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Due to its characteristics, the sinonasal inverted papilloma continues to represent a challenge for the ENT surgeon, because the increased regional aggressivity, the tendency to recurrence, the possibility of multicentric lesions or the potential for malignant transformation still raise enough problems, especially related to therapeutic behavior. The authors aim to discuss the clinical case of a patient with such a pathology, presenting the main elements of applied surgical therapeutic management. The particularities related to the location and origin of the tumor, the type of surgical approach used, the advantages and disadvantages of both classical external surgery and transnasal endoscopic surgery are highlighted for the successful resolution of such a case and for obtaining superior results in the medium and long term. [ABSTRACT FROM AUTHOR]

Rhinosinusitis, in its various forms of clinical manifestation, is one of the most common and important diseases of recent decades, with serious implications, affecting the quality of life of patients and with socioeconomic costs involved. If in the past, only the external approach was used to address rhinosinusal disorders, now, with the development and improvement of endoscopic surgical techniques, the endonasal endoscopic approach is increasingly used. Rhinosinusal infectious-inflammatory pathology currently represents an indication of choice for endoscopic surgery. The classic external approach retains its usefulness in certain specific situations, especially related to complicated sinusitis, mainly frontal, endoscopy failure or complications of endoscopic surgery. The authors aim to discuss the main clinical situations we may encounter, to debate and summarize the surgical indications and approaches depending on the particularities of cases, as well as the advantages or disadvantages of the two types of surgery. [ABSTRACT FROM AUTHOR]

The sinonasal tract is one of the least frequent sites for squamous cell carcinoma in the head and neck. In addition, the unique and complex anatomy of the sinonasal tract can make proper staging and management of patients’ tumors quite challenging. Surgery plays an important role in the treatment of sinonasal cancer. Many surgical approaches have been described, including open, endoscopic, or combined approaches. The choice is based on several criteria: general criteria related to the oncological results and morbidity of each technique, tumor extensions, tumor pathology, the patient, or the surgeon himself. The authors present a combined endoscopic transnasal and transcuta­ neous frontal approach, less invasive, less morbid, and with less surgical complications compared to the open surgery. [ABSTRACT FROM AUTHOR]

The authors report the case of a giant concha bullosa in a 16 years old patient, referred to our department for chronic nasal obstruction, right purrulent nasal discharge, recently intensified headache. After clinical examination of the patient, nasal endoscopy and CT scan, a diagnosis of concha bullosa with accompaning pansinusitis was made; the management in this case was surgical – FESS (functional endoscopic sinus surgery) under general anesthesia, with good postoperative outcome. [ABSTRACT FROM AUTHOR]

Craniopharyngiomas have always had a prominent place in neurosurgery due to both the technical difficulty and controversy regarding the optimal treatment of these benign tumors. Harvey Cushing famously described craniopharyngiomas in 1936 as “the most forbidding of the intracranial tumors.” Seventy years later, Rutka still wrote: “There is no other primary brain tumor that evokes more passion, emotion, and, as a result, controversy than does the craniopharyngioma”. Endoscopic surgery techniques had been advancing in these last two decades. Transsphenoidal approach endoscopic surgery to the skull base provides better visualization of the operation field compared to microscopic surgery, and also brings lower morbidity than other techniques. [ABSTRACT FROM AUTHOR]

Vascular tumors of the head and neck are a heterogenous group of conditions that raise numerous problems re garding diagnosis and optimal therapeutic strategy. Heman gio mas are benign vascular tumors which are only exceptionally found in the nasal cavity and paranasal si nuses. His tologically, the mixed type is extremely rarely found in the lite rature. The authors present a series of particular aspects regarding the approach of such tumors, exem pli fying with a case of sinonasal giant hemangioma from the author’s own casuistry. Problems found in the diag nostic process, difficulties encountered during the treat ment of large vascular sinonasal tumors, as well as particular elements regarding the succesfull total intravenous anesthesia are presented. Total intravenous anes thesia (TIVA) allowed the adequate hemodynamic stability, facilitating a superior intraoperative hemostasis, there fore leading to the complete endoscopic ablation of the sinonasal hemagioma. [ABSTRACT FROM AUTHOR]

Chondrosarcomas are rare heterogeneous slow growing malignant tumors of bone that produce chondroid (cartilaginous) matrix. Only about 5-10% of chondrosarcomas are found in the head and neck region, the most common sites being mandible, paranasal sinuses, maxilla and, rarely, nasal septum. A review of the literature from 1927 to date lists approximately 69 cases of chondrosarcoma originating from the nasal septum. A 31-year-old patient presented with persistent nasal obstruction for three years. Imaging showed a sinonasal tumor, which was subsequently removed endoscopically in its entirety. This case report proves the feasibility of using endoscopic techniques in aiding with the resection of sinonasal malignant tumors. The patient is being followed-up regularly and three years post treatment there is no evidence of any residual or recurrent lesion. [ABSTRACT FROM AUTHOR]

