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.
The terminal nerve (cranial nerve zero, cranial nerve XIII, the nerve “N”) was discovered in fish in 1894. In the early 90’s, it was found in human embryos and human adults. In the anterior fossa, it courses on the inner side of the olfactory tract and bulb; it then spreads fibers through the cribriform plate to distribute beneath the nasal septum mucosa. Being provided with intrinsic ganglion cells, its functions are weakly suggested by studies in different species. It may be connected with the visual system, it could act upon the intracranial vascular system, or it could ensure the pathway for pheromone-mediated behaviours. The cranial nerve zero deserves a better attention equally from anatomists and ENT specialists.
Frodita Jakimovska, Marina Davceva Cakar and Dejan Dokic
BACKGROUND. Septal deviations are usually diagnosed by a patient’s subjective complaint of nasal stuffiness and a physical examination by the otorhinolaringologist. The decision for surgery is not always based on objective measurements. Acoustic rhinometry and rhinomanometry are objective tools for assessment of nasal patency but is still a controversial subject. In our populations, there are no general accepted methods for screening patients for septal surgery.
OBJECTIVE. To analyse the effectiveness of acoustic rhinometry and rhinomanometry in predicting the outcomes of septoplasty and rhinoseptoplasty and their usefulness in preoperative screening of septal deviations.
MATERIAL AND METHODS. 69 patients were included in this prospective study. Acoustic rhinometry and rhinomanometry were performed before and one year after surgery for the investigation of nasal obstruction. Several parameters were analysed before and after decongestion of the nasal mucosa. VAS (visual analogue scale) was also included for evaluation of the subjective symptom score pre- and postoperatively. After surgery, a short questionnaire was applied to investigate patients’ postoperative satisfaction.
RESULTS. The mean subjective scores of nasal patency improved significantly after surgery with 77%. Several parameters of acoustic rhinometry and rhinomanometry were analysed with binary logistic regression, to evaluate the predictive values on the postoperative satisfaction. The preoperative decongested overall MCA (minimal cross-sectional area) on the deviation side, the decongested bilateral MCA and the decongested Flow ratio had significantly the highest impact on the postoperative satisfaction (p<0.001).
CONCLUSION. Acoustic rhinometry and rhinomanometry as objective tools can serve as objective evidence for the efficacy of septoplasty and rhinoseptoplasty. The parameters of rhinomanometry and anterior rhinometry are useful in the preoperative screening for septal deviations and in predicting postoperative satisfaction between different degrees of nasal septal deviations.
Elena Patrascu, Claudiu Manea and Codrut Sarafoleanu
A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.
Ivan Lulchev Chenchev, Dimitar Todorov Atanasov and Dilyana Vicheva
OBJECTIVE. The purpose of this study was to compare the options for treatment of Miller’s Class I and Class II gingival recessions using coronally advanced flap (CAF) and platelet-rich fibrin membrane (PRFm) with CAF and connective tissue graft (CTG).
MATERIAL AND METHODS. A surgical treatment was carried out on 30 subjects (23 women and 7 men), with a total of 118 symmetrical recessions of Class I and Class II by Miller on different places of the jaws, using two different methods. On one side of the jaw was held a plastic covering of the recessions with CAF in combination with PRFm (test group), and on the other side – CAF in combination with connective tissue graft (control group). The clinical evaluation includes: gingival recession depth (GRD), probing pocket depth (PPD), clinical attachment level (CAL), keratinized gingival width (KGW), gingival thickness (GTH), mean percent of root coverage (RC %). The results were observed six months postoperatively.
RESULTS. The average values for the GRD measured six months postoperatively for the control group were 0.37±0.36 mm and 0.70±0.41 mm for the test group. The results for CAL for the control group were 2.01±0.44 mm and 2.28±0.50 mm for the test group, while the mean percentage of root coverage (RC %) was 90.29±9.05% for the control group and 80.48±10.19% for the test group. The values for GTH were 1.04±0.16mm for the control group and 0.92±0.09 mm for the test group.
CONCLUSION. Both compared methods show good results in terms of all evaluated parameters. The group treated with CAF + CTG showed better results with a statistically significant difference for the RC% and the average values for GRD, GTH and CAL. The results of our study demonstrate a good potential for PRFm used in the treatment of Miller’s Class I and Class II gingival recessions.
We present a case of paediatric nasal foreign body removal using a flexible nasopharyngolaryngoscope, which is used both as an endoscope for visualization and as a hook for the rapid and complete removal of the nasal foreign body (“Visual Hook“).
Adelina Birceanu, Anca Evsei, Adrian Dumitru, Maria Sajin and Codrut Sarafoleanu
BACKGROUND. Primary malignant lymphomas of the salivary gland are rare, accounting for 2% of salivary gland tumors and 5% of all extranodal lymphomas. The clinical presentation is not particularly characteristic, a feature that usually leads to diagnostic and treatment delays.
CASE REPORT. We report a case of a parotid gland triple-hit diffuse large B-cell (DLBCL) lymphoma associated with follicular lymphoma in a 76-year-old female patient with a unique personal history, which included a diagnosis of Sjogren Syndrome and exposure to a toxic working environment with pesticides. Diffuse large B-cell lymphomas are uncommon given the fact that most lymphoid malignancies are low-grade lymphomas, with MALT (mucosa associated lymphoid tissue) lymphomas being the most common. Triple-hit DLBCL are extremely rare and the diagnosis can be challenging. Parotidectomy, as the first step, must be followed by histopathology and immunohistochemistry for final diagnosis and treatment.
CONCLUSION. This case highlights the fact that B-cell lymphoma in the salivary gland can be unrecognized due to unspecific symptoms and requires immunohistochemistry studies for confirmation. It is important to recognize triple-hit lymphoma due to its worse prognosis and differentiated treatment. Patients with Sjogren syndrome have additional risk factors for progression to lymphoma.
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).
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.
Medicine is in an era of technical development and innovation. Creating a tympanic membrane by using a 3D printer can exceed the disadvantages that classic graft materials have. The field of otolaryngology can be experiencing a paradigm shift towards the use of 3D-printer.