Medicina

Editorial

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2 pages, 233 KiB

Open AccessEditorial

Multidisciplinarity and Transdisciplinarity as Current Trends in Otorhinolaryngology and Head and Neck Pathology

by Daniela Vrinceanu, Codrut Sarafoleanu, Mahmut Tayyar Kalcioglu and Adriana Neagos

Medicina 2022, 58(11), 1661; https://doi.org/10.3390/medicina58111661 - 16 Nov 2022

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Abstract

The specialty of otorhinolaryngology and cervicofacial surgery has experienced accelerated development in recent decades through the development of the techniques and technologies involved [...] Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

Research

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10 pages, 5756 KiB

Open AccessArticle

Sheep’s Head as an Anatomic Model for Basic Training in Endoscopic Sinus Surgery

by Constantin Stan, Laszlo Peter Ujvary, Cristina Maria Blebea, Doiniţa Vesa, Mihai Ionuţ Tănase, Mara Tănase, Septimiu Sever Pop, Doinel Gheorghe Rădeanu, Alma Aurelia Maniu and Marcel Cosgarea

Medicina 2023, 59(10), 1792; https://doi.org/10.3390/medicina59101792 - 9 Oct 2023

Cited by 2 | Viewed by 1709

Abstract

Background and Objectives: This study aims to establish the sheep head as a viable anatomical model for training in functional endoscopic sinus surgery through comprehensive anatomical examination and training-based assessment of participants’ satisfaction. Materials and Methods: Participants were divided into three [...] Read more.

Background and Objectives: This study aims to establish the sheep head as a viable anatomical model for training in functional endoscopic sinus surgery through comprehensive anatomical examination and training-based assessment of participants’ satisfaction. Materials and Methods: Participants were divided into three groups according to their prior experience in endoscopic sinus surgery; in total, 24 participants were included. Each participant in the study was assigned to perform the designated procedures on a single sheep’s head. Following the completion of the procedures, each participant was provided with a 14-item comprehensive satisfaction questionnaire with a scale attributed from 1 to 5. The normality of distribution was checked by applying the Shapiro-Wilk Test. The Kruskal–Wallis test was applied to compare study group sentiment of agreement towards individual procedures. Results: No significant differences were noted between the answers of the different groups. For the resident group, the average satisfaction score was 4.09 ± 0.54; junior specialist group 4.00 ± 0.55; for the senior specialist group overall satisfaction average score was 4.2 ± 0.77. Conclusions: The sheep’s head can be successfully used for learning and practicing manual skills and the use of instruments specific to functional endoscopic sinus surgery. Moreover, the sheep head model can be used for training in other diagnostic or surgical procedures in the field of otorhinolaryngology, such as endoscopy of the salivary glands, open laryngotracheal surgery, or in otologic surgery, but also in other different surgical fields such as neurosurgery, ophthalmology or plastic surgery. Despite the differences between the ovine model and human anatomy, it provides a resourceful and cost-effective model for beginners in endoscopic nasal surgery. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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11 pages, 1265 KiB

Open AccessArticle

Efficacy of Continuous Suctioning in Adenoidectomy Haemostasis—Clinical Study

by Veronica Epure, Razvan Hainarosie and Dan Cristian Gheorghe

Medicina 2023, 59(9), 1534; https://doi.org/10.3390/medicina59091534 - 24 Aug 2023

Viewed by 1131

Abstract

Introduction: Adenoidectomy is often the first major surgical challenge for the child’s haemostatic system, and controlling intraoperative bleeding can be a challenge for the surgeon. Different methods have been used intraoperatively by surgeons in order to enhance haemostasis. The cold air effect [...] Read more.

Introduction: Adenoidectomy is often the first major surgical challenge for the child’s haemostatic system, and controlling intraoperative bleeding can be a challenge for the surgeon. Different methods have been used intraoperatively by surgeons in order to enhance haemostasis. The cold air effect (continuous suctioning) has been used by some surgeons during adenoidectomy; however, no documentation of its haemostatic effect has been made. Objectives: Our prospective randomised controlled study enrolled a sample of 140 children undergoing adenoidectomy, and we studied the effect of continuous suctioning on the duration of haemostasis in paediatric adenoidectomy. Materials and Methods: We evaluated the effect of using continuous suctioning during haemostasis at the end of adenoidectomy procedures, comparing variables such as total surgery time, total haemostasis time, and intraoperative blood loss, between two groups: 70 adenoidectomy procedures where no continuous suctioning was used to enhance haemostasis versus the other 70 patients where continuous suctioning was the haemostatic method employed. RESULTS: After statistical analysis of the recorded data, we found that the total duration of adenoidectomy, the duration of haemostasis in adenoidectomy, and the intraoperative blood loss were significantly lower in patients in whom cold air was used for haemostasis. Intraoperative haemostasis failure (and consequent use of electrocautery for haemostasis) was more frequent in patients in whom no suctioning was used; as for the rates of postoperative primary bleeding after adenoidectomy, they were similar in both groups of patients, regardless of the technique used for haemostasis. Conclusions: The use of continuous suctioning during adenoidectomy haemostasis significantly shortens total surgical and haemostasis time, reduces intraoperative blood loss, and reduces the incidence of haemostasis failure (with the consequent need for bipolar electrocautery haemostasis). Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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11 pages, 3420 KiB

