[Orbital Fractures in Children]. / Fraktura orbity v detském veku.

PURPOSE OF THE STUDY Diagnosis and treatment of fractures of the facial skeleton in children can be difficult due to the skeletal growth. MATERIAL AND METHODS The 9-year retrospective study included patients admitted with the orbital fracture diagnosis to the University Hospital Brno, Children s Hospital, Department of Paediatric ENT, Department of Paediatric Anaesthesiology and Resuscitation, and Department of Paediatric Surgery, Orthopaedics and Traumatology. We looked into the number of patients admitted to the hospital with the orbital fracture diagnosis and the cause of the injury, the age of patients, and the used treatment method - surgical or non-operative treatment were analysed. The following assumptions were applied: 1. Incidence of the injury (orbital fracture) increases with the age of the patient, 2. Incidence of the injury in individual years is constant. RESULTS In the followed-up period, between 2010 and 2018, a total of 47 patients, of whom 8 girls and 39 boys, with the orbital fracture diagnosis were treated. 12 patients underwent surgery, 35 patients were treated non-operatively. The study group included 47 patients with the age range of 1 to 18 years, with the median age 12 years. When the results were processed, a trend was revealed showing an increase in the number of injuries as well as an in the age of patients at the time of injury. The number of injuries increases with age and year. Both the correlations, however, are statistically insignificant and the trend can be considered statistically insignificant. DISCUSSION Both the non-operative and surgical treatment of patients lead to excellent results, even in the long-term follow-up. In paediatric patients, the surgical approach should be opted for only in cases when the non-operative approach is impossible due to the extent and characteristics of fracture and damage to soft tissues. CONCLUSIONS The surgical treatment aims at the best possible anatomical reconstruction of the orbit with no subsequent functional or cosmetic defects. If surgical treatment is necessary, then the transconjunctival approach is most appropriate in children, namely because of the good overview over the operating field, simple procedure as well as the cosmetic outcome. In most cases it is enough to reposition the orbital soft tissues. In complicated cases, with an orbital floor defect, it needs to be covered with a suitable material. Also, the non-operative approach has its place in therapy and the case-by-case approach must be applied. Orbital fractures should always be treated by experienced specialists (ENT, dental surgeon, traumatologist) specialising in paediatric patients. Key words: fracture, orbit, childhood, surgical, non-operative treatment.

Histological analysis of retraction pocket pars tensa of tympanic membrane in children.

AIMS: Histological and histochemical analysis of retraction pocket of pars tensa of tympanic membrane in children. Identification of morphological abnormalities in comparison with a healthy tympanic membrane as it is described in standard textbook. Identification of signs typical for cholesteatoma and support for a retraction theory of cholesteatoma formation. STUDY DESIGN: A prospective study analysing 31 samples of retraction pockets taken during surgery. DEPARTMENTS: University Hospital, Children's Medical Centre METHODS: Samples of retraction pockets were processed by a standard process for light microscopy, stained by haematoxylin-eosin. Van Gieson's stain was used for differential staining of collagen, Verhoeff's stain for elastic fibre tissues, Alcian blue for acidic polysaccharides and PAS (Periodic Acid Schiff) method for basement membrane polysaccharides. RESULTS: The following findings were observed in the samples of retraction pockets: hyperkeratosis (100%), hypervascularisations (100%), subepithelial fragmented elastic fibres (96%), myxoid changes (87%), subepithelial inflammatory infiltration (84%), rete pegs (71%), papilomatosis (71%), intraepithelial inflammatory cellularizations, (48%), intraepithelial spongiosis (16%) and parakeratosis (3%). No basement membrane continuity interruptions were observed. Thickness of retraction pocket, thickness of epidermis, occurrence of rete pegs and frequency of fragmented elastic fibres was higher in a Grade III stage RP than Grade II stage RP (according to Charachon). CONCLUSION: Morphological abnormalities in the structure of retraction pockets in comparison with a healthy tympanic membrane were described. The changes are typical for a structure of cholesteatoma (these changes are common in matrix and perimatrix), supporting retraction theory of its origin. Our observations show that it is inflammation that probably plays a key role in the pathogenesis of retraction pocket. The frequency of some of the changes increases with the stage of retraction pocket (II-III according to Charachon). Basement membrane continuity interruptions are not typical for retraction pockets.

Risk posed to children by stationery items in the upper airways.

