Claudiu Manea | University of Medicine and Pharmacy "Carol Davila" Bucharest (original) (raw)
Papers by Claudiu Manea
BACKGROUND: Fungal rhinosinusitis are more and more present in otorhinolaringological practice, b... more BACKGROUND: Fungal rhinosinusitis are more and more present in otorhinolaringological practice, but still frequently underdiagnosed. This is due to the fact that, until now, there is no diagnostic algorithm widely accepted. Also the therapeutic approach is still controversial. OBJECTIVE: To evaluate the efficiency of various diagnostic methods used for noninvasive fungal rhinosinusitis. MATERIAL AND METHODS: Prospective study on 111 consecutive patients diagnosed with non-invasive allergic or non-allergic fungal rhinosinusitis. All the patients underwent surgery and had histopathologic identification of fungal material. We evaluated the efficiency of mycological and radiological diagnostic methods. RESULTS: Anatomopathologic exam is superior to mycologic culture methods in our experience, and the sensibility of this examination method is influenced by the type of sampling (endoscopic, intraoperatory, by sinusoscopy etc.). CT scan is the most valuable radiologic method in the diagnos...
Nasal packing is currently used as a step of the nasal surgery in order to prevent hemorrhage and... more Nasal packing is currently used as a step of the nasal surgery in order to prevent hemorrhage and to ensure a normal wound healing process. The range of materials used for this purpose is wide, including both removable and absorbable materials. Because currently there is no standardization in this matter, the choice is in the surgeon's hand, according to his abilities, beliefs, or technical possibilities. This article reviews the literature on the use of both absorbable and removable materials used for hemostasis after nasal surgery in the last decades, trying to reveal the advantages and also the weak points for both methods.
Multiple systemic diseases may have an expression in the sinonasal area, developing various, slow... more Multiple systemic diseases may have an expression in the sinonasal area, developing various, slow and atypical clinical manifestations, difficult to diagnose. An increased index of suspicion on behalf of the otolaryngologist and also a good multidisciplinary collaboration is required in order to establish a correct diagnosis and to treat this kind of pathology. This article is a review of the most common clinical entities with sinonasal manifestation, emphasizing on the diagnosis and therapeutic algorithm used for each pathological entity. KEYwORDS: granulomatous diseases, Wegener’s granulomatosis, sarcoidosis, Churg-Strauss syndrome, mucociliary diseases
Chirurgia, 2013
OBJECTIVES The aim of this study is to present a clear picture of the epidemiological aspects per... more OBJECTIVES The aim of this study is to present a clear picture of the epidemiological aspects pertaining to the cases of neck trauma addressing to the ENT Emergency Room, as well as to display the complexity of the diagnostic and therapeutic management employed in two important Romanian ENTDepartments - „Sfantul Spiridon” Hospital Iasi and SfantaMaria Hospital Bucharest MATERIAL AND METHODS We conducted a retrospective study on 538 patients with neck trauma that were referred to the abovementioned ENT Departments between March 2009 – March 2011, selecting 27 cases with forensic implications. RESULTS In terms of aetiological mechanism, the most frequentneck injuries in our study were penetrating neck injuries due to assault or self-mutilation with white weapons (knives, razor blades, forks, glass) - 56%, followed by blunt trauma cases due to car accident, strangulation or accidental fall – 44%. The most important clinical findings recorded at admission were polytraumas (24.14%), hema...
Nasal packing is currently used as a step of the nasal surgery in order to prevent hemorrhage and... more Nasal packing is currently used as a step of the nasal surgery in order to prevent hemorrhage and to ensure a normal wound healing process. The range of materials used for this purpose is wide, including both removable and absorbable materials. Because currently there is no standardization in this matter, the choice is in the surgeon’s hand, according to his abilities, beliefs, or technical possibilities. This article reviews the literature on the use of both absorbable and removable materials used for hemostasis after nasal surgery in the last decades, trying to reveal the advantages and also the weak points for both methods.
