IgG4-related inflammatory orbital pseudotumors : a retrospective case series

Orbital diseases may be divided into congenital defects of the orbit, infectious and inflammatory diseases, orbital tumors (including malignant and benign tumors) and injuries. Idiopathic inflammatory syndromes are often encountered within the orbit and are usually classified as orbital pseudotumors. The etiology of pseudotumors of the vision organ is unknown. Infectious agents, autoimmune disorders and improper healing are taken into consideration in the pathogenesis of this disorder. Thanks to detailed studies conducted in recent years, a new disease syndrome was identified in 2001. It is known as IgG4-related disease, and its differentiation is based on the analysis of IgG4 levels in the affected tissues. Orbital locations of the disease were first reported in Japan as late as at the end of 2009. This finding triggered the European studies on this subject. To date, no such studies have been conducted in Poland. The starting study population consisted of 167 patients with isolated infiltrative tumor diseases within the orbital region treated at the Department of Otolaryngology, Head and Neck Surgery of the Medical College Jagiellonian University in Krakow. Detailed analysis and diagnostic screening for IgG4-related disease was performed in a total of 17 patients diagnosed with orbital pseudotumor

Extensive neck trauma in material of Otolaryngology Department of the Jagiellonian University in Krakow 2009-2012

Isolated laryngeal fractures quite rarely can occur following trauma to the neck region, but because of the variety and dynamic growth of symptoms or possible injury of the main structures on the neck may be life-threatening. The appropriate treatment of these patients is quick surgical intervention proceeded by imaging techniques. Here we report the cases of three patients treated in our Department between 2009 and 2012: two of them with penetrating injury and one with blunt trauma. The appropriate treatment of these patients requires that airway patency be the first priority and if possible quick reconstruction. These cases illustrate the individualized treatment and multidisciplinary approach in managing such cases

Ból ucha a choroby innych narządów w obrębie głowy i szyi

Earache or otalgia may occur as a consequence of the ongoing disease in the ear (primary otalgia) or can be projected pain, which occurs in the course of diseases which have no connection with the organ of hearing (secondary or referred otalgia). In many cases it is difficult to identify the underlaying disease of referred otalgia. The ear receives an extensive sensory innervation arising from six nerve roots: four cranial nerves and two cervical nerves. Many other structures in the head, neck and thorax share a common neuronal pathway with the ear. Consequently, the differential diagnosis is extensive and varied. Making an accurate diagnosis relies on an understanding of the complex distribution of nerve fibres and a structured approach to patient assessment. Referred otalgia may be caused by neoplasms, dental abnormalities, temporomandibular joint dysfunction, cervical arthritis, sinus, pharyngeal or salivary gland infections, or neuralgias. This article reviews the anatomic basis for otalgia, overviews the common etiologies and current treatments.Ból ucha, czyli otalgia może pojawiać się, jako konsekwencja choroby toczącej się w samym uchu (otalgia pierwotna) lub też może być bólem rzutowanym, który pojawia się w przebiegu schorzeń nie mających związku z narządem słuchu (otalgia wtórna). W wielu przypadkach jest trudno zidentyfikować przyczynę bólu ucha. Ucho jest unerwione sensorycznie przez sześć korzeni nerwowych (cztery nerwy czaszkowe i dwa nerwy szyjne). Wiele innych struktur w obrębie głowy, szyi i klatki piersiowej ma wspólne unerwienie z uchem. W związku z tym, diagnostyka różnicowa jest rozległa i skomplikowana. Dokonanie dokładnej diagnozy opiera się na zrozumieniu złożonej dystrybucji włókien nerwowych i całościowego podejścia do oceny stanu pacjenta. Ból ucha może być spowodowany przez: nowotwór, choroby zębów, dysfunkcję stawu skroniowo-żuchwowego, zapalenie stawów szyjnych, zatok, gardła lub infekcję gruczołów ślinowych a także nerwobóle. W pracy omawiamy anatomiczną podstawę rozwoju otalgii, jej etiologię oraz sposoby leczenia

Zatokowy ból twarzoczaszki – trudności diagnostyczne w różnicowaniu

Diagnosis of craniofacial pain is not an easy issue, it is a pr oblem which often requires an interdisciplinary collaboration of experts in the field of otolaryngology, neurology, surgery, dentistry, ophthalmology, radiology and psychiatry. One of the most common symptoms reported by patients with sinusitis is a headache and facial pain. Pathomechanism of facial pain in the course of sinusitis is uncl ear and not fully understood. The impact of a variety of disease causing headache and facial pain is more frequent than expected, as demonstrated by numerous reports on researchers. This group of pain can include myofascial pain, migraine and neuropathic pain. Setting the correct diagnosis is crucial in making appropriate treatment and receive therapeutic success.Diagnostyka bólów części twarzowej czaszki nie jest zagadnieniem łatwym, jest to problem interdyscyplinarny często wymagający współpracy specjalistów z dziedziny otolaryngologii, neurologii, chirurgii. stomatologii szczękowej, stomatologii okulistyki, radiologii i psychiatrii. Jedną z najczęstszych dolegliwości podawanych przez pacjentów z zapaleniem zatok jest ból głowy i twarzy. Patomechanizm bólu twarzy w przebiegu zapalenia zatok jest niejasny i nie do końca wyjaśniony. Wpływ różnorodnych chorób wywołujących ból głowy i twarzy jest częstszy niż przypuszczano, wskazują na to liczne doniesienia badaczy. Do tej grupy bólów zaliczyć można bóle mięśniowo -powięziowe, nadrdzeniowe, migrenowe i ból neuropatyczny. Postawienie właściwego rozpoznania ma kluczowe znaczenie w podjęciu odpowiedniego leczenia i odniesieniu sukcesu terapeutycznego

Immunoglobulin G4-related disease (IgG4-RD) in the orbit : mucosa-associated lymphoid tissue (MALT)-type lymphomas

BACKGROUND: MALT lymphomas were classified for differential diagnostics of IgG4-dependent disease due to their exceptional predilection to intraorbital localization. Therefore, the goal of our studies was large retrospective analysis of patients diagnosed with MALT lymphomas within the orbital tissues, since no such studies have been conducted in Poland. MATERIAL/METHODS: The starting study population consisted of 167 patients with isolated infiltrative tumor diseases within the orbital region treated at the Department of Otolaryngology, Head and Neck Surgery of the Medical College Jagiellonian University in Cracow. The immunohistochemical assays using anti-IgG, anti-IgG4 and anti-CD138 antibodies were used to estimate the IgG4(+)/CD138(+) and IgG4(+)/IgG(+) ratios. RESULTS: Of all the studied and analyzed patients, a final group of 19 patients with orbital MALT lymphomas was selected to undergo diagnostic examinations for IgG4-related disease. Detailed analysis and diagnostic screening for IgG4-related disease was performed and results meeting the criteria of IgG4-dependent disease were obtained in 10 out of 19 patients with the diagnosis of MALT tumor established on the basis of immunohistochemical assays. CONCLUSIONS: MALT lymphomas are the most common of all lymphomas occurring within orbital tissues. In this study, results consistent with the criteria of IgG4-related disease were obtained in approximately 50% patients with immunohistochemical diagnosis of orbital MALT lymphoma