ZNANSTVENI PROGRAM / SCIENTIFIC PROGRAMME (.pdf)

Zagreb, 23.-25. veljače 2012. 

Organizator 

Rinološka sekcija Hrvatskog društva za 

otorinolaringologiju i kirurgiju glave i vrata 

ZBORNIK SAŽETAKA 

PROCEEDINGS 

s međunarodnim sudjelovanjem with International Participation 

Pod pokroviteljstvom ERS-a 

Under the auspices of ERS 

Zagreb, Croatia, February 23-25, 2012 

Organizer 

Rhinologic Section of Croatian Society for 

Otorhinolaryngology and Head and Neck Surgery

120207 Samo za zdravstvene radnike 

7. 2. 2012. 

Snažan u dišnim putovima! 

GeloMyrtol ® forte 

standardizirani mirtol 

NOVO! 

• lijek izbora kod akutnog i kroničnog 

sinusitisa i bronhitisa 

• učinkovit mukocilijarni čistač 

• više od 25 kliničkih studija 

• pogodan za dugotrajnu uporabu 

U svim 

ljekarnama 

bez recepta 

Naziv: GeloMyrtol ® forte 300 mg meke želučanootporne kapsule 

standardizirani mirtol Indikacije: akutni i kronični bronhitis i sinusitis 

Kontraindikacije: upalni poremećaji probavnog sustava i žuči kao i 

teška bolest jetre, preosjetljivost na bilo koji sastojak lijeka Nuspojave: 

mogu se javiti probavne tegobe; rijetko mučnina, povraćanje ili proljev, te 

reakcije preosjetljivosti (npr. kožni osip, svrbež…) Broj odobrenja: UP/I- 

530-09/10-01/196 Način izdavanja: bez recepta Nositelj odobrenja: 

Medis Adria d.o.o., Kolarova 7, Zagreb 

Doziranje: Akutna stanja: Djeca od 6 do 12 godina: 1 kapsula 2 x 

na dan; odrasli i djeca starija od 12 godina: 1 kapsula 3–4 x na dan. 

Kronična stanja: Djeca od 6 do 12 godina: 1 kapsula 1–2 x na dan; 

odrasli i djeca starija od 12 godina: 1 kapsula 2–3 x na dan. Popijte 

barem pola sata prije obroka uz dovoljnu količinu hladne tekućine. 

Ovaj promotivni materijal sadrži bitne podatke o lijeku koji su istovjetni 

cjelokupnom odobrenom sažetku svojstava lijeka te cjelokupnoj 

odobrenoj uputi sukladno čl. 15. Pravilnika o načinu oglašavanja o 

lijekovima i homeopatskim proizvodima (NN, br. 118/2009). 

Medis Adria d.o.o.

2. hrvatski rinološki kongres 

2 nd Croatian Rhinologic Congress 

ZBORNIK SAŽETAKA 

PROCEEDINGS 

s međunarodnim sudjelovanjem 

with International Participation

Iz bilo kojeg razloga 

u bilo kojoj sezoni 1 

Oslobađa i sprječava od simptoma alergijskog rinitisa 1 

SKRAĆENI SAŽETAK OPISA SVOJSTAVA LIJEKA 

NAZIV LIJEKA AVAMYS 27,5 mikrograma/potisnoj dozi Sprej za nos, suspenzija KVALITATIVNI I KVANTITATIVNI 

SASTAV Jedna potisna doza spreja sadrži 27,5 mikrograma flutikazonfuroata. Cjeloviti popis pomoćnih tvari naveden 

je u Poglavlju 6.1. FARMACEUTSKI OBLIK Sprej za nos, suspenzija. Bijela suspenzija. KLINIČKI PODACI Terapijske 

indikacije Odrasli, adolescenti (12 i više godina) i djeca (6-11 godina) Avamys se primjenjuje u liječenju simptoma alergijskog 

rinitisa. Doziranje i način primjene Odrasli i adolescenti (12 i više godina): Preporučena početna doza je dvije inhalacije 

spreja jednom na dan (27,5 mikrograma flutikazonfuroata po svakoj inhalaciji spreja) u svaku nosnicu (ukupna dnevna 

doza 110 mikrograma). Djeca (6 do 11 godina): Prep oručena početna doza je jedna inhalacija spreja (27,5 mikrograma 

flutikazonfuroata po svakoj inhalaciji spreja) u svaku nosnicu jednom na dan (ukupna dnevna doza 55 mikrograma). Djeca 

ispod 6 godina starosti: Iskustvo primjene lijeka u djece ispod 6 godina starosti je ograničeno (vidi poglavlje 5.1 i 5.2). 

Sigurnost i učinkovitost primjene lijeka u ovoj skupini nisu dobro utvrđene. Kontraindikacije Preosjetljivost na djelatnu 

tvar ili neku od pomoćnih tvari lijeka Avamys. Posebna upozorenja i mjere opreza Flutikazonfuroat prolazi ekstenzivni 

metabolizam prvog prolaza te je stoga vjerojatno povećanje sistemske izloženosti intranazalnom flutikazonfuroatu kod 

bolesnika s teškim oboljenjem jetre, što može rezultirati većom učestalošću sistemskih nuspojava (vidi poglavlje 4.2 i 

5.2). Savjetuje se oprez u liječenju spomenutih bolesnika. Može doći do pojave sistemskih učinaka nazalno primjenjenih 

kortikosteroida, osobito pri visokim dozama propisanima u produljenom razdoblju. Ovi učinci variraju među bolesnicima i 

različitim kortikosteroidima (vidi poglavlje 5.2). Liječenje višim dozama nazalno primjenjenih kortikosteroida od preporučenih 

može imati za posljedicu klinički značajnu adrenalnu supresiju. Ako postoji dokaz o primjeni viših doza od preporučenih, 

potrebno je razmotriti dodatnu zaštitu od sistemskih kortikosteroida tijekom stresnih razdoblja ili elektivnih kirurških zahvata. 

flutikazonfuroat 

Rješenje za oči i nos 

Flutikazonfuroat 110 mikrograma jednom na dan nije bio povezan sa supresijom osovine hipotalamushipofiza-nadbubrežna 

žlijezda (HPA) kod subjekata odrasle, adolescentske i dječje dobi. Međutim, 

potrebno je smanjiti intranazalnu dozu flutikazonfuroata na najnižu dozu kojom se učinkovito održava 

kontrola simptoma rinitisa. Avamys sadrži benzalkonij klorid, koji može izazvati iritaciju sluznice 

nosa. Nuspojave Poremećaji dišnog sustava, prsišta i sredoprsja. Vrlo često: epistaksa. 

Često: ulceracija nosa. Epistaksa je općenito bila blagog do umjerenog intenziteta. Kod 

odraslih i adolescenata, stopa incidencije epistakse bila je viša u dugotrajnoj primjeni (dulje od 

6 tjedana) nego u kratkotrajnoj primjeni (do 6 tjedana). U pedijatrijskim kliničkim ispitivanjima, 

u trajanju do 12 tjedana, stopa incidencije epistakse bila je slična između bolesnika koji su 

primali flutikazonfuroat i bolesnika koji su primali placebo. Sadržaj pakiranja Avamys sprej 

za nos je plastična naprava žućkastobijele boje, s otvorom dozirnog indikatora, svijetloplavom 

bočnom ručicom za aktivaciju i poklopcem koji sadrži čep. Plastična naprava sadržava sprej za 

nos u obliku suspenzije u smeđoj (staklenoj) bočici tipa I, s odmjernom pumpicom raspršivača. 

Lijek je dostupan u veličini pakiranja: 120 doza. NOSITELJ ODOBRENJA ZA STAVLJANJE 

GOTOVOG LIJEKA U PROMET GlaxoSmithKline d.o.o., Livadarski put 7, 10 000 Zagreb. 

KLASA RJEŠENJA O ODOBRENJU ZA STAVLJANJE GOTOVOG LIJEKA U PROMET 

UP/I-530-09/08-01/344. DATUM PRVOG ODOBRENJA/OBNOVE ODOBRENJA 04. lipnja 2009. 

Sastavni dio ovog promotivnog materijala predstavlja i cjelokupni odobreni Sažetak opisa svojstava lijeka, sukladno 

pravilniku o načinu oglašavanja o lijekovima i homeopatskim proizvodima, Narodne novine br.118/09. 

GlaxoSmithKline d.o.o. Prilaz baruna Filipovića 29, 10000 Zagreb Referenca: 1. Avamys Sažetak opisa svojstava lijeka, zadnja odobrena verzija. Samo za zdravstvene radnike 

AVYS-06/02/2012-ADV CRO/FF/0007/12

Poštovane kolegice, poštovani kolege, 

Nakon što smo 2010. organizirali 1. hrvatski rinološki kongres, nastavljamo s drugim 

kongresom kako bismo ispunili svoje obećanje o stvaranju tradicije dobrih rinoloških kongresa. 

Prvi hrvatski rinološki kongres bio je jedan od većih rinoloških događaja u Europi i najveći 

rinološki skup u ovom dijelu Europe do sada održan. 

Kako smo prošle godine uspjeli izboriti organizaciju 26. kongresa Europskog rinološkog društva 

i 33. ISIAN-a, koji će se održati u Dubrovniku 2016. godine, i ovaj kongres i svi ostali koji će se 

do 2016. organizirati, na neki su način uvod u taj veliki događaj. 

Cilj nam je da 2. hrvatski rinološki kongres bude još kvalitetniji u znanstvenom i društvenom 

programu od prijašnjeg i na taj način unaprijedimo svoje rinološko znanje i učvrstimo naše 

prijateljstvo. 

Svojim dolaskom i sami pridonosite postizanju tog cilja. 

Dear colleagues, 

After having organized the 1st Croatian Rhinologic Congress in February 2010 we are 

organizing another Congress aiming to fulfill the promise to start a series of high quality 

rhinology congresses. 

The first congress was one of the biggest rhinology events in Europe last year, and the greatest 

rhinology meeting ever held in this part of Europe. 

In 2016 Croatia will host the organization of the 26th Congress of ERS and 33rd ISIAN in 

Dubrovnik. Therefore, the next year’s Congress, and other rhinology meetings to be held in 

between, will be a sort of preparation for this great event. 

We are planning to have a quality scientific and social program of the Congress, and to further 

improve the knowledge in rhinology and strenghten friendship bonds between all participants 

of the Congress. 

Your participation makes a contribution to the goal. 

Prof. dr. sc. Tomislav Baudoin 

2 nd Croatian Rhinologic Congress / Proceedings 

7

8 

Organizacijski odbor / Organizing Committee 

Organizator: Rinološka sekcija Hrvatskog društva za otorinolaringologiju i kirurgiju glave i vrata 

Organizer: Rhinologic Section of Croatian Society for Otorhinolaryngology and Head and Neck Surgery 

Predsjednik / President 


Dopredsjednik / Vice President 

Prof. dr. sc. Goran Račić 

Tajnik / Secretary 

Prof. dr. sc. Ivica Klapan 

Predsjednik kongresa / Congress President 


Počasni predsjednik / President of Honour 

Prof. dr. sc. Livije Kalogjera 

Organizacijski odbor / Organizing Committee 

Marica Grbešić 

Goran Geber 

Darko Solter 

Dejan Tomljenović 

Alan Pegan 

Ivan Rašić 

Ana Pangerčić 

Znanstveni odbor / Scientific Committee 

Vladimir Bedeković 

Boris Grdinić 

Marko Velimir Grgić 

Martin Jurlina 

Livije Kalogjera 

Ivica Klapan 

Darko Manestar 

Duška Markov Glavaš 

Damir Miličić 

2. hrvatski rinološki kongres / Zbornik sažetaka 

Ranko Mladina 

Ivana Pajić Penavić 

Boris Pegan 

Gorazd Poje 

Ratko Prstačić 

Goran Račić 

Željka Roje 

Asja Stipić-Marković 

Boris Šimunjak

Međunarodni znanstveni odbor / International Scientific Committee 

Rumen Benchev 

Nicolas Busaba 

Pavel Doležal 

Marco Domenico Caversaccio 

Bogdan Čizmarević 

Christos Georgalas 

Frodita Jakimovska 

Ljiljana Jovančević 

Pozvani predavači / Invited Speakers 

Aleksić A. Bosnia and Herzegovina 

Anzić S. A. Croatia 

Bauer V. Croatia 

Bedeković V. Croatia 

Benchev R. Bulgaria 

Braut T. Croatia 

Busaba N. USA 

Caversaccio M. D. Switzerland 

Čizmarević B. Slovenia 

Čerina V. Croatia 

Doležal P. Slovakia 

Džepina D. Croatia 

Gagro A. Croatia 

Geber G. Croatia 

Georgalas C. Netherlands 

Grdinić B. Croatia 

Grgić M. V. Croatia 

Jakimovska F. Macedonia 

Jelavić B. Bosnia and Herzegovina 

Jovančević Lj. Serbia 

Kabakchiev P. Bulgaria 

Kalogjera L. Croatia 

Petko Kabakchiev 

Jeffrey Koempel 

Gabriela Kopačeva-Barsova 

Jane Netkovski 

Glenis Scadding 

Dilyana Vicheva 

Stephan Vlaminck 

Klapan I. Croatia 

Koempel J. USA 

Kopačeva Barsova G. Macedonia 

Mladina R. Croatia 

Milkov M. Bulgaria 

Netkovski J. Macedonia 

Obrovac K. Croatia 

Pajić-Penavić I. Croatia 

Perić A. Serbia 

Poje G. Croatia 

Rotim K. Croatia 

Račić G. Croatia 

Ravnik J. Slovenia 

Roje Ž. Croatia 

Scadding G. Great Britain 

Stipić Marković A. Croatia 

Šimunjak B. Croatia 

Vagić D. Croatia 

Včeva A. Croatia 

Vicheva D. Bulgaria 

Vlaminck S. Belgium 

Zadravec D. Croatia 


9

10 

SPONZORI / SPONSORS 

2. hrvatski rinološki kongres / Zbornik sažetaka 

Glavni sponzor / General sponsor 

Zlatni sponzor / Gold sponsor 

Srebrni sponzor / Silver sponsor 

Brončani sponzori / Bronze sponsors 

Ostali sponzori / Other sponsors

SADRŽAJ / CONTENTS 

OPĆE INFORMACIJE / GENERAL INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 

PROGRAM / PROGRAMME 

Thursday, February 23, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 

Friday, February 24, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 

Saturday, February 25, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 

USMENA IZLAGANJA / ORAL PRESENTATIONS 

SADRŽAJ / CONTENTS 11 

Impact of intermittent and persistent allergic rhinitis 

on the development of bronchial hyperreactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 

Aleksandra Aleksić, Dmitar Travar, Slobodan Spremo, Dalibor Vranješ and Zorica Novaković 

Laryngeal symptoms – caused by allergy or laryngopharyngeal reflux? . . . . . . . . . . . . . . . . . . . . . . . . . .29 

Zorica Alerić and Vladimir Bauer 

Correlation between laryngopharyngeal reflux and chronic rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . .30 

Srđan Ante Anzić 

Standardization for the use of navigation in FESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 

Tomislav Baudoin 

Voice quality in allergic rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 

Vladimir Bauer, Zorica Alerić, Bojana Knežević, Dubravka Prpić and Anita Kaćavenda 

Rhinology in Croatian General Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 

Vladimir Bauer 

External rhinoplasty (decortication) – pros and cons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33 

Vladimir Bedeković and Mirko Ivkić 

Treatment of habitual snoring and mild forms of sleep apnoe by 

palatoplasty using cartilage implants from the nasal septum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 

Rumen Benchev and Svetla Vasileva 

FESS - preoperativna CT analiza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 

Tamara Braut, Milodar Kujundžić, Dubravko Manestar, Jelena Vukelić, 

Dean Komljenović, Radan Starčević i Dubravka Mateša-Anić 

Endoscopic transnasal control of epistaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 


2 nd Croatian Rhinologic Congress / Proceedings

12 


Computer-assisted surgery and robot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 


Middle turbinate osteoblastoma with intracranial extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37 

Draško Cikojević 

Pure endoscopic endonasal transsphenoidal technique: A new method in pituitary surgery . . . . . . . . . .37 

Vatroslav Čerina, Krešimir Rotim, Milan Vrkljan and Ivan Kruljac 

Kasne komplikacije poslije ozljeda frontalnog sinusa i prednje lubanjske baze . . . . . . . . . . . . . . . . . . . . .38 

Bogdan Čizmarević, Boštjan Lanišnik, Primož Levart, Tomislav Grošeta i David Debevc 

Management of patients with sinonasal carcinoma and olfactory 

neuroblastoma: Comparison of results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 

Pavel Doležal and Jana Hanzelová 

Reconstructive surgery of the nasal valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 

Davor Džepina 

Impact of allergic rhinitis on asthma development and control in children . . . . . . . . . . . . . . . . . . . . . . . .40 

Alenka Gagro 

Extended endonasal approaches to the skull base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 


Što nas očekuje u akreditaciji bolnica? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42 


The goals in endoscopic surgery for chronic rhinosinusitis and nasal polyposis . . . . . . . . . . . . . . . . . . . .43 


Orientation in endoscopic anterior skull base surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 


Sphenoid sinus volume measurements on the basis of computer postprocessing of data 

acquired by high resolution computerized tomography and possible relationship with age, 

sex and mastoid pneumatization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 

Rozita Gulić, Višeslav Ćuk, Stanko Belina, Željko Vranješ and Davor Vagić 

Rhinoseptoplasty: Managing of the nasal pyramid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 

Frodita Jakimovska and Gabriela Kopačeva Barsova 

Helicobacter pylori sinonasal colonization: relationship with nasal 

polyp histopathology or rhinosinusitis symptom severity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 

Boris Jelavić, Violeta Šoljić, Dragana Karan, Hrvoje Čupić, Marko Grgić and Tomislav Baudoin 

Clinical application of nasal nitric oxide measurements in rhinology . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 

Ljiljana Jovančević, Slobodan Savović and Rajko Jović 

Rhinoplasty - beauty and function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 


2. hrvatski rinološki kongres / Zbornik sažetaka


Rhinoplasty in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 

Petko Kabakchiev and Dimitrina Todorova 

Evidence based medicine and the treatment of rhinosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 


Do we believe that computer integrated surgery and virtual reality (VR) in rhinology provide 

better interactive VE-navigation using augmented reality and 3D-operating planning system? . . . . . . . .50 

Ivica Klapan 

Rhinosinusitis in children: Current concepts in the U.S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 


Nasal tip projection, asymmetries after rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 

Gabriela Kopačeva-Barsova, Frodita Jakimovska, Lidija Dubrovska Miletić, 

Maja Kirjas and Maja Damjanovska 

Nasal obstruction after rhinoseptoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 

Gabriela Kopačeva-Barsova and Frodita Jakimovska 

Učilo-model za vježbanje endoskopske kirurgije nosa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 

Dubravko Manestar, Sven Maričić, Mladen Perinić i Darko Manestar 

Sinuitis u djece – dijagnoza i liječenje . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 

Duška Markov-Glavaš 

Therapy of vasomotor rhinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 


Combined approach to obstructive sleep apnea and snoring with 

intraoral and intranasal devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 

Mario Milkov 

The lamb’s head dissection: A novel and unique method for the training of 

endonasal endoscopic surgical techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55 

Ranko Mladina 

“Five-steps” technique for endonasal endoscopic orbital decompression . . . . . . . . . . . . . . . . . . . . . . . .56 

Ranko Mladina 

Cobweb rhinitis: A new clinical entity on the horizon? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 

Ranko Mladina 

Endoskopska endonazalna kirurgija klivalnih tumora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 

Ranko Mladina 

Reduction rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 

Jane Netkovski and Biljana Shirgoska 

Integrirani sustav za 3D vizualizaciju i navigaciju u području rinokirurgije . . . . . . . . . . . . . . . . . . . . . . . . .59 

Karlo Obrovac, Goran Vasiljević, Alan Mutka, Josip Nižetić i Jadranka Vuković Obrovac 


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Uloga Chlamydophila pnemoniae u nastanku kroničnog rinosinuitisa . . . . . . . . . . . . . . . . . . . . . . . . . . .60 

Ivana Pajić-Penavić, Nenad Pandak, Davorin Đanić, Alen Sekelj i Danijela Babler 

Cavernous hemangioma of the nasopharynx: A case report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 

Ana Pangerčić and Tomislav Baudoin 

Operativni zahvati izvedeni metodom FESS-a u razdoblju 2008./2009. i 2010./2011. god. 

na Klinici za ORL i kirurgiju glave i vrata KBC „Sestre milosrdnice“ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 

Alan Pegan i Tomislav Baudoin 

Effects of long-term low-dose treatment by clarithromycin on Th2 cytokines, 

CCL5 and ECP in nasal secretions of patients with nasal polyposis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 

Aleksandar Perić and Danilo Vojvodić 

Image-guided endoscopic sinus and skull base surgery: our experience . . . . . . . . . . . . . . . . . . . . . . . . . .63 

Gorazd Poje and Ranko Mladina 

Učinkovitost i sigurnost kirurškog liječenja pacijenata s poremećajima disanja tijekom spavanja: 

naša iskustva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 

Goran Račić, Željka Roje, Mirnes Selimović, Zoran Đogaš, Renata Pecotić, Maja Valić i Vana Bulić 

Rinokirurške operacije u razdoblju 2008./2009 i 2010./2011. – septoplastika i septorinoplastika . . . . . . .65 

