Körner's septum (petrosquamosal lamina): the anatomical variant or clinical problem?

Körner's septum (KS) or petrosquamosal lamina is a bony lamina beginning at the articular fossa, extending above the middle ear, and running inferiorly and laterally to the facial nerve canal as it proceeds to the mastoid apex. This septum marks the junction of petrous and squamous bones. The paper presents details of the anatomical structure of KS, which is most often present at the level of the head of the malleus and/or the anterior semicircular canal. Attention is paid to embryological aspects of temporal bone development that lead to the formation of KS. Two imaging techniques most frequently used to diagnose KS are described, high resolution computed tomography (HRCT) and cone-beam computed tomography. Also presented is a case report of a 6-year-old patient suffering from chronic otitis media who developed a cholesteatoma due to presence of KS, illustrated with HRCT images and intraoperative capture. The authors describe diagnostic difficulties associated with this anatomical variant in the middle ear. The article also discusses the more frequent occurrence of this clinical problem in ears operated on due to chronic inflammation, retraction pocket or tympanosclerosis in comparison to healthy ears.

Health-related quality of life of parotid carcinoma patients-a comparative study with parotid adenoma patients and assessment of the influence of demographic, treatment, and pathological factors.

The aim of this study was to compare the health-related quality of life (HRQoL) of patients treated for parotid carcinoma (PC) and parotid adenoma (PA). The impact of demographic, treatment, and pathological factors was analyzed within the PC group. The EORTC QLQ-C30 and QLQ-H&N35 questionnaires were completed by 45 PC patients and 46 PA patients. A number of HRQoL domains were significantly worse in the PC group than in the PA group: global health status, pain, insomnia, loss of appetite, mouth opening, swallowing problems, dry mouth, sticky saliva, problems with senses and speech, social eating, and cognitive functioning (P<0.05). In the PC group, significantly worse scores were found for age >55years, radical parotidectomy, neck dissection, radiotherapy, recurrence of the disease, pT3/T4 stage, pN+ status, and high-grade tumour (P<0.05). Worse results were related to global health status, social contact, mouth opening, weight and appetite loss, physical, role, emotional, and social functioning, fatigue, speech problems, social eating, and financial difficulties. The study results demonstrate worse HRQoL in PC patients in comparison to PA patients. Older age, radical parotidectomy, neck dissection, radiotherapy, T3/T4 stage, pN+, high-grade tumours, and recurrence had a significant influence on HRQoL in PC patients.

Hyperbaric oxygen therapy in the treatment of complications of irradiation in head and neck area.

BACKGROUND AND PURPOSE: We have investigated the treatment results of hyperbaric oxygen (HBO2) to patients with radiation-induced tissue complications. MATERIAL AND METHODS: Eight patients (1.4%) from 548 with head and neck cancers treated surgically with post- or preoperative radiotherapy or radiotherapy alone in standard doses who developed postradiation complications (6 patients with laryngeal chondroradionecrosis, 1 patient with osteoradionecrosis of the temporal bone, and 1 patient with soft tissue radionecrosis) are presented. To evaluate radiation reactions occuring in the head and neck region, we used the Chandler grading system for classification of postradiation larynx injuries and SOMA/LENT score for classification of postradiation injuries of mucosa of upper aerodigestive tract. Grades I and II in those grading systems are expected side effects of radiation therapy, thus our cases were all in grades III and IV. The HBO2 was performed after failure of the conventional treatment (antibiotics, steroids, topical therapy). The number of HBO2 expositions was from 8 to 39 and the delay to therapy from 2 to 22 months. RESULTS: Symptoms resolved in all treated patients. Six patients with laryngeal chondroradionecrosis had no symptoms after therapy and in three of them after partial laryngectomy the decannulation was performed. In one patient with mucosal radionecrosis after total laryngectomy, the esophageal fistula was closed and in one patient with osteoradionecrosis of the temporal bone, wound debridement followed. CONCLUSION: The authors' experience supports the increasing clinical evidence that HBO2 is an effective adjunct therapy for treatment of complications of irradiation in head and neck area.

Intracranial complications of acute and chronic mastoiditis: report of two cases in children.

