[Crista galli pnevmatization: prevalence and clinical significance]. / Pnevmatizatsiya crista galli: rasprostranennost' i klinicheskoe znachenie.

OBJECTIVE: Determine the frequency of crista galli (crest of the rooster) pneumatization and the presence of communication of the pneumatized crista galli with the paranasal sinuses. MATERIAL AND METHODS: Computed tomography data of the paranasal sinuses of 251 patients. The patients' age ranged from 23 to 70 years. Variations in crista galli were classified according to the degree of pneumatization. RESULTS: The pneumatic type of crista galli structure was observed in 14.7% of cases. The most commonly crista galli pneumatized had a connection with the frontal sinus. In some cases, in the presence of sinusitis, the crista galli cavity was involved in the inflammatory process. The article presents a case of inflammation of pneumatized crista galli, in which a patient complained of a stubborn headache in the frontal sinus. Attention is drawn to the importance of diagnosing this pathology using objective imaging methods. Videoendoscopy and computed tomography revealed crista galli pneumatization with thickening of the mucous membrane and the presence of fluid. As a result, the optimal surgical approach was chosen - transseptal dissection with removal of one of the walls of pneumatized crista galli.

[Rare observation of petrositis complicated by parapharyngeal abscess in an 8-year-old patient]. / Redkoe nablyudenie petrozita, oslozhnennogo parafaringeal'nym abstsessom, u patsienta 8 let.

A clinical case of diagnosis and treatment of an 8-year-old patient with bilateral acute suppurative otitis media (ASOM) complicated by left mastoiditis and petrositis is presented. By itself, such a rare complication of ASOM as petrositis manifested itself not in the form of the classic Gradenigo triad, but as a parapharyngeal abscess (PPA), due to the destruction of the lower wall of the temporal bone pyramid. Complications arose as a result of contact and hematogenous pathways for the spread of the infection, which debuted in the middle ear cavities 1 month before the patient was admitted to the hospital. The combination of factors such as an aggressive pathogen, the anatomical structure of the middle ear, a decrease in the immune reactivity of the child's body, the spread of infection through the lower cells of the temporal bone pyramid and the lack of timely antibiotic therapy, led to destructive changes in the bony walls of the temporal bone and the spread of a purulent process to the temporal pyramid bones, and then to the parapharyngeal space. The destruction by inflammation of the lower wall of the pyramid of the temporal bone led to the development of PPA, and not meningoencephalitis, which could have fatal consequences.

[Comparative morphological assessment of the damaging effects of cold plasma and radio wave energy on the mucous membrane of the lip in the experiment]. / Sravnitel'naya morfologicheskaya otsenka povrezhdayushchego vozdeistviya kholodnoplazmennoi i radiovolnovoi energii na slizistuyu obolochku guby v eksperimente.

The aim of this study was a comparative morphological assessment of changes in the mucous membrane of the lip in the field of radio wave and cold plasma exposure in the experiment. MATERIAL AND METHODS: Experimental animals removed a portion of the mucous membrane of the inner surface of the lip with a Surgitron radio knife (group 1) and an electrode of the Coblator II cold plasma apparatus (observation group 2). Tissue was taken from the edge of the surgical wound as a trapezoidal flap containing mucous and submucous membranes immediately after the incision and 3 weeks after the surgery. Histological sections were prepared, which were stained with hematoxylin and eosin, as well as according to van Gieson. RESULTS: It was found that, both in cases of using a radio knife and a coblator along the edges and in the depth of the wound, coagulation tissue necrosis was observed, which was more evident in group 1 of observations. In addition, after the radio wave exposure, in the areas close to the defect, the epithelial lining was disrupted to one degree or another, which was not observed when using the coblator. After 3 weeks of the experiment, the stratified squamous non-keratinizing epithelium in both groups had a normal histological structure. At the same time, when using the coblator, the lamina propria of the mucous membrane was completely restored, and in cases with the use of a radio knife, sclerotic processes with the formation of scar tissue took place in the lamina propria of the mucous membrane in some areas. CONCLUSIONS: The use of a coblator should be recognized as a more gentle method, since a comparative analysis of histological changes immediately after the incision showed a more intense damaging effect of the radio knife on the surrounding tissues, which in later stages was accompanied by incomplete regeneration (substitution) of the lip mucosa.