Fibrous dysplasia (FD) is a very rare condition, a bone disease characterized by areas of abnorma... more Fibrous dysplasia (FD) is a very rare condition, a bone disease characterized by areas of abnormal growth or lesions in one or several bony structures. The process is related with the mutation in the gene that encodes the subunit of a stimulatory G protein (Gsα)1,2 located on chromosome 20 (20q13.2-13.3)3,4, manifested as a localized defect in osteoblastic differentiation and maturation; the osteoblastic cells elaborate a fibrous tissue in the bone marrow instead of normal bone. Fibrous dysplasia of the bone is a non-heritable disease, which can occur in any bone. It is not a form of cancer and does not increase a person’s susceptibility to cancer. Fibrous dysplasia represents about 5% of all benign bone tumors4. This rare disorder is usually diagnosed in childhood or early adulthood; about 75% of the cases are found under the age of 30 years5. There is no recognized gender predilection, males and females of any race being equally affected6. The true incidence of this disorder is un...
Due to technical developments in the last decades, as well as the improvement of otorhinolaryngol... more Due to technical developments in the last decades, as well as the improvement of otorhinolaryngologic endoscopic surgery methods, coupled with a growing concern for patients’ life quality, indications for external surgery in the treatment of ENT inflammatory and tumoral disorders have become more and more limited. This is mainly due to the transition that has been made from FESS – functional endoscopic sinus surgery, developed in the late 70s of the last century, to EESS – extended endoscopic sinus surgery, respectively transnasal endoscopic surgery for the treatment of orbitonasal borderline pathology or that of the skull base (TES – transnasal endoscopic surgery) (Figure 1). This is the reason why there should be no overlap between the concepts of external surgery and radical surgery, since at present endoscopic endonasal techniques may allow extensive resections similar to the external approach1-3. At the same time, endoscopic laryngeal surgery, performed by suspension laryngosco...
Romanian Journal of Rhinology
Nasal reconstruction is challenging, considering surgical techniques complexity and difficulties ... more 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, imposi...
Romanian Journal of Legal Medicine, 2015
Objectives: Due to the continuous development of invasive dental procedures, presently we encount... more Objectives: Due to the continuous development of invasive dental procedures, presently we encounter a permanent growing of medical complications, like protrusion of foreign bodies into the maxillary sinus during therapeutic maneuvers on the superior dental arch. Plus that we can find neglected foreign bodies in the maxillary sinuses after ENT surgical procedures. With this clinical study we evaluated the most frequent etiology of the iatrogenic foreign bodies of the maxillary sinus, the improper surgical maneuvers that can lead to protrusion of foreign bodies, and the complications produced by these. Material and methods: We performed a prospective clinical study on 49 consecutive patients with various types of foreign bodies of the maxillary sinus admitted in our Department between January 2010-January 2013. In all cases we performed craniofacial CT scans and dental panoramic radiography. The removal of the foreign bodies was performed surgically. Results: Most common foreign bodies encountered were dental implants (19 patients, representing 38.77%), followed by amalgam fragments (14 patients, 28.57%), Guttapercha points (5 patients, 10.20%), pieces of gauze used for nasal or sinusal packing (4 patients, 8.16%), tooth fragments (3 patients, 6.12%), dental burr (2 patients, 4.08%), Kerr needles (2 patients, 4.08%). The complications encountered were: acute or chronic rhinosinusitis (37 patients 75.51%), with 11 cases of fungal colonization proved at histopathological exam, and the rest of 26 rhinosinusitis patients with bacterial infection, 12 cases of oro-antral fistula (24.29%), 1 case of orbital abscess, 1 case of malar abscess. Conclusion: Most of the cases of iatrogenic foreign bodies in the maxillary sinus are due to inadequate dental treatments. Dental implants and root canal fillings materials are the most frequent iatrogenic FB inserted into the maxillary sinus. Untreated, they can produce inflammatory-infective sinus pathology, like bacterial or fungal sinusitis, or even abscesses of the surrounding structures.
