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AIM: This article focuses on the lateral sinus thrombophlebitis, which is a serious complication of the supurated otopathies. MATERIAL AND METHODS: It is based on a study of a significant number of both exo- and endocranial complications treated in the the "Sf Spiridon" Hospital- ORL department and at the "Prof. dr. N. Oblu"- Neurosurgery department (57 out of 251 cases admitted in the past 5 years). RESULTS: Among the 57 cases, there were 8 lateral sinus thrombophlebitis, as well as 6 cases where meningitis coexisted with other endocranial complications, such as lateral sinus thrombophlebitis or brain abscess. The article contains details about some cases with special problems of diagnostic and treatment. CONCLUSIONS: The symptoms of the presented cases are completely different from the common symptomatology. However, the diagnostic of such cases is possible due to the modern imaging methods as well. The lateral sinus thrombophlebitis is usually determined by different causes, one of them being the misuse of the antibiotics (class and daily/total dose). When endocranial complications occur the symptoms of the meningitis are masking the symptoms of other complications. Even if the CT scan or MRI exams performed right on the patient's admission show no other complications, the patient should be followed for a period of 15 up to 30 days after the treatment of the meningitis, by repeating imaging tests to identify a possible complication.

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UNLABELLED: In European Union every day millions of employees are exposed to noise at work and the risk this can entail. AIM: this study presents the sound spectrum in Iasi heavy industry: metal foundries industry, punching and embossing of metal sheets, cold and hot metal processing. MATERIAL AND METHODS: it was used a type 2 Sound Level Meter (SLM) and the considered value was the average value over 10 test values in 10 consecutive days for each octave band in common audible frequency range. RESULTS AND DISCUSSIONS: It is obviously that the large values of sound intensities in the most of frequency octave band exceed maximum admissible and legal values. CONCLUSIONS: The study reveals the necessity of hardware, medical and managerial measures in order to reduce the occupational noise and to prevent the hearing acuity damage of the workers.

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UNLABELLED: One area of anatomy, which is a true passage of secrecy, is the anatomy of the potential anatomical spaces. The study of the fascial layers of the head and neck and the potential spaces they make-up is both fascinating and confusing. Much of the confusion is a function of the multiple synonymous terms and classifications that various authors use, and not the basic anatomical description. Their anatomy and communications, to the base of skull and downward to diaphragm, acts like a route through which infection from mouth and throat can reach the superior mediastinum. CONCLUSIONS: Understanding the anatomy of the parapharyngeal space is important in making a correct diagnosis and surgical plan for removing tumors in this region.

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UNLABELLED: Facial pain can be the presenting, and sometimes the only, complaint of many disorders that originate from cranial structures. One causes of facial pain/headache is sinusitis, in both its acute and its chronic presentation. Successful management of headache is preceded by the identification of an etiology and precise diagnosis. MATERIAL AND METHODS: A prospective study was carried out on a series of 71 patients treated in the ENT Department of Iasi "Sf. Spiridon" Hospital between January and august 2009 for pathology implying facial pain, headache, facial pressure, nasal obstruction, rhinorrhea. The therapy was medical and surgical and pursued nasal desobstruction, sinusal drainage and ventilation. Data regarding different parameters were analyzed pre and post therapy. RESULTS: After the proper treatment for each situation, the parameters analyzed improved significantly, although, in some cases the main accuses regarding the pain remained unchanged or slightly ameliorated. CONCLUSIONS: Depending on the clinical suspicion of the possible etiologies of facial pain and headache, the appropriate consultations should be made. For concerns of head and neck lesions or sinus-related headache, an otolaryngologist should be consulted. If a primary headache syndrome or a cranial neuralgia is of concern, the patient should be evaluated by a neurologist. Dentists and oral surgeons should be involved. In some cases, a psychiatry referral is appropriate. The surgical treatment can be effective if the pathology meets the criteria of sinonasal facial pain.

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UNLABELLED: Dysphagia following laryngeal surgery is a common and severe symptom. Two life-threatening complications can compromise the patiens quality of life: pneumonia and malnutrition. Diagnostic procedures of swallowing disorders are represented by videofluoroscopic evaluation, CT scan and fiberoptics endoscopy. MATERIAL AND METHODS: A retrospective evaluation was performed in a sample of 261 patients undergoing laryngectomy, hospitalized in the E.N.T Clinic of "St. Spiridon" Hospital, between 2006 and 2010. Postlaryngectomy dysphagia was diagnosed in 74 patients and was predominant in males (97.3%) aged between 50 and 60 years (37.8%). RESULTS: Main causes of dysphagia were pharingocutaneous fistulas, tumor recurrences, postoperative cervical infections and hipopharyngeal stenosis. CONCLUSIONS: This study reveled the predominance of dyphagia in rural male patients undergoing total laryngectomy. Gastroesophageal reflux can represents a favoring factor of this type of dysphagia.

