[The cartilage graft in middle ear microsurgery. Indications, technique, results]. / Zastosowanie chrzastki w mikrochirurgii ucha srodkowego. Wskazania, technika, wyniki.

AIM: The use of cartilage in tympanoplasties in the shape of monolytic cartilage-perichondrium autografts or several particles as a cartilage-palisade. MATERIALS AND METHODS: The retrospective analysis concerned 216 clinical cases. The cartilage palisade technique was performed in 163 tympanoplasties. In 53 cases the tympanoplasty was carried out with the use of the monolytic cartilage-perichondrial composite graft: cartilage-island, cartilage-cork or cartilage-mat. RESULTS: In the type I and II of tympanoplasty the air bone gap (ABG) <10dB showed 70% of patients operated with the use of monolytic cartilage-perichondrial composite autografts and 73% using the cartilage-palisade technique. CONCLUSIONS: The usefulness of cartilage in tympanoplasties is much the same in cartilage-palisade technique as well as in monolytic, non-palisade technique.

[Endonasal microscopic surgery of the lacrimal duct stenosis--long-term results]. / Mikrochirurgia wewnatrznosowa w leczeniu niedroznosci dróg lzowych--wieloletnie wyniki wtasne.

AIM: The value of a complex endonasal microsurgical treatment of lacrimal duct stenosis. MATERIAL AND METHODS: in a group of 418 patients we performed 455 dacryocystorhinostomy (DCR) including 37 bilaterally. They were 263 females (62.9%) and 155 males (37.1%). Age ranged from 1.5 to 87, mean age 54.3 years. Performance: general anaesthesia with controlled hypothension, semi sitting position of patient and adjustable headrest, operating microscope (300 mm lens). Operative procedure: septum mobilization and anterior ethmoidectomy, dacryocystorhinostomy (DCR). RESULTS: satisfactory results were obtained in 436 of cases (95.8%), 19 no change (4.2%). Only 18 cases received a prosthesis. There were only 2 complications (0.2) not serious. CONCLUSION: endonasal microscopic dacryocystorhinostomy preserves intact bony support and frame of lacrimal ducts and the nasal function of the lacrimal pump. It allows simultaneous management of the concomitant sino-nasal pathology as well as shorter operation times, lower complication rates and reduced patient morbidity.

[The new insight into the pathogenic unity of the upper and lower airways]. / Nowe spojrzenie na jednosc patogenetyczna górnych i dolnych dróg oddechowych.

Between the upper and the lower respiratory tracts exists a link. Numerous epidemiological, immunological studies and clinical observations suggest the pathogenic unity of the upper and lower airways. The most important observations regarding the nose-lung interaction is rhinitis and asthma. The inflammatory process in the nose is the same as in the bronchi, clinically defined as rhinosinusitis, nasal polyps, asthma, bronchial hyperreactivity, allergy, viral infections. The strict link between the rhinosinusitis and asthma implies new possibility of influencing one of the two complaints by treating the other one with an integrated therapy (pharmacotherapy, endonasal microsurgery).

[Sinobronchitis--historical aspect]. / Zespól zatokowo-oskrzelowy w aspekcie historycznym.

There is evidence that a link exists between the upper and lower respiratory tracts. During the last fifty years many clinical observations has lead to a new pathogenic view of rhinosinusitis and asthma defined as Sinobronchial Syndrome. The inflammatory process in the nose and bronchi explains some of the complex interactions among different clinical diseases, such as rhinosinusitis, asthma, bronchial hyperresponsiveness and viral infections.

[History of endaural surgery]. / Historia chirurgii wewnatrzusznej.

History of the endaural mastoid surgery and the development of this approach to the temporal bone begins with the first paracentesis, which is the oldest endaural operation of the middle ear. Prior to the invention of the ear mirror paracentesis was a difficult operation. In 1885 Kessel reported endaural radical ear surgery. A great inconvenience is the narrow operative field within the external auditory meatus. It influenced the surgeon to extend the incision posteriorly into the auricle. In 1930 Heermann H. described antero-superior extracartilaginous endaural incision.

[Pleomorphic adenoma of the palate. Case report]. / Gruczolak wielopostaciowy podniebienia. Opis przypadku.

Report on a huge pleomorphic adenoma (diameter 6 cm) of the right palate extending into the posterior part of the oral cavity. The dimension of the tumour and anatomical relations were documented with the use of nuclear magnetic resonance.

[The use of palisade technique in tympanoplasties after Heermann]. / Zastosowanie techniki palisadowej w tympanoplastykach wedlug Heermanna.