Chronic cough (cough persisting more than 3 weeks) is the one of the most common presenting sympt... more Chronic cough (cough persisting more than 3 weeks) is the one of the most common presenting symptom in adults seeking medical care. Given the fact that the variety of diseases that can produce this symptom is great, the correct management of chronic cough should include a close cooperation between pneumologist, gastroenterology specialist and otorhinolaryngology specialist, in another words a multidisciplinary approach. The purpose of this article is to reveal this symptom from the otolaryngologist perspective, emphasising on the main diseases involved, and also on the diagnosis and treatment alternatives of chronic cough.
Romanian Journal of Rhinology
BACKGROUND. Sleep apnea is a pathology with an ever-increasing spread, the causes being the most ... more BACKGROUND. Sleep apnea is a pathology with an ever-increasing spread, the causes being the most diverse. In this study we focus on sleep breathing disorders caused by nasal obstruction and also by soft palate and uvula anatomical changes. The right treatment recommended in this pathology according to the American Academy Sleep Medicine (AASM) is non-invasive ventilation – positive airway pressure (CPAP). A substantial percentage of patients with obstructive sleep apnea seek alternatives to CPAP and the solution for this can be upper airway surgery. OBJECTIVE. The attempt to demonstrate the viability of upper respiratory tract surgery as an alternative to CPAP treatment, demonstrating objectives by pre- and postoperative polysomnographic control. RESULTS. Aggregating the data from all 54 patients with nasal obstruction and pharyngeal modifications, we observed a decrease in AHI from 20.406/h to 15.86/h, representing 32.36%, an improvement in sleep architecture and especially REM sle...
Romanian Journal of Rhinology
Juvenile nasopharyngeal angiofibroma is a rare benign tumour of vascular origin found in adolesce... more Juvenile nasopharyngeal angiofibroma is a rare benign tumour of vascular origin found in adolescent males, originating around the sphenopalatine foramen. Although the exact pathogenesis of the tumour is not yet known, natural history and growth patterns can be predicted. JNA progressively involves the nasopharynx, nasal cavity, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and, in severe cases, an orbital or intracranial extension can be seen. Early diagnosis based on clinical examination and imaging is mandatory to ensure the best resectability of the tumour, as small to moderate tumours can be managed exclusively endoscopically. Preoperative angiography can reveal the vascular sources and allow embolization to prevent significant bleeding. We present a brief literature review followed by our case series of endoscopic removal of 7 juvenile nasopharyngeal angiofibromas.
Romanian Journal of Rhinology
BACKGROUND. Signal void, or the absence of signal on MRI sequences, in the sinonasal region may b... more BACKGROUND. Signal void, or the absence of signal on MRI sequences, in the sinonasal region may be encountered in fungal rhinosinusitis cases with the aspect of a pseudo-pneumatized sinus, leading to diagnostic errors. CASE REPORT. We present the case of a 75-year-old woman referred to our clinic for complete and persistent right-sided nasal obstruction. The patient was evaluated using sinus CT and contrast-enhanced head MRI. Opacification of the right maxillary, ethmoid and frontal sinuses as well as of the right nasal fossa were seen on CT, with maxillary sinus expansion and osseous erosion. The MRI showed T2 signal void in the maxillary sinus with extension to the nasal fossa, creating the appearance of a pseudo-pneumatized sinus, and hyperintense signal in the ipsilateral anterior ethmoid and frontal sinuses. The patient underwent endoscopic sinus surgery. The dual imaging evaluation of the patient aided the preoperative differential diagnosis and choosing the surgical approach.
Romanian Journal of Rhinology
BACKGROUND. Crista galli is an anatomical structure localized in the midline, that derives from t... more 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 cris...
Romanian Journal of Rhinology
Obstructive sleep apnea is a chronic disease characterized by the appearance of apnea or hypopnea... more Obstructive sleep apnea is a chronic disease characterized by the appearance of apnea or hypopnea episodes during sleep. This condition is associated with several risk factors. Among them, the most important is obesity and it is the only potentially curable. The treatment is polimodal and it involves several therapeutic directions. The purpose of this paper is to establish the role of obesity in the etiology of sleep apnea, as well as the role of the weight loss in its management, both through intensive lifestyle interventions and surgical therapy.
Romanian Journal of Rhinology
We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who ... more We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery. The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.
