1,721,030 research outputs found
Possibilities of diagnostic errors in paralysis of the 7th cranial nerve
No full textApproximately 5% of all facial paralyses are of neoplastic origin while approximately 80% represent idiopathic or Bell's palsies. Whenever a tumor is suspected accurate testing is imperative; testing aimed at the nerve trunk both above and especially below the stilomastoid foramen. In fact, occult neoplasms are much more frequently located within the parotid. The present work presents a case where facial palsy was associated with profound ipsilateral hearing loss. Diagnostic efforts were, therefore, focussed on the cerebello-pontine angle and the Fallopian canal, thus delaying recognition of its real etiology (a mucoepidermoid carcinoma of the parotid)
La gestione del paziente disfonico: possibilità di un nuovo approccio
No full textWith reference to a recent report of the italian SIFEL association, we evaluate the actual behaviour toward the dysphonic patient, underlyning limits and pitfalls which often are responsible of more expensive and delayed rehabilitation. Therefore we suggest to modify the actual trend by purposing a strict program of prevenction, for examplewith diffusion of more radical tendence to vocal health. This new behaviour which exceeds rhe actual one, could present a partial solution for thids clinical proble
Coronal CT in the indication of the endoscopic surgery of the sinus
No full textIn this paper the Authors affirm that Functional Endoscopic Sinus Surgery is the technique of choice for treatment of nonneoplastic pathologies of paranasal sinuses, particularly in chronic infective and polypoid sinusitis. Furthermore, they confirm CT scans are mandatory in preoperative planning in order to delineate precisely the structures surrounding the surgical field (the lamina papyracea and possible dehiscences, the brain, the lacrimal duct, the internal carotid artery and the optic nerve), and thereby avoid any possible damage during surgery. If endoscopic examination and clinical history suggest a massive involvement of ethmoid cavities, both axial and coronal CT scans are necessary. Inasmuch as the crucial point in the development of chronic sinus pathology is the ostio-meatal complex, the Authors indicate that this structure can be clearly identified and studied by means of coronal CT scans, since in this case it is not necessary to clarify the depth of the nasal fossae, but, instead, to reveal the exact situation and configuration of the two fundamental lamellae, the uncinate process and the bulla. These structures lie on a vertical plane and cannot be studied with axial CT scans without reviewing several series scans made in close proximity, which increases the patient's exposure to x-rays as well as the expense of the study. This paper is an attempt to shorten and rationalize routine radiologic procedures when a limited ethmoid involvement, previously detected by careful endoscopic examination, is under investigation
Post-operative recurrence of naso-sinus polyposis
No full textMaxipolyposis, i.e. severe, diffuse nasosinusal polyposis, is generally treated with an onerous surgery. Therefore, recurrence, roughly rangling from 15% to 25%, are quite a disagreable outcome which is to be minimized. To this purpose, it may be useful to differentiate the residual from the recurrent polyposis, as is usually done in cases of cholesteatoma. Residual polyposis can be reduced by a thorough surgical resection. The authors detail their present technique, which joins microsurgery, used to perform ethmoidectomy, with endoscopic surgery, employed to manoeuvre within the sphenoid and maxillary sinus, as well as to drain the frontal sinus, i.e. to treat areas out of the direct view. Moreover, patients are warned of the need for close postoperative controls which should always be performed through telescopes in order to secure a sound inspection of the surgical cavities. Any slight, incipient recurrence should be immediately resected in the office by means of endoscopic technique. Recurrent polyposis must be treated with the drug therapies now in use, a waiting complete elucidation of the pathogenic mechanism. Association with systemic diseases, such as asthma, may contraindicate major surgery, as it increases the recurrence expectancy. Simple polypectomy often attains the same result in these cases, that is temporary ventilation of the nasal fossae
Transnasal sinusectomy with combined microscopic and endoscopic technique
No full textSevere, diffuse polyposis can be adequately treated through a transnasal approach which combines microscopic and endoscopic surgery. The operating microscope is used to perform ethmoidectomy, usually from the front to the back, and to open the sphenoid sinus and the antral window. The telescopes allow the sphenoid and maxillary sinuses to be cleaned under direct view control as well as enabling good drainage to be performed from the frontal sinuses. The results from 22 consecutive patients were good, with a very low rate of minor post-operative complications
- …
