Gabriela Musat, Laura Florina Neaga and Raluca Enache
BACKGROUND. Functional connection between the stomatognathic system and the acoustic-vestibular apparatus is approached with interest in topical studies, in an attempt to elucidate in depth the cause-effect relationship between pathology and symptom. The temporomandibular joint disorder may be accompanied by a series of otological symptoms such as otalgia, tinnitus and vertigo. For this reason, for a correct diagnosis, a complex clinical examination is required both on the acousticvestibular analyzer and on neighbouring structures.
MATERIAL AND METHODS. We conducted a clinical study, on a group of 97 patients diagnosed with temporomandibular joint disorder (TMJD) and treated for this pathology. All patients included in the study were evaluated by the dentist and the ENT specialist. The patients were treated at the dental clinic and then returned to the ENT clinic two months after completion of the treatment for re-examination, recording changes in otologic symptoms in order to obtain the results of the study.
RESULTS. Of the 97 patients with TMJD, 58 also associated otic symptomatology (otalgia – 74.13%, tinnitus – 53.45%, vertigo – 43.10%). The evaluation done two months after treatment of the temporomandibular joint disorder revealed a significant remission of otalgia (decrease in Mean VAS from 6.05 to 2.49), followed by vertigo (from 5.08 to 2.52) and by tinnitus (from 4.84 to 3.84). Important changes also occurred in the results of the vestibular assessments.
CONCLUSION. The most common otological symptom of patients with TMJD is auricular pain. Otalgia, tinnitus and vertigo can be improved by dental treatment of the temporomandibular dysfunction, auricular pain having the highest rate of remission.
Ioan Alexandru Bulescu, Octavian Munteanu, Razvan Stanciulescu, Cosmin Pantu, Mihai Enyedi, Florin Filipoiu and Vlad Andrei Budu
Morphological variability of paranasal sinuses is well known for endoscopic surgeons and anatomists alike. The ethmoid sinus is the most complex and variable of all paranasal sinuses, due to the fact that its development is not yet well known and is influenced by many factors. Volumetric studies of the sinuses have been made using dried skulls, cadaver heads and imaging studies, but there are still not sufficient data in order to name a standard value for each sinus. Few data can be found especially regarding the ethmoid sinus. In this paper, we measured the volumes of ethmoid lateral masses, and for anterior and posterior groups of cells, using imaging studies and a volumetric feature of our imaging studies. Results showed an average volume between 7.34 cm3 and 8.39 cm3 for the ethmoid lateral mass, between 4.33 cm3 and 4.92 cm3 for the anterior ethmoid and between 3.01 cm3 and 3.47 cm3 for the posterior ethmoid groups. We also found that the average volume of the anterior ethmoid occupies between 58-59% of the whole volume, while the posterior ethmoid occupies only 41-42% of this volume.
Lacrimal stents were used in the past to preserve the caliber of the lacrimal pathways after surgery, trauma, reconstruction, etc. Recently, their role in preventing functional epiphora has also been highlighted. Over the years, the stents have evolved and different models, materials and surgical techniques for positioning have appeared. Extensive and accurate knowledge of the type and design of the stent, the correct insertion technique offer optimal results depending on the anatomical area and the type of disorder of the lacrimal pathways. We will present the advantages of a simple catheterization technique for the lacrimal sac, endoscopic post-dacryocystorhinostomy.
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.
Ricardo de Hoyos, Michele Loglisci, Hugo Anibal Rodriguez and Desiderio Passali
Cervical and parotideal abscess is a rare finding in all populations and even more so in the paediatric population. The antibiotic resistance of the bacteria that cause these diseases can make it very dangerous. We present a paediatric case in which there is a combined left-cervical and parotideal abscess in a female 3-month-old baby who presented fever, pain and cervical swelling.
Dan Cristian Gheorghe and Adina Zamfir-Chiru-Anton
Tumors of the maxillary sinus pose difficult challenges in a young patient. Our paper presents a very rare case of an odontogenic myxoma extended to the maxillary sinus, in a 14-year-old girl. The clinical picture suggested a malignancy or a local infection. The surgical removal was complete and the diagnosis was confirmed by immunohistochemistry. Discussions are made from the perspective of already published cases. A review of the disease is performed.
CONCLUSION. Myxoma is a benign but aggressive tumor, needing complete surgical excision for a good long-term outcome.
Vlad Budu, Tatiana Decuseara, Bogdan Mocanu, Raluca Baican, Mihai Tusaliu, Diana Cojocaru and Ion Bulescu
BACKGROUND. Endoscopic dacryocystorhinostomy is known to be the ideal treatment for saccal and postsaccal stenosis of the lacrimal apparatus. Following this surgery, an important inconvenient would be the stenosis of the created ostium with consecutive epiphora.
MATERIAL AND METHODS. 20 patients with chronic unilateral lacrimal duct obstruction were operated in “Prof. Dr. D. Hociota” Institute of Phono-Audiology and Functional ENT Surgery, Department I, between January 2015 and July 2015. After creating the dacryocystorhinostoma, a stent was inserted transnasally to the bottom edge of the lacrimal sac and positioned to the bony margin of the ostium. Stents used varied in size from 1 to 3 mm in diameter. We followed-up our patients at 2 weeks and 1, 3, 6 months, assessing the symptoms of the lacrimal apparatus, especially the epiphora.
RESULTS. The mean age of patients varied between 31 and 65. Most of our patients were women (n=14). In a total number of 16 patients epiphora disappeared, it decreased in 2 patients, and persisted in 2 patients. There were two patients with no changes who have spontaneously eliminated the stent 2 or 3 days after the surgery. The most widely used stent size was 3 mm diameter, with a success rate of 90%.
CONCLUSION. The endoscopic approach may be an effective procedure in patients with pathologies of the lacrimal apparatus. In order to achieve an efficient result, both a preoperative rigorous preparation and also postoperative medical care are necessary. In conclusion, ostium stenting represents a better way to ensure a longer period of maintaining the permeability of the lacrimal apparatus.
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.