Surgical Endoscopic Treatment of Odontogenic Sinusitis.

Introduction: Odontogenic sinusitis is a frequent disease of the maxillary sinus, resulting from a dental inflammatory condition or a foreign body migrated in the sinus cavity. We performed a clinical retrospective study aimed to review the two surgical endoscopic approaches for odontogenic maxillary sinusitis middle and inferior meatotomy, in terms of realistic indications, efficacy, outcomes, and possible complications. Materials and Methods: In our study, we included a number of 400 patients with odontogenic maxillary sinusitis divided into two groups, treated in our hospital over five years, from January 2019 to December 2023. The patients included in this research were over 18 years old, diagnosed with odontogenic maxillary sinusitis, and underwent either middle meatal antrostomy or inferior meatotomy. Results: We examined the medical records of 400 patients. The vast majority of patients had a history of dental interventions, and the most affected tooth was the first maxillary molar. The symptoms at admission were typical for sinusitis: nasal obstruction, anterior or posterior rhinorrhea, hyposmia to anosmia, cacosmia, and pain or facial pressure. 80% of the patients in the study underwent middle meatal antrostomy, while 20% underwent inferior meatotomy. There were no significant differences between these two approaches in terms of efficacy, complication rates, recovery, or relapses. The complications that occurred after the surgical treatment were minor and with a very low frequency. The most reported were middle meatus synechiae and the persistence of the meatotomy ostium, with mucus recirculation (in patients with inferior meatotomy). Conclusions: Endoscopic surgical treatment of odontogenic maxillary sinusitis can be done as middle or inferior meatotomy, each having specific indications. The maxillary antrostomy is preferred in the majority of cases, as it is a procedure in which the natural ostium of the maxillary sinus is enlarged, thereby maintaining the natural drainage pathway of the sinus. However, the inferior meatotomy is preferred in the case of foreign bodies or maxillary sinus retention cysts localized at the level of the sinus floor or in the alveolar or lateral recesses, or as part of a combined approach (inferior and middle meatotomy), when the ablation of a "fungus ball" is required.

Multidisciplinarity and Transdisciplinarity as Current Trends in Otorhinolaryngology and Head and Neck Pathology.

The specialty of otorhinolaryngology and cervicofacial surgery has experienced accelerated development in recent decades through the development of the techniques and technologies involved [...].

Correlations between ultrasonography performed by the ENT specialist and pathologic findings in the management of three cases with thyroglossal duct cyst.

Thyroglossal duct cyst (TDC) has an increasing incidence. We present a series of three cases that benefited from the use of ultrasonography performed first hand by the ENT specialist. All cases underwent Sistrunk procedure and the diagnosis was confirmed by pathology results: one uncomplicated TDC, a thyroglossal duct carcinoma, and an infected TDC with the risk of becoming a diffuse cervical suppuration. Ultrasonography performed first hand by the ENT specialist enables a quick and thorough planning of the surgical procedure and management of the case.

Nasal Muco-ciliary transport time alteration: efficacy of 18 B Glycyrrhetinic acid.

BACKGROUND: Mucociliary clearance is the main self-clearing system of the nasal cavity and paranasal sinuses.This is a very important means of non specific defence against continuous organic and inorganic contamination conveyed by air. It works by trapping particles and microorganisms in the mucus and then by transporting the mucous film to the pharynx where it is eliminated with a cough or swallowed. Its congenital or acquired abnormalities are involved in the occurrence of widespread infectious and often severe nose and paranasal sinuses diseases; generally concerning the rhinopharyngealtubal district.Restoring mucociliary clearance of the nasal epithelium when altered thus represents a key therapeutic tool against rhinosinus chronic diseases.This study evaluates the clinical efficacy of the inhalation of a natural compound (Narivent® nasal spray) in chronic vasomotor rhinitis. METHODS: The study involved 79 patients suffering from chronic vasomotor rhinitis presenting an increased mucociliary clearance time. Patients were randomized into 2 groups: a first group of 49 subjects and a second group of 30 subjects.The first group was treated with a nasal spray (Narivent® nasal spray) (2 sprays per nostril twice a day) for 30 days.The second group was treated with a nasal spray containing isotonic solution in the same way and for the same period of the first group.Nasal Mucociliary transport time was measured in the patients of both groups before treatment, after 15 days of treatment, and at the end of the 30 days treatment. RESULTS: The study shows how one of the treatments carried out determines a major objective reduction of the mucociliary clearance time in the patients under examination, using the method which involves the use of an insoluble coloured tracer (vegetable carbon), bringing the values back within normal range. At the end of the study we objectivated an increase in the rate of mucociliary transport in 97.9% percentage of patients we enrolled. CONCLUSIONS: This study shows the effectiveness of treatment with natural extracts with nasal mucosa restoring function in the treatment of chronic vasomotor rhinitis, a nasal inflammatory disease characterized by morphological and functional alteration of the normal nasal mucosa.

