Yasser W. Khafagy

Endoscopic Repair of Bilateral Congenital Choanal Atresia

Objective The literature about endoscopic repair of bilateral choanal atresia is scarce. The advantages and difficulties encountered with this technique are discussed.

Preoperative embolization of nasopharyngeal angiofibroma: a report of 34 cases

Abstract Preoperative embolization was performed in 34 patients with nasopharyngeal angiofibroma (NAF). Thirty-seven embolization procedures were done in those patients (three patients had tumor recurrence and repeated embolizations were performed). Embolization was done using Gelfoam (seven embolizations), contour particles (24 embolizations) and Ivelon (six embolizations). The internal maxillary artery (IMA) was embolized bilaterally in four patients (four embolizations), and unilaterally in 30 patients (33 embolizations). In 25 patients, intraoperative blood loss at primary surgery was insignificant (no blood transfusion was required) while in nine patients, the intraoperative blood loss ranged from 400 to 1500 ml (average 650 ml), and the average blood transfusion was 944.4 ml. Only three patients showed recurrence of the tumor after primary surgery (8.8%). Minor complications were seen in most of the patients in the form of mild to moderate local pain in the vascular territory of the embolized artery and slight temperature elevation. Other minor complications included nausea in three patients and local subcutaneous edema in only one patient. A major complication was encountered in only one patient who had left retinal artery occlusion and temporary visual loss due to embolization of the left ophthalmic artery. The results indicated that pre-operative embolization of the internal maxillary artery in patients with nasopharyngeal angiofibroma is a relatively safe technique, effective in reducing intraoperative blood loss and contributes to improving surgical results. We recommend it as a routine pre-operative adjunct to surgery for nasopharyngeal angiofibroma.

Gunshot injuries of the temporal bone

Despite an increasing incidence of gunshot wounds to the temporal bone, there is little in the literature regarding management of survivors of these serious injuries. Twelve patients were treated for such wounds between 1986 and 1994. The most frequent presentations were cranial nerve injury, especially facial paralysis (9 patients), hearing loss (7), vascular injury (4), and vestibular dysfunction (3). Persistent cerebrospinal fluid otorrhea was uncommon (1 patient) in this series. Computed tomography and audiovestibular testing were helpful in evaluating the severity of injury and guiding the surgical approach when necessary. Electroneurography was helpful in evaluating facial nerve function; however, documented disruption of the facial nerve canal in itself was considered an indication for surgical exploration. Other indications for surgical intervention included evidence of dural tear, vascular injury, and severe disruption of the external auditory canal.

Endoscopic management of a pediatric nasoethmoidal mucocele with intraorbital extension

Objective To evaluate the transnasal endoscopic marsupialization of a pediatric nasoethmoidal mucocele with intraorbital extension in terms of technique, difficulty, and surgical outcome. Design Prospective study. Patients and methods Seven patients presented with a mucocele with intraorbital extension; they ranged in age from 8 to 14 years (average 11 years), and were treated using the transnasal endoscopic approach from March 2008 to March 2010. All patients underwent transnasal endoscopic marsupialization and were monitored clinically, radiologically, and endoscopically for a mean follow-up period of 15.3 months. Results Postoperative nasal examination showed no findings with improved orbital manifestations in all cases. Also, nasal congestion, obstruction, and postnasal discharge disappeared completely. Postoperative computed tomography evaluation indicated a significant improvement on comparison with the preoperative computed tomography score. No major complications were found in the study. Conclusion Transnasal endoscopic marsupialization of a pediatric mucocele with intraorbital extension is a safe technique and can be carried out successfully. Combined intensive medical treatment with surgery is important in a mucocele with an orbital manifestation. Nevertheless, this technique requires good experience with the relevant anatomy in a pediatric age group.