Schwannoma nerwu twarzowego w odcinku pozaczaszkowym – opis przypadku

Schwannoma (nerwiaki osłonkowe) to łagodne, dobrze odgraniczone guzy powstające z komórek Schwanna, tworzących osłonki mielinowe nerwów obwodowych, czaszkowych lub korzeni nerwów rdzeniowych. 25–45% z nich lokalizuje się w obrębie głowy i szyi, głównie w przestrzeni przygardłowej. Lokalizacja wewnątrzprzyusznicza jest rzadko spotykana. Etiologia nowotworu nie jest znana. Diagnostyka przedoperacyjna zarówno radiologiczna, jak i cytologiczna jest trudna i często nie daje prawidłowego rozpoznania. Radiologicznie zwykle podejrzewany jest gruczolak wielopostaciowy, a materiał z biopsji cienkoigłowej nie jest diagnostyczny. Leczenie z wyboru to chirurgiczne usunięcie zmiany z próbą zachowania funkcji nerwu twarzowego

Trudności diagnostyczne w rozpoznaniu COVID-19 u pacjenta po laryngektomii całkowitej

Coronavirus disease (COVID-19) is caused by the SARS-CoV-2 virus and often presents with flu-like symptoms that can have varying degrees, which may subsequently lead to acute respiratory distress (ARDS). The genetic material of the virus in samples of respiratory secretions is identified by way of basic diagnostic tests. Due to the altered course of the respiratory tract, patients after total laryngectomy require special attention in the diagnosis of SARS-CoV-2 infection. We present a case of a patient after laryngectomy who obtained different results of COVID-19 tests depending on the site of sampling.Choroba COVID-19 wywoływana jest przez wirusa SARS-CoV-2 i często manifestuje się objawami grypopodobnymi, które mogą przebiegać z różnym nasileniem. W dalszej kolejności może prowadzić do ostrej niewydolności oddechowej (ARDS). Podstawowe testy diagnostyczne identyfikują materiał genetyczny wirusa w próbkach wydzielin z dróg oddechowych. Chorzy po laryngektomii całkowitej z uwagi na zmieniony przebieg dróg oddechowych wymagają szczególnej uwagi pod względem diagnostyki w kierunku zakażenia SARS-CoV-2. W naszej pracy przedstawiamy przypadek pacjenta po laryngektomii, u którego uzyskano różne wyniki testów w kierunku COVID-19 w zależności od miejsca pobrania próbek. Słowa kluczowe: SARS-CoV-2, laryngektomia, drogi oddechow

A schwannoma of facial nerve in the extracranial segment – a case report

The report aims to present a rare case of facial nerve schwannoma within the parotid gland. Schwannomas are benign, welldefined tumours arising from Schwann cells that form the myelin sheaths of peripheral, cranial or spinal nerves. 25–45% of them are located within the head and neck, mainly in the parapharyngeal space. The intraparotid localisation is rare. The aetiology of cancer is unknown. Preoperative diagnosis, both radiological and cytological, is difficult and often does not give the correct diagnosis. Radiologically, a multiform adenoma is usually suspected, and fine needle aspiration biopsy is nondiagnostic. Due to the rarity and benign nature of the tumour, there has been debate over the need for surgical treatment

Unique Characteristics and Applications of Reverse Superior Labial Artery Island Flaps: A Case Series

Background: The reverse superior labial artery (rSLA) island flap can be used to reconstruct the cheek, ala, columella and vestibule of the nose when other techniques appear insufficient or impractical. The aim of this case series was to present applications of rSLA pedicle flaps in the post-ablative oncologic reconstruction of the face. Patients and Methods: Using a retrospective case-series study design, the investigators enrolled a cohort of patients undergoing procedures involving rSLA flaps treated at a Polish Otolaryngology Department for facial reconstruction after tumour excision. The main outcomes were functional and aesthetic aspects. Descriptive statistics were computed as appropriate. Results and Conclusions: The use of rSLA flaps allows surgeons to obtain a large skin island with only minimal cosmetic and functional alterations. In all of the cases in this series, the use of this pedicle flap resulted in both optimal healing and satisfactory cosmetic and functional outcomes

Effectiveness of Evaluation of Adenoid Hypertrophy in Children by Flexible Nasopharyngoscopy Examination (FNE), Proposed Schema of Frequency of Examination: Cohort Study

