The Effect of Hospital-Based Liquid Diet and Commercial Formulas on Laboratory Parameters and Postoperative Complications in Patients with Head and Neck Cancer.

Background: Patients with head and neck cancer (HNC) are at high risk of malnutrition. The aim of this study was to compare the effect of polymeric formulas available commercially and a high-protein liquid diet prepared in the hospital on laboratory parameters and postoperative complications in patients undergoing surgery for HNC. Methods: This single-center retrospective study included 149 patients who underwent surgery for HNC between 2008 and 2017. The following data were collected: patient and tumor characteristics, postoperative complications, and laboratory parameters measured at baseline and after surgery, including creatinine, alanine transaminase (ALT), aspartate transaminase (AST), and blood glucose levels. Correlations between the duration of enteral nutrition and blood parameters were assessed. Results: After surgery, patients receiving commercial formulas had lower creatinine and blood glucose levels and higher ALT and ASP levels than those on the hospital-based diet. The longer duration of feeding with commercial formulas before surgery was associated with enhanced preoperative levels of ALT and ASP and with lower postoperative blood glucose. Patients on the hospital-based diet had a higher rate of postoperative complications than those receiving commercial formulas (16.1% vs. 3.3%). Conclusions: There were no clinically important differences in blood parameters among patients with HNC depending on the type of preparations used for enteral feeding. However, increased levels of liver enzymes in patients fed with commercial formulas were notable. The early initiation of enteral nutrition before surgery helped achieve normal blood glucose levels after surgery. The use of commercial preparations contributed to reducing the number and incidence of postoperative complications.

Off-label drugs in otolaryngological practice against the background of legal conditions of Polish legislation.

<b><br>Introduction:</b> 'Off-label drug use' refers to the administration of drugs for unapproved indications or age groups, a different dosage or other form of administration. Considering the legal issues, there clearly exists a need to implement rules that would regulate the use of pharmaceuticals outside the scope of a marketing authorisation. The brevity and diversity of Polish laws in the field of health care leads to many interpretative doubts associated with particular legal acts.</br> <b><br>Aim:</b> We aimed to present clinical examples from everyday practice of off-label drug use from the medical and legal perspectives, and to support it with relevant legal acts.</br> <b><br>Material and method:</b> Off-label drug use in various otolaryngology subspecialties - otology (mesna), laryngology (bevacizumab, cidofovir and botulinum toxin) and head and neck surgery (botulinum toxin) - are presented and discussed in detail.</br> <b><br>Results:</b> Fourteen Polish legal acts regarding off-label drug use and 4 from EU legislation are commented on. The algorithm of cascade of decision-making processes in off-label drug use is shown.</br> <b><br>Conclusions:</b> Off-label use of medicinal products is not prohibited in Poland or the EU; nevertheless, it is undeniable that the unclear legal situation regarding the use of medicinal products for nonregistered indications creates difficulties. To minimise a doctor's liability risk, obtaining the informed consent from the patient for such treatment is advisable.</br>.

Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts.

Summary: The algorithm of follow-up in patients with head and neck cancer (HNC) has been prepared by a board of Polish Head Neck and Oncology Experts. The aim of this research is to focus on the specificity of HNC monitoring, to review the current trends in follow-up, and to adapt the evidence-based medicine international standards to the capabilities of the local healthcare service. Materials and methods: The first methodological step was to categorize HNCs according to the estimated risk of failure after the adequate first-line treatment and according to the possibility of effective salvage treatment, resulting in improved overall survival. The final method used in this work was to prepare an authors' original monitoring algorithm for HNC groups with a high, moderate, and low risk of recurrence in combination with a high or low probability of using an effective salvage. Results: Four categories were established: Ia. low risk of recurrence + effective organ preservation feasible; Ib. low risk of recurrence + effective salvage feasible; II. moderate risk of recurrence + effective salvage feasible; III. high risk of recurrence + effective salvage feasible; and IV. high risk of recurrence + no effective salvage feasible. Follow-up visit consisting of 1. ENT examination + neck ultrasound, 2. imaging HN tests, 3. chest imaging, 4. blood tests, and 5. rehabilitation (speech and swallowing) was scheduled with a very different frequency, at the proposed monthly intervals, tailored to the needs of the group. The number of visits for individual groups varies from 1 to 8 in the first 2 years and from 1 to 17 in the entire 5-year monitoring period. Group IV has not been included in regular follow-up, visits on own initiative of the patient if symptomatic, or supportive care needs, having in mind that third-line therapy and immune checkpoint inhibitors are available. Conclusion: Universal monitoring algorithm for HNC four groups with a high, moderate, and low risk of recurrence after the adequate treatment in combination with a high or low probability of using an effective salvage is an innovative approach to redeploying system resources and ensuring maximum benefit for patients with HNC.

