Marcus Gunn (jaw-winking) phenomenon in pediatric otorhinolaryngology practice.

Marcus Gunn phenomenon (MGP) is a rare form of congenital facial synkinesis known as jaw-winking or pterygoid-levator synkinesis. The MGP is the raising of the affected eyelid is synchronous and proportionate to the opening of the mouth. The etiology is unclear. Most authors claim that a branch of trigeminal nerve has been congenitally misdirected into position of the oculomotor nerve which supplies the levator muscle of the upper lid. The MGP deals with number of problems which have to be manage by ENT doctors, but they are not well­documented. We describe the first time Marcus Gunn phenomenon associated with an olfactory nerve disturbance. We have especially emphasized laryngological aspect of MGP diagnosis and the need for deeper interdisciplinary diagnostics in each child with olfactory dysfunction.

Kallmann syndrome in pediatric otorhinolaryngology practice - Case report and literature review.

BACKGROUND: Kallmann syndrome (KS) is an isolated form of hypogonadotrophic hypogonadism (HH) in combination with a defect in olfactory function. The diagnosis of KS before maturation is often difficult to make due to the broad spectrum of presentation and genetic heterogeneities. ENT examination including smell test is essential for proper diagnosis of olfactory disturbances and non olfactory abnormalities in craniofacial region which may also be existent in KS. CASE: A 17-year-old girl admitted to ENT Department because of the olfactory sense disturbances since two years. The patient reported also amenorrhea caused by primary HH. A diagnostic work-up using double-checked Sniffin' Sticks test and 6-items olfactory test confirmed serious hyposmia and identified the presence of KS. CONCLUSION: Usually anosmia is not recognized by the affected individuals, so it is recommended to perform olfactory screening tests and obligatory ENT examination in the event of a HH even when patient reports a normal sense of smell. It leads to early diagnosis of KS and will benefit the relevant patient care.The KS diagnosis should be done at an early stage, but symptoms and clinical manifestations are not always evident both in ENT and pediatric field. In this article we would like to highlight the need for a multidisciplinary assessment and awareness for KS symptoms in pediatric practice as a hole.

Analysis of implementiation of 4th Head and Neck Cancer Awareness Week in Department of Otolaryngology in Miedzyleski Hospital in Warsaw.

INTRODUCTION: The aim of the study was to analyze the profile of patients applying for free preventive examinations within The Forth European Head an Neck Cancer (HNC) Awareness Week in the Department of Otorhynolaryngology in Miedzyleski Hospital in Warsaw (ORL MSS). MATERIAL AND METHODS: A media campaign was designed to inform HNC risk patients about the opportunity to receive free preventive examinations in ORL MSS. 225 patients were enrolled to the study. Patient age ranged from 26 to 92 (average 63 years). Women accounted for 66% (149) and males 34% (76). Each patient completed a questionnaire assessing risk factors for HNC, including reported symptoms and lifestyle. ENT examination was performed. Some patients were referred for further diagnostics and treatment. RESULTS: The following HNC risk factors connected with lifestyle were found: nicotine in 22%, alcohol in more than once a week in 12%, oral sex in 17%, multiple sexual partners in 10%, rare dental tests in 24%, prosthetic restorations in 45%. The symptom that most often prompted patients to participate in the HNC prevention week was chronic hoarseness (64%) of people, dry mouth (39%), swallowing (37%), nasal obstruction (6%), neck tumour (5%). One per every five patients was referred to further diagnostics: imaging screening 7% (15 persons), fiber optic examination 11% (25 persons), the excision of the lesion 8% (18 persons). 17 patients were referred for further oncological treatment, of which 13 had benign tumors and 4 had malignant tumors. CONCLUSIONS: The HNC Awareness Program increases public consciousness and should systematically includes people with risk factors. The introduction of the Program in the ORL Department has made possible to detect and treat cancer in early stages in 7.5% of those who applied for the program. The use of adequate diagnostics and treatment requires, however, adequate financial resources and systemic solutions.

Parotid gland tumours in the ENT Department in Miedzyleski Hospital in Warsaw between 2007 and 2014.

