<abstract><title style='display:none'>Abstract</title> Cystic lesions of the maxilla are benign entities with both odontogenic and non-odontogenic origins. The maxillary cyst is a benign tumor of the bones of the jaw, which has a membrane and contains a fluid, semi-solid or mixed (liquid / semi-gaseous) material. These often lead to deformities in the jaw area. Cases are specific by framing pathological rarity, etiology, pathogenesis and clinical symptoms.Considering the large entity of cystic formations that can be found in the maxilla region, we selected two patients with cystic formations of the upper jaw, which were part of different pathological etiology categories, with special rarity occurring, evolutionary appearance and difficult to classify in terms of pathognomonic signs.</abstract>

ENT Department, Braila Emergency County Hospital, Braila,

Department of Oral and Maxillofacial Surgery, Braila Emergency County Hospital, Braila,

Case report. Cystic lesions of the maxilla – clinical considerations and differential diagnosis

<abstract><title style='display:none'>Abstract</title>ENT surgeons frequently encounter a variety of neoplastic, non-neoplastic and inflammatory masses involving the nasal cavity, the paranasal sinuses or the nasopharynx. Among these, the angiomatous polyp or angiectatic nasal polyps are rare and account for 4-5% of all inflammatory nasal polyps. They have variable growth patterns and clinical features. In angiomatous nasal polyps, there is a prominent component of dilated capillary-type blood vessels. We present a review of the literature regarding the most important features of this pathology and an unusual case of a large angiomatous polyp arising from the maxillary sinus.</abstract>

Bleeding angiomatous polyps of the maxillary sinus: Review of literature and a rare case report

<abstract>
<title style='display:none'>Abstract</title>
Squamous cell carcinoma (SCC) has several variants based on its histopathological features. Nuclear protein in testis (NUT) carcinoma (NC) is a rare and aggressive variant of SCC, previously described exclusively in midline sites. The histopathological features of NC are similar to poorly differentiated carcinoma or undifferentiated carcinoma. Abrupt keratinization in an otherwise undifferentiated carcinoma is an important diagnostic clue. The confirmatory diagnosis is dependent on molecular techniques such as Immunohistochemistry, Fluorescent in situ hybridization technique or RT-PCR to detect mutations in NUT gene. It is most commonly found in middle aged, in lungs and head and neck regions. Since NC features overlap with poorly differentiated and undifferentiated carcinomas, these cases need to be suspected and evaluated for NUT gene mutations thoroughly. Due to their rarity and less known facts, NC cases are required to be reported on large scale.
Here, we report a middle-aged woman with a mass on the forehead diagnosed as NC based on molecular evaluation, with a review of the literature emphasizing the rarity of NUT carcinoma and the importance of careful histopathology as well as immunohistochemistry evaluation.
</abstract>

NUT carcinoma in head and neck region: Case report with literature review

<abstract><title style='display:none'>Abstract</title>The facial nerve, the seventh pair of cranial nerves, has an essential role in non-verbal communication through facial expression. Besides innervating the muscles involved in facial expression, the complex structure of the facial nerve contains sensory fibres involved in the perception of taste and parasympathetic fibres involved in the salivation and tearing processes. Damage to the facial nerve manifested by facial paralysis translates into a decrease or disappearance of mobility of normal facial expression.Facial nerve palsy is one of the common causes of presenting to the Emergency Room. Most facial paralysis are idiopathic, followed by traumatic, infectious, tumor causes. A special place is occupied by the child’s facial paralysis. Due to the multitude of factors that can determine or favour its appearance, it requires a multidisciplinary evaluation consisting of otorhinolaryngologist, neurologist, ophthalmologist, internist.Early presentation to the doctor, accurate determination of the cause, correctly performed topographic diagnosis is the key to proper treatment and complete functional recovery.</abstract>