Ivan Rašić i Tomislav Baudoin 

Expanded endoscopic endonasal approach to the skull base pathology . . . . . . . . . . . . . . . . . . . . . . . . . .65 

Janez Ravnik 

How to handle a patient with a sleep-disordered breathing? Split protocol . . . . . . . . . . . . . . . . . . . . . . .66 

Željka Roje 

Update on ARIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67 


Biološka terapija u astmi i alergijskim bolestima . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68 

Asja Stipić Marković 

Diagnostic imaging of the paranasal sinuses and anterior skull base fossa . . . . . . . . . . . . . . . . . . . . . . . .70 

Goranka Šimac-Kubat, Karmen Mršić, Dražen Lovrić and Nikola Bilić 

The effectiveness of combined method od radio-frequency and cold knife 

uvulopalatoplasty in the treatment of primary snoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71 

Boris Šimunjak, Boris Filipović, Ivan Raguž and Marica Žižić-Mitrečić 

Rinokirurške operacije u razdoblju 2008./2009. i 2010./2011. na Klinici za ORL 

i kirurgiju glave i vrata KBC „Sestre milosrdnice“ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72 

Dejan Tomljenović i Tomislav Baudoin 

Allergic rhinitis in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72 

Andrijana Včeva, Hrvoje Mihalj, Željko Zubčić, Željko Kotromanović, Darija Birtić and Josip Maleš 

The future Bulgarian-Croatian rhinology collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 




Sinus and headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 


The malignant tumors of the maxillofacial region: a radiological approach . . . . . . . . . . . . . . . . . . . . . . . .75 

Dijana Zadravec 

POSTERI / POSTERS 

Ectopic canine in the maxillary sinus: A case of tacit stowaway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 

Ana Bernić and Niko Krakar 

Kako smo rekonstruirali defekt prednjeg zida frontalnog sinusa – prikaz slučaja . . . . . . . . . . . . . . . . . . . .77 

Aleksandar Ljubičić, Milanko Milojević, Dražen Ivetić i Biserka Vukomanović-Đurđević 

Exploring possibilities in nasal polyposis treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 

Hrvoje Mihalj, Josip Maleš, Željko Zubčić and Andrijana Včeva 

Effect of septoplasty on nasal functions and quality of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 

Goran Račić, Željka Roje, Mirnes Selimović and Željana Matutinović 

Akustičke i perceptivne karakteristike nazala u ezofagealnih govornika . . . . . . . . . . . . . . . . . . . . . . . . . .79 

Smiljana Štajner-Katušić, Damir Horga i Marko Liker 

Acoustic rhinometry for diagnosis of nasal obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 


Vrijednost magnetne rezonancije u analizi perineuralne infiltracije malignih 

tumora paranazalnih sinusa i nosne šupljine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 

Dijana Zadravec, Andrijana Jović, Nataša Katavić, Darko Solter, Mirko Ivkić i Ivan Krolo 

ZABILJEŠKE / NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 


16 

OPĆE INFORMACIJE / GENERAL INFORMATION 

ZEMLJA PARTNER 

PARTNER COUNTRY 

Novost koju uvodimo od ovog kongresa je “zemlja partner”. Cilj je ove ideje da se u bilateralnim 

razmjenama iskustva i znanja vezanih za struku dva nacionalna rinološka društva 

bolje upoznaju i tako zajednički pridonesu unapređenju nacionalnih rinologija. 

Čast nam je što će prvi partner Kongresa biti Bugarska čiji će rinolozi u većem broju 

sudjelovati u radu Kongresa. 

From this year on we are proud to introduce a “partner country” as a novelty in the organization 

of the congress. The aim of this idea is to raise bilateral exchange of professional 

knowledge to a higher level, and to help members of the two rhinology societies to better 

know each other. 

We are honoured to announce Bulgaria as the first partner country of the next year’s 

congress. A greater number of members of the Bulgarian Rhinology Society will be attending 

to the Congress. 



Mjesto i vrijeme održavanja kongresa Place and Time of the Congress 

Zagreb, Hotel International 

Zagreb, Hotel International 

23.-25. veljače 2012. 

23-25 February, 2012 

TEHNIČKI OGRANIZATOR / PCO PROFESSIONAL CONGRESS ORGANIZER 

Spektar putovanja PCO agency 

Tkalčićeva 15, 10000 Zagreb 

Tel: +385 1 4862 600 

Fax: +385 1 4862 622 

Email: pco1@spektar-holidays.hr 

SLUŽBENI JEZIK / OFFICIAL LANGUAGE 

Službeni jezik kongresa je engleski, simultanog prevođenja neće biti. 

The official language of the Congress is English. No simultaneous translation will be provided. 

KOTIZACIJA / REGISTRATION FEES 

Sudionici-liječnici / Participants-Physicians 2.500,00 kn 

Specijalizanti / Residents 2.000,00 kn 

Osobe u pratnji / Accompanying Persons 600,00 kn 

Izlagači / Exhibitors 500,00 kn 

Registracija uključuje: 

• Tiskani materijal simpozija 

• Pristup predavanjima – za sudionike 

(za osobe u pratnji predavanja nisu uključena) 

• Svečanost otvaranja i koktel dobrodošlice – za 

sudionike, izlagače i prateće osobe 

• Kave i ručkove tijekom stanke – 

za sudionike i izlagače 

VRIJEME REGISTRACIJE / REGISTRATION AND INFO DESK 

Četvrtak / Thursday 23.02.2012. 07,30-18,00 

Petak / Friday 24.02.2012. 08,00-18,00 

Subota / Saturday 25.02.2012. 08,00-13,00 


Registration fee includes: 

• Congress materials 

• Admission to all congress sessions 

for participants & residents 

(accompanying persons excluded) 

• Opening ceremony and welcome 

for participants, exhibitors 

• Coffee and lunch during the breaks 


17

18 


BODOVANJE / CERTIFICATE OF ATTENDANCE 

Povjerenstvo za medicinsku izobrazbu liječnika HLK kategoriziralo je i vrednovalo stručni skup 

pod nazivom „2. hrvatski rinološki kongres s međunarodnim sudjelovanjem“, i to kako slijedi: 

According to Croatian Medical Chamber participants at the Congress will be rated as follows: 

Predavači: 20 bodova / Speakers: 20 points 

Slušači: 10 bodova / Delegates: 10 points 

PROSTOR ZA IZLOŽBU / EXHIBITION AREA 

Vrijeme postavljanja izložbe / Set up time: 

Srijeda, 22. veljače 2012. od 17,00 sati / Wednesday, February 22, 2012, from 05.00 p.m. 

Vrijeme raspremanja izložbe / Dismantling time 

Subota, 25. veljače 2012. od 13,00 sati / Saturday, February 25, 2012, from 01.00 p.m. 

POSTER SEKCIJA / POSTER SECTION 

Posteri će biti izloženi od četvrtka, 23. veljače 2012. 

od 08,00 sati do subote 25. veljače 2012. do 09,00 sati. 

All posters will be exhibited from Thursday, February 23, 2012, 

08.00 a.m. to Saturday, February 25, 2012, 09.00 a.m. 


Dobro došli u Zagreb, 

glavni grad Republike Hrvatske! 

Zagreb je stari srednjoeuropski grad. 

Stoljećima se razvijao kao bogato kulturno i 

znanstveno te snažno trgovačko i gospodarsko 

središte. 

Nalazi se na sjecištu važnih prometnica 

između jadranske obale i srednje Europe. 

Zagreb je i poslovno središte, sveučilišni 

centar, grad kulture, umjetnosti i zabave. 

Iz Zagreba potječu i u njemu djeluju mnogi 

glasoviti znanstvenici, umjetnici i sportaši. 

Svojim gostima Zagreb nudi barokni ugođaj 

Gornjega grada, slikovite tržnice na otvorenom, 

raznovrsne trgovine i bogat izbor 

obrtničkih proizvoda, ukusnu domaću kuhinju. 

Zagreb je grad zelenih parkova i šetališta, s 

brojnim izletištima u prekrasnoj okolici. U 

treće tisućljeće ušao je kao milijunski grad. 

Unatoč brzom razvoju gospodarstva i prometa, 

sačuvao je osebujnu ljepotu i ugođaj 

opuštenosti, što ga čini pravim gradom po 

mjeri čovjeka. 

Iz arhive Turističke zajednice grada Zagreba 


Welcome to Zagreb, the capital city of 

the Republic of Croatia 

Zagreb is an old Central European city. For 

centuries it has been a focal point of culture 

and science, and now of commerce and 

industry as well. 

It lies on the intersection of important routes 

between the Adriatic coast, Central and East 

Europe. Zagreb is also the hub of the business, 

academic, cultural, artistic and sporting worlds 

in Croatia. Many famed scientists, artists and 

athletes come from the city, or work in it. 

Zagreb can offer its visitors the Baroque 

atmosphere of the Upper Town, picturesque 

open-air markets, diverse shopping facilities, 

an abundant selection of crafts and a choice 

vernacular cuisine. 

Zagreb is a city of green parks and walks, with 

many places to visit in the beautiful surroundings. 

The city has entered into the third 

millennium with a population of one million. 

In spite of the rapid development of the 

economy and transportation, it has retained 

its charm, and a relaxed feeling that makes it 

a genuinely human city. 


19

20 

Usmena izlaganja / Oral Presentations Program / Programme 

Posteri / Posters 

PROGRAM / PROGRAMME 

THURSDAY, FEBRUARY 23, 2012 GRAND SALON 

07.30 – 08.30 

Registration 

08.30 – 09.15 

OPENING CEREMONY AND WELCOME ADDRESS 

T. Baudoin – President, Rhinologic Section 

Gitaristički orkestar Guellyba 

Introduction lecture: Sinus and headaches 

S. Vlaminck (Bruges – Belgium) 

President, Belgian Rhinologic Society 

09.15 – 10.30 

Round table 1: CAS 

Chairperson: I. Klapan (Zagreb – Croatia) 

Moderators: M. D. Caversaccio, I. Klapan 

Participants: M. D. Caversaccio, I. Klapan, K. Obrovac, G. Kubat-Šimac 

Computer-assisted surgery and robot 

M. D. Caversaccio (Bern – Switzerland) 

Do we believe that computer-integrated surgery and virtual reality (VR) in rhinology 

provide better interactive VE-navigation using augmented reality and 3D-operating 

planning system? 

I. Klapan (Zagreb – Croatia) 

Integrirani sustav za 3D vizualizaciju i navigaciju u području rinokirurgije 

K. Obrovac (Zagreb) 

Diagnostic imaging of the paranasal sinuses and anterior skull base fossa 

G. Kubat-Šimac, K. Mršić, D. Lovrić, N. Bilić (Zagreb – Croatia) 


10.30 – 11.00 Coffee break 

11.00 – 12.15 

Round table 2: UNITED AIRWAYS 

Chairperson: G. Scadding (London – UK) 

Moderators: L. Kalogjera, A. Stipić Marković 

Participants: G. Scadding, L. Kalogjera, A. Stipić Marković, A. Gagro 

Update on ARIA 

G. Scadding (London – UK) 

Evidence-based medicine and the treatment of rhinosinusitis 

L. Kalogjera (Zagreb – Croatia) 

Biološka terapija u astmi i alergijskim bolestima 

A. Stipić Marković (Zagreb) 

Impact of allergic rhinitis on asthma development and control in children 

A. Gagro (Zagreb – Hrvatska) 

12.15 – 12.45 

Sponzorirano predavanje Medis Adria 

GeloMyrtol – snažan u dišnim putovima 

G. Geber (Zagreb) 

12.45 – 14.00 Lunch 

14.00 – 15.15 

Round table 3: FESS 

Chairperson: J. Koempel (Los Angeles – USA) 

Moderators: R. Mladina, T. Baudoin 

Participants: T. Baudoin, J. Koempel, R. Mladina, T. Braut 

Standardization for the use of navigation in FESS 

T. Baudoin (Zagreb – Croatia) 

Rhinosinusitis in children: Current concepts in the U. S. 

J. Koempel (Los Angeles – USA) 


21 

Program / Programme Usmena izlaganja / Oral Presentations 

Posteri / Posters

22 



The lamb’s head dissection: A novel and unique method for the training of endonasal 

endoscopic surgical techniques 

R. Mladina (Zagreb – Croatia) 

“Five-steps” technique for endonasal endoscopic orbital decompression 


FESS - preoperativna CT analiza 

T. Braut, M. Kujundžić, Du. Manestar, J. Vukelić, D. Komljenović, R. Starčević, D. Mateša-Anić 

(Rijeka) 


15.30 – 17.00 

Round table 4: RHINOSINUSITIS 

Chairperson: I. Pajić-Penavić (Slavonski Brod – Croatia) 

Moderators: Lj. Jovančević, S. A. Anzić 

Participants: I. Pajić-Penavić, Lj. Jovančević, A. Perić, S. A. Anzić 

Uloga Chlamydophila pneumoniae u nastanku kroničnog rinosinuitisa 

I. Pajić-Penavić, N. Pandak, D. Đanić, A. Sekelj, D. Babler (Slavonski Brod) 

Clinical application of nasal nitric oxide measurements in rhinology 

Lj. Jovančević, S. Savović, R. Jović (Novi Sad – Serbia) 

Effects of long-term low-dose treatment by clarithromycin on Th2 cytokines, CCL5 and 

ECP in nasal secretions of patients with nasal polyposis 

A. Perić, D. Vojvodić (Belgrade – Serbia) 

Correlation between laryngopharyngeal reflux and chronic rhinosinusitis 

S. A. Anzić (Karlovac – Croatia) 

17.00 – 18.00 GRAND SALON 

Meeting of the EXECUTIVE COMMITTEE of the CROATIAN SOCIETY OF ENT 

& HEAD AND NECK SURGERY 

20.00 Get Together Party (MATIS ABSOULT LOUNGE BAR) 


FRIDAY, FEBRUARY 24, 2012 GRAND SALON 

09.00 – 11.00 

Round table 5: SEPTORHINOPLASTY 

Chairperson: V. Bedeković (Zagreb - Croatia) 

Moderators: G. Kopačeva, P. Kabakchiev 

Participants: P. Kabakchiev, D. Džepina, F. Jakimovska, G. Kopačeva-Barsova, 

J. Netkovski, V. Bedeković 

Rhinoplasty - beauty and function 

P. Kabakchiev (Sofia – Bulgaria) 

Rhinoplasty in children 

P. Kabakchiev, D. Todorova (Sofia – Bulgaria) 

Plastično-rekonstruktivna kirurgija nosa 

D. Džepina (Zagreb) 

Rhinoseptoplasty: Managing of the nasal pyramid 

F. Jakimovska, G. Kopačeva-Barsova (Skopje – Macedonia) 

Nasal tip projection: Asymmetries after rhinoplasty 

G. Kopačeva-Barsova, F. Jakimovska, L. Dubrovska Miletić, M. Kirjas, 

M. Damjanovska (Skopje – Macedonia) 

Nasal obstruction after rhinoseptoplasty 

G. Kopačeva-Barsova, F. Jakimovska (Skopje – Macedonia) 

Reduction rhinoplasty 

J. Netkovski, B. Shirgoska (Skopje – Macedonia) 

External rhinoplasty (decortication) – pros and cons 

V. Bedeković, M. Ivkić (Zagreb – Croatia) 


11.30 – 11.50 

Keynote lecture: Endoscopic transnasal control of epistaxis 

N. Busaba (Boston – USA) 


23 


Posteri / Posters

24 



11.50 – 13.30 

Round table 6: SDB and OSA 

Chairperson: G. Račić (Split - Croatia) 

Moderators: R. Benchev, B. Šimunjak 

Participants: G. Račić, R. Benchev, B. Šimunjak, Ž. Roje, M. Milkov 

Učinkovitost i sigurnost kirurškog liječenja pacijenata s poremećajima disanja tijekom 

spavanja: naša iskustva 

G. Račić, Ž. Roje, M. Selimović, Z. Đogaš, R. Pecotić, M. Valić, V. Bulić (Split) 

Treatment of habitual snoring and mild forms of sleep apnoe by palatoplasty using 

cartilage implants from the nasal septum 

R. Benchev, S. Vasileva (Sofia – Bulgaria) 

The effectiveness of combined method od radio-frequency and cold knife uvulopalatoplasty 

in the treatment of primary snoring 

B. Šimunjak, B. Filipović, I. Raguž, M. Žižić-Mitrečić (Zagreb – Croatia) 

How to handle a patient with a sleep-disordered breathing? Split protocol 

Ž. Roje (Split – Croatia) 

Combined approach to obstructive sleep apnea and snoring with intraoral and intranasal 

devices 

M. Milkov (Sofia – Bulgaria) 

13.30 – 14.30 Lunch 

14.30 – 15.30 

Round table 7: CROATO-BULGARIAN RHINOLOGIC SESSION 

Moderators: D. Vicheva, T. Baudoin 

Participants: T. Baudoin, D. Vicheva, R. Benchev, V. Bauer, B. Grdinić, P. Kabakchiev, M. Milkov 

The future Bulgarian-Croatian rhinology collaboration 

D. Vicheva (Plovdiv – Bulgaria) 

Rhinology in Croatian general hospitals 

V. Bauer (Karlovac – Croatia) 

Što nas očekuje u akreditaciji bolnica? 

Boris Grdinić (Pula) 


15.30 – 16.30 

Round table 8: TUMORS & POLYPS 

Chairperson: P. Doležal (Bratislava – Slovakia) 

Moderators: M. V. Grgić, B. Jelavić 

Participants: P. Doležal, D. Zadravec, B. Jelavić, M. V. Grgić 

Management of patients with sinonasal carcinoma and olfactory neuroblastoma: 

Comparison of results 

P. Doležal, J. Hanzelová (Bratislava – Slovakia) 

The malignant tumors of the maxillofacial region: A radiological approach 

D. Zadravec (Zagreb – Croatia) 

Helicobacter pylori sinonasal colonization: relationship with nasal polyp 

histopathology or rhinosinusitis symptom severity 

B. Jelavić, V. Šoljić, D. Karan, H. Čupić, M. V. Grgić, T. Baudoin (Mostar, Zagreb – Bosnia and 

Herzegovina, Croatia) 

The goals in endoscopic surgery for chronic rhinosinusitis and nasal polyposis 

M. V. Grgić (Zagreb – Croatia) 


16.45 – 18.00 

Round table 9: RHINITIS 

Chairperson: R. Mladina (Zagreb – Croatia) 

Moderators: D. Markov-Glavaš, A. Včeva 

Participants: D. Miličić, A. Aleksić, D. Markov-Glavaš, R. Mladina, A. Včeva 

Therapy of vasomotor rhinitis 

D. Miličić (Zagreb – Croatia) 

Impact of intermittent and persistent allergic rhinitis on the development 

of bronchial hyperreactivity 

A. Aleksić, D. Travar, S. Spremo, D. Vranješ, 

Z. Novaković (Banja Luka – Bosnia and Herzegovina) 

Sinuitis u djece – dijagnoza i liječenje 

D. Markov-Glavaš (Zagreb) 


25 


Posteri / Posters

26 



Cobweb rhinitis: A new clinical entity on the horizon? 


Allergic rhinitis in children 

A. Včeva, H. Mihalj, Ž. Zubčić, Ž. Kotromanović, D. Birtić, J. Maleš (Osijek – Croatia) 

20.00 GALA DINNER (Grand Salon – Hotel International) 

SATURDAY, FEBRUARY 25, 2012 GRAND SALON 

09.00 – 11.00 

Round table 10: SKULL BASE 

Chairperson: K. Rotim (Zagreb – Croatia) 

Moderators: B. Čizmarević, C. Georgalas 

Participants: B. Čizmarević, R. Mladina, V. Čerina, K. Rotim, C. Georgalas, 

G. Poje, J. Ravnik, M. V. Grgić 

Kasne komplikacije poslije ozljeda frontalnog sinusa i prednje lubanjske baze 

B. Čizmarević, B. Lanišnik, P. Levart, T. Grošeta, D. Debevc (Maribor – Slovenia) 

Endoskopska endonazalna kirurgija klivalnih tumora 

R. Mladina (Zagreb) 

Pure endoscopic endonasal transsphenoidal technique: A new method in pituitary 

surgery 

V. Čerina, K. Rotim, M. Vrkljan, I. Kruljac (Zagreb – Croatia) 

Extended endonasal approaches to the skull base 

C. Georgalas (Amsterdam – The Netherlands) 

Image-guided endoscopic sinus and skull base surgery: Our experience 

G. Poje, R. Mladina (Zagreb – Croatia) 

Expanded endoscopic endonasal approach to the skull base pathology 

J. Ravnik (Maribor – Slovenia) 

Orientation in endoscopic anterior skull base surgery 

M. V. Grgić (Zagreb – Croatia) 



11.30 – 13.00 

Round table 11: FREE PAPERS 

Chairperson: D. Cikojević (Split – Croatia) 

Moderators: V. Bauer, D. Tomljenović 

Participants: D. Tomljenović, V. Bauer, R. Gulić, Du. Manestar, Z. Alerić, 

D. Cikojević, A. Pegan, I. Rašić, A. Pangerčić 

Rinokirurške operacije u razdoblju 2008./2009. i 2010./2011. godine na Klinici za ORL i 

kirurgiju glave i vrata KBC „Sestre milosrdnice“ 

D. Tomljenović, Tomislav Baudoin (Zagreb) 

Voice quality in allergic rhinitis 

V. Bauer, Z. Alerić, B. Knežević, D. Prpić, A. Kaćavenda (Karlovac – Croatia) 

Sphenoid sinus volume measurements on the basis of computer postprocessing of data 

acquired by high resolution computerized tomography and possible relationship with 

age, sex and mastoid pneumatisation 

R. Gulić, V. Ćuk, S. Belina, Ž. Vranješ, D. Vagić (Zabok, Osijek, Zagreb – Croatia) 

Učilo-model za vježbanje endoskopske kirurgije nosa 

Du. Manestar, S. Maričić, M. Perinić, Da. Manestar (Rijeka) 

Laryngeal symptoms – caused by allergy or laryngopharyngeal reflux? 

