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BACKGROUND. The relationship between the maxillary sinus floor and the roots of the teeth in the upper arch is essential, especially in the correct diagnosis and treatment of odontogenic maxillary sinusitis. The aim of this study was to determine exactly this distance and to observe the most common teeth situated closely to the maxillary sinus. MATERIAL AND METHODS. The study was performed in 2020, in the ENT Department of “Sfanta Maria” Hospital, and was made based on computed tomography (CT) scans of the sinuses from the clinic’s archive. The image analysis was performed with a radiologic software. For each tooth, from both right and left upper hemiarcade, the distance between the dental root and the bony floor of the maxillary sinus was measured and the average distances were compared. RESULTS. Among the present teeth analysed, those with the closest distance were the 1st M (95.15% on the right side and 96.23% on the left side), then the second molars (96.08% on the right side and 90% on the left side). The 2nd and 3rd PM had a similar percentage of the sinusal approach, which varied between 82% and 86%. CONCLUSION. Knowing these dento-sinusal relationships, there is a win-win situation for both the ENT doctor and the dentist. The paraclinical examination necessary for the analysis of the dento-alveolo-sinusal relation and of the afferent pathology is the imaging one, of choice being the CT and CBCT scans.

The sphenoid bone has a specific development during fetal life, until it reaches its complete dimensions. The sphenoid cavities are usually undeveloped at birth and they reach their full volume only after puberty. Pneumatization of the sphenoid sinus is unpredictable and different for each person. The authors do not intend to develop a literature review or to compare their experience with data already published. The paper is not an original imagistic study of the authors, it only represents a short communication on the imagistic anatomy of the sphenoid sinus, in order to avoid complications during surgery in the area. Based on their patients own CT-scan examination, the authors try to classify the anterior, lateral and posterior extensions in close connection with the surgical endoscopic approach of the sphenoid sinus.

Blastic plasmacytoid dendritic cell neoplasms (BPDCNs) are extremely rare and aggressive hematological malignancies that derive from precursors of plasmacytoid dendritic cells (pDC) and frequently involve skin lesions and bone marrow infiltration. They mostly affect the elderly population and the prognosis is poor with the therapeutic choices currently available. Diagnosis is made with the help of tools such as immuno-histochemistry and flow cytometry. Here, we present a particular case of BPDCN with a positive FLT3-D835 mutation and we discuss the possible impact this may have on the evolution of the disease and response to treatment.

The objective of this review is to summarize specialty data regarding possible manifestations of diffuse idiopathic skeletal hyperostosis in general otorhinolaryngology practice in order to increase awareness of this entity. Research on the topic was based on consulting specialty books, electronic databases like PubMed, Scopus (Elsevier), Web of Science, Research Gate, Up-to-date and also, on clinical experience. Even though asymptomatic in most patients and many times found during cervical pain investigations or by accident, this overlooked disorder, in rare cases, may cause two of the main complains in practice, dysphagia and dyspnea.

Recurrent laryngeal papillomatosis is a disease caused by human papillomaviruses (HPVs), which currently does not benefit from a curative treatment. Due to the fact that HPV has the action of modifying cellular DNA, with changes in the expression of interleukins and interferon, with insufficient maturation of T cells and intracellular overpopulation of immunosuppressive cells, the association of RRP (Recurrent Respiratory Papillomatosis) with an autoimmune disease may cause particular difficulties in the therapeutic management of patients diagnosed with RRP. Immunosuppressive medication negatively influences the development of papillomatosis, increasing the number of local relapses and, respectively, the need for surgical intervention due to the increased viral multiplication and the proliferation of papillomatous lesions. In order to exemplify the difficulties encountered in treating RRP associated with an autoimmune disorder, the authors present the case of a 21-year-old patient diagnosed with juvenile recurrent laryngeal papillomatosis genotype 6, with multiple antecedent surgeries, who was diagnosed with pemphigus vulgaris at the age of 19. The peculiarity of the case lies in the difficulty of managing the RRP associated with an immunosuppressive disorder whose therapeutic indication is cortisone and immunosuppressive treatment, which led to exacerbation of viral multiplication and proliferation of papillomatous lesions.