OBJECTIVE: The clinical picture of mastoiditis, sigmoid sinus thrombosis and brain abscess has changed with the advent of antibiotics. A delay in the recognition of intracranial complications in children and in the institution of appropriate therapy may result in morbidity and mortality. Increased mortality of the children has been correlated with the neurological status of the patient on admission to hospital. METHOD: A retrospective study was made of two children with acute mastoiditis and sigmoid sinus thrombosis and chronic mastoiditis with cerebellar abscess treated in 1997 in the ENT Department of the Medical University of Gdansk. RESULTS: We present two cases of intracranial complications in children (13 and 11 years old) originating from acute and chronic otitis media. The first case, of a 13-year-old boy with sigmoid sinus thrombosis as a complication of acute otitis media took its course as a typical Symonds Syndrome. Mastoidectomy, thrombectomy and jugular vein ligation associated with antibiotics and edema-reducing drugs and anticoagulants proved to be successful. The second case of an 11-year-old boy with exacerbated chronic otitis media with cholesteatoma and mastoiditis, was complicated by suppurative meningitis, cerebellar abscess, perisinual abscess and sigmoid sinus thrombophlebitis. Neurosurgical approach by suboccipital craniotomy and abscess drainage was ineffective. Otological treatments of modified radical mastoidectomy, thrombectomy, jugular vein ligation, perisinual and cerebellar abscess drainage associated with wide-spectrum antibiotics and edema-reducing drugs were performed with a very good outcome. After 3 years of follow-up the patients remain without any neurological and psychiatric consequences. CONCLUSION: The authors show different courses of both presented complications and imaging techniques and surgical procedures performed in these children. The sigmoid sinus trombosis with Symonds Syndrome may be difficult to diagnose due to previous antibiotics valuable in establishing the diagnosis and the extent of disease. The successful therapy is based on understanding of pathogenesis of the intracranial complication and the cooperation of an otolaryngologist, a neurologist, a neurosurgeon and an ophthalmologist.

[Metastases to cervical nodes from unknown primary tumor]. / Przerzuty wezlowe na szyi z nieznanego ogniska pierwotnego.

The authors presented clinical analysis of 19 patients with cervical nodes metastases from an unknown primary site, treated in Department of Otolaryngology Medical University of Gdansk in the period from 1981 to 1998. As the primary site of cancer was not found, basing on histopathological and clinical examination 4 patients underwent surgical treatment and in 15 patients combined therapy was applied. In two cases primary tumor was found in lung and trachea after a four months of treatment initiation. Treatment failure was observed in 12 cases, 7 patients survived, 2 of them over 4 years.

[Bacteriologic evaluation of otitis externa and chronic otitis media]. / Ocena bakteriologiczna zapalen ucha zewnetrznego i przewleklego zapalenia ucha srodkowego.

The authors present results of bacteriological examinations in 187 patients with chronic otitis media (OMC) and otitis externa treated in ENT Department, Medical University of Gdansk in the years 1997-1998. Ear swabs and aspirates were investigated for aerobes and anaerobes 254 bacterial isolates were obtained. Among 150 patients with OMC aerobes were isolated in 130 (86.7%) in 13 (8.5%) mixed aero-anaerobes flore and in 20 (19.3%) no bacterial growth was observed. From patients with COM there were 199 bacterial isolates among them 177 aerobes cultures, 13 anaerobes and 9 fungal. From the external ear canal there were 55 cultures, among them 45 (81.8%) aerobes, 6 (10.9%) mixed aero-anerobes and 4 (7.3%) fungal. The most frequent observed bacteria were Staphylococcus aureus, Pseudomonas aeruginosa and Proteus mirabilis which showed the best susceptibility on ciprofloxacine and amikacine.

Epithelial-mesenchymal cell interactions and participation of the neuroendocrine markers in tumor development. Immunohistochemical study.

