Meatoplasty with intraoperative topical mitomycin C application: technique and outcome

The present study was designed to evaluate the outcome of meatoplasty using Z-shaped incision with application of mitomycin C as trial to enlarge the external auditory meatus of patients undergoing modified radical mastoidectomy in comparison to classic meatoplasty with application of mitomycin C. The study included 40 patients; 25 males and 15 females with mean age of 38.7 +/- 8.4 years. All patients underwent Jull history taking, complete otorhinolaryngological examination and CT scanning and then were randomly allocated into two equal groups [n=20] according to the procedure assigned: Classic meatoplasty [C group] and Z-shaped meatoplasty [Z group] using Z-shaped skin incision made along the posterior and inferior conchal borders and extended along the posterior ear canal meatus. In both groups, mitomycin C, 0.4 mg/ml solution was applied on a sponge to the edge of the remnants of conchal cartilage for 5 minutes. Patients were examined bi-weekly till the ear was fully healed. Meatoplasty was assessed as regards the feasibility of easy examination and debridement with the use of simple otologic tools and an operating microscope. Both groups were compared as regards age, sex, operative time and amount of intraoperative bleeding. All cases passed smooth intraoperative course with non-significantly longer operative time and non-significantly more bleeding during Z-meatoplasty compared to classic meatoplasty. All Z flaps healed completely with good take without sloughing or change in color and the meatus was so enlarged to allow inspection of mastoid cavity and easy debridement with simple tools and allowed frequent otoscopic examination for cavity inspection. Only one ear, in Z group, developed hypertrophic scar that did not impose significant narrowing of the meatus. On contrary; 3 ears had classic meatoplasty developed keloid formation and significant narrowing of the meatus that hampered cavity examination and debridement. Another ear, in C group, developed postoperative perichondritis that resolved with local care and oral antibiotics, but unfortunately developed meatal stenosis. Thus, Z-meatoplasty showed a success rate of 95% which is significantly higher compared to classic meatoplasty [80%]. It could be concluded that application of mitomycin C in conjunction with Z-meatoplasty is an effective modality for reduction of possibility for hypertrophic meatal scar with its subsequent problems. Also, classic meatoplasty with mitomycin C application provided acceptable frequency of hypertrophic meatal scar and is recommended wherever Z-meatoplasty was technically difficult

Significance of different diagnostic tools for diagnosis of malignant thyroid gland tumours

Objectives: The objective of this study was to determine the diagnostic accuracy of clinical examination ,computed tomography [CT], neck ultrasound [US], thyroid scintigraphy [SC], and fine needle aspiration cytology [FNAC] as a different diagnostic tools for diagnosis of cancer thyroid gland in correlation to the final histopathological examination

Patients and Methods: From a series of 60 patients with different thyroid diseases, this study was conducted on 18 patients [15 females and 3 males with age range from 41 to 63 years] diagnosed clinically and proved histopathologically as cancer thyroid gland. All patients were subjected to full history taking, complete clinical examination, computed tomography [CT], neck ultrasound [US], thyroid scintigraphy [SC] and fine needle aspiration cytology [FNAC]. All the patients with malignant cytological evaluation underwent total thyroidectomy, with selective lateral neck lymph node dissection, for patients with palpable cervical lymphadenopahty, postoperatively histopathological examination of the operative specimens were done. The accuracy, of clinical examination, computed tomography, neck ultrasound, thyroid scintigraphy, and fine needle aspiration cytology, in diagnosis of cancer thyroid was estimated in correlation to the final histopathological examination

Results: The results showed that, the diagnostic accuracy of fine needle aspiration cytology [FNAC] in diagnosis of cancer thyroid gland was 88.9%, while the diagnostic accuracy of computed tomography [CT] was 76% where the diagnostic accuracy of neck ultrasound and clinical examination were 72%, and finally the diagnostic accuracy of scintgraphy was 55.6%

Conclusion: Fine needle aspiration cytology is a safe, cost-effective, sensitive and still the most accurate diagnostic tool in diagnosis of malignant thyroid lesions in clinically suspected cases [cases with regional lymphadenopathy, hoarseness of voice, history of rapid tumour growth, hard and fixed tumour and cases with tumour size >4cm], while CT and sonography, had a nearly similar results in detection of the thyroid malignancy. It is suggested that sonography, is a useful adjunctive test after detection of thyroid lesions on CT

Comparative study between virtual laryngoscopy and direct laryngoscopy in diagnosis of cancer larynx

The purpose of this study was to evaluate the accuracy, clinical value and limitation of virtual laryngoscopy in diagnosis of cancer larynx in comparison to direct laryngoscopy with histopathological correlation. Thirty patients diagnosed clinically and proved pathologically as laryngeal carcinoma were subjected to fiberoptic endoscopy [FO], biopsy, spiral computed tomography [CT]. and virtual laryngoscopy [VL]. The accuracy of fiberoptic endoscopy. virtual laryngoscopy and CT was estimated with pathological correlation. It was found that; the accuracy of fiberoptic endoscopy. virtual laryngoscopy and CT for detection of the site of the lesion was different. Regarding to the epiglottis. the accuracy of FO, VL and CT. were 100%. As for the false vocal cord, the accuracy of FO was 81% while CT and VL were 100%. For the ventricle, the accuracy of FO was 71% while VL, and CT were 100% .For the true vocal cord, the accuracy of FO was 70% while in CT and VL was 100%. For the anterior commissure, the accuracy of FO was 72%. VL was 94% and CT was 100%. For the posterior commissure, the accuracy of FO was 50%, VL was 83% and CT was 100%. For the subglottic region, the accuracy of FO was 62% while 100% in virtual and CT. For the vallecultae, the FO, VL, and CT showed the same accuracy, 100%. In conclusion, virtual laryngoscopy is sensitive in assessment of the larynx beyond the large supraglottic and glottic masses obscuring the view of fiberoptic endoscopy. It is particularly useful in the presence of sever laryngeal stenosis especially in the subglottic regions and does not require sedation and additional scanning. It is of a value In follow up patients with previous laryngeal carcinoma treated by radiotherapy or conservative surgery. On the other hand. virtual laryngoscopy show limits In the identification of early laryngeal lesion which can be detected by fiberoptic endoscopy

Frontal sinus oblitration with bioglass

Many alloplastic materials have been used in clinical frontal sinus obliteration. It has been difficult to find reliable obliteration material without short- or long term complications. Most common problem in frontal sinus obliteration is the resorption of occlusion material. This study was made to evaluate the efficacy of Bioglass as an alternative to autologous fat in the obliteration of the frontal sinus. Standard surgical techniques were used to obliterate the frontal sinus. Eight patients underwent Bioglass frontal sinus obliteration. There were 2 women and 6 men in the series with age ranges from 30 to 55 [mean, 38 years]. Two patients underwent obliteration for chronic infections with mucopyocele. Follow-up radiographs were obtained at 3, 6 and 12 months after obliteration of the sinus with Bioglass. No patient has developed clinical or radiographic evidence of recurrent frontal sinusitis. No implant has been rejected. Seven patients reported complete resolution of all symptoms. Bioglass had demonstrated efficacy in obliteration of frontal sinus. The material has the advantage that it takes well, no reaction or rejection and it is also of reasonable expense. The obstruction of the frontonasal duct by this material was ensured. Bioglass offers the advantages of no donor site morbidity and the potential for complete osseointegration