Romanian Journal of Rhinology
A 40-year-old female patient presented to our clinic for bilateral nasal obstruction, anteroposte... more A 40-year-old female patient presented to our clinic for bilateral nasal obstruction, anteroposterior mucopurulent rhinorrhea, recurrent micro-epistaxis, anosmia, left otodynia, fever and sweating. The ENT findings and CT scan detected a septal tumor with predominant extension in the left nostril, with erosive character of the osteo-cartilaginous septal structure, without sinusal involvement and left lateralcervical adenopathy. Resection of the entire septal tumor formation was performed. The histopathological outcome revealed non-Hodgkin’s small-type NK/T extranodal nasal-type lymphoma – immunohistochemical tests confirmed histogenesis.
Journal of pharmacology & pharmacotherapeutics
Romanian Journal of Rhinology
A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the sku... more A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally i...
Romanian Journal of Rhinology
Background. Neuroendocrine tumors of the larynx represent a rare group of neoplasms characterized... more Background. Neuroendocrine tumors of the larynx represent a rare group of neoplasms characterized by pathological and biological heterogeneity. The histological and immunohistochemical diagnosis is the most important step in the appropriate management of these tumors and the prognosis varies according to histological types. Conventional anatomical and functional imaging can be complementary for diagnosis, staging and monitoring of treatment response. Material and methods. Here we report on a case of a laryngeal neuroendocrine small cell carcinoma occurring in a 67-year-old man who was referred to our clinic for clinical reevaluation, diagnosis and treatment. The clinical presentation, the histopathological and immunohistochemical examination and management of this kind of tumor are highlighted. Conclusion. Small cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Very low...
BACKGROUND: Fungal rhinosinusitis are more and more present in otorhinolaringological practice, b... more BACKGROUND: Fungal rhinosinusitis are more and more present in otorhinolaringological practice, but still frequently underdiagnosed. This is due to the fact that, until now, there is no diagnostic algorithm widely accepted. Also the therapeutic approach is still controversial. OBJECTIVE: To evaluate the efficiency of various diagnostic methods used for noninvasive fungal rhinosinusitis. MATERIAL AND METHODS: Prospective study on 111 consecutive patients diagnosed with non-invasive allergic or non-allergic fungal rhinosinusitis. All the patients underwent surgery and had histopathologic identification of fungal material. We evaluated the efficiency of mycological and radiological diagnostic methods. RESULTS: Anatomopathologic exam is superior to mycologic culture methods in our experience, and the sensibility of this examination method is influenced by the type of sampling (endoscopic, intraoperatory, by sinusoscopy etc.). CT scan is the most valuable radiologic method in the diagnos...
Nasal packing is currently used as a step of the nasal surgery in order to prevent hemorrhage and... more Nasal packing is currently used as a step of the nasal surgery in order to prevent hemorrhage and to ensure a normal wound healing process. The range of materials used for this purpose is wide, including both removable and absorbable materials. Because currently there is no standardization in this matter, the choice is in the surgeon's hand, according to his abilities, beliefs, or technical possibilities. This article reviews the literature on the use of both absorbable and removable materials used for hemostasis after nasal surgery in the last decades, trying to reveal the advantages and also the weak points for both methods.
Multiple systemic diseases may have an expression in the sinonasal area, developing various, slow... more Multiple systemic diseases may have an expression in the sinonasal area, developing various, slow and atypical clinical manifestations, difficult to diagnose. An increased index of suspicion on behalf of the otolaryngologist and also a good multidisciplinary collaboration is required in order to establish a correct diagnosis and to treat this kind of pathology. This article is a review of the most common clinical entities with sinonasal manifestation, emphasizing on the diagnosis and therapeutic algorithm used for each pathological entity. KEYwORDS: granulomatous diseases, Wegener’s granulomatosis, sarcoidosis, Churg-Strauss syndrome, mucociliary diseases
Chirurgia, 2013
OBJECTIVES The aim of this study is to present a clear picture of the epidemiological aspects per... more OBJECTIVES The aim of this study is to present a clear picture of the epidemiological aspects pertaining to the cases of neck trauma addressing to the ENT Emergency Room, as well as to display the complexity of the diagnostic and therapeutic management employed in two important Romanian ENTDepartments - „Sfantul Spiridon” Hospital Iasi and SfantaMaria Hospital Bucharest MATERIAL AND METHODS We conducted a retrospective study on 538 patients with neck trauma that were referred to the abovementioned ENT Departments between March 2009 – March 2011, selecting 27 cases with forensic implications. RESULTS In terms of aetiological mechanism, the most frequentneck injuries in our study were penetrating neck injuries due to assault or self-mutilation with white weapons (knives, razor blades, forks, glass) - 56%, followed by blunt trauma cases due to car accident, strangulation or accidental fall – 44%. The most important clinical findings recorded at admission were polytraumas (24.14%), hema...
