Search

Epistaxis is one of the most common ear, nose and throat emergencies. The management of epistaxis has evolved significantly in recent years, including the use of nasal cautery and packs. However, a correct treatment requires the knowledge of nasal anatomy, potential risks, and complications of treatment. Epistaxis is often a simple and readily treatable condition, even though a significant bleed may have potentially severe consequences. At present, there are very few guidelines concerning this topic. The current Survey explored the pragmatic approach in managing epistaxis. A questionnaire, including 7 practical questions has been used. The current International Survey on epistaxis management reported a relevant prevalence (21.7%), mainly during childhood and senescence, an important hospitalization rate (11.8%), the common use of anterior packing and electrocoagulation, and the popular prescription of a vitamin supplement and intranasal creams. (www.actabiomedica.it)

Ossifying fibroma is a benign fibro-osseous tumour that rarely involves the ethmoid sinuses and orbit. It is classified as a benign fibroosseous lesion, a term that is synonymous with a variety of lesions reported in the literature. Recurrence rate with deleterious effects in cases of extramandibular ossifying fibroma is the impetus for open en bloc resection of the tumour. Continuously evolving techniques in endonasal endoscopic sinus surgery has rendered resection of large benign sinonasal and cephalonasal tumours possible. The authors report a case of ossifying fibroma involving the ethmoid sinus, orbit and anterior skull base in a 65-year-old previously healthy woman completely resected by endonasal endoscopic sinus surgery. The patient was free from postoperative complications and was dismissed from hospital on the sixth postoperative day. At present, the patient is disease-free at a regular five-year postoperative follow-up. Endonasal endoscopic resection of sinonasal ossifying fibromas is an excellent therapeutic option when performed by a surgeon experienced in endoscopic sinonasal surgery. The advantages of an endonasal endoscopic approach include direct visualization, enhanced visibility and magnification resulting in decreased intraoperative and postoperative morbidity. Aesthetic outcome is excellent in the absence of facial scars.Il fibroma ossificante è un tumore fibro-osseo benigno che solo raramente interessa il seno etmoidale e l’orbita. Viene classificato come una lesione fibro-ossea benigna, una dicitura che raggruppa una discreta varietà di lesioni riportate in letteratura. Una tendenza alla recidiva con importanti sequele ha rapresentato la spinta verso una resezione open en bloc nelle forme extramandibolari di questo tipo di lesione. La continua evoluzione delle tecniche di endoscopia endonasale ha reso possibile la resezione delle grandi lesioni benigne nasali e cefalo-nasali. Gli autori descrivono l’asportazione completa di un voluminoso fibroma ossificante interessante seno etmoidale, orbita e basicranio anteriore in una paziente di 65 anni in buone condizioni generali. La paziente non ha avuto complicanze postoperatorie ed è stata dimessa in sesta giornata. La paziente è al momento al quinto anno di follow-up e si presenta libera da malattia. L’asportazione endoscopica del fibroma ossificante endonasale è un’ottima scelta terapeutica nelle mani del chirurgo esperto. I vantaggi della tecnica includono la visualizzazione diretta della neoformazione e la sua maggiore magnificazione, che portano a una riduzione delle complicanze intra e postoperatorie. L’outcome estetico è ovviamente eccellente per l’assenza di cicatrici.

WOS: 000387634400010 PubMed: 29727128 Objectives: the possible impact of nasal septal deformities (SD) on cardiac pathology has not been well studied, despite growing evidence among data showing that upper airway obstruction has a negative effect on cardiac function in general and a "deviated nasal septum" being considered one of the most frequent factors responsible for impaired nasal breathing. Methods: a retrospective, case-control, double-blind study was performed on 249 patients who survived an acute coronary syndrome (ACS) attack. All patients underwent coronary angiography and were divided into coronary angiography positive (123 pts) and coronary angiography negative (126 pts) groups. The quality of nasal breathing was not considered in this study, but morphological aspects of the nasal septum (nasal septal deformities) were observed by anterior native rhinoscopy and endoscopic examination of the nose following the application of superficial anaesthesia. Mladina classification of nasal septal deformities was used. Results: there was a statistically significant difference between coronary angiography negative and positive patients in Mladina type 1 to Mladina type 7 groups (p=0.000, X-2=54.605). The incidence of nasal SD types 5 and 6 was higher in the group of ACS patients with the positive coronary angiography, whereas general distribution of the particular types of nasal septal deformities as they appear in the general population was found in the coronary angiography negative group. Conclusion: the fact that types 5 and 6 are inherited deformities and not related to trauma against the nose suggests the possible genetic predisposition for the onset of ACS with positive coronary angiography.

