Polish Journal of Otolaryngology最新文献

The authors would like to present the possibilities of reconstructive surgery using free microvascular flaps with bone elements in the treatment of cavities in the head and neck area. The cavities in the presented article resulted both from resection of tumors in the head and neck area as well as congenital defects and radiation damage. The authors would like to discuss the difficulties that may arise during the postoperative period, including the maintenance of the graft's viability, the healing of the donor site and systemic problems. The article presents 33 reconstruction surgeries performed on 31 patients using different flaps, briefly describing their advantages and technical difficulties that may arise during the microvascular anastomoses. The authors emphasise the importance of a well-conducted qualification for the surgery as well as the need to discuss the course of the surgery and recovery and other possible treatment options with patients and their families. The complications that happened in the presented group and how they were treated are described. The authors discuss in details the 3 cases with different types of reconstructive procedures and draw attention to the importance of postoperative care consisting of the constant monitoring of the viability of the graft carried out by qualified personnel of the Otolaryngology Department and appropriately conducted anticoagulant therapy.

Otitis media with effusion (OME), is a common childhood disease and is characterized by long-term fluid retention in the middle ear spaces without signs of acute infection. Surgical treatment of OME in the form of a tympanostomy is one of the most commonly performed medical procedures by pediatric ENT surgeons worldwide. In February 2022, the Journal of Otolaryngology - Head and Neck Surgery published updated guidelines from the American Academy of Otolaryngology - Head and Neck Surgery for tympanostomy tuba in children between 6 months and 12 years of age. They are aimed at both otolaryngologists and pediatricians, as well as other medical personnel who are directly involved in the care of patients with tympanostomy tuba or are candidates for the procedure. The previous version of the guidelines was developed in 2013. With the cooperation of the Board of Expert chaired by the National Consultant in Pediatric Otorhinolaryngology, Prof. Wieslaw Konopka, PhD, during the VII International Conference "Otology, 2022" which took place on September 15-17, 2022 in Torun, the previously published recommendations and consensuses from other countries, both European and non-European, were analyzed and the task of developing new national diagnostic and therapeutic recommendations for OME was undertaken.

SummaryIntroduction. . The aim of the study was the analysis of reasons for the occurrence and treatment results of chronic inflammation of the paranasal sinuses in own materail.

Material and methods: The study was performed on 520 women aged 18 - 87 and 789 men aged 19-85, diagnosed and treated for the chronic inflammation of the paranasal sinuses in 2016 - 2020. The analysis was based on disease medical history, taking into account: gender; age of patients; type of symptoms; allergy diagnosis; probable cause of inflammation; type of anatomical anomalies; assessment of the advancement of lesions based on CT images in the Lund- Mackay scale; number of operations; histopathological result of the removed lesions; complications that occured after surgical treatment.ResultsThe study showed that the hospitalized patients were most often aged 41-50, 51-60 and 31-40 among women and men aged 51-60, 41-50 and 31- 40 . The results of allergological diagnostics among patients with chronic inflammation of the paranasal sinuses showed that women were most often allergic to pyralgin + ketonal + paracetamol + ibuprofen in 4.50 % , to penicillins in 1.07 % and to house dust saprophytes in 0.92%, while among men, positive reactions were found in 3.36 % for pyralgin + ketonal + paracetamol + ibuprofen, 0.99% for house dust saprophytes and 0.92% for cats and dogs fur. Absence of anatomical anomalies was found among 20.75 % of woman and 26.36 % of men, but most often they occurred in the form of nasal septal curvature and excessively dilated middle nasal turbinate. In the histopathological examination of the lesions from the paranasal sinuses, the following were found: chronicinflammation of mucous membrane, chronic polypoid inflammation, chronic cystic inflammation and chronic allergic inflammation.

Conclusions: The main symptoms among patients with chronic inflammation of paranasal sinuses were: nasal congestion + rhinorrhea, nasal congestion + rhinorrhea + smell impairment and nasal congestion + rhinorrhea+ headache. The most common probable causes for chronic inflammation of nasal sinuses among the examined patients were: anatomical anomalies, allergies, irritant factors, including tobacco smoke. Depending on the assessment of the severity of changes in the paranasal sinuses according to the Lund- Mackay scale, it appears that medium and large inflammatory lesions prevailed in the examined patients.

Key words: reason/cause, occurrence, treatment results, chronic inflammation of the paranasal sinuses.

