Search Results (82)

Background/Objectives: Advanced glycation end products (AGEs) accumulate in long-lived extracellular matrix proteins and have been implicated in skin aging and tissue remodeling, particularly in photo-exposed skin. High-frequency ultrasound (HFU) offers a non-invasive assessment of structural skin parameters that may reflect these changes. This study aimed to explore the associations between serum AGEs and HFU-derived structural parameters of cervico-facial skin, with a focus on UV-exposed dermal tissue. Methods: This cross-sectional study included 113 adults recruited in Cluj-Napoca, Romania. Fasting serum samples were analyzed for fructosyl-lysine (FruLys), pyrraline (Pyr), methylglyoxal-derived hydroimidazolone-1 (MG-H1), carboxyethyl-lysine (CEL), carboxymethyl-lysine (CML), arginine (Arg), and lysine (Lys). HFU, using a 22 MHz probe, was performed on the left zygomatic area to assess epidermal depth and density, UV-exposed dermal damage depth and density, dermis depth and density, and subcutaneous tissue depth and density. Associations between serum AGEs and HFU parameters were evaluated using Spearman correlation, with Benjamini–Hochberg false discovery rate (FDR) correction for multiple testing. Results: After FDR correction, epidermal depth was inversely correlated with serum CML (r = −0.402, adjusted p = 0.018). UV-exposed dermal density was inversely correlated with serum Pyr (r = −0.547, adjusted p < 0.019), Arg (r = −0.369, adjusted p < 0.019), and Lys (r = −0.270, adjusted p < 0.019). Subcutaneous tissue depth was also inversely correlated with serum CML (r = −0.290, adjusted p = 0.020). Conclusions: The study showed that higher levels of specific serum AGEs were associated with selected HFU-derived structural alterations in cervico-facial skin, particularly in UV-exposed dermal tissue. These exploratory findings support the biological plausibility that systemic glycation may be reflected by non-invasive skin ultrasound parameters. Full article

Background: Emphysema is a rare complication of dental procedures. The highest incidence has been associated with the use of air turbine handpieces. If not recognized and treated promptly, this complication can lead to serious outcomes. Methods: We present a case of a 43-year-old man who developed deep cervicofacial and subcutaneous emphysema of the face, neck and chest along with the specific voice change due to nose blowing shortly after alveolectomy of the lower right third molar. Results: The patient was hospitalized, conservatively treated, monitored and treated with intravenous antibiotic therapy. After two weeks he made a full recovery. Conclusions: It is essential to recognize and adequately manage emphysema, and to inform patients postoperatively not to blow their nose after third molar alveolectomy to prevent this rare but potentially serious complication. To our knowledge, this is the first reported case of voice alteration caused by nasopharyngeal emphysema following third molar alveolectomy. Full article

Background: Cervicofacial actinomycosis is an uncommon chronic bacterial infection that can mimic neoplasia or granulomatous disease because of its infiltrative presentation. Diagnosis is often delayed, particularly in pregnant patients in whom imaging and invasive procedures may be limited. Case report: A 25-year-old woman at 14 weeks of gestation presented with a multiple-fistulized cervical mass. The lesion was initially diagnosed as a cutaneous furuncle in a private dermatology practice and treated with topical therapy, resulting in only transient improvement. Two weeks later, multiple fistulizations developed, prompting consultation in the emergency department. ENT assessment and ultrasound raised suspicion of cervical actinomycosis versus fistulized tuberculous lymphadenitis. Considering the pregnancy, drainage of the collection was performed under local anesthesia and empiric antibiotic therapy with amoxicilin-clavulanic acid was started. Microbiological confirmation of Actinomyces (Schaalia) georgiae led to infectious disease evaluation that established a long-term antibiotic therapy while monitoring fetal safety. Progressive clinical improvement was observed, with complete resolution after three months. The pregnancy progressed without complications and fetal morphology remained normal under therapy. Conclusions: This case illustrates the diagnostic complexity of cervicofacial actinomycosis caused by A. georgiae during pregnancy, representing the first such report in the current literature, and emphasizes the need for a multidisciplinary approach. Full article

