Insulin resistance is associated with impaired olfactory function in adult patients with type 1 diabetes: A cross-sectional study.

AIM: To investigate whether insulin resistance is a predictor for decreased olfactory function in adult type 1 diabetes patients (T1DM). MATERIALS AND METHODS: The following parameters were examined in the group of 113 T1DM participants: body mass index (BMI), waist-hip ratio (WHR), TG/HDL ratio, glycated hemoglobin (HbA1c ), visceral fat (VF) in body bioimpedance, specific calculators (eGDR, VAI). Bilateral olfactory test score (BOTS) was performed using 12-odour-tests from Sniffin' Sticks. Then participants were allocated to one of two groups: normosmia (10-12 odours identified) or hyposmia/anosmia (0-9 odours). The association between BOTS and insulin resistance indicators was analyzed using: Spearman's rank correlation, multivariate linear regression analysis, and receiver operating characteristic (ROC) curve. RESULTS: 49.6% participants were diagnosed with hyposmia/anosmia, median BOTS was 10. BOTS correlated significantly with: WHR, TG, VF index, TG/HDL ratio, VAI, and eGDR. In multivariate linear regression analysis higher WHR turned out to be statistically significant independent predictor of lower BOTS (ß = -0.36; P = .005) after adjustment for age, sex, TG and peripheral neuropathy (R2 = 0.19; P = .0005). The ROC analysis indicated a WHR cut-off of 0.92 [area under the ROC curve (AUC): 0.737; 95% confidence interval (CI): 0.647-0.828, P < .0001] as the best among evaluated factors significantly affecting hyposmia/anosmia occurrence (sensitivity of this cut-off 0.50 and specificity 0.86). CONCLUSIONS: We have provided evidence of an association between lowered insulin sensitivity expressed in bioelectrical impedance analysis, anthropometrical (WHR), laboratory (TG/HDL ratio) measurements, specific calculators (eGDR, VAI) and deteriorated olfactory function.

Simultaneous treatment of intracranial complications of paranasal sinusitis.

PURPOSE: The objective of this study was to analyse 51 patients with intracranial complications of sinusitis treated in the Department of Otolaryngology and Laryngeal Oncology at Poznan University of Medical Sciences from 1964 to 2016. MATERIALS AND METHODS: Males made up a significant portion of study participants at 70.5%. Treatment included simultaneous removal of inflammatory focal points in the paranasal sinuses and drainage of cerebral and epidural abscesses and subdural empyemas under the control of neuronavigation preceded by the implementation of broad-spectrum antibiotics continuously for 4 weeks. Seventy-three intracranial complications were found among 51 patients. Of the 51 patients, 25 had frontal lobe abscesses (including multiple abscesses). Other complications included the following: 16 epidural abscesses, 9 subdural empyemas, 15 meningitis cases, 3 intracerebral abscesses, 3 sinus thrombosis cases and 2 patients with cerebritis. Co-occurrence of these complications worsened the state of the patient and increased the duration of treatment. Patients with frontal lobe abscesses had a better prognosis and less pronounced neurological symptoms in recent years versus earlier treatment approaches. CONCLUSIONS: Simultaneous treatment of intracranial complications of sinusitis is an effective treatment method that has minimal burden for the patient. From 1964 to 1978, three deaths (17%) were reported among patients with these complications. Since 1978, no deaths were reported in the clinic.

Skin flap complications after cochlear implantations.

The objective of the study was to analyse and present the surgical management strategy for major skin flap complications (MSFC) after cochlear implantations. Patients fitted with a titanium-silicone-coated implant of the same kind, operated on between 1994 and 2013 with a standardised procedure (1076 medical charts) were analysed. Analysis aimed to identify and study individuals with skin problems related to the cochlear implant treatment, i.e. requiring surgical treatment in hospital defined as MSFC and focused on incidence, risk factors and treatment of MSFC. MSFC were diagnosed in 1.76 % of patients: 2.06 % of children and 1.35 % of adults, 2.43 % after implantation with a long "C"-shaped incision and 1.28 % after short retroauricular incision. Registered risk factors included head trauma, acute otitis media, poor hygiene in children, and general comorbidities in adults. The primary intervention was dependent on skin complication severity and included revision surgery with wound closure over an implant (52.6 %) and revision surgery with explantation (47.4 %). Revision surgery without explantation was successful in 40 % and the most effective approach was debridement with a two-layer rotational flap. Explantation led to ultimate wound healing in all cases. Major skin flap complications after cochlear implantation are rare, but their treatment is complex and difficult. Revision surgery with resection of infected tissue, formation of a rotational two-layer flap preceded and supplemented by intensive targeted antibiotic therapy can be effective and should be the first treatment option. Spontaneous implant explantation, abscess formation or unsuccessful primary treatment necessitate implant removal as the ultimate solution.