AIM: The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to stationery items according to age and gender of patients, FB characteristics and foreign body (FB) location, circumstances of the accident, as emerging from the ESFBI study. METHODS: A retrospective study in major hospitals of 19 European countries was realized on children aged 0-14 having inhaled/aspired or ingested a stationery item. In the years 2000-2003 a total of 2094 FB injuries occurred in children aged 0-14 years. The characteristics of the child, the FB consistency and the occurrence of complications were analyzed. RESULTS: Among FB injuries, 62 (3%) were due to a stationery item: 32 were due to objects insertion in the ears while 30 occurred in the upper and lower respiratory tract. Objects most frequently involved are parts of pens in children younger than 3 years and eraser in older. 39% of children needed hospitalization. The most documented complication was inflammation of external ear. Almost 24% of injuries happened under adults' supervision. CONCLUSION: Injuries are events that in many cases can be prevented with appropriate strategies. Passive environmental strategies, including product modification by manufacturers, are the most effective. Our study testifies that stationary is involved in a non negligible percentage of FB injuries. This results confirm the fact that when passive preventive strategies are not practical, active strategies that promote behaviour change are necessary and information about this issue should be included in all visits to family pediatricians.

[Injuries of the orbit caused by foreign body]. / Verletzungen der Augenhöhle durch Fremdkörper.

Four cases of injury of the orbit by a big foreign body without damage to the bulbus are described. The bodies were extracted and the healing was without complications. Two of these bodies penetrated into the brain and in one case surgical intervention was necessary. In both instances vision was lost because of damage to the optic nerve.

[Midline granuloma]. / Problematika midline-granulomu.

Midline malignant granuloma is the term used for a histogenetically heterogeneous group of diseases characterized by progressing destruction of tissues of the sinonasal area. The difficulty of differentiation of basic clinical pathological units included in this group, which is of fundamental importance for the subsequent therapeutic procedure, is demonstrated on two cases of Wegener's granulomatosis and sinonasal pleomorphous reticulosis.

[Surgical treatment of Zenker's diverticulum]. / Chirurgická lécba Zenkerova divertiklu.

The authors present an account of diagnostic methods, endoscopic problems and surgical treatment of Zenker's diverticula of the oesophagus. They analyze possibilities of X-ray and endoscopic diagnosis; a frequent problem is the insertion of an oesophageal probe before operation; tamponade of the diverticula before operation is useful. Surgical treatment is indicated in major diverticula, small flat ones are followed up. The surgical approach is from the left side of the neck. In the authors' department always total resection of the dicerticulum was performed in major diverticule, invagination could be used in minor diverticula. Early and late complications of operations are discussed.

[Reconstruction of the facial skeleton using Pallacos R]. / Rekonstrukce oblicejového skeletu pomocí Pallacosu R.

Defects of the facial skeleton cause frequently severe aesthetic facial changes with negative repercussions also on the patient's mental state. The skeleton may be affected by injury, a neoplastic disease and iatrogenically when it is necessary to remove a part of the skeleton during operation. One possible way how to replace and reconstruct the skeleton is to use bone cement Pallacos R. This method was used in 8 patients with skeletal affections. The use of Pallacos R has the advantage that it can be used quickly, that it is easy to work with directly at the site of the defect and that its tolerance is satisfactory. It permits also to preserve the physiological shape of the paranasal sinuses. The method is one approach to individually indicated reconstruction.

[Rational treatment of necrotizing external otitis]. / Racionální lécba nekrotizující externí otitidy.

Advances in the diagnosis and treatment of necrotizing external otitis (NEO) during the past 20 years improved substantially the prognosis of this disease. The use of hyperbaric oxygen therapy greatly potentiates the effect of newly developed highly effective antibiotics. Radioisotope examination of the petrous bones facilitates the diagnosis and indicates the time to terminate treatment. Medicamentous treatment is preferable to surgical treatment, which is reserved for exceptional very advanced cases of the disease. As NEO has been known for 30 years and the means to control it have been improved, it is no longer "malignant" for the majority of patients where the disease is diagnosed in time and treated adequately.

[Penetration of an orbital foreign body into the intracranial space]. / Cizí orbitální teleso penetrující do nitrolebí.

The authors describe a case of orbitocerebral injury by a wooden foreign body, size 66 x 7.5 mm which penetrated by the upper palpebral aperture into the middle cranial fossa. The extraction was performed by nasal lower orbitotomy.