Medial Wall Research Articles

ORBITAL TRAUMA IN A CHILD WITH RETROBULBAR HEMORRHAGE

Introduction : Retrobulbar hemorrhage vision threatening condition associated with cranio- facial trauma. Rapidly fill the orbit and cause an “orbital compartment syndrome” that subsequently cuts off perfusion to vital ocular structures. Treatment must be initiated immidietly to prevent permanent visual loss.
 Case Illustration : 10-year-old boy, with left eye blurring of vision, swelling and multiple facial injury post motor accident. Visual acuity was perception of light on left eye, 6/5 and right eye with upper and lower lid laceration wounds. He had a dense afferent pupillary defect and the ocular movements of the left eye were limited in all directions of gaze. The orbit was tense with significant resistance to retropulsion. Diagnosed with acute retrobulbar haemorrhage following blunt trauma with medial wall fracture. Intravenous acetazolamide and timolol was commenced continued with emergency lateral canthotomy. His vision immediately improved to 6/60 and 3 hours later was 6/18. He was treated for left traumatic optic neuropathy with IV Mehtylprednisolone for 3 days followed two weeks oral prednisolone
 Discussion :
 Conclusion : Retrobulbar haemorrhage is a vision-threatening emergency often necessitating immediate lateral canthotomy for preservation of vision. In children, as the optic nerve canal is smaller, a lesser volume is available for the nerve to expand, thus early visual impairment could occur following trauma. Prompt recognition and appropriate treatment of this ocular emergency is imperative, for timely management determines the ultimate outcome.

Endoscopic Endonasal Transsphenoidal Transcavernous Transoculomotor Triangle Approach for Resection of an Invasive Pituitary Adenoma Extending Into the Parapeduncular Space Through the Cavernous Sinus.

A subset of invasive pituitary adenomas invade not only the medial wall of the cavernous sinus but can progress superiorly through the cavernous sinus roof at the oculomotor triangle and reach the subarachnoid parapeduncular space. We describe a series of 2 of 3 cases where an endoscopic endonasal approach was used to reach the parapeduncular space through the oculomotor triangle for tumor decompression. Images of the third case are presented. Case 1: We present a 2-dimensional surgical video of a recurrent corticotroph adenoma post gamma knife radiotherapy which was invading the left cavernous sinus and extending into the left parapeduncular space. Histopathological examination revealed densely granulated corticotrophin adenoma. The patient had reduction in the serum cortisol level postoperatively and was induced into remission medically. Postoperative third nerve palsy recovered partially, and sixth nerve palsy recovered completely at the 3-month follow-up. Case 2 : A case of recurrent silent corticotrophin adenoma invading the right parapeduncular space through the right cavernous sinus was operated through the same approach as case 1. Only a subtotal excision of the tumor in the cisternal space was possible. The patient developed a complete right third cranial palsy in the immediate postoperative period with near total recovery at the 6-month follow-up. Endoscopic endonasal approach to the parapeduncular space through a transcavernous transoculomotor route is reasonably safe and effective, as long as key anatomic landmarks and structures are identified and preserved while using natural tumor corridors to achieve tumor clearance.

Combined Endoscopic Transmaxillary Approach for Resection of an Extracranial V3 Schwannoma: 2-Dimensional Operative Video.

Tumours of the pterygopalatine (PPF) and infratemporal fossa (ITF) are rare tumours and are difficult to access. The lateral cervical approach is hampered by the mandibular angle and the vascular nervous elements.1 The classic endonasal endoscopic medial maxillectomy approach has been developed over the past 2 decades but does not allow good control of the most lateral and inferior part of the ITF.2 The surgical video presents a 68-year-old woman with trigeminal neuralgia. The radiologic workup showed a trigeminal V3 schwannoma (TS) into the PPF and ITF. This tumor grew during the follow-up despite fractionated radiosurgery. A 2-dimensional intraoperative video illustrates the gross total removal of the TS through a combined endoscopic endonasal and transgingival transmaxillary approach. The combination of these 2 approaches allows on the one hand, a better view of the lateral and inferior part of the maxillary sinus and ITF and on the other hand, a gain of handling in the operating field and security for our surgical procedure.3 The mini-Caldwell-Luc approach gives good aesthetic results without stomatological complication. Neuralgia disappeared after the surgery, and a gross total resection was achieved, and no recurrence was observed during the follow-up. This combined approach is a good alternative of medial extended maxillectomy, which presents a risk for the lacrimal duct risk and postoperative aesthetic deformity because of the removal of the medial and anterior wall of the maxillary sinus. The patient consented to the procedure and publication of her image.

