[The results of surgical treatment of the facial nerve paralysis]

Paralysis of the facial nerve reveales some symptoms which are very unfavourable for esthetic point of view (deformity of the face with incompetence of the palpebal function). It is recognized as the one of the most invalidity for humane life. There are many surgical techniques to reconstructive facial nerve such as: decompression, end to end or side to end anastomosis with hypoglosal, glosopharyngeal, axesorius or mandibular nerves. Reconstruction technique depends upon the extent of injury, the availability of the proximal stump and time since injury and duration of muscle denervation. In the presence of facial paralysis electrodiagnostic tests should be performed before surgery and every 3 mounts after, during rehabilitation, which play also the most important role in recovery.

MATERIAL AND METHODS

The authors present the outcome of the surgical treatment of the facial nerve paresis in 31 patients cured in the Silesian Department of Laryngology in Katowice from 1991 to 2002. The reasons of the paresis were otitis media with cholesteatoma and granuloma in 18 cases, head trauma in 2 patients and iatrogenic impairment after ear operations in 11 cases. The decompression of the facial nerve was done in 20 patients, anastomosis end to end in 3, crossover anastomoses between the facial nerve and the hypoglossal nerve was done in 1 case, and transplantation of auricular major nerve in 7 cases.

RESULTS

The outcome was good in 20 patients (64.5%), satisfactory in 10 patients (32.3%) and non satisfactory in one case (3.2%).

CONCLUSION

In our material the most of cases was caused by otitis media with cholesteatoma. The best outcome was obtained after decompression of the facial nerve. The rehabilitation before and after surgery play the very important role in the recovery.

[A 20-year retrospective histoclinical analysis of parotid gland tumors in the ENT Department AM in Katowice]

INTRODUCTION

Salivary gland neoplasms represent the diverse group of tumours encountered by the head and neck surgeons.

MATERIAL AND METHODS

The study is analysis of 531 patients with parotid gland tumours in patients treated in ENT Department during 1986-2006. We analysed surgical treatment and intraoperative tumour stage. The results of histological diagnosis were presented.

RESULTS

The frequency of incidence of benign neoplasm was 80%. The most frequent tumour was pleomorphic adenoma--75% and adenolymphoma--16%. Malignant tumours constituted 20% of all gland tumours. Mucoepidermoid (27%) and adenoid cyst (22%) carcinomas were the most common malignant tumour. Tumour stages T3-T4 was in 90%.

[The histo-clinical analysis of 95 malignant neoplasms of parotid gland]

INTRODUCTION

Malignant tumors constituted 25% of all gland tumors, the most frequently in parotid gland.

MATERIAL AND METHODS

The study is analysis of 436 patients with parotid gland tumors who underwent surgery in ENT Department. The results of histopatological diagnosis are presented. We analysed surgical treatment, intraoperative tumor stage and accuracy of fine - needle aspiration cytology in diagnosis.

RESULTS

Malignant tumors constituted 22% of all gland tumors. Mucoepidermoid (27%) and adenoid cyst (22%) carcinomas were the most common malignant tumor. Tumor stage T3-T4 was in 88,5% cases. Accuracy of fine-needle aspiration cytology in diagnosis of parotid tumors is 81,2%.

Glycosoaminoglycans in nasal polyps

CONCLUSION

The qualitative and quantitative compositions of GAGs were comparable in all the polyps examined.

OBJECTIVE

Glycosoaminoglycans (GAGs) are an integral component of proteoglycans, which are constituents of connective tissue. The qualitative and quantitative compositions of GAGs occurring in proteoglycans determine their biological role. In this work, individual fractions of GAGs occurring in nasal polyps were isolated and estimated.

MATERIAL AND METHODS

Polyps were obtained over a 2-year period from 31 patients (18 males, 13 females; age range 28-70 years) who underwent polypectomy and evaluated using routine histopathology.