Observations on hearing preservation in patients with hybrid-L electrode implanted at Poznan University of Medical Sciences in Poland.

The objective of the paper is to evaluate the hearing preservation rate in patients with high frequency hearing loss, treated with Cochlear Nucleus Freedom Hybrid-L implant in the Otolaryngology Department, Poznan University of Medical Sciences in Poland. Study was designed as the retrospective analysis. Twenty-one patients were operated and implanted with Nucleus Freedom Hybrid-L implant. Pure tone thresholds were recorded prior to the surgery and at the time of speech processor switch-on. Patients were subdivided into two groups with respect to their PTA thresholds: group A-classic indications and group B-extended indications. Average PTA for three frequencies (250, 500, 1,000 Hz) were calculated for each patient pre- and postoperatively. In the group of 21 implanted patients in 17 cases we have observed preservation of hearing (12 patients from group A, 5 patients from group B) with a mean value of 13.1 dB. In 4 out of 21 patients deafness on the implanted ear was noted. Our results clearly indicate that with standard procedure hearing preservation can be obtained in majority of patients. Hearing preservation was not achieved in 19 %, but owing to design of the electrode of the Cochlear Nucleus Hybrid-L that enables to work as CI platform alone, in patients who lost their hearing after surgery re-implantations were not required. This proves that EAS is a safe and reliable method to help patients with specific type of hearing loss.

[Results of treatment of 101 otogenic brain abscesses--56-years experience]. / Wyniki leczenia 101 usznopochodnych ropni mózgowia na przestrzeni 56 lat.

INTRODUCTION: Inflammatory process in the areas of the middle ear creates a possible danger related with the development of extratemporal and intratemporal complications. The most dangerous of those include meningitis and cerebral abscesses, which are still present. AIM: The aim of the work is to present 101 patients with cerebral, in temporal lobe, and cerebellar abscesses of aural origin throughout the period of 56 years, namely between 1953 and 2009. MATERIAL AND METHOD: Data concerning the patients have been obtained retrospectively on the basis of medical files. The analysis covered otolaryngological and neurological examinations, as well as method related with diagnosing abscesses. The thesis distinguished three periods of diagnosing otogenic brain abscess, depending on available diagnostic techniques. The first period covers the years 1956-1978, when constituted the basis of diagnosis. During the second period, falling between 1979 and 1989, the diagnosis was based on computed tomography of the head, while within the third period, including the years between 1990 and 2009, diagnosis focused on nuclear magnetic resonance. During the last two years neuronavigation was utilized for puncturing abscesses. CONCLUSIONS: The survival rate equalled 65% between 1953 and 1978, reached 86% between 1979 and 1989, and 91% after the year 1990, however, it is worth mentioning that after the year 1995 there were no fatal cases.

Balloon sinuplasty in one-day surgery.

INTRODUCTION: Balloon sinus dilation is becoming an increasingly common procedure, finding a niche as an invaluable tool in endoscopic sinus surgery. AIM: To assess the effectiveness of balloon sinus dilation (BSD) in 1-day surgery in patients with chronic rhinosinusitis without polyps based on our own experience. MATERIAL AND METHODS: The study group consisted of 9 patients. The Lund-Mackay scale for computed tomography of the paranasal sinuses was assessed prior to surgery. Endoscopy was performed on the basis of the Lund-Kennedy scale and patients were asked to perform the SNOT-22 survey. Two patients underwent balloon sinuplasty under general and seven under local anaesthesia. RESULTS: Twelve maxillary and eight frontal sinuses were widened (four attempts were unsuccessful). The SNOT-22 survey was assessed the day after surgery (average of 8 points) and a month after surgery (average of 15.5 points). CONCLUSIONS: BSD only allows widening of the ostia of the maxillary, frontal and sphenoid sinuses. BSD offers shorter post-surgical recovery, and a more rapid return to work because of its less invasive and less traumatic nature.

[Tracheal stenting in patients treated due to carcinoma of the larynx]. / Protezowanie tchawicy za pomoca stentów u chorych leczonych z powodu raka krtani.

