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The aim of this study was to present data of the cochlear implant programme in Crete. Our series consists of 51 patients, 35 adults and 16 children, in a nine year period. The average age of our patients was 31 years (range from three to 68). The average duration of deafness among our patients was seven years (range from two to 22). Our series included 32 postlingual patients and 19 prelingual patients. The cause of deafness in our series was unknown in approximately 40 per cent of cases. Standard selection criteria and operative techniques were used for all cases. Postoperative programming and rehabilitation were performed according to the individual needs of each patient. Implantation was successful in all patients except one who had to undergo a second operation with good results. No major postoperative complications were noted, while minor complications included temporary facial weakness and undesired stimulation of the facial nerve during implant function in two and three patients, respectively. All patients showed significant improvement in perception and discrimination of sound and speech. Better results have been noted in prelingual patients under the age of six, as well as in postlingual adults with a recent history of deafness. As cochlear implant technology evolves and surgical techniques continue to improve, our department will continue its efforts to provide effective hearing rehabilitation of deaf children and adults in Crete. Copyright © 2008 John Wiley & Sons, Ltd [ABSTRACT FROM AUTHOR]

A response by Alexander D. Karatzanis and George A. Velegrakis to a letter to the editor about their article "Anaphylactic reactions on the beach: a cause for concern?" in the 2009 issue is presented.

Abstract: Objective: Mandibular indices, measured on panoramic radiographs, may be useful screening implements for low skeletal bone mass density (BMD). Recent studies suggest that radiographic examination of mandible may constitute an effective process for the early diagnosis of osteoporosis. Biochemical markers of bone turnover may be of value for prediction of individual bone loss and they may help in predicting risk of fracture in elderly women. In contrast to the vast information available on dental radiographic findings and BMD only scarce data exist on the relationship between panoramic mandibular indices and biochemical markers. The aim of this study was to examine the diagnostic performance of dental panoramic radiography and biochemical markers of bone turnover in relation to BMD at the spine in a group of postmenopausal women. Subjects and methods: An assessment of the number of lost teeth, mandibular cortical width (MCW) at the mental region and morphologic classification of mandibular inferior cortex (MIC grade) was performed on dental panoramic radiographs in a group of 141 postmenopausal women 38–81 years of age. BMD at the lumbar spine was measured by dual energy X-ray absorptiometry. BMD values were categorized as normal (T-score greater than 1.0), and as indicative of osteopenia (T-score −1.0 to −2.5) or osteoporosis (T-score less than −2.5) according to the World Health Organization classification. Serum bone alkaline phosphatase (BAP) was measured with an enzyme immunoassay. Cross-linked N-telopeptides of type I collagen (NTx) corrected for creatinine secretion, was measured with a competitive-inhibition enzyme-linked immunosorbent assay ELISA. Results: In our study, a decrease in MCW by 1mm increases the likelihood of osteopenia or osteoporosis to 47% (p-value<0.05), having taken into consideration the effect of the years elapsed since menopause. The increase of alkaline phosphatase (ALP) per unit increase the likelihood of osteopenia or osteoporosis to 14% (p-value<0.05), having checked the effect of the years since menopause. A decrease in MCW by 1mm increases the likelihood of moderately or severely eroded cortex to 97% (p-value<0.001). The increase in ALP per 1 unit increases the likelihood of moderate or severe erosion per 10% (p-value<0.05), taking into account the years since menopause. Conclusions: Our results suggest that dentists have sufficient clinical and radiographic information that enables them to play a significant role in early diagnosis of osteoporosis in postmenopausal women. Panoramic radiographs and biochemical markers of bone turnover may be of value for prediction of individual bone loss and they may help in predicting risk of fracture in elderly women. [Copyright &y& Elsevier]

