Hypoplastic maxillary antra

Background: Maxillary sinus hypoplasia is an uncommon pathology of the paranasal sinuses, which might be encountered in the clinical practice. Computed tomography scan confirms its existence and any associated anatomical anomaly and variations that might coexist

Objective: To present three cases of maxillary sinus hypoplasia which were diagnosed and managed surgically

Design: A Retrospective Study

Setting: Otorhinolaryngology Department, Bahrain Defence Force Hospital, Bahrain

Method: Three cases of maxillary sinus hypoplasia were managed from January 2012 to December 2015. The clinical presentation, radiological findings and surgical management of these patients were documented and found to be distinct from other cases

Result: The first case was a fourteen-year-old male with long-standing nasal symptoms, which were not relieved by medical treatment. Sinus CT scan revealed an ill-defined infundibular passage and complete opacified small right maxillary sinus; CT was classified as hypoplasia type 2 according to Bolger et al and was successfully treated surgically

The second case was a twenty-seven-year-old male with persistent left sided facial heaviness and left-sided headache. Sinus CT scan revealed left side normal uncinate process with well-defined infundibular passage indicating type 1 maxillary sinus hypoplasia

The third case was a thirty-four-year-old pregnant female with diplopia and left-sided headache. MRI revealed left maxillary sinus and inferiorly displaced left orbital floor with non-homogenous fluid-like signal intensity suggesting marked left long-standing sinusitis

The patient was managed by an antral lavage under local anesthesia. After delivery, she was reassessed by CT scan of the sinuses, which revealed left side small sized partial opacified type 2 maxillary sinus hypoplasia

Conclusion: Symptomatic maxillary sinus hypoplasia patients with a diseased blocked ostiomeatal complex have special diagnostic considerations and therapeutic challenges

Investigating psychosocial impact of cleft lip and palate on patients and parents

The objectives of this study are to evaluate the psychosocial impact of cleft lip and palate [CLP] condition among non-syndrome patients and their parents in Malaysia. Total eighty three CLP patients [age > 10 years] and eighty three parents were selected from university of Malaya medical centre [UMMC] and Hospital Kota Bharu I Hospital Raja Perumpuan Zainab II [HKB I HRPZII] Kelantan Malaysia. The Questionnaires were used for determining impact of CLP condition on psychosocial status of patients and parents. It was found that due to CLP condition majority of patients were teased. In addition, the self-confidence of CLP patients was also adversely affected. Among the parents 22.9% felt upset always, 36.1% felt upset often while 8.4% felt upset sometimes about their child oral cleft in the current study. Only 26.5% of the patients reported that they have problems at school due to their CLP condition. About 54.2% of patients were having very good relationship with other children, 37.3% had reasonably good and 8.4% were having quite good relationship with other children. The prevalence of teasing was quite high among the oral cleft patients. The self-confidence was adversely affected because of the cleft condition among majority of the patients

Demographic data on the characterization of oral clefts in Malaysia

The aim of this study was to investigate current epidemiology of several types of oral clefts among the patients receiving treatment at two tertiary care hospitals, namely University Malaya Medical Centre [UMMC] Kuala Lumpur, and Hospital Kota Bharu / Hospital Raja Perumpuan Zainab II [HKB/ HRPZII] Kelantan. This study evaluated the records of 526 cleft lip and palate [CLP] patients with or without additional malformations, who came for treatment during 2003 to 2007. Of the total 526 patients registered in the study hospital records during the study period, 338 were from HKB/ HRPZ II and 188 from UMMC. Majority 86.7% of these patients were in the age group

Impacted mandibular third molar surgery; the role of dexamethasone in postoperative swelling and trismus

The objective of this study was to evaluate the therapeutic effect of dexamethasone in post-operative edema and trismus after impacted third molar surgery. It was a prospective randomized control study carried in Department of Oral and Maxillofacial surgery, BADC, Larkana from March 2012 to Feb 2013. Patients age between 20-45 years of either gender; unilateral mandibular impacted third molars [right or left] were included. Patients divided in two groups by using random allocation number. Patients in Group-A were given intramuscular 8 mg dexamethasone 1 hour before surgery and four tablets [2mg] dexamethasone orally immediate postoperatively and 24 hours after surgery. The facial swelling was checked before surgery, after 24 hours [1st day], after 48 hours [2nd day], after 72 hours [3rd day] and on 7th postoperative day Inter-incisor distance was checked on every follow up. Data was analyzed by SPSS version 17. Mean and standard deviation was calculated for age and gender. Mean and SD of facial swelling and mouth opening was calculated before extraction, on 1st, 2nd, 3rd and on 7th post-operative day in both groups. The dexamethasone group showed significant reduction in swellingcompared with control group at all intervals. Dexamethasone resulted in significantly less trismus than controls on day 2 postoperatively, but there was no significant difference among the groups at 7thday. Dexamethasone is effective in minimizing swelling and trismus after removal of impacted lower third molar and improves the social life of individual

Composite 3 layers tympanoplasty - promising and reliable technique for management of dry central tympanic membrane perforation

Numerous graft materials and methods of placement have been described to reconstruct the tympanic membrane. Cartilage was shown both experimentally and clinically to be well tolerated by the middle ear and has long-term survival. A twelve-year-old female presented with history of recurrent episodes of right ear pain and discharge. She experienced slight hearing impairment in the right ear. On examination, she was found to have perforation in antero-inferior quadrant of tympanic membrane of the right ear which was operated successfully with a new technique utilizing a composite 3 layers graft [Perichondrium-Cartilage-Perichondrium] via transcanal approach.

