Doron Sagiv

Novel Anatomic Characteristics of the Laryngeal Framework A Computed Tomography Evaluation

Objective The thyroid cartilage (TC) in men has a more prominent thyroid notch and a narrower interlaminae angle (ILA) as compared with women. Anatomy textbooks classically stipulate that the ILA is 90° in men and 120° in women. Our observation, based on thyroid chondroplasty operations, of a much narrower angle led to the current investigation. Study Design Cohort imaging study. Setting Tertiary academic referral center. Subjects and Methods Computed tomography angiography neck images of adult patients were studied. The ILA was measured on 2 axial planes: at the level of the vocal processes (and the upper portion of thyroarytenoid muscles) and 5 mm superior and parallel to the former. The anterior projection of the TC and the vertical dimensions of the midline cricothyroid membrane (CTM) were also measured. Results A total of 126 patients were included in the study. The average ILAs were 63.5°±20.6° and 93.3°±16.6° for men and women, respectively (P < 10−14), and were significantly narrower at the upper level in comparison with the vocal process level (P < 10−7 for men, P = .004 for women). The anterior projection of the TC in men was more prominent as compared with women (P = .0003) and significantly correlated with the ILA (P = .0159). The length of the midline CTM was 11.1±2.3 mm in men and 10.3±1.7 mm in women (P = .0355). Conclusions The ILA is narrower than that reported in the classic anatomy textbooks. In male patients, the upper part of the TC becomes narrower and projects anteriorly like a “jug’s spout.” The mean vertical dimension of the midline CTM was 10 to 11 mm.

The anatomical evolution of the thyroid cartilage from childhood to adulthood: A computed tomography evaluation

To enhance knowledge and understanding of the laryngeal framework maturation in different age groups and genders.

Recurrent pleomorphic adenoma: is treatment considerably delayed thus affecting surgical morbidity?

Abstract Objective: To examine the incidence of late presentation of patients with recurrent pleomorphic adenoma (RPA) of the parotid gland. Methods: This is a retrospective analysis of patients treated in our center. We examined patients demographics, disease characteristics, treatment, and outcome and as well as the time period length from the first discovery of a recurrent mass until seeking treatment at our clinic and its effect on morbidity. Results: A total of 30 patients were included. 26% underwent initial enucleation in other institutions. In eight patients (26%), the recurrence of the mass was second or higher. The patients average time period length until seeking treatment was 2.48 years, with 33% of patients showing a time period length of over three years. Multifocal tumor, tumor diameter larger than 2 cm and facial nerve involvement were found in 15 (50%),16 (53.3%) and seven (25%) patients respectively. Patients delay of presentation by ≥3 years was associated with a tumor size of ≥2 cm (Relative Risk [RR] = 2, p = .02). Patients delay of presentation by ≥2 years was also associated with a trend towards a higher rate of post-operative facial nerve palsy (RR = 3.37, p = .07, CI = 0.88–12.85). Conclusion: Most patients with RPA were presented late, thus affecting disease extent and surgical morbidity.

Epistaxis in the setting of antithrombotic therapy: A comparison between factor Xa inhibitors, warfarin, and antiplatelet agents: Factor Xa Inhibitor Therapy and Epistaxis

To describe the characteristics and severity of epistaxis in patients taking factor Xa inhibitors novel anticoagulants.

Mobile phone usage does not affect sudden sensorineural hearing loss

OBJECTIVE Recent studies found that mobile phone users had a significantly greater risk of having elevated thresholds in speech frequencies. This study investigated the correlation between the laterality of sudden sensorineural hearing loss, handedness and the preferred ear for mobile phone use. METHODS The study included all patients who presented with sudden sensorineural hearing loss to the Department of Otolaryngology - Head and Neck Surgery in our tertiary referral medical centre between 2014 and 2016. Patients were asked to indicate their dominant hand and preferred ear for mobile phone use. RESULTS The study comprised 160 patients. No correlation was found between the dominant hand or preferred ear for mobile phone use and the side of sudden sensorineural hearing loss. There was no correlation between the side of the sudden sensorineural hearing loss (preferable or non-preferable for mobile phone use) and audiometric characteristics. CONCLUSION No correlation was found between the laterality of ears used for mobile phone and sudden sensorineural hearing loss.

Nasal vestibulitis: etiology, risk factors, and clinical characteristics: A retrospective study of 118 cases☆

BACKGROUND Nasal vestibulitis (NV) is a common infection; however, scant data is available in the literature as it pertains to NV. We aim to describe the clinical characteristics of NV in respect to its potential complications. METHODS A retrospective chart review of 118 NV cases admitted to a tertiary medical center between 2008 and 2015. RESULTS Identified risk factors for NV included nasal hair plucking (n=15, 14.41%), nose blowing (n=10, 9.32%), nose picking (n=9, 8.47%) and nose piercing (n=5, 3.39%). Twelve patients (10.17%) were diabetic, and 3 patients were immunosuppressed. Mid-facial cellulitis was observed in the majority of patients (78.81%), and abscess of the nasal vestibule was observed in almost half (48.30%). Cultures were taken from 33.33% of patients demonstrated MSSA as the most common isolate (81.25%). No complications were observed. CONCLUSION Even in complicated cases of NV requiring admission, the risk of major complications is extremely low.