Correction of post-palatoplasty velopharyngeal insufficiency by two different techniques

Evaluation the success of 2 different techniques in treating post-palatoplasty residual velopharyngeal insufficiency [VPI]. Prospective study on 48 cases of post-palatopl asty hypernasality. The cases classified into 3 groups according to the type of velopharyngeal closure. Group A had coronal closure pattern and treated by sphincter pharyngoplasty, group B had sagittal closure pattern and treated by pharyngeal flap and group C had circular closure pattern and treated by sphincter pharyngoplasty. Postoperative follow-up by flexible nasopharyngoscopy, auditory perceptual assessment and parent's questionnaire. The incidence of residual VPI after sphincter pharyngoplasty was 11.5% while it was 9% after pharyngeal flap [p value=0.784]. The satisfactory speech improvement was 88.5% for cases underwent sphincter pharyngoplasty and 91% for cases underwent pharyngeal flap [p value=0.784]. The incidence of snoring was 3.8% for cases underwent sphincter pharyngoplasty and 27% for cases underwent pharyngeal flap [p value=0.038]. No cases developed sleep apnea after pharyngoplasty while it was developed in 13.5% after pharyngeal flap [p value=0.089]. No statistically significant difference in outcomes between the 2 procedures for speech assessment score [p value=0.540]. Mobility was detected in the flaps of sphincter pharyngoplasty while the posterior pharyngeal flaps were static. Sphincter pharyngoplasty and pharyngeal flap are good operations for correction of post-palatoplasty hypernasality. But in cases with circular closure pattern, sphincter pharyngoplasty is the operation of choice as it carries low risk of obstructive complications and it is dynamic

Post-operative pain in relation to different tonsillectomy techniques

Tonsillectomy, with or without adenoidectomy, is a commonly performed operation. The surgical procedure is recommended for recurrent infected tonsils as well as enlarged tonsils, which can lead to pediatric sleep apnea and other breathing disorders. The pain can be severe, and patients are often unable to perform in work or school or eat regular food for a number of days after surgery. Our study investigated four different tonsillectomy techniques in order to show the effect of different techniques on post-operative pain and these techniques were performed on 60 patients indicated for tonsillectomy. All patients were above the age of 12 years. The choice of the age above 12 years is due to the fact that pain is experienced more after tonsillectomy in adults and also to ensure better cooperation in post-operative questionnaire. In our study we divided the 60 patients into 3 equal groups; we removed the right tonsil by conventional dissection technique in all cases and used as a control side while the left tonsil was removed by different technique in each group; laser in group A, bipolar diathermy in group B and dissection with obliteration of the bed in group C. All patients received similar post operative treatment regimen and followed up for 15 days. We found that each technique has some advantages and also disadvantages as regards post-operative pain and healing and so the conventional technique is the safest for our patients and easy technique and has less complications as it decreases the morbidity after tonsillectomy

Endoscopic versus open approaches in trating huge locally advanced angiofibromas

Juvenile nasopharyngeal angiofibroma [JNA] is a combined vascular and fibrous neoplasm arising in the nasopharynx of prepubertal and adolescent males. Studies indicate that surgery is a good form of treatment, especially when there is no intracranial involvement. The surgical approach depends on the pre-operative findings. Recurrence is a common problem in JNA treatment. A recent study by Radkowski et al. found that pre-operative tumor stage was the most important factor in determining the chances of recurrence after surgery. A retrospective chart analysis study was done for 42 cases of histologically proved angiofibromas staged II or III -according to Andrew's [Modified Fisch] classification- managed in the department of otolaryngology faculty of medicine Cairo University in the period between February 1996 and March 2003 with Minimal follow up of 3 years. Group 1, 29 patients were subjected to open surgical approach [Mainly before 2001] in the form of 1-ateral rhinotomy in 14 cases, and 2-facial degloving approach in 15 cases. Group 2, 13 patients mainly after 2001 were treated with endoscopic removal of tumor. Comparative analysis was done between both groups as regard local control parameters and morbidity parameters. Endoscopic approaches were superior to open approaches as regard total eradication of neoplasm as the incidence of residual tumor was nearly the double with open approaches compared to endoscopic approaches. As regard recurrent tumor both techniques were nearly equal as regard the incidence of recurrent tumors As regard the Morbidity Parameters, endoscopic approaches were associated with much less morbidity than open approaches. From previous results it is quite clear that endoscopic approach offers patients with huge advanced angiofibromas less morbidity with equal or even better local control