Objective: The use of mandibular anatomic indicators on panoramic radiographs, i.e. the number of lost teeth, mandibular cortical width at the mental region (MCW), panoramic mandibular index (PMI), alveolar crest resorption degree (M/M ratio) and morphologic classification of the mandibular inferior cortex (MIC grade) can be useful in the evaluation of bone resorption in different age groups of women to determine the presence of osteoporosis. The purpose of this study was to assess the validity of mandibular radiomorphometric measurements and to determine the frequency of tooth loss in postmenopausal women. Subjects and Methods: An assessment of the number of lost teeth, MCW, PMI, M/M ratio and MIC grade was performed on dental panoramic radiographs in a group of 133 postmenopausal women 38-80 years-of-age. BMD at the lumbar spine was measured by dual energy X-ray absorptiometry. BMD values were categorized as normal (T-score greater than 1.0), and as indicative of osteopenia (T-score -1.0 to -2.5) or osteoporosis (T-score less than -2.5) according to the World Health Organization classification. Results: In our study when the T-score at the lumbar spine is decreased, the age of menopause is increased, and the MCW is decreased to a point of statistical significance. A decrease in MCW by 1mm increases the likelihood of osteopenia or osteoporosis to 43%, having taken into consideration the effect of the years elapsed since menopause. It was also shown that age, years since menopause, MCW value, and the number of teeth lost have a statistically important effect on the incidence of moderate or severe cortical erosion. Moreover, when the MCI is C2 or C3 (mild or severe erosions) the age is increased, the years since menopause are increased and the MCW is decreased to a point of statistical significance. As far as tooth loss is concerned, an increase by 1 unit in the number of teeth lost, increase the likelihood of moderate or severe erosion to 6%, having taken into account the years elapsed since menopause. Our study also demonstrated that postmenopausal women tend to lose their teeth at an age older than 50 years. They usually lose the 1st and 2nd mandibular molars and the 1st and 2nd maxillary premolars. Loss of front teeth and canines occurs at an age older than 60 years (except for the lateral maxillary incisors). At a younger age they tend to lose the 2nd maxillary premolars more frequently than their mandibular counterparts. Conclusions: In conclusion, panoramic radiographs constitute an integral part of almost every routine dental evaluation and can be useful for the early diagnosis of osteoporosis in postmenopausal women. Dentists have sufficient clinical and radiographic information that enables them to play a significant role in patient screening for osteoporosis. [ABSTRACT FROM AUTHOR]

Objectives: To assess various prognostic factors influencing the outcome in paediatric patients with serous otitis media, who have undergone laser assisted tympanostomy without ventilation tube placement. Emphasis is given to children with allergies who underwent the procedure. Method: Laser assisted tympanostomy was performed on a total of 130 ears (92 individuals) with chronic otitis media with effusion. To determine the quality of patient outcome, the following parameters were evaluated: external auditory canal anatomy, type of anaesthesia used, tympanic membrane and middle ear fluid characteristics, myringotomy size, a history of allergies and the laser device parameters. Results: Multivariable statistical analysis demonstrated that the presence of allergies in children with chronic serous otitis media is significantly correlated with a poor outcome (P<0.0047). Moreover, the presence of a thick tympanic membrane and/or high viscosity (glue) fluid in the middle ear cavity can also independently influence patient outcome (P<0.025). Simultaneous adenoidectomy and/or tonsillectomy, type of anaesthesia (general versus local), external canal anatomy (wide or narrow) and sex, were not statistically important prognostic factors. The type of anaesthesia used, myringotomy size and the laser device parameters were not found to be associated with patient outcome. Conclusion: A history of allergies, the presence of a thick tympanic membrane and/or high viscosity fluid in the middle ear cavity are all contraindications for laser assisted tympanostomy without tympanostomy tubes, in children who suffer from chronic serous otitis media. The selection criteria for this procedure in the paediatric population are addressed in detail. [Copyright &y& Elsevier]

Objective: Descending goiter has been a focus of controversy in thyroid surgery until nowadays. This study aims to investigate the diagnosis and treatment options of thyroid goiters extending into the mediastinum and the thoracic cavity.Methods and Materials: A retrospective study was conducted assessing all cases of substernal goiter managed in a tertiary care referral center within 22 years. Demographics, clinical, operative, anatomical, and pathological data of the patients were recorded and analyzed.Results: Among 3.028 total thyroidectomies, 212 procedures for substernal goiters were studied. All cases underwent total thyroidectomy. The surgical approach was cervical in all but two cases. A very low rate of complications and zero mortality were noted. Incidence of malignancy on permanent histology was 16%.Conclusion: Descending goiter constitutes a major indication for thyroid surgery. The overwhelming majority of descending goiters may be managed surgically through a neck incision. In experienced hands good results with low morbidity should be expected. Such cases should be considered as challenging, however, and therefore management in a referral center may be necessary in order to ensure optimal results. [ABSTRACT FROM AUTHOR]

We present a case of a desmoid tumor recurrence in a patient with a history of a resected desmoid tumor of the right neck area with free surgical margins six months earlier. The neoplasm was found to invade the parapharyngeal space, and wide excision was performed including most of the sternocleidomastoid muscle (SCM), the thrombosed internal jugular vein (IJV), and the infiltrated spinal accessory nerve (SAN). The histopathologic findings displayed free microscopic margins, with close margins at the site of the parapharyngeal space extension. After 3 months, there was no sign of tumor recurrence. After 6 months, local tumor recurrence was identified on clinical examination and imaging. The decision of the Oncology Board was further treatment with radiotherapy (RT). Response to treatment was satisfactory, and the patient was on close follow-up for twelve months. Desmoid tumors are very rare benign neoplasms of mesenchymal origin with negligible mortality but high morbidity, due to their high recurrence rates, local tissue infiltration, and unpredictable disease course and response to treatment. No universally acceptable treatment protocols have been introduced to date. Appropriate patient counseling and close follow-up are warranted in all cases. [ABSTRACT FROM AUTHOR]

