Catalina Craiu, Mihai Sandulescu and Mugurel Constantin Rusu
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.
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.
Aru Chhabra Handa, Anup Singh and Jai Prakash Sharma
Wegener’s granulomatosis (Granulomatosis with Polyangiitis) is an autoimmune granulomatous disorder of unknown etiology. The basic pathology is necrotizing granulomatous inflammation with necrotizing vasculitis involving medium-sized blood vessels. The typical triad of involvement of the upper and lower respiratory tracts and the kidneys is observed in varying proportions in individual patients. The sinonasal involvement is observed in the majority of patients and it can be involved in isolation in up to a quarter of affected individuals. The sinonasal changes involve both the soft tissue and bony architecture, with refractory chronic sinusitis associated with erosion of the cartilaginous and bony skeleton and may lead to saddle nose and other facial deformities in advanced cases. The radiology has a contributory role as diagnostic and diseases monitoring aid.
The various radiological findings associated with the disease (bone erosion with osteoneogenesis) have been mentioned in the literature. We present the progression of a radiological abnormality in a patient with a localized form of Wegener’s Granulomatosis and highlight some peculiar appearances observed on radiology in the patient.
Adriana Neagos, Alexandra Cirticioiu, Alex George Stanciu and Iren Csiszer
OBJECTIVE. The aim of the study was to determine the impact of the nasal pathologies over nasal mucociliary clearance and rhinomanometric parameters.
MATERIAL AND METHODS. This is a retrospective analytical observational clinical study during a period of 6 months, between 2014 and 2015. 123 subjects, 63 of whom had nasal pathology and 60 of whom were healthy controls, were enrolled in this study. The diagnosis of nasal pathology was made based on clinical examination, nasal endoscopy and anterior rhinomanometry. A methylene blue test was used to evaluate the mucociliary clearance.
RESULTS. The subjects with nasal pathology had nasal septum deviation (No=50), chronic rhinitis (No=42), rhinosinusitis (No=15) and nasal polyposis (No=17). The mean total air flow in inspiration in nasal pathology patients group was 546.7 ml/s (millilitre/second), with a median of 594 ml/s, comparing with the control group who had the mean air flow of 865.5 ml/s, with a median of 866.5 ml/s. In expiration, the mean air flow in those with nasal pathology was 603.9 ml/s and a median of 611 ml/s, comparing with the control group who had the mean air flow of 871.1 ml/s and a median around 872 ml/s. The mean time from the application of methylene blue liquid to first seeing it in patients with nasal pathology was 23.41 minutes for the right nostril and 23.32 minutes for the left nostril, comparing with the control group who had the mean of mucociliary clearance of 6.76 minutes for the right nostril and 6.93 minutes for the left one.
CONCLUSION. The results obtained in anterior rhinomanometry and methylene blue liquid test showed that nasal pathology does affect nasal physiology and it is an important factor to evaluate the mucociliary clearance.
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.
Gabriela Musat, Alina Anghel, Lucia Radu and Roxana Decusara
BACKGROUND. Vestibular disorders are a group of widely spread diseases that have as a common denominator the disturbance of the equilibrium system. The assessment of vestibular disorders consists in a complex examination of the patient including a thorough anamnesis, a rigorous clinical examination and multiple functional explorations.
OBJECTIVE. To asses weather there is a correlation between the data obtained in posturography and those obtained in the videonystagmography in patients with peripheral vestibular disorders.
MATERIAL AND METHODS. Collecting data from the observation sheets of patients diagnosed with peripheral vestibular syndrome and examined in the Department of Otorhinolaryngology of the “Sfanta Maria” Hospital in Bucharest over a period of 18 months.
RESULTS. We analyzed a number of 97 cases of patients diagnosed with peripheral vestibular disorder. A large number of patients (49) had correlated changes in the caloric tests and also in the posturography. A second group of patients (43) had changes in caloric tests but with no changes in posturography. The third group of 5, paradoxically, had a vestibular deficiency in posturography associated with normal caloric reactivity.
CONCLUSION. The results obtained with the videonystagmography are correlated with those of the caloric and rotational videonystagmographic tests in the case of acute vestibular diseases. In chronic vestibular diseases, it is possible to find caloric vestibular paresis in the presence of a normal posturography. The “vestibular omission” is a phenomenon in which the patient does not use the vestibular input of a normal labyrinth with caloric and rotary tests within normal limits. As no vestibular examination can be considered as selfstaging diagnosis, we always have to establish the final diagnosis correlating the results of all the tests available.
Veronica Trombitas, Alina Anda Nagy, Diana Vlad, Ilea Aranka and Silviu Albu
Chronic rhinosinusitis (CRS), fairly common disease in the field of otorhinolaryngology, is the focal point of thorough study of the pathophysiology and treatment strategies for a favourable evolution of patients with this problem. Although there have been important advances in the treatment of CRS, signs and symptoms still remain long after functional endoscopic sinus surgery (FESS), indicating the persistence of the biofilm infection on the sinus mucosa. This review aims to highlight the relationship between bacterial biofilm and CRS, and also the available treatment strategies of the latter.
Daniela Vrinceanu, Mihai Dumitru, Maria Sajin, Carmen Maria Salavastru and Adrian Costache
BACKGROUND. Lymph node tuberculosis is a pathology with an increasing incidence and prevalence in middle income countries.
MATERIAL AND METHODS. We present a series of 4 cases with cervical lymph node tuberculosis. We review current principles of diagnosis and treatment from the perspective of the ENT surgeon in a tertiary university clinic.
RESULTS. In each case we underline diagnosis difficulties and treatment options. These cases presented management difficulties due to associated morbidities. All cases underwent surgical excision of the afflicted lymph nodes with subsequent microscopic confirmation of tuberculosis. We illustrate key concepts leading to the microscopy diagnosis of lymph node tuberculosis.
CONCLUSION. There are various surgical incidents and accidents that the young surgeon must be aware of when approaching neck tuberculous lymph nodes. Further referral of the patient for long-term tuberculosis treatment is mandatory. All patients were supervised for a minimum of 1 year after the initial diagnosis and treatment with no sign of recurrence. A close cooperation between the ENT surgeon, the infectious disease specialist and the pathologist is the key to an optimum approach to lymph node tuberculosis at the head and neck level.
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.