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OBJECTIVES. The aim of this study was to reevaluate the implication of early diagnosis of chronic adenoid syndrome and tonsillar hypertrophy in the prophylaxis and control of facial and dental deformities in children. MATERIAL AND METHODS. The authors conducted a prospective study on 42 paediatric patients with chronic adenoid syndrome admitted in the ENT and Orthodontic Departments of “Sf. Spiridon” Emergency Hospital and “Sf. Maria” ENT Paediatric Department, Iasi, treated in collaboration with orthodontic and logopaedic specialists, with follow-up on the improvement of symptomatology and morphofunctional deficiencies. RESULTS. Late diagnosis and treatment of the obstructive adenoid hypertrophy can cause difficulty in managing cases, consequently maintaining the aesthetic deficiencies and morphofunctional disorders within a follow-up period of 2 years. Furthermore, we present the chronic complications due to obstructive adenoid hypertrophy (rhinosinusal and ear-related diseases, obstructive sleep apnea), as well as the progression of these cases after interdisciplinary approach. CONCLUSION. Chronic adenoiditis and tonsillar hypertrophy can increase the incidence of malocclusion in children, as well as causing changes in length and shape of the upper jaw and mandible, resulting in maxillofacial deformities.

Otitis and middle ear disease present high morbidity rates in spite of current medical treatment, especially in the younger population. Otitis media with effusion (OME) is a chronic disease that is often found in school age children. Its evolution, recurrence, complications and resolution still present a challenge to otologists. For some time, middle ear ventilation tubes were used for this pathology, thus assuring proper middle ear ventilation and higher disease resolution rates. In the current paper, we investigate the connection between ventilation tube usage, the materials out of which they are made, the techniques involved and how these factors may influence disease resolution rates.

BACKGROUND. Fractures of the naso-orbito-ethmoido-maxillary (NOEM) complex are frequently acquired post-traumatic lesions, with both aesthetic and functional consequences, if the diagnosis is not promptly established and the surgical correction is delayed. OBJECTIVES. This study was conducted in order to facilitate the diagnosis of NOEM complex fractures by using anthropometric measures. The aim was to obtain normal mean values of the evaluated parameters from a lot of healthy volunteers. MATERIAL AND METHODS. The measurements were conducted on patient-specific three-dimensional models obtained from processing the CT scan images and building further stereolithographic models. 64 Caucasian patients were enrolled, with ages between 19 and 93 years, both female and male volunteers, without previous surgical history of the middle floor of the face. Measurements were performed between certain craniometric points (Nasion, Dacryon, Infraorbital foramen, Rhinion and Frontomalare orbitale) and a database was created. RESULTS. Although some expected variation arised, we have obtained normal-considered intervals for each of the defined and measured segments between the mentioned craniometric points. We find these measurements useful especially for elaborating a presurgical plan for the best outcome. CONCLUSION. Simple measurements could orient a fast diagnosis, could help establish a surgical plan, an optimal surgical timing by combining clinical and imaging data.

Laryngeal papillomatosis represents a challenging disease for the ENT surgeon. It has a recurrent pattern, with lesions that tend to be more and more extensive and affect the quality of life of the patient. Due to it’s viral etiology, multiple medical therapies have been attempted for these patients. Their results are still somewhat controversial, taking into account the local and systemic side effects. Diabetes mellitus (DM) patients are considered to be relatively immunocompromised and the laryngeal papillomatosis is more severe. The lesions occur at an epithelial level. The earlier the diagnosis, the better the outcome of the patient. The advancements made in the field of medical technologies made possible ample surgical interventions that maintain the natural airway. Out of these, the most used today is the CO2 LASER, with good results when correctly managed. The purpose of this paper is to present the use of an endoscopic method of examination, that uses SPIES filters, for a more accurate diagnosis of the epithelial lesions, which allows a better evaluation and more thorough follow-up of our patients. We believe attention should be paid to this topic due to the surgical, epidemiological and biological reasons.

