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Flavia Baderca,1,2 Dana Vincze,3 Nicolae Balica,4 Caius Solovan5,61Department of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 2Service of Pathology, Emergency City Hospital, Timisoara, Romania; 3Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 4Otolaryngology Department, 5Department of Dermatology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania; 6Department of Dermatology, Emergency City Hospital, Timisoara, RomaniaAbstract: Melanomas are malignant tumors that originate from melanocytes. They are most frequently localized in the skin, but 5% of all melanomas interest also extracutaneous sites as mucosal surfaces, parenchymatous organs, the retroperitoneum area, and the ocular ball. The purpose of this study was to investigate the epidemiologic and morphologic data of mucosal melanomas diagnosed at Emergency City Hospital (Timisoara, Romania) during a period of 12 years. The study included 17 cases of extracutaneous, extraocular melanomas, with 16 primary melanomas and one secondary melanoma. All our patients were older than 53 years and were mostly men. Most of the patients presented with localized disease; only one case had regional lymph node metastases, and another one had systemic metastases at the time of diagnosis. Regarding localization, nine of 16 melanomas were in the head and neck region, six were diagnosed in the gastrointestinal and urogenital tracts (three cases each), and one case had a rare localization (retroperitoneum). The most common histologic type was represented by epithelioid cells, and the majority of the tumors were achromic. Mucosal melanoma is a tumor associated with aging, all our patients being older than 53 years. Because of unspecific symptoms and low incidence, the diagnosis is often delayed and requires teamwork among the clinician, pathologist, radiologist, and oncologist. Different genetic fingerprints impose a correct diagnosis to offer the patient the best novel, personalized therapy.Keywords: mucosal melanoma, melanocytes, molecular classification, kit gene mutations, immunohistochemistry

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We present the case of a 12 years-old male patient with maxillary diastema induced and maintained by labial frenum in which we performed a laser-assisted labial frenectomy. [ABSTRACT FROM AUTHOR]

Developing in a limited space, rare tumors located at the nose and paranasal sinuses are sometimes difficult to diagnose due to their modest clinical presentation, which is uncorrelated with anatomopathological diversity. This limits the preoperative diagnosis without added immune histochemical study; for that reason, we present our experience with these tumors with the intention of raising awareness. The patient included in our study was investigated by our department through clinical and endoscopic examination, imaging investigations, and an anatomic-pathological study. The selected patient gave consent for participation and inclusion in this research study in compliance with the 1964 Declaration of Helsinki.

Failure in the embryological development of the thyroid in adults is rarely seen. We present the case of a 79-year-old female patient who complained of dysphagia and progressive upper respiratory obstruction, which started 12 months prior to her admission. An ENT clinical exam revealed a tongue base, spherical, well-defined tumour covered by normal mucosa. Further assessments established the diagnosis of the tongue base ectopic thyroid tissue. Due to the patient’s symptoms, a transhyoid tongue base tumour removal was performed. The selected patient gave consent for participation and inclusion in this paper, in compliance with the 1964 Helsinki declaration.