Sinonasal malignancies continue to pose many diagnostic and especially treatment challenges and represent a formidable chapter in current medical practice. Adenocarcinoma, one of the most common sinonasal malignancies, is generally diagnosed in a later stage, often marked by aggressive regional evolution. The authors present the therapeutic conduct followed in a patient with a right nasal sinus malignancy, namely a stage T3-type intestinal adenocarcinoma – a locally advanced sinonasal tumor involving the right nasal fossa, the right ethmoidal sinus and the right maxillary sinus. The biggest challenge posed in such a case is establishing an optimal therapeutic strategy. The applied therapeutic management – namely, endonasal endoscopic surgical treatment – demonstrates the increasing importance of endoscopic surgical procedures used for such a pathology, especially since this was the only treatment used in this specific case. [ABSTRACT FROM AUTHOR]

The use of lasers has revolutionized the minimally invasive surgery of the larynx. The physical principles of the laser functioning and the interaction between laser and the biological tissue are discussed in this article. We mention the most frequently used types of lasers in laryngology, the difference among them and the comparative characteristics. The precaution and safety measures in using lasers are described. We also discuss the advantages of laser surgery in different clinical applications. The accumulation of a more significant clinical material is required in order to determine the indications and the role of a certain type of laser for the treatment of a certain pathology of the larynx. However, it is important to mention that the efficiency of all types of lasers is highly dependent upon operative technique and the skills of the surgeon. [ABSTRACT FROM AUTHOR]

Inverted papilloma is a benign form of sinonasal tumor characterized by aggressive local evolution, tendency to local recurrence and a significant risk of malignancy. The tumor often originates in the lateral nasal wall, while in a small percentage of cases (<10%) an exclusively sinusal location is encountered. A sphenoidal sinus origin of the tumor is rare. We present the therapeutic management of a patient initially diagnosed with inverted papilloma, originating in the left sphenoid sinus, that subsequently maligned. We emphasize a few particularities of the endoscopic endonasal approach: timing of the surgery, anatomical and surgical risk elements, complete resection difficulties [ABSTRACT FROM AUTHOR]

Objectives. The involvement of bacterial biofilms in the pathophysiology of chronic rhinosinusitis (CRS) is intensively debated, despite the acknowledgement of their negative impact on postoperative evolution of the disease. This study aimed to evaluate the relationship between bacterial biofilms and inflammatory infiltrate of sinus mucosa, and the influence of comorbidities on biofilm development. Materials and methods. The study comprised 50 CRS patients, treated by endoscopic surgery. For biofilm identification and inflammatory infiltrate evaluation, sinus mucosa samples were taken during surgical intervention and studied by haematoxylin-eosin and toluidine blue staining. Results. Biofilms were present in 34 patients (68%). Among them, 22 patients displayed an abundant inflammatory infiltrate of the sinus mucosa, this association being statistically significant (p < 0.001). Biofilm development was also significantly associated with the following comorbidities: bronchial asthma (p = 0.006) and atopic background (p < 0.001). Conclusions. Bacterial biofilms were significantly associated with an abundant inflammatory infiltrate of the sinus mucosa, demonstrating an intensive local inflammatory response. Among the comorbidities frequently associated with CRS, bronchial asthma and atopic background proved a significant increase in the odds of biofilm development. [ABSTRACT FROM AUTHOR]

In the last years, endoscopic ear surgery has gathered around a lot of followers among ear surgeons, representing, in selected cases, an effective alternative to microscope techniques. Endoscopic surgery of the ear is not simply a technique for performing surgery through the external auditory canal, but it represents the introduction of the concept of functional surgery in order to maintain or restore the anatomy and physiology of the ear as close as possible to the normal condition. In this paper, the author points out the indications and the surgical endoscopic techniques, focusing on the pros and cons of each surgical approach compared to the established surgical ear interventions. [ABSTRACT FROM AUTHOR]

The authors present the case of a 58-year-old female patient with a history of multiple episodes of acute dacryocistitis, treated by irrigation of the lacrimal punctum. She is admitted to our clinic for swelling of the lacrimal sac and mucopurulent discharge on applying pressure over the lacrimal sac. In spite of several irrigations, patients' symptoms persisted and thus surgical treatment was decided. We performed a dacryocystorhinostomy with a lacrimal stent which was inserted by endonasal approach to reestablish the nasolacrimal connection. The patient didn't require nasal packing and was discharged three days after surgery. [ABSTRACT FROM AUTHOR]

