Sinonasal undifferentiated carcinoma: Case report and short literature review

We present a case of a 48-year-old male patient who was admitted in our clinic for right nasal obstruction, antero-posterior mucopurulent rhinorrhea, recurrent right micro-epistaxis, hyposmia, cacosmia and right hemicrania. ENT findings and CT scan detects proliferative, polylobate, vascularized tumor formation occupying the right nasal nostril, with muco-purulent secretions lining the tumor formation. The tumor pushes the intersinusal wall to the side and the nasal septum to the contralateral nostril. The apparent origin is at the level of the right middle nasal meatus, but we could not identify a clear limit from the nasopharynx lateral and posterior wall. Resection of the entire tumor formation was performed under endoscopic control. The histopathological outcome revealed undifferentiated carcinoma; immunohistochemical tests were performed and support the myoepithelial origins.

Method of surgical treatment of chronic dacryocystitis and its effectiveness in monitoring patients in the early postoperative period

The aim. To develop a method for endonasal endoscopic dacryocystorhinostomy (EEDCR) and evaluate its effectiveness in monitoring patients in the early postoperative period. Materials and methods. The study group (1st group) consisted of 45 patients with chronic dacryocystitis (CD), who underwent EEDCR according to the developed method, the comparison group (2nd group) included 36 patients who, after performing the developed EEDCR, an implant was installed in the dacryorhinostoma zone. The control group (3rd group) included 28 patients who underwent EEDCR according to the generally accepted method. Patients of groups 1 and 2 were divided into 2 subgroups: 1A and 2A included patients who underwent computed tomography of the lacrimal ducts in the preoperative period according to the developed method, and patients of subgroups 1B and 2B – according to the traditional algorithm. Reliably the best results of restoring lacrimation function were in subgroups 1A and 1B already from the 3rd day of observation after surgery, as well as in the subsequent periods of observation. The worst values of lacrimation function were recorded in the control clinical group with a statistically significant difference from other groups (p<0.05). When comparing the results of treatment of subgroups 1A with 1B and 2A with 2B, the best indicators were observed in subgroups 1A and 2A, but due to the small sample of patients, statistical significance in the differences could not be achieved (p>0.05). Results. A method of EEDCR has been developed, a comparative analysis of groups of patients according to the above indicators has been performed when observing patients in the early postoperative period. On the first day after surgery, the mean score of the severity of lacrimation according to the Munk scale significantly decreased in all groups and gradually decreased on the 7th day and after 2 weeks (p<0.05). Significantly better indicators were in subgroups 1A and 1B in the entire early postoperative period (p<0.05). The degree of edema of the mucosa of the dacryorhinostoma zone and the middle nasal meatus at all periods of observation was the lowest in subgroup 1A from 3rd day and in each subsequent period of observation with a statistically significant difference from other groups (p<0.05). On the 7th day, significantly more patients with mucous discharge in the area of dacryorhinostoma and middle nasal meatus were observed in subgroup 2B and in 3rd group (p<0.05), and significantly better results were noted in subgroup 1A, where more than 2/3 patients had no mucous discharge. Reliably the best results of restoring lacrimation function were in subgroups 1A and 1B already from the 3rd day of observation after surgery, as well as in the subsequent periods of observation. The worst values of lacrimation function were recorded in the control clinical group with a statistically significant difference from other groups (p<0.05). When comparing the results of treatment of subgroups 1A with 1B and 2A with 2B, the best indicators were observed in subgroups 1A and 2A, but due to the small sample of patients, statistical significance in the differences could not be achieved (p>0.05). Conclusions. The developed EEDCR method complies with the principles of sparing surgery, is effective in the treatment of patients with CD, while there is a faster rate of recovery of the lacrimal function and mucosa, improves the quality of life of patients

A Study on 615 Cases of Idiopathic Epistaxis

Epistaxis is one of the most common complaints encountered in the field of otorhinolaryngology. Although hemostasis can be achieved by outpatient treatment in many cases, we have also encountered some difficult-to-treat patients who developed rebleeding or required admission and surgery. We conducted a retrospective analysis of the clinical features of 615 patients with idiopathic epistaxis who were seen at our hospital between 2012 and 2019. We analyzed the patient data and clinical factors associated with epistaxis, including the age, gender, month (season) of visit to our hospital, accompanying systemic complications, bleeding points, procedures used for treatment, history of rebleeding, and history of hospitalization. The patients with epistaxis were predominantly males in their 70s. In regard to the season of presentation, patients with epistaxis were encountered more frequently in the winter than in the summer. Most patients had initially been treated by electrocoagulation. Hypertension was the most common underlying disease. Rebleeding within 7 days after the primary treatment occurred in 11.5% (71/615) of patients. Analysis identified heart and liver disease and antithrombotic drug use as significant risk factors for rebleeding. Although in the overall subject population the bleeding point was most frequently observed in Kiesselbach plexus area, the bleeding point was observed more often in the middle nasal meatus or olfactory cleft in the patients with rebleeding. The most common indication of hospitalization was difficulty in hemostasis, and the bleeding point in most of the hospitalized cases was unknown or in the posterior nasal cavity. The analysis revealed that it may be important to attempt endoscopic hemostasis in patients in whom the bleeding point is identified in the posterior nasal cavity.

