Lobna El Fiky

Anatomic Variations of the Sphenoid Sinus and Their Impact on Trans-sphenoid Pituitary Surgery

INTRODUCTION The trans-sphenoid access to the pituitary gland is becoming the most common approach for pituitary adenomas. Preoperative evaluation of the anatomy of the sphenoid sinus by computed tomography (CT) scan and magnetic resonance imaging (MRI) is a routine procedure and can direct the surgical decision. PURPOSE This work determines the incidence of the different anatomical variations of the sphenoid sinus as detected by MRI and CT scan and their impact on the approach. METHODS The CT scan and MRI of 296 patients operated for pituitary adenomas via a trans-sphenoid approach were retrospectively reviewed regarding the different anatomical variations of the sphenoid sinus: degree of pneumatization, sellar configuration, septation pattern, and the intercarotid distance. RESULTS There were 6 cases with conchal pneumatization, 62 patients with presellar, 162 patients with sellar, and 66 patients with postsellar pneumatization. There was sellar bulge in 232 patients, whereas this bulge was absent in 64 patients. There was no intersphenoid sinus septum in 32 patients, a single intersphenoid septum in 212 patients, and an accessory septum in 32 patients. Intraoperatively, the sellar bulge was marked in 189 cases and was mild in 43 cases. DISCUSSION The pattern of pneumatization of the sphenoid sinus significantly affects the safe access to the sella. A highly pneumatized sphenoid sinus may distort the anatomic configuration, so in these cases it is extremely important to be aware of the midline when opening the sella to avoid accidental injury to the carotid and optic nerves. The sellar bulge is considered one of the most important surgical landmarks, facilitating the access to the sella. The surgical position of the patient is also a crucial point to avoid superior or posterior misdirection with resultant complications. It is wise to use extreme caution while removing the terminal septum. CONCLUSION Different anatomical configurations of the sphenoid sinus can seriously affect the access to the sella via the nose. The surgeon should be aware of these findings preoperatively to reach the sella safely and effectively.

Complications of Suppurative Otitis Media : Still a Problem in the 21st Century

The purpose of this study was to review the incidence of complicated suppurative otitis media in 10 years at a tertiary referral university hospital. During this period, 3,364 patients with suppurative otitis media (acute and chronic) were admitted to the department. The number of patients presenting with complications was 422 (12.54%). The ratio of extracranial to intracranial complications was nearly 1:1. The most frequent extracranial complication was mastoiditis while the most frequent intracranial one was lateral sinus thrombophlebitis. Multiple complications may present in the same patient. The onset of complications was insidious and 96% of the patients were already aware of their disease. There were 6 mortalities (1.42%), and additional morbidity was recorded in 16 patients (3.79%). Changes in the clinical picture should always alert the physician to the onset of a complication. Complications tended to occur in young patients from a lower socioeconomic class and without sex preponderance. Physicians should be aware of the continuing incidence of complications and the subtleness of their onset and investigate patients for the presence of more than one complication.

LARYNGEAL CANCER IN EGYPT: QUALITY OF LIFE MEASUREMENT WITH DIFFERENT TREATMENT MODALITIES

Quality of life (QOL) reflects the need to assess the patients overall sense of well‐being. A nonrandomized, prospective longitudinal study was conducted to evaluate QOL in Egyptian patients treated for laryngeal cancer.

Small Cell Carcinoma of the Larynx: A Case Report

The larynx is one of the common sites for extrapulmonary small cell neuroendocrine carcinoma. Although these neoplasms are infrequent, accounting for about 0.5% of all primary laryngeal carcinomas, they are not as rare as once believed. The presence of metastatic disease or a neck node in a patient with a small laryngeal tumor should alert the clinician to the possibility of a neuroendocrine tumor. We present the case of a 48-year-old male heavy smoker presenting with a rapidly enlarging left-sided upper deep cervical lymph node 3 × 4 cm in diameter, of 3 months duration. Fibro-optic examination of the larynx revealed a small lesion on the laryngeal surface of the epiglottis. The diagnostic and therapeutic processes are outlined and the patient is free of disease after 1 year of follow-up. http://www.entnet.org/journal/casereports/OTO-26.pdf/

Simple clinical system for the prediction of recurrence of nasal polypi

OBJECTIVE A trial to determine a simple way to predict recurrence of nasal polypi to determine the need for long term medical therapy. METHODS Retrospective clinical analysis of the records of 100 patients with nasal polypi and studying various parameters including radiological, intra-operative and bacteriological data. RESULTS Among the various parameters studied, maxillary antral involvement, and positive bacterial cultures seemed the most predictive criteria of recurrence. Patients without polypoid involvement of the maxillary sinus and/or with negative cultures were less likely to have early recurrence of their disease. CONCLUSION Using simple clinical criteria, two patient populations could be defined. One in which recurrence is inevitable requiring continuous local steroid therapy after surgery and another group requiring occasional local treatment after an initial short course of local steroid spray.

