[The evolution of ideas about cyst-like stretching of the paranasal sinuses. Part I]. / Evolyutsiya predstavlenii o kistovidnom rastyazhenii okolonosovykh pazukh. Chast' I.

Treatment of patients with severe chronic and recurrent forms of sinusitis, complicated by pathological stretching of the paranasal sinuses, is not a trivial task. This is especially true for those clinical cases where a pathological increase in the size of the sinus leads to widespread destruction of its walls and may be accompanied by serious complications from adjacent structures. The paper presents an analytical review of publications on the topic of pathological stretching of the paranasal sinuses. Potential factors influencing the development of this pathology, mechanisms of pathogenesis and classification options are described in detail. Modern approaches are considered in the surgical treatment of this pathology, which can be carried out in one or two stages, depending on the presence of secondary aesthetic defects.

[Intraosseous cavernous hemangioma of the middle turbinate. Clinical cases]. / Vnutrikostnaya kavernoznaya gemangioma srednei nosovoi rakoviny. Klinicheskie sluchai.

Intraosseous vascular pathology of the turbinates is extremely rare in the practice of an otorhinolaryngologist and can be presented in various histopathological variants. The article presents two clinical cases in which an intraosseous cavernous hemangioma was hidden under the mask of a hypertrophied middle turbinate. The final diagnosis was established by the results of histological examination. The analysis of these clinical cases indicates that, despite the low prevalence, atypical clinical and CT picture, intraosseous formations of the nasal cavity can be of a vascular nature and certainly require a comprehensive examination, including CT, CT with contrast and/or MRI of the nose and paranasal sinuses. These clinical observations indicate that preliminary embolization of feeding vessels before surgical treatment is not required.

[Dynamic indicators of the use of puncture method for the treatment of acute maxillary sinusitis in healthcare institutions of the city of Moscow]. / Dinamicheskie pokazateli primeneniya punktsionnogo metoda lecheniya ostrogo verkhnechelyustnogo sinusita v uchrezhdeniyakh zdravookhraneniya goroda Moskvy.

According to the statistical forms medical and preventive treatment centres (MPTC), the analysis of dynamic indicators of the treatment of patients with acute sinusitis (AS) in outpatient polyclinic centers (OPC) and ENT hospitals in Moscow for the period from 2017 to 2021 was carried out. The total number of visits to an otorhinolaryngologist in the OPC in Moscow for 2017-2021 amounted to 6 834 952 patients, including 245 172 patients with AS (3.6%).The total number of hospitalizations in the departments of otorhinolaryngology for the same period amounted to 184 735 patients, including 12 906 patients with AS (7%).The number of patients with AS who was consulted by an otorhinolaryngologist from 2017 to 2021 decreased by 18.2%, which can be explained by a change in the routing of patients with mild form of AS to general practitioners. An analysis of the dynamic indicators of maxillary sinus punctures carried out in the medical and preventive treatment centres (MPTC) in Moscow during the period from 2017 to 2021 showed that there was a redistribution of this manipulation from ENT hospitals to the OPC. At the same time, the proportion of patients requiring puncture treatment in the OPC for 2017-2019 was stable and amounted to 9.3%. However, since 2020, there has been an increase in this indicator by more than 2 times (21.7%), which probably indicates an increase in the treatment of patients with moderate forms of AS in the OPC. The frequency of maxillary sinus punctures that were performed in ENT hospitals in 2017-2019 amounted to 83.5%, in 2020-2021 decreased to 63.4%. The average number of maxillary sinus punctures per patient in ENT hospitals from 2017 to 2019 was 13.3. Since 2020, this value has decreased by about 2 times and has become equal to 8.5. The decrease in the number of maxillary sinus punctures that were performed in ENT hospitals is probably due to the fact that patients with severe and complicated forms of acute sinusitis hospitalized from 2020 to 2021 required more radical surgical treatment.

[Assessment of the structural features of the hard palate in endonasal surgery]. / Otsenka anatomii tverdogo neba v khirurgii peregorodki nosa.

