[Life-threatening complications following endoscopic recanalization of cicatricial tracheal stenosis]. / Zhizneugrozhayushchie oslozhneniya pri endoskopicheskoi rekanalizatsii rubtsovykh stenozov trakhei.

The authors report an attempt of tracheal stenosis bougienage complicated by tracheal rupture. Particularities of diagnosis and treatment of patients with cicatricial stenoses of breathing pathways are analyzed.

[New approach to treatment of polypous rhinosinusitis]. / Novyi vzlyad na lechenie polipoznogo rinosinusita.

ANNOTATION: Polypous rhinosinusitis (PRS) is a hardly treatable disease due to the unknown etiology and recurrent course. Standard treatment regimens are aimed at removing polyps and reducing the activity of inflammation, while little attention is paid to pathogenesis factors such as oxidative stress and mucociliary insufficiency. OBJECTIVE: To improve the combined treatment of PRS. MATERIAL AND METHODS: The study involved 98 patients (50 people - the study group, 48 people - control group). The structure of the comorbid pathology of patients in the control group was selected so as to correspond to the pathology in the study group. Patients of both groups received combined treatment, including surgical treatment in accordance with the FESS principles, followed by the prescription of 200 mcg mometasone furoate in each half of the nose for 6 months. The treatment of patients of the study group also included the drug N-acetylcysteine - 3 ml (300 mg) in each maxillary sinus intrasurgicaly, then 600 mg orally in the morning after meals for 6 months. Survey methods included a questionnaire survey using the SNOT-22 questionnaire, the prevalence of the polypous process was assessed by endoscopy (Claus Bachert scale) and CT (Lund-Mackay scale), and mucociliary function was also evaluated by performing a saccharin test. The results were compared with each other before surgery and after 6, 12 and 24 months after surgery. RESULTS: Patients who have been taking N-acetylcysteine for a long time have a more pronounced and long-term improvement in their general condition (according to SNOT-22, an average by 1.7 times, p<0.05) compared with patients in the control group. Also, the frequency of relapses decreases and the effectiveness of surgical treatment increases (according to the Lund-Mackey scale - 5.02 in the experimental group and 10.75 in the control; according to S. Bachert - 1 point and 3 points, respectively). CONCLUSIONS: Long-term use of N-acetylcysteine in PRS increases the effectiveness of surgical treatment, reduces the frequency of relapses, and also improves the general condition of patients.

[Modification of the method for closing the defect of the medial wall of the maxillary sinus]. / Modifikatsiya sposoba zakrytiya defekta medial'noi stenki verkhnechelyustnoi pazukhi.

Pathological ventilation of the maxillary sinus (MS) is one of the risk factors for the formation of chronic maxillary sinusitis. PURPOSE OF STUDY: Is to evaluate the effectiveness of the method of restoring the medial wall of the MS with an autograft - a quadrangular cartilage of the nasal septum using the butterfly technique (Patent Application No. 2018140468, priority of 11/19/2018). MATERIAL AND METHODS: The study included patients who underwent septoplasty, endoscopic surgery on the MS with plasty of the medial wall of the MS (1st, main group, n=136), as well as patients who underwent surgery according to Caldwell-Luc with the formation of persistent nasoantral anastomosis in the lower nasal passage (2nd, control group, n=56). The criteria for the inclusion of patients in the study were as follows: the presence of MS fungal body; inverted papilloma with lesions of the MS; cysts and/or a foreign body of the MS with localization in the alveolar bay without involving the natural anastomosis in the pathological process; concomitant 3rd or 4th, or 5th or 6th types of curvature of the nasal septum according to R. Mladina (1987). An objective assessment of the condition of the patients was carried out using the SNOT-22 clinical questionnaire, and for analysis the state of aerodynamics of the nasal cavity and MS in patients of various groups after surgical treatment used the method of computational aerodynamics. RESULTS: In patients with nasoantral ostium in the lower nasal meatus, the pathological maxillary sinus aeration one was observed. It is recommended to close the nasoantral ostium to prevent violations of the aerodynamics of the nasal cavity and the maxillary sinus during surgery through the lower nasal meatus. CONCLUSION: Our proposed method for closing a defect in the lower nasal passage is effective. The autograft is well established, contributes to the speedy restoration of normal sinus aerodynamics.

[Vac-therapy in the management of tension pneumomediastinum and subcutaneous emphysema]. / Vakuum-terapiya v lechenii napryazhennogo pnevmomediastinuma i podkozhnoi emfizemy.

Pneumomediastinum and subcutaneous emphysema are the main manifestations of gas syndrome in patients with tracheal injury. Traditional mediastinal decompression in case of tension emphysema is carried out through different types of cervical or transpleural mediastinotomy and subsequent passive drainage. Clinical observation of the use of VAC-therapy in the patient with injury of the membranous part of trachea followed by tension pneumomediastinum is presented. Cervicotomy with dissection of anterior mediastinum and installation of vacuum-assisted dressing were performed. Fast regression of subcutaneous emphysema and relief of pneumomediastinum were noted. There were no complications. The patient was discharged in 6 days after admission. Effectiveness of VAC-therapy in patients with tension subcutaneous emphysema and pneumomediastinum was confirmed.

