Oral cavity morphology among children at risk of sleep disordered breathing.

PURPOSE: The aim of this study was to evaluate oral cavity morphology in children at risk of sleep disordered breathing (SDB). METHODS: The study included children 3-17 years of age. The risk of SDB was evaluated using the paediatric sleep questionnaire (PSQ); afterwards, children at risk of SDB were enrolled in the study group. A control group was randomly established from patients with negative PSQ results. The oral cavity morphology evaluation included assessment of the oropharynx using Mallampati classification (MC), palatine tonsil size using the Pirquet scale, occlusion and the presence of a high-arched palate and lingual frenulum. RESULTS: A total of 131 children were evaluated, 65 in the study and 66 in the control group. The mean ages were 9.5 ± 3.0 and 9.4 ± 3.1 years, respectively. The presence of higher scores on the MC, higher scores in the Pirquet scale, a crossbite, a high-arched palate and a short frenulum were significantly more frequent in the study group than the control group. CONCLUSION: The evaluation of oral morphology is an important part of paediatric examination. Enlarged palatine tonsils; higher scores on the MC; and the presence of a crossbite, short lingual frenulum and high-arched palate may suggest abnormal breathing during sleep in children.

Inflammatory cytokines gene expression in bone tissue from patients with chronic rhinosinusitis- a preliminary study.

BACKGROUND: It is unclear whether mucosal inflammation has an effect on the bone under the mucosa in patients with chronic rhinosinusitis (CRS). OBJECTIVES: The aim of this study was evaluation of inflammatory cytokines genes expression in bone tissue taken from the patients who had undergone endoscopic sinus surgery for CRS. METHODS: A total group of a consecutive 49 patients with diagnosis of chronic rhinosinusitis based on EPOS 2007 criteria undergoing endoscopic sinus surgery for CRS were enrolled in the study. Based on histopathologic findings of the mucosal and bone tissues we evaluated the rate of inflammation. Expression of target genes: interleukin 1ß (IL1ß), interleukin 6 (IL6), interleukin 11 (IL11), tumor growth factor ß (TGF ß) and tumor necrosis factor α (TNF α) were analysed by real-time PCR method in samples of the ethmoid bone taken during endoscopic sinus surgery for CRS. RESULTS: Based on histopathological findings in the studied population we found symptoms of osteitis in 5 patients. In the studied population we found significant differences between patients with osteitis and without osteitis with respect to IL6 gene expression in bone tissue (p=0.0003), IL11 gene expression (p=0.02) and TNFα gene expression in bone tissue (p=0.0035). CONCLUSION: In our study we have demonstrated that in some patients with CRS and coexisting symptoms of osteitis some inflammatory markers genes expression are increased in this population.

[Endoscopic intranasal microsurgery in the management of cerebrospinal fluid rhinorrhea]. / Zastosowanie endoskopowej mikrochirurgii wewnatrznosowej w leczeniu plynotoku nosowego.

The surgical management of cerebrospinal fluid rhinorrhoea has changed significantly after the introduction of functional endoscopic sinus surgery in the management of chronic rhinosinusitis. It gave the excellent visualization and atraumatic surgical technique in the management of eight cases of cerebrospinal fluid leaks treated in Department of Otolaryngology Medical University of Warsaw. Five of them were grafted with a pedicled middle turbinate mucosal flap. In the next three cases cerebrospinal fluid leaks came from sphenoid sinus and were stopped by free autograft of temporal fascia or abdominal fat. The indications and the advantages of the endoscopic management of cerebrospinal fluid leaks were discussed.

[The concentration of IgE antibodies in patients with cystic fibrosis]. / Stezenie IgE u pacjentów z mukowiscydoza.

The aim of the study was to evaluate the total IgE levels and correlation between total IgE concentration in CF and allergy rhinitis patients and in healthy donors, as well as estimation of the activity of some groups of allergens by measurement of specific IgE concentration. The purpose of the study was to estimate correlation between concentration of specific IgE and skin prick tests. The concentration of total and specific IgE was measured by immunoassay. The study groups contained 16 with CF and 10 with allergy rhinitis patients, the control group contain 15 healthy donors. The highest concentration of total IgE we noted in rhinitis subjects, statistically higher than in CF patients and in the control group. The analysis of the concentration of specific IgE showed that allergens as dermatophagoides, food and grasses are the most effective in CF patients. We did not found correlation between specific IgE level and skin prick tests.

