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The etiology of maxillofacial injuries is represented by car accidents, human aggression, and work-related trauma. Trauma to the maxillofacial area requires a complex treatment that involves functional and aesthetic rehabilitation. To restore the functionality of the damaged areas, a correct surgical technique is necessary along with the use of the ideal prostheses for a better reconstruction. Along with the development and improvement of facial fractures osteosynthesis techniques, an attempt was made to identify the right material to complete these surgical methods. We analyze in this paperwork the benefits of polyetheretherketone-based materials in the prosthetics of different facial fractures in comparison with other materials like titanium.

Otitis and middle ear disease present high morbidity rates in spite of current medical treatment, especially in the younger population. Otitis media with effusion (OME) is a chronic disease that is often found in school age children. Its evolution, recurrence, complications and resolution still present a challenge to otologists. For some time, middle ear ventilation tubes were used for this pathology, thus assuring proper middle ear ventilation and higher disease resolution rates. In the current paper, we investigate the connection between ventilation tube usage, the materials out of which they are made, the techniques involved and how these factors may influence disease resolution rates.

Congenital epulis is a rare benign tumor of the newborn that could be detected in the prenatal period. Females are more often affected than males and the premaxillary region is usually the predilection site for this oral mass. Excision is the treatment of choice and no recurrences have been reported so far. We present our experience with two cases of congenital epulis, detected in the second trimester of gestation and treated shortly after birth with no further complications. Histopathology should differentiate between congenital epulis and other congenital oral tumors even if its clinical appearance is usually enough to make a tentative diagnosis. A multidisciplinary assessment in the management of this tumor can avoid unwanted complications such as airway obstruction or bleeding.

Laryngeal papillomatosis represents a challenging disease for the ENT surgeon. It has a recurrent pattern, with lesions that tend to be more and more extensive and affect the quality of life of the patient. Due to it’s viral etiology, multiple medical therapies have been attempted for these patients. Their results are still somewhat controversial, taking into account the local and systemic side effects. Diabetes mellitus (DM) patients are considered to be relatively immunocompromised and the laryngeal papillomatosis is more severe. The lesions occur at an epithelial level. The earlier the diagnosis, the better the outcome of the patient. The advancements made in the field of medical technologies made possible ample surgical interventions that maintain the natural airway. Out of these, the most used today is the CO2 LASER, with good results when correctly managed. The purpose of this paper is to present the use of an endoscopic method of examination, that uses SPIES filters, for a more accurate diagnosis of the epithelial lesions, which allows a better evaluation and more thorough follow-up of our patients. We believe attention should be paid to this topic due to the surgical, epidemiological and biological reasons.

In this prospective, observational, analytical and statistical study we identified the clinical situations in which an oro-tracheal intubation on the pathological larynx is necessary and the necessary conduct in this case. Descriptive analysis of clinical cases selected according to various parameters, calculation of fundamental statistical parameters, their graphical representation was performed using Excel, using the commands Function Statistical, Chart, Picot Tables, Data Analysis. Performing qualitative statistical tests were performed using the exact Fisher test (the exact variant of the Chi-square test). Of all the means of control and facilitation of the oro-tracheal intubation used, the rhino-pharyngeal-laryngo-tracheal fibroscopes were noted. Intra-laryngeal lesions that define „pathological larynx“ represented in our study 88% of patients. The risk of difficult orotracheal intubation (OTI) is due to the presence of pathological larynx.