Objectives: To demonstrate the effectiveness of endoscopic assessment of the pharyngeal tonsil in defining the size of the adenoid hypertrophy in endoscopic examination that would be equivalent to intraoperative assessment as a large adenoid, and to determine the lowest necessary frequency of tests to assess the variability of its size. Methods: The study is based on an analysis of two groups of children diagnosed and treated in a children’s ENT outpatient clinic and ENT department. In the first group, adenoid size was assessed based on flexible endoscopy, and then with a consequent adenoid surgery with assessment of the intraoperative size of the adenoid, we compared the size of the adenoid. The second part of the study included a group of 81 children. We analyzed performed flexible nasopharyngoscopy examinations (FNE) of each child, and compared the change of adenoid size in a minimum of two subsequent examinations over a period of 1 year or more. Results: The sensitivity of flexible endoscopic examination in the assessment of the pharyngeal tonsil was determined at 97.3%, and specificity at 72.7%. The ROC curve shows the value of adenoid-to-choana (A/C) ratio as 75% or more in the preoperative FNE, indicating that the tonsil during surgery is assessed as large. Among the children, 26.3% had a change in adenoid size of more than 15% in the A/C ratio in 1 year of observation, and 45% of the children had A/C ratio changed above 15% in a period of 3 years of observation. Conclusions: FNE examination is highly effective in assessing the size of the pharyngeal tonsil. We proposed a schema for frequencies of FNE examinations and treatment dependent on A/C ratio and worsening of ailments

The Impact of the Thermal Seasons on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study

Background: The purpose of this study is to analyze seasonal differences in adenoid size and related mucus levels via endoscopy, as well as to estimate changes in middle ear effusion via tympanometry. Methods: In 205 children with adenoid hypertrophy, endoscopic choanal assessment, adenoid hypertrophy assessment using the Bolesławska scale, and mucus coverage assessment using the MASNA scale were performed in two different thermal seasons, summer and winter. The study was conducted in two sequences of examination, summer to winter and winter to summer, constituting two separate groups. Additionally, in order to measure changes in middle ear effusion, tympanometry was performed. Results: Overall, 99 (48.29%) girls and 106 (51.71%) boys, age 2–12 (4.46 ± 1.56) were included in the study. The first group, examined in summer (S/W group), included 100 (48.78%) children, while the group first examined in winter (W/S group) contained 105 (51.22%) children. No significant relationship was observed between the respective degrees of adenoid hypertrophy as measures by the Bolesławska scale between the S/W and W/S groups in winter (p = 0.817) and in summer (p = 0.432). The degrees of mucus coverage of the adenoids using the MASNA scale and tympanograms were also comparable in summer (p = 0.382 and p = 0.757, respectively) and in winter (p = 0.315 and p = 0.252, respectively) between the S/W and W/S groups. In the total sample, analyses of the degrees of adenoid hypertrophy using the Bolesławska three-step scale for seasonality showed that patients analysed in the summer do not differ significantly when compared to patients analysed in the winter (4.39%/57.56%/38.05% vs. 4.88%/54.63%/40.49%, respectively; p = 0.565). In contrast, the amount of mucus on the adenoids increased in winter on the MASNA scale (p = 0.000759). In addition, the results of tympanometry showed deterioration of middle ear function in the winter (p = 0.0000149). Conclusions: The obtained results indicate that the thermal seasons did not influence the size of the pharyngeal tonsils. The increase and change in mucus coverage of the adenoids and deterioration of middle ear tympanometry in winter may be the cause of seasonal clinical deterioration in children, rather than tonsillar hypertrophy. The MASNA scale was found to be useful for comparing endoscopy results

The Long-Term Effects of 12-Week Intranasal Steroid Therapy on Adenoid Size, Its Mucus Coverage and Otitis Media with Effusion: A Cohort Study in Preschool Children

Background: The purpose of this study is to analyse the long-term effects of a 12-week course of topical steroids on adenoid size and its mucus using endoscopy and on middle ear effusion measured by tympanometry. Methods: The study presents an endoscopic choanal assessment of the change in adenoid size (adenoid to choanae ratio, A/C ratio) and its mucus coverage in 165 children with Grade II and III adenoid hypertrophy three to six months after finishing a 12-week course of intranasal steroid treatment with mometasone furoate. Additionally, tympanometry was performed to measure middle ear effusion. Changes in the tympanograms were analysed. Results: The mean A/C ratio before treatment was 65.73%. Three to six months after finishing a 12-week course of intranasal steroid treatment, the mean A/C ratio decreased to 65.52%, although the change was not statistically significant (p = 0.743). There was no change in adenoid mucus according to the MASNA scale before and three to six months after the end of the steroid treatment (p = 0.894). Long-term observations of tympanograms before and three to six months after the end of the treatment did not show improvement (p = 0.428). Conclusions: The results indicate that there was no effect of topical steroids on adenoid size, its mucus and otitis media with effusion (OME) three to six months after finishing a 12-week course of treatment. In the light of performed study, decision of adenoidectomy and tympanostomy should not be procrastinated