Open AccessArticle

Management of Capillary Hemangioma of the Sphenoid Sinus

by Irina-Gabriela Ionita, Viorel Zainea, Catalina Voiosu, Cristian Dragos Stefanescu, Cristina Aura Panea, Adrian Vasile Dumitru, Ruxandra Oana Alius and Razvan Hainarosie

Medicina 2023, 59(5), 858; https://doi.org/10.3390/medicina59050858 - 28 Apr 2023

Cited by 1 | Viewed by 3427

Abstract

Background and objectives: Capillary hemangiomas are rare, benign vascular tumors that mainly affect the skin and soft tissue, with scarce appearance within the nasal cavities and paranasal sinuses. Materials and methods: We present a case report of capillary hemangioma of the sphenoid sinus [...] Read more.

Background and objectives: Capillary hemangiomas are rare, benign vascular tumors that mainly affect the skin and soft tissue, with scarce appearance within the nasal cavities and paranasal sinuses. Materials and methods: We present a case report of capillary hemangioma of the sphenoid sinus and a review of the literature in the last ten years. Results: Clinical and endoscopic examination of the nose, radiologic assessment and particular histologic features contribute to the correct diagnosis of capillary hemangioma of the nose and paranasal sinuses. Conclusions: Transnasal endoscopic resection of capillary hemangioma located in the nose and paranasal sinuses is a valuable treatment method with good outcomes. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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14 pages, 2646 KiB

Open AccessArticle

Multidisciplinary Therapeutic Management in Complex Cervical Trauma

by Florentina Severin, Andrei-Mihail Rosu, Mirela Tiglis, Laura-Elisabeta Checherita, Gina Stegaru, Mihail Dan Cobzeanu, Razvan Hainarosie, Bogdan Mihail Cobzeanu and Octavian Dragos Palade

Medicina 2023, 59(3), 596; https://doi.org/10.3390/medicina59030596 - 17 Mar 2023

Cited by 2 | Viewed by 1673

Abstract

Background and Objectives: In the current literature, mandatory surgical exploration is a controversial topic, with some advocating for it and others against it, proposing a selective conservative management. This multidisciplinary therapeutic approach is based on clinical examination and serial paraclinical explorations associated [...] Read more.

Background and Objectives: In the current literature, mandatory surgical exploration is a controversial topic, with some advocating for it and others against it, proposing a selective conservative management. This multidisciplinary therapeutic approach is based on clinical examination and serial paraclinical explorations associated with supportive drug treatment. Materials and Methods: The study group consisted of 103 patients with complex cervical trauma pathology produced by various mechanisms such as car or domestic accidents, aggression, ballistic trauma, self-inflicted attempts, hanging or strangulation hospitalized in the Ear, Nose and Throat (E.N.T.) Clinic, at “St. Spiridon” Iași Hospital, between 2012 and 2016. Results: The universal clinical indication for urgent surgical exploration of the patient with complex cervical trauma is the presence of the following symptoms: unstable vital signs, significant pulsatile bleeding, hematoma with a substantial increase in size, shock, airway obstruction, open airway wound, hematemesis, or hemoptysis. In this context, we considered it worthwhile to research the management of complex cervical trauma in a reference university medical center, alongside the analysis of the patient’s characteristics under different aspects (demographic, pathological aspects, therapeutic). Conclusions: Complex cervical trauma has a variety of clinical aspects, with a variable evolution, which involves multidisciplinary therapeutic management. The increasing trauma rate is one of the main public health problems, requiring epidemiological studies, and the implementation of control strategies. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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18 pages, 7090 KiB

Open AccessArticle

Towards Regenerative Audiology: Immune Modulation of Adipose-Derived Mesenchymal Cells Preconditioned with Citric Acid-Coated Antioxidant-Functionalized Magnetic Nanoparticles

by Adeline Josephine Cumpata, Dragos Peptanariu, Ana-Lacramioara Lungoci, Luminita Labusca, Mariana Pinteala and Luminita Radulescu

Medicina 2023, 59(3), 587; https://doi.org/10.3390/medicina59030587 - 16 Mar 2023

Cited by 1 | Viewed by 2233

Abstract

Introduction and Background: Based on stem cells, bioactive molecules and supportive structures, regenerative medicine (RM) is promising for its potential impact on field of hearing loss by offering innovative solutions for hair cell rescue. Nanotechnology has recently been regarded as a powerful [...] Read more.