AGE-RELATED VARIABILITY OF THE WIDTH OF THE NASAL MEATUSES ACCORDING TO DATA OF THE CRANIOMETRY

The use of video-endoscopic equipment in pediatric rhino-surgery necessitates a thorough study of the structure of the nasal cavity structures at different age periods. The aim of the study was to study the width of the nasal meatuses in childhood based on craniometrics data. Craniometry of 65 children's skulls was performed, divided into six groups (infancy, early childhood, first and second childhood, adolescence and youth). It was found that the width of the nasal meatuses increases unevenly with the age of the child; periods of the permanency are replaced by periods of growth. The maximum values of the width of the lower and middle nasal meatuses of the skull reach in adolescence, and the general meatuses - in adolescence. Also, an increase in the width of the middle and common nasal meatuses was revealed along their length from the anterior to posterior edges of the nasal conches by an average of 30%, while the width of the lower nasal meatuses remains constant. The ratios of the width of the lower and middle nasal meatuses to the width of the common nasal passages were determined depending on age. The width of the inferior nasal meatus to the width of the common nasal meatus at 1-1.5 years is 1: 2 at the level of the anterior end of the inferior nasal conchae and 1: 3 at the level of its posterior end, in other age groups it is 1: 1.5 and 1: 2 respectively. The width of the middle nasal meatus to the width of the common nasal meatus at the level of both ends of the middle meatus in each age group is 1: 1. The obtained data are of clinical importance for the choice of trans-nasal surgical access, for the choice of the size of endoscopic instruments, the diameter and angle of view of endoscopes, the preservation of age-related physiological relationships of the structures of the nasal cavity, and the reduction of the risk of intraoperative complications. Up to 4 years old, it is recommended to use endoscopes and endoscopic instruments of the smallest diameter; over 4 years old, the size of the nasal passages makes it possible to increase the diameter of the endoscopic set to improve access.

Clinical analysis and surgical treatment of frontal sinus mucoceles: 10 years` experience of seven cases

Introduction/Objective. A mucocele is a benign cystic but extremely expansive change in paranasal cavities, first described in literature by Langenbeck in 1820. The etiology of mucoceles is still a subject of debate. It is assumed that the obstruction of the frontal sinus duct and drainage impairment into the middle nasal meatus, as a consequence of a chronic infection, trauma, or tumor, represent one of the main causes of their occurrence. The aim of this study was to describe ophthalmological and clinical properties of frontal sinus mucoceles. Methods. Our retrospective study covered a period of 10 years during which seven patients with mucocele in the frontal sinus were operated on. Results. Predisposing factors for the appearance of frontal sinus mucoceles were observed in six out of seven patients ? the existence of a previous surgical intervention in two patients, the existence of a previous injury in four, and one patient did not exhibit the existence of predisposing factors. Four out of seven mucoceles were located in the rear segments of the frontal sinus. The destruction of the anterior sinus wall was observed in one patient, while the process propagation toward the endocranium and the orbit was present in three out of the seven patients. Postoperative epistaxis was noted in two out of three patients treated with transfacial approaches. Conclusion. Transcranial and transfacial approaches are treatment methods for advanced mucoceles with a present intraorbital, intracranial, and endonasal process propagation.

The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis

Aim: This multicenter study was focused on the identification of the microorganisms inhabiting the maxillary sinus and middle nasal meatus in chronic rhinosinusitis. Methodology: 112 middle meatus swabs and 112 maxillary sinus aspirates from 103 patients were available for culture. Results: A total of 244 strains of microorganisms representing more than 50 families were identified in the maxillary sinus and middle nasal meatus (164 and 80, respectively). These included 154 (63.0%) strains of aerobic bacteria from 32 species and 90 (37.0%) strains of anaerobic bacteria from 23 species. Aerobes were more common than anaerobes in both the nasal cavity (78.7% vs. 21.3%) and in the maxillary sinus (55.2% vs. 44.8%). Species of Streptococci (28.8%) and Prevotella (17.8%) were the most common findings in the maxillary sinus aspirates. S. pneumonia, H. influenza, and S. aureus were relatively rare, and found in only 6.7%, 5.4%, and 8.9% of the samples, respectively. Conclusions: The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.