Mucoceles are benign, expansive, cystic tumors, affecting especially the adult, with development in the paranasal sinuses. Clinical symptoms are not specific. These are rare conditions that originate within the sinusal mucosa, favoured by the obstruction of the sinus ostium. Due to the inflammation and the expansive character of the tumor, with the erosion of the bony walls, combined forms can develop, with the involvement of two or more sinuses, most frequently with fronto-ethmoidal localization. The authors carry out a clinical retrospective study on 25 cases of mucoceles of the paranasal sinuses, diagnosed and treated in the ENT Clinic of the “Sfantul Spiridon” Emergency Clinical Hospital Iasi, during 2015-2019. The authors insist on aspects related to clinical and radiological diagnosis (CT scanner), as well as surgical treatment by external approach. The postoperative evolution is generally simple, with full recovery, without complications or recurrences. The diagnosis of the mucoceles of the paranasal sinuses consists in radiologic techniques by preoperative CT scan examination, intraoperative macroscopic aspect and histopathological result. Surgical approach with complete excision of the tumor and creating a new sinusal drainage path prevents the occurrence of recurrences.

We sought to determine the clinical significance of delayed complications after different neurosurgical procedures, such as chronic sinusitis and frontocutaneus fistula. These can be managed by endoscopic closure or by external approach, depending on the cause and extent of sinusitis. We report a case of a 65-year-old woman who was presented to our ENT Department with a frontocutaneus fistula and was surgically managed.

Sinonasal mucormycosis is an extremely challenging pathology for the ear, nose and throat (ENT) surgeon from a therapeutic point of view. The disease affects immunocompromised patients and exhibits lethal potential. Although the diagnosis is relatively easy to suspect due to the distinctive clinical aspects which consists of black crusting present in the nasal fossae able to be confirmed by biopsy, the treatment requires resection of all affected tissue with safety limits. Due to the tendency of invasion associated with this fungal infection and taking into account the location involved (the sinonasal area) and the grave condition of these patients, it is extremely important to perform only the minimal resection necessary, but that includes all tissue infected by the fungus. This article presents a minimally invasive method of evaluation that can be performed during endoscopic surgical intervention and that aids the surgeon to better evaluate the affected area. It is associated with no additional risks for the patients, but it helps the surgeon to perform the intervention efficiently while not damaging healthy tissue. The authors consider that the method presented will aid the surgeon during the endoscopic surgical intervention in evaluating the lesion and resecting all the affected tissue while preserving healthy areas.

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.

It is extremely difficult to synthesize in a paper the extremely wide diversity of the issues related to such a vast chapter such as the tumours in the ENT area and the cervical-facial region. The review analyses the variety of benign and malignant types of tumours, presenting various types of tumours on anatomical organs or regions, insisting with more extensive data from the literature on less frequent tumours or involving more distinct therapies, perhaps leading to a lack of balance and uniformity. Tumours are defined as excessive proliferation of abnormal cells that resemble more or less the tissue in which they develop and end up by acquiring biological autonomy. The study performed presents a batch of 425 patients diagnosed with benign tumours - 306 cases (72.0%) and 119 cases with ENT and cervical-facial malignant tumours that had extensions to the surrounding organs and metastatic adenopathies, admitted and treated at the Clinical Maxillofacial Surgery Clinic of the County Clinical Hospital between 1.01.2015 - 31.12.2018. The entire cancerous lesion is surgically removed together with a small surrounding healthy tissue area to ensure that all malignant cells have been removed. The purpose of the surgery is to remove all affected tissues without compromising the integrity of the structures in the other areas of the oral cavity. Tumours develop from the oropharynx: the tonsils, the base of the tongue, the soft palate, the pharyngeal posterior wall. Most often, the tumour affects the tongue floor, the mucous of the mouth and the tonsils.