Introduction and Background: Based on stem cells, bioactive molecules and supportive structures, regenerative medicine (RM) is promising for its potential impact on field of hearing loss by offering innovative solutions for hair cell rescue. Nanotechnology has recently been regarded as a powerful tool for accelerating the efficiency of RM therapeutic solutions. Adipose-derived mesenchymal cells (ADSCs) have already been tested in clinical trials for their regenerative and immunomodulatory potential in various medical fields; however, the advancement to bedside treatment has proven to be tedious. Innovative solutions are expected to circumvent regulatory and manufacturing issues related to living cell-based therapies. The objectives of the study were to test if human primary ADSCs preconditioned with magnetic nanoparticles coated with citric acid and functionalized with antioxidant protocatechuic acid (MNP-CA-PCA) retain their phenotypic features and if conditioned media elicit immune responses in vitro. MNP-CA-PCA was synthesized and characterized regarding size, colloidal stability as well as antioxidant release profile. Human primary ADSCs preconditioned with MNP-CA-PCA were tested for viability, surface marker expression and mesenchymal lineage differentiation potential. Conditioned media (CM) from ADSCs treated with MNP-CA-PCA were tested for Il-6 and IL-8 cytokine release using ELISA and inhibition of lectin-stimulated peripheral blood monocyte proliferation. Results: MNP-CA-PCA-preconditioned ADSCs display good viability and retain their specific mesenchymal stem cell phenotype. CM from ADSCs conditioned with MNP-CA-PCA do not display increased inflammatory cytokine release and do not induce proliferation of allergen-stimulated allogeneic peripheral blood monocytes in vitro. Conclusions: While further in vitro and in vivo tests are needed to validate these findings, the present results indicated that CM from ADSCs preconditioned with MNP-CA-PCA could be developed as possible cell-free therapies for rescuing auditory hair cells. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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11 pages, 1717 KiB

Open AccessArticle

Patterns and Characteristics of Midface Fractures in North-Eastern Romania

by Andrei-Mihail Roșu, Florentina Severin, Oana Cristina Roșu, Bogdan Mihail Cobzeanu, Stefan Gherasimescu, Florin Petrică Sava, Dragoș Octavian Palade, Cristian Ilie Drochioi, Victor Vlad Costan and Mihail Dan Cobzeanu

Medicina 2023, 59(3), 510; https://doi.org/10.3390/medicina59030510 - 6 Mar 2023

Cited by 3 | Viewed by 2048

Abstract

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional [...] Read more.

Midface fractures are common injuries that are the result of interpersonal violence, traffic accidents, falls, work-related accidents, sports-related accidents, or animal aggression. In the northeastern part of Romania, these injuries are a significant health concern that, if left untreated, may lead to functional and esthetic sequelae. Background and Objectives: This study aims to update the statistical data available to help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Materials and Methods: This research was conducted over five years and included 651 patients of both sexes, with ages between 3 and 95 years, that addressed our center for midface fracture treatment. Results: The authors of this study found that men are more predisposed to fractures of the middle third of the face, with anterior laterofacial fractures being the most common type of fracture. Interpersonal violence was the most incriminated etiology for all midface fractures. Conclusions: The present study regarding midfacial fractures shows similar results compared to the medical literature. These findings could help promote a different lifestyle, with awareness campaigns to prevent aggression, accidents, and domestic violence. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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13 pages, 2444 KiB

Open AccessArticle

The Prevalence and Treatment Costs of Non-Melanoma Skin Cancer in Cluj-Napoca Maxillofacial Center

by Cosmin Ioan Faur, Mădălina Anca Moldovan, Mădălina Văleanu, Horațiu Rotar, Laura Filip and Rareș Călin Roman

Medicina 2023, 59(2), 220; https://doi.org/10.3390/medicina59020220 - 23 Jan 2023

Cited by 9 | Viewed by 2853

Abstract

Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from [...] Read more.

Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients’ features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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Review

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13 pages, 1671 KiB

Open AccessReview

Effect of Infraorbital and/or Infratrochlear Nerve Blocks on Postoperative Care in Patients with Septorhinoplasty: A Meta-Analysis

by Do Hyun Kim, Jun-Beom Park, Sung Won Kim, Gulnaz Stybayeva and Se Hwan Hwang

Medicina 2023, 59(9), 1659; https://doi.org/10.3390/medicina59091659 - 14 Sep 2023

Viewed by 1951

Abstract

Background and Objectives: Through a comprehensive meta-analysis of the pertinent literature, this study evaluated the utility and efficacy of perioperative infraorbital and/or infratrochlear nerve blocks in reducing postoperative pain and related morbidities in patients undergoing septorhinoplasty. Materials and Methods: We reviewed [...] Read more.

Background and Objectives: Through a comprehensive meta-analysis of the pertinent literature, this study evaluated the utility and efficacy of perioperative infraorbital and/or infratrochlear nerve blocks in reducing postoperative pain and related morbidities in patients undergoing septorhinoplasty. Materials and Methods: We reviewed studies retrieved from the PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to August 2023. The analysis included a selection of seven articles that compared a treatment group receiving perioperative infraorbital and/or infratrochlear nerve blocks with a control group that either received a placebo or no treatment. The evaluated outcomes covered parameters such as postoperative pain, the amount and frequency of analgesic medication administration, the incidence of postoperative nausea and vomiting, as well as the manifestation of emergence agitation. Results: The treatment group displayed a significant reduction in postoperative pain (mean difference = −1.7236 [−2.6825; −0.7646], I² = 98.8%), as well as a significant decrease in both the amount (standardized mean difference = −2.4629 [−3.8042; −1.1216], I² = 93.0%) and frequency (odds ratio = 0.3584 [0.1383; 0.9287], I² = 59.7%) of analgesic medication use compared to the control. The incidence of emergence agitation (odds ratio = 0.2040 [0.0907; 0.4590], I² = 0.0%) was notably lower in the treatment group. The incidence of postoperative nausea and vomiting (odds ratio = 0.5393 [0.1309; 2.2218], I² = 60.4%) showed a trend towards reduction, although it was not statistically significant. While no adverse effects reaching statistical significance were reported in the analyzed studies, hematoma (proportional rate = 0.2133 [0.0905; 0.4250], I² = 76.9%) and edema (proportional rate = 0.1935 [0.1048; 0.3296], I² = 57.2%) after blocks appeared at rates of approximately 20%. Conclusions: Infraorbital and/or infratrochlear nerve blocks for septorhinoplasty effectively reduce postoperative pain and emergence agitation without notable adverse outcomes. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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12 pages, 372 KiB

