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What is new in tympanoplasty?


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.

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Evaluation of ostiomeatal complex pathology related to endoscopic sinus surgery – a retrospective analysis


BACKGROUND. The ostiomeatal complex (OMC) is the anatomical region situated between the middle turbinate and the lateral nasal wall, at the level of the middle meatus. Common anatomical variations of OMC are concha bullosa, hypertrophy of the uncinate process and of the bulla ethmoidalis and Haller’s cell. Our study was aimed to investigate the prevalence of these conditions and their relations to different symptoms.

MATERIAL AND METHODS. The study is a retrospective descriptive study based on 256 files of patients who were hospitalized and treated for OMC pathology in our clinic between January 2009 and January 2014. The data acquired were included into Excel Worksheets and statistically analyzed using GraphPad Software.

RESULTS. The most common finding was concha bullosa (63.67%), followed by hypertrophy of the bulla ethmoidalis (10.93%) and of the uncinate process (10.15%). Haller’s cell was found in only 3% of cases. The most common symptom for all patients was nasal obstruction, followed by nasal discharge. The majority of symptoms improved after functional endoscopic sinus surgery for OMC drainage.

CONCLUSION. OMC pathology is a frequent indication for functional endoscopic sinus surgery. The most common condition that determines blockage of OMC and need for surgical treatment is concha bullosa. The most common complaint of patients with OMC pathology is nasal obstruction.

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Book Review
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Original study. The clinical value of foam posturography in assessing patients with peripheral vestibular dysfunction – our experience


BACKGROUND. Computerized dynamic posturography is the most important battery test designed to assess the ability to use visual, vestibular and proprioceptive cues in the maintenance of posture. Foam posturography reduces the availability of proprioceptive inputs, which makes more difficult the balance control.

OBJECTIVE. The objective of the study was to assess the clinical use of foam posturography in evaluating peripheral vestibular dysfunction.

MATERIAL AND METHODS. We evaluated 41 patients with vestibular disorders and 41 normal patients by using the sensory organization test in eyes opened, eyes closed and mislead vision conditions with and without the foam. We measured several parameters: the position of the center of pressure, the displacement in the center of pressure in anteroposterior and mediolateral planes and Romberg’s ratio on static and foam rubber.

RESULTS. The values of all parameters were significantly higher in patients with peripheral vestibular disorders than in the control group (p<0.05). Also. comparing the Romberg test results, the foam surface used by the patient was larger than the static one.

CONCLUSION. Foam posturography can be a reliable test in assessing patients with peripheral vestibulopathy, being also able to identify the visual and proprioceptive dependence levels.

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Misdiagnosis of laryngeal sarcomatoid squamous cell carcinoma – case report


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.

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Some forensic aspects of the nasal septal deformities


OBJECTIVES. We reviewed the foreign aspects in nasal septal deformities.

MATERIAL AND METHODS. Mladina classification of the nasal septal deformities was used.

RESULTS. Types 5 and 6 have been dominantly inherited. The mechanism of the onset and possible connection to the trauma against the nose, as well as clinical implications of the remaining four types of the nasal septal deformities, have been explained and described in detail, giving the court expert witnesses the excellent opportunity to make a reliable and valuable finding.

CONCLUSION. Type 5 and type 6 nasal septal deformities are never the consequence of the trauma against the nose. In most of the cases, this also concerns type 3. This type as well as type 7 require the latero-lateral and anterior-posterior X-rays of the nasal bones in cases when the nasal pyramid is concurrently deformed. Types 1 and 2 in most of the cases are connected to trauma against the nose.

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Squamous cell carcinoma of the pterygopalatine fossa - A case report


The pterygopalatine fossa is an inverted pyramid-shaped space of the viscerocranium, protected by bony structures. Surgical access to this anatomical space is difficult, especially for tumor resection. There are numerous open surgical techniques for accessing this space, but nowadays, minimally-invasive endoscopic approaches are preferred in order to increase postoperative quality of life and reduce postoperative morbidities.

