Sarcoidosis is a chronic multisystem inflammatory disease characterized by non-caseous granulomas, most commonly in the lungs and intrathoracic lymph nodes. The nasopharyngeal disease is a rare localization of sarcoidosis. Clinical presentations include difficulty in nasal breathing, rhinophonia, and postnasal syndrome. Nasopharyngeal endoscopy, computed tomography, and magnetic resonance imaging are the main diagnostic methods for detecting lesions in this area. The histological examination provides the diagnosis verification. Considering the frequent secondary spread of sarcoidosis, all patients should consult a rheumatologist to select adequate systemic therapy. We provide a clinical case illustrating the management of a patient with nasopharyngeal sarcoidosis.
Osteoma is a benign neoplasm consisting of highly differentiated bone tissue cells. Frontal sinus is the most frequent localization of the bone neoplasms. The only treatment of the frontal sinus osteomas is surgical intervention. There are several surgical approaches to excision of frontal sinus osteomas. Transnasal endoscopic approach is applied rather seldom, however it has a number of advantages. The article describes the experience of transnasal endoscopic approach in excision of the frontal sinus osteomas.
The article describes the specific aspects of the combined method of plastic reconstruction of skull base defects in patients with nasal liquorrhea with sphenoid sinus localization. 15 patients with CSF fistula localization in sphenoid sinus underwent this surgery. In 8 cases meningocele was diagnosed. The main advantages of this technique are as follows: good visualization of all sphenoid sinus section, secure plasty of liquor fistula, functionality, preservation of anatomic continuity of nasal cavity and sphenoid sinus.
A clinical case in patient with a recurrent frontal sinus mucocele is described. An extended endoscopic frontotomy of the Draf IIb type was performed; a mucoperiosteal flap was used to prevent postoperative stenosis of the neo-ostium. However, within a year after the intervention, ostium stenosis developed with recurrence of the mucocele due to severe hyperostosis, which required repeated surgical treatment. The method of choice was an extended frontotomy of the Draf III type using a combination of pedicled flap and free mucosal graft to reduce the risk of restenosis of the frontal sinus ostium.
Inverted papilloma (IP) is a benign sinonasal lesion that has a known propensity for recurrence, local aggressiveness and an association with transformation to squamous cell carcinoma. Due to the high rate of recurrence, association with malignancy and a tendency of multicentricity, the surgical approaches to treatment are controversial. Over the years there has been a slow evolution from aggressive (en bloc) resection by lateral rhinotomy to endoscopic techniques. This progress corresponds to the advances that have been made in endoscopic sinus surgery over the past 15 years. Technological advances have allowed the detection of sinonasal IP before its extension beyond the sinonasal region, thus enabling minimally invasive techniques to be used in the treatment of selected cases of IP. In terms of aetiology there is certain evidence that the presence of HPV in IP could be predictive of malignant transformation. Parameters such as hyperkeratosis, squamous epithelial hyperplasia and a high mitotic index are negative prognostic indicators, which could be useful in the future follow-up of patients with IP.
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