Oesophageal Foreign Bodies--from Diagnostic Challenge to Therapeutic Dilemma.

Ingestion of foreign bodies, common in the emergency services, remains a challenge for physicians despite preventive measures and technical progress due to the frequency and possible complications, serious complications that can darken vital prognosis or may be a source of remote morbidity. Clinical experience at "St. Mary" Hospital included, between 2000-2015, 39 patients diagnosed with FB ingestion, of which 26 fixed in the oesophagus, with the remaining 13 having spontaneously progressed along the digestive tract (5 recovered from the stomach, 6 naturally evacuated, and 2 cases with colic perforation). Oesophageal foreign bodies occur consecutively to (in)voluntary ingestion, the vast majority of them passing unnoticed. The most frequently encountered types are coins, batteries, needles, various sharps objects, food, bone fragments, cartilages, pieces of plastic, glass, etc., FB impaction at oesophageal level being usually conditioned by the 3 anatomical narrowings. Typically, FB ingestion occurs at extreme ages, 60% of patients being pre-school children (<6 years), with an even higher percentage--between 70-80% between 6 months and 2 years of age--and only 15% elderly, frequently edentulous. Usual clinical signs, in the absence of complications, are: dysphagia, hypersialorrhoea, low cervical and/or chest strain, sometimes vomiting. Not at all infrequently (30%!), we notice the absence of any sign. Alarming manifestations, which indicate the development of complications, are pyrexia, general physical health deterioration, pain (with vertebral/interscapular projection), pulping, subcutaneous cervical emphysema. Diagnosis via various imaging methods (simple radiography, barium swallow, CT, MRI) remains the essential link in identifying the lesion and establishing a therapeutic approach. Endoscopic evaluation (rigid or flexible) is mandatory, also allowing therapeutic gestures. In terms of progression, 80-90% of FB pass into the stomach, being eliminated naturally, about 10-20% require endoscopic extraction, and only 1% of cases require surgical intervention. Treatment of uncomplicated cases is essentially endoscopic, surgery to extract the foreign body being necessary in exceptional cases. In case of complications, surgery is the only reliable therapeutic resource. Oesophageal foreign bodies frequently represent an emergency, with symptomatic functional features contrasting with the poor clinical signs present, requiring extraction via the natural pathways as treatment in most cases. The most effective "treatment" remains prevention and raising awareness in parents with children ≤6 years, while the most important element in the management of FB is to maintain the airways free.

Septoplasty in children.

OBJECTIVES: Physicians have long had concerns about the potential harmful effects of pediatric septoplasties on the nasoseptal growth process because septal cartilage is important for the growth and development of the face. METHODS: In this review article, pediatric septoplasty and its indications are discussed, together with a literature survey. In addition, overviews of development of the nasal skeleton from neonate to adult, nasal growth, and cartilaginous septum are presented. Important issues and comments on pediatric septoplasties are provided. RESULTS: During septoplasty procedures, elevation of the mucoperichondrium unilaterally or bilaterally does not negatively affect growth of the face. Stabilization of the septum may be easier when mucosal elevation is performed unilaterally. The nasal floor mucosa should not be elevated so to avoid damage to the incisive nerves. Corrections and limited excisions may be done from the cartilaginous septum. Separation of the septal cartilage from the perpendicular plate, especially at the dorsal part, should not be performed because this area is important for the length and height of the nasal septum and nasal dorsum. Incisions or excisions should not be performed through the growing and supporting zones, especially at the sphenoethmoid dorsal zone. CONCLUSION: If there are severe breathing problems related to the septal deviation, septoplasty should be performed. In the majority of cases, septal surgery may be conducted in 6-year-old children. However, if necessary, septal surgery may be performed in younger children and even at birth.

Adult cervical lymphangioma - ultrasonography, surgical removal, and pathology results. Case report.

Lymphangioma is a rare pathology in children and even more exotic when encountered in adults. We review the current data on this subject underlining possible controversies and limitations. This is the case of an adult male who underwent a complete clinical examination and ENT performed ultrasound exam, along with contrast CT prior to complete surgical removal of the mass. The mass was 6 cm in diameter and compressed the left lobe of the thyroid gland. Pathology result confirmed the diagnosis of lymphagioma.

Ultrasonographic anatomy of head and neck--a pictorial for the ENT specialist.

