Samy Elwany

Inferior turbinectomy : comparison of four techniques

As yet, there is not totally satisfactory means for treating hypertrophied turbinates and the proper management of turbinate dysfunction remains in question. In the present series, four of the widely practiced surgical procedures for the reduction of the size of the inferior turbinates were evaluated and compared. In all cases turbinectomy was performed as an isolated procedure. Eighty patients with chronic non-allergic rhinitis and hypertrophied inferior turbinates were selected, randomly divided into four groups, and followed up post-operatively for one year. Study of the results indicated that the beneficial effect of the operation is mainly mechanical by reduction of the resistance to nasal airflow. The post-operative improvement in smell acuity correlated positively with the increased patency of the nasal airway. None of the procedures had a deleterious effect on olfactory acuity. In contrast, the operation failed to enhance the mucociliary clearance rate or significantly decrease nasal drainage. Partial inferior turbinectomy and laser turbinectomy improved nasal breathing in 77 per cent of patients, and enhanced olfactory acuity in 78 per cent of patients who had pre-operative hyposmia. The results of turbinoplasty and cryoturbinectomy were less favourable. The surgical technique, advantages, and drawbacks of each of these procedures are discussed.

Radiofrequency bipolar submucosal diathermy of the inferior turbinates.

Fifty nonatopic patients with chronic hypertrophic rhinitis and suffering from chronic nasal obstruction due to hypertrophied inferior turbinates were subjected to bipolar submucosal diathermy using a radio frequency unit and a bipolar turbinate probe. One year postoperatively, 76% of patients showed significant improvement of their nasal breathing and another 16% reported partial improvement. The minimal cross sectional has also significantly increased from 0.58 ± 0.05 cm2 to 0.72 ± 0.04 cm2 and the decongestive effect was statistically significant. Electron microscopic examination of the nasal mucosa at the end of the follow up period revealed intact healthy epithelium as well as intense fibrosis of the underlying stroma. The results of the work showed that bipolar submucosal diathermy is a safe, effective outpatient procedure that does not require nasal packing or expensive instrumentation. The procedure can be repeated, if necessary, according to the patients needs.

Surgical anatomy of the sphenoid sinus.

In recent years the trans-sphenoidal approach to the pituitary gland has come into vogue and a study of the surgical anatomy of the sphenoid sinus has become increasingly important in order to avoid many surgical mishaps. Moreover, the sphenoid sinus has complicated relationships and its diseases may and do give rise to a complexity of symptoms. The anatomy of the sphenoid sinus has been described by Ridpath (1947), Dobromylsky and Scherbatov (1966), Davies and Coupland (1967), Simpson et al. (1967), Montgomery (1972), Last (1972), Ballenger (1977), Hamilton and Harrison (1979), and Davies (1980). The present work was designed to study the anatomy of the sphenoid sinus and its surgical applications. Particular attention was focused on the relationships of the sella turcica to the sphenoidal sinuses.

The adenoidal-nasopharyngeal ratio (AN ratio) its validity in selecting children for adenoidectomy

The present study disclosed that the AN ratio measured on simple lateral skull radiographs reliably expressed the adenoidal size and patency of the nasopharyngeal airway, and correlated well with the clinical assessment score and the weight of adenoids removed at operation. The inter-observer agreement was satisfactory, and for practical purposes, a value of AN ratio greater than 0.73 may be considered indicative of pathological enlargement of the adenoids. Hopefully this study will facilitate more accurate detection of those children most likely to benefit for adenoidectomy.

Endoscopic anatomy of the sphenoid sinus.

The anatomy of the sphenoid sinus, as it relates to endoscopic sinus surgery, was studied in 93 cadaver heads (186 sphenoid sinuses) using endoscopic dissections as well as sagittal sections. The relationship of the sphenoid sinuses to the carotid artery, optic nerve, floor of sella turcica, as well as other important structures, were verified and discussed. The recesses of the sinus as well as its ostium and accessory septa and crests were described and their clinical importance was discussed. Pertinent measurements were included wherever appropriate.