Background Management of advanced laryngeal cancer is complex and ideal strategy is yet to be defined. This study evaluates the experience of a single head and neck oncologic centre in the management of T4 laryngeal cancer. Methods Retrospective assessment of cases primarily treated for T4a squamous cell carcinoma of the larynx, between 1980 and 2007, at a tertiary referral center. Results A total of 384 cases were studied. Five-year disease specific survival was 56.2% and local control 87.4%. Regional and distal control estimates were 90.3% and 88.3% respectively. Prognosis was significantly superior for cases treated with primary surgery compared to cases solely managed with non-surgical modalities. Positive surgical margins and regional disease worsened prognosis. Conclusion This study suggests that primary surgery remains a key element in the treatment of advanced laryngeal cancer. The need for well-designed, prospective, randomised studies in order to further evaluate the remaining role of primary surgery in the modern management of locally advanced laryngeal lesions is emphasized. [ABSTRACT FROM AUTHOR]

Recurrent laryngeal nerve (RLN) palsy is one of the most important complications after thyroid and parathyroid surgery. There is controversy in the literature regarding whether or not intraoperative nerve monitoring decreases the risk of injury. We report our experience using Nerve Integrity Monitoring (NIM) system in cases of revision thyroidectomy, providing clear indications for its use. A series of 97 patients who underwent revision thyroidectomy with and without intraoperative NIM alternately was evaluated. There were 121 RLN patients at risk. Use of NIM during revision thyroidectomy was not statistically significant compared to revision operation without monitoring ( p value = 0.059). Furthermore, comparison of operative times either with or without NIM showed that use of NIM led to statistically significant prolonged operation time ( p value <0.001). There is no strict indication to use RLN monitoring during thyroid surgery, especially as there is no statistical evidence that the use of this technique decreases the incidence of RLN palsy, although there is a trend especially in difficult revision cases. [ABSTRACT FROM AUTHOR]

Abstract: There has been a considerable increase in the diagnosis of allergic diseases over the last decades. Prevalence of allergies in high-income countries and urban areas appears higher than in rural environments. While environmental factors like pollution or nutrition can be important, it is more likely that in the end they have a small association with allergies. Childhood infections and exposure to certain microbial antigens on the other hand seem to present a strong negative correlation with allergies, and therefore the increase of the allergic burden in the Western world has been frequently related to a decline of childhood infections giving birth to the “Hygiene Hypothesis”. We address the issue with emphasis on the associated pathophysiology tightrope walking between the skepticism of the critics, which cast doubt on it, and the pilgrims’ belief of having discovered allergy's Holy Grail. [Copyright &y& Elsevier]

Objective: The purpose of this study was to identify voice risk factors for female kindergarten teachers and nurses in Heraklion, Crete. Patients and Methods: A questionnaire consisting of voice use and lifestyle activities was given to 200 kindergarten teachers in Heraklion, Crete, of which 151 were returned (75.5%). A group of 89 nurses served as the control group. Both groups also completed the Greek version of the Voice Handicap Index (VHI-G). Results: Kindergarten teachers sing more often, speak loudly more often when they are at work and present with more infections of the upper respiratory tract compared to nurses. They talk less than 30 min per day on the phone, drink less alcohol and water and smoke less in comparison with nurses. The median VHI-G score for the kindergarten teachers was significantly higher than that for the nurses. Conclusion: The results suggest that there is a difference in the factors that may be responsible for the appearance of voice problems in kindergarten teachers and in nurses. For kindergarten teachers, the risk factors for voice disorders are primarily related to vocal load factors and for nurses appear to be lifestyle-related more than voice use alone. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The objective of the present study was to investigate the possible electrophysiological time-related changes in auditory pathway during mobile phone electromagnetic field exposure. Thirty healthy rabbits were enrolled in an experimental study of exposure to GSM-900 radiation for 60 min and auditory brainstem responses (ABRs) were recorded at regular time-intervals during exposure. The study subjects were radiated via an adjustable power and frequency radio transmitter for GSM-900 mobile phone emission simulation, designed and manufactured according to the needs of the experiment. The mean absolute latency of waves III-V showed a statistically significant delay (p < 0.05) after 60, 45 and 15 min of exposure to electromagnetic radiation of 900 MHz, respectively. Interwave latency I-III was found to be prolonged after 60 min of radiation exposure in correspondence to wave III absolute latency delay. Interwave latencies I-V and III-V were found with a statistically significant delay (p < 0.05) after 30 min of radiation. No statistically significant delay was found for the same ABR parameters in recordings from the ear contralateral to the radiation source at 60 min radiation exposure compared with baseline ABR. The ABR measurements returned to baseline recordings 24 h after the exposure to electromagnetic radiation of 900 MHz. The prolongation of interval latencies I-V and III-V indicates that exposure to electromagnetic fields emitted by mobile phone can affect the normal electrophysiological activity of the auditory system, and these findings fit the pattern of general responses to a stressor. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Objective: To address the long-term results of our method that combines intranasal laser-assisted dacryocystorhinostomy with the use of surgical microscope. Methods: The procedure is a modification of the West method. A retrospective series of the long-term results are presented in 105 patients that underwent 118 DCR procedures, over the past 6 years. Selection criteria were mainly acquired idiopathic nasolacrimal duct obstruction. Results: 113 DCR cases (95,8%) were free of symptoms postoperatively (mean follow-up: 24 months). Conclusion: Our method when compared with traditional methods is correlated with excellent postoperative long-term results. [Copyright &y& Elsevier]