In recent years, increased attention has been directed to sleep apnea syndrome due to its high prevalence and preventable severe health consequences. Besides enhancing the risk of cardiovascular, cerebrovascular, and metabolic disorders, it determines increased daytime somnolence, cognitive impairment, and delayed reaction time. These symptoms, determined by sleep fragmentation and chronic hypoxemia, can result in a decrease in professional performance and, moreover, could have tragic implications, especially in patients with high-risk professions. We present the case of a 58-year-old male-truck driver, known to suffer from uncontrolled OSA and chronic obstructive pulmonary disease, who presented to our ENT department for incapacitating daytime somnolence and severe nasal obstruction. These symptoms were caused by a voluminous sinonasal inverted papilloma, occupying the entire left cavity with extension in the nasopharynx. Following nose permeabilization, the patients’ APAP compliance grew substantially, with a dramatic decrease in daytime sleepiness and improvement in polysomnographic parameters. Due to the overlap syndrome of OSA and COPD, an oxygen supplementation was added to PAP therapy by a pulmonologist, improving pulse-oximetry parameters and resulting in the best outcome for the patient. Through this case report, we aim to emphasize the importance of multimodal, personalized treatment of sleep apnea with a focus on nasal surgical permeabilization. At the same time, we sustain a multidisciplinary approach, especially in patients with sleep apnea and associated pathologies, to obtain therapeutic success. We propose increased attention to the early recognition and proper treatment of sleep apnea in patients with high-risk professions as it prevents catastrophes.

Sinonasal mucormycosis is an extremely challenging pathology for the ear, nose and throat (ENT) surgeon from a therapeutic point of view. The disease affects immunocompromised patients and exhibits lethal potential. Although the diagnosis is relatively easy to suspect due to the distinctive clinical aspects which consists of black crusting present in the nasal fossae able to be confirmed by biopsy, the treatment requires resection of all affected tissue with safety limits. Due to the tendency of invasion associated with this fungal infection and taking into account the location involved (the sinonasal area) and the grave condition of these patients, it is extremely important to perform only the minimal resection necessary, but that includes all tissue infected by the fungus. This article presents a minimally invasive method of evaluation that can be performed during endoscopic surgical intervention and that aids the surgeon to better evaluate the affected area. It is associated with no additional risks for the patients, but it helps the surgeon to perform the intervention efficiently while not damaging healthy tissue. The authors consider that the method presented will aid the surgeon during the endoscopic surgical intervention in evaluating the lesion and resecting all the affected tissue while preserving healthy areas.

Burn injuries can trigger tissue changes that can explain the variation in the level of different biochemical markers that can be recorded both locally or systemically. Some events observed in burn wounds such as vascular hyperpermeability have been associated with the release of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) after trauma. Because it is unknown whether the serum levels of MMP-9 and TIMP-1 are a consequence of these destructions or a local response to thermal damage, we decided to follow their dynamics. Twenty-five patients (mean age 49.40±17.55 years) with a total body surface area (TBSA) affected by a thermal burn of

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine carcinoma of the skin, with very aggressive behavior. Etiological factors contributing to MCC development, include exposure to UV radiation, infection with Merkel cell polyomavirus (MCPyV) and chronic immunosuppression. It is commonly found in regions of the body that are exposed to sun -55% of cases are located in the head and neck. The 5 years survival rate for metastatic disease is approximately 25%. The estimated mortality rate for MCC is between 33% and 46%. Therapeutic options for MCC depends on disease characteristics (stage of disease at presentation, location of the tumor, regional lymph node involvement, comorbidities and performance status of the patient) and it includes multimodal treatments like surgery, chemotherapy and emerging immunotherapeutic treatments with early promising results. Our clinic experience is very limited with this type of malignancy, only three cases were diagnosed and treated in our department, but with encouraging results regarding the newest immunotherapeutic options, with good quality of life and results similar with the data from the literature.

New non-surgical esthetics is the most dynamic field in contemporary medicine. At the same time, it is greatly influenced by our contemporary society. This paper reviews modern methods used in non-surgical esthetics, especially in Romania. From injectology and non-surgical face lifting to non-surgical body contouring, we analyzed all procedures performed by Romanian physicians, and we show the advantages and disadvantages of the advanced esthetic procedures. Injectology typically implies hyaluronic acid, botox and mesotherapy (for wrinkles and rejuvenation). Laser and radiofrequency treatment are used for wrinkles as well, with fewer unwanted adverse reactions and results exceeding those of injectables. Non-surgical lifting has gained more ground because it requires little recovery time and the results are very positive. Elective treatment for facial discoloration is the laser approach. For non-surgical body contouring, cryolipolisis, vacuum, radio frequency, and infrared systems have all revolutionized this part of esthetics, but each has limitations, and only after establishing the correct course of action, might we think of achieving favorable results and thus raising to the expectations of patients.

