Rare benign pleomorphic adenoma of the nose: short study and literature review.

Pleomorphic adenoma is one of the most common benign tumors of the major salivary glands. It can also occur in the minor salivary glands, which exist in the nasal cavity. Intranasal pleomorphic adenoma usually originates from glands of the nasal septum mucosa. We present the results of endoscopic endonasal surgery of this pathology. The aim of the study was to present the endoscopic technique for nasal septum pleomorphic adenoma surgery. The retrospective examination of 3 patients was performed. There were 2 women and 1 man. Age ranged from 15 to 46 years. All the patients presented with nasal obstruction and occasional epistaxis for at least for 6 months. We performed endoscopic surgery to remove the tumors. In all cases we dissected the septal perichondrium to achieved free margins of the tumor. The microscopic examination revealed an epithelial and myoepithelial component with tubular structures composed of two cell layers, ducts, and a solid area found in a loose myxochondroid area. Additionally, immunohistochemical staining was performed using antibodies against cytokeratin, Ki-67, and vimentin. Patients' postoperative course was uneventful, and no complications were encountered. No recurrence was present during patients' postoperative visits. Nasal benign pleomorphic adenoma is a rare tumor which should be taken into consideration in the nasal cavity during surgery. The correct histological diagnosis can be confirmed by additional histological studies. Endoscopic endonasal surgery is reserved for small tumors.

Evaluation of fully biodegradable nasal packings in functional endoscopic sinus surgery ­ a multi-centre study.

THE AIM: This work was to compare an innovative solution, i.e. a fully biodegradable nasal packing Nasopore®, with a traditional one, in the aftercare of patients subjected to functional endoscopic sinus surgery. MATERIAL AND METHOD: Prospective, blinded study with sequential enrollment conducted at three study centres. One of the investigators evaluated during surgery the level of bleeding in each of the nasal cavities and at the end of surgery he applied the test packing, the biodegradable dressing Nasopore®, to one randomly chosen nasal cavity, and a control packing to the other one. The other investigator removed during aftercare the control packing and conducted the follow-up. During the control visits (24-48 hours, 10 and 30 days post-op.) the subjects evaluated their headache, pain in the nose, pressure in the forehead as well as their nasal obstruction. RESULTS: A total of 39 women and 44 men at the age of 47 years on average (min. 19, max. 82) were qualified for the study. The largest differences between different types of nasal dressings were observed with regard to reduction of nasal obstruction in the fist 10 days after surgery (P<0.005). In relation to the pain in the area of the head and nose as well the pressure in the forehead on every visit, better outcomes were observed for the test dressing. Statistical difference (P<0.05) was observed on the fist follow-up visit for the headache and pressure in the forehead as well as on the fist and second visit for the pain in the nose. CONCLUSION: The fully biodegradable nasal dressing Nasopore® may constitute significant improvement and facilitation of aftercare in functional endoscopic sinus surgery while increasing the patients' satisfaction and lowering the postoperative discomfort.

Expression of metalloproteinases 2 and 9 and tissue inhibitors 1 and 2 as predictors of lymph node metastases in oropharyngeal squamous cell carcinoma.

BACKGROUND: The matrix metalloproteinases (MMPs) and their tissue inhibitor of metalloproteinases (TIMPs) can decompose extracellular matrix (ECM) components and brake down basement membranes and, thus, promote tumor local invasion and metastasis. METHODS: We studied 41 patients with squamous cell carcinoma (SCC) of the oropharynx who underwent surgical treatment. Material was diagnosed by routine procedure and examined by immunohistochemical analysis and dot blot technique. We searched for correlations between expressions of MMPs, such as MMP-2 and MMP-9 and their tissue inhibitors TIMP-1 and TIMP-2 and treatment outcome. RESULTS: We found cytoplasmic expression of analyzed proteins, both in cancer cells and tumor stroma. The expression of analyzed antigens was higher in patients with lymph node metastases comparing patients without lymph node involvement. CONCLUSION: Our data suggest that microenvironment changes are one of key factors in tumor progression. Divergent expression of MMPs and their inhibitors might be used as prognostic factor of oropharyngeal carcinoma progression.