Extent of pathological changes in the paranasal sinuses of patients with cystic fibrosis: CT analysis.

The aim of the study was to define the characteristic changes revealed by computed tomography (CT) examination of the paranasal sinuses in patients with cystic fibrosis (CF). The group of 30 CF patients was evaluated in the outpatient clinic of the Department of Otorhinolaryngology, Medical University of Warsaw, from 1996 to 1998. The control group consisted of 30 patients with chronic rhinosinusitis (CRS). CT scans were obtained from both groups of patients, and findings revealed more advanced pathological changes in the CF than CRS group. The extensive inflammatory process observed in CT scans of CF patients resulted in the impairment of frontal and maxillary sinus development, destruction of bony structures, and medial projection of the lateral nasal wall.

Anatomic variations of the lateral nasal wall in the computed tomography scans of patients with chronic rhinosinusitis.

The development of computed tomography (CT) technique results in the advance in visualization of the anatomic structures of the lateral nasal wall. It allows the anatomic variations of this region to be identified precisely, which is important in surgical treatment of chronic rhinosinusitis. The aim of this study was to determine the incidence of anatomic variations of the lateral nasal wall in a group of patients with chronic rhinosinusitis. The preoperative, frontal plane CT scans of the study group were evaluated using the method of the four-zone interpretation. The incidence of the anatomic variations of the lateral nasal wall was consistent with the results reported by other authors.

[Paranasal sinuses CT scans analysis of patients with cystic fibrosis]. / Analiza obrazów tomografii komputerowej zatok przynosowych u chorych z mukowiscydoza.

Thirty patients with cystic fibrosis (CF) were diagnosed of the otolaryngological outpatient clinic, a part of Department of Otorhinolaryngology Medical Academy in Warsaw, in 1996-1998. The control group was formed by thirty patients with chronic rhinosinusitis (CRS). Computed tomography (CT) scans were estimated in all cases. Results showed, that inflammatory changes are more advanced in patients with cystic fibrosis than in patients with chronic rhinosinusitis. The high progression of inflammatory changes in patients with cystic fibrosis, observed in CT scans, caused: disturbed development of a frontal and maxillary sinuses, destruction of bony structures formed the lateral wall of the nasal cavity, medical bulging of the lateral nasal wall.

[Evaluation of the results of surgical treatment of patient with paranasal sinusitis and cystic fibrosis]. / Ocena wyników leczenia operacyjnego przewleklego zapalenia zatok przynosowych u pacjentów z mukowiscydoza.

30 patients diagnosed from cystic fibrosis in the Department of Otorhinolaryngology, the Medical University in Warsaw in 1996-1998 participated in this study. In whole group of patients the advanced inflammatory changes in paranasal sinuses were found. In 7 cases endoscopic surgery of paranasal sinuses has been performed. The follow up has been kept by 2 years. In 2 cases reappearance of symptoms and nasal polyps observed after few months post the operation. In the remaining number of patients we noticed the satisfactory result of the treatment and the improvement of the life quality. A good nasal patency and recovery od smell were gained.

[Classification of rhinosinusitis]. / W sprawie klasyfikacji zapalen zatok przynosowych.

Rhinosinusitis is a multifactorial disease which has been variously defined by far. There is a strong need among all physicians to create a commonly accepted classification of rhinosinusitis, providing indications for an appropriate evaluation, diagnosis and treatment of the disease. The goal of this review is to present leading definitions of different forms of rhinosinusitis as well as classifications based on clinical findings, temporal considerations and the patophysiology of rhinosinusitis.

Chronic rhinosinusitis: relationship between the time of illness, extent of the disease process and results of surgical treatment. / Przewlekle zapalenie zatok przynosowych--zaleznosc miedzy zaawansowaniem procesu chorobowego, czasem jego trwania i uzyskanymi wynikami leczenia operacyjnego.

The object of this study was to determine the relationship between the extent of the disease in the paranasal sinuses and the time of illness. The study included a group of 158 patients treated surgically because of CRS. The evaluation of the extent of the disease process was done according to Kennedy's classification. Statistical correlation between the time of the illness and the extent of the disease process was observed. It was shown that in the group of patients where the disease process was longer than 3 years, changes due to the disease were present on both sides in the ethmoid and dependent sinuses. A relationship was also proved between the time of the illness and the results of the surgical treatment. The patients having had the illness for less than 3 years had a complete recovery rate of 83%. However, those who were ill for over 3 years had only a 49% complete recovery rate.

