BACKGROUND. There are not many works devoted to the structures of a nasal cavity in odontogenic maxillary sinusitis and to a condition of an alveolar ridge of the maxilla with a rhinogenous genesis of the disease.
MATERIAL AND METHODS. 100 patients (N) with chronic sinusitis hospitalized at the ENT (N=50) and Oral and Maxillofacial Surgery (N=50) Departments were examined. The character of anatomic options of a nasal septum in chronic maxillary sinusitis is estimated according to a cone-beam computed tomography (CBCT) with use of our own developed scheme of coordinates in the form of “triangles” which allows establishing versions of the block of the ostiomeatal complex and nasal septum deviation.
RESULTS. In cases of rhinogenous and odontogenic causes of maxillary sinusitis, the triangle deviation is detected more often, including a perpendicular plate of the ethmoid bone, the vomer and the quadrangular cartilage, contributing to the block of the ostiomeatal complex. This scheme has allowed us to establish a group of patients with the mixed genesis of maxillary sinusitis in the Otorhinolaryngology and MFS Departments (36% and 42% respectively) and that, in its turn, requires a cross-disciplinary approach when choosing a strategy of treatment.
CONCLUSION. In case of rhinogenous genesis of the disease, the bilateral nature of the process with involvement of other paranasal sinuses in the inflammatory process is detected more often. The category of patients with mixed genesis (rhinogenous plus odontogenic) of sinusitis demands a cross-disciplinary approach to diagnosis and making a decision about treatment strategies.
Wegener’s granulomatosis (Granulomatosis with Polyangiitis) is an autoimmune granulomatous disorder of unknown etiology. The basic pathology is necrotizing granulomatous inflammation with necrotizing vasculitis involving medium-sized blood vessels. The typical triad of involvement of the upper and lower respiratory tracts and the kidneys is observed in varying proportions in individual patients. The sinonasal involvement is observed in the majority of patients and it can be involved in isolation in up to a quarter of affected individuals. The sinonasal changes involve both the soft tissue and bony architecture, with refractory chronic sinusitis associated with erosion of the cartilaginous and bony skeleton and may lead to saddle nose and other facial deformities in advanced cases. The radiology has a contributory role as diagnostic and diseases monitoring aid.
The various radiological findings associated with the disease (bone erosion with osteoneogenesis) have been mentioned in the literature. We present the progression of a radiological abnormality in a patient with a localized form of Wegener’s Granulomatosis and highlight some peculiar appearances observed on radiology in the patient.
BACKGROUND. The malignant sinonasal tumour is very rare. Sinonasal adenocarcinoma comprises only 10-20% of all primary malignant sinonasal tumours. The commonest type is the maxillary squamous cell carcinoma. It commonly presents with nasal blockage, nasal discharge and epistaxis during the early stage. Headache and blurry vision may occur at an advanced stage when it has invaded the brain, the eye or the optic nerve.
CASE REPORT. We present a 63-year-old patient with acute progressive worsening unilateral blurry vision and headache for 1 month. Epistaxis with anosmia developed only later. The patient had a neuroimaging by both Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) scan which showed a skull base tumour, but early biopsy was inconclusive. He underwent combined transcranial and transsphenoidal tumor debulking in view of clinical impression of olfactory neuroblastoma. The histopathological examination showed adenocarcinoma. He was sent for postoperative radiotherapy.
CONCLUSION. We highlighted that a patient with sinonasal adenocarcinoma may present initially with the symptom of invasion to neighbouring structures prior to the local symptom.
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.
BACKGROUND. Acinic cell carcinoma (ACC) is a rare malignant salivary gland tumour. It is of a low-grade type. The commonest site involved is the parotid gland. ACC is not common in minor salivary glands; this tumour type mainly arises in the oral cavity.
CASE REPORT. We present an 84-year-old Malay man with spontaneous, self-limiting, left-sided epistaxis for 2 days. He also had progressive left-sided nasal blockage. There was no hyposmia, blurry vision or headache. He had underlying hypertension. The clinical examination showed he was normotensive. There was no external nasal deformity. The anterior rhinoscopy demonstrated a fungating irregular mass filling up the left nasal vestibule. There was no neck node. The computed tomography showed a tumour localized in the nasal cavity. The biopsy showed features of acinic cell carcinoma. We proceeded with left lateral rhinotomy and wide excision. Intraoperatively, we discovered that the tumour aroused from the nasal septum and part of the septum had to be sacrificed for margin clearance. Currently, he is on routine surveillance and tumour-free.
