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Lymph node tuberculosis – The ENT surgeon approach in four cases

Abstract

BACKGROUND. Lymph node tuberculosis is a pathology with an increasing incidence and prevalence in middle income countries.

MATERIAL AND METHODS. We present a series of 4 cases with cervical lymph node tuberculosis. We review current principles of diagnosis and treatment from the perspective of the ENT surgeon in a tertiary university clinic.

RESULTS. In each case we underline diagnosis difficulties and treatment options. These cases presented management difficulties due to associated morbidities. All cases underwent surgical excision of the afflicted lymph nodes with subsequent microscopic confirmation of tuberculosis. We illustrate key concepts leading to the microscopy diagnosis of lymph node tuberculosis.

CONCLUSION. There are various surgical incidents and accidents that the young surgeon must be aware of when approaching neck tuberculous lymph nodes. Further referral of the patient for long-term tuberculosis treatment is mandatory. All patients were supervised for a minimum of 1 year after the initial diagnosis and treatment with no sign of recurrence. A close cooperation between the ENT surgeon, the infectious disease specialist and the pathologist is the key to an optimum approach to lymph node tuberculosis at the head and neck level.

Open access
Olfactory functions in Behçet’s disease: A review

Abstract

OBJECTIVES. We reviewed the relationship between olfactory functions and Behçet’s disease (BD).

MATERIAL AND METHODS. We searched Pubmed, Google, Google Scholar and Proquest Cebtral Database with the key words of “olfactory”, “functions”, “smell”, “nasal” and “Behçet’s disease”.

RESULTS. Behçet’s disease influences the nasal mucosa. Nasal mucosal inclusion causes mucosal ulcers, pain, burning, nasal obstruction, epistaxis, nasal itching and dysosmia. Nasal cartilage deformity is also reported. The higher rate of comorbid chronic rhinosinusitis (CRS) in BD patients may likewise be because of the complex mechanism of the disease inclining the host tissues to bacterial infections. Olfactory functions may decrease in BD. Odor identification may be lower in patients BD.

CONCLUSION. An olfactory dysfunction may be seen in patients with BD. BD patients should be evaluated for the involvement of the olfactory function and may require treatment because of a malfunction of the olfactory system that influences the quality of life. Neurological involvement associated with BD might play a more important role in causing olfactory dysfunction than mucosal involvement.

Open access
A paradigm shift: “Defect of the fontanel” instead of “Accessory ostium” and classified nasal septal deformities instead of “septal deviation”

Abstract

OBJECTIVES. The purpose of this article is to highlight some terms which have been ingrained in the rhinosinusology literature.

MATERIAL AND METHODS. It regards the term “accessory ostium” and the term “septal deviation”. The well-known and deeply ingrained term “accessory ostium” has been widely used for decades, but essentially it is absolutely incorrect. “Septal deviation” is an inadequate term for the changes of the nasal septum form.

RESULTS. From the linguistic point of view, “accessory” means something (or someone) which (or who) helps someone or gives support (to something or someone) in some process. We recommend the use of the term “defect of the fontanel” instead of “accessory ostium”. The use of the term “septal deformity” (from Latin: de forma, meaning the change in the shape) is etymologically much more appropriate. Septal deformities appear in man in several, well defined shapes and, therefore, can be correctly classified. The classification contributes to the further scientific conversations regarding the clinical issues connected to the changes of the nasal septum form.

CONCLUSION. The usual term “accessory ostium” suggests almost a normal finding on the lateral nasal wall, but, on the contrary, it clearly signalizes that the respective maxillary sinus is chronically inflamed. The usual term “septal deviation” is not at all specific and only suggests that something is wrong with the position of the nasal septum. It does not at all imply any of the six well known types of septal deformities in man.

Open access
Abducens nerve palsy on a patient with sphenoid fungal rhinosinusitis and cavernous sinus meningioma – Case report

Abstract

We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery.

The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.

Open access
Comparison of the thermal effects of Coblation and Radiofrequency waves in a porcine turbinate model

Abstract

BACKGROUND. Radiofrequency reduction and Coblation are widely used procedures for the treatment of functionally enlarged turbinates with an appropriate outcome. Bleeding and crusting are postoperative complications for Coblation. Thermographic measurements and histological analyses were used to elucidate the causes.

MATERIAL AND METHODS. In a porcine turbinate model, double-needle electrodes of different lengths were tested using a 4MHz radiofrequency current with either automatic energy limitation or a predetermined energy amount of 200 J. Coblation, according to the manufacturer’s instructions, was carried out with a Reflex Ultra 45 wand. The generated temperature was measured with thermo-probes at the tip of the electrodes. The mucosa was subsequently investigated histologically.

