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Background and objectives: Capillary hemangiomas are rare, benign vascular tumors that mainly affect the skin and soft tissue, with scarce appearance within the nasal cavities and paranasal sinuses. Materials and methods: We present a case report of capillary hemangioma of the sphenoid sinus and a review of the literature in the last ten years. Results: Clinical and endoscopic examination of the nose, radiologic assessment and particular histologic features contribute to the correct diagnosis of capillary hemangioma of the nose and paranasal sinuses. Conclusions: Transnasal endoscopic resection of capillary hemangioma located in the nose and paranasal sinuses is a valuable treatment method with good outcomes.

Background and objectives: Bipolar electrocautery is commonly used to control bleeding after cold-instrument pediatric adenoidectomy, but the surgeon should be aware of the possible side effects. OBJECTIVE: The aim of our study is to investigate the effects of bipolar electrocautery when used for bleeding control at the end of an adenoidectomy procedure. Materials and Methods: We evaluated the effect of electrocautery on postoperative pain, velopharyngeal insufficiency symptoms, postoperative nasal obstruction, and rhinorrhea in a group of 90 children undergoing adenoidectomy in our ENT department over a period of 3 months. Results: After statistically analyzing the data, we found that the duration of postoperative pain, the duration of rhinorrhea and nasal obstruction, and the duration of painkiller administration, as well as the velopharyngeal insufficiency symptoms, were significantly longer in patients in whom electrocautery was used for hemostasis. A significantly higher incidence of posterior neck pain and halitosis (oral malodor) was noted in the patients in whom electrocautery was used for adenoidectomy hemostasis. Conclusions: Bipolar electrocautery use should be limited during pediatric adenoidectomy hemostasis because of the possible side effects: longer postoperative pain, prolonged nasal obstruction, rhinorrhea and velopharyngeal insufficiency, and halitosis. We noted some side effects that were specific to electrocautery use during adenoidectomy: posterior neck pain and oral malodor. Acknowledging the risk for these symptoms can help to alleviate the anxiety of both the parents and the patients regarding the expected postoperative outcomes.

Background and Objectives: In the current literature, mandatory surgical exploration is a controversial topic, with some advocating for it and others against it, proposing a selective conservative management. This multidisciplinary therapeutic approach is based on clinical examination and serial paraclinical explorations associated with supportive drug treatment. Materials and Methods: The study group consisted of 103 patients with complex cervical trauma pathology produced by various mechanisms such as car or domestic accidents, aggression, ballistic trauma, self-inflicted attempts, hanging or strangulation hospitalized in the Ear, Nose and Throat (E.N.T.) Clinic, at “St. Spiridon” Iași Hospital, between 2012 and 2016. Results: The universal clinical indication for urgent surgical exploration of the patient with complex cervical trauma is the presence of the following symptoms: unstable vital signs, significant pulsatile bleeding, hematoma with a substantial increase in size, shock, airway obstruction, open airway wound, hematemesis, or hemoptysis. In this context, we considered it worthwhile to research the management of complex cervical trauma in a reference university medical center, alongside the analysis of the patient’s characteristics under different aspects (demographic, pathological aspects, therapeutic). Conclusions: Complex cervical trauma has a variety of clinical aspects, with a variable evolution, which involves multidisciplinary therapeutic management. The increasing trauma rate is one of the main public health problems, requiring epidemiological studies, and the implementation of control strategies.

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.

No prospective study has specifically examined the serum levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the early shock phase of burn-injured patients. Thus, we aimed to detect early changes, activity dynamics, and the predictive value of MMP-9, TIMP-1, and the MMP-9/TIMP-1 ratio to better understand the early repair mechanisms for the development of future therapies for patients with thermal burns. Twenty-five patients with a total body surface area (TBSA) affected by burn

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

In head and neck cancers, the effectiveness of cisplatin (CisPt) treatment is limited by its toxicity, especially when higher doses are necessary, and the possible occurrence of cisplatin resistance. This study evaluated the effects of resveratrol (RSV) on the expression of different genes involved in the response of human tumor cells (FaDu, PE/CA-PJ49) to cisplatin therapy. Our results revealed that RSV induced apoptosis amplification in both FaDu and PE/CA-PJ49 cells and modulated the expression of specific genes differently than in normal HaCaT cells. In FaDu cells, combined CisPt + RSV treatment induced an increase in apoptosis, which was associated with an increase in c-MYC and TP53 and a decrease in BCL-2 expression. While CisPt + RSV treatment induced apoptosis in PE/CA-PJ49 cells by inhibition of BCL-2 associated with high levels of MDM-2 and subsequently led to inhibition of TP53 gene expression. Decreased c-MYC expression in PE/CA-PJ49 treated with CisPt + RSV was accompanied by cell cycle blockage in G0/G1 phase. In conclusion, RSV influences tumor cell response to CisPt by inducing apoptosis and modulating gene expression. In addition, in normal HaCaT cells, RSV was able to reduce the harmful effects of CisPt.

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.

