BIOFILM AND HISTOPATHOLOGICAL GRADING OF MAXILLARY SINUS MUCOSA IN PATIENTS WITH ANTROCHOANAL POLYPS.

The aim of this cross-sectional study was to determine the signs of biofilm in the maxillary sinus of patients with antrochoanal polyps (ACP), and status of the mucosa on which the biofilm occurred. Mucosal samples from maxillary sinus in 40 ACP patients who underwent endoscopic sinus surgery were analyzed histopathologically and by scanning electron microscopy. Results were compared with maxillary mucosa samples of 40 patients without endoscopic and radiological signs of sinus disease. The existence of biofilm and its relation to the degree of histopathological changes according to Terrier classification of chronic mucosal inflammation of maxillary sinus were statistically analyzed. Biofilm was detected in 23 of 40 (57.5%) ACP patients; the incidence was significantly lower in the control group (2/40, 5%). Biofilm was not found in type 1 mucosa according to Terrier classification. In conclusion, biofilm showed a significant incidence in the maxillary sinus mucosa of ACP patients (57.5%). Occasionally, biofilm can be found in patients with no signs of sinus disease, but not on histologically normal mucosa. Results of this study support the theory that biofilm formation does not represent the initial stage of the inflammatory process.

DO ORTHOPTIC EXERCISES HAVE ANY INFLUENCE ON CHILDREN AND ADOLESCENTS DIAGNOSED WITH CONVERGENCE INSUFFICIENCY AND ATTENTION DEFICIT/HYPERACTIVITY DISORDER?

The aim was to determine whether improvement of near point of convergence (NPC) and binocular vision after orthoptic exercises had any impact on children and adolescents diagnosed with attention deficit/hyperactivity disorder (ADHD) and convergence insufficiency (CI). In this clinical trial, 50 children and adolescents aged 6 to 18 years diagnosed with ADHD and CI received orthoptic therapy that included home-based exercises (pencil push-ups and stereograms) and office-based therapy on synoptophore. Binocular vision and NPC were measured before, during and after therapy. Study subjects showed significant improvement (p<0.05) in NPC and binocular vision after orthoptic exercises. We found statistically significant correlation between stereovision improvement (Lang I) and near point of convergence, suggesting that improvement of binocular function is possible in children with ADHD and CI. Our results showed that NPC enhancement improved stereovision in patients with ADHD. Since progress of binocular function has positive effect on near work and diminishes visual symptoms in children and adolescents with ADHD and CI, it might be reasonable to suppose that orthoptic therapy helps these children improve concentration as well. Further studies are needed to determine whether it might have positive impact on attention.

Silicon foil patching for blast tympanic membrane perforation: a retrospective study.

AIM: To establish whether covering the tympanic membrane perforation after war blast injury with silicon foil can enhance the ear drum healing rate and to determine the appropriate timing of silicon patching. METHODS: We retrospectively analyzed the charts of 210 patients wounded during the Homeland War in Croatia 1991-1995, with 315 blast tympanic membrane perforations. In 44 patients (61 perforations), the eardrum perforation was covered by silicon foil, whereas in 166 patients (254 perforations) it was left to heal spontaneously. The patients who underwent the patching procedure were divided in two groups according to the time period between the blast injury and the procedure: 38 perforations were treated within 3 days and 23 perforations were treated 4 to 6 days after the blast injury. RESULTS: The rate of tympanic membrane healing in the silicon foil patching group was significantly higher (91.8%) than that in the group of perforations left to heal spontaneously (79.9%, P=0.029). The healing rate was significantly higher in the group treated within 3 days after the blast injury (97.4%) than in the group treated 4 to 6 days after the injury (82.6%, P=0.042). CONCLUSION: Covering the perforation after the war blast injury with silicon foil significantly improves the rate of tympanic membrane healing. To obtain the best healing outcome, the procedure should be performed within the first 72 hours after the trauma.

Anatomical study of the facial nerve canal in comparison to the site of the lesion in Bell's palsy.

The term Bell's palsy is used for the peripheral paresis of the facial nerve and is of unknown origin. Many studies have been performed to find the cause of the disease, but none has given certain evidence of the etiology. However, the majority of investigators agree that the pathophysiology of the palsy starts with the edema of the facial nerve and consequent entrapment of the nerve in the narrow facial canal in the temporal bone. In this study the authors wanted to find why the majority of the paresis are suprastapedial, i.e. why the entrapment of the nerve mainly occurs in the proximal part of the canal. For this reason they carried out anatomical measurements of the facial canal diameter in 12 temporal bones. By use of a computer program which measures the cross-sectional area from the diameter, they proved that the width of the canal is smaller at its proximal part. Since the nerve is thicker at that point because it contains more nerve fibers, the authors conclude that the discrepancy between the nerve diameter and the surrounding bony walls in the suprastapedial part of the of the canal would, in cases of a swollen nerve after inflammation, cause the facial palsy.

Small cell neuroendocrine carcinoma in the petrous apex.

With the exception of moderately differentiated neuroendocrine carcinoma of the larynx, neuroendocrine carcinomas are very rare head and neck malignancies. We report a case of a small cell neuroendocrine carcinoma in the petrous apex of the temporal bone. This unusual site for this tumour has not yet been reported in the literature. We confirmed the location and extent of the primary tumour by positron-emission tomography scan. The final histopathological diagnosis was of small cell carcinoma, and this was confirmed by immunohistochemistry. We treated this patient with surgery followed by radiotherapy and chemotherapy. After the treatment was completed there was subtotal remission of the tumour, with no distant metastases.

Biochemical changes in the sublingual and submandibular glands after interruption of chorda tympani.

The left chorda tympani nerve was interrupted through meatus acusticus externus in ten dogs. In total, 40 dog salivary glands (20 submandibular and 20 sublingual) innervated via chorda tympani were examined. Twenty glands (10 submandibular and 10 sublingual) on the left side were deprived of parasympathetic innervation by chordectomy, whereas contraleteral glands, on the right side, served as controls. Biochemical analysis showed that the interruption of chorda tympani did not cause any significant changes in the concentrations of eight enzymes investigated, i.e. lactate dehydrogenase, alkaline phosphatase, acid phosphatase, amylase, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and creatine kinase. There were no significant changes in the concentrations of most important extracellular ions (sodium, potassium, chloride and phosphorus) in the right glands, but the loss of parasympathetic innervation in the left glands was found to cause a statistically significant decrease in the concentration of potassium as intracellular cation and of phosphorus as extracellular anion.

Correlation between the minimal cross-sectional area of the nasal cavity and body surface area: preliminary results in normal patients.

Nasal symptoms often are inconsistent with rhinoscopic findings. However, the proper diagnosis and treatment of nasal pathology requires an objective evaluation of the narrow segments of the anterior part of the nasal cavities (minimal cross-sectional area [MCSA]). The problem is that the value of MCSA is not a unique parameterfor the entire population, but rather it is a distinctive valuefor particular subject (or smaller groups of subjects). Consequently, there is a need for MCSA values to be standardized in a simple way that facilitates the comparison of results and the selection of our treatment regimens. We examined a group of 157 healthy subjects with normal nasal function. A statistically significant correlation was found between the body surface area and MCSA at the level of the nasal isthmus and the head of the inferior turbinate. The age of subjects was not found a statistically significant predictor for the value of MCSA. The results show that the expected value of MCSA can be calculated for every subject based on anthropometric data of height and weight.