[Melanoma of the nasal septum]. / Czerniak przegrody nosa.

Sinonasal mucosal melanoma is a rare neoplasm, accounting for less than 1% of all melanomas. It is more aggressive than its cutaneous counterpart, with a very poor prognosis. We report a case of melanoma arising from mucosae of the nasal septum in a 73-year-old man. Clinical features, diagnosis, and treatment are described and a review of literature is made. Nasal location and relatively nonspecific symptoms frequently delay diagnosis. Optimal treatment guidelines are not established because of its rare occurrence.

[Metallic foreign bodies in the orbit]. / Metaliczne cialo obce oczodolu.

Authors present a case of metallic foreign bodies (part of the hammer) in apex of the orbit in a 57-year-old man. In CT scan it was localized between rectus lateral muscle and optic nerve. We remove it through transantral approach. We discuss about diagnosis and indication to transnasal and transsinusal (trough maxillary and ethmoidal sinuses) approaches to the retrobulbar part of the orbit.

Evaluation of selected cognitive functions before and after surgery for primary hyperparathyroidism.

BACKGROUND AND AIMS: Cognitive functions have been reported to be impaired in patient with primary hyperparathyroidism (pHPT). The aim of this psychological study was to evaluate cognitive disturbances in pHPT in relation to serum calcium levels before and after surgery. PATIENTS AND METHODS: A prospective, case-control study with 1-year follow-up of 35 pHPT patients versus 35 matched controls was undertaken. All patients were tested before surgery and at 12-18 months following surgery with a battery of selected cognitive function psychological tools: Benton Visual Retention Test (BVRT), Wisconsin Card Sorting Test (WCST), Memory Verbal Learning Test (DCS), The Rey's Auditory Verbal Learning Test (RAVLT), Trail Making Test A & B, Verbal Fluency Test, and Beck Depression Inventory. In addition to psychological testing, serum calcium, parathyroid hormone and phosphate levels were evaluated. RESULTS: The following cognitive functions of pHPT patients versus controls were deteriorated before surgery: impaired concentration, decreased nonverbal learning process, difficulties in using direct memory, verbal fluency and visual constructive abilities. However, no correlation was found between serum calcium levels and the results of neuropsychological tests. In longitudinal comparison of pHPT patients before and 1 year after surgery, there was a significant improvement in visual memory, visual-constructive abilities and direct memory. CONCLUSIONS: pHPT patients have significantly decreased concentration level, nonverbal learning process, access to verbal resources and constructional and visual memory ability. Thus, neuropsychological testing may be useful in the decision making for early surgery in patients with mild asymptomatic disease in order to avoid further deterioration of cognitive functions.

[Orbital decompression for thyroid orbitopathy]. / Dekompresja oczodolu w przypadku orbitopatii tarczycowej.

Thyroid orbitopathy may result in significant proptosis that causes visual lost. Besides pharmacologic and radiotherapeutic procedures surgically decompression of the orbital skeleton occasionally is managed. We present series of 3 patients (5 procedures) who underwent orbital decompressions. The preoperative proptosis ranged from 22 to 31mm. Decompression was performed by an external Walsh-Ogura approach in 3 orbits and in 2 by an endoscopic approach. The reduction in proptosis was 4-6mm in external approach cases and 4-5mm in endoscopic procedures. Diplopia was noted in 2 patients preoperatively, and no one had new postoperative diplopia. Surgical orbital decompression is occasionally necessary procedure or visual lost rescue in thyroid orbitopathy and in cases of diplopia can not improve muscular function. Endoscopic surgery is a safe and effective management in moderate proptosis. Autoimmunologic inflammatory changes in nasal mucosa do not increase postoperative complication risk.

[Intracranial mucocele of the frontal sinus]. / Sluzowiak zatoki czolowej penetrujacy do jamy czaszki.

We discuss a case of 49-year-old man admitted to our Department with headache and tumor of frontal region since 3 months. We report clinical features and imaging data of mucocele of frontal sinus that penetrates into cranial cavity. The mucocele had damaged anterior and posterior walls of frontal sinus with intracranial penetration. There was intact dura of anterior fosse. External approach with coronal incision was performed, mucocele was evacuated and mucosa was removed. Then frontal sinus was cranialized with reconstruction of anterior wall and finally wide nasal drainage was performed. Intracranial mucocele of the frontal sinus is rere evidence. The key difficulties may be related to dura preservation and reconstruction of anterior wall of frontal sinus.

