[Endonasal surgery of choanal atresia].

This paper was designed to study clinical manifestations of choanal atresia (CA) in 11 patients with a view to optimizing methods for medical and diagnostic management of this severe pathology using endonasal surgical techniques. Detailed analysis of possible causes of congenital CA and mechanisms of acquired CA was performed using computed tomography (CT) and retrograde endoscopy with the help of rigid optics. Potential of certain instruments designed and manufactured in Russia for the management of CA is demonstrated, such as retrograde 110o Sekunda endoscope and silicone horseshoe-shaped protectors. An original diagnostic algorithm is proposed allowing for the development of indications for surgical intervention, determination of its extent, and the choice of the post-operative treatment. Improved surgical instruments have been designed for the purpose. A case of hereditary CA in a child and his mother are presented along with results of treatment of nasopharyngeal scleroma in two patients. Clinical manifestations of CA concomitant with scleroma, diphtheria, and chemical chaonal burns are considered.

[Peculiarities of surgical technique for the treatment of rhinogenic abscesses of the frontal cerebral lobe].

Peculiar features of the clinical picture of rhinogenic abscesses of the frontal cerebral lobe (RAFCL) were studied for the purpose of optimization of medical and diagnostic measures intended for the early detection of this severe disease. Causes and pathways of infection penetrating in the cranial cavity and possibilities of RAFCL diagnosis were thoroughly analysed in 4 patients with the help of computerized tomography (CT), in 1 patients by brain ultrasound study (BUS) during osteoplastic trepanation (OPT), and in 9 patients using neurologic diagnostic tools. A total of 14 patients were given treatment for RAFCL; one of them died. The study has demonstrated the possibility to use BUS in situations where CT is unfeasible. The method proposed by V.I. Morokhoev [9] was employed that comprises an algorithm for the search, opening, and drainage of RAFCL along with adequate combined therapy by means of simultaneous catheterization of the temporal artery at the site of RAFCL localization. Opening of RAFCL through the frontal sinus was shown to be less traumatic than OPT indications for which are currently limited. It is emphasized that the mechanism of cooperation between otorhinolaryngologists and neurosurgeons in this country needs to be further improved.

[Olfactory dysfunction: its diagnosis and surgical treatment]. / Oboniatel'naia disfunktsiia: diagnostika i khirurgicheskoe lechenie.

This paper discusses the results of diagnosis and surgical therapy of olfactory dysfunction. It describes a method of qualitative and quantitative olfactometry which involves olfactory investigation by means of an olfactory unit and an olfactometer based on the smelling principle. The olfactory unit and olfactometer permit qualitative and quantitative olfactory measurements. Objective olfactometry was performed in 34 patients using the galvanic skin reflex, olfactory-pupillary reflex (OPR), pneumography, and ECG. The method, developed by the present author for recording pupils responses by means of an optic pupillometer, allows differentiation of olfactory and trigeminal sensitivity during OPR examination. Objective olfactometry demonstrated that olfactory investigation with the aid of a custom built olfactometer gives reliable data. The procedure of endonasal operation of concha nasalis media in the olfactory fissure area in the case of hypertropic rhinitis accompanied by olfactory dysfunction is described.

[Errors in the early diagnosis of malignant tumors of the ethmoid sinus]. / Oshibki v rannei diagnostike zlokachestvennykh opukholei pazukhi reshetchatoi kosti.

This paper discusses the factors responsible for delayed diagnosis of malignant tumors of ethmoidal sinuses. It presents 9 cases: keratinizing type (6 cases) and nonkeratinizing type (1 case) of squamous cell carcinoma, nasopharyngeal poorly differentiated carcinoma (1 case), esthesioneuroblastoma (1 case). The diagnosis was made on the basis of a detailed study of case histories (spontaneous nasal bleeding and recurrent polyposis) and X-raying (total, contrast and tomographic). The clinical investigation was supplemented with operational green filter optics that helped detect tumor specific lesions. The final diagnosis was made on the basis of histological examinations.

[Various aspects of endonasal corrective surgery]. / Nekotorye aspekty éndonazal'noi korrigiruiushchei khirurgii.

This paper discusses the results of 649 rhinoseptoplastic and 139 rhinoconchoplastic operations performed according to modified methods of Killian and Cottle. The surgical intervention led to the following complications: 1) deformation of the nasal septum in the vestibule area (11 patients); 2) perforation of the nasal septum of atrophic origin (15 patients); 3) saddle-like deformation of external nose (7 patients); 4) vibration of the nasal septum which occurred in most patients after total resection of the cartilage and vomer. The author elaborated methods of plastic operations of: the vestibule of the nose in order to prevent its postoperative deformation, the vomerine zone in order to preserve intraosseous vessels in the foramen incisivum area, the ridge of the nose in order to avoid the saddle-like nose, and implantation of the zigzag cartilage graft in order to prevent vibration of the nasal septum. Analysis of the rhinoconchoplastic operations allowed the author to propose medial positioning of the nasal concha in the case of hypotrophic rhinitis and implantation of autocartilage into the nasal concha in order to enlarge it in the case of hypotrophy.

[Play olfactometry for children]. / Detskaia igrovaia ol'faktomeriia.

The method presented includes recording of motor responses to odor stimulation reinforced by electric games. Game olfactometry was performed in 34 young children before and after adenotomy using a specially designed olfactometer which measured an increase in the threshold concentration of odor stimulation. As an olfactory stimulus we used 50% aqueous solution of dimethoxybenzene on identification threshold values. In parallel, we recorded the following physiological parameters: galvanic-skin response, pneumography and ECG. In order to develop a stable reflex, 23 children needed from 7 to 9 reinforcements and 8 children needed from 11 to 12 reinforcements. It was found that the level of identification threshold olfactory stimulation was directly proportional to the number of reinforcements. Our findings allow us to recommend the above method for clinical application.