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Of the tumors of the neck some are very uncommon, difficult to diagnose both clinically and paraclinically. Two of the most rare tumors are osteolipoma and soft tissue sarcoma. We present 2 such cases admitted to and operated at the ENT Department of the Iasi "St. Spiridon" Emergency Hospital in the last 5 years, with emphasis on the atypical clinical and imaging features of these tumors. Surgery and histopathological examination were the methods used to make the diagnosis.

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OBJECTIVES: Malignant lymphomas of larynx and trachea are rare tumors and require special diagnostic and therapeutic attention. The authors present an unexpected case of nonHodgkin Lymphoma localized in the subglottic larynx and upper cervical trachea. The clinical presentation, diagnostic and therapeutic approach, evolution and prognosis are discussed. METHOD: We report a case of 25-year-old male patient, with progressive dyspnea, presented in our ENT Department with severe airway obstruction caused by a large subglottic tumoral mass migrated in the glottic space during an accidental fall. An emergency tracheotomy was performed. The flexible endoscopy and CT-scan revealed a large mass arising from the subglottic larynx and anterior wall of upper cervical trachea with the obstruction of 2/3 of the laryngotracheal lumen. RESULTS: After a complex assessment, the tumor was excised by external approach (median thyrotomy). The histopathologic exam of the surgical specimen showed malignant nonHodgkin lymphoma and the immunohistochemical profiles were evaluated in order to establish the therapeutic strategy including chemotherapy in the Department of Oncology. CONCLUSIONS: Invasion of the subglottic larynx and trachea by lymphoma is an uncommon problem which can cause severe airway obstruction and requires multidisciplinary approach (ENT, pneumology, oncology/hematology). The clinicopathological features of this case have been described and compared with previously reported cases.

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Acute respiratory insufficiency defines that status in which the respiratory system is not able to supply the metabolic requirements of the organism. The laryngo-tracheal segment plays an important role in the respiratory function, an obstruction at this level inducing an important limitation of oxygen intake. Due to the requirement of fast repermeabilisation of this segment, it is necessary to define all criteria (clinical and laboratory examination) required to diagnose and to evaluate the respiratory failure. The present paper depicts the clinical aspects, the acid-base equilibrium impairment induced by high level airway obstruction and the functional investigations available by ventilation tests.

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Aside from distant metastasis, cervical nodal metastases are the worst prognostic indicator for survival in patients with head and neck carcinoma. Presence of nodal metastases decreases survival by fifty percent. This paper refers to surgical therapy of cervical adenopathy known as the radical neck dissection, for clinically positive nodal metastases, follow by chemotherapy or radiotherapy depending on the primary tumor site.

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The authors present a retrospective study on 84 cases with laryngo-pharyngo-esophageal stenosis treated in ENT Department of "Sf. Spiridon" Emergency Clinical Hospital from Iasi, over 25 years, between 1980-2005 which were solved by surgical treatment. In order to solve the different types of the superior laryngeal stenosis and the hypo-pharynx, there have been used deltoid-pectoralis cutaneous flaps. In all these cases, the anatomical integrity of the recurrent nerve and his branches was preserved in order to obtain a good respiratory function.

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The paper presents a study of the evolutional morphogenetic stages of the lymphatic and conjunctive neck structures formation. The authors make particular appreciations concerning the pattern of organization and also, the functional connections of lymphatic and conjunctive elements at intravisceral, perivisceral and perivascular level. Our study proves that these structures form the barriers but also, the spread pathways of the tumoral and inflammatory process which, after an endocavitary development, diffuse either on the adjacent organs or to the main cervical lymph nodes. We emphasized the importance of these anatomical structures in the neck oncological surgery.

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The authors present a study on 7 cases of extramedullary plasmocytoma localized in E.N.T. area, hospitalized and solved in the E.N.T. Department of the the "Sf. Spiridon" Universitary Hospital, in the last 15 years, between 1983-1997. We insist on the last solved case, presenting a double isolated localization, a laryngeal and a rhinosinusal one. We consider that the most indicated treatment in the isolated extramedullary plasmocytoma, is the radiosurgical therapy with a good rate of survival.

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The schwannomas situated at the neck or at the lower part of the skull are rare; very often they appear as on isolated tumoural mass with borrowed symptoms due to the compression of the surrounding structures, signs intra-operation objectivated and anatomo-pathologically confirmed. The authors present statistically the cases of cervico-facial schwannoma hospitalized and surgically solved in the O.R.L. I Clinic Iasi during 1975-1995, which are 17 cases, statistics that correspond to the others from the specialized literature. The cases were confirmed histologically; there was just one case of malignant degeneration of a double schwannoma. In the following pages we present the last 2 cases of schwannomas hospitalized and solved in the O.R.L. I Clinic Iasi.

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An extremely rare case (the 15th case reported in the literature, according to our knowledge) of the infection with Actinomyces Israeli localized at the level of thyroid gland is presented. Although the clinical and imaging data, the fine needle aspiration biopsy, and the intraoperative aspect clearly suggested the diagnosis of thyroid cancer, the microscopic examination surprisingly identified "sulfur granules", specific to actinomycosis, so that treatment and prognosis were reconsidered.

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