Endoscopic surgery with curative intent for malignant tumors of the nose and paranasal sinuses.

AIM: To assess the efficacy of endoscopic surgical treatment in patients with nasal and paranasal sinus malignancies. PATIENTS AND METHODS: During the period 1991-2006, 16 patients with nasal and paranasal sinus malignancies underwent endoscopic surgery with curative intent. The lesions included 11 carcinomas, two malignant melanomas, one olfactory neuroblastoma, one hondrosarcoma and one leiomyosarcoma. Tumors originated from the ethmoids in eight, and from the nasal cavity in another eight patients. Oncologic radicality of resection was verified by intraoperative frozen-section examination of biopsy specimens from the margins of the defect site. RESULTS: Radical resection was accomplished in 15 out of 16 operated patients. There were no major intra- or postoperative complications. Ten patients were postoperatively irradiated. Follow up of the treated patients ranged from 15 to 178 months (median 67 months). One patient with malignant melanoma died of generalized disease nine months after treatment, another with malignant melanoma recurred locally 30 months and again 49 months after first operation and is at the time of evaluation disease free and one died 21 months after operation without evidence of disease. CONCLUSIONS: It seems that in selected cases, endoscopic surgery with curative intent for removal of malignant tumors of the nasal and paranasal cavities in the hands of highly experienced surgeon is justified.

Inflammatory myofibroblastic tumour of paranasal sinuses with fatal outcome: reactive lesion or tumour?

Inflammatory myofibroblastic tumours (IMTs) are clinicopathologically distinctive but biologically controversial entities, which have been described in the lungs, abdomen, retroperitoneum, and extremities, but rarely affect the head and neck region. IMT usually follows a benign clinical course after radical excision, but invasive, locally recurrent, and metastatic forms of abdominal and mediastinal IMT have also been described. This report describes a case of IMT of the paranasal sinuses with a fatal outcome. A 22 year old woman was admitted to hospital as a result of epistaxis. Computed tomography scan and magnetic resonance imaging showed an expansive process in the paranasal sinuses, extending into the nasal cavity, orbita, and endocranium. The tumour progressed despite several surgical procedures. Radiotherapy, corticosteroids, and chemotherapy were unsuccessful, and the patient died four years after diagnosis, as a result of extensive intracranial spread of the tumour. This is the first known case of an IMT of the head and neck region with a fatal outcome. It shows that the aggressive behaviour of IMTs is not limited to abdominal and mediastinal locations, and supports recent observations that at least a subset of IMTs represents true neoplasia rather than reactive myofibroblastic proliferation.

Flow cytometric analysis of lymphocytes isolated from nasal polyps.

We analyzed by flow cytometry the expression of IL-2 receptors (alpha subunit-CD25) and ICAM-1 adhesion molecules (CD54) on T cells and subsets (CD4, CD8) isolated from nasal polyp tissue in allergic and non-allergic patients. We found a significant increase in IL-2 receptor and ICAM-1 molecule expression on T cells isolated from nasal polyp tissue compared to peripheral blood lymphocytes. We also found a significantly increased expression of ICAM-1 molecules on CD8+ cells in non-allergic compared to allergic patients. The latter may reflect a difference in cytotoxic immune response between allergic and non-allergic patients, but the result should be confirmed in a more extensive study including cytokine and immunoglobulin analysis. We hope that it would enable us to obtain a deeper insight into the local immune events and further to clarify the etiology and pathogenesis of nasal polyps and their relation to allergy.

Unusual inflamed thyroglossal cyst.

The authors report a case of an unusual inflammatory reaction in a thyroglossal cyst. It consisted of broad papillary intraluminal projections covered by histiocytes and occasional multinucleate giant cells. This benign process should not be confused with a true papillary neoplasm, a rare complication of a thyroglossal cyst.

A comparison of intravenous and inhalational maintenance anaesthesia for endoscopic procedures in the aspirin intolerance syndrome.

Intravenous (n = 21) and inhalational maintenance anaesthesia (n = 21) were compared by random allocation in patients with the aspirin intolerance syndrome undergoing endoscopic nasal procedures. Premedication was with oral midazolam and intravenous methylprednisolone sodium succinate 10 mg kg-1. Anaesthesia was induced in both groups with etomidate and alfentanil and ventilation was controlled. Anaesthesia was maintained in the intravenous group by infusion of alfentanil 1-1.5 micrograms kg-1 min-1 and injections of midazolam 2.5-5 mg h-1, and in the inhalational group by isoflurane up to 2%. Moderate arterial hypotension (70 mmHg) was achieved with nitroglycerine 0.5-5 micrograms kg-1 min-1 in the intravenous group, and with isoflurane up to 2% in the inhalational group. Adrenaline 1: 200 000 with 2% lignocaine was injected into the operative field. One patient in the inhalational group developed a resistant tachyarrhythmia but there was no overall significant difference (P = 0.34) in the frequency of dysrhythmias precipitated by adrenaline and lignocaine between the two groups. In one patient of each group methylprednisolone precipitated bronchospasm. On later challenge testing, 125 mg of intravenous methylprednisolone significantly reduced the peak expiratory flow (P < 0.05) in one of these patients. The results suggest that intravenous and inhalational maintenance anaesthesia are equally suitable for patients with aspirin intolerance syndrome. Corticosteroids during surgery should be given by the same route used pre-operatively (spray, oral, or spray plus oral) because intravenous injection may have adverse effects.

[The role of the otolaryngologist in the treatment of children with clefts]. / Uloga otorinolaringologa u lijecenju djece sa shizama.

Cheilognathopalatoschises are a complex therapeutic problem not yet completely solved and demanding collaboration of a number of medical and paramedical branches. In a therapeutic team, an otorhinolaryngologist has an important role since he has to deal with impaired hearing, impaired nasal breathing, as well as with disturbed speech development. On the basis of an analysis of the state of hearing in children who were treated at the University Clinic for Otorhinolaryngology and Cervicofacial Surgery in Ljubljana, it was found that more than 76% of them suffered from hearing loss of different levels. Almost in all children with uni-or bilateral cheilognathopalatoschises nasal breathing was disturbed, due to deformities of alae and caudal border of septum. In all these children signs of chronic rhinitis were pronounced. A silent inflammation in the nose and in the epipharynx together with hyperplastic adenoids and disturbed function of the eustachian tube cause conduction hearing loss and recurrent otitis media, which hinders speech training. The authors are of the opinion that additional surgical interventions enabling nasal breathing and function of the middle ear should be implemented more frequently and sooner than up till now. All children with cleft-lip-palate should be permanently followed up by a group of subspecialized otorhinolaryngologists which would lead to a more successful and complete rehabilitation.