Correlation of preoperative sinusitis patients' characteristics with final diagnostic findings

Chronic rhinosinusitis [CRS] is a common disease which is usually diagnosed clinically, considering the combination of natural history, physical examination and imaging studies. This study aimed to evaluate the clinical value of routine postoperative histopathologic examination [POHE] in patients with a clinical diagnosis of chronic rhinosinusitis with polyposis [CRSWP], or without polyposis [CRSWOP One hundred of patients with clinically approved CRSWP and CRSWOP were enrolled in this study. All patients underwent complete physical examination, scoring paranasal sinuses involvement by Lund-Mackay [LM] CT scoring scale, determining the extent of polyposis by Stumberger's endoscopic classification, and assessing health related quality of life by Sinonasal Test 22 [SNOT22] questionnaire. After FESS, histopathologic results were compared with preoperative clinical diagnosis. Among our patients, 65% were male, and the rest of them were female. Also, 66% of them suffered from CRSWP, and the rest of them were CRSWOP. LM CT score and SNOT22 score was 36.62 +/- 12, 17.11 +/- 6, and 43.62 +/- 20 respectively. Only in one of patients with CRSWP, POHE was other than what was expected preoperatively [adenoid cystic carcinoma]. In all other cases, POHE was well correlated with preoperative clinical diagnosis. HRQOL was better in males, absence of septal deviation and CRSWOP [P<0.05]. Para nasal sinuses involvement in preoperative CT was more severe in the presence of eosinophil in POHE [P=0.008] and in patients with class 3 Stumberger's classification [P<0.001]. This study suggested preoperative clinical diagnosis of CRS considering the combination of natural history, physical examination and imaging studies can be accurate, and POHE is indicated only in suspicious cases.

Augmentation rhinoplasty with combined use of medpor graft and irradiated homograft rib cartilage in saddle nose deformity

We used the irradiated homograft rib cartilage as an augmentation tip support and Medpore alloplast for reconstruction of the dorsum in patients with saddle nose deformities. Thereafter, the safety and efficiency of this method was evaluated to determine if this can be a safe and efficient technique for patients with saddle nose deformities. A total of 32 patients who suffered from saddle nose deformities due to past trauma or aggressive rhinoplasty underwent reconstruction using the Medpor prosthesis for dorsum reconstruction and irradiated rib cartilage as acolumellar strut during the same technique. After at least one year follow up, patients' satisfaction and their aesthetic indexes were evaluated and compared with preoperative results. More than 84% of patients were satisfied from the results of the surgery and only one patient had a complication of the infection which resulted in removal of the prosthesis. There were statistically significant differences between most of the pre- and postoperative aesthetic indexes. Despite the superiority of autogenous material in nose reconstruction, lack of such materials in revision rhinoplasty cases present challenges to surgeons. This study proposes the safety and efficiency of the Medpor alloplast for reconstruction of the dorsum and irradiated rib cartilage for the tip, at least for a short period of time

Airway management in a toddler with a giant hemangioma of the tongue

Induction of general anesthesia in a patient with compromised airway has always caused dilemma to anesthesiologist, especially for toddler this is paramounted. An 18 month old boy had a huge sized lingual mass which not only filled entire oral cavity but protruded outside the mouth up to about 5 cm. Having in mind the diagnosis of hemangioma, prior to induction it was attempted to reduce the mass but could be reduced only minimally by manual decompression. While the tongue, still outside the mouth, with full preparedness for anesthesia was induced maintaining the spontaneous ventilation. During laryngoscopy and intubation the tongue was pulled out of the oral cavity to ease the passage of the endotracheal tube. The mass was excised successfully and patient had an uneventful postoperative course. Maintenance of spontaneous ventilation is the crucial safety element during induction

giant hemangioma of the tongue

Vascular abnormalities are relatively uncommon lesions, but head and neck is a common region for vascular malformation which is classified as benign tumors. In this paper, the authors report a rare presentation of vascular malformation in the tongue and its managements. An 18 months 2 old child presented with a giant mass of tongue which caused functional and aesthetic problem. The rapid growth pattern of cavernous hemangioma was refractory to corticosteroid. The lesion was excised without any complication. Since the mass was so huge that not only filled entire oral cavity but was protruding outside, airway management was a great challenge for anesthesia plan and at the same time surgical technique was difficult to select. Despite different recommended modalities in managing hemangiomas of the tongue, in cases of huge malformations, surgery could be the mainstay treatment and provided that critical care measures are taken in to account, could be performed very safely

Association between audiometric profile and intraoperative findings in patients with chronic suppurative otitis media

Although the incidence and prevalence of chronic suppurative otitis media [CSOM] has been decreased in recent decades, but it is still a major health problem in both developing and developed countries. CSOM can cause major and life-threatening complications such as hearing loss, meningitis and cerebral abscess. Since hearing loss is the most common complication of CSOM, we aimed to evaluate audiometric profile in patients with CSOM and its relation with intra-operative pathologic findings Between 2008-2010, 80 patients with CSOM subjected to tympanomastoidectomy or tympanoplasty entered this study. The detailed patients' history, physical examination, audiometric evaluations and findings during surgeries were collected. Finally, the associations between data were analyzed. CSOM had higher prevalence among female [67.5%], but difference was not statically significant. Speech recognition test and air-bone gap were significantly associated with CSOM [P<0.001]. While cholesteatoma and granulation significantly associated with air-bone gap [P=0.044] and speech recognition test [P=0.032], respectively, ossicular defects significantly associative with both of them [P=0.001 and P=0.032, respectively]. There was not any association between sclerosis and audiometric parameters. Also presence of the cholesteatoma and ossicular defects associated with size of the tympanic perforation [P=0.001]. The preoperative and surgical findings can predict the patients' conductive hearing loss in chronic otitis media, but this relationship is not significant in all variables

Epidemiological aspects of cleft lip and palate in Iran

Orofacial clefts, including cleft lip with or without cleft palate [CL [P]], are common congenital malformations, second only to clubfoot in frequency of occurrence. The epidemiology and genetics of this disorder have been studied extensively in various countries by several investigators. The objective of this study is to assess the epidemiology and some genetic aspects of orofacial clefting at Imam Khomeini Hospital in Tehran. This study was a 7-year case series [retrospective] study from 1999 to 2006. The setting for the study was Imam Khomeini Hospital in Tehran, and the participants were all consecutive surgical cases with orofacial clefts referred to this hospital. One hundred and 77 cases of cleft lip and/or cleft palate were recorded during these 7 years. Seventy four of them [41.8%] were female and 103[58.2%] were male [M/F Ratio=l .39]. Of all patients, 40 persons [22.6%] had isolated CP, 45 [25.4%] had cleft lip without cleft palate, and 92 [52%] had cleft lip with cleft palate [CL+P]. Their M/F ratios were 1.66, 0.6 and 1.96 respectively. Of all CL [P] probands, 41 patients [29.9%] were bilaterally affected. In unilateral cases, the left side was affected nearly twice as frequently as the right side. Among the patients, 23 cases [13%] had other malformations; most commonly head and face abnormalities and then congenital heart disease. Fifty-four patients [30.5%] had consanguine parents; 33 [18.6%] were first cousins, 7 [4%] were second cousins, and 14 [7.9%] were distant relatives. There was a positive family history for cleft syndrome in 23 cases; most commonly CL-P. Our study reveals that the epidemiologic aspects of oral clefts in Iran are very similar to other Caucasian populations. It also suggests that a routine screening such as echocardiography and ruling out skeletal, hearing and visual problems may be necessary in cleft patients especially in children. It seems that genetic counseling and karyotyping can be very useful in patients with multiple malformations