Long-term results of total hip arthroplasty in severe congenital hip disease: A ten- to 20-year follow-up study

IntroductionThe impact of bone deformities, previous surgeries, and the surgical technique in total hip arthroplasty (THA) for congenital dislocation of the hip (CDH) at a long-term has not been clearly defined yet. In this single-centre observational study we sought to assess patients undergoing THA due to osteoarthritis secondary to severe CDH with low or high dislocation ten- to 20-years after surgery. To determine this purpose, we assessed: (1) THA-related complications and reoperations; (2) the clinical outcome, patients’ satisfaction and radiological results; and (3) the possible risk factors for reoperation with particular attention to the surgical technique and the influence of prior surgeries. HypothesisWe hypothesized that an anatomical reconstruction of the hip would decrease the reoperations rates in patients undergoing THA with severe CDH. MethodsSeventy-five patients (85 hips) operated between 1999 and 2012 at our large tertiary hospital were analyzed. Fifty-six hips were diagnosed as low dislocation (group 1) and 29 hips as high dislocation (group 2). The existence of prior surgeries was frequent: group 1, pelvic osteotomies 6 hips, femoral osteotomies 7, tectoplasty (shelf) 6, resection arthroplasty 1 and lowering of the greater trochanter 1; group 2 included pelvic osteotomies 10 hips, femoral osteotomies 10, and a femoral lengthening 2. The number of additional procedures during THA was: group 1 (19/56 [34%]), acetabular roof bone autograft 8 hips, acetabular medial wall autograft 2, hardware removal 6, extended femoral osteotomy 2, and a femoral shortening 1; group 2 (20/29 [69%]), acetabular bone autograft 12 hips, medial autograft 1, hardware removal 1, extended femoral osteotomy 2, and a femoral shortening 4 hips. The clinical and the radiological analysis were compared in both groups for a minimum follow-up of ten years. Cox regression models were used to detect risk factors for reoperation. ResultsNine patients (13.8%) required reoperation for the following reasons: cup loosening (5 hips), periprosthetic femoral fracture (3) and stem loosening (1); seven had prior surgeries. The 12-year survival rate for reoperation for any reason was 96.3% (95% confidence interval [CI] 91.2–100) in group 1 and 75.7% (95% CI, 65.8–90.8) in group 2 (p=0.003). Patients with high dislocation (p=0.02, hazard ratio [HR]: 6.25, 95% CI, 1.26–30.9) and those with an acetabular component inclination placed out of the target zone between 35° and 50° (p=0.03, HR: 4.27, 95% CI, 1.13–16.1) had a higher risk of reoperation. DiscussionAn optimal placement of the acetabular component decreased the reoperation rates in patients undergoing THA for severe CDH. Hips with high dislocation and the existence of prior surgery can affect THA implantation. Level of evidenceIII; retrospective; comparative.

Uretero-Pelvic Junction Obstruction with Calcification of Renal Pelvis Wall

A 45-year-old male presented with dull pain in right lumber region. On ultra-sonography, he had severely hydro- nephrotic right kidney with thinned out parenchyma and markedly dilated renal pelvis. On Computed Tomography, there was severe right hydronephrosis and linear calcification on the medial wall of renal pelvis confirmed further on DTPA Renal scan. It was a non-functioning kidney with a normal functioning contra-lateral kidney. The right nephrectomy was performed and a 7 x 7 cm rounded disc like calcification was seen in the medial pelvic wall. Upon histopathology, it was a dystrophic calcification of renal pelvis wall which is a rare finding.