Asbestos structure and composition contribute to the lung injury and to the inflammation induced by this natural fiber. The result of this study is that neutrophile to lymphocyte ratio correlates significantly to timing of progress of the radiological lesions in the evolution of patients with asbestosis, followed for 5 years. If confirmed in larger studies, this could become a cost-effective biomarker for the asbestosis evolution.

The treatmentdecision for rhinosinusal tumours requires accurate knowledge of the therapeutic principles specific to each histological type and tumoral extension. Therapy strategies have been developed based on the pathophysiological knowledge and the history of these tumors. Postoperative assessment remains necessary, to establish patient-specific oncological management. The purpose of this study is the retrospective analysis of cases with rhinosinusalmalignancies, diagnosed and treated in the Otolaryngology Unit of the Spiridon Emergency Clinical Hospital in Iasi. We evaluated the characteristics of the patient group using a statistical analysis that highlights the therapeutical modalities used in multimodal treatment, surgical techniques, chemotherapy, radiotherapy, and the therapeutic protocols, all of these beeing adapted to each patient so that, their effectiveness to be maximal. Rinosinusal tumours show particular elements of severity through late diagnosis due to lack of symptomatology, thus limiting the therapeutic means and their curative potential.In order to ensure a correct and complete treatment of this disease, an interdisciplinary collaboration between the ENT surgeon, ophthalmologist, neurosurgeon, imagist, oncotherapist, anatomopathologist, OMF surgeon both preoperatively in the setting of a therapeutic and postoperative strategy is absolutely necessary.Surgery has its well-established place in multimodality complex treatment whether it is curative or palliative.

Cancer of the nasal cavity and paranasal sinuses is a rare malignancy. The tumours of the nasal cavity are thus associated with the maxillary and ethmoidal sinuses. Those that start from the nasal vestibule and nasal septum raise particular problems and, although rare, form a particular group of cases among the rhinosinusal tumours. Radiation exposure, viral infections and constitutional factors were associated with the occurrence of rhinosinusal neoplasia also, but the evidence is inconclusive and indicates that only a small proportion of all squamous carcinomas can be attributed. The purpose of this study is the complex retrospective analysis of the cases of rhinosinusal malignancies diagnosed and treated in the Otolaryngology Clinic of the St. Spiridon Emergency Clinical Hospital in Iasi. We evaluated the characteristics of the patient group using a statistically significant analysis of the age, gender, background, and factors of affiliation. Specific tests and indicators have been used. It is not to be neglected the effects of the poor economic conditions andthe lack of education of the population, by postponing the moment of presentation tophysician, influencing the therapeutic decision, postoperative evolution. Thesepatients often present different degrees of malnutrition,immunodepression, etc. Statistical processing showed that thesepatients have a twofold risk of developing rhinosinusal tumours.

Nocturia, cardio-vascular diseases and diabetes are frequent in patients with sleep related breathing disorders. In this study, we had analyzed the influence of the intermittent hypoxia on nocturia prevalence and found that cardio-vascular diseases, obesity, age and apnea hypopnea indexpredict 27.1% of nocturia�s variance (Nagelkerke R square-=.271, c2= 68.35).In AHI [28, the chance of nocturia is 50% and the difference dependents on the presence or absence of the cardio-vascular diseases. For values of AHI ]28, the risk of nocturia becomes independent of the presence of the cardio-vascular disease.