[CFD simulation study of aerodynamics in nasal cavity in a case of septal perforation]. / Vychislitel'naia aérodinamika vozdushnykh potokov v polosti nosa pri perforatsii peregorodki nosa.

Perforation of the nasal septum remains an actual problem. The success of surgical closure of perforation of the nasal septum depends not only on the surgeon's skill, but also on the degree of disturbance of the nasal cavity physiology. Traditionally, CFD studies of nasal septal perforations are dedicated to the analysis of changes in speed value of the inhaled air depending on the size and localization of perforation of the nasal septum. But there is a lack of studies about warming and moistening of the inhaled air in a case of nasal septal perforation. These studies are necessary not only for studying the pathophysiology of perforation of the nasal septum, but also for planning surgery.

[Our first experience with endoscopic ear surgery]. / Opyt primeneniia éndoskopicheskoi tekhniki v otokhirurgii u detei.

INTRODUCTION: For the last decades endoscopic ear surgery has become a common practice. Advantages of the endoscopic technique in middle ear surgery are high definition and magnification of the endoscope with a modern camera and the ability to 'look around the corner' with the angled scope. MATERIAL AND METHODS: From March 2017 to November 2019 in NSRC PHOI named after Dmitry Rogachev in the Department of Oncology and Pediatric Surgery 53 patients (81 surgeries) have undergone endoscopic-assisted ear surgery: 3 biopsies for middle ear neoplasm with the transcanal endoscopic approach, 1 endoscopic tympanoplasty for attic retraction pocket with cholesteatoma, 2 endoscopic removal of middle ear tumors (including 1 combined approach) and 32 endoscopic myringoplasties, 22 canal wall down mastoidectomies for extensive middle ear and mastoid cholesteatoma, 21 second-look surgery with ossiculoplasty with overall good outcome. Age of the patients varied from 2 months to 16 years. Follow up period varied from 1 month to 3 years. RESULTS: Two cases of middle ear tumor removal via endoscopic transcanal approach are described. In one case endoscopic transmeatal approach was used as an addition to the middle fossa approach for removal of facial nerve neurinoma located on the upper surface of petrous bone with expansion to the middle ear cavity. In the second case endoscopic transmeatal approach was used alone for removal of benign tumor (salivary gland choristoma) of middle ear cavity with extension to pneumatic system of petrous bone. In both cases endoscopic approach allowed to biopsy the tumor first and then to remove the tumor in a less invasive way, which lead to faster patient recovery. CONCLUSION: In the majority of cases endoscopic technique is a method of assistance in otologic surgery, but sometimes could be a used a single method in middle ear surgery, allowing less traumatic approach and the implementation of high-definition camera for more precise disease control. In our preliminary experience endoscopic technique could be used in pediatric practice independently of the patient's age.

[The effectiveness of the intra-tympanic administration of methylprednisolone and gentamycin for the treatment of Meniere's disease]. / Éffektivnost' intratimpanal'nogo vvedeniia metilprednizolona i gentamitsina pri bolezni Men'era.

Meniere's disease is an inner ear pathology characterized by periodic fits of systemic dizziness, fluctuating low-frequency sensorineural loss of hearing, stuffiness in the ear and tympanophonia. The objective of the present study was to evaluate the effectiveness of the intra-tympanic administration of methyl prednisolone in the combination with gentamycin used to treat the patients presenting with Meniere's disease. The study included 18 patients at the age varying from 18 to 70 years presenting with this condition. Group 1 was formed to treat the patients with gentamycin, group 2 was comprised of the patients treated with methyl prednisolone. Special emphasis was placed on the recording of dynamics of the parameters of tonal threshold audiometry and cervical evoked vestibular myogenic potentials. The episodes of dizziness were characterized based on the results of comparison of the number of systemic dizziness episodes within the first 6 months after the first injection of methyl prednisolone or gentamycin with the number of such episodes during one month prior to the onset of the treatment. The results were estimated based on the Dizziness Handicap Inventory (DHI scale). It was shown that the patients comprising group 2 experienced a more pronounced reduction in the number of dizziness episodes compared with those in group 1 (91.56 and 69.81% decrease respectively). Moreover, hearing improved by 35% in the patients of group 2, whereas the improvement was altogether absent the patients of group 1. The patients of both groups reported comparable reduction of subjective tympanophonia estimated based on the DHI scale. The results of the comparison were evaluated based on the DHI scale (54.9% in group 2 and 53.8% in group 1).

[CFD-simulation of the air flows in the maxillary sinus]. / CFD-modelirovanie vozdushnykh potokov v verkhnecheliustnoi pazukhe.