Nasal packing is currently used as a step of the nasal surgery in order to prevent hemorrhage and... more Nasal packing is currently used as a step of the nasal surgery in order to prevent hemorrhage and to ensure a normal wound healing process. The range of materials used for this purpose is wide, including both removable and absorbable materials. Because currently there is no standardization in this matter, the choice is in the surgeon’s hand, according to his abilities, beliefs, or technical possibilities. This article reviews the literature on the use of both absorbable and removable materials used for hemostasis after nasal surgery in the last decades, trying to reveal the advantages and also the weak points for both methods.
Fibrous dysplasia (FD) is a very rare condition, a bone disease characterized by areas of abnorma... more Fibrous dysplasia (FD) is a very rare condition, a bone disease characterized by areas of abnormal growth or lesions in one or several bony structures. The process is related with the mutation in the gene that encodes the subunit of a stimulatory G protein (Gsα)1,2 located on chromosome 20 (20q13.2-13.3)3,4, manifested as a localized defect in osteoblastic differentiation and maturation; the osteoblastic cells elaborate a fibrous tissue in the bone marrow instead of normal bone. Fibrous dysplasia of the bone is a non-heritable disease, which can occur in any bone. It is not a form of cancer and does not increase a person’s susceptibility to cancer. Fibrous dysplasia represents about 5% of all benign bone tumors4. This rare disorder is usually diagnosed in childhood or early adulthood; about 75% of the cases are found under the age of 30 years5. There is no recognized gender predilection, males and females of any race being equally affected6. The true incidence of this disorder is un...
Due to technical developments in the last decades, as well as the improvement of otorhinolaryngol... more Due to technical developments in the last decades, as well as the improvement of otorhinolaryngologic endoscopic surgery methods, coupled with a growing concern for patients’ life quality, indications for external surgery in the treatment of ENT inflammatory and tumoral disorders have become more and more limited. This is mainly due to the transition that has been made from FESS – functional endoscopic sinus surgery, developed in the late 70s of the last century, to EESS – extended endoscopic sinus surgery, respectively transnasal endoscopic surgery for the treatment of orbitonasal borderline pathology or that of the skull base (TES – transnasal endoscopic surgery) (Figure 1). This is the reason why there should be no overlap between the concepts of external surgery and radical surgery, since at present endoscopic endonasal techniques may allow extensive resections similar to the external approach1-3. At the same time, endoscopic laryngeal surgery, performed by suspension laryngosco...
Romanian Journal of Rhinology
Nasal reconstruction is challenging, considering surgical techniques complexity and difficulties ... more 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, imposi...
