Angelos Chatziavramidis

Pediatric sialendoscopy under local anesthesia: Limitations and potentials

OBJECTIVE Sialendoscopy in children is a recently described procedure. The small amount of existed literature presents the procedure under general anesthesia. We report our experience on pediatric sialendoscopy under local anesthesia at an outpatient setting. METHODS In a period of 1.5 years 9 children with age >8 years suffering from recurrent parotid swellings were assessed with sialendoscopy. In 8 out of 9 cases the parents accepted a procedure under local anesthesia. In 7 cases the procedure was completed uneventfully however in one case was discontinued and repeated under general anesthesia. The endoscope used was a 1.1mm Marchal type. Prior to endoscopy xylocaine solution 4% was applied on the papilla area for 15min. Intraductal injection of xylocaine 2% (5ml) was performed prior the insertion of the endoscope. During the procedure parents evaluated pain by means of a 6-point smiley scale. Social life and school activity were also evaluated by means of an 11-point scale pre- and 1 year post-sialendoscopy. RESULTS Seven out of eight children (8 sialendoscopies) tolerated and completed the sialendoscopy assessment. The mean duration of the procedure was 39.2min. No major complications were reported at the early post-endoscopy period. Four children presented no further swellings, two experienced one recurrence and one needed a repeat sialendoscopy (3 recurrent episodes). Sialendoscopy findings showed fibrinous debris in 4 children, mucous plugs in 2, evidence of sialodochitis with purulent debris in one child and stenosis in 3 children. The diagnosis in our cases was Juvenile Recurrent Parotitis in 6 children and chronic microbial parotitis in one case. Social life and school activity were improved in 6 children 1-year post-sialendoscopy according to parents ratings. CONCLUSIONS Sialendoscopy under local anesthesia can be an alternative option in children of age >8 years and satisfactory cooperative skills, avoiding unnecessary general anesthesias and hospital stay.

Effects of smoking on taste: Assessment with contact endoscopy and taste strips

This study aims to compare the taste function between smokers and nonsmokers with clinical testing, subjective ratings, and contact endoscopy of the tongue.

Longstanding rhinolith leading to anatomical alterations of the ipsilateral inferior nasal meatus and turbinate.

Rhinoliths consist of a central nidus with calcification resulting in calcareous concretions within the nasal cavity. They are uncommon in the literature despite a propensity particularly in children to insert foreign bodies into their nose and ears. We present the case of a 62-year-old woman with a longstanding undetected rhinolith with mild uncharacteristic symptoms. Radiographic examination revealed anatomical alteration of the inferior turbinate that was attributed to the long presence of the rhinolith in the nasal cavity. The management of the rhinolith and a review of the literature are presented.

Sizeable acquired subglottic cyst in a baby with Williams-Beuren syndrome: association or coincidence?

We describe a case of an acquired subglottic cyst presented with persistent stridor and voice hoarsening in a baby diagnosed with Williams-Beuren syndrome that was born premature and required intubation during neonatal period. We also comment on whether this is a coincidence or there can be an association between impaired elastogenesis, a feature of patients with the syndrome and the formation of a subglottic cyst.

Intranasal trigeminal function in patients with empty nose syndrome

Trigeminal nerve mediates the perception of nasal airflow. This study examines whether impaired intranasal trigeminal function is a part of the paradoxical nasal obstruction sensation in patients with empty nose syndrome (ENS).

Olfactory dysfunction as first presenting symptom of cranial fibrous dysplasia.

Fibrous dysplasia (FD) is a benign bone disorder presenting with a variety of clinical manifestations. This is the first reported case of anosmia as presenting symptom of FD. We present the case of a 72-year-old female patient with a progressive olfactory dysfunction. Clinical examination revealed evidence of chronic rhinosinusitis; therefore the patient was treated with a course of oral corticosteroids. The patient had no improvement in her olfactory ability and imaging studies were ordered. Bony lesions characteristic of craniofacial FD were found, causing obstruction of the central olfactory pathway. This case emphasises the need to conduct further investigations in patients with rhinosinusitis and olfactory dysfunction especially when they present no response to oral steroid treatment.