Data on the features of the anatomical structure of the hard palate are little described in the scientific literature, and therefore are not taken into account when planning surgical treatment. One of the intraoperative complications during intervention on the lower part of the nasal septum is perforation of the bottom of the nasal cavity, which can develop during a christotomy. This complication mainly depends on the features of the anatomical structure of the hard palate. OBJECTIVE: To study the anatomical structure of the hard palate from the point of view of rhinosurgery, using vector analysis of multispiral computed tomography (MSCT), and to establish anatomical features that should be taken into account when performing surgical interventions on the nasal septum. MATERIAL AND METHODS: 107 patients (30 men, 77 women) were examined without congenital cleft palate and surgical interventions on the structures of the nasal cavity and hard palate. All patients underwent MSCT of the nose and paranasal sinuses (PNS) followed by multiplanar image reconstruction. The key point relative to which the measurements were carried out was the posterior wall of the incisor canal from the side of the nasal cavity. The line corresponding to the bottom of the nasal cavity was chosen as the main vector. In the work, measurements of the thickness of the hard palate (THP) at the level of the palatal suture and the width of the palatal suture (WPS) were carried out. RESULTS: Statistical analysis of the obtained results showed that the THP is 1.74 mm [min 0.28; max 6.46], the WPS is 0.9 mm [min 0.2; max 2.51] (conditional norm). In 19 patients (17.8%), the THP was 0.82 mm, in 2 patients (1.9%) - 0.2 mm. In 3 patients (2.8%), the WPS was equal to 2.5 mm. CONCLUSION: Thus, the data obtained by us indicate that the surgical anatomy of the hard palate is characterized by significant variability, while in some patients the THP can be reduced by 8.8 times, and the WPS increased by 2.7 times compared to normal values. Such anatomical features of the structure of the hard palate should be taken into account when planning septoplasty, since this contingent of patients has an increased risk of developing iatrogenic perforation of the nasal floor during surgical intervention on the lower floor of the nasal septum.

[Combined method of treatment of synechiae of the nasal cavity]. / Kombinirovannaya metodika lecheniya sinekhii polosti nosa.

Diseases of the nasal cavity and paranasal sinuses lead to the development of clinical symptoms, among which difficulty in nasal breathing is among the most common complaints of patients in the practice of otorhinolaryngologists. To prevent the development of synechiae of the nasal cavity in surgery, the following principles are defined: 1) to reduce tissue injury, which is achieved by using modern equipment (endoscopic, laser, radio frequency, etc.); 2) to create a barrier between nearby areas of the nasal mucosa by introducing various intranasal splints; 3) to improve the process of tissue regeneration with the help of medicines (regenerants, reparants, etc.). Currently, there is no single approach to the surgical treatment of synechiae of the nasal cavity. The high frequency of postoperative relapses indicates the need to develop effective methods for the prevention of synechiae of the nasal cavity. The choice of surgical tactics is usually carried out taking into account the localization and extent of synechiae of the nasal cavity. All known methods of surgical treatment, depending on the instruments used for excision of synechiae of the nasal cavity, can be conditionally divided into cold and hot. The Sverzhevsky Research Clinical Institute of Otorhinolaryngology has developed a method of complex treatment and prevention of synechiae of the nasal cavity using laser technologies, silicone splints and a hydrogel material based on sodium alginate with derinate.

[Chronic pharyngitis. Modern approaches to diagnosis and treatment]. / Khronicheskii faringit. Sovremennye podkhody k diagnostike i lecheniyu.

The relevance of the problem of chronic inflammatory diseases of the pharynx is due to the significant prevalence of this pathology. Among all forms of chronic pharyngitis, the most adverse effect on the quality of life is observed in chronic athrophic pharyngitis. According to the literature, in this category of patients there are no clear criteria for assessing the functional state and morphological picture of the mucous membrane of the posterior pharyngeal wall. Most of the described signs of atrophic pharyngitis are insufficienyly informative, which necessitates further improvement of existing and possible search for new diagnostic methods. Many of the modern methods of treatment do not provide a lasting effect due to the presence of only a local effect on the altered mucous membrane of the posterior pharyngeal wall, without taking into account the changes that are caused by a violation of trophic processes in the tissue, which necessitates the search for new effective methods of treating this disease.The review article outlines modern ideas about the methods of diagnosis and treatment of chronic pharyngitis, presents promising areas in the treatment of patients with atrophic pharyngitis. In foreign countries, the term «chronic tonsillopharyngitis¼ is most often used. Due to the existing difference in terminology, the predominant part of the material on the problem of chronic pharyngitis is presented by domestic literature sources.

[Rhinolith - diagnosis and treatment features]. / Rinolit ­ osobennosti diagnostiki i lecheniya.

