Vladimir Kljajic

Endoscopic repair of cerebrospinal fluid rhinorrhea

INTRODUCTION Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. OBJECTIVE The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. METHODS This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. RESULTS Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. CONCLUSION Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate.

Rhinoplasty: Open Techniques

On the basis of incisions that are made in order to lift soft nasal tissue and showing the skeleton of the nasal pyramid as well as the septum, all surgical techniques can be divided into open and close ones. In close techniques, incisions are inside the nasal cavity and are not visible whereas in the open ones the first incision on columella skin. The authors discuss surgical indications, incisions, the surgical procedure, problems with the nasal tip, nasal valve problems, and graft materials.

[Nasal hump--five year analysis].

INTRODUCTION The nose has a prominent central position in the face and therefore it considerably contributes to the esthetic appearance and facial harmony. On the anterior view, the face is dominated by the nasal length and width, as well as medial location. On the lateral view, the nasal dorsum is most important; although it is the dimension we cannot see ourselves, it is the most common cause of surgery. MATERIAL AND METHODS This five-year retrospective study included 216 patients of both sexes; their average age was 22 years, and they underwent surgery at the Ear, Throat and Nose Clinic in Novi Sad in the period from 2001 to 2006. There were 89 male, and 127 female patients. RESULTS Most patients were aged 18-22 years (57%). A nasal pyramid deformity with septal deviation was present in 81.1% of patients, whereas 18.9% (41 patients) presented only with a nasal pyramid deformity. Out of the total number of patients, 24 patients had both nasal kyphosis and scoliosis. All patients underwent closed rhinoplasty with obligatory correction of the tip of the nose. The nasal hump removal with lateral osteotomy was also performed in all patients. Two patients underwent reoperation, due to small dorsal humps within the cartilage, while one patient had a postoperative septal perforation. One patient presented with a postoperative abscess of the nasal dorsum, which was conservatively managed. CONCLUSION Nasal hump is the most common nasal pyramid deformity, often without a nasal septum deviation. It is quite easily treated by surgery. Two patients have already undergone reoperation with good results, and two patients had postoperative complications. Postoperative complications were recorded in 1.85% of patients.

Mastoiditis in children: A retrospective analysis of clinical characteristics

Introduction. Acute mastoiditis is the most common otogenic complication among infants and young children and is always considered a serious complication. In addition to determining the age at which mastoiditis usually occurred in children, the time of onset of clinical signs in relation to the onset of symptoms of middle ear inflammation, as well as the most common clinical signs of mastoiditis, the study has been aimed at finding out whether mastoiditis is of seasonal character. Material and Methods. A retrospective study of children surgically treated for mastoiditis was conducted at the Department of Ear, Nose and Throat Disease of the Clinical Center of Vojvodina in Novi Sad in the period January 1, 2002 - December 31, 2011. The sample included 56 children (30 boys - 53.57%, and 26 girls - 46.42%), up to 17 years of age. The obtained results were statistically analyzed and presented using Microfsot EXCEL for statistical analysis. Results. Mastoiditis is most common in children up to 2 years of age, 39/56 (69.82%). It has a seasonal character, with the peak season in the autumn-winter period, with a statistically significant difference compared to the spring-summer period (p = 0.0449, i.e. p<0.05). In 25 children (44.64%), the middle ear symptoms lasted up to three weeks before operation. Otomicroscopic findings showed that the tympanic membrane was thickened and stiff in 41 children (73.21%) and 9 children (16.07%) presented with thickened tympanic membrane and lowering of the posterior wall of the external auditory canal. Conclusion. Mastoiditis in children is most common among children up to 24 months of age. It has a seasonal tendency. In nearly half of the cases, clinical manifestations of mastoiditis appear 3 weeks after the onset of the first symptoms of middle ear inflammation, whereas the key otomicroscopic finding is stiffness and thickening of the tympanic membrane.