Background: Suffocation due to foreign bodies (FB) is a leading cause of death in children aged 0-3. No data from the former U.S.S.R. are available in the international scientific literature. Methods: Consecutive patients admitted at the Iashvili Central Children Hospital in Tbilisi, Georgia from 1989 to 2011 were analyzed. Injuries in the upper airways due to foreign bodies' inhalation were collected and compared with the Susy Safe Registry and the pooled estimates of the meta-analysis. Results: 2896 cases were collected. Distribution of injuries in children younger than 3 years was significantly higher than in the Susy Safe Registry and in the "High-Income" countries in the meta-analysis. Percentage of injuries due to organic objects (86%) was significantly higher than in published data. Conclusions: Since Georgia is not showing any substantial difference, both in epidemiology and treatment of foreign bodies injuries, as compared to the other case series, translation of public health initiatives from other most advanced prevention experiences is possible and it is likely to be effective. Level of evidence: Level V, Epidemiological case series. © 2015 Elsevier Ireland Ltd.

Objectives: To provide an epidemiological framework of symptoms related to Foreign Body (FB) injuries due to Button Battery (BB). Methods: Data on BB ingestion/inhalation have been obtained from the ButtonBatteryDB. The ButtonBatteryDB is a database collecting information on BB injuries in children (0-18 years of age). Data on 348 BB injures have been derived from the Registry of Foreign Body Injuries "Susy Safe" (269 cases) and from published scientific literature reporting case reports of FB injuries (79 cases). Results: Most of injured children were male and BBs were found more often in the mouth/esophagus/stomach (ICD935) and in the nose (ICD932). Analyzing symptoms related to BB located in the esophagus/mouth/stomach, we found that children had higher probability of experiencing dysphagia (30.19%, 95% C.I. 17.83-42.55), fever and cough (26.42%, 95% C.I. 14.55-38.28), compared to the other symptoms. Referring to the probability that symptoms occurred simultaneously, fever and cough are more likely (3.72%, 95% C.I. 1.0-6-43) to jointly showing up in children with BB in mouth/esophagus/stomach (ICD935), followed by fever and dysphagia (2.66%, 95% C.I. 0.36-4.96) and by fever and irritability/crying, fever and drooling, dysphagia and irritability/crying (2.13% C.I. 0.00-4.19, 95% C.I.). Conclusions: These findings provide new insight in clinical presentation of BB injuries: the identification of unique patterns of symptoms related to BB injuries is useful to perform an early diagnosis (and to guarantee a prompt medical reaction), also when the injury is un-witnessed. © 2015 Elsevier Ireland Ltd.

Septal deformities are very frequent in patients suffering from chronic rhinosinusitis (CRS). The question is whether or not some types of septal deformities are involved more frequently in this process or not. The authors observed the incidence of particular types of septal deformities in a group of CRS patients using Mladina classification. The same has been done with a control group that consisted of healthy volunteers. In the literature, type 7 has been found very frequently, i.e. in nearly 30% of all CRS cases. Herein, type 7 was mostly composed of types 3 and 5. Type 3 can be accurately recognised on axial MSCT scans, while type 5 can be accurately recognised on coronal views. Concomitant septal surgery at the time of endoscopic sinus surgery is recommended.Le deformità del setto nasale sono molto frequenti in pazienti affetti da rinosinusite cronica (CRS). La domanda è se alcune deformità possono aggravare più di altre questo processo patologico. In questo lavoro gli autori hanno studiato l'incidenza di particolari tipi di deformità in un gruppo di pazienti affetti da CRS usando la classificazione di Mladina. Lo stesso è stato fatto in un gruppo di controllo costituito da volontari sani. Il tipo 7 molto è stato riscontrato nel 30% dei casi di CRS. Tale tipo risulta essere caratterizzato dalla presenza contemporanea di diverse deformità e più frequentemente dall'associazione del tipo 3 e 5. Il tipo 3 evidenziabile accuratamente con scansioni TC assiali ed il tipo 5 con scansioni coronali. Gli autori concludono sostenendo l'importanza e l'utilità di una settoplastica da eseguirsi, in pazienti, che presentano una deformazione tipo 7, in concomitanza con la FESS.