Introduction: Acute rhinosinusitis is a very common disorder that at one time or another affects most people. From a temporal standpoint acute rhinosinusitis lasts for up to 4 weeks. Streptococcus pneumoniae (20%-45%) and Haemophilus influenzae (22%-35%) are the predominant organisms in acute bacterial rhinosinusitis in adults. An external ethmoidectomy is an alternative approach for treating orbital complications of acute rhinosinusitis, such as a subperiosteal abscess. Complications include diplopia from injury to the trochlea or medial rectus, blindness, exposure keratitis, corneal abrasions, skull base injury, and CSF leak. Case Report: We present the patient V.G. 18 years old which first addressed to the Infectious Diseases Department and 2 weeks later to the ENT Department with the following diagnosis: Left Fronto-Ethomoido-Maxillary Acute Baterial Rhinosinusitis, Left Subperiosteal Abscess with Exophthalmia, Left Upper Eyelid Abscess, Left Chemosis, Left Lower Eyelid Inflammatory Edema. The blood cultures were negative. The treatment consisted in administration of i.v. broad spectrum antibiotics for 15 days. On ENT clinic and nasal rigid endoscopic 0º exam revealed purulent material at the level of left middle meatus, which is blocked, bilateral normal aspect of the inferior turbinates, rhynopharynx with purulent material from the left middle meatus. We performed a maxillary sinus puncture with lavage (+++) and silicon tube insertion. The patient was addressed for a contrast enhancement CT exam. In ENT Department we performed left external ethmoidectomy, left subperiosteal and upper eyelid abscesses drainage followed by Phenoxymethylpenicillin potassium 2g./day -- 7 days. As postoperative protective antibiotic was used for 7 days Cilopen (Phenoxymethylpenicillin potassium) 2g./day. At seven postoperative days the signs (left subperiosteal abscess, exophthalmia, left upper eyelid abscess, left chemosis, left lower eyelid inflammatory edema) were resolved. The evolution was favorable with almost complete remission of the symptoms and signs. One month after the surgical procedure the patient presented a slight left proptosis and a slight divergent strabismus. Control CT exam was performed one month postoperative and showed a normal aeration of the paranasal sinuses. Conclusion: Orbital and nasal signs and symptoms at one month after the surgical procedure were resolved, the patient presented a slight left proptosis and a mild divergent strabismus.. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this study was to correlate the mother's biological status and related extrinsic factors during pregnancy and growth retardation and anemia in neonates. Material and method. We have done a prospective study on 75 mothers who delivered in 2013 in Obstetrics and Gynecology Clinics of Emergency County Hospital Timisoara and their newborns. Maternal extrinsec factors pre- or during pregnancy were related with the percentage distribution of neonates with IUGR and anemia. Results. Smoking habits (53%), lack of education (44%) and precarious socioeconomic conditions (42.7%) were the first three extrinsec factors well represented. The percentage distribution of newborns was 43% AG Sinonasal squamous cell carcinomas are relatively uncommon, representing only 3% of all head and neck malignancies. The treatment modality (surgery, radiotherapy, chemotherapy) poses several challenges. First of all, the patients are often diagnosed with advanced stage disease. Secondly, close proximity of critical structures and complex anatomy of the region, compromise surgical removal and radiation deliverance. Thirdly, important uncertainty issues surround fundamental aspects of treatment hence the optimal therapy protocol remains to be determined. We present an 18-yearold male patient with right sinonasal non-keratinizing squamous cell carcinoma and hard palate, middle infraorbital area, middle cranial fossa space involvement. Admission clinical signs and symptoms were: recurrent sinusitis, right sinonasal tumor and bilateral cervical lymph node involvement. A biopsy was performed and sent to the Pathology Service. The specimen was prepared with the routine histological technique. On hematoxylin eosin slides, the lesion was polypoid showing a connective tissue core with seromucous acini and moderate quantity of inflammatory cells (neutrophils, eosinophils, lymphocytes, histiocytes). The overlying epithelium was pseudostratified, being composed of ciliated columnar cells and presenting areas of squamous metaplasia. From these zones, originated a malignant tumor formed by epithelioid cells, with eosinophilic cytoplasm and vesicular nucleus containing prominent nucleolus. The cells were disposed in sheets, surrounded by fibrous connective stroma. Moreover, as precursor lesion, at transition site between normal epithelium and malignant tumor, was noted severe dysplasia. The histopathological aspects were consistent with a non-keratinizing squamous carcinoma arising in a fibro-glandular polyp with concomitant severe epithelial dysplasia, as a precursor lesion. The patient underwent radiochemotherapy for primary tumor and cervical lymph nodes metastases; at 12 months after treatment no recurrence was noted. [ABSTRACT FROM AUTHOR]

