Vlad Budu, Tatiana Decuseara, Ioan Alexandru Bulescu, Lavinia Ilinca and Alexandru Panfiloiu
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.
Vlad Andrei Budu, Tatiana Decuseara, Silviu Crac, Alexandra Gheorghe, Alexandru Panfiloiu and Cristina Goanta
Osteomas are slow-growing tumors of the paranasal sinuses, usually found in the frontal and ethmoidal sinus. In many cases, these tumors are discovered by chance or after an imagistic exam for a non-responsive to medical treatment headache. In asymptomatic tumors, conservative treatment is indicated, while in big tumors with complications the gold standard is surgical resection of the tumor. We present two cases of rather similar anterior ethmoidal osteomas in which the therapeutic management was decided according to the symptomatology of the patient and the imagistic CT exam. We decided different ways of treatment for the two cases based on the CT scan, which has a major role in predicting intraoperative complications during endoscopic sinus surgery.
Vlad Budu, Tatiana Decuseara, Bogdan Mocanu, Raluca Baican, Mihai Tusaliu, Diana Cojocaru and Ion Bulescu
BACKGROUND. Endoscopic dacryocystorhinostomy is known to be the ideal treatment for saccal and postsaccal stenosis of the lacrimal apparatus. Following this surgery, an important inconvenient would be the stenosis of the created ostium with consecutive epiphora.
MATERIAL AND METHODS. 20 patients with chronic unilateral lacrimal duct obstruction were operated in “Prof. Dr. D. Hociota” Institute of Phono-Audiology and Functional ENT Surgery, Department I, between January 2015 and July 2015. After creating the dacryocystorhinostoma, a stent was inserted transnasally to the bottom edge of the lacrimal sac and positioned to the bony margin of the ostium. Stents used varied in size from 1 to 3 mm in diameter. We followed-up our patients at 2 weeks and 1, 3, 6 months, assessing the symptoms of the lacrimal apparatus, especially the epiphora.
RESULTS. The mean age of patients varied between 31 and 65. Most of our patients were women (n=14). In a total number of 16 patients epiphora disappeared, it decreased in 2 patients, and persisted in 2 patients. There were two patients with no changes who have spontaneously eliminated the stent 2 or 3 days after the surgery. The most widely used stent size was 3 mm diameter, with a success rate of 90%.
CONCLUSION. The endoscopic approach may be an effective procedure in patients with pathologies of the lacrimal apparatus. In order to achieve an efficient result, both a preoperative rigorous preparation and also postoperative medical care are necessary. In conclusion, ostium stenting represents a better way to ensure a longer period of maintaining the permeability of the lacrimal apparatus.
Vlad Budu, Tatiana Decuseara, Andreea Nicoleta Costache, Loredana Ghiuzan, Lavinia Sava, Monica Hodor, Vadim Palii and Mihai Tusaliu
BACKGROUND. The most frequent benign nasal tumor is the osteoma. It is commonly asymptomatic and usually an incidental finding and can be caused by multiple factors. The therapeutic approach for symptomatic osteomas is strictly surgical.
CASE REPORT. The authors present a patient with giant ethmoido-frontal osteoma, causing the compression of the ocular globe and the right frontal lobe. Considering the intracranial extension, a combined surgical team consisting of an ENT surgeon and neurosurgeon decided to deal with the case. The tumoral mass was removed with no recurrence after a follow-up of two years.
CONCLUSION. Surgery via external and endoscopic approach aims to completely resect the osteoma with frontal sinus origin and orbital or intracranial extension.
Vlad A. Budu, Tatiana Decuseara, Ioan Bulescu, Andrei Panfiloiu, Lavinia Georgiana Sava and Mihai Tusaliu
Graves ophthalmopathy, an autoimmune disease, associated with hypermetabolism, enlargement of the thyroid gland and exophthalmia are the most frequent expressions of Graves’ disease, which often require surgical treatment. We present the case of a 41-year-old male with severe Graves ophthalmopathy for which we performed an endoscopic orbital decompression with good surgical outcome, the patient being discharged after 48 hours.
V. A. Budu, Tatiana Decuseară, Andreea Nicoleta Costache, I. Bulescu, Alexandra Guliga, A. Panfiloiu and M. Tusaliu
Choanal atresia is the most frequent nasal congenital malformation, which, depending on the unilateral or bilateral location, has a different symptomatology. The diagnosis is confirmed through the patient’s medical history, nasal endoscopy and imagistic examination (computed tomography). The treatment is surgical and aims the (fibrous and bone) tissue disintegration which blocks the choana, and is performed through endoscopic surgical techniques. The blocked area is maintained functional by mounting a stent at the choanal tunnel level. The authors aim to describe their own experience regarding both the diagnoses as well as the treatment of this pathology, the results being compared to those from the quoted literature. The surgical technique differs depending on the type of choanal atresia: bone or membranous. The duration to maintain a fix position of the stent and the material used for the stent represent the variables which provide the success of the endoscopic surgical intervention of the choanal atresia. Subsequently, the patient is followed up at 2, 6, 12 months in the first year and then annually until 18 years of age. Choanal atresia is solved through endoscopic surgical techniques by mounting a silicone stent which shall be maintained in position for a minimum period of 3 months. The endoscopic approach of the unilateral choanal imperforation is the method of choice with minimum complications, increased success rate and fast recovery.
Vlad Budu, Tatiana Decuseara, Andreea Nicoleta Costache, Loredana Ghiuzan, Monica Hodor, Gabriel Dascalu, Mihai Tusaliu and Ioan Bulescu
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.
Vlad Budu, Andreea Costache, Tatiana Decuseara, Alexandru Coman, Alexandra Guliga, Raluca Baican, Alexandru Panfiloiu, Ioan Bulescu, Cristina Goanta, C. Ionita and Mihail Tusaliu
The authors present a case of recurrent frontal rhinosinusitis, for which the drug therapy was ineffective. To avert the risk of complications, multiple classic and endoscopic surgical procedures were performed on the frontal sinus pathology.
The bacterium involved in this form of rhinosinusitis was represented by a Methicillin-resistant Staphylococcus aureus (MRSA) diagnosed during the first endoscopic approach (the second surgical procedure) for which the treatment corresponding to the antibiogram was followed. At the last hospitalization, the patient has underwent a frontal bilateral drainage surgery (modified Lothrop procedure) and started an adequate anti-MRSA treatment.
The authors wondered whether multiple recurrences of frontal rhinosinusitis are determined by an incomplete drainage, by a persistent infection with MRSA or by both.
V. Budu, A. Panfiloiu, Alexandra Guliga, Tatiana Decuseara, Andreea-Nicoleta Costache, Dianamaria Mistra, Lavinia Sava, I. A. Bulescu and M. Tusaliu
In the last decades, rhinology has developed in a great manner concerning new surgical techniques and extending the use of compatible biomaterials in order to achieve normal morphology and normal functional aspect after surgery (endoscopic or open approach). Since biomaterials are integrated in biological active organs and systems, they have to be easily accepted by the receiver with no toxicity, inflammation or other side effects. The authors try to review all biocompatible materials used in several rhinological pathologies in order to obtain the best results after functional or reconstructive surgery. In rhinological surgery there are usually used homograft’s but the use of biomaterials like alloplastics (silicone, high density polyethylene, polytetrafluoroethylene, etc.) has widely increased. The authors present their experience in endoscopic approach of choanal atresia using nasal stents, closure techniques for septal perforation using nasal splints, endoscopic drainage and sinus ventilation using balloon sinuplasty, lacrimal pathway obstruction using double margin stent and some materials used in cosmetic and reconstructive rhinoplasty.