INTRODUCTION: Stenosis of the trachea and main bronchia can occur in patients with lung, larynx, thyroid gland, esophagus, in metastatic tumors, can be also caused by trauma and foreign bodies. Treatment in this condition can be difficult. Tracheal stenosis in patients after total removal of the larynx is relatively rare. It can be caused by recidiv tumor and inflammation processes. AIM OF THE STUDY: Was to evaluate usefulness of stents in patient with stenosis of the trachea after total laryngectomy due to squamous cell carcinoma. MATERIAL AND METHODS: Authors described two cases of patient after total laryngectomy. Nitinol, expandable, tracheal stents were used in both cases. Placement of the stent into the trachea was relatively simple. Patients have undergone this procedure in short general anesthesia. RESULTS: After stenting patients exhibited dramatic improvement in their respiratory symptoms and quality of life. CONCLUSIONS: Stents are useful in cases of tracheal stenosis and the effect is related to the reason of stenosis.

[Four hands surgery in endoscopic sinus surgery--our experience]. / Technika czterech rak w operacjach endoskopowych nosa i zatok przynosowych--doswiadczenia wlasne.

Endoscopic surgery in chronic sinusitis became a gold standard since Stammberger and Kennedy describe there technique in '80 s. During last 20 years an enormous progress has been done in that field. Tumors of the nose and paranasal sinuses became a target for endonasal surgery, alternatively to open approaches. This surgery is more bloody, needs more tools, so the next step was to introduce the second surgeon into endoscopic sinus surgery and the four hands technique has born. Three models of four hands technique are present in the literature. Since November 2006 at the ENT department at Medical University in Poznan 24 patients have been operated on with this technique out of wich 12 suffered from tumors and 12 patients have been diagnosed with chronic sinusitis. This paper describe the surgical technique and our experience based on this 24 operations.

[Endoscopic surgery for selected tumors of the nose and paranasal sinuses--practical sense of the four hands technique]. / Endoskopowe leczenie wybranych guzów nosa i zatok przynosowych--przydatnosc techniki czterech rak.

Endoscopic sinus surgery is a gold standard in chronic sinusitis since middle '80. More and more attention is put on endosnasal tumor removal with the endoscopic technique. Two major pathologies are present in the literature, the inverted papilloma and the angiofibroma. Other tumors are rare. In the ENT Department of Poznan Medical University, endoscopic removal of tumors of the nose and paranasal sinuses is done with the four hands technique. Since November 2006 to July 2007 12 cases were operated in our institution. Fully endoscopic removal was performed in 7 cases. In 2 cases an endoscopic assisted surgery was performed. In 3 cases a convertion to open surgery was necessary. Endoscopic approach to nonmalignant tumor of the nose and parana sal sinuses is an alternative to open surgery of tumor of the nose and paranasal sinuses. The four hands technique is very helpful and leads to extend limits of this surgery. Performing an endoscopic surgery of tumor one has to be prepared to make an intraoperative convertion to open surgery.

[Head and neck amyloidosis]. / Amyloidoza w obrebie glowy i szyi.

INTRODUCTION: Amyloid is a pathological protein which can accumulate in almost every tissue, consequently resulting in illness (amyloidosis). Amyloid has a red color when the slice preparation is stained with Congo red staining and under polarized light exhibits a characteristic apple-green color. Over 26 different proteins, that can form amyloid, have been described. AL, AA and ATTR amyloidosis are the most frequent type of amyloidosis. Head and neck is a rare region for amyloidosis, which can be localized and/or systemic. Early diagnosis and precise classification of the amyloidosis is essential for treatment planning. Various treatment strategies: antinflammatory management, chemotherapy, immunotherapy, surgery, gene therapy, to name just a few, are already readily available or are currently being explored or researched. MATERIAL AND METHODS: Three cases are presented here: an elderly women with tongue and neck tumor and two patients with laryngeal tumors. The biopsy of the lingual and laryngeal tumor and ultrasonography in the first case have been performed in the ENT-Department and Ambulance. RESULTS: In the Internal Medicine Department the patient with lingual and neck tumor, due to symptoms such as: swallowing disorders, dysartria, painful joints swelling and carpal syndrome in anamnesis, previously underwent an examination in order to rule out scleroderma. The investigation appeared to be negative. The histopathology investigation of the lingual tumor identified amyloidosis. USG has not revealed any significant findings. The two patients with laryngeal tumor, except for hoarseness, has not manifested other symptoms suggesting general illness. The biopsy established that there was localized amyloidosis. CONCLUSION: Diagnosis of amyloidosis and its correct classification continue to pose a great challenge. Two factors play a pivotal role in the identification of local or systemic amyloidosis: the local and/or systemic manifestation and Congo red staining as a gold diagnostic standard.