[Quantification of the loudness of snoring according to Watch-PAT-200 and its relationship with the severity of obstructive sleep apnea syndrome]. / Kolichestvennaya otsenka gromkosti khrapa po dannym Watch-PAT-200 i ee vzaimosvyaz' so stepen'yu vyrazhennosti sindroma obstruktivnogo apnoe sna.

PURPOSE OF THE STUDY: Evaluate the capabilities of Watch-PAT-200 in obtaining data to determine the relationship between the loudness of snoring and the severity of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: From 2017 to 2019, 208 patients with complaints of nocturnal snoring were examined. Apnea / hypopnea indices (AHI) and respiratory distress index (RDI) were assessed. The study was carried out on a Watch-PAT-200 portable device (Itamar Medical, Israel). The average volume of snoring (dB) and the proportion (%) of sleep time with the intensity of snoring over 50.60 and 70 dB were measured. The correlation of the obtained data with the AHI and RDI indices is estimated. RESULTS: During the study, it was found that the volume of snoring increases as the severity of OSAS increases, therefore, the volume of snoring can be an indicator of the severity of OSAS. There are ample opportunities for screening diagnostics of the loudness of snoring with the subsequent consultation of a somnologist and timely prescription of treatment. Due to the objectivity of the obtained data and ease of use, the Watch-PAT-200 device can be used in outpatient practice for screening diagnostics of snoring and OSAS in the population.

[Comparative cytological analysis of the middle ear exudate in different children's groups]. / Sravnitel'nyi tsitologicheskii analiz ekssudata srednego ukha u raznykh detskikh grupp.

The purpose: to compare the types of cytograms of exudate from the middle ear between patients with exudative otitis media (EOM) with congenital clefts of the lip/palate (CCLP) and without CCLP, determining the stages of chronic disease and the significance of surgery on the middle ear. PATIENTS AND METHODS: Two clinics was parallel conducted a cytological examination of exudate of the middle ear in children. The first group consisted of 30 patients aged 2 to 17 years with EOM without CCLP (n=54 ears). The 2nd group included 17 patients aged 1 year 4 months to 10 years with EOM with CCLP (n=34 ears). RESULTS: In the 1st group, in 61% of cases (n=33), an inflammatory-regenerative type of cytogram was detected, in 39% (n=21) - a regenerative, inflammatory type of cytogram was not detected. In the 2nd group, in 82.4% of cases (n=28), an inflammatory type of cytogram was observed, in 14.7% (n=5) - an inflammatory-regenerative type, in 2.9% (n=1 ear) - a regenerative type. CONCLUSION: With CCLP, the inflammatory nature of the cytogram of the resulting exudate from the middle ear is more common, which is characterized by signs of destruction of the mucous membrane, decay and degradation of the basal and cell membranes. Patients with CCLP often suffer from EOM. They are more likely to development of chronic purulent otitis media, including with cholesteatoma. Destructive changes in the mucous membrane of the middle ear are found in children of different ages. Taking into account the analysis of cytograms of the exudate of the middle ear with CCLP, the imposition of long-term ventilation tubes is justified.

[The species composition and sensitivity of pathogenic microflora responsible for the development of otitis externa diffusa to the components of Polidexa]. / Vidovoi sostav i chuvstvitel'nost' vozbuditelei naruzhnogo otita k komponentam preparata Polideksa.

The objective of the present work was to study microflora of the external auditory meatus in the patients presenting with bacterial otitis externa diffusa. The authors have analyzed the results of microbiological investigations involving 102 patients with this condition undergoing the treatment with 'Polidexa'. The characteristic of species composition of microflora associated with otitis externa diffusa is presented. The sensitivity of the most common pathogens responsible for the development of this pathology towards antibiotics contained in ear drops has been analysed. The advantages of the use Polidexa for the treatment of this acute ear disease are described.

[CFD-simulation of the air flows in the maxillary sinus]. / CFD-modelirovanie vozdushnykh potokov v verkhnecheliustnoi pazukhe.