The aim of this study is to review the long-term results of endonasal endoscopic dacryocystorhinostomy (DCR) according to our experience as well as to evaluate potential prognostic factors for long-term outcomes. The files of 165 patients who underwent endonasal DCR at a tertiary referral centre between 1991 and 2001 were retrospectively assessed. Furthermore, these cases were clinically evaluated at least 5 years after surgery and completed a subjective result evaluation questionnaire. A cure was reported by a total of 112 (67.9%) subjects and significant improvement without need for further treatment was noted in 23 cases (13.9%). Thirty (18.2%) cases were considered as failures. The overall successful outcome according to the subjective symptom evaluation was 81.8%. Poor correlation between clinical findings and subjective report of symptoms was found. None of the prognostic factors that were assessed affected outcomes significantly. In conclusion, long-term success rates for endonasal DCR seem to be comparable to previously published short-term results. [ABSTRACT FROM AUTHOR]

The prevalence of laryngopharyngeal reflux (LPR) has been constantly rising in the western world and affects today an alarmingly high percentage of the general population. Even though LPR and gastroesophageal reflux disease (GERD) are both the product of gastroesophageal reflux and seem to be sibling disorders, they constitute largely different pathological entities. While GERD has been for a long time identified as a source of esophageal disease, LPR has only recently been associated with head and neck disorders. Despite the high incidence of LPR and its great impact on patients’ quality of life, little is known regarding its pathogenesis. On the other hand, studying the molecular and genetic basis of a disease is of fundamental importance in medicine as it offers better insight into the pathogenesis and opens new, disease-specific therapeutic trends. The aim of this study is to enlighten any known or suspected molecular mechanisms that contribute to the pathogenesis of LPR, and to suggest new trends for future research. [ABSTRACT FROM AUTHOR]

Background. The commonest causes of anaphylaxis include hymenoptera bites, high-risk food, exercise, and jellyfish bites and may often be encountered on the beach. Therefore, millions of visitors at popular touristic locations are exposed to increased risk of anaphylactic reactions every year. At least 35 cases of acute allergic reactions requiring medical attention took place on the beaches of Crete, Greece during the previous summer. Objective. To evaluate the level of training of lifeguards working on the beaches of the island of Crete, Greece, with regard to emergency management of anaphylaxis as well as to assess the sufficiency of medical equipment that lifeguards possess to treat an anaphylactic reaction. Methods. A questionnaire was prepared by the authors and administered to 50 lifeguards working on various beaches of Crete. Queries included the definition of anaphylaxis, proper medical treatment, and the existence or not and composition of an emergency kit with regard to the management of acute allergic reactions. Results. Our series consisted of 50 lifeguards, 39 (78%) male and 11 female (22%). Although 41 (80%) lifeguards were aware of an acceptable definition of anaphylaxis, no one knew that epinephrine is the first-choice treatment, and 32 (60%) lifeguards replied that steroids should be used for emergency treatment. Additionally, no one possessed an emergency kit that would qualify for management of acute allergic reactions. Conclusions. The beach should be considered as a high-risk place for the appearance of anaphylactic reactions. Lifeguards who would be the first trained personnel to encounter this condition should be sufficiently trained and equipped for emergency treatment. Our department is currently introducing a training program to local authorities for the proper training and equipping of lifeguards in the island of Crete. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To present the experience of our department on microscopic surgery of the nose and sinuses and compare our results with those of other standard approaches. Furthermore we attempt to specify the main indications for the use of the method. Methods: During the period between January 1990 and December 2002, the prementioned technique was performed in a total of 250 patients. The preoperative evaluation, surgical technique and postoperative management of all patients are described in detail. Results: Most common diagnoses included nasal polyps and chronic rhinosinusitis. The average age of patients was 42 years. Males accounted for 48%. No major postoperative complications were noted. Minor complications such as epistaxis and midfacial pain were observed in 24% of cases. While the majority of patients reported severe symptomatology preoperatively, 91% reported substantial improvement of their clinical condition within 3 months after surgery. Conclusion: Microscopic surgery is a technique which can be used alternatively to traditional procedures. It provides an excellent, clear, stereoscopic vision and allows the surgeon to work bimanually. Complications are rare and easily controlled. Our experience favors the use of microscopic technique compared to common endoscopic approaches, especially in cases of nasal polyps and chronic rhinosinusitis. [Copyright &y& Elsevier]

