Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study / Tampão nasal absorvível embebido em esteroides versus antibióticos para cicatrização de feridas após cirurgia endoscópica nasossinusal: estudo randomizado, duplo cego, placebo controlado

Abstract Introduction: Endoscopic sinus surgery can lead to crusting or synechiae formation, which can affect the healing process. Objective: The aim of our study was to compare the influence of steroid versus antibiotic versus saline solution impregnated absorbable nasal spacers on postoperative wound healing and patient satisfaction. Methods: Eighty patients, 33 women and 47 men, were enrolled in this study. At the end of the surgery, two pieces of 4 cm biodegradable material were applied in each ethmoid cavity. One of them was impregnated with saline solution, while the second one with steroid, or with antibiotic. Results: We observed statistically significant differences in the Lund-Kennedy score between the control and both treatment groups: for the Antibiotic-group on days 10 and 30 (p = 0.009; p = 0.009) and for the Steroid-group on day 90 (p = 0.008). The extended endoscopic appearance of nasal mucosa indicated statistically significant differences in crust formation on day 10 comparing the steroid and control dressing (p = 0.025), in secretion type on days 10 and 30 comparing the antibiotic and control dressing (p = 0.003; p = 0.016) and additionally for steroid and control on day 90 (p = 0.046). On Day 90 we observed statistically significant differences in the absence of mucosal edema in the S-group compared to controls (p = 0.007). Conclusions: The results of this study reveal the significant positive influence of steroid- and antibiotic-impregnated biodegradable nasal packing on the postoperative healing process and patient satisfaction compared to the saline soaked dressing.

Resumo Introdução: A cirurgia endoscópica nasossinusal pode levar à formação de crostas e sinéquias, o que pode afetar o processo de cicatrização. Objetivo: O objetivo do nosso estudo foi comparar a influência do espaçador nasal absorvível embebido em esteroide versus antibiótico versus solução salina na cicatrização de ferida pós-operatória e na satisfação do paciente. Método: Oitenta pacientes, 33 mulheres e 47 homens, foram incluídos neste estudo. Ao final da cirurgia, dois tampões de material biodegradável de 4 cm foram aplicados em cada cavidade etmoidal. Um deles foi embebido em solução salina, enquanto no segundo foi utilizado esteroide, ou antibiótico. Resultados: Observamos diferenças estatisticamente significantes no escore de Lund-Kennedy entre os grupos controle e ambos os grupos tratamentos: para o grupo antibiótico nos dias 10 e 30 (p = 0,009; p = 0,009) e para o grupo esteroide no dia 90 (p = 0,008). O aspecto endoscópico da mucosa nasal indicou diferenças estatisticamente significantes na formação de crostas no dia 10, na comparação do esteroide com o curativo controle (p = 0,025), no tipo de secreção nos dias 10 e 30, na comparação do antibiótico com o curativo controle (p = 0,003; p = 0,016) e adicionalmente para esteroide e controle no dia 90 (p = 0,046). No dia 90, observamos diferenças estatisticamente significantes na ausência de edema da mucosa no grupo E (esteroide) em relação aos controles (p = 0,007). Conclusões: Os resultados deste estudo revelam uma influência positiva significante no uso de tampão nasal biodegradável embebido em esteroides e antibióticos no processo de cicatrização pós-operatória e satisfação do paciente em comparação com o curativo embebido em solução salina.

Expression of Matrix Metalloproteinase-2/9 and Tissue Inhibitor of Metalloproteinase-1/2 as Predictive Factors in Oropharyngeal Squamous Cell Carcinoma.

INTRODUCTION: Metalloproteinases and their tissue inhibitors play an important role in the metastases formation. A multistage process of carcinogenesis requires the involvement of numerous enzymes and compounds that facilitate the expansion of tumor cells. The formation of metastases depends on both metalloproteinases and tissue inhibitors activation leading to the activation of neoangiogenesis. The changes of the expression in stromal and tumor proteins could be prognostic factors in patients with oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS: This study was conducted on a total of 34 patients with squamous cell carcinoma of the oropharynx divided into 2 groups, including 20 patients with neck metastasis and 14 patients without lymph node metastasis. Immunohistochemistry was performed with a standard protocol. RESULTS: The results of the present analysis indicated a higher expression of metalloproteinases 2 in the stroma than in tumor with increasing tumor grade. The dynamics of changes in the expression of metalloproteinases showed the increase in metalloproteinases 2 and the decrease in metalloproteinases 9 depending on the tumor size. Dynamics of changes in the expression of tissue inhibitor 1 in the tumor stroma significantly increased with the tumor stage. In the assessment of nodal staging from N0 to N3, the expression of tissue inhibitor 1 and 2 were higher in the tumor tissues. The increase of metalloproteinases 2, tissue inhibitor 1 in the tumor, and metalloproteinases 9 in the stroma were characterized by a reduction in the odds ratio of patient's survival. CONCLUSION: The complex evaluation of the expression of metalloproteinases and tissue inhibitors may be used for the prognosis of the patient's survival.

