[Harmonic scalpel tonsillectomy--personal experience and review of literature]. / Tonsillektomia z zastosowaniem skalpela harmonicznego--doswiadczenie wlasne i przeglad literatury.

INTRODUCTION: The harmonic scalpel has been used in tonsil surgery for several years. The comparison of harmonic scalpel tonsillectomy with other tonsillectomy techniques has been the subject of many studies. The research results proved to be contradictory, particularly concerning postoperative complications and complaints. Most authors observed reduced intraoperative bleeding during harmonic scalpel tonsillectomy. OBJECTIVE: Analysis of harmonic scalpel tonsillectomy results and review of literature. Material and methods. The harmonic scalpel was used for 71 tonsillectomies in the Department of Otolaryngology UJ CM between 2002-2007. The surgical procedure and postoperative results were analyzed retrospectively and compared with other tonsillectomy techniques. RESULTS: The harmonic scalpel provided sufficient intraoperative hemostasis in 67% of cases. 33% of patients required electrocautery, vessel ligation in the operation field or suturing of the marginal tissue to control bleeding. Postoperative hemorrhage requiring surgical intervention occurred in 3 patients. No other severe postoperative complications were observed in either group. CONCLUSIONS: Harmonic scalpel tonsillectomy is an effective and safe alternative technique in tonsil surgery. In some cases however other hemostasis techniques may be necessary to control intense bleeding.

[Orbital complications of sinusitis treated endoscopically]. / Endoskopowe leczenie chorych z powiklaniami oczodolowymi zapalen zatok przynosowych.

BACKGROUND: Subperiosteal inflammatory disease, subperiosteal abscess and orbital cellulitis are the most common sequelae of both acute and chronic sinusitis. Early, appropriate evaluation and management observing signs and symptoms of orbital inflammation are required to prevent blindness. Computerised tomography (CT) is the investigation of choice in diagnosing the discussed pathological conditions. Cellulitis does not require drainage of the orbit on a routine basis. Conventionally, the orbital abscess is drained via an external incision and sinus surgery is performed at the same time to remove the focus of infection. More recently, successful treatment both of the sinuses and decompression of the orbit has been accomplished endoscopically via an intranasal approach. AIM: The aim of the paper was to analyse the results of intranasal endoscopic procedures performed in individuals with orbital complications of sinusitis in search for optimal treatment of this group of patients. MATERIAL AND METHODS: Records of 7 patients aged from 14 to 68 (mean 33) years treated in our department for orbital complications of sinusitis between February 2005 and August 2006 were analysed retrospectively. One retrobulbar abscess was diagnosed. In the remaining 6 patients the diagnosis of cellulitis, in one case complicated with cavernous sinus thrombosis, was established. 7 endoscopic frontosphenoethmoidectomies, one with endonasal decompression of the orbital abscess, were performed. RESULTS: All preoperative symptoms subsided in all operated individuals. No complications were observed. CONCLUSIONS: Surgical treatment of the focus of infection in the sinuses and drainage of orbital abscess can be accomplished endoscopically via an intranasal approach with little morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic result. Our experience suggests that the optimal method of treatment consists in surgical endoscopic removal of the focus of infection located in the sinuses with simultaneous drainage of the abscess in the orbit.

Osteomas of the paranasal sinuses: surgical treatment options.

BACKGROUND: Osteomas are relatively common, benign, slow-growing, often asymptomatic neoplasms of the paranasal sinuses occurring mainly in the frontal and ethmoid sinuses. Surgical removal is done if they extend beyond the boundaries of the sinus, continue to enlarge, are localized in the region adjacent to the nasofrontal duct, or if signs of chronic sinusitis are present and, regardless of size, in symptomatic tumors. Progressive headaches and chronic inflammation of the adjacent mucous membrane are the most common symptoms. Surgical approaches are divided into external, endoscopic drill-out, and combined endoscopic and external procedures. MATERIAL/METHODS: Seventeen patients with osteomas of the paranasal sinuses were studied (mean age: 42.7 years, range: 15-73 years). Most commonly involved was the frontal sinus (11 cases, including a giant tumor comprising both frontal sinuses and 2 osteomas penetrating to the orbit), followed by ethmoid cells (3) and maxillary sinuses (2). RESULTS: One osteoma was diagnosed in the sphenoid sinus. All were removed surgically. Eight open procedures were performed to remove frontal and maxillary osteomas, five tumors were removed under endoscopic guidance, and four via combined procedures. No postoperative complications were observed. No recurrences were noted. All patients remain asymptomatic. CONCLUSIONS: Resection of small and medium-sized osteomas of the paranasal sinuses can be safely and radically performed using endoscopic techniques. It allows their radical resection and very good cosmetic effects. Giant frontal sinus osteomas can be effectively approached by a combined external and endoscopic procedure. Obliteration of the sinus is not mandatory if the mucous membrane is intact.

[Self-assessment of the effect of dysphagia on the quality of life in patients after partial laryngectomy for cancer initially located in the supraglottic area]. / Samoocena wplywu dysfagii na poziom jakosci zycia chorych po operacjach czesciowego usuniecia krtani z powodu raka o pierwotnej lokalizacji w pietrze nadglosniowym.

Dysphagia is frequent in patients after partial laryngectomy for cancer initially located in the supraglottic area. To ensure the best quality of life, establishing how the patient feels after treatment is necessary. Therefore, a self-administered questionnaire was designed to evaluate the dysphagia. 95 patients (75 male and 20 women) who were operated in ENT Department CMUJ between 1998-2004 participated in this study. The MDADI questionnaire in the Polish version was used. The subjective evaluation by the patient of dysphagia is directly related to the size of the tumor and the extent of the partial laryngectomy treatment. Patients, whose tumor was located in supraglottic-glottic area, had subtotal laryngectomy m. Miodonski. Their quality of life was significantly worse due to dysphagia than those with tumors located only in the supraglottic area. Swallowing dysfunctionality was significantly greater after the resection of the hyoid bone. Reconstruction of the base of a tongue by a graft of angiopedunculated submandibular gland diminished the difficulties in swallowing. Moreover, the longer the period after treatment, the higher the quality of life becomes because of the improvement in the swallowing functionality.

[Bezold's abscess: a rare complication of otitis media]. / Ropien Bezolda--rzadkie usznopochodne powiklanie.

The authors present the case of a 21-year-old female in who, during the course of cholesteatoma, extracranial complications occurred twice in the form of Bezold's abscess. This type of the complication of otitis media occurs extremely rare. Medical literature has recorded about 20 cases of such complications. Due to commonly applied antibiotic therapies, extracranial and intracranial complications are rarely recorded in the course of otitis media, their mortality rate, however, amounts to a dozen or so per cent. The paper presents the way in witch the infection of otitis media spreads towards the neck. The authors stress the significance of computer tomography in diagnostic. Radical mastoidectomy and exploration of the neck were performed on the patient. Antibiotic regimens were based on antimicrobial sensitivity patterns. Presently, the patients is under constant laryngologist observation.