144 research outputs found
Management of a cocaine-induced palatal perforation with a nasal septal button.
No full textA cocaine-induced midline destructive lesion (CIMDL) is a rare consequence of cocaine insufflation that involves the nose, sinuses, and occasionally the palate. Palatal perforations compromise swallowing, mastication, and speech. An obturator prosthesis can be used to overcome these complications. In selected cases, a nasal septal button is a good alternative for the sealing of a palatal perforation, especially when surgery is not indicated, such as in cases of persistent cocaine abuse. Abstinence from cocaine is the most effective long-term management option for patients with a CIMDL, and surgical correction of the defect should be postponed until the patient stops sniffing cocaine and the lesion becomes stable. We describe the case of a 39-year-old cocaine abuser whose oronasal communication was plugged with a nasal septal button, which resulted in an immediate alleviation of his oronasal reflux
Endoscopic treatment of frontal sinus mucoceles with lateral extension
No full textTo describe a new and useful criterion to identify endoscopically approachable lateral frontal sinus mucoceles. We retrospectively reviewed all patients diagnosed with frontal mucocele with lateral extension who underwent endoscopic sinus surgery (ESS) at the Department of Otorhinolaryngology, San Raffaele Scientific Institute over a 4 year period, from January 2008 to March 2012. We analyzed patient charts, pre- and post-operative imaging, operative reports, postoperative periods, and follow-up records. Our series is composed of seven patients, four males and three females, with a mean age of 56 years. Symptoms at presentation varied depending on the extent of mucocele growth and orbital and intracranial invasion. Mucocele extension medially to a virtual sagittal plane tangential to the medial side of the ocular globe was also evaluated with computed tomography, to determine the appropriateness and feasibility of an ESS procedure. After pre-operative investigations, patients underwent marsupialization of the mucocele with ESS. Postoperative follow-up ranged from 1 to 4 years. At present, all patients remain free of disease, as documented by radiological imaging. In defining endoscopically approachable lesions, it is essential to determine their extension beyond a virtual sagittal plane tangential to the medial side of the ocular globe. The success of the endoscopic procedures described was undoubtedly linked to the localization of the mucocele medial wall. This criterion is more important than the size of the mucocele, and accurate computed tomography evaluation can identify those mucoceles approachable with ESS, even if laterally extended
Maxillary sinusitis caused by dental implants extending into the maxillary sinus and the nasal cavities.
No full textThis report describes the case of a patient who underwent osseointegrated dental implant placement. The implants were misplaced inside the nasal fossae and in the right maxillary sinus, causing chronic purulent sinusitis. CT scan without contrast showed signs of right maxillary sinusitis and confirmed the misplacement of four dental implants that surfaced into the nasal cavities. The imaging also revealed the presence of another implant that emerged inside the maxillary sinus. The patient underwent functional endoscopic sinus surgery with complete symptom remission at the long-term follow-up. We propose that sinusitis caused by protrusion of implants and by sinus floor lift procedures could share common physiopathological patterns and predisposing factors
Back-and-forth endoscopic septoplasty: analysis of the technique and outcomes
No full textBackground: To describe our clinical experience in 218 consecutive
patients undergoing endoscopic back-and-forth
septoplasty (EBFS), examining surgical indications, technique,
and follow-up.
Methods: From January 2005 to November 2008, 218
patients underwent EBFS at the Department of Otorhinolaryngology,
San Raffaele Hospital, Milan, Italy. The
indication for EBFS in this series was nasal airway obstruction
(NAO). Patients were studied with nasal rigid endoscopy
and in some cases computed tomography (CT)was
used to exclude rhinosinusitis. The most common concomitant
diagnoses included allergic rhinitis and turbinate hypertrophy.
EBFS facilitates the interruption of perichondrial
and periosteal bridges, which are more represented
in the anterior portion of the septum between the caudal
quadrangular cartilage and the vomeropremaxillary
crest. Septal splints were positioned. No nasal packing was
required.
Results:No cases required conversion to a traditional headlight
approach, and no intraoperative complications were
encountered. Intraoperative mucosal microlacerations occurred
in 77.98% of cases; suturing was required in only
8.25%of cases.Of 218 patients, 74.77% experienced resolution
of NAO, while 16.06% experienced only improvement;
9.17% noted the persistence of symptoms. Complications
included transient dental pain/hypesthesia (6.88%), septal
hematoma (5.04%), synechiae formation (2.29%), epistaxis
(1.83%), septal perforation (1.83%), cheek swelling (0.45%),
and septal abscess (0.45%).