Open AccessReview

Vertigo Associated with Otosclerosis and Stapes Surgery—A Narrative Review

by Violeta Necula, Alma Aurelia Maniu, László-Péter Ujváry, Maximilian-George Dindelegan, Mara Tănase, Mihai Tănase and Cristina Maria Blebea

Medicina 2023, 59(8), 1485; https://doi.org/10.3390/medicina59081485 - 18 Aug 2023

Cited by 3 | Viewed by 3549

Abstract

Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of osteolysis and osteogenesis. This condition progressively leads to hearing loss, tinnitus, and vertigo. Stapedotomy, a surgical procedure involving the [...] Read more.

Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of osteolysis and osteogenesis. This condition progressively leads to hearing loss, tinnitus, and vertigo. Stapedotomy, a surgical procedure involving the removal of the stapes superstructure and its replacement with a prosthesis, is the treatment of choice to improve hearing in individuals with otosclerosis. However, vestibular dysfunction is a significant complication associated with this procedure, which can occur intraoperatively or postoperatively, ranging from the immediate postoperative period to weeks, months, or even years after surgery. This paper aims to provide a comprehensive review of the most important causes of vertigo associated with otosclerosis and stapes surgery with the goal of minimizing the incidence of this complication. Understanding the underlying factors contributing to vertigo in this context is crucial for the prevention and effective management of vertigo in patients undergoing stapedotomy. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

14 pages, 665 KiB

Open AccessReview

Quality Standard for Rehabilitation of Young Deaf Children Receiving Cochlear Implants

by Leo De Raeve, Marinela-Carmen Cumpăt, Aimée van Loo, Isabel Monteiro Costa, Maria Assunção Matos, João Canossa Dias, Cristian Mârțu, Bogdan Cavaleriu, Alois Gherguț, Alexandra Maftei, Ovidiu-Cristian Tudorean, Corina Butnaru, Roxana Șerban, Tatiana Meriacre and Luminița Rădulescu

Medicina 2023, 59(7), 1354; https://doi.org/10.3390/medicina59071354 - 24 Jul 2023

Cited by 3 | Viewed by 3418

Abstract

Background and objectives: More and more children with severe-to-profound hearing loss are receiving cochlear implants (CIs) at an early age to improve their hearing and listening abilities, speech recognition, speech intelligibility, and other aspects of spoken language development. Despite this, the rehabilitation outcomes [...] Read more.

Background and objectives: More and more children with severe-to-profound hearing loss are receiving cochlear implants (CIs) at an early age to improve their hearing and listening abilities, speech recognition, speech intelligibility, and other aspects of spoken language development. Despite this, the rehabilitation outcomes can be very heterogeneous in this population, not only because of issues related to surgery and fitting or the specific characteristics of the child with his/her additional disabilities but also because of huge differences in the quality of the support and rehabilitation offered by the therapist and the family. These quality standards for the rehabilitation of young deaf children receiving CIs are developed within the European KA202 Erasmus+ project “VOICE”—vocational education and training for speech and language therapists and parents for the rehabilitation of children with CIs, Ref. No.: 2020-1-RO01-KA202-080059. Material and methods: To develop these quality standards, we used the input from the face-to-face interviews of 11 local rehabilitation experts in CIs from the four partner countries of the project and the outcomes of the bibliographic analysis of 848 publications retrieved from six databases: Pub Med, Psych Info, CINAHL, Scopus, Eric, and Cochrane. Based on all this information, we created a first set of 32 quality standards over four domains: general, fitting, rehabilitation, and for professionals. Further on, the Delphi method was used by 18 international rehabilitation experts to discuss and agree on these standards. Results: The results from the literature analysis and the interviews show us that more than 90% of the consulted international experts agreed on 29 quality standards. They focus on different aspects of rehabilitation: the multidisciplinary team, their expertise and knowledge, important rehabilitation topics to focus on, and programming issues related to rehabilitation. Conclusions: These quality standards aim to optimize the activity of speech rehabilitation specialists so that they reach the optimal level of expertise. Also presented is the necessary equipment for the IC team to carry out the rehabilitation sessions in good conditions. This set of quality standards can be useful to ensure the appropriate postoperative care of these children. As a result, the rehabilitation process will be more relaxed, and therapists will have the opportunity to focus more on the specific needs of each child, with the provision of quality services, which will result in better results. This theme is particularly complex and dependent on multifactorial aspects of medicine, education, speech therapy, social work, and psychology that are very intricate and interdependent. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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19 pages, 25504 KiB