Steroid vs. antibiotic impregnated absorbable nasal packing for wound healing after endoscopic sinus surgery: a randomized, double blind, placebo-controlled study.

INTRODUCTION: Endoscopic sinus surgery can lead to crusting or synechiae formation, which can affect the healing process. OBJECTIVE: The aim of our study was to compare the influence of steroid versus antibiotic versus saline solution impregnated absorbable nasal spacers on postoperative wound healing and patient satisfaction. METHODS: Eighty patients, 33 women and 47 men, were enrolled in this study. At the end of the surgery, two pieces of 4cm biodegradable material were applied in each ethmoid cavity. One of them was impregnated with saline solution, while the second one with steroid, or with antibiotic. RESULTS: We observed statistically significant differences in the Lund-Kennedy score between the control and both treatment groups: for the Antibiotic-group on days 10 and 30 (p=0.009; p=0.009) and for the Steroid-group on day 90 (p=0.008). The extended endoscopic appearance of nasal mucosa indicated statistically significant differences in crust formation on day 10 comparing the steroid and control dressing (p=0.025), in secretion type on days 10 and 30 comparing the antibiotic and control dressing (p=0.003; p=0.016) and additionally for steroid and control on day 90 (p=0.046). On Day 90 we observed statistically significant differences in the absence of mucosal edema in the S-group compared to controls (p=0.007). CONCLUSIONS: The results of this study reveal the significant positive influence of steroid- and antibiotic-impregnated biodegradable nasal packing on the postoperative healing process and patient satisfaction compared to the saline soaked dressing.

Ophthalmic complications of endoscopic sinus surgery / Complicações oftálmicas da cirurgia endoscópica dos seios nasais

Abstract Introduction: The proximity of the paranasal sinuses to the orbit and its contents allows the occurence of injuries in both primary or revision surgery. The majority of orbital complications are minor. The major complications are seen in 0.01-2.25% and some of them can be serious, leading to permanent dysfunction. Objective: The aim of this study was to determine the risk and type of ophthalmic complications among patients operated due to a chronic rhinosinusitis. Methods: This is a retrospective study of 1658 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with or without polyps or mucocele. Surgeries were performed under general anesthesia in all cases and consisted of polyps' removal, followed by middle metal antrostomy, partial or complete ethmoidectomy, frontal recess surgery and sphenoid surgery if necessary. The ophthalmic complications were classified according to type, frequency and clinical findings. Results: In our material 32.68% of the patients required revision surgery and only 10.1% had been previously operated in our Department. Overall complications occurred in 11 patients (0.66%). Minor complications were observed in 5 patients (0.3%) with the most frequent being periorbital ecchymosis with or without emphysema. Major complications were observed in one patient (0.06%) and were related to a lacrimal duct injury. Severe complications occurred in 5 cases (0.3%), with 2 cases and referred to a retroorbital hematoma, optic nerve injury (2 cases) and one case of extraocular muscle injury. Conclusions: Orbital complications of endoscopic nasal surgery are rare. The incidence of serious complications, causing permanent disabilities is less than 0.3%. The most important parameters responsible for complications are extension of the disease, previous endoscopic surgery and coexisting anticoagulant treatment.