This article summarizes the results of computer simulation of the air flows in the nasal cavity and the maxillary sinus by the computational fluid dynamics (CFD) method. The objective of the study was to apply the method of computational aerodynamics to simulate the air flows in the nasal cavity and the maxillary sinus under the normal conditions and after the surgical interventions on the middle nasal meatus. The normal air space of the nasal cavity and paranasal sinuses was simulated and the computer modeling of the main options for the surgical approach to the maxillary sinus through the middle nasal meatus was performed including balloon sinuplasty, functional endoscopic sinus surgery, and uncinate process mobilization. The study has demonstrated the increase of the air flow velocity in the maxillary sinus after computer-assisted balloon sinuplasty. The computer simulation of functional endoscopic sinus surgery including the removal of the uncinated process revealed the mass exchange between the maxillary sinus and the nasal cavity.

[Certain morphometric characteristics of the normal maxillary sinus]. / Nekotorye morfometricheskie pokazateli verkhnecheliustnoi pazukhi v norme.

Maxillary sinus is more than any other paranasal sinuses amenable to various pathological conditions that may require the surgical treatment. The objective of the present work was to study the age-related and the individual specific anatomical features of the walls of the maxillary sinus and to develop the principles of sinus surgery based on the results of the anthropometric studies. We analyzed the cone-beam CT scans obtained from 586 patients at the age varying from 5 to 60 years who were allocated to six different groups. The measurement of different anthropometric indicators of the maxillary sinus was undertaken. The study has demonstrated the feasibility of using boron as a means to obtain the access to the maxillary sinus for the purpose of the external surgical intervention. The maxillary sinuses having the thickness of the anterolateral wall of more than 1.5 mm most frequently occurred in the patients under 12 years of age. The surgical access to the maxillary sinus through the lower nasal passage having the medial wall thickness greater than 1 mm proved to be limited; this feature was found to be characteristic of the patients at the age below 12 years. It is shown that the depth of the lower lateral wall in the nasal passage did not depend on the age of the patients; the same was true of the angle formed between this wall and the bottom of the nose. Taken together, the obtuse angle (more than 100°) and the depth of the lateral wall of the inferior nasal meatus of more than 5 mm facilitated the surgical access to the maxillary sinus through the inferior meatus.

[The morphological and clinical aspects of the curvature of the nasal septum]. / Morfologicheskie i klinicheskie aspekty iskrivleniia peregorodki nosa.

The curvature of the nasal septum (NS) is one of the most widespread deformations of the facial skeleton. The objective of the present study was to substantiate the principles of and develop the rationale for the surgical correction and conservative treatment of this condition based on the morphological features of various types of deflection of the nasal septum. We have undertaken the morphological analysis of the osseous and cartilaginous structures determining the type and the shape of the curvature of the nasal septum together with the clinical analysis of different morphological variants of the deflection of the nasal septum making use of the R. Mladina classification. Type I-IV vertical deflections are regarded as the acquired deformities whereas type II deviations can just as well be congenital malformations. Types V and VI deflections can be a consequence of the birth injury resulting in the displacement of the nasal structures and leading to the curvature of the nasal septum. The authors describe the defects in the anatomical structures adjoining the nasal cavity associated with various types of the deflection of the nasal septum that the surgeons should take into account when planning and performing septoplasty.

[The replacement of defects in the frontal walls of the paranasal sinuses by the allotransplants]. / Zameshchenie defektov litsevykh stenok okolonosovykh pazukh allotransplantatami.

The aim of the present work were the development and clinical testing of the method for the closure of defects in the anterior wallsof the frontal and maxillary sinuses with the use of the allotransplants. We have carried out the experimental studies with the transposition of the cartilaginous allograft into the bone defect by means of the press-fit technique. Within six months after the operation, the transplantation resulted in the formation of a regenerate composed of the lamellar bone tissue. We have also undertaken the clinical testing of the method forthe closure of defects in the anterior wallsof the frontal and maxillary sinuses using the cartilaginous allograft. In all the cases, the favourable clinical outcome has been achieved as evidenced by the integrity of the restored anterior wall of the sinus.

[The prevention and treatment of nasal liquorrhea in transnasal surgery of the base of the skull]. / Profilaktika i lechenie nazal'noĭ likvorei v transnazal'noĭ khirurgii osnovaniia cherepa.

The objective of the present study was to estimate the effectiveness of different methods for the reconstruction of defects in the base of the skull. It was shown that the use of the modern technique for this purpose decreases the risk of the development of postoperative complications. The vascularized flaps can be applied to hermetically close defects in the base of the skull during surgery with the use of the extended transnasal approach. It is concluded that the proposed procedure accelerates the healing process and allows the flaps to be used repeatedly if necessary.

