Secondary Logo

Journal Logo

Reply: Primary Intranasal Lining Injury Cause, Deformities, and Treatment Plan

Menick, Frederick J. M.D.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 925e
doi: 10.1097/PRS.0000000000001178

St. Joseph’s Hospital, Tucson, Ariz.

Correspondence to Dr. Menick, 1102 North El Dorado Place, Tucson, Ariz. 85715,

Back to Top | Article Outline


Leishmaniasis is a parasitic disease transferred by the bite of a sandfly. Multiple species of Leishmania exist in the tropics and subtropics worldwide. Leishmaniasis presents as a cutaneous, mucocutaneous, or visceral infection of the reticuloendothelial system. Parasites spread from skin lesions to the naso-oropharyngeal mucosa, often months or years after the cutaneous lesions appear, causing bleeding and ulceration and, ultimately, destruction of the nasopharyngeal mucosa.

The disease and the specific parasite species are diagnosed by culture and molecular or biochemical testing. Serologic assays cannot differentiate between active and quiescent infection. The diagnosis and treatment are individualized and require expert consultation. Treatment depends on the health of the host, the geographic location where the infection was acquired, the specific Leishmania species, and the type of infection. As emphasized by Joob and Wiwanitkit, medical control of this parasitic disease can be difficult. It has been classified as a neglected tropical disease by the Centers for Disease Control and Prevention. Multiple research studies are underway.

The article entitled “Primary Intranasal Lining Injury: Cause, Deformities, and Treatment Plan” clarifies the process of destruction caused by primary lining injury and identifies the characteristic, progressive deformities. The injury is determined by the site, depth, and extent of injury, and the consequence of scar contraction, regardless of cause. Obviously, the primary disease must be controlled, by means of avoidance of cocaine use, cure of intranasal cancer, modulation of immune disease, and elimination of infection. Although cause may vary, the pathophysiologic injury is similar. The deformity is attributable to progressive lining loss, which leads to the destruction of cartilaginous support and, later, may progress to the covering skin. Although most often conceived of as a loss of septal support with a secondary saddle collapse, secondary healing and scar contracture are the primary causes of deformity. The lining injury must be addressed by excision of scar and recreation of the defect. Then, the missing lining, according to the site and dimensions of the defect, must be replaced to correct the specific deformity. Only then can support or external skin deficiencies be addressed.

Back to Top | Article Outline


The author has no financial interest to declare in relation to the content of this communication.

Frederick J. Menick, M.D.

St. Joseph’s Hospital

Tucson, Ariz.

Back to Top | Article Outline


Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

©2015American Society of Plastic Surgeons