The formation level of the inferior vena cava in the vertebral column was found to be at the level of L3 -L4 and L5 - S1, with differences between genders. The total length of the inferior vena cava ranged between 187.10 and 278.3 mm. Interiliac angle measured 48.40 and 85.80o. The length of the IVC from its formation point up to the termination of the right renal vein in the IVC ranged between 78.50 and 135.0mm, and the length of the IVC from its formation point to the termination of the left renal vein into the IVC ranged between 89.80 and 119.0mm. The length of the IVC from its formation up to the termination of the hepatic veins ranged between 197.20 and 263.70mm. The diameter of IVC at the point of its formation ranged between 18.0 and 26.20 mm, at the level of the right infrarenal level ranged between 20.10 and 28.70 mm, in 78.08% of the cases. In female cases, the diameter ranged between 18.06 and 25.69 mm, the diameter of the IVC at the level of the right suprarenal ranged between 19.82 and 31.09mm, the diameter at the level of the left infrarenal ranged between 18.59 and 32.49mm, at the level of the left suprarenal vein ranged between 19.10 and 33,80 mm, the diameter at the intrahepatic level ranged between 20.30 and 33.40mm, and the diameter of the IVC at the suprahepatic level ranged between 23.10 and 37.0mm.

Sinonasal inverted papilloma is a rare benign epithelial tumor. Its three main clinical characteristics are the tendency of recurrence, the destructive ability of nearby structures and malignant transformation. The primary manifestations of this tumor include nasal obstruction, headaches, runny nose, hemorrhage and impaired sense of smell. The diagnosis is based on the clinical and endoscopic examination completed by CT or MRI scans and biopsy of the lesion. Allergies, chronic inflammation, nicotinism and viral infections such as HPV infection are considered possible causes of pathogenesis and potential risk factors for relapse and malignancy. The treatment for this condition is the complete removal of the tumor with disease-free margins. Postoperative follow-up is essential for the early detection of recurrence or malignant transformation. One of the most basic and important steps in managing these patients is to acknowledge the presence of the mentioned risk factors and avoid exposure. Due to the high risk of relapse, the follow-up must be aggressive and thorough and always include the endoscopic examination. In our article, we wish to highlight the importance of the proper surgical intervention, but also the difference in the overall outcome of the patient ensured by the correct management of the risk factors, allowing us to prevent recurrence and malignant transformation.

Chemotherapy-induced peripheral neuropathy (CIPN) is the type of toxicity that affects treatment decisions often. Oncology specialists usually grade it using Common Terminology Criteria for Adverse Effects version (CTCAE), with some limitations. Dyck scale is a more objective method that is usually used for diabetic neuropathy grading.The present study included retrospectively registered patients (n=80) treated with platinum salts, taxanes, fluoropyrimidines or vinorelbine that subsequently developed CIPN. In some, the decision to lower the chemotherapy dose or withhold the treatment altogether was taken. CIPN was graded using both CTCAE 4.0 and Dyck scale for each patient. The aim of the study was to determine how the grades of each scale influenced the decision on the oncological treatment and whether objective, measurable changes are directly proportional to the impact CIPN has on the patients life. The present study reports high sensibility for both CTCAE and Dyck scale in deciding to modify the dose or interrupt chemotherapy. CTCAE should have more importance for the clinician in the early stages of CIPN. If CIPN presents as advanced, a less subjective alternative like the Dyck scale is a more suitable alternative. Dyck scale should be the most important argument in the decision regarding oncological treatment if the patients� scores more than 2a on this grading system.The decision to lower the dosage or stop oncological treatment due to CIPN is a complex one and both grading systems are useful. However, when dealing with a more severe case of CIPN, the more objective Dyck scale should be the more important argument.

Noise is considered as an unpleasant sound . Since ancient times noise was perceived like a disruptive element. In the last three centuries, particularly in industrialized countries, the noise became a major public health issue, especially for the hearing system. The harmful effects of noise are felt not only by the hearing system, but also by other systems (cardiovascular, central nervous system by affecting sleep and cognition) and it was recently pinpointed that the immune system and the fetus are affected. Studies conducted in several large cities from Romania, starting with the year 2000 show that a significant percent of population living in urban areas is exposed to over 55 dB noise during the day and above 50dB at night, the situation being identical with the one existing in other EU countries. There are more than two decades since the EU has been working on developing a harmonized noise policy. Until 2020, the EU policy s main objective is to ensure that noise pollution in the Union will significantly decrease, moving closer to WHO-recommended levels .