INTRODUCTION: Parotid gland tumours comprise 3% of all head and neck tumours. Although uncommon they are a histologically diverse group of tumors. The WHO classification of salivary gland tumours from 2005 recognizes 24 different malignant subtypes. They present different clinical courses and varying prognoses. Nearly 80% of salivary gland tumours are located in the parotid gland. MATERIAL AND METHODS: Our study evaluated retrospectively 445 patients with parotid gland tumours treated in our hospital in the period between 2007 and 2014. We analyzed surgical treatment and histological diagnosis. RESULTS: There were 253 (56.9%) women and 192 (43.1%) men. The incidence of benign neoplasms was 90%. The most frequent benign tumour was pleomorphic adenoma (46%) and Whartin's tumour (35%). The most commonly found malignant tumour was acinic cell carcinoma (23%) and adenocarcinoma (13%). Non-Hodgin lymphoma in the parotid gland constituted nearly 17% of all malignant lesions. Hybrid tumours were diagnosed in 5 cases. Each patient underwent surgical procedure. Temporary facial nerve paralysis after surgery was diagnosed among 10 patients. Additionally, among 4 patients permanent facial nerve paralysis was diagnosed, which appeared before surgery or during surgical resection of the infiltrated facial nerve. DISCUSSION: In this study the frequency of benign neoplasms was higher and its histopathology was different than in the literature. The most common malignant parotid gland neoplasm was acinic cell carcinoma. The study presents 5 cases of hybrid neoplasms which are very uncommon and cause difficulties with prognostic evaluation and treatment selection.

Massive myiasis in an advanced metastatic neck tumor.

Only a small number of cases of myiasis have been previously reported in patients with a head and neck malignancy; most of these occurred in patients with primary or metastatic skin cancer. We report a case of massive Lucilia sericata myiasis in the neck of a 57-year-old man with primary squamous cell carcinoma of the larynx and hypopharynx that metastasized to the neck lymph nodes. The neck disease manifested as necrosis and skin involvement. Clinical examination revealed an extensive wound within the neck tumor at levels II and V on the right that was heavily infested with maggot larvae. Removal of larvae clusters was performed, and the isolated larvae were subsequently identified as L sericata. To the best of our knowledge, this is the first report of an infestation of L sericata myiasis in a metastasis to the neck lymph nodes.

[Cat scratch disease--a diagnostic problem, case report]. / Choroba kociego pazura--problem diagnostyczny, opis przypadku.

AIM OF THE STUDY: Cat scratch disease as a possible cause of neck limphadenopathy. MATERIAL AND METHODS: We present a case of 40-years old men operated in our department on regional unilateral lymphadenopathy. The diagnosis of cat scratch disease was confirmed by the histopathologic examination. CONCLUSIONS: Regional lymphadenopathy with history of contact with cats or other animals suggests the diagnosis of cat scratch disease. If we considered this disease in differential diagnosis it would mean less traumatic treatment for the patient. Cat scratch disease is diagnosed in Poland very rarely; we need to spread the knowledge about this infectious disease.

[Differential diagnosis and treatment of neck masses. A study based on observation in Otolaryngology Department of Miedzyleski Specialistic Hospital in Warsaw]. / Diagnostyka róznicowa i leczenie guzów szyi w materiale oddzialu Otolaryngologii Miedzyleskiego Szpitala Specjalistycznego w Warszawie.

In otolaryngology practice we quite often encounter neck masses in all age group patients. The differential diagnosis is extensive and represents a variety of pathologic conditions of various origins, especially in relation to patient age. The authors present a retrospective analysis of patients with a neck mass treated in Otolaryngology Department of Miedzyleski Specialistic Hospital in Warsaw over the period of two years. Patients were divided into groups according to their age. Within each group the incidence of congenital, inflammatory and neoplastic disease was assessed. The most numerous was the group of adults older than 40 years of age with the highest incidence of malignant neoplasms. The location of metastatic lymph nodes in relation to primary site was described. Finally, methods of management for each tumour type were presented. Then we discuss a work-up of a neck mass with regard to literature data.

[Parotid tumors: a two-year experience of Otolaryngology Department at MSS Hospital in Warsaw]. / Guzy slinianki przyusznej w dwuletnim materiale Oddzialu Otolaryngologii Miedzyleskiego Szpitala Specjalistycznego.