Introduction: Odontogenic infections are polymicrobial in origin and can be life-threatening. Antibacterial failure is an important issue in the treatment of odontogenic infections. This study aimed to determine the factors associated with antibacterial failure in patients with head and neck infections with odontogenic sources.

Material and method: This retrospective epidemiological study was performed using data collected from 229 patients with head and neck infections with an odontogenic source who had been operated on in Shahid Rajaee hospital from March 2014 to December 2019.

Results: 123 (53.7%) patients were female and there were106 (46.3%) males. The mean age ± SD was 33.01±13.37 years (range 7 to 80). The most common offending teeth were lower molars (81.7%) and lower premolars (5.7%). The most common site of infection was the submandibular area (36.4%) followed by the buccal (20.4%) and pterygomandibular (17.1%) regions. The most common pathogen was Streptococcus haemolyticus. The length of hospitalization was higher (4.66 days) in patients with failure of treatment compared to those without it (6.00 days) (p=0.002). A combination of penicillin G and metronidazole was prescribed for all patients with failure of treatment compared with 57.6% in patients without failure of treatment (p=0.002). There was no statistically significant difference between the two groups regarding age, duration of illness before hospitalization, WBC, gender and history of chemotherapy, hypertension, smoking, pregnancy, alcohol usage, diabetes mellitus, the rate of fever, trismus, dysphagia, malaise, antibiotic before hospitalization, and surgical approach.

Conclusion: Possible determinants in this study were not associated with antibacterial failure. Further studies should be conducted to investigate this relationship.

<b>Introduction:</b> Odontogenic infections are polymicrobial in origin and can be life-threatening. Antibacterial failure is an important issue in the treatment of odontogenic infections. Aim: This study aimed to determine the factors associated with antibacterial failure in patients with head and neck infections of odontogenic origin.</br></br> <b>Material and method:</b> This retrospective epidemiological study was performed using data collected from 229 patients with head and neck infections of odontogenic origin who were operated on in Shahid Rajaee hospital from March 2014 to December 2019.</br></br> <b>Results:</b> 123 (53.7%) patients were female and there were 106 (46.3%) males. The mean age SD was 33.01 13.37 years (range 7 to 80). The most common offending teeth were lower molars (81.7%) and lower premolars (5.7%). The most common site of infection was the submandibular area (36.4%) followed by the buccal (20.4%) and pterygomandibular (17.1%) regions. The most common pathogen was Streptococcus haemolyticus. The length of hospitalization was higher (4.66 days) in patients with failure of treatment compared to those without it (6.00 days) (P = 0.002). A combination of penicillin G and metronidazole was prescribed for all patients with failure of treatment compared to 57.6% in patients without failure of treatment (P = 0.002). There was no statistically significant difference between the two groups regarding age, duration of illness before hospitalization, WBC, gender, history of chemotherapy, hypertension, smoking, pregnancy, alcohol consumption, diabetes mellitus, the rate of fever, trismus, dysphagia, malaise, antibiotic before hospitalization, or surgical approach.</br></br> <b>Conclusion:</b> Possible determinants in this study were not associated with antibacterial failure. Further studies should be conducted to investigate this relationship.

Susac syndrome is a rare connective tissue disorder. The pathology affects the small vessels of the brain, retina, and inner ear, and therefore the main symptoms of the disease include encephalopathy, visual disturbances, and sensorineural hearing loss. The aim of this article is to review the current medical knowledge on Susac syndrome and to present our clinical experience regarding this disease entity. In the paper, we are also presenting a case of a 25-year-old patient who was diagnosed with Susac syndrome on the basis of clinical presentation and additional test results. Susac syndrome should be differentiated from multiple sclerosis and other causes of multifocal brain damage as early diagnosis and treatment play a key role in later prognosis.

Susac syndrome is a rare autoimmune vasculopathy involving the small precapillary arterioles of the brain, retina, and inner ear. It is characterized by a triad of symptoms: encephalopathy, visual disturbances due to obstruction of retinal artery branches, and sensorineural hearing loss. The study aimed to review the current medical knowledge on Susac syndrome and present our clinical experience regarding this disease entity. The paper also presents a case of a 25-year-old patient who was diagnosed with Susac's syndrome based on the clinical picture and the results of additional tests. This syndrome should be considered in the differential diagnosis of multiple sclerosis and other multifocal lesions of the central nervous system because early diagnosis of the disease and immunosuppressive treatment significantly alleviates its course and improves the prognosis.

