Aleksandra Ślaska-Kaspera

Analiza histokliniczna guzów ślinianek przyusznych u chorych operowanych w okresie 20 lat w Klinice Laryngologii ŚlAM w Katowicach

Summary 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%.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%.

Usefulness of intraoperative monitoring of oculomotor and abducens nerves during surgical treatment of the cavernous sinus meningiomas

PURPOSE We analyzed the usefulness and prognostic value of intraoperative monitoring for identification of the oculomotor (III) and the abducens (VI) nerve in patients with cavernous sinus meningiomas. MATERIAL/METHODS 43 patients diagnosed with cavernous sinus meningiomas were divided according to their topography. Function of the nerves was scored on original clinical and neurophysiological scales. RESULTS The percentage of nerves identified correctly with the monitoring was significantly higher (91% vs. 53% for nerve III and 70% vs. 23% for nerve VI, p<0.001). The fractions of nerves III and VI identified correctly by means of the monitoring were significantly higher in the case of tumors with intra- and extracavernous location (89% vs. 32%, p<0.01) and intracavernous tumors (80% vs. 20%, p<0.05), respectively. The quality of post-resection recording correlated with functional status of both the nerves determined 9 months after the surgery (R=0.51, p<0.001 for nerve III and R=0.57, p<0.01 for nerve VI). Even a trace or pathological response to the post-resection stimulation was associated with improved functional status (90% vs. 50%, p<0.05 for nerve III and 93% vs. 38%, p<0.01 for nerve VI). CONCLUSIONS Neurophysiological monitoring of ocular motor nerves enables their intraoperative identification during resections of the cavernous sinus meningiomas. Intraoperative monitoring of nerve III is particularly important in the case of tumors with extra- and intracavernous location, and the monitoring of nerve VI in the case of intracavernous tumors. The outcome of the post-resection monitoring has prognostic value with regard to the clinical status of the nerves on long-term follow-up.

Blood flow velocity in the arteries of the anterior cerebral artery complex in patients with an azygos anterior cerebral artery aneurysm: A transcranial color-coded sonography study

OBJECTIVE It is presumed that increased blood flow through the single azygos anterior cerebral artery (Az) may contribute to the formation of an Az aneurysm. The aim of this study was to assess the blood flow velocities in the arteries of the anterior cerebral artery (ACA) complex in patients with the Az aneurysm. PATIENTS AND METHODS A series of three patients (2 men, aged: 65, 52 and 41) with an aneurysm (unruptured in two cases) of the distal Az was examined. Blood flow velocities in the Az and the A1 segment of the ACA were measured by means of a transcranial color-coded duplex sonography (TCCS) and the Az to A1 segment (Az/A1) velocity ratio was calculated. The control group consisted of 22 healthy subjects (mean age: 44 years). RESULTS There was a trend toward decreased (p=0.06) mean blood flow velocity in the Az compared to the A2 segment of the ACA of the control group. Blood velocity in the A1 segment did not differ between the study and control groups. Pulsatility and resistance indices in the Az were similar to those in the A2 segment of the control group. There were no differences between the Az/A1 ratio in the study group and the A2/A1 velocity ratio in the control group. CONCLUSION Our results suggest that Az aneurysms are not associated with increased blood flow velocity in the Az. Possibly, a hemodynamic stress related to the Az bifurcation geometry, together with a bent course of this artery around the genu of the corpus callosum, predispose to aneurysm formation.

Mięsień strzemiączkowy – aktualne poglądy na temat anatomii i fizjologii☆

Summary The authors present current opinions about anatomy and physiology of the stapedius muscle and its role of the hearing process. The stapedius muscle is the smallest striped muscle of the human body and contracts reflexive in response to acoustic stimulation. The stapedius muscle puls the neck of the stapes in the direction of the stapedius tendon. This movement causes stiffening of the incus and the malleus and also changes the pressure of the perilymph in the inner ear. This is the protective inner ear action of the stapedius reflex against hearing damage by noise. The stapedius reflex shows bilateral interactions and its center is located in the brainstem. The binaural interaction of the stapedius reflex plays an important role in the maintaining of the sound direction. The stapedius tendon also plays role in the vascularization of the long process of the incus.

Fibrous dysplasia of sphenoid bone – diagnostic difficulties

STRESZCZENIE: Dysplazja włóknista kości jest łagodną zmianą o niedokładnie poznanej etiologii. Istotą choroby jest zastąpienie prawidłowego utkania kostnego przez tkankę włóknistą. Lokalizacja w kości klinowej jest niezwykle rzadka. Badanie histopatomorfologiczne jest niezbędne do potwierdzenia rozpoznania. W niniejszej pracy autorzy prezentują przypadek 58-letniej pacjentki z dysplazją włóknistą kości klinowej. Chora uskarżała się na bóle głowy trwające od wielu lat, bez innych objawów towarzyszących. Wykonane badania obrazowe MRI i TK nie potwierdziły jednoznacznie łagodnego charakteru zmiany, jednak wyniki biopsji wykonanej z dostępu endoskopowego z wykorzystaniem neuronawigacji wykazały obecność dysplazji włóknistej kości klinowej.