Open AccessReview

Extracranial Facial Nerve Schwannoma—Histological Surprise or Therapeutic Planning?

by Daniela Vrinceanu, Mihai Dumitru, Matei Popa-Cherecheanu, Andreea Nicoleta Marinescu, Oana-Maria Patrascu and Florin Bobirca

Medicina 2023, 59(6), 1167; https://doi.org/10.3390/medicina59061167 - 17 Jun 2023

Cited by 9 | Viewed by 2624

Abstract

Schwannomas (neurilemomas) are benign, slow-growing, encapsulated, white, yellow, or pink tumors originating in Schwann cells in the sheaths of cranial nerves or myelinated peripheral nerves. Facial nerve schwannomas (FNS) can form anywhere along the course of the nerve, from the pontocerebellar angle to [...] Read more.

Schwannomas (neurilemomas) are benign, slow-growing, encapsulated, white, yellow, or pink tumors originating in Schwann cells in the sheaths of cranial nerves or myelinated peripheral nerves. Facial nerve schwannomas (FNS) can form anywhere along the course of the nerve, from the pontocerebellar angle to the terminal branches of the facial nerve. In this article, we propose a review of the specialized literature regarding the diagnostic and therapeutic management of schwannomas of the extracranial segment of the facial nerve, also presenting our experience in this type of rare neurogenic tumor. The clinical exam reveals pretragial swelling or retromandibular swelling, the extrinsic compression of the lateral oropharyngeal wall like a parapharyngeal tumor. The function of the facial nerve is generally preserved due to the eccentric growth of the tumor pushing on the nerve fibers, and the incidence of peripheral facial paralysis in FNSs is described in 20–27% of cases. Magnetic Resonance Imaging (MRI) examination is the gold standard and describes a mass with iso signal to muscle on T1 and hyper signal to muscle on T2 and a characteristic “darts sign.” The most practical differential diagnoses are pleomorphic adenoma of the parotid gland and glossopharyngeal schwannoma. The surgical approach to FNSs requires an experienced surgeon, and radical ablation by extracapsular dissection with preservation of the facial nerve is the gold standard for the cure. The patient’s informed consent is important regarding the diagnosis of schwannoma and the possibility of facial nerve resection with reconstruction. Frozen section intraoperative examination is necessary to rule out malignancy or when sectioning of the facial nerve fibers is necessary. Alternative therapeutic strategies are imaging monitoring or stereotactic radiosurgery. The main factors which are considered during the management are the extension of the tumor, the presence or not of facial palsy, the experience of the surgeon, and the patient’s options. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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11 pages, 8892 KiB

Open AccessReview

Postoperative Outcomes of Endoscopic versus Microscopic Myringoplasty in Patients with Chronic Otitis Media—A Systematic Review

by Iemima Stefan, Cristian Dragos Stefanescu, Ana Maria Vlad, Viorel Zainea and Răzvan Hainarosie

Medicina 2023, 59(6), 1074; https://doi.org/10.3390/medicina59061074 - 2 Jun 2023

Cited by 3 | Viewed by 3110

Abstract

Endoscopes are increasingly being used in middle ear surgery as an adjunct to or replacement for the operative microscope. The superior visualization of hidden areas and a minimally invasive transcanal approach to the pathology are some of the endoscope’s advantages. The aim of [...] Read more.

Endoscopes are increasingly being used in middle ear surgery as an adjunct to or replacement for the operative microscope. The superior visualization of hidden areas and a minimally invasive transcanal approach to the pathology are some of the endoscope’s advantages. The aim of this review is to compare the surgical outcomes of a totally endoscopic transcanal approach with a conventional microscopic approach for type 1 tympanoplasty in patients with chronic otitis media (COM) in order to establish if endoscopic myringoplasty (EM) could be a better alternative to microscopic myringoplasty (MM). A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. The selected articles were identified by searching PubMed Central, PubMed, MEDLINE and Embase databases for the relevant publications. Only studies where the same surgeon in the department performed both endoscopic and microscopic myringoplasty have been included in the review. The results suggest that with an endoscopic approach, minimally invasive myringoplasty can be achieved with a similar graft success rate and postoperative air–bone gap (ABG) improvement, a shorter operative time and less postoperative complications compared to a microscopic approach. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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9 pages, 3085 KiB

Open AccessReview

Management of Aesthetic and Functional Deficits in Frontal Bone Trauma

by Mihai Dumitru, Daniela Vrinceanu, Bogdan Banica, Romica Cergan, Iulian-Alexandru Taciuc, Felicia Manole and Matei Popa-Cherecheanu

Medicina 2022, 58(12), 1756; https://doi.org/10.3390/medicina58121756 - 30 Nov 2022

Cited by 17 | Viewed by 3881

Abstract

Frontal bone trauma has an increasing incidence and prevalence due to the wide-scale use of personal mobility devices such as motorcycles, electric bicycles, and scooters. Usually, the patients are involved in high-velocity accidents and the resulting lesions could be life-threatening. Moreover, there are [...] Read more.

