Two-centre experience in the treatment of thyroglossal duct remnants using the modified muscle-sparing Sistrunk technique.

The Sistrunk procedure has long been the method of choice for treating patients with thyroglossal duct remnants (TDRs). However, the extent of the surgical resection in the suprahyoid segment of the TDR remains controversial, as this anatomical site is the origin of both disease recurrence and surgical morbidity. The aim of this two-centre retrospective cohort study was to investigate the outcomes of a modified muscle-sparing Sistrunk procedure in primary TDRs. The primary predictor was the surgical approach, and the outcome variable was the recurrence rate. A total of 110 consecutive patients (62 (56.4%) male, 48 (43.6%) female) who underwent a modified muscle-sparing Sistrunk procedure were included in the study. Their mean age at presentation was 26.9 ± 18.9 years. A modified muscle-sparing Sistrunk procedure using cold instruments, electrocautery, and a harmonic scalpel was performed in all patients. Recurrence was recorded in six (5.5%) patients. The median hospital stay was 2 days (range 1-7 days), and the median follow-up duration was 7 years (range 2-13 years). There was no significant difference in recurrence rate between the conventional and modified muscle-sparing Sistrunk procedure in primary TDRs. The study findings showed that the modified muscle-sparing Sistrunk procedure had low recurrence and complication rates in the context of primary TDR.

Endonasal endoscopic resection of ossifying fibroma involving the ethmoid sinus, orbit and anterior skull base: case report and literature review.

Ossifying fibroma is a benign fibro-osseous tumour that rarely involves the ethmoid sinuses and orbit. It is classified as a benign fibroosseous lesion, a term that is synonymous with a variety of lesions reported in the literature. Recurrence rate with deleterious effects in cases of extramandibular ossifying fibroma is the impetus for open en bloc resection of the tumour. Continuously evolving techniques in endonasal endoscopic sinus surgery has rendered resection of large benign sinonasal and cephalonasal tumours possible. The authors report a case of ossifying fibroma involving the ethmoid sinus, orbit and anterior skull base in a 65-year-old previously healthy woman completely resected by endonasal endoscopic sinus surgery. The patient was free from postoperative complications and was dismissed from hospital on the sixth postoperative day. At present, the patient is disease-free at a regular five-year postoperative follow-up. Endonasal endoscopic resection of sinonasal ossifying fibromas is an excellent therapeutic option when performed by a surgeon experienced in endoscopic sinonasal surgery. The advantages of an endonasal endoscopic approach include direct visualization, enhanced visibility and magnification resulting in decreased intraoperative and postoperative morbidity. Aesthetic outcome is excellent in the absence of facial scars.

Could nasal septal deformities type 5 and 6 be a predictive factor of the indi- vidual genetic predilection for the onset of an acute coronary syndrome?.

OBJECTIVES: the possible impact of nasal septal deformities (SD) on cardiac pathology has not been well studied, despite growing evidence among data showing that upper air-way obstruction has a negative effect on cardiac function in general and a "deviated nasal septum" being considered one of the most frequent factors responsible for impaired nasal breathing. METHODS: a retrospective, case-control, double-blind study was performed on 249 patients who survived an acute coronary syndrome (ACS) attack. All patients underwent coronary angiography and were divided into coronary angiography positive (123 pts) and coronary angiography negative (126 pts) groups. The quality of nasal breathing was not considered in this study, but morphological aspects of the nasal septum (nasal septal deformities) were observed by anterior native rhinoscopy and endoscopic examination of the nose following the application of superficial anaesthesia. Mladina classification of nasal septal deformities was used. RESULTS: there was a statistically significant difference between coronary angiography negative and positive patients in Mladina type 1 to Mladina type 7 groups (p=0.000, X²=54.605). The incidence of nasal SD types 5 and 6 was higher in the group of ACS patients with the positive coronary angiography, whereas general distribution of the particular types of nasal septal deformities as they appear in the general population was found in the coronary angiography negative group. CONCLUSION: the fact that types 5 and 6 are inherited deformities and not related to trauma against the nose suggests the possible genetic predisposition for the onset of ACS with positive coronary angiography.

Nasal septal deformities in chronic rhinosinusitis patients: clinical and radiological aspects.

Septal deformities are very frequent in patients suffering from chronic rhinosinusitis (CRS). The question is whether or not some types of septal deformities are involved more frequently in this process or not. The authors observed the incidence of particular types of septal deformities in a group of CRS patients using Mladina classification. The same has been done with a control group that consisted of healthy volunteers. In the literature, type 7 has been found very frequently, i.e. in nearly 30% of all CRS cases. Herein, type 7 was mostly composed of types 3 and 5. Type 3 can be accurately recognised on axial MSCT scans, while type 5 can be accurately recognised on coronal views. Concomitant septal surgery at the time of endoscopic sinus surgery is recommended.