Rhinosinusitis in cystic fibrosis: not a simple story.

OBJECTIVE: Chronic inflammation of sinuses and nasal mucosa is found in 74-100% patients suffering from cystic fibrosis, whereas nasal polyps in 6-44% patients. The aim of this paper is to assess rhinosinusitis types taking into account the forms of cystic fibrosis and the kind of CFTR gene mutation. MATERIAL AND METHODS: The author presents material of 126 cystic fibrosis patients, 90 with typical clinical features and 36 with atypical phenotype. Genetic tests were carried out to determine the genotype of CFTR gene. The sample was divided into four groups according to the genotype effect on the chloride canal function. Cytological examination of nasal mucosa was carried out in all the patients. RESULTS: In 71.5% of patients with cystic fibrosis, infectious chronic non-specific rhinosinusitis was found. Other types of rhinosinusitis--acute infectious, chronic allergic and non-allergic with eosinophilia were found in 21.4% of patients, whereas in 7.1% of patients no clinical symptoms of rhinosinusitis were found. Nasal polyps were found in 23 (18.3%) patients with cystic fibrosis: in 21 patients with a typical form and in 2 patients with an atypical form. Nasal polyps were more frequent in groups with the genotype consisting of both "strong" mutations than in the group with unknown or "mild" mutations. CONCLUSION: Rhinosinusitis in cystic fibrosis patients is not homogenous pathology. Infectious chronic non-specific rhinosinusitis is found the most frequently, but other forms of rhinosinusitis appear quite often and they require proper treatment.

[Nd:YAG laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnea syndrome]. / Uwulopalatoplastyka z uzyciem lasera Nd:YAG (LAUP) u chorych z zespolem obturacyjnych bezdechów podczas snu.

INTRODUCTION: Surgical treatment of OSAS is focused on removal of narrowing that increase airway resistance in upper respiratory tract. Nd:YAG laser beam penetrates deeper into tissue than CO2 laser followed by superior scarification ability. In this study we investigate efficacy of surgery with Nd:YAG laser assisted uvuloplasty (LAUP). MATERIAL AND METHODS: The subject was 51 patients with OSAS treated in Department of Otolaryngology, Medical University of Gdansk during the 2004-2005 period. All patients underwent all-night PSG and the ESS (Epworth Sleepiness Scale) score was used to assess the daytime sleepiness. Surgery treatment was performed and all patients underwent LAUP and additionally lingual base laser vaporization, tonsillectomy and nasal surgery where needed. The postoperative control ENT examination including ESS and all-night PSG was performed after 6 months. RESULTS: Success was found in 29 patients, they achieved AHI<10 and ESS<12. In another 22 patients improvement at PSG parameters and ESS score were evaluated but they were still beyond normal range. Success was obtained in 14/16 patients with preoperative AHI I degree, 10/19 AHI II, and 4/16 AHI III. Nasal surgery for enlargement of airway passage was performed more frequently (25/32) in the group with success then in the group with partial improvement (9/19). Preoperative PSG parameters were better in patients with nasal obstruction. Patients with BMI> or =30 succeeded rarely (10/22) in compare with patients with BMI<30 (success in 24/29). Preoperative PSG parameters were better in patients with BMI<30. CONCLUSION: LAUP with Nd:YAG laser wit additional tonsillectomy, lingual base surgery and nasal surgery were needed is successful method for surgery at light and medium stage of OSAS in nonobese patients.

[Orbital trauma]. / Urazy oczodolu.

INTRODUCTION: Single or multifragmental orbital fractures may be a difficult diagnostic and therapeutic dilemma. Dislocation of the orbital contain into maxillary and ethmoid sinus may take place during trauma. The main topics: is when and what surgical technique should be applied in these cases. MATERIAL AND METHODS: Material consists of retrospective analysis of 23 cases with fracture of medial and interior wall of orbit hospitalized in ENT Department of Medical University in Gdansk from 1999 to 2005. External ethmoidectomy was performed in cases with medial wall fracture and loose bone fragments are removed with reposition of orbit tissue. Transantral approach was applied in cases with inferior wall fractures. Loose bone fragments were replaced with autogenic bone or fascia graft, or synthetic material--bone cement. RESULTS: Complete or partial recovery was achieved in 91% of cases. Only in 2 cases (9%) recovery was not obtained after surgery--in these cases treatment started later then 60 days after fracture. CONCLUSIONS: In our opinion the optimal results of surgery may be achieved when treatment is begining before 14 day after fracture. If the later treatment is applied the worse results are achieved. Most of the cases must had been completed by rehabilitation after surgery.

