multidisciplinary group.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Surgical indication was given when persistent airway obstruction symptoms, poor weight gain and failure to thrive continued despite medical management.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Rule of tens (ten weeks old, ten pounds of weight and a level of 10<span class="elsevierStyleHsp" style=""></span>g/dL of hemoglobin) was waited in all patients when possible.</p><p id="par0045" class="elsevierStylePara elsevierViewall">All patients underwent the same surgical procedure by the same surgeon, using a sublabial approach, through submucosal dissection of the nasal processes of the maxillary bones. Drilling from the edge of the pyriform aperture was made carefully without damaging the nasal mucosa, inferior turbinates or nasolacrimal duct (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Post-operative care consisted of nasal wash with normal saline and feeding support. Follow up was made evaluating nasal stertor, respiratory distress growth and development.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">On the previous seven years, 13 patients were diagnosed with CNPAS and taken to surgery (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Male patients were more prevalent with 8 patients (62%) compared to 5 females (38%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">All patients were symptomatic at birth with difficulty breathing and nasal stertor, diagnosis was confirmed with CT scan with PA measurements between 3.1 and 9.0<span class="elsevierStyleHsp" style=""></span>mm, mean width was 5.5<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Solitary median maxillary central incisor (SMMCI) was seen in three patients and other associated anomalies were present in five patients (5/13) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). One patient with Raine syndrome, agenesis of the corpus callosum (ACC) and hydrocephalus. Other anomalies were microphthalmia, craniosynostosis, hypogammaglobulinemia, epilepsy, atrial septal defect (ASD), ventricular septal defect (VSD), choanal atresia, Congenital Midnasal Stenosis and laryngomalacia (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In this series no patient had holoprosencephaly or hypopituitarism.</p><p id="par0065" class="elsevierStylePara elsevierViewall">All patients taken to surgery had failure with medical management because of difficulty breathing, intolerance to nasal or oral airways and failure to thrive.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Rule of tens was applied in all patients to define the moment for the surgery. Two patients had to be intervened earlier because of prolonged intubation and intolerance to nasal and oral airways. No complications were seen. Most patients were operated between 2 and 4 months of life and one patients had 17 months at the time of the surgery because she arrived to the institution after one year of failed medical treatment and multiple intubations.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Surgical management with sublabial approach and drill of the PA was indicated in all patients. Four patients (31%) had also Congenital Midnasal Stenosis that affected the pattency of the nasal airway and were managed with turbinoplasty. One patient had choanal atresia that was repaired with nasal endoscopic technique. Molds or stents were not used postoperative.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Follow up was made in all patients with improvement of the respiratory distress, only one patient had persistent symptoms requiring reintervention. This patient had severe craniofacial dysmorphisms and other neurologic anomalies that could lead to a decreased pulmonary capacity with less tolerance of decreased airway patency.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">These neonates might present as a medical emergency, the classic triad is episodic apnea with cyclic cyanosis and difficulty feeding.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Never the less this is not a surgical urgency, the establishment of a safe airway with nasal irrigation with normal saline and topical steroids may allow this kids to breathe calmly, feed and grow normally. Topical decongestants are not recommended because of the harmful adverse effects they can have on these neonates and its comorbidities.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Preferably the airway should be secured with an appropriately sized nasopharyngeal tube (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), properly placed approximately 10<span class="elsevierStyleHsp" style=""></span>mm over the epiglottis. The position is very important, it should be measured based on the height and weight of the infant and confirmed with an endoscope. This way is preferred because it is easier to handle and clean, has better tolerability by neonates and allows oral feeding. These devices are not harmless, when positioned by unexperienced hands can cause more obstruction, serial damage of the mucosa, synechias, or septal perforations and in the hypopharynx it may lacerate the palate, base of the tongue or the epiglottis.</p><p id="par0100" class="elsevierStylePara elsevierViewall">If nasal airway is not possible the options are a mc govern nipple or guedel canula which are placed orally.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Feeding problems are very common in this patients, evaluation must be made in every patient with bedside swallow evaluations, videofluoroscopic swallow study and fiberoptic endoscopic swallowing study. This provides the information needed for proper therapy and helps indicate the surgery when abnormal.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Some patients with this care and normal growth will improve its nasal patency and properly develop avoiding the need for surgery.