Improved quality of surgical field during endoscopic sinus surgery after clonidine premedication--a pilot study.

BACKGROUND: Inadequate surgical field visualization due to intraoperative bleeding during endoscopic sinus surgery (ESS) can cause major complications. The aim of this prospective study was to compare the effect of preoperative administration of clonidine and melatonin on the quality of the surgical field visualization and selected aspects of presurgical premedication. METHODS: Twenty-six patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or melatonin as preoperative premedication. During the operation, the quality of the surgical field was assessed and graded using the scale proposed by Boezaart. The evaluations were done at 15, 30, and 60 minutes after incision. The effect of this premedication choice on the intraoperative and postoperative hemodynamic profile was examined in each group. Anxiolytic effects of both premedication agents were assessed using the visual analogue scale for anxiety (VAS-A). Propofol dose and induction time (the time for bispectral index [BIS] to reach 45), anesthesia and surgical procedures time, and recovery time (the time for BIS to reach 90) were assessed in both groups as well. RESULTS: The quality of the surgical field was consistently better in 2 of 3 time points in the clonidine group. Perioperative mean arterial pressure and intraoperative heart rate had a more favorable profile in patients premedicated with clonidine. There were no differences in other measured parameters between groups. CONCLUSION: Premedication with clonidine before ESS provides better quality of surgical field and more favorable hemodynamic profile as compared to melatonin.

CUP-syndrome diagnostic procedure scheme.

Patients with CUP-Syndrome represent a small percentage of patients treated by ENT doctor. Often, in spite of the implementation detailed diagnostics, detection of the primary tumor fails. Very important element is to follow the correct sequence of tests and taking into account conditions outside ENT. I our article, we would like to propose a diagnostic scheme including interview with patient, laryngological and imaging tests and multi-disciplinary consulting. We hope that this scheme will facilitate the treatment of patients with CUP-Syndrome and increase the efficiency of detection of primary tumor.

[The results of operational otosclerosis treatment after stapedotomy]. / Wyniki operacyjnego leczenia otosklerozy u chorych po wykonanej stapedotomii.

INTRODUCTION: There are many ways of presenting the treatment's results for otosclerosis. Because of loss of the uniform standard, it is impossible to compare these results between various health centres. But the most important is, which way of presenting seems to be the best. AIM: The aim of the study was to propose a scheme of presenting the treatment's results for otosclerosis. MATERIAL AND METHODS: In order to devise method, medical documentation of 81 patients, treated for otosclerosis in Otolaryngological and Oncological Laryngology Clinic with Audiology and Phoniatrics Department, was analysed retrospectively. RESULTS: The received results were analysed for each patient and divided into 3 groups: first - changes of the air conduction, second - changes of the air-bone gap, third - changes of the bone conduction. The value of the air-bone gap is a measure of surgeon's effectiveness interpreting as the reconstruction of the conductive chain in the middle ear. The loss of bone conduction before and after the operation can evaluate the improving hearing after the operation of otosklerosis due to overclosure and also can take under consideration the sensoneurinal hearing loss induced by moving of the stapes. Only comparison these three parameters is correct to evaluate the operation's results, especially the air conduction. So that de Bruijn et al. proposed a diagram, called Amsterdam Evaluation Hearing Plots - AEHPs. That diagram compares the pre-operative mean air-bone gap to post-operative change of loss of air - conduction. Thanks to that, the overclosure and post-operative sensorineurinal hearing loss were taken under consideration. CONCLUSIONS: The presentation of the treatment's results for otosclerosis should include, besides the air-bone gap, the air conduction and bone conduction too. The AEHPs meet the requirements.

[Sarcoidosis of the lacrimal sac as a cause of dacriostenosis]. / Sarkoidoza woreczka lzowego jako przyczyna niedroznosci dróg lzowych.

