Sinonasal symptoms are a common early manifestation of several systemic inflammatory diseases and may precede multisystem involvement by days to years. Because nasal obstruction, drainage, epistaxis, crusting, and hyposmia are frequently attributed to chronic rhinosinusitis, diagnoses such as antineutrophil-cytoplasmic antibody-associated vasculitis, immunoglobulin G4-related disease, relapsing polychondritis, and sarcoidosis are often delayed. Recognition of atypical sinonasal symptoms and associated systemic findings is critical to distinguishing these entities from primary sinonasal inflammation. This article focuses on rheumatologic diseases with nasal involvement, highlighting key clinical, radiographic, and histopathologic clues that should prompt systemic evaluation and disease-specific management.

The objective was to describe a modification of the greater palatine artery (GPA) flap, oriented obliquely toward the sphenoid sinus, and to compare it with the traditional vertical design in the treatment of septal perforations (SP). Anatomical principles, surgical technique, and clinical outcomes were evaluated. A retrospective study was conducted including 46 patients with SP who underwent reconstruction using GPA flaps. Thirty patients were treated with the classic vertical flap (vGPA), and sixteen with the modified oblique flap (oGPA). Anatomical variables, quality of life (SNOT-22, NOSE-Perf), individual and total nasal symptoms (SNT7, visual analogue scale), aetiology, olfactory function (Barcelona Smell Test / BAST-24), and reperforation rate were analysed. Both flap designs produced significant functional improvements in SNT7 scores and quality of life measures. Reperforation occurred in two patients (4.9%), both in the vGPA group, with no statistically significant difference between techniques according to Fisher's exact test. Perforation size showed no statistically significant association with reperforation. Neither technique had a negative impact on olfactory function. The oblique design allowed for greater advancement length and a wider distal portion without increasing pedicle tension. This study concludes that the oblique GPA flap represents a safe and anatomically advantageous alternative to the vertical design. Its superoposterior orientation improves reach, reduces axial stress on the pedicle, and optimizes coverage of large or high septal perforations.

Nasal septal perforation repair remains technically demanding, with technique selection guided by perforation size, location, etiology, and patient risk factors. Contemporary evidence supports mucosal advancement flaps for small perforations (< 1 cm), bilateral advancement with interposition grafting or trilayer temporoparietal fascia-polydioxanone constructs for medium perforations (1-2 cm), and pedicled flaps for large (≥ 2 cm) or revision cases, with overall closure rates ranging from 84% to 98%. Modifiable risk factors, including active smoking, uncontrolled diabetes, and ongoing intranasal drug use, should be optimized preoperatively, as they are independently associated with significantly increased failure rates.

Uncovering the identity of "dark fungi" is crucial for understanding fungal taxonomy, diversity, and phylogenetic relationships. Previous exploratory analysis of the mycorrhizal fungi of the partially mycoheterotrophic orchid Nervilia nipponica revealed an association with a particular group of Agaricomycetes, tentatively designated "unidentified Agaricomycetes X" (uAX). Two culture strains were successfully isolated from the mycorrhiza, which enabled the phylogenetic position of this fungus to be determined using ultrastructural and multigene phylogenetic analyses. Transmission electron microscopy observations of the two cultures of uAX revealed that the dolipore septum is associated with perforate septal pore caps (SPCs), the margins of which are reflexed outwards. This combination of characters has not previously been reported in any order of Basidiomycota. Combined phylogenetic analyses based on sequence data from four loci [5.8S and 28S ribosomal DNA (rDNA), translation elongation factor 1-α, and RNA polymerase II second large subunit] indicate that uAX is an early-diverging clade of Agaricomycetes that cannot be accommodated in any known order of Basidiomycota. The name Reflexicalyptrales is proposed here for this new order of Basidiomycota. Furthermore, BLAST searches of the internal transcribed spacers of nuclear ribosomal DNA (nrDNA) and phylogenetic analyses reveal that closely related taxa have previously been detected in soil, leaf litter, and living root samples collected at various locations worldwide. This suggests that the group is ubiquitously distributed and probably exhibits a saprotrophic lifestyle.