Ioana Maria Porfire (Irimia)

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease of real interest for researchers due to its heterogenicity and complex pathophysiological mechanisms. Identification of the factors that ensure success after treatment represents one of the main challenges in CRSwNP research. No consensus in this direction has been reached so far. Biomarkers for poor outcomes have been noted, but nonetheless, their prognostic value has not been extensively investigated, and needs to be sought. We aimed to evaluate the correlation between potential prognostic predictors for recalcitrant disease in patients with CRSwNP. Methods: The study group consisted of CRSwNP patients who underwent surgical treatment and nasal polyp (NP) tissue sampling. The preoperative workup included Lund–Mackay assessment, nasal endoscopy, eosinophil blood count, asthma, and environmental allergy questionnaire. Postoperatively, in subjects with poor outcomes, imagistic osteitis severity was evaluated, and IL-33 expression was measured. Results: IL-33 expression in NP was positively and significantly correlated with postoperative osteitis on CT scans (p = 0.01). Furthermore, high osteitis CT scores were related to high blood eosinophilia (p = 0.01). A positive strong correlation was found between postoperative osteitis and the Lund–Mackay preoperative score (p = 0.01), as well as the nasal endoscopy score (p = 0.01). Conclusions: Our research analyzed the levels of polyp IL-33, relative to blood eosinophilia, overall disease severity score, and osteitis severity, in patients with CRSwNP. These variables are prognostic predictors for poor outcomes and recalcitrant disease. Considering the importance of bone involvement in CRSwNP, this research aims to provide a better insight into the correlations of osteitis with clinical and biological factors.

Paranasal sinus osteomas are the most common benign fibro-osseous lesions that occur in the paranasal sinuses, having potential serious complications. With a prevalence ratio of 2:1 towards males, in 95% of the cases, the osteomas are situated most commonly in the frontoethmoidal region. However, osteomas of the maxillary sinus account for less than 5% of cases. The management of symptomatic paranasal sinus osteomas is surgical and is decided based on tumor size and location, patient symptoms, and experience of the surgeon. The Caldwell–Luc procedure, lateral rhinotomy, or craniotomy as external standard procedures remain mandatory if endonasal endoscopic surgery fails. In most reported cases, large tumors are excised by an external approach or in conjunction with an endoscopic technique. Endoscopic treatment of such tumors is a huge challenge for the operator. We report on a 42-year-old male patient presenting with a giant calcified mass in the right maxillary sinus. In this case, an endonasal approach was the most appropriate management even with the large size of the tumor. No recurrence at 24 months follow-up was reported.

Background and Objectives: Endoscopic sinus surgery is considered the gold management strategy for difficult-to-treat chronic rhinosinusitis. The inflammatory bony process is incriminated as being involved in the unfavorable evolution and recurrence of the disease. Osteitis is significantly increased in patients that have been previously submitted to surgery, and it is more often present in patients with extended radiological disease and in patients undergoing revision surgery. The aim of the research is to demonstrate the presence of inflammations and neo-osteogenesis associated with nasal mucosal surgical injury and the correlation between their severity and to evaluate the efficacy of low-pressure spray cryotherapy in reducing inflammation and bone remodeling. Materials and Methods: The experimental murine model was conducted over a period of 80 days and included a total of 60 adult female Wistar rats, with three periods of withdrawal of 20 individuals each from the experiment. After inducing a bilateral mechanical injury by brushing, low-pressure spray cryotherapy application was performed unilaterally, and tissue samples were prepared specifically for histological analysis. The scores for inflammation and osteitis were compared over time and between the two nasal fossae. Results: Osteitis and inflammation were induced by a simple mucosal brushing lesion, similar to surgical injury. We identified the presence of inflammation in 95% of the specimens, and it was present over time. Moreover, criteria for bone remodeling were clearly highlighted in a percentage of 72% of the specimens. There was a direct correlation between the severity of inflammation and neo-osteogenesis, with a statistical significance of p = 0.050. Low-pressure spray cryotherapy was safe and effective in reducing inflammation (p = 0.020) and osteitis (p = 0.000) with a safety profile. Conclusions: Low-pressure cryotherapy reduces the severity of mucosal inflammation and osteitis in lesion-induced neo-osteogenesis.

Warthin’s tumor (WT) is the second most common benign tumor of the parotid gland. Located almost exclusively in the parotid gland and presenting a slow growth rate, WT usually does not exceed 4 cm and rarely benefits from early surgical treatment. The aim of this paper is to present a case of giant parotid Warthin’s tumor. The occurrence of large and deforming WT is rare, previous research showed a single similar reported case. The patient’s computed tomography scans showed a solid and cystic 15 × 13 cm² mass of the parotid gland, without visible signs of invading the adjacent structures. Superficial parotidectomy with tumor excision was performed, with preservation of glandular and facial nerve functions. The paper also presents a brief literature review addressing the main controversies regarding etiopathology, epidemiology, diagnostic methods and treatment options for this parotid gland tumor.