RESULTS

The amount of hyaluronic acid in nasal polyps was high, the amounts of dermatane sulphate and chondroitine-6-sulphate were slightly lower and the amounts of chondroitine-4-sulphate, heparin, heparan sulphate and keratan sulphate were the lowest.

[Treatment results in external and middle ear malignant neoplasms of patients treated at the Laryngology Department of Medical University of Silesia between 1991-2001]

The authors present 18 patients with malignant neoplasms of the ear and temporal bone who were treated in the Clinic of Laryngology Medical University of Silesia in Katowice in the years 1991-2001. The most frequent was squamous cell carcinoma (11 patients--61%). The neoplasm was located on the auricle in 7 patients (39%), in the external auditory canal in 4 (22%) patients, in the middle ear in 5 patients (28%) and in 2 cases (11%) it was difficult to establish primary site. Ten patients (55.5%) were treated in stage T4. All patients had surgery and in advanced cases the radiotherapy was added. The best outcomes were in auricular neoplasms. The treatment results were much worse in neoplasms of the external auditory canal and the middle ear. Over 3 year follow-up in 10 patients (55%) with ear and temporal bone neoplasms shows no recurrence.

[Analysis of 216 cases of pleomorphic adenoma of the parotid gland]

Pleomorphic adenoma is the most frequent benign tumour of the salivary glands. The most common localization is the parotid gland. The authors present a clinical analysis of the group of 216 patients, who was treated in ENT Department and who was diagnosed as pleomorphic adenoma. The frequency of incidence of mixed tumours is 50.70% of all 426 cases of parotid gland's tumours. In 92, 13% cases the tumours was localized in the superficial part, only in 7.87% in deep part of the gland. Sixteen patient was operated on because of the recurrence of mixed tumours. In one case we observed the syndrome of the auriculotemporal nerve. The temporary paresis of facial nerve after operation occurred in 19 patients. We don't noticed the incidence of salivary fistula in our material.

[Disabling positional vertigo (DPV): syndrome of vestibulo-cochlear organ impairment during vascular compression of the vestibulo-cochlear nerve (VCS)]

In 1984 Jannetta et al. introduced a new term-disabling positional vertigo (DPV). DPV is a term used to describe syndrome of cochleo-vestibular organ impairment during vascular compression syndrome of eight cranial nerve. They introduced this term to distinct this syndrome from other established vertigo syndromes on the basis of recognized in angio - MRI exam compression of VIII nerve by vessel and clinical and electrophysiological criteria. Existence of DPV syndrome is still not universally accepted, because it is difficult to diagnose vertigo as vascular compression syndrome of the eight cranial nerve when there are no specific finding to detect this syndrome. Only Moller proposed specific ABR abnormalities as a criterion in DPV diagnosis (prolongation of I - III interval). The authors performed retrospective analysis of 28 patients (16 female, 12 men, average age 43) with recognized on basis angio - MRI vascular compression syndrome of eight cranial nerve. Contrasted magnetic resonance imaging identified a vascular loop near to cochleo - vestibular nerve in all 28 cases. All patients were performed pure tone audiometry, DPOAE, ABR and ENG exam. The most common symptoms were unilateral tinnitus (89% cases), unilateral hearing loss (86%) and dizziness (61%). The most frequent abnormalities in above mentioned exams were sensorineural hearing loss in pure tone audiometry (92%). ABR data were interpreted with respect to Mollerís criteria and asymmetry of the I - III, III - V and I - V interval and prolongation of V waves in the auditory brainstem response was found in 36% cases. Abnormal changes in electronystagmography were found: absence (10%) or weakness (36%) of caloric response. The differential diagnosis of DPV syndrome are discussed. We could not find any specific clinical findings valuable for DPV diagnosis. There is no significantly more weakness or absence of caloric response of vestibular organ in patients with DPV. Disabling positional vertigo is the syndrome which should be considered in differential diagnosis in every case of vertigo.