The postoperative digestive fistula is the most feared complication of gastrointestinal surgeries. We performed a retrospective study over a period of 6 years, in which we included 28 patients who developed postoperative esophageal, gastric or duodenal fistulae in the General Surgery Department of “Bagdasar–Arseni” Emergency Hospital. We assessed the risk factors for this complication, its management and its results. Most patients were males and the mean age was 61.1 years. For 15 patients, the surgeries were required for benign lesions while the rest of 13 patients had malignant disease. Regarding the type of the fistula, 14 were duodenal stump fistulas, 13 were anastomotic leakages and one was a dehiscence of a sutured duodenal ulcer. Six cases required emergency relaparotomy for sepsis and peritonitis. Sixteen patients had a favourable outcome while death occurred in 12 cases. The mortality was higher for patients with sepsis and peritonitis as the first clinical manifestations of fistula and with the need for an emergency reoperation.

The nasal swell body (NSB) is considered to be an enlarged region of the nasal septum, which is located superiorly to the inferior nasal turbinate and anteriorly to the middle nasal turbinate, with a potential effect upon the airflow nasal valve. The histological studies of the NSB demonstrated that it is a glandular formation, not a venous structure, and it is formed by septal cartilage and bone, as well as a thick mucosa. Recent studies emphasized the functional role of the nasal swell body and it is thought to interfere with the nasal airflow and air humidification, due to its proximity to the internal nasal valve and its histological characteristics (venous sinusoids and seromucinous glands). The nasal swell body is strongly related to the presence of rhinosinusal chronic inflammations (allergic rhinitis and chronic rhinosinusitis) and the septal deviation. In case of the presence of the nasal swell body, surgical treatment is not commonly done, due to the absence of a consensus between the ENT practitioners. Most of them consider surgery as being too aggressive because of the presence of seromucinous glands, with slight impact upon the nasal obstruction. Most probably, the lack of consensus is determined by inconsistent anatomical and histological study results.

The term chronic rhinosinusitis (CRS) comprises of an assortment of diseases that share a common feature: inflammation of the sinonasal mucosa. The phenotype classification of CRS, based on the presence of polyps, has failed to offer a curative treatment for the disease, particularly in refractory cases. Chronic rhinosinusitis with nasal polyps (CRSwNP) remains a challenging entity. Researchers have made efforts trying to characterize subtypes of the disease according to the endotypes, which are delineated by different immunological pathways, using biomarkers. Even if the inflammatory processes controlling CRSwNP are not fully understood, data suggested that the disease associated with a type 2 inflammatory mechanisms can be also linked to the type 1 or type 3 pathomechanism, being highly heterogeneous. Biomarkers for CRSwNP are proposed, such as: eosinophil count, cytokines, metalloproteinases, bitter and sweet taste receptors, and the nasal microbiome. For endotyping to be clinically applicable and simply determined, biomarkers referring to the intrinsic biomolecular mechanism still need to be found. Precision medicine is becoming the new standard of care, but innovative therapies such as biologics may be rather challenging for the clinicians in their daily practice. This new approach to CRSwNP implies patient selection and a simple algorithm for deciding the right treatment, easy to implement and adjust. Our review points out the ongoing new research on the pathophysiology of CRSwNP, biomarkers and treatment opportunities. It allows clinicians to keep abreast of current evidence-based knowledge and to individualize the management of CRSwNP, especially in refractory cases.

Osteomas are slow-growing tumors of the paranasal sinuses, usually found in the frontal and ethmoidal sinus. In many cases, these tumors are discovered by chance or after an imagistic exam for a non-responsive to medical treatment headache. In asymptomatic tumors, conservative treatment is indicated, while in big tumors with complications the gold standard is surgical resection of the tumor. We present two cases of rather similar anterior ethmoidal osteomas in which the therapeutic management was decided according to the symptomatology of the patient and the imagistic CT exam. We decided different ways of treatment for the two cases based on the CT scan, which has a major role in predicting intraoperative complications during endoscopic sinus surgery.

Inverted papilloma is a rare benign sinonasal tumor with a still unclear etiology. In the last decades, HPV implication in inverted papilloma etiopathogeny has been studied and demonstrated in some scientific research papers, but with no causality proven. Imagistic investigations and the Krouse classification establish the surgical approach. Endoscopic surgery represents the golden standard treatment for most cases of inverted papilloma, while external or combined approaches present limited indications. The authors present a case and therapeutic plan of an inverted papilloma located in the ethmoid sinus, with origin in the lamina papyracea and high-risk HPV implication.