Allergy is thought to be one of the etiologic factors in otitis media. The purpose of this study was to determine the histopathologic effects of H1 histamine receptor antagonists in an experimental histamine-induced middle ear inflammation model. In group A (20 rabbits), histamine challenge followed a 3-day intramuscular pretreatment with a single dose of 0.1 ml hydroxyzine hydrochloride (50 mg/ml) per day. In group B (20 rabbits), histamine challenge followed a 3-day pretreatment with a single dose 1.2 mg desloratadine per day orally. In group C (20 rabbits), histamine challenge followed a 3-day pretreatment with a single dose 1.2 mg levocetirizine per day orally. On the fourth day after baseline otomicroscopy 0.5 ml histamine 20 mg/ml was injected transtympanically on the right. Middle ear mucosa was removed and the following parameters were assessed: edema, vascular dilatation and congestion, inflammation, acute inflammatory component, presence of eosinophils, activity of the inflammation and fibrosis. A semi-quantitative grading system of 0–3 was used for grading of all parameters and statistical analysis performed by using the Mann–Whitney non-parametric test. Group A mucosae showed lower grades of all the parameters evaluated compared with those of group B. Histopathology of the mucosae of group C showed lower grade of inflammation compared with group B with significant statistical difference for the seven parameters tested. Our data validate the use of antihistamines in the treatment of refractory OME of allergic origin. Oldest H1 antagonists can be replaced by the newest agents who counteract successfully histamine effects, without any interactions or adverse effects from central nervous system. [ABSTRACT FROM AUTHOR]

Background: Tetanus (lockjaw) is a rare disease in developed countries. Methods: An otorhinolaryngologist can be the first physician to see a patient with tetanus. In our department, we have seen 10 such cases presenting with head and neck symptoms. We report 2 of these cases followed by an investigation of the immune status of the adult Cretan population against tetanus using 200 random patients who visited our clinic. Results: A negative history of complete childhood immunization was recorded in 37% of individuals. Of the male population, 88.5% had received active immunization during adulthood, although 47% had received all three doses. Only 12.6% of the females had received full-dose immunization during adulthood, Overall, only 8.5% of the studied population had received either complete immunization or a scheduled booster dose during the last decade. Conclusions: In many cases, an otorhinolaryngologist can be the first physician to examine a patient with tetanus. The incidence of the disease in Crete, Greece, is significantly higher than in most parts of developed countries. [ABSTRACT FROM AUTHOR]

Ectopic internal carotid artery (ICA) is a very rare variation. The major congenital abnormalities of the ICA can be classified as agenesis, aplasia and hypoplasia, and they can be unilateral or bilateral. Anomalies of the neck artery may be vascular neoplasms or ectopic position. Carotid angiograms provide absolute confirmation of an aberrant carotid artery, while EcoColorDoppler (ECD) gives also important information about the evaluation of carotid vassels. Nevertheless Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the neck provide spatial information about the adjacent pharyngeal anatomy and are less invasive than angiogram. Injuries to the ICA during simple pharyngeal surgical procedures can be catastrophic due to the risk of massive bleeding. We report a case of a 56 year-old male patient suffering from dysphagia associated with aberrant ICA manifesting itself as a pulsative protruding of the left lateral wall of the oropharynx. [ABSTRACT FROM AUTHOR]