Z. Alerić, V. Bauer (Karlovac – Croatia) 

Middle turbinate osteoblastoma with intracranial extension 

D. Cikojević (Split – Croatia) 

Operativni zahvati obavljeni metodom FESS-a u razdoblju 2008./2009. i 2010./2011. na 

Klinici za ORL i kirurgiju glave i vrata KBC „Sestre milosrdnice“ 

A. Pegan, T. Baudoin (Zagreb) 

Rinokirurške operacije u razdoblju 2008./2009. i 2010./2011. – septoplastika i septorinoplastika 

I. Rašić, T. Baudoin (Zagreb) 

Cavernous haemangioma of the nasopharynx: A case report 

A. Pangerčić, T. Baudoin (Zagreb – Croatia) 

13.00 Adjourn 


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USMENA IZLAGANJA / ORAL PRESENTATIONS 

1. 

IMPACT OF INTERMITTENT AND PERSISTENT ALLERGIC RHINI- 

TIS ON THE DEVELOPMENT OF BRONCHIAL HYPERREACTIVITY 

Aleksandra Aleksić, Dmitar Travar, Slobodan Spremo, Dalibor Vranješ and Zorica Novaković 

Department of Otorhinolaryngology, Banja Luka University Clinical Center, Banja Luka, Bosnia and 

Herzegovina 

Introduction: Bronchial hyperreactivity (BHR) in a certain number of patients suffering 

from allergic rhinitis, and confirmed by bronchial methacholine test, is suspected as a 

predictor for the development of asthma. Objective: This study is aimed at confirming the 

presence of severe BHR in patients with intermittent (IAR) and persistent (PER) allergic 

rhinitis, as well as to investigate possible risk factors for the onset of BHR. Material and 

methods: The prospective study included 50 patients, who were all studied out of season. 

All patients underwent clinical examination, skin-prick test, spirometry and methacholine 

bronchial challenge. Results: The average age of patients was 33.62 yrs, 20 in male and 30 

in female patients. 48% of patients had IAR, and 52% of patients had PER. Sixteen (32%) 

patients had BHR, 8 (16%) of them had very mild, 5 (10%) mild and 3 (6%) moderate BHR. 

There was no statistically significant difference between the onset of severe BHR and the 

type of allergic rhinitis. Positive predictive value is, in our case, the duration of allergic 

rhinitis >5 years, sensitization to Dermatophagoides pteronyssinus and pollen (polysensitization). 

These factors are statistically significantly associated (p

2. 

LARYNGEAL SYMPTOMS - CAUSED BY ALLERGY OR LARYNGO- 

PHARYNGEAL REFLUX? 

Zorica Alerić and Vladimir Bauer 

Department of Otorhinolaryngology, Karlovac General Hospital, Karlovac, Croatia 

The upper aerodigestive tract can be adversely affected, directly and indirectly, by gastroesophageal 

reflux and by environmental allergens. Clinical manifestations of laryngopharyngeal 

reflux (LPR) are similar to the appearance of the larynx in allergy. The aim of this 

study is to show that the specific laryngeal symptoms and signs could be primarily caused 

not only by reflux but the allergy, more often than is thought. Thirty four patients, 23 

females and 11 males, with laryngeal symptoms were included in the study. All patients 

underwent clinical examination, skin prick testing (SPT), nasal cytology, RIST and eosinophilic 

cationic protein serum analysis, as well as videolaryngoscopy with assessment of 

the laryngeal symptoms and signs using the reflux finding score (RFS) and reflux symptom 

score (RSI). Patients with vocal fold lesions, neurologic disorders and asthma were 

excluded. Eleven (32%) patients were diagnosed with allergic rhinitis and 16 (47%) with 

LPR. Seven patients did not match the criteria for either of the entities. Two out of allergic 

patients also filled criteria for LPR. RFS scores in SPT negative group were significanthly 

higher than in the group with positive SPT, p

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3. 

CORRELATION BETWEEN LARYNGOPHARYNGEAL REFLUX AND 

CHRONIC RHINOSINUITIS 

Srđan Ante Anzić 

Department of Otorhinolaryngology, Karlovac General Hospital, Karlovac, Croatia 

Background: The etiology of chronic paranasal sinus inflammation has not yet been sufficiently 

clarified. The hypothesis of this study is based on the correlation between laryngopharynegeal 

reflux (LPR) and chronic paranasal sinus inflammation (CPSI). The aim of this 

study was to ascertain whether treating the LPR with proton pump inhibitors influences 

the quality of the chronic rhinosinusitis treatment.Methods: The research was carried 

out as a double-blind placebo controlled study. Sixty patients with the LPR symptoms and 

evidence of CPSI underwent testing, which included the reflux symptom index (RSI), reflux 

finding score (RFS), pathohistological examination of the lower turbinate, eosinophil 

cationic protein (ECP) analysis of the nasal lavage fluid, and the 24-hour pH-evaluation 

using nasopharyngeal, oropharyngeal and esophageal sensors. For 60 days, one patient 

group was given proton pump inhibitors (omeprazole) in 20 mg doses, while the controlgroup 

was given placebo. The initial testing was repeated after completion of the therapy. 

Results: There is a strong correlation between RSI and RFS, as well as between KRS and 

EN. Before the therapy, there was no statistically significant difference in RFS in placebo 

group and the therapy group. After the therapy, RFS was lower in the therapy group (p0, 

05). After the therapy, ECP was statistically significantly lower (p=0,000). Conclusion: The 

results support the hypothesis of this study. The RSI score was lower after the therapy, but 

statistically not significant in connection to the applied therapy. That leads to the conclusion 

that further research of the chosen dose and the duration of treatment is needed. 

4. 

STANDARDIZATION FOR THE USE OF NAVIGATION IN FESS 

Tomislav Baudoin 

Department of Otorhinolaryngology & Head and Neck Surgery, Zagreb School of Medicine, Sestre 

milosrdnice University Medical Center, Zagreb, Croatia 

Functional endoscopic sinus surgery (FESS) has been developing since 80’s very fast. 

Messerklinger conceived FESS in the first place to manage chronic sinusitis. Nowadays, 


any pathology in the region of the nose and paranasal sinuses and many pathological processes 

in adjacent areas such as skull base, orbit or even brain can be successfully treated 

by FESS. ENT navigation tremendously improved FESS. The problem is that navigation 

system has not yet been used on a regular basis. Navigation system should be used routinely 

in everyday surgery in any case, even the easiest one, and by each surgeon doing 

the FESS. It means, not just for selected severe pathology and not solely in special medical 

facilities. The reasons are multifold: medical, ethical, legal and - surgical. An important 

condition for the use of the navigation system is to standardize this surgical process and 

in this way it will no longer be used randomly, but systemically. In this way ENT navigation 

will be used according to some algorithm for each single endoscopic sinus surgery 

procedure. Our algorithm is based on five compartments which should be marked on the 

navigation system: 1. vestibulum nasi chamber, 2. OMC chamber, 3. anterior ethmoid 

chamber, 4. posterior ethmoid chamber, and 5. sphenoid chamber. Each compartment 

consists of four points and natural ostia as additional points, two in the third compartment 

– anterior ethmoid compartment, and one in the fifth compartment – sphenoid 

compartment. Three of them make a triangle, and one is inside the chamber. During FESS 

and before any surgical activity in formerly mentioned chambers, at least two of four 

points should be recognized, and one of the two should be a point inside the chamber. 

Also, ostia must be marked in the chambers where they exist. Of course, some important 

anatomical structures could be marked besides these obligate points, as optional points. 

Any pathology within the chambers must be marked as an obligate point. 

5. 

VOICE QUALITY IN ALLERGIC RHINITIS 

Vladimir Bauer, 1 Zorica Alerić, 1 Bojana Knežević, 2 Dubravka Prpić2 and Anita Kaćavenda2 1 Department of Otorhinolaryngology, Karlovac General Hospital, and 2Karlovac SUVAG Polyclinic, 

Karlovac, Croatia 

There are only a few studies about voice changes in allergic rhinitis (AR). The aim of this 

study is to evaluate subjective and objective changes in voice quality in patients with 

persistent AR. Twenty patients, mean age 40.7±11.2, 8 male and 12 female with AR and 

16 sex and age-matched indivinduals of the control group were assessed. Subjective voice 

impairment was scored according to Voice Handicap Index (VHI). Patient’s perceptual 

voice analysis was assessed using GRBAS scale including Grade of Dysphonia, Roughness, 

Breathiness, Asthenia and Strain items. The analyzed objective voice parameters were: 


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fundamental frequency, highest frequency, lowest frequency, voice range, jitter, shimmer 

and maximum phonation time. Patients underwent videolaryngostroboscopic examination. 

All patients had symptoms of persistent AR confirmed with skin prick tests on inhaled 

allergens (positive reaction on dust mites). Nasal symptoms were scored according to total 

nasal symptom score (TNSS). Compared with the control group we found significant 

differences in VHI (18.9 in AR group and 4.8 in controls, p

cameras) with other surgical profiles is rather the exception than the rule. No navigation 

system has been used for the sinus surgery. There is a possibility for olfactometry in 

quarter of the hospitals, for radio frequency surgery in three, and for rhinomanometry 

only in two hospitals. Skin prick test is performed in just one ENT service; all others use 

allergologic services in collaborative hospital departments. Rhinology in the state general 

hospitals share the achievements and difficulties of the overall medicine in Croatia, with 

some good results but still with a lot of space left for improvement. Vision and strategy of 

the development are needed. 

7. 

EXTERNAL RHINOPLASTY (DECORTICATION) – PROS AND CONS 

Vladimir Bedeković and Mirko Ivkić 



The pioneer of aesthetic surgery of the nose, Jacques Joseph, performed his first operations 

using an external approach. This approach was not widely accepted until prof. Padovan 

introduced this approach in the United States in the 1970s. Since then, rhinoplasty 

surgeons have employed this approach in their everyday practice. The external approach 

had, at the beginning, a great number of opponents. Their main objections were that 

there is a scar on the collumela, that stability of the nasal tip is disturbed and that edema 

is much longer than in an internal approach, not to mention the prolonged operation 

time. However, those objections do not stand. On the contrary, the biggest advantage of 

this approach is in the stabilization of the nasal tip and the possibility of grafting, suturing 

and remodelling the nasal tip. Here we come to the main point which is remodelling, and 

sculpturing, not only operating. The most commonly used techniques in surgery of the 

nasal tip aim toward the narrowing of the nasal tip, but years after the healing process 

and scarring ends, the final result is a small, narrow but bulbous tip. Since the bony pyramid 

stabilizes and stays this way, inadequate surgery on the cartilaginous components 

results in disturbance of the harmony of the upper, middle and lower parts of the nose. 

Using an external approach, this negative scenario can be avoided and a long term result 

can be achieved. The external approach is just another approach to nasal structures and it 

provides possibilities for solving problems in a more adequate way. A rhinoplasty surgeon 

must be familiar with the external approach, not only the intranasal approach. 


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8. 

ТREATMENT OF HABITUAL SNORING AND MILD FORMS OF 

SLEEP APNOE BY PALATOPLASTY USING CARTILAGE IMPLANTS 

FROM THE NASAL SEPTUM 

Rumen Benchev 1 and Svetla Vasileva 2 

1 St. Pantaleimon Hospital and 2 Medical Institute of the Ministry of Interior, Sofia, Bulgaria 

The goal of the report is to share our results in the treatment of habitual snoring and 

mild forms of sleep apnoe by implanting cartilages from the nasal septum in the soft 

palate. The following method was used in cases with nasal obstruction due to septal deviation 

and snoring, the cartilages left after the inferior and posterior chondrotomy were 

implanted into the palate. The idea for stabilization of the soft palate with autological 

cartilage was taken from The Pillar Procedure, where allogenic implants are inserted in 

the middle of the soft palate by special pistol. Twenty seven patients from 27 to 64 years 

of age were operated upon, 70% of them were males. The indications for surgery were 

set after endoscopic and functional assessment of the upper respiratory tract, Мüller’s 

test, questionnaires, visual-analogue scale /VAS/ and polisomnography in patients suspected 

for obstructive sleep apnoe. The results of the surgical treatment were measured 

by functional assessment of nasal breathing and VAS. Subjective improvement of snoring 

was found in 82% and objective improvement of nasal breathing in 86% of the patients 6 

month after the operation. It is concluded that the described method could be used successfully 

in well selected patients. 

9. 

FESS - PREOPERATIVNA CT ANALIZA 

Tamara Braut, Milodar Kujundžić, Dubravko Manestar, Jelena Vukelić, Dean Komljenović, Radan 

Starčević i Dubravka Mateša-Anić 

Klinika za otorinolaringologiju i kirurgiju glave i vrata KBC Rijeka, Rijeka 

Razvoj endonazalne sinusne kirurgije od liječenja upalnih bolesti prema benignim i malignim 

tumorima pospješen je detaljnim informacijama prikupljenim novim radiološkim 

tehnikama. Suvremeni CT visoke prostorne rezolucije omogućuje uvid u točne anatomske 

odnose te daje preciznu prezentaciju tankih koštanih struktura sinonazalnih zidova. Svakoj 

funkcionalnoj endoskopskoj kirurgiji sinusa treba prethoditi podrobna CT analiza pa- 


anazalnih sinusa pacijenta. Informacije dobivene CT analizom neophodne su za ispravno 

planiranje vrste i opsežnosti zahvata koji slijedi. G. Sulsenti je rekao „bit dobrog kirurga je 

biti dobar anatomičar“. Cilj CT analize paranazalnih sinusa jest: 1. evaluacija predispozicijskih 

anatomskih faktora koji mogu dovesti do poremećaja mukocilijarnog transporta i 

drenaže, 2. prepoznavanje anatomskih varijanata koje predstavljaju kirurški rizik te mogu 

dovesti do potencijalnih operacijskih komplikacija, 3. procjena lokoregionalne propagacije 

patološkog procesa i 4. identifikacija komplikacija bolesti. Anatomske varijante vrlo su 

česte, brojne su asimptomatske, a samo ako kompromitiraju mukocilijarnu drenažu, treba 

ih tretirati kao patološki nalaz. Pacijenti s kroničnim upalama (kao što su jake alergije 

ili sinonazalna polipoza) trebali bi primiti medikamentnu terapiju nekoliko tjedana prije 

skeniranja. Za dobru CT analizu potrebno je veliko iskustvo, pravilni presjeci te poznavanje 

složene anatomije paranazalnih sinusa kako bi se operateru pružile sve potrebne informacije 

za siguran zahvat. Ovisno o patologiji i planiranom zahvatu kirurg treba zatražiti od 

radiologa detaljniju analizu regije od interesa. Samo uz dobru preoperativnu CT analizu 

moguće je sa sigurnošću pristupiti funkcionalnoj endoskopskoj kirurgiji sinusa. 

10. 

ENDOSCOPIC TRANSNASAL CONTROL OF EPISTAXIS 


Harvard Medical School and Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA 

Introduction: Epistaxis is a common clinical disorder. Treatment is dictated by its frequency, 

severity, and location. The majority of anterior epistaxis cases can be controlled with 

conservative measures. Posterior epistaxis is typically more severe and harder to control. 

The traditional modes for controlling posterior epistaxis include various forms of packing, 

arterial embolization, and surgery. Transantral internal maxillary and ethmoid artery ligation 

can be associated with significant morbidity. Objective: Describe our experience with 

endoscopic transnasal control of epistaxis. Material and Methods: This is a retrospective 

review of 35 consecutive patients who presented with posterior epistaxis and failed nasal 

packing. Clinical data reviewed included patient demographics, sinus CT imaging, nasal 

endoscopy findings, surgical technique, operative complications, and length of hospital 

stay. Results: The study group consisted of 24 males and 11 females with a median age of 

57 years. CT and CT angiogram aided in surgical planning. The source of bleeding was superior 

nasal septum in 12 patients, posterior nasal septum in 6 patients, and lateral nasal 

wall in 17 patients. Hemostasis was achieved by endoscopic cauterization in 22 patients 

and sphenopalatine artery (SPA) ligation in the remaining 13 patients. Average surgical 


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time was 50 minutes, average blood loss was 50 ml, and average hospital stay was one 

day. There were no operative complications. The surgical technique of SPA ligation will 

be described with a video demonstration. Conclusion: Transnasal endoscopic control of 

epistaxis is effective in the treatment of posterior epistaxis. The surgery allows for an 

accurate diagnosis of the source of bleeding and targeted hemostasis. In addition, it has 

low morbidity, short operative time, and short hospital stay. The majority of cases does 

not require formal SPA ligation, and hence may be staffed by any otolaryngologist familiar 

with endoscopic techniques. 

11. 

COMPUTER-ASSISTED SURGERY AND ROBOT 


Department of ENT, Head and Neck Surgery, University Hospital, Bern, Switzerland 

For 15 years we have been performing CAS at our ENT-university clinic. Different researches 

were performed together with the Institute for Surgical Technology and the Artorgcenter. 

The main clinical focus is the application of CAS-robot in endonasal surgery/skull 

base as well as lateral skull base. New technologies will be presented like CAS afterloading, 

augmented reality in the endoscope, PET-CT guided navigation and telemanipulator 

(robot). 

Acknowledgments: 

NCCR CO-ME (www.co-me.ch) 

ISTB (www.istb.unibe.ch) 

ARTORG (www.artorg.unibe.ch) 

Inselspital (www.hno.insel.ch) 


12. 

MIDDLE TURBINATE OSTEOBLASTOMA WITH INTRACRANIAL 

EXTENSION 

Draško Cikojević and Marisa Klančnik 

Department of Otorhinolaryngology & Head and Neck Surgery, Split University Hospital Center, 

Split, Croatia 

Benign osteoblastoma is an uncommon bone tumor, representing 1% of all benign tumors 

and 3% of all primary bone tumors. It is most commonly located in the vertebral column 

and metaphysis or diaphysis of the long bones. Intranasal or paranasal osteoblastoma 

is particularly rare. They occur most commonly within the frontal sinus (52%), followed 

by the ethmoid (22%), the maxillary sinus (5.1%) and the sphenoid (1.7%). It is very rare 

for an osteoblastoma to arise in the nasal cavity or turbinates. Only five middle turbinate, 

one superior turbinate and one inferior turbinate osteoblastoma cases have been 

reported in the literature to date. Osteoblastomas usually occur in patients

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area, a superior close up of the anatomy and an improved working angle represent some 

of the advantages brought by the use of the endoscope to the pituitary surgery. The additional 

use of computer-based neuronavigation lowers complication rates and shortens 

operation’s length. In comparison to microsurgical technique, PEETS is associated with 

decrease in length of hospital stays and operative times, mean blood loss, immediate 

postoperative diabetes insipidus, some rhinologic complications and patient’s pain and 

discomfort since it does not require nasal packing. Despite the advantages of endoscopic 

technique, the extent of tumor resection and hormonal excess normalization in functional 

pituitary adenomas generally do not differ in these two techniques. This is possibly due 

to lack of prospective randomized studies. In our series of 117 consecutive patients who 

underwent PEETS in period between 2007 and 2010, remission was achieved in 84% of 

patients: in 100% microadenoma and in 70% of macroadenoma patients anatomical complications 

occurred in only four patients (3.4%). Based on our results and experience, we 

claim that PEETS is an effective new technique in pituitary surgery. 

14. 

KASNE KOMPLIKACIJE POSLIJE OZLJEDA FRONTALNOG SINUSA I 

PREDNJE LUBANJSKE BAZE 

Bogdan Čizmarević, Boštjan Lanišnik, Primož Levart, Tomislav Grošeta i David Debevc 

Odjel za otorinolaringologiju, cervikalnu i maksilofacijalnu kirurgiju UKC Maribor, Maribor, Slovenija 

U liječenju ozljeda frontalnog sinusa cilj je uspostavljanje normalne funkcije sinusa i 

sprečavanje mogućih kasnih komplikacija koje se mogu pojavljivati više godina poslije 

ozljede. U retrospektivnoj analizi pregledali smo liječničke kartone svih ozljeđenika koji su 

bili liječeni na našem odjelu od 1996. do 2008. godine. Bolesnike smo podijelili u dvije skupine. 

Prvu skupinu činili su bolesnici u razdoblju od 1996. do 2003. godine, a drugu bolesnici 

od 2004. do 2008. Kao rane komplikacije shvaćamo one koje se pojavljuju odmah nakon 

liječenja do šest mjeseci poslije, kao rane kasne one koje se pojavljuju do tri godine i kao 

kasne one koje se pojavljuju poslije tri godine. U prvoj grupi imali smo 72, a u drugoj 32 

bolesnika. U prvoj grupi kasne posljedice pojavile su se u trojice ozlijeđenih (2 mukokele 

i jedan osteitis), a u drugoj grupi u jednog bolesnika (osteitis). Svi ozlijeđeni bili su liječeni 

po istim principima. Kad je bilo moguće, učinjena je konzervativna operacija, a kad to nije 

bilo moguće, učinjena je kranijalizacija. Kasnih komplikacija relativno je malo i približno isto 

(procentualno) u obje grupe. U prvoj grupi imamo nešto više ranih komplikacija, koje su posljedice 

čuvanja manjih koštanih fragmenata. U drugoj grupi takvih komplikacija više nema. 