[Sphenoid sinusitis]. / Zapalenie zatoki klinowej.

INTRODUCTION: Isolated sphenoid sinusitis is being diagnosed quite rare and it is caused by uncharacteristic evidences. Acute sphenoid sinusitis is usually diagnosed when intracranial complications are seen. MATERIAL AND METHODS: 11 cases aged 8-74 years hospitalized between 1999-2005 are retrospective analyzed. Diagnosis of isolated sphenoid sinusitis was made after ENT and radiological examination. RESULTS: The most common evidence (10/11 cases) was headache, they last 1 week-1 year, in 1 case 30 years. Acute inflammation was diagnosed in 2 cases and in all intracranial complication was developed. Meningitis, temporal lobe abscesses, orbital cellulitis and paresis of CN VI in case of 11 years old girl and in other case of 37 years old man aseptic meningitis developed. Chronic sinusitis was diagnosed in 6 cases and in other 3 mucocele was present. Progressive atrophy of CN II was the only complain in case of 8 years boy, in rest of cases of chronic sinusitis headache was the only complain. External approach sphenoidotomy in 3 cases and endoscopic approach in 8 cases was managed. CONCLUSIONS: Isolated sphenoid sinusitis was usually diagnosed when neurological or ophthalmologic evidences were being evaluated. Surgical treatment is indicated in chronic sinusitis and in cases with no recovery after i.v. antibiotic course or when complication develops. Complications of isolated sphenoid sinusitis often anticipate rhinologic evidences that can be absent.

[Noninvasive fungal sinusitis (fungus ball)--diagnostic difficulties]. / Nieinwazyjne grzybicze zapalenie zatoki (grzybniak)--trudnosci diagnostyczne.

Noninvasive fungal sinusitis (fungus ball) is usually found in one sinus and the most frequently is caused by Aspergillus. Diagnostic criteria are based on histopathology, and fungal cultures are frequently negative. The clinical symptomatology mimics chronic rhinosinusitis and radiology, specially CT and MRI are helpful for making decision of surgery. The authors present 4 cases of fungus ball of the paranasal sinus. In one case clinical symptoms, endoscopic examination of nasal cavity and CT scans suggested foreign body in the maxillary sinus. In other case clinical and radiological evidences made us to thing of neoplasmatic disease of the frontal sinus. In remaining two cases mycetoma was found in the sphenoid sinus. Surgical removal was the treatment in all cases and followed by systemic antifungal therapy in one case because of bone destruction. Histopathology revealed hyphae of Aspergillus without evidence of tissue invasion, fungal cultures in two cases were negative, an in other two Aspergillus fumigatus culture were obtained.

[Fibrous dysplasia in 8 year old child. Case report]. / Dysplazja wlóknista szczeki u 8-letniego dziecka. Opis przypadku.

The authors described fibrous dysplasia in 8 years old boy with inferior orbit wall destruction and with penetration of the lesion inside the orbit. Surgery with facial degloving approach was performed. Well therapeutic and cosmetic outcome was achieved. Usefulness of imaging data, especially CT, in diagnostic procedure was stressed. The review of contemporary literature on fibrous dysplasia was discussed.

[Chronic maxillary atelectasis (silent sinus syndrome)]. / Przewlekle zarostowe zapalenie zatoki szczekowej (silent sinus syndrome).

INTRODUCTION: We discuss 3 cases with chronic maxillary atelectasis presenting as enophthalmos without any particular evidences of sinus pathology. MATERIAL AND METHODS: We report clinical features and imaging data of sinus atelectasis in 2 men and 1 woman, 20-39 years old. Only 1 patient complained of diplopia, in 2 patients we found allergic rhinitis, in 2 cases septal deviation. Hertel enophthalmometry demonstrated enophthalmos 1-4 mm. Evidences have lasted for 2-6 months. CT scans revealed unilateral complete antral opacification, inward bowing of the antral medial and postero-lateral walls and collapse of orbital floor. RESULTS: Three patients with enophthalmos and asymptomatic maxillary sinus disease were identified. All patients underwent successful functional endoscopic sinus surgery with endoscopic maxillary antrostomy and in one case anterior ethmoidectomy. Additionally septoplasty was performed in two cases. We did not need to repair orbital floor in any case. Patient with diplopia achieved spontaneous return of orbital floor to almost normal position with enophthalmos -1 mm and all three were asymptomatic. Intrasinus manometry was performed in one case and confirmed the presence of negative pressure (-2,8 cm H2O). CONCLUSION: Chronic maxillary atelectasis presenting as enophthalmos is a rare evidence and sinus component of the disease mostly remains asymptomatic. The most effective treatment is endoscopic maxillary antrostomy.

