Talal Al-Khatib

Severe Vitamin D Deficiency A Significant Predictor of Early Hypocalcemia after Total Thyroidectomy

Objective To assess the role of preoperative serum 25 hydroxyvitamin D as predictor of hypocalcemia after total thyroidectomy. Study Design Retrospective cohort study. Setting University teaching hospital. Subjects and Methods All consecutively performed total and completion thyroidectomies from February 2007 to December 2013 were reviewed through a hospital database and patient charts. The relationship between postthyroidectomy laboratory hypocalcemia (serum calcium ≤2 mmol/L), clinical hypocalcemia, and preoperative serum 25 hydroxyvitamin D level was evaluated. Results Two hundred thirteen patients were analyzed. The incidence of postoperative laboratory and clinical hypocalcemia was 19.7% and 17.8%, respectively. The incidence of laboratory and clinical hypocalcemia among severely deficient (<25 nmol/L), deficient (<50 nmol/L), insufficient (<75 nmol/L), and sufficient (≥75 nmol/L) serum 25 hydroxyvitamin D levels was 54% versus 33.9%, 10% versus 18%, 2.9% versus 11.6%, and 3.1% versus 0%, respectively. Multiple logistic regression analysis revealed preoperative severe vitamin D deficiency as a significant independent predictor of postoperative hypocalcemia (odds ratio [OR], 7.3; 95% confidence interval [CI], 2.3-22.9; P = .001). Parathyroid hormone level was also found to be an independent predictor of postoperative hypocalcemia (OR, 0.6; 95% CI, 0.5-0.8; P = .002). Conclusion Postoperative clinical and laboratory hypocalcemia is significantly associated with low levels of serum 25 hydroxyvitamin D. Our findings identify severe vitamin D deficiency (<25 nmol/L) as an independent predictor of postoperative laboratory hypocalcemia. Early identification and management of patients at risk may reduce morbidity and costs.

Desmoid tumor (fibromatosis) of the head and neck

Desmoid tumors (fibromatosis) are rare benign tumors, they arise from musculoaponeurotic structures throughout the body. They are locally infiltrative, resulting in a high rate of local recurrence following surgical resection. Due to the rarity of these tumors in the head and neck region, we report a case of a patient with a desmoid tumor in the upper neck that was diagnosed and treated in our institution, to increase the awareness of the Otolaryngology-Head and Neck surgeons, and report available treatment options of this condition.

Outcomes of Saudi Arabian Patients With Nasopharyngeal Cancer Treated With Primarily Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiotherapy

Purpose Nasopharyngeal cancer (NPC) is the most common head and neck cancer in Saudi Arabia. This study reports the locoregional disease control and survival outcomes in patients with NPC treated in King Abdulaziz University Hospital. Methods Patients treated for NPC between June 2007 and October 2014 were retrospectively reviewed. Demographic information, clinicopathologic variables, and chemotherapy data were collected and analyzed. Cumulative survival and disease control rates were calculated by Kaplan-Meier product-limit actuarial method. Results Thirty-nine patients with NPC were reviewed. Thirty-five (90%) patients received definitive radiotherapy (RT) and four (10%) had palliative RT. Mean prescribed dose for definitive RT was 68 Gy (range, 60 to 70.2 Gy), delivered with mean doses per fraction of 1.9 Gy (range, 1.8 to 2.1 Gy). After a median follow-up of 15 months (range, 1 to 84 months), 22 (63%) patients who underwent definitive RT were disease free and 13 (37%) were still with disease. During this period, seven (18%) patients died of the disease; five (13%) of them received definitive RT. After 2 years’ follow-up, the actuarial estimate rates were: 85.7% for local control, 91.4% for nodal control, and 85.7% for distant control. Conclusion Our study showed a disease with clinical behavior similar to what has been observed in East and Southeast Asia. Further it explored the neoadjuvant chemotherapy approach in treating NPC with results that are comparable to literature. However, little is known about the molecular pathogenesis of this disease in this region, and further research integrating clinical and molecular biomarkers is required.