Frontal bone trauma has an increasing incidence and prevalence due to the wide-scale use of personal mobility devices such as motorcycles, electric bicycles, and scooters. Usually, the patients are involved in high-velocity accidents and the resulting lesions could be life-threatening. Moreover, there are immediate and long-term aesthetic and functional deficits resulting from such pathology. The immediate complications range from local infections in the frontal sinus to infections propagating inside the central nervous system, or the presence of cerebrospinal fluid leaks and vision impairment. We review current trends and available guidelines regarding the management of cases with frontal bone trauma. Treatment options taken into consideration are a conservative attitude towards minor lesions or aggressive surgical management of complex fractures involving the anterior and posterior frontal sinus walls. We illustrate and propose different approaches in the management of cases with long-term complications after frontal bone trauma. The team attending to these patients should unite otorhinolaryngologists, neurosurgeons, ophthalmologists, and maxillofacial surgeons. Take-home message: Only such complex interdisciplinary teams of trained specialists can provide a higher standard of care for complex trauma cases and limit the possible exposure to further legal actions or even malpractice. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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Graphical abstract

Other

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9 pages, 16397 KiB

Open AccessCase Report

Mixed Eccrine Cutaneous Tumor with Folliculo–Sebaceous Differentiation: Case Report and Literature Review

by Dimitrinka Kisova, Tihomir Dikov, Vesela Ivanova, Hristo Stoyanov and Greta Yordanova

Medicina 2023, 59(8), 1465; https://doi.org/10.3390/medicina59081465 - 16 Aug 2023

Cited by 1 | Viewed by 1775

Abstract

Background/Introduction: Cutaneous mixed tumor is a rare benign neoplasm that exhibits a wide range of metaplastic changes and differentiation in the epithelial, myoepithelial, and stromal components, which is often confused with various other skin lesions. Case report: We present an unusual case of [...] Read more.

Background/Introduction: Cutaneous mixed tumor is a rare benign neoplasm that exhibits a wide range of metaplastic changes and differentiation in the epithelial, myoepithelial, and stromal components, which is often confused with various other skin lesions. Case report: We present an unusual case of a 58-year-old woman with a mixed tumor of the upper lip, previously misdiagnosed as adnexal carcinoma on a preoperative biopsy. The excision biopsy shows a well-circumscribed lesion composed of various cells and structures featuring folliculo–sebaceous differentiation embedded in a prominent chondromyxoid stroma. The immunohistochemical study proves the various lineages of differentiation and classifies the neoplasm as the less common eccrine subtype of cutaneous mixed tumor. Discussion: The common embryologic origin of the folliculo–sebaceous apocrine complex leads to a great histological variety of cellular components of mixed tumors and the formation of structures that resemble established types of adnexal neoplasms, which could be a diagnostic pitfall, especially on a small incision biopsy. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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15 pages, 2896 KiB

Open AccessSystematic Review

Comparative Efficacy of Velopharyngeal Surgery Techniques for Obstructive Sleep Apnea: A Systematic Review

by Ana Maria Vlad, Cristian Dragos Stefanescu, Iemima Stefan, Viorel Zainea and Razvan Hainarosie

Medicina 2023, 59(6), 1147; https://doi.org/10.3390/medicina59061147 - 14 Jun 2023

Cited by 2 | Viewed by 2577

Abstract

Background: In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifting from an aggressive removal of redundant excess [...] Read more.

Background: In recent years, surgical interventions for obstructive sleep apnea (OSA) have evolved rapidly, with numerous techniques described in the literature. The approach to velopharyngeal surgery for obstructive sleep apnea has transformed over time, shifting from an aggressive removal of redundant excess soft tissue to less invasive reconstruction techniques that aim to preserve pharyngeal function while effectively managing sleep apnea. This review aims to evaluate and compare the efficacy of the surgical techniques utilized for OSA at the level of the palate and pharynx. It will cover both traditional and novel procedures. Methods: A comprehensive search of the major databases, such as PubMed/MEDLINE, Web of Science, and Scopus, was conducted to identify the relevant literature. We included articles written in English that analyzed the outcomes of adult patients who received velopharyngeal surgery for sleep apnea. Only comparative studies that examined at least two techniques were considered. Results: In all of the studies combined, the total number of patients who underwent velopharyngeal surgery was 614 in eight studies. All surgical procedures resulted in improvements in the apnea–hypopnea index (AHI). The highest success rates and best outcomes were achieved by barbed reposition pharyngoplasty (BRP) in most studies, ranging from 64.29% to 86.6%. BRP also demonstrated the most significant improvements in both objective and subjective parameters closely followed by ESP that obtained similar efficiency in some studies, especially when combined with anterior palatoplasty (AP), but with a higher incidence of complications. While LP showed moderate efficiency compared with BRP or ESP, the UPPP techniques exhibited greater outcome variability among studies, with a success rate ranging from 38.71% to 59.26%, and the best results observed in a multilevel context. Conclusions: In our review, BRP was the most preferred, effective, and safe among all velopharyngeal techniques, closely followed by ESP. However, older described techniques also showed good results in well-selected patients. Larger-scale studies, preferably prospective, that rigorously incorporate DISE-based strict inclusion criteria might be needed to assess the efficacy of different techniques and generalize the findings. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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9 pages, 1828 KiB