Laryngomalacia (LRM), is the most common laryngeal abnormality of the newborn, caused by a long curled epiglottis, which prolapses posteriorly. Epiglottis prolapse during inspiration (acquired laryngomalacia) is an unusual cause of airway obstruction and a rare cause of obstructive sleep apnea syndrome (OSAS). We present a minimally invasive technique where epiglottis on cadaveric larynx specimens was treated with CO2 laser. The cartilage reshaping effect induced by laser irradiation was capable of exposing the glottis opening widely. This technique could be used in selected cases of LRM and OSAS due to epiglottis prolapse as an alternative, less morbid approach. [ABSTRACT FROM AUTHOR]

Summary: Objective: To introduce and assess a new method of tonsillectomy with thermal welding technology (TWT) using the thermal ligating shear (TLS2), in pediatric population. Method: TWT provides a new surgical instrument that combines heat and pressure to simultaneously coagulate and divide tissue. Among the headpieces available for the TWT generator, the TLS2 handpiece was selected. A prospective study was conducted in our Department, on 60 children who underwent tonsillectomy with the use of TWT. Inclusion criteria were obstructive sleep apnea syndrome, peritonsilar abscess history and chronic tonsillitis. Patients undergoing adenoidectomy, or any other procedure together with tonsillectomy were excluded from this study. All patients’ data, including intraoperative blood loss, operation time and complication rates were recorded in a database. Results: Our series consisted of 60 patients (39 male and 21 female). There was no measurable bleeding during surgery in any of the cases. The mean operative time was 20min. Only one case of postoperative hemorrhage occurred. Mild uvula edema was noticed in 25 patients. Conclusion: TWT is a safe method for tonsillectomy. Among the several handpieces available for the TWT generator, the TLS2 is very effective and easy to use in tonsillectomy procedures, providing sufficient heamostasis and diminished operative time. [Copyright &y& Elsevier]

Describes the case of a 33-year-old man diagnosed with nasopharyngeal carcinoma. Histologic subtypes of nasopharyngeal carcinoma; Symptoms presented by the patient; Result of the patient's biopsy.

Presents a patient with sweet's syndrome (SS) or acute febrile neutrophilic dermatosis associated with acute rhinosinusitis. Clinical characteristics of SS; Symptoms and causes of the disorder; Medical history of the patient studied.

Background: Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected. Methods: We present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases. Results and discussion: The prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performed. Conclusion: The Baudet technique has been used successfully in two cases of traumatic ear amputation due to human bites. It is a simple technique, without the need for microsurgery, and produces excellent aesthetic results, while preserving all neighboring tissues in case of failure with subsequent need for another operation. [ABSTRACT FROM AUTHOR]

Background: In Greece, primary care is still developing. The aim of this study was to define the epidemiologic profile of common otorhinolaryngological, head and neck disorders in order to help general practitioners to deal with them in a primary care future. Methods: A total of 6771 patients attended the Otorhinolaryngology emergency department of the University General Hospital of Heraklion (Crete), between January and December 2004. All cases were included in this retrospective study. The registry of the Otorhinolaryngology emergency department was analysed and age, sex, seasonality and clinical diagnosis were tabulated. All patients were evaluated by Otorhinolaryngologists. The classification of the cases was based on the main symptom or clinical sign that conditioned the reason for seeking care. Diagnoses were also coded according to the International Classification of Diseases (ICD-10). Results: The male to female ratio was 1:1. The mean age for females was 36.3 years standard deviation (SD): 21.1 and for males was 36.8 years (SD = 22.0). Eight hundred eighty six patients (13.1%) formed the paediatric sub-group. Over 60% of the cases were classified in ten major groups of diagnosis. Acute tonsillitis (12.3%) and acute pharyngitis (9.0%) were the most common causes of all medical visits, followed by otitis media (7.6%) and external ear canal obstruction by ear wax (6.2%). Oedema of the larynx was detected in 0.4%. A negative diagnosis of otorhinolaryngological, head and neck disorder was formulated in 553 patients (8.2%). Hospitalization rate was 5.2%. The highest rate of visits was registered in March. Conclusion: Most patients used the facility as a primary care service. Real emergencies were a minority. Recovering data about which areas of Otorhinolaryngology deserve more emphasis might help primary health care providers to diagnose and manage the common otorhinolaryngological, head and neck disorders properly. [ABSTRACT FROM AUTHOR]

Arteriovenous malformations of the head and neck are rare lesions with unclear pathogenesis. They usually present during childhood, growing proportionately to the child. Although preoperative superselective embolization followed by surgical resection is the treatment of choice, complete removal is often not feasible, leading to high recurrence rates. The case of a patient with an arteriovenous malformation of the floor of the mouth diagnosed late in her adulthood and its management are presented. [ABSTRACT FROM AUTHOR]

