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Ranko Mladina, Neven Skitarelić, Cemal Cingi and Nuray Bayar Muluk

Abstract

OBJECTIVES. We reviewed the foreign aspects in nasal septal deformities.

MATERIAL AND METHODS. Mladina classification of the nasal septal deformities was used.

RESULTS. Types 5 and 6 have been dominantly inherited. The mechanism of the onset and possible connection to the trauma against the nose, as well as clinical implications of the remaining four types of the nasal septal deformities, have been explained and described in detail, giving the court expert witnesses the excellent opportunity to make a reliable and valuable finding.

CONCLUSION. Type 5 and type 6 nasal septal deformities are never the consequence of the trauma against the nose. In most of the cases, this also concerns type 3. This type as well as type 7 require the latero-lateral and anterior-posterior X-rays of the nasal bones in cases when the nasal pyramid is concurrently deformed. Types 1 and 2 in most of the cases are connected to trauma against the nose.

Open access

Alexis Vuzitas, Marian Petrica and Claudiu Manea

Abstract

BACKGROUND. Signal void, or the absence of signal on MRI sequences, in the sinonasal region may be encountered in fungal rhinosinusitis cases with the aspect of a pseudo-pneumatized sinus, leading to diagnostic errors.

CASE REPORT. We present the case of a 75-year-old woman referred to our clinic for complete and persistent right-sided nasal obstruction. The patient was evaluated using sinus CT and contrast-enhanced head MRI. Opacification of the right maxillary, ethmoid and frontal sinuses as well as of the right nasal fossa were seen on CT, with maxillary sinus expansion and osseous erosion. The MRI showed T2 signal void in the maxillary sinus with extension to the nasal fossa, creating the appearance of a pseudo-pneumatized sinus, and hyperintense signal in the ipsilateral anterior ethmoid and frontal sinuses. The patient underwent endoscopic sinus surgery. The dual imaging evaluation of the patient aided the preoperative differential diagnosis and choosing the surgical approach.

Open access

Anca Evsei, Adelina Birceanu-Corobea, Violeta Melinte and Codrut Sarafoleanu

Abstract

BACKGROUND. Primary sinonasal mucosal melanoma is a rare tumor with a poor survival rate. There is an inherent difficulty in diagnosing these lesions, especially because their complex anatomic locations and symptoms can be frequently confused with other benign or malignant processes. The purpose of our study was to report a difficult case and review the literature and recent research on therapeutic modalities.

MATERIAL AND METHODS. We herein report a 61-year-old female patient, with a history of right eye enucleation and prosthesis, who presented with obstruction of the left nostril, anterior and posterior mucopurulent rhinorrhea, anosmia, left facial numbness, left exophthalmia accompanied by ipsilateral epiphora and decreased visual acuity.

RESULTS. Clinical and imagistic testing revealed a large, grayish, fleshy tumor localized in the left maxillary sinus, with extension to the left orbit (producing osteolysis of the inferior and medial orbital walls), nasopharynx, ethmoidal cells and left frontal sinus. Pathological and immunohistochemical examination confirmed the diagnosis of mucosal melanoma. Other primary sites were excluded. The patient succumbed shortly after, following only palliative treatment.

CONCLUSION. Early diagnosis of primary sinonasal mucosal melanoma is essential but very difficult to detect. Any symptoms such as unilateral epistaxis or nasal obstruction in a patient over the age of 60 should be rendered suspicious. Pathological and immunohistochemical examination for diagnosis and prognostic factors are important. Although surgery is the first option for treatment, one must consider, according to tumor staging, radiotherapy and chemotherapy with immunotherapy as a viable course of treatment for advanced cases.

Open access

Gabriela Musat, Laura Florina Neaga and Raluca Enache

Abstract

BACKGROUND. Functional connection between the stomatognathic system and the acoustic-vestibular apparatus is approached with interest in topical studies, in an attempt to elucidate in depth the cause-effect relationship between pathology and symptom. The temporomandibular joint disorder may be accompanied by a series of otological symptoms such as otalgia, tinnitus and vertigo. For this reason, for a correct diagnosis, a complex clinical examination is required both on the acousticvestibular analyzer and on neighbouring structures.

MATERIAL AND METHODS. We conducted a clinical study, on a group of 97 patients diagnosed with temporomandibular joint disorder (TMJD) and treated for this pathology. All patients included in the study were evaluated by the dentist and the ENT specialist. The patients were treated at the dental clinic and then returned to the ENT clinic two months after completion of the treatment for re-examination, recording changes in otologic symptoms in order to obtain the results of the study.

RESULTS. Of the 97 patients with TMJD, 58 also associated otic symptomatology (otalgia – 74.13%, tinnitus – 53.45%, vertigo – 43.10%). The evaluation done two months after treatment of the temporomandibular joint disorder revealed a significant remission of otalgia (decrease in Mean VAS from 6.05 to 2.49), followed by vertigo (from 5.08 to 2.52) and by tinnitus (from 4.84 to 3.84). Important changes also occurred in the results of the vestibular assessments.

CONCLUSION. The most common otological symptom of patients with TMJD is auricular pain. Otalgia, tinnitus and vertigo can be improved by dental treatment of the temporomandibular dysfunction, auricular pain having the highest rate of remission.

Open access

Violeta Melinte, Oana Musteata and Codrut Sarafoleanu

Abstract

Nasal haemorrhage or epistaxis is the most common otolaryngologic emergency. It affects about 60% of the population and a percentage of 6% do not cease spontaneously, medical approach being needed.