Anterior Cruciate Ligament Tear Treated with Arthroscopic Primary Repair - A Case Report and Literature Review

Anterior cruciate ligament (ACL) tear is one of the most common injuries encountered in Orthopaedics worldwide1. ACL is a vital ligament attached on the medial wall of the lateral femoral condyle, the lateral intercondylar ridge marking its anterior border, proximally. Distally, it attaches between the intercondylar eminences on the anterior tibia.It consists of two bundles, anteromedial and posterolateral. Primarily, it prevents the anterior translation of the tibia on the femur2. In the extended knee, the posterolateral bundle is tight and the anteromedial bundle is lax. As the knee is flexed, the anteromedial bundle tightens and the posterolateral bundle relaxes. The anteromedial bundle is the primary restraint against anterior tibial translation while the posterolateral bundle stabilizes the knee in full extension especially against rotatory loads. The nerve supply to the ACL originates from the tibial nerve serving as vasomotor, sensory and proprioceptive functions. The blood supply to the ACL originates from branches of the middle genicular artery which form a network around the ligament.

Trouillas’s Grading and Post-Surgical Tumor Residue Assessment in Pituitary Adenomas: The Importance of the Multidisciplinary Approach

Background: We aim to assess the role of a multidisciplinary approach in pituitary adenomas (PitNETs) classification, evaluate criteria concordance, and compare intraoperative assessments with post-operative MRIs for tumor remnants. Methods: Clinical, radiological, histological, and intra- and post-operative data of the treated PitNETs were extracted from prospectively created records. PitNETs were graded according to Trouillas, and the evaluation of the tumor remnants was recorded. Results: Of 362 PitNETs, 306 underwent surgery, with Trouillas grading assigned to 296. Eight-nine radiologically non-invasive PitNETs progressed to grades 1b (27), 2a (42), or 2b (20) due to proliferative or surgical invasiveness criteria. Twenty-six radiologically invasive tumors were graded 2b due to proliferative criteria. Surgical resection details and post-surgical MRI findings revealed that residual tumors were more common in grades 2a and 2b. During surgery, small tumor remnants were documented in 14 patients which were not visible on post-surgical MRI. Post-surgical MRIs identified remnants in 19 PitNETs not seen during surgery, located in lateral recesses of the sella (4), retrosellar (2), or suprasellar regions (7), along the medial wall of the cavernous sinus (6). Conclusions: The Pituitary Board allows for the correct grading of PitNETs to be obtained and an accurate identification of high-risk patients who should undergo closer surveillance due to tumor remnants.

The Effect of Electrode Position on Behavioral and Electrophysiologic Measurements in Perimodiolar Cochlear Implants.

The shape and position of cochlear implant electrodes could potentially influence speech perception, as this determines the proximity of implant electrodes to the spiral ganglion. However, the literature to date reveals no consistent association between speech perception and either the proximity of electrode to the medial cochlear wall or the depth of insertion. These relationships were explored in a group of implant recipients receiving the same precurved electrode. This was a retrospective study of adults who underwent cochlear implantation with Cochlear Ltd.'s Slim Perimodiolar electrode at the Royal Victorian Eye and Ear Hospital between 2015 and 2018 (n = 52). Postoperative images were obtained using cone beam computed tomography (CBCT) and analyzed by multi-planar reconstruction to identify the position of the electrode contacts within the cochlea, including estimates of the proximity of the electrodes to the medial cochlear wall or modiolus and the angular depth of insertion. Consonant-vowel-consonant (CVC) monosyllabic phonemes were determined preoperatively, and at 3 and 12 months postoperatively. Electrically evoked compound action potential (ECAP) thresholds and impedance were measured from the implant array immediately after implantation. The relationships between electrode position and speech perception, electrode impedance, and ECAP threshold were an analyzed by Pearson correlation. Age had a negative impact on speech perception at 3 months but not 12 months. None of the electrode-wide measures of proximity between electrode contacts and the modiolus, nor measures of proximity to the medial cochlear wall, nor the angular depth of insertion of the most apical electrode correlated with speech perception. However, there was a moderate correlation between speech perception and the position of the most basal electrode contacts; poorer speech perception was associated with a greater distance to the modiolus. ECAP thresholds were inversely related to the distance between electrode contacts and the modiolus, but there was no clear association between this distance and impedance. Speech perception was significantly affected by the proximity of the most basal electrodes to the modiolus, suggesting that positioning of these electrodes may be important for optimizing speech perception. ECAP thresholds might provide an indication of this proximity, allowing for its optimization during surgery.

