COMBINED APPROACH FOR LARGE TUMORS OF THE NOSE AND PARANASAL SINUSES--CASE REPORT.

Due to the insidious onset and common symptoms, the diagnostic of sinonasal tumors is late in the evolution. Usually, at that time, the preferred endoscopic approach alone is not recommended, therefore a mixed openendoscopic approach appears to be the best choice in terms of exposure of the tumor and a clear margin resection. The purpose of this case report study is to demonstrate the necessity of careful preoperative assessment and the advantages of combined approach for a complete resection and favorable long-term results.

Retromolar trigone--oropharynx junction maligns tumor surgery: transmandibular versus oral approach.

AIM: This study proposes a new approach to a borderline pathology between Otorhinolaryngology (E.N.T.) and Oral and Maxillofacial Surgery (O.M.F.), the malignant tumors of the oropharyngeal and retromolar trigone junction. MATERIAL AND METHODS: 52 cases of retromolar trigone and oropharynx malign tumors were solved in the ENT department of "St. Spiridon" Universitary Hospital Iasi between 2012 and 2014. All patients were males, 35-64 years old, in different TNM stages. The novelty stands in the multidisciplinary approach, with an operating team consisting of both E.N.T. and O.M.F. surgeons, which joined their knowledge and expertise in order to offer a better treatment for the patient. Human Papilloma Virus (HPV) infection has been known as a trigger factor in head and neck cancers. The connection between HPV infection and malignant tumors of the oropharyngeal--retromolar trigone junction, together with the other traditional risk factors (smoking, alcohol, stress and sexual behavior) are involved in the therapeutic protocols, improving the life quality, the survival rate and reducing the treatment costs. RESULTS AND DISCUSSION: Excision of the malignant tumors at the level of the junction between the oropharynx and retromolar trigone often requires repairing the tissular defects that remain using different flaps. Postsurgical mecanotherapy (physiotherapy) under the surveillance of an experienced physiotherapist is also needed for a complete recovery. CONCLUSIONS: This therapeutical protocol aims to assure a better life quality for the patients, with a faster postsurgical recovery and social reinsertion by reducing the healing time of the areas affected by inflammation and necrosis generated by the neoplastic process.

THE TRIBES AND TRIBULATIONS OF LARYNGOPHARYNGEAL REFLUX: A REVIEW OF RECENT STUDIES WITH IMPLICATIONS FOR INTERDISCIPLINARY COLLABORATIONS BETWEEN OTOLARYNGOLOGISTS AND GASTROENTEROLOGISTS.

Laryngopharyngeal reflux has been recognized since 2006 (Montreal Consensus) as an extradigestive manifestation of gastroesophageal reflux disease. However, despite numerous research studies, the relationship between these two pathologies is yet to be fully understood. The aim of this paper is to review the literature of the last five years available via the PubMed database, looking at the controversies about the prevalence, pathophysiology and diagnosis of laryngopharyngeal reflux.

Epidemiological features and management of complex neck trauma from an ENT surgeon's perspective.

OBJECTIVES: The aim of this study is to present a clear picture of the epidemiological aspects pertaining to the cases of neck trauma addressing to the ENT Emergency Room, as well as to display the complexity of the diagnostic and therapeutic management employed in two important Romanian ENTDepartments - "Sfantul Spiridon" Hospital Iasi and SfantaMaria Hospital Bucharest MATERIAL AND METHODS: We conducted a retrospective study on 538 patients with neck trauma that were referred to the abovementioned ENT Departments between March 2009 ­ March 2011, selecting 27 cases with forensic implications. RESULTS: In terms of aetiological mechanism, the most frequentneck injuries in our study were penetrating neck injuries due to assault or self-mutilation with white weapons (knives, razor blades, forks, glass) - 56%, followed by blunt trauma cases due to car accident, strangulation or accidental fall ­ 44%. The most important clinical findings recorded at admission were polytraumas (24.14%), hematomas, fractures, subcutaneous emphysema or skin perforation with visceral damages(representing each 13.8%) and tissue rip (10.34%), important bleedings (6.89%), as well as perforation of neck organs(3.45%). The most frequent postoperative complications were postoperative pharyngo-cutaneous fistula (7.4%) and laryngotrachealstenosis (7.4%). There were also 3 other patients with long-term complications, such as acute mediastinitis (3.4%)recurrential paralysis with Gerhardt's syndrome (3.4%) and dysphagia (3.4%).