The characteristics of Polish patients with salivary gland tumors: a ten-year single-center experience.

OBJECTIVES: The study aims to provide insights into the characteristics of Polish patients with different salivary gland pathologies. MATERIALS AND METHODS: This is a retrospective study conducted at a single center, including patients who underwent surgery for salivary gland pathologies between 2012 and 2022. RESULTS: This study included 239 patients who underwent surgery for salivary gland tumors or inflammatory diseases. Malignant tumors were diagnosed in 9.8% of participants, while 64% had benign tumors and 21% suffered from inflammation. The occurrence of complications after surgery was relatively low, with 9.9% of participants experiencing slight facial weakness or mild dysfunction, and 3% experiencing complete paralysis of the facial nerves. Significant differences were observed between patients with cancers and those with benign tumors and inflammation in terms of age. Cancers were more common in females (67% vs. 33%) and predominantly localized in the parotid glands (95%). CONCLUSION: Benign tumors, such as Warthin's tumors and polymorphous adenoma, were predominantly found in the parotid glands of patients aged 39-72 years. On the other hand, inflammatory diseases were primarily localized within the submandibular glands of males aged 40-68 years. Additionally, the presence of a malignant tumor was associated with longer hospitalization periods related to surgery and a higher risk of severe complications. CLINICAL RELEVANCE: This study on Polish patients with salivary gland tumors provides valuable clinical insights that can aid in diagnosis, treatment planning, patient counseling, and further research in the field of oncology. It contributes to the overall understanding of salivary gland tumors, potentially benefiting both patients and healthcare providers.

Health care system efficiency in otolaryngological surgeries during COVID-19 pandemic in years 2020-2021 compared to years 2018-2019: data from the Military Institute of Medicine in Warsaw.

<b>Introduction:</b> Coronavirus disease 19 (COVID-19) pandemic had a great impact on the health care system. This resulted not only from changes in the way medical facilities operated but also from the need to treat a huge number of patients. On the other hand, uninfected people feared visiting the doctor.</br></br> <b>Aim:</b> The aim of the study was to assess the impact of the COVID-19 pandemic on the diagnostics and treatment of patients with head and neck cancer.</br></br> <b>Materials and methods:</b> This retrospective study involved analysis of data of patients from a single hospital unit who underwent surgical procedures due to head and neck cancer during the COVID-19 pandemic in years 2020-2021 (pandemic group) compared to years 2018-2019 (pre-pandemic group).</br></br> <b>Results:</b> Patients in the pandemic group (n = 123) were older and were more likely to have grade 3 cancer than patients in the pre-pandemic group (n = 116). Cancer stages were similar in both groups. During the pandemic, time from the first outpatient visit to surgery was longer (median 1.6 vs. 0.8 months), while time to radiotherapy was shorter (median 50.5 vs. 63 days) than in the pre-pandemic period.</br></br> <b>Conclusion:</b> During the pandemic, patients had to wait slightly longer for surgery but not for radiotherapy when compared with the pre-pandemic period. Despite this, they did not have more advanced disease.

The Effect of Nasogastric Feeding after Surgery in Patients with Head and Neck Cancers - Retrospective Single Center Experience.