Nasopharyngeal fibromas are benign tumors that may come across as malignant due to their aggressive clinical evolution with the destruction of the surrounding tissues. These tumors originate in the nasopharynx and are most often seen in adolescent males. The authors present the case of a 21-year-old male, athlete, who was admitted for a massive nasal and oral bleeding with nasal obstruction. The patient had previously underwent nasal packing in another ENT clinic, but continued to bleed during packing removal attempts. Based on the clinical examination and the paraclinical investigations, the diagnosis of nasopharyngeal fibroma invading the left maxillary sinus was made. The medical treatment consisted in hydroelectrolytic rebalancing, antibiotics and blood transfusions with the same ABO and RhD group. Further treatment involved selective embolization followed by endoscopic tumor ablation. [ABSTRACT FROM AUTHOR]

The sellar and parasellar region is an anatomically complex area where a number of neoplastic, inflammatory, infectious, malformative and vascular diseases can develop. Although most sellar lesions are due to pituitary adenomas, a number of other pathologies involving the sellar/parasellar region can present in a similar manner. The management of these pathologies involves a multidisciplinary approach. Our multidisciplinary team includes doctors from several specialties: neurosurgery, otolaryngology, anesthesiology, endocrinology, neurology, ophthalmology, radiology, pathology, oncology, clinical laboratory. For a precise staging and planning, the magnetic resonance imaging and computed tomography scans are analyzed with the neuroradiologist. An endocrine and ophthalmological assessment should be performed before and after the surgery. Our surgical team, that includes neurosurgeon and ENT surgeon, performs transnasal endoscopic surgery with the patient under general controlled hypotensive anesthesia; it is important to have a neuroanesthesiologist with experience in intracranial surgery. The neuronavigation system with CT-scan/MRI fusion is used for all our surgeries to help anatomical orientation and reduce complications related to the approach. The endoscopic endonasal approach to the skull base provides a direct anatomical route to the lesion, with very good visibility, without traversing any major neurovascular structures, obviating brain retraction. Postoperatively a MRI is performed and the hidroelectrolytic balance is closely monitored in order to detect diabetes insipidus. We consider that rhinosurgical-neurosurgical cooperation shortens the learning curve and offers interdisciplinary benefit, with less surgical morbidity and better surgical results. Interdisciplinary collaboration facilitates decision making in all phases of the complex treatment. [ABSTRACT FROM AUTHOR]

Autorii prezintă experiența lor în abordarea afecțiunilor din patologia tumorală benignă pediatrică rezolvabilă prin chirurgia endoscopică transnazală. În lucrare sunt exemplificate manevrele complexe pentru ablația unui encefalocel la un copil în vârstă de 3 luni, pentru excizia unui meningo-encefalocel la un pacient în vârstă de 2 ani și jumătate, pentru un meningocel la o pacientă în vârstă de 7 ani, pentru un cordom de clivus la un pacient de 6 ani şi un caz foarte rar de fibromatoză juvenilă la o pacientă în vârstă de 2 ani, punând accentul pe momentele-cheie ale intervențiilor: închiderea intraoperatorie a fistulelor LCR, hemostaza eficientă, utilizarea instrumentarului de microlaringoscopie suspendată în timpul manevrelor de îndepărtare a tumorii din regiunea retrosfenoidală sau utilizarea navigației chirurgicale și a CT-ului sau RMN-ului intraoperator. Toate intervențiile descrise au fost rezolvate exclusiv de către echipa monodisciplinară ORL. [ABSTRACT FROM AUTHOR]

The ethmoidal mucocele represents a cystic structure/ formation with an external membrane, an inner epithelial layer and mucoid content. It is most commonly caused by the obstruction of the mucosal glands' drainage, with a slow growth and destruction of the adjacent bony structures. From the stage of early mucocele up to the development of orbital complications, the ENT practitioner must acknowledge the best surgical approach. The rhinosinusal mucocele may appear in any paranasal sinus (the frontal sinus is the most frequently affected). The ethmoidal mucocele causes the most frequent orbital complications. The author's goal is to focus on the different sites of the rhinosinusal mucoceles, the surgical endoscopic techniques and the orbital complications that may appear. [ABSTRACT FROM AUTHOR]

This paper is an overview of the potential complications that can occur during regular endoscopic sinonasal surgery and also in skull base surgery. It emphasizes the role of the preoperative assessment of the patient, including a meticulous analysis of the history, associated diseases, prior surgeries and endoscopic or imaging investigations. Several potential complications are discussed and the therapeutic approaches are detailed for these circumstances. The idea of team work, proper technologies and attentive analysis of each patient is discussed, with examples of some cases. Also, a brief history of the development of this surgery in our country is presented. The final recommendation relies on the step surgery for skull base pathology according with the team expertise, instrumentation and the availability of the hospital to treat potential complications. [ABSTRACT FROM AUTHOR]