Resumo Introdução: A proximidade dos seios paranasais à órbita e seu conteúdo tornam possível a ocorrência de lesões tanto na cirurgia primária como na de revisão. A maioria das complicações orbitais são menores. As maiores são observadas em 0,01%-2,25% e algumas delas podem ser graves levando a disfunção permanente. Objetivo: O objetivo deste estudo foi identificar o risco e o tipo de complicações oftalmológicas em pacientes operados devido a rinossinusite crônica. Método: Foi realizado um estudo retrospectivo com 1.658 pacientes submetidos a cirurgia endoscópica sinusal devido a rinossinusite crônica com ou sem pólipos ou mucocele. As cirurgias foram realizadas sob anestesia geral em todos os casos e consistiram de remoção de pólipos, seguida de antrostomia meatal média ou etmoidectomia parcial ou completa, cirurgia de recesso frontal e cirurgia de esfenoide se necessário. As complicações oftalmológicas foram classificadas de acordo com o tipo, frequência e achados clínicos. Resultados: Em nosso material 32,68% dos pacientes necessitaram de cirurgia de revisão e apenas 10,1% haviam sido anteriormente operados em nosso departamento. As complicações gerais ocorreram em 11 pacientes (0,66%). Complicações menores foram observadas em 5 pacientes (0,3%), sendo que a mais frequente foi equimose periorbital com ou sem enfisema. Complicações maiores foram observadas em um paciente (0,06%) e atribuída à lesão do ducto lacrimal. Complicações graves ocorreram em 5 casos (0,3%) e foram referidas como hematoma retrorbital (2 casos), lesão do nervo óptico (2 casos) e um caso de lesão muscular extraocular. Conclusões: As complicações orbitais da cirurgia endoscópica nasal são raras. A incidência de complicações graves que causam incapacidade permanente é de menos de 0,3%. Os parâmetros mais importantes responsáveis por complicações são extensão da doença, cirurgia endoscópica anterior e tratamento anticoagulante coexistente.

Clinical outcome and patient satisfaction using biodegradable (NasoPore) and non-biodegradable packing, a double-blind, prospective, randomized study / Desfecho clínico e satisfação do paciente com o uso de tampão biodegradável (NasoPore) e não biodegradável: estudo prospectivo, duplo-cego e randomizado

Abstract Introduction Nasal packing after endoscopic sinus surgery is used as a standard procedure. The optimum solution to minimize or eliminate all disadvantages of this procedure may be accomplished using biodegradable packs. Objective The aim of this study was to compare patient satisfaction and clinical outcome associated with absorbable and non-absorbable packing after FESS. Methods In total, 50 patients were included in a prospective, double-blind, randomized trial. One side was packed with polyurethane foam, while the opposite side was packed with gauze packing. On the 2nd, 10th, and 30th postoperative day, the patients were questioned with the aid of a visual analog scale. The standardized questionnaires for bleeding, nasal breathing, feeling of pressure, and headache were used. The presence of synechiae, infection, or granulation was noted and recorded with the video-endoscopy. Results A significant difference according to lower pressure was found in the NasoPore group compared to the controls on day ten after surgery. The NasoPore packing had lower scores with respect to postoperative nose blockage on the 2nd and 10th days. Mucosal healing was better for the NasoPore group, both at day ten and 30 compared with the control group. Conclusion The overall patient comfort is higher when using NasoPore compared to non-resorbable traditional impregnated gauze packing. Intensive saline douches applied three to four times per day are mandatory after the operation to prevent synechiae formation and fluid resorption by the packing.

Resumo Introdução O tamponamento nasal após cirurgia sinusal endoscópica é procedimento de rotina. A solução ideal para minimizar ou eliminar as desvantagens desse procedimento pode ser alcançada com o uso de tampões biodegradáveis. Objetivo Comparar a satisfação do paciente e o desfecho clínico associados ao uso de tampões absorvíveis e não absorvíveis após a cirurgia funcional dos seios paranasais (FESS- Functional Endoscopic Sinus Surgery). Método Foram incluídos 50 pacientes neste estudo prospectivo, duplo-cego e randomizado. Um dos lados foi tamponado com espuma de poliuretano, enquanto no outro lado foi feito um tamponamento com gaze. Nos 2º, 10º e 30º dias após a operação, os pacientes foram perguntados com a ajuda de uma escala analógica visual. Foram empregados questionários padronizados para sangramento, respiração nasal, sensação de pressão e cefaleia. A presença de sinequias, infecção ou granulação foi registrada por videoendoscopia. Resultados Foi observada diferença significante, da sensação de pressão, menor no lado tratado com NasoPore vs. controles no 10º dia após a cirurgia. O tamponamento com NasoPore obteve escores mais baixos com respeito ao bloqueio nasal pós-operatório no 2º e 10º dias. A cicatrização da mucosa foi melhor no lado do NasoPore, mas no 10º e 30º dias os resultados foram comparáveis com os do lado de controle. Conclusão O conforto geral do paciente é maior com o uso de NasoPore vs. tamponamento tradicional com gaze besuntada não reabsorvível. O uso vigoroso de jatos de solução salina aplicados 3-4 vezes ao dia é um procedimento obrigatório após a cirurgia, para evitar a formação de sinequias e para uma absorção natural do tampão.