The extracellular signal-regulated kinases (ERKs) are key transducers of the extracellular signals into intracellular responses and represent major molecular players in tumorigenesis. The aim of this study was to determine how curcumin (CRM) used as an adjuvant supports the apoptotic process induced by a single chemical agent treatment (cisplatin-CisPT) on two head and neck squamous cell carcinoma cell lines (FaDu and PE/CA-PJ49) and the involvement of ERK1/2 and/or p53 activation in this process. Data have shown that the CisPt effect is potentiated by CRM. CRM induced an increase of p53 protein phosphorylation in both cell lines. CisPt decreased p53 protein phosphorylation in FaDu cells, but increased it in PE/CA-PJ49 cells. Data showed that the constitutive expression of activated ERK1/2 protein-kinase was different in the two analyzed tumor cell lines. ERK1/2 activation status was essential for both cell processes, proliferation and apoptosis induced by CisPt and/or CRM treatment on squamous cell carcinoma cells. Our data suggest that p53 phosphorylation in the apoptotic process induced by CRM treatment might require the involvement of ERK1/2. In this regard the CisPt treatment suggested that p53 phosphorylation is ERK1/2 independent in FaDu cells having a p53 gene deletion and ERK1/2 dependent in PE/CA-PJ49 cells having a p53 gene amplification. Moreover, in both tumor cell lines our results support the involvement of p53 phosphorylation-ERK1/2 activation-dependent in the apoptosis induced by combined treatments (CisPt and CRM). The use of CRM as adjuvant could increase the efficiency of chemotherapy by modulating cellular activation processes of ERK1/2 signaling pathways. In conclusion, the particular mode of intervention by which ERK1/2 might influence cell proliferation and/or apoptosis processes depends on the type of therapeutic agent, the cells' particularities, and the activation status of the ERK1/2.

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.

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.

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.

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.

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.

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.

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.

Variable pH values for skin have been reported in the literature, all within the acidic range, varying from 4.0 up to 7. 0. The origin of the acidic pH remains conjectural, and several factors have been incriminated with this role, such as eccrine and sebaceous secretions as well as proton pumps. Keeping low levels of pH prevents microbial dispersal as well as multiplication. The skin in the external auditory canal is also covered with this acidic mantle with antimicrobial value. Changes of pH in the external ear can lead to acute otitis externa. This condition is defined by the inflammation and infection of the cutaneous and subcutaneous tissues of the external auditory canal. 10% of the world�s population may suffer from acute otitis externa at least once in their lifetime. This paper aims to consolidate the relevance of an acidic pH in the healthy external ear and its relation to the pathogenesis and treatment of otitis externa through a prospective and interventional clinical study on 80 patients who presented to the outpatient department at Prof. Dr D. Hociota ENT Institute in Buch

Cerebrospinal fluid rhinorrhea represents drainage of cerebrospinal fluid into the nasal cavity. The first steps in diagnosing CSF rhinorrhea are a thorough history and physical examination of the patient. Other diagnostic procedures are the double ring sign, glucose content of the nasal fluid, Beta-trace protein test or beta 2-transferrin. To establish the exact location of the defect imagistic examinations are necessary. However, the gold standard CSF leakage diagnostic method is an intrathecal injection of fluorescein with the endoscopic identification of the defect. In this paper we analyze a staining test, using Methylene Blue solution, to identify the CSF leak�s location.

Lingual squamous cell carcinoma is one of the most frequent localization of the oral carcinomas. The tongue neoplasia represents nearly 40% of the oral carcinomas. Recent studies showed an increasing trend of lingual carcinoma in young patients. Several staining tests have been described to early detect the disease. After detection, disease free margins resection will increase the survival rate. This study aims to analyze the methylene blue staining test in achieving disease free resection margins in lingual squamous cell carcinoma.

Tongue localization of squamous cell carcinomas is one of the most common sites of intraoral carcinomas, representing nearly 40% of these. The most frequent localization of the tumor is on the posterior lateral border and the ventral surface of the tongue. Recent papers have mentioned an ascendant trend in the incidence of tongue carcinoma in young adults. Early detection of the tongue carcinoma is mandatory because the prognosis of the patient depends on the early diagnostic. The aim of the paper is to analyze the use of lugol iodine solution staining in early diagnostic of tongue carcinoma. The authors propose a protocol for using lugol iodine solution in the screening of tongue carcinoma.

Laryngeal cancer represents an important problem in the public health department, mainly due to the fact that the lack of early symptoms leads to most cases being diagnosed in advanced stages, when surgical procedures must be extensive and will affect the quality of life of the patient. Nowadays, the problem of early diagnosis of laryngeal cancer and procedures that may facilitate it is of great importance, with contact endoscopy following in vivo methilene blue coloration being one of the most promising options.

