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.
Atanas Vlaykov, Dian Sharlanov and Dilyana Vicheva
Background. Supernumerary teeth are described as an excess of the normal teeth number of 20 deciduous and 32 permanent teeth and can occur in any dental region.
Material and methods. The authors present the case of a 12-year-old female child with a paramolar in the maxilla, discovered accidentally during an orthopantomogram, emphasising the treatment modality and the complications that can appear.
Conclusion. Supernumerary teeth can be present in any region of the oral cavity. Both practitioners and clinicians should be aware of the various types of paramolars and make a treatment plan after an accurate clinical and radiographic examination.
Alex George Stanciu, Alexandra Cirticioiu and Adriana Neagos
BACKGROUND. Nowadays, snoring and obstructive sleep apnea are the most common sleep-related breathing disorders (SRBD) found in the medical practice and they are estimated to affect approximately 4% of men and 2% of women in the middle-aged workforce. There are some ENT pathologies that are involved in snoring, and also in obstructive sleep apnea syndrome. The nose plays an important part in both breathing and SRBD. The aim of this study was to determine the role of posterior rhinomanometry in the diagnoses of snoring and obstructive sleep apnea syndrome.
MATERIAL AND METHODS. We present a retrospective observational study that took place during a three-year period, between 2009 and 2012. In this study were included 110 subjects, who have undergone polysomnographic investigations, as well as an ENT clinical examination focused on endoscopy and posterior rhinomanometry evaluation.
RESULTS. The mean age was 46.09 ± 10.91 years, the mean height was 177.58 ± 10.02 cm and the mean weight was 98.45 ± 17.74 kg. Analysing these results, we found a significant correlation between them and the severity of the sleep pathology. The posterior rhinomanometry results were correlated with nasal allergic rhinitis (p = 0.06) and not correlated with other nasal pathology, such as nasal septum deviation. The changes in the size and shape of the tongue base or epiglottis proved to have an important impact upon rhinomanometric values, with a statistically significant value (p = 0.03, respectively p = 0.08).
CONCLUSION. All diagnostic methods must be interpreted in connection with each other.
Andreea Grosu-Bularda, Claudiu Manea and Ioan Lascar
Olfactory ensheathing cells (OECs) join olfactory axons in their entrance to the central nervous system, representing a unique population of glial cells with functions in olfactory neurogenesis, axonal growth and olfactory bulb formation. Olfactory ensheathing cells have a great potential to induce repair for neural injuries, in central nervous system and peripheral nervous system, existing numerous experimental and clinical studies lately, reporting beneficial effects in anatomical and functional recovery. Studies are also conducted in order to establish possible pro-regenerative effects of the OECs, their potential in tissue repair and ability to modulate the immune system. The aim of this paper was to review the properties of olfactory ensheathing cells and their potential therapeutic role in regenerative medicine.