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Elena Patrascu and Claudiu Manea

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

Krishnamoorthy Madhusudhan, Nor Eyzawiah binti Hassan, Norasnieda binti Md Shukri, Shahrul bin Hitam and Ikmal Hisyam bin Bakrin

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

Georgi Petrov Kukushev and Dilyana Vicheva

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

Codrut Sarafoleanu and Raluca Enache

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

Daniela Vrinceanu, Ana Maria Oproiu, Mihai Dumitru, Madalina Georgescu and Mariana Costache

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

Klaus Vogt, Inese Daine-Loza and Maris Sperga

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

Andreea Marza and Claudiu Manea

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

Vasilka Rendžova, Sonja Apostolska, Marina Eftimoska, Biljana Džipunova and Vesna Filipovska

Summary

Introduction Musculoskeletal disorders (MSDs) are one of the most common types of work-related diseases that affect health workers, especially dentists. The aim of our study was to examine the presence of musculoskeletal disorders among dentists at the university dental clinic in correlation with risk factors.

Materials and methods A questionnaire survey was carried out among 78 dental practitioners aged between 20 to 60 years old, employed at the university dental clinic. Questions included data on physical and psychosocial workload, perceived general health and occurrence of musculoskeletal complaints in the past 12 months, chronic complaints, frequency and length of breaks, exercising habits as well as medical care seeking.

Results Pain in the back, neck and shoulders (84.6% / 85.9%) was the most common complaint among the majority of respondents, while reduced range of movement was noticed among significantly fewer subjects, mostly between 40-60 years of age. Prolonged statistic position was considered to be one of the main causes of MSDs (82.05%) while 73.08% of respondents stated at least two more reasons beside this one.

Conclusion The percentage of MSDs prevalence among dentists in public health sector is high. More extensive surveys should be undertaken to cover larger group of dentists from both private and public sector, in order to obtain complete analysis of the prevalence of occupational disorders in our country.

Open access

Svjetlana Janković, Aleksandra Žuža, Bojana Davidović, Ivana Simić and Lado Davidović

Summary

Introduction Tooth and other oral tissue damage can occur at any time of life. Traumatic extraction is a complex traumatic injury characterized by complete dislodgement of the tooth from its alveolus. The diagnosis of traumatically injured teeth includes X-rays and a detailed clinical examination.

Case report A twelve-year-old boy reported at the dental clinic of the Faculty of Medicine due to the injury in the anterior maxillary region. It was a sport injury. The time elapsed since the accident was 2 hours and 20 minutes. According to the clinical examination and X-rays the diagnosis was: The teeth 11 and 21 – Complete traumatic dental avulsion and fracture; 22-Hypodontia and chin contusion and laceration. The teeth were brought in physiological solution. After applying local anesthetic, soft tissue was cleaned, the teeth positioned back in their alveoli and an immobilizing splint of fiberglass fibers placed. The patient was administered antibiotics and recommended tetanus prophylaxis. Seven days after the injury, teeth were treated endodontically. After one month, the immobilizing splint was removed. The tooth 21 was definitely obturated and composite buildups were done on both teeth. Calcium hydroxide dressing was left in the canal of the tooth 11. One month and 3 weeks after the injury, a fistula appeared above the tooth 11, and the treatment was finally completed after seven months.

Conclusion Traumatic tooth injuries, of any kind, require urgent treatment as time loss usually reduces chances for successful treatment. One year after the injury, the patient had no symptoms and the result was functional and aesthetically acceptable.

Open access

Lucian Lapusneanu, Marlena Radulescu and Florin Ghita

Abstract

The cases with sphenoid sinusitis associated with abducens nerve palsy are rarely cited in the literature. We present the case of a 41-year-old patient who was hospitalized for right hemicrania and ipsilateral paresis of the abducens nerve, without any other ENT previous pathology. The ENT, ophthalmologic, neurological and paraclinical evaluations (nasal endoscopy, MRI examination) have established the diagnosis of right sphenoid rhinosinusitis complicated with unilateral abducens nerve palsy. In such cases, it is important to make a differential diagnosis with tumor pathology as well as that of an infection outbreak located intracranially. In this case, the patient’s evolution was favourable after endoscopic surgical treatment of the sphenoid rhinosinusitis.