Soft Tissue Robotic Assisted Orbital Surgery Using da Vinci SP: A Cadaveric Experience.

Robotic surgical techniques have transformed many surgical specialties however robotic techniques and applications have been much more limited in ophthalmology. This study aims to evaluate the feasibility of robotic assisted orbital surgery using a single-port novel robotic platform, the da Vinci SP. A series of orbital procedures were performed in cadaveric specimens utilizing the da Vinci SP robotic system. The procedures performed included lacrimal gland dissection and biopsy, medial and lateral orbital wall dissections, enucleation, and lid-sparing orbital exenteration. Successful completion of each procedure was defined by the operating surgeon and was considered the primary outcome and marker of feasibility. Seven cadaveric procedures were performed in 3 cadaveric specimens. All 7 procedures were completed successfully without complication. Setup optimization occurred throughout the study and setup and operative times were acceptable. Three instrument arms and 1 endoscope were utilized throughout the study allowing 3 arm operating and dynamic retraction. Instrument size was found to limit surgical access and precision particular at the orbital apex. This preclinical study demonstrates that the da Vinci SP can be utilized within the orbit and is feasible for several applications. Robotic surgical systems offer significant advantages over conventional techniques and should be embraced. However, current commercially available robotic platforms are not optimized for the orbit and have their limitations although they may be suitable for some clinical applications.

Bell’s palsy: a case report of unusual presentation in a patient with rhino-orbital cerebral mucormycosis

BackgroundMucormycosis is a fungal infection caused by the Mucorales order of fungi. This fungus is commonly found in soil and can cause disease in immunocompromised patients. On the other hand, Bell’s palsy is an idiopathic condition that results in the sudden onset of unilateral facial muscle weakness, affecting the facial nerve.Case presentationA 51-year-old Persian housewife with a history of poorly controlled diabetes mellitus presented with a splitting headache that had been ongoing for 1 week and an inability to close her left eye or make facial expressions on the left side of her face. The patient’s vital signs were normal, but physical examination revealed a yellow-grey scar on the left side of her hard palate and Bell’s palsy on the left side. A neurological examination showed that she could move both eyes but could not close her left eye, move up her left eyebrow, or smile. Further investigations were performed, including laboratory tests, radiologic imaging, and functional endoscopic sinus surgery. The patient underwent three rounds of debridement for bony erosion in the medial and posterior walls of the left maxillary sinus and the hard palate. Pathological examination confirmed mucormycosis infection in the hard palate and mucosa.ConclusionFungal infection must be considered a potential diagnosis for immunocompromised adults who exhibit symptoms of Bell’s palsy.

Tratamento cirúrgico de fratura orbitária Blow-out com tela de titânio: Relato de caso