Introduction. The parotid gland, the largest salivary gland, can be the site of various pathology. Any swelling located in the parotid gland requires thorough investigations. Symptoms usually include a painless, unilateral tumor, with a slow evolution. Histology establishes the therapeutic plan. Case presentation. We present the case of a 60 years-old patient, known with a tumoral mass in the parotid region for 3 years, who came to our clinic for a history of 3 months persistent dysphonia. Endoscopic laryngoscopy revealed a tumoral mass occupying two thirds of the right vocal cord, covered in keratin plates, with normal mobility of both vocal cords. From the patient’s record, we note an ultrasound fine needle aspiration biopsy, performed at the onset of the parotid tumoral mass, which did not reveal any malignancy criteria. Conclusions. Differential diagnosis for parotid gland pathology must include inflammatory, infectious and tumoral conditions. A complete set of investigations must be performed in order to establish the therapeutic approach. Treatment, depending on the histological type of the tumor, is commonly surgical and can be followed by radiotherapy and in some cases, chemotherapy.

Background: The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymphadenopathy (N0) remains controversial. Neck palpation, as the method used in tumor, node, metastasis (TNM) staging, has limitations and can provide false negative results in some cases. Lymph node metastases are associated with a reduced survival rate but at the same time, neck dissection for the patient with N0 neck is not without risks or complications. Objectives: In prospective study, we compared palpation, ultrasonography (US) examination of the neck and histopathological examination in patients with cancers of the pharynx and larynx. Patients, Materials and Methods: Forty-six patients with cancers of the pharynx and larynx that presented with a N0 neck were prospectively analyzed. They were divided in two groups: 23 patients operated with an external approach including the control of the lymph node areas, and a second group of 23 patients operated using endoscopy and carbon dioxide (CO2) laser, no neck dissection – “watchful waiting policy”. All patients have had a flexible endoscopy of the pharynx and larynx, US of the neck and all received surgical treatment for their primary tumor. Imaging was performed in selected cases. All the removed lymph nodes were sent for histopathology. US was also used as a follow-up method. The US features of the examined lymph nodes were: diameters [longitudinal (L) and transverse (T)]; the ratio of the two diameters (L/T); shape; lymph node area; central hypodensity; regular/irregular margins; aspect (homogeneous or not). Results: US has detected 25 lymph nodes in the open surgery group and intraoperatively, we excised 31 (sensitivity of 80.6%). Ten lymph nodes showed metastases, with 100% accuracy of US, which have been confirmed both pathologically and immunohistochemically. US in the second group – patients treated with CO2 laser – detected at four patients 10 cervical lymph nodes that did not presented any malignant features. At recurrence alone, the US confirmed 100% presence of nodes metastases. Conclusions: US was superior to palpation and this method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis (N0).

Nowadays, the ergonomic issues become more and more important in all economic activity domains. Work-related Musculoskeletal Disorders (MSDs) represent the main problem generated by the poor ergonomic design of the workplaces. The healthcare domain involves high level ergonomic risks related to physical and mental load of the work which could lead to MSDs. The paper presents an analysis of these ergonomic risks for physiotherapy activity and identifies potential measures to improve the health and safety in this domain. The physical load of the physiotherapist’s work is generated by the risk factors such as awkward postures, repetitive movement or working with patients with motor disabilities. The mental load of the physiotherapist’s work depends on risk factors such as working with patients with cognitive impairment and daily or weekly patient flows. The proposed preventive measures are organisational and technical. The organisational measures are based on the requirements of the occupational health and safety (OHS) legislation and on the good practice examples. The technical measures are based on the analysing the documentation of physiotherapy modern equipment. The results of the study can be used to improve the ergonomics and the health and safety of any workplace in physiotherapy activity.

Aims: Vertebral lesions, either primary or more frequently metastasis, are difficult targets for percutaneous guided biopsies and surgical biopsies and are associated with greater risks of complications. We investigated the feasibility of endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsy in the assessment of vertebral osteolytic tumors as an alternative to CT guided biopsy which is the technique currently used.Material and methods: Four patients with osteolytic tumors of the vertebral bodies identified by imaging methods (CT or MRI) – 3 patients, and one with a tumor detected primarily during EUS procedure were included in order to evaluate the feasibility of the procedure. The lesions were located either at the dorsal or lumbar vertebrae. In all cases we performed EUS FNA of the osteolytic vertebral body lesions with 22G needles using the transesophageal or transgastric approach.Results: In all cases EUS FNA provided enough tissue for an accurate histopathological report, with no procedural complication. We diagnosed lung adenocarcinoma, hepatocarcinoma and a pancreatic adenocarcinoma vertebral metastasis and one case of lymphoma.Conclusions: EUS FNA is a valuable technique which should be considered in selected cases, when a “traditional approach” is not applicable or associated with a higher risk. Treatment guidelines are based on the histology of the tumor, histopathological examination being nowadays mandatory. Therefore, we propose for selected cases a feasible technique, with significantly lower procedural risks, as an alternative for open surgical biopsies or computed tomography guided biopsies