[Paratracheal lymph nodes in patients with larynx and hypopharynx cancer in radiological and clinical examination]. / Wezly chlonne przytchawicze u chorych na raka krtani i gardla dolnego w ocenie radiologicznej i klinicznej.

INTRODUCTION: Paratracheal lymph nodes receive the lymph from the larynx, hypopharynx, esophagus, thyroid gland and trachea. It is evaluated, that metastases to these nodes occur in about 10-30% of patients with cancer of the larynx, hypopharynx or cervical esophagus. These metastases can lead to the most tragic complication after total laryngectomy, which is the stomal recurrence, Paratracheal lymph nodes are not accessible to examine by palpation or ultrasonography. AIM: The aim of this study was to estimate the usefulness of CT, MRI and clinical intraoperative investigation in the search for enlarged paratracheal lymph nodes. MATERIAL AND METHODS: The investigation was performed in 15 patients with advanced larynx and/or hypopharynx cancer. In all the patients we carried out palpation and ultrasonography of the neck, in 7 cases CT and in another 8 cases MRI of the neck. In all the patients who were operated (14 cases) the exact search for enlarged paratracheal lymph nodes during operation was performed. RESULTS: Palpation and ultrasonography of the neck did not found any enlarged paratracheal lymph nodes in anybody of the patients. CT showed one enlarged prelaryngeal lymph node in one patient. MRI showed one enlarged pretracheal lymph node in another one patient. During operation we found one enlarged paratracheal lymph node, which was not seen in MRI. All these nodes were pathologically not metastatic. CONCLUSIONS: The analysis of the state of paratracheal lymph nodes is very important in prophylaxis of stomal recurrence after total laryngectomy. However preoperative estimation of these nodes is very difficult and limited. It seems to us, that the best way of estimation of the state of paratracheal lymph nodes is intraoperative exploration of the area between trachea and esophagus and excision even loose tissue to pathological examination.

[Value of angiography and embolisation in treatment of head and neck vascular malformations at Otolaryngology Department, Poznan University of Medical Sciences, Poland]. / Znaczenie angiografii i embolizacji w leczeniu malformacji naczyniowych glowy i szyi w materiale Kliniki Otolaryngologii Uniwersytetu Medycznego w Poznaniu.

Angiography is an invasive, radiological investigation of vascular system. It plays an important role within variety of diagnostic tools in head and neck pathologies. In selected cases with well defined tumor supply vessels, angiography may be combined with intravascular obliteration. This possibility widen indications, which comprise diagnostic arteriographies - visualization of blood supply and extension of vascularization; therapeutic and diagnostic arteriographies - palliative or radical in character, dependent on pathology; and therapeutic angiographies as adjuvant therapy prior to surgical treatment. Authors present their experience with endovascular techniques application in head and neck pathologies. Material comprised 59 angiographies performed in patients treated at Otolaryngology Department at Poznan University of Medical Sciences between 2000-2007. In conclusion authors emphasize advantages and disadvantages, as well as, the role of the endovascular treatment in head and neck surgery.

Middle Fossa Approach for Cochlear Implantation.

OBJECTIVE: To present qualification criteria, surgery, and results of cochlear implantation via the middle fossa approach. STUDY DESIGN: A retrospective analysis of medical charts of patients. SETTING: Cochlear implant program in academic medical center. PATIENTS: Six adults after middle ear surgery due to chronic otitis media with bilateral deafness or profound hearing loss. INTERVENTION: Analysis aimed to identify patients qualified for cochlear implantation via middle fossa approach and to present surgery and result. MAIN OUTCOME MEASURE: Qualification criteria, details of surgery and surgical, functional and audiological results. RESULTS: Surgery was completed in four patients and in the remaining two it was stopped because of adhesions and bleeding from the dura. In three patients, there were no postoperative complications and in one individual intracranial hematoma occurred. Postoperative computed tomography showed the intracochlear position of the electrode in all the implanted patients. All of the patients use their implant for 14 to 16 hours daily. One year after the implantation, they had hearing thresholds in the sound-free field of between 25 and 45 dB sound pressure level, number recognition scores between 80 and 100% and monosyllabic words recognition between 30 and 90%. CONCLUSION: Successful cochlear implantation via middle fossa approach results in satisfactory hearing, bringing deaf people into a hearing environment. However, this approach is technically difficult and provides the risk of intracranial complications. In our opinion this approach should be used in special cases only (e.g., postmeningitis or otosclerotis patients with obliteration of basal turn of cochlea). In analysed group it should not be considered the primary solution.