Facial nerve paralysis

<abstract><title style='display:none'>Abstract</title>Surgical treatment of chronic rhinosinusitis is indicated after failure of correctly conducted maximal drug therapy or the occurrence of complications. Radical maxillary sinus surgery has been abandoned nowadays, to the detriment of endoscopic sinus surgery, for several reasons, such as: increased incidence of complications, decreased healing rate compared to the endoscopic technique. The literature cites many situations in which the Caldwell-Luc procedure is used as a first-line surgical technique: recurrent chronic rhinosinusitis, malignant tumors of the maxillary sinus extending to the lateral wall of the nasal fossa and the pterygomaxillary space, the cases where an extensive approach to the pterygopalatine fossa is required – for ligation of the internal maxillary artery or the approach of the vidian canal in vidian neurectomy.The authors highlight the use of Caldwell-Luc procedure in endoscopic sinus surgery era, by reviewing the complications rates, indications and long-term effectiveness of the two surgical techniques.</abstract>

Indications of the Caldwell-Luc procedure in the era of endoscopic sinus surgery

<abstract><title style='display:none'>Abstract</title>Whiplash syndrome is a quite common pathology and can be defined as a neck injury produced by a sudden acceleration-deceleration, the consequence of which is a sudden forward and backward movement of the head and neck. The main production mechanism is a sudden acceleration-deceleration process that has as a consequence the sudden extension/flexion of the neck. Starting from the many structures involved, the whiplash syndrome is an interdisciplinary challenge (ENT specialist, neurologist, orthopedist, ophthalmologist, psychologist) and can be described by multiple signs and symptoms.Whiplash syndrome is a complex pathology both through the mechanism of production and symptoms, and through the forensic implications that it has. The interdisciplinary medical collaboration, the implementation of stricter rules on wearing the seat belt and the development by car manufacturers of chairs and head restraints that protect the head and neck of passengers, would be the preventive step in the occurrence and especially the chronicization of these lesions.</abstract>

Whiplash Syndrome

<abstract>
<title style='display:none'>Abstract</title>
<bold>BACKGROUND.</bold> Obstructive sleep apnea (OSA) is characterized by frequent episodes of breathing cessation during sleep, resulting in low oxygen and high carbon dioxide levels, leading to daytime sleepnes, cognitive issues, and increased cardiovascular risk. The objective of this study was to assess the effectiveness of the anterior palatoplasty (AP) procedure in the treatment of patients with mild and moderate obstructive sleep apnea.
<bold>MATERIAL AND METHODS.</bold> Sixteen patients diagnosed with mild and moderate OSA underwent AP in our clinic between 2021-2023. All patients were &gt; 18 years old, body mass index &lt; 30, with an apnea-hypopnea index (AHI) from 10 to 40 and disfunction of the velopharyngeal or of the retropalatal space. Patients underwent a one-night polysomnography examination prior to the surgical procedure, as well as six months after the procedure. Additionally, patients were asked to complete the Epworth Sleepiness Scale (ESS) both prior to and six months following the surgery. The procedure was done under general anaesthesia and involved AP surgery with or without reducing of the uvula.
<bold>RESULTS.</bold> The average of total AHI values decreased from 28.89 per hour prior to surgery to 11.14 per hour six months after surgery. The oxygen desaturation index decreased after surgery with 2.57%. ESS scores of patients also decreased from 10.40 to 7.80 and all patients felt less tired.
<bold>CONCLUSION.</bold> We believe that AP is an effective technique in the treatment of mild and moderate OSA caused by a disfunction of the velopharyngeal or retropalatal space. Additionally, we consider that AP is linked with a lower incidence of post-surgical complications compared to other surgical options.
</abstract>

Anterior palatoplasty as a treatment for mild and moderate obstructive sleep apnea: our experience

<abstract>
<title style='display:none'>Abstract</title>
In this material, two clinical cases are described, regarding the use of CAD-CAM technology for producing the wax pattern of the metal substructure for a fixed prosthetic restoration. In fact, in these cases, it is about making a digital design and milling from a block of wax the patterns of future fixed metal-ceramic prosthetic restorations.
</abstract>

Technological considerations regarding the use of CAD-CAM systems in the metal substructure design of some metal-ceramic prosthetic restoration