Laryngeal morphological changes due to gastroesophageal reflux disease.

UNLABELLED: Chronic laryngitis may have life impact on professional voice users. Besides smoking and excessive alcohol intake, GERD is a determiniing factor in the etiology of dysphonia. AIM: To evaluate the laryngeal alteration due to GERD in professional voice users. MATERIAL AND METHODS: The study included 96 vocal professionals (teachers, actors, singers and priests), 58 males and 38 females, with a mean age of 38.3 +/- 7.5 years, presented for chronic laryngeal symptoms. The patients filled out a standardized questionnaire and were examined laryngoscopically. RESULTS: Laryngeal changes were scaled 0 (absence) to 7 (maximum) - arytenoid edema (5.07 +/- 1.08), interarytenoid edema (6.18 +/- 1.12), vocal folds edema (5.67 +/- 1.04), ventricular bands edema (4.96 +/- 0.97), laryngeal edema 4.12 +/- 0.83). CONCLUSIONS: Laryngoscopic changes may suggest the concomitance of GERD in professional voice users with dysphonia.

[Diagnostic and treatment algorithm for pharyngolaryngeal reflux]. / Algoritm de diagnostic si tratament in faringolaringita de reflux.

Pharyngolaryngeal reflux (PLR) refers to backflow of stomach contents into the throat and larynx. Its diagnosis is difficult because of a variety of atypical symptoms, low sensitivity of traditional tests of gastrointestinal tract, and no consensus on the diagnostic algorithm. The aim of this study was to provide an algorithm for the diagnosis and treatment of PLR. There were no pathognomonic symptoms or findings, but the characteristic symptoms validate the Reflux Symptom Index and Reflux Findings Score as tools in the initial diagnosis. The first approach is empirical medical treatment for 3 month, based on endoscopic findings at laryngofiberscopy; then objective demonstration of reflux events using multichannel intraluminal impedance and pH monitoring. Proton pump inhibitors represent the mainstay of therapy for the patients with PLR, but they require a more aggressive and prolonged treatment than the patients with gastroesophageal symptoms.

[Rare tumors of the neck--report of two cases]. / Tumori rare ale regiunii cervicale--prezentare de caz.

Of the tumors of the neck some are very uncommon, difficult to diagnose both clinically and paraclinically. Two of the most rare tumors are osteolipoma and soft tissue sarcoma. We present 2 such cases admitted to and operated at the ENT Department of the Iasi "St. Spiridon" Emergency Hospital in the last 5 years, with emphasis on the atypical clinical and imaging features of these tumors. Surgery and histopathological examination were the methods used to make the diagnosis.

Laryngotracheal non-Hodgkin's lymphoma.

OBJECTIVES: Malignant lymphomas of larynx and trachea are rare tumors and require special diagnostic and therapeutic attention. The authors present an unexpected case of nonHodgkin Lymphoma localized in the subglottic larynx and upper cervical trachea. The clinical presentation, diagnostic and therapeutic approach, evolution and prognosis are discussed. METHOD: We report a case of 25-year-old male patient, with progressive dyspnea, presented in our ENT Department with severe airway obstruction caused by a large subglottic tumoral mass migrated in the glottic space during an accidental fall. An emergency tracheotomy was performed. The flexible endoscopy and CT-scan revealed a large mass arising from the subglottic larynx and anterior wall of upper cervical trachea with the obstruction of 2/3 of the laryngotracheal lumen. RESULTS: After a complex assessment, the tumor was excised by external approach (median thyrotomy). The histopathologic exam of the surgical specimen showed malignant nonHodgkin lymphoma and the immunohistochemical profiles were evaluated in order to establish the therapeutic strategy including chemotherapy in the Department of Oncology. CONCLUSIONS: Invasion of the subglottic larynx and trachea by lymphoma is an uncommon problem which can cause severe airway obstruction and requires multidisciplinary approach (ENT, pneumology, oncology/hematology). The clinicopathological features of this case have been described and compared with previously reported cases.