PURPOSE: (1) To present a Danish quality register (AMETO) concerning dental implant treatment for dental agenesis, assess its indicators and standards, and compare them with those acknowledged and outlined by the Institute of Medicine (IoM), World Health Organization (WHO), and Organization for Economic Cooperation and Development (OECD), classified as the quality domains efficiency, effectiveness, patient-centered care, timely care, safety, and equitability; and (2) to perform a systematic literature search and review to verify whether any quality register exists according to the six quality domains.MATERIALS AND METHODS: (1) The AMETO register is comprised of 16 process and result indicators and standards, which were compared to the six quality domains outlined by the IoM and WHO. (2) A systematic literature search was carried out using the search engines PubMed, Embase, CINAHL, Web of Science, and SveMed+. The included articles were assessed for quality indicators and standards to determine whether they conformed to the six quality domains.RESULTS: AMETO indicators and standards conformed to the quality domains outlined by the IoM. A search of "(dental agenesis) AND (dental implants)" yielded a total of 381 publications, of which 27 were included for qualitative synthesis. A search on quality indicators and dental agenesis registries yielded no results. Due to considerable heterogeneity in the reported quality indicators related to effectiveness, patient-centered care, and safety, a meta-analysis could not be conducted.CONCLUSION: AMETO conforms to the quality domains described by the IoM, WHO, and OECD. Few studies have investigated dental implant treatment of dental agenesis. Moreover, no published quality register for dental implant treatment currently exists.

Aim: Endoscopic ultrasound (EUS) has become an indispensable method for diagnosis in gastroenterology and new indications for EUS continue to emerge. However, there are limited data regarding the accuracy of EUS-guided biopsy of hepatic focal lesions. The aim of this study was to assess the diagnostic yield of EUS-guided fine needle aspiration (FNA) of focal liver lesions.Material and methods: We conducted a prospective study in which patients with focal liver lesions, detected by transabdominal ultrasound and computed tomography or magnetic resonance imaging, underwent EUS-guided FNA to determine the diagnostic yield of the procedure.Results: In 47/48 of patients, the results of EUS-FNA were positive for malignancy, while in one case the acquired fragment was insufficient for appropriate histological analysis. Diagnostic yield was 0.98. In 83% of the cases biopsies were taken from the left lobe and in 17% from the right lobe with the same technical success rate. The most common diagnosis was metastatic adenocarcinoma of the pancreas (26% cases) followed by cholangiocarcinoma (17% cases). Concurrent sampling of other sites in addition to the liver and/or primary tumor was realized in 35% of the cases, with results that correlated with the liver biopsy and with the primary tumor biopsy. We reported no immediate or long-term complications in any of the patients.Conclusions: EUS guided fine needle aspiration/biopsy of focal liver lesions is safe, provides a very high diagnostic accuracy and should not be considered only as a rescue method after failure of percutaneous guided biopsies.

Laryngomalacia is a disease that is the most common etiology causing stridor in infants and in most cases the patient presents with inspiratory stridor that worsens during feeding, crying, supine position or agitation. In laryngomalacia the supraglottic structures collapse into the airway during inspiration causing airway obstruction. Typical symptoms are not present at birth, but appear within the first 4 months of life and disappear at maximum 24 months of age. The most common associated symptoms are swallowing dysfunctions, regurgitation, cough and sleep apnea. Laryngomalacia is a self-limiting disease with about 20% of the patients present with severe disease and they require surgical treatment.

Malignant lymphoma is one of the topical problem of modern medicine. Among head and neck malignancies, lymphoma is the second most common cause. Most of the extranodal lymphomas are represented by non‑Hodgkin’s lymphomas. Non‑Hodgkin’s lymphomas localized in the upper aerodigestive tract are classified into three categories, depending on the frequency of these types: oral cavity lymphomas, pharynx and Waldeyer’s ring lymphoma, nasal sinuses, throat, pharynx and trachea lymphomas. Main therapeutic approaches used in the therapy of malignant lymphomas are: conventional chemotherapy, radiotherapy, surgery, „salvage“ therapy, interferon therapy, monoclonal antibody therapy, bone marrow transplant, peptides treatment. Cytotoxic chemotherapy is the main treatment for medium and high grade malignant lymphomas. However, studies have shown increased toxicity and did not find a significant benefit compared to the use of CHOP cure (cyclophosphamide, doxorubicin, vincristine and prednisone), both in terms of survival at 3 years and time until therapeutic success. Using third generation of therapeutic protocols allows to achieve complete remission in approximately 50% of non‑Hodgkin’s lymphoma cases. Considering the endeavor to diagnose correctly and to adopt an appropriate therapy of a malignant lymphoma suitable in head and neck area , a complex approach, with integration of clinical, morphological and cytogenetic elements, interdisciplinary collaboration between pathologist, hematologist, oncologist, radiotherapist, nutritionist, psychologist, represents the most justified method for a patient with malignant lymphoma.

