ABSTRACT
Objectives/Hypothesis: Stenosis of the middle meatus antrostomy (MMA) represents a major cause of recurrent disease following endoscopic sinus surgery (ESS). Various strategies have been developed to prevent the occurrence of MMA stenosis. The aim of the present study was to evaluate the effects of spray cryotherapy (SC) on nasal wound healing following ESS. Methods: This is a prospective within-subject, randomized, and controlled trial. Twenty-six patients submitted to bilateral ESS with chronic rhinosinusitis without polyps were included. Following surgery, patients were randomized to receive SC on one side and saline contralaterally. Outcomes were represented by MMA diameter and area, histology of nasal mucosa, and nasal symptoms. Variables were assessed at 3 and 12 months postoperatively. Results: The MMA size in the SC group at 3 and 12 months (area-0.578 ± 0.1025 cm2, diameter-0.645 ± 0.1024 cm; 0.605 ± 0.1891 cm2, 0.624 ± 0.0961 cm, respectively) was significantly larger (p = 0.000) than in the control group. Histology established that cell infiltration, goblet cells, edema, and epithelial hyperplasia were prominent and persistent in the control side compared to the SC side. Nasal obstruction and discharge were significantly improved in the SC group compared to the control group. Conclusion: SC is a promising therapy following ESS, since it precludes MMA stenosis and decreases inflammation, edema, and goblet cell hyperplasia.
ABSTRACT
The commonest cause of head and neck malignancy in pediatric patients is lymphoma. A particular case is the tonsillar lymphoma. Even though unilateral tonsillar enlargement represents an ominous sign for neoplasia, clinical manifestations vary and are non-specific. Therefore, a delayed diagnosis is performed which compromises optimal therapy and hinders the prognosis. We present the case of a 5-year-old boy who was initially diagnosed with obstructive sleep apnea, without reported systemic complaints. Asymmetric tonsillar hypertrophy created the premises for performing a tonsillectomy to rule out malignancy. The pathological evaluation of the resected tonsils revealed a malignant non-Hodgkin's lymphoma, with immunophenotypic features consistent with sporadic type Burkitt lymphoma. The aim of this paper is to emphasize the importance of the histopathological examination and of the immunohistochemistry testing for the prompt and accurate diagnosis of all asymmetric tonsillar hypertrophy in children undergoing tonsillectomy. Furthermore, immunohistochemical diagnosis is vital for establishing a personalized multi-agent chemotherapy regimen, which dramatically improves the survival rate. We recommend histopathological evaluation in all children with asymmetric tonsillar hypertrophy undergoing tonsillectomy for various reasons. Needless to say, it is better to be cautious and exclude the presence of tonsillar lymphoma, than to confront with the severe consequences of misdiagnosis.
Subject(s)
Lymphoma/diagnosis , Sleep Apnea, Obstructive/diagnosis , Tonsillar Neoplasms/diagnosis , Cell Membrane/metabolism , Child , Diagnosis, Differential , Epstein-Barr Virus Infections/pathology , Humans , Immunohistochemistry , Lymphoma/pathology , Male , Palatine Tonsil/pathology , Sleep Apnea, Obstructive/pathology , Tonsillar Neoplasms/pathologyABSTRACT
Due to the insidious onset and common symptoms, the diagnostic of sinonasal tumors is late in the evolution. Usually, at that time, the preferred endoscopic approach alone is not recommended, therefore a mixed openendoscopic approach appears to be the best choice in terms of exposure of the tumor and a clear margin resection. The purpose of this case report study is to demonstrate the necessity of careful preoperative assessment and the advantages of combined approach for a complete resection and favorable long-term results.