Conclusion: EBFS as a variation of endoscopic septoplasty
(ES) represents a viable procedure with good outcomes
and a low rate of complications. The technique allows lysis
of tissue fibers while preserving the integrity of mucosa
at the critical area using less force and reduces the probability
of mucosal tears, based on embryologic knowledge of
anatomical dissection
ANCA-Associated Vasculitis—ENT Involvement
No full textAntineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are idiopathic, immunologically mediated diseases predominantly affecting small vessels throughout the body (capillaries, venules arterioles, and small arteries), which are pathogenetically associated with pauci-immune vasculitis and with either proteinase 3-ANCA (PR3-ANCA or c-ANCA) or myeloperoxidase-ANCA (MPO-ANCA or p-ANCA). The 2012 revised Chapel Hill Consensus Conference (CHCC) defined microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA, formerly Wegener’s granulomatosis), eosinophilic granulomatosis with polyangiitis (EGPA, also known as Churg–Strauss syndrome), and single-organ manifestations (e.g., acute renal-limited disease known as pauci-immune necrotizing crescentic glomerulonephritis, NCGN) as the main clinic-pathological variants within the AAV spectrum. Head and neck involvement in the course of AAV is a quite frequent finding, and not uncommonly a first and stand-alone sign of active disease. This is particularly true for GPA and EGPA, especially in limited forms of disease: for this reason, otorhinolaryngologists become key figures in the multidisciplinary team approaching these conditions, especially in the diagnostic phase. Collaterally to AAV, the so-called cocaine-induced midline destructive lesions (CIMDL) are emerging pathologies caused by habitual cocaine insufflation commonly presenting with clinical, endoscopic, serological, and histopathological features resembling those of systemic vasculitis. Differential diagnosis of CIMDL from a sinonasal, limited form of GPA is often challenging, owing to their large similarity and the reluctance of patients in admitting cocaine addiction: this must always be kept in mind in AAV diagnostic algorithms
Decrease of Horizontal Canal Vestibulo-Oculomotor Reflex Gain in the Elderly with Dysequilibrium without Lifetime Vertigo
No full text<b><i>Background/Aims:</i></b> Unsteadiness in the elderly is a frequent complaint and a strong predictor of falls and psychological distress. Although there is a general consensus that it is a multifactorial condition, recent studies have focused on the role of aging of the vestibular system as a possible cofactor. The aim of our work was to assess horizontal canal function in the elderly. <b><i>Methods:</i></b> We evaluated the gain of horizontal vestibulo-ocular reflex (VOR) with a video head impulse test on a sample of 58 subjects aged >70 years without lifetime episodes of vertigo and correlated the value with different clinical conditions (hypertension, diabetes, prior cardiovascular and vascular disorders of the central nervous system, and falls). <b><i>Results:</i></b> The mean value of the gain was 0.86 ± 0.12, and people aged between 70 and 80 years presented higher values (0.90 ± 0.1) compared to those >80 years (0.81 ± 0.13; <i>p</i> = 0.025). Previous vascular disorders of the central nervous system were a predictor of decreased VOR gain (<i>p</i> = 0.0003). A nonparametric analysis demonstrated that sex, age, and VOR gain (<i>p</i> &#x02C2; 0.0001) were predictive of falls. <b><i>Conclusions:</i></b> Our data support the hypothesis of a decrease of VOR gain in the elderly. The decrease of canal function may therefore play a role in the risk of falls in the elderly.</jats:p
Hemostatic validity of the rinsed with iced (5°C) normal saline solution in endoscopic sinus surgery to avoid nasal packing.
No full textLa anestesia locale nella chirurgia endoscopica naso-paranasale. In Piragine F.: Anestesia Locale in Otorinolaringoiatria. Stamperia e Legatoria Pisana, Pisa
No full textUso di cocaina e lesioni distruttive facciali: linee di indirizzo per gli specialisti otorinolaringoiatri
No full textL’uso di cocaina e la sua assunzione per via inalatoria comportano costantemente nei consumatori una lunga serie di problematiche mediche e sociali ma anche di lesioni, di vario ordine e grado, soprattutto a livello delle fosse nasali, delle strutture delle prime vie aeree e del palato.
Il riscontro di queste alterazioni da parte dei medici specialisti ORL necessita di conoscenze più specifiche su quello che l’uso di cocaina può comportare sia per il riscontro in alcuni casi di evoluzioni maligne e destruenti della struttura mucosa, cartilaginea ed ossea, sia per l’importante opera di diagnosi precoce di uso di sostanze stupefacenti a cui questi specialisti possono concorrere, orientando ed indicando ai pazienti idonei percorsi di cura e, nel caso dei minori, allertando i genitori su un possibile uso di cocaina nei figli.
Queste linee di indirizzo sono dirette agli specialisti ORL, ma anche ai medici di medicina generale ed ai genitori al fine di incrementare la rete di attenzione al problema, fornendo elementi tecnico-scientifici in ambito diagnostico specialistico ed orientamenti pratici per poter eseguire diagnosi differenziali più precoci e corrette. Tutto questo anche con la finalità di concorrere a prevenire una eventuale evoluzione da un uso occasionale di cocaina verso forme di dipendenza, e/o di far entrare in trattamento persone che hanno già sviluppato dipendenza ma che non hanno ancora maturato la consapevolezza della necessità del trattamento. Il Dipartimento Politiche Antidroga della Presidenza del Consiglio dei Ministri, in collaborazione con il Ministero della Salute e con la Società Italiana di Otorinolaringoiatria, ha messo a punto queste linee di indirizzo che vogliono essere anche un contributo ulteriore agli interventi contro l’uso di tutte le droghe, in questo caso, della cocaina
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