Graves ophthalmopathy, an autoimmune disease, associated with hypermetabolism, enlargement of the thyroid gland and exophthalmia are the most frequent expressions of Graves’ disease, which often require surgical treatment. We present the case of a 41-year-old male with severe Graves ophthalmopathy for which we performed an endoscopic orbital decompression with good surgical outcome, the patient being discharged after 48 hours.

For individuals with conductive or mixed hearing loss, a bone conduction system can be a very effective treatment option. These systems bypass the outer and middle ear to send sound vibrations directly to the cochlea. This offers a natural sound quality for recipients. BONEBRIDGE is the first active, intact skin hearing implant for bone conduction stimulation, ideal for moderate to severe conduction hearing losses. It is a semi-implantable system, consisting of a surgical implantable part and an externally worn audio processor. Biomaterials used proved their safety, with very low rate of medical complications (skin infections, chronic suppurative otitis media, biofilm formation or extrusion).

Nasal meningoencephaloceles are rare findings, represented by protrusions of intracranial contents into the nasal cavity. They present as unilateral masses, and commonly determine unilateral nasal obstruction, rhinorrhea and non-characteristic headaches. We present the case of a 34-year-old patient diagnosed with a posttraumatic transethmoidal meningoencephalocele. The patient presented with unilateral nasal obstruction, mild headache and episodic watery rhinorrhea. The treatment was endoscopic endonasal surgical excision and repair of the skull base defect, in a mixt ENT-neurosurgical team. Patient follow-up showed no remaining mass or symptoms and normal closure of the skull base defect.

Morphological variability of paranasal sinuses is well known for endoscopic surgeons and anatomists alike. The ethmoid sinus is the most complex and variable of all paranasal sinuses, due to the fact that its development is not yet well known and is influenced by many factors. Volumetric studies of the sinuses have been made using dried skulls, cadaver heads and imaging studies, but there are still not sufficient data in order to name a standard value for each sinus. Few data can be found especially regarding the ethmoid sinus. In this paper, we measured the volumes of ethmoid lateral masses, and for anterior and posterior groups of cells, using imaging studies and a volumetric feature of our imaging studies. Results showed an average volume between 7.34 cm3 and 8.39 cm3 for the ethmoid lateral mass, between 4.33 cm3 and 4.92 cm3 for the anterior ethmoid and between 3.01 cm3 and 3.47 cm3 for the posterior ethmoid groups. We also found that the average volume of the anterior ethmoid occupies between 58-59% of the whole volume, while the posterior ethmoid occupies only 41-42% of this volume.

BACKGROUND. The most frequent benign nasal tumor is the osteoma. It is commonly asymptomatic and usually an incidental finding and can be caused by multiple factors. The therapeutic approach for symptomatic osteomas is strictly surgical. CASE REPORT. The authors present a patient with giant ethmoido-frontal osteoma, causing the compression of the ocular globe and the right frontal lobe. Considering the intracranial extension, a combined surgical team consisting of an ENT surgeon and neurosurgeon decided to deal with the case. The tumoral mass was removed with no recurrence after a follow-up of two years. CONCLUSION. Surgery via external and endoscopic approach aims to completely resect the osteoma with frontal sinus origin and orbital or intracranial extension.

