The immune status in situ of recurrent tonsillitis and idiopathic tonsillar hypertrophy.

OBJECTIVE: To analyze the immune status in situ of tonsils of patients with recurrent tonsillitis (RT) and idiopathic tonsillar hypertrophy (ITH) with the aim to discuss the indications of tonsillectomy (TE) and tonsillotomy (TT) in young children. METHODS: The histological and immunohistological study of tonsillar tissue of RT and ITH in correlation with immunological parameters in peripheral blood in 13 patients with RT and 16 patients with ITH. RESULTS: In the RT group, we found a higher degree of fibrosis with a higher density of memory lymphocytes (CD45R0+), B-lymphocytes (CD20+) and cytotoxic T-lymphocytes (CD8+) in surface epithelium of tonsils compared to the ITH group (NS). The density of immunoglobulin IgG in the crypt epithelium in RT was significantly higher than in the ITH group (p = 0.041). We also measured a higher sera concentration of immunoglobulines (IgG, IgM, IgA) and TNF-α in RT compared to the ITH group (NS) and TH-1 immune response in tonsillar tissue based on differences between local cytokine concentration TNF-α and IL-4. CONCLUSIONS: RT has a higher inflammatory reaction in tonsillar tissue as a result of persistent bacterial antigenic stimulation. In patients with RT, the tonsillectomy might be the only option for surgical treatment. In patients with ITH with mild symptoms, the tonsillotomy should be preferred (Tab. 3, Ref. 24).

Nasal dermoids without intracranial extension in teenagers.

BACKGROUND: Nasal dermoid cysts are benign, cystic midline masses. They contain mature tissues and often pocket hair, fat or sebum. Patients usually present with nasal enlargement or with a wide nasal dorsum with or without a fistula, causing an unacceptable cosmetic appearance. OBJECTIVE: To define a reliable surgical approach and method of removing dermoid with no intracranial extension in adolescent age. METHODS AND RESULTS: We retrospectively present diagnostic and therapeutic procedures in three teenagers ages 15, 17 and 18. All patients underwent prior surgeries at different hospitals. In the first case, the incision and exstirpation of the fistula's opening, followed by the fistula's canal, was performed. In the other two patients, the nasal dermoids were removed via the open approach with the transcollumelar incision. In all patients, we performed rhinoplasty with osteotomies to achieve an improved cosmetic effect. The esthetic results are presented. CONCLUSION: The diagnosis of nasal swelling requires imaging. Total excision of the cyst is considered the casual treatment. The open rhinoplasty is an adequate method in patients with nasal dermoids without an intracranial extension. Experienced surgeons should manage the functional and esthetical aspects together during the same surgery.