Performance measures for upper gastrointestinal endoscopy:A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

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Glossopexy for upper airway obstruction in a patient with Pierre Robin Sequence

Introduction: Pierre Robin sequence (PRS) is a congenital malformation. One of its typical sign is micrognathia, which often causes retroposition of the tongue with possible significant airway obstruction and feeding difficulties. The symptoms usually disappear around one year of the age, when the lower jaw, the oropharynx, and tongue musculature are more developed. If conservative treatment is not sufficient, a surgical procedure such as a tongue-lip adhesion can be performed. Material/Methods: The case report of premature twin baby with PRS is presented. The baby was born at 27th gestation week by Caesarean operation with typical signs of PRS included micrognatia. Immediate postnatal adaptation was good. However, at the age of four month repeated episodes of desaturation occurred. Retroposition of the tongue and very narrow retrolingual space was diagnosed using flexible endoscopy. Repeated episodes of desaturation happened again, so that labioglossopexy was performed. Dehiscence of the suture with repeated episodes of desaturation occurred 11th day after surgery. So that a new tongue-lip adhesion was performed. Further course was uneventful. Three month after surgrery is child doing well, without any episodes of desaturation.Results: Labioglossopexy (tongue-lip adhesion) is an effective procedure of treatment the respiratory obstruction associated with retroposition of the tongue typical for PRS. Surgical technique and its advantages and possible complications are discussed.Conclusions: Labioglossopexy in patients with PRS should be balanced against the other operations, namely tracheostomy and mandibular distraction. Labioglossopexy is less invasive method then tracheostomy, simplifies nursing care, shortens hospital stay and makes homecare less demanding.Der Erstautor gibt keinen Interessenkonflikt an

Surgical Treatment of Nasal Carcinoma Spreading into Infratemporal Fossa

Introduction: Sinonasal malignancies represent less than 1% of all malignancies, the most frequent type (in 70-80%) is squamous cell carcinoma. The standard treatment of the sinonasal squamous cell carcinoma is complete surgical removal and postoperative radiotherapy. The surgery should be as radical as necessary, but as minimally traumatic as possible. As a result of the surgery, aesthetic and/or functional problems may arise in some extensive cases. Methods: A squamous cell carcinoma was diagnosed in 70-year-old patient with obstruction of the left nasal cavity lasting for one month. Computed tomography showed extensive tumor of the paranasal sinuses with destruction of the hard palate and spreading into infratemporal fossa (T4N0M0). Tumor was removed using combination of external (subtotal maxillectomy) and endoscopic approach (infratemporal fossa region). As a part of the surgery, hard palate was resected and large communication between oral and nasal cavity resulting in significant swallowing a speech problems came up. Therefore, as it was planned, the reconstruction of the hard palate with the radial forearm fasciocutaneous free flap was performed one week later. Adjuvant radiotherapy started one month later. Results: Complete removal of the tumor was possible using combined external and endoscopic approach. Hard palate was restored using free flap with perfect swallowing result. Conclusions: Combined external and endoscopic approach with subsequent reconstruction of hard palate can be used as appropriate surgical option for large tumors of the paranasal sinuses with good functional result and preservation of quality of life.Unterstützt durch: Institutional Support of the Ministry of Health no. 2 RVOFNOs/2013, GA MZCR NT13725-4/2012Der Erstautor gibt keinen Interessenkonflikt an