INTRODUCTION: The palisade tympanoplasties-technique with using of tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall was described. MATERIAL AND METHODS: The operation started with the endaural incision. Tragal and conchal autograft palisade fragments with perichondrium for reconstruction of the tympanic membrane and the auditory canal wall have been used up to 1996 in 15,300 cases. We placed palisaded cartilage fragments parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "tunnel plasty" in the eustachian tubal entrance is performed with "simmering", "architrave" and "anti-architrave" to keep the tubal entrance open. This "tunnel plasty" results in a nice reconstruction of the tympano-meatal niche. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus, crossing the promontory and reducing adhesions. This annulus-stapes bridge is fixed with a further palisade cartilage, "step plasty", which connects the "tunnel-plasty" with "annulus-stapes plate". The palisade-epitympanum-antrum plasty allows ventilation of the antrum via a tunnel constructed of well-fitting parallel pieces of cartilage fixed by self-tension (no glue) and replacing the bony canal wall. The "columella-tunnel plasty" has an L-shaped notch in the "annulus-stapes plate" fixing a columella of cartilage, placed in the oval window. Only in a case with a narrow oval window niche, a type IV palisade plasty can be performed or a prosthesis placed. RESULTS: The "annulus-stapes cartilage plate" is more stable reconstruction in type III tympanoplasties than are incus of foreign body interpositions. Adhesions on the promontory are found more often with fascia than with cartilage fragments. Histologic study of autograft cartilage showed good preservation of cartilage cells even 26 years after transplantation. CONCLUSIONS: The use of palisade cartilage technique brings very good functional and better long-term results.

[Review of the basic methods of surgical treatment of lacrimal duct stenosis]. / Przeglad podstawowych metod chirurgicznego leczenia niedroznosci dróg lzowych.

Nasolacrimal duct obstruction is a common condition in patients who visit otolaryngologists and ophtalmologists. The patients complain of epiphora and blurred vision. Reconstruction of lacrimal drainage provides great improvement in a patient's quality of life. On the base of the world literature and the own experience, several surgical techniques of the lacrimal system are presented and analyzed regarding indications and results: dacryocystorhinostomy (DCR), canaliculodacryocystorhinostomy (CanDCR), con-junctivodacryocystorhinostomy (ConDCR) and intubation. External DCR usually involves extensive removal of bone at the lacrimal fossa and hence risks disruption of the lacrimal pump mechanism. The development of endonasal microsurgery (endoscope, microscope) have awakened interest in an internal DCR in treatment nasolacrimal obstruction. Endonasal microscopic dacryocystorhinostomy become an important alternative to the classical external DCR. This method preserves intact the normal function of the lacrimal pump, yields cosmetic excellent results and allows at the same time management of the concomitant sino-nasal pathology.

[History of endonasal microsurgery of lacrimal system]. / Historia mikrochirurgii wewnatrznosowej dróg lzowych.

The history and development of surgical treatment of lacrimal system from rhinological point of view was presented. The lacrimal drainage system has provoked great deal of investigation throughout history, because ophtalmologists couldn't attain persistent and permeable drainage between the lacrimal and the nose. The change came, when first Italian rhinologist Toti described external dacryocystorhinostomy (DCR), and later West performed endonasal DCR. The use of microscope and endoscope in rhinosurgery caused the significant progress also in lacrimal surgery. The development of endonasal microsurgery enabled to introduce other non invasive procedure, such as endoscopic laser dacryocystorhinostomy or transcanalicular dacryo-cystorhinostomy (endo-canalicular DCR). One of the newest method in the treatment of complete and partial obstruction of lacrimal drainage system is also baloon dacryocystoplasty.

[Assessment of the hearing results in tympanoplasties with the use of palisade-technique]. / Ocena wyników sluchowych po tympanoplastykach uzyskanych metoda techniki palisadowej.

UNLABELLED: The cartilage has been successfuly used in reconstructive ear surgery for more than one hundred years. Histologic study of autografts cartilage (tragal or conchal) showed good long-term preservation of cartilage cells. The aim of this paper is to assess the hearing results in tympanoplasties with the use of cartilage palisade technique. MATERIAL AND METHODS: The retrospective analysis concerned 108 operated clinical cases. The cartilage palisade technique was performed in 28 tympanoplasties type I, 47 tympanoplasties type II, 21 tympanoplasties type III with columella and in 2 tympanoplasties type IV. Clinical assessment included otoscopy, test for eustachian tube ventilation, test with tuning fork, audiometry on a range 0,5, 1, 2 kHz and subjective evaluation based on questionaire. RESULTS: The Air Bone Gap (ABG) was noted as follows: < 10 dB among 67,8% of patients and 11-20 dB among 21,4% of patients in tympanoplasty type I. In tympanoplasty type II the ABG was responsively: < 10 dB - 80% patients, 11-20 dB - 10% patients. In the type III of tympanoplasty 40,4% of patients showed ABG < 10 dB and 42,5% of patients 11-20 dB. In the type III with columella we noted 15% patients with ABG < 10 dB and 65% of them with ABG 11-20 dB. CONCLUSIONS: The cartilage is a good autograft for reconstruction of the tympanic membrane, middle ear and the auditory wall because of stability and lack of secondary perforations. Long-term results in hearing are also satisfactory.

[Long-term results after operation of otosclerosis with the use of partial stapedectomy technique after Heermann]. / Dlugoletnie wyniki po operacjach otosklerozy technika stapedektomii czesciowej wedlug Heermanna.