[The state of vegetative homeostasis in the patients presenting with ronchopathy]. / Sostoianie vegetativnogo gomeostaza u bol'nykh ronkhopatieĭ.

The objective of the present work was the clinical and instrumental study of the vegetative nervous system in 25 patients of different age presenting with ronchopathy. The results of the study indicate the prevalence of the vagotonic type of primary vegetative tone and the specific features of vegetative reactivity differing from those in the control subjects (n=12). Moreover, all the patients were shown to have concomitant diseases of the upper respiratory tract. The data obtained give evidence of vegetative disbalance in the patientspresenting with ronchopathy which makes it necessary to design and develop new methods producing the vegetostabilizing effect for the treatment of snoring during sleep to be used together with other conservative and surgical methods.

[The role of mycological culture studies in diagnostics of otomycoses]. / Znachenie mikologicheskogo kul'tural'nogo issledovaniia v diagnostike otomikozov.

The present work was designed to analyze the results of themycological culture study involving 350 patients at the age varying from 14 to 75 years with the diagnosis otomycosis. The pathogenic fungi known to induce the clinical picture of otomycosiswere identified in 227 (64.8%) patients. The majority of the pathogeneticall most significant species belonged to the genus Candida (45.4%). The mold fungi occurred in 30.8% of the patients. In 11.5% of the cases, they occurred together with bacterial microflora and in 6.7% of the cases in association with the yeast fungi. The species of the genus Aspergillus prevailed among the mold fungi. It is concluded that the complicated forms of otomycosisdevelop as a result of infection caused not only by mold fungi but also by yeast fungi and/or associations of the two groups. These findings suggestthe necessity of usingthe differential approach to the prescription of the adequate medications.

[The paranasal sinuses as the nitric oxide depot]. / Okolonosovye pazukhi kak depo oksida azota.

This paper was designed to report the currently available data on physiology of the nasal cavity and paranasal sinuses together with the results of national and international investigations on the computer modeling of the air flow in these structures. Also discussed are the gas composition in the paranasal sinuses and the potential factors responsible for the changes in the concentration of nitric oxide with the chemical formula of NO in the nasal cavity and paranasal sinuses.

[The experimental substantiation of the application of bone cement for the reconstruction of postoperative defects in the walls of paranasal sinuses].

The objective of the present study was to evaluate the biocompatibility of bone cement used in plastic surgery of the anterior wall of the paranasal sinusis. This material was used to shape a fragment corresponding to the bone defect to be placed subperiosteally. This experimental study has demonstrated that the anterior wall of the paranasal sinusis can be reconstructed within 1.5--3 months after surgery owing to the formation of a granulation tissue replaced in the course of time by the connective tissue, coarse-fibred tissue and, locally, bone plate tissue (in that order).

[Comprehensive diagnostics of the patients presenting with Eustachian tube dysfunction].

The objective of the present work was comprehensive diagnostics of Eustachian tube dysfunction as exemplified by 82 patients with this disorder. The examination using the standard techniques was supplemented by active anterior rhinomanometry, audiometry, and tympanometry. Three-dimensional computed tomography (3D X-ray CT) was used for detailed diagnostics of the state of the nasal structures and paranasal sinuses. The study has demonstrated that 96.3% of the patients with Eustachian tube dysfunction suffer a concomitant pathology of the paranasal sinuses, nasal cavity, and nasopharynx. Difficulties of nasal breathing were experienced by 62% of the patients.

[Specific immunological and morphological features of chronic rhinitis].

Samples of mucosal tissue from inferior nasal conchae for histological and immunological studies were collected during surgical intervention on 25 non-allergic patients with different clinical and morphological forms of chronic hypertrophic rhinitis. It was shown that the pathological process extends over all structures of conchal mucosa, namely, epithelium, lamina propria, and cavernous sinuses. However, proliferative activity of the epithelium may be spared, the structure of vascular endothelium, basement membranes of epithelium, glands and blood vessels remains either normal or only slightly affected, IgA synthesis persists, and immunocompetent cells (CD45 RO(+) T-lymphocytes, CD20(+) B-lymphocytes, and CD68(+) macrophages) retain functional activity. Taken together, these findings suggest high regenerative potential of nasal mucosa and preservation of mechanisms of local protection including cellular and humoral immunity despite the on-going pathological process. It implies the necessity of great caution during surgical interventions.