This study aimed to assess clinical factors that could predict the need for nasogastric feeding after surgery in patients with head and neck cancer (HNC) and evaluate the effect of tube feeding on selected laboratory parameters.This single-center retrospective study included 153 patients who underwent surgery for HNC. Data on patient and tumor characteristics were collected, along with laboratory measurements. Logistic regression was used to identify the predictors of the need for nasogastric feeding. Laboratory parameters were compared between patients who required nasogastric feeding vs those who did not.Nasogastric feeding was required in 90 patients (59%). Significant predictors of nasogastric feeding in HNC patients after surgery, which were revealed by univariate regression analysis, included low body mass index (odds ratio [OR] = 0.84), squamous cell carcinoma histology (OR = 8.05), T2 tumor stage (OR = 2.27), red blood cell count (M/µL) (OR = 0.44), hemoglobin levels (g/dL) (OR = 0.80), and mean corpuscular volume (fL) (OR = 1.10). Multivariate analysis showed that low BMI (OR = 0.87) and red blood cell count (M/µL) (OR = 0.32) were prognostic factors for nasogastric feeding. A significant percentage increase in white blood cell count from admission to discharge was noted in patients who required nasogastric feeding vs those who did not (p = 0.003).Determining factors that predict the need for nasogastric feeding in HNC patients after surgery may support more personalized treatment planning to optimize clinical outcomes.

Concordance between Clinical and Pathological T and N Stages in Polish Patients with Head and Neck Cancers.

BACKGROUND: The TNM (tumor, node, metastasis) staging system is important for the successful treatment of head and neck cancers (HNCs). This study aimed to evaluate the concordance between clinical and pathological T and N stages in patients with HNCs in Poland. METHODS: In this single-center retrospective study, clinical and pathological TNM staging data on 203 patients undergoing surgical treatment for HNC between 2011 and 2018 were collected and compared. The study group was classified as underdiagnosed, overdiagnosed, or correctly diagnosed with HNC based on pathological TNM staging. The concordance between clinical and pathological staging was evaluated using the kappa coefficient. RESULTS: Clinical and pathological TNM staging showed concordance in 59.9% of patients for primary tumor (T) and in 79.3% of patients for lymph node (N) classifications. Moderate agreement between the clinical and pathological stages was shown for stage T, while substantial agreement was revealed for stage N. The size and extent of the tumor were underestimated or overestimated in 73 of the 182 patients (40.1%), while lymph node involvement was downstaged in 11 of the 53 patients (20.7%). CONCLUSIONS: The disparities between clinical and pathological staging of HNC demonstrate the need for standardization in physical and pathological examinations, as well as radiographic imaging.

Biologicals in the treatment of chronic rhinosinusitis with nasal polyps ­ position of the Polish Society of Otorhinolaryngologists ­Head and Neck Surgeons and the Polish Society of Allergology experts

Chronic rhinosinusitis with nasal polyps (CRSwNP) has a significant impact on the well-being and social functions of the patient. The generalized inflammatory process with the formation of nasal polyps and excess eosinophils in the mucosa of the paranasal sinuses is called type 2 inflammation, which is mediated by Th2 lymphocytes ­ cells of the immune system responsible for chronic inflammatory processes. Today, we also know the key pro-inflammatory mediators against which new drugs have been developed, the so-called biological drugs, are produced in cell lines. In this document, we present currently available biologicals approved for the treatment of patients with T2-related chronic rhinosinusitis.

Do Symptoms Correlate with the Signs in Odontogenic Sinusitis with Periapical Lesions?