[The implications of cervical spine degenerative and traumatic diseases in the pathogenesis of cervical vertigo and hearing loss]. / Implicatiile bolilor degenerative si traumatice ale coloanei cervicale in geneza vertijului cervical si a hipoacuziei.

AIM: Cervical spine together with vestibular system,visual system and proprioceptive afferents plays an important role in mentaining balance. Spine damage causes distortions in transmitting informations to the brain,favoring vertigo. MATERIAL AND METHOD: The authors point out the occurrence of positional vertigo on 23 patients (20 patients with cervical spondylosis and 3 patients with cervical spine injury) due to blood flow disturbance through vertebral artery. RESULTS: The mechano-receptors located in intervertebral disks and cervical spine muscles are activated by column movement. Changes of blood flow in the vertebral and basilar arteries are showed up by cervical X-Rays, intracranial Doppler ultrasound or angio-MRI, an audiogram marking out the degree of hearing loss or tinnitus occurence. ENT complex treatment outcomes are analyzed and balneo-physio-therapy performed in order to improve vertigo and hearing loss. CONCLUSIONS: Stress beside muscle overload and cervical spine injures causes alteration in the ear blood-flow circulation that leads to hearing loss, vertigo and tinnitus. It emphasies the need for collaboration between balneologist and ENT specialist in solving balance and hearing disorders with cervicogenic cause.

[Voice exploratory methods into professional vocal singers]. / Metode de explorare a vocii la solistii profesionisti.

The aims of this study was to evaluated methods of voice explored to professional vocal singers. The modern methods microlaryngoscopy, stroboscopy, electroglottography are presented and comparatively evaluated with classic explorations, as direct and indirect laryngoscopy.

[Reconstructive surgical procedures in the treatment of tissue defects of cervico-facial oncological pathology]. / Metode reconstructive de tratament al defectelor tisulare în chirurgia oncologica cervico-faciala.

The frequency of head and neck cancer is on an ascending path and a lot of cases are discovered in advanced stages. The treatment is difficult and requires the use of reconstructive methods to solve the tissue defects. The authors conducted a retrospective study on 121 cases solved in the ENT Department of "Sf. Spiridon" University Hospital Iasi hospitalized with oncologic pathology in advanced stages, between 2000-2004. The tissue defects after surgical excision were solved by different types of myocutaneous flaps, necessary to cover or reconstruct visceral or cervicofacial tissue defects. We insisted on difficulties and complications that can appear after this kind of oncological surgery. The results of this study generally prove the usefulness of the myocutaneous flaps in the treatment of the advanced head and neck cancer.

[The gastro-esophageal reflux disease and its psycho-somatic component]. / Boala de reflux gastroesofagian si componenta psihosomatica.

Different factors may be involved in the occurrence of gastro-esophageal reflux disease (GERD) symptoms. This review presents the importance of psychic factors in GERD symptom genesis, especially in patients with no esophagitis. In addition, these factors could be involved in the pharmacological therapy, with educational and behavioral implications increasing the cost-efficacy of the therapy.

[Castleman disease of the neck]. / Boala Castleman cu localizare cervicala.