To pripisujemo tome da umjesto manjih koštanih fragmenata koristimo titanijevu mrežicu. 


15. 

MANAGEMENT OF PATIENTS WITH SINONASAL CARCINOMA 

AND OLFACTORY NEUROBLASTOMA: COMPARISON OF RESULTS 

Pavel Doležal and Jana Hanzelová 

Otorhinolaryngologic Clinic, University Hospital Bratislava, Bratislava, Slovakia 

Background: Current management of sinonasal malignancies includes endoscopic transnasal 

anterior skull base resection, craniofacial resection from external approach and nonsurgical 

oncologic procedures. Material: from 2004 to 2009 37 patients with sinonasal 

malignant tumors were treated in Otorhinolaryngologic Department, University Hospital 

in Bratislava. Retrospective study evaluating 21 patients with cancer of the nasal cavity 

and paranasal sinuses, and 6 patients with olfactory neuroblastoma (ONB) is presented. 

Distribution of patients with carcinoma was as follows - squamocellular carcinoma (SCC) 

14, adenocarcinoma (ADC) 5, sinonasal undifferentiated carcinoma (SNUC) 2. Methods: 

In 21 patients with cancer, endoscopic resection (ER) was performed in 6 cases, external 

approach in 8 cases and primary non-surgical therapy in 7 cases. All patients with ONB 

were treated by ER, then in 4 cases of tumor persistence by external approach (anterior 

subcranial resection – 3, partial resection of maxilla – 1) followed by radiotherapy. Results: 

Overall suvival rate for ADC is 25% ( med. 50 months), for SCC a SNUC 18% (med. 40 

months), for ONB 74% (med. 85 months). Conclusion: Locoregional tumor extension and 

free margins during resection are the dominant prognostic indicators. Orbital exenteration 

did not improve oncological results. 

16. 

RECONSTRUCTIVE SURGERY OF THE NASAL VALVE 

Davor Džepina 



The nasal valve is complex and frequently overlooked term in nasal functional and aesthetic 

surgery. We divide it into internal and external nasal valve. Both entities belong 

to anatomically strictly defined areas which need to be recognized and carefully preserved 

in nasal surgery. Nasal obstruction can result from internal as well as external 

valve problems, before and after septorhinoplasty. There are several surgical methods 


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and techniques that succesfully deal with the nasal valve insufficiency. To resolve nasal 

obstruction at the internal valve, spreader grafts and rotation flaps, upper lateral splay 

graft, butterfly graft, flaring sutures, M-plasty, Z-plasty, and suspension sutures have been 

described. Further, surgical management of the external valve is made possible by lateral 

crural modification, lateral crural strut grafts, alar batten grafts, lateral crural turn-in flap, 

alar rim grafts, and other methods. Sometimes combining both approaches offers best 

possible solution for problem. Careful preoperative clinical exam and documentation are 

obligatory steps in recognizing and choosing appropriate surgical approach. Only after a 

thorough examination and data analysis, the underlying cause of the nasal obstruction 

can be well understood, and one or multiple procedures can be chosen according to each 

individual problem. 

17. 

IMPACT OF ALLERGIC RHINITIS ON ASTHMA DEVELOPMENT 

AND CONTROL IN CHILDREN 

Alenka Gagro 

Department of Pediatrics, Children’s Hospital Zagreb, Sestre milosrdnice University Medical Centre, 

Zagreb, Croatia 

The presence of rhinitis at the age of seven was associated with an approximate threefold 

risk of subsequently developing asthma. Asthma is similarly associated with allergic 

and nonallergic rhinitis, suggesting a link between upper and lower airways beyond allergy 

associated inflammation. Another well-known risk factor for the development of 

both rhinitis and asthma is the presence of atopy in infants with eczema; however, the 

impact of early treatment of infant’s eczema on the development of allergic rhinitis and 

asthma is not known. Environmental factors such as exposure to tobacco smoke but not 

obesity also affect the presence or progression of „The Allergic March“. The nature of association 

of rhinitis and asthma is poorly understood and there is a lack of data investigating 

this association especially in young children. Nasal symptoms, airflow and markers of 

inflammation directly correlate with lower airway involvement. Local tissue factors, such 

as microbial stimuli and systemic inflammatory mechanisms, play a role in the clinical 

expression of the allergic airway syndrome also. Taking these complex interactions into 

account it is presumed that early and appropriate recognition and treatment of rhinitis influence 

both prevention and control of asthma in children. However, in contrast to adults, 

treatment of allergic rhinitis did not affect lower airway inflammation (as measured by 


exhaled NO). Management strategies that target the underlying cause of allergic rhinitis 

in children, such as specific immunotherapy, have the potential to offer additional symptom 

control in asthmatic children, and possibly prevent disease progression. Prospective 

studies are required to determine if treatment of rhinitis can prevent the development of 

asthma, and/or decrease airway inflammation to improve asthma outcomes in those with 

established asthma. This is particularly important for pediatric population since allergic 

rhinitis is often overlooked or undertreated. 

18. 

EXTENDED ENDONASAL APPROACHES TO THE SKULL BASE 


Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands 

In the past 10 years the ENT/Neurosurgical team of the Academic Medical Center in Amsterdam 

made the transition from the traditional endoscopic approach for pituitary tumors 

to the extended approach. Our experience with complete removal of large pituitary 

tumors with cavernous sinus involvement or suprasellar extension, motivated us to move 

on to other pathologies of the anterior skull base. We followed the modular approach 

of Pittsburg team, with increasing levels of complexity, up to level 4B (see table 1). In 

the past year we removed meningiomas of the tuberculum sellae, the olfactory groove 

and the petroclival region, sellar and retro-chiasmatic craniopharyngeomas and clival 

chordomas in 16 patients from 10 to 75 years of age. Closure of the cranial base was 

typically done with fascia lata and a pedicled mucoseptal flap. Complete tumor removal 

was possible in all but two cases. The access and visualization of the extended approach 

offered in these cases is superior to any craniotomy. It has now become possible to see, 

and thus often preserve, the pituitary gland and stalk in craniopharyngioma patients, although 

pituitary function was not initially preserved. Arterial supply of the optic nerves 

and chiasm can be visualized like never before. Although data that will definitely prove 

that this approach provides better results than conventional approaches are missing, we 

were impressed with the immediate improvement of pre-existing visual field defects in 

the majority of our patients. Particularly in pediatric patients (8 years and older depending 

on sinus pneumatization), this approach seems promising. We feel that a graduated 

approach, good teamwork and constant critical appraisal of our results were decisive factors 

in making this move in a relatively short period of time. The extended endonasal 

approach is becoming our approach of choice for all cranial base midline pathologies with 

relatively limited lateral extension. 


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19. 

ŠTO NAS OČEKUJE U AKREDITACIJI BOLNICA? 


Djelatnost za bolesti uha, nosa i grla Opće bolnice Pula, Pula 

Akreditacija je metoda vanjskog vrednovanja koja ocjenjuje usklađenost s akreditacijskim 

standardima u sklopu jasno definiranog akreditacijskog postupka, a ujedno je 

najučinkovitija metoda vanjskog vrednovanja rada u smislu unapređenja kvalitete i sigurnosti 

zdravstvene zaštite. Za akreditaciju se do sada prijavila 21 hrvatska bolnica i u tijeku 

su prilagodbe prijavljenih ustanova akreditacijskim standardima, a to su: sustav osiguranja 

i poboljšanja kvalitete zdravstvene zaštite, uprava bolničke zdravstvene ustanove, 

zaposlenici bolničke zdravstvene ustanove, pregled korištenja zdravstvenih usluga, prava 

pacijenata, služba za medicinsku dokumentaciju, zdravstvena njega, planiranje otpusta, 

kontrola infekcija i sustav upravljanja sigurnošću. Bolnica mora vrednovati sve kliničke i 

nekliničke usluge, pokazatelje kvalitete, neželjene događaje za pacijente i zaposlenike, 

primjenu kliničkih smjernica, kliničkih putova i algoritama, uporabu lijekova, kontrolu infekcija, 

visokorizične postupke, primjenu svih oblika anestezije, uporabu krvi i krvnih pripravaka, 

ograničavanje/odvajanje pacijenata, preuzimanje pacijenata, pregled korištenja 

usluga, pravovremeno i čitko popunjavanje medicinskih kartona pacijenata, inovacije zaposlenika, 

sigurnost okruženja, iskustvo i zadovoljstvo pacijenata i zaposlenika. U bolnici 

mora biti uspostavljen sustav za upravljanje neželjenim događajima, koji mora uključivati 

prijavu neželjenih događaja, procjenu rizika, odgovarajuću analizu i primjenu popravnih 

i preventivnih radnji, povratnu informaciju te postupak obavješćivanja pacijenata o 

neželjenim događajima. U izlaganju će težište biti na postupcima koje će svi liječnici, pa 

tako i rinolozi morati usvojiti u svakodnevnoj praksi: sustavni klinički pregled, kirurški sustavni 

pregled, smjernice za najčešće bolesti, pristanak informiranog bolesnika, kontrola 

medicinske dokumentacije, prijave neželjenih događaja i još puno toga! 


20. 

THE GOALS IN ENDOSCOPIC SURGERY FOR CHRONIC RHINOSI- 

NUSITIS AND NASAL POLYPOSIS 




The endoscopic surgery for chronic sinusitis with or without nasal polyps is reserved for 

the cases that do not respond to conservative medical therapy. Although this therapeutic 

modality is well established, there are still several related issues prone to discussion. The 

most important ones are indication and extent of surgery. It is not always simple to decide 

whether to operate or not. The decision is not a problem in massive polyposis, in cases 

with mucocellae with bone destruction, or in cases with complications. But in patients 

with less dramatic symptoms it might not be that simple. Another issue which arises 

when we indicate operation is the extent of surgery required for the specific patient. 

There is no consensus regarding this, and the extent of surgery should be discussed with 

patient before surgery. It is questionable whether the greater extent of surgery is related 

to longer lasting results, but undoubtedly it is related to greater risk of complications. 

Every surgeon should be aware of discrepancy between severity of treated symptoms 

and severity of possible complications. Next important issue is the durability of surgical 

results. Surgeon should know how to predict the results of his operation, and the patient 

should be aware of that as well, to avoid disappointment with results. 

21. 

ORIENTATION IN ENDOSCOPIC ANTERIOR SKULL BASE SURGERY 




The evolution of endoscopic instruments and techniques has dramatically changed the 

possibilities and philosophy in anterior skull base surgery. Starting with simple polypectomies 

at the beginning, today’s possibilities include management of lesions that extend far 

beyond the sinuses and nasal cavity. It has become obvious that this kind of surgery requires 

not only ENT expertise, but also neurosurgical and ophthalmologic training. There 


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are suggestions to fuse those different levels of trainings into a new one – skull base surgeon. 

Until it happens, endoscopic skull base surgery is going to be multidisciplinary area. 

There are several important issues when considering to manage the skull base pathology 

endoscopically. Availability of appropriate equipment is mandatory, and will not be discussed 

here. One of the most difficult things in performing endoscopic surgery for the 

novice but even for more experienced surgeon is to keep orientation during the surgery. 

The key elements how to keep orientation are discussed here. The thorough knowledge 

of individual patient’s anatomy is of utmost importance. This requires a detailed study of 

preoperative CT scan of the same patient. Awareness of the angle of endoscope is also 

very important since the error can lead the surgeon in wrong direction. The use of intraoperative 

navigation – so called computer-assisted surgery – can be helpful, but it cannot 

be overemphasized that the main instruments for navigation are surgeon’s eyes and 

brain. Advantages and drawbacks of computer-assisted navigation are discussed. 

22. 

SPHENOID SINUS VOLUME MEASUREMENTS ON THE BASIS OF 

COMPUTER POSTPROCESSING OF DATA ACQUIRED BY HIGH 

RESOLUTION COMPUTERIZED TOMOGRAPHY AND POSSIBLE 

RELATIONSHIP WITH AGE, SEX AND MASTOID PNEUMATIZATION 

Rozita Gulić, 1 Višeslav Ćuk, 1 Stanko Belina, 1 Željko Vranješ, 2 Davor Vagić, 3 

1 Zabok General Hospital, Zabok, Croatia 

2 Department of Otorhinolaryngology, Osijek Clinical Hospital Center, Osijek, Croatia 

3 Department of Otorhinolaryngology & Head and Neck Surgery, Zagreb School of Medicine, Sestre 


The aim of this study was to investigate relationship between sphenoid sinus volume 

and mastoid air cells pneumatization. Measurements were performed by Syngo 2006G 

volumetric software on the basis of three-dimensional (3D) reconstruction of high resolution 

computed tomography (HRCT) scans of temporal bones and paranasal sinuses. HRCT 

scans were stored in DICOM format. We performed HRCT of temporal bones and paranasal 

sinuses in 66 subjects. Median age was 54 years (range 17-84). There were 35 female 

and 31 male subjects. Median volume of right mastoid was 4,86 cm3 whereas it was 5,31 

cm3 on the left side. Median sphenoid total volume was 10,12 cm3. We found significant 

positive correlation between sphenoid total volume and both left and right mastoid pneumatization. 

(Spearman rs=0,528, p=0,0001 and rs=0,450, p=0,0001, respectively). Sphe- 


noid volume was positively but not significantly correlated with age (rs=0,186; p=0,136). 

Both right and left mastoid pneumatization was negatively correlated with age (rs=-0,391; 

p=0,001 and rs=-0,379; p=0,002). Sphenoid sinus volumes of male subjects were larger 

than those of females, but the mastoid air cells showed no differences between the sexes. 

23. 

RHINOSEPTOPLASTY: MANAGING OF THE NASAL PYRAMID 

Frodita Jakimovska and Gabriela Kopačeva Barsova 

University ENT Department, University Hospital, Skopje, Macedonia 

As the central feature of the face, the nose has a profound effect on facial aesthetic values. 

The rhinoseptoplasty is the surgical intervention addressed to the nasal pyramid and 

the airways with aesthetical and functional purpose. Creating a normal appearing dorsum 

postoperatively requires an understanding of the surgical anatomy of the dorsum 

– specifically those characteristics and relationships that determine external appearance. 

Three anatomical nasal components are responsible for the preoperative profile appearance: 

the nasal bones, the cartilaginous septum, and the alar cartilages. Generally, all 

three must undergo modification to create a pleasing and natural profile alignment. It is 

often useful to evaluate the nasal pyramid from the frontal view. The deviated dorsum 

comes in many forms and in no way can a single operation be universally applied to all 

patients. The nose with a bony deviation is entirely different from the collapsed upper 

lateral cartilage or the dislocated caudal septum, although both may resemble a “twisted 

nose”. The septum may also have a direct or indirect role in solving aesthetic problems of 

the nose. The saddle nose, tension nose, or crooked nose usually cannot be satisfactorily 

corrected without a septoplasty. At the same time, altering the septal cartilage can also 

affect the appearance of the nasal tip. Structural principles will serve as the foundation, 

emphasizing the areas in the nose in which the intersection of form and function are most 

important. 


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24. 

HELICOBACTER PYLORI SINONASAL COLONIZATION: RELATION- 

SHIP WITH NASAL POLYP HISTOPATHOLOGY OR RHINOSINUS- 

ITIS SYMPTOM SEVERITY 

Boris Jelavić, 1 Violeta Šoljić, 2 Dragana Karan, 2 Hrvoje Čupić, 3 Marko Grgić4 and Tomislav Baudoin4 1 Department of Otorhinolaryngology, Mostar University Hospital, Mostar, Bosnia and Herzegovina 

2 Department of Pathology, Cytology and Forensic Medicine, Mostar University Hospital, Mostar, 

Bosnia and Herzegovina 

3 Ljudevit Jurak Department of Pathology, Zagreb School of Medicine, Sestre milosrdnice University 

Medical Center, Zagreb, Croatia 

4 Department of Otorhinolaryngology & Head and Neck Surgery, Zagreb School of Medicine, Sestre 


A sowing of the nasal mucosa with Helicobacter pylori (HP), bacterium prevalent in gastric 

contents, is one of the possible mechanisms by which laryngopharyngeal reflux may contribute 

to refractory chronic rhinosinusitis (CRS). A higher prevalence of sinonasal HP in 

patients with CRS was found in comparison with rhinologic patients without CRS. 

The aim of this study was to determine the relationship of HP sinonasal colonization with 

nasal polyp histopathology or rhinosinusitis symptom severity. Nasal polyps of 40 patients 

with CRS, undergoing FESS, were scored for cellular (mast cells, neutrophils, eosinophils), 

and epithelial (goblet cells, basement membrane thickening) markers. Semiquantitative 

scoring of eight rhinosinusitis symptoms was performed. Nasal polyps were analyzed 

for presence of HP using immunohistochemistry (IHC). Patients were categorized as to 

whether the IHC was positive (HP+ group) or negative (HP- group). HP+ group and HPgroup 

were compared according to the histologic inflammatory markers, and to the preoperative 

single symptom and the total symptom scores. 

25. 

CLINICAL APPLICATION OF NASAL NITRIC OXIDE MEASURE- 

MENTS IN RHINOLOGY 

Ljiljana Jovančević, Slobodan Savović and Rajko Jović 

ENT Department, Clinical Centre of Vojvodina, Novi Sad, Serbia 

Nitric oxides (NO) is a colourless, odourless gas, present in air exhaled through the nose 


(nasal NO – nNO) or mouth (exhaled NO – eNO). NO is secreted in the respiratory tract, 

with a major contribution from the paranasal sinuses. Guidelines for nasal nitric oxide 

measurements were published in 2005 but are not still fully standardized, so nasal NO 

measurement is currently a research tool. Nasal NO can be normal, increased or decreased 

in different pathological conditions of the nose and paranasal sinuses. The lowest 

possible findings are usually found in patients with primary ciliary dyskinesia (PCD), so it 

is used as a screening tool. The concentration of nNO is found to be decreased in patients 

with acute and chronic rhinosinusitis and is especially low in patients with nasal polyposis, 

which is considered to be the consequence of the obstruction of the sinus ostia and 

impairment of gas transfer out from the sinuses. Measurement of nNO with humming 

has been proposed as a test of sinus ostia patency which could easily be used in clinical 

practice. Some researchers found that nNO in patients with allergic rhinitis is normal, 

while others found levels to be increased. In patients with allergic rhinitis and asthma, 

the concentrations of nNO are consistently detected as increased. Non-asthmatics with 

allergic rhinitis can have a subclinical inflammation in lower airway, but so far, there were 

no means of predicting of which patient will develop a clinical asthma. There is a concept 

that supports the idea that by means of measuring nNO in patients with allergic rhinitis, 

we could predict the risk of asthma appearance in some patients. In the future, clinical 

use of nasal nitric oxide measurements will certainly be established in everyday rhinologic 

and pulmologic practice, since it posseses a potentially great support in „united airway 

disease“ concept in respiratory tract diseases treatment. 

26. 

RHINOPLASTY - BEAUTY AND FUNCTION 


University Hospital Lozenets, Sofia, Bulgaria 

Rhinoplasties, becoming increasingly popular procedures, have in last years seen changes 

of opinion in how this surgery should be performed, such as more attention to protecting 

or enhancing architectural integrity. The appearance of the nose depends on the relationship 

between all of the parts. When a surgeon alters one area, it influences the appearance 

of other areas of the nose. This is very important in cases when the surgeon looking 

for the perfect esthetic, underestimates the effect of the lateral osteotomies or over 

reduction of the nasal tip / supratip over the functional breathing. Today it’s important 

to maintain architectural integrity because noses change over time. Twenty years after 

surgery, noses don’t look the way they did five years after surgery. The skin sleeve, the fat 


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layer and muscle overlying the cartilages and bones of the nose eventually get thinner. 

Most rhinoplasties are performed to change the cosmetic appearance of the nose and 

most are performed in teenagers and young adults. The numbers of adults, in their 50s or 

60s are increasing too in recent years, but those patients are candidates mostly because 

of breathing problems. We would like to share our experience and some results from our 

practice, where a vast majority of rhinoplasties are performed with the closed technique. 

The second technique is open rhinoplasty, which requires an incision on the columella. 

The open rhinoplasty is indicated when the anatomy of the nose, particularly tip and 

supratip area, is more complex. It is also used in secondary rhinoplasties in which the procedure 

requires more direct exposure to the tip cartilage than you can get with a closed 

approach. You can obtain exposure to the nasal anatomy with either technique. Closed 

rhinoplasties take less time to heal. Open is more invasive and has more swelling. With 

closed rhinoplasty you need good 3-dimensional thinking to understand the anatomy and 

how the changes that you make will look afterward. 

27. 

