Sarcoidosis is a rare condition, presenting with granulomatous lesions typically located in the lungs, spleen and lymph nodes. We present an atypical case of sarcoidosis, with an initial lesion located in the nasopharynx. The patient is a 38-year-old male, with the complaints of cephalalgia, nasal obstruction and hyposmia, detected during further examination with degenerative spinal modifications, prostate inflammation and lung-based sarcoidosis. A biopsy of the lesion located in the postnasal cavity revealed granulomatous origin. The patient underwent total endoscopic adenoid removal and radiofrequency-assisted bilateral turbinate reduction, with favourable post operatory evolution. Atypical localizations of sarcoidosis lesions must be considered in the case of unusual lesions, regardless of localisation.
OBJECTIVE. The purpose of this paper is to describe a simple and safer silicone tube insertion technique in endoscopic dacryocystorhinostomy.
MATERIAL AND METHODS. In our technique, steel wire is inserted into a rigid suction tube (3 mm in diameter) immediately after the medial wall of the sac under endoscopic view. The duration of retrieving the wire from the sac and out of the nasal passage, the number of mucosal lacerations and bleeding were compared with conventional methods such as using retrieval device or forceps.
RESULTS. The duration of retrieving the wire from the sac and out of the nasal passage and mucosal laceration were statistically reduced (P<0.05) in this novel technique when compared with other methods.
CONCLUSION. Sheltering the sharp end of the wire with a suction cannula is a safe and easy method without using any additional tools
In the international literature, there is no consensus on patient selection for turbinate surgery. Surgery is usually indicated to the patients on the basis of subjective complaint of nasal obstruction and surgeon´s clinical examination. Although most surgical techniques demonstrate a subjective and objective improvement in postoperative nasal airflow and subjective scores, it is hard to say which technique is best suited for treating inferior turbinate enlargement. Inferior turbinate reduction for nasal obstructive symptoms caused by enlarged turbinates is a useful procedure and is reserved for patients who are not responding to medical treatment or in whom the medical management is contraindicated.
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).
OBJECTIVE. The aim of the study was to evaluate the endoscopic dacryocystorhinostomy (DCR) with some particularities and its advantages over external DCR.
MATERIAL AND METHODS. We evaluated 3 female patients (age range 35-84 years) diagnosed with chronic dacryocystitis - lacrimal sac abscess (2 cases) and lacrimal sac fistula (1 case). All patients presented a history of repeated episodes of acute dacryocystitis initially treated with broad spectrum antibiotics by the ophthalmologist. The evaluation protocol consisted in cranio-facial CT scan or MRI for the evaluation of the lacrimal sac and nasal structures, an ophthalmologic examination with the catheterization of the superior and inferior lacrimal punctum with a light probe to verify the permeability of the lacrimal pathway, and the Jones test with fluorescein to receive information about the common lacrimal path. Lacrimal syringing with regurgitation of fluid from the opposite punctum was the only criteria to decide the surgery. In all three cases we performed an endoscopic DCR, with stent insertion in two cases and a laco-dacryo-rhinostomy in one case. In only one case a reintervention was needed 12 months later.
CONCLUSION. The endoscopic DCR, with its different particularities, is a safe surgical procedure with a low rate of complications, being the treatment of choice for the treatment of nasolacrimal duct 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.
BACKGROUND. Chronic maxillary sinusitis is a frequently encountered pathology, resistant to treatment, which can cause significant economic losses. Considering these aspects, it is necessary to develop new methods of treatment.
OBJECTIVE. The purpose of this study was to assess the therapeutic efficacy of the “Cahul” ozonated mineral water in the treatment of experimentally induced chronic rhinosinusitis and its action on the mucosa of the maxillary sinus.
MATERIAL AND METHODS. The experimental study was conducted on a group of 14 chinchilla rabbits, aged between 8 and 12 months, weighing 2.5-3.0 kg, kept in vivarium conditions. In the first stage of the study, chronic rhinosinusitis was induced. 3 months after, maxillary antrostomy in the medial wall was performed on all animals included in the study; the intervention was performed under general anesthesia. The rabbits were divided into two groups. The rabbits enrolled in the study group underwent daily inhalations and maxillary sinus lavage with the “Cahul” ozonated mineral water. In the control group, inhalations and lavage were performed with 0.9% NaCl solution. Efficacy of the treatment was assessed observing the clinical character of the pathology. On days 2, 5 and 9 of the experiment, endoscopic and histological examinations were performed.
RESULTS. On the ninth day of treatment, if in the study group the appearance of the sinus mucosa was almost normal, in the control group, the histological examination revealed: epithelial hyperplasia, cylindrical cell hyperplasia, thickening of the basement membrane and lymphocyte infiltration. Mucosal fragments harvested after 5 days revealed submucosal fibrosis, leukocyte infiltration in the control group being more pronounced than in the study group.
CONCLUSION. Maxillary sinus lavage with the “Cahul” ozonated mineral water improves mucociliary clearance and stimulates regeneration of affected cells.
BACKGROUND. The reconstructive surgery is a domain in continuous research for new techniques and alloplastic materials for replacement of complex defects. Different biomaterials are used in soft tissue reconstruction including polypropylene meshes covered with collagen, which have the best results in abdominal and pelvic surgery, but are not yet used in nasal surgery.
MATERIAL AND METHODS. We analysed the studies from the literature regarding the different alloplastic implants used in nasal reconstruction surgery, their benefits and contraindications for nasal defects.
RESULTS. The most used polymers are Silicone, Medpor®, Mersilene® and polypropylene. Silicone is no longer widely used in facial reconstructive surgery because of its many complications. Medpor® (high-density polyethylene) is used for reconstruction of the facial skeleton and for aesthetic contour enhancement, including nasal reconstruction. Mersilene® (polyethylene terephthalate) is used for dorsum nasal defect reconstruction. Gore-Tex® is used for soft-tissue augmentation in the nose and is not recommended as a structural graft. Polypropylene meshes (Marlex®) are widely used in abdominal and chest wall reconstructive surgeries, with few studies on using them in nasal cartilage reconstruction.
CONCLUSION. Nasal reconstructive surgery is a difficult part of plastic surgery than can cause many problems to the surgeon, the need for soft tissue and cartilage reconstruction are difficult to solve in a repeatedly operated nose with few autogenous graft options and complex reconstructive surgeries, especially in posttraumatic defects and revision rhinoplasties. There are many alloplastic implants that can be used with excellent results.
Nasal polyposis represents a late stage of long-lasting inflammation of the sinonasal mucosa, characterized by increased inflammatory cells infiltration and anomalous tissue remodelling. A wide range of chemical mediators such as cytokines, chemokines, cell adhesion molecules are involved in the pathomechanism of nasal polyposis, but their significance has not been completely clarified.
Eosinophils are the dominant inflammatory cell population in nasal polyposis and are thought to be the central effector cells responsible for the onset and maintenance of the inflammatory process. Persistent inflammation of the sinonasal mucosa can lead to structural changes, such as epithelial damage, thickened basement membrane, stromal edema, formation of pseudocysts. This review summarizes prior and current knowledge regarding the involvement of the inflammatory process in the pathogenesis of nasal polyposis.
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.