Evaluation of different techniques for correction of nasal septal perforation

Perforations of the septum are a well-recognized complication of septal surgery. Most of the post surgical perforations follow the classic Killian submucous resection. Other iatrogenic causes of perforations include cautery, unrecognized or untreated septal hematoma, which becomes complicated by abscess formation and perforation. Twenty patients with septal perforations of less than 2 cm in the cartilagenous septum were selected for this study. Ten cases were repaired with a tragal cartilage-temporoparietal and deep temporal fascia sandwich technique [group 1]. The other ten cases were repaired using endonasal dissection, suture of the borders of the perforation on at least one side and the interposition of a graft of temporal fascia with bone, either a perpendicular plate of ethmoid [four], if available, or mastoid cortex [six], if not [group 2]. A successful complete closure was achieved in three patients, partial closure in other two patients in group 1. While, a complete closure occurred in four patients and a partial closure in three patients in group 2 after an observation time of up to one year. Both techniques may be considered for the repair of septal perforation. The incomplete closure was most probably due to the migration of the graft immediately after surgery. The remaining perforation was in the posterior part of the septum, which was sufficient to relieve the patient of the symptoms. A complete failure of healing may be due to infection. There was no morbidity of the donor site. No major complications were encountered

Complications after surgery for oral and oropharyngeal malignancy

This study included 31 patients with oropharyngeal malignancy. Group I included 15 patients, 13 had stage II squamous cell carcinoma of the anterior 2-thirds of the tongue and 2 patients had squamous cell carcinoma of the floor of the mouth stage II. An adequate excision of the primary, repair of the residual part of the tongue, plus suprahyoid neck dissection were done for every patient in this group. Group II included 16 patients, in whom 7 had stage III squamous cell carcinoma of the anterior two thirds of the tongue, 5 patients had stage II squamous cell carcinoma of the retromolar trigone and 4 patients had stage II squamous cell carcinoma of the tonsillar region. Commando's operation was done with reconstruction by PMC flaps for every patient of this group. The patients were followed up meticulously in the postoperative period. Most of the complications were seen in group II after the Commando's operation, whether anatomical complication [nerves injury], functional [mastication, speech problems or dysphagia], esthetic [asymmetry of the face] and recurrence of the neoplasm after stage III. From this study, it was concluded that early presentation of patients, accurate, preoperative assessment and correction of any medical problem are important. The team therapy approach is an essential corner stone to minimize the postoperative complications as well as to help the patients and their family to expect better result from the treatment program and mode of rehabilitation. In addition, the proper choice of treatment planning and good surgical technique and the postoperative team [health care personnel] cooperation are mandatory for rehabilitation

Evaluation of the efficacy of concurrent cisplatin and radiotherapy in locally advanced head and neck cancer

Thirty-six patients with locally advanced unresectable head and neck squamous cell carcinoma were included in this study. All patients received radiotherapy by cobalt60 machine. They received 70 Gy to the tumor area in 35 fractions for 7 weeks and 50 Gy to the uninvolved cervical and supraclavicular LN in 25 fractions for 5 weeks duration [cisplatin]. Concurrent cisplatin [CDDP] was infused in 3 hours and 1/2 hour before radiotherapy. The dose of CDDP was 20 mg/m2 from day 1 to 5, day 22 to 26 and day 43 to 47. The patients were evaluated for response at three weeks after the completion of irradiation and every month for six months, then every three months. The assessment of the response to treatment showed that the overall response was 75% [61% complete remission [CR] and 14% partial remission [PR]]. Six patients showed a stationary course and three patients showed disease progression. Acute toxicity was tolerable and no treatment interruption occurred. The most frequent toxicity was vomiting GI in 21 patients, stomatitis GII in 17 patients and dryness of the mouth GII in 23 patients. Finally, the results of concurrent radio- and chemotherapy were encouraging and a large number of patients and a long time follow up are needed to assess the improvement in survival

CT-guided percutaneous biopsies of parapharyngeal space lesions

Fine needle aspiration biopsy [FNA] of superficial and deep-seated lesions of the head and neck has been used extensively with high sensitivity and specificity. Several articles have stressed the role of computed tomography in detecting and staging head and neck tumors. FNA has been paired with imaging guided localization for the cytologic assessment of lesions in the parapharyngeal space. This work presented a series of 30 CT-guided percutaneous biopsies performed between January 1997 and January 2000 at Assiut University Hospital. The age of the patients ranged from 13 to 60 years [mean 37] with 21 males and 9 females. Analysis of the results showed 8 inflammatory lesions, 12 benign tumors and 10 malignant neoplasms. Correlation with histopathology of true-cut needle or incisional biopsy showed a diagnostic accuracy of 88.0% but certain lesions could not be diagnosed by this procedure. FNA can replace incisional biopsy, which may be hazardous in this area. Surgery can be avoided for inflammatory lesions