RHINOPLASTY IN CHILDREN 

Petko Kabakchiev and Dimitrina Todorova 

University Hospital Lozenets, Sofia, Bulgaria 

The nose is part of the face which is most frequently exposed to trauma especially in 

children. Associated epistaxis usually is self limited and edema of the soft tissues masks 

the lesions and often assumed by parents for the important symptoms - pain and nasal 

obstruction. Only when the edema disappears deviation of the nasal septum and nasal 

bones become evident, unfortunately often practically consolidated when first seen by 

an otorhinolaryngology specialist. Even when early diagnosis is made, surgery is refused 

in most cases for several reasons - lack of enough experience of the ENT and anesthesia 

specialists, anesthesia risk, and uncertainty in long-term results and difficulties in the 

evaluation of the further cosmetic damage in children. As well there is no clear algorithm 

of the diagnostic and treatment policy of the nasal traumas in children. Still some surgeries 

in pediatric nose are inevitable - reposition of fractured nasal bones, septal hematoma 

(and abscess), cerebrospinal fluid rhinorrhea. X-ray films of nasal traumas are of little 

utility and digital palpation and visual inspection are the primary diagnostic methods. To 

rule out an occult nasoethmoid injury in severe nasal traumas the proper is the CT imaging. 

There are many reports that tried to determine the consequence of the early childhood 

traumas of the facial skeleton, including nasal surgery, cleft lip and palate repair. It 


is obvious that adult nasal deformities are due to alteration of the proportional growth 

but still there is no final conclusion – they are consequence of the injury or the surgical 

repair itself. Our opinion, we would like to present for discussion, is that there are two 

basic reasons for performing plastic surgery in children and teens. The most important is 

the first - reconstructive surgery is aimed to repair defects that impair normal function/ 

breathing. The other reason - cosmetic surgery to be done to improve self-confidence 

and self-esteem. 

28. 

EVIDENCE-BASED MEDICINE AND THE TREATMENT OF RHINOSI- 

NUSITIS 




Although chronic rhinosinusitis (CRS) is one of the most common chronic disorders, and 

major advances in minimally invasive endoscopic surgery and potent antimicrobial and 

anti-inflammatory conservative treatment have been accomplished in the past few decades, 

the evidence for most effective treatment is still lacking. Reasons for this may be 

the fact that surgical treatment may not easily be placebo controlled, due to ethical reasons. 

Case controlled studies of endoscopic sinus surgery have shown a 91% (73-97.5%) 

improvement with major complications rate of 1.6%. Still, at long term follow-up, improvement 

rate drops to 50% in revision cases and patients with systemic disease (allergy, 

asthma). High quality randomized controlled trials (RCT), which provide the best possible 

evidence, in terms of testing the efficacy of surgical treatment of CRS are too few, and 

placebo controlled trials in sinus surgery are not existing. On the other hand, number of 

RCT and double blind randomized placebo controlled trials on medical treatment of CRS 

have increased significantly in the past decade, however, meta analysis of these trials, as 

the highest levels of evidence, have been published only recently. So far, highest level of 

evidence for efficacy in the treatment of CRS, with and without nasal polyps, confirmed 

in a meta analysis of double blind randomized placebo controlled trials, exists only for 

topical steroids and nasal saline lavages. Meta analysis of topical and systemic antimycotic 

treatment for CRS did not reveal any significant benefit. 


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29. 

DO WE BELIEVE THAT COMPUTER-INTEGRATED SURGERY AND 

VIRTUAL REALITY (VR) IN RHINOLOGY PROVIDE BETTER INTER- 

ACTIVE VE-NAVIGATION USING AUGMENTED REALITY AND 3D- 

OPERATING PLANNING SYSTEM? 

Ivica Klapan 

Zagreb and Osijek University Schools of Medicine, and Polyclinic Klapan Medical Group, Zagreb, 

Croatia 

3D image analysis and processing, tissue modelling, virtual endoscopy and surgery, 3D- 

CAS, as well as tele-3D-CAS, represent a basis for various realistic simulations in medicine, 

and can definitely create an impression of immersion of a physician in a non-existing virtual 

environment. The possibility of exact preoperative, non-invasive visualization of the 

spatial relationships of anatomic and pathologic structures, size and extent of pathologic 

process, etc., allows the surgeon to achieve considerable advantage in the preoperative 

examination of the patient and to reduce the risk of intraoperative complications, all this 

by use different VR methods. In rhinology, research in the area of 2D and 3D image analysis, 

visualization, tissue modelling, and human-machine interfaces provides expertise 

necessary for developing successful VR applications. To understand the idea of 3D-CAS/ 

VR it is necessary to recognize that the perception of surrounding world created in our 

brain is based on information coming from the human senses, such as i.e. virtual endoscopy 

(VE) of the patient’s head, that does not exist in reality (called VR). VR applications as 

well as 3D reconstruction of anatomic units becomes a routine preoperative procedure, 

as we already showed in our surgical activities in the last two decades (our first CAS/June 

1994, tele-3D-CAS/October 1998), providing a highly useful and informative visualization 

of the regions of interest, thus bringing advancement in defining the geometric information 

on anatomical contours of 3D-human head-models by the transfer of so-called “image 

pixels” to “contour pixels” (www.poliklinika-klapan.com). 

References: Klapan I, et al. 

(2002) Am J Otolaryngol, 23(1):27-34. 

(2002) Otolaryngology Head Neck Surg, 127:549-557. 

(2006) Ear Nose Throat J, 85(5):318-321. 

(2008) Coll Antropol, 32(1):217-219 

(2011) Virtual Reality in Medicine, ISBN 978-953-307-518-1, Intech, 303-336. 


30. 

RHINOSINUSITIS IN CHILDREN: CURRENT CONCEPTS IN THE U.S. 


Childrens’ Hospital Los Angeles, USA 

A very briefly review of the published guidelines on the diagnosis and treatment of rhinosinusitis 

in children in the United States will be presented. Further discussion will include 

the current areas of research and how this new information may affect our approach to 

this disease. 

31. 

NASAL TIP PROJECTION: ASYMMETRIES AFTER RHINOPLASTY 

Gabriela Kopačeva-Barsova, Frodita Jakimovska, Lidija Dubrovska Miletić, Maja Kirjas and Maja 

Damjanovska 


Nose is the central point on the face, so its symmetry is very important for facial aesthetics. 

Nasal tip projection must be assessed not only in relation to the nasal dorsum but also 

in relation to overall facial proportions. The most frequent single factor for postoperative 

deformities after rhinoplasty is nasal tip projection. Stability is based on connective tissue 

between both alar cartilages and the support of the alar-complex by the nasal septum 

and upper lateral cartilages. Rhinoplasty maneuvers include reshaping, remodelling, inevitably 

increase, preserve, or decrease nasal tip projection. The desired preservation or 

change in projection of the nasal tip should be assessed and surgical maneuvers chosen 

accordingly. The results of these incisions will be decreased in tip protection by the pressure 

of the soft tissue envelope. The complexity of nasal tip dynamics must also be carefully 

considered because alterations in nasal tip projection are intimately associated with 

alterations in tip rotation and nasal length. 


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32. 

NASAL OBSTRUCTION AFTER RHINOSEPTOPLASTY 

Gabriela Kopačeva-Barsova and Frodita Jakimovska 


Nasal obstruction is a frustrating sequel of rhinoplasty both for the patient and the surgeon. 

Physiologic problems are caused by altered vasomotor mechanisms of the lining. 

Mechanical obstruction results from over-correction of the nasal supporting structures, 

infracture of long nasal bones, septal irregularities, and surgical adhesions. Long-term 

impacts on the quality of life and contributions to the pathophysiology of sleep-related 

breathing disorders have both been documented. This article focuses on the etiology, 

diagnosis, and treatment of post septorhinoplasty nasal obstruction, with particular attention 

to the nasal valve area. Simple and effective techniques for correcting each of 

these problems are described. About 10% of patients who underwent rhinoseptoplasty 

had some nasal obstruction postoperatively. The majority of patients in whom the authors 

performed the primary rhinoplasty had an obstructive, vasomotor type of rhinitis 

that ensued, and which usually could be cured by the injection of corticosteroids into the 

turbinates. Ten patients had undergone rhinoplasty by other surgeons, and most of those 

patients requested surgical correction to relieve the nasal obstruction and/or to improve 

the external nasal appearance. In those patients the causes of nasal obstruction were: 

pre-existent, undetected, or diagnosed but uncorrected, septal deviations; caudal septal 

dislocation; or turbinate hypertrophy; intranasal adhesions; scar tissue web formation in 

the nasal vault; inadequate nasal tip support, and alar collapse. The author’s technique 

of surgical repair for each of these conditions is outlined. Provided that the cause of nasal 

obstruction was appropriately diagnosed and corrected with the correct surgical procedure, 

the patient has a very good chance of resolution of symptoms of nasal obstruction. 

33. 

UČILO-MODEL ZA VJEŽBANJE ENDOSKOPSKE KIRURGIJE NOSA 

Dubravko Manestar, 1 Sven Maričić, 2 Mladen Perinić 2 i Darko Manestar 1 

1 Klinika za otorinolaringologiju i kirurgiju glave i vrata KBC Rijeka i 2 Tehnički fakultet, Rijeka 

Stalan rast i razvoj računalnih aplikacija omogućavaju bolje modeliranje u području medicinskih 

CAD/CAM sustava. Zahvaljujući razvijenim brojnim tehnološkim sustavima medicinske 

dijagnostike, značajno je poboljšana kontrola operativnog postupka i smanjen postotak 

komplikacija endoskopskih zahvata. Povećanim vježbanjem na modelima očekuje 


se smanjenje postotka komplikacija. Glavni cilj projekta bila je izrada novog modela za 

vježbanje kirurga endoskopičara uz pomoć CAD/CAM računalnih tehnika. Proces izrade 

detaljnih presjeka lubanje sastojao se od kombinacije nekoliko faza u kojima su korištene 

različite tehnologije. U prvoj fazi radilo se o digitalizaciji podataka (lubanje) pomoću 

kompjuterizirane tomografije. Zatim je slijedila segmentacijska računalna obrada i CAD/ 

CAM faza. U finalnoj fazi napravljen je probni i finalni ispis na 3D pisaču pomoću Rapid 

prototyping tehnologije. Iz dobivenih CT i MR snimki razvijeno je učilo-model od tanjih 

ploha sa mogućnošću prikazivanja detalja važnih za učenje operativnih tehnika. Završna 

faza uključila je izradu dvodijelnih produkcijskih kalupa i probne serije odljevaka. Razvijeni 

model osigurava bolju edukaciju početnika endoskopičara. 

34. 

SINUITIS U DJECE - DIJAGNOZA I LIJEČENJE 

Duška Markov-Glavaš 

Klinika za bolesti uha, nosa i grla i kirurgiju glave i vrata, KBC Zagreb, Zagreb 

Paranazalni sinusi su najčešće mjesto upale u djece i adolescenata. Važno je razlikovati 

virusni sinuitis od akutnog bakterijskog sinuitisa. Oko 80% virusnih sinuitisa i 20% alergijskih 

su predisponirajući faktori za razvoj bakterijskog sinuitisa. Samo 5% virusnih sinuitisa 

progedira u bakterijsku upalu. Najčešća podjela sinuitisa je prema trajanju simptoma: 

akutni sinuitis ne traje dulje od 10 dana, rekurentni sinuitis ako dijete ima tri ili više upala 

svakih šest mjeseci ili četiri upale godišnje i kronični je karakteriziran jačim simptomima 

i trajanjem više od 12 tjedana. Postoje brojne kontroverzije u dijagnostici sinuitisa u 

djece. Dijagnoza akutnog sinusitisa uglavnom se postavlja na osnovi anamneze i kliničkog 

pregleda. CT sinusa potrebno je raditi samo u djece s komplikacijama akutnih bakterijskih 

sinuitisa, kod recidivnih i kroničnih sinuitisa koji ne odgovaraju na konzervativno liječenje. 

Liječenje je virusnih rinosinusitisa simptomatsko, a kod bakterijskih je simptomatsko uz 

peroralno davanje antibiotika ili parenteralno antibiotici u slučaju pogoršanja simptoma 

ili rezistentnih bakterija. U liječenju sinuitisa važna je suradnja pedijatra, alergologa, infektologa 

i otorinolaringologa. 


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35. 

THERAPY OF VASOMOTOR RHINITIS 


Sun Polyclinic, Zagreb 

Introduction: Vasomotor rhinitis is one of the most common diagnoses of nasal breathing 

disorder. Allmost all conditions which cannot be categorized as allergic or inflammatory 

disorder are named as vasomotor one. In last decade some new terms and causes 

are beeing connected with impaired nasal breathing. The last main problem is how to 

try to cure such conditions and resolve the patient’s problems. Material and methods: 

An overview of known therapeutic methods and medications. Analysis of their possible 

usefullness in therapy of vasomotor rhinitis regarding known pharmacological effects and 

physiology/pathophysiology of the nasal function. Conclusions: Use of hypertonic buffered 

saline 1.7% and pH 7.9 can improve nasal breathing and produce long-term release 

of the patient’s nasal problems. Its physiologic influence on nerve function is still to be 

fully examined and approved but clinical experience supports its beneficial properties. 

36. 

COMBINED APPROACH TO OBSTRUCTIVE SLEEP APNEA AND 

SNORING WITH INTRAORAL AND INTRANASAL DEVICES 

Mario Milkov 

Prof. Paraskev Stoyanov Medical University of Varna, Varna, Bulgaria 

Introduction: Methods of treatment of OSA and snoring significantly improved during 

the last years. There are several conservative treatment methods. In one of them intraoral 

devices are used, while in other cases intranasal devices are preferred. Material and 

methods: Twenty one patiens with OSA and snoring were treated using combined approach 

for a period of two years. In all cases sleep analysis was done – somnography, 

rhinomanometry and spirometry. In five patients radio-frequent surgery was done for 

reduction of the lower nasal concha and the soft palate using electrodes of Olympus – 

Celon. In these cases only intraoral devices were used. In 14 patients intranasal devices 

of Nasanita company were used, as well as intraoral devices of Tonomed company. Three 

of the patients were treated only with intranasal devices. Conclusion: The use of intraoral 

and intranasal devices contributes for significant improvement of snoring and in a smaller 

degree for the reduction of apneas per hour. 


37. 

THE LAMB’S HEAD DISSECTION: A NOVEL AND UNIQUE METH- 

OD FOR THE TRAINING OF ENDONASAL ENDOSCOPIC SURGICAL 

TECHNIQUES 

Ranko Mladina 

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Rebro - KBC 

Zagreb, Zagreb, Croatia 

The beginners in endoscopic sinus surgery frequently have two main technical problems: 

a) orientation of the endoscope and b) skills of bimanual work in combination with simultaneous 

watching the procedure on the screen. They usually spend remarkable amount 

of money and energy as to just try to simultaneously use two hands and present an operating 

field, working on the human cadavers! Human cadaveric dissection has been employed 

for training purposes for decades. However, there is a huge number of countries 

nowadays where the legislative rules do not allow doctors to approach dead people for 

educational purposes. Croatia has the same situation since 2005. The completely new 

concept for the realistic and useful FESS training has been built: the lamb’s head dissection. 

The dimensions of the lamb’s head are very similar to those of the human head, so 

the same instruments that are used in humans can be used for the training on the lamb’s 

head. The quality of the tissues (bone, mucous membrane), their firmness and elasticity 

are also very similar to those in humans. A special head-holder for the purposes of 

this type of dissection has been developed together with the neuro-navigation software 

for the lamb’s head. Endonasal endoscopic surgical procedures that can be performed 

and trained on the lamb’s head are numerous: middle antrostomy, ethmoidectomy, orbital 

decompression, Draf 1, 2 and 3 procedures on the frontal sinus, CSF-leak repair etc. 

Lamb’s head animal model is simple to use, superb, very suitable and cheap solution for 

the training of the endonasal endocopic sinus surgery technique. Once the candidate can 

perform lamb’s head dissection smoothly, she or he is ready to go for the human cadaver 

dissection. 


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38. 

“FIVE-STEPS” TECHNIQUE FOR ENDONASAL ENDOSCOPIC 

ORBITAL DECOMPRESSION 

Ranko Mladina 

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Rebro - KBC 

Zagreb, Zagreb, Croatia 

“Five-steps” endonasal endoscopic orbital decompression was performed in 332 orbits of 

321 patients, mostly suffering from Graves’ ophthalmopathy. In 227 patients the surgery 

was performed because of active ophthalmopathy non-responsive to conservative treatment, 

and in 94 patients for esthetic reasons. Preoperative and postoperative examination 

included visual acuity, examination of the eyelids and cornea, ocular motility, cover 

testing, Hertel exophthalmometry and applanation tonometry. Visual acuity improved 

from preoperative 0.81±0.28 (mean±standard deviation) to postoperative 0.92±0.21 

(p=0.0032, Student t-test). Retraction of upper and lower eyelids, as well as exposure keratitis, 

was reduced after operation (p

in the facial projection of the maxillary sinus and the nasal obstruction of the ipsilateral 

nasal cavity. Surprisingly, both anterior rhinoscopy and nasal endoscopy before and after 

the decongestion of the nasal mucosa showed no remarkable morphologic finding in 

terms of particularly swollen nasal mucosa, any type of septal deformity or any kind of 

nasal polyposis. Anterior rhinomanometry and acoustic rhinometry findings were within 

normal ranges as well. CT scans of the paranasal sinuses showed normal appearance in 

both axial and coronal projections. The bacteriological samples showed negative results 

after 72-hours of incubation at the usual agars. However, after four weeks some colonies 

of moulds have been found at the agars, completely accidentally! There was only one 

unusual clinical finding in the nose: transparent, very gracile filaments extended between 

the medial surfaces of the inferior and middle turbinate on one side and septal mucosa of 

the other side, resembling a cobweb. 

Because of the negative bacteriologic finding, a very simple treatment by nasal irrigations 

by means of sterile sea water nasal-spray have been employed and all symptoms disappeared! 

40. 

ENDOSKOPSKA ENDONAZALNA KIRURGIJA KLIVALNIH TUMORA 

Ranko Mladina 

Klinika za bolesti uha, nosa i grla i kirurgiju glave i vrata Medicinskog fakulteta Sveučilišta u Zagrebu, 

KBC Zagreb, Zagreb 

Autor prikazuje metodu endonazalne endoskopske tehnike za odstranjivanje klivalnih tumora. 

Klivalni su tumori klasičnim, takozvanim otvorenim kirurškim tehnikama relativno 

nedohvatljivi i podrazumijevaju tehnički zahtjevan pristup. Endoskopski pristup također 

nije jednostavan, zahtjevan je, ali znatno manje rizičan jer omogućava izravan pristup na 

tumor najkraćim putem kroz nos uz minimalno odstranjivanje zdravih struktura oko tumora, 

osobito uz pomoć neuronavigacijskih sustava. Morbiditet je nakon endoskopskih 

zahvata neusporedivo manji, uključujući i znatno kraći boravak u bolnici. Dijagnostičke 

metode kojima raspolažemo u dijagnosticiranju ovih tumora su MSCT (Multi-Slice Computed 

Tomography) i nuklearna magnetska rezonancija (NMR). Endoskopski pristup 

podrazumijeva široko otvaranje sfenoidalna sinusa te odstranjivanje njegova dna jer se 

klivalni tumor može širiti sve do prvog cervikalnog kralješka. 


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41. 

REDUCTION RHINOPLASTY 

Jane Netkovski and Biljana Shirgoska 


The aesthetic appearance of the face is determined by the combination and degree of 

harmony between the facial features and the shape of the nose. As an important and 

centrally positioned element of the face it presents the most targeted aesthetic point. 

Rhinoplasty as the queen of facial plastic surgery is one of the most demanding facial 

surgical operations. Patient selection is of utmost importance and conversation is obliged 

to hear and to respect patients’ considerations and desires. Initial step of preoperative 

patient assessment includes eye contact, conversation and detailed analysis of the individual 

anatomic situation. Evaluation of the external nose is realized by inspection and 

wet finger palpation, assessment of septal resistance and tension produced by the medial 

and lateral crura of the alar cartilage as well as the junction of the alar and triangular cartilages. 

The thickness and consistency of the skin and subcutaneous muscle-aponeurotic 

system must be taken into consideration. Rhinoplasty surgeons must be innovative and 

possessing knowledge of many diverse approaches and surgical techniques thus improving 

the nasal appearance and existing facial harmony without causing functional impairment. 

Technological pre and intraoperative innovations can help the surgeon make the 

operation much safer and faster than in the past. Excellent rhinoplasty outcome depends 

on exact preoperative assessment, patient’s individual anatomy, perfect surgical execution 

that comprises correcting abnormal features while respecting and preserving normal 

anatomic structures and correct post op care. The end result in rhinoplasty is never exactly 

predictable, but excellence doesn’t mean ideal nose but natural and functional one. 

Saddle nose was more fashionable in the past but nowadays natural and non-operated 

look is getting more demanding patients’ desire. 


42. 

INTEGRIRANI SUSTAV ZA 3D VIZUALIZACIJU I NAVIGACIJU U 

PODRUČJU RINOKIRURGIJE 

Karlo Obrovac, 1 Goran Vasiljević, 2 Alan Mutka, 2 Josip Nižetić 3 i Jadranka Vuković Obrovac 1 

1 Ortogen d.o.o., Zagreb 

2 Fakultet elektrotehnike i računalstva, Zagreb 

3 Cognitus d.o.o., Zagreb 

Napretkom digitalnih tehnologija, medicinskoj znanosti i praksi omogućuje se primjena 

brojnih alata koji pridonose boljem razumijevanju, dijagnostici i tretmanu različitih 

stanja. Primjenom navigacijskih sustava u kirurgiji, zahvat postaje manje invazivan te je 

unapređena brzina njegova izvođenja. U skorijoj budućnosti ovakvi sustavi zacijelo će 

postati standardni alat u većini operacijskih dvorana. Iako su takvi sustavi prisutni u praksi 

već više od 20 godina, njihovu primjenu ipak prate brojna pitanja i poteškoće. Ona su 

ponajprije vezana uz njihovu robustnost, ponovljivost mjerenja, te konačno i njihovu cijenu. 