Existence of the organ stem cell population seems to decide on ability of the tissue to regenerate and, likewise, on carcinogenesis. The source of the organ specific stem cells may be perivascular mesenchyma of thin-walled vascular channels. Our previous study on the breast cancer indicates that the perivascular mesenchyma of thin-walled vessels appears to be source of myoid cells (myofibroblasts) from which cancer cells arise. Similar results have been observed in the cancers of lung, salivary gland and colon, investigated in the current study. The perivascular cells of thin-walled channels are the source of myoid cells with expression of synaptophysin (Syn) and/or chromogranin A (Chg A), and from these cells neoplastic cells could originate. Syn and/or Chg A positive neoplastic cells were particularly well visible in connection with the vascular channels on the peripheries of tumors while other parts of tumors were only weak positive or negative for those neuroendocrine markers. Similarly as in breast cancers, the S100-protein positive dendritic cells with various of distribution were seen, expressing intimate connection with neoplastic cells. The epithelial pearls especially abundant in non-small cell lung carcinomas demonstrated immunohistochemical analogy to Hassall's bodies: they had monocytogenic cell inside and they displayed thymosin alpha 1 (TA1), as well as mucin secretion and minute calcification. Some epithelial cells expressed desmin and Syn. All types of investigated cancers demonstrated TA1. Results of our present study suggest that the perivascular cells have a differentiation defect. Such defect may initiate abnormal stromal environment, commonly observed in neogenesis, however, the presence of thymic growth factors may favor tumor growth.

Clinical and immunohistochemical analyses of parotid gland tumors.

Clinical, histological and immunohistochemical data on 71 parotid gland tumors were analyzed. Benign neoplasms accounted for 71.8% of the case material and malignant tumors 22.6%. Chronic parotitis occurred in 5.6% of the total case number. Pleomorphic adenomas and mucoepidermoid carcinomas were the most frequently occurring benign and malignant neoplasms. Pleomorphic adenomas stained positive for S-100 protein, tenascin, smooth muscle actin, synaptophysin and chromogranin A. This immunohistochemical, histological and clinical analysis was believed to be of potential assistance in the diagnosis, treatment and prognosis of parotid gland tumors.

[A case of schwannoma in the parotid gland]. / Przypadek nerwiaka oslonkowego slinianki przyusznej.

The authors described a very rare case of intraparotid Schwannoma in 39 year old female. The tumor originated from jugulare ramus at the facial nerve. The patient undergone surgical treatment.

A case of multiple post-anginal complications.

The paper presents an unusual case of multiple post-anginal complications in a 21-year old male patient that included a peritonsillar abscess, parapharyngeal space phlegmon, a deep intrafascial phlegmon of the neck, internal jugular vein thrombophlebitis, septicopyemia, lung abscess and pneumonia, and a pyothorax. The patient was cured surgically and with broad-spectrum antibiotics and antifungal medication. The unusual course of the disease with presumed mycotic etiology as a complication of antibiotic therapy is discussed.

[Crystallization test in patients with head and neck neoplasms]. / Test krystalizacyjny u chorych z nowotworami zlosliwymi glowy i szyi.

The authors try to estimate a clinical value of crystallization test with cupric chloride solution. 21 patients with planoepithelial cancer of the head and neck, and 10 healty volunteers underwent the test. 71.5% of positive results was obtained in cases with the cancer, what suggest a high sensitivity of the analyzed test.

[Neurogenic tumors of the head and neck]. / Neurogenne guzy glowy i szyi.

The authors present case studies of 65 patients with neurogenic tumors of the head and neck treated in the Department of Otolaryngology of the Medical University of Gdansk in the years 1948-1993. Age and sex of patients, localization of tumor, symptoms, histopathology and treatment were analysed. This resulted in the noting of difficulties in diagnosis and in showing the importance of immunohistochemical examinations, CT, MRI, USG in the diagnostics of malignant neurogenic neoplasms. Patients with benign tumors, in the majority of cases, were subjected to surgery. Patients with malignant neoplasms were subjected to surgery combined with high voltage radiotherapy. The positive effect of combined chemotherapy in cases of esthesioneuroblastoma is worthy of note. The results of the treatment of benign tumors are positive, whereas in the case of malignant tumors--the results are still not satisfactory.

[Esthesioneuroblastoma. Personal opinion about diagnosis and treatment]. / Nerwiak wechowy. Obecne poglady na diagnostyke i leczenie.

The authors present material of 6 cases esthesioneuroblastoma observed in ENT Department Medical University of Gdansk. The tumors were seen in 3 children and 3 adults. According to Kadish staging there were one A, two B, two C and one D stage tumor. Investigation and treatment methods, and obtained results were discussed.

[Triton tumor]. / Guz trytona.

A lethal case of a very rare Triton Tumor is described in a 57 year old woman who was treated surgically and postoperatively radiated with Co-60. Finally an adjuvant chemotherapy was performed on her. The characteristic of the tumor and difficulties in diagnosis and management were pointed out.