Siblings’ Risk of Adenoid Hypertrophy: A Cohort Study in Children

Background: The aim of this study was to compare adenoid size in preschool-age siblings using flexible nasopharyngoscopy examination (FNE) when they reach the same age. The occurrence of adenoid symptoms in these patients was also analyzed. This study was conducted to analyze the adenoid size in siblings when they reach the same age and substantiate a correlation between adenoid hypertrophy (AH) and adenoid symptoms. Methods: We analyzed and reported on the symptoms, ENT examination results, and FNE of 49 pairs of siblings who were examined at the same age. Results: There was a strong association in adenoid size between siblings when they are at a similar age (r = 0.673, p o AH (A/C ratio > 65%) had a risk of IIIo AH 26 times greater than patients whose older sibling did not have IIIo AH (OR = 26.30, 95% CI = 2.82–245.54). Over 90% of snoring children whose siblings had confirmed IIIo AH would develop IIIo AH by the time they reach the same age. Second-born children in whom snoring occurs and whose older siblings have a IIIo AH have about a 46 times higher risk of IIIo AH compared to patients who did not meet these two conditions (p o AH) and their younger sibling presents adenoid symptoms, particularly snoring, it is highly probable that they will also have an overgrown adenoid

Wyniki czynnościowe operacji tympanoplastycznych

Wstęp Tympanoplastyki stanowią obecnie podstawową metodę leczenia przewlekłego zapalenia ucha środkowego, ze względu na oszczędzający charakter i nacisk na rekonstrukcję, co przekłada się na dobre wyniki czynnościowe słuchu. Materiał i metoda Materiał zebrano wśród pacjentów leczonych z powodu przewlekłego zapalenia ucha środkowego w Klinice Otolaryngologii i Laryngologii Onkologicznej Collegium Medicum Uniwersytetu Mikołaja Kopernika w Bydgoszczy w latach 2004-2010. Dokonano analizy wyników audiometrii tonalnej w zależności od typu operacji tympanoplastycznej oraz czasu, jaki upłynął od jej przeprowadzenia. Wyniki Analizując wyniki średniej rezerwy ślimakowej odnotowano poprawę słuchu po operacji w każdym punkcie czasu dla wszystkich typów tympanoplastyk. Istotność statystyczną stwierdzono w grupach 1, 2 oraz 3. W ocenie wyników odległych (po trzech latach od zabiegu) stwierdzono istotne statystycznie pogorszenie wyników jedynie dla tympanoplastyki typu 2. W pozostałych grupach z upływem czasu wyniki nieco pogarszały się, ale nie odnotowano między nimi istotności statystycznej. Wnioski Najlepsze rezultaty funkcjonalne oparte o pomiar rezerwy ślimakowej uzyskujemy po tympanoplastyce typ 1, a najgorsze po tympanoplastyce typ 4. Średnia rezerwa ślimakowa po 3 latach od zabiegu (w obserwacji odległej) notowana po tympanoplastyce typ 2 i tympanoplastyce typ 3 jest podobna, natomiast w obserwacji krótkoterminowej (3 miesiące i 1 rok po zabiegu) jest mniejsza w przypadku tympanoplastyki typu 2. Biorąc po uwagę aspekt upływu czasu poprawa słuchu z użyciem materiału autogennego jest bardziej trwała w przypadku tympanoplastyki typ 3 niż tympanoplastyki typ 2

Functional outcomes of tympanoplasty surgery

Objective: We reviewed functional outcomes of tympanoplasty. Study design: The results of tympanoplastic surgery are changing in time. We present late treatment outcomes among different types of tympanoplasty. Methods: Eighty-six patients who underwent tympanoplasty were enrolled in the study. The results of pure tone audiometry performed 7 days before, then at 3 months, 1 year, and 3 years after the surgery were assessed. Type II tympanoplasty involved implantation of a partial ossicular replacement prosthesis and type III tympanoplasty involved reconstruction with a total ossicular replacement prosthesis and the use of autogenous homogenous material. Statistical analysis was performed. Results: With all four types of tympanoplasty, hearing improvement was achieved at 3 months and 1 year after surgery based on the magnitude of the mean ABG reduction (p<0.001). In patients who underwent type I, type III, and type IV tympanoplasty, the ABG reduction at 3 years after surgery was maintained at the level reported at 3 months and 1 year after surgery (p<0.001). In patients who underwent type II tympanoplasty, however, the mean ABG value was increased at all tested frequencies (p<0.05). The mean ABG values reported 3 years after type II and type III tympanoplasty were similar. Conclusions: Based on the results over time, hearing improvement seems to be less durable after reconstruction with the partial ossicular replacement prosthesis procedure compared to the total ossicular replacement prosthesis procedure