Diabetes mellitus is a serious condition, causing multiple health problems due to the disease itself, but also to the complications that these patients are predisposed to. Being a current health problem, many patients tend to disregard the doctor's recommendations concerning the necessary measures to maintain adequate and continuous control of the glycaemia levels. This, in turn, may cause complications, which include neuropathy, microangiopathy and a predisposition to infections due to weak local defence mechanisms. In otorhinolaryngology, the infectious pathology is one of the most often causes for presentation to the physician. Ranging from common otitis, acute pharyngitis or laryngitis and sinusitis, these different entities will cause significant discomfort for the patient, prompting the need for medical care. In patients with diabetes, the natural course of the disease is altered, with more severe symptoms, a more extended period of recovery and the predisposition for aggravated cases with the tendency to complications. Such complications may be life-threatening if we take into account the complications associated with acute sinusitis for example, which include orbital or cerebral abscesses. Our paper aims to present the authors experience on the complete approach of patients with infectious pathology concerning the sinuses associating diabetes mellitus. Always, we must keep in mind that patients with diabetes represent a particular class of patients that require a personalized approach. They are predisposed to a vicious circle, in which the infection causes diabetes imbalance, which in turn decreases the defense mechanism and predisposes to complications. The correct management must always include a proper control of diabetes, a complete evaluation that will determine if complications are already present and aggressive management of the infection, with regular check-ups to determine the evolution of the patient.
The authors will present a case report of a woman that presented a giant sphenoidal tumor with endocranially extension and compression of the cerebral trunk. The patient was already presented in a neurosurgical service where due to the tumor volume, the high-risk surgical elements involved was sent to our ENT department to try to perform an endoscopic biopsy. Using the endoscopic optical and mechanical ensemble the authors performed trans nasally a biopsy. The histopathologic result was a surprise and was confirmed with three different immune- histochemistry exams.
The evolution of the endoscopic skull base surgery in the last ten years had led to the development of new surgical reconstructive techniques. In the endoscopic reconstructive surgery of the CSF leaks both synthesis and natural materials. The advancement of the endoscopic reconstructive surgery was closely linked with the production of new synthesis materials. The aim of the paper is to compare the efficacy of synthesis versus natural materials in the closure of CSF leaks and to point out certain rules of when and where to use a synthesis or natural material. INTRODUCTION In the reconstructive surgery of the skull base, the surgeon can use both natural and synthesis materials. The developments of the endoscopic surgery of the skull base had led to removing bigger tumors from high-risk areas that were not suitable for endoscopic surgical approach up to now. The endoscopic surgical approaches tend to replace the external approaches even in malignant tumors of the skull base in selected cases. Because of that, the surgeon started to encounter more defects at the level of the skull base with or without CSF leaks. New surgical reconstructive techniques started to be developed in close connection with the production of new surgical reconstructive materials and adhesives. [1] The materials used in the reconstruction of the skull Corresponding author: Silviu Pițuru piturus@yahoo.com base defect can be divided in autologous tissue and synthesis reconstructive materials. Autologous tissues that are used in the reconstructive skull base surgery are: fascia, cartilage, bone, fat, free mucosal grafts, vascularize flaps and free flaps with micro anastomosis. Fat can be used to obliterate dead space or to plug a CSF leak.[1] Fascia lata or fascia temporalis can be placed in an underlay technique between the dura and the skull base or overlay technique in the sinus cavities. Multilayered fascia lata was the effective especially management of open cisterns or in cases of another type of high-pressure CSF leak.[2] in Bone or septal cartilage are placed in the underlying tech- 1 The “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania 2 “Prof. Dr. Dorin Hociotă” Institute of Phonoaudiology and Functional ENT surgery, Bucharest, Romania 29