Open AccessCase Report

Olfactory Neuroblastoma—A Challenging Fine Line between Metastasis and Hematology

by Trandafir Cornelia Marina, Balica Nicolae Constantin, Baderca Flavia, Sarau Oana Silvana, Poenaru Marioara and Cristian Andrei Sarau

Medicina 2023, 59(4), 731; https://doi.org/10.3390/medicina59040731 - 8 Apr 2023

Cited by 1 | Viewed by 2274

Abstract

Developing in a limited space, rare tumors located at the nose and paranasal sinuses are sometimes difficult to diagnose due to their modest clinical presentation, which is uncorrelated with anatomopathological diversity. This limits the preoperative diagnosis without added immune histochemical study; for that [...] Read more.

Developing in a limited space, rare tumors located at the nose and paranasal sinuses are sometimes difficult to diagnose due to their modest clinical presentation, which is uncorrelated with anatomopathological diversity. This limits the preoperative diagnosis without added immune histochemical study; for that reason, we present our experience with these tumors with the intention of raising awareness. The patient included in our study was investigated by our department through clinical and endoscopic examination, imaging investigations, and an anatomic-pathological study. The selected patient gave consent for participation and inclusion in this research study in compliance with the 1964 Declaration of Helsinki. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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10 pages, 13030 KiB

Open AccessCase Report

Persistent Stapedial Artery, Oval Window Atresia and Congenital Stapes Agenesis—Case Report

by Dan Cristian Gheorghe, Veronica Epure, Doru Oprea and Adina Zamfir-Chiru-Anton

Medicina 2023, 59(3), 461; https://doi.org/10.3390/medicina59030461 - 25 Feb 2023

Cited by 6 | Viewed by 3153

Abstract

Background: The persistent stapedial artery (PSA) is a rare congenital vascular malformation involving the middle ear. It is usually associated with pulsatile tinnitus and/or conductive hearing loss and can account for multiple risks during middle ear surgery. Case Report: we present [...] Read more.

Background: The persistent stapedial artery (PSA) is a rare congenital vascular malformation involving the middle ear. It is usually associated with pulsatile tinnitus and/or conductive hearing loss and can account for multiple risks during middle ear surgery. Case Report: we present a case of a 9-year-old male child with conductive hearing loss and persistent stapedial artery in his right ear, who was admitted to our ENT Department for hearing loss. During surgery, we discovered PSA along with congenital stapes agenesis and oval window atresia, as well as an abnormal trajectory of the mastoid segment of the facial nerve. After ossicular reconstruction (transcanal total ossicular replacement prosthesis) with cochleostomy, no surgical complications were recorded and hearing improvement was monitored by pre- and postoperative audiometry. Conclusion: Stapedial artery is a rare anatomical middle ear abnormality that can prevent proper surgical hearing restoration and can be associated with other simultaneous temporal bone malformations. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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9 pages, 1780 KiB

Open AccessCase Report

The Role of Inverted Papilloma Surgical Removal for Sleep Apnea Treatment Success—A Case Report

by Ana Maria Vlad, Cristian Dragos Stefanescu, Catalina Voiosu and Razvan Hainarosie

Medicina 2023, 59(3), 444; https://doi.org/10.3390/medicina59030444 - 23 Feb 2023

Cited by 1 | Viewed by 3641

Abstract

In recent years, increased attention has been directed to sleep apnea syndrome due to its high prevalence and preventable severe health consequences. Besides enhancing the risk of cardiovascular, cerebrovascular, and metabolic disorders, it determines increased daytime somnolence, cognitive impairment, and delayed reaction time. [...] Read more.

In recent years, increased attention has been directed to sleep apnea syndrome due to its high prevalence and preventable severe health consequences. Besides enhancing the risk of cardiovascular, cerebrovascular, and metabolic disorders, it determines increased daytime somnolence, cognitive impairment, and delayed reaction time. These symptoms, determined by sleep fragmentation and chronic hypoxemia, can result in a decrease in professional performance and, moreover, could have tragic implications, especially in patients with high-risk professions. We present the case of a 58-year-old male-truck driver, known to suffer from uncontrolled OSA and chronic obstructive pulmonary disease, who presented to our ENT department for incapacitating daytime somnolence and severe nasal obstruction. These symptoms were caused by a voluminous sinonasal inverted papilloma, occupying the entire left cavity with extension in the nasopharynx. Following nose permeabilization, the patients’ APAP compliance grew substantially, with a dramatic decrease in daytime sleepiness and improvement in polysomnographic parameters. Due to the overlap syndrome of OSA and COPD, an oxygen supplementation was added to PAP therapy by a pulmonologist, improving pulse-oximetry parameters and resulting in the best outcome for the patient. Through this case report, we aim to emphasize the importance of multimodal, personalized treatment of sleep apnea with a focus on nasal surgical permeabilization. At the same time, we sustain a multidisciplinary approach, especially in patients with sleep apnea and associated pathologies, to obtain therapeutic success. We propose increased attention to the early recognition and proper treatment of sleep apnea in patients with high-risk professions as it prevents catastrophes. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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7 pages, 1923 KiB