[Results of stapedotomy in the cases of "floating footplate"]

One of the problems in the stapes surgery is the floating footplate. The frequency of incidence of this complication is 2% to 5.8% of all operations. The authors present the results of stapes operations in a group of 28 cases (2.5%) from all the 1120 operations, in which the surgeon experienced a floating footplate. The hearing results were evaluated on the base of the average gain of air-conduction thresholds and air-bone gap levels at 500, 1000, 2000 and 3000 Hz. The improvement of hearing we observed in 24 patients, 4 patients heard worse.

[30 years of stapes surgery]

This study reports the results of otosclerosis surgery performed during the past thirty years (1973-2002) in the ENT Clinic in Katowice. The authors present difficult anatomic relationships in the tympanic cavity which might have an influence on stapes surgery. Audiometric evaluation of 100 bilateral stapedotomies performed in 50 patients revealed that a small--hole stapedotomy is a safe technique and could be performed bilaterally. The group of 55 stapedotomies with stapedial tendon preserved was compared to the group of 55 stapedotomies with dissected tendon. SRT was better in the group where the tendon was preserved. In the group of 32 patients ABR before and after stapedotomy was recorded. The latency of V wave after the operation was reduced to the normal values what indicated a correct function of the ossicular chain postoperatively. In the group of 60 patients DPOAE prior and after stapedotomy was evaluated. Prior to the operation no signal of otoacoustic emission was registered, in 37 patients out of 60 the signal was present after the operation. DPOAE obtained postoperatively indicated successful ossicular chain restoration and inner ear function. Audiometric evaluation in reference to the group of 905 stapedotomies performed in years 1992-2001 showed that most of the patients were in group B--443/905 and C--402/905 according, in A group--60/905 according to Shambaugh. A-B gap < or = 10 dB was obtained in 469/905 (51.8%), the mean of the hearing threshold at 500, 1000, 2000 and 4000 Hz was 24.3 dB (+/- 8.3, med. 25.0) in A group and 32.0 dB in B and C group. The result of stapedotomy in reference to tinnitus based on the patients' subjective opinion. We may conclude that the key to the stapes surgery lies in the training and skillfulness of the surgeon using save small hole technique with stapedial tendon preservation to obtain the optimal physiologic function of the middle ear and to gain the best hearing results.

[Results of myringoplasty and type I tympanoplasty with the use of fascia, cartilage and perichondrium grafts]

Since the publication of Miodoński, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplasty. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplasty in comparison with the material used. The studies included a selected group of 142 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. The comparison group consisted of 30 patients when fascia of the musculus temporalis was used to close a defect of the eardrum. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery. The comparison of operation results showed that there was no significant difference between the two groups.

[Adenolymphoma of parotid gland--analysis of 75 cases]

The authors present a clinical analysis of the group of 75 patients, who was treated in Department of Otolaryngology in the years 1986-2000 and who was diagnosed as adenolymphoma. The frequency of incidence of Warthin's tumour is 17,6% of all 426 cases of parotid gland's tumours. In 72 cases (96%) the tumour was localized in the superficial part, only in 3 cases (4%)--in the deep part of the gland. In one patient we observed recurrence of adenolymphoma. In one case adenolymphoma coexisted with carcinoma planoepitheliale of parotid gland.

[The estimation of air--conduction threshold in extended range of high frequencies in young adult patients suffering from primary arterial hypertension]

The aim of the study was evaluation of the hearing ability on the base of air conduction threshold at extended range of high frequencies in young subjects with primary arterial hypertension. Lack of internationally accepted reference value of air conduction hearing threshold at extended frequency range resulted in own evaluation of the audiometric zero point for air conduction at the range 8-18 kHz in "otologically healthy" subjects younger than 20 years. Detection of impaired hearing of the extended high frequencies range in young subjects with primary arterial hypertension may be useful in diagnostics of hypertension as well as in prophylactic examinations in the group of individuals with high risk of primary hypertension. Evaluation of air conduction threshold at extended frequency range allows to detect sensorineural hearing impairment undetectable with application of conventional frequency range.