INTRODUCTION: Endodontic pathology is one of the most common causes of odontogenic sinusitis, and its evaluation is challenging. Omission of periapical lesions in diagnostic process leads to recurrent sinusitis after cessation of medical therapy. METHODS: Sixty-one symptomatic patients presented with odontogenic sinusitis with periapical lesions of teeth adjacent to the maxillary sinus were included in the study. Symptoms evaluated with SNOT-22 and OHIP-14 questionnaires were compared to signs during endoscopic and radiological evaluation. RESULTS: Coexistence of odontogenic sinusitis with nasal polyps significantly decreases the quality of life, especially concerning the emotional domain (p = 0.047). Patency of ostiomeatal corresponds well with the severity of sinonasal symptoms reported with SNOT-22 (p = 0.051). Extent of maxillary sinus opacifications scored with Zinreich scale correlates positively with the presence of discharge (p = 0.001) and edema (p = 0.072) in the endoscopic Lund-Kennedy scale. Among 67 teeth with periapical lesions, 73.1% had undergone previous root canal treatment, but in 47.8% of cases, it was defined as incomplete. Endodontic status did not affect the severity of patient's complaints. CONCLUSION: In case of odontogenic sinusitis of endodontic origin, endoscopic signs correlate better than radiological with the self-reported symptoms. In order to better evaluate the severity of the disease and possible need of surgical intervention, both otolaryngologists and dental specialists should focus on extent of inflammatory lesions in the maxillary sinus.

A rare combination of tumor-induced osteomalacia caused by sinonasal glomangiopericytoma and coexisting parathyroid adenoma: case report and literature review.

BACKGROUND: Tumor-induced osteomalacia (TIO) is a rare, acquired disease of renal phosphate wasting and disturbed vitamin D homeostasis as a result of the action of a phosphaturic protein - FGF-23, produced by a neoplasm. Although the clinical and biochemical profile of the syndrome is characteristic, it remains underreported and unrecognized by clinicians. Hyperparathyroidism is rarely associated with oncogenic osteomalacia, but it should be considered because of potentially life-threatening hypophosphatemia caused by both conditions. CASE PRESENTATION: We report a case of a 42-year-old woman admitted to the Department of Otolaryngology of the Military Institute of Medicine in Warsaw for the endoscopic resection of hormonally active glomangiopericytoma extending into the anterior skull base. She presented with a 5-year history of musculoskeletal pain and progressive weakness of the extremities which finally led her to become bedridden. After the excision of the tumor her symptoms and laboratory results gradually improved except increasing PTH serum levels. Further examination revealed a parathyroid proliferative tumor, which was surgically removed. The patient walked without aids at follow-up 16 months after the surgery. CONCLUSIONS: This case is unusual because of tumor-induced osteomalacia and parathyroid adenoma occurring concomitantly. Further investigations of FGF-23 and PTH interplay should be conducted to elucidate the pathogenesis of hyperparathyroidism and tumorigenesis in some cases of TIO. By presenting this case, we wanted to remind clinicians of a rare and misdiagnosed paraneoplastic syndrome and highlight the importance of monitoring PTH concentrations during the follow-up of patients with TIO.

Clinical characteristics of odontogenic sinusitis with periapical lesions.

