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Open access

Carmen Badea, Codrut Sarafoleanu and Andreea Marza

Abstract

Rhinosinusal mucormycosis is a life-threatening disease caused by fungus of the order Mucorales, which commonly affects individuals with diabetes and those in immunocompromised states. It is the most common form of mucormycosis with a high mortality rate (50-80%). Treatment options include reversal of the underlying risk factors when it is possible, systemic antifungal medication and radical surgical debridement. Prognosis is reserved because of the high potential of invasiveness, so diagnosis and early treatment are essential.

Herein, we make a review about the most important features of this pathology and we report two cases of rhinosinusal mucormycosis with similar presentations who followed the same treatment protocol – extended surgical debridement of the necrotic tissue combined with systemic antifungal treatment (Amphotericin B). Complete recovery was achieved in one patient, whereas in the other one, due to late presentation, massive extension and incomplete surgical debridement, the disease was complicated with multiple organ dysfunction and cerebral stroke.

By presenting these cases, we would like to point out the importance of early diagnosis, appropriate medical and surgical therapy to obtain a significant survival rate in patients with this fatal disease.

Open access

Codrut Sarafoleanu, Elena Patrascu, George Bacarna and Gabriela - Violeta Melinte

Abstract

BACKGROUND. Unfortunately, tuberculosis is still being diagnosed among patients, independent of their age, gender, provenance or social category. The etiologic agent of tuberculosis is Mycobacterium tuberculosis, which is known to have a period of latency between the initial infection and the clinical manifestation. The most common localization is pulmonary, but it can affect, secondarily, other organs, especially in the ENT regions, mimicking other systemic diseases.

MATERIAL AND METHODS. We are presenting a case of a 51-year-old female patient, who was referred to our ENT Clinic with the suspicion of Behcet’s disease with rhinosinusal manifestations. She had a pulmonary assessment in another hospital, as she was known with left lung bronchiectasis, but the sputum samples were negative. The clinical otorhinolaryngologic examination together with the rheumato-logical assessment and the result of the nasal mucosa biopsy were suggestive for Behcet’s disease and the patient received 6 weeks of Prednisolone. The specific immunologic tests (cANCA, pANCA, HLA B51) were negative. The patient returned to our clinic after 2 months, accusing symptomatology reacutization with right otorrhea and bilateral hearing loss aggravation. Nasal and rhinopharyngeal mucosa biopsies were repeated and the anatomopathological result was specific for tuberculosis.

RESULTS. She was referred to the Pneumology Service where she received the diagnosis of pulmonary tuberculosis with rhinosinusal and otic manifestations. Currently, the patient is under tuberculostatic treatment.

CONCLUSION. Extrapulmonary tuberculosis symptoms might be confused with other systemic diseases with rhinosinusal manifestations. Thorough examination and multidisciplinary approach are mandatory in order to establish a correct diagnosis followed by an appropriate treatment.

Open access

Bogdan Mihail Cobzeanu, Dragos Octavian Palade, Andrei Rosu, Patricia Sonia Vonica, Cristian Martu, Luminita Radulescu, Daniela Carmen Rusu, Luiza Maria Cobzeanu and Mihail Dan Cobzeanu

Abstract

The authors conduct a review of the etiopathogenesis, the main diagnostic methods and the treatment principles in cervico-facial pain. Pain in otorhinolaryngology is a multifactorial symptom, based on the rich innervation and vascularisation of the cephalic extremity. Pain can be of central or peripheral origin, acute and chronic. With the diversification of methods for exploring pain-generating lesions, different treatment protocols could also be achieved.

Open access

Violeta Melinte and Codrut Sarafoleanu

Abstract

Congenital anosmia, isolated or as a symptom of Kallmann or Klinefelter syndrome, is a rare condition found in young patients and children. Anosmia is detected during childhood, being reported by the patient or by his/her family. Besides the clinical examination and olfactometric evaluation, imaging is mandatory for the olfactory pathways investigation. Multidisciplinary approach is needed for these patients in order to determine the etiology of the smell loss. In the current paper, we are presenting the case of an 11-year-old child diagnosed in our ENT Department with congenital anosmia.

Open access

Padmanabhan Karthikeyan, Sneha Mary Joy, Davis Thomas Pulimootil and Neelima Vijayan

Abstract

ENT surgeons frequently encounter a variety of neoplastic, non-neoplastic and inflammatory masses involving the nasal cavity, the paranasal sinuses or the nasopharynx. Among these, the angiomatous polyp or angiectatic nasal polyps are rare and account for 4-5% of all inflammatory nasal polyps. They have variable growth patterns and clinical features. In angiomatous nasal polyps, there is a prominent component of dilated capillary-type blood vessels. We present a review of the literature regarding the most important features of this pathology and an unusual case of a large angiomatous polyp arising from the maxillary sinus.

Open access

Neelima Vijayan, Padmanabhan Karthikeyan, Nirmal Coumare Venkataramanujam, Ramiya Ramachandran Kaipuzha and Davis Thomas Pulimoottil

Abstract

OBJECTIVE. This study aimed to analyse the association of absolute eosinophil count (AEC), serum IgE and spirometry with co-morbid bronchial asthma in patients with allergic rhinitis.