Obstruction of the nasal valve

Obstruction of the nasal valve is an important cause of chronic nasal obstruction in adults. In a series of 500 patients, obstruction at the level of the nasal valve was diagnosed in 65 of them (13 per cent). The obstruction was unilateral in 57 patients (88 per cent). Forty-seven patients (72 per cent) had history of previous nasal surgery of accidental trauma. Causes of obstruction of the nasal valve included high septal deviations, a weak or deformed upper lateral cartilage, adhesions, and alar collapse. All patients underwent corrective nasal surgery and the surgical procedures were tailored according to the existing pathology. Post-operatively, the mean nasal patency score increased from 2.9 to 8.6, the mean nasal airflow increased from 579.5 to 727 cm/sec (at 150 Pa), and the mean nasal resistance decreased from 0.31 to 0.23 Pa/cm3 sec-1.

Effects of saline sprays on symptoms after endoscopic sinus surgery

Background Topical saline is commonly recommended after endoscopic sinus surgery. The efficacy in this situation has never been shown. Methods We performed a controlled clinical trial to determine the effect of saline sprays on symptoms after endoscopic sinus surgery. Patients were randomized to receive normal saline (NS; n = 20), buffered hypertonic saline (HS; n = 20), or no spray (n = 20). A questionnaire measured symptoms of nasal obstruction, discharge, pain, headache, and trouble sleeping. Daily pain medication usage was recorded. Results Symptom scores over the first 5 postoperative days showed higher nasal discharge scores in the HS group. Day-by-day comparisons showed that the HS group reported significantly higher pain scores during some postoperative days. The NS group showed similar scores to control. Conclusion NS and HS sprays do not have a beneficial effect on symptoms compared with no treatment. HS sprays enhanced nasal drainage and pain. Our results do not support prescribing saline sprays early after sinus surgery but do not exclude the use of topical saline in other forms or for other uses, although they may be used for other intentions.

Chronic subglottic and tracheal stenosis: endoscopic management vs. surgical reconstruction

Laryngotracheal stenosis has been and remains one of the most vexing problems in the field of head and neck surgery. Two treatment modalities prevail, endoscopic and external. The indication for each modality is not yet clearly defined. This undefined situation motivated our current work, and we decided to assess laser-assisted endoscopy (with or without stenting) vs. open surgery for treating chronic laryngotracheal stenosis. Our study included 28 cases of chronic laryngotracheal stenosis that were classified according to treatment in two main groups: group I included 13 patients who were endoscopically treated and group II included 15 patients with surgical reconstruction. The mean follow-up period was 12.58 months for group I and 27.43 months for group II. Respiratory function tests (RFT) were carried out preoperatively, 1-month postoperatively and on completion of follow-up. Except for age, which was significantly higher in group I ( P <0.001), there was no significant difference between both groups. Although the incidence of complications was higher in group I (69%) than in group II (47%), it was nonsignificant. The postoperative RFT improved significantly in both groups. Although the improvement was higher in group I than group II, the difference was nonsignificant. The correlation between preoperative stridor and all other variables demonstrated that preoperative stridor correlated with the diameter of the stenosed segment ( r s=−0.631, P <0.001) and the peak expiratory flow rate (PEFR) ( r s=−0.488, P =0.030). Our results indicate that open surgery is the treatment of choice. Compared with endoscopic treatment, it provides a higher success rate and better functional results, especially long term. However, if contraindications to open surgery exist, whether local or general, laser-assisted endoscopy with stenting can offer good palliative results.

Delayed ultrastructural radiation induced changes in the human mesotympanic middle ear mucosa

The irradiation-induced changes in the middle ear mucosa of six patients were described and discussed. The epithelium showed marked reduction of the cytoplasmic mass, variable degrees of ciliary loss and widening of the intercellular spaces with disruption of some of the maculae adherentes. The connective tissue stroma showed increased production of collagenous fibrous tissue and increased number of synthetically active fibroblasts. New gland formation has been observed and the glands exhibited reduced activity. The endothelial cells of some blood capillaries were swollen and the basal lamina was duplicated. The lumina of other capillaries were completely obliterated and replaced by a cord of fibrous tissue.

Histologic and Histochemical Study of Effects of Anabolic Steroids on the Female Larynx

The larynges of 30 unmated, mature female albino mice were examined histologically and histochemically after injecting them with 19-nandrolone phenylpropionate. Permanent irreversible changes, in the form of parakeratosis and squamous metaplasia of the epithelium, and hypertrophy of the muscle fibers, were observed together with persistence of increased alkaline phosphatase enzyme intensity in the endothelium of capillaries and increased activity of nonspecific esterase in the muscles. Similar changes may be responsible for the alteration in the human females voice after prolonged treatment with anabolic steroids.