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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
Odontogenic suppurative rhinosinusitis with oculo-orbital and cerebral complications - case series

Abstract

BACKGROUND. Odontogenic rhinosinusal suppurations have a high potential for major ocular-orbital and cerebral complications because of the presence of anaerobic bacteria flora, with continuity, contiguity and haematogenous propagation mechanisms. This pathology is often diagnosed in other departments than ENT such as ophthalmology, neurosurgery or OMF surgery.

MATERIAL AND METHODS. We present three clinical cases of odontogenic rhinosinusal suppurations with major complications: a 36-year-old patient with odontogenic pansinusitis complicated with orbital phlegmon and cerebral frontal lobe abscess; a 19-year-old patient with complicated maxillary-ethmoidal-frontal sinusitis complicated with frontal subdural empyema and frontal bone osteomyelitis (with a history of craniofacial trauma one year before); a 66-year-old patient with odontogenic maxillary-ethmoidal sinusitis complicated with orbital apex syndrome.

RESULTS. The treatment was surgical, by external approach, with endoscopic nasal control, in interdisciplinary teams. We have associated massive antibiotic therapy. Surgical drainage for complicated rhinosinusitis should be done in emergency, within the first 24 hours after admission, according to guidelines. The bacteriological examination for aerobic and anaerobic flora can guide the diagnosis - two cases associated maxillo-ethmoidal aspergilloma lesions. The evolution of the cases was favourable.

CONCLUSION. Interdisciplinary teams have successfully solved these complicated odontogenic rhinosinusal suppurations. Two of the cases were admitted and cured within 2 weeks, in the context of very hot weather, which exacerbated dormant dental infections.

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
Bleeding angiomatous polyps of the maxillary sinus: Review of literature and a rare case report

Abstract

ENT surgeons frequently encounter a variety of neoplastic, non-neoplastic and inflammatory masses involving the nasal cavity, the paranasal sinuses or the nasopharynx. Among these, the angiomatous polyp or angiectatic nasal polyps are rare and account for 4-5% of all inflammatory nasal polyps. They have variable growth patterns and clinical features. In angiomatous nasal polyps, there is a prominent component of dilated capillary-type blood vessels. We present a review of the literature regarding the most important features of this pathology and an unusual case of a large angiomatous polyp arising from the maxillary sinus.

Open access
The ethical and moral responsibility of the surgeon, hospital and government for the hospitalization after adenotonsillectomy

Abstract

Adenotonsillectomy is one of the most performed surgical procedures in otorhinolaryngology. When it comes to hospitalization duration, there are no general available truths. Every patient is unique and only the physician should decide for how long he/she has to remain in the hospital after adenotonsillectomy, taking into consideration the used technique, the intraoperatory evolution and also the associated risk factors.

The authors present some general aspects of this theme and their own point of view in what adenotonsillectomy is concerned in terms of ethics and moral responsibility of the surgeon, hospital and government for the hospitalization after the surgical intervention.

Open access