Osim toga, pojedine regije ljudskog tijela u većoj su ili manjoj mjeri prikladne za 

primjenu takvih sustava, pa su potrebne posebne modifikacije programske podrške, hardwera 

za mjerenje te instrumenta koji se prati kako bi očitanja prostornih pozicija bila stabilna. 

Oslanjajući se na rezultate rada na području razvoja softwarea za 3D vizualizaciju 

struktura iz slika dobivenih tijekom dijagnostičkih snimanja sa CT i NMR uređjaja te rezultata 

na području razvojnih mjernih sklopova za digitalizaciju i praćenje, razvijen je portabilan 

navigacijski sklop, te njegova inačica za primjenu u kirurgiji nosa i epifarinksa. Sklop se 

oslanja na programski paket za 3D rekonstrukciju odabranih struktura iz DICOM snimaka, 

hardware postav za registraciju, software za praćenje setova markera te određivanja prostornog 

odnosa prema modelu kao i vizualnog i numeričkog prikaza pozicije instrumenta. 

Za potrebe umjeravanja sustava izrađeni su na CNC stroju i RP uređaju brojni fizički modeli 

na kojima je ispitivana točnost mjerenja kao i ostali parametri neophodni za stabilan 

rad sustava. Dosadašnji rezultati provedenih mjerenja ohrabrujući su i daju mogućnost za 

skoro pokretanje više testne faze. 


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43. 

ULOGA CHLAMYDOPHILAE PNEUMONIAE U NASTANKU 

KRONIČNOG RINOSINUITISA 

Ivana Pajić-Penavić, 1 Nenad Pandak, 2 Davorin Đanić, 1 Alen Sekelj 1 i Danijela Babler 1 

1 Odjel za otorinolaringologiju i cervikofacijalnu kirurgiju i 2 Odjel za infektivne bolesti Opće bolnice 

„Dr. Josip Benčević“, Slavonski Brod 

Upala sluznice sinusa nastaje u toku akutne infekcije gornjeg dišnog sustava, najčešće 

virusne etiologije, ili u tijeku alergijskih upalnih zbivanja. Upalni procesi dovode do 

oštećenja mukocilijarnog epitela i do usporavanja ili potpunog prestanka mukocilijarnog 

transporta, što rezultira nakupljanjem i stazom sluzi u sinusnim šupljinama. Edem 

sluznice, nastao zbog upalnih zbivanja u sinusima dovodi do djelomične ili potpune opstrukcije 

sinusnih ušća, što dodatno usporava ili onemogućava izlučivanje sluzi iz sinusnih 

šupljina. Mukostaza, hipoksija, raspadni produkti nastali direktnim djelovanjem mikroorganizama 

kao i medijatori upale, te toksični proteini nastali tijekom kronične upalne reakcije 

pridonose dodatnom oštećenju mukocilijarnog aparata i podržavanju upalne reakcije, 

što može rezultirati kroničnim rinosinuitisom. Kronični rinosinuitis je složeni upalni proces 

koji traje najmanje 12 tjedana unatoč poduzetim medicinskim mjerama. Na sluznici sinusa 

u bolesnika s kroničnim rinosinuitisom najčešće su prisutni Staphylococcus epidermidis, 

Staphylococcus aureus, Streptococcus viridans, Enterobacteriaceae i Klebsiela spp. Bakterija 

Chlamydophila pneumoniae najčešće izaziva akutne respiratorne infekcije (faringitis, 

bronhitis, sinuitis, pneumonija, akutna egzacerbacija kroničnog bronhitisa). Potvrđen 

je povoljan učinak antibiotika djelotovrnih protiv klamidija na funkciju disanja u bolesnika 

s astmom koji imaju dokazanu prisutnost klamidije u dišnim putovima. Uloga klamidije 

u etiologiji kroničnog sinuitisa nije razjašnjena. U našim rezultatima vidi se u 37,5% 

bolesnika pozitivan serum na specifična anti C. pneumoniae protutijela IgA klase, što je 

pokazatelj perzistentne (kronične) infekcije. Takvi podaci upućuju na mogućnost da Chlamydophila 

pneumoniae ima određenu patofiziološku ulogu u nastanku i/ili podržavanju 

upalne reakcije barem u dijelu bolesnika s kroničnim rinosinusitisom. 


44. 

CAVERNOUS HAEMANGIOMA OF THE NASOPHARYNX: A CASE 

REPORT 

Ana Pangerčić and Tomislav Baudoin 

Department of Otorhinolaryngology and Head and Neck Surgery, Zagreb School of Medicine, 

Sestre milosrdnice University Medical Center, Zagreb, Croatia 

Cavernous haemangioma of the nasal cavity are rare benign vascular tumours which originate 

in the skin, mucosa and deep structures such as bones, muscles and glands. They 

usually do not present until adulthood with a peak incidence in the fourth decade of 

life. Epistaxis and haemoptysis are the most common symptoms. We describe a case of 

a 62-year-old woman who was admitted to our Department for recurrent epistaxis in the 

past four months. On anterior rhinoscopy, she had an obstruction of both nasal cavities 

and choanas. Oropharyngoscopically the tumour was pushing the soft palate anteriorly, 

lying on the mucosa of posterior nasopharyngeal wall and going below the uvula. Computed 

tomography and magnetic resonance imaging of the head and neck demonstrated 

a well-defined lesion that was lying from the roof of the nasopharynx to the soft palate. 

The lesion was excised via endonasal approach in general anaesthesia. No complications 

occurred during the postoperative period. Histological examination identified the tumour 

as a cavernous haemangioma. 

45. 

OPERATIVNI ZAHVATI IZVEDENI METODOM FESS-A U RAZDO- 

BLJU 2008./2009. I 2010./2011. GOD. NA KLINICI ZA ORL I KIRUR- 

GIJU GLAVE I VRATA KBC „SESTRE MILOSRDNICE“ 

Alan Pegan i Tomislav Baudoin 

Klinika za otorinolaringologiju i kirurgiju glave i vrata Medicinskog i Stomatološkog fakulteta 

Sveučilišta u Zagrebu, KBC „Sestre milosrdnice“, Zagreb 

Za bolesnike s kroničnim rinosinuitisom (KRS) u kojih ne postoji zadovoljavajući odgovor 

na konzervativnu terapiju, izborna je metoda funkcionalna endoskopska sinusna kirurgija 

(FESS). FESS je minimalno invazivna kirurška metoda, koja se izvodi radi ponovne 

uspostave funkcije paranazalnih sinusa, uz poboljšanje aerizacije i održan mukocilijarni 

transport. Na Klinici za ORL i kirurgiju glave i vrata u KBC „Sestre milosrdinice“ oper- 


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acije paranazalnih sinusa tom se metodom izvode već više od 20 godina. U ovom retrospektivnom 

istraživanju uspoređujemo podatke dviju skupina bolesnika operiranih 

FESS-om u dva dvogodišnja razdoblja: 2008./2009. i 2010./2011. godine. Bolesnici u 

istraživanju razvrstani su po spolu, dobi, uputnoj dijagnozi i opsegu zahvata. U navedenom 

četverogodišnjem razdoblju FESS-om je operirano ukupno 1515 bolesnika s dijagnozom 

KRS s nosnom polipozom ili bez nje. U razdobolju 2008./2009. operirano je 687 bolesnika, 

a u razdoblju 2010./2011. operirano je 828 bolesnika. Opseg zahvata najčešće je 

uključivao polipektomiju, kombiniranu s maksilarnom antrostomijom i etmoidektomijom. 

Usporedbom dviju skupina bolesnika vidljiv je porast u ukupnom broju bolesnika operiranih 

metodom FESS-a. Navedeni trend objašnjavamo poboljšanjem izobrazbe liječnika 

uključenih u proces liječenja KRS (liječnika primarne zdravstvene zaštite, otorinolaringologa, 

pulmologa, alergologa i pedijatara), dostupnijim imaging tehnikama, raširenošću 

metode te boljom obaviještenošću bolesnika. 

46. 

EFFECTS OF LONG-TERM LOW-DOSE TREATMENT BY CLAR- 

ITHROMYCIN ON TH2 CYTOKINES, CCL5 AND ECP IN NASAL 

SECRETIONS OF PATIENTS WITH NASAL POLYPOSIS 

Aleksandar Perić 1 and Danilo Vojvodić 2 

1 Department of Otorhinolaryngology, Rhinology Unit, Military Medical Academy, and 2 Institute of 

Medical Research, Division of Clinical nad Experimental Immunology, Military Medical Academy, 

Belgrade, Serbia 

Background/Aim: The results of previous studies suggest that macrolides can be effective 

in treatment of chronic rhinosinusitis and nasal polyposis. However, little is known about 

the effects of macrolide antibiotics on cytokines and chemokines that can modulate the 

function of eosinophils. The aim of this prospective study was to examine whether or 

not long-term low-dose treatment by clarithromycin (CAM) affects the levels of these 

inflammatory mediators in nasal discharge of patients with nasal polyps. Methods: 22 

non-allergic and 18 allergic patients with nasal polyps were administered CAM 500 mg/ 

day single oral dose for eight weeks. We measured the levels of Th2 cytokines IL-4, IL-5 

and IL-6, chemokine CCL5 (RANTES), and eosinophilic cationic protein (ECP) in nasal secretion 

samples, before and after treatment. We also scored each of the 40 patients before 

and after therapy according to nasal symptom score and endoscopic score. Results: After 

macrolide treatment, we found significantly reduced levels of CCL5 (p

cretions in non-allergic and allergic patients. Treatment by CAM decreased the level of 

ECP only in non-atopic (p

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48. 

UČINKOVITOST I SIGURNOST KIRURŠKOG LIJEČENJA PACI- 

JENATA S POREMEĆAJIMA DISANJA TIJEKOM SPAVANJA: NAŠA 

ISKUSTVA 

Goran Račić, 1 Željka Roje, 1 Mirnes Selimović, 2 Zoran Đogaš, 3 Renata Pecotić, 3 Maja Valić 3 i Vana 

Bulić 3 

1 Klinika za bolesti uha, grla i nosa s kirurgijom glave i vrata KBC Split, 2 Ustanova za hitnu medicinsku 

pomoć i 3 Katedra za neuroznanost Medicinskog fakulteta Split, Split 

Cilj rada: Procijeniti sigurnost i učinkovitost kirurškog liječenja pacijenata s poremećajima 

disanja tijekom spavanja. Ispitanici i metode: U ovoj prospektivnoj studiji uključeno je 18 

pacijenata koji su se javili u ambulantu za poremećaje disanja tijekom spavanja zbog hrkanja, 

opstrukcijske sleep apneje i prekomjerne dnevne pospanosti i umora. Ispitivanje je 

provedeno u Laboratoriju za poremećaje disanja tijekom spavanja Medicinskog fakulteta 

u Splitu i u Klinici za bolesti uha, nosa i grla s kirurgijom glave i vrata KBC-a Split. Glavni 

uključujući kriterij bio je polisomnografski nalaz apnea-hipopnea indeksa (AHI) veći od 5. 

U bolesnika s AHI >30 kirurško liječenje je korišteno kao priprema za primjenu CPAP-a. 

Operacije su izvodila dva kirurga, dijelom u općoj, dijelom u lokalnoj anesteziji, ovisno 

o zahtjevnosti kirurškog postupka (septoplastika, tonzilektomija, uvulopalatoplastika). 

Nakon tri mjeseca provedena je kontrola koja je uključivala: ciljanu anamnezu i heteroanamnezu, 

otorinolaringološki pregled i cjelonoćnu polisomnografiju. Rezultati: Studija 

obuhvaća 18 bolesnika (16 muškaraca i 2 žene). Prosječna dob ispitanika bila je 49,5 (5- 

69) godina. Prosječna vrijednost indeksa tjelesne mase je 28 (24-32). Nakon kirurškog 

liječenja AHI se smanjio sa 30 na 16 (49%). Ni u jednog ispitanika nisu zabilježene značajne 

popratne pojave (krvarenje, infekcija). U 80% bolesnika bila je prisutna značajna postoperacijska 

bol (prvi postoperacijski dan), rangirana na vizualno-analognoj skali brojem 

8 (5-10). Zaključak: Rezultati istraživanja potvrđuju da je kirurško liječenje bolesnika s 

poremećajima disanja tijekom spavanja sigurno i učinkovito te da se može koristiti kao 

jedini i/ili komplementarni način liječenja. 


49. 

RINOKIRURŠKE OPERACIJE U RAZDOBLJU 2008./2009. I 

2010./2011. – SEPTOPLASTIKA I SEPTORINOPLASTIKA 

Ivan Rašić i Tomislav Baudoin 



Plastičnorekonstruktivna kirurgija je grana kirurgije koja se bavi oblikovanjem bilo kojeg dijela 

ljudskog tijela koji je deformiran ili oštećen. Primarna je zadaća plastičnorekonstruktivne 

kirurgije korekcija defekata, uspostava izgubljene funkcije i poboljšanje kvalitete života. Još 

od rimskog arhitekta Vitruvija na kojeg je podsjetio Leonardo da Vinci poznatim crtežom “Vitruvijski 

čovjek” poznato je kako nos po svojoj dužini iznosi trećinu dužine lica. Nos dominira 

licem te ne čudi što je septorinoplastika jedna od najčešćih operacija u otorinolaringologiji. 

S druge strane, nos ima višestruku ulogu u procesu disanja, pa su i deformacije septuma 

čest razlog za operaciju. U ovom radu prikazana je analiza septoplastike i septorinoplastike 

od siječnja 2008. do prosinca 2011. godine. U 2008. i 2009. godini izvedeno je ukupno 819 

septoplastika i septorinoplastika. U navedenom razdoblju operirano je 400 (48%) muških 

pacijenata i 419 (52%) ženskih pacijenata. Kod operiranih odnos septoplastika i septorinoplastika 

iznosi 606:213, odnosno 73%:27%. Obje operacije podjednako su bile zastupljene u 

oba spola. U razdoblju 2010./2011. izvedeno je 869 septoplastika i septorinoplastika. Odnos 

septoplastika i septorinoplastika ostao je nepromijenjen, 638:231 (73%:27%), kao i odnos 

muških prema ženskim pacijentima. Ovakvi rezultati upućuju na stalni rast broja operiranih 

pacijenata na Klinici za otorinolaringologiju i kirurgiju glave i vrata KBC “Sestre milosrdnice” 

čemu pridonosi individualni pristup pacijentu i operaciji te, shodno tome, kraći boravak u 

bolnici, brži oporavak i povratak svakodnevnim aktivnostima. 

50. 

EXPANDED ENDOSCOPIC ENDONASAL APPROACH TO THE 

SKULL BASE PATHOLOGY 

Janez Ravnik 

UKC Maribor, Maribor, Slovenia 

The advent of the endoscopy made possible to approach the central and anterior skull 

base through the minimally invasive approach. We describe our experience and evolution 

of the expanded endonasal approach in a relatively low volume center. The versatility and 


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proficiency were achieved through mastering crucial competencies by each team member. 

The ENT team member must draw the experience from advanced FESS and must learn 

all techniques of duraplasty. Neurosurgeon must be well acquainted with neuromuscular 

surgery and microsurgical dissection techniques. The major skill that neurosurgeon must 

master is the use of screen monitor instead of binocular microscope. This may pose some 

problems, but with use of simple exercises and starting the surgery one step before entering 

through the dura (e.g. drilling off the rostrum) will effectively eliminate this problem. 

We believe that use of image guidance through the procedure with navigated aspirators 

is beneficial in decision making process and is saving surgical time. Twenty-seven patients 

(17 men, 11 women) were operated during the period from 2005 to 2011. Surgery was 

performed for 5 adenocarcinomas, 3 malignant melanomas, 1 undifferentiated sinonasal 

carcinoma, 2 estesioneuroblastomas, 9 pituitary macroadenomas, 4 meningiomas and 1 

congenital prepontine cyst. Three optic nerve decompressions were also performed with 

this approach. Skull base reconstruction for all complex tumors was performed using the 

naso-septal flap. All patients recovered well after surgery. Among patients with visual disturbances, 

postoperatively vision improved in eight patients, remained the same in one 

patient and was worse in one patient. There was one case of CSF leak that needed revision 

and one patient had subdural hematoma that needed no intervention. The results 

are encouraging with a low morbidity. We believe that EEA can be safely used even in low 

volume centers with appropriate experience in conventional surgery. 

51. 

HOW TO HANDLE A PATIENT WITH A SLEEP-DISORDERED 

BREATHING? SPLIT PROTOCOL 

Željka Roje 

ENT Department, University Hospital Center Split, Split, Croatia 

Sleep-disordered breathing (SDB) is an umbrella term for several chronic conditions in which 

partial or complete cessation of breathing occurs many times throughout the night, resulting 

in daytime sleepiness or fatigue that interferes with a person’s ability to function and reduces 

quality of life. Symptoms may include snoring, pauses in breathing described by bed 

partners, and disturbed sleep. Obstructive sleep apnea (OSA), which is by far the most common 

form of sleep-disordered breathing, is associated with many other adverse health consequences, 

including an increased risk of death. A major problem is the lack of recognition 

of the disorder by both, the patient and physician. This unawareness may lead to delayed 

diagnosis. In order to recognize, diagnose and treat these patients on time we established 


our Split protocol for SDB diagnosis and treatment. A complete history and careful physical 

examination by ENT doctor are paramount in assessing SDB. The patient’s risk factors 

should be assessed, including male gender, increase in weight, ingestion of alcohol, allergies, 

nasal obstruction, trauma, GERB, use of muscle-relaxing medications, and smoking. An 

assessment of daytime functioning, including concentration levels, work performance, and 

sleepiness, should be documented by specialized questionnaires: Epworth Sleepiness scale, 

Berlin and STOP questionnaire. Additional tests can be obtained if necessary: 24-hours pHmetry, 

hormonal status (TSH) and rhinomanometry but polysomnography remains the gold 

standard to diagnoz SDB. If we consider the patient for surgical treatment, Apneagraph is 

mandatory. According to these results „Sleep medicine team“ (ENT, somnologist) suggests 

the best treatment modality for each patient (individual approach). Adequate treatment of 

SDB results in improvement of symptoms and can alter morbidity and mortality rates. 

52. 

UPDATE ON ARIA 


Allergy and Rhinology Department, National Throat, Nose and Ear Hospital, London, UK 

ARIA (Allergic Rhinitis and its Impact on Asthma) is the most disseminated guideline in 

allergic rhinitis. It has been developed and updated several times during past decade. It 

is the first guideline in chronic respiratory diseases to include specialists, general practitioners 

and patients in its development. Latest revision and updates (2008 and 2010) 

were developed using independent methodologists and were revised by experts, using 

World Health Organization-accepted method by GRADE Working Group (The Grading 

of Recommendations Assessment, Development and Evaluation), which made revisions 

more evidence-based than the first edition in 2001. Assessing the quality of evidence 

(high, moderate, low and very low as categories) and strength of recommendation (strong 

and weak) was based on weighing up the desirable and undesirable effects of management 

strategies, considering values and preferences influencing recommendations, and 

resource implications. Both levels of recommendation indicate the best course of action 

for given patient population, but the implementation requires different considerations. 

Recommendations deal with the prevention of allergic disease, the use of oral and topical 

medications, allergen specific immunotherapy and complementary treatments in patients 

with allergic rhinitis as well as patients with both allergic rhinitis and asthma. For 

strong recommendations benefits clearly outweight risk and burden, or vice versa, while 

the concerning the weak ones, benefits are closely balanced with harm and burden. 


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53. 

BIOLOŠKA TERAPIJA U ASTMI I ALERGIJSKIM BOLESTIMA 

Asja Stipić Marković 

Odjel za alergologiju, kliničku imunologiju, reumatologiju i pulmologiju, Interna klinika Medicinskog 

fakulteta Sveučilišta u Zagrebu, Klinička bolnica “Sveti Duh”, Zagreb 

Alergijske bolesti su kronične, sistemske reakcije imunološkog sustava s lokaliziranjem 

imunološke reakcije kojom ravnaju TH-2 subpopulacije pomoćničkih stanica, u različitim 

anatomskim mjestima. Jedan od glavnih uzroka imunološke devijacije u alergijskim 

bolestima je smanjena mikrobna stimulacija imunoloških stanica preko Tollu sličnih receptora 

(TLR, engl. Toll-like receptors) s posljedičnim niskim stvaranjem interleukina-12 I 

interferona-γ. Tipične alergijske bolesti poput rinitisa, astme, ekcema ili nutritivne alergije 

u najvećeg broja bolesnika se učinkovito liječe, zahvaljujući spektru lokalnih kortikosteroida. 