Exogenous foreign bodies enter the nasal cavity through the nostrils or in some cases through the choana and usually get stuck in the lower or middle nasal meatus. An alien body that has been in the nasal cavity for a long time serves as a nucleus around which calcium and magnesium salts, organic components, are deposited from the nasal secretions, and contributes to the formation of rhinolith (nasal stone, from Greek rhino - nose, lithos - stone). Endogenous material (thick mucous secret or a blood clot drying into the crusts, desquamated epithelium, an atypically located tooth, products of cellular lysis and necrosis of the mucous membrane) can also serve as a potential nucleus for salt deposition. Narrowing of the nasal passages due to the curvature of the nasal septum, hypertrophy of the nasal conchae, violation of mucociliary transport and inflammatory changes in the mucous membrane in chronic rhinitis or rhinosinusitis can lead to a delay in the mucous discharge in the nasal cavity, pH changes, excessive saturation of the secretion with crystalloids, initiate crystallization around the nucleus and deposition of salts. This article presents the results of clinical examination and surgical treatment of a patient with rhinolith formed by prolonged inhalation of construction dust.

[Comprehensive assessment of the respiratory function of nasal packs with airway tubes]. / Kompleksnaya otsenka respiratornoi funktsii «dyshashchikh¼ vnutrinosovykh tamponov.

Intranasal packs with breathing tubes are one of the possible methods of postoperative management of patients after endonasal surgery. The role of these devices is to provide the possibility of nasal breathing of patients to facilitate the course of the postoperative period. However, the possibility of providing proper nasal breathing with these devices has not been studied. The aim of the work is to study the calculated and clinical possibilities of nasal breathing when using intranasal packs with breathing tubes after endonasal surgical interventions. MATERIAL AND METHODS: We studied packs with air tubes from two manufacturers: Medtronic and Spiggle & Theis. During the experimental part, measurements of the air tubes and their study using acoustic rhinometry were carried out. In the clinical part, there were two groups of patients with different types of tampons and control group of volunteers with normal nasal breathing, the total number of participants was 45 people. All patients of groups 1 and 2 underwent septoplasty, bilateral lower partial conchotomy. In the postoperative period, rhinomanometry, rhinoflowmetry, a study of the duration of nasal breathing, and a subjective assessment of nasal breathing were performed. RESULTS: According to measurements and acoustic rhinometry, the airway tubes of the tampons have a cross-sectional area that is more than 4 times smaller than the narrowest part of the nasal cavity in healthy volunteers. According to the results of a clinical study, the tampons in question are not able to provide a level of nasal breathing comparable to normal, even after clearing the lumen by a doctor. Medtronic packs provide somewhat better airway function due to the larger internal diameter of the tubes, but also do not create conditions for satisfactory nasal breathing. CONCLUSION: Improving the respiratory function of tampons in the future can be achieved by increasing the internal lumen of the breathing tubes while maintaining comfort of use.

[The efficacy of the extended endoscopic frontal sinus drill-out in cases of repeatedly operated polypous-purulent pansinusitis accompanied by a whistle in the front wall of the frontal sinus]. / Effektivnost' rasshirennoi endonazal'noi endoskopicheskoi frontotomii pri mnogokratno operirovannom khronicheskom polipozno-gnoinom pansinusite, oslozhnennom formirovaniem svishcha perednei stenki lobnoi pazukhi.

Treatment of patients with severe chronic and recurrent forms of frontal sinusitis, often caused by scarring as a result of repeated interventions in the frontal sinuses, is a difficult task. In such cases, for adequate drainage of the frontal sinus and ensuring stable patency of the nasolabial anastomosis, an endoscopic extended frontotomy can be the choice operation, the possibility of which certainly depends on the experience of the surgeon, anatomical features of the structure of the frontal sinus and the nature of the pathological process. The article shows the effectiveness of surgical treatment of chronic purulent frontal sinusitis that developed after 5 interventions on the paranasal sinuses with external and combined access, accompanied by the development of a fistulous passage of the anterior wall of the frontal sinus. For wide drainage of the frontal sinus and stable preservation of patency of the nasolabial fistula, the patient underwent extended endoscopic frontotomy (Draf III operation according to the international classification).

[Surgical interventions on the pharynx in the structure of otorhinolaryngological care to the population of the city of Moscow]. / Khirurgicheskie vmeshatel'stva na glotke v strukture otorinolaringologicheskoi pomoshchi naseleniiu Moskvy.

