Comparison of clinical data, CT, and bone histopathology in unilateral chronic maxillary sinusitis.

OBJECTIVES: To evaluate bone changes demonstrated by computed tomography (CT) as a predictor of the severity of chronic rhinosinusitis. STUDY DESIGN: Cross-sectional study. SETTINGS: Tertiary referral university medical center. SUBJECTS AND METHODS: Thirty-eight patients diagnosed with unilateral chronic maxillary sinusitis underwent endoscopic sinus surgery from 2003 to 2009. Preoperative CTs of all patients were reviewed by a single radiologist blinded to the pathologic diagnosis. Bone density was evaluated and expressed in Hounsfield units (HU). Sinus wall thickness (WT) was also measured and compared with the contralateral side. All the histopathologic specimens were reviewed. A database was constructed containing demographic data, clinical symptoms, CT measurements, and histopathologic findings. RESULTS: Average age was 44.07 years, with 22 women (57.9%) and 16 men (42.1%). The average wall density (WD) was 828.7 HU, and no correlation was found between the density of the diseased maxillary sinus bony walls and the severity of the histopathologic inflammatory process of the soft tissue (P = .474). The average wall thickness of the diseased sinuses was 2.6 mm, and a correlation was found between inflammation severity and wall thickness (P = .018). Wall thickening was found in 97.3% of the cases and an increase in density in 78.9% without correlation between WD and WT. CONCLUSION: Wall thickness but not WD obtained from CT scans may be a simple index for evaluation of unilateral chronic rhinosinusitis and its severity. Further studies confirming these results and comparing them with clinical correlates are indicated.

Cystic lesions of the jaws - a clinicopathological study of 322 cases and review of the literature.

Three hundred and twenty-two patients (192 male and 130 female) with cystic lesions of the jaw were successfully diagnosed and treated. One hundred and fifty-five (48%) were radicular cysts, 80 (25%) were dentigerous cysts, 23 (7%) were odontogenic keratocyst (=keratocystic odontogenic tumor), 19 (6%) were eruption cysts, 16 (5%) were traumatic bone cysts, and 29 (9%) were non-odontogenic cysts. There were 95 in the pediatric age group (1 month to 16 years) and 227 in the adult age group (17 years and older). Male to female ratio was 1 in the pediatric age group and 1.7 in the adult age group. The treatment modalities were: marsupialization, enucleation, enucleation with bone grafting, or resection. The distribution and characteristics of jaw cysts in children are different from those in adults. In children there is a relatively high rate of developmental cysts, whereas in adults the inflammatory cysts are more common. Following enucleation of a cystic jaw lesion, the entire surgical specimen and not only a biopsy specimen, should be examined histopathologically to prevent any possibility of an intramural squamous cell carcinoma that may be overlooked. The differences in prevalence of each type of jaw cyst during a lifetime may point toward a multifactorial polygenic pattern rather than a monogenic pattern.

Pediatric invasive sinonasal Scopulariopsis brevicaulis--a case report and literature review.

OBJECTIVE: Acute invasive fungal sinusitis (AIFS) appears mainly in immunocompromized patients and may be caused by various pathogens. We describe a teenager with invasive sinonasal Scopulariopsis brevicaulis and review all the reports on this rare pathogen. METHODS: A literature search on Scopulariopsis sinonasal invasive infections was performed and clinical data including age, gender, co-morbidities, treatment and prognosis was collected on all the patients. RESULTS: A 17 years old boy with acute myelocytic leukemia and Scopulariopsis brevicaulis sinonasal infection was successfully treated at our department with a combination of extensive surgical debridement and antifungal antibiotics. We found six articled describing six patients with AIFS due to Scopulariopsis species. Four patients were adults and two were children, 3 males and 3 females. Two had an infection with Scopulariopsis acremoium, one with Scopulariopsis candida and for 3 patients no data was given on the specific Scopulariopsis species. All the patients except one were immunocompromized. One patient was treated with antifungal drugs, 2 with surgery and 4 patients received antifungals and were operated. One patient died due to the fungal infection and two patients died due to other causes. CONCLUSIONS: Scopulariopsis AIFS is a life threatening disease affecting mainly immunocompromized patients, both children and adults. No clear treatment regimen has been established yet. We describe the first case of a teenager with Scopulariopsis brevicaulis sinonasal infection treated successfully with a combination of wide local excision and antifungal therapy.

The influence of epidural anesthesia on the hearing system after normal labor.

OBJECTIVE: The purpose of our study was to evaluate the influence of epidural anesthesia on the hearing system in women undergoing normal labor. DESIGN: We examined two groups of patients: women with epidural anesthesia underwent four tests of distortion product otoacoustic emissions(DPOAEs): on admission, and fifteen minutes, one hour, and three hours after the last epidural bolus of local anesthetic. Auditory brainstem response (ABR) tests were performed on admission, and one hour, and three hours after the last epidural bolus. Women who gave birth without epidural anesthesia underwent DPOAEs tests on admission, during a uterine contraction, during active delivery, and three hours after labor. ABR tests were performed on admission, during a uterine contraction, and three hours after labor. STUDY SAMPLE: twenty patients participated in the study. Twelve gave birth with epidural anesthesia and eight without anesthesia. RESULTS: No significant changes in DPOAEs and ABR recordings were found between the two groups. CONCLUSIONS: Epidural anesthesia does not impair the sensory or the neural elements of the hearing system and therefore does not influence hearing.

