Combined Approach of the Anterior Skull Base in Sinonasal Tumours

Abstract

Malignancies of the nasal cavity and the paranasal sinuses are rare, counting for less than 3 % of the ENT-cancers. The insidious onset of these tumours with non-specific symptoms often leads to a delayed diagnostic. Advanced disease stage combined with the complex anatomy of the sinonasal cavities and anterior skull base encouraged surgeons to extend beyond the boundaries the classic surgical techniques. Surgical approaches to anterior skull base lesions can be divided into open approches: craniofacial, subcranial, endoscopic techniques or combined approaches when a craniotomy is associated with an endonasal endoscopic approach. The indication must take into consideration the oncologic principles, histopathology exam, extent of disease and surgeon skill and experience. Combined approach should be taken into consideration for patients with extended disease or significant intraorbital or intracranial extension. For certain tumours that require a craniotomy for the superior, superolateral, and anterior extensions of the disease and also a nasal and paranasal sinus tumor that could be removed endoscopically, an endoscopic-assisted approach can be considered.

The TAC and MDA Values in Patients with Chronic Suppurative Otitis Media

“…Our study showed statistically significant higher levelsof TAC in the healthy group compared to groups with CSOM with or without cholesteatoma, thus demonstrating the existence of an imbalance between oxidant-antioxidant systems. Vascular proliferation, leukocyte infiltration, epithelial thickening, local oedema was linked to the overproduction of oxidants and the tissue damage in the middle ear [12][13][14]. Some studies show a decrease in the level of oxidative stress by ventilation tube insertion that decrease the local inflammation [15,16].…”

Multimodality Approach to Treatment of Rhinosinusal Tumours

“…One aspect worth noting is the succession of chemotherapy and radiotherapy. In the past years oncologists opted for initial radiotherapy followed by surgery and then chemotherapy, but histology studies dismantled this theor y demonstrating that after radiotherapy the fibrosis of irradiated tissues with local hypoperfusion, do not allow chemotherapy drugs to penetratethe remaining tumour tissue [19][20][21][22].…”

Chemical and Biological Factors in Infectious Diseases The oral microbial flora

“…It is important to know that by respecting the measures of oral hygiene it is intended the removal of the bacterial plaque from the hard structures but the oral environment will never be a sterile one. Maintaining the balance of the oral microbial ecosystem is essential because commensal bacteria have a protective role, helping the immune response and preventing the development of other pathogenic species that make the organism ill [19][20][21][22].…”