THE AIM OF THE STUDY: Tumors of the salivary glands represent about 3% of head and neck neoplasms. Most of theme--up to 80%--originate from the parotid gland. The aim of the study is to present current epidemiological data, most frequent complains, our surgical technique, histopathological diagnosis, complications rate and follow-up. MATERIAL AND METHODS: Retrospective analysis of 100 patients, operated at our department from 01.2007 to 03.2009, was performed. We analyzed the age, sex, symptoms of the dissease, histopathological findings, complications and follow-up. All of the patients had ultrasound examination prior to operation to estimate the spread and the type of the tumor. In doubtful cases the ultrasound-guided fine-needle aspiration for biopsy and cytology, computer tomography and magnetic resonance were performed. RESULTS: The frequency of incidence of benign tumours was 90% and the most frequent histopathological diagnosis was pleomorphic adenoma (49%) and adenolymphoma (42%). By 6% of our patients malignant neoplasms were developed and tumours of non-neoplastic origin by 4% of theme. The most frequent complication was sensory deficit about the cheek and ear (35%), temporary facial nerve paresis (5%), hematoma (1%), salivary fistula (1%). CONCLUSION: Superficial and total parotidectomy are safe procedures of treatment in case of salivary gland tumors. Using the microscope during parotidectomy is extremely useful in order to preserve the continuity of the facial nerve branches.

[Adenoma polymorphum localised out of salivary glands in material of ENT Department MSS Hospital between 2007-2009 - two cases]. / Pozasliniankowa lokalizacja gruczolaka wielopostaciowego w materiale Oddzialu Otolaryngologii MSS w latach 2007-2009--opis dwóch przypadków.

The adenoma polymorphum is benign salivary glands tumor. The most common location of occurrence is the parotid followed by the minor salivary glands in which the palate, upper lip and buccal mucosa are most commonly affected. It is a demarcated from the surronding, painless, capsulated and slow growing mass. Microscopically these tumors are composed of varying proportions of epithelial and mesenchymal tissue. Treatment of adenoma polymorphum is complete surgical excision with a surronding margin of normal tissue. This procedure avoids local recurrence. In two years (2007-2009) In Otolaryngology Ward In Miedzyleski Szpiatl Specjalistyczny treated four patients with adenoma polymorphum localised out of salivary glands. The authors described two cases of tumor mixtus localised on soft palate and in external ear canal. The first is a 57-year old male presented a painless swelling over the palate of four months duration. Admitted to ENT Unit on april 2009. He denier dysphagia and dyspnoea. On examination there was a firm, circumscribed tumor of the palate in the right side. CT scans show a right soft palate well-defined mass. He underwent transoral surgical excision. Postoperative period was uneventful. Another case is 18-year old girl with progressive worsening of hearing .On examination external ear canal was blocked due to firm and round tumor on his upper wall. The tumor was excised In local anesthesia. During two years observation there was no evidence of local reccurence.

[Unusual pathology of submandibular gland--Küttner tumor]. / Rzadka patologia slinianki podzuchwowej--guz Küttnera.

Küttner tumor (chronic sclerosing sialadenitis) is a chronic, benign lesion of salivary gland. Its clinical course resamble malignant process. Authors report two typical cases of CSS affecting submandibular gland. We inform, that we start follow up of those cases consist of--us imaging /twice a year/, indication of LE and IgG level, protein electrophoresis.

[Facelift incision parotidectomy: preliminary report]. / Parotidektomia z dostepu do liftingu twarzy--doniesienie wstepne.

INTRODUCTION: Traditional approaches parotidectomy leaves a visible scar and a hollow on the face and neck, which might be dissappointing to some patients. AIM OF THE STUDY: Assessment of usefulness of facelift approach to the parotid gland PATIENT AND METHODS: A retrospective study was performed. In June 2009 eight patients with benign parotid tumour underwent superficial parotidectomy. Four of them were included in the rhytidectomy approach parotidectomies and SMAS advancement flap was carried out to reconstruct the parotid bed and prevent Frey's syndrome. The latter patients underwent the classical technique parotidectomies. After two months from the operation both groups of patients were asked to assess the cosmetic outcome of the surgery in five degree scale. RESULTS: The duration of the operation increased by an average of 20 minutes in the rhytidectomy approach group. No major difficulties in exposing the facial nerve and its branches were observed. Patients were more satisfied when facelift approach was performed. CONCLUSION: A rhytidectomy approach to the parotid gland seems to be safe method and aesthetic results are more satisfactory as comparing to classical approach.