An increased pressure on ENT departments has evolved as head and neck pathology is showing a higher incidence and prevalence. Therefore, the ENT specialist should develop good skills in ultrasonographic examination of patients with head and neck masses. The aim of this paper is to enable the ENT specialist to identify anatomical landmarks on ultrasonographic images in order to expedite the diagnosis with a higher degree of certainty. We describe the steps for a proper ultrasound examination of the patient. We illustrate the following anatomical areas: submandibular gland, thyroid gland, parathyroid glands, oropharinx, larynx, parotid glands, etc. Moreover we emphasize the differential diagnosis that should be taken into account when examining pathology in these regions. Ultrasonographic examination of head and neck pathology is cost efficient, non irradiating and permits fast follow up with serial examination of the lesions. Furthermore one can perform an initial TNM staging of the case prior to other expensive imaging studies such as CT and MRI. We hope to raise the awareness of fellow ENT specialists in performing ultrasonography as future developments such as elastography and CEUS will increase the specificity and sensitivity of this diagnostic method.

International study of the incidence of particular types of septal deformities in chronic rhinosinusitis patients: the outcomes from five countries.

BACKGROUND: Chronic rhinosinusitis (CRS) may be more frequent in patients with particular types of septal deformities. The aim of this article was to investigate the incidence of particular types of septal deformities in adult CRS patients and healthy volunteers in various countries to determine whether some of them are more frequent in those groups. METHODS: This international multicentric study involved 505 subjects from five countries: Croatia, Romania, Italy, Russia, and Turkey. The types of septal deformities were observed and grouped according to the Mladina classification. Subjects were examined by means of native anterior rhinoscopy, anterior rhinoscopy after decongestion, and fiber endoscopy with topical anesthesia. CRS patients have been diagnostically proved by computed tomography scanning of the paranasal sinuses. RESULTS: Considering the CRS patients, the prevalence of so-called vertical deformities (types 2, 3, and 4) was seen. Among them, type 3 deformity was found most frequently in Turkey, Croatia, Italy, and Romania. CONCLUSION: Type 3 deformity has been found frequently in CRS patients in all five of the countries. Russian subjects exhibited a high frequency of type 4 deformity. Because this type consists of types 2 and 3, the later, again, has been proven to be prevalent in CRS patients also in this group of patients.

PLUNC proteins positivity in patients with chronic rhinosinusitis: a case-control study.

INTRODUCTION: Innate immunity is the first protection against microorganisms. Nowadays, there is a growing interest in innate immune molecule known as palate, lung, nasal epithelial clone (PLUNC). PLUNC is a specific product of the airways, of approximately 25 kDa, encoded by adjacent genes found within a 300 kb region of chromosome 20; these proteins must be detected predominantly in the upper respiratory tract. MATERIALS AND METHODS: We performed a case-control study to investigate the presence of this protein in nasal tissue of patients affected by chronic rhinosinusitis. 59 patients were enrolled (44 cases, 15 controls). We have examined the correlation between the presence of pathology and the PLUNC proteins positivity. RESULTS: 100% of controls have a +++ rated PLUNC proteins positivity, while cases have a lower percentage of positivity. We used χ (2) statistical test to analyze the results of the study and there is a difference statistically significant between cases and controls in PLUNC proteins positivity. CONCLUSIONS: These observations suggest that, in response to agents or chemical factors, nasal mucosal epithelium will react and produce PLUNC proteins. So PLUNC proteins have a protective function on upper airways mucosa, as we can see by evaluating the high positivity in control group.

Retrospective study on Romanian foreign bodies injuries in children.

BACKGROUND: Foreign bodies (FB) injuries are an issue that has been recognized and investigated since many years; despite that, the impact of this subject in literature and research is still small. Such kind of injuries identifies all incidents due to ingestion, inhalation, insertion and aspiration of an object into the aero digestive tract. FBs injuries located in the upper airways can be a very serious event, sometimes resulting in fatal outcome. METHODS: A retrospective study was performed on FB injuries in the aerodigestive tract in paediatric patients 1-17 years old, recorded from the ENT Department of the M. S. Curie Hospital in Bucharest. RESULTS: 455 cases were reported from the M. S. Curie Hospital, ENT Department. Prevalence in female patients is higher than the males (225 males and 230 females). Mean age observed was 4.12 years. The distribution of injuries according to the retrieval location showed a higher prevalence in the nose (44.62% of cases), with a higher occurrence in females (50.74%) followed by the digestive system (24.28% of cases) were the distribution between males and females is equal. The highest prevalence was represented by nuts and seed (23.96%), followed by marble and coins (respectively 12.75% and 12.53%). CONCLUSIONS: As generally described in scientific literature, injuries usually concerned toddlers and preschoolers, while school-aged children less often place foreign objects in their noses. Our results confirm the fact that when passive preventive strategies are not practical, active strategies that promote behaviour change are necessary. Active strategies require that a caregiver changes his or her behaviour each time the child begins an activity that has the potential to cause injury. Education is critical to these active strategies and plays a complementary role to environmental changes and legal mandates.

Serum perioperative profile of cytokines in patients with squamous cell carcinoma of the larynx.