Romanian Journal of Legal Medicine, 2015
Objectives: Due to the continuous development of invasive dental procedures, presently we encount... more Objectives: Due to the continuous development of invasive dental procedures, presently we encounter a permanent growing of medical complications, like protrusion of foreign bodies into the maxillary sinus during therapeutic maneuvers on the superior dental arch. Plus that we can find neglected foreign bodies in the maxillary sinuses after ENT surgical procedures. With this clinical study we evaluated the most frequent etiology of the iatrogenic foreign bodies of the maxillary sinus, the improper surgical maneuvers that can lead to protrusion of foreign bodies, and the complications produced by these. Material and methods: We performed a prospective clinical study on 49 consecutive patients with various types of foreign bodies of the maxillary sinus admitted in our Department between January 2010-January 2013. In all cases we performed craniofacial CT scans and dental panoramic radiography. The removal of the foreign bodies was performed surgically. Results: Most common foreign bodies encountered were dental implants (19 patients, representing 38.77%), followed by amalgam fragments (14 patients, 28.57%), Guttapercha points (5 patients, 10.20%), pieces of gauze used for nasal or sinusal packing (4 patients, 8.16%), tooth fragments (3 patients, 6.12%), dental burr (2 patients, 4.08%), Kerr needles (2 patients, 4.08%). The complications encountered were: acute or chronic rhinosinusitis (37 patients 75.51%), with 11 cases of fungal colonization proved at histopathological exam, and the rest of 26 rhinosinusitis patients with bacterial infection, 12 cases of oro-antral fistula (24.29%), 1 case of orbital abscess, 1 case of malar abscess. Conclusion: Most of the cases of iatrogenic foreign bodies in the maxillary sinus are due to inadequate dental treatments. Dental implants and root canal fillings materials are the most frequent iatrogenic FB inserted into the maxillary sinus. Untreated, they can produce inflammatory-infective sinus pathology, like bacterial or fungal sinusitis, or even abscesses of the surrounding structures.
Chronic cough (cough persisting more than 3 weeks) is the one of the most common presenting sympt... more Chronic cough (cough persisting more than 3 weeks) is the one of the most common presenting symptom in adults seeking medical care. Given the fact that the variety of diseases that can produce this symptom is great, the correct management of chronic cough should include a close cooperation between pneumologist, gastroenterology specialist and otorhinolaryngology specialist, in another words a multidisciplinary approach. The purpose of this article is to reveal this symptom from the otolaryngologist perspective, emphasising on the main diseases involved, and also on the diagnosis and treatment alternatives of chronic cough.
Romanian Journal of Rhinology
BACKGROUND. Sleep apnea is a pathology with an ever-increasing spread, the causes being the most ... more BACKGROUND. Sleep apnea is a pathology with an ever-increasing spread, the causes being the most diverse. In this study we focus on sleep breathing disorders caused by nasal obstruction and also by soft palate and uvula anatomical changes. The right treatment recommended in this pathology according to the American Academy Sleep Medicine (AASM) is non-invasive ventilation – positive airway pressure (CPAP). A substantial percentage of patients with obstructive sleep apnea seek alternatives to CPAP and the solution for this can be upper airway surgery. OBJECTIVE. The attempt to demonstrate the viability of upper respiratory tract surgery as an alternative to CPAP treatment, demonstrating objectives by pre- and postoperative polysomnographic control. RESULTS. Aggregating the data from all 54 patients with nasal obstruction and pharyngeal modifications, we observed a decrease in AHI from 20.406/h to 15.86/h, representing 32.36%, an improvement in sleep architecture and especially REM sle...
Romanian Journal of Rhinology
Juvenile nasopharyngeal angiofibroma is a rare benign tumour of vascular origin found in adolesce... more Juvenile nasopharyngeal angiofibroma is a rare benign tumour of vascular origin found in adolescent males, originating around the sphenopalatine foramen. Although the exact pathogenesis of the tumour is not yet known, natural history and growth patterns can be predicted. JNA progressively involves the nasopharynx, nasal cavity, paranasal sinuses, pterygopalatine fossa, infratemporal fossa and, in severe cases, an orbital or intracranial extension can be seen. Early diagnosis based on clinical examination and imaging is mandatory to ensure the best resectability of the tumour, as small to moderate tumours can be managed exclusively endoscopically. Preoperative angiography can reveal the vascular sources and allow embolization to prevent significant bleeding. We present a brief literature review followed by our case series of endoscopic removal of 7 juvenile nasopharyngeal angiofibromas.