Sarcoidosis is a systemic granulomatous disease of unknown aetiology. The course of sarcoidosis ranges from asymptomatic to severe. It could affect people of all ages. The disease affects predominantly the lungs and lymph nodes, skin, abdominal organs or eyes. Sarcoidosis of lacrimal sac is very uncommon. We describe a young man with lacrimal sac and nasal mucosa sarcoidosis present with epiphora. Few years before the onset of dacriocystitis the patient was treated because of lymph nodes sarcoidosis. The lacrimal sac sarcoidosis developed five years after systemic disease remission. An endoscopic dacriocystorhinostomy with intubation of nasolacrimal duct was performed. We used postoperatively systemic and local steroids for 3 months period. The patient is under observation for over four years with good health. The abnormal looking nasal or lacrimal sac mucosa could be associated with granulomatous disease as sarcoidosis and Wegener's or malignancies. If the sarcoidosis is established, it could be the first manifestation of sarcoidosis leading to future systemic sarcoidosis development or it may develop many years after the onset of systemic disease. Endoscopic dacriocystorhinostomy with intubation followed by intensive therapy with systemic and local corticosteroids may be helpful to maintain lacrimal drainage patency.

[Papilloma of the lacrimal sac]. / Brodawczak plaskonablonkowy woreczka lzowego.

The benign lesions of the lacrimal sac are very rare. The most typical epithelial tumor is squamous papilloma. This tumors often present with symptoms of dacryostenosis and dacriocystitis. Human papillomavirus (HPV) infection is known to be causative agent in the development of epithelial tumor. Lacrimal sac tumors could transform to malignant neoplasms, especially if they are developed of coexisting HPV infection. We present a patient with a squamous papilloma of the lacrimal sac and discussed the method of treatment. The patient was suffered from epiphora and recurrent dacriocystitis. An endoscopic surgery with dacriocystorhinostomy and local resection of the tumor could be an effective method of choice. The usage of a shaver for wide removal of the lacrimal sac wall is recommended to prevent local recurrence. The histopathology examination showed squamous papilloma. The patient is free of the disease over 8 months of follow up. Primary lacrimal sac papilloma require long term follow up for recurrence or malignant transformation. HPV infection could be associated with the development of lacrimal sac papillomas.

[Intraoperative navigation system in endoscopic sinus surgery]. / Nawigacja sródoperacyjna w chirurgii endoskopowej zatok przynosowych.

UNLABELLED: Intraoperative navigation systems have been developed to increase the safety and efficiency of endoscopic sinus surgery. The objective of this study was to compare the application and utilization of optical and electromagnetical navigation systems in our own experience during the endoscopic surgery. MATERIAL AND METHODS: An optical-based image guidance systems (MatrixPolar Navigation System, Xion, Germany; Karl Storz Surgical Cockpit Navigation Panel Unit, Karl Storz, Germany; Stryker Navigation CartII ENT, Stryker, USA) and electromagnetic (Fusion ENT Navigation System, Medtronic, USA; Fiagon, fiagon GmbH, Germany) was used to performed 40 sinonasal and skull base surgeries. We compared the precision and accuracy of both types of systems and additional time necessary for setting up the system and real operating room time. We also analysed the convenience of navigation according to possibilities of easy instruments manipulation and fluency of navigation process. RESULTS: The mean measured accurancy of anatomical localization at start of the surgery for optical systems was 1.62 ± 0.4mm and for electromagnetic respectively 1.79 ± 0.39 mm. The time to set up the optical system was longer than for electromagnetic one (12 vs 5 minutes). Operating room time was increased for both systems, for optical to 22 vs 8 minutes for electromagnetic one. Surgeon's working comfort during operation was better for electromagnetic systems and allowed for fluently movements with instruments. CONCLUSIONS: Intraoperative navigation systems assist the surgeon with anatomical localization during endoscopic sinus surgery and improve its safety and efficacy. The choice of optical or electromagnetic system should be compared of effective costs and surgeon's preferences.

Kartagener's syndrome--anaesthetic considerations for ENT surgery.