<abstract>
<title style='display:none'>Abstract</title>
<bold>BACKGROUND.</bold> Patients were likely hesitant to communicate with physicians during the pandemic, when everyone saw others as potentially infectious. Every other was seen as the most likely to be infected as they were in close contact with infected persons. Likewise, physicians might have been wary of communicating with their patients, who might have been virus carriers. In our study, the communication between physicians (particularly pulmonologists) and geriatric patients was evaluated to develop recommendations for improvement if necessary.
<bold>MATERIAL AND METHODS.</bold> The study was conducted as an online evaluation questionnaire via e-mail or WhatsApp. The evaluation form, the Social Communication Skills Rating Scale, collected data regarding the respondents’ demographic characteristics, whose reliability and validity have been proven in previous studies. The volunteer pulmonologists completed the questionnaire.
<bold>RESULTS.</bold> The research comprised 200 doctors; 111 (55.5%) were women and 89 (44.5%) were men. Of the doctors who participated in the study, over 40% were in their forties. Pulmonologists’ communication skills with their geriatric patients were deemed adequate, and their interactions were evaluated as successful, despite the high risk of infection during the pandemic, the difficulty of examining patients while wearing protective clothing, and the typical communication difficulties of geriatric patients. This has been a crucial advantage for the senior patient group, as, throughout the COVID-19 pandemic, this group has communicated with pulmonologists predominantly owing to medical needs.
<bold>CONCLUSION.</bold> The pulmonologists’ effective communication with their geriatric patients could have made them feel good during the difficult time of the past pandemic period. It could have also been a source of pride for physicians.
</abstract>

Communication levels of pulmonologists with geriatric patients during the COVID-19 pandemic

<abstract>
<title style='display:none'>Abstract</title>
<bold>BACKGROUND.</bold> Extramedullary plasmacytoma is an extremely rare solitary plasma cell neoplasm that occurs in locations other than bone, without involving the bone marrow. It is commonly located in the upper aerodigestive tract. In the head and neck region, the most frequent location is the sinonasal region.
<bold>MATERIAL AND METHODS.</bold> A systemic review in accordance with the PRISMA guidelines was done with research works in PubMed, Elsevier database, Cochrane library, Web of Science, Scopus, Crossref and Google Scholar. The search was carried out using the keywords “plasmacytoma and nose”, “extramedullary plasmacytoma”, “extramedullary plasmacytoma of nose”, “plasmacytoma and nasal cavity”, and “extramedullary plasmacytoma of nasal cavity”.
<bold>RESULTS.</bold> We analysed 27 research works with a total number of 32 cases. The most common presenting symptoms were nasal cavity bleeding. The disease showed a male preponderance (78.1%). Bone erosion was seen in 7 cases. The histopathological examination showed plasma cells arranged predominantly as a uniform population or sheet-like appearance. A common immunohistochemical marker was CD138 (11 cases). Treatment was primarily radiotherapy (43.7%). We are also reporting a case of a 53-year-old male with plasmacytoma of the middle turbinate managed by wide resection and postoperative radiotherapy.
<bold>CONCLUSION.</bold> Though a less common condition, in a case of polypoidal-like lesion with bleeding tendency, the clinician should keep in mind the possibility of extramedullary plasmacytoma. The diagnosis is made with histopathological examination and immunohisto-chemistry of the tissue involved. Treatment can be radiotherapy, surgery, or a combination of modalities.
</abstract>

Nasal cavity extramedullary plasmacytoma: literature review and clinical experience