INTRODUCTION: Although the symptoms and radiographic signs may mimic rhinogenic sinusitis, odontogenic sinusitis (OS) with periapical lesions (PALs) is fundamentally an endodontic infection. It is considered to be one of the main causes of OS, especially when presented unilaterally. Despite this routine dental examination is not performed and periapical infection frequently remains undiagnosed by otolaryngologists and radiologists. MATERIAL AND METHODS: This prospective observational study covered a group of 61 patients with symptomatic OS with PAL. Assessment of quality of life was done using the 22-item Sino-Nasal Outcome Test-22 (SNOT-22) and Oral Health-Impact Profile-14 (OHIP-14). Temporal and etiological relationship between the dental cause and sinonasal complication was established among the otolaryngologist and dental specialist based on the clinical symptoms, nasal endoscopy described according to the modified Lund-MacKay scale, computed tomography (CT) scans measured and scored in compliance with Lund- Kennedy, Zinreich and Estrela scales. RESULTS: Out of 61 patients, 28 (46%) were women and 33 (54%) men. Group median age 49.1 years, ranged from 22.8 to 78.9 years. Total OHIP-14 score was 12.7 ± 11.3, with the highest value obtained in domains describing physical pain (mean 2.9 ± 2.4, median 3) in which the highest score was obtained in item 3 - painful aching in mouth and/or teeth - scored ≥2 by 52.5% of participants. Concerning dental symptoms 11.5% of patients were asymptomatic. Total SNOT-22 score was 40.7 ± 21.1, with the highest value in domains describing nasal symptoms. 23% of patients reported mild, 44.3% moderate and 32.7% severe symptoms. In the endoscopic evaluation 86.8% of cases presented discharge, 73.8% mucosal edema. In 11.5% of cases the polypoid tissues was observed in nasal cavities. The first molar tooth was the most frequently affected with an incidence of 42.6%, followed by the second molar (27.9%). In 33 (48.5%) of cases the inflammatory process caused the discontinuity of the sinus floor, which in 51.5% coexisted with total maxillary sinus opacification. 10 teeth (14.7%) had the periapical lesions with a diameter exceeding 8 mm. In case of the multi-rooted teeth, PALs were usually encountered at more than one root (57.4%). Maxillary and ethmoid sinus were affected in 54% of cases and additional frontal sinus involvement in 32.8%. In 69.6% patients, ostiomeatal complex was obstructed. CONCLUSIONS: Persistent sinonasal symptoms such as rhinorrhea, post-nasal drip and nose congestion along with dental pain may suggest endodontic nature of OS, especially after previous root-canal treatment. The bigger the PAL is in diameter and the closer to the maxillary sinus, the greater effect on its mucosal involvement and obstruction of ostiomeatal complex is observed. PALs around molar or premolar tooth apexes with coexistence of unilateral sinus opacifications should be noticed and mentioned by radiologists and evaluated by dental specialists in order to refer the patient to further treatment.

Adjuvant radiotherapy in parotid gland pleomorphic adenoma - recommendations.

<b>Introduction:</b> Standard treatment for pleomorhic adenoma (PA) of the parotid gland is complete surgical excision. Radiotherapy (RT) as a primary treatment method is controversial and generally is not applied. However, RT might be considered as an adjuvant therapy in some selected cases. </br></br> <b>Aim:</b> The aim of this work was to define recommendations for RT in patients with parotid gland PA after primary surgical treatment.</br></br> <b>Material and methods:</b> Based on the results currently published in the literature and the authors' own experiences from leading Polish laryngological and oncological clinical centers dealing with the treatment of salivary gland tumors, the indications for irradia- tion and its methods in patients with PA of the salivary glands were discussed. </br></br> <b>Results and discussion:</b> Authors recommend personalized treatment based on multidisciplinary panel decisions in each patient. Adjuvant RT should be considered in cases of suboptimal resection of primary PA (close margin, intraoperative tumor spillage, risk of recurrence based on clinical factors and histological features), and in cases of PA recurrence. Doses/ fractions and techniques of irradiation are recommended depending on the clinical extension of the primary or recurrent tumor. </br></br> <b> Conclusions:</b> Adjuvant RT in PA treatment should be a result of a personalized multidisciplinary decision after considering all possible risks of irradiation consequences. Recommendations for this treatment should be taken into consideration.

Drug-induced diseases in otolaryngology - causes, clinical signs, treatment.

In the daily practice of an otolaryngologist, we encounter cases where the symptoms are not the result of disease but result from pharmacotherapy. In the case of symptoms such as hearing loss, tinnitus, or dizziness, polytherapy may be used as the basis for their occurrence, which, due to the lack of rationality in combining drugs, leads to symptoms that the patient and the doctor very often interpret as a new disease syndrome. The aim of the study is to show and to raise awareness of the fact that the symptoms of hearing organ impairment are frequently drug-related and only a modification of the currently used pharmacotherapy is a rational procedure in such cases. This paper describes 30 cases who developed side effects of polypharmacy in the form of hearing disorders, dizziness, and tinnitus. The causes of drug-related complications were discussed, as well as effective methods of their prevention.

The impact of intraoperative antiseptic nasal irrigation during endoscopic sinus surgery on early postoperative results.