Wyniki badań przesiewowych słuchu u wybranej populacji dzieci szkół podstawowych na Śląsku

Summary The aim of this study was analysis of results of audiologic evaluation in the group of 191 children with hearing loss. Children were selected from the group of 8885 pupils of primary schools in Silesia by screening test „Slysze” in 2002. Universal Screening Program of Hearing in Children and Teenage „Slysze” was created and introduced in to the clinic practice by Institute of Physiology and Pathology of Hearing in Warsaw in 1999. The screening program consists of: pure tone examination and speech audiometry in noise. Children with hearing loss detected by this test in 2002 were followed laryngological and audiological examination. Special attention was paid on articulation disturbances, communicational and educational problems in children with hearing loss. The authors focused also attention on „discreet signs of hearing deficiency” (not reacting to commands, turning up a TV-set, loud speech). The validation of screening test „Slysze” was also conducted. In the selected population of primary schoolchildren in Silesia hypoacusis occurred in 6% of examined children, in „city” schools the percentage proved to be higher than in „village” schools. In the group aged 6 to 10 the conductive hearing loss occurred considerable more frequently. Eustachian tube dysfunctions in children with conductive hearing loss occurred more frequently in the group of the younger ones. Older than 10 years old in most cases proved to have perceptive-type of hearing loss. The hearing loss hinders a childs psycho-intellectual development, it is important to detect it as early as possible. The evaluations showed that despite frequent occurrence of „discreet symptoms of hypoacusis”, only 17,8% of parents suspected hearing loss in their own child. According to the frequency of parents’ signals of „discreet symptoms of hypoacusis” it was found that the fact of turning up TV sound was the most powerful sign indicating the probability of hearing loss (45,5%). The most common risk factors of hearing loss in schoolchildren were also estimated. A characteristic, homogenous group of 34 children (17,8%) was the group with MSHL minimal sensorineral hearing loss of high frequencies (6–8 kHz). Results obtained give evidence of low level of awareness in the society concerning the problem of hypoacusis, which confirms the necessity to screening of hearing in schoolchildren and improving of health care in this respect. Diagnosing hypoacusis in case of children is an interdisciplinary problem, requiring cooperation of medical circles but also teachers, speech therapists and parents.

Endoscopic approach to the resection of adenoid cystic carcinoma of paranasal sinuses and nasal cavity: case report and own experience

AbstractAdenoid cystic carcinoma (ACC) is a rare malignant tumor that might occur in nasal cavity and paranasal sinuses. It is characteristic for poor prognosis, especially the solid histopathological subtype of the tumor. ACC might spread along nerves and fascias and it is usually diagnosed at advanced stage. Computed tomography and magnetic resonance imaging together with fine-needle biopsy are the gold standards in the diagnostic procedure of the cancer. Surgery with adjuvant therapy are the most common methods of treatment. Among the surgical approaches, the functional endonasal sinus surgery seems to be the most appropriate and favorable way of treatment. In the study, the authors present a case of a 62-year-old patient with T4aN0M0 ACC tumor treated endoscopically at the Department of Laryngology and ENT Oncology, WSS No. 5 in Sosnowiec. The authors indicate the usefulness of FESS procedure in the treatment of malignancies of nasal cavity and paranasal sinuses. They also review the recent publications on endonasal versus open approach in similar cases. In conclusions, the authors favor endonasal approach as a mini-invasive method of surgical treatment of ACC of paranasal sinuses that results in satisfactory oncological outcome and high quality of patient’s life.

Reoperacje w otosklerozie

Summary The authors present 68 cases of revision stapes surgery in otosclerosis. This review analyzed intraoperative findings and postrevision hearing results. According to our observations, the most common causes of failure after the first operation were: fibrous adhesions, dislocated prosthesis. Postreoperative hearing improvement was achived in 69,1% cases. The results obtained by revision are poorer than can be obtained by the primary procedures.

Wyniki operacji naprawczych porażeń nerwu twarzowego

Summary 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.UNLABELLED 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.

Ocena skuteczności testu przesiewowego „Słyszę” na podstawie wyników badań skryningowych słuchu u dzieci na Śląsku w 2002 roku ☆

Summary Introduction The measure of efficaciency of screening test is specificality and sensitivity. The validation of the screening test by using Program “Slysze” in Silesia in year 2002 was done. Material and methods The Program consisted of two parts: 1. The screening test in schools: a) pure-tone test, b) speech audiometry in noice, and 2. Audiometric verifying of “positive results” of the test. 8885 children were tested in Silesia in 2002. 919 schoolchildren (10,3%) had “positive results”. 465 pupils reported to a verifying examination. The hearing loss was confirmed in 191 children. 6 months after the end of Program the control audiometric examinations to validate the Program “Slysze” were done in 100 children, who gained “negative results” in screening test. Results Program “Slysze” had a high specificality – 0,93, sensitivity – 0,70, ability to identify – 0,92. A positive predictive value was – 0,40, and negative predictive value was – 0,98.