UNLABELLED: Castleman Disease is a rare disorder characterized by benign lymph node hyperplasia involving lymphatic tissue in the neck, mediastinum, abdomen, axilla. There are three types of Castleman Disease: hyalin-vascular type localized nodal involvement, asymptomatic form; plasma cell type and generalized and multicentric type. MATERIAL AND METHOD: Between 2000-2004, 5 cases with Castleman Disease hyalin-vascular type with cervical lymph node involvement were diagnosed and treated in E.N.T. Department of "St. Spiridon" Hospital Iasi. 2 of these cases are presented: a 24 year old male and a 13 year old female were admitted with a asymptomatic neck mass with slow progressive growth. Paraclinical exams (radiology, cervical and abdominal echography, CT scanner) confirmed the lymphadenopathy and excluded another localization. Differential diagnosis included tuberculosis, metastatic lymphadenopathy, lymphoma, branchial cyst etc. RESULTS: The treatment of choice was surgical excision by cervicotomy in all cases, followed by vascular proliferation and hyalinization in affected lymph nodes. Postoperative controls no revealed recurrences. CONCLUSIONS: The prognosis of localized form of Castleman Disease hyalin-vascular tape is better than multicentric form surgical excision is both diagnostic and therapeutic.

[Significance of auditory and kinesthetic feedback in vocal training of young professional singers (students)]. / Importanta feedback-ului auditiv si a celui kinestezic în antrenamentul vocal al tinerilor artisti lirici.

The study was to estimate the significance of auditory and kinesthetic feedback to an accurate control of fundamental frequency (F0) in 18 students beginning a professional singing education. The students sing an ascending and descending triad pattern covering their entire pitch range with and without making noise in legato and staccato and in a slow and fast tempo. F0 was measured by a computer program. The interval sizes between adjacent tones were determined and their departures from equally tempered tuning were calculated, the deviation from this tuning were used as a measure of the accuracy of intonation. Intonation accuracy was reduced by masking noise, by staccato as opposed to legato singing, and by fast as opposed to slow performance. The contribution of the auditory feedback to pitch control was not significantly improved after education, whereas the kinesthetic feedback circuit was improved in slow legato and slow staccato tasks. The results support the assumption that the kinesthetic feedback contributes substantially to intonation accuracy.

[Video-stroboscopy, a method for exploration of laryngeal pathology]. / Videostroboscopia, metoda de explorare în afectiunile laringiene.

The authors present the importance of stroboscopy in the larynx examination. They insist to prove the functional modifies of the voice specially at the singers also all patients who use the voice more frequently. This method permits to make a differential diagnosis between the inflammatory and tumoral diseases of the larynx.

[The surgical importance of the thyro-laryngo-pharyngeal lymphatic interconnections]. / L'importance chirurgicale des interconnexions lymphatiques thyro-laryngo-pharyngiennes.

The paper presents a study of the evolutional morphogenetic stages of the lymphatic and conjunctive neck structures formation. The authors make particular appreciations concerning the pattern of organization and also, the functional connections of lymphatic and conjunctive elements at intravisceral, perivisceral and perivascular level. Our study proves that these structures form the barriers but also, the spread pathways of the tumoral and inflammatory process which, after an endocavitary development, diffuse either on the adjacent organs or to the main cervical lymph nodes. We emphasized the importance of these anatomical structures in the neck oncological surgery.

Therapeutical aspects of the plasmocytoma localized at the level of head and neck.

The authors present a study on 7 cases of extramedullary plasmocytoma localized in E.N.T. area, hospitalized and solved in the E.N.T. Department of the the "Sf. Spiridon" Universitary Hospital, in the last 15 years, between 1983-1997. We insist on the last solved case, presenting a double isolated localization, a laryngeal and a rhinosinusal one. We consider that the most indicated treatment in the isolated extramedullary plasmocytoma, is the radiosurgical therapy with a good rate of survival.

A retrospective study of the cervico-facial nervous tumours from the E.N.T. Department of Iassy, Romania, during 1975-1995.

The schwannomas situated at the neck or at the lower part of the skull are rare; very often they appear as on isolated tumoural mass with borrowed symptoms due to the compression of the surrounding structures, signs intra-operation objectivated and anatomo-pathologically confirmed. The authors present statistically the cases of cervico-facial schwannoma hospitalized and surgically solved in the O.R.L. I Clinic Iasi during 1975-1995, which are 17 cases, statistics that correspond to the others from the specialized literature. The cases were confirmed histologically; there was just one case of malignant degeneration of a double schwannoma. In the following pages we present the last 2 cases of schwannomas hospitalized and solved in the O.R.L. I Clinic Iasi.