Blow-out fractures are known to affect the floor or medial wall of the orbit, an anatomical region located in the middle third of the face. For an accurate diagnosis of this fracture, a thorough clinical examination associated with imaging is necessary, among them, multi-slice computed tomography is considered the “gold standard” for diagnosis and planning the approach to this type of fracture, as it allows visualization all structures without interferences, and also allowing the degree of bone comminution to be measured. Among the tomographic planes, the coronal section stands out for enabling a better assessment of the orbital floor and medial wall. Signs and symptoms are usually diplopia, enophthalmos, malar changes, restricted ocular mobility, infraorbital nerve paresthesia, periorbital ecchymosis. There are several types of surgical approaches for treating this type of trauma and to reconstruct blow-out fractures, alloplastic materials, autogenous or heterogenous grafts are chosen. The objective of this paper is to report a clinical case of blow-out orbital fracture, the surgical approach, reduction and fixation with a 1.5mm system mini-plate on the left infra-orbital rim and reconstruction of the left orbital floor with a titanium mesh, giving emphasis on the treatment of orbital floor fractures, with titanium mesh and the good prognosis without signs of contamination or postoperative foreign body reaction. Adequate clinical and anamnestic examination, plus imaging examination, followed by convergent planning, increases the chances of a good prognosis, always with the aim of achieving, when possible, the reconstruction of the form, function and aesthetics of the traumatized area.

Quality of life in patients with Graves' orbitopathy submitted to orbital decompression: comparison between balanced and inferomedial techniques.

To compare inferomedial wall orbital decompression to balanced medial plus lateral wall orbital decompression in patients with Graves' orbitopathy in the inactive phase with regard to exophthalmos reduction and the effects on quality of life. Forty-two patients with inactive Graves' orbitopathy were randomly divided into two groups and submitted to one of two orbital decompression techniques: inferomedial wall orbital decompression or medial plus lateral wall orbital decompression. Preoperative and postoperative assessments included Hertel's exophthalmometry and a validated Graves' orbitopathy quality of life questionnaire. The results of the two groups were compared. Compared to preoperative measurement, exophthalmos reduction was statistically significant in both groups (p<0.001) but more so in patients undergoing medial plus lateral wall orbital decompression (p=0.010). Neither orbital decompression techniques increased the visual functioning subscale score on the Graves' orbitopathy quality of life questionnaire (inferomedial wall orbital decompression p=0.362 and medial plus lateral wall orbital decompression p=0.727), but a statistically significant difference was observed in the score of the appearance subscale in patients submitted to medial plus lateral wall orbital decompression (p=0.006). Inferomedial wall orbital decompression is a good alternative for patients who do not require large exophthalmos reduction. However, medial plus lateral wall orbital decompression offers greater exophthalmos reduction and greater improvement in appearance (higher Graves' orbitopathy quality of life questionnaire scores), making it a suitable option for esthetic-functional rehabilitation.

The influence of orbital architecture on strabismus in craniosynostosis

PurposeTo better characterize the correlation of bony orbital dysmorphology with strabismus in craniosynostosis. MethodsThe medical records of patients with craniosynostosis with and without strabismus seen at Rady Children’s Hospital (San Diego, CA) from March 2020 to January 2022 were reviewed retrospectively in this masked, case-control study. Computed tomography scans of the orbits were analyzed to obtain dimensions of the orbital entrance and orbital cone. Primary outcome was correlation of strabismus with orbital measurements. ResultsA total of 30 orbits from 15 patients with strabismus and 15 controls were included. Craniofacial disorders included in the study were nonsyndromic craniosynostosis (63%), Crouzon syndrome (13%), Apert syndrome (13%), and Pfeiffer syndrome (10%). Orbital index (P = 0.01) and medial orbital wall angle (P = 0.04) were found to differ significantly between the strabismus and control groups. ConclusionsIn our small cohort, bony orbital dimensions, including the ratio of orbital height to width and bowing of the medial orbital wall, were associated with strabismus in craniosynostosis.

Сравнительная характеристика микроскопической организации рецепторного аппарата дополнительной обонятельной системы бобра обыкновенного и овцы