Impaired olfactory function is related to the presence of neuropathy in adults with type 1 diabetes.

INTRODUCTION: Olfactory dysfunction is suggested to be a clinical manifestation of central diabetic neuropathy. The aim of the study was to assess olfactory function in adult patients with type 1 diabetes. MATERIALS AND METHODS: A total of 106 patients with type 1 diabetes and 30 healthy subjects were included in the study. We evaluated the metabolic control of diabetes and the presence of chronic complications. Olfactory function was assessed with Sniffin' Sticks. RESULTS: We found a negative correlation between olfactory identification scores and body mass index ( Rs -0.2; p = 0.04) and triglycerides ( Rs = -0.2; p = 0.04). We showed lower olfactory identification scores in neuropathy group versus non-neuropathy group [8 (interquartile range, 7-9) vs 10 (interquartile range, 9-11) points; p = 0.005]. In multivariate linear regression, impaired olfaction was independently associated with neuropathy (beta, -0.3; p = 0.005). In multivariate logistic regression, diabetes duration (odds ratio, 1.06; 95% confidence interval, 1.00-1.11; p = 0.04) and olfactory identification score (odds ratio, 0.61; 95% confidence interval, 0.43-0.85; p = 0.003) were independently associated with neuropathy. CONCLUSION: Olfactory dysfunction is observed in patients with type 1 diabetes and diabetic peripheral neuropathy.

[Rare case of the Recklinghausen disease in the head and neck region]. / Rzadki przypadek choroby Recklinghausena w obrebie glowy i szyi.

INTRODUCTION: Neurofibromatosis type I (Recklinghausen disease) is one of the most common genetic disorders. Symptoms in head and neck region are present in nearly 30% of cases, but the most frequent are skin café-au-lait lesions or lesions localized in craniofacial region. Neurinomas of the last four cranial nerves are also described. MATERIAL AND METHODS: We discuss a case of a 50-year woman admitted to our department because of chronic pain symptoms localized in the head and neck region. A rare case of neurinoma of the X and XII nerves in the neck region was stated. This patient was successfully treated surgically with removing tumors, which involved vagal and hypoglossal nerve on the right side. CONCLUSIONS: The causal treatment is until now unknown and patients are carefully observed and scan with MRI. The possible treatment for patients are surgery when the lesion become painful or for cosmetic reasons. Also surgery with radiotherapy is require for tumors with malignant transformation which is possible in 5% of cases. The genetic guidance should be proposed to NF1 patients.

[Neurovascular conflicts]. / Konflikty naczyniowo-nerwowe.

Neuro-vascular conflict is a pathophysiologic phenomenon which is implicated in several cranial neuropathies. The most common are trigeminal neuralgia and hemifacial spasm. Spasmodic torticolis, glosopharyngeal neuralgia, disabling positional vertigo may be due to neural compression as well, but other pathologies such as neurogenic hypertension and limited cases of tinnitus, although rare, highly susceptible to the neurovascular conflict, should be taken into considerration. Current diagnostic approach comprises clinical and radiological evaluation. Along with thorough otoneurological examination, MRI scans are essential to diagnose the conflict. This provides information about the presence of neuro-vascular conflict and involved structures. The microvascular decompression (MVD) is a treatment of choice, based on the separation of offending vessel from the nerve. Those procedures are safe, with high rate success according to the literature ranging from 70-90%. Additionaly, in early 90. a new minimally invasive approach with use of rigid endoscopes were proposed. Those gave the possibility to reduce morbidity and improve results by providing wider insight into the operating field with smaller intraoperative injury. Authors present 9 patients diagnosed with neuro-vascular conflict in the ENT department in Poznan. Clinical findings comprised 5 cases of hemifacial spasm, 3 with unilateral tinnitus and 1 with trigeminal neuralgia. Due to variety of symptoms, it is proposed that specialized centers should be formed to diagnose and treat cranial nerves neuropathies. Team approach composed of neurologist, neurosurgeon, radiologist and otologist is essential in terms of good treatment results. Authors describe symptomatology, diagnosis and treatment options of neuro-vascular conflicts.

[Stomal recurrence after total laryngectomy]. / Wznowa wokól tracheostomy po calkowitym usunieciu krtani.