Ipak, kod mnogih bolesnika se ne može uspostaviti kontrola nad simptomima, a kod 

svih liječenih nakon prestanka primjene simptomi recidiviraju. Zbog toga se istražuju 

nove terapijske mogućnosti, prvenstveno specifičnim zahvatom u alergijsku kaskadu monoklonskim 

protutijelima. Na tablici 1 pokazani su biološki modulatori već u upotrebi u 

Klinici, te oni koji se istražuju: inhibitori IgE (omalizumab), citokini (IL-4, IL-13, IL-5, IL-2) te 

kemoatraktantna receptorska molekula na površini TH-2 stanica (CRTH2, engl. chemoattractant 

receptor-homologous molecule expressed on helper T cells). U kliničkoj medicini 

samo je jedan lijek, omalizumab, odobren za primjenu u bolesnika s teškom alergijskm 

astmom. Analiza više studija s oko 3400 bolesnika pokazala je sigurnost primjene 

i učinkovitost omalizumaba u teških asmatičara s atopijom, koji imaju simptome astme 

unatoč maksimalnim dozama primijenjene najbolje konvencionale terapije. Terapija monoklonskim 

protutijelima protiv IL-4 i fragmentom topljivog receptora za IL-4 nije imala 

učinka u bolesnika s astmom, ali je primjena IL-4 mutantnog proteina, koji se veže za α 

jedinicu receptora za IL-4, dovela do poboljšanja plućne funkcije i smanjenja NO u izdahnutom 

zraku. Unatoč ulozi koju ima TNF-α u teškoj astmi primjena inhibitora TNF-α nije 

dovela do kliničkog poboljšanja bolesnika. Studija anti TNF-α monoklonskim protutijelom 

golimumab, prekinuta je zbog brojnih teških infekcija i solidnih neoplazmi u usporedbi s 

bolesnicima koji su dobivali placebo. Primjena pet intravenoznih tretmana mepolizumaba 

u astmi ovisnoj o steroidima i eozinofilijom omogućila je snižavanje doze prednizona, 

smanjenje egzacerbacija te smanjenje eozinofila u krvi i sputumu. 


Tablica 1. Biološki lijekovi u alergijskim bolestima 

Vrsta lijekova Mehanizam djelovanja Klinički učinci 

Anti-IgE 

Omalizumab monoklonsko protutijelo protiv Rodrigo sur.: analiza 8 ispitivanja 

IgE; spušta nivo IgE; down-regu- s 3,429 bolesnika: smanjenje eg- 

Modulacija citokina 

lacija IgE receptora. 

zacerbacija, doza kortikosteroida 

i hospitalizacija, poboljšanje 

kvalitete života u add-on terapiji. 

Bez poboljšanja plućne funkcije. 

Altrakincept fragment topljivog IL-4 R; neutral- Adcock i sur.: bez učinka u veizira 

IL-4 

likom kliničkom pokusu faze 3 

Pascolizumab monoklonsko antitijelo protiv IL- 4 Hart i sur.: faza 2 ispitivanja 

prekinuta zbog neučinkovitosti 

Pitrakinra IL-4 mutant protein, veže α jed. 

IL-4 R 

CAT-354/IMA- 

638/QAX576 

monoklonsko antitijelo protiv 

IL-13 

Wenzel i sur.: inhalacije poboljš. 

plućnu funkciju i smanjuju NO 

(faza 2a studija) 

Dimov i sur.: dokazana 

učinkovitost u fazi 2 kliničkih 

studija 

Mepolizumab monoklonsko antijelo protiv IL-5. Haldar i sur, Nair i sur.: manje 

egzacerb. astme, bolja kvaliteta 

života, manja potreba za prednizonom 

kod teške, refraktorne, 

eozinofilne astme 

Daclizumab monoklonsko antijelo protiv IL-2. Busse i sur.: 115 bolesnika ovisnih 

o ICS kroz 12 tjedana, pokušaj 

smanjenja ICS. Bolji je FEV1, 

manje simptoma i SABA 

Potrebna su dodatna temeljna znanstvena istraživanja da bi se rasvijetlila patofiziologija teške 

astme. Zbog razlika u patofiziologiji, individualni slab odgovor na terapiju može se postići kombinacijom 

više lijekova. Isto tako, tretman koji ne dovodi do poboljšanja plućne funkcije može 

biti djelotvoran ako se evaluira redukcijom pojava egzacerbacija ili poboljšanjem kvaliteta života 

bolesnika s astmom. 


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54. 

DIAGNOSTIC IMAGING OF THE PARANASAL SINUSES AND AN- 

TERIOR SKULL BASE FOSSA 

Goranka Šimac Kubat, Karmen Mršić, Dražen Lovrić and Nikola Bilić 

Sun Polyclinic, Zagreb 

Multislice CT (MSCT) is a method of choice in imaging paranasal sinuses and the anterior 

skull base fossa, especially when imaging the patient with difficulty lying still for the time 

required for MR scanning. High resolution CT (HRCT) can be used to demonstrate exquisitely 

normal anatomy, anatomical variations and pathological changes. This method is 

also routinely performed in preoperative planning, staging and evaluation of inflammatory 

changes. 3 D reconstruction and multiplanar reconstruction (MPR) allows us to display 

the finest anatomy of the bone structure and soft tissues in axial, sagittal and coronal 

plane. MPR is the most valuable tool in the diagnosis of fractures and erosions of the 

bone. Virtual endoscopy (VE) is a step further in modern imaging allowing us vivid demonstration 

of anatomical structures and mucosa. Performance of a low dose protocol by 

lowering mA s and kV and increasing the pitch can reduce radiation dose significantly with 

a little decrease in the image quality which is still satisfactory in imaging most of cases 

such as inflammatory diseases .When suspected neoplastic lesion, after contrast imaging 

allows us to delineate normal structures from the pathologic ones, as well as the local 

infiltration of the nearby anatomical structures or intracranial progression of the lesion. 

Magnetic resonance imaging (MRI ) is superior in the tissue contrast discrimination which 

allows us distinguishing liquid, blood, fat and soft tissue structures better MRI is inferior, 

though, when imaging bone or calcifications. Nevertheless, MRI has a valuable place in 

imaging inflammatory diseases and tumors, especially when imaging the children. 


55. 

THE EFFECTIVENESS OF COMBINED METHOD OF RADIO-FRE- 

QUENCY AND COLD KNIFE UVULOPALATOPHARYNGOPLASTY IN 

THE TREATMENT OF PRIMARY SNORING 

Boris Šimunjak, Boris Filipović, Ivan Raguž and Marica Žižić-Mitrečić 

Department of Otorhinolaryngology, Head and Neck Surgery, Sveti Duh University Hospital, Zagreb 

The objective of this study was to evaluate the effectiveness of combined method of 

radio-frequency and cold knife uvulopalatopharyngoplasty in the treatment of primary 

snoring. Forty of 104 patients who underwent UPPP between January 2010 and December 

2011 with a follow-up period of 4-19 months were included in this study conducted at 

ENT Department, Sveti Duh University Hospital. Forty patients with mild OSAS and socially 

disruptive snoring underwent a baseline polysomnogram along with a battery of visual 

analog scales (VASs) to measure sleep disturbances, snoring level and daytime sleepiness. 

After radio-frequency and cold knife combined tissue reduction of the soft palate, they 

were re-evaluated with a mean follow-up after the procedure of 18.2+/-4.6 (mean+/-SD) 

weeks. Mean preoperative snoring index in polysomnography was 211.3+/-148.9 and 

postoperative value was 43.8+/-71.3, yielding a statistically significant difference from its 

preoperative value (P=0.00052). As rated by the patients and their bed partners, a significant 

reduction in the level of snoring occurred in more than 80% of patients, with a 

mean pretreatment snoring level of 8.8+/-2.1 to a mean posttreatment snoring level of 

2.6+/-1.4. (Student t-test, P < 0.0001). Objective findings suggest that UPPP is inadequate 

in treating OSAS but UPPP is an effective tool in treating subjective symptoms of primary 

snoring in selective group of patients. 


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56. 

RINOKIRURŠKE OPERACIJE U RAZDOBLJU 2008./2009. I 

2010./2011. NA KLINICI ZA ORL I KIRURGIJU GLAVE I VRATA KBC 

„SESTRE MILOSRDNICE“ 

Dejan Tomljenović i Tomislav Baudoin 



Od ukupnog broja tumora glave i vrata, tumori nosa i paranazalnih šupljina zauzimaju mali 

dio: manje od 1% svih malignih tumora, odnosno do 3% malignih tumora aerodigestivnog 

trakta. Benigni tumori znatno su češći od malignih (ciste, polipi, hemangiomi, osteomi), 

najčešće zastupljeni maligni tumori su planocelularni karcinomi, potom slijede adenokarcinomi, 

maligni limfomi i melanomi. Po učestalosti zahvaćenosti sinusa na prvom je mjestu 

maksilarni sinus, potom slijede tumori nosne šupljine, etmoidnih sinusa te sfenoidnog 

i frontalnog sinusa. U ovom radu prikazana je usporedba rezultata rinokirurških operacija 

benignih i malignih tumora u dva dvogodišnja razdoblja: 2008./2009. i 2010./2011. U 

razdoblju od 2008./2009. izvedeno je oko 1400 rinokirurških operacija, od kojih je bilo 

150 operacija tumora nosa i paranazalnih sinusa, dok je u razdoblju 2010./2011. učinjeno 

1700 operacija, od kojih 230 otpada na tumorske operacije. 

57. 

ALLERGIC RHINITIS IN CHILDREN 

Andrijana Včeva, Hrvoje Mihalj, Željko Zubčić, Željko Kotromanović, Darija Birtić and Josip Maleš 

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Centre Osijek, 

Osijek, Croatia 

Allergic rhinitis (AR) is the most common condition in the pediatric population and the 

prevalence has been reported to be 20-40% worldwide. It is a growing problem in Croatian 

children and still is under-diagnosed and under-treated. Although it is often trivialized 

by clinicians the personal and social impact of AR is staggering. The cause and risk factors 

for the development of AR are incompletely defined but involve both genetic and environmental 

elements.The classification of AR in children is the same as in adults according 

to ARIA guidelines. It is based on the frequency and severity of symptoms. Children with 

AR present with sneezing, rhinorrhoea, nasal obstruction, itchy nose and red and itchy 


eyes. Many of children have allergic faces which may include allergic shiners, facial pallor, 

a nasal crease and the allergic salute. Children with AR frequently miss school days, 

have disruption of sleep (OSA) with associated fatigue and impaired concentration. Their 

ability to perform well in school and extracurricular activities is also effected by AR. These 

challenges can cause emotional problems, isolation and poor self-esteem. AR has a negative 

impact on the quality of life of the whole family because it can cause interference 

on social life and financial costs. A significant number of children with AR experience comorbid 

conditions such as otitis media, infective sinusitis, uncontrolled asthma, adenoid 

hypertrophy. These co-morbid conditions must be actively looked. Diagnosing AR in the 

pediatric population presents unique challenges and is based on a good history, detailed 

environmental history, clinical examination and appropriate investigations (allergy testing 

in vivo-skin testing or in vitro-RAST testing). The management of AR and its co-morbidities 

involves a combination of environmental therapy, pharmacotherapy and immunotherapy. 

It requires a multidisciplinary approach involving the paediatrician or paediatric allergist 

and the otolaryngologist. 

58. 

THE FUTURE BULGARIAN-CROATIAN RHINOLOGY 

COLLABORATION 


Medical University, Plovdiv, Bulgaria 

The Bulgarian Rhinologic Society has had a longstanding tradition of producing leaders 

in Bulgarian otorhinolaryngology. Originally started in 2004 under the leadership of Ognyan 

Despotov. Every year the Bulgarian Rhinologic Society provides the highest level 

of dedicated rhinologic subspecialty training programmes, courses and education of the 

residents. In Europe we will have to collaborate more intensively with other rhinologic 

societies. The Bulgarian Rhinologic Society has a wonderful collaboration with the Croatian 

rhinologists, because we have the same traditions, similar language, similar health 

ex communistic system. We want to start with our future rhinology activities including 

exchange programmes for residents and specialists, clinical and research experience, rhinology 

research laboratory experiments etc. The future of rhinology is in the international 

friendships, fellowships and grant programmes. Bulgaria and Croatia will be among the 

leaders in the European Rhinologic society. 


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59. 

SINUS AND HEADACHES 


ENT Department AZ St-John Hospital Bruges, Belgium 

Facial pain or pressure is by many patients believed the result of “self-diagnosed” sinusitis. 

This view is often reinforced by the General Practitioners (GP) or other hospital physicians. 

Thus resulting in the prescription of Antibiotics together with anti inflammatory 

medication. Those prescriptions are frequently not supported by endoscopic nasal evaluation 

or CT scan investigation. Moreover when referred to the rhinologic clinic endoscopy 

and CT Scan may be normal. First level message to the GP aims at awareness that headache 

without inflammatory signs (no pus in the nose!) is not simply sinusitis. 

Acute infective rhinosinusitis often causes pain whereas chronic infective rhinosinusitis 

usually causes pain only when there is an acute exacerbation. Facial headache is not included 

in the symptoms defined for the diagnosis of chronic rhinosinusitis. There is increasing 

evidence that Functional endoscopic surgery (FESS) does not resolve problems of 

headache and therefore should not be proposed to the patient as the ultimate solution. 

Increasing evidence shows psychological or neurochemical factors might play a role in 

the facial pain disorders together with neurological issues. Basic work by NS Jones (literature) 

describes the entity of the “midfacial segment pain” as an entity in the description 

of such clinical presentations. Literature also supports in those patients treatment with 

tri-cyclic anti depressives from basic 6 weeks extending to 6 months (amitriptyline). The 

author through a personal prospective observation of 615 consecutive patients during 2 

months- evaluates the presence and frequency of this facial pain phenomenon in the ENT 

daily practice. The conclusion beholds three levels. The first level being the observation 

of missed diagnosis leading to wrongly prescribed medication. The second level contains 

the recognition of a headache with a different etiology than sinusitis. The third level is to 

consider if by any means the treatment / prescription of antidepressive drugs by the ENT 

physician might help these patients on the long run. 


60. 

THE MALIGNANT TUMORS OF THE MAXILLOFACIAL REGION: A 

RADIOLOGICAL APPROACH 

Dijana Zadravec 

Clinical Institute for Diagnostic and Intervention Radiology, Sestre milosrdnice University Medical 

Center, Zagreb, Croatia 

Detection and analysis of the malignant tumors of the maxillofacial region request a multidisciplinary 

approach. Given a fast-developing technology in the last two centuries, new 

digital radiological imaging methods are emerging, as the radiological algorithm is changing, 

in both preoperative diagnosis and postoperative tracking of the malignant tumors 

patients. The algorithm which is recognized today, had almost minimized the classic xray 

examinations of the patients, while the multislice computed tomography (MSCT) and 

magnetic resonance (MR) became indispensable. MSCT and MR allow the detection, the 

estimation of size and spreading of the disease, and the relation to the surrounding structures. 

A specially important value is the detection of a tumor perineural infiltration and 

its relation to the vascular structures. MSCT and MR are both characterized by excellent 

special and contrast resolution, availability, non-invasivity, and speed of the examination 

and also by an extremely precise diagnostic information. Concerning that the maxillofacial 

area is prone to diverse pathologic processes and anatomically an extremely demanding 

area, the importance of the digital radiology methods is amplified by the fact that 

they allow a possibility of multiplanar reconstructions, volume rendering (3D), angiography 

(CTA, MRA), and „maximum intensity projection“ (MIP) of the vascular structures. 

Also, these allow an estimation of the pathologic process function applying perfusion 

techniques. Each method mentioned above has its advantages and disadvantages, but it 

remains a fact that MSCT and MR are complementary methods. The choice depends on a 

clinic request, an estimated diagnostic responses and the state of the patient. The recent 

literature and our recent research reveal the advantage of MR over MSCT. Out of experience, 

the choice of the adequate diagnostic algorithm and the most suitable therapy 

method is most effective when the clinicians and the radiologists cooperate. 


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POSTERI / POSTERS 

61. 

ECTOPIC CANINE IN THE MAXILLARY SINUS: A CASE OF TACIT 

STOWAWAY 

Ana Bernić and Niko Krakar 

ENT Department, Dr. Ivo Pedišić General Hospital, Sisak, Croatia 

Hitherto there are only several cases of ectopic teeth in the maxillary sinus reported in 

the literature. Although usually asymptomatic, some patients report aggravated upper 

respiratory infections or comorbid sinus diseases. This rare anomaly of odontogenic development 

is commonly presumed to be associated with odontogenic cysts, trauma, or 

idiopathic etiology. A 12-year-old boy presented with a pyrexia of unknown origin. During 

the investigations the X-ray imaging of paranasal sinuses detected a mass in the right 

maxillary sinus. The patient was referred to our ENT clinic for further evaluation. He was 

found asymptomatic on examination. In his medical history, he suffered with mild allergic 

rhinitis and was sensitive to dust, dust mites and seasonal pollen. His mother also noted 

that during the past acute respiratory infections he would at times suffer with slight facial 

oedema corresponding to the region of the maxillary sinus. CT confirmed the presence of 

the tooth and demonstrated horizontally positioned an ectopic canine with its root abutting 

the medial wall of the sinus. In agreement with patient and his parents, the decision 

was made to proceed with surgical excision and a Caldwell-Luc procedure was carefully 

performed. The intraoperative inspection revealed an intact sinus mucosa and the tooth 

was found to be a well formed canine with an intact root. The patient recovered from 

the operation rapidly and without incident. At follow-up visits, he reported no complications. 

Of interest, the patient and his parents additionally reported that his allergic rhinitis 

significantly abated since the operation. In summary, we describe a very rare case of an 

ectopic canine in the maxillary sinus that was successfully treated surgically. 


62. 

KAKO SMO REKONSTRUIRALI DEFEKT PREDNJEG ZIDA FRON- 

TALNOG SINUSA - PRIKAZ SLUČAJA 

Aleksandar Ljubičić, 1 Milanko Milojević, 2 Dražen Ivetić 2 i Biserka Vukomanović-Đurđević 3 

1 Klinika za otorinolaringologiju, 2 Klinika za neurohirurgiju i 3 Zavod za patologiju i sudsku medicinu 

Vojnomedicinske akademije, Beograd, Srbija 

Cilj je rada prikazati način na koji smo riješili defekt prednjeg zida frontalnog sinusa uzrokovanog 

mukokelom. Imali smo pacijenticu staru 39 godina kojoj je prije 11 godina u 

drugoj ustanovi izvedena osteoplastična operacija oba frontalna sinusa bez obliteracije 

zbog mukokele u sinusima. Nakon toga je dolazilo do povremenih upala sinusa sa čeonim 

glavoboljama. U siječnju 2011. pacijentica je uočila oteklinu na čelu s pomicanjem lijeve 

očne jabučice. Učinjeni su CT i MR i otkriveno je postojanje sadržaja u frontalnim sinusima 

gustoće između mekog tkiva i guste tekućine s defektom prednjeg zida oba frontalna sinusa 

i defektom na krovu lijeve orbite uz potiskivanje očne jabučice laterokaudalno. Bila 

je prisutna i protruzija kroz izvodne kanale oba frontalna sinusa u obje nosne šupljine. 

Odlučeno je da se izvede osteoplastična operacija s obliteracijom uz zatvaranje defekta 

prednjeg zida frontalnog sinusa pločicama. Zahvat je izveden početkom ožujka 2011. 

Oba frontalna sinusa su otvorena i pod kontrolom operacijskog mikroskopa odstranjen 

je kompletan mekotkivni sadržaj iz sinusa. Obliterirani su masnim tkivom uzetim od pacijentice. 

Defekt na krovu orbite nije zatvaran. Defekt na prednjem zidu sinusa zatvoren je 

titanijskom mrežicom zbog svoje veličine, a time je postignut i zadovoljavajući kozmetski 

učinak. Histološki je potvrđeno da se radi o kroničnoj inflamiranoj sluznici s mukokelom. 

U zaključku navodimo da veličina defekta, raspoloživi materijal, kao i obučenost kirurga 

nalažu izbor materijala kojim će defekt biti zbrinut. 


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78 



63. 

EXPLORING POSSIBILITIES IN NASAL POLYPOSIS TREATMENT 

Hrvoje Mihalj, Josip Maleš, Željko Zubčić and Andrijana Včeva 

Department of Otorhinolaryngology and Head and Neck Surgery, Osijek University Hospital Centre, 

Osijek, Croatia 

Aim: To validate different operative techniques commonly used for nasal polyposis (NP) 

treatment. Methods: This is a retrospective study exploring data on the NP surgery during 

a five-year period at the ENT and Head and Neck Surgery Department at Clinical Hospital 

Centre Osijek, Croatia. Data were analyzed regarding patients’ gender, age, type of the 

surgery performed, and possible recurrence. Recurrence rate among patients that were 

followed up during that period of time and operated by different techniques (FESS vs. 

classical polipectomy) was compared. Results: Overall most frequent operative technique 

used was classical bilateral polypectomy, in 62.9% (154/245) of cases. The frequency of 

classical polypectomy was significantly decreased from 42/46 (91.3%) in 2006 to 34/60 

(56.7%) cases in 2010, whereas the frequency of FESS in combination with classical polypectomy 

was significantly increased during that period (p

adult participants with symptomatic nasal obstruction due to septal deviation. Clinical 

exam (anterior and posterior rhinoscopy), NOSE scale, QOL visual analog scale (VAS) and 

rhinomanometry before and 6 months after surgery were administered to assess treatment 

outcomes. QOL was scored on 0 – 10 scale (0 – significantly affects QOL, 10 – no 

impact on QOL). All patients underwent septoplasty under general anaesthesia. Results: 

Our study included 269 participants, 148 (55%) male and 121 female (45%). According 

to Mann-Whitney’s test there were no statistically significant differences between sexes 

(p>0.001) in any of the examined variables (symptoms, VAS and rhinomanometry). The 

most common symptoms before septoplasty were difficult nasal breathing, sleep-related 

breathing (96%) and nasal stuffiness (93%). After septoplasty difficult nasal breathing was 

present at 120 (44%), sleep-related breathing at 152 (56%) and nasal stuffiness at 162 

(60%) participants. Septoplasty was the most efficient in resolving symptom of difficult 

nasal breathing (p

80 



ezofagealnih govornika te se uspoređuju s govorno zdravim govornicima. Nazalni se suglasnici 

u hrvatskom izgovaraju tako da se usni prolaz zatvori (bilabijalno, alveolarno ili palatalno), 

a nosni otvori spuštanjem mekog nepca. Odstranjivanjem larinksa taj mehanizam 

ne bi trebao biti narušen, ali zbog statusa cjelokupnog govornog aparata u ezofagealnih 

govornika mogu se očekivati promjene u izgovoru nazalnih glasnika u njihovim spektralnim, 

intenzitetskim i vremenskim parametrima pa onda i stupnju njihove razabirljivosti u 

odnosu na zdrave govornike. 