[The evaluation of distortion product otoacoustic emissions after stapedotomy]

34 patients with otosclerosis operated at the ENT Clinic, were enrolled in this study. Prior and 4 months after stapedotomy the signal of DPOAE and the threshold levels for air and bone conduction were evaluated. No signal of otoacoustic emissions was registered in any of the patients prior stapedotomy. After operation DPOAE was registered in 23 out of 34 examined patients (67.6%).

[A case of bilaterally elongated styloid processes]

Elongated styloid process gives a complex of symptoms described by Eagle such as unilateral craniofacial and cervical pain, recurrent throat pain, dysphagia and foreign body sensation. Symptoms might be similar to those caused by calcified stylohyoid ligament. Diagnosis of the elongated styloid process is based on the palpation of the tonsillar area and should be confirmed radiologically. Surgical shortening of the elongated process is the only way to give symptomatic relief to the patient. The authors present a surgically treated case of bilaterally elongated styloid processes and unilateral symptoms.

[The evaluation of cartilage and perichondrium grafts for the reconstruction of the tympanic membrane]

Since the publication of Miodoński, Zollner and Wullstein different methods and grafting materials have been promoted in tympanoplastic surgery. The purpose of this study was to demonstrate the anatomical and functional results of tympanoplastic surgery with the use of cartilage and perichondrium grafts. The studies included a selected group of 112 patients who were operated on because of perforation of tympanic membrane. The analysed group consisted of 112 patients when perichondrium and cartilage were used to reconstruct the tympanic membrane. In all cases before and after operation there was made tonal audiometry with indication for air and bone conduction within range from 500 to 4000 Hz, verbal audiometry after operation with indication of speech detection and speech reception threshold using mono-syllable NLA-93 test, tympanometry after operation and evaluation of anatomical results after surgery.

[Spectral and spectrographic voice acoustic analysis in selected patients after various types of partial laryngectomy for malignant neoplasms after radiotherapy]

The aim of this study is the assessment of voice pathology in patients after various types of partial laryngectomy because of malignant neoplasms and after Co--60--therapy. Voice quality in above mentioned diseases and in healthy patients was compared. Voice was analysed by subjective (videostroboscopy) and objective spectrographic methods. This method seems to be very valuable to assess social efficiency of voice.

[Schwannoma of the cervical plexus: a case report]

A case of 70 years old man with cervical plexus schwannoma is presented. The tumor was removed surgically using extracapsular technique. The differential diagnosis and surgical techniques are discussed. The pre-operative symptoms, impressions and post-operative neurological status were shown and discussed. The review of literature is presented.

[An extremely rare case of primary lipoma of the middle ear in an 8-year old girl]

Authors described an extremely rare case of primary lipoma of the middle ear in 8-years old girl. A histological structure, localisation and occurrence of this tumor in the temporal bone was discussed on the basis of the literature. Authors have presented symptomatology, diagnosis difficulties and treatment of primary lipoma of the middle ear. They have paid attention to the course of disease and non-characteristic symptoms, which imitated the symptoms of the chronic otitis media.

[The estimation of hearing threshold for high frequencies in children from the Upper Silesia]

Study was carried out in frequency range 8-18 kHz with audiometer AS 10 HF. Lack of internationally accepted reference value of the hearing threshold of air conduction at extended frequency range resulted in own evaluation of the audiometric zero point for air conduction at the range 8-18 kHz in "otologically healthy" subjects younger than 20 years. They were divided into subgroup A and B according to age. Investigation of the threshold values for air conduction at extended range of high frequencies were base for evaluation of the audiometric zero value for the used equipment.

[Alloplastic valve vocal prosthesis to serve for rehabilitation speech after total laryngectomy]

The authors have presented structure and method of implantation of alloplastical valve vocal prosthesis to serve for rehabilitation speech after total laryngectomy.

