Validity of parentral nutrition after major neck surgeries

Assessment of parentral nutrition as a substitute therapy to enteral nutrition after major neck surgeries with primary pharyngeal repair. Forty patients were included in this study underwent various neck surgeries were prospectively randomized to receive either enteral nutrition [20] patients or parentral nutrition [20] patients. The patients were monitored for postoperative complications, wound healing, hospital stay, time to natural feeding and weight loss. The compared items were similar in both groups [mean duration of nutrition was 9.65, 9.9 days for TPN and NGT group respectively, mean hospital stay was 11.65, 11.9 days for TPN and NGT groups respectively, wound dehiscence and infection was in 15%, 20% in TPN and NGT respectively and also same result for pharyngocutaneous fistula, weight loss was 2.6 Kgm for TPN group and 2.39 Kgm for NGT group; p value was insignificant in all items. There were no major postoperative complications in both groups. The present study reveals that there was no significant statistical difference between parentral and enteral nutrition when used for postoperative nutrition after major neck surgeries

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

Reconstruction of subtotal and total tympanic membrane perforations using cartilage palisade technique

The purpose of this study was to evaluate the use of palisade cartilage technique for reconstruction of subtotal and total tympanic membrane [TM] perforations compared with temporalis fascia [TF] graft. Prospective study consists of ninety five patients suffering from chronic inactive suppurative otitis media with subtotal and total TM perforations. The patients underwent full history taking, clinical examination and audiological evaluation. The patients were classified into two groups: group A [75 patients] in whom cartilage palisade technique was used and group B [20 patients] in whom TF graft was used. Closure of TM perforation was achieved in 71 patients [94.6%] of group A and in 7 patients [35%] in group B. As regards hearing results, there was highly significant postoperative improvement in pure tone averages as well as air-bone gap averages in both groups. In group A, the air-bone gap was closed to less than 10 dB in 26.6% and from 10-25 dB in 56% and to more than 25dB in 17.4%. While in group B, the air-bone gap was closed to less than 10 dB in 25% and from 10 - 25 dB in 65% and to more than 25dB in 10%. In this study, the average pre and postoperative air-bone gap were 26.1 dB and 13 dB respectively for cartilage group and 25.3 dB and 13.1 dB for fascia group. This study revealed that, the palisade technique is an effective, straight foreword technique with high success rate and good hearing results without postoperative complications

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

Immediate posterior canal wall reconstruction by alloplastic bone cement

To evaluate the author's experience in immediate reconstruction of the posterior canal wall [PCW] using Polymethyl Methacrylate [PMMA] bone cement. Between January 2004 and March 2006, PMMA bone cement was used for immediate reconstruction of the posterior canal wall in 28 patients undergoing mastoidectomy procedure for removal of cholesteatoma. The age of the patients ranged from 18 to 48 years. The patients were followed up with a mean of 16 months. In 28 patients the PCW defect was reconstructed successfully by PMMA bone cement with normal appearance of the external canal skin in 27 patients. Postoperative complications included: middle ear infection in 3 cases, granulation tissue in 4 cases and dehiscence of the external canal skin in one case. From this study, the use of PMMA bone cement is a reliable and easy alternative method for repair of bony defects in the posterior canal wall

effectiveness of injection snoreplasty in treatment of simple snoring

Injection snoreplasty is introduced as an innovative, and effective palatal rigidity procedure with minimal cost and discomfort for controlling simple snoring. A well-described sclerosing agent, ethanolamine oleate 5%, is injected into the soft palate for reduction and/ or elimination palatal flutter snoring. Thirty four patients with a diagnosis of simple palatal flutter snoring [apnea / hyponea index less than 5] were enrolled in this study. Office treatment sessions were performed 6 weeks apart. Success was judged by subjective improvement in snoring and evidence of palatal scarring. Thirty two patients reported significant decrease in snoring. There were no significant postinjection complications. Visual analog pain scale confirmed minimal discomfort. Most patients received more than one injection [average 1.8] in order to induce optimal palatal stiffening. Injection snorepiasty is a simple, safe, and effective office treatment for simple snoring, Advantages over current snoring procedures include simplicity, low cost, decreased posttreatment pain levels, and minimal or no convalescence