The objectives of the study: Advanced or recurrent sinonasal malignancies sometimes need, besides an ablative step, a reconstructive step. If this occurs, the reconstructive step may require advanced knowledge of reconstructive surgery because of the complex remnant defects after ablation. The methodology: The authors present a surgical reconstructive solution that can be used in cases of advanced sino nasal tumors which associate the destruction of the malar region. This requires a midfacial flap which will provide a solid support for the paramedial forehead flap. Conclusions: The use of the reversed midfacial flap is an original method that can provide a good mechanical support for any reconstructive flap in the midfacial region. Keyw ords: sino nasal malignancies, reconstruction, flap

Introduction: The palatine tonsil is one of the most common locations of oropharyngeal cancer. In the early stages T1, T2 and selected cases T3 the transoral surgical approach is preferred. Case presentation: We present the case of a 42 years old patient, who underwent the surgical removal of malignant tumor located at the level of the right tonsil extended to the soft palate, retromolar trigone and hypopharynx, through combined approach followed by modified radical neck dissection. The postablative defect was reconstructed using a rotated musculo-cutaneous flap from the sternocleidomastoid muscle located on the same side as the lesion. Results: Postoperative controls performed at 1.2 and 3 months did not reveal signs of local recurrence, and demonstrated the viability of the used flap. Conclusions: Although contested in the literature, the SCM musculocutaneous flap is a viable and easy method for the reconstruction of the medium-sized pharyngeal defects.

Early detection of the vocal fold malignancies is usually done using the flexible or rigid endoscopic exam. Video stroboscopy can be used to early detect an abnormal vibration of a portion from the vocal fold. Video contact endoscopy is an endoscopic technique that will provide the surgeon to observe histological modifications of the superficial layer and the superficial vascular network of the vocal fold. The authors started to use the contact endoscopy 10 years ago and try to have a critical point of view regarding this method. Observing the abnormal vessel patterns and histological characters will guide the surgeon to perform a targeted biopsy that will be used in early detection and follow up in patients with vocal fold malignancies.

The therapeutic approach in sensorineural hearing loss (ISSNHL) is far from a consensual protocol among ENT (ear, nose and throat) doctors. The present paper describes our experience with Hyperbaric Oxygen Therapy (HBOT) as salvage treatment for selected patients with the sudden sensorineural hearing loss. The HBOT method has shown an efficacy of 50% in our study, as salvage treatment in ISSNHL after initially corticoids therapy. Thus, we can assert without doubt that HBOT represents a viable option for those patients who want to continue the effort to regain hearing. Under the auspices of the national ENT society, through a collective effort, can be achieved a therapeutic consensus in the sensorineural hearing loss. In this consensual document, HBOT can be found both as initial and salvage therapy, alone or in the multimodal therapeutical variant. Further, the National Health Insurance House should introduce the reimbursement of HBOT sessions in the methodological norms, in order to offer this new therapeutic solution to all patients.

The therapeutic approach in tinnitus is still an open subject. Perhaps, the correct approach would be the management of a patient with a chronic suffering that occurred at the active ageand who, in the absence of an adequate intervention, may be incapacitated. Sound therapy, counseling and cognitive behavioral psychotherapy are the widely accepted by specialized physicians in tinnitus. Patients are still looking for medical treatment and the physician is required to integrate new drugs into his or her therapeutic arsenal. Melatonin is a relatively recently introduced substance in Romania and its primary therapeutic use is in sleep disorders. The present paper describes our experience with melatonin as treatment for selected patients with tinnitus. The melatonin treatment has shown an efficacy of 80% in our study, as secondary treatment in tinnitus after initially counseling. The obtained results can also be a prerequisite for the integrative approach of the patients with tinnitus in the context of the pathological conditions and not as an isolated clinical picture. Considering the etiopathogenetic mechanisms of tinnitus and the other therapeutic effects of melatonin (central nervous system modulator and antioxidant), more extensive and multicenter studies are needed.

Throughout the years, minimally invasive methods have gained ground when considering the surgical field. Most of all, these techniques are used in tissue ablation as they associate less operative and postoperative bleeding, high rate of recovery, as well as minimal scaring. One of these minimally invasive methods refers to the use of chemical ablation or coblation when regarding tissues ablation, thus using a chemical reaction based technique despite the regular use of mechanical or thermal interactions in order to achieve tissue ablation. Widely used in the area of ENT surgery, coblation could easily be defined as an extremely effective technique in dealing with the submucosal tissue in volumetric reduction of inferior turbinate. Different length and angulation probes ensure the applicability of this technique to better correlate with any anatomical variants and local features of the targeted structures to be ablated. Although the duration of surgery by using this method is slightly higher than with the use of other inferior tubinate volumetric reduction techniques such as radiofrequency or use of the shaver, the low degree of postoperative discomfort and the good local hemostasis provided by this technique are markers that support its elective use if it is available for the surgeon.

Rhinitis represents the inflammation of the mucous membrane inside the nasal cavity. The main causes of the inflammation are viruses, bacteria or allergens. The treatment of this pathology has two stages. The first option is the conservative treatment followed by surgical treatment if the patient does not respond well to medication. In this paper, we will present coblation turbinate reduction method and its benefits.