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Extracranielle Indikationen

Abstract

BACKGROUND. Starting from the European and American guidelines regarding sedation during gastrointestinal investigations and continuing with the American Society of Anesthesiologists (ASA) recommendations, we have developed a software that helps the ENT specialist to decide whether the patient can undergo a moderate sedation in the operating room, or in the outpatient office, during the drug-induced sleep endoscopy.

MATERIAL AND METHODS. The application is written in C#, using the. NET Framework, and is available for the Windows operating system. The application has a very simple and user-friendly interface, and a bare-bones implementation, focusing strictly on the decision-making process.

RESULTS. The application involves the information obtained from patient history, clinical examination and polysomnography. After filling all the patient’s data, it will show the result that can be one of the following: ”treatment can be ambulatory”, “treatment should be done in the hospital” or “treatment is not recommended”.

CONCLUSION. The decision-making software application may substitute the evaluation of the anaesthesiologist during drug-induced sleep endoscopy in certain conditions.

Abstract

BACKGROUND. Nasal septum deviations are disorders in which the nasal septum has an abnormal conformation that affects nasal breathing. Surgical correction of the deviated nasal septum, performed by various techniques, is one of the methods of repermeabilization of the upper airway. The aim of the present study was to evaluate the efficacy of endoscopic surgical treatment of the nasal septum deviation on the nasal obstruction, as well as to evaluate the frequency of postoperative complications compared to classical septoplasty.

MATERIAL AND METHODS. A retrospective longitudinal study was performed on a group of 92 patients diagnosed with nasal septal deviation, between 2014-2018. 32 patients were excluded from the study after the exclusion criteria were applied. Two groups of 30 patients each were formed: Group I, endoscopic septoplasty was performed; Group II, the conventional septoplasty was used. An objective endoscopic and rhinomanometric evaluation, as well as a subjective assessment of symptoms (nasal obstruction, headache, posterior rhinorrhea, sneezing), was performed preoperatively and at 3 months postoperatively.

RESULTS. The study showed better results (p<0.05) and fewer complications in endoscopic septoplasty compared to the traditional one, the endoscopic septoplasty providing better lighting and improved access, allowing a limited incision.

CONCLUSION. Endoscopic septoplasty can be considered a reliable alternative to traditional techniques. It is essential to correctly identify the type of preoperative deformity in order to select the appropriate surgical strategy.

Abstract

Fungus ball of the maxillary sinus (FBMS) is the most common form of chronic fungal rhinosinusitis in adults. It is a condition of old age, usually with unilateral involvement, and with female preponderance. It is especially described in immunocompetent individuals and is characterized by a slow and benign evolution. Although the etiology, pathogenesis and natural history of fungal rhino-sinusitis have been studied extensively, they are far from being fully understood. The clinical presentation and endoscopic findings in patients with fungus ball of the maxillary sinus are nonspecific, often identical to those of chronic bacterial rhinosinusitis and the cultures are often negative. Imaging evaluation by CT scan suggests, by characteristic signs, a correct diagnosis, which is then correlated with the histological identification of fungal hyphae. Microbiological, histopathological and mycological examinations of nasal secretion established with certainty a variety of bacteria (70%) and fungi (61.7%) in a group of 60 patients with FBMS included in a three-year study. The most commonly detected bacterial floras were Staphylococcus aureus, Citrobacter Koseri, Haemophilus influenzae, Pseudomonas aeruginosa, Moraxella catarrhalis and Klebsiella oxytoca. On culture media, the most common fungal agents were Aspergillus fumigatus and Aspergillus flavus.

Abstract

Mucoceles are benign, expansive, cystic tumors, affecting especially the adult, with development in the paranasal sinuses. Clinical symptoms are not specific. These are rare conditions that originate within the sinusal mucosa, favoured by the obstruction of the sinus ostium. Due to the inflammation and the expansive character of the tumor, with the erosion of the bony walls, combined forms can develop, with the involvement of two or more sinuses, most frequently with fronto-ethmoidal localization.

The authors carry out a clinical retrospective study on 25 cases of mucoceles of the paranasal sinuses, diagnosed and treated in the ENT Clinic of the “Sfantul Spiridon” Emergency Clinical Hospital Iasi, during 2015-2019. The authors insist on aspects related to clinical and radiological diagnosis (CT scanner), as well as surgical treatment by external approach.

The postoperative evolution is generally simple, with full recovery, without complications or recurrences.

The diagnosis of the mucoceles of the paranasal sinuses consists in radiologic techniques by preoperative CT scan examination, intraoperative macroscopic aspect and histopathological result.

Surgical approach with complete excision of the tumor and creating a new sinusal drainage path prevents the occurrence of recurrences.

Abstract

BACKGROUND. Septoplasty is an age-old surgery performed mainly for a deviated nasal septum. Various methods have been described and the surgery is left to the choice of the surgeon. Traditional septoplasty has taken a back seat in the modern era because of various complications. Newer techniques are being practiced owing to better outcomes. Hydrodissection for septal flap elevation has been both criticized and appreciated because of multiple reasons. In this study, we have used this technique in practice and evaluated its outcome.

MATERIAL AND METHODS. 184 patients with Deviated Nasal Septum (DNS) were evaluated. 82 in Group 1 underwent conventional septoplasty with Freer’s elevator and 102 in Group 2 underwent septoplasty with hydrodissection using Normal Saline (NS). Time taken to perform flap elevation, status of the mucoperichondrial flap intra-operatively and scoring of adhesions 4 weeks postoperatively were the parameters of study.

RESULTS. 19 out of 82 cases had tears in the mucoperichondrium in Group 1, amounting to 23.17%. 11 patients out of 102 had tears in Group 2, amounting to 10.78%. The average time taken to perform the flap elevation was 11 minutes in Group 1 and 5 minutes in Group 2. Average score in crusting/adhesions was 0.66 in Group 1 and 0.53 in Group 2, out of a possible 4.

CONCLUSION. Hydrodissection in septoplasty for the elevation of the mucoperichondrium and mucoperiosteum is a useful step in surgery provided that it is performed using Normal Saline. It is easy to perform, inexpensive and completely safe to perform without any serious complications.