[A rare case of multiple neoplasms of parotid gland: adenolymphoma and squamous cell carcinoma]

The authors have presented a very rare case of multiple primary neoplasms of parotid gland: adenolymphoma and squamous cell carcinoma. Primary multiple neoplasms and multifocal neoplasms are a very complex problem and therefore have been a topic of many articles. The authors describe mechanism of origin, frequency of occurrence, possibilities of diagnostics. The main reason of these neoplasms origin are simultaneously exposure of the tissue to damaging factors and special tissue sensitivity.

[A rare case of the thyroid tissue in the right carotid triangle]

Authors have described a rare case of split of the thyroid tissue in the right carotid triangle in 41 years-old-man. They lay stress on difficulty with making right preoperative diagnosis. A growth in the right carotid triangle was surgically excised, and the microscopic examination of the specimen revealed thyroid tissue with collide goiter. Because this entity cannot be clinically distinguished from the others neck tumors, split of the thyroid tissue should be considered in the differential diagnosis.

[Histological and clinical analysis of mesenchymal malignant neoplasms (soft tissue sarcomas) of head and neck region in the data of I ENT Department of Silesian Medical Academy]

Between the years 19890-1998 in I ENT Department of Silesian Medical Academy were treated surgically 15 patients suffering from soft tissue sarcomas of head and neck region. Patomorphological examination showed: fibrosarcoma (4 cases), haemangioendothelioma malignum (2 cases), rhabdomyosarcoma (2 cases), schwannoma malignum (2 cases), fibrohistiocytoma malignum (2 cases), tumor mixtus mesenchymalis (1 case), haemangiopericytoma malignum (1 case), extrasceletal osteosarcoma (1 case). Sarcomas were localised in paranasal sinuses (7 cases), orbita (5 cases), parapharyngeal space (1 case), parotid gland (1 case) and bucca (1 case). All those patients were treated surgically and most of them were irradiated postoperatively. The authors have presented the diagnostic and methods of treatment of soft tissue sarcomas. According to our experience and data of the literature the method of choice in treatment soft tissue sarcomas should consist of surgery and radiation therapy postoperatively.

[Prosthesis to reconstruction of transmissive system in the middle ear]

Authors have described prothesis to reconstruction of transmissive system in middle ear, which has received using patent no PL 54142 Y1.

[Air conduction threshold values in expanded range of frequencies (250 Hz-18 kHz) in otologically normal persons as assessment of mobility hearing organ in presbycusis]

High-frequency hearing loss is most significant for the organ of hearing aging. Air conduction threshold measurements were taken in 4 groups (aged 31-40, 41-50, 51-60, 61-70 years) of otologically normal persons in expanded range of frequencies (250-18,000 Hz). The threshold of air conduction increase parallel to age and to pure tone frequency was stated.

[Cases of pleomorphic adenoma originating in the minor salivary glands]

The authors present 6 cases of adenoma pleomorphum localized out of salivary glands-2 of them on palate, 1 in external auditory canal, 1 in larynx, 1 in lacrimal gland and 1 in parapharyngeal space. All patients were treated surgically.

[The assessment of lateral orbitotomy by Krönlein-Reese-Berke in surgical treatment of primary non-malignant orbital tumors]

AIM

The assessment of lateral orbitotomy by Krönlein-Reese-Berke was made to evaluate the possibility of radical removal of primary orbital tumors, function of visual system and cosmetic effect after lateral orbitotomy.

MATERIAL AND METHODS

The authors analysed a group of 14 patients treated for primary non-malignant orbital tumors. They were treated in I ENT Clinic of Silesian Medical Academy in Katowice surgically by Krönlein-Reese-Berke lateral orbitotomy. A control examination (after 3 years) performed in all 14 patients did not show recurrence of tumor, the motility of the eye ball and visual function was normal, cosmetic effect was good.

CONCLUSIONS

We suggest that in the cases of primary non-malignant tumors localised in the lateral part of the orbita, orbitotomy by Krönlein-Reese-Berke is the optimal surgical approach.