Congenital aural atresia: transmastoid approach

The objective of this study is to re-evaluate the mastoid cavity as a problem in those patients and to review the embryologic development of the ear for understanding the altered surgical anatomy of congenital aural atresia. Twenty children with congenital aural atresia were included in this study. All had functioning cochlea on evoked response audiometry and normal cochlear morphology with pneumatized mastoid on CT scan. Transmastoid approach was used for reconstruction of the external auditory canal with covering of the newly created canal using split thickness skin graft. Reconstruction of the tympanic membrane was carried out by temporalis fascia graft. Follow up of the patients for one year was carried out. Surgical success is considered on restoration of hearing and maintenance of a patent, infection-free ear canal. This study showed a successful hearing result of 65-80% at 3-6 months postoperatively, this result diminished to 60% at one year. The incidence of canal restenosis was 15%; the narrowing was in the outer cartilaginous part. No cases presented with facial nerve paralysis or sensorineural hearing loss postoperatively. Congenital aural atresia is one of the most difficult and challenging surgeries for the otologic surgeon. However; in the hands of experienced otologists, repair of this deformity can be performed safely and with predictable results using transmastoid approach

Treatment of Submucous cleft palate by pharyngeal flap as a primary procedure

Submucous cleft palate is a type of cleft palate. Its incidence is about 1 in 1200 live births. It is defined by a bifid uvula, muscular diastasis of the soft palate, and notching of the posterior border of the hard palate. Most cases of this condition are asymptomatic but those children are predisposed to velopharyngeal incompetence because of the abnormal musculature of their velopharyngeal sphincter especially if the anatomy of this area was altered by adenoidectomy or even involution of the adenoid pad. For individuals with submucous cleft complaining of velopharyngeal incompetence, the most common treatment is surgical. The surgery consists of reconstruction of the abnormal tissues using palatal repair with or without pharyngeal flap. A primary goal of this surgery is to allow for normal speech production. In this study, 9 cases of symptomatic submucous cleft palate were subjected to treatment by pharyngeal flap only as a primary and single procedure after failure of speech therapy. Flexible nasopharyngoscopy was carried out for all children to determine the degree of the velopharyngeal gap; the results were recorded on videotape and reviewed in the operating theatre for determination of the width of the pharyngeal flap. Follow up flexible nasopharyngoscopy showed complete closure of the lateral ports in eight cases [89%] while one case [11%] showed incompetence. Hypernasality was improved in all cases witnessed by parent's questionnaire and this improvement was satisfactory in seven cases [78%] but not satisfactory in two cases [22%]. One of the last two cases reached to satisfactory level after speech therapy, while the other case showed no further improvement

use of platysma myocutaneous flap and auricular cartilage graft for cervical tracheal reconstruction an experimental study in dogs

Cervical tracheal reconstruction using platysma myocutaneous trap door flap strengthened with. auricular cartilage was studied in 16 dogs. Window defects involving 5 and 10 tracheal rings from the anterior tracheal wall were produced in different 2 groups of animals [group A and B]. The results were evaluated by clinical follow up to 3 months. In group A. six of the 8 animals completed the scheduled follow up while in. group B. five animals completed the follow up of 3 months without significant complications. Gross examination of the animals of both groups which completed the pre-established period of follow-up showed maintenance of the intraluminai diameter at the levels of the reconstructed segment. The mucosal cutaneous junction was healed with no apparent granulation tissue free edges of the resected tracheal rings were closely attached to the rotated flap. Hair was fully grown and covered with mucous. Histologically, the flap was covered by stratified squamous epithelium which was closely attached to the free margin or the trachea by fibrous tissue. The cartilage was seen intact with mature chondocytes. The use of platysma cutaneous door flap strengthened with auricular autologous gives relatively good anatomic and functional results in. reconstruction of tracheal defects. This may call for considering the clinical use of flap in selected cases of tracheal wall lesions in human

Impact of implementation of hearing conservation program on hearing threshed among noise exposed workers

