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Open access

Dhara B. Dhaulakhandi, Alok K. Ravi, Lalit C. Garg and Karvita B. Ahluwalia

Abstract

Rhinosporidiosis is a chronic polypoidal infection of the nose, conjunctiva and other sites, believed to be caused by a fungus, Rhinosporidium Seeberi, with a doubtful taxonomy. Polyps contain histological round bodies and the exact mode of infection is not known. The round bodies are filled up with spherules. In tissue the organism forms spherical round bodies approaching 50-500µ in diameter that contain innumerable single-celled organisms that mature at different rates. Mature organisms are approximately 7-9µ in size and escape through a pore that develops in the wall of the round body. The round body does not exist in nature outside the host.

The organism in rhinosporidiosis was believed to be uncultivable, until we cultured it for the first time in our laboratory. We further modified the culture medium and succeeded in culturing the causative agent of the disease in CBEML (Cell Biology and Electron Microcopy Laboratory) medium. Here we present some of the peculiar conspicuous features of the organism in culture leading to symmetry patterning.

Open access

Ionut Tanase, Claudiu Manea and Codrut Sarafoleanu

Abstract

Usually, patients with sleep disorders may complain of tiredness, fatigue, daytime sleepiness, difficulty in concentrating, and can reach up to falling asleep in inappropriate situations – condition known as the Pickwick syndrome. To avoid these unpleasant symptoms, a series of surgical procedures regarding the anatomical structures involved in sleep apnea were developed.

The article is a general review regarding the sleep disorders and the influence of upper airways permeability on the quality of sleep and the sleep staging distribution. Also, we present some preliminary data obtained in a clinical study underwent in CESITO Centre “Sfanta Maria” Hospital, Bucharest, involving patients with sleep pathology that had polysomnographic evaluations before and after various surgical procedures of nasal and pharyngeal permeabilization.

AIMS. To determine that permeabilization surgery of the upper airway tract may be used successfully in order to decrease the sleep fragmentation and increase the time of slow-wave sleep.

CONCLUSION. 6 months after the permeabilization surgery of the upper airway tract, the polysomnography reveals that the arousals index decreased and the sleep architecture undergoes changes that consist in decreasing the Stage 1 and Stage 2 sleep, therefore REM sleep reaches a better score.

Open access

Adriana Neagos, Alexandra Cirticioiu, Alex George Stanciu and Iren Csiszer

Abstract

OBJECTIVE. The aim of the study was to determine the impact of the nasal pathologies over nasal mucociliary clearance and rhinomanometric parameters.

MATERIAL AND METHODS. This is a retrospective analytical observational clinical study during a period of 6 months, between 2014 and 2015. 123 subjects, 63 of whom had nasal pathology and 60 of whom were healthy controls, were enrolled in this study. The diagnosis of nasal pathology was made based on clinical examination, nasal endoscopy and anterior rhinomanometry. A methylene blue test was used to evaluate the mucociliary clearance.

RESULTS. The subjects with nasal pathology had nasal septum deviation (No=50), chronic rhinitis (No=42), rhinosinusitis (No=15) and nasal polyposis (No=17). The mean total air flow in inspiration in nasal pathology patients group was 546.7 ml/s (millilitre/second), with a median of 594 ml/s, comparing with the control group who had the mean air flow of 865.5 ml/s, with a median of 866.5 ml/s. In expiration, the mean air flow in those with nasal pathology was 603.9 ml/s and a median of 611 ml/s, comparing with the control group who had the mean air flow of 871.1 ml/s and a median around 872 ml/s. The mean time from the application of methylene blue liquid to first seeing it in patients with nasal pathology was 23.41 minutes for the right nostril and 23.32 minutes for the left nostril, comparing with the control group who had the mean of mucociliary clearance of 6.76 minutes for the right nostril and 6.93 minutes for the left one.

CONCLUSION. The results obtained in anterior rhinomanometry and methylene blue liquid test showed that nasal pathology does affect nasal physiology and it is an important factor to evaluate the mucociliary clearance.

Open access

Claudiu Manea and Alina Diaconescu

Abstract

An irreversible disease, cystic fibrosis (CF), is responsible for affecting multiple organ systems containing epithelia. It is well known that the sinonasal disease caused by CF has consequences for the incidence of the lower airway exacerbations, as well as affecting the quality of life of those patients. This review provides an update by evaluating the available literature regarding pathogenesis, management and treatment of cystic fibrosis patients. To gain a better view of the disease and obtain a higher life expectancy, further studies are needed.

Open access

Georgiana Pasu

Abstract

In recent years, the clinical importance of laryngeal electromyography (LEMG) has been recognized. This method of investigation proved itself to be a valuable and indispensable tool regarding voice disorder management and requires multidisciplinary approach.

In this article, we focus on the clinical usefulness of LEMG to assess inferior and superior motor neuron integrity by recording action potentials generated by muscle fibers of the larynx in the new field known as neurolaryngology. To facilitate the clinical application of this electrophysiologic test, we present a detailed description of LEMG techniques, which were applied for simultaneous bilateral recordings of the thyroarytenoid, cricothyroid and posterior cricoarytenoid muscles. Also, we analysed and measured the following electrophysiological parameters: 1) insertional activity; 2) spontaneous activity; 3) recruitment; 4) morphology of waveform.