MATERIAL AND METHODS. This study involved 50 patients with signs and symptoms of allergic rhinitis who underwent a clinical examination and various tests, including spirometry, and were followed up regularly. Patients found to have bronchial asthma or nasal polyposis were treated accordingly.

RESULTS. The study found the prevalence of bronchial asthma in patients with allergic rhinitis to be 58% and that the severity of bronchial asthma was reduced significantly, with lesser acute attacks and reduced hospitalizations with the effective treatment of allergic rhinitis (p=0.064).

CONCLUSION. This study showed that elevated AEC and serum IgE were significantly associated with co-existing allergic rhinitis and bronchial asthma and increased the chance of co-existence of these two pathologies. Spirometry is a useful tool for observing the response to treatment.

Open access

Dorin Sarafoleanu and Raluca Enache

Abstract

Whiplash syndrome is a quite common pathology and can be defined as a neck injury produced by a sudden acceleration-deceleration, the consequence of which is a sudden forward and backward movement of the head and neck. The main production mechanism is a sudden acceleration-deceleration process that has as a consequence the sudden extension/flexion of the neck. Starting from the many structures involved, the whiplash syndrome is an interdisciplinary challenge (ENT specialist, neurologist, orthopedist, ophthalmologist, psychologist) and can be described by multiple signs and symptoms.

Whiplash syndrome is a complex pathology both through the mechanism of production and symptoms, and through the forensic implications that it has. The interdisciplinary medical collaboration, the implementation of stricter rules on wearing the seat belt and the development by car manufacturers of chairs and head restraints that protect the head and neck of passengers, would be the preventive step in the occurrence and especially the chronicization of these lesions.

Open access

Elena Patrascu, Violeta Melinte, Carmen Paraschiv-Ferariu and Codrut Sarafoleanu

Abstract

Salivary gland cancers are represented by a heterogeneous histologic group of tumors, with low incidence, which may appear both in major and minor salivary glands. This article presents a review of the difficulties which may be encountered in this pathology during the treatment. The diagnosis of salivary gland cancers is often delayed, due to the histopathologic and immunohistochemistry results given in different period of times. There can be several difficulties in following the oncologic pre-treatment protocols, in terms of imaging technique, as MRI, useful for disease staging.

The treatment of salivary gland cancers is complex, due to the local anatomy and their aggressive potential. Because of their decreased incidence, there are few data that investigate the treatment in the case of these diseases. The current therapy available for the patients with salivary gland cancers is represented by complete surgical resection. Several treatment difficulties in cancers of the salivary glands may come from the surgical limitations and the insufficient data for adjuvant and palliative treatment. Due to the limitations of the local health system, there is a heterogeneous distribution of the oncologic centers, lack of equipment, prolonged time to follow general protocols, despite the aspect of case-individualized therapy according to the guidelines. We must not forget the tumor behaviour and individual reactivity of different patients to the same treatment protocol.

Open access

Ala Istratenco

Abstract

Chronic rhinosinusitis with nasal polyps (CRSwNP) is considered a multifactorial pathology with negative impact on the quality of life and considerable socio-economic effects. The pathogenesis of CRSwNP has not yet been fully elucidated despite remarkable studies in this field. This limits the pathogenic treatment and, therefore, the pathological process is expressed by a greater tendency of recurrence. Patients with recurrent CRSwNP remain in a severe state and therapeutically uncontrolled. In recent studies, the involvement of oxidative stress (OS) in the pathogenesis of CRSwNP has been more frequently mentioned. CRSwNP is considered a response of the sinonasal tissue on the inflammatory state, associated with OS and production of reactive oxygen species, causing injury to sinonasal tissues. It was demonstrated that the amount of ROS in the nasal polyp tissue corresponds to the severity of CRSwNP.

A literature review on the role of OS in the pathogenesis of CRSwNP was undertaken. The relevant information was identified using a search of electronic databases. Keywords used to highlight relevant papers were a combination of “chronic rhinosinusitis with nasal polyps” and “oxidative stress”.

This review demonstrates that there is a strong relationship between OS and CRSwNP pathogenesis. It is hypothesized that antioxidants may have a preventive role in CRSwNP. Nevertheless, additional research is required to further evaluate the effectiveness of antioxidant therapy.

Open access

Vlad Budu, Tatiana Decuseara, Ioan Alexandru Bulescu, Lavinia Ilinca and Alexandru Panfiloiu

Abstract

Inverted papilloma is a rare benign sinonasal tumor with a still unclear etiology. In the last decades, HPV implication in inverted papilloma etiopathogeny has been studied and demonstrated in some scientific research papers, but with no causality proven. Imagistic investigations and the Krouse classification establish the surgical approach. Endoscopic surgery represents the golden standard treatment for most cases of inverted papilloma, while external or combined approaches present limited indications.

The authors present a case and therapeutic plan of an inverted papilloma located in the ethmoid sinus, with origin in the lamina papyracea and high-risk HPV implication.