[Congenital and acquired cholesteatoma middle ear in children]. / Perlak wrodzony i nabyty ucha srodkowego u dzieci.

Cholesteatoma of the middle ear in children may cause hypoacusis. Early diagnosis and optimal treatment is neccessary for good functional effect. We present 57 children (58 ears) with cholesteatoma treated in ENT Department of Medical University in Gdansk in 1991-2002. The age of patients ranged between 3 and 16 years, the most common 11-15 years. In 52 (89.6%) cases acquired cholesteatoma and in 6 (10.4%) congenital cholesteatoma was diagnosed. Epitympanal cholesteatoma was found in 32 children (55.1%) whereas in posterior part of tympanic cavity--in 20 children (34.5%). In 6 cases (10.4%) intact tympanic membrane was found. Mean air-bone gap in acquired cholesteatoma before treatment was 18.7 dB, after treatment 15.7 dB. In congenital cholesteatoma mean air-bone gap before treatment was 13.6 dB, after treatment 14 dB. The most frequent symptom was hearing loss (98.3%) and purulent otorrhea (85.4%). Positive bacteriological culture was obtained in 43.1% of the cases. X-ray revealed sclero-pneumatic mastoid in 26 (34.5%) cases, sclerotic in 25 (43.1%) and pneumatic mastoid in 7 (12.1%) cases. Intracranial complications were found in 2 cases, intratemporal in 2 cases and extracranial complication in 1 case. Radical surgery was performed in 23 cases (39.7%) and in each case, which required reoperation, modified radical mastoidectomy in 20 cases (34.4%), in another 15 children (25.9%) tympanoplasty was done. The most frequent failure was purulent otorrhea in 21 (36.2%) cases. Reoperation in cholesteatoma recurrence was performed in 17 children (29.3%). Improvement or the same as preoperatively hearing level was obtained in 35 (60.3%) ears, hearing loss was revealed in 23 (39.7%) ears. Treatment of temporal bone cholesteatoma in children is difficult due to silent beginning, aggressive growth and frequent recurrence. The best treatment results in children cholesteatoma are obtained in early clinical stage and with open tympanoplasty procedure.

[Radiographic findings in paranasal sinuses in cystic fibrosis patients]. / Obrazy radiologiczne zatok przynosowych u chorych na mukowiscydoze.

Chronic rhinosinusitis is diagnosed in majority of cystic fibrosis patients. Author discusses radiographic changes and analyses them considering type of rhinitis, cystic fibrosis phenotype and patients age. In 39 (48.75%) patients all sinuses were totally opaque in a bilateral fashion and in 39 (48.75%) patients mucosal thickening were found in X-rays, in 36 (46.8%) patients frontal sinuses were absent, in 2 (2.5%) patients normal X-ray features were presented. Totally opaque sinuses were found in patients with infective chronic nonspecific rhinitis and with nasal polyposis, partially opaque sinuses were found most frequent in patients with infective acute rhinitis. Patient with typical clinical features had totally opaque sinuses and frontal sinuses were absent most frequently. In atypical cystic fibrosis patients partially opaque sinuses were found. There were similar radiological findings in patient before age of 12 years and older ones.

[Rhinitis in patients with cystic fibrosis]. / Niezyty nosa u chorych na mukowiscydoze.

The author presents material of 110 cystic fibrosis patients, 81 with typical clinical features and 29 with atypical phenotype. Based on clinical examination and nasal cytological smears infective chronic nonspecific rhinitis (n = 80), infective acute rhinitis (n = 16), perennial allergic rhinitis (n = 4), nonalergic rhinitis with eosinophilia (n = 2), and moreover 19 patients with nasal polyposis, and 8 patients without nasal symptoms were distinguished. Infective chronic nonspecific rhinitis and infective acute rhinitis were present in typical and atypical cystic fibrosis patients with similar frequency but in patients with atypical phenotype perennial allergic rhinitis and nonalergic rhinitis with eosinophilia were observed more frequently. Nasal polyposis was associated with typical cystic fibrosis phenotype, and with two "severe" mutations.