Clinical outcome and patient satisfaction using biodegradable (NasoPore) and non-biodegradable packing, a double-blind, prospective, randomized study.

INTRODUCTION: Nasal packing after endoscopic sinus surgery is used as a standard procedure. The optimum solution to minimize or eliminate all disadvantages of this procedure may be accomplished using biodegradable packs. OBJECTIVE: The aim of this study was to compare patient satisfaction and clinical outcome associated with absorbable and non-absorbable packing after FESS. METHODS: In total, 50 patients were included in a prospective, double-blind, randomized trial. One side was packed with polyurethane foam, while the opposite side was packed with gauze packing. On the 2nd, 10th, and 30th postoperative day, the patients were questioned with the aid of a visual analog scale. The standardized questionnaires for bleeding, nasal breathing, feeling of pressure, and headache were used. The presence of synechiae, infection, or granulation was noted and recorded with the video-endoscopy. RESULTS: A significant difference according to lower pressure was found in the NasoPore group compared to the controls on day ten after surgery. The NasoPore packing had lower scores with respect to postoperative nose blockage on the 2nd and 10th days. Mucosal healing was better for the NasoPore group, both at day ten and 30 compared with the control group. CONCLUSION: The overall patient comfort is higher when using NasoPore compared to non-resorbable traditional impregnated gauze packing. Intensive saline douches applied three to four times per day are mandatory after the operation to prevent synechiae formation and fluid resorption by the packing.

Ophthalmic complications of endoscopic sinus surgery.

INTRODUCTION: The proximity of the paranasal sinuses to the orbit and its contents allows the occurence of injuries in both primary or revision surgery. The majority of orbital complications are minor. The major complications are seen in 0.01-2.25% and some of them can be serious, leading to permanent dysfunction. OBJECTIVE: The aim of this study was to determine the risk and type of ophthalmic complications among patients operated due to a chronic rhinosinusitis. METHODS: This is a retrospective study of 1658 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with or without polyps or mucocele. Surgeries were performed under general anesthesia in all cases and consisted of polyps' removal, followed by middle metal antrostomy, partial or complete ethmoidectomy, frontal recess surgery and sphenoid surgery if necessary. The ophthalmic complications were classified according to type, frequency and clinical findings. RESULTS: In our material 32.68% of the patients required revision surgery and only 10.1% had been previously operated in our Department. Overall complications occurred in 11 patients (0.66%). Minor complications were observed in 5 patients (0.3%) with the most frequent being periorbital ecchymosis with or without emphysema. Major complications were observed in one patient (0.06%) and were related to a lacrimal duct injury. Severe complications occurred in 5 cases (0.3%), with 2 cases and referred to a retroorbital hematoma, optic nerve injury (2 cases) and one case of extraocular muscle injury. CONCLUSIONS: Orbital complications of endoscopic nasal surgery are rare. The incidence of serious complications, causing permanent disabilities is less than 0.3%. The most important parameters responsible for complications are extension of the disease, previous endoscopic surgery and coexisting anticoagulant treatment.

Assessment of voice quality after carbon dioxide laser and microdebrider surgery for Reinke edema.

OBJECTIVES: Surgery of Reinke edema requires reduction of the degenerated superficial lamina propria and preservation of the vibratory epithelium. MATERIAL AND METHODS: Sixteen patients were included for microdebrider and 10 patients for carbon dioxide (CO2) laser surgery. Vocal analysis was performed before and at 1 and 3 months after surgery. Subjective rating of voice quality was completed by the grade, roughness, breathiness, asthenia, and strain scale. The objective assessment was conducted by Multi-Dimensional Voice Program software. RESULTS: We found consistent improvement in all parameters both in CO2 laser and microdebrider group. The normalization of all parameters were statistically better after microdebrider surgery. The most statistically significant improvements were accounted in reduction in grade of hoarseness, roughness, and asthenia and acoustic analysis. CONCLUSIONS: Microdebrider is a useful and safe tool for Reinke edema treatment. The oscillatory cutting knife and low suction protect lamina propria resulting in better vibratory function.

Association between infection of virulence cagA gene Helicobacter pylori and laryngeal squamous cell carcinoma.

