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Original study. Effectiveness of endoscopic posterior nasal neurectomy for the treatment of intractable rhinitis

Abstract

BACKGROUND. Chronic rhinitis is a clinical condition affecting more than 20% of the world population. The standard treatment strategy is medical. Surgical management can be considered in patients with intractable rhinitis. Various surgical techniques have been documented with varying success rates, but none of them is considered as a gold standard. Hence, we are studying the effectiveness of posterior nasal neurectomy (PNN) in patients who have intractable rhinitis, refractory to maximum medical therapy.

MATERIAL AND METHODS. A prospective study was conducted in the ENT Department, Padmavathy Medical Foundation, Kollam, Kerala, India, from January 2015 to February 2016. Adult patients, in the age group of 20 to 60 years, diagnosed with chronic rhinitis, presenting two or more symptoms of rhinitis, refractory to maximum medical therapy for a period of at least 3 or more years and whose quality of life was significantly affected were enrolled and PNN was done for them.

RESULTS. We observed a statistically significant improvement in subjective symptoms and patient quality of life at the end of 6 months post-operatively.

CONCLUSION. PNN is a safe and less invasive procedure, which can provide a significant relief in symptoms of intractable rhinitis. Fewer complications and better results make it superior over vidian neurectomy.

Open access
Infected nasopalatine cyst or neoplasm

Abstract

The cyst is accumulated fluid or mass in a cavity lined by pathological epithelium. The mandible and the maxilla are bones with high prevalence of cyst formation in the human body. Cystic affections, with or without bone destruction of the hard palate, are considered benign tumours. We present the case of a 20-year-old young man with a cystic lesion of the hard palate having lasted for 7 months.

Open access
Primary neuroendocrine small cell carcinoma in larynx: case report and literature review

Abstract

Background. Neuroendocrine tumors of the larynx represent a rare group of neoplasms characterized by pathological and biological heterogeneity. The histological and immunohistochemical diagnosis is the most important step in the appropriate management of these tumors and the prognosis varies according to histological types. Conventional anatomical and functional imaging can be complementary for diagnosis, staging and monitoring of treatment response. Material and methods. Here we report on a case of a laryngeal neuroendocrine small cell carcinoma occurring in a 67-year-old man who was referred to our clinic for clinical reevaluation, diagnosis and treatment. The clinical presentation, the histopathological and immunohistochemical examination and management of this kind of tumor are highlighted. Conclusion. Small cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Very low incidence of neuroendocrine tumors in the larynx and specifically very poor prognosis of neuroendocrine small cell carcinoma encouraged an extensive literature review.

Open access
Permeabilization surgery of the upper respiratory tract and its effects on sleep fragmentation and REM sleep

Abstract

Usually, patients with sleep disorders may complain of tiredness, fatigue, daytime sleepiness, difficulty in concentrating, and can reach up to falling asleep in inappropriate situations – condition known as the Pickwick syndrome. To avoid these unpleasant symptoms, a series of surgical procedures regarding the anatomical structures involved in sleep apnea were developed.

The article is a general review regarding the sleep disorders and the influence of upper airways permeability on the quality of sleep and the sleep staging distribution. Also, we present some preliminary data obtained in a clinical study underwent in CESITO Centre “Sfanta Maria” Hospital, Bucharest, involving patients with sleep pathology that had polysomnographic evaluations before and after various surgical procedures of nasal and pharyngeal permeabilization.

AIMS. To determine that permeabilization surgery of the upper airway tract may be used successfully in order to decrease the sleep fragmentation and increase the time of slow-wave sleep.

CONCLUSION. 6 months after the permeabilization surgery of the upper airway tract, the polysomnography reveals that the arousals index decreased and the sleep architecture undergoes changes that consist in decreasing the Stage 1 and Stage 2 sleep, therefore REM sleep reaches a better score.

Open access
Orbital decompression for inverted papilloma – Case report

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.