Vitamin D3 Deficiency and its Association with Nasal Polyposis in Patients with Cystic Fibrosis and Patients with Chronic Rhinosinusitis

Background Currently vitamin D3 (VD3) or cholecalciferol is considered an immunomodulator that may be implicated in nasal polyposis (NP) pathophysiology. Objectives This study aimed to investigate if deficiency of VD3 is associated with the presence of NP in patients with cystic fibrosis (CT) and patients with chronic rhinosinusitis (CRS). Methods In total, 152 adult participants were included in five phenotypic groups: CT with NP (CTwNP) (n = 27), CT without NP (CTsNP) (n = 31), CRS with NP (CRSwNP) (n = 32), CRS without NP (CRSsNP) (n = 30), and controls (n = 32). The serum levels of 25(OH)-VD3 <20 ng/mL are considered as a deficiency, 21–29 ng/mL as insufficiency, and >30 ng/mL as sufficiency. Endoscopic and imaging staging of the mucosal disease performed with the Lund-Kennedy (LK) and Lund-Mackay (LM) scoring systems, respectively. The genotype of the patients with CT and the nasal microbial colonization of the patients with CT and patients with CRS were also recorded. Results The patients with CTwNP had the lowest percentage of sufficiency in VD3 and the highest percentage in insufficiency among all the groups. The LM imaging scores were inversely correlated with the VD3 levels in both arms of the study (CT and CRS). Moreover, the LK endoscopic scores had a similar correlation in the CT groups; however, this was not the case with the CRS groups. The genotype of the patients with CT was not correlated with the VD3 serum levels. The patients with positive microbial colonization (mainly Pseudomonas and Staphylococcus aureus) had significantly lower VD3 serum levels in both the CT and CRS process. Conclusion VD3 deficiency seemed to be associated with the presence of nasal polyps in the patients with CRS and in the patients with CT in a similar manner. The lower the level of serum VD3, the more severe the mucosal disease was found in the imaging studies and the more frequent microbial colonization of the patients with CT and the patients with CRS.

Conservative management of bilateral pneumoparotitis with sialendoscopy and steroid irrigation

Pneumoparotitis is a rare condition related to retrograde airflow into the ductal system of the gland and secondary infections. Although counselling is enough in the majority of cases, persistent problems require surgery. Sialendoscopy and ductal irrigation with steroids have never been described as a treatment option. We present the case of a 61-year-old man with recurrent bilateral parotid swellings who had three episodes of sialadenitis on the right side within 2 years. Massage of the glands revealed air bubbles coming out from both papillae. A previous CT scan confirmed the presence of air in both parotid glands. The patient underwent sialendoscopy and irrigation of the ductal system with prednisolone. Ductal irrigation with steroids in three additional sessions led to a significant improvement of symptoms 6 months later. Sialendoscopy and irrigation with steroids could be another treatment modality in cases of recurrent pneumoparotitis avoiding major surgery.

Sialendoscopy with the use of a syringe pump

Sialendoscopy has emerged for more than two decades as a diagnostic and interventional method for salivary gland ductal pathologies. Innovative technologies applied for the development of endoscopes with reduced diameters, higher image quality andmicro-instruments for use via the working channel have increased the therapeutic effectiveness of the method. The usual setting of a diagnostic and/or interventional sialendoscopy demands specific instrumentation, an endoscopic tower and an assistant for continuous administration of rinsing solution by syringe through the endoscope’s irrigation channel that enables/enhances visualisation. In the case of an interventional sialendoscopy, the assistant also participates to the handling of micro-instruments. There is no doubt that the assistant’s role is crucial to the successful outcome especially of the interventional method. However, when the role of the assistant is limited to rinse solution as in diagnostic procedure, this leads to a redundant binding of human resources. This led our team to try a setting with one examiner and automated rinsing system during the diagnostic procedures.

Brush cytology with immunocytochemical evaluation of VEGF expression versus biopsy in clinically precancerous laryngeal lesions: can we diagnose laryngeal cancer only with brush cytology?

Introduction. Laryngeal squamous cell carcinoma (LSCC) is the most common SCC of the head and neck. The high incidence of this malignancy and the low survival rate necessitate the development of novel diagnostic approaches. Aim of this study is to compare the diagnostic value of laryngeal brush cytology combined with VEGF immunocytochemistry versus histopathology of clinically precancerous lesions of the larynx. Material and Methods. Thirty patients with precancerous or suspected malignant laryngeal lesions underwent microlaryngoscopy, during which samples were taken for cytological, immunocytochemical, and histological analysis. Cytology and histology results were classified as follows: benign lesions, atypia/moderate dysplasia, and malignancy, whereas the expression of VEGF was evaluated as strong, moderate, weak, and zero expression, based on the percentage of cells stained. Results. The cytology results were in accordance with the histology results in 86.7% of the patients. The exfoliative cytologys sensitivity was estimated at 85% and its specificity at 90%. Its positive prognostic value was 94%, while its negative prognostic value was 75%. The additional immunocytochemical evaluation of VEGF expression increased all the noted parameters. Discussion. Exfoliative cytology of laryngeal lesions is a minimal-invasive, easily applicable procedure during microlaryngoscopy and reliable in terms of diagnostic value. Under certain conditions it could be held also in local anesthesia. Concurrent immunocytochemical analysis of VEGF expression further enhances its diagnostic value.