<abstract>
<title style='display:none'>Abstract</title>
<bold>BACKGROUND.</bold> Children’s communication with the family and the environmental surroundings begins immediately after birth and development continues throughout life. Impairment of hearing due to the presence of congenital hypoacusis results in severe language development disorders. The purpose of the study was to identify the main factors involved in the auditory-verbal rehabilitation process of children with hearing impairment.
<bold>MATERIAL AND METHODS.</bold> A descriptive, observational study was conducted on a group of 35 carers of hearing-impaired children proposed for auditory-verbal rehabilitation through cochlear implantation. The study carried out was based on the parents’ statements, analyzing the essential factors that can influence the quality of life of parents with hearing-impaired children: the child’s age at the time of the positive diagnosis, the child’s communication skills before implantation, the time elapsed from the intervention to implant activation, participation in auditory-verbal rehabilitation sessions with a speech therapist, parental commitment during the immediate pre- and post-implant period, the parent’s level of education.
<bold>RESULTS.</bold> The dominance of the female gender can be noted - 91.43%. 60% of adult participants were college graduates, 20% discontinued their education after completing high school, 17.14% graduated from a post-secondary school. 57.14% of the parents reported being employed in some form of work during the period before and immediately after the cochlear implantation of their children. 82.85% reported the diagnosis of their child’s hypoacusis in the pre-kindergarten group. Out of the total number of children, 68.57% were recipients of bilateral cochlear implants, 31.43% had unilateral implants. The periods during which children benefited from post-implantation speech therapy were between 1 and 6 months (5.71%), 1 and 2 years (2.86%), &gt;2 years (17.14%). In 71.43% of cases, families were in the rehabilitation phase with speech therapy at the time of filling out the form.
<bold>CONCLUSION.</bold> In the auditory-verbal rehabilitation process of a hearing-impaired child, there are a number of factors and conditions that must be considered in a specific manner for each individual patient.
</abstract>

Assessment of the main factors involved in the auditory-verbal rehabilitation process in children with cochlear implants

<abstract>
<title style='display:none'>Abstract</title>
<bold>BACKGROUND.</bold> Endoscopic sinus surgery (ESS) has revolutionized the treatment of nasal and paranasal sinus conditions, offering minimally invasive techniques with improved patient outcomes. However, ESS can be challenging, lengthy, and physically demanding. This article presents a comprehensive overview of factors to consider before and during ESS to enhance surgical ease and patient comfort.
<bold>MATERIAL AND METHODS.</bold> The paper is a literature review sustaining a point of view on the factors influencing the outcome of endoscopic sinus surgery.
<bold>RESULTS.</bold> Preoperative considerations encompass a thorough assessment of surgical indications, weighing against medical alternatives as per guidelines. Attention to patient comorbidities, medication management and infection control are paramount. Intraoperatively, collaboration with anesthesiologists is crucial for optimizing patient stability and minimizing complications. Ergonomic considerations, patient positioning and surgical environment optimization contribute to surgeon comfort and procedural efficiency. The surgical procedure entails meticulous preparation of the nasal cavity, preservation of anatomical structures, and adherence to standardized techniques. The sphenoethmoidectomy is described as a sequential five-door procedure, emphasizing anatomical landmarks and meticulous dissection techniques. Hemostasis and the judicious use of powered shavers play pivotal roles in minimizing bleeding and optimizing tissue removal. Navigation systems offer additional support, particularly in complex cases or revision surgeries.
<bold>CONCLUSION.</bold> ESS requires meticulous planning, technical proficiency, and interdisciplinary collaboration to optimize outcomes. Anticipation and adherence to standardized protocols are paramount in navigating the challenges of ESS, ultimately enhancing surgical ease and patient comfort.
</abstract>

