Ahmed Musaad Abd El-Fattah

Pepsin assay: A marker for reflux in pediatric glue ear

Objective To evaluate if analysis of pepsin/pepsinogen in middle ear effusions can be considered a diagnostic marker for laryngopharyngeal reflux (LPR) in children with otitis media with effusion (OME). Material and Methods Ambulatory 24-hour dualprobe pH monitoring was carried out on 31 children with OME. Middle ear effusions were collected from 17 children during myringotomy. Total pepsin/pepsinogen concentrations in effusions were measured by ELISA using antipepsin antibody. Results Dual-probe pH monitoring showed that 22/31 (71%) of the studied children had significant LPR. The concentrations of pepsin/pepsinogen in middle ear effusions, ranged from 0.085 to 5.02 μg/ml, were found to be up to 4.5 to 231.44 times higher than the serum levels. There was a significant positive correlation between the level of pepsin/pepsinogen assayed in the effusions of the 17 children and the number of pharyngeal reflux episodes measured by pH monitoring. Conclusions Control of LPR may be an essential component in the successful management of OME in pediatric patients. Pepsin/pepsinogen analysis in effusions of children, using ELISA, can be considered a reliable marker for assessment of reflux in children with OME.

Cervical sympathetic schwannoma with postoperative first bite syndrome

Extracranial schwannomas occurring in the head and neck region may arise from cranial, peripheral or autonomic nerves. Determination of the nerve of origin is not often made until the time of surgery. Schwannomas arising from the cervical sympathetic chain are extremely rare. These interesting tumors along with schwannomas in general and the remaining class of neurogenic tumors are known for their ability to mimic the physical and radiological findings of carotid body tumors. Surgery is the treatment of choice and major complications are infrequent. However, we report a case of cervical sympathetic chain schwannoma with postoperative first bite syndrome.

Pre-emptive triple analgesia protocol for tonsillectomy pain control in children: double-blind, randomised, controlled, clinical trial.

INTRODUCTION This double-blind, controlled, parallel-group study was designed to determine the efficacy of pre-emptive triple analgesia for paediatric post-tonsillectomy pain management. MATERIALS AND METHODS One hundred and thirty-five children were randomised into two groups: pre-emptive triple analgesia (n = 55) and control (n = 80). Pain was assessed using a visual analogue scale (in hospital) and the Parents Postoperative Pain Measure (at home), and scores recorded. RESULTS Visual analogue scale scores on awakening and for 6 hours post-surgery were significantly better in the study group than the control group (p < 0.05). The Parents Postoperative Pain Measure scores of control group children were significantly higher within the first 3 post-operative days (p = 0.000), with a greater percentage of children experiencing significant pain and requiring more analgesia. CONCLUSION The proposed multimodal, pre-emptive analgesia protocol for paediatric post-tonsillectomy pain results in less post-operative pain, both in hospital or at home.

Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III-IV tracheal stenosis.

INTRODUCTION Laryngotracheal stenosis is currently one of the most common complications associated with nasal and orotracheal intubation and tracheotomy. Once established, tracheal stenosis can be a complex and difficult problem to manage. PATIENTS AND METHODS We retrospectively analysed 2004-2010 data for 12 male patients with postintubation cervical tracheal stenosis (grade III-IV) treated in the otolaryngology department, Mansoura University Hospitals. All patients had a tracheostomy at presentation, and all underwent tracheal resection with primary cricotracheal anastomosis and suprahyoid release. RESULTS Grade III stenosis was present in five patients (41.7 per cent) and grade IV stenosis in seven patients (58.3 per cent). The length of trachea resected ranged from 2 to 4 cm, representing one to four tracheal rings. In all 12 patients, the procedure allowed successful tracheotomy decannulation. Minor complications comprised surgical emphysema (n = 2) and wound infection (n = 1), and were managed conservatively. Major complications consisted of restenosis (n = 3), managed in two patients by repeated dilatation; one patient was lost to follow up. CONCLUSION Segmental tracheal resection with cricotracheal anastomosis was successful in 11/12 (92 per cent) patients with severe cervical tracheal stenosis. The strategy for treatment of airway stenosis is now well established and success rates are high, with minimal or no sequelae.