The tumors of the pterygopalatine fossa can be benign or malignant, and can occur primarily in the fossa or as secondary extensions from the surrounding regions through the multiple canals and foramina in its walls. Squamous cell carcinomas of this space have been described to appear as extensions from the nasopharynx, the paranasal sinuses or through perineural extension from the cutaneous branches of the maxillary nerve.

In this paper the authors present a rare case of squamous cell carcinoma of the pterygopalatine fossa, which was excised in an endoscopic transnasal approach after preoperative selective embolization.

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Olfaction and traumatic head injury - Is it possible to discriminate between malingering and patients with smell disorders based on nowadays knowledge?


BACKGROUND. Olfaction is one the most important senses; however, even nowadays it is incompletely known in humans from an anatomical and physiological point of view, but also as concerns the assessment methods and treatment. The main causes for acquired olfactory dysfunctions involve inflammatory pathology (local or general) and head trauma. Olfactory impairment after traumatic head injury (THI) is more frequent than believed. Today there are a number of tests for assessing the loss of smell, but more studies are needed in order to establish standardized protocols for patients with such pathology after THI. This uncertainty is more and more exploited by malingerers.

OBJECTIVE. The aim of the paper was to find in literature the necessary information in order to permit a correct management of a patient with olfactory impairment after head trauma and to establish new protocols that may help identify malingerers when medico-legal implications exists.

MATERIAL AND METHODS. We studied an amount of works and studies in order to highlight the diagnosis options specialist have, if such a case is encountered (olfactory loss after THI).

RESULTS. Recent studies show that great progress has been made, but more scientific research is needed. Specialists still search correlation between all diagnosis methods.

CONCLUSION. Olfactory disorders are an important topic given their importance in patient quality of life, but also for the medico-legal implications.

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Anatomic patterns of maxillary sinus drainage


Background. Functional endoscopic sinus surgery may be indicated when certain anatomic variations impede the normal drainage of the paranasal sinuses through the ostiomeatal complex. We aimed at studying the drainage system of the maxillary sinus which consists of the maxillary infundibulum, the main ostium of the maxillary sinus, the ethmoidal infundibulum and the hiatus semilunaris inferior.

Material and methods. The study was performed retrospectively on cone beam computed tomography (CBCT) scans of 60 subjects (N=120 maxillary sinuses). The anatomical pattern of the maxillary sinus drainage was studied on coronal scans.

Results. As related to different morphological possibilities in the supero-lateral limit of the maxillary sinus drainage system, five different patterns were defined: in type I (55%) there was no pneumatization in that situs, in type II (18%) there was an infraorbital recess of the maxillary sinus placed above the sinus ostium, in type III (14%) an ethmoidal recess of the maxillary sinus was expanded within the ethmoid bone, above the ethmoidal infundibulum, in type IV (3%) there were Haller cells above the sinus ostium, while in type V (10%) there were non-infraorbital ethmoid air cells above and draining into the ethmoidal infundibulum.

Conclusion. It appears that CBCT is a reliable tool to make an anatomical distinction of the variable pattern of pneumatization impeding a normal drainage of the maxillary sinus, between maxillary sinus- and ethmoid-derived air-filled spaces.

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Silent sinus syndrome - Case presentation


BACKGROUND. Silent sinus syndrome (SSS) is known as a relatively new pathology with clinical characterizations, represented by the facial asymmetry determined by progressive enophthalmos and hypoglobus and the absence of nasal symptoms. The theory that sustained this pathology is based on the negative maxillary pressure and the chronic evolution of symptomatology.

CASE REPORT. A 49-year-old white female presented in our clinic for facial asymmetry, right facial pressure, right depression of the orbital floor and hypoglobus, without diplopia. The CT scan showed an opaque right maxillary sinus with the depression of the orbital floor.

CONCLUSION. The pathogenesis, clinical and imagistic features are the most important in the SSS for diagnosis and correct treatment.

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