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2016| January-June | Volume 6 | Issue 1
Online since
July 26, 2016
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ORIGINAL ARTICLES
Impact of resection of the head of the middle turbinate in endoscopic sinus surgery
Hamza El-Shafaai A Ahmed, Mohamed M Osman
January-June 2016, 6(1):11-15
DOI
:10.4103/2090-7540.183734
Aim
The aim of the present study was to evaluate the effects of middle turbinate head resection (MTR) on the outcome of endoscopic sinus surgery.
Patients and methods
Patients with bilateral nasal polyps were bilaterally operated upon. From one side, the polyps were removed with preservation of the head of the middle turbinate. From the other side, polyps were removed with MTR. Patients were followed up at 1, 2, 4 weeks, 6 months, 1, and 2 years postoperatively for the presence of crusts, adhesions, polyp recurrence, smell affection, frontal sinus drainage pathway obstruction, and overall nose patency. Moreover, the duration of surgery for both sides was compared.
Results
No statistically significant differences were observed in the presence of crusts, adhesions, polyp recurrence, smell affection, frontal sinus drainage pathway obstruction, or overall nasal patency between the findings on the two operated sides. The operative time was significantly shorter for the group with MTR.
Conclusion
MTR carries no adverse effects and can be carried out safely in endoscopic sinus surgery.
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Outcomes of the three-layer technique of nasal alar defect repair
Abdelrahman E. M Ezzat, Marwa M El-Begermy, Mustafa I Eid, Mohamed O Ouf
January-June 2016, 6(1):1-4
DOI
:10.4103/2090-7540.183733
Background
Nasal defects are usually defined as 'partial' or 'full' thickness. The main role of reconstructive surgery is replacement of the defective tissues with nearly similar tissues.
Design
This study was a retrospective case series with chart review. The study was conducted at academic tertiary care medical centers. The aim of this study was to evaluate a three-layer reconstruction (functional and esthetic evaluation).
Patients and methods
Nine patients presented to our office with a defect in the lower third of the nose after an accident or secondary to nasal lesion removal. In our technique, we described a single-stage, three-layer reconstruction. This technique was used to repair the full thickness alar and lower lateral cartilage defects. We designed the new three-layer repair based on the normal anatomy and histology using bilobed skin flap and lateral nasal wall mucosal rotational flaps with septal cartilage graft.
Results
Aesthetically acceptable results were obtained without the compromise of the nasal valve function, which was assessed using acoustic rhinometry. The acoustic rhinometric evaluation for the nasal valve (1.5–2 cm from the nostril) function showed that the cross-sectional area on the repaired side was 0.46–0.78 cm
2
and it was 0.52–0.81 cm
2
on the other site (
P
= 0.670), with a normal nasal cycle and without compromising the airway. Moreover, minimal donor site morbidity was observed.
Conclusion
The bilobed skin flap and rotational mucosal flap with septal cartilage graft for full thickness alar defect, is a novel technique with minimal donor site morbidity, acceptable postoperative shape and good functional results.
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CASE REPORTS
Pleomorphic adenoma of the nasal septum: a case report and review of the literature
Ali Al Momen, Abdulrahman Al Khatib
January-June 2016, 6(1):36-38
DOI
:10.4103/2090-7540.183985
Intranasal pleomorphic adenomas are quite rare and are frequently misdiagnosed . We report a nasal septal pleomorphic adenoma in a 60-year-old man. Rigid endoscopy of the nose revealed a large polypoid mass filling the right posterior nasal cavity. Computed tomography scan of the paranasal sinuses demonstrated well-pneumatized paranasal sinuses and a soft tissue mass in the posterior aspect of the right nasal cavity arising from the posterior part of the septum. A submucous resection was used as an approach to the tumor and as a method of excising the mass with the segment of septum attached to it. After 4 years, the patient had experienced no further problems with the nasal airway, and repeated nasal endoscopic examination revealed no recurrence of the disease.
