ABSTRACT
Background: synechia and ostial obstruction are major factors in the pathogenesis of recurring sinusitis after surgical endoscopic sinus surgery. Mitomycin C is an antineoplastic drug used in glaucoma filtration operations to prevent closure of trabeculectomy by inhibiting replication of fibroblast
Objective: the purpose of the study was to find out if intraoperative application of topical Mitomycin C to the surgical cavity at the completion of functional endoscopic sinus surgery for primary chronic sinusitis would diminish the rate of synechia formation, ostium stenosis and have any adverse effects on sinonasal mu- cosa
Materials and Methods: forty patients with primary bilateral chronic sinusitis were subjected to functional endoscopic sinus surgery. At the end of the surgery cotton pledges of 0.5-mg/ml Mitomycin C solution were placed for 5 min in the surgical cavity. The contra lateral surgical cavity served as control. No intranasal splints were used and anterior nasal packs were inserted and removed after 2 days. Patients were reviewed in outpatient clinic and endoscopic intranasal assessment for presence of synechia, ostial stenosis and integrity of nasal mucosa was done at one week, one month, 3 months, and 6 months after surgery
Results: the follow-up period of this study ranged from 6 moths to 18 months. Thirty patients were continued to follow up and they were considered the study group. Facial cellulites ipsilateral to the nasal cavity received topical Mitomycin C was noted in one patient after surgery. It disappeared with systemic corticosteroid and anti-inflammatory on the 5th day. No synechia has been detected on the sides receiving Mitomycin C whereas synechiae were present in the control sides [20%] in 6 cases. Antrostmies stenosis started one month postoperatively were noted in 3 nasal cavities did not receive topical application of Mitomycin; in compare to none of the cavities receive topical application of Mitomycin C. The mucosa of the nasal cavities of all patients appeared to heal well without evidence of infection
Conclusion: topical application of Mitomycin C on sinonasal mucosa prevents synechia formation and ostial stenosis after FESS without significant adverse effect. Large prospective, randomized clinical trials are necessary to study this medication before its general use as an adjuvant to fess
ABSTRACT
Objective: this study was designed to evaluate transnasal trans-sphenoidal endoscopic-controlled approach and compare it to the standard sublabial transnasal transseptal trans-sphenoidal microsurgical approach for sellar lesions
Design: prospective study
Materials and Methods: forty patients with sellar lesions were included in this work that was conducted between June 1997 and January 2002. Twenty patients were approached by the classic sublabial transnasal transseptal transsphenoidal microsurgical technique described by Hardy and another group of 20 patients were managed endoscopically Patients were allocated randomly to either group. All patients had clinical, radiological, ophthalmic and endocrine evaluation prior to surgery. Both techniques were compared as regard accessibility, visibility, duration of surgery, completion of lesion resection, morbidity including trauma to nasal skeleton and length of hospitalization and return to work
Results: lesions accessibility, visibility and completion of resection were better with the endoscopic-controlled technique. Mean [SD] operative times were significantly reduced in the endoscopic group vs. the sublabial group: 2.7 [0.7] hours vs. 3.4 [0.9] hours. Hospital stay ranged between 1-3 days for endoscopic group and 4-10 days for the sublabial microsurgical group. There was significant reduction in trauma to nasal skeleton in endoscopic group. There were no major complications in both techniques
Conclusion: the emerging endoscopic-controlled transnasal trans-sphenoidal approach for lesions in the sella is safe and effective alternative to the standard sublabial transnasal transseptal transsphenoidal microsurgical approach. It has the advantage of minimal invasiveness
ABSTRACT
The management of pediatric cholestetoma is still controversial. We report our experience with one-stage procedure canal wall down technique in children who had acquired cholesteatoma with evaluation of the hearing status pre and post operatively. Single-stage CWD mastoidectomy approach has a good hearing result with low rate recidivism [7.5%,] and minimal cavity problem. Hearing was preserved in [32%], improved [40%] and became worse [28%] of cases postoperatively. Single-stage approach has low rate of recidivism during follow-up period and overcome the social problems of multi-stage procedure in children