The main objective of the study was to determine the validity of intraoperative antiseptic treatment during endoscopic sinus surgery and the impact of such a treatment on the postoperative outcomes. Fifty-five patients with chronic sinusitis, qualified for surgical treatment were enrolled into the trial. It was designed as a prospective, randomized, blinded study. The surgical procedures were performed on both sides, in the same scope. In the next stage, after opening, one side was flushed with saline solution, and the other side with octenidine solution. The analysis showed a statistically significant reduction in postoperative crusting measured using the Lund-Kennedy scale between the test and the control group. Intraoperative lavage of the paranasal sinuses in both control and study group showed an effect on decreasing the total number of positive postoperative cultures relative to preoperative ones. Study showed a beneficial effect of the intervention consisting in rinsing with Octenisept on the reduction of crusting in the postoperative assessment.

Gastroesophageal reflux disease - from the point of view of a gastroenterologist, otolaryngologist and surgeon.

Gastrooesophageal reflux disease is the regurgitation of stomach contents into the esophagus, which causes troublesome symptoms or complications for the patient. Before starting the treatment, it is always necessary to objectively confirm gastroesophageal reflux disease, especially in correlation with ENT symptoms, as extra esophageal complications. In diagnostics, the "gold standard" is a 24-hour impedance-pH supplemented with endoscopy. Treatment without objective confirmation of the disease is not recommended, the more so that non-acid gas proximal reflux, detectable only in the MIIpH test, causes the greatest number of laryngological complications. It is important to confirm the coexistence of clinical symptoms of GERD with ESS. Considering the time of treating the disease and its consequences, it is worthwhile to be cautious and careful with the diagnosis of the disease, and the treatment should be carried out for a long time in relation to the recommendation, preferably in cooperation with an ENT specialist and gastroenterologist. The greatest therapeutic effectiveness is achieved by combining PPI with itopride while maintaining the appropriate doses of drugs and observing a sufficiently long duration of treatment, while maintaining the correct dose reduction and drug discontinuation regimen. In case of failure of pharmacological treatment, antireflux surgery should be take into consideration.

Drug-induced diseases in otolaryngology - causes, clinical signs, treatment.

<b>Introduction:</b> In the daily practice of an otolaryngologist, we encounter cases where the symptoms are not the result of disease but result from pharmacotherapy. In the case of symptoms such as hearing loss, tinnitus, or dizziness, polytherapy may be used as the basis for their occurrence, which, due to the lack of rationality in combining drugs, leads to symptoms that the patient and the doctor very often interpret as a new disease syndrome. <br><b>Aim:</b> The aim of the study is to show and to raise awareness of the fact that the symptoms of hearing organ impairment are frequently drug-related and only a modification of the currently used pharmacotherapy is a rational procedure in such cases. <br><b>Material:</b> This paper describes 30 cases who developed side effects of polypharmacy in the form of hearing disorders, dizziness, and tinnitus. The causes of drug-related complications were discussed, as well as effective methods of their prevention.

Tonsillectomy in own material.

<b>Introduction:</b> Tonsillectomy belongs to the most frequently performed surgical treatments; however, the necessity of its performance is questioned. Therefore, there are many attempts to unify and define the indications for the procedure. <br><b>Aim:</b> The main objective of the current dissertation was an analysis of the clinical symptoms occurring in patients qualified for tonsillectomy, as well as a comparison of those with a histopathological image of the removed tonsils in a repeatedly carried out, unified pathomorphological examination. The secondary objective was the designation of the demographic profile, existing comorbidities, and complications in the form of postoperative bleeding in patients after tonsillectomy in own material. <br><b>Material and method:</b> A retrospective analysis of 301 procedures of palatine tonsil removal was performed, which were completed in the years 2017-2019 at the Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery of the Military Institute of Medicine, Warsaw, Poland. The indications were defined on the grounds of data from the anamnesis. Based on unified criteria, the removed material was divided into 2 groups: with the signs of Chronic Tonsillitis (CT) as well as Tonsillar Hyperthrophy (TH). <br><b>Results:</b> The average size of tonsils was the greatest in a group of patients under 35 years of age, and smallest in the group over 51 years of age. As patients aged, the reduction in size of the palatal tonsils was observed. In the examined group, the histopathological diagnosis in the form of HT was found in 165 patients (54.8%), while CT in 136 (45.2%). It was proven that the larger the tonsils in the clinical picture, the more often the histopathological image responded to HT. Among clinical symptoms reported by patients qualified for tonsillectomy, the following were observed: recurring tonsil inflammation in 211 (70.1%), snoring and sleep apnea in 47 (15.6%), as well as sleep apnea in 33 (11%) patients. Primary bleeding occurred in 10 patients (3.34%), and secondary in 8 patients (2.66%). The most common comorbidities were cardiovascular burdens. <br><b>Conclusions:</b> For most cases, clinical symptoms were confirmed by adequate features of removed material in histopathological examination. The most common histopathological diagnosis was tonsillar hyperthrophy.