Occupational noise-induced hearing loss [NIHL] is an important yet often overlooked illness that can affect an individual's performance and safety at work. This study was conducted on twenty male workers exposed to both noise and vibration hazards generated from metal grinding and wood sanding in one of the military factories in Helwan. The average daily noise intensity was 105 +/- 7.9 dB. The examined group was all males with age ranging from 28 - 58 years with a mean duration of exposure of 10.75 +/-3.62 years. The workers were evaluated using a self- administered questionnaire, a medical examination including an ear examination, audiological assessment, and serum cortisol as a bioindicator for stress. Reassessment was done after one year from implementation of a noise damping procedure by shifting the workers to a new building opened from the sides and reducing the impact noise transmission by floating floors. So, the average noise level decreased to 80.6 +/- 4.0 dB. The study showed that maxim ii diminution of hearing was observed in the high tones more than 2000 Hz], with significant improvement in hearing threshold after establishing the engineering control, The improvement is more significant at higher frequencies, 4 kHz and higher. The mean level of plasma cortisol was 24.6 +/- 7.15 microg%, then decreased to 13.0 +/- 3.81 microg% after the engineering control with a difference of about 11.6 microg%. Both systolic and diastolic blood pressures were higher among the examined group and were markedly decreased after implementation of the engineering program and medical treatment with a mean difference of about 41.5 mmHg in systolic and 17 mmHg in diastolic blood pressure. Also, 75% of the workers reduced their dose of the treatment after implementation of the HCP but still most of them are controlled by medication. It is recommended that engineering control should be the first order of protection from excessive noise exposure. Physicians should become aware about the medical consequences of excessive noise, support legislation to reduce the problem and promote program aiming at noise control and prevention of hearing loss aiming at improving psychosocial stresses and increasing the performance capacity

Tympanoplasty for anterior perforation

This study included 25 patients having chronic mucosal suppurative otitis media with anterior perforation. The surgical closure of the anteriorly located tympanic membrane perforation can present a problem. Anterior canaloplasty together with a good support of the graft which is placed medial to the tympanic membrane remnant, lateral to the malleus and deep to the tympanomeatal flap anteriorly and posteriorly can increase the success rate. The success rate [determined by an intact tympanic membrane at the end of the follow up period, which was one year] was 96% with only one case presented with graft failure identified at two months postoperatively. The postoperative mean air-bone gap gain was 9.5 dB at the four frequencies tested. The use of this method was recommended on the repair of the anteriorly located tympanic membrane perforation

Bone cement in ossiculoplasty

This study included 30 patients having conductive hearing loss secondary to chronic otitis media with ossicular discontinuity. Biocompatible polymethylmethacrylate [PMMA] bone cement was used as a locally manufactured prosthesis for ossicular reconstruction in the forms of PORP and TORP. In ears with intact stapes superstructure, PORP was used [18 cases]; while, in ears with absent stapes superstructure, a similar TORP was used [12 cases]. The postoperative mean air-bone gap gain was 20 dB at the speech frequencies of 500 Hz-1000 Hz, 2000 Hz-4000 Hz in 22 cases. An extrusion of the prosthesis occurred in two cases. It was concluded that this locally made prosthesis is efficient in closing air-bone gap as well as cost- effective

Effects of adenotonsillectomy on pediatric O S A, supported by polysomnographic changes.

Thirty children with adenotonsillar hypertrophy were evaluated by polysomnography. It showed that 53% had mild apnea, 33% had moderate apnea, while 13% had severe apnea. Follow up after adenotonsillectomy by the use of polysomnography was carried out and showed a marked improvement with a variable degree according to the severity of apnea

Bioactive-glass powder obliteration of open mastoid cavity

Forty patients with chronic suppurative otitis media of the cholesteatomatous type were included in this study. Their open radical mastoid cavity were obliterated using a new bioactive glass powder; 30 of them as a primary procedure at the time of radical mastoidectomy and 10 as a secondary procedure later on. The study aimed to evaluate a new bioactive glass powder [particulates] as an obliterative material in open mastoid cavities. The results of this technique were promising. It was concluded that bioactive glass powder is a safe and effective biomaterial to be used as on obliterative material in open mastoid cavities

Adenotonsillar hypertrophy and cor pulmonale in children

Pulmonary heart disease occurring in children with chronic upper airway obstruction resulting from adenotonsillar hypertrophy was previously described. Sixty children with adenotonsillar hypertrophy were subjected to cardiac evaluation using chest radiography, ECG and echocardiography as well as arterial blood gas analysis. Chest radiographs showed cardiomegaly in seven cases, ECG showed right ventricular hypertrophy in six cases, while echocardiography showed right ventricular hypertrophy in nine cases with pulmonary hypertension in twelve cases. Adenotonsillectomy was carried out for all children included in the study. Six months later, all cases improved except one case remained with pulmonary hypertension and right ventricular hypertrophy