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ORIGINAL ARTICLES
Endoscopic nasopharyngectomy for nasopharyngeal carcinoma
Reda Hussien Kamel, Mohamed Salah Eldeen Hassan, Ahmed Elfarouk Abdelfattah, Ahmed Selim Fouad, Sameh Medhat Zamzam
January-June 2016, 6(1):5-10
DOI
:10.4103/2090-7540.186904
Background
The radiosensitivity of nasopharyngeal carcinoma has led to effective primary treatment using radiation with or without chemotherapy. Despite modern radiotherapy techniques, recurrent or persistent disease remains challenging.
Materials and Methods
This study included 10 patients who underwent endoscopic nasopharyngectomy: two primary cases of nasopharyngeal carcinoma, five cases recurrent after finishing treatment with chemoradiation by 7–14 months, and three patients showed residual disease just after finishing therapy using chemoradiotherapy confirmed with biopsy. The average age was 43.5 years. Chemoradiotherapy was performed postoperatively for all patients. Margin status and complications were evaluated. Repeated nasopharyngeal endoscopic assessment plus computed tomography and MRI imaging with contrast were carried out, with a mean follow-up period of 17.5 months.
Results
One patient showed recurrence (10%) and was managed with resurgery. No deaths were recorded due to the disease (overall survival rate, 100%) until the end of this study, and there were no major complications.
Conclusion
Endoscopic nasopharyngectomy is a feasible, direct, effective, and safe surgical procedure. Long-term follow-up is necessary for better assessment.
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Desipramine plus levocetirizine as a treatment for persistent allergic rhinitis
Diaa El Din Mohamed El Hennawi, Mohamed Rifaat Ahmed, Ashraf Saad Abou-Halawa, Wael Abdelkafy, Ahmed Geneid
January-June 2016, 6(1):22-26
DOI
:10.4103/2090-7540.183736
Background
Persistent allergic rhinitis has significant effects on the quality of life (QOL), especially on sleep and work performance, and is associated with specific psychiatric syndromes.
Aim
The aim of the present study was to verify the efficacy of combined desipramine and levocetirizine in the treatment of psychological stress related to persistent allergic rhinitis, and to thereby improve the QOL of the patient.
Patients and methods
A total of 132 psychologically stressed persistent allergic rhinitis patients (positive Kessler Psychological Distress Scale scores ≥12) were randomly divided into two groups: the control group, which received levocetirizine, and the study group, which received levocetirizine plus desipramine. QOL for all patients was assessed by using a seven-point scale after the treatment period.
Results
There was a highly statistically significant better QOL in the study group (6.79) compared with the control group (2.21) (
t
-test=15.17 and
P
= 0.0001).
Conclusion
Desipramine and levocetirizine have a better effect on the QOL outcomes in the treatment of patients with persistent allergic rhinitis, and having psychological stress disorders. Level of evidence: 3b.
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CASE REPORTS
Intravascular papillary endothelial hyperplasia (Masson's tumor) as a nasal mass: a case report and review of the literature
Khalid H Al-Qahtani
January-June 2016, 6(1):33-35
DOI
:10.4103/2090-7540.183731
Intravascular papillary endothelial hyperplasia (Masson's tumor) is a rare non-neoplastic vascular proliferative process in a normal blood vessel or vascular malformation. Nose and paranasal sinuses are extremely rare location for this type of tumor. We report a case of Masson's tumor in a 33-year-old female, presented with an obstructing nasal mass in the right side, repeated epistaxis and rhinorrhea for eight months associated with anosmia, frontal headache and proptosis.
