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Cranielle und Spinale Indikationen


We sought to determine the clinical significance of delayed complications after different neurosurgical procedures, such as chronic sinusitis and frontocutaneus fistula. These can be managed by endoscopic closure or by external approach, depending on the cause and extent of sinusitis. We report a case of a 65-year-old woman who was presented to our ENT Department with a frontocutaneus fistula and was surgically managed.


In the recent years, the development of stomatology with emphasis on dental implants procedures has led to an increase in the number of sinonasal complications. Sinonasal complications of dental disease and treatment are an important cause of sinus pathology, being responsible for 10-12% of all causes of chronic maxillary rhinosinusitis.

The main etiological factors involved in odontogenic sinusitis are represented by dental fillings, tooth roots in traumatic extraction, dental implants displacement and parts of broken instruments. The diagnostic work-up includes evaluation of the symptoms, history of dental treatment, dental examination, CT scan and nasal endoscopy.

The treatment is surgical and can be represented by transnasal endoscopic technique performed by the otorhinolaryngologist or a transoral technique performed by the maxillofacial surgeon when oro-antral fistulas are present. The endoscopic approach is preferred but has its limits when the tooth root is placed in the alveolar recess, or at the level of the anterior, medial and lateral wall of the maxillary sinus. Concurrent middle and inferior antrostomy provides a better view of the sinus and increases effectiveness of the surgical treatment with minimal physiological damage.


BACKGROUND. Smell disorders may be classified in quantitative and qualitative. The literature shows that the main causes of odour disorders, both qualitative and quantitative, are due to aging, viral infections and tumors of the upper respiratory tract, craniocerebral trauma, neurodegenerative diseases of the nervous system, drug use or exposure to various toxic substances. Total laryngectomy and oncologic treatment causes smell disorders.

OBJECTIVE. The aim of this study is to evaluate the aspects related to the patient’s smell disorders after total laryngectomy, during the oncological treatment represented by radiotherapy.

MATERIAL AND METHODS. A prospective observational study was performed on a group of 52 patients, over a period of one year (2016-2017), who benefited from total laryngectomy and who underwent oncological treatment, represented by radiotherapy. Patients were evaluated before starting radiotherapy and during radiotherapy sessions. All patients underwent quantitative and qualitative smell assessment.

RESULTS. At the end of week 7 of radiotherapy, none of the patients was considered normosmic, 10 patients were considered to be suffering from hyposmia and 42 from anosmia. Statistically significant changes in the quantitative determination of odour occurred in the fourth week, respectively at the radiation dose of 40Gy. Qualitative odour assessment in this study showed a statistically significant decrease starting with the fifth week of radiotherapy, respectively with a radiation dose of 50Gy.

CONCLUSION. Radiation therapy has a major impact on the quality of life of patients with laryngeal cancer, which has the lowest scores at the beginning and end of the treatment.


The facial nerve, the seventh pair of cranial nerves, has an essential role in non-verbal communication through facial expression. Besides innervating the muscles involved in facial expression, the complex structure of the facial nerve contains sensory fibres involved in the perception of taste and parasympathetic fibres involved in the salivation and tearing processes. Damage to the facial nerve manifested by facial paralysis translates into a decrease or disappearance of mobility of normal facial expression.

Facial nerve palsy is one of the common causes of presenting to the Emergency Room. Most facial paralysis are idiopathic, followed by traumatic, infectious, tumor causes. A special place is occupied by the child’s facial paralysis. Due to the multitude of factors that can determine or favour its appearance, it requires a multidisciplinary evaluation consisting of otorhinolaryngologist, neurologist, ophthalmologist, internist.

Early presentation to the doctor, accurate determination of the cause, correctly performed topographic diagnosis is the key to proper treatment and complete functional recovery.


Surgical treatment of chronic rhinosinusitis is indicated after failure of correctly conducted maximal drug therapy or the occurrence of complications. Radical maxillary sinus surgery has been abandoned nowadays, to the detriment of endoscopic sinus surgery, for several reasons, such as: increased incidence of complications, decreased healing rate compared to the endoscopic technique. The literature cites many situations in which the Caldwell-Luc procedure is used as a first-line surgical technique: recurrent chronic rhinosinusitis, malignant tumors of the maxillary sinus extending to the lateral wall of the nasal fossa and the pterygomaxillary space, the cases where an extensive approach to the pterygopalatine fossa is required – for ligation of the internal maxillary artery or the approach of the vidian canal in vidian neurectomy.

The authors highlight the use of Caldwell-Luc procedure in endoscopic sinus surgery era, by reviewing the complications rates, indications and long-term effectiveness of the two surgical techniques.


BACKGROUND. Complications of rhinosinusitis are rare due to the widespread use of antibiotics. The complications are most commonly seen in young adults due to the presence of highly vascular diploic veins and are relatively infrequent in the elderly population.

CASE REPORT. We present a case of a 70-year-old male admitted to ENT Outpatient Department with chief complain of fever, headache, blurring of vision. The cranio-cerebral MRI revealed fluid collection in the left frontal sinus and in the bilateral frontal lobes. A diagnosis of frontal sinusitis and bilateral frontal lobe abscess was established. We performed endoscopical surgical drainage of the frontal sinus, with pus evacuation and we administered broad-spectrum antibiotic and systemic corticosteroids therapy for 14 days.

CONCLUSION. Rhinosinusitis with intracranial complication in elderly people is scarce to find because of less chance of sinus and middle ear infection and also because of less vascular diploic veins. Also, there may be no history or previous symptoms of sinusitis. A high index of suspicion with early surgical and medical intervention are utmost important in the management of these patients.


Introduction: Graves’ disease (GD), an autoimmune disorder caused by high levels of auto-antibodies against the thyroid-stimulating hormone receptor, is considered the most common cause of thyrotoxicosis, characterized by features such as goiter, ophthalmopathy and dermopathy. In our country, the administration of antithyroid drugs (ATD) is the first line of treatment in this disease. Side effects are rare but some of them, such as agranulocytosis or liver damage, may become serious.

Case presentation: We report the case of a 20-year-old female patient who was diagnosed with GD after being previously diagnosed with viral hepatitis A. Treatment was initiated with methimazole 30 mg/day, and three weeks later she developed intense hepatic cytolysis and cholestatic syndrome, therefore the ATD was stopped. A suspicion of autoimmune liver disease was raised, and a liver biopsy was performed in order to establish the diagnosis. The next therapeutic option for hyperthyroidism was radioactive iodine (RAI). Three months following RAI, the patient presented severe hypothyroidism, thereupon treatment with levothyroxine was initiated.

Conclusions: Although severe acute liver injury is rare, mild liver dysfunction is quite common in patients with GD. The overproduction of thyroid hormones, or the treatment with ATD through immune mediated processes or drug reactions, represent possible mechanisms responsible for liver damage.