Otalgia during airplane flights is a common complaint among patients. This occurs due to the changes in air pressure during take-off and landing that affect middle ear and inner ear. The eustachian tube is responsible with equalizing pressure but in many cases, it happens insufficiently leading to mild to severe pain, hearing loss, tympanic membrane rupture and even inner ear lesions. The aim of this paper is to asses the efficacy of two decongestants, oral pseudoephedrine versus topical xylometazoline in preventing otic barotrauma.

Evidence regarding the relation between SARS-CoV-2 mortality and the underlying medical condition is scarce. We conducted an observational, retrospective study based on Romanian official data about location, age, sex and comorbidities for COVID-19 fatalities. Our findings indicate that males, hypertension, diabetes, obesity and chronic kidney disease were most frequent in the COVID-19 fatalities, that the burden of disease was low, and that the prognosis for 1-year survival probability was high in the sample. Evidence shows that age-dependent pairs of comorbidities could be a negative prognosis factor for the severity of disease for the SARS-CoV 2 infection.

Since their first mention, almost 60 years ago, there were a plethora of articles about oxidative stress and antioxidants, published in a wide range of journals (biochemistry, cell physiology, molecular biology or environmental biology). Also, in the last decade the definition of oxidative stress (OS) undergone different changes, and currently OS is seen as a disruption of redox signalling and control. This review aims to offer the perspective of Complexity Theory on antioxidants framework, and diabetes disease is taken as an example.

There is ongoing debate regarding the role of neck dissection in differentiated thyroid cancer, about its usefulness in elective settings, and the increased costs regarding morbidity and operative time. This retrospective study aimed to determine the rate of metastases in cervical lymph nodes, to examine the morbidity of this surgery, and to assess whether a pattern of distribution of tumor cells concerning neck lymphatic compartments exists. The most frequent type of cancer to metastasize was papillary cancer, the majority of patients were young with a median of 30 years, predominantly females. Differentiated thyroid cancer frequently metastasizes to the central and lateral compartments of the neck. The morbidity is minimal in a high-volume center. Radical neck dissection is safe and feasible in selected patients with confirmed invaded or enlarged lymph nodes due to differentiated thyroid cancer, and postoperative complications are minimal if the anatomy is correctly identified and the cases strictly selected.

Melatonin, the primary hormone produced by the pineal gland, is intensely assessed for its anticancer properties. This study aimed to reveal the clinical significance of serum melatonin levels in predicting the severity of oral squamous cell carcinoma (OSCC). For this purpose, 40 male patients with OSCC and 30 healthy subjects were enrolled in this study. The serum levels of melatonin were determined by ELISA. The results revealed that the melatonin concentrations were significantly lower in the patients with OSCC compared with the controls (18.2 vs. 47.6 pg/ml, P

Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by repeated breathing pauses during sleep, with slee disruption, intermittent hypoxia, and cardiac, metabolic and neuropsychological disturbances. Metabolic syndrome (MS) is an association of cardiovascular risk factors centered on insulin resistance.The study objective is to calculate the prevalence of MS and its components in a large group of OSAHS patients. We evaluated 350 patients addressed to The Military Hospital Iasi between 2016 and 2017 from the clinical, metabolic and polygraphic poins of view. In 235 of the 350 de patients we found OSAHS. Of the 235 patients with OSAHS, 140 (60%) meet the criteria for MS, versus 29% of the group withut OSAHS (OR = 3.608, CI = 2.1787 - 5.975). Patients with OSAHS were older, more obese, more sedentary, sleepier and presented higher cholesterol values both total cholesterol and HDL fraction, higher tryglicerides values, higher blood sugar values and blood pressure values than patients without OSAHS. The prevalence of the MS in OSAHS patients is 60%, similar to what whas reported and higher by 31% than in the non OSAHS group. Certain components and associated conditions are characteristically linked to OSAHS.