Kartagener's syndrome is a rare autosomal recessive disorder presenting a triad of sinusitis, bronchicetasis and situs inversus with dextrocardia. It occurs in 50% of patients with situs inversus. The most important anesthetic implications of Kartegener's syndrome surgery are assessement of pulmonary and cardiac structure and function. We present a case of 43-year-old woman with chronic rhinosinusitis with polyps and bilateral sectetory otitis media. The chest radiograph and CT scans showed dextrocardia and situs inversus with chronic bronchitis without bronchiectasis. Spirometry showed forced expiratory volume in one second (FEV1) of 2.66 L and forced vital capacity (FVC) of 3.62 L. Electroechography showed no cardiac abnormalities with 55-60% of EF. The anesthetic implications of Kartagener's syndrome are varied. The regional or general anesthesia might be involved with sinus surgery, ear surgery, pulmonary surgery, infertility or abdominal and cardiac surgery. The main anesthetic considerations among patients with Kartagener's syndrome are related to the pulmonary function which include preoperative respiratory infections due to bronchiectasis. We should also monitor potentially occluded congenital heart diseases. Kartagener's syndrome is a rare disease and when the patient need an operation we have to consider surgery with regional or general anesthesia. The general anesthesia would be safe after complete preanaesthetic examination of the patient. The ECG, chest CT scans, spirometry and echocardiography are mandatory before the operation.

[The early functional effects of tympanoplasty in the Otolaryngology and Laryngological Oncology Department of the University School of Medicine in Bydgoszcz, Poland, from 2004 to 2009]. / Wczesne wyniki czynnosciowe operacji tympanoplastycznych w materiale Kliniki Otolaryngologii i Onkologii Laryngologicznej CM UMK w Bydgoszczy w latach 2004-2009.

OBJECTIVE: The aim of the study was to evaluate the results of the tympanoplasty in chronic otitis media in its functional aspect. METHODS: We analysed and categorized 489 tympanoplasties using Wullstein classification. The operations were performed in the Otolaryngology and Laryngological Oncology Department of the University School of Medicine in Bydgoszcz, Poland, from 2004 to 2009. The group consisted of 421 patients (221 women, 253 men, mean age 52.2 years). RESULTS: Type I tympanoplasty was performed in 133 patients (31.59%), type II tympanoplasty was performed in 191 patients (45.36%), type III tympanoplasty was performed in 93 patients (22.09%) and type IV tympanoplasty was performed in 4 patients (0.95%). The audiometry was done one year after the operations. We observed good effect in 116 cases (86.9%) of type I tympanoplasty, good or satisfactory in 150 cases (78.6%) of type II tympanoplasty and satisfactory in 63 cases (67.7%) of type III tympanoplasty. There were no hearing improvement and its deterioration results in 61 cases (14.48%), including all treated by type IV tympanoplasty. CONCLUSIONS: 1. There were improvement of hearing in audiometry in majority of our patients. 2. The functional effect of hearing depends on the function of conductive mechanism of the ear before the treatment. 3. We prefer among all types canal wall-up tympanoplasty.

Endoscopic surgery for Warthin's tumor of the nasopharynx.

Warthin's tumor almost exclusively occurs in the parotid gland. It is the second most common tumor after the pleomorphic adenoma. The extraparotid or ectopic Warthin's tumor is rare and is normally situated in the submandibular gland, cervical lymph node, lip, cheek, tongue, hard palate, lacrimal gland and larynx. In this paper we present a case of the Warthin's tumor with ectopic localization in the nasopharynx with asymptomatic outcome. A 56-year-old man has been diagnosed for 10-year history of headache. He had no past history of any otolaryngologic disease. The axial and coronal NMR scans showed a round-shaped, cyst-like tumor of approximately 12 mm in diameter. The tumor was in the middle line of the nasopharynx without compression of the Eustachian tubes. The histopathologic diagnosis was consisted with Warthin's tumor. The patient underwent tumor removal using an endoscopic transnasal approach. The Warthin's tumor is a benign lesion with extremely rare occurrence in the nasopharynx. The symptoms are varied and sometimes it could be recognized accidentally. In a very rare cases it may transform to malignant neoplasm. The optional approach to the nasopharynx must be selected after careful consideration of the individual case. An endoscopic power instrumentation surgery are recommended for small lesions.

[Craniofacial resection for tumors of paranasal sinuses involving the anterior skull base]. / Dostep czaszkowo-twarzowy w leczeniu guzów zatok przynosowych z zajeciem przedniego dolu czaszki.