The morphology and physiology of odonto-periodontal units, muscles, temporomandibular joints, maxillary bones, ligaments are in a constant balance, even if all these components are subject to continuous transformation. Affecting a systemic element will attract imbalances to other levels, and the therapeutic solution will require knowledge and understanding of the ensemble. A complete dental exam must allow identification of all factors responsible or likely to cause imbalance in the stomatognat system. The maxillary compression is an abnormality characterized by a transversal developmental deficiency in the upper jaw and / or the mandibular, showing morpho-functional changes that denote a complex disruption in the development of the dento-maxillary apparatus. The common modification of all the fractured cases is the insufficient development in a transversal sense, dental arcades (mono - or bimaxilar), along with facial and maxillary bone changes, disturbances of inter - maxillary or occlusion blocking, functional deficits and disturbances. The strictly mandibular compression situation is very rare and addresses cases by affecting growth at the condylian level. The study includes 27 cases with jaw compression and benefited from orthognat surgery in the Maxillofacial Surgery Clinic between 2015 - 2018. If untreated, the abnormality determines the appearance of many cavities especially in the front teeth, difficulty in performing dental hygiene will lead to chronic marginal periodontitis, the occurrence of abnormal contact between teeth with joint pain, decreased chewing field. The jaw compression is revealed by multiple facial and oral signs, as well as by functional changes. Orthognatic surgery is the only effective treatment for many patients in jaw compression.

The wide concept of health does not benefit of a single definition, but of multiple definitions and this plurality is related to the knowledge assimilated and the socio-economic dynamics. This is due to the fact that health is an ongoing process, its notion changing with the passage of time. Thus, at international level, health is nowadays defined considering multiple criteria. In the last decade, the analysis of relevant statistical data presents an unfavourable evolution for the three major components of population dynamics: natality, mortality and external migration, accompanied by the deterioration of the entire demographic construction and tendencies of heading towards an imminent demographic drift. Humans protect themselves against the microbial aggression by using their inborn barriers and mechanisms that are completed and modulated by acquired barriers and mechanisms. For a microorganism to reach the internal environment and generate an infectious process, it must get through and overcome these barriers. In order to overcome these barriers, the infectious agent must first adhere to the surface of epithelial cells and then pass through the epithelium. Local defence mechanisms help limit the infection and present the antigen to the regional lymphatic ganglions, contributing at the initiation of the immune response. On the other hand, the infectious agent present in the lymphatic system causes lymphangitis and satellite adenitis, which stand as a filter in the infections� way. The study included 127 patients with bacterial infections that were studied from 2014 to 2018. Infection can be caused by certain species of germs whose main feature is pathogenicity. Specific infections are caused by a foreign infectious agent that has accidentally reached the oral cavity causing oral lesions (appear in the secondary phase of the general infection). Specific infections are individualized, caused by a single microbe (monomicrobial) while the non-specific ones are associated (polymicrobial).

The oxidative stress is linked to many chronic diseases.The aim of the study was to assess the oxidative stress in chronic suppurative otitis media. The prospective study included a group of 60 patients with different forms of chronic suppurative otitis media (CSOM), cholesteatoma recidivism and a control group of 30 healthy people. The total antioxidant capacity (TAC) and malondialdehyde (MDA) concentrations were determined in serum of thepatients. We noticed a significant lower mean of TAC levels (p[ 0.001) in patients with chronic suppurative otitis media (CSOM) with and without cholesteatoma compared to the control group. The MDA had significantly higher mean values (p[ 0.001) compared to the healthy group.The imbalance of antioxidant systems to oxidizing molecules plays an important role in the pathogenesis of CSOM with and without cholesteatoma.