In the article, in a comparative aspect, the description of the tissue and cellular organization of the vomeronasal organ (VNO), its vascular system and innervation in two species of animals of different habitats – the common beaver and the Katada sheep breed is given. It is shown that in the studied animals, in particular, the epithelial lining of the lateral and medial walls, has general patterns characteristic of the mammalian vomeronasal system. The innervation of the EIT of a beaver and a sheep has no significant differences between them. At the same time, the sheep's EIT has a more complex surface relief, resembling an inverted letter of the Greek alphabet "delta", which is a species-specific feature of this animal species. In addition, the cavity of the beaver is located ventromedially with respect to the central vein, and the sheep is located dorsomedially. Along with this, in the ventral part of the epithelial layer of the beaver, there is a depression lined with a multilayer cubic epithelium, which is not found in the sheep's EIT. Also, in the submucosal base of the lateral wall of the beaver's EIT, there are single neurons that are absent in the sheep's EIT. The submucosal base of the sheep's EIT, in comparison with the submucosal base of the beaver's EIT, contains a large number of serous glands concentrated mainly along the perimeter from the central vein, there are also single groups of mucous glands, whereas in the beaver's EIT, these types of glands are extremely few and concentrated dorsally in relation to its cavity.

Mixed reality for spine surgery: a step into the future with a human cadaveric accuracy study.

Current application of mixed reality as a navigation aid in the field of spinal navigation points to the potential of this technology in spine surgery. Crucial factors for acceptance include intuitive workflow, system stability, reliability, and accuracy of the method. The authors therefore aimed to investigate the accuracy of the system in visualization of anatomical structures using mixed reality in the example of pedicles of the thoracic spine in a human cadaveric study. Potential difficulties and limitations are discussed. CT scans of a human cadaveric spinal column specimen were performed. After segmentation and import into the advanced HoloLens 2 software, the vertebrae were exposed. The vertebral arches were preserved on one side for a landmark-based surface registration, whereas pedicles were exposed on the other side in order to measure and evaluate deviation of the overlay holographs with regard to the exact anatomical structure. Accuracy was measured and statistically evaluated. In this work it was demonstrated that the overlay of the virtual 3D model pedicles with the real anatomical structures with anatomical landmark registration was within an acceptable surgical accuracy with the mean value of 2.1 mm (maximum 3.8 mm, minimum 1.2 mm). The highest accuracy was registered at the medial and lateral pedicle wall, and the measurement results were best in the region of the middle thoracic spine. The accuracy analysis for mixed reality (i.e., between the virtual and real anatomical situation of the thoracic spine) showed a very good agreement when focus was on the pedicles. This work is thus a rare proof of the precision of segmentation to the potential surgical area. The results encourage researchers to open up mixed reality technology in its development and application for spinal navigation.

Эндоскопически ассистированная биопсия вомероназального органа овцы

The article describes the original technique of conducting a biopsy of the vomeronasal organ (VNO) in sheep during rhinoscopy, and also presents its characteristic structural features, namely the morphology of the shell structure, angioarchitectonics and nervous support. The research was carried out on the basis of the Departments of Anatomy and Histology of Animals named after Professor A.F. Klimov and Veterinary Surgery of the Moscow State Academy of Veterinary Medicine and Biotechnology – MBA named after K. I. Scryabin. The work was carried out on clinically healthy Romanov sheep at the age of 1 year, who reached sexual and physiological maturity, biopsy was performed under anesthesia. Based on the method of light microscopy, it was found that the sheep's VNU is located in the ventral nasal passage bilaterally from the cartilaginous nasal septum, and is protected from the outside by a layer of its own hyaline cartilage, which is covered with the mucous membrane of the nasal cavity. The structure of the EIT contains the lateral (olfactory) and medial (sensorineural) walls, between which its own cavity is located. A large number of groups of serous glands located around the central vein, as well as cavernous bodies, providing regulation of the lumen of the internal cavity of the VNU, were found in the submucosal base of the VNU. Innervation of the vomeronasal organ is carried out concentrically due to the topographic features of the course and branching of the trunks of the vomeronasal nerve.

Bony orbital decompression in thyroid eye disease

This article summarizes the results of research on the morphological and functional features of different types of orbital bone decompression in thyroid eye disease (TED) and presents an analysis of surgical anatomy of the lateral orbital wall in the context of performing deep lateral bone decompression of the orbit was carried out. The study includes an analysis of the results of orbital bone decompression with resection of the greater wing of the sphenoid bone using ultrasound osteodestructor in comparison with osteodestruction using a high-speed drill, description of transethmoidal orbital decompression with endonasal access both as a single method of surgical treatment of TED and in combination with lateral bone decompression of the orbit, including the advantages and disadvantages of the method, and presents a morphological description of the pathological changes in the medial orbital wall bone fragments obtained during endonasal transethmoidal orbital decompression in patients with TED.

