Nadia Syafeera Naserrudin and Mohammed Azman Mohammad Raffiq
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.
Neelima Vijayan, Padmanabhan Karthikeyan, Nirmal Coumare Venkataramanujam, Ramiya Ramachandran Kaipuzha and Davis Thomas Pulimoottil
OBJECTIVE. This study aimed to analyse the association of absolute eosinophil count (AEC), serum IgE and spirometry with co-morbid bronchial asthma in patients with allergic rhinitis.
MATERIAL AND METHODS. This study involved 50 patients with signs and symptoms of allergic rhinitis who underwent a clinical examination and various tests, including spirometry, and were followed up regularly. Patients found to have bronchial asthma or nasal polyposis were treated accordingly.
RESULTS. The study found the prevalence of bronchial asthma in patients with allergic rhinitis to be 58% and that the severity of bronchial asthma was reduced significantly, with lesser acute attacks and reduced hospitalizations with the effective treatment of allergic rhinitis (p=0.064).
CONCLUSION. This study showed that elevated AEC and serum IgE were significantly associated with co-existing allergic rhinitis and bronchial asthma and increased the chance of co-existence of these two pathologies. Spirometry is a useful tool for observing the response to treatment.
Bogdan Mihail Cobzeanu, Dragos Octavian Palade, Andrei Rosu, Patricia Sonia Vonica, Cristian Martu, Luminita Radulescu, Daniela Carmen Rusu, Luiza Maria Cobzeanu and Mihail Dan Cobzeanu
The authors conduct a review of the etiopathogenesis, the main diagnostic methods and the treatment principles in cervico-facial pain. Pain in otorhinolaryngology is a multifactorial symptom, based on the rich innervation and vascularisation of the cephalic extremity. Pain can be of central or peripheral origin, acute and chronic. With the diversification of methods for exploring pain-generating lesions, different treatment protocols could also be achieved.
Congenital anosmia, isolated or as a symptom of Kallmann or Klinefelter syndrome, is a rare condition found in young patients and children. Anosmia is detected during childhood, being reported by the patient or by his/her family. Besides the clinical examination and olfactometric evaluation, imaging is mandatory for the olfactory pathways investigation. Multidisciplinary approach is needed for these patients in order to determine the etiology of the smell loss. In the current paper, we are presenting the case of an 11-year-old child diagnosed in our ENT Department with congenital anosmia.
Carlos Miguel Chiesa Estomba and Isabel Rocio González Guijarro
BACKGORUND. Simulation models have slowly been gaining a place in training and surgical skills, before attending the operating theatre. This paper presents a model that allows the trainee to practise the functional endoscopic sinus surgery (FESS) training in a safe, non-patient facing environment.
MATERIAL AND METHODS. The method can be practised away from the operating theatre and the skills developed can then be transferred to the operating theatre. To create our FESS simulator, we use a cardboard tube and sheet, scissors, markers, cutter, foam, needles, catheters, plasticine, an inflatable balloon, a 10g lumbar puncture needle, one 5 cc syringe, two Blakesley forceps (straight and angled) and a 0° and 30° Hopkins rigid optics. In this simulator you can practise a puncture of the inferior turbinate, the endoscopic depth, remove a polyp, balloon dilation, a partial ethmoidectomy.
RESULTS. We describe a cheap and easy to build FESS training model, which allows the resident to practise this technique in a risk-free environment, while guaranteeing the reproducibility of the technique under similar conditions.
CONCLUSION. The high cost of digital simulators does not allow possible spreading this technology in every department. For that reason, the purpose of this paper is the acquisition of a set of skills that allow the resident to go to the operating room with clear concepts about the basic techniques.
OBJECTIVE. The aim of the study was to evaluate the endoscopic dacryocystorhinostomy (DCR) with some particularities and its advantages over external DCR.
MATERIAL AND METHODS. We evaluated 3 female patients (age range 35-84 years) diagnosed with chronic dacryocystitis - lacrimal sac abscess (2 cases) and lacrimal sac fistula (1 case). All patients presented a history of repeated episodes of acute dacryocystitis initially treated with broad spectrum antibiotics by the ophthalmologist. The evaluation protocol consisted in cranio-facial CT scan or MRI for the evaluation of the lacrimal sac and nasal structures, an ophthalmologic examination with the catheterization of the superior and inferior lacrimal punctum with a light probe to verify the permeability of the lacrimal pathway, and the Jones test with fluorescein to receive information about the common lacrimal path. Lacrimal syringing with regurgitation of fluid from the opposite punctum was the only criteria to decide the surgery. In all three cases we performed an endoscopic DCR, with stent insertion in two cases and a laco-dacryo-rhinostomy in one case. In only one case a reintervention was needed 12 months later.