Rationale and aim: The aim of the present study is to acquire a better understanding of Non Food Foreign Bodies (NFFB) injuries in children with particular regard to the quantification of the risk of complications and hospitalization associated with patient characteristics, FB features, FB location and circumstances of the accident, as emerging from the SUSY Safe Web-Registry. Methods: The present study uses data provided by the SUSY Safe Project, a DG SANCO co-funded project which was aimed to collect as many scientific data as possible regarding Foreign Bodies (FB) injuries in children aged 0-14 years and to serve as a basis for a knowledge-based consumer protection activity in the Europe market. FBs were characterized by size, shape and consistency. Descriptive statistics (absolute and relative number or median, I and III quartile according to the categorical or continuous variable, respectively) were calculated for each considered non food item characteristics; FB features distribution by children class age and site of obstruction were assessed. Two different outcomes were considered: hospitalization and complication. FBs which most frequently cause complications were identified. The association between children age, adult presence, object characteristics and outcomes was computed using crude odds ratios and the related 95% confidence intervals. Results: 16,878 FB injuries in children aged 0-14 yrs have been recorded in the Susy Safe databases. FB type was specified in 10,564 cases; among them 7820 (74%) were due to a non food item. Almost two thirds of injuries occurred in patients 3 years or more old. 53% of patients were males, while 47% were females. When injury happened, the great part of children (86%) was playing. Almost 30% (2339) of injuries happened under adults' supervision. Complications occurred in 299 cases and the most documented was infections (10% of cases) followed by perforation (5%). Conclusions: The inhalation/aspiration of a FB, as well as the ingestion and the insertion in the orifices of a FB may result in significant morbidity. Particularly, long-standing or hazardous foreign bodies can cause extensive damage. Some objects, because of their composition, contour, or location, are particularly hazardous: for instance, objects with sharp edges pose a significant risk of laceration and perforation, while fragments of toys have been found only in 2 cases. Parents are frequently unconscious of hazard related with some objects and they are not adequately able to promptly recognize dangerous objects and risky situations. Moreover, also clinicians seem to pay little attention to adult role in the dynamic of the accident: in fact in case series descriptions, data regarding adult presence are often under-reported. On the contrary, since many injuries to children cannot be prevented without some degree of active behavior on the part of parents, the dissemination of information regarding safe behaviors and the implementation of educational strategies aiming to improve parent's attention toward this issue could be fundamental in preventing injuries and need to be promoted by family pediatricians and health practitioners. © 2012 Elsevier Ireland Ltd.

Objectives: to collect relevant, up-to-date, representative, accurate, systematic information, related to foreign bodies (FB) injuries. Methods: The "Susy Safe" registry, a DG SANCO co-funded project gathering data on choking in all EU Countries and beyond, was established in order to create surveillance systems for suffocation injuries able to provide a risk-analysis profile for each of the products causing the injury. Main findings after 4 years of activities are resumed here. Results: 16,878 FB injuries occurred in children aged 0-14 years have been recorded in the SUSY SAFE databases; 8046 cases have been reported from countries outside EU. Almost one quart of the cases involving very young children (less than one year of age) presented a FB located in bronchial tract, thus representing a major threat to their health. Esophageal foreign bodies are still characterizing injuries occurred to children younger than one year, in older children the most common locations are the ears and the nose. FB type was specified in 10,564 cases. Food objects represented the 26% of the cases, whereas non-food objects were the remaining 74%. Among food objects, the most common were bones, nuts and seed, whereas for the non-food objects pearls, balls and marbles were observed most commonly (29%). Coins were involved in 15% of the non-food injuries and toys represented the 4% of the cases. Conclusions: this data collection system should be been taken into consideration for the calculation of the risk of injuries in order to provide the EU Commission with all the relevant estimates on FB injuries. © 2012 Elsevier Ireland Ltd.