Open AccessCase Report

Tongue Base Ectopic Thyroid Tissue—Is It a Rare Encounter?

by Balica Nicolae Constantin, Trandafir Cornelia Marina, Stefanescu Horatiu Eugen, Enatescu Ileana and Gluhovschi Adrian

Medicina 2023, 59(2), 313; https://doi.org/10.3390/medicina59020313 - 8 Feb 2023

Cited by 1 | Viewed by 2151

Abstract

Failure in the embryological development of the thyroid in adults is rarely seen. We present the case of a 79-year-old female patient who complained of dysphagia and progressive upper respiratory obstruction, which started 12 months prior to her admission. An ENT clinical exam [...] Read more.

Failure in the embryological development of the thyroid in adults is rarely seen. We present the case of a 79-year-old female patient who complained of dysphagia and progressive upper respiratory obstruction, which started 12 months prior to her admission. An ENT clinical exam revealed a tongue base, spherical, well-defined tumour covered by normal mucosa. Further assessments established the diagnosis of the tongue base ectopic thyroid tissue. Due to the patient’s symptoms, a transhyoid tongue base tumour removal was performed. The selected patient gave consent for participation and inclusion in this paper, in compliance with the 1964 Helsinki declaration. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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6 pages, 6393 KiB

Open AccessCase Report

Myoepithelial Carcinoma Arising in a Salivary Duct Cyst of the Parotid Gland: Case Presentation

by Michał Gontarz, Jolanta Orłowska-Heitzman, Krzysztof Gąsiorowski, Jakub Bargiel, Tomasz Marecik, Paweł Szczurowski, Jan Zapała and Grażyna Wyszyńska-Pawelec

Medicina 2023, 59(2), 184; https://doi.org/10.3390/medicina59020184 - 17 Jan 2023

Cited by 1 | Viewed by 2453

Abstract

Cystic lesions observed in parotid glands are relatively rare and comprise 2–5% of all parotid primaries. A salivary duct cyst (SDC) is a true cyst representing 10% of all salivary gland cysts. The risk of malignant transformation of SDC’s epithelium is extremely rare. [...] Read more.

Cystic lesions observed in parotid glands are relatively rare and comprise 2–5% of all parotid primaries. A salivary duct cyst (SDC) is a true cyst representing 10% of all salivary gland cysts. The risk of malignant transformation of SDC’s epithelium is extremely rare. In the literature, only three cases of carcinoma ex SDC of the parotid gland are described. This report presents the first in the literature case of myoepithelial carcinoma (MECA) arising from a parotid SDC. A 75-year-old male patient was referred to the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University in Cracow, Poland due to a cystic tumor arising from the right parotid gland. Superficial parotidectomy with facial nerve preservation was performed. Histological examination confirmed a rare case of MECA emerging from the SDC. The immunohistochemical profile of MECA ex SDC was presented. During 6 months of the follow-up, local recurrence or distant metastasis was not observed. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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9 pages, 2263 KiB

Open AccessCase Report

Granulomatosis with Polyangiitis (GPA)—A Multidisciplinary Approach of a Case Report

by Cornelia M. Trandafir, Nicolae Constantin Balica, Delia I. Horhat, Ion C. Mot, Cristian A. Sarau and Marioara Poenaru

Medicina 2022, 58(12), 1837; https://doi.org/10.3390/medicina58121837 - 13 Dec 2022

Viewed by 2186

Abstract

Granulomatosis with polyangiitis is an atypical, multisystem disease with unknown etiology that generally affects both genders equally, with a predominance in the Caucasian racial group for individuals in their fourth decade. The disease affects the small vessels of the respiratory system, lungs, and [...] Read more.

Granulomatosis with polyangiitis is an atypical, multisystem disease with unknown etiology that generally affects both genders equally, with a predominance in the Caucasian racial group for individuals in their fourth decade. The disease affects the small vessels of the respiratory system, lungs, and kidneys. ENT manifestations are common, but ocular involvement is also frequent and can occur as an initial harbinger of the disease. The signs and symptoms of the disease are non-pathognomonic and sometimes localized, but it carries a poor prognosis if left untreated. Early diagnosis of granulomatosis with polyangiitis can be difficult and is established by a clinical examination along with laboratory tests for anti-neutrophil cytoplasmic antibodies (ANCA) and anatomopathological exam results that showcase necrosis, granulomatous inflammation, and vasculitis. Although the ocular involvement is not life threatening, it can cause blindness and may also be a sign of the active form of this systemic fatal disease. Treatment strategies involving immunosuppression and adjuvant therapies improve the prognosis. In this article we present a rare case of a patient diagnosed with granulomatosis with polyangiitis in our ENT department in 2003, with a follow-up for19 years in our clinic. Full article

(This article belongs to the Special Issue Current Trends in Otorhinolaryngology and Head and Neck Pathology)

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