An animal model for endoscopic endonasal surgery and dacryocystorhinostomy training: uses and limitations of the lamb's head.

OBJECTIVES: Structured training in endoscopic sinus surgery is essential, considering the serious potential complications. We have developed a detailed endoscopic endonasal surgery training programme, using a lamb's head model. This study aimed to assess the possibilities of using such a model for endoscopic dacryocystorhinostomy training. MATERIALS AND METHODS: Dacryocystography was performed on lamb's head models, which were then meticulously dissected, both macroscopically and endoscopically, to assess the nasolacrimal system. RESULTS: Dacryocystography showed the absence of a lacrimal sac in all the lamb's heads dissected. This result was confirmed by dissection. CONCLUSION: Lamb's heads are excellent models with which to teach endoscopic sinus surgery techniques. However, this study clearly demonstrated the absence of a lacrimal sac in all such models dissected. Thus, this animal model is inappropriate for endoscopic dacryocystorhinostomy training.

A biofilm exists on healthy mucosa of the paranasal sinuses: a prospectively performed, blinded, scanning electron microscope study.

OBJECTIVES: Based on our hypothesis that biofilm is nothing else but normal, otherwise abundantly colonised mucosal mucous blanket, the aim of this study was to check out whether bacterial biofilm exists exclusively at the diseased mucosal surfaces or at healthy mucosa of paranasal sinuses as well. DESIGN: Prospective and blinded. SETTING: Tertiary academic hospital. PARTICIPANTS: The patients suffering from the diseases not related to the chronic inflammation of the paranasal sinuses. Mucosal tissue samples from healthy sphenoid sinuses were taken from 48 patients who underwent pituitary gland surgery and from ethmoidal sinuses mucosa of the 17 patients who underwent endonasal endoscopic orbital decompression because of Graves' disease. MAIN OUTCOME MEASURES: The samples were submitted blindly along with similar samples from patients with chronic rhinosinusitis to two scanning electron microscope experts. In all samples the looked for the main signs of biofilm presence of: the 'towers', rod-shaped bacteria and water channels. RESULTS: Signs of biofilm presence were found in 45 out of 48 pituitary gland surgery patients (94%) and in all of 17 EEOD patients (100%). CONCLUSIONS: Our study showed the presence of the biofilm at the surface of the healthy mucosa of the paranasal sinuses. This suggests that perhaps so called bacterial biofilm is nothing else but regular respiratory mucosal blanket, a part of the mucociliary system itself, containing a great number of bacteria.

Cervical necrotizing fasciitis: sources and outcomes.

BACKGROUND: Abscesses of the peritonsillar region are among the most common deep abscesses of the head and neck. However, cervical necrotizing fasciitis (CNF) associated with a peritonsillar abscess is an extremely rare condition, with only 12 well-documented cases described. PATIENTS: We reviewed and compared all 12 cases of CNF arising from peritonsillar abscesses, including our own case. CNF that developed after peritonsillar abscesses was also compared with that developing predominantly after odontogenic infection. RESULTS: The overall mortality was higher in the group with peritonsillar abscesses (33% vs 25%). CONCLUSION: It is probable that of all cases of CNF, that arising from peritonsillar abscess has the worst prognosis.

Necrotizing fasciitis after peritonsillar abscess in an immunocompetent patient.

Cervical necrotizing fasciitis (CNF) is a rapidly progressive, severe bacterial infection of the fascial planes of the head and neck. Group A beta haemolytic Streptococcus spp. (GABHS), Staphylococcus spp., or obligatory anaerobic bacteria are the most common causative pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CNF. Review of the literature reveals only seven such cases, with four successful outcomes. The authors present the case of a 50-year-old immunocompetent female with CNF arising from a peritonsillar abscess. Intravenous immunoglobulins in conjunction with surgery and antibiotics were used successfully. The authors also suggest the importance of the early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and possible usefulness of the intravenous immunoglobulins in the treatment of CNF, especially when the disease is associated with toxic shock syndrome.

[Post-streptococcal reactive arthritis: diagnostic problems]. / Poststreptokokni reaktivni artritis: dijagnosticke teskoce.

The authors present clinical, microbiological and scintigraphic findings in eight children with poststreptococcal reactive arthritis, hospitalized in the Zadar General Hospital from 1990 to 1992. In all patients an antecedent throat infection was noticed, 7-10 days before the first symptoms and signs of arthritis developed. Antistreptolysin O microtitration and/or throat culture revealed streptococcal infection in all patients. Scintigraphic examination with Te-99m yielded four positive (50%) results. In the follow-up one of the positive scans was later suggestive of tumorous process. The authors conclude that accurate diagnosis of poststreptococcal reactive arthritis depends on microbiological identification of streptococcal infection and longitudinal clinical follow-up in which scintigraphy may be of differential diagnostic benefit.