RESULTS. Without preoperative saline injection, all procedures generate temperatures < 100° C. After saline injection, excessive temperatures are reached by Coblation after the release of plasma in a closed system. The follow-up is a severe deterioration of the microscopic structures of the mucosa. The low-temperature advantages of Coblation are only effective if the mandatory saline solution rinses the surface. The Radiofrequency applications deliver more predictable results.

CONCLUSION. For the treatment of the functional enlargement of the turbinates, Radiofrequency current with proofed settings should be chosen.

Open access
Complex facial reconstruction after removal of giant nasal ulcerated acantholytic squamous carcinoma

Abstract

BACKGROUND. Excision of facial cutaneous carcinomas requires further reconstruction in a combined team with plastic surgeons. Among the traditional risk factors, the unprotected occupational exposure to sunlight can be identified. Giant masses at the level of the nose are frequently squamous carcinomas in origin. Moreover, repeated tumor trauma favours local-regional and remote extension.

MATERIAL AND METHODS. We present step by step the surgical management of an old woman with a nasal mass of 58/36/20 mm. Also, the patient presented right genian tumefaction of approximately 6 months in evolution.

RESULTS. The patient was submitted to surgical resection with free margins, leaving a considerable nasal and genian groove defect. Teaming up with the plastic surgeon, we applied complex reconstruction techniques with a satisfactory aesthetic and functional result. The histopathologic diagnosis confirmed our suspicion of an acantholytic squamous cell carcinoma with lymph nodes metastasis.

CONCLUSION. Our case exhibited traditional risk factors, living in a rural environment. The tumor degree of aggressiveness was increased by repeated self-inflicted trauma. Late presentation to healthcare services implied complex facial reconstruction for the combined resection of the nasal tip and genian lymph node.

Open access
Preliminary outcomes in transcutaneous neuromuscular electrical stimulation use in patients with dysphagia

Abstract

Dysphagia is a common disorder associated with a large number of etiologies like aging, stroke, traumatic brain injury, head and neck cancer, neurodegenerative disorders, structural changes or congenital abnormalities. The type of the treatment and its results depend on the type, severity and the cause of dysphagia. The primary goal of dysphagia treatment is to improve the swallowing process and decrease the risk of aspiration.

Along with the existing rehabilitation swallowing treatments, new adjunctive therapy options developed, one of them being the neuromuscular electrical stimulation (NMES).

The authors present the principles of NMES, a small literature review about the results of this therapy and their experience in using transcutaneous NMES in dysphagia patients.

Open access
Rigid chip-on-the-tip endoscope for rhinosurgery and diagnosis

Abstract

BACKGROUND. The rigid endoscope developed by Karl Storz in 1961 led to a great advance in diagnosis and surgery and nowadays it is the gold standard in routine ENT practice. In addition, the development of video cameras has enhanced the surgical abilities as well as teaching opportunities in endoscopic sinus surgery.

OBJECTIVE. We developed a new prototype endoscope using the “chip-on-the-tip” technology. The aim of our non-clinical study was to observe and discuss the experimental data collected from laboratory tests on plastic models.

MATERIAL AND METHODS. The prototype rigid chip-on-the-tip endoscope has two parts - inner and outer. The inner part includes the chip-on-the-tip camera, light source and the cable. The outer part is a metal tube ending with a 0-degree lens. We performed laboratory tests of the rigid chip-on-the-tip endoscope for rhinosurgery and diagnosis.

RESULTS. We have observed technical parameters of the rigid chip-on-the-tip in order to compare them to conventional endoscopes connected with camera head units that are standard equipment for rhinosurgery and diagnosis.

CONCLUSION. Its advantages compared to the conventional Hopkins endoscope, connected to a standard camera head, are the smaller size, weight and the necessity of only one cable instead of two, allowing easy handling.

Open access
Small cell neuroendocrine carcinoma: A rare second primary malignancy after treatment of nasopharyngeal carcinoma

Abstract

Small cell neuroendocrine carcinoma (SCNEC) of the nasopharynx and nasal cavity is a rare condition. It is an aggressive malignancy with a high recurrence rate. Despite its rarity in the sinonasal region, it may occur as a second primary malignancy. Patients with cancer of the head and neck region are more prone to develop a second primary tumor due to the field cancerization phenomenon, and a higher incidence is seen in those who have previously received radiation therapy. A detailed clinical and histopathological examination is pivotal to diagnose SCNEC as a second primary malignancy. We wish to highlight such a peculiar case from our center.

Open access
Weight loss therapy for obstructive sleep apnea – Literature review

Abstract

Obstructive sleep apnea is a chronic disease characterized by the appearance of apnea or hypopnea episodes during sleep. This condition is associated with several risk factors. Among them, the most important is obesity and it is the only potentially curable. The treatment is polimodal and it involves several therapeutic directions. The purpose of this paper is to establish the role of obesity in the etiology of sleep apnea, as well as the role of the weight loss in its management, both through intensive lifestyle interventions and surgical therapy.

Open access