Summary: Objective:: To evaluate and introduce a new method of tonsillectomy with the use of Ligasure™ vessel sealing system (LVSS) in pediatric population. Method:: A prospective study was conducted on children undergoing tonsillectomy with the use of LVSS. Indications included chronic tonsillitis, peritonsilar abscess history, and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with bleeding disorders were excluded. Among the available headpieces, the ‘Precise’ instrument was used, both as haemostatic and dissection tool. Intraoperative bleeding, operative time, and complication rates, were evaluated. Results:: Our series consisted of 83 children among 103 patients undergone LVSS tonsillectomy. There was no measurable bleeding during surgery in any of the cases. In 18 children limited peritonsilar edema was noticed. No postoperative hemorrhage or other complication occurred. Mean operative time was 16min. Conclusions:: LVSS was found quite effective and safe, providing sufficient haemostasis, minimal intraoperative blood loss, and safety against the variant Creutzfeld–Jakob disease transmission. [Copyright &y& Elsevier]

The article presents the study on abscess in the cervical prevertebral area secondary to corticosteroid injection. Fasciae are sheet of connective tissues connecting the muscle and the organ together. Within it are layers that organize spaces, including prevertebral space, capable of protecting arteries, veins and plexuses. The prevalence of prevertebral abscess is very rare but a serious type of disease. It is usually a secondary complication after infection in the vertebra.

Objective: To determine the efficacy of the laser-assisted uvulopalatoplasty (LAUP) procedure on snoring and ApneaHypopnea-Index (AHI) improvement in patients with snoring and mild obstructive sleep apnea syndrome (OSAS). Study Design: Prospective, nonrandomized, nonblinded assessment of outcomes after LAUP in patients suffering from benign habitual snoring and/or mild OSAS. Methods: Fifty-nine patients with habitual snoring and 25 patients with mild OSAS underwent LAUP (6 of them underwent simultaneous classic tonsillectomy and 20 carbon-dioxide laser tonsillotomy). All patients and their bed partners completed pre- and post-treatment questionnaires ranking snoring, whereas the patients with mild OSAS underwent postoperative polysomnography (PSG). Results: During a 6-month to 5-year follow-up (mean 40 months), 91.5% of the patients with habitual snoring reported significant short-term improvement based on post-treatment questionnaires, whereas 79.7% reported long-term subjective improvement. Nineteen of 25 patients (76%) with mild OSAS reported significant improvement of snoring based on posttreatment questionnaires. According to the postoperative PSG, only 2% showed a worse AHI, whereas 60% showed reduction of the AHI to < 5. Eight patients (32%) showed little or no improvement of AHI. Conclusions: LAUP, in combination with carbon-dioxide laser tonsillotomy in some cases, is a safe, cost-effective, outpatient procedure for the treatment of many cases of habitual snoring and mild OSAS when preceded by careful selection of the candidates. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study is to review the clinical manifestations associated with small vessel vasculitis (SVV) as they pertain to the head and neck region.Methods: A retrospective analysis was performed, including 34 individuals that filled the American College of Rheumatology criteria for the diagnosis of necrotizing vasculitis. Seven patients were classified as suffering from Wegener's granulomatosis (WG), 18 from microscopic polyangitis (MPA), and the remaining 19 were unclassified (unclassified small vessel vasculitis, USVV).Results: The percentage of ENT manifestations in the early clinical picture of WG patients was 86%, dropping to 44.5 and 22% for MPA and USVV patients, respectively. The overall percentage of ENT manifestations for SVV patients in their initial clinical profile was 47%.Conclusion: The results of our investigation highlight the importance of an ENT clinical examination as a guide for diagnosis of an important percentage of SVV patients. [ABSTRACT FROM AUTHOR]

The earliest reports on removal of the entire tonsil using a method of careful dissection came in the early 1900 s by American and British otorhinolaryngologists. These descriptions are credited as the first of the so-called modern tonsillectomy. In this report we present a technique of tonsillectomy conceived by Nikolaos Taptas, a Greek physician and citizen of the Ottoman Empire, which was introduced at the same period with the ones previously mentioned. Taptas practiced his technique in the very early 1900 s. He used his own instruments and reported excellent post-operative results with very few complications. He should therefore be considered among the pioneers of modern tonsillectomy. [ABSTRACT FROM AUTHOR]