CONCLUSION. The endoscopic DCR, with its different particularities, is a safe surgical procedure with a low rate of complications, being the treatment of choice for the treatment of nasolacrimal duct obstruction.
Codrut Sarafoleanu, Alexis Vuzitas and Claudiu Manea
Malignancies of the upper aerodigestive tract are high morbidity bearing and life-threatening diseases, which require thorough care from diagnostic suspicion and confirmation to surgical and/or oncologic treatment and rehabilitation. Difficulties in managing head and neck cancers arise from delays in diagnosis and treatment caused by either patient-related factors or healthcare system-related factors. Tumor origin and stage determine whether surgical excision is feasible, the approach required for safe excision, the extent of functional and aesthetic sacrifice required to attain oncologic safety and the need for reconstructive surgery. A thorough and systematic preoperative risk versus benefits assessment to select potential surgical candidates and give realistic outcomes is important from both a medical and a legal point of view. Because tumors in the head and neck region frequently involve more than one system and sensory organ, potential loss of function from either the disease course, surgical or nonsurgical treatment should be taken into account form a quality of life perspective. Effective management of head and neck cancer patients requires the cooperation and combined effort of a multidisciplinary team of surgeons, physicians and other workers over a long period of time which, in the absence of a specialised head and neck cancer centre and guidelines, can lead to increased morbidity and mortality, and patient dissatisfaction.
Vlad Budu, Tatiana Decuseara, Andreea Nicoleta Costache, Loredana Ghiuzan, Lavinia Sava, Monica Hodor, Vadim Palii and Mihai Tusaliu
BACKGROUND. The most frequent benign nasal tumor is the osteoma. It is commonly asymptomatic and usually an incidental finding and can be caused by multiple factors. The therapeutic approach for symptomatic osteomas is strictly surgical.
CASE REPORT. The authors present a patient with giant ethmoido-frontal osteoma, causing the compression of the ocular globe and the right frontal lobe. Considering the intracranial extension, a combined surgical team consisting of an ENT surgeon and neurosurgeon decided to deal with the case. The tumoral mass was removed with no recurrence after a follow-up of two years.
CONCLUSION. Surgery via external and endoscopic approach aims to completely resect the osteoma with frontal sinus origin and orbital or intracranial extension.
Diana Vlad, Veronica Trombitas, Mircea Capusan and Silviu Albu
Chronic rhinosinusitis is a very common medical condition that affects nasal and paranasal sinuses mucosa in both adults and children. Its pathology, however, still remains unclear and researchers focus more and more on the role of nitric oxide (NO), a free radical produced in normal conditions by the paranasal sinuses epithelium in healthy patients, in the development of this disease. NO’s role in the upper airway disease is not completely known, but it appears to act like a first-line host defence agent, maintaining the sinuses sterile due to its antiviral and bacteriostatic properties and by increasing mucociliary clearance. NO levels in the exhaled air of patients with CRS are lower than in healthy patients. One explanation for this might be the sinus obstruction that occurs in CRS because subjects with complete sinus opacification have the lowest levels. Furthermore, NO levels decrease after CRS treatments, suggesting that its measurement might help in monitoring the patient’s response to therapy. In this review, we discuss the NO synthesis in the respiratory tract, its involvement in airway pathology, its role in the pathogenesis of CRS and the current clinical uses for NO in CRS and several other airway diseases.
Vlad A. Budu, Tatiana Decuseara, Ioan Bulescu, Andrei Panfiloiu, Lavinia Georgiana Sava and Mihai Tusaliu
Graves ophthalmopathy, an autoimmune disease, associated with hypermetabolism, enlargement of the thyroid gland and exophthalmia are the most frequent expressions of Graves’ disease, which often require surgical treatment. We present the case of a 41-year-old male with severe Graves ophthalmopathy for which we performed an endoscopic orbital decompression with good surgical outcome, the patient being discharged after 48 hours.