BACKGROUND. Inverted papilloma is a benign tumor of the nose and sinuses, with a high risk of recurrence and malignant degeneration. The inverted papilloma is a slow growing tumor that can be approached through an endoscopic or external approach, depending on its stage.
OBJECTIVE. The aims of the study are to identify the particularities of diagnosis of the inverted papilloma, to establish the correct steps in surgical treatment of this tumor and to open the access for other steps of treatment.
MATERIAL AND METHODS. The authors present their experience in managing the sinonasal inverted papilloma in a 15-year retrospective clinical study, which included 162 patients. The preoperative protocol consisted in clinical examination, nasal endoscopy, radiologic imaging (CT scan) and biopsy with histopathology results and immunohistochemistry findings. Surgical removal of the inverted papilloma was performed by endoscopic techniques, according to the stage of the tumor. We were interested in the recurrence rate of the tumor and its malignancy after a long-term follow-up.
RESULTS. In our series, we included 162 patients and we had 26 (16.04%) recurrences and 12 (7.40%) malignant degenerations. All our patients were diagnosed in Krouse stages I, II and III and underwent endoscopic resection of the tumor.
CONCLUSION. In order not to have any leftover tumor (the most important factor of recurrence and malignant transformation), it is mandatory to have a complete diagnosis of the inverted papilloma, a precise surgical technique and a rigorous followup. In some cases, the surgical treatment is associated with other type of treatment (antiviral, antiangiogenetic).
The nasal swell body (NSB) is considered to be an enlarged region of the nasal septum, which is located superiorly to the inferior nasal turbinate and anteriorly to the middle nasal turbinate, with a potential effect upon the airflow nasal valve. The histological studies of the NSB demonstrated that it is a glandular formation, not a venous structure, and it is formed by septal cartilage and bone, as well as a thick mucosa. Recent studies emphasized the functional role of the nasal swell body and it is thought to interfere with the nasal airflow and air humidification, due to its proximity to the internal nasal valve and its histological characteristics (venous sinusoids and seromucinous glands). The nasal swell body is strongly related to the presence of rhinosinusal chronic inflammations (allergic rhinitis and chronic rhinosinusitis) and the septal deviation. In case of the presence of the nasal swell body, surgical treatment is not commonly done, due to the absence of a consensus between the ENT practitioners. Most of them consider surgery as being too aggressive because of the presence of seromucinous glands, with slight impact upon the nasal obstruction. Most probably, the lack of consensus is determined by inconsistent anatomical and histological study results.
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.
BACKGROUND. The ostiomeatal complex (OMC) is the anatomical region situated between the middle turbinate and the lateral nasal wall, at the level of the middle meatus. Common anatomical variations of OMC are concha bullosa, hypertrophy of the uncinate process and of the bulla ethmoidalis and Haller’s cell. Our study was aimed to investigate the prevalence of these conditions and their relations to different symptoms.
MATERIAL AND METHODS. The study is a retrospective descriptive study based on 256 files of patients who were hospitalized and treated for OMC pathology in our clinic between January 2009 and January 2014. The data acquired were included into Excel Worksheets and statistically analyzed using GraphPad Software.
RESULTS. The most common finding was concha bullosa (63.67%), followed by hypertrophy of the bulla ethmoidalis (10.93%) and of the uncinate process (10.15%). Haller’s cell was found in only 3% of cases. The most common symptom for all patients was nasal obstruction, followed by nasal discharge. The majority of symptoms improved after functional endoscopic sinus surgery for OMC drainage.
CONCLUSION. OMC pathology is a frequent indication for functional endoscopic sinus surgery. The most common condition that determines blockage of OMC and need for surgical treatment is concha bullosa. The most common complaint of patients with OMC pathology is nasal obstruction.
BACKGROUND. Even if it is a rare variant growth pattern of squamous cell carcinoma, sarcomatoid carcinoma seems to have almost the same clinical manifestations and risk factors as conventional squamous cell carcinoma.
CASE REPORT. This paper presents a complex case of a 59-year-old female patient known with laryngeal papillomatosis, who presented in our Department for moderate to severe inspiratory dyspnea associated with dysphonia and difficulty in swallowing. We mention that the patient had been previously evaluated by a pneumologist for apnea, snoring and daytime sleepiness and diagnosed and treated for sleep apnea syndrome. Clinical, laboratory, imaging and pathologic examinations revealed the association of upper airway obstruction with laryngeal cancer. Surgical intervention consisted in total laryngectomy and selective neck dissection associated with permanent tracheotomy. The microscopic appearance was that of a bilateral transglottic sarcomatoid squamous cell carcinoma without metastasis in the right lymph node.
CONCLUSION. It is important to evaluate the clinical and imagistic status of patients with laryngeal tumors in order to make a correct decision concerning their treatment policy. We emphasize that cooperation between multiple departments is absolutely necessary in order to adequately resolve, explore, diagnose and treat patients with laryngeal pathology.
The pterygopalatine fossa is an inverted pyramid-shaped space of the viscerocranium, protected by bony structures. Surgical access to this anatomical space is difficult, especially for tumor resection. There are numerous open surgical techniques for accessing this space, but nowadays, minimally-invasive endoscopic approaches are preferred in order to increase postoperative quality of life and reduce postoperative morbidities.
The tumors of the pterygopalatine fossa can be benign or malignant, and can occur primarily in the fossa or as secondary extensions from the surrounding regions through the multiple canals and foramina in its walls. Squamous cell carcinomas of this space have been described to appear as extensions from the nasopharynx, the paranasal sinuses or through perineural extension from the cutaneous branches of the maxillary nerve.
In this paper the authors present a rare case of squamous cell carcinoma of the pterygopalatine fossa, which was excised in an endoscopic transnasal approach after preoperative selective embolization.
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.
Recurrent laryngeal papillomatosis is a disease caused by human papillomaviruses (HPVs), which currently does not benefit from a curative treatment. Due to the fact that HPV has the action of modifying cellular DNA, with changes in the expression of interleukins and interferon, with insufficient maturation of T cells and intracellular overpopulation of immunosuppressive cells, the association of RRP (Recurrent Respiratory Papillomatosis) with an autoimmune disease may cause particular difficulties in the therapeutic management of patients diagnosed with RRP.
Immunosuppressive medication negatively influences the development of papillomatosis, increasing the number of local relapses and, respectively, the need for surgical intervention due to the increased viral multiplication and the proliferation of papillomatous lesions. In order to exemplify the difficulties encountered in treating RRP associated with an autoimmune disorder, the authors present the case of a 21-year-old patient diagnosed with juvenile recurrent laryngeal papillomatosis genotype 6, with multiple antecedent surgeries, who was diagnosed with pemphigus vulgaris at the age of 19. The peculiarity of the case lies in the difficulty of managing the RRP associated with an immunosuppressive disorder whose therapeutic indication is cortisone and immunosuppressive treatment, which led to exacerbation of viral multiplication and proliferation of papillomatous lesions.
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.