Abstract: Malignant myoepithelioma is a rare salivary gland neoplasm that can arise either de novo or within a pre-existing pleomorphic adenoma. We report a case of malignant myoepithelioma arising from a pleomorphic adenoma of the soft palate. A 70-year-old woman presented in our department with a very large tumor of the soft palate. The patient had a history of a pleomorphic adenoma at the same location that was surgically removed 2 years ago. A second operation, with intraoral excision of the tumor was performed. Histological examination of the recurrence revealed a malignant spindle cell neoplasm with an infiltrative growth pattern and a high mitotic rate. Immunohistochemical investigation confirmed the diagnosis of a low-grade carcinoma of myoepithelial origin with free surgical margins. The patient remains free of disease for more than twelve months after the end of treatment. [Copyright &y& Elsevier]

Abstract: We report the case of a 57-year-old man complaining of headaches and adult onset seizures. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a process which proved to be a huge frontal sinus mucocele, eroding the posterior wall of the frontal sinus and compressing the left frontal lobe. An osteoplastic flap procedure with cranialization and obliteration of the frontal sinus was performed. The seizures and headache disappeared postoperatively. Clinical manifestations, diagnosis and surgical approaches for grand frontal sinus mucoceles are briefly discussed. [Copyright &y& Elsevier]

Voice disorders often remain undiagnosed. Many self-perceived questionnaires exist for various medical conditions. Here, we used the Greek Voice Handicap Index (VHI) to address the aforementioned problem. Everyone can fill in the VHI questionnaire and rate their symptoms easily. The innovative feature of this research is the global cut-off score calculated for the VHI. Therefore, the VHI is now capable of helping clinicians establish a more customizable treatment plan with the cut-off point identifying patients without normal phonation. For the purpose of finding the global cut-off point, a group of 180 participants was recruited in Greece (90 non-dysphonic participants and 90 with different types of dysphonia). The voice disordered group had higher VHI scores than those of the control group. In contrast to previous studies, we provided and validated for the first time the cut-off points for all VHI domains and, finally, a global cut-off point through ROC and precision-recall analysis in a voice disordered population. In practice, a score higher than the well-estimated global score indicates (without intervention) a possible voice disorder. Nevertheless, if the score is near the threshold, then the patient should definitely follow preventive measures. [ABSTRACT FROM AUTHOR]

The article describes the case of an obese 63-year-old woman with hypercapnia due to pneumonia who was admitted to the intensive care unit for monitoring. Topics discussed include her anaesthesiologic evaluation which indicates non-invasive mechanical ventilation, the pulsative mass protruding from the left lateral wall of her oropharynx, and her parapharyngeal internal carotid artery aberrations which is considered a risky condition for tracheal intubation.

The article offers information on the case of an elderly patient who was diagnosed with refractory status epilepticus caused by a partial denture aspirated and embedded in the laryngeal entrance.

Several quizzes about medicine are presented, including a picture quiz on an immunocompromised patient with an ulcerated nasolabial skin lesion, the case of an agitated, 23 year old Afro-Caribbean man, and a randomised controlled trial that investigated the efficacy of a psychological intervention in enhancing the mother-infant relationship and security of infant attachment postpartum.

OBJECTIVE: To investigate the role of ABR (Auditory Brain Stem Response) and ASSR (Auditory Steady State Response) in the diagnosis of sensorineural hearing loss in children. MATERIALS and METHODS: ASSR and click ABR (auditory brain stem response) were used for the detection of sensorineural hearing loss in sixty five children (ages 1 to 6; mean, 14 months old). ASSR and ABR were performed in all cases and statistical analysis was performed. RESULTS: Significant correlation was found between the results of click ABR and ASSR in children with sensorineural hearing loss. CONCLUSION: A significant correlation between the results of ASSR and ABR as a diagnostic method of sensorineural hearing loss inchildren was found. The use of ASSR revealed more information in cases of severe and profound hearing losses. Both techniques should be complementary in the diagnostic approach of hearing problems in pediatric population. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To access the efficacy of ASSR and ABR testing in paediatric patients, without the use of any kind of sedation. MATERIALS and METHODS: Since February 2011 a group of 184 children were examined. In 29 of them (15.8%) there was a need of performing hearing examination using evoked auditory brainstem responses and/or Auditory Steady State Responses without sedation. This was due to contraindications to administration of chloral hydrate, previous reported side effects and the need to perform the examination without the collaboration of a paediatrician. RESULTS: The process of sleep was normal in 24/29 (83%) cases and no disturbances were observed. In the rest 5 cases (17%) the examination had to be repeated several days later.The obtained responses from brainstem were not interfered by any artifacts and basic waves were legible and easy for interpretation. Normal results of the ABR examination were obtained in 21/29 (72%) children, while in 7/28 (24%) various degree of hearing loss was detected. CONCLUSIONS: The results of this study suggested that ABR and/or ASSR examination without sedation can be a reliable alternative and perhaps can be used wider for clinical practice. [ABSTRACT FROM AUTHOR]