Rationale and aim: The purpose of this study is to acquire a better understanding of Food Foreign Bodies (FFB) injuries in children characterizing the risk of complications and prolonged hospitalization due to food items according to patients' characteristics, circumstances of the accident, Foreign Body (FB) features and FB location, as emerging from the SUSY Safe Web-Registry. Methods: The present study uses data provided by the SUSY Safe Project, a DG SANCO co-funded project started in February 2005, which was aimed at establishing an international registry of cases of Foreign Bodies (FB) injuries in children aged 0-14 years. The analysis was carried out on injuries due to a food item.FB location was reported according to ICD9-CM code: ears (ICD931), nose (ICD932), pharynx and larynx (ICD933) trachea, bronchi and lungs (ICD934), mouth, esophagus and stomach (ICD935).Age and gender injury distributions were assessed. Data regarding adult supervision and activity before injury were also evaluated. FBs which most frequently cause complications were identified. The association between children age, adult presence, object characteristics and hospitalization/complications was computed using unweighted odds ratios and the related 95% confidence intervals. Results: 16,878 FB injuries occurred in children aged 0-14 years have been recorded in the SUSY Safe databases. FB type was specified in 10,564 cases; among them 2744 (26%) were due to a food item. FB site was recorded in 1344 cases: FB was located in the ears in 99 patients, while 1140 occurred in the upper and lower respiratory tract; finally, 105 food items were removed from mouth, esophagus and stomach. Complications occurred in 176 cases and the most documented was pulmonary or bronchial infections (23%) followed emphysema or atelectasis and by and asthma (7%). Bones were the commonest retrieved FFB encountered in this study, while nuts seem to be the FFB most frequently associated to complications. Conclusions: On the basis of this study we make the strong recommendation that parents should be adequately educated and provide age-appropriate food to their children and be present in order to supervise them during eating especially during a critical period ranging from 2 to 3 years of age. © 2012 Elsevier Ireland Ltd.

Rationale and aim: Foreign body (FB) injuries are a relatively frequent event in young children. Clinical picture can be evidently affected from different variables. Among those size, shape, type and FB location cover an important issue. Increased attempts have been made in order to encourage normative interventions for products devoted to children's care and entertainment, reaching acceptable safety level; on the contrary, fewer efforts have been devoted to investigate the risk associated to objects that - even if not expressly created for children - are easy accessed by children, like stationery.The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to stationery items according to age and gender of patients, FB characteristics and FB location, circumstances of the accident, as emerging from the Susy Safe Registry. Methods: From 2005 to 2010 case were collected from 70 centers in 32 different countries. Details on the injuries, identified by means of the International Classification of Diseases, Ninth Revision (ICD-9) codes listed on hospital discharge records, were gathered through a standardized case report form, that provides a full set of information on injuries, with specific details on age and gender of the child, location, shape, volume, consistency and ellipticity of the foreign body, behavioral aspects linked to the injury, like the supervision of the parents or the activity concomitant to the accident, any complication occurred, length of hospitalization. Results: In the years 2005-2010 a total of 17,205 FB injuries in children aged 0-14. years were registered in Susy Safe Database. Among them 425 (2.5%) were due to a stationery item. The majority of FBs were retrieved in the nose (179, meaning 42.1%) and in the ears (176, 41.4%) only 5 cases were observed in children younger than 1. year, while most of the cases, 80.6%, were recorded in children older than 3. years. 193 patients (45.4%) were female, while 232 (54.6%) were male. Adult supervision was indicated in 212 cases. In 143 of these accidents the adult was present (33.6% of the whole group). The most frequent stationery retrieved was rubber, counting for 209 cases (49.2%). According to the FBs types, mostly all cases reported a 3D volume and a rigid or semirigid consistency (49.3%). Looking to the outcomes, 31 (7%) children needed hospitalization and complications were seen in 38 children (8.9%). No significant associations were seen between the outcomes and the FBs' characteristics, excluded those between the consistency of the FB (rigid) and the necessity of hospitalization and the shape (2D) and the presence of complication. Conclusions: Injuries are events that in many cases can be prevented with appropriate strategies. Passive environmental strategies, including product modification by manufacturers, are the most effective. However, regulation regarding small parts of potentially dangerous objects covers products addressed to children use but objects not projected for children, such as stationary items, are excluded. Our study testifies that stationary is involved in a non-negligible percentage of FB injuries, mainly due to insertion in the ears. Frequently, injuries happen under adult supervision. These results confirm the fact that when passive preventive strategies are not practical, active strategies that promote behavior change are necessary and information about this issue should be included in all visits to family pediatricians. © 2012 Elsevier Ireland Ltd.