From a practical point of view, in our country, LEMG performance is still not a routine procedure in ENT and Phoniatric Departments. The difficulty of practical use of LEMG in Romania consists in technical limitations and it depends on the physician’s experience regarding the examination technique and also the interpretation of electrophysiological results.

Our current clinical experience shows that the use of LEMG contributes especially to the diagnosis, prognosis and treatment of patients with neurolaryngological disorders.

Open access

Cristina Julieta Sava and Mugurel Constantin Rusu

Abstract

Sinoliths are calculi found particularly in paranasal sinuses, the rarest location being the ethmoid air cells. There were previously reported only 4 cases of unilateral large ethmoidal sinoliths (ES), this one being the fifth report. We report here the incidental bilateral evidence in a 34-year-old female patient evaluated in Cone Beam Computed Tomography (CBCT) of minor ES. The left ES, of 1.6 mm2 sagittal size, occupied the suprabullar cell, in front of the ground lamella and behind the anterior ethmoidal canal. The right ES, of 7.6 mm2, was located behind the ground lamella. The radiodensity of each ES was about 1000 HU, their bone quality being thus assessed. This is the first evidence of bilateral and clinically silent ethmoidal sinoliths. Being small-sized and incidentally found, it seems reasonable to consider that ethmoidal sinoliths could have a higher incidence but they are overlooked due to the lack of clinical manifestations.

Open access

Frodita Jakimovska, Marina Davceva Cakar and Dejan Dokic

Abstract

BACKGROUND. Septal deviations are usually diagnosed by a patient’s subjective complaint of nasal stuffiness and a physical examination by the otorhinolaringologist. The decision for surgery is not always based on objective measurements. Acoustic rhinometry and rhinomanometry are objective tools for assessment of nasal patency but is still a controversial subject. In our populations, there are no general accepted methods for screening patients for septal surgery.

OBJECTIVE. To analyse the effectiveness of acoustic rhinometry and rhinomanometry in predicting the outcomes of septoplasty and rhinoseptoplasty and their usefulness in preoperative screening of septal deviations.

MATERIAL AND METHODS. 69 patients were included in this prospective study. Acoustic rhinometry and rhinomanometry were performed before and one year after surgery for the investigation of nasal obstruction. Several parameters were analysed before and after decongestion of the nasal mucosa. VAS (visual analogue scale) was also included for evaluation of the subjective symptom score pre- and postoperatively. After surgery, a short questionnaire was applied to investigate patients’ postoperative satisfaction.

RESULTS. The mean subjective scores of nasal patency improved significantly after surgery with 77%. Several parameters of acoustic rhinometry and rhinomanometry were analysed with binary logistic regression, to evaluate the predictive values on the postoperative satisfaction. The preoperative decongested overall MCA (minimal cross-sectional area) on the deviation side, the decongested bilateral MCA and the decongested Flow ratio had significantly the highest impact on the postoperative satisfaction (p<0.001).

CONCLUSION. Acoustic rhinometry and rhinomanometry as objective tools can serve as objective evidence for the efficacy of septoplasty and rhinoseptoplasty. The parameters of rhinomanometry and anterior rhinometry are useful in the preoperative screening for septal deviations and in predicting postoperative satisfaction between different degrees of nasal septal deviations.

Open access

Sabari Nath

Abstract

We present a case of paediatric nasal foreign body removal using a flexible nasopharyngolaryngoscope, which is used both as an endoscope for visualization and as a hook for the rapid and complete removal of the nasal foreign body (“Visual Hook“).

Open access

Ricardo de Hoyos, Michele Loglisci, Hugo Anibal Rodriguez and Desiderio Passali

Abstract

Cervical and parotideal abscess is a rare finding in all populations and even more so in the paediatric population. The antibiotic resistance of the bacteria that cause these diseases can make it very dangerous. We present a paediatric case in which there is a combined left-cervical and parotideal abscess in a female 3-month-old baby who presented fever, pain and cervical swelling.

Open access

George Anastasopoulos, Dilyana Vicheva, Eleni-Christina Tsiompanou and Eleftherios Ferekidis

Abstract

BACKGROUND. The tendency of the nasal polyps for recurrence is well established and recognized. A potentially effective measure to reduce this tendency seems to be the replacement of the mucosa responsible for polyp growth.

MATERIAL AND METHODS. Since February 2012, we have used this method in fifteen patients with intractable polyposis. After a short course of preoperative medication, we performed a detailed computed scan analysis to study the anatomy of the ethmoidal complex and calculate the area and contour of the graft. Under general anaesthesia, we removed the mucosa of the nasal roof and replaced it with a split-thickness skin graft. For maintenance, only a short course of nasal drops every three months seems to suffice.

RESULTS. Excluding the first two cases due to a poor surgical technique, the rest of the cases may be considered successful. All patients experience a functional nose with restored nasal breathing and occasionally olfactory function with only a minimal pharmaceutical aid. Polyps still grow, but they show a much more benign course and are readily responsive to medical treatment. Interestingly, polyps present squamous metaplasia postoperatively. This feature needs further investigation.

CONCLUSION. The method of dermoplasty presents a high potential for control of polyp growth. With only an hour prolongation of surgical time, a minor increase in complication rate and a small increase in morbidity rate, the technique deserves further attention from the rhinological society.