CONCLUSION. We highlighted the importance of recognizing nasal acinic cell carcinoma and the fact that early biopsy is important as surgery provides a good prognosis even in the extreme age group.
Inverted papilloma is a rare benign sinonasal tumor with a still unclear etiology. In the last decades, HPV implication in inverted papilloma etiopathogeny has been studied and demonstrated in some scientific research papers, but with no causality proven. Imagistic investigations and the Krouse classification establish the surgical approach. Endoscopic surgery represents the golden standard treatment for most cases of inverted papilloma, while external or combined approaches present limited indications.
The authors present a case and therapeutic plan of an inverted papilloma located in the ethmoid sinus, with origin in the lamina papyracea and high-risk HPV implication.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is considered a multifactorial pathology with negative impact on the quality of life and considerable socio-economic effects. The pathogenesis of CRSwNP has not yet been fully elucidated despite remarkable studies in this field. This limits the pathogenic treatment and, therefore, the pathological process is expressed by a greater tendency of recurrence. Patients with recurrent CRSwNP remain in a severe state and therapeutically uncontrolled. In recent studies, the involvement of oxidative stress (OS) in the pathogenesis of CRSwNP has been more frequently mentioned. CRSwNP is considered a response of the sinonasal tissue on the inflammatory state, associated with OS and production of reactive oxygen species, causing injury to sinonasal tissues. It was demonstrated that the amount of ROS in the nasal polyp tissue corresponds to the severity of CRSwNP.
A literature review on the role of OS in the pathogenesis of CRSwNP was undertaken. The relevant information was identified using a search of electronic databases. Keywords used to highlight relevant papers were a combination of “chronic rhinosinusitis with nasal polyps” and “oxidative stress”.
This review demonstrates that there is a strong relationship between OS and CRSwNP pathogenesis. It is hypothesized that antioxidants may have a preventive role in CRSwNP. Nevertheless, additional research is required to further evaluate the effectiveness of antioxidant therapy.
Salivary gland cancers are represented by a heterogeneous histologic group of tumors, with low incidence, which may appear both in major and minor salivary glands. This article presents a review of the difficulties which may be encountered in this pathology during the treatment. The diagnosis of salivary gland cancers is often delayed, due to the histopathologic and immunohistochemistry results given in different period of times. There can be several difficulties in following the oncologic pre-treatment protocols, in terms of imaging technique, as MRI, useful for disease staging.
The treatment of salivary gland cancers is complex, due to the local anatomy and their aggressive potential. Because of their decreased incidence, there are few data that investigate the treatment in the case of these diseases. The current therapy available for the patients with salivary gland cancers is represented by complete surgical resection. Several treatment difficulties in cancers of the salivary glands may come from the surgical limitations and the insufficient data for adjuvant and palliative treatment. Due to the limitations of the local health system, there is a heterogeneous distribution of the oncologic centers, lack of equipment, prolonged time to follow general protocols, despite the aspect of case-individualized therapy according to the guidelines. We must not forget the tumor behaviour and individual reactivity of different patients to the same treatment protocol.
Whiplash syndrome is a quite common pathology and can be defined as a neck injury produced by a sudden acceleration-deceleration, the consequence of which is a sudden forward and backward movement of the head and neck. The main production mechanism is a sudden acceleration-deceleration process that has as a consequence the sudden extension/flexion of the neck. Starting from the many structures involved, the whiplash syndrome is an interdisciplinary challenge (ENT specialist, neurologist, orthopedist, ophthalmologist, psychologist) and can be described by multiple signs and symptoms.
Whiplash syndrome is a complex pathology both through the mechanism of production and symptoms, and through the forensic implications that it has. The interdisciplinary medical collaboration, the implementation of stricter rules on wearing the seat belt and the development by car manufacturers of chairs and head restraints that protect the head and neck of passengers, would be the preventive step in the occurrence and especially the chronicization of these lesions.
OBJECTIVE. To study and compare the benefits of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery in terms of subjective and objective improvement in symptoms of nasal polyposis.
MATERIAL AND METHODS. This study involved 60 patients with bilateral sinonasal polyposis scheduled to undergo Endoscopic Sinus Surgery. The patients were randomized into two groups: Group A -Conventional endoscopic sinus surgery and Group B -Microdebrider-assisted endoscopic sinus surgery.
RESULTS. There was a significant difference in the mean VAS at 3 months postoperatively in Group B, but no significant difference at 6 months postoperatively following either of the two methods. The mean time for surgery (p<0.01) and the mean intraoperative blood loss (p<0.01) were significantly lower in Group B.
CONCLUSION. A well-trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal injury and regular proper follow-up will have similar postoperative results with both methods.