use of non ceramic hydroxyapatite in mastoid cavity obliteration and posterior canal wall reconstruction

Despite the higher security [concerning cholesteatoma recurrence using the open cavity procedure, yet such technique represents some disadvantages including: lifelong care for the cavity, often discharging granulations, and vestibular vertigo due to the lack of labyrinthine protection. Most of these disadvantages can be avoided by mastoid cavity obliteration, which involves different materials described in literature. In this study we used non ceramic bioactive Hydroxyapatite micro granules [Osteo Graf / LD-300] with polycaboxylic acid to form a paste for mastoid cavity obliteration. In addition, we placed a conchal cartilage graft to replace the deep part of posterior canal wall, which acted as a support for the filling material and separated the middle ear cavity from the obliterated attic. Also temporal fascia grafting to repair the tympanic memberane was done. Such technique helped in a later second ossiculoplasty procedure to improve hearing in such patients. Our technique was assessed for its validity to obtain a permanent stable bony mastoid obliteration and secondary hearing gain reconstructive procedures; our assessment was clinical, radiological, and audiological. Our use of bony obliteration. The latter statement is true, as only expensive serial contrast enhanced MRI studies are needed for the detection of such recurrence when soft tissue is used for mastoid cavity obliteration

role of MMP2 and nm23H1 in predicting the aggressiveness and lymph node metastasis in laryngeal carcinoma

we examined the degree of expression of both MMP2 and nm23 H1 proteins in 24 cases with primary laryngeal carcinoma using immunohistochemistry and correlated the results with the clinical, radiological and histopathological data, in order to evaluate their role in predicting the local spread and/or lymph node status. Preoperative clinical evaluation of these patients included; a full history taking, thorough ENT and neck examination and direct laryngoscopy. Radiological assessment via CT neck thin axial cuts was done. Then laryngeal and nodal specimens were examined histopathologically and immunohistochemically for nm 23H1 and for MMP2 proteins. There was a significant correlation between MMP2 expression and the site of the tumor since much lowering of MMP2 was mainly associated with glottic carcinoma [P<0.05]. Concerning the tumor stage, advanced tumor stages were associated with increase in MMP2 expression, yet it didn't reach statistical significance [P0.07]. However, the presence of lymph node metastasis was significantly related to excess expression of MMP2 [P<0.05]. As regard nm23Hl, a statistically significant correlation was found between nm3H1 expression and tumor stage [P< 0.05]. Moreover, the presence of lymph node metastasis was significantly correlated to the loss of nm23H 1 expression and vice versa [P<0.05]. But correlating the expression levels of MMP2 and nm 23H1, it was statistically insignificant [P >0.05]. Although MMP2 and nm23Hl were correlated to the aggressiveness of malignancy, yet the statistical correlation of their expression levels were statistically insignificant [P >0.05]. Collectively, MMP2 increased expression was related to the occurrence of nodal metastasis of the tumor and also to the tumor sites characterized by frequent metastasis [supraglottic and transglottic]. On the contrary, nm23Hl expression was inversely related to the advancement of tumor stage and the nodal metastatic state