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ORIGINAL ARTICLES
Effect of middle turbinate intervention on outcomes of middle meatal endoscopic surgery
Khaled M Bofares
January-June 2016, 6(1):27-32
DOI
:10.4103/2090-7540.186905
Background and objective
Middle turbinate position, bulk, and shape play a significant role in the determination of drainage and ventilation at the middle meatus. The middle turbinate constitutes the corner stone for the performance of drainage as well as ventilation functions at the area of the ostiomeatal complex. As one of the major aims of middle meatal endoscopic surgery is providing sufficient drainage and ventilation at the level of this complex, the middle turbinate should be assessed properly before the surgery with regard to its position, size, and shape, which may predispose for sinusitis through the obliteration of the ostiomeatal complex as in cases of paradoxical middle turbinate, concha bullosa of the middle turbinate, hypertrophy of the middle turbinate, and double middle turbinate. These varieties of abnormal middle turbinate need to be interfered accordingly to reduce the risk for recurrence of sinusitis after the surgery. In addition, the normal middle turbinate may lateralize postoperatively and subsequently result in the reobstruction of the drainage and ventilation at the middle meatal area. Therefore, for the purpose of maintenance of sufficient drainage and ventilation after middle meatal endoscopic surgery, it is suggested to interfere with the normal middle turbinate either by means of its partial resection at its lower part, its medialization and further fixation of it to the nasal septum with a stitch, or by creating a synechia with the mucoperiosteal flap over the nasal septum. For this reason the serial analytic coherent clinical study was planned prospectively to postulate as to which technique is the best among the previously mentioned three techniques and compared further with noninterfered middle turbinate cases.
Patients and methods
Sixty patients between 14 and 63 years of age with chronic sinusitis presented with clinical as well as radiological evidence of maxilloethmoidal sinusitis with or without frontal and sphenoidal involvement at ENT OPD, Al-Tarahom Private Center (Elbyda, Libya), during the period between July 2013 and March 2015 and underwent functional endoscopic sinus surgery. The patients were divided into four groups, group A (
n
= 16), group B (
n
= 18), group C (
n
= 6), and group D (
n
= 20), which included those patients who proceeded after middle meatal endoscopic surgery with the medialization of the ipsilateral middle turbinate and creation of a synechia between it and the nasal septum, partial resection of the ipsilateral middle turbinate at its lower third, medialization and further fixation of the ipsilateral middle turbinate to corresponding nasal septal flap using a vicryl stitch material, or just medialization of the ipsilateral middle turbinate without any further fixations, respectively. The four groups were compared in relation to postoperative patency persistence of the ipsilateral middle meatus and correlated with the incidence of sinusitis recurrence after the surgery.
Results and conclusion
An overall 49% of the patients who underwent just medialization of the ipsilateral middle turbinate without any further fixations developed recurrence of sinusitis due to reobliteration of the middle meatus either by means of a synechia between the middle turbinate and the lateral wall or by means of extreme lateralization of the middle turbinate compared with the other groups. All patients in other groups achieved complete improvement without any evidence of recurrence of sinusitis after 1 year of follow-up, apart from 12% of patients in group B who presented with evidence of sinusitis recurrence after 3–6 months postoperatively. Broadly speaking, the intervention with the normal middle turbinate can be considered as one of the important steps during the middle meatal endoscopic surgery that may help significantly toward the improvement of outcomes of this commonly performed procedure.
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The incidence of complications after prelacrimal recess approach versus endoscopic sinus surgery of maxillary sinus lesions
Mohammed A AlAyadi, Sherif A Raafat, Khalid A Ateya, Fadi M Gharib, Abdullah M AlMurtada
January-June 2016, 6(1):16-21
DOI
:10.4103/2090-7540.186903
Aim of work
The aim of the study was to evaluate the incidence of complications after prelacrimal recess approach (PLRA) and compare it with endoscopic sinus surgery for maxillary sinus lesions.
Patients and methods
This was a prospective study in which 20 patients were recruited between July 2013 and September 2015 from the otorhinolaryngology outpatient clinic of Kasr Al-Ainy Hospital, Cairo University. Patients with bilateral maxillary sinus lesions underwent endoscopic sinus surgery on one side and PLRA on the other side. Postoperative complications during 2-year follow-up were assessed.
Results
Two patients had epiphora at the PLRA side; one cured spontaneously, and the other was treated accordingly. Four patients had adhesions at the PLRA side, whereas two patients had adhesions at the middle meatal antrostomy side. Two patients developed numbness at the PLRA side, and one patient had persistent facial pain at the PLRA side. Intraoperatively there was excessive bleeding in three patients and an inferior turbinate destabilization in three patients at the PLRA side.
Conclusion
Our study demonstrated that, although PLRA is a minimally invasive technique, it still carries a risk for complications.
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© Pan Arab Journal of Rhinology | Published by Wolters Kluwer -
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th
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