PURPOSE: Narrow-band imaging is the state of the art in the diagnosis of mucosal lesions of the vocal cords. It is also used in the follow-up of patients after surgical therapy. Unfortunately, if a patient has received radiotherapy the follow-up is much more difficult. Radiation induces inflammatory changes in the mucosa, which lead to changes in the vascular architecture and thus affect the results of the examination. The dynamics and time dependence of vascular changes after radiotherapy have not yet been described. The purpose of this study is to describe the evolution of the vascular pattern in vocal cords after primary radiotherapy for glottic cancer. METHODS: This was a retrospective cohort study. Each patient underwent NBI videolaryngoscopy and was followed every 3 months. RESULTS: The tumor-related mucosal changes diminished at 3 months after radiotherapy. Afterward, growth of new longitudinal vasculature was observed and significantly slowed after 9 months. No perpendicular vasculature or tumor recurrence was observed during the course of the study. CONCLUSIONS: According to our data, we can conclude that post-radiation mucosal vasculature changes are only longitudinal.
In this study, we aimed to observe the effects of positive airway pressure (PAP) on individual levels of obstruction during drug-induced sleep endoscopy (DISE) of the upper airways (UA), to evaluate at which pressures the obstruction disappeared or worsened, and to identify cases in which PAP was ineffective. This prospective study was conducted from June 2018 to June 2022. PAP testing was performed during DISE in patients with moderate and severe OSA. The pressure was gradually increased over the range from 6.0 to 18.0 hPa. Our findings were evaluated using the VOTE classification. The examination was performed in 56 patients, with a median apnea-hypopnea index (AHI) of 26.4. Complete obstruction of the soft palate was observed in 51/56 patients (91%), oropharyngeal obstruction in 15/56 patients (27%), tongue base obstruction in 23/56 patients (41%), and epiglottic collapse in 16/56 patients (29%). PAP was most effective in cases of complete oropharyngeal obstruction, and least effective in cases of epiglottic collapse, where it was ineffective in 11/16 patients. DISE with PAP is a simple diagnostic method that can be helpful for identifying anatomic and dynamic reasons for PAP intolerance. The main indication is ineffective PAP treatment.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The aim of this study was to present the indications for a combined endoscopic transnasal and sublabial transantral approach for the surgical treatment of orbital lesions. MATERIAL AND METHODS: This case study enrolled 10 patients scheduled for endoscopic transnasal surgery for treating orbital lesions from 2009 to 2020. When the tumour was localised to the medial part of the orbit, patients underwent endoscopy with a transnasal mononostril approach. Alternatively, when the tumour was localised to the mediocaudal part of the orbit, and when instrument manoeuvreability was limited, the transnasal approach was combined with a sublabial transantral approach. Herein, we evaluate the indications, complications, and advantages of monoportal and combined two-portal approaches. RESULTS: 8/10 patients (80%) underwent surgery with the transnasal mononostril approach, and 2/10 (20%) underwent surgery with the combined transnasal mononostril and sublabial transantral approach. In the two latter cases, visualisation of the operation field was excellent, and there was adequate room for manipulating instruments. CONCLUSIONS: The combined mononostril-transantral approach provided the space necessary to manoeuvre instruments and to visualise the surgical field in treating mediocaudal orbital lesions. CLINICAL IMPLICATIONS: This two-portal approach enables extensive resections of intraconal lesions. It should be considered to be a suitable and safer alternative to the binostril approach.
- MeSH
- endoskopie * metody MeSH
- lidé MeSH
- nádory orbity * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Passage of nasal airflow during breathing is crucial in achieving accurate diagnosis and optimal therapy for patients with nasal disorders. Computational fluid dynamics (CFD) is the dominant method for simulating and studying airflow. The present study aimed to create a CFD nasal airflow model to determine the major routes of airflow through the nasal cavity and thus help with individualization of surgical treatment of nasal disorders. The three-dimensional nasal cavity model was based on computed tomography scans of the nasal cavity of an adult patient without nasal breathing problems. The model showed the main routes of airflow in the inferior meatus and inferior part of the common meatus, but also surprisingly in the middle meatus and in the middle part of the common nasal meatus. It indicates that the lower meatus and the lower part of the common meatus should not be the only consideration in case of surgery for nasal obstruction in our patient. CFD surgical planning could enable individualized precise surgical treatment of nasal disorders. It could be beneficial mainly in challenging cases such as patients with persistent nasal obstruction after surgery, patients with empty nose syndrome, and patients with a significant discrepancy between the clinical findings and subjective complaints.
- Publikační typ
- časopisecké články MeSH
Izolovaný mykotický zánět klínové dutiny je relativně vzácné onemocnění s nespecifickými projevy. Nejčastějším příznakem jsou bolesti hlavy, typické projevy zánětu vedlejších nosních dutin mohou zcela chybět. V diagnostice hraje významnou roli CT vyšetření se specifickými radiologickými známkami, definitivní diagnózu určí histologické vyšetření. Vzhledem k lokalizaci klínové dutiny může opožděná diagnostika v některých případech způsobit závažné následky. V článku je prezentována kazuistika pacienta s izolovaným mykotickým zánětem klínové dutiny. Cílem je poukázat na nespecifické projevy onemocnění a typické radiologické známky, které nám mohou pomoci v diagnostice.