OBJECTIVE: Altered immune, inflammatory, and angiogenesis responses have been noticed in head and neck cancer, and many of these responses have been associated with a poor clinical outcome. The objective of this study was to evaluate several immune mediators in the sera of patients with squamous cell carcinoma (SCC) of the larynx undergoing curative surgery in connection with clinicopathologic factors. METHODS: Multiplex analysis of cytokines (interleukin [IL]-6, IL-8, IL-10, tumour necrosis factor α [TNF-α], interferon-γ [IFN-γ]), chemokines (monocyte chemoattractant protein 1 [MCP-1], macrophage inflammatory protein 1α [MIP-1α], and epithelial neutrophil-activating protein 78 [ENA-78]), and growth factors (vascular endothelial growth factor and basic fibroblast growth factor) in the serum of patients with laryngeal cancer and healthy controls was performed using xMap technology. RESULTS: Patients with SCC presented an altered cytokine profile compared to healthy controls, both preoperatively (higher levels of IL-8 and IL-10) and postoperatively (higher values for IL-6, IL-8, IL-10, and TNF-α). Heavy smoking was associated with significantly lower levels of ENA-78 and higher levels of IL-8. CONCLUSION: Differences noticed in patients' immune mediator profiles seem to be attributable to both disease and treatment. Further longitudinal studies are necessary to elucidate the involvement of immune mediators in disease progression and clinical evolution.

Modified endoscopic DCR without stenting and laser assisted.

To evaluate the outcomes of endoscopic LASER assisted dacryocystorhinostomy without stenting, a total of 39 patients (41 eyes) with complains of epiphora and diagnosed with nasolacrimal duct obstruction were included in a prospective study. All the patients had the same preoperative assessment, including radiological and ophthalmologic evaluation, with repeated lacrimal washouts, to confirm the postsacal obstruction. The surgical technique's goal was to create a wide opening of the medial wall of the sac, using drilling of the frontal process of the maxillary bone and some of the lacrimal bone, incision of the lacrimal sac and the radial vaporisation of the incision margins performed with Diode LASER, in order to create a 0.7 - 1 cm opening in the medial wall of the sac. Patients were examined endoscopically, at postoperative intervals of 1 month, 3 month, 6 and 9 month minimum (follow-up period ranged between 9 to 21 months, average 11, 8 months). We obtained a good permeability of the opening of the lacrimal sac in 87.8% of our cases (36 eyes). 5 patients (12.2%) required re-evaluation of the medial sac wall area and re-intervention using different methods. The success criteria were considered the patient's relief of symptoms and the endoscopic visualization of a patent stoma. In conclusions, in the hands of an experienced surgeon, endoscopic LASER assisted dacryocystorhinostomy without stenting compares favourably with other techniques.

[Monosymptomatic posterior rhinorrhea]. / Rinoreea posterioara monosimptomatica.

Monosymptomatic posterior rhinorrhea is a common syndrome found in medical practice, being the starting point for many pulmonary and ENT diseases. It is a solitary symptom, not accompanied by other clinical manifestations (nasal obstruction, anterior rhinorrhea, impaired smell, itching or sneezing) and it is giving the patient the sensation that something is dripping down into the oro and hypopharynx. Border pathology, posterior rhinorrhea consequences may bring the patient in Respiratory or ENT Clinics. A correct diagnosis and an appropriate treatment is the main objective in the management of this syndrome. The purpose of the article is to present this syndrome with its consequences and the main therapeutic methods.

[Chronic cough--etiological and therapeutical considerations in the otorhinolaryngological practice]. / Tusea cronica--consideratii etiologice si terapeutice în practica otorinolaringologica.

Chronic cough (cough persisting more than 3 weeks) is the one of the most common presenting symptom in adults seeking medical care. Given the fact that the variety of diseases that can produce this symptom is great, the correct management of chronic cough should include a close cooperation between pneumologist, gastroenterology specialist and otorhinolaryngology specialist, in another words a multidisciplinary approach. The purpose of this article is to reveal this symptom from the otolaryngologist perspective, emphasising on the main diseases involved, and also on the diagnosis and treatment alternatives of chronic cough.

Prognostic factors in sudden hearing loss.

Sudden hearing loss is a sensorineural hypoacusis, unilateral in most of the cases, with an incidence peak in young adult. This article is the result of a four years retrospective study, in which we have tried to see how age, severity of hearing loss, presence or absence of vertigo, the timing of treatment initiation can influence the hearing recovery. 47 patients were included in this inpatient study. They were investigated (clinical, lab and imaging studies) and the treatment protocol included vasodilators, anti-inflammatory agents, vitamins, plasma expander. In conclusion, a good prognosis in the hearing recovery was associated with absence of vertigo, early treatment (the first 7 days), and hearing loss less than 50dB. Age had no influence on the recovery process.