A Case Report : Aggressive Fibromatosis in a One-Year Old Child

Aggressive fibromatosis, also defined as desmoid tumor, is an uncommon tumor. A review of literature detected less than 100 cases that have been reported of pediatrics aged 16 years or younger with aggressive fibromatosis in the head and neck. In this study we report a 1-year old girl who presented with an oral mass . The clinical , radiological, the histopathological features, and treatment are discussed .

Accuracy of preoperative fine needle aspiration in diagnosis of malignant parotid tumors

Objectives: To determine the diagnostic accuracy of fine needle aspiration (FNA) for detecting malignant parotid tumors. Methods: We conducted a retrospective study of all patients diagnosed with benign or malignant parotid gland tumors in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2004 and May 2015. The records of 65 subjects were obtained. Histopathological findings and data from FNA examinations were obtained from medical records. Twenty-three subjects were excluded due to missing FNA, histopathology results or both. The sensitivity, specificity, negative predictive value, and positive predictive value of FNA for detecting malignant lesions were estimated and compared with the gold standard, histopathology. Results: The specimens of 5 cases were insufficient for diagnosis; therefore, 38 cases were diagnosed by FNA and had histopathological reports. Three cases were diagnosed positive for cancer using histopathology and missed by FNA, 3 were diagnosed as malignant lesions using both FNA and histopathology, and 32 cases were determined benign based on histopathology and FNA analysis. The total prevalence of parotid malignancies was 15.8%. The sensitivity of FNA for detecting malignancy was 50%, and the specificity was 100%; with a positive predictive value of 100% and negative predictive value of 91.4%. Conclusion: Fine needle aspiration is a highly specific, but only moderately sensitive test. We support the use of this method as an initial tool for diagnosing parotid gland malignancies, as it is a safe, rapid, and painless procedure, compared to histopathology.

Endoscopic anatomy of the lacrimal sac for dacryocystorhinostomy. A cadaveric study

Objectives: To assist the endoscopic localization of the lacrimal sac (LS) relative to nearby landmarks. Methods: This is a descriptive prospective anatomical study. Sixteen lateral nasal walls were dissected endoscopically to identify and localize the LS between October and November 2015. Multiple measurements were obtained from the NS to the anterior and posterior walls of the LS, as well as to the middle turbinate axilla (MTA) and from the MTA to the LS borders. Results: The average distance from the NS to the anterior border of the LS was 42.0 mm and the posterior border was 48.5 mm. The average widths of the LS were 7.55 mm superiorly, and 6.6 mm inferiorly representing a mathematical proof that the LS is a trapezoid shape. The mean distance from the NS to the MTA was 47.3 mm. Nine of the 16 lacrimal sacs (56.3%) were found to be partially overlapped by the MTA. The LS was only totally overlapped and lying posterior to the MTA in one side (6.3%), while in 6 sides (37.5%) the LS lay anterior to the MTA. Conclusion: Endoscopic surgeons should be aware of the location of the LS relative to nearby landmarks, particularly the MTA. Representing a mathematical proof that the LS is wider at it upper part than lower part best presented as a trapezoid shape. We have provided additional measurements that may prove useful in cases of difficult exposure.

Comparison of two approaches to lateral nasal osteotomy in Saudi patients

BACKGROUND Nasal deformity is an abnormality in the appearance of the nose due to either congenital defect or trauma. In traumatic cases, patients often present with combined functional and cosmetic complaints. Therefore, otolaryngologists take into account both breathing and aesthetic nasal issues. OBJECTIVES To evaluate the changes in the nasal dorsum and base; compare breathing and aesthetic satisfaction scores between two approaches to lateral nasal osteotomy: low-to-low and low-to-high. DESIGN Comparative observational; data gathered retrospectively and prospectively. SETTING Head and Neck and Skull Base Center, King Abdullah Medical City, Makkah, Saudi Arabia. PATIENTS AND METHODS Patients who received hump reduction rhinoplasty from 2013 to 2016 met the inclusion criteria. MAIN OUTCOME MEASURE(S) The differences in dorsal (DW) and ventral (VW) widths with a fixed interpupillary distance (IPD). Satisfaction scores for both cosmetic perspective and breathing functionality. RESULTS We included 46 patients; 28 patients underwent low-to-low osteotomy and 18 patients underwent low-to-high osteotomy. With both approaches, there were statistically decreases from preoperative to postoperative ratios of VW/IPD and DW/IPD. However, differences in DW/IPD ratio and VW/IPD ratio (pre- versus post-op) were significantly higher in the low-to-low group (P<.0001). All showed breathing satisfaction postoperatively regardless of the operative approach. Only patients who underwent the low-to-high osteotomy were neutral or dissatisfied with aesthetic sensibility. CONCLUSION Both types of osteotomy showed a satisfactory outcome in both objective and subjective measures. However, low-to-low osteotomy was superior in pre- to post-operative differences in DW/IPD and VW/IPD ratios. LIMITATIONS Sampling was by convenience. The study was conducted in a single tertiary center and was a small sample.