[The parotid gland's tumours in material of Otolaryngology Department Medical Academy in Warsaw in 1990-2006]. / Guzy slinianki przyusznej w materiale Kliniki Otolaryngologii w Warszawie w Latach 1990-2006.

INTRODUCTION: The purpose of this work was the desire for handing over authors' experience in diagnostic and operative procedures in the case of the parotid gland's tumours, presenting gathered material, ways of removing tumours and curing results. They are paying special attention for dealing with tumours infiltrating skull base, penetrating intracranial, requiring practicing "the saving surgery". MATERIAL AND METHODS: The study is the analysis of 317 patients; 180 (58%) women and 131 (42%) men with parotid gland tumours in patients treated in ENT Department between X. 1989 - XII. 2006. In 222 cases they made a partial parotidectomy, in 63 total, in 11 radical parotidectomy, in 21 cases radical parotidectomy widened for the radical neck dissection, where 8 patients were subjected to the radical saving surgery - subtotal petrosectomy and craniotomy. Authors analyzed surgical treatment and intraoperative tumours stage. The results of histological diagnosis were presented. RESULTS: The period of follow-up is from 1.5 year to 16 years. The frequency of incidence of benign tumours was 81%. The most frequent tumours were pleomorphic adenoma and adenolymphoma. Malignant tumours constituted 19% of all parotid gland tumours. The most common malignant tumours were adenoid cyst (15%) and undifferenciated (15%) carcinomas. Out of 59 patients with malignant tumours 29 died. CONCLUSIONS: (1) There were 81% cases of benign neoplasm and 19% malignant neoplasm in presented material. (2) The result of parotid gland treatment depends on tumor's histopathology, the period of disease, the size of tumour, its expansion into the neighbourhood, infiltrating of the facial nerve and metastases into the lymph nodes. (3) Radical resection of tumour and metastases, reconstructing the continuity of tissues and maintaining the quality of patients life, should be the principle of surgical treatment.

[Neoplasms of paranasal sinuses in material of ENT Department MSS Hospital in Warsaw between 2006-2007]. / Nowotwory zatok przynosowych w materiale oddzialu Otolaryngologii Miedzyleskiego Szpitala Specjalistycznego w Warszawie w Latach 2006-2007.

Tumors of paranasal sinuses present a small percent of tumors detected in the region of head and neck 3-4% and they present a fraction of a percent of tumors in general /0.16%/. MATERIAL: In the years 2004 and 2005, the National Register of Neoplasms recorded 120 and 132 cases of malignant tumors of paranasal sinuses, respectively. Between 2006-2007 we treated 15 patients with tumors of paranasal sinuses underwent treatment at the ENT department of the MiEdzyleski Szpital Specjalistyczny in Warsaw. The following were analyzed: the advancement stage of the tumor, symptoms, the time that has elapsed from the first appearance until the admission for treatment at the department, the methods of treatment, and the histological differentiation of neoplasms. THE RESULTS: We detected the following:--benign neoplasms: 2 cases of angiofibroma, 3 cases of inverted papilloma;--malignant tumors: 4 cases of Ca planoepitheliale, 1 instance of adenocarcinoma, 1 instance of Ca anaplasticum, 1--melanoma, 1--esthesioneuroblastoma, 1--lymphoma malignum, 1--metastatic tumor. THE CONCLUSIONS: at the moment of the admission for treatment at the ENT department, the advancement stage of tumor T3/T4, from the first signs until the proper diagnosis was that marked with the passage of eight months. Ca planoepitheliale is the most common type of malignant tumors of paranasal sinuses. It is only good cooperation between the surgeon and the pathologist which makes it possible to put the proper diagnosis.

[A sudden sensorineural hearing loss caused by a thunderbolt]. / Nagla gluchota spowodowana uderzeniem pioruna.