INTRODUCTION: Craniofacial resection is a treatment of choice for paranasal malignant and benign tumors invading the skull base. THE AIM OF THE STUDY: In this article the authors present the experience in craniofacial resection for malignant tumors invading the anterior skull base. MATERIALS AND METHODS: The material consisted of four patients operated in the Department of Otolaryngology and Laryngology Oncology CM UMK between 2007 and 2010. The patients were treated for malignant neoplasms of the paranasal sinuses with anterior skull base involvement. THe age range of the group were between 60 and 75 years. Of these patients three were females and one male. RESULTS: We performed a lateral rhinotomy for laryngological acces for the tumor. The neurosurgeon performed anterior skull base osteotomy at and appropriate site above. The patients recovered uneventfully. The follow up period ranged between 13 and 42 months. The overall 3-year survival for all patients in our series was 66,6%. CONCLUSIONS: Combined craniofacial resection of tumors of the anterior skull base is an effective approach for the management of these pathologies. This type of approach in elderly patients over 70 years old could be associated with increased mortality and complications leading to poorer outcome.

Nasolacrimal duct obstruction after toxic epidermal necrolysis.

Toxic epidermal necrolysis also known as Lyell's syndrome is acute dermatomyositis as an adverse drug reactions. It is characterized by erosions of skin over 30% of total body surface area and is associated with significant mortality of 25%-50% of cases. The conjunctival mucosa involvement could result in cornea erosion and ulceration. Other ocular complications are: purulent conjunctivitis with pseudomembrane formation, entropion, symblefaron and synechiae with nasolacrimal duct obstruction or punctual stenosis. The authors present a very rare complication of nasolacrimal duct obstruction after toxic epidermal necrolysis in young girl. The endoscopic dacricystorhinostomy with one lacrimal point intubation was performed. Early ophthalmic assessment and frequent follow-up could be helpful to avoid metaplasia of epithelium, vascular neoplasia in conjunctiva and cornea. This will protect from dysfunction of tears secretion causing nasolacrimal duct or lacrimal point obliteration. If there is a permanent epiphora the endoscopic dacriocystorhinostomy, with silicone tube intubation could be the method of choice. A satisfactory results are also obtained after opening a passage of only one occluded lacrimal point.

[Early and late complications after implantation of the Provox 2 voice prosthesis in patients after total laryngectomy]. / Powiklania wczesne i pózne po implantacji protezy glosowej Provox 2 u chorych po laryngektomii calkowitej.

INTRODUCTION: Effective communication is an important element of social life. For a long time depravation of the capacity of such communication has been perceived as one of the most aggravating disabilities. It happens when the necessity to remove the larynx in patients with cancer appears. Contemporary methods of speech rehabilitation in patients after total laryngectomy create the possibility to communicate by three methods. One of them is generated speech with the use of voice prosthesis. MATERIAL AND METHODS: The examination included group of 76 patients (7 women, 69 men) after total laryngectomy with implanted voice prosthesis Provox 2. All the patients were operated on at the Department of Otolaryngology CM UMK. The early and late complication after implantation of voice prosthesis was analyzed. RESULTS: In our material we observed more frequentyly late complications. In 97.4% a leakage through or around the prosthesis was observed. In 35 cases we observed leakage through the wide tracheooesophagal fistula with good outcome due to spontaneusly contract of it after removal of the prosthesis. In four cases we used stitches above the fistula and in three patients we did tracheostomal plastic. The granulation tissue from the region of the fistula was removed in 11 patients. Spontaneous falling out of the prosthesis appeared in 6 cases. The late complications as tracheal immflamation, stricture of the oesophagus or occlusion of the fistula were less common. CONCLUSIONS: The late complications after implantation of Provox 2 prosthesis are more common in this type of patients' rehabilitation. The leakage through or around the prosthesis required its exchange and generated additional medical costs, which should be reserved in medical insurance policies.

Detection of Helicobacter pylori and cagA gene in nasal polyps and benign laryngeal diseases.