Introduction: Diaphragmatic injuries are produced by blunt or penetrating thoracoabdominal trauma. They are potentially life-threatening due to the herniation of abdominal organs into the pleural cavities and severe associated lesions. The aim of this retrospective study was to analyse the clinical presentation and management of patients admitted with diaphragmatic rupture in our institution. Material and Method: We performed a 5-year retrospective study of patients admitted with acute blunt or penetrating diaphragmatic rupture in the Department of General Surgery of "Bagdasar- Arseni" Emergency Hospital. We have studied sex, age, mechanism of trauma, side-location, timeto-diagnosis, concomitant injuries, surgical treatment and outcome. Results: Fifteen patients (8 males, 7 females, mean age: 42 years) with diaphragmatic rupture (left-side: 13, right-side: 2) following blunt (8 patients) or penetrating (7) trauma were included. Patients with blunt diaphragmatic injury had larger tears and abdominal viscera herniation was observed in 6of these cases. A direct suture was performed for all 15 patients. Laparotomy was the surgical approach preferred in most of the cases. Mortality rate was 20%, mainly caused by severe associated lesions. Conclusion: Although traumatic diaphragmatic lesions are frequently associated with severe cerebral and thoraco-abdominal trauma that is also the main cause of death, a prompt diagnosis and treatment can lead to good outcome.

The sphenoid is one of the paranasal sinuses with the greatest number of anatomic variants. The complexity of the sphenoid sinus requires close clinical and radiological examination, prior to surgery, in order to prevent life-threatening complications during surgery. This paper presents the tomographic particularities of the sphenoid sinus in order to illustrate the importance of proper pre-operative preparation in endoscopic approach to sphenoidal sinus pathology.

The authors present a case of recurrent frontal rhinosinusitis, for which the drug therapy was ineffective. To avert the risk of complications, multiple classic and endoscopic surgical procedures were performed on the frontal sinus pathology. The bacterium involved in this form of rhinosinusitis was represented by a Methicillin-resistant Staphylococcus aureus (MRSA) diagnosed during the first endoscopic approach (the second surgical procedure) for which the treatment corresponding to the antibiogram was followed. At the last hospitalization, the patient has underwent a frontal bilateral drainage surgery (modified Lothrop procedure) and started an adequate anti-MRSA treatment. The authors wondered whether multiple recurrences of frontal rhinosinusitis are determined by an incomplete drainage, by a persistent infection with MRSA or by both.

The pterygopalatine fossa is an inverted pyramid-shaped space of the viscerocranium, protected by bony structures. Surgical access to this anatomical space is difficult, especially for tumor resection. There are numerous open surgical techniques for accessing this space, but nowadays, minimally-invasive endoscopic approaches are preferred in order to increase postoperative quality of life and reduce postoperative morbidities. The tumors of the pterygopalatine fossa can be benign or malignant, and can occur primarily in the fossa or as secondary extensions from the surrounding regions through the multiple canals and foramina in its walls. Squamous cell carcinomas of this space have been described to appear as extensions from the nasopharynx, the paranasal sinuses or through perineural extension from the cutaneous branches of the maxillary nerve. In this paper the authors present a rare case of squamous cell carcinoma of the pterygopalatine fossa, which was excised in an endoscopic transnasal approach after preoperative selective embolization.

BACKGROUND. Endoscopic dacryocystorhinostomy is known to be the ideal treatment for saccal and postsaccal stenosis of the lacrimal apparatus. Following this surgery, an important inconvenient would be the stenosis of the created ostium with consecutive epiphora. MATERIAL AND METHODS. 20 patients with chronic unilateral lacrimal duct obstruction were operated in “Prof. Dr. D. Hociota” Institute of Phono-Audiology and Functional ENT Surgery, Department I, between January 2015 and July 2015. After creating the dacryocystorhinostoma, a stent was inserted transnasally to the bottom edge of the lacrimal sac and positioned to the bony margin of the ostium. Stents used varied in size from 1 to 3 mm in diameter. We followed-up our patients at 2 weeks and 1, 3, 6 months, assessing the symptoms of the lacrimal apparatus, especially the epiphora. RESULTS. The mean age of patients varied between 31 and 65. Most of our patients were women (n=14). In a total number of 16 patients epiphora disappeared, it decreased in 2 patients, and persisted in 2 patients. There were two patients with no changes who have spontaneously eliminated the stent 2 or 3 days after the surgery. The most widely used stent size was 3 mm diameter, with a success rate of 90%. CONCLUSION. The endoscopic approach may be an effective procedure in patients with pathologies of the lacrimal apparatus. In order to achieve an efficient result, both a preoperative rigorous preparation and also postoperative medical care are necessary. In conclusion, ostium stenting represents a better way to ensure a longer period of maintaining the permeability of the lacrimal apparatus.

Tornwaldt’s cyst represents a benign tumor which develops in the midline of the nasopharyngeal mucosa. Due to the fact that it doesn’t usually cause any symptoms, it is often discovered incidentally during a nasal endoscopy or another imaging investigation (either CT or MRI). Treatment is only advised when the cyst becomes symptomatic. In this paper, the authors aim to illustrate the optimal approach when dealing with a Tornwaldt’s cyst and to underline the importance of a correctly executed endoscopic surgery.