This article summarizes the results of computer simulation of the air flows in the nasal cavity and the maxillary sinus by the computational fluid dynamics (CFD) method. The objective of the study was to apply the method of computational aerodynamics to simulate the air flows in the nasal cavity and the maxillary sinus under the normal conditions and after the surgical interventions on the middle nasal meatus. The normal air space of the nasal cavity and paranasal sinuses was simulated and the computer modeling of the main options for the surgical approach to the maxillary sinus through the middle nasal meatus was performed including balloon sinuplasty, functional endoscopic sinus surgery, and uncinate process mobilization. The study has demonstrated the increase of the air flow velocity in the maxillary sinus after computer-assisted balloon sinuplasty. The computer simulation of functional endoscopic sinus surgery including the removal of the uncinated process revealed the mass exchange between the maxillary sinus and the nasal cavity.

[Certain morphometric characteristics of the normal maxillary sinus]. / Nekotorye morfometricheskie pokazateli verkhnecheliustnoi pazukhi v norme.

Maxillary sinus is more than any other paranasal sinuses amenable to various pathological conditions that may require the surgical treatment. The objective of the present work was to study the age-related and the individual specific anatomical features of the walls of the maxillary sinus and to develop the principles of sinus surgery based on the results of the anthropometric studies. We analyzed the cone-beam CT scans obtained from 586 patients at the age varying from 5 to 60 years who were allocated to six different groups. The measurement of different anthropometric indicators of the maxillary sinus was undertaken. The study has demonstrated the feasibility of using boron as a means to obtain the access to the maxillary sinus for the purpose of the external surgical intervention. The maxillary sinuses having the thickness of the anterolateral wall of more than 1.5 mm most frequently occurred in the patients under 12 years of age. The surgical access to the maxillary sinus through the lower nasal passage having the medial wall thickness greater than 1 mm proved to be limited; this feature was found to be characteristic of the patients at the age below 12 years. It is shown that the depth of the lower lateral wall in the nasal passage did not depend on the age of the patients; the same was true of the angle formed between this wall and the bottom of the nose. Taken together, the obtuse angle (more than 100°) and the depth of the lateral wall of the inferior nasal meatus of more than 5 mm facilitated the surgical access to the maxillary sinus through the inferior meatus.

[The morphological and clinical aspects of the curvature of the nasal septum]. / Morfologicheskie i klinicheskie aspekty iskrivleniia peregorodki nosa.

The curvature of the nasal septum (NS) is one of the most widespread deformations of the facial skeleton. The objective of the present study was to substantiate the principles of and develop the rationale for the surgical correction and conservative treatment of this condition based on the morphological features of various types of deflection of the nasal septum. We have undertaken the morphological analysis of the osseous and cartilaginous structures determining the type and the shape of the curvature of the nasal septum together with the clinical analysis of different morphological variants of the deflection of the nasal septum making use of the R. Mladina classification. Type I-IV vertical deflections are regarded as the acquired deformities whereas type II deviations can just as well be congenital malformations. Types V and VI deflections can be a consequence of the birth injury resulting in the displacement of the nasal structures and leading to the curvature of the nasal septum. The authors describe the defects in the anatomical structures adjoining the nasal cavity associated with various types of the deflection of the nasal septum that the surgeons should take into account when planning and performing septoplasty.

[The replacement of defects in the frontal walls of the paranasal sinuses by the allotransplants]. / Zameshchenie defektov litsevykh stenok okolonosovykh pazukh allotransplantatami.

The aim of the present work were the development and clinical testing of the method for the closure of defects in the anterior wallsof the frontal and maxillary sinuses with the use of the allotransplants. We have carried out the experimental studies with the transposition of the cartilaginous allograft into the bone defect by means of the press-fit technique. Within six months after the operation, the transplantation resulted in the formation of a regenerate composed of the lamellar bone tissue. We have also undertaken the clinical testing of the method forthe closure of defects in the anterior wallsof the frontal and maxillary sinuses using the cartilaginous allograft. In all the cases, the favourable clinical outcome has been achieved as evidenced by the integrity of the restored anterior wall of the sinus.

[The paranasal sinuses as the nitric oxide depot]. / Okolonosovye pazukhi kak depo oksida azota.

This paper was designed to report the currently available data on physiology of the nasal cavity and paranasal sinuses together with the results of national and international investigations on the computer modeling of the air flow in these structures. Also discussed are the gas composition in the paranasal sinuses and the potential factors responsible for the changes in the concentration of nitric oxide with the chemical formula of NO in the nasal cavity and paranasal sinuses.

[Variant anatomy of maxillar sinus according to the data of computer tomography with 3D function].

The paper presents the data on variant and individual anatomy of the maxillary sinus in 400 men and women of the I and II periods of adulthood obtained using by computer tomography with 3D function. It was found that in the I period of adulthood, 12.5% of individuals had the bony septa in the alveolar recess of the maxillary sinus which were oriented frontally--Underwood's septa. Individuals of the II period of adulthood had this septa in 20% of cases. Also in the second age group, 7.2% of the cases demonstrated the septa which are oriented sagittally. These structures were often associated with the bony canal of the infraorbital nerve. The detected variants of individual variability of the maxillary sinus have both theoretical and practical importance. In particular, during the planning of micromaxillotomy (through the endonasal access or fossa canina), the presence of bone septa, their location and the course of the infraorbital nerve canal should be taken into account.