Isolated sphenoid fungal sinusitis is a relatively rare disease with non-specific symptoms. The most common symptom is headache and the typical symptoms of sinusitis may be completely absent. A CT examination with specific radiological signs plays an important role in the diagnostic process but the definitive diagnosis is determined by a histological examination. Due to the location of the sphenoid sinus, in some cases, the delayed diagnosis may cause serious consequences. The article presents a case report of a patient with isolated mycotic inflammation of the sphenoid sinus. The aim of the article is to point out the non-specific symptoms of the disease and the typical radiological signs that can help us in the diagnostics.
The aim of this study was to compare the success of endoscopic dacryocystorinostomy with and without bicanalicular intubation in the treatment of distal nasolacrimal duct obstruction.METHODS: In a prospective, randomized, comparative study, endoscopic dacryocystorinostomy without bicanalicular silicone intubation (Group I) and endoscopic dacryocystorinostomy with intubation (Group II) were performed in patients with distal nasolacrimal duct obstructions. The tubes were removed 3 months after surgery in Group II, and the patients were followed up for 6 months after surgery. Therapeutic success was defined as the fluorescein dye disappearance test grade 0-1 corresponding with a complete resolution of symptoms. RESULTS: Thirty patients, aged 23-86 years, were included in the study. The success rate was 13/15 (86.67%) in Group I and in 14/15 (93.33%) in Group II. The difference between the two groups was not statistically significant (p = 0.483). Most common complications were granulations that occurred in 1/15 (6.67%) patient in Group I and in 2/15 (13.33%) patients in Group II. Adhesions in rhinostomy with epiphora and persistent secretion were observed in 1/15 (6.67%) patient in Group II. CONCLUSIONS: Bicanalicular intubation does not significantly increase the success rate of EDCR in distal nasolacrimal obstruction in adults.
- Publikační typ
- časopisecké články MeSH
Drug-induced sleep endoscopy (DISE) reveals epiglottic collapse to be a frequent cause of obstructive sleep apnea (OSA) and intolerance of positive airway pressure (PAP). These patients require different management. This prospective study aimed to compare transoral laser epiglottopexy outcomes in patients with OSA caused by epiglottic collapse with the patients' previous PAP outcomes. Fifteen consecutive adult patients with OSA and epiglottic collapse during DISE were included; ten were analyzed. Before inclusion, PAP was indicated and ineffective in six patients, one of whom underwent unsuccessful uvulopalatopharyngoplasty. PAP was performed during DISE in all patients before epiglottopexy and was uniformly ineffective. ENT control was performed at 1 week and 1 month, and control limited polygraphy to 6 months after surgery. The apnea-hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) were significantly improved (p < 0.001 and p = 0.003, respectively) in all patients after epiglottopexy. Surgery was successful in 9/10 patients; the remaining patient had a significantly decreased AHI and could finally tolerate PAP. Transoral laser epiglottopexy is used to treat OSA in patients with epiglottic collapse. Unlike other methods, it significantly reduces both AHI and ESS and should be considered for these patients. An active search for OSA patients with epiglottic collapse is recommended to prevent treatment failure.
- Publikační typ
- časopisecké články MeSH
- MeSH
- jazyk diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidní obezita MeSH
- obstrukční spánková apnoe * chirurgie MeSH
- tracheostomie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
Souhrn: Obstrukční spánková apnoe (dále OSA) je chronické onemocnění charakterizované epizodami obstrukce horních cest dýchacích během spánku se zástavou dechu, doprovázené poklesem saturace hemoglobinu kyslíkem v krvi a následnou aktivací sympatiku. Tento stav vede k probouzecím reakcím, k fragmentaci spánku a může způsobovat zvýšenou denní spavost. OSA je samostatným rizikovým faktorem pro kardiovaskulární, cerebrovaskulární a metabolická onemocnění. Ke správné diagnostice je potřeba odebrat kompletní anamnézu pacienta, doplněnou fyzikálním vyšetřením a monitorací spánku pomocí limitované polygrafie nebo polysomnografie. Vhodné je také provedení endoskopického vyšetření horních dýchacích cest otorinolaryngologem v uměle navozeném spánku (Drug Induced Sleep Endoscopy – DISE), které je užitečným nástrojem, umožňujícím lokalizovat funkčně-anatomickou obstrukci, a může napomoci následné účinné terapii OSA.
Summary: Obstructive sleep apnea (OSA) is a chronic disease characterized by recurrent partial or complete upper airway obstruction during sleep, resulting in a decrease in peripheral blood oxygen saturation and subsequent sympathetic activation. This condition leads to awakening reactions and sleep fragmentation and may be related with increased daytime sleepiness. OSA is a separate risk factor for cardiovascular, cerebrovascular and metabolic diseases. For proper diagnosis and subsequent effective therapy of OSA, a complete patient history should be taken into account, supplemented by physical examination and sleep monitoring with limited polygraphy or polysomnography. Drug Induced Sleep Endoscopy (DISE) is used to locate functional-anatomical airway obstruction during sleep and may assist subsequent effective therapy of OSA.
