Septoplasty in children.

OBJECTIVES: Physicians have long had concerns about the potential harmful effects of pediatric septoplasties on the nasoseptal growth process because septal cartilage is important for the growth and development of the face. METHODS: In this review article, pediatric septoplasty and its indications are discussed, together with a literature survey. In addition, overviews of development of the nasal skeleton from neonate to adult, nasal growth, and cartilaginous septum are presented. Important issues and comments on pediatric septoplasties are provided. RESULTS: During septoplasty procedures, elevation of the mucoperichondrium unilaterally or bilaterally does not negatively affect growth of the face. Stabilization of the septum may be easier when mucosal elevation is performed unilaterally. The nasal floor mucosa should not be elevated so to avoid damage to the incisive nerves. Corrections and limited excisions may be done from the cartilaginous septum. Separation of the septal cartilage from the perpendicular plate, especially at the dorsal part, should not be performed because this area is important for the length and height of the nasal septum and nasal dorsum. Incisions or excisions should not be performed through the growing and supporting zones, especially at the sphenoethmoid dorsal zone. CONCLUSION: If there are severe breathing problems related to the septal deviation, septoplasty should be performed. In the majority of cases, septal surgery may be conducted in 6-year-old children. However, if necessary, septal surgery may be performed in younger children and even at birth.

International study of the incidence of particular types of septal deformities in chronic rhinosinusitis patients: the outcomes from five countries.

BACKGROUND: Chronic rhinosinusitis (CRS) may be more frequent in patients with particular types of septal deformities. The aim of this article was to investigate the incidence of particular types of septal deformities in adult CRS patients and healthy volunteers in various countries to determine whether some of them are more frequent in those groups. METHODS: This international multicentric study involved 505 subjects from five countries: Croatia, Romania, Italy, Russia, and Turkey. The types of septal deformities were observed and grouped according to the Mladina classification. Subjects were examined by means of native anterior rhinoscopy, anterior rhinoscopy after decongestion, and fiber endoscopy with topical anesthesia. CRS patients have been diagnostically proved by computed tomography scanning of the paranasal sinuses. RESULTS: Considering the CRS patients, the prevalence of so-called vertical deformities (types 2, 3, and 4) was seen. Among them, type 3 deformity was found most frequently in Turkey, Croatia, Italy, and Romania. CONCLUSION: Type 3 deformity has been found frequently in CRS patients in all five of the countries. Russian subjects exhibited a high frequency of type 4 deformity. Because this type consists of types 2 and 3, the later, again, has been proven to be prevalent in CRS patients also in this group of patients.

PLUNC proteins positivity in patients with chronic rhinosinusitis: a case-control study.

INTRODUCTION: Innate immunity is the first protection against microorganisms. Nowadays, there is a growing interest in innate immune molecule known as palate, lung, nasal epithelial clone (PLUNC). PLUNC is a specific product of the airways, of approximately 25 kDa, encoded by adjacent genes found within a 300 kb region of chromosome 20; these proteins must be detected predominantly in the upper respiratory tract. MATERIALS AND METHODS: We performed a case-control study to investigate the presence of this protein in nasal tissue of patients affected by chronic rhinosinusitis. 59 patients were enrolled (44 cases, 15 controls). We have examined the correlation between the presence of pathology and the PLUNC proteins positivity. RESULTS: 100% of controls have a +++ rated PLUNC proteins positivity, while cases have a lower percentage of positivity. We used χ (2) statistical test to analyze the results of the study and there is a difference statistically significant between cases and controls in PLUNC proteins positivity. CONCLUSIONS: These observations suggest that, in response to agents or chemical factors, nasal mucosal epithelium will react and produce PLUNC proteins. So PLUNC proteins have a protective function on upper airways mucosa, as we can see by evaluating the high positivity in control group.

Ultrastructural features of human adipose-derived multipotent mesenchymal stromal cells.

Multipotent mesenchymal stromal cells (MMSCs) are plastic-adherent cells with a well-established phenotype. Equine, but not human, adipose MMSCs have been characterized ultrastructurally. The purpose of our study was to evaluate ultrastructurally the adipose-derived human MMSCs. Cell cultures were prepared from human lipoaspirate. The flow cytometry evaluation of surface markers of cultured cells confirmed the expected profile of MMSCs, that were positive for CD73, CD90 and CD105, and negative for CD34 and CD45. We examined these human adipose-derived MMSCs in transmission electron microscopy (TEM) by Epon en-face embedding the fixed MMSCs. The main ultrastructural features of MMSCs were the extremely rich content of endosomal/vesicular elements, long mitochondria, dilated RER (rough endoplasmic reticulum) cisternae, and abundant intermediate filaments and microtubules. We found two types of MMSCS prolongations: (a) thick processes, with opposite, vesicular and filaments-rich, sides and (b) slender processes (pseudopodes and filopodes), with occasional proximal dilated segments housing mitochondria, vesicles and secretory granules. These TEM features of MMSCs characterized an in vitro cell population and could use to distinguish between different cell types in culture.

Modified endoscopic DCR without stenting and laser assisted.

To evaluate the outcomes of endoscopic LASER assisted dacryocystorhinostomy without stenting, a total of 39 patients (41 eyes) with complains of epiphora and diagnosed with nasolacrimal duct obstruction were included in a prospective study. All the patients had the same preoperative assessment, including radiological and ophthalmologic evaluation, with repeated lacrimal washouts, to confirm the postsacal obstruction. The surgical technique's goal was to create a wide opening of the medial wall of the sac, using drilling of the frontal process of the maxillary bone and some of the lacrimal bone, incision of the lacrimal sac and the radial vaporisation of the incision margins performed with Diode LASER, in order to create a 0.7 - 1 cm opening in the medial wall of the sac. Patients were examined endoscopically, at postoperative intervals of 1 month, 3 month, 6 and 9 month minimum (follow-up period ranged between 9 to 21 months, average 11, 8 months). We obtained a good permeability of the opening of the lacrimal sac in 87.8% of our cases (36 eyes). 5 patients (12.2%) required re-evaluation of the medial sac wall area and re-intervention using different methods. The success criteria were considered the patient's relief of symptoms and the endoscopic visualization of a patent stoma. In conclusions, in the hands of an experienced surgeon, endoscopic LASER assisted dacryocystorhinostomy without stenting compares favourably with other techniques.

[Chronic cough--etiological and therapeutical considerations in the otorhinolaryngological practice]. / Tusea cronica--consideratii etiologice si terapeutice în practica otorinolaringologica.

Chronic cough (cough persisting more than 3 weeks) is the one of the most common presenting symptom in adults seeking medical care. Given the fact that the variety of diseases that can produce this symptom is great, the correct management of chronic cough should include a close cooperation between pneumologist, gastroenterology specialist and otorhinolaryngology specialist, in another words a multidisciplinary approach. The purpose of this article is to reveal this symptom from the otolaryngologist perspective, emphasising on the main diseases involved, and also on the diagnosis and treatment alternatives of chronic cough.