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.
Irina Predescu, Dragos Predescu, Codrut Sarafoleanu and Silviu Constantinoiu
Background. The increased incidence of accidental or non-accidental ingestion of corrosive substances or drug compounds leading to postcaustic esophagitis represents a major public health issue. The treatment of postcaustic esophagitides is difficult and long lasting, calling for a complex team trained in this borderline pathology: gastroenterologist, general surgeon, otorhinolaryngologist, anesthesiologist, psychiatrist. In cases when preventive treatment has failed, the only effective therapy remains the surgical one.
Material and methods. Our study involved an analysis of the cases treated and/or operated in the Department of General and Esophageal Surgery of the “Sfanta Maria” Hospital in Bucharest, between 1981-2014; respectively 195 patients who benefited from reconstructive esophageal interventions. Of the selected patients, 191 were operated for corrosive pathology produced by ingestion of caustic soda and only four cases by ingestion of acids. The lesion balance showed that, besides the esophagus, the oropharynx (28 patients), the larynx (7 patients) and the stomach (31 patients) had been affected by the corrosion process, requiring particular surgical solutions. The bypass reconstruction (preserving the esophagus) was the standard treatment, esophagectomy having been performed in only 4 patients.
Results. The main remote postoperative complaint was feeding inability, a consequence of various causes: cervical anastomosis stenosis, motor dysfunctions of the graft or of the laryngopharyngeal complex, over-time alteration of the graft, technical vices or the degradation of intra-abdominal assemblies, traumatic injuries of the presternal substituent.
Conclusion. One of the most important moments during the esophageal reconstruction surgery remains the duration of the cervical anastomosis, since the postoperative complication rate and the remote functional outcome depend on it. Minimizing postoperative risks and complications requires a complete mastery of surgical methods, of the small technical “artifices” and of the necessary therapeutic refinements adapted to each individual case.
Carlos Miguel Chiesa Estomba, Frank Alberto Betances Reinoso and Carmelo Santidrian Hidalgo
BACKGROUND. Functional endoscopic sinus surgery (FESS) is a reliable option in the treatment of sinus pathology, but the presence of the anatomical variant and difficult cases like massive polyposis or revision FESS can generate some problems to surgeons.
MATERIAL AND METHODS. After performing an unciformectomy, a partial anterior ethmoidectomy and maxillary ostium antrostomy, we slide a cottonoid back to the basal lamella of the middle turbinate with a Cottle dissector and introduce it in the superior meatus. After that, we return to the middle meatus and proceed to open the basal lamella finding the cottonoid placed there previously.
RESULTS. An easy technique, safe and reproducible, that allows us to advance in our dissection, avoiding damaging important structures.
CONCLUSION. In this paper we present a safe way to approach the posterior ethmoidal cells complex in the classic way through the basal lamella of the middle turbinate, under the guidance of a cottonoid, a safe and easy maneuver to do this procedure in the beginning of our formation or in complex cases.
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.
Andreea-Ioana Derjac-Arama, Codrut Sarafoleanu, Mugurel Constantin Rusu and Anca Vereanu
Background. Few studies approached the process of blood vessels formation in the Schneiderian membrane. We aimed at investigating by immunohistochemistry the processes that are responsible for forming new blood vessels in the human Schneiderian membrane.
Material and methods. We applied CD31 and CD34 markers on bioptic samples gathered from eight adult patients negative for malignant pathologies. Filopodia-projecting endothelial tip cells (ETCs) were found and indicated processes of sprouting angiogenesis. Also, CD31-expressing monocyte-derived cells were found being involved in processes of vasculogenesis. These cells were projecting filopodia, thus being assessed as endothelial progenitor tip cells (EpTCs). Aggregates of CD31+ EpTCs were also analyzed. Further stages of lumen acquisition and large diameter vessels formation, specific for vasculogenesis, were evaluated.
Results. It resulted that, specifically within the maxillary sinus mucosa, vascular remodelling is equally ensured by adult vasculogenesis and sprouting angiogenesis.
Conclusion. This is, to our knowledge, the first evidence of adult vasculogenesis in the maxillary sinus mucosa, supported by bona fide bone marrow-derived CD31+ cells. The guidance mechanism of EpTCs protrusions needs further investigations for finding similarities, or dissimilarities, with the endothelial tip cells prolongations.
Claudiu Manea, Codrut Sarafoleanu, Cristina Iosif and Elena Patrascu
BACKGROUND. Innate immunity represents the first way of protection against different pathogenic agents. Recently, it has been a permanent interest regarding an innate immune molecule, that is known as palate, lung, nasal epithelial clone (PLUNC). PLUNC is a specific result found in the airways, of approximately 25 kDa, whose encoding is realized by adjacent genes located within a region of 300 kb in chromosome 20; these proteins must be detected predominantly in the superior respiratory tract.
MATERIAL AND METHODS. We performed a prospective clinical study on 34 patients with chronic rhinosinusitis and 10 controls, in order to investigate the expression of this protein in nasal tissue of patients affected by chronic rhinosinusitis. We tested the correlation between the existence of this disease and PLUNC proteins positivity.
RESULTS. 100% of controls have a+++ rated PLUNC proteins positivity, while cases have a lower percentage of positivity. There were no differences statistically significant between patients with CRSwNP and those with CRSsNP.
CONCLUSION. As a response to different irritating agents (bacteria, viruses, chemical factors), nasal mucosa will react by producing PLUNC proteins. PLUNC proteins have a defensive role in the upper airways mucosa.
Ionut Tanase, Claudiu Manea and Codrut Sarafoleanu
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.
Lucian Lapusneanu, Marlena Radulescu, Adrian Arhire and Andreea Filip
Cystic lesions of the maxilla are benign entities with both odontogenic and non-odontogenic origins. The maxillary cyst is a benign tumor of the bones of the jaw, which has a membrane and contains a fluid, semi-solid or mixed (liquid / semi-gaseous) material. These often lead to deformities in the jaw area. Cases are specific by framing pathological rarity, etiology, pathogenesis and clinical symptoms.
Considering the large entity of cystic formations that can be found in the maxilla region, we selected two patients with cystic formations of the upper jaw, which were part of different pathological etiology categories, with special rarity occurring, evolutionary appearance and difficult to classify in terms of pathognomonic signs.
Desiderio Passali, Leandro Politi, Lei Chen, Cemal Cingi, Codrut Sarafoleanu and Pasquale Cassano
Nasolacrimal duct obstruction (NLDO) is a common event in clinical practice. The authors, all members of the Italian Society of Rhinology, analysed 100 cases from different ENT Departments. The causes of NLDO, according to the etiology, can be divided into two classes: idiopathic primary acquired nasolacrimal duct obstruction and secondary. The aim of the study was to describe an association between the sign and symptoms of chronic rhinosinusitis and a complaint of epiphora.
Aurelian Radu Budurca, Teodor Stamate, Mihail Dan Cobzeanu and Angelica Balaur
We present a reconstruction of a posttraumatic nasal lobular and alar defect in a three-stage intervention. The first operation restored the cartilaginous support by a combination of a free conchal composite graft and a septal chondromucosal pivotal flap covered by a paramedian forehead pedicled flap. The second operation separated the pedicle of the flap, followed one month later by cosmetic refinements. We restored both length and shape of the nose and a functional symmetrical nostril. Surgical options are discussed regarding available donor areas and techniques.
Conclusion. Lobule reconstruction must be performed as an entire esthetic unit and must address all three layers - skin, cartilage and internal lining. Careful planning is fundamental in ensuring good cosmetic results.