Introduction: In order to quickly estimate an individual's cochlear duct length (CDL), a research software application was developed. Clinicians can use this information to select the cochlear electrode array size that is individually suited to each cochlear implant (CI) recipient. The objective was to evaluate the usefulness and reliability of the research software application for the estimation of an individual's CDL as a basis for electrode selection. Methods: Before surgery, the maximum basal turn diameter (value "A") was measured on a coronal section of highresolution computed tomography (HRCT) of the temporal bone. Based on "A", the research software application calculated the CDL, and the appropriate electrode was chosen for implantation. After implantation, the results of 21 consecutive patients (23 ears) obtained using the research software applications were compared to their postoperative X-ray measurements and to the surgeon's intraoperative notes. Results: The "A" distance measured on CT scans varied from 7.8mm to 9.7mm with a mean value of 9.14mm; The mean CDL was 34.05mm ± 1.72. Full insertion was achieved in all but 2 cases but there were no contacts of the array outside the cochlea. There was no misplaced electrode array or electrode fold over detected on imaging. We inserted the electrode mostly through the round window (18/23). For 17 long electrode arrays, the software application suggested an insertion depth of 30.7mm which ultimately was 29.4 mm (average) according to Xray measurements. For the 5 shorter electrode arrays, the predicted insertion depth was 27.4 mm with a actual depth of 26.6 mm as measured via X-ray. In one case we used an even shorter electrode as suggested by the software. Conclusion: The results show a good correlation between the preoperatively predicted insertion depths using the software application and postoperatively measured using X-ray. [ABSTRACT FROM AUTHOR]

Laryngeal neoplasm contributes to 30-40% of carcinomas of the head and neck. Mast cells are normal connective tissue residents, well represented in the respiratory tract. Experimental evidence suggests that the growth of a tumor beyond a certain size requires angiogenesis, which may also permit metastasis. The aim of this study was to evaluate the correlation between mast cell density, microvascular density, histopathological type and histological grade. Our study included 38 laryngeal carcinomas as follows: adenoid cystic carcinoma (2 cases), malignant papilloma (2 cases) and squamous cell carcinoma (34 cases). The combined technique of CD 34-alcian blue safranin (ABS) was used to identify microvessel and mast cell density, which was quantified by the hot spot method. A significant correlation was found between both mast cell and microvascular density, and G1/G2 histological grade (p=0.002 and p=0.004, respectively). Squamous cell carcinoma was significantly correlated with mast cell density (p=0.003), but not with microvascular density (p=0.454).

The performance of the cochlear implant recipients varies considerably and many factors have been taken into account in an attempt to explain this situation. We discuss further about one of these factors, namely the type of insertion. It seems that a single type of cochleostomy is not ideal in all cases, and the concept of "one size fits all" proves once again to be wrong. We compare the round window membrane (RWM) and the bony cochleostomy approaches. Thin, straight electrodes seem better suited for RWM insertion, but should be considered for bony cochleostomy insertion when the anatomy is not favorable. Thicker or pre-curved electrodes may be best inserted by bony cochleostomy. [ABSTRACT FROM AUTHOR]

Otogenic lateral sinus thrombosis (OLST) is a rare intracranial complication of otitis media. The management is controversial. It still represents a potential life-threatening condition despite the modern antibiotic treatment. This study aims to report the clinical presentation and management in a series of OLST over a 10-year period. Materials and method. The medical charts of 8 patients diagnosed with OLST were reviewed. These patients were identified from a search of 536 subjects with a diagnosis of mastoiditis operated over a 10-year period (2010-2019). Results. A total of 8 patients (six males and two females), with ages ranging from 11 to 68 years old, were diagnosed with OLST. All of them had a history of chronic ear disease. Seven patients were under antibiotic therapy prior to admission. The most commonly reported symptoms were headache, ear discharge and hearing loss. Imaging studies and microbiological cultures were performed in all patients. Other complications were simultaneously present: intracranial abscess (n=2). The treatment in all cases comprised of i.v. broad-spectrum antibiotics, mastoid surgery, and long-term hypocoagulation. Sigmoid sinus exposure was performed in all patients. All patients had a satisfactory resolution of their symptoms, and the mortality rate was of 0%. Conclusions. The clinical course of OLST can be masked by previous antibiotic therapy. The neurologic symptoms may dominate the presentation. Therefore, a high suspicion index is needed for diagnosis. The high recanalization rate and zero rate of mortality can be obtained with a timely combination of i.v. antibiotics, mastoid surgery and hypocoagulation. [ABSTRACT FROM AUTHOR]