Introduction: COVID-19 pandemic has had a significant impact on healthcare systems around the world. The rapid spread of the virus caused several restrictions, including limited access to outpatient clinics. The purpose of the study was to compare the characteristics and reasons of the visits of otolaryngological patients conducted during the first three waves of the COVID-19 pandemic with those of the prepandemic period.

Materials and methods: Volume, demographic data, type of visits, additional tests, referral types, and reasons for consultation were analyzed.

Results: There were 1578 visits performed before the pandemic and, respectively, 434, 1198 and 1299 during the first, second and third waves. The patients in the first and second waves were older than the patients before the pandemic (mean age 59, 56, and 52 years, respectively, for both comparisons p<0.0001). Regarding the type of visit, the vast majority were in-person visits in all groups. The highest percentage of teleconsultations was in the first wave and was equal to 3.46%. Before the pandemic, patients were admitted mainly due to upper respiratory system diseases (52.15%), while during the first wave the main reasons were tumors (39.86%, malignant and benign tumors comprised 29.26% and 10.6%, respectively).

Conclusions: The COVID-19 pandemic, especially the first wave, changed the profile of ambulatory patients. In the first wave, a higher prevalence of tumor patients and a lower prevalence of patients with diseases of the upper respiratory system were observed. The COVID-19 pandemic caused an increase in number of teleconsultations, but its role was limited.

Introduction: The clinical syndrome that includes asthma, nasal polyps and hypersensitivity to nonsteroidal anti-inflammatory drugs is referred to as airway disease exacerbated by nonsteroidal anti-inflammatory drugs. Patients usually have the most severe form of nasal polyps. Asthma and chronic rhinosinusitis with nasal polyps share a common inflammatory profile, involving type 2 helper T lymphocytes. T-cell activity can be inhibited via the programmed death receptor, PD-1, leading to modulation of the immune response. Therefore, the purpose of this study is to evaluate the expression of genes encoding PD-1 and its ligand PD-L1 in nasal polyp tissue in patients with asthma exacerbated by non-steroidal anti-inflammatory drugs and to correlate the results with clinical data.

Material and methods: The material used for the study consisted of 54 tissue sections of nasal polyps. In the specimens, the expression of PD-1 and PD-L1 genes was determined at the mRNA level by qPCR. Statistical analysis was used to evaluate the results of the study.

Results: The expression of PD-1 and PD-L1 genes in the tissue of polyps was statistically significantly higher than in the nasal mucosa of patients in the control group. In addition, there was a correlation between the expression of both genes at the mRNA level and the severity of nasal polyps in the paranasal sinuses analyzed from computed tomography images of the paranasal sinuses and assessed using the Kennedy scale.

Conclusions: Determining the expression of PD-1 and PD-L1 genes may provide a marker for the severity of polypoid lesions. In addition, learning more about the PD-1/PD-L signaling pathway and how it can be modulated may provide a potential therapeutic strategy for patients with inflammatory diseases.

Introduction: Injury of the external branch of the superior laryngeal nerve can cause a hoarse or weak voice due to the functional loss (dysergia) of the cricothyroid muscle. Defining the anatomical variations of the external branch of the superior laryngeal nerve and estimating the frequency of it, it makes crucial for surgical interventions.

Aim: To reveal the topography of the external branch in the Anatolian population, to prevent injury of it during the surgical intervention in the anterior neck region.

Materials and methods: Twenty-six bilateral hemilarynges (4 females, 22 males) were dissected. The morphometric and morphological features of the external branch were examined. The obtained results were compared statistically left and right.

Results: Landmarks such as the thyroid gland and laryngeal prominence were determined for the detection of the external branch. The variations of the course of the external branch and the points of piercing the cricothyroid muscle or inferior constrictor pharyngeal muscle were evaluated.

Discussion: Although safe approaches have been described for nerve protection during neck surgeries, it can expose injuries during preliminary surgery approaches as the nerve is thinner and more superficial than other branches of the vagus nerve. However, it can be detected more easily and safely during the surgical approach by knowing the defined anatomical landmarks and morphological variations of the external branch.

Conclusion: The anatomical variations described can be a safe and important guide in surgical approaches to be applied in the anterior neck region.