Romanian Journal of Rhinology
BACKGROUND. Signal void, or the absence of signal on MRI sequences, in the sinonasal region may b... more BACKGROUND. Signal void, or the absence of signal on MRI sequences, in the sinonasal region may be encountered in fungal rhinosinusitis cases with the aspect of a pseudo-pneumatized sinus, leading to diagnostic errors. CASE REPORT. We present the case of a 75-year-old woman referred to our clinic for complete and persistent right-sided nasal obstruction. The patient was evaluated using sinus CT and contrast-enhanced head MRI. Opacification of the right maxillary, ethmoid and frontal sinuses as well as of the right nasal fossa were seen on CT, with maxillary sinus expansion and osseous erosion. The MRI showed T2 signal void in the maxillary sinus with extension to the nasal fossa, creating the appearance of a pseudo-pneumatized sinus, and hyperintense signal in the ipsilateral anterior ethmoid and frontal sinuses. The patient underwent endoscopic sinus surgery. The dual imaging evaluation of the patient aided the preoperative differential diagnosis and choosing the surgical approach.
Romanian Journal of Rhinology
BACKGROUND. Crista galli is an anatomical structure localized in the midline, that derives from t... more 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 cris...
Romanian Journal of Rhinology
Obstructive sleep apnea is a chronic disease characterized by the appearance of apnea or hypopnea... more Obstructive sleep apnea is a chronic disease characterized by the appearance of apnea or hypopnea episodes during sleep. This condition is associated with several risk factors. Among them, the most important is obesity and it is the only potentially curable. The treatment is polimodal and it involves several therapeutic directions. The purpose of this paper is to establish the role of obesity in the etiology of sleep apnea, as well as the role of the weight loss in its management, both through intensive lifestyle interventions and surgical therapy.
Romanian Journal of Rhinology
We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who ... more We report a case of a 47-year-old patient recently diagnosed with left abducens nerve palsy, who was admitted in our clinic with diplopia. The cranio-facial CT scan revealed left sphenoid fungal rhinosinusitis and the patient underwent endoscopic surgery with complete removal of the fungal material. The immediate postoperative evolution of the patient was favourable, with partial improvement of diplopia. The first month follow-up visit revealed the recurrence of the diplopia, so the patient performed an MRI scan of the brain that showed a cavernous sinus meningioma. The patient was referred to a neurosurgeon who choose a “wait-and-see” strategy instead of surgery. The paper presents the limits of computed tomography versus magnetic resonance imaging in the radiologic diagnosis of intracranial tumors.
Romanian Journal of Rhinology
A 40-year-old female patient presented to our clinic for bilateral nasal obstruction, anteroposte... more A 40-year-old female patient presented to our clinic for bilateral nasal obstruction, anteroposterior mucopurulent rhinorrhea, recurrent micro-epistaxis, anosmia, left otodynia, fever and sweating. The ENT findings and CT scan detected a septal tumor with predominant extension in the left nostril, with erosive character of the osteo-cartilaginous septal structure, without sinusal involvement and left lateralcervical adenopathy. Resection of the entire septal tumor formation was performed. The histopathological outcome revealed non-Hodgkin’s small-type NK/T extranodal nasal-type lymphoma – immunohistochemical tests confirmed histogenesis.
Journal of pharmacology & pharmacotherapeutics
Romanian Journal of Rhinology
A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the sku... more A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally i...
Romanian Journal of Rhinology
Background. Neuroendocrine tumors of the larynx represent a rare group of neoplasms characterized... more Background. Neuroendocrine tumors of the larynx represent a rare group of neoplasms characterized by pathological and biological heterogeneity. The histological and immunohistochemical diagnosis is the most important step in the appropriate management of these tumors and the prognosis varies according to histological types. Conventional anatomical and functional imaging can be complementary for diagnosis, staging and monitoring of treatment response. Material and methods. Here we report on a case of a laryngeal neuroendocrine small cell carcinoma occurring in a 67-year-old man who was referred to our clinic for clinical reevaluation, diagnosis and treatment. The clinical presentation, the histopathological and immunohistochemical examination and management of this kind of tumor are highlighted. Conclusion. Small cell neuroendocrine carcinomas are very aggressive neoplasms. Patients could benefit from surgery, but radiotherapy and chemotherapy remain the treatment of choice. Very low...