[Mucocele of the paranasal sinuses]. / Mucocoele zatok przynosowych.

Twelve cases selected from the group of 123 chronic rhinosinusitis patients are presented in the paper. Severe headaches were noted as the most typical complaints of the clinical picture of the disease. The most cases were accompanied by rhinitis and paranasal sinusitis symptoms. The best diagnostic method of mucocele is MRI. The endoscopic sinus surgery is a safe and effective method of the treatment in a case of mucocele.

[The role of endoscopic surgery in the treatment of chronic inflammation of paranasal sinuses]. / Rola czynnosciowej chirurgii endoskopowej w leczeniu przewleklego zapalenia zatok przynosowych.

This paper discusses the latest advances in diagnosis, medical treatment, and functional surgery for the treatment of chronic rhinosinusitis.

[Aspergillosis in the anterior ethmoid: case report]. / Aspergilloza sitowia przedniego i zatoki szczekowej--opis przypadku.

The case of aspergillosis in the anterior ethmoid and maxillary sinus was described. The clinical course, diagnostic and treatment were discussed.

[Iatrogenic esophageal perforation]. / Jatrogenne przedziurawienie przelyku.

A total of 213 patients with a foreign body in the oesophagus was treated in our unit between 1980-1990. Most of the foreign bodies were impacted in the cervical oesophagus. Oesophagoscopy were carried out under general anaesthesia in all cases. iatrogenic perforation of oesophagus was encountered in ten cases. Our results suggest that most instrumental perforation of the esophagus should be managed surgically. Drainage and closure of cervical perforations yields good results. Nonoperative management night be entertained in minimally symptomatic patients harboring a late, locally contained perforation without signs of ongoing sepsis.

[Foreign body in the frontal sinus]. / Cialo obce zatoki czolowej.

The authors describe the case of the foreign body in frontal sinus left there after prior surgery. The case was treated surgically with good results.

[Laryngeal cancer: postop complications and possibilities of their correction]. / Niepowodzenia leczenia operacyjnego raka krtani i mozliwosci ich korygowania.

The aim of the paper is to present the surgical methods applied in a 76 year old patient treated for carcinoma of the larynx. As an effect of the carried out total laryngectomy, extensive pharyngeal fistula occurred. The fistula was closed with myocutaneous flap which was pedunculated on double reversed pectoral major muscle. Due to lymphatic metastases surgical dissection of lymphatic system of the left side of the neck was performed 2 years after laryngectomy. During this operation the left common cervical artery was removed (Goretex graft). Next-cobaltotherapy was applied. After following 2 years the skin necrosis just over the flap occurred. It was caused by shirt collar pressure. Because of the major bleeding common cervical artery was oligated. During this procedure the frontal wall of the oesophagus was damaged and again pharyngeal fistula appeared. Attempts at closing it with flaps pedunculated on pectoral major muscle and trapezius muscle did not succeed. Finally fistula was closed with cylindric flap from the abdomen connected with the cutaneous flap from surrounding fistula tissues. Following recognition of this illness the patient had undergo nine consecutive, extensive operations. Ten years after diagnosis he is still alive and leads a life appropriate to his age.

[The classification of nonallergic eosinophilic rhinitis and sinus]. / Klasyfikacja niealergicznych eozynofilowych niezytów nosa i zatok.

Eosinophil granulocyte plays a crucial role in the pathogenesis of allergic and non-allergic upper and lower respiratory tract diseases. A number of diseases and syndromes of nonallergic mechanisms (non IgE mediated) with nose and sinus symptoms and the presence of eosinophilic cells have been described in the recent decade. The paper focuses on the discussion of the symptomatology and classification of such cases.

[Indications and counterindications for topical corticosteroidotherapy]. / Wskazania i przeciwskazania do miejscowej kortykosteroidoterapii.

This paper presents indications for topical corticosteroidotherapy in rhinitis and nasal polyps. The differential diagnosis including etiology and pathogenesis of diseases especially aspirin intolerance, are taken into consideration. The main indication for topical corticosteroidotherapy is local nasal eosinophilia. The authors everyday clinical practice help to establish considerations for the use of corticosteroids.