Midline nasofrontal dermoids in children: A review of 29 cases managed at Mansoura University Hospitals

OBJECTIVES Nasal dermoids are congenital anomalies constituting 3.7-12.6% of dermoids in the head and neck. Most of lesions are superficial but there is always a risk that it may end blindly within the deep structures of the nose or extend intracranially. Complete excision, regardless of extension, is essential and must be balanced against cosmoses. This study reviews the clinical characteristics and imaging findings as well as the appropriate surgical approach adopted for 29 cases managed at Mansoura University Hospitals. METHODS A retrospective analysis was performed in 29 patients admitted for management of nasal dermoid between Jan 2001 and Jan 2015 at the Otolaryngology department of our tertiary referral university hospital. Recorded data included patients demographics, complaint, lesions site, pre-operative radiological findings, surgical technique, intra-operative findings, and post-operative squeal. RESULTS This series included 12 (41%) female and 17 (59%) male children, with a mean age of 2.5 years. Twenty seven children presented with a nasofrontal swelling of which 20 had an apparent sinus. Other presentations included a swelling in the inner canthum (1), nasal tip and columella (1). Nine (31%) patients had a history of infection and two patients gave a positive history of meningitis. Intracranial extradural extension was identified in 10 patients (34.5%) during preoperative imaging. Surgical modalities included local excision and direct closure (12), open rhinoplasty (7), bicoronal excision and craniotomy (10). In 9 cases, the tract was adherent to the dura but was carefully dissected and in one case resection required excision of a segment of dura and reconstruction. In a follow up period of 1-8 years, recurrence was detected in one case and the cosmetic results were satisfactory. CONCLUSIONS Those lesions are rare and require early precise surgical planning to achieve complete en bloc excision. This study reports a low morbidity associated with management of nasal dermoids with intracranial extension.

Efficacy of unilateral combined (superficial and deep) cervical plexus block as a preemptive analgesia for unilateral neck dissection surgery

Abstract Objectives The objectives of this study were designed to evaluate the intra- and postoperative analgesic efficacy of unilateral superficial and deep cervical plexus block for unilateral neck dissection surgery. Patients and methods Twenty eight patients were randomly assigned into two groups to receive either saline (control group) or bupivacaine (study group), hemodynamic monitoring. Bispectral index (BIS) monitor and MAC of isoflurane were recorded. Postoperative visual analogue score were recorded, operative time and postoperative first time to take analgesic were recorded. Results Compared to the control group, patients received bupivacaine for unilateral superficial and deep cervical plexus block showed lower intraoperative isoflurane concentration and bispectral index, decreased postoperative visual analogue score, longer duration of analgesia, decreased plasma cortisol level. No patients developed adverse effects. Conclusion Unilateral combined superficial and deep cervical plexus block is an effective technique to reduce intraoperative anesthetics and reduce postoperative analgesic requirements in patients undergoing unilateral block neck dissection surgery without any adverse effects.

Endoscopic stapedotomy: Merits and demerits

Introduction Surgical microscopes are still preferred to perform stapes surgery; but the use of the endoscopes would offer much benefits such as good panoramic view and easy accessibility to the oval window niche, the stapes and facial nerve. In this study, we aimed to analyze and compare the outcomes and complications of endoscopic versus microscopic stapes surgery. Patients and methods This work was done at the Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Egypt, between September 2015 and July 2016. The patients; diagnosed as having otosclerosis and full filled the selection criteria; were randomly divided into 2 groups. Results The group A (microscopic group) included 28 patients (aged 19-60 years) and the group B (endoscopic group) included 14 patients (aged 22-56 years). Mean follow-up durations were 4.5 months (1-8.5) in the endoscopic group and 5.5 months (1.5-8) in the microscopic group. The difference in preoperative and postoperative air-bone gap in two groups was statistically significant (p = 0.031). But there was no statistical difference for hearing results between two groups and the two techniques have similar audiological outcomes. The main merits of endoscopic stapedotomy are the good quality panoramic image, well identification and visualization of vital structures of the middle ear, minimal handling of chorda tympani nerve if needed with practically no curettage of bony wall. Conclusions The present series shows that it is possible to perform stapes surgery using only the 4mm in diameter and 18cm long endoscopes of different angulations, without major difficulties.