Introduction. In order to quickly estimate an individual's cochlear duct length (CDL), a research software application was developed. The clinicians can use this information to select the cochlear electrode array size that is individually suited to each cochlear implant (CI) recipient. Furthermore, the research software application allows to postoperatively determine the percentage of cochlear coverage, the insertion depth and the insertion angle of individual electrode contacts. The objective was to evaluate the usefulness and reliability of the research software application for the estimation of an individual's CDL as a basis for electrode selection. Methods. Before surgery, the maximum basal turn diameter (value “A”) was measured on a coronal section of high-resolution computed tomography (HRCT) of the temporal bone. Based on “A”, the research software application calculated the CDL, and either the longest, or a shorter electrode was chosen for implantation. After implantation, the results of 21 consecutive patients (23 ears) obtained using the research software applications were compared to their postoperative X-ray measurements and to the surgeon's intraoperative notes. Results. The application was used in 21 consecutive patients (19 children, 2 adults). The “A” distance measured on CT scans varied from 7.8 mm to 9.7 mm, with a mean value of 9.14 mm; SD=0.415. The measured “A” distances correspond to CDLs varying from 28.5 mm to 36.4 mm. The mean CDL was 34.05 mm; SD=1.72. Full insertion was achieved in all but two cases, but there were no electrodes outside the cochlea. There was no electrode fold over detected on imaging. In all but 4 cases, the electrode was chosen based on the research software application's indication. We inserted the electrode mostly through the round window (18/23). For 17 long electrode arrays, the software application suggested an insertion depth of 30.7 mm and it was 29.4 mm (mean value) according to measurements on the X-ray. For 5 shorter electrode arrays, the predicted insertion depth using the software application was 27.4 mm, and it was 26.6 mm (mean value) according to measurements on the X-ray. In one case, we used an even shorter electrode. Conclusion. The results suggest a good correlation between the insertion depths predicted preoperatively using the software application and calculated postoperatively using the X-ray. The insertion length predicted by software was always longer than the one calculated on X-ray. [ABSTRACT FROM AUTHOR]

Cochlear implantation has a very low complication rate, but if these complications require explantation, the situation becomes very problematic, especially in children, for more than obvious reasons. The classic approach (mastoidectomy, posterior tympanotomy, cochleostomy or round window insertion) is the most used technique all over the world. There are few feared steps - e.g. posterior tympanotomy, with its known risk of inadvertently damage the facial nerve - and this is why alternative techniques have been developed. However, these techniques carry their own specific risks which should not be underestimated so there is no risk free option. There is still a debate which insertion method to be chosen: cochleostomy or Round Window (RW). The landmark for bothis the RW niche, so the first step is to be sure that you have a RW (checkthe CT scan). The insertion angle through the RW membrane is not the optimal one so to see enough of the RW membrane is a prerequisite. Attempts at adequately visualize the RW membrane may end up in accidentally (and sometimes unnoticeably) uncovering the facial nerve and the electrode array being in contact with it. Performing a cochleostomy without positively identifying the RW niche is risky business because the chances to end up in the scala vestibuli is very high. The position of the cochleostomy is of paramount importance for a traumatic insertion. Straightforward surgery? It is for everyone to decide. [ABSTRACT FROM AUTHOR]

Copyright of ORL.ro is the property of MEDICHUB MEDIA, S.R.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article offers information on a study which examines the method to threat bilateral vocal chord paralysis. It states that cordotomy procedure was performed in patients using Kashima techqniue, which involves separation of one vocal chord from the vocal process, creation of posterior gap for respiration and maintenance of vocal chord for phonation. It suggests that bilateral vocal chord paralysis can be treated through posterior cordotomy.

The article offers information on a study which investigates the functional and analytical results of short and long-term cartilage tympanoplasty and compare the results with fascia grafting, the commonly used method for eardrum reconstruction. It states that the study involved patients aged 15-55, who undergone noncholesteatous surgery in the middle ear. It suggests that the materials used for reconstruction does not affect the results in the residual perforations and hearing.