66. 

ACOUSTIC RHINOMETRY FOR DIAGNOSIS OF NASAL 

OBSTRUCTION 


Medical University, Plovdiv, Bulgaria 

The evaluation of nasal obstruction is important for the treatment of perennial allergic 

rhinitis. Although, nasal resistance induced from rhinomanometry is useful, several authors 

reported that nasal resistance was not correlated with the sensation of nasal obstruction. 

Acoustic rhinometry was introduced by Hilberg (1989) to asses the geometry of 

nasal cavity. The method based on sound reflection analysis provides an estimate of the 

cross sectional area of the nasal cavity as a function of the distance from the nostril. The 

aim of this study is to evaluate the changing of nasal mucosa in patients with perennial 

allergic rhinitis and normal subjects and to investigate the benefit of acoustic rhinometry. 

Material and methods: We investigated 21 normal subjects and 22 patients with perennial 

allergic rhinitis were measured acoustic rhinometry before and after local decongestant. 

The values of changing nasal volume (0.8-4cm) (0-7cm) and cross-sectional area in 

patients were higher than those in normal subjects. And the value of nasal volume and 

cross-sectional area in patients with perennial allergic rhinitis was same as the value of 

normal subjects. Results: These results suggest that nasal mucosa of patients with perennial 

allergic rhinitis is more swelling than normal subjects. The values of nasal volume 

and nasal cross-sectional area are able to define the structure of nasal cavity. Conclusion: 

In conclusion, acoustic rhinometry is useful method to understanding nasal physiology 

especially in allergic rhinitis. 


67. 

VRIJEDNOST MAGNETNE REZONANCIJE U ANALIZI PERINEU- 

RALNE INFILTRACIJE MALIGNIH TUMORA PARANAZALNIH 

SINUSA I NOSNE ŠUPLJINE 

Dijana Zadravec, 1 Andrijana Jović, 1 Nataša Katavić, 1 Darko Solter, 2 Mirko Ivkić, 2 and Ivan Krolo 1 

1 Klinički zavod za intervencijsku i kliničku radiologiju i 2 Klinika za otorinolaringologiju i kirurgiju 

glave i vrata Medicinskog i Stomatološkog fakulteta Sveučilišta u Zagrebu, KBC „Sestre milosrdnice“, 

Zagreb 

Uvod: Maligni tumori paranazalnih sinusa i nosne šupljine pokazuju sklonost perineuralnoj 

infiltraciji. Osobitu sklonost perineuralnom širenju tumora pokazuju adenocistični 

karcinom i planocelularni karcinomi. Potvrda tumorske perineuralne infiltracije može 

konvertirati kirurški zahvat u radioterapiju ili kemoterapiju. Ponekad je perineuralna infiltracija 

jedini znak da je tumor maligan. Perineuralna infiltracija u većini slučajeva utječe 

na funkciju zahvaćenog živca što rezultira neurološkim ispadima, no ponekad je i asimptomatska, 

stoga je radiološka verifikacija perineuralne infiltracije od velike važnosti. Bolesnici 

i metode: Četrdeset i dva ispitanika s potvrđenim malignim tumorima paranazalnih 

sinusa i nosne šupljine analizirani su magnetnom rezonancijom. Dobiveni rezultati su 

statistički obrađeni i uspoređeni s kirurškim i patohistološkim rezultatima. Određivani su 

osjetljivost, specifičnost, točnost te pozitivna i negativna prediktivna vrijednost metode. 

Rezultati: Od 42 pacijenta s malignim tumorima paranazalnih sinusa i nosne šupljine, u 

njih 11 patohistološkom je analizom potvrđena perineuralna infiltracija. Osjetljivost MR-a 

u prikazu perineuralne infiltracije bila je 91%, a specifičnost 96,7%. Točnost MR-a u analizi 

perineuralne infiltracije bila je 94,7%. Pozitivna prediktivna vrijednost bila je 91%, a 

negativna prediktivna vrijednost 94,7%. Zaključak: Temeljem statističke obrade vidljivo je 

da je MR vrijedna dijagnostička metoda pri utvrđivanju perineuralne infiltracije. Potvrda 

perineuralne infiltracije potvrđuje malignu narav tumora, te bitno utječe na izbor terapije, 

premda sam ishod bolesti, po recentnim prikazima u literaturi ostaje nepromijenjen. 


81 


Posteri / Posters

Xyzal ® ima povoljan 

sigurnosni profil: 1-6 

• bez poznatih interakcija s drugim lijekovima 

• bez poznate kardiotoksičnosti 

• bez poznatog utjecaja na kognitivne i 

psihofizičke funkcije (pamćenje, 

pozornost) 

XYZAL 5 mg FILMOM OBLOŽENE TABLETE - Skraćeni sažetak opisa svojstava lijeka 

Naziv lijeka: Xyzal 5 mg fi lmom obložene tablete. Kvalitativni i kvantitativni sastav: Svaka 

fi lmom obložena tableta sadrži 5 mg levocetirizindiklorida. 

Terapijske indikacije: Simptomatsko liječenje alergijskog rinitisa (uključujući perzistirajući 

alergijski rinitis) i kronične idiopatske urtikarije. Doziranje i način primjene: Filmom 

obložena tableta se uzima oralno, proguta se cijela s tekućinom i može se uzeti sa ili bez 

hrane. Preporuča se uzeti cijelu dnevnu dozu odjednom. Odrasli i adolescenti iznad 12 

godina: Preporučena dnevna doza je 5 mg (1 fi lmom obložena tableta). Odrasli: Prilagodba 

doze se preporuča u odraslih bolesnika s umjerenim do jakim oštećenjem bubrežne funkcije 

(pogledajte ispod: Bolesnici s oštećenjem bubrežne funkcije). Djeca od 6 do 12 godina: 

Preporučena dnevna doza je 5 mg (1 fi lmom obložena tableta). Za djecu od 2 do 6 godina 

starosti nije moguće prilagoditi dozu fi lmom obložene tablete. Preporuča se primijeniti 

pedijatrijski oblik levocetirizina. Bolesnici s oštećenjem bubrežne funkcije: Intervali doziranja 

moraju biti prilagođeni s obzirom na individualnu bubrežnu funkciju. Prilagodite dozu u skladu 

s danom tablicom. 

Klirens 

Skupina 

kreatinina 

(ml/min) 

Normalna ≥ 80 

Blago oštećenje 50–79 

Umjereno oštećenje 30–49 

Jako oštećenje < 30 

Najsuvremeniji antihistaminik za 

djelotvorno liječenje alergijskog 

rinitisa i kronične idiopatske urtikarije 

Doza i 

učestalost 

doziranja 

1 tableta 

dnevno 

1 tableta 

dnevno 

1 tableta svaka 

2 dana 

1 tableta svaka 

3 dana 

Krajnja faza bubrežne bolesti – bolesnici na dijalizi < 10 Kontraindiciran 

U pedijatrijskih bolesnika s oštećenjem bubrežne funkcije treba individualno prilagoditi dozu 

s obzirom na bolesnikov bubrežni klirens i tjelesnu težinu. Nema posebnih uputa za djecu 

s oštećenjem bubrežne funkcije. Bolesnici s oštećenjem jetrene funkcije: Nije potrebna 

prilagodba doze u bolesnika s oštećenjem jetrene funkcije. U bolesnika s oštećenjem jetrene 

i bubrežne funkcije preporuča se prilagodba doze (pogledajte iznad: Bolesnici s oštećenjem 

bubrežne funkcije). Trajanje primjene: Povremeni (intermitentni) alergijski rinitis (simptomi 

prisutni < 4 dana tjedno ili manje od 4 tjedna) treba liječiti u skladu s prirodom bolesti i poviješću 

bolesti. Liječenje se može prekinuti ako se simptomi povuku te se može ponoviti kod ponovne 

pojave simptoma. U slučaju stalno prisutnog (perzistirajućeg) alergijskog rinitisa (simptomi 

prisutni > 4 dana tjedno ili dulje od 4 tjedna), bolesniku se može preporučiti kontinuirano 

liječenje u razdoblju izloženosti alergenima. Kliničko iskustvo s levocetirizinom od 5 mg u 

obliku fi lmom obloženih tableta trenutačno je dostupno za period terapije od šest mjeseci. 

Za kroničnu urtikariju i kronični alergijski rinitis dostupno je jednogodišnje kliničko iskustvo s 

racematom. Kontraindikacije: Preosjetljivost na levocetirizin ili na neki od sastojaka oblika ili 

na derivate piperazina. Bolesnici s jakim oštećenjem bubrežne funkcije s klirensom kreatinina 

manjim od 10 ml/min. Bolesnici s rijetkim nasljednim poremećajem nepodnošenja galaktoze, 

nedostatkom Lapp laktaze ili glukoza-galaktoza malapsorpcijom ne bi trebali uzimati ovaj 

lijek. Posebna upozorenja i mjere opreza pri uporabi: Primjena fi lmom obloženih tableta 

ne preporuča se u djece mlađe od 6 godina jer kod ovog oblika lijeka nije moguće prilagoditi 

Preporučeno dnevno doziranje: 

Xyzal ® otopina 

200 ml otopina 

od 0,5 mg/ml 

levocetirizina 

Xyzal ® Djeca starija 

Djeca od 2 

od 6 godina 

do 6 godina 

i odrasli 

tablete 

5 ml 10 ml 

30 filmom 

obloženih 

tableta od 5 mg 

levocetirizina 

— 1 tableta 

dozu na odgovarajući način. Preporuča se uzimati pedijatrijski oblik levocetirizina. Primjena 

levocetirizina u djece i novorođenčadi mlađe od 2 godine nije preporučena. Oprez je potreban 

kod uzimanja alkohola. Nuspojave: U terapijskim istraživanjima kod žena i muškaraca starih 

između 12 i 71 godine, 15,1% bolesnika koji su uzimali levocetirizin od 5 mg imali su najmanje 

jednu nuspojavu, u odnosu na 11,3% placebo skupine. 91,6 % ovih nuspojava bilo je blago 

do umjereno. U terapijskim ispitivanjima do prekida terapije uslijed nuspojava došlo je u 

1,0% slučajeva (9/935) kod uzimanja levocetirizina od 5 mg te u 1,8% slučajeva (14/771) 

kod placeba. Klinička terapijska ispitivanja s levocetirizinom obuhvatila su 935 osoba koje su 

uzimale lijek u preporučenoj dnevnoj dozi od 5 mg. U ovom uzorku zabilježene su sljedeće 

nuspojave incidencije 1% (< 10%, često) kod uzimanja levocetirizina od 5 mg ili kod placeba: 

Placebo (n = 771) Levocetirizin 5 mg (n = 935) 

Glavobolja 25 (3,2%) 24 (2,6%) 

Somnolencija 11 (1,4%) 49 (5,2%) 

Suha usta 12 (1,6%) 24 (2,6%) 

Umor 9 (1,2%) 23 (2,5%) 

Primijećene su i manje česte incidencije (> 0,1%, < 1%) nuspojava poput slabosti ili 

abdominalne boli. Incidencija sedativnih nuspojava poput somnolencije, umora ili slabosti 

bila je veća (8,1%) kod uzimanja levocetirizina od 5 mg nego kod placeba (3,1%). Osim gore 

navedenih nuspojava zabilježenih tijekom kliničkih ispitivanja, nakon stavljanja lijeka u promet 

zabilježeni su i vrlo rijetki slučajevi sljedećih nuspojava. Poremećaji imunološkog sustava: 

preosjetljivost uključujući anafi laksiju; Psihijatrijski poremećaji: agresivnost, uznemirenost; 

Poremećaji živčanog sustava: konvulzije; Poremećaji oka: vidne poteškoće; Srčani 

poremećaji: palpitacije; Poremećaji dišnog sustava, prsišta i sredoprsja: dispneja; Poremećaji 

probavnog sustava: mučnina; Poremećaji jetre i žuči: hepatitis; Poremećaji kože i potkožnog 

tkiva: angioneurotski edem, alergijska reakcija na lijek koja se javlja uvijek na istom mjestu 

(“fi xed drug eruption”, FDE), svrbež, osip, urtikarija; Poremećaji mišićno-koštanog sustava i 

vezivnog tkiva: mijalgija; Pretraga: povećana težina, nenormalni testovi jetrene funkcije. Naziv 

i adresa odobrenja za stavljanje gotovog lijeka u promet: Medis Adria d.o.o., Kolarova 

7, Zagreb. Klasa rješenja o odobrenju za stavljanje gotovog lijeka u promet: 30 (3 x 10) 

tableta: UP/I-530-09/05-01/981. Datum revizije sažetka opisa svojstva lijeka: 29. lipnja 

2010. 

Samo za zdravstvene radnike. Ovaj promotivni materijal sadrži bitne podatke o lijeku koji su istovjetni cjelokupnom odobrenom 

sažetku opisa svojstava lijeka te cjelokupnoj odobrenoj uputi sukladno članku 15. Pravilnika o načinu oglašavanja o 

lijekovima i homeopatskim proizvodima (»Narodne Novine« broj 118/2009). 

Reference: 1. de Bilic J et al. Pediatr Allergy Immunol 2005; 16:267-275 2. Potter PC. Ann Allergy Asthma Immunol 2005; 

95:175-180 3. Cranswick N et al. Int J Clin Pharm Therap 2005;43:172-7 4. Hindmarch I et. Al. Curr Med Res Opin 2001; 

17:241-55 5. Gandon JM et al. Br J Clin Pharmacol 2002; 54:51-8 6. Verster JC et al. J Allergy Clin Immunol 2003; 111:623-7. 

Medis Adria d.o.o.

84 

ZABILJEŠKE / NOTES 


ZABILJEŠKE / NOTES 


85

HNO 68.1/06/11/A-HR 

UNIDRIVE ® S III ENT 

Power Meets Precision 

KARL STORZ GmbH & Co. KG, Mittelstraße 8, D-78532 Tuttlingen/Germany, Phone: +49 (0)7461 708-0, Fax: +49 (0)7461 708-105, E-Mail: info@karlstorz.de 

KARL STORZ Adria Eos d.o.o., Zadarska 80, 10000 Zagreb, Croatia, Phone: +385 1 6406 070, Fax: +385 1 6406 077, E-Mail: info@karlstorz.hr 

www.karlstorz.com

ENT 65/E/09/08/P 

Navigation Panel Unit

Klavocin® bid 

amoksicilin/klavulanska kiselina 

• Iskustvo 

• Učinkovitost 

• Sigurnost 

ANTIBIOTIK KOJEM VJERUJETE 

Klavocin bid 1 g tablete (amoxicillinum, acidum clavulanicum) 

Terapijske indikacije: infekcije gornjih dišnih putova, osobito sinusitis, rekurentni tonzilitis, otitis media); česti uzročnici tih infekcija su Streptococcus 

pneumoniae, Haemophilus inyuenzae*, Moraxella catarrhalis i Streptococcus pyogenes. Infekcije donjih dišnih putova (akutna egzacerbacija 

kroničnog bronhitisa (osobito ako se smatra teškom), bronhopneumonija); česti uzročnici tih infekcija su Strepiococcus pneumoniae, Haemophilus 

inyuenzae i Moraxella caiarrhalis. Infekcije genitourinarnog trakta i abdomena, osobito cistitis (posebno rekurentni ili komplicirani-ali koji ne uključuje 

prostatitis), septički abortus, pelvična ili puerperalna sepsa i intraabdominalna sepsa) česti uzročnici tih infekcija su Enterobacteriaceae (najčešće 

Escherichia coli), Staphylococcus saprophyticus i Enterococcus species. Infekcije kože i mekih tkiva osobito celulitis, ugrizi životinja i teški dentalni 

apscesi s celulitisom; Česti uzročnici tih infekcija su Staphylococcus aureus, Streptococcus pyogenes i Bacteroides species. Doziranje i način 

primjene: Odrasli i djeca s tjelesnom masom 40 kg i više: kod težih infekcija ( uključujući kronične i rekurentne infekcije urinarnog trakta i donjeg 

respiratornog trakta): 1 tableta po 1 g dva puta na dan. Starije osobe: Nije potrebna prilagodba doze. Dozirati kao u odraslih osim ako je poremećena 

bubrežna funkcija. Doziranje u bolesnika s oštećenom funkcijom bubrega: Klavocin bid 1 g tablete smiju se koristiti samo u bolesnika kod kojih je 

glomerularna filtracija >30 ml/min. Blago oštećenje (klirens kreatinina >30 mil/min): nije potrebna prilagodba doze. Doziranje u bolesnika s oštećenom 

funkcijom jetre: Klavocin u bolesnika s oštećenom funkcijom jetre treba dozirati oprezno i u pravilnim razmacima pratiti jetrenu funkciju. Način 

primjene: Tablete treba progutati cijele, bez žvakanja. Zbog smanjenja mogućih probavnih nuspojava Klavocin treba uzeti na početku obroka. Kontraindikacije: 

Preosjetljivost na amoksicilin, klavulansku kiselinu ili druge penicilinske antibiotike. Treba obratiti pozornost na moguću križnu preosjetljivost 

s drugim betalaktamskim antibioticima, npr. cefalosporinima. Ranija pojava žutice ili poremećaja jetrene funkcije uzrokovana kombinacijom 

amoksicilina i klavulanske kiseline ili penicilinskim antibioticima. Posebna upozorenja i mjere opreza pri uporabi:U nekih bolesnika koji su 

uzimali kombinaciju amoksicilina i klavulanske kiseline zabilježene su promjene vrijednosti testova jetrene funkcije. Kombinaciju amoksicilina i klavulanske 

kiseline treba primjenjivati s oprezom u bolesnika s postojećim ili prethodnim oštećenjem funkcije jetre. Rijetko je zabilježena kolestatska 

žutica, koja može biti teška, ali je obično reverzibilna. Znakovi i simptomi možda neće biti očiti i do nekoliko tjedana nakon završetka liječenja.U bolesnika 

s oštećenom bubrežnom funkcijom Klavocin treba se primjenjivati s oprezom te treba voditi računa o primijenjenoj dozi. Vrlo rijetko je zabilježena 

kristalurija u bolesnika u kojih je smanjena količina urina, pretežito u onih koji su primali parenteralnu terapiju. Tijekom primjene visokih doza 

amoksicilina, treba održavati odgovarajući unos tekućine, kako bi se smanjila mogućnost nastanka kristalurije. U bolesnika koji se liječe penicilinima 

zabilježeni su slučajevi teških, a ponekad i fatalnih reakcija preosjetljivosti (anafilaktoidnih reakcija). Vjerojatnije je da će se takve reakcije pojaviti u 

osoba s anamnezom preosjetljivosti na penicilin. U bolesnika s infektivnom mononukleozom nakon primjene Klavocina može se pojaviti eritematozni 

osip, stoga se ne preporučuje uporaba Klavocin bid tableta kod bolesnika s infektivnom mononukleozom. Najčešće nuspojave: Infekcije i infestacije: 

mukokutana kandidijaza. Poremećaji živčanog sustava: vrtoglavica, glavobolja. Poremećaji probavnog sustava: proljev, mučnina, povraćanje, 

žgaravica. Poremećaji jetre i žuči: umjereni porast AST i/ili ALT. Poremećaji kože i potkožnog tkiva: kožni osip, svrbež, urtikarija. Naziv i adresa nositelja 

odobrenja za stavljanje gotovog lijeka u promet: PLIVA Hrvatska d.o.o., Prilaz baruna Filipovića 25, 10 000 Zagreb, Hrvatska. Klasa i datum 

rješenja o odobrenju za stavljanje gotovog lijeka u promet: UP/I-530-09/06-02/226 od 27. travnja 2007. Način izdavanja: Na recept, u ljekarni. 

Ovaj promotivni materijal sadrži bitne podatke o lijeku koji su istovjetni cjelokupnom odobrenom Sažetku opisa svojstava lijeka te cjelokupnoj 

odobrenoj Uputi o lijeku sukladno članku 15. Pravilnika o načinu oglašavanja lijekova i homeopatskih proizvoda (“Narodne novine” broj 118/09). SA- 

MO ZA ZDRAVSTVENE DJELATNIKE. PLIVA HRVATSKA d.o.o. Prilaz baruna Filipovića 25, 10000 Zagreb, Hrvatska, Tel: + 385 1 3720 000 / Faks: 

+ 385 1 3724 962; www.pliva.hr, www.plivamed.net 01-11-KLV-01-NO/25-11/01-12

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