Endoscopic treatment of salivary glands affected by autoimmune diseases.

PURPOSE: To asses the possibility of an endoscopic technique to diagnose, treat, and maintain the salivary glands in patients with Sjögren syndrome and systemic lupus erythematosus. PATIENTS AND METHODS: A total of 8 patients with Sjögren syndrome and 2 with systemic lupus erythematosus with affected salivary glands were included in the present study. The treatment approach included parotid sialoendoscopy with thorough rinsing, and Stenson's duct dilation using hydrostatic pressure and a high-pressure balloon. Hydrocortisone 100 mg was injected through direct vision into the duct. The study was exempt by the Barzilai Medical Center review board. RESULTS: The main diagnosis of the patients was chronic recurrent parotitis, with the exception of 1 patient, who presented with salivary stones. CONCLUSIONS: The pathologic features of the salivary glands resulting from Sjögren syndrome and systemic lupus erythematosus can be managed successfully using an endoscopic approach.

Intravital staining with methylene blue in tympanoplasty.

Objective of the study is to investigate usefulness of the methylene blue staining for the operation of tympanoplasty in surgical training process with randomized, controlled trial. Two hospitals were involved: Department of Otolaryngology, Assaf Harofeh Medical Center, and Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center. Tympanoplasty with graft placement was performed by young surgeons on 30 patients (30 ears) with anterior perforations using intraoperative staining of tympanoplasty grafts with methylene blue (Group 1). The same number of patients/ears was operated by the young surgeons without intraoperative staining (Group 2). 76 patients operated without staining by experienced surgeons served as a control group. Results showed tympanic membrane healing (graft take) in 30 (100%) cases in Group 1 and in 26 (86.66%) cases in Group 2. The pure-tone audiogram testing revealed significant improvement of hearing in all successful cases (p < 0.05). No side immediate or postponed effects were detected. We conclude that intravital staining with methylene blue in tympanoplasty simplifies the operation and could assist in better visualization and proper placement of the graft. This technique could be most useful in a training process for resident surgeons.

Peritonsillar abscess in children in the southern district of Israel.

OBJECTIVE: Peritonsillar abscess is the most common deep neck infection and still provides a challenge to care givers in terms of diagnosis and treatment in the pediatric population. This study reviews our experience over the years 2004-2007 at the Soroka University Medical Center in the southern district of Israel in treating children with peritonsillar abscess. We compared our results with data regarding peritonsillar abscess in adults. METHODS: We performed a retrospective chart review of 126 children diagnosed and proved to have a peritonsillar abscess. Data regarding: age, sex, ethnicity, number of patients per year, seasonality, prior history of tonsillar infection, prior antibiotic treatment, length of hospitalization, surgical treatment, bacterial results and in hospital antibiotic treatment was collected from the medical charts of the patients. RESULTS: The average age of children with peritonsillar abscess was 12.8 years. 92 patients (73%) were above 10 years of age. We did not find an increase in the number of children with peritonsillar abscess per year over the time period of the study. The number of patients with peritonsillar abscess was significantly higher in the autumn and spring, 79 (62.6%) patients did not have prior history of tonsillar infections and 64 (67.4%) children were treated with antibiotics prior to the diagnosis of an abscess. In 95 (75.4%) patients the drainage method was needle aspiration, in 30 (28.3%) patients incision and drainage was performed and only one patient underwent bilateral quinsy tonsillectomy (0.8%). The bacterial culture was negative in 37 (36.7%) patients. In 29 patients (45% of positive cultures) the causative organism was Streptococcus group A. Mixed culture was present in 10 (15.6%) patients, nine cultures (14%) were positive for anaerobes, alone or in combination with other pathogens. Eighty-one patients (64.2%) were treated with amoxicillin-clavulanate potassium, 24 (19%) received cefuroxime and 17 (13.5%) were treated with cefuroxime+ metronidazole. The average hospital stay was 3 days. CONCLUSION: Peritonsillar abscess, a potentially life threatening infection, is similar in presentation and bacteriology in the pediatric and the adult population. Based on our review we conclude that peritonsillar abscess in children can be effectively treated by the same methods used in the adult population.

3D computer-assisted assessment of complicated penetrating foreign bodies cases in ENT practice.

A retrospective research was performed in order to evaluate three-dimensional (3D) computer-assisted detection of penetrating foreign bodies (FB) in the ENT practice in order to assess its usefulness and to specify its application. FBs in the head and neck were detected using 3D CT imaging in order to assess the usefulness of 3D images in the ENT operative practice. Three blinded surgeons were involved in comparison between plain and 3D CT images in order to assess 3D usefulness for precise formulation of a surgical plan. The observed relationship of the FBs to anatomical structures of the ethmoidal sinuses, eye orbit, and neck tissues was found instrumental for surgeon's decision making in planning the approach to operative removal of the FB. It helps to understand the relationships between a FB and surrounding anatomical structures better then the plain X-rays or CT-scan. There was no significant difference in cost between plain CT and 3D images. 3D computer-assisted detection of FBs increase our diagnostic abilities and appears to be a valuable addition to our diagnostic technique. Its main importance, however, lies in its capacity to help a surgeon plan an operation much more carefully avoiding improvisation during the operation itself.