Background/Objectives: Subcutaneous emphysema is a rare but potentially life-threatening complication of dental procedures caused by the penetration of pressurized air into submucosal tissues and its spread through cervicofacial and mediastinal spaces. This review aimed to summarize all reported cases of subcutaneous emphysema following periodontal interventions and to identify procedure and device-related etiologic factors associated with its occurrence. Methods: A comprehensive literature search was conducted, and case reports published between 1957 and 2025 were included without language restrictions. Cases related to trauma, maxillofacial surgery, endodontic, restorative, or prosthetic procedures were excluded. Results: A total of 34 publications reporting 36 clinical casesmet the inclusion criteria. The median patient age was 48 years (range: 8–76), and 66.7% of cases occurred in female patients. Air-powder abrasive devices were the most frequently implicated etiologic factor (66.7%), followed by dental lasers (11.1%) and air-water syringes (8.3%). Mediastinal spread was reported in 41.7% of cases. Most patients received prophylactic antibiotic therapy, and the median resolution time was 5 days (range: 3–14). Conclusions: Subcutaneous emphysema following periodontal interventions is most frequently reported in association with the use of pressurized air-driven devices, particularly air-powder abrasive systems. Although the clinical course described in the included cases was generally benign, the observed patterns highlight the relevance of procedural and device-related factors in the development and extent of this complication. Full article

Background/Objectives: Early differentiation of odontogenic cervicofacial necrotizing fasciitis (NF) from odontogenic abscess (OA) is clinically challenging yet critical due to the need for urgent surgical and antimicrobial escalation. We evaluated whether a novel C-reactive protein-to-platelet inflammatory index (CPII = CRP/platelets), combined with a symptom-based Symptom Severity (SS) score, improves early discrimination of NF from OA. Methods: This retrospective cohort study included 234 hospitalized patients with cervicofacial odontogenic infections treated between January 2010 and December 2023 (25 NF, 209 OA). Admission clinical variables, SS and SIRS scores, and laboratory parameters were analyzed. CPII and established immunoinflammatory indices (including AISI, SII, NLR, PLR, and LMR) were calculated. Group comparisons were performed using nonparametric and categorical tests. Diagnostic performance was assessed by ROC analysis, and multivariable logistic regression evaluated independent associations with NF. Results: Compared with OA, NF patients were older (median 42 [IQR 35–59] vs. 35 [IQR 26–49] years; p = 0.0098) and more frequently had comorbidities (52% vs. 25.4%; OR 3.19; p = 0.0087). Trismus and dysphagia were more common in NF (84% vs. 60.8%, p = 0.0272; 88% vs. 53.6%, p = 0.0010), with higher SS and SIRS scores (both p < 0.0001). NF was associated with longer hospitalization (median 17 vs. 6 days; p < 0.0001) and more complications (40% vs. 5.7%; OR 10.94; p < 0.0001). CRP was markedly higher in NF (median 287 vs. 111.5 mg/L; p < 0.0001), platelets were lower (median 210 vs. 249 × 10⁹/L; p = 0.0091), and CPII was substantially higher (median 1.23 vs. 0.45; p < 0.0001). AISI did not differ between groups (p = 0.861). ROC analysis demonstrated excellent discrimination for SS score (AUC 0.9328, cut-off 12), CRP (AUC 0.9109, cut-off 221 mg/L), and CPII (AUC 0.9271, cut-off 0.75), whereas AISI showed limited discrimination (AUC 0.5108). In multivariable analysis, both SS score (adjusted OR 2.08 per 1 point) and CPII (adjusted OR 6.87 per 0.5 units) were independently associated with NF; the combined SS + CPII model achieved an AUC of 0.9726. Conclusions: CPII is a simple, admission-available biomarker that differentiates odontogenic cervicofacial NF from OA with excellent accuracy and provides strong complementary value when combined with SS score. AISI, despite prior utility for odontogenic abscess severity assessment, did not discriminate NF from OA in this cohort. Full article