The article offers information on a study which examines the efficacy of cochlear implant surgery method in children. It mentions 32 cases of cochlear implant surgery in which small incision were performed in children between January 2003 and December 2011. It notes that the standard method of posterior tympanotomy and cochleostomy were performed using sature fixation in the cranial periosteum. It suggests that the suture fixation method of the receiver stimulator is the most effective method.

The article presents a study which examines the surgical reconstruction in chronic noncholesteatomatous disease of the middle ear through grafting. The study compared 58 cases tympanoplasty with 42 tympanoplastie and found that four of the five postoperative perforations in which temporalis fascia was used occurred near the anterior tympanomeatal angle. Furthermore, the study concludes that cartilage is an ideal grafting material in eardrum reconstruction in poor ventilated ears.

Titanium represents a more and more used material in tympano-ossicular reconstruction. Titanium biocompatibility depends fundamentally on biomolecular adhesion, chemical processes and implantable surface roughness. In this study, the authors have assessed the titanium, stainless steel and iron cytotoxic effect on mice fibroblast cells. The authors prepared the growth medium (DMEM), cultivated mice fibroblastic cells and evaluated the cytotoxicity degree over the cells with flowcytometry analysis using 7AAD as a flowcytometric marker over the cellular death. The metallic samples used are represented by titanium commercial implants, orthopedical plates from medical stainless steel and plates from untreated iron. By the flowcytometric analysis of the samples with stainless steel extract, the cellular death could be revealed beginning with a concentration of 250 μl and by the flowcytometric analysis of the samples with titanium extract, not even the slightest modification of the cells could be observed, even at the concentration of 300 μl. The study results confirm titanium excellent biocompatibility and justifies the more and more frequent usage of the titanium for the accomplishment of the necessary prosthesis for the reconstruction of the ossicular chain. [ABSTRACT FROM AUTHOR]

Objective: Juvenile recurrent laryngeal papillomatosis (RLP) is a viral disease caused by Human Papilloma Virus type 6 and 11, with an incidence of 4-7 cases/1 million people characterized by multiple recurrences of benign tumours of the larynx mucosa and significant morbidity on paediatric patient and strain on their families. It represents the most frequent benign tumour of the larynx with a high morbidity, difficult to treat due to its recurrences and respiratory tract dissemination. The aim of this study was to evaluate the results of combined treatment with CO2 laser microsurgery and interferon (IFN) alpha 2b in children suffering from laryngeal papillomatosis. Materials and Method: In the study were included, during a 13 years period (1996-2008), 28 patients aged from 2,9 to 9 years diagnosed with laryngeal papillomatosis. CO2 laser microsurgery (microsurgical excision and progressive vaporization of papillomas) followed by IFN adjuvant therapy was the management applied. Tracheotomy was not necessary in any of the cases. Results: Clinical examination revealed regression of papillomas in all patients. 19 patients (67.85%) had complete regression after primary CO2 laser microsurgery and additional IFN treatment, and 9 patients (32.15%) had partial response to the combined treatment. In these cases second intervention was needed. We encountered no perioperative or postoperative complications or severe side-effects. Conclusions: The method of choice in laryngeal papillomatosis in children is the combination of CO2 Laser microsurgery and additional IFN treatment, improving the prognosis of this recurrent viral disease. Reachable functional results, good tumour control, short hospitalization makes it a favourable treatment in paediatric patients. [ABSTRACT FROM AUTHOR]

Carcinogens injury on the laryngeal mucosa gives birth to genetic alterations, which then translate into premalignant lesions (hyperplasia, dysplasia, in situ carcinoma). Between 2006 and 2008, 67 patients were admitted in the ENT Department in Timisoara with chronic laryngeal diseases and precancerous lesions associated. They have been investigated by suspended microlaryngoscopy and biopsy with histopathological examination. Hyperplasia was the most frequent lesion (65.67%) associated with chronic laryngitis, laryngeal papilloma, laryngeal polyp and Reinke oedema. Mild dysplasia was present in 7.46% of the cases, moderate dysplasia in 14.92% and the severe form in 1.49% of the cases. The carcinoma in situ has been diagnosed in 7 patients (10.44%). [ABSTRACT FROM AUTHOR]