Solitary angiokeratoma of the tongue.

Angiokeratoma is a rare cutaneous lesion. It can be either a generalized systemic form, presenting as multiple asymptomatic papules on the skin, associated with metabolic diseases or a solitary cutaneous form. Oral cavity involvement is more common in the systemic form, as a part of a more generalized cutaneous disease, but very rare in the localized form of angiokeratoma. A 45-year-old female presented with a painless lesion on the tongue of one months duration, which bled occasionally. On clinical examination, a lesion of approximately 5 mm in diameter was observed on the left surface of the tongue. The lesion was purple in color with a granulomatous appearance. There were no other changes in the oral mucosa. On dermatologic examination, no angiokeratomas were found, anywhere on the skin. The lesion was excised under local anesthesia. The histologic diagnosis was angiokeratoma. A case of a solitary angiokeratoma of the tongue is reported. We report here the third intra-oral case and the second case in the tongue with solitary angiokeratoma.

Endoscopic treatment of salivary gland injuries due to facial rejuvenation procedures.

OBJECTIVE: The purpose of this article is to describe innovative surgical techniques for treatment of salivary gland injuries caused by facial rejuvenation procedures. METHODS: Between 2001 and 2007, a total of 14 patients, all females ages 46 to 70 who suffered from salivary gland injuries caused by facial rejuvenation procedures, were treated, primarily by an endoscopic-guided technique that involved location of the injury and endoscopic repair. RESULTS: There were four types of postsurgical injuries of the salivary glands that were caused by operations for facial rejuvenation: 1) compression of salivary ducts with temporary swelling (n = 1); 2) laceration of the capsule of the salivary gland (n = 3); 3) stretching and compression of the ducts with penetration of the capsule of the duct leading to sialocele and long-term swelling (types 1 and 2 combined) (n = 5); and 4) complete cut or penetration of the main salivary duct or of one of its main branches resulting in sialocele (n = 5). The endoscopic technique treatment was successful in all cases. CONCLUSION: The main reasons for salivary gland injuries due to facial rejuvenation procedures in our patients were: poor anatomical identification of the border between the superficial muscular aponeurotic system (SMAS) and the parotid capsule; penetration of the salivary gland capsule by blunt or sharp dissection; unnecessary use of sharp-tip scissors; and a tear of the salivary duct by hooks during a face-lift procedure. Plastic surgeons should be aware of these complications and try to improve their techniques accordingly. To avoid atrophy of the salivary gland, once the diagnosis it made, it is advisable to send the patient to a maxillofacial or ENT surgeon skilled in endoscopy.

Drill failure during ORIF of the mandible. Complication management.

A case of a drill breakage during open reduction and internal fixation (ORIF) of a mandibular fracture is reported. The clinical decision, diagnosis and surgical management of the complication are described.

The role of tinnitus evaluation tests in differentiating functional versus organic tinnitus.

OBJECTIVE: To evaluate the usefulness of tinnitus tests in differentiating patients with functional tinnitus from patients with organic tinnitus. DESIGN: One hundred ninety-six patients with tinnitus were divided into 2 groups. Forty-three patients, group 1, were not exposed to noise and had sensorineural hearing loss. One hundred fifty-three patients, group 2, were exposed to noise and claimed disability. All the patients underwent 4 tinnitus evaluation tests: pitch matching, intensity matching, residual inhibition, and tinnitus masking. We compared the results of the tinnitus tests between the 2 groups. RESULTS: Group 1 patients had a high-frequency, low-intensity tinnitus that tended to be more inhibited by narrow-band noise, was usually consistent with type I Feldman masking curve, and could be effectively masked. Group 2 patients had tinnitus that could not be characterized. The results of the tinnitus tests were significantly different between the groups. CONCLUSION: Tinnitus tests may help us differentiate functional tinnitus that is not of cochlear origin from genuine tinnitus.

Stafne bone cavity--magnetic resonance imaging.

A case of Stafne bone cavity (SBC) affecting the body of the mandible of a 51-year-old female is reported. The imaging modalities included panoramic radiograph, computed tomography (CT) and magnetic resonance (MR) imaging. Panoramic radiograph and CT were able to determine the outline of the cavity and its three dimensional shape, but failed to precisely diagnose the soft tissue content of the cavity. MR imaging demonstrated that the bony cavity is filled with soft tissue that is continuous and identical in signal with that of the submandibular salivary gland. Based on the MR imaging a diagnosis of SBC was made and no further studies or surgical treatment were initiated. MR imaging should be considered the diagnostic technique in cases where SBC is suspected. Recognition of the lesion should preclude any further treatment or surgical exploration.