Oral Rehabilitation for a Patient with Cocaine‐Induced Midline Destructive Lesions

Background. Cocaine is the second most consumed drug worldwide, more than 0.4% of the global population, and has become a real public health problem in recent years. Its inhalation causes significant centrofacial lesions, grouped under the name cocaine‐induced midline destructive lesion (CIMDL). These destructions are due to the conjunction of the vasoconstrictor, local prothrombogenic effects, and cytotoxic effects of cocaine. The ischemia produced by this substance is due to vasoconstriction that leads to nasal tissue necrosis and perforation of the nasal septum secondary to chondral necrosis. Case Presentation. A 36‐year‐old man, previously grappling with cocaine addiction, was hospitalized to undergo comprehensive clinical, microbiological, and radiological examinations because he was suffering from the emergence of crusts and ulceration in the nasal mucosa, accompanied by a palate perforation, a 39°C fever, and chills. Standard bacteriological culture was positive for coagulase‐negative staphylococci and Escherichia coli, while mycological culture was positive for Candida tropicalis. The CT scan images of the sinuses confirmed the presence of palatal perforation and total destruction of the nasal septum, cartilaginous portion, maxillary sinus medial wall, lower and middle turbinates, and middle meatus. Nasal endoscopy revealed an exposition of the bony wall and displayed the exposition of the occipital bone’s clivus. A diagnosis of CIMDL was confirmed. Antibiotic therapy was decided based on antibiogram results by the consulting microbiologist. Debridement of necrotic tissue was done by nasal endoscopy with local cleaning and was repetitive during the first week to maintain the best cleanliness possible. The patient was discharged with oro‐nasal hygiene instructions and referred for prosthetic rehabilation. As for the cocaine addiction, the patient was in follow‐up with a psychologist in a specialized centre. Conclusion. The care is multidisciplinary. Psychological help and assistance are essential to guide patients to become cocaine free and to avoid a relapse. Weaning is a prerequisite for surgery. Rehabilitation of speech and swallowing is necessary. Many local flaps or micro‐anastomoses are possible.

Морфофункциональная оценка слизистой оболочки надтубарного кармана и переднего эпитимпанального синуса

Based on autopsy and biopsy material, a morpho-functional assessment of the mucous membrane of the anatomical spaces of the medial wall of the tympanic cavity — separated by fold of the tensor tympani muscle —was carried out. It has been shown that in most cases samples of the mucous membrane of the supratubal recess are represented by multirow or pseudostratified epithelium with loose connective tissue of the lamina propria. On the other hand, the mucous membrane of the anterior epitympanic recess in most cases is represented by flat epithelium with compact connective tissue of the lamina propria, which determines the high gas-absorbing capacity of the mucous membrane. Establishing the boundary of the mucous membrane with a high gas-absorbing capacity in practical terms determines the formation of the tympanic segment when performing open-type tympanoplasty.

MORPHOLOGICAL CHARACTERISTICS OF THE UTERUS OF WHITE OUTBRED RATS

Using light microscopy methods, the histological structure of the uterus of white outbred rats at the level of the body and cervix was clarified. It has been established that the walls of the right and left uterine horns grow together, forming a double body and neck. Whose cavities remain separated from each other by a thin septum and open into the vagina with two separate openings. The area of fusion of the medial walls is characterized by the union of the perimeter and the supravascular layer of the myometrium. The data obtained can be used to illuminate the relevant sections of reference and educational literature when writing sections on evolutionary, functional, comparative species morphology and reproductive biology. Based on the histological study, it was established thatin rats, despite the general type of uterine structure, there are significant differences that mainly affect their lower segment at the borders.