Background: Vertigo and dizziness in children represent diagnostically challenging conditions with heterogeneous etiologies. At initial presentation, a substantial proportion of pediatric patients remain without a definitive etiological diagnosis. Evidence on the impact of longitudinal follow-up on etiological classification in pediatric vertigo is limited. Methods: This observational cohort study uses prospectively collected clinical data. Children aged 1–17 years who presented to a tertiary ENT clinic with vertigo and/or dizziness between 2015 and 2020 were systematically enrolled and followed. The present study represents a retrospective revision of a previously published cohort of 257 children. In 2025, extended follow-up data were reviewed to reassess etiological classification using the same diagnostic categories as in the original analysis. Descriptive statistics were applied to compare etiological distributions at initial evaluation and after follow-up revision. Results: After data revision, the proportion of children with unclassified etiology decreased from 44% to 10%. Central etiologies accounted for 35% of cases, peripheral vestibular disorders for 18%, hemodynamic causes for 16%, psychogenic etiologies for 10%, and other specific causes for 7%. Follow-up duration ranged from 0 to 132 months (mean 17.6 months; median 4.5 months). Diagnostic investigations were frequently performed; however, the etiological yield of certain tests, particularly cranial computed tomography, was low. Conclusions: Extended follow-up significantly improves etiological classification in children with vertigo and dizziness, demonstrating that diagnostic uncertainty at initial presentation often reflects evolving clinical phenotypes rather than the absence of an underlying disorder. A longitudinal, clinically guided, and multidisciplinary approach is essential to enhance diagnostic accuracy and optimize the use of diagnostic investigations in pediatric vertigo. Full article

Background/Objectives: The aim of this study was to assess the short-term and long-term effectiveness of group voice therapy in changing vocal behaviour and improving voice quality (VQ) among teachers with hyperfunctional voice disorders (HFVD), using both subjective and objective measures. Methods: Thirty-one teachers participated in a structured group voice therapy programme. Participants underwent videoendostroboscopic evaluation of laryngeal morphology and function, perceptual assessment of voice, acoustic analysis of voice samples, and aerodynamic measurements of phonation. Patients’ self-assessment of VQ and its impact on quality of life were measured using a Visual Analogue Scale (VAS) and the Voice Handicap Index-30 (VHI-30). Evaluations were conducted at four time points: pre-therapy (T0), immediately post-therapy (T1), and at 3-month (T3) and 12-month (T12) follow-up visits. Results: Significant improvement was observed between T0 and T1 in perceptual voice evaluations: grade, roughness, asthenia, strain, loudness, fast speaking rate, as well as in neck muscle tension, shimmer, patients’ most harmful vocal behaviours, VHI-30 scores, patients VQ evaluation, and its impact on quality of life (all p < 0.05). Almost all parameters of subjective and objective voice assessment improved over the 12-month observation period, with the greatest improvement between T0 and T12 (all p < 0.05), indicating lasting reduced laryngeal tension and improved phonatory efficiency. Conclusions: Group voice therapy has been shown to be an effective treatment for teachers with HFVD, leading to significant and long-lasting improvements in perceptual, acoustic, and self-assessment outcomes. Therapy also promoted healthier vocal and lifestyle behaviours, supporting its role as a successful and cost-effective rehabilitation and prevention method for occupational voice disorders. Full article