Although it seems to be an exhausted subject at first glance, the therapeutic approach in obstructive sleep apnea syndrome (O.S.A.S.) is still an open subject. The continuous positive airway pressure (C.P.A.P.) represents the gold standard of therapy in O.S.A.S. However, this therapeutic process with C.P.A.P. has a low rate of compliancy, over 50% of patients quit in the first year of use. Implicitly, surgical solutions or mandibular advancement devices remain an alternative for many of these patients. High costs, complexity and risks associated with surgery have led to the identification of more accurate methods for topographic and functional diagnosis in O.S.A.S. Drug-induced sleep endoscopy (D.I.S.E.) with target-controlled infusion (T.C.I.) using propofol in the management of patients with obstructive sleep apnea is a relatively recently introduced method in Romania. The present paper describes our experience with D.I.S.E for selected patients, who have undergone surgery on the upper airway for O.S.A.S. The D.I.S.E method has led to the modification of the initial surgical plan in over 60% of patients with multi-level obstruction. Under these conditions, the surgical success rate in patients of the study increased to 80% at 6 months. Considering the specific endowment of each tertiary sleep center, the presence or absence of an operator block and the anesthetist�s experience with target-controlled (T.C.I.) infusion using propofol, more extensive and multicenter studies are needed for standardization of D.I.S.E.

Microsatellite instability (MSI) is a feature of colorectal tumors that develops as a result of inactivation of the DNA mismatch repair system. It is found in about 15% of all colorectal cancers and is an important prognostic molecular marker when assessing patients with colorectal cancer. It can influence prognosis and treatment decisions in both the advanced and early stages. Although in early stages this marker suggests a favorable prognosis and presents an important argument against adjuvant treatment in stage II disease, in metastatic stages it no longer associated with such an optimistic outcome. The present trial is a prospective, single-center study which included 122 colorectal cancer patients who were tested for MSI using immunohistochemistry. The trial included patients with stage II to IV colorectal cancer, treated in the Prof. Dr. Agrippa Ionescu Emergency Hospital, Bucharest, Romania. Follow-up data were collected during a 24-month period. The study attempted to determine whether differences exist in overall survival for MSI (microsatellite instability) vs. MSS (microsatellite stable) colorectal cancer and to ascertain whether sex of the patient influences prognosis in MSI patients, irrespective of stage or treatment. Results demonstrated no significant differences in survival for MSI vs MSS colorectal patients, and patients’ gender proved not to influence the outcome in MSI patients.

The incidence of thyroid cancer is significantly different between male and female patients. Thyroid cancer is also the only form of cancer where age can be considered a staging variable. Identifying biological prognostic factors such as age or sex is important as it helps select an optimal personalized therapy. The present analysis is an observational, prospective study that enrolled all patients with thyroid disease who were operated upon at a single center. The study aimed to determine the most frequent age at presentation, the predominance of one sex over the other, the incidence of malignant thyroid disease, and the relative risk for each sex to develop thyroid carcinoma. The incidence of thyroid carcinoma was higher for women than for men, with a higher relative risk in the female subgroup. Incidence was also highest in the 50-60-year-old group. Given that studies show better survival for women and for younger patients, even when presenting with advanced disease, compared with older, male patients, such prognostic indicators should be a factor in the treatment decision.

Various interventions require tissue ablation in ENT surgery. This can be achieved using a multitude of methods, but the tendency today is to use minimally invasive methods. The development of new technologies has allowed us to consider the use of coblation for tissue ablation, which is based on a chemical reaction, instead of a thermal or mechanical ablation. The technology proved to be extremely used in the field of ENT. Its indications range from functional surgery to benign or even malignant tumors and it can be used in the nose, pharynx and larynx, with probes of different length and angulation. This minimally invasive method of tissue ablation associates less scaring, a faster recovery and a lower postoperative discomfort. Although the time required for the intervention may be somewhat longer, the overall results are superior to the classical methods, considering it provides instant hemosthasis as well. We consider it to be a reliable method, fit for a wide range of indications.