[Primary orbital tumors treated surgically in ENT department of Silesian Medical Academy in Katowice]

Primary tumours of orbital cavity are a difficult diagnostic and therapeutic problem from a borderline of ophthalmology, laryngology and neurosurgery. Particular anatomical relations of orbital cavity surrounded by paranasal sinuses, cranial cavity cause that it has become an interdisciplinary region and the best method of therapy is multispecialistic surgical treatment ("team approach"). In this article the classification and general symptomatology of orbital cavity primary tumours were presented. 37 patients suffering from primary orbital tumours were treated surgically in the ENT Department of Silesian Medical Academy in Katowice. The patients were aged from 23 (woman with neurosarcoma) to 73 (man with melanoma). All patients were treated surgically: 15 of them by orbital exenteration, 10 by lateral orbitotomy m. Kronlein-Reese-Berk, and 12 by canthotomy. Special attention was paid to possible postoperative complications.

[Plastic tracheostomy tube of Luer's type]

The authors describe a plastic tracheostomy tube which has been accepted as the registered model No: PL 54620 Y1. The presented tube is applied in patients in I ENT Department of the Silesian Medical Academy in Katowice. The authors presented advantages of plastic tracheostomy tube.

[A rare case of multiple primary malignant neoplasms of parotid gland: fibrosarcoma and squamous cell carcinoma]

Primary multiple malignant neoplasms and multifocal neoplasms are a very complex problem and therefore have been a topic of many articles. The mechanism of origin, frequency of occurrence, co-existence of neoplasms in functionally similar organs (uterus, mammary gland), heredity, a possibility of diagnostic and therapy are the most interesting aspects. Frequency of multiple primary malignant neoplasms occurrence is about 2-8% and still increases. Pathogenesis of multifocal and multiple neoplasms has rarely been a subject of articles. A simultaneous exposure of a tissue to damaging factors and special tissue sensitivity are the main reasons for neoplasms origin in this group. The authors present a rare case of parotid gland multiple neoplasm: fibrosarcoma and squamous cell carcinoma, as well as discuss the diagnostics, therapy, and prognosis of multiple neoplasms.

[Laryngocele]

Author present four cases of mixed laryngocoele. Planocellular carcinoma of larynx was recognized at one of the four patients after 17 months from the operation of laryngocoele. A rare case of bilateral laryngocoele described by the authors was found in a woman, who was operated on in 1981 because of the internal laryngocoele at the left side. She was reoperated in 1995 a mixed laryngocoele at the right side was removed.

[Rare primary malignant orbital neoplasms treated surgically in the I Clinic of Otolaryngology of the Silesian Medical Academy in Katowice in the years 1992-1995]

14 patients suffering from primary orbital tumours were treated surgically in the Otolaryngological Department in Silesian Medical Academy in Katowice in the years 1992-1995. The patients were aged from 23 (woman with neurosarcoma) to 67 (woman with haemangioma). All patients were treated surgically: 8 of them by lateral orbitotomy m. Krönlein-Reese-Berk, 3 of them by orbital exenteration, and 3 of them by canthotomy. The author analysed 3 very rare cases of primary orbital malignant neoplasms: neurosarcoma, rhabdomyosarcoma and additionally I case with fibrosarcoma, osteosarcoma and chondrosarcoma simultaneously.

[The accuracy of fine needle aspiration biopsy (BAC) for pathomorphological diagnosis of head and neck neoplasms]

The authors present the results of fine needle aspiration biopsy in 58 patients with tumors of head and neck. Cytological and pathomorphological correlation was evaluated in all patients. The highest accuracy of cyto-pathomorphological was obtained in parotid gland tumors, both benign and malign, and in lymph nodes of the neck. The lowest accuracy was obtained in tumors of the orbit.

[Device for controlling hemorrhage in the nasal cavity]

Authors describe a controlling device in a nasal haemorrhage which has been accepted as the registered model No: PL 52469-Y1. The presented device has been applied in many cases of nasal haemorrhage in patients in First Department of Laryngology of the Silesian University School of Medicine in Katowice.