BACKGROUND AND AIMS: Helicobacter pylori is the most common etiological factor of chronic infection worldwide. It has also been found in human dental plaques, mouth, saliva, tonsils and adenoid tissue, medial ear or nasal polyps and sinuses mucosa, as well in several benign and malignant lesions of the larynx and pharynx. The aim of the study was to investigate the association of H. pylori colonization in chronic rhinosinusitis and benign laryngeal diseases. METHODS: The prospective, controlled study involved a series of 30 patients with nasal polyps and normal nasal mucosa and 30 patients with benign laryngeal diseases. Samples of 10-15 mg obtained from fresh tissues were used for nucleic acid purification. All samples were subjected to H. pylori ureA detection by the PCR H. pylori diagnostic test. Samples that were positive for ureA H. pylori gene were evaluated for cagA H. pylori gene. RESULTS: H. pylori DNA (ureA gene) was detected in all patients with nasal polyps, concha bullosa and laryngeal diseases. Presence of H. pylori cagA gene was identified in 7 (23.3%) of 30 patients of H. pylori-positive larynx samples and no positive result was observed in nasal polyps and concha bullosa. CONCLUSIONS: Our results reveal the presence of H. pylori DNA in nasal polyps, concha bullosa and benign larynx diseases. cagA-positive H. pylori was observed only in laryngeal tissues. These results may have implications for a possible role of H. pylori in laryngeal diseases.

[Reconstruction after maxillectomy using the temporalis muscle flap--our experience]. / Rekonstrukcja po maksylektomii z zastosowaniem plata miesnia skroniowego--doswiadczenia wlasne.

THE AIM OF STUDY: The study presents a method of a reconstruction of the palatum after maxillectomy. This method is choosen in selected cases of malignant tumors of the maxilla. MATERIAL AND METHODS: The method is combined of preparation of the temporalis muscle flap and its dislocation it under arcus of zygoma into the oral cavity. The surface of the flap covered with temporal fascia is oriented into the oral cavity and has been stitched in the hole of the palatum. The surface of the flap covered with periostium is connected to postoperative cavity of the maxilla. The flap covered the palatum tightly divides oral cavity from postoperative cavity of the maxilla. The vascular pedicle of the flap, with deep temporal vessels supply blood for proper healing of the palatum. Oncologic control of the postoperative cavity is performed using imaging investigation (computer tomography, magnetic resonance). The loss of tissue in the temporal fossa is covered by temporal fossa fat or synthetic material. RESULTS AND CONCLUSIONS: The reconstruction method brings satisfactory functional result. The method allows to avoid using inconvenient prostheses--obturators of palatum--in patients after maxillectomy. Complications in this method as postoperative perforation of the palatum and necrosis of the muscle flap are rare--less than 5% cases.

Episodes of repeated sudden deafness following pregnancies.

Sex hormones influence and provoke changes in hearing levels. Sudden deafness is rarely observed in pregnant women. The effective treatment of sudden deafness in pregnant women is a challenging problem. We present a case of repeatable, completely regressed sudden deafness in a woman during her first and second pregnancies.

[Dacryocystitis as a complication of maxillofacial fracture repair with reconstruction]. / Niedroznosc dróg lzowych powiklaniem operacji rekonstrukcyjnej po urazie twarzoczaszki.

AIM: The aim of the study is a revision of a case of darcyocystitis as a result of dislocation of cartilaginous implant after maxillofacial fracture repair. The author discussed the operative technique of this case. MATERIAL AND METHODS: A woman treated after fracture of ethmoid and nasal bone because of a diplopia of the left eye. The external reposition of bones were done with replacement of the orbital content to the orbit and occlusion of the bony defect with cartilaginous implant. After the operation dadryocystitis occurred as a complication of the reposition witch was treated with endoscopic dacryocystorhinostomy with nasolacrimal system intubation. RESULTS AND CONCLUSION: Dacryocystitis as a acute or delayed complication of maxillofacial fracture repair could be a result of a scar formation or dislocation of the implant. The reasonable method of treatment in this case is endoscopic dacryocystorhinostomy with nasolacrimal system intubation for 6 months.