Vogt-Koyanagi-Harada syndrome(VKH) is a multisystemic disorder characterized by granulomatous panuveitis and cutaneous, otorhynolaryngologic and neurologic involvement, due to an autoimmune reaction against melanocytic antigens. Autoinflammatory associations of VKH, including inflammatory bowel disease and psoriasis, were rarely described. SAPHO syndrome (an acronym for synovitis, acne, hyperostosis, pustulosis and osteitis) is a rare autoinflammatorymusculo-scheletal disease. This paper reports on a male patient presenting for long-lasting bone and joint pain, dysphagia,having a ten-year history of bilateral optic neuritiswhich required high-dose corticosteroids. Fundoscopy revealed diffuse chorioretinalnonpigmented atrophic lesions. Vitiligo, acne scars, clavicular deformity, recurrent chest pain and sacroiliitis pointed to a long-standing SAPHO syndrome and late-phase VKH. Blood tests found inflammation and anti-hepatitis C antibodies with repeatedly undetectable viremia. Bone scintigraphy with the characteristic bull�s head upper chest uptake and the radiographs confirmed SAPHO syndrome. The patient was treated with sulphasalazine and cyclosporin A, with alleviation of the articular and bony disease. In conclusion, SAPHO syndrome may add to the list of the diseases associated with VKH. Although VKH and SAPHO syndrome may have appeared coincidentally, a common pathogenesis involving an infectious trigger and IL-17 could be considered.

Three-dimensional printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. Nowadays, 3D printing is very well integrated in the surgical practice and research. Also, the field of head and neck reconstructive surgery is constantly evolving because of the three-dimensional printing, a technology which can be widely used in a variety of situations such as reconstruction of tissue defects, surgical planning, medical modeling and prosthesis. By using 3D printing into tissue engineering and materials, it may be possible for otolaryngologists to implant 3D printed functional grafts into patients and will also provide a rapid production of personalized patient-specific devices. Advances in 3D printed implants and future tissue-engineered constructs will bring great progress to the field of otorhinolaryngology.

Malignancies of the nasal cavity and the paranasal sinuses are rare, counting for less than 3 % of the ENT-cancers. The insidious onset of these tumours with non-specific symptoms often leads to a delayed diagnostic. Advanced disease stage combined with the complex anatomy of the sinonasal cavities and anterior skull base encouraged surgeons to extend beyond the boundaries the classic surgical techniques. Surgical approaches to anterior skull base lesions can be divided into open approches: craniofacial, subcranial, endoscopic techniques or combined approaches when a craniotomy is associated with an endonasal endoscopic approach. The indication must take into consideration the oncologic principles, histopathology exam, extent of disease and surgeon skill and experience. Combined approach should be taken into consideration for patients with extended disease or significant intraorbital or intracranial extension. For certain tumours that require a craniotomy for the superior, superolateral, and anterior extensions of the disease and also a nasal and paranasal sinus tumor that could be removed endoscopically, an endoscopic-assisted approach can be considered.

Background: Total ear amputation is a relatively rare trauma with an absolute indication for surgical treatment. Numerous techniques for auricular reconstruction have been described. When local and general conditions allow microsurgical replantation, this must be the first choice. We propose the association of microsurgical techniques with some modification (modified Baudet technique) to obtain higher survival rate of the reimplanted stump. Methods: This study included cases of 3 male patients with total ear amputation, the injuries and their mechanism (workplace accident) being identical. Chief complaints were pain, bleeding, important emotional impact due by an unaesthetic appearance. The established diagnosis was traumatic complete ear amputation (grade IV auricular injury according to Weerda classification). Microsurgical replantation was performed only with arteriorraphy, and no vein anastomosis. Cartilage incisions and skin excisions were made to enlarge the cartilage-recipient site contact area. Medicinal leeches were used to treat venous congestion, to which systemic anticoagulant therapy was added. Results: The results showed the survival of the entire replanted segment in all cases, with good function and esthetical appearance. Patients were fully satisfied with the final outcome. Conclusion: Microsurgical replantation is the gold standard, for the surgical treatment of total ear amputation. We believe that cartilage incisions and the increased surface of contact between cartilage and recipient site has an adjuvant role in revascularization of the amputated stump (with only arterial anastomosis) and the use of hirudotherapy helps to relieve early venous congestion.