INTRODUCTION: One of the best method for restoring hearing in otosclerosis is partial stapedectomy according to Heermann's proposition. MATERIAL AND METHODS: The retrospective study is refering to 98 patients with otosclerosis who underwent in 1987 year partial stapedectomy after Heermann. The assessment of long-term hearing results was based on audiometric examination after a lapse of 7 years and 15 years. RESULTS: 7 years after the operation we found the improvement of hearing in 90,6% of the patients with the air bone gap (ABG) < 10 dB and in 9,4% of them with ABG 11-20 dB. After 15 years the results were as follows: 23 patients with ABG 0-10 dB, 8 patients ABG 11-20 dB, 1 patients ABG 21-30 dB and 2 patients ABG > 30 dB. Any complications were noted. CONCLUSIONS: Partial stapedectomy is not only the safe method, but also very cheap with good results.

[Microscopic endonasal dacryosurgery: modification of dacryocystorhinostomy]. / Mikrochirurgia wewnatrznosowa dróg lzowych: modyfikacja dacryocystorhinostomii.

INTRODUCTION: The own experiences in the surgical treatment of lacrimal duct stenosis are presented as a part of microscopic endonasal surgery. MATERIAL AND METHODS: A group of 418 patients suffering from lacrimal duct stenosis was treated with the use of modified microscopic endonasal dacryocystorhinostomy (DCR) combined simultaneously with other intranasal procedures, such as septoplasty, ethmoidectomy, mucotomy. RESULTS: Modified dacryocystorhinostomy concerned 455 procedures carried out in the group of 418 patients, 37 of them were operated bilaterally. The following procedures have been made: 387 (85,1%) dacryocystorhinostomies, 50 (11,0%) canaliculodacryocystorhinostomies and 18 (3,9%) conjunctivorhinostomies with prosthesis. Out of the total 455 operated sides, we gained good results in 420 (92,3%) cases. An improvement was reported by 16 (3,5%), and 19 (4,2%) no change. CONCLUSIONS: The modified microscopic endonasal dacryocystorhinostomy is a gratifying and in most of cases successful procedure with low risk of complications. This noninvasive method, based on rhinosurgical experiences, occured very usefull and without any cosmetics problems.

[Evaluation of diagnostic and rhinologic aspects in the treatment of lacrimal duct stenosis]. / Ocena aspektów diagnostycznych i rynochirurgicznych w leczeniu niedroinosci dróg lzowych.

INTRODUCTION: Diagnostic and rhinosurgical problems relevant to surgical treatment of lacrimal duct stenosis are discussed. MATERIAL AND METHODS: A group of 418 patients suffering from lacrimal duct stenosis were subjected at the same time to 455 procedures of endonasal dacryocystorhinostomy combined with other intranasal interventions, such as septoplasty, ethmoidectomy, mucotomy. Rhino-ophtalmologic evaluation included: micro-endoscopic examination, CT of paranasal sinuses, dacryocystography or dacryoscintygraphy. RESULTS: In the most of the patients we noted at least some anatomical alterations of the nasal cavity. Most common were septal deviations (85.9%), followed by hypertrophy of the inferior turbinates (78,0%), pathology of ostio-meatal complex (24.8%), concha bullosa (15.0%) or various combinations of these. Chronic rhinosinusitis was noted among 23.2% of patients. Radiological examinations showed the predominance of postsaccal stenosis in 15.3-17.0% cases (respectively to the right or left side), saccal stenosis in 12.7-11.7% cases and presaccal in 4.3-3.6% cases. CONCLUSIONS: This combined procedure makes easy not only the operation on lacrimal duct but removes the pathologic changes and has a good influence on healing.

[The 80-th anniversary of the use of an operating microscope in otorhinolaryngology. Part II. Technical principle and operation of surgical microscope]. / W 80. rocznice zastosowania mikroskopu operacyjnego w otorynolaryngologii. Czesc II. Budowa i zasady dzialania mikroskopu operacyjnego.

The first step to microsurgery is getting to know about technical principle and operation of the surgical microscopes. Special attention is paid to those modules and items of microscopes, which surgeon use most frequently, such as objectives, binocular tubes, eyepieces.

[The 80-th anniversary of the use of surgical microscope in otorhinolaryngology. Part I. History of optical instruments]. / W 80. rocznice zastosowania mikroskopu operacyjnego w otorynolaryngologii. Czesc I: Historia aparatury optycznej.

Before 80 years a microscope was used to otological operation. It caused a development of otosurgery and audiology. A new surgical method--microsurgery--has changed the character of surgical procedure from radical to conservative, non-invasive and functional. Then optical instrument was introduced to endolaryngeal microsurgery. Rhinology is the last part of the otorhinolaryngology, where optical equipment, such as endoscope and microscope, has changed not only our knowledge on the pathogenesis of chronic rhinosinusitis, but also created new method of therapy. Now an operation microscope is the basic instrument in every ENT department.