BACKGROUND: The aim of the study was to evaluate the presence of cagA gene Helicobacter pylori in etiopathogenesis of initiation and development of larynx squamous cell carcinoma (LSCC) and its predictable role as a prognostic factor. MATERIAL AND METHODS: The prospective, controlled study involved a series of 75 patients (65 male, 10 female, mean age 59.1 years, range 43 to 79 years) with larynx cancer. Samples of larynx cancerous tissue, each of 10-15 mg, were obtained from fresh tissues and were used for nucleic acid purification. DNA was extracted from 225 samples (larynx tumor - I (75), margin of tumor and normal tissue - II (75) and normal larynx tissue from opposite side to the tumor - III). All samples were subjected to H. pylori ureA detection by the PCR H. pylori diagnostic test. Samples that were positive for ureA H. pylori gene were evaluated for cagA H. pylori gene. RESULTS: Presence of H. pylori cagA gene was identified in 46,7% to 49,3% of 75 H. pylori ureA gene-positive larynx cancer depending of tissue location. There was a correlation of high incidence of positive cagA gene in larynx cancer tissue in supraglottic versus subglottic and glottic location. We observed a predominance of cagA gene in LSCC in patients with positive cervical lymph nodes and clinical stage T3 and T4. CONCLUSIONS: H. pylori is present in larynx tissue and may be a possible carcinogen or co-carcinogen in LSCC development, but that must be addressed by future investigations. The presence of cagA gene in larynx cancer tissues significantly decreases survival rate and increases the disease recurrence possibilities.

[Multiple bilateral lymphatic adenomas of the parotid glands]. / Mnogie obustronne gruczolaki limfatyczne slinianek przyusznych.

INTRODUCTION: Multiple primary tumours of the parotid glands are very rare. They may occur unilaterally or bilaterally, synchronously or metachronously. Whartin's tumour is mostly find in bilateral parotid gland tumours. MATERIAL AND METHODS: The authors present an unusual case of 60 years old man with bilateral, multifocal Whartin's tumour of the parotid glands. The tumours have appeared synchronously two years before the diagnosis was done. We performed bilateral superficial partial parotidectomy with removal of the tumours. RESULTS AND CONCLUSION: The multifocal, synchronous bilateral Whartin's tumours of the parotid glands are very rare. Minimal surgery procedures with tumour excision is the method of choice. The recurrence rate is very low.

Parapharyngeal space foreign body.

We present a case of an unusual toothbrush foreign body in the parapharyngeal space in a 1.5-year-old child. Children are most affected by this kind of trauma. Quicker and exact diagnosis guarantee proper treatment and recovery. The toothbrush had broken and one-third (about 6 cm) of it was left in the child's mouth, causing some swallowing problems. We do not observe any injury of neurovascular structures or inflammation complications. Under general anesthesia, neck exploration was undertaken and the toothbrush removed. External exploration of the neck is the method of choice in the treatment of big parapharyngeal space foreign body as we demonstrated in our case. This method guarantees a good exposure of the neurovascular structures of the neck.

[Antioxidants enzymes activity and concentration of lipid peroxidation products in chronic tonsillitis before and after surgery]. / Aktywnosc enzymów antyoksydacyjnych i poziom produktów peroksydacji lipidów w przebiegu przewleklego zapalenia migdalków podniebiennych przed operacja i po operacji.

INTRODUCTION: Chronic tonsillitis is one of the most often disease in otolaryngological practice. Free radicals release during chronic inflammation process are responsible for tissue destruction. The aim of the study was to estimate the free radicals production and the activity of antioxidative enzymes during chronic tonsillitis before and after surgery. MATERIAL AND METHODS: The study was performed in group of 60 patients and 32 healthy persons as a control group. We analized the activity of enzymes in blood and serum from the patients before the operation and on 7 day, 4 week and 6 months after the operation. RESULTS: The obtained results shows a lower activity of superoxide dismutase before the operation. After the surgery the activity of the enzyme increased to values observed in control group. The catalase and glutathione peroxidase activity were higher during chronic inflammation, and after the operation the activity decreased, but it was still higher then in control group. Concentration of lipid peroxides products (malondialdehyde) in erythrocytes and serum were higher before the surgery. Then the concentration decreased to values observed in healthy subjects. CONCLUSIONS: The measuring and monitoring the activity of antioxidative enzymes and the concentration of lipid peroxidation products (malondialdehyde) could be useful in proper diagnosis of chronic tonsillitis and in adequately early qualification for surgery.