How to make your sinus surgery more comfortable: our point of view

<abstract><title style='display:none'>Abstract</title> BACKGROUND. Crista galli is an anatomical structure localized in the midline, that derives from the ethmoid bone, with a compact bone structure, sometimes pneumatized. The connection between the pneumatized crista galli and the adjacent paranasal structures is usually performed through an opening similar with a sinusal ostium.MATERIAL AND METHODS. We performed a retrospective clinical study about the incidence of the pneumatization of crista galli in 196 patients with chronic sinusitis. We evaluated the degree of pneumatization and the drainage pathways of crista galli, trying to correlate the radiological findings with the symptomatology of the patients with crista galli “sinusitis”.RESULTS. Pneumatization of crista galli was found in 30.1% of cases. From 59 patients with chronic rhinosinusitis and pneumatized crista galli, 66.4% had no opacification, 23.7% various degrees of opacification and 11.9% showed complete opacification. The presence of an opening of the pneumatized crista galli into surrounding air-cells was found in 16.98% of the patients. Headache was encountered in 76.2% of the patients with CRS and pneumatized crista galli sinusitis.CONCLUSION. When analyzing a CT scan of a patient with CRS, we should also take into consideration the pneumatization of crista galli, which has a high variability. Most of the patients included in our study had also a certain degree of opacification of the pneumatized crista galli. Headache had a higher incidence in patients with crista galli inflammation than in CRS patients who showed no pneumatization or opacification of the crista galli (76.2% versus 60.5% in “simple” CRS patients).</abstract>

CESITO Centre, “Sfanta Maria” Hospital, 37-39 Ion Mihalache Blvd., District, Bucharest, Romania

“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

ENT Department, Clinical Hospital Center Zagreb, Croatia

Crista galli sinusitis – a radiological impression or a real clinical entity

<abstract><title style='display:none'>Abstract</title>The current study aims to investigate the effect of smartphone usage on the upper extremity performance among Saudi youth. A goniometer to measure the Range of Motion (ROM), the Smartphone Addiction Scale (SAS), McGill Pain scale and Chattanooga stabilizer were used to perform the current study on a sample of 300 university students from Al-Imam Mohammed Bin Saud University. The results have shown that smartphone addiction is negatively correlated to the elbow flexion, shoulder flexion, shoulder extension, shoulder abduction, shoulder adduction, and both shoulder internal and external rotation. Furthermore, the results have shown that McGill pain scores were positively correlated to elbow flexion, shoulder flexion, shoulder extension, shoulder abduction, shoulder adduction, and both shoulder internal and external rotation. The study has concluded that smartphone usage among Saudi youth negatively affects the upper extremity and causes a significant increase in the pain intensity. The study has recommended that there is an urgent need for a significant awareness campaign to warn the community regarding the impact of using smartphones for long periods of time.</abstract>

The effect of smartphone usage on the upper extremity performance among Saudi Youth, KSA

<abstract><title style='display:none'>Abstract</title>Fungal rhinosinusitis is an important pathological entity, a highly controversial topic in the medical world today, by the various research directions it offers. In order to be able to predict a patient’s prognosis and his response to treatment, first we must have a classification of fungal rhinosinusitis. The authors considered it is important to make a distinction between invasive and noninvasive forms of fungal rhinosinusitis. The most important step in the management of fungal rhinosinusitis is to have a correct diagnosis, based on strong criteria, which will lead to a better prognosis of this disease. Because of its invasiveness potential, especially in patients at risk, it is essential to have a correct and fast diagnosis in case of fungal rhinosinusitis, in order to begin the treatment as fast as possible, for a favourable prognosis. The only way to establish diagnosis in a reliable way is to make a detailed clinical examination and to take biopsy samples.</abstract>

ENT&HNS Department, “Sfanta Maria” Clinical Hospital, Bucharest, Romania

Difficulties in the diagnosis of fungal rhinosinusitis – Literature review

<abstract><title style='display:none'>Abstract</title> BACKGROUND. Chronic rhinitis is a clinical condition affecting more than 20% of the world population. The standard treatment strategy is medical. Surgical management can be considered in patients with intractable rhinitis. Various surgical techniques have been documented with varying success rates, but none of them is considered as a gold standard. Hence, we are studying the effectiveness of posterior nasal neurectomy (PNN) in patients who have intractable rhinitis, refractory to maximum medical therapy.MATERIAL AND METHODS. A prospective study was conducted in the ENT Department, Padmavathy Medical Foundation, Kollam, Kerala, India, from January 2015 to February 2016. Adult patients, in the age group of 20 to 60 years, diagnosed with chronic rhinitis, presenting two or more symptoms of rhinitis, refractory to maximum medical therapy for a period of at least 3 or more years and whose quality of life was significantly affected were enrolled and PNN was done for them.RESULTS. We observed a statistically significant improvement in subjective symptoms and patient quality of life at the end of 6 months post-operatively.CONCLUSION. PNN is a safe and less invasive procedure, which can provide a significant relief in symptoms of intractable rhinitis. Fewer complications and better results make it superior over vidian neurectomy.</abstract>