Comparative efficacy of two methods of skin preparation of the perineal and genital skin of male urological patients

To compare the efficacy of two methods of skin antiseptic preparations of the genitalia and perineum in male urological patients. Prospective study. Mubarak Hospital, Kuwait. Adult male patients of two study groups numbering 114 [group-1] and 117 [group-2] admitted for cystoscopic procedures. The perineum and genitalia of patients in both groups were prepared by applying chlorhexidine-cetrimide mixture [CCM] and CCM plus povidone-iodine solution respectively. Swab specimens were obtained from the perineum and genitalia, before cleaning and disinfection [specimen A], after disinfection and draping [specimen B] and after the completion of the operative procedure [specimen C]. Specimens were cultured on appropriate media and representative colonies identified by standard methods. In groups 1 and 2, the A specimen yielded bacterial growth in 35.1 and 63% of patients, respectively. The commonest isolates in both groups were Gram-positive bacteria [89.2%] while Gram-negative bacteria accounted for only 10.8%. The B and C specimens in group-1 yielded positive bacterial culture in 7.1 and 11.4% patients respectively. In group-2, specimens B and C yielded bacterial growth in 5.1 and 2.6% patients respectively. In both groups, there was a significant reduction of patients with culture-positive B specimens after skin disinfection [p < 0.001]. The isolation rate of bacteria in specimen C in group-2 was significantlylower than group-1 patients [p < 0.001]. The addition of povidone-iodine to the CCM based regimen of perineal skin antiseptic preparation is associated with longer and more effective skin disinfection in male urological patients

Infective endocarditis: diagnostic algorithm and surgical perspectives

With the introduction of new subspecialty in the discipline of surgery in Sudan, such as open-heart surgery, renal transplantation and haemodialysis, infective endocarditis is changing its face. More cases are seen with different presentations, resistance to treatment and sometimes-poor outcomes. In this review, we tried to give an update on the current clinical guidelines for the diagnosis and management of this fatal disease. In particular, we tried to emphasize the importance of team- work approach and implementing clinical algorithms and pathway. Additionally, we highlight the experience at Ahmed-Gasim Hospital, Khartoum North, and stress the need for improvement particularly in the area of training, research and information systems

Effectiveness of epley's maneuver in the treatment of benign paroxysmal positional vertigo [BPPV]

To evaluate the effectiveness of Epley's Maneuver in the treatment of BPPV. Retrospective study. Twenty four patients who were fulfilling the presentation and clinical diagnosis of Benign Paroxysmal Positional Vertigo [BPPV], were seen in ENT clinic between March 2001 and June 2004, all were managed by Epley's Maneuver. A questionnaire was designed, stressing the various applicable issues to vertigo among which were the nature and duration of vertigo, its relevant symptoms, accompanying complaints and associated chronic medical illness. Additionally, we considered the effectiveness of Epley's Maneuver as reflected by the recurrence of symptoms, future need for labyrinthine sedatives, and the improvement in the patient's quality of life.Twenty-four patients were included in the study; males were 15 [62.5%], females 9 [37.5%]. Their age ranged between 20 and 60 years [mean age = 42.7 years]. All the patients were found to have normal ENT and CNS examination, except for a positive Dix- Hallpike test confirming the clinical suspicion of BPPV. In Thirteen patients [54.1%], nausea and vomiting were found to be a common associated symptom, while five patients [20.8%] were found to have some other associated aural complaints. While all the patients had head positional changes as a trigger for the vertigo episode, some postural element was found in 15 patients [62%]. Thirteen patients [58%] were found not to have any associated chronic medical illness, 5 [21%] were diabetics, 6 [25%] were hypertensive, one [4%] was suffering from hyperlipidemia, and one patient [4%] was known to have ischemic heart disease. Positive history of head injuries was revealed in one patient [4%]. The patients scored the negative impact of vertigo on the quality of their life and their daily activity. Pre-Epley's, eleven patients [48%] gave a score of 10 [very badly affected], while post-Epley's maneuver 21 patients [88%] scored 0 [no effect at all on their life]. Twenty-two patients [91.7%] revealed a significant improvement post-therapy. In this study, we found that Epley's Maneuver is an effective and very efficient modality of treatment for BPPV