UNLABELLED: Stomal recurrence after total laryngectomy is a very serious complication, in general with dismal prognosis. There are only a few possibilities of treatment, so stress should be put on prevention. MATERIAL: In the ENT Department Poznan University of Medical Sciences between 1997-2004 829 total laryngectomy were performed, because of advanced laryngeal cancer (T3, T4). In this group until may 2005 37 cases of stomal recurrence were found. AIM: The aim of this study was to analyse the group of patients stomal recurrence. RESULTS: Stomal reccurence developed in 35 men and 2 women. The age of patients was 43-79 years (mean 59 years). The time of lasting the symptoms before laryngectomy was 6-12 months (mean 8 months). The emergency tracheotomy was performed in 16 patients (43%). The time between tracheotomy and laryngectomy was 2 days to 3 weeks (mean 6 days). The subglottic extension was observed in 24 patients (65%). 19 patients (51%) was classified as T3, 18 (49%) as T4. 12 patients (32%) was classified as N0, 5 (14%) as N1, 16 (43%) as N2 and 4 (11%) as N3. 4 patients were earlier treated because of larynx cancer (2 of them has laser chordectomy and 2 fronto-lateral laryngectomy). The time between laryngectomy and radiotehrapy was 4-15 weeks (mean 7 weeks). 22 patients (59%) were classified (due Sisson at al) as type I, 12 (32%) type II, 2 (6%) type III and 1 (3%) type IV. The treatment of stomal recurrences consisted of surgical resection of tumor, chemiotherapy, radiotherapy, brachytherapy or palliative treatment. 34 patients died, 2 are presently treated and 1 is near 5 years free of disease after surgical treatment. CONCLUSIONS: Patients with stomal recurrences begun primary treatment in locally and regionally advanced disease. In more that 60% of patients subglottic extension was observed. Emergency tracheotomy may predispose to stomal recurrence. Limited possibilities of treatment of stomal recurrences are the reason of very poor prognosis in this group of patients. During total laryngectomy paratracheal lymphatic nodes should be looked for and dissect.

[Functional endoscopic sinus surgery assisted by navigation system--own experience]. / Czynnosciowo-endoskopowa chirurgia zatok przynosowych wspomagana systemem nawigacyjnym--doswiadczenia wlasne.

Functional endoscopic sinus surgery is nowadays a gold standard in case of chronic sinusitis. Microscopes and endoscopes are routinely used and the plan of the operation is based on physical examination and high resolution computed tomography of paranasal sinuses done in the bone frame. In the last few years trials were done with intraoperative navigation systems. This kind of system was tested in the ENT department of Karol Marcinkowski University in Poznan. Surgery was performed using electromagnetic and optical one. Thirteen patients with chronic sinusitis underwent surgery. A high resolution computed tomography was done in three planes. Then the data were transferred to the computer system. Those data were used to plan the surgery (determination of the "safe corridor") and in the intraoperative monitoring of the position of surgical instruments. We can state an improvement of the comfort for the surgeon and safety for the patient. We did not state disturbances in system work due to patient displacement during surgery. Accuracy and rapidity of the computer system allowed to perform safe surgery. Authors accentuate the usability of this system in case of reoperation, extensive pathological changes and in congenital malformations.

[A case of laryngeal papilloma with sudden dyspnea]. / Przypadek brodawczaka krtani przebiegajacego z nagla dusznoscia.

Laryngeal papilloma is one of the most common non-malignant tumors of the larynx. In adult they are included to pre-cancerous diseases. In morphological examination, it is a solid tumor. Often it is possible to cure them during one surgical procedure. The disease is mostly localized on the anterior commissurae region, vocal fold, ventricules, and on the laryngeal surface of the epiglottis. If the malignant transformation is suspected, a large excision with margin has to be performed, completed by a histological evaluation. A case of a huge laryngeal papilloma with dyspnea is presented.

[Sphenoid sinus surgery]. / Operacje zatoki klinowej.

Sphenoid sinus surgery due to specific localization is placed in otolaryngologists and neurosurgeons field of interest. Surgery of this area, from one side, causes number of problems, which usually arise due to close neighbourhood of important structures, but on the other, serves as alternative approach, eliminating necessity of extended operations with craniotomies. The article summarizes results of sphenoid sinus surgery at ENT Department, University of Medical Sciences in Poznan between 1990 and 2003, as well as points out characteristic features of the surgery in this specific localization.