The management of epistaxis varies depending on its severity and etiology. The therapeutic conduct of this ENT emergency is based on three main principles: 1. local haemostasis; 2. detection and ceasing of the cause; 3. evaluation and correction of hypovolemia if necessary. Haemostasis can be done by chemical or electric cauterisation after identifying the bleeding source, by nasal packing, by endoscopic or external surgery or, in special cases, when none of the above methods returns any results, embolization. The current paper emphasizes our experience and a brief literature concerning epistaxis management in patients presented in the Emergency Room, in chronic cases of vascular intranasal tumors with recurrent bleeding, in iatrogenic haemorrhages, and none of the least we will bring into discussion the treatment applied for patients diagnosed with hereditary hemorrhagic telangiectasia.

Open access

Vlad Budu, Tatiana Decuseara, Andreea Nicoleta Costache, Loredana Ghiuzan, Monica Hodor, Gabriel Dascalu, Mihai Tusaliu and Ioan Bulescu

Abstract

Nasal meningoencephaloceles are rare findings, represented by protrusions of intracranial contents into the nasal cavity. They present as unilateral masses, and commonly determine unilateral nasal obstruction, rhinorrhea and non-characteristic headaches.

We present the case of a 34-year-old patient diagnosed with a posttraumatic transethmoidal meningoencephalocele. The patient presented with unilateral nasal obstruction, mild headache and episodic watery rhinorrhea. The treatment was endoscopic endonasal surgical excision and repair of the skull base defect, in a mixt ENT-neurosurgical team. Patient follow-up showed no remaining mass or symptoms and normal closure of the skull base defect.

Open access

Anca Evsei, Cristina Iosif, Simona Enache, Claudiu Manea and Codrut Sarafoleanu

Abstract

Background. Neuroendocrine tumors of the larynx represent a rare group of neoplasms characterized by pathological and biological heterogeneity. The histological and immunohistochemical diagnosis is the most important step in the appropriate management of these tumors and the prognosis varies according to histological types. Conventional anatomical and functional imaging can be complementary for diagnosis, staging and monitoring of treatment response. Material and methods. Here we report on a case of a laryngeal neuroendocrine small cell carcinoma occurring in a 67-year-old man who was referred to our clinic for clinical reevaluation, diagnosis and treatment. The clinical presentation, the histopathological and immunohistochemical examination and management of this kind of tumor are highlighted. Conclusion. Small cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Very low incidence of neuroendocrine tumors in the larynx and specifically very poor prognosis of neuroendocrine small cell carcinoma encouraged an extensive literature review.

Open access

Desiderio Passali, Leandro Politi, Lei Chen, Cemal Cingi, Codrut Sarafoleanu and Pasquale Cassano

Abstract

Nasolacrimal duct obstruction (NLDO) is a common event in clinical practice. The authors, all members of the Italian Society of Rhinology, analysed 100 cases from different ENT Departments. The causes of NLDO, according to the etiology, can be divided into two classes: idiopathic primary acquired nasolacrimal duct obstruction and secondary. The aim of the study was to describe an association between the sign and symptoms of chronic rhinosinusitis and a complaint of epiphora.

Open access

Vasile Cabac, Veronica Polovei and Ala Istratenco

Abstract

Empty nose syndrome (ENS) is a clinical entity lacking consensual meaning, illustrating a rare nose surgery complication, particularly of nasal conchae surgery, which results in the destruction of the normal nasal tissue. In severe forms it may become debilitating; the inability in identification and appreciation of this syndrome turns detrimental to the patient. Physiopathology remains controversial, which probably implies disorders caused by excessive nasal permeability, affecting neurosensory receptors as well as the humidification functions and conditioning of inhaled air. Neuropsychological involvement is being suspected. Symptomatology is both variable and changeable, the most evident sign outlining paradoxical nasal obstruction. The diagnosis is based on a series of symptoms that need to be collected precisely, the objective examination that highlights the permeability of nasal fossae. The management is problematic; there are implemented a complete range of simple hygiene and humidification techniques of the nasal cavity and, for more severe cases, surgery is provided, regardless of technique, the surgery targeting partial filling of the nasal airways. Prevention is the most essential strategy along with basic conservative surgical techniques.

Open access

Codrut Sarafoleanu, Alexis Vuzitas and Claudiu Manea

Abstract

Malignancies of the upper aerodigestive tract are high morbidity bearing and life-threatening diseases, which require thorough care from diagnostic suspicion and confirmation to surgical and/or oncologic treatment and rehabilitation. Difficulties in managing head and neck cancers arise from delays in diagnosis and treatment caused by either patient-related factors or healthcare system-related factors. Tumor origin and stage determine whether surgical excision is feasible, the approach required for safe excision, the extent of functional and aesthetic sacrifice required to attain oncologic safety and the need for reconstructive surgery. A thorough and systematic preoperative risk versus benefits assessment to select potential surgical candidates and give realistic outcomes is important from both a medical and a legal point of view. Because tumors in the head and neck region frequently involve more than one system and sensory organ, potential loss of function from either the disease course, surgical or nonsurgical treatment should be taken into account form a quality of life perspective. Effective management of head and neck cancer patients requires the cooperation and combined effort of a multidisciplinary team of surgeons, physicians and other workers over a long period of time which, in the absence of a specialised head and neck cancer centre and guidelines, can lead to increased morbidity and mortality, and patient dissatisfaction.