The authors present a case of 12-years old girl with sudden sensorineural hearing loss caused by computer adapter explosion during the storm. She denied any tinnitus and vertigo. She was admitted immediately to ENT Ward. Audiometric examination showed rigt ear deaffness. She administered vasodilatators, oxygen, Vitamin B complex, 1% xylocain, dextran, betahistin and steroids i.v. After few days she started to hear her rigt ear. Conrtol audiometric examination showed hearing in normal range. In a case of sudden deaffness is important to strart treatment as qiuck as is possible. And we should remember that new technics with nature could be dangerous to our health.

[A rare case of cerebrospinal fluid rhinorrhea]. / Rzadki przypadek plynotoku nosowego.

INTRODUCTION: Cerebrospinal fluid rhinorrhea is a result of a damage to bones and dura mater of the anterior cranial fossa base. In more than 90% it is of trauamatic etiology. AIM: The aim of the study was to present a case of a 23 year old female patient with post-traumatic rhinorrhea. Cerebrospinal fluid rhinorrhea occured as a result of unintentional damage of cribriform plate of the ethmoid bone on the right side when the patient was opening a box of cosmetic with the use of a screwdriver. MATERIAL AND METHODS: Two days after the accident she was admitted to our Department with apparent cerebrospinal fluid rhinorrhea and forehead headache. Radiological and laboratory testing were performed, than she was consulted by a neurologist and a neurosurgeon. It was decided to introduce conservative management in the ENT department. RESULTS: During 24 days of hospitalization with medical management including avoidance of activities that increased the intracranial pressure, head elevation and antibiotics the cerebrospinal fluid rhinorrhea decreased and ceased. This was confirmed by physical examination, nasal endoscopy, radiological studies and neurosurgical consultation. CONCLUSIONS: After more than 3 months of follow-up, there was no evidence of rhinorrhea.

[The syndrome of dyskinetic cilia as the cause of chronic sinusitis]. / Zespól nieruchomych rzesek, jako przyczyna przewleklego zapalenia zatok.

UNLABELLED: The syndrome of dyskinetic cilia is the cause of chronic inflammatory processes of upper and lower airways. The research studies concerning cilia's structure were held during 50s. About 20 types of cilia's defects were characterized by now, classified as inborn defects. OBJECTIVES: The presentation of the case is because of both the rarity of incidence and diagnostical's problem and treatment. In this case, we observed who re-occurrence of chronic inflammation accompanied by having infections of lower respiratory tract it is necessary to expand diagnosis to find out the reasons of such disease. MATERIALS AND METHODS: A 7 years old girl was admitted to our Clinic. Since couple years she has been under assistance of Specialist Clinic. She was also hospitalized because of aggravation inflammatory state of lower airways. After computers tomography of sinuses she was qualified to surgical treatment. During operation a material to study of cilia immobility was taken. The electron microscope study confirm the diagnosis of the group of dyskinetic cilia. RESULTS: The follow-up examination was held 14 months after operation. During this time the girl did not take any antibiotic (before antibiotherapy was held couple times during the year). Clinical status proved. Better results were also on computer tomography. CONCLUSIONS: In this case, re-occurrence, inflammatory process both upper and lower respiratory tract are necessary to expand the diagnostics to find out the cause of illnesses. The methods of treatments the group of in-movement's cilia based on the symptomatic treatment, but the role of physiotherapy of respiratory system is stressed as the operation of removal of secretion's retention. There is an important role of regular laryngology care and surgical treatment allow partly to control the disease.

[Cancer in branchiogenic cyst--primary focus or metastasis?]. / Rak w obrebie torbieli bocznej szyi--proces pierwotny czy przerzut?

The authors report the case of 68 year old male operated upon for the branchial cyst of the neck. Histopathological examination showed carcinoma in the wall of the cyst. Ipsilateral tonsillectomy was done and pathology revealed primary focus in the palatine tonsil. Diagnosis of the branchiogenic cancer should be made only when all the criteria defined by Martin in 1950 are met. Patients with carcinoma cells found in branchial cyst should be diagnosed and treated as metastasis from Waldeyer's ring to the lymph nodes of the neck. Ipsilateral tonsillectomy is indicated as blind biopsy. When histopathological examination of the tonsil is negative the patients should be treated as metastasis to the neck from unknown primary focus.