Modified ribbon gauze packing technique versus merocel nasal packing in reducing nasal adhesions following functional endoscopic sinus surgery. A randomized controlled study

Objective: This study compares the efficacy of 2 common techniques of nasal packing [compressed sponge [Merocel] and Vaseline ribbon gauze] in preventing intranasal adhesions following functional endoscopic sinus surgery [FESS] in adult patients

Study design: Prospective, blinded, randomized controlled trial. Setting: Tertiary care referral hospital

Patients: Sixty seven adult patients aged between 19 - 70 years, who had undergone FESS for chronic sinusitis, were included in the study. All patients had diagnostic nasal assessment and preoperative coronal and axial CT scanning of nasal and paranasal sinuses. FESS was performed following Messerklinger technique. Additional surgical procedures were performed as indicated. After completion of surgery, one side of the nasal cavity was packed with compressed sponge [Merocel] and the other side with Vaseline ribbon gauze filling the nasal cavity from above downward

Main outcome measure: Three months post-operatively, all patients were assessed endoscopically for the development of postoperative intranasal adhesions. Anatomical distribution of post-FESS adhesions was noted

Results: One hundred and thirty four sides were operated upon. On 3 months post-operative follow up, nasal adhesions developed in 18 [27%] and 6 [9%] of sides packed with Merocel and ribbon gauze respectively [p = 0.007]. The described modified technique of ribbon gauze nasal packing has reduced the incidence of post operative adhesions mainly between the middle turbinate and lateral nasal wall. No major complications were recorded in association of either packing technique. Two out of six sides [33%] packed with ribbon gauze had symptoms of recurrent sinusitis and showed endoscopic signs of persistent infection at the middle meatus while 4 out of 18 sides [22%] packed with Merocel showed similar signs. All these patients improved with medical treatment and none of them required revision surgery with a mean follow up 5 months

Conclusion: Vaseline ribbon gauze nasal packing is more effective than compressed sponge [Merocel] in reducing postoperative nasal adhesions. This packing technique is safe and could reduce the need for further [revision] endoscopic surgery

Endoscopic trans-septal choanoplasty for congenital choanal atresia

To describe endoscopic trans-septal approach for treatment of choanal atresia. Prospective case series in a tertiary care center. Seventeen patients [7 with bilateral and 10 with unilateral choanal atresia] underwent trans-septal endoscopic choanoplasty. Removal of the vomer and shaving of the medial pterygoid plate were achieved by a small chisel with the use of a 4-mm 0 degree telescope. Nasal stents were not used following creation of the neochoanae. All cases were examined with the endoscopes 4 weeks postoperatively and any granulations or polyps at the site of the neochoanae were removed at that time. One year postoperatively, 16 [out of 17] patients had patent neochoanae. Granulation tissues were encountered in three cases and successfully managed on routine endoscopic examination. Endoscopic trans-septal approach is a direct, wide and safe one day surgery for repair of choanal atresia

Nodal level affection in elective neck dissection for squamous cell carcinoma of the larynx

The best prophylactic treatment for the NO neck is a subject of debate. Some authors propose lateral selective lymph node dissection [levels II-IV] for laryngeal squamous cell carcinoma [SCC] on the basis of probability of finding occult metastases in those lymph nodes. The necessity of routine dissection at level IV has been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent lateral neck dissection. We retrospectively evaluated 54 patients with N0 supraglottic and transglottic SCC who underwent total laryngectomy and selective [level II-IV] neck dissection. Twelve patients [22.2%] had occult neck metastases, 3 of them had also contralateral occult positive nodes. Level IV involvement occurred only in one patient [1.85%] ipsilaterally who had also other positive ipsilateral nodes at level II-III. Extracapsular spread [ECS] occurred in 23.8% of positive nodes. Elective dissection of level IV in clinically NO supraglottic and transglottic SCC may be unnecessary and reserved for cases with highly suspicious involvement of level II-III nodes to avoid occasional morbidity associated with its dissection

Complications of anterior craniofacial resection for management of malignant Sino nasal tumors involving anterior skull base

Management of malignant Sino nasal tumors with skull base involvement constitutes a challenging problem for head and neck surgeons. Surgery in this area confronts with life threatening risks of infections, orbital complications and cerebrospinal fluid leaks. Avoidance of these complications demand the co-operation between head and neck surgeons, neurosurgeons and radiotherapists, high surgical experience as well as proper reconstruction of skull base. The aim of this work is to study retrospectively the complications of anterior craniofacial resection for malignant Sino nasal tumors involving anterior skull base and to find out how to minimize these complications. In this study, we reviewed retrospectively the complications of twenty-one craniofacial resections done in Otolaryngology department Mansoura University Hospital. From September 1996 lo January 2004 with median follow-up period of 22 months. From this study, we found that the overall complications rate was about 30%. Anosmia. and psychological changes were the commonest complications and infectious complications were the least. We concluded that most of the complications of craniofacial resection are avoidable by good selection of patients, high surgical experience, and proper reconstruction of the anterior cranial base and good postoperative care

Middle ear functional changes associated with bilateral anterior nasal packing

Objective: the purpose of this study was to investigate the middle ear functional changes that associate with bilateral anterior nasal packing

Study Design: prospective study group consisted of thirty-eight consenting patients with bilateral anterior nasal packs, twenty males and eighteen females. Their age ranged from 18 to 50 years. The tymapanometric results of 76 ears that underwent bilateral anterior nasal packing after endoscopic nasal operations for chronic sinusitis were measured. The measurement was done before, during, and after nasal packing

Results: type A tympanogram was observed in 31 ears [40%] during bilateral anterior nasal packing and 59 ears [77%] after removal of the pack. While 34 ears [44 %] had type C tympanogram during bilateral anterior nasal packing and only 12 ears [15 %I had type C tympanogram after removal of the pack. Discussion: In this study, there was significant statistical difference between both middle ear functions before and after removal of the bilateral anterior nasal packing. However, there was no significant statistical dr8erence between the right and left ears affliction during the packing or after its removal by one week

Conclusions: this study revealed that there was a high incidence of Eustachian tube dysfunctions in patients with bilateral anterior nasal packs. However, with removal of the pack the middle ear pressure improves towards the pre-nasal pack condition with restoration of the middle ear physiological function after its removal