Počeci transfacijalnog pristupa paranazalnim sinusima i prednjoj lubanjskoj osnovici datiraju iz prve polovice 20. stoljeća, prije svega pionirskim radom neurokirurga Hirscha, Schloffera i Cushinga. Kako se radilo o transnazalnim pristupima u područje sfenoidnog sinusa i hipofize ne smatramo ih transfacijalnim pristupima u užem smislu. Valja svakako napomenuti, obzirom na preantibiotsku eru, zapanjujuće nisku stopu mortaliteta od svega 5%, najčešće posljedicom meningitisa. Daljnjim usavršavanjem kirurške tehnike, poglavito kirurgije tumora paranazalnih sinusa, razvijaju se transfacijalni pristupi u užem smislu. Pravi zamah i puni smisao transfacijalni pristupi paranazalnim sinusima i prednjoj lubanjskoj bazi dobivaju tek u drugoj polovici 20. stoljeća uvođenjem antibiotika u svakodnevnu kliničku praksu i poglavito razvojem kraniofacijalne kirurgije. Transfacijalni pristupi u užem smislu su: a) Lateralna rinotomija (Moureau), koja nam pruža izvrstan prikaz nosne šupljine i lateralnog nosnog zida te je pogodna za medijalne maksilektomije. Njezinom modifikacijom po Weber - Fergusonu dobivamo izvrsnu ekspoziciju za totalne i radikalne maksilektomije. b) Totalna rinotomija, izuzetno korisna za ekstenzivni prikaz rešetnice i ostatka prednje lubanjske osnovice. Često se rabi kao dio kraniofacijalnih resekcija, c) "Midface degloving" incizija, kojom izbjegavamo ožiljke na licu. Pogodna je prije svega za inferiorne medijalne maksilektomije i ne pruža idealan prikaz cijeloga krova nosne šupljine. Ovim radom smo željeli prikazati uporabu transfacijalnih pristupa u kirurgiji benignih i malignih tumora nosa, paranazalnih sinusa i prednje lubanjske osnovice te valorizirati prednosti i nedostatke svakog od njih ponaosob.

Aim of the study: The absence of normal, expected values of the minimal cross sectional area (MCA) in normal (healthly) population seems to be the biggest obstacle towards further development of the acoustic rhinometry. The authors believe that the values of the MCA can and must be standardized in a simple way, i.e. they need a corrective factor. Rubner discovered over a hundred years ago that the energy waste, oxygen consumption, respiratory volume and minute heart volume in all animals with the constant body temperature are in a linear proportion to their average body surface area (BSA). The aim of this study is to investigate possible correlation between MCA and BSA in normal population. Material and methods: Overall 220 normal subjects were analyzed by means of acoustic rhinometry. They were ranged according to the age: group I (6-7 year of age, children), group II (13-14 year of age, puberty age), group III (18-19 year of age, adolescent age), group IV (23-24 year of age, young adults) and group V (over 30 year of age, adults). The acoustic rhinometry was performed before and after nasal denongestion with 0.05% oxymethazoline nasal spray solution. The results of the MCA were correlated to BSA, age, gender, height and weight. Results: The results of our investigation suggest that the value of BSA is the only relevant and statistically significant predictor for the value of MCA among anthropometric predictors (age, gender, height, weight). Conclusions: Strong correlation between the values of BSA and MCA suggests that the expected value of the MCA (eMCA) can be calculated for each subject based on their anthropometric data of body surface area using baseline value and the corrective factor.

Bacterial biofilms are involved in many human bacterial infectious processes and in chronic rhinosinusitis as well. The aim of this study was to determine whether biofilm exists in nasal polyps, both in diffuse nasal polyposis (DNP) and antrochoanal polyps (ACP). Method: Tissue samples were taken front seven patients suffering from DNP and three patients suffering from ACP, based on the defined patient inclusion and exclusion criteria. After the preparation, the tissue samples were analyzed by means of scanning electron microscopy (SEM) for signs of biofilm formation. Results: Signs of biofilm presence were found in all DNP patients. In ACP cases, biofilm was found in the stalk and nasal, polypoid part of the ACP, whereas there were no signs of biofilm on diseased mucosa of the posterior wall of the maxillary sinus. Conclusions: Our preliminary study showed a possible role of bacterial biofilm in pathogenesis and maintenance of both DNP and ACP. There are no obvious differences in the SEM appearance of biofilms in DNP and ACP Future research is needed to explain why biofilm is present in cases of diffuse nasal polyposis and at the nasal part of ACP, but not on the maxillary sinus part of ACP.