The paper presents the results of a students' survey carried out at "Vasile Alecsandri" University of Bacau, Romania, on the quality of educational process on online platforms in the context of the COVID-19 pandemic. The study was addressed to students from the Faculty of Engineering and the Faculty of Physical Education and Sports. The results of survey highlighted that most of students were satisfied with the measures taken by the university during the lockdown period and the way the teaching-learning-assessment process took place. However, some negative aspects were reported as: lack of an adequate infrastructure for some students, less effective teacher-student communication and interaction, impossibility of performing practical applications, lack of socialization, lack of learning motivation, less objective examination (e.g., possibility of cheating), possibility of physical and mental health degradation (e.g., too much time spent in front of screens, installation of a sedentary lifestyle). Consequently, for the new academic year, effective, and efficient measures must be implemented by the management of the university to remove, as much as possible, these negative issues and to improve the performance of online educational process.

Almost half of patients with sleep apnea syndrome (SAS) have asymptomatic left ventricular (LV) dysfunction, this incidence may vary depending on the criteria used. Along with metabolic syndrome, dyslipidemia, smoking status and lack of exercise, obstructive sleep apnea increases cardiovascular risk. SAS has a high incidence in patients with high cardiovascular risk profile and asymptomatic left ventricular dysfunction. The first phase of evaluating the cardiac dysfunction in an SAS patient is to identify patients with multiple cardiovascular risk factors who will be asked to answer the Berlin and Epworth Questionnaires. Those patients with high scores and clinical suspicion of SAS should be referred to a clinic for further evaluation. This will include polysomnography and screening echocardiography for all the patients. Patients diagnosed by polysomnography with SAS will perform an ENT examination that assesses the presence of obstructive disorders that may contribute to the onset or worsening of SAS. This examination will also indicate whether the surgery to remove the obstacle will be performed. Where considered appropriate there should be initiated specific therapy with ventilator assistance devices during sleep. Therapy consists in SAS treatment and cardiac treatment as well.

Endoscopic ultrasonography (EUS) has become an indispensable method for diagnosis and therapeutic procedures in gastroenterology. As experience with this technique grows, new indications continue to emerge. Due to the vicinity of the transducer to the liver, endoscopic ultrasonography provides detailed images of the liver segments and its vascular and biliary structures. Endosonographers have made an effort to define a clinical role for endoscopic ultrasound in liver diseases; however, not much is known about endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in hepatic focal lesions. This review summarizes the available evidence regarding the usefulness of endoscopic ultrasound-guided fine needle aspiration in patients with focal liver lesions.

BACKGROUND. The ostiomeatal complex (OMC) is the anatomical region situated between the middle turbinate and the lateral nasal wall, at the level of the middle meatus. Common anatomical variations of OMC are concha bullosa, hypertrophy of the uncinate process and of the bulla ethmoidalis and Haller’s cell. Our study was aimed to investigate the prevalence of these conditions and their relations to different symptoms. MATERIAL AND METHODS. The study is a retrospective descriptive study based on 256 files of patients who were hospitalized and treated for OMC pathology in our clinic between January 2009 and January 2014. The data acquired were included into Excel Worksheets and statistically analyzed using GraphPad Software. RESULTS. The most common finding was concha bullosa (63.67%), followed by hypertrophy of the bulla ethmoidalis (10.93%) and of the uncinate process (10.15%). Haller’s cell was found in only 3% of cases. The most common symptom for all patients was nasal obstruction, followed by nasal discharge. The majority of symptoms improved after functional endoscopic sinus surgery for OMC drainage. CONCLUSION. OMC pathology is a frequent indication for functional endoscopic sinus surgery. The most common condition that determines blockage of OMC and need for surgical treatment is concha bullosa. The most common complaint of patients with OMC pathology is nasal obstruction.