Intranasal steroid therapy - EPOS 2020.

INTRODUCTION: Due to their strong, multidirectional anti-inflammatory activity, intranasal glucocorticoids are the mainstay of treatment in rhinosinusitis, including acute rhinosinusitis, chronic rhinosinusitis, and chronic rhinosinusitis with nasal polyps, as well as allergic rhinitis. Owing to its high systemic safety and high anti-inflammatory efficacy, mometasone furoate - a new-generation intranasal glucocorticoid - was approved in 2019 as an over-the-counter medication for Polish patients diagnosed with allergic rhinitis. Scientific societies and expert groups recommend the use of intranasal glucocorticoids in a much broader range of indications. In February 2020, an updated version of the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) was published. AIM: This article discusses the role of nasal glucocorticoids in regimens used in the treatment of nasal sinusitis as published in EPOS 2020 with Polish country-specific realities being taken into account.

Endoscopic medial maxillectomy in patients treated at the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008-2018.

<b>Introduction:</b> Endoscopic medial maxillectomy (EMM) refers to surgical resection of the medial wall of the maxillary antrum. The primary indications for EMM are recalcitrant maxillary sinusitis, ablation of malignant and specific benign diagnoses such as Schneiderian Papilloma. Maxillectomy is potentially complicated by injuries to the orbital contents, lacrimal apparatus, optic nerve, ethmoidal arteries that may be accompanied by brisk bleeding. <br><b>Aim:</b> The purpose of this paper is to conduct a retrospective analysis of patients treated with EMM surgery at the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008-2018. <br><b>Material and methods:</b> The retrospective analysis was conducted on patients who underwent EMM treated at the the Otorhinolaryngology and Laryngological Oncology Clinic of Military Institute of Medicine in Warsaw in the years 2008-2018. The research included 18 patients aged 15-94; 8 women and 10 men. <br><b>Results:</b> Out of 18 patients, 8 had been operated before EMM. 16 of them presented with histological examinations, though 5 of which were not confirmed with postoperative histological result. The most common indication for the operation was inverted papilloma. <br><b>Conclusion:</b> Endoscopic surgical approach is effective and precious way to manage tumors which involve the neighboring structures especially medial maxillary sinus. EMM itself is a safe surgical method in managing maxillary sinus disorders and is favored for its decreased invasiveness and avoidance of the deformity of face.

Comparison of quality of life before and after open septorhinoplasty with the WHOQOL-BREF questionnaire.

INTRODUCTION: The study aimed to assess the influence of rhinoplasty on the quality of different aspects of life. The study group included 79 patients with congenital or posttraumatic nasal deformities (38 males, 41 females) aged from 17 to 49 (mean age 20 years) with open septorhinoplasty. MATERIALS AND METHODS: Quality of life was assessed before and 3 months after surgery, using the WHOQOL-BREF questionnaire. Other patient data including demographic data, other surgeries and comorbidities were also registered. Completion of 71 preoperative and 70 postoperative questionnaires was accomplished. R esults showed statistically significant differences in the quality of life in all domains. DISCUSSION AND CONCLUSION: Based on the conducted studies and after analysis of available literature, it may be concluded that functional and plastic surgeries including septorhinoplasty have an influence on the quality of life. To control postoperative results, tools evaluating this aspect should be used.