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Imaging is very important for diagnosis and surgical planning. Traditionally for diagnosis the measurement of less than 11.0<span class="elsevierStyleHsp" style=""></span>mm in the piriform aperture on CT axial sections at the level of the inferior meatus was enough but as this malformation represents a spectrum of midline cranial defects and is frequently associated with midnasal stenosis each image needs to be considered individually. Axial measurements of the mid nasal third and the Maxillary-Nasal Angle confirm this diagnosis and suggest that only drilling the piriform aperture won’t be enough.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">12,13</span></a> It is described that 3D CT images are used for precise evaluation of the excessive portion of the nasal process of the maxilla and surgical drill planning preoperative.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> We do not use them routinely.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Studies have suggested that an PA diameter of less than 5.7<span class="elsevierStyleHsp" style=""></span>mm has an 88% sensibility to predict a surgical need. That's why every patient with an inferior diameter of less than 5<span class="elsevierStyleHsp" style=""></span>mm should be prepared for surgery first, the rest can be managed medically and followed.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Before surgical management we try to wait the “rule of tens”, this dogma, described by Millard in 1976 was created to diminish perioperative complications and improve healing and outcomes. Recent analysis have concluded that improvements in surgical management and pediatric anesthesia have diminished this morbidity and currently only patient weight has significant predictive value for postoperative complications. Nevertheless, this is not an urgent procedure and in most children waiting is affordable and assures better outcomes.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">During this time investigation for other associated abnormalities that could need prompt treatment should be made. Cerebral MRI to discart holoprosencefalia, Endocrine testing for hypopituitarism, ocular examination for visual anomalies, hearing screening studies and Cytogenetic testing searching for possible syndromes and family counseling<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1,6</span></a> are mandatory.</p><p id="par0135" class="elsevierStylePara elsevierViewall">When surgery is indicated, sublabial approach with careful submucosal dissection of the PA is the most important step. For this maneuver is important to have pediatric specialized instruments, ear microdissectors are useful to preserve nasal mucosa avoiding postoperative stenosis. The drilling is limited to the PA avoiding damage to the mucosa, the inferior turbinate or the nasolacrimal duct.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In this case series, postoperative stents were not used, because of the frequent blockage, risk of migration, granulations, infection, ulceration, synechiae, alar necrosis and alar stenosis. Also, it is difficult to take them out, occasionally needing more anesthesia and surgical time and in our experience the results are good without them.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Postoperative care is made with nasal irrigation with normal saline and topical steroids.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nasal dilation using the natural plasticity of facial bones and cartilages may be an option for patients with CNPAS and Congenital Midnasal Stenosis before or after surgical management. It can be made with hegar dilators or ballons.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> It is a treatment option in addition to those currently in use.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Late complications of the surgery are sinechiae, septal ulcers, septal perforations and stenosis.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">14</span></a> In this series no postoperative complications were seen.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Other groups are presenting new treatments for this neonates with rapid maxillary expansion widening the nasal base. It's an orthodontics procedure with an acrylic device positioned on the hard palate and linked to a mini-expansive screw that gives maxillary expansion daily. In one patient it was used with successful results. This procedure opens new possibilities for the treatment of CNPAS in neonates.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0165" class="elsevierStylePara elsevierViewall">Even though this is a small series, this congenital malformation is a rare cause of nasal obstruction in neonates and our experience and good results are important to publish. The complete diagnosis with images, evaluation of feeding disorders and comorbidities is important for a complete and appropriate management. All patients should be managed medically, nasopharyngeal tubes are effective and easy to use. Surgery is recommended in patients who fail medical therapy, preferably delayed until the rule of tens is accomplished. Mid third stenosis is frequently seen and must be approached for successful results. Stents are not needed, close follow up is required.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no funding or financial relationships or conflict of interest to disclose.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1332665" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aim" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1227785" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1332666" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1227786" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-12-05" "fechaAceptado" => "2019-05-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1227785" "palabras" => array:4 [ 0 => "New-born" 1 => "Nasal obstruction" 2 => "Airway Management" 3 => "Pyriform aperture stenosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1227786" "palabras" => array:4 [ 0 => "Recién nacido" 1 => "Obstrucción nasal" 2 => "Manejo de la vía aérea" 3 => "Estenosis de la apertura piriforme" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of nasal obstruction in neonates with respiratory distress manifestations. Diagnosis is made with craniofacial computed tomography, prompt and precise treatment creates good outcomes in these patients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To present our experience in diagnosis and management considerations with this rare pathology and a case series of our surgically managed patients.