BACKGROUND. Inverted papilloma is a benign tumor of the nose and sinuses, with a high risk of recurrence and malignant degeneration. The inverted papilloma is a slow growing tumor that can be approached through an endoscopic or external approach, depending on its stage. OBJECTIVE. The aims of the study are to identify the particularities of diagnosis of the inverted papilloma, to establish the correct steps in surgical treatment of this tumor and to open the access for other steps of treatment. MATERIAL AND METHODS. The authors present their experience in managing the sinonasal inverted papilloma in a 15-year retrospective clinical study, which included 162 patients. The preoperative protocol consisted in clinical examination, nasal endoscopy, radiologic imaging (CT scan) and biopsy with histopathology results and immunohistochemistry findings. Surgical removal of the inverted papilloma was performed by endoscopic techniques, according to the stage of the tumor. We were interested in the recurrence rate of the tumor and its malignancy after a long-term follow-up. RESULTS. In our series, we included 162 patients and we had 26 (16.04%) recurrences and 12 (7.40%) malignant degenerations. All our patients were diagnosed in Krouse stages I, II and III and underwent endoscopic resection of the tumor. CONCLUSION. In order not to have any leftover tumor (the most important factor of recurrence and malignant transformation), it is mandatory to have a complete diagnosis of the inverted papilloma, a precise surgical technique and a rigorous followup. In some cases, the surgical treatment is associated with other type of treatment (antiviral, antiangiogenetic).

Isolated fetal ventriculomegaly is the most common cerebral anomaly encountered in utero during a routine pregnancy scan. Ultrasonography remains the most easy to access tool in the examination of the fetal brain, although fetal MRI is a more accurate method of evaluating fetal ventriculomegaly— associated brain anomalies are found in 17% of the cases after performing fetal MRI. Amniocentesis with chromosomal evaluation must be performed, because kariotype anomalies are more frequently encountered in fetuses with enlargement of the ventricular atrium, but the ventriculomegaly can be a cosequence of congenital infection with CMV, Toxoplasma or Rubella. Fetal isolated ventriculomegaly is a significant risk factor for developmental delay in children. How to cite this article Vladareanu S, Traistaru VA, Vladareanu R. Fetal Isolated Ventriculomegaly: Is There any Neonatal Consequences? Donald School J Ultrasound Obstet Gynecol 2015;9(1):75-79.

Headache is a borderline pathology, faced by physicians of various specialties, which has to be thoroughly investigated to establish the etiology and appropriate treatment. The authors present a case of concha bullosa mucocele managed by endoscopic sinus surgery. The mucocele was responsible for persistent nonsystemized headache and also for the chronic rhinosinusitis of the maxillary, ethmoidal and frontal sinus because of the blockage of the middle meatus. The drainage of the anterior sinuses and the mucocele of the concha bullosa were successfully managed by endoscopic sinus surgery.

The paranasal sinus osteoma is a benign tumor characterized by a slow growth rate. Initially, the symptoms are uncharacteristic in most of the cases, afterwards they can cause headaches, nasal obstruction, epiphora etc. The authors present the case of a 45-year-old patient from IFACF - ENT “Prof. Dr. D. Hociota” with a history of frontal headache and retrobulbar pain, which started about 6 months ago. The endoscopic and computer tomographic exam mark the presence of a left frontoethmoidal tumor with bone consistency. The surgical approach was combined, with the complete macroscopic removal of the tumor and ensuring the physiological frontal sinus drainage.

Functional endoscopic sinus surgery gained increasing popularity among otolaryngologists in the last decades. During any endoscopic sinonasal surgery the major limiting factors are its complex anatomy and the high vascularity. Often, even a small hemorrage is sufficient to reduce visibility of the operating field. From the surgical perspective, there are novel technologies that reduce bleeding, thus, improving the visualization of the operating field. We present some methods of hemostasis used in endoscopic sinus surgery

Aims: There are few data on the use of endoscopic ultrasound (EUS) for the biopsy of suspected malignant lesions of the lung. The main objective of this study was to evaluate the performance of transesophageal EUS fine needle aspiration (EUSFNA) for the diagnosis of paraesophageal lung tumors and also for the confirmation of metastatic sites of lung cancer during the same procedure.Material and methods: We performed a retrospective study in a tertiary care unit including 19 patientswith paraesophageal lung tumors referred to our department for a lung biopsy. Transesophageal EUS-FNA was performed using a linear echoendoscope and 22G needles.Results: In all 19 patients with suspected lung tumors the confirmation of the malignant disease was achieved. Pathological examination revealed 16 cases of non-small cell lung cancers, 2 small cell lung cancers and one case of lung metastases. Diagnostic yield of lung EUS-FNA was 1, with no post-procedural complications. In 7 cases, we performed also biopsies of suspected metastasis and all biopsies revealed the same histopathological type as the primary tumor.Conclusions: Our study supports the use of this minimally invasive technique for paraesophageally locatedlung tumors and demonstrates that EUS-FNA is safe and has an excellent diagnostic yield.