Prolonged peripheral facial nerve paralysis in a child — think of temporal bone rhabdomyosarcoma: case report

Rhabdomyosarcoma is the most common type of soft tissue sarcoma in childhood. When localized in the middle ear and temporal bone, they are highly aggressive, whereas the outcome directly depends on an accurate and timely diagnosis, stage of the disease, and adequate multimodal therapy. Early clinical diagnosis of the temporal bone rhabdomyosarcoma is often difficult since clinical signs are not specific for this disease. We present a case of an embryonal rhabdomyosarcoma, botryoid subtype, of the middle ear in a girl aged 4 years and 4 months, diagnosed 34 days after the first symptoms — right ear pain with peripheral facial nerve palsy on the same side. The overall symptoms were poor, in no way suggesting such a serious condition. After the treatment, control follow-ups for more than 3 years showed no recurrence of the disease, while signs of the right peripheral facial palsy persist.ConclusionIn cases of prolonged peripheral facial nerve palsy in children, not responding to conservative treatment, a temporal bone rhabdomyosarcoma should be considered in a differential diagnosis.

The Tubular Technique in Otoplasty

Protruding ears are diagnosed if the auriculocephalic angle, determined by the line from the root of the helix to its most lateral edge and the mastoid plane, is over 25°. The most common causes of ear protrusion are underdeveloped or poorly developed antihelix. The authors discuss preoperative preparation, postoperative care, and complications. The tubular technique is described in a step-by-step fashion. When using this surgical procedure, complications are extremely rare. The basic advantage of this procedure is that the anterior auricular surface is spared of damage.

Hemangiomas of the external auditory canal:a literature review and two new case reports

AimThe aim of this paper is to present two case reports of patients with hemangiomas of the external auditory canal, and to overview all cases published in English language literature so far.MethodsTwo patients with hemangiomas of the external auditory canal have undergone clinical and morphofunctional examination, surgical procedures, histopathological examination, and postoperative follow up.ResultsIn a 38-year-old female patient transmeatal approach was used to remove the cavernous hemangioma of the external auditory canal. The postoperative period was eventless, with normal morphofunctional findings during a 5-month postoperative follow-up period. In the second patient, a 68-year-old female, a capillary-cavernous hemangioma was removed using retroauricular approach.ConclusionCavernous hemangiomas are rare lesions of the external auditory canal. In the morphological diagnosis, computed tomography of the temporal bones is the leading diagnostic procedure, along with otoendoscopy and endocranial magnetic resonance imaging which are important in evaluation of the spread of the lesion. Biopsy of vascular lesions is not recommended. Complete surgical excision of hemangioma of the external auditory canal is the therapy of choice with a minor risk of hearing impairment.

Surgical approach and results of treating two subcategories pT2 glottic carcinoma of the larynx

Background: T2 glottic carcinoma is a nonhomogenous localization of laryngeal carcinoma with two subcategories. The aim of the study was to retrospectively analyze the results of surgically treated pT2 glottic carcinomas and to determine the importance of subcategories of glottic carcinomas in diagnostics, surgical treatment, and patients’ survival. Methods: During the period 1990-2000, 71/701 (10%) patients were diagnosed. with pT2 glottic carcinoma. All patients were treated with different surgical techniques. Results: Total laryngectomy was performed in 14/71 patients. Involvement of anterior commisure in local spreading of the cancer was found in 24/71 patients; total laryngectomy was performed in 13/24 and reconstructive surgery in 11/24. Selective resection of neck was done in 49 patients and metastases were found in 2 of these patients. Out of fifty-seven patients who had reconstructive laryngeal surgery local disease recurrence appeared in 8 patients. These 8 patients were treated with total laryngectomy. Overall 5-year survival was 90.1% with a slight difference between subcategories (89.1% subcategory I; 93.7% subcategory II) which was not statistically significant (p>0.05). Disease free 5-year survival was 83.6% with a difference between subcategories (81.1% subcategory I; 93.3% subcategory II) which was not statistically significant (p>0.05). Conclusion: Spreading of glottic carcinoma toward supraglottic and subglottic structures complicates exact preoperative evaluation of tumor size regardless to preoperative diagnostic procedures. Just owing to that, larger surgical resections performed bring more radicalness with less percentage of local recurrence and better effects on overall survival and disease free survival rate.