The Tonsillectomy in children or adults is an intervention commonly encountered in the ENT (Ear Nose and Throat) and�Head�and�Neck surgeon practice. The current tendency is to perform this type of surgery in major ambulatory surgery centers. Two objectives are thus pursued: first of all, the increase of the patient quality of life through the reintegration into the family as quickly as possible and secondly, the expenses associated with continuous hospitalization are reduced. Any tertiary (multidisciplinary) sleep center must ensure the complete diagnosis and treatment (including surgery) of sleep respiratory disorders. Under these conditions the selection of patients and especially the implementation of the specific protocols in order to control the postoperative complications it becomes essential. The present paper describes our experience of tonsillectomy as treatment for selected patients with chronic rhonchopathy (snoring) and mild to moderate obstructive sleep apnoea. It was presented the impact of antibiotics protocols in reducing the main morbid outcomes following tonsillectomy, in our day surgery center. The obtained results can also be a prerequisite for the integrative approach of the patients with sleep apnoea who were recommended surgical treatment. Considering the wide range of therapeutic modalities used in sleep apnoea, each with its specific advantages and disadvantages, more extensive and multicenter studies are needed.

Approximately 2% of head and neck malignancies are represented by tumors of the soft palate. The main risk factors associated are smoking, alcohol abuse, human papilloma virus infections, poor oral hygiene, mechanical irritation. The treatment of the soft palate cancer depends on the staging of the tumor and of the pathologic type of the carcinoma. In this article, we will present coblation under endoscopic control as a new method of resection of the soft palate neoplasms.

The pharyngeal tonsil is a lymphatic tissue mass located in the roof of the nasopharynx. The function of the pharyngeal tonsil is to prevent infections with the help of antibodies. Chronic inflammation and allergies lead to hyperplasia of the adenoids that is found almost exclusively in children. The treatment of choice is surgical treatment; conservative treatment is only indicated preoperatively or if surgery is contraindicated. In this paper, we will present a new surgical method for adenoidectomy performed trans-orally with coblation, under endoscopic control.

There is no perfect method of nasal reconstruction. All reconstruction types have advantages and disadvantages equally. Perhaps, the personalized medicine can be best illustrated by this surgical pathology. The present paper describes our experience with locoregional fasciocutaneous flaps together with cartilage grafts as surgical treatment for patients with nasofacial cutaneous tumors. After describing the general conditions for the 12 patients included in the study we presented the surgical management of an old woman with a nasal tumor (basal cell carcinoma) of 50/40/35 mm. Favorable results (from aesthetic and functional point of view) were obtained for most patients included in the study. There was only one recurrence, at 1 year postoperatively to the patient diagnosed with malignant melanoma. Considering the etiopathogenetic mechanisms of nasofacial cutaneous tumors and the other nasal reconstruction procedures, more extensive and multicenter studies are needed.

Laryngo-tracheal stenosis represents a challenging pathology that requires multi-stage surgical approach, and a multidisciplinary team. The diagnosis is based on clinical examination, endoscopic assessment, and imagistic evaluation. Coblation is a surgical technology based on chemical ablation of the tissue, that is suitable for tracheal stenosis approach.We present our experience with coblation for the management of laryngo-tracheal stenosis, and highlight the advantages, and disadvantages of coblation for tracheal stenosis. We consider chemical ablation of the cartilaginous tissue through coblation a valuable surgical technology for the treatment of tracheal stenosis.

Cerebrospinal fluid rhinorrhea is a rare medical problem but with increased mortality potential due to the risk of meningitis. This condition can be either traumatic or nontraumatic, based on the etiology. The traumatic CSF fistulas represent almost 80% of the entire CSF fistulas, surgical procedures cause nearly 16% of the CSF leaks in the anterior skull base, and the nontraumatic CSF leaks represent only 4%, and they are divided in normal-pressure and high-pressure fistulas. The diagnosis of CSF leaks is made by demonstrating the evidence of extracranial CSF. The diagnostic methods are double ring sign, glucose content of the nasal fluid, Beta-trace protein test, Beta2-transferrin test. To eliminate this risk of meningitis, when a CSF leak is discovered, the defect must be closed surgically. The challenge is to determine the exact location of the defect, mainly in cases of spontaneous CSF fistulas. The imagistic examination consists of CT scans and MRI tests. The gold standard for detecting CSF leakage is still intrathecal injection of fluorescein with endoscopic localization of the dural defect. This paper aims to analyze a staining test, using Lugol solution, to detect the location of the CSF fistula. The Lugol staining test that we proposed is quick, cheap, it does not produce a toxic reaction, excepting the Iodine allergic patients, and it can be used to detect the location of the skull base defect and the CSF leak.