Nontuberculous Mycobacteria (NTM), often referred to as environmental or atypical mycobacteria, are opportunistic pathogens phylogenetically as well as clinically distinct from both the Mycobacterium tuberculosis complex and Mycobacterium leprae. In the pediatric age group, NTM disease manifests with a diverse range of clinical phenotypes. Cervicofacial lymphadenitis stands out as the most common presentation among children who are immunocompetent. Conversely, skin and soft tissue infections, pulmonary disease and disseminated infections constitute less prevalent, yet clinically important, disease forms. Accurate identification is paramount, as differentiating NTM infections from tuberculosis (TB) remains challenging based solely on clinical symptoms, initial laboratory analyses, or standard radiological findings. This distinction is critical because treatment protocols for NTM infections differ substantially from those for tuberculosis. This narrative review offers a comprehensive and up-to-date summary of NTM infections in children. It examines the spectrum of clinical presentations and their prevalence, addresses the complexities of diagnosis and therapy, and underscores the importance of differential diagnosis against tuberculosis. Furthermore, we explore current diagnostic strategies, available therapeutic options, and the link between specific clinical syndromes and tailored management, pointing out existing knowledge gaps and suggesting priorities for future research. The absence of rapid, species-specific diagnostic tools often results in delayed initiation of targeted treatment, while overlapping clinical features with TB can lead to misdiagnosis. Therapeutic management is complicated by the necessity for prolonged drug courses, frequent occurrences of drug intolerance, limited availability of child-appropriate formulations, and the rising tide of antimicrobial resistance. Successfully tackling these issues demands enhanced surveillance, precise species-level identification, the creation of child-friendly drug formats, and the development of evidence-based treatment guidelines specifically designed for the pediatric population. Full article

Introduction: The tongue base, hypopharynx, and supraglottis (TngHpxSgl) play distinct roles in snoring and obstructive sleep apnea (OSA). Aim of the Study: To assess the level of consensus on the assessment and decision-making for the management of snoring and OSA associated with TngHpxSgl. Methods: A set of statements on the assessment and decision-making for the management of snoring and OSA associated with TngHpxSgl was developed based on the literature and circulated among 12-panel members of European experts on sleep surgery, using the modified Delphi method, seeking at least 80% consensus. Responses were categorized as agree or disagree for each statement, and the comments from the panelists were used to assess the level of consensus. Statements containing aggregated anonymized responses and comments were sent to each panel member in the second and final rounds of the survey. Results: The final set included 147 statements. Of these, 52.6%, 14.7%, and 5.8% achieved consensus among all 12, 11, and 10 panelists, respectively. Conclusions: There was a high level of consensus (73.2%) among European sleep surgery experts on the statements. This consensus will help establish standards and guide further research on snoring and OSA related to TngHpxSgl. Full article

Cervicofacial actinomycosis is a well-recognized infectious disease caused by Actinomyces, a Gram-positive filamentous bacterium. In contrast, Nocardia, a morphologically similar, hyphae-forming organism, is an exceedingly rare cause of cervicofacial abscesses, and even more uncommon associated osteomyelitis of mandible. We present such a case involving a kidney transplant recipient who presented with opioid-induced constipation, along with left jaw pain and swelling. CT scan of the soft tissue in the neck revealed a complex cervicofacial abscess with enhancement of underlying mandible. Culture growth and RNA sequencing of USG-guided aspirate identified a Nocardia species closely related to N. beijingensis/exalbida. The patient initially received broad-spectrum antibiotics, including ceftriaxone, imipenem, and trimethoprim-sulfamethoxazole (TMP-SMX). Imipenem was later discontinued in view of new-onset unexplained encephalopathy and replaced with linezolid, which was subsequently switched to minocycline following thrombocytopenia development. Minocycline therapy was intended for a total of 12 months. TMP-SMX was avoided long-term due to avoid nephrotoxicity risk in kidney transplant patients. On six-month follow-up, the patient showed clinical and radiological improvement; minocycline was discontinued after additional six months. This case highlights the importance of considering Nocardia as a differential diagnosis in immunosuppressed patients presenting with cervicofacial symptoms, especially following orofacial surgery or trauma. Early recognition, prompt diagnosis, and appropriate antibiotic therapy with adequate bone penetration seem crucial for optimal management and may help avoid the need for surgical intervention. Full article