Correlation between culture-identified bacteria in the middle nasal meatus and CT score in patients with chronic rhinosinusitis

The aim of this study was to compare bacteriological findings in the middle nasal meatus in patients with chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) and healthy controls, and to investigate the correlation between the prevalence of culture-identified bacteria and the severity of sinus disease. Bacterial culture was performed using a swab from the middle nasal meatus under endoscopic control in 72 patients with CRSwNP, 25 patients with CRSsNP and 59 healthy controls. Computed tomography (CT) scans were graded for severity using the Lund–Mackay scoring system. Patients with more severe forms of CRS with and without nasal polyps had significantly higher rates of pathogenic bacteria in the middle nasal meatus compared with patients with lower CT scores of the paranasal sinuses. There were no significant differences in bacterial species among CRSwNP, CRSsNP and control patients. These results demonstrate, for the first time, that colonization by pathogenic bacteria in patients with CRSwNP and CRSsNP is associated with a more severe form of the disease, as assessed by a pre-operative CT scan of the paranasal sinuses. The results suggest a role for bacterial infection in the pathogenesis of CRS. However, bacteria do not appear to play a role in the development of nasal polyposis in patients with CRS.

Microbiology and Antimicrobial Susceptibility Patterns of Commensal Flora in the Middle Nasal Meatus

Objectives: We examined the microbiology and antimicrobial susceptibility patterns of commensal flora in the middle nasal meatus of normal subjects who were free of health care–associated risks and sinonasal disease. Methods: A prospective study was performed on 70 healthy volunteers without health care–associated risks or sinonasal disease. Middle meatal specimens were carefully taken by an endoscopically guided swab technique. The specimens were cultured for aerobic and anaerobic bacteria. Antimicrobial susceptibility testing was performed by the broth disc method. Results: Bacterial growths were recovered in 66 of the 70 specimens (94.3%). Coagulase-negative staphylococci (CNS) were the most common isolates (61.6%), followed by Staphylococcus aureus (11.6%) and Corynebacterium sp (9.3%). All growths were quantified as very rare (73.3%), rare (13.9%), or few (12.8%). Obligate anaerobic bacteria were not identified. The samples positive for CNS showed multiple resistances to antibiotics, including erythromycin stearate (30.2%), clindamycin hydrochloride (28.3%), oxacillin sodium (a clinical substitute for methicillin sodium; 18.9%), and sulfamethoxazole-trimethoprim (9.4%). Conclusions: A small amount of CNS with or without multiple antibiotic resistances and/or S aureus cultured from the middle meatus can be considered contaminants in middle meatal culture during an episode of rhinosinusitis.

Influence of anatomic variations of the middle nasal meathus on sinonasal diseases

Introduction The most common anatomic variations of the structures of the middle nasal meatus are variations of agger nasi cells, variations of the middle turbinate, variations of uncinate process, variations of the ethmoidal bulla, deviations and deformations of nasal septum in the region of the middle nasal meatus, Haller's cell (orbitoethmoidal) and Onodi's cell(sphenoethmoidal cell). In 1997, the Otorhinolaryngology-Head Neck Surgery, Tasc Force on Chronic Rhinosinusitis defined chronic sinusitis and nasal disease initially by including sinusitis and rhinitis with one term-chronic rhinosinusitis. This was done because it was apparent to many that nasal disoders often affected the sinuses, and vice versa. Also they established baseline parameters, major and minor signs and symptoms, for definition of rhinosinusitis. Two major factors or one major factor and two minor factors constitute a strong history for rhinosinusitis. Material and methods The following methods were used in the study: 1. Anamnestic data processing about: disease symptoms that were recognired by American Academy for ENT as major and minor criteria in diagnosing nosinusitis; the duration of symptoms; the kind of sinonasal disorder and the secondary disorders. 2. Data processing obtained by anterior/posterior rhinoscopy. 3. Data processing obtained by endoscopic examination. 4. Data processing obtained by CT of paranasal cavities and the nose. The data about anatomic variations were statistically processed by Eives's correlation coefficient that indicates the degree of correlation between sinonasal disorders and anatomic variation. Results By analyzing the obtained data in the examined patients with sinonasal disorders, anatomic variations were present in over 50% of the patients and are defined by percentage. I. The deviation of nasal septum in 83.33% patients. 2. The variations of the form of the middle nasal chonha in 58.92% patients. 3. The presence of agger nasi cells in 50% patients. 4. Variations of the form of ethomoidal bulla in 50% patients. Eives's correlation coefficient i.e. the degree of correlation between sinonasal disorders and the presence of anatomic variation statistically significantly correlate at r >/= ft 05 of anatomic variation of the middle nasal chonha (r =0.23) and the presence of deviation/deformation of nasal septum (r = 0.6) with sinonasal disorders. Discussion and conclusion Anatomic variations of the structures of the middle nasal meatus can additionally complicate the anatomy of the lateral nasal wall and the conditions of the ostiomeatal unit. Therefore we must view these variations as factors predisposing to more rapid and frequent appearance and persistence of chronic inflammations. Also, familiary with the variations in sinonasal anatomy is a prerequisite to safe and effective surgical treatment of sinonasal disease. Recognition of this anatomic variation should minimize catastrophic violation of vital structures such as orbit or skull base.