Carotid Body Tumor with Skull Base Extension

Patient: Male, 59 Final Diagnosis: Benign carotid body tumor Symptoms: Neck mass Medication: — Clinical Procedure: — Specialty: Otolaryngology Objective: Rare disease Background: Carotid body tumors are rare tumors that arise from the paraganglionic cells of the carotid body. They are usually benign, requiring surgical resection as the treatment of choice. Case Report: We present a case of a 59-year-old man with a benign left carotid body tumor that progressed to a very large size, compromised the patient’s airway, completely encased the carotid vessels, vagus and hypoglossal nerves ipsilaterally, and reached the contralateral carotid vessels and ipsilateral skull base. Because of the cranial extension of the tumor, the patient had to undergo preoperative endovascular coiling of the carotid vessels prior to total excision of the tumor. Conclusions: Due to the critical location of carotid body tumors, their vascularity, and high risk of neurovascular complications, surgical resection can be quite challenging, especially when the tumor is large. We propose an approach to managing large parapharyngeal tumors by endovascular occlusion of the internal carotid artery above the skull base. Further, a suggestion is made to add a category to Shamblin’s classification – Shamblin IV – for patients with skull base extension requiring preoperative endovascular intervention.

Kimura disease. No age or ethnicity limit

Kimura disease is a chronic inflammatory disease that mainly manifests as a lump in the cervical region. Although the underlying pathophysiology is not clear yet, the diagnosis can be established based on specific histopathological characteristics. The first case of this disease was described in China, as well as the majority of subsequent cases that were also described in the Far East countries made Kimura disease traditionally a disease of adult patients of Asian descent. This report describes the occurrence of Kimura disease in pediatric non-Asian patient with a similar clinicopathologic presentation.

The perception of otolaryngology: Head and neck surgery speciality among physicians at a tertiary care hospital

Objective: To assess the awareness of physicians at King Abdulaziz University Hospital (KAUH), a tertiary care centre in Jeddah, Saudi Arabia, about the scope of practice of otolaryngologist (OTL) - head and neck surgeons. Furthermore, to identify diseases of the head and neck in which physicians may underestimate the role of OTLs. Study Design: Cross-sectional analysis. Background: The scope of practice of ear, nose and throat surgeons has impressively widened to include many subspecialities such as head and neck surgery (HNS). Encountering diseases that used to be or could be handled by other surgical specialities may cause confusion among physicians. This confusion may extend to mislead some physicians while referring. Methods: A total of 336 questionnaires were distributed to physicians at KAUH. The questionnaire targeted consultants, specialists and residents of different departments. The survey asked the responders which specialty they believed was the expert in managing certain clinical conditions related to OTLs. The respondents were allowed to choose one or more speciality for each question. Results: One hundred and seventeen questionnaires of the total 336 were analysed with a response rate of 34.8%. The analysis showed that 94.9% of the respondents believed that OTLs were experienced in dealing with pharyngeal lesions. Regarding hoarseness, 96% of the physicians thought that it was a symptom managed by OTLs. About 94% of the respondents chose OTLs as experts in managing patients with a foreign body ingestion. Almost 89% (88.9%) thought that OTLs were the physicians who perform tracheostomies. However, regarding cold or flu and oral lesions, OTLs only scored 68.4% and 64.1%, respectively. Conclusion: The study revealed the awareness of physicians at KAUH in regards to the extent of services provided by OTL-HNS as not fully satisfactory. It is our job as OTLs to raise awareness of our speciality among colleagues of other departments.