The authors studied the reporting documentation of otorhinolaryngological hospitals of the city of Moscow on the surgical treatment of pharyngeal pathology in adults from 2002 to 2017. It was found that for 16 years surgical treatment of 290 362 patients with ENT-diseases was performed: 181.206 (62.4%) patients with diseases of the nose and paranasal sinuses, 24.981 (8.6%) patients with ear pathology, 60.346 (20.8%) patients with diseases of the pharynx and 23.829 (8.2%) - with diseases of the larynx. The assessment of the overall dynamics of the studied indicators was carried out on the 'trend lines'. For the considered period, the number of patients with surgical pathology of the pharynx increased by 33.2%. The proportion of tonsillectomies increased by 1.85 times to 56.5%, drainage of peritonsillar abscesses and abscesses-tonsillectomies decreased by 19%, uvulopalatoplastic increased 4.1 times, removal of neoplasms of the pharynx increased 2.2 times, adenotomies decreased by 2.4 times. Analysis of the data allowed to establish that, against the background of an ever-increasing number of surgical interventions for diseases of the pharynx in adults, a descending trend was noted only in the treatment of complicated forms of chronic tonsillitis and hypertrophy of the pharyngeal tonsil.

[Angioneurotic edema. Classification, diagnosis, prophylaxis, treatment tactics]. / Angionevroticheskii otek. Klassifikatsiia, diagnostika, profilaktika, taktika lecheniia.

The article highlights the current understanding of the etiology and various mechanisms of development, patterns of angioneurotic edema. Detailed clinical and laboratory picture of allergic and non-allergic forms of angioedema are presented.

[Angioedema of the upper airways during a routine surgery]. / Angionevroticheskii otek verkhnikh dykhatel'nykh putei, razvivshiisia u bol'noi vo vremia planovoi operatsii.

The article describes a rare clinical case of the development of angioedema of the larynx and pharynx in a patient during a surgery under endotracheal anesthesia. The authors of the article indicate that in the practice of clinic is 1 case for 32011 people, which is 0.003% of all hospitalized in the hospital for the elective surgical treatment of diseases of the upper respiratory tract. After removal of the tonsils and cyst of the nasopharynx, the surgeon noted a pronounced edema of the uvula, the mucous membrane of the soft palate, the lateral walls of the laryngopharynx and larynx. The patient was not taken out of the anesthesia. The mechanical ventilation was continued and the patient was transferred to the intensive care unit and intensive care unit where antiedematous and symptomatic therapy was conducted. On the 3rd day of treatment, the upper respiratory tract edema reduced, the patient was extubated. The authors present an algorithm for the examination and treatment of patients with angioedema.

[Differential diagnostics of headache associated with pathological changes in the nasal cavity and paranasal sinuses]. / Differentsial'naia diagnostika golovnoi boli pri patologii polosti nosa i okolonosovykh pazukh.

Headache is not infrequently one of the major complaints in the patients visiting the otorhinolaryngologist's office. It was estimated to occur in 24% of the patients presenting with chronic sinusitis. The cause of headache may be pathological processes either in the nasal cavity or in the paranasal sinuses as well as a primary disorder in the nervous system. The present article is concerned with the peculiar features of rhinogenic headache and that of a different etiology. It was shown that the patients suffering from headache are in need not only of the obligatory otorhinolaryngological examination including endoscopy of the nasal cavity, X-ray study and, sometimes, specialized tests but also of neurological counseling. However, the surgical treatment does not always results in the elimination or relief of the rhinogenic headache. Hence, the importance of the evaluation of the risks and benefits of such treatment for an individual patient. The formation of the contact points in the nasal mucosa is considered to be one of the possible causes of rhinogenic headache. However, this opinion needs to be confirmed by the results of large-scale comparative clinical studies.

[Differential diagnostics and the treatment strategy for the management of the nasopharyngeal cystic lesions]. / Differentsial'naia diagnostika i taktika lecheniia kistoznykh obrazovanii nosoglotki.

The nasopharyngeal cystic lesions are quite common (affecting up to 14% of the general population) even though the majority of the cases are asymptomatic. Sometimes this condition is associated with the obstruction of nasal breathing, runny nose, hearing impairment, and other non-specific clinical manifestations. The endoscopic examination of the nasal cavity allows the preliminary clinical diagnosis to be established, however, MRI and CT visualization are necessary for more reliable differential diagnostics of this pathology and adequate planning of its treatment. The nasopharyngeal cysts require the surgical treatment, with endoscopic transnasal marsupialization in the combination with coblation, radiowave or laser irradiation being the main currently available option.