Craniocaudal Extension as an Indication of Surgical Outcome in Transsphenoidal Surgery for Pituitary Adenomas

Transsphenoidal approach is considered the treatment of choice for pituitary adenoma removal. Suprasellar extension is regarded a drawback for complete removal of these tumors through this approach. Evaluate the correlation between the preoperative radiologic craniocaudal extension on MRI of pituitary adenomas and the extent of tumor removal. A retrospective study. Tertiary care hospital. 560 patients underwent transsphenoidal removal of pituitary adenomas. The degree of removal of pituitary tumor in the follow-up imaging of the patients was correlated with the preoperative extension in mid-Coronal T1 W Gd. Tumors with suprasellar extension can be classified into: Type I tumors with extension confined to the sellar boundaries, resulted in complete removal in all cases (100%), type II tumors with suprasellar extension reaching the floor of the 3rd ventricle, resulted in complete removal in 70.2% of the cases, type III tumors with suprasellar extension above the 3rd ventricle, had only 13.5% of complete removal. Integration of radiologic findings into a scheme for the preoperative determination of possibility of total removal of the tumor through transsphenoidal approach, can give better correlation to the surgical outcome of pituitary tumors.

Evaluation of upper airway lesions by virtual endoscopy

Abstract Objective: The utility of virtual endoscopy (VE) is compared to direct laryngoscopy and was also investigated with respect to accuracy of diagnosis and reproduction of images. Patients and methods: Twenty-one patients with various degrees of upper airway obstruction were examined by helical spiral CT axial images. The data was reconstructed using a VE software program. The cause of obstruction was identified and the results were compared to the direct endoscopic findings done by the otolaryngologists under G.A. Results: Virtual endoscopy evaluation of the upper airway was accurate in assessing stenosis width and length of fixed airway lesions. Correlation between direct laryngoscopy and VE was excellent with respect to the shape and contour of the stenotic segment. VE added little information in cases of laryngeal tumors and it could not illustrate any of the cases of impaired vocal fold mobility. Conclusion: Virtual endoscopy was excellent for the measurement and definition of the fixed airway lesions yet it was not as sensitive as actual endoscopy in detecting the cause of airway obstruction based on dynamic movement.

Congenital Cholesteatoma: The Silent Pathology

Background: Congenital cholesteatomas (CC) arise from epithelial remnants around the petrous bone. They enlarge gradually causing progressive destruction and functional damage to the ear and surrounding structures. Because of their insidious course, most patients are misdiagnosed and present late with complications. Methods: This is a retrospective study of 41 cases diagnosed as CC and followed up for 2 years. All patients underwent full audiological evaluation and a radiological study (CT, MRI). Results: The male:female ratio was 2.3: 1, and the mean age was 30.89 years. The mean delay before presentation was 13 months. The commonest presentations in order of frequency were: discharge (60.9%), hearing loss (51.2%), facial paralysis (31.7%) and intracranial complications (31.7%). Forty patients were treated surgically by a variety of approaches depending on the extensions and functional status. The facial nerve was decompressed in 9 cases and cable grafted in 4. Two cases underwent VII-XII anastomosis later on. Conclusion: CC present with a myriad of clinical manifestations and should be suspected in all patients with unexplained otological signs and symptoms. They must be completely excised and the functional status of the ear rehabilitated either immediately or later. Follow-up must be indefinite as they have a high recurrence rate.

Pediatric parapharyngeal lesions: Criteria for malignancy

INTRODUCTION Parapharyngeal space (PPS) pediatric lesions represent a heterogeneous group of uncommon neoplasms of both benign and malignant nature. These tumors tend to be locally advanced by the time they are diagnosed; consequently, an early presumptive diagnosis of malignancy is of utmost importance. OBJECTIVE To highlight the occurrence of malignant PPS tumors in pediatric population, to determine their incidence and to describe probable warning clues for diagnosis. PATIENTS AND METHODS The charts of 23 pediatric patients with PPS swellings were retrospectively reviewed to analyze clinical and pathologic data. We describe possible criteria to suspect malignancy by clinical and radiological examination. RESULTS Twenty-three patients presented with neoplastic lesions in the PPS, benign tumors in 43.5% and malignant in 56.5%. Malignancy was suspected in 13 cases according to combined clinical and radiological criteria: a painless intraoral and neck swelling in children below one year old, presentation with cranial nerve palsy, nasopharyngeal mucosal or sub-mucosal irregular lesion, the presence of multiple lymph nodes with no evidence of infection, and adjacent bony skull base destruction with intracranial extension. CONCLUSION Occurrence of malignancy in PPS tumors in the pediatric population is not uncommon. Clinicians should deliberately look for associated secondary signs that predict malignancy. The surgeon must understand the pathological spectrum of tumors of this space and the proper use of imaging studies to make a preoperative diagnosis. This allows for planning of a sound surgical approach and a proper preoperative counseling.