Partial cricotracheal resection for severe upper tracheal stenosis: Potential impacts on the outcome

OBJECTIVE The aim of this study was to investigate the potential impact of multiple preoperative and intraoperative variables on the outcome of partial cricotracheal resection and tracheal resection anastomosis (PCTR/TRA). METHODS The study was conducted on 35 consecutive patients of grade III and IV upper tracheal stenosis with or without subglottic involvement. The indication of PCTR/TRA was post intubation stenosis in all patients. Overall complications (major and minor) occurred in 18 patients. Perioperative mortality occurred in 1 patient. Anastomotic complications do not always mean failure of surgery. They may indicate one or more interventions; such as removal of granulation tissue or dilatation of restenosis, with good results in most cases. RESULTS At the end of treatment, 30 (85.7%) patients were decannulated successfully with effortless breathing and with good phonation and swallowing. Several perioperative factors were found to have a significant impact on the outcome of PCTR/TRA. Of these factors, comorbidities had the most significant negative impact, and indeed all the three patients who had comorbidities, were not successfully decannulated. Duration of intubation, length of resected segment and previous open airway interventions was reported to have a significant negative impact on the outcome of surgery. CONCLUSION PCTR/TRA for treatment of post traumatic subglottic or upper tracheal stenosis has a high success rate, especially in healthy patients without comorbidities, and without previous open airway interventions.

Surgical correction of bifid nose

OBJECTIVES Evaluation of the aesthetic outcome and functional aspect after surgical correction of bifid nose by combined Millard forked flap with external rhinoplasty BACKGROUND Bifid nose is a rare congenital anomaly that results during facial development but the explicit mechanism is not clearly understood. Clinical findings are quite variable with a wide range of severity. Surgical correction still represents great challenge to facial plastic surgeons; extensive deformities in many cases, rarity of condition and paucity of publications are contributing factors. METHODS Surgical correction of six patients with bifid nose by a combined Millard forked flap with external rhinoplasty RESULTS The aesthetic and functional outcomes were acceptable for all patients and parents. There were no considerable postoperative complications. CONCLUSIONS This approach is highly effective for various grades of bifid nose. Early management is preferable to avoid psychological morbidity. Secondary rhinoplasty is usually needed for cosmetic refinement.

Transoral, minimally invasive, video-assisted technique for lingual thyroid

Introduction Lingual thyroid is a rare developmental congenital anomaly. Symptoms may not develop unless the gland enlarges because of gland hypertrophy or malignancy. When removal is advocated, most proposed techniques are invasive and associated with substantial morbidity. Materials and methods The approval of the Otolaryngology Department Research and Ethics Committee, Mansoura University, to perform an analysis of a new minimally invasive surgical technique for the management of a case of obstructive lingual thyroid gland was obtained before study commencement. Careful preoperative assessment of the diagnosis of the lingual thyroid gland included an 131 I scan and an MRI of the head and neck with and without gadolinium. Results A transoral, minimally invasive, video-assisted thyroidectomy, using Harmonic shears, was performed on a 22-year-old man with a longstanding lingual thyroid that had begun to cause dysphagia and upper airway obstruction. The procedural time was 85 min, and the estimated blood loss was 20 cm 3 . The patient tolerated a regular diet with minimal discomfort and was discharged home within 24 h. Conclusion The combination of the transoral endoscope-guided technique with Harmonic vascular control is considered a surgically minimally invasive satisfactory option in well-trained hands familiar with such tools.