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective, analytical study of CNPAS patients surgically managed over a period of seven years. Evaluation and follow up was reviewed.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Thirteen patients were evaluated; pyriform aperture mean width was 5.5<span class="elsevierStyleHsp" style=""></span>mm. Of these patients, 31% also had Congenital Midnasal Stenosis. Medical treatment failed for all the patients and they required surgical enlargement of the pyriform aperture. No complications were seen and all patients improved in symptoms and development.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Congenital nasal obstruction can be fatal in new-borns, CNPAS is a rare differential diagnosis that must be completely evaluated, properly treated with conservative management and if it fails, with well-planned and executed surgery. Follow-up shows high rates of success.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aim" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La estenosis congénita de la apertura piriforme nasal (CNPAS, por sus siglas en inglés) es una causa poco frecuente de obstrucción nasal en los recién nacidos, con manifestaciones de dificultad respiratoria. El diagnóstico se realiza por tomografía computarizada cráneo-facial. Se requiere un tratamiento rápido y preciso para mejorar los resultados en estos pacientes.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Presentar nuestra experiencia en el diagnóstico y las consideraciones del tratamiento de esta enfermedad. Se evalúa una serie de casos de pacientes tratados quirúrgicamente.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo y analítico de pacientes con CNPAS tratados quirúrgicamente en un período de 7 años. Revisión de la evaluación y seguimiento.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron 13 pacientes; la anchura media de la apertura piriforme fue de 5,5<span class="elsevierStyleHsp" style=""></span>mm. El 31% de los pacientes también tenían estenosis nasal media congénita. Todos los pacientes fallaron al tratamiento médico y requirieron agrandamiento quirúrgico de la apertura piriforme. No se observaron complicaciones en los pacientes, mejorando los síntomas y el desarrollo.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La obstrucción nasal congénita puede ser letal en los recién nacidos, siendo la CNPAS un diagnóstico diferencial poco frecuente que debe evaluarse por completo, y tratarse adecuadamente de manera conservadora; en caso de fallo, debe realizarse cirugía bien planificada y ejecutada. El seguimiento muestra altas tasas de éxito.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1417 "Ancho" => 1417 "Tamanyo" => 73595 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Coronal CT scam slice highlighting bone overgrowth in the nasal processes of the maxillary bones.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1417 "Ancho" => 1417 "Tamanyo" => 110986 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Axial CT-scan slice highlighting Pyriform aperture stenosis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 546 "Ancho" => 1300 "Tamanyo" => 81798 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Patient with CNPAS, airway secured with a nasopharyngeal tube.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 625 "Ancho" => 850 "Tamanyo" => 55046 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sublabial approach. Submucosal dissection of the nasal processes of the maxillary bones, carefully without damaging the nasal mucosa.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age at surgery \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SMMCI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other malformations \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laryngomalacia – Congenital Midnasal Stenosis VSD – ASD – Epilepsy – Hypogammaglobulinemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laryngomalacia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Raine Syndrome – ACC – Congenital Midnasal Stenosis – Hydrocephalus – Craniofacial dysmorphism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Craniosynostosis, Congenital Midnasal Stenosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microphthalmia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CASE 13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unilateral Choanal atresia, Congenital Midnasal Stenosis \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2284280.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of CNPAS patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0185" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early identification of pituitary dysfunction in congenital nasal pyriform aperture stenosis: recommendations based on experience in a single centre" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.C. 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Original article
Congenital nasal pyriform aperture stenosis: Diagnosis, management and technical considerations
Estenosis de la apertura piriforme nasal: diagnóstico, tratamiento y consideraciones técnicas
Gilberto E. Marrugo Pardoa, Juan S. Parra Charrisb,
, Andrés E. Parra Charrisc, Daniel F. Villa Zuluagad
Autor para correspondencia
a Department of Otorhinolaryngology, Fundación Hospital de la Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
b Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, Colombia
c Universidad de la Sabana, Bogotá, Colombia
d Universidad Nacional de Colombia, Bogotá, Colombia