Ahmed Aly Ibrahim

Effect of Passive Smoking on the Ultrastructure of the Nasal Mucosa in Children

Passive exposure to cigarette smoke has been implicated in a number of respiratory childhood disorders. Most studies concerning smoking were directed to its carcinogenic effect on the lungs. However, the effects of smoking on nasal respiratory mucosa have not been widely studied. The aim of the present study was, therefore, to study the ultrastructural changes in the nasal mucosa of a pediatric population exposed to passive smoking.

The safe gate to the posterior paranasal sinuses: reassessing the role of the superior turbinate

Surgery of the posterior ethmoid and sphenoid sinuses can be challenging. In 1999, a technique was described for identification of the superior turbinate and utilizing it as a landmark in endoscopic posterior ethmoidectomy and sphenoidotomy. Although this was more than a decade ago, it has not been supported by further studies. In our practice, we have routinely adopted this technique, and have modified it to allow further orientation during endoscopic surgery of the posterior sinuses. To describe a review of our technique, and to prospectively assess the value of the superior turbinate as a useful landmark during endoscopic posterior ethmoidectomy and sphenoidotomy. Fifty patients listed for endoscopic posterior ethmoidectomy with or without sphenoidotomy were included in a prospective study utilising our surgical technique. Data were collated for the success or failure of identification of the landmarks, and for any complications during the surgery. A total of 93 sides of endoscopic posterior ethmoidectomy and 73 sides of endoscopic sphenoidotomy were performed. The superior turbinate was identified in 100% of the cases. The coronal part of the superior turbinate basal lamella was identified in 60.22% of the cases, and the axial part in 88.17% of the cases. The natural sphenoid ostium was identified medial to the posterior part of the superior turbinate in 98.63% of the cases. The axial part of the superior turbinate basal lamella was a constant landmark for the level of the sphenoid ostium. The number of transverse septae between the axial part of the superior turbinate basal lamella and the skull base was studied, and was found never to exceed one septum. No major complications were recorded. One case of small posterior septal perforation was detected with no post-operative effects. Our study represents the first report of identifying the two parts of the superior turbinate basal lamella intra-operatively. It also represents the first report of using the axial basal lamella of the superior turbinate as a landmark for the level of the sphenoid sinus ostium, as well as a landmark for the level of the skull base. The superior turbinate represents a constant landmark for performing a safe posterior ethmoidectomy and sphenoidotomy.

Traumatic cerebrospinal fluid leakage following septorhinoplasty

Septoplasty/septorhinoplasty is a common ear, nose and throat procedure offered for those patients with deviated septum who are suffering from nasal obstruction and functional or cosmetic problems. Although it is a basic and simple procedure, it could lead to catastrophic complications including major skull base injuries which result in cerebrospinal fluid (CSF) leaks. We describe two different cases of traumatic CSF leaks following septoplasty/septorhinoplasty at two different sites. The first patient suffered a CSF leak following septoplasty and presented to Alexandria University Hospital. The leak was still active at presentation and identified as coming from a defect in the roof of the sphenoid sinus and was repaired surgically. The second patient presented 4 days after her cosmetic septorhinoplasty with a CSF leak and significant pneumocephalus. She was managed conservatively. Understanding the anatomical variations of the paranasal sinuses and implementing proper surgical techniques are crucial in preventing intracranial complications when performing either septoplasty or septorhinoplasty. A good quality computed tomography of the nose and paranasal sinuses is a valuable investigation to avoid major complications especially CSF leaks following either procedure.

Endoscopic approach to the infratemporal fossa

Abstract Introduction Multiple surgical approaches have been described to access the infratemporal fossa. One of them is the endoscopic endonasal transpterygoid approach to the infratemporal fossa. The endoscopic endonasal transpterygoid approach is considered the best to access the midline structures such as the nasopharynx, Eustachian tube, sella, and clivus. Through this work, we try to describe the anatomical structures and landmarks of the infratemporal fossa from the endosopic endonasal transpterygoid point of view. Methods A cadaveric study was performed on five adult specimens. Endoscopic medial maxillectomy and complete resection of the posterior wall of the maxillary antrum were performed. Extension of the medial maxillectomy anteriorly was done to reach the lateral part of the infratemporal fossa. Endoscopic Denker’s or Sturman–Canfield approach was done. Dissection of the pterygopalatine fossa was done with identification of maxillary artery branches, V2 (maxillary nerve) and masticatory muscles. Resection of the lateral pterygoid muscle and drilling the lateral pterygoid plate improve exposure of the infratemporal fossa, including V3 (mandibular nerve), which lies posterior to the lateral pterygoid plate. Results A total of ten infratemporal and pterygopalatine fossae (five cadaveric specimens) were dissected endoscopically using a transpterygoid approach. Dissection of different anatomical structures in the infratemporal fossa was done to describe the anatomical structures and landmarks of the infratemporal fossa. Conclusions Endoscopic endonasal transpterygoid approach is considered one of the most useful surgical solutions to manage selected tumors that involve the infratemporal fossa. A good understanding of the endoscopic anatomy of infratemporal fossa allows safe and complete resection of lesions arising or extending to infratemporal fossa.