Open access
The chronic cough syndrome

Abstract

Cough is a common symptom encountered in medical practice and can occur throughout the life of a person. From a physiological point of view, it represents a mechanism responsible for the elimination of secretions from the airways. At the same time, cough may be the first symptom of an illness. There are many causes that may lead to the emergence of a chronic cough syndrome, the most frequent being pulmonary diseases. Besides the bronchopulmonary pathology, there are a number of extrapulmonary disorders that may manifest with coughing. The first step in evaluating the patient with chronic cough is performing a correct and complete anamnesis, followed by the physical examination of the patient. The treatment of the chronic cough syndrome must address mainly the underlying disease but, in case of failure of the established treatment, the antitussive therapy is used.

Open access
Comparative analysis of features of chronic maxillary sinusitis of various genesis

Abstract

BACKGROUND. There are not many works devoted to the structures of a nasal cavity in odontogenic maxillary sinusitis and to a condition of an alveolar ridge of the maxilla with a rhinogenous genesis of the disease.

MATERIAL AND METHODS. 100 patients (N) with chronic sinusitis hospitalized at the ENT (N=50) and Oral and Maxillofacial Surgery (N=50) Departments were examined. The character of anatomic options of a nasal septum in chronic maxillary sinusitis is estimated according to a cone-beam computed tomography (CBCT) with use of our own developed scheme of coordinates in the form of “triangles” which allows establishing versions of the block of the ostiomeatal complex and nasal septum deviation.

RESULTS. In cases of rhinogenous and odontogenic causes of maxillary sinusitis, the triangle deviation is detected more often, including a perpendicular plate of the ethmoid bone, the vomer and the quadrangular cartilage, contributing to the block of the ostiomeatal complex. This scheme has allowed us to establish a group of patients with the mixed genesis of maxillary sinusitis in the Otorhinolaryngology and MFS Departments (36% and 42% respectively) and that, in its turn, requires a cross-disciplinary approach when choosing a strategy of treatment.

CONCLUSION. In case of rhinogenous genesis of the disease, the bilateral nature of the process with involvement of other paranasal sinuses in the inflammatory process is detected more often. The category of patients with mixed genesis (rhinogenous plus odontogenic) of sinusitis demands a cross-disciplinary approach to diagnosis and making a decision about treatment strategies.

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
Variations of sphenoid pneumatization: a CBCT study

Abstract

BACKGROUND. The pneumatization pattern of the sphenoid sinus seems rather unpredictable, as resulted from previous studies. It is however extremely important for endoscopic approaches to target structures of the middle cranial fossa, such as the pituitary gland.

MATERIAL AND METHODS. We aimed at documenting by Cone Beam Computed Tomography (CBCT) the possibilities of anatomic variation of the sphenoid sinus. 25 randomly selected patients were retrospectively analyzed.

RESULTS. In 56%, the left and right sphenoidal sinuses were bilaterally symmetrical with respect to the sagittal pneumatization type: four patients had sellar types, one had presellar type and in nine cases the sphenoidal sinuses were reaching posteriorly to the sella turcica. Only in 8% of cases were found conchal types of pneumatization, but they were part of anatomical pictures including Onodi air cells. Such an Onodi cell presented a posterior (sphenoidal) recess reaching posteriorly and superiorly to the pterygopalatine fossa. The recesses of the sphenoid sinus were also documented: anterior or septal, ethmoidal, maxillary, clinoidal and lateral. In 32% was found a lateral recess only engaged between the vidian and maxillary nerve canals.

CONCLUSION. It appears that CBCT is a reliable tool for accurate anatomic identification of the sphenoid sinus pneumatization pattern, on a case-by-case basis.

Open access
Clinical and imagistic correlations in the inflammatory pathology of nasosinusal cavities

Abstract

This article reviews the pathophysiology and the clinical and imaging diagnosis of rhinosinusal inflammations.

Chronic sinusitis usually develops after an incompletely treated acute sinusitis.

Complications occur through fungal superinfection, osteomyelitis, extension of the inflammatory process in the orbit or adjacent meningoencephalic structures.

The imaging investigation is indicated as the symptoms get worse, for the elucidation of sinus contents, for establishing the therapeutic protocol, for identifying and finding solutions to solve nearby complications.

Open access