Difficult airway management is a common situation when the anesthesiologist deals with patients with hypo pharyngeal tumors. The volume of the tumor usually covers the glottis plan and modifies the local anatomy, making the intubation process difficult or almost impossible. Intubation laryngoscopes developments are minor and adding a CCD camera at the tip of the laryngoscope is the best improvement made in our days. Today, on the market, an intubation device designed properly for the patients with extensive hypo pharyngeal tumors does not exist. The aim of the paper is to present an innovative device designed for patients with hypo pharyngeal tumors.

Laryngeal papillomatosis, although a viral and benign disease, poses a great challenge for the ENT surgeon from a therapeutical point of view. The lack of a curative treatment and the tendency of the papillomatosis to recur in an extensive manner require an aggressive treatment. Although multiple medical therapies are available, their results are not always the desired ones. That is why nowadays the focus of the therapy is on the surgical approach. The best results may be obtained thru multiple surgeries, with resection of all papilloma foci. Although this approach may impact the quality of life of the patients due to the multiple interventions required, the overall result translates into a physiologic airway. Because the site where the lesions first appear is at an epithelial level, tendency to use methods of early diagnosis, that make the disease recognizable before extensive lesions, is the natural tendency. Also, it is extremely important to remove all papilloma lesions during surgery, thus minimizing the chances of recurrence or at least increasing the interval between interventions.The aim of this paper is to present the methylene blue staining test as an adjuvant method of evaluating the resection margins during surgery for laryngeal papillomatosis. This method can improve the results of surgery and increase the patient�s adherence to treatment, by decreasing the number of interventions required.

Vocal fold carcinomas represent a pathology that has an important incidence. Recent studies showed that 70% of the dysplastic lesions can skip the phases of mild and severe dysplasia directly to carcinoma. For that reason early detection of a malignancy of the vocal fold is mandatory. If the lesion is discovered in an early stage it must be aggressively treated using CO2 LASER surgery and disease free margins must be obtained. Because frozen sections are not always available in all medical centers we are proposing a new protocol to assess disease free margins during CO2 LASER assisted laryngoscopy. Methylene blue contact endoscopy is not a new method, as it was introduced in laryngology by professors Oscar Diaz and Mario Andreea in 1994. We are proposing a protocol designed to assess disease free margins using an enhanced video contact endoscopy with SPIES software filters. The SPIES filters technology is a relatively new technology proposed by Karl Storz in 2013. A critical analysis of the method will be done comparing the results with paraffin histopathology exam.

Methylene blue video contact endoscopy was imagined for the first time in the early �70s by a gynecologist named Hamou. He was the first one to perform contact colposcopy using methylene blue staining. Because of the poor medical optic technology at that time the method was abandoned. Prof. Mario Andreea and Oscar Diaz preformed in 1994 the first video contact endoscopy of the vocal fold. We propose a new way to enhance the video contact endoscopy�s power to detect early malignancies of the vocal fold using SPIES software filters. The method will be critically analyzed.

Septoturbinar synechia is a pathological adherence between the mucosa of the turbinate and the nasal septum. Synechiae result after endoscopic sinus surgery or can be caused by trauma, infections, autoimmune pathologies, drug abuse, chemical burns, radiotherapy or intensive nose packing. The treatment for septoturbinar synechiae is surgery with the ablation of adherences. In this paper we will present a new surgical method for the ablation of synechiae under endoscopic control, using coblation.