Zmiany krtani i gardła dolnego w obrazie gastroskopowym

W czasie badania gastroskopowego, istniej możliwość obserwacji zmian patologicznych w obrębie krtani i gardła środkowego oraz dolnego. Celem pracy jest przedstawienie obrazu najczęściej spotykanych patologii, o różnej etiologii: zmiany zapalne, przednowotworowe oraz nowotworowe, pourazowe, o podłożu neurologicznym; oraz stanów po leczeniu onkologicznym (chirurgia i radioterapia); praca zawiera zarówna zdjęcia wykonane w czasie gastroskopii oraz z badań laryngowideostroboskopowych krtani. Stwierdzenie nieprawidłowość w obrębie krtani i gardła, wymaga diagnostyki laryngologicznej i/lub foniatrycznej. Należy pamiętać, że zmiany organiczne w obrębie krtani mogą być przyczyną powstawania wtórnych zmian czynnościowych, oraz na odwrót – zmiany pierwotne czynnościowe, mogą doprowadzić do powstania zmian organicznych. Zmian jakości głosu, bez widocznych zmian organicznych w obrębie krtani, wymaga pełnej oceny foniatrycznej

Extended Draf IIb Procedures in the Treatment of Frontal Sinus Pathology

ObjectivesDraf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures.MethodsPatients treated with extended Draf IIb procedures in a single center were retrospectively assessed.ResultsTen patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient. Six patients had undergone prior surgery, including external procedures in 3 cases. Modifications of Draf IIb were classified as the following: removal of the anterosuperior nasal septum adjacent to the nasal beak, removal of the intersinus septum, and a combination of the above-mentioned methods (upper nasal septum and intersinus septum removal). There were 3 patients operated on with type 1 modification, one patient with type 2 modification, and 6 patients with type 3 modification. There were no perioperative complications.ConclusionIn selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease

Methods of surgical treatment of bilateral vocal fold paralysis.

Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency withthe preservation of the phonatory and protective functions of the larynx.Bilateral vocal fold paralysis presents as their complete or partial immobilization. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnea. For many years the iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a life-threatening condition requiring not only corticosteroid administration and intubation which only constitute a short-term symptomatic therapy, but also a surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx

Strategy for the surgical treatment of vestibular schwannomas in patients with neurofibromatosis type 2

Objective Guidelines for appropriate management of vestibular schwannomas in NF2 patients are controversial. In this paper we reviewed our experience with patients with NF2 for the results of surgical treatment with particular reference to hearing and facial nerve preservation. Methods We included in the study 30 patients (16 women and 14 men) with the diagnosis of NF2 treated in our department between 1998 and 2014 who underwent surgery for vestibular schwannoma removal with a follow-up for at least 1 year. In 3 cases, the vestibular schwannomas were unilateral. Six patients with bilateral vestibular schwannomas underwent unilateral procedure. Therefore, 51 acoustic tumors were studied in 30 patients. Results No operative death we noted. Significant deterioration to the non-functional level occurred in 19 out of 22 cases with well-preserved preoperative hearing. Only three ears maintained their preoperative good hearing. Hearing was preserved in cases of small schwannoma not exceeding 2cm. Among 21 patients who underwent bilateral operations hearing was preserved in 3 out of 7 cases when smaller tumor or better hearing level side was attempted at first surgery. In contrary none of the 14 patients retained hearing when the first operation concerned the worse-hearing ear. Among 14 tumors up to 2cm there was only one case of moderately severe facial nerve dysfunction (House–Brackmann Grade IV) in the long follow-up. Conclusion Early surgical intervention for vestibular schwannoma in NF2 patient is a viable management strategy to maintain hearing function and preserve facial nerve function

Przyzwojak przebiegający z objawami niedystonicznego kręczu karku

Przyzwojak to rzadki nowotwór wywodzący się z chemoreceptorów ciałek przyzwojowych, należący do licznej grupy nowotworów głowy i szyi. Charakteryzuje się powolnym wzrostem i zróżnicowaną manifestacją kliniczną. Autorzy przedstawili przypadek 63-letniej pacjentki z przyzwojakiem powodującym nieprawidłowe ustawienie głowy oraz jednostronny niedosłuch

Assessment of Dysphagia as a Risk Factor of Chronic Cough

Background: The aim of the study was to determine the prevalence of dysphagia in patients with chronic cough and its relationship with the long-term persistence of these symptoms. Methods: Thirty consecutive patients. All patients underwent physical examination, ENT assessment, videolaryngoscopy, functional phoniatric assessment at rest and speech, Water-Swallow Test, and Fiberoptic Endoscopic Evaluation of Swallowing disorders with Reflux Finding Score. Reflux Symptom Index questionnaire was performed. The study was approved by the local Ethics Committee Review Board (KB/39/A/2016). Results: The results of the RFS and the RSI questionnaire showed the risk of reflux in participating patients. The patients presented episodes of spillage, double swallows, penetration, aspiration and residue of food at the hypopharynx. The results of functional assessment correlated with the Water-Swallow Test. The correlation between Fiberoptic Endoscopic Evaluation of Swallowing disorders and Water-Swallow Test results was found for aspiration risk, spillage, and retention of saliva. Conclusion: The results of the study showed prevalence of dysphagia in most patients with chronic chough. It seems that phoniatric assessment in those cases should be expanded and the following tests should be performed: assessment of the laryngeal elevation, Water-Swallow Test, and Fiberoptic Endoscopic Evaluation of Swallowing disorders