Transnasal endoscopic treatment of cerebrospinal fluid leaks: 10 years' experience.

The endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine procedure. This study describes the endoscopic closure of CSF leaks in a large series (36 patients) at the Jagiellonian University over 10 years (1999 to 2009). We describe the aetiology, defect location, graft material, presence of encephalocele, history of meningitis, intracranial pressure, recurrence, and follow-up. In our studies the aetiology of CSF leak was spontaneous in 4 cases, traumatic in 9, and iatrogenic in 23. The defect was most commonly located near the ethmoid and sphenoid bones. Our initial success rate after transnasal endoscopic treatment was 88.9% (32/36). However, the overall success rate of 97.2% (35/36) and the low morbidity in this series support the endoscopic approach as the standard of care for CSF leak closure. Follow-up ranged from 3 months to 5 years. Importantly, this high success rate can be achieved without the use of intrathecal fluorescein or a lumbar drain.

A case of respiratory epithelial adenomatoid hamartoma of the sinonasal tract.

Respiratory epithelial adenomatoid hamartoma is a rare, non-neoplastic tumour characterised by an abnormal mixture of tissues that are indigenous to the region. REAH are shiny, polypoid, exophytic masses with a rubbery to firm texture. They may arise and co-exist in the setting of inflammatory polyps. We present a case of a 49-year-old patient who was referred to the department with a clinical diagnosis of chronic nasal sinusitis. Results of post-op histopathological examination show a mild change of the respiratory epithelium requiring, among others, differentiation from inverted papilloma and adenoid carcinoma.

A giant cranial aneurysmal bone cyst associated with fibrous dysplasia.

An aneurysmal bone cyst (ABC) is a rare, benign fibro-osseous lesion, considered a vascular phenomenon secondary to fibrous dysplasia or a giant-cell tumour, and occurs mainly in long bones and vertebrae. In this case report a 16-year-old male presented with massive epistaxis. He was admitted with a 3-year history of chronic rhinitis, headaches, right ocular pain and recurrent epistaxis. CT scans showed a predominantly cystic, expansive mass obstructing both nasal cavities, extending to all paranasal sinuses and both orbits, with evidence of anterior cranial fossa skull base destruction. The patient underwent a craniofacial resection of the tumour performed with an external approach and an immediate reconstruction of the dural defect. Histology confirmed the lesion was an ABC associated with fibrous dysplasia. The patient's recovery was complete. A large facial aneurysmal bone cyst can damage the facial skeleton and skull base, and requires excision by a combined external approach.

Profile of laryngological abnormalities in patients with amyotrophic lateral sclerosis.

Few studies have described laryngological evaluation of patients with amyotrophic lateral sclerosis. We assessed the laryngological abnormalities of 35 such patients (24 bulbar onset and 11 limb onset). In nine limb onset patients, we discovered signs of early vagal nerve dysfunction, prior to any clinical presentation of bulbar failure. However, in all bulbar onset patients studied, we noticed changes in the uni/bilateral position of the vocal folds and in the voice quality.

Evaluation of cervical lymph node metastasis of 1400 patients with cancer of the larynx.

OBJECTIVE: The main goal of the paper was to evaluate the results of surgical treatment of patients with laryngeal carcinoma, among whom cervical lymph node metastases were observed. The results of treatment were assessed after prior analysis of the following factors localization of laryngeal carcinoma, local and regional advancement, number of lymph nodes affected by metastases, the incidence of 'occult metastases', the presence of metastases in the pre-laryngeal node, the regions of the neck which were most frequently affected by metastases and supplementary irradiation treatment. METHODS: An analysis of a group of 1400 patients who underwent surgery for laryngeal carcinoma in the period 1948-1992, was carried out. In all of the cases, a partial or total laryngectomy accompanied by a unilateral or bilateral surgery of the cervical lymph node system was performed. The results of the above treatment were assessed over a 5-year survival period. RESULTS: In patients among whom metastases to the lymph nodes were observed, it is the following factors that exert an influence on survival chances: supraglottic and glottic localization of the tumor, an increase of regional and organ advancement of the tumor, number of lymph nodes affected by metastases, the presence of metastases in the 'pre-laryngeal' node and the level of the neck affected by metastases. CONCLUSION: The incidence of metastases in regional lymph nodes is a prognostic factor in the treatment of patients suffering from laryngeal carcinoma.

[Primary orbital tumors in children]. / Pierwotne nowotwory oczodolu u dzieci.

We present the incidence, diagnosis and clinical picture of the primary orbital tumors in children. They were treated in ENT Clinic CM UJ in Kraków between 1981-1990 years. Discovered was preponderance of primary non malignant tumors. The most frequently encountered tumors were dermatomas, angiomas and among the malignant tumors-rhabdomyosarcoma.

[Surgeries of the orbit]. / Operacje oczodolu.

Krönlein was the first ophthalmologist to carry out orbital surgery. He described the temporal approach. The purpose of this paper is to report the earliest findings and results in tumors of the orbit in 101 patients who was treated with surgery in ORL CM UJ Clinic in Kraków. Retrobullar tumors of the orbit require a bone orbitotomy.

[The clinical significance of metastatic cancer of the larynx to the Delphi node]. / Kliniczne znaczenie przerzutu do wezla delfickiego w raku krtani.

Between years 1965-1987, 920 patients with cancer of the larynx were operated on. In this time we identified 9 cases of histologically proven metastasis to the Delphian node. In all patients except one, the neck was clinically negative but a positive Delphian node was discovered at partial or total laryngectomy. Five patients developed metastasis postoperative. Seven of 9 patients have died from their laryngeal cancer. The frequency of neck metastasis and local recurrences is very high in patients with a positive Delphian node.

[Neurofibroma of the larynx]. / Neurofibroma krtani.

During the years 1986--90 about 480 patients with tumors of the larynx were treated in Cracow Otolaryngological Clinic. In this group were two cases of neurofibroma of the larynx. These patients were treated upon by various types of surgically operations.

[The use of the lingual flap in the primary reconstruction of the hypopharynx]. / Pierwotna rekonstrukcja krtaniowej czesci gardla platem jezykowym.

From September 1991 till January 1994 in ENT Clinic in Cracow 5 patients with far advanced laryngeal cancer involving hypopharynx were treated surgically. Total laryngectomy with partial or total hypopharyngectomy was performed and then the reconstruction of hypopharynx one stage procedure using lingual flap was done. In all patients functional results were acceptable. The main contraindications for using lingual flap is tumor infiltration of the base of tongue.

[Laryngeal changes in mucoviscidosis]. / Zmiany laryngologiczne w mukowiscydozie.

Mucoviscidosis (cystic fibrosis) is congenital and hereditary disease of excretion glands expose in infancy and school age. In clinical practice we very rare meet cases of mucoviscidosis with laryngological symptoms. Our study include 5 children examined in Children Hospital in Cracow. Three children were operated due to polyps in nose and paranasal sinuses. Two children are observed due to return infections in the parotid glands.

[Esthesioneuroepithelioma in a 66 year old man]. / Esthesioneuroepithelioma u 66-letniego mezczyzny.

Authors presented a rare case of esthesioneuroepithelioma in a 66 year old man treated surgically and radiologically.