Department of Otorhinolaryngology, Sri Siddhartha Medical College, Tumakuru, Karnataka,

Department of Dentistry, Padmavathy Medical Foundation, Kollam, Kerala,

Department of Anatomy, Sri Siddhartha Medical College, Tumakuru, Karnataka,

Original study. Effectiveness of endoscopic posterior nasal neurectomy for the treatment of intractable rhinitis

<abstract><title style='display:none'>Abstract</title> Fungus ball (FB) of the paranasal sinuses has a distinctive clinicopathological presentation. The disease occurs more frequently in elderly patients and has a female preponderance. Classically, it involves only one paranasal sinus in more than 90% of the cases, most commonly the maxillary sinus. Imaging characteristics (calcifications and / or erosion of the inner wall of the sinus visible on CT) and histopathological ones (luminal aggregation of fungal hyphae) confirm the diagnosis.Allergic fungal rhinosinusitis (AFRS) usually occurs in younger, immunocompetent patients, with a history of atopy, including allergic rhinitis and / or asthma, or a long clinical picture of chronic rhinosinusitis (CRS), refractory to antibiotic treatment. Nasal polyps (NP) are present in almost all patients, while extra-sinusal complications are described only in some of them. Usually, there is involvement of several sinuses, as well as bilateral damage. The definitive diagnosis is confirmed only by examining surgical specimens - the characteristic appearance of eosinophilic mucin is the most reliable indicator of AFRS.</abstract>

Department of Otorhinolaryngology, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, 165 Stefan Cel Mare si Sfant Blvd., MD-2004, Chisinau,

Department of Otorhinolaryngology, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, Republic of Moldova

Department of Otorhinolaryngology, Republican Clinical Hospital, Chisinau,

Literature review. Noninvasive fungal rhinosinusitis

<abstract><title style='display:none'>Abstract</title>Nasal reconstruction is challenging, considering surgical techniques complexity and difficulties in remodelling a tridimensional structure. Reconstructive requirements are: correct deformity evaluation, selecting the most suitable treatment option, respecting the principle of aesthetic subunit, appropriate reconstruction of each affected nasal layer, long-term stabile functional and aesthetic results. Reconstructive procedures range from simple to very complex. Conventional techniques can fail in restoring a satisfactory appearance in severely disfigured patients, for whom a new possibility arises: Vascularized Composite Allografts (VCA) transplantation.In this paper, we focus on nasal skeletal framework restoration. Structural defects may require a large amount of reconstructive material obtained usually from cartilage or bone autografts. Autologous cartilage is the gold standard in nasal architectural recovery, but in some cases, autologous graft sources are not available, imposing the necessity to use alternative solutions represented by the allografts or alloplastic materials. We analysed the specific features of skeletal allografts used in nasal reconstruction.With current clinical experience, the use of cartilage and bone allografts (especially irradiated cartilage homografts) shows a promising reconstructive option for nasal structural defects. For extensive facial defects, including midface deformities, impossible to restore with traditional surgical techniques, a new reconstructive era was open through the development of the VCA field.</abstract>

Department of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital, Bucharest, Romania

ENT&HNS Department, “Sfanta Maria“ Hospital, Bucharest, Romania

The role of cartilage and bone allografts in nasal reconstruction

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Romanian Journal of Rhinology

Rhinology, as an important part of Otorhinolaryngology, addresses a very frequent and diverse pathology, with important interdisciplinary implications. In the last decades, this medical field was...

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Rhinology, as an important part of Otorhinolaryngology, addresses a very frequent and diverse pathology, with important interdisciplinary implications. In...