Background/Objectives: Previous studies have shown that hypothyroidism with myxedema may significantly affect the vocal folds. The aim of this study was to investigate thyroid dysfunction and other possible risk factors, including smoking, for the development of Reinke’s edema (RE) in a group of men. Methods. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) were measured in a group of men with first occurrence or recurrent RE and in age- and gender-matched control subjects without laryngeal pathology. All participants completed a questionnaire on other possible etiologic factors for the development of RE, especially smoking. Risk factors were compared between the two groups. Levels of TSH and thyroid hormones were also compared between patients with recurrent disease and those with a first occurrence of RE. Results. A total of 53 men with RE (mean age 53.82 years) and 45 controls (mean age 57.71 years) completed the study protocol. TSH and thyroid hormone levels were within the normal limits in all participants. Serum fT3 levels were significantly higher in patients with RE compared to controls (p = 0.034). After univariate analysis, all risk factors were included in a multivariate regression model. Only smoking remained a significant variable. Thyroid hormone levels did not differ between patients with first-onset RE and those with recurrent RE. Conclusions. An association between hypothyroidism and the development of RE was not confirmed. The significantly higher fT3 levels in patients compared to controls were still within the normal range and may reflect normal variation. Regression analysis of possible risk factors for RE showed the primacy of smoking. Full article

Objectives: To evaluate the loss of quality of life (QoL) in patients with chronic obstructive sialadenitis (COS) using the Chronic Obstructive Sialadenitis Questionnaire (COSQ). Methods: The COSQ was administered to patients diagnosed with COS, with the diagnosis confirmed by sialendoscopy. Epidemiological data, obstructive causes and potentially obstructive entities were collected. QoL was assessed using the COSQ. Results: A total of 344 glands in 278 patients with COS were analyzed. Most patients were women (71.94%), and the main obstructive cause was stenosis (47.96%), followed by lithiasis, lack of papilla distensibility (LPD), and mucus plug. Stenosis was significantly more frequent in the parotid gland and in women, whereas lithiasis predominated in the submandibular gland and in men. The mean COSQ score was 30.55 and it was significantly higher in women (p < 0.005), parotid gland (p < 0.005), and in long-standing cases (p < 0.05). Stenosis and LPD were the obstructive causes with the greatest impact on QoL (p < 0.005), while lithiasis had the least impact. Potentially Obstructive Entities (POEs), such as eosinophilic sialodochitis, Sjögren’s syndrome, or radioiodine-induced sialadenitis, were associated with a notable loss of QoL. Likewise, patients without associated POEs presented significantly lower COSQ values (p < 0.05). Conclusions: COS significantly affects QoL, particularly in women and in cases of parotid gland, stenosis, and LPD. Lithiasis has the least impact on QoL. It is important to standardize a thorough evaluation of COS using validated tools such as the COSQ, which are fundamental for understanding the disease and predicting the outcomes of therapeutic interventions. Full article

Background: Data on the incidence of IgG4-related disease (IgG4-RD) are scarce. Our aim was to determine the incidence of IgG4-RD in a well-defined region. Methods: This retrospective study covered the Ljubljana region over the period from January 2012 to December 2024. A review of cases diagnosed with IgG4-RD was performed at several departments of the University Medical Centre Ljubljana—an integrated secondary/tertiary university teaching hospital (rheumatology, nephrology, angiology, gastroenterology, abdominal surgery, ENT surgery, ophthalmology). While IgG4-RD cases at the Department of Rheumatology were collected prospectively, potential cases at other departments were retrieved by searching electronic medical database for the keyword “IgG4”. In addition, the Institute of Pathology, Faculty of Medicine, University of Ljubljana, provided a list of patients with histological features consistent with IgG4-RD. Year-specific incidence rates and an average incidence rate over the 13-year period were determined. Clinical features of patients were analysed. Results: During the observation period, 58 cases of IgG4-RD were diagnosed. Of these, 35 patients were residents of the Ljubljana region, which had an average adult population of 541,600. The estimated average annual incidence rate of IgG4-RD was 5.0 per million (95% confidence interval: 3.5; 6.9), with year-specific incidence rates fluctuating between 1.8 and 9.3 per million adults. The cases were stratified into four phenotypic categories: pancreato-hepato-biliary (17%), retroperitoneal fibrosis-aortitis (43%), head and neck-limited (14%), and Mikulicz syndrome with systemic involvement (26%). Conclusions: The average annual incidence rate of IgG4-RD was 5 per million adults, with the retroperitoneal fibrosis-aortitis phenotype predominating in our cohort. Full article

Objectives: This study assesses the efficacy of tracheotomy-primed sclerotherapy in craniofacial venous malformations (VMs), establishes evidence-based airway intervention criteria, and develops site-specific safety protocols to optimize treatment timing and safety in cases with upper airway compromise. Methods: We retrospectively collected the clinical data of 35 patients treated by our center between January 2008 and November 2024, who were diagnosed with cervicofacial VMs involving the upper respiratory tract. All patients underwent direct tracheotomy or tracheotomy after sclerotherapy for lesions located in the anterior cervical area. Sclerotherapy was performed under fluoroscopy or laryngoscopy after tracheotomy. Results: 35 patients underwent 225 sclerotherapy sessions. Nineteen patients underwent tracheotomy directly, and sixteen patients received sclerotherapy at the anterior cervical area before tracheotomy. All patients presented improvement according to magnetic resonance imaging (MRI) findings, and 94.29% (33/35) of patients reported improvement in clinical presentations. All patients experienced improvement in quality of life (QoL). No major complications occurred. Decannulation was successfully performed in all 35 patients after finishing sclerotherapy. Conclusions: Tracheotomy followed by sclerotherapy is safe and effective for VMs involving the upper respiratory tract. This is necessary for patients with lesions involving the laryngopharyngeal region, tongue base, and bilateral pharyngeal walls. In high-risk prophylactic tracheostomy candidates, anterior cervical sclerotherapy–tracheostomy–sclerotherapy (ACSTS) is an effective strategy for managing airway obstruction. Full article

Background: Reconstruction of nasal, septal, and nasosinusal defects is challenging when the native mucosa is absent or damaged. Oral mucosal grafts have been proposed as a reconstructive option due to their favorable biological properties, but their use in rhinology remains poorly defined. Objective: To evaluate the clinical efficacy and technical characteristics of oral mucosal grafting for nasal, septal, nasosinusal, and skull base reconstruction. Data Sources: PubMed, Embase, Web of Science, and Cochrane Library were searched for studies published between January 2005 and May 2025. Study Eligibility Criteria: We included original human studies (case reports or series) reporting the use of free or pedicled oral mucosal grafts in nasal, septal, nasosinusal, or skull base reconstruction. Non-original studies, animal or preclinical studies, and articles not in English or Spanish were excluded. Methods of Review: One reviewer screened titles, abstracts, and full texts using Rayyan. Methodological quality was assessed using JBI tools for case reports and case series. A narrative synthesis was conducted due to clinical heterogeneity and absence of comparison groups. The resulting assessments were reviewed by the co-authors to confirm accuracy and resolve any potential discrepancies. Results: Of 467 records identified, 10 studies were included. All were case reports or series involving buccal, palatal, or labial mucosa. Most reported good graft integration, low complication rates, and favorable functional outcomes. No randomized studies or comparative analyses were found. Limitations: Included studies had small sample sizes, lacked control groups, and showed heterogeneous methods and follow-up. The certainty of evidence could not be formally assessed. Conclusions: Oral mucosal grafting is a promising reconstructive option in selected nasosinusal and skull base defects. However, stronger comparative studies are needed to determine its clinical superiority. Registration: This review was not registered in any public database. Full article