Epidemiologic and ethiologic evaluation of deep neck infection in Shiraz Khalili hospital during 1996 - 2005

infections of the head and neck spaces are serious and dangerous due to vicinity to the great vessels and mediastinum. The most common source of infection leading to head and neck space abscess, are dental infection. This retrospective study was performed to determine the prevalence of head and neck space infections following dental infections, the spaces involved, the most common microorganisms involved in these infections and to determine the prevalence of head and neck space infections according to age and sex of the patients. In this retrospective study, the charts of 241 patients with head and neck space infections referring to Khalili hospital during the past 10 years was reviewed and data well assessed. The most common source of head and neck space infections was dental infections occurring in 141 patients [58.5%]. From these 141 patients, 79 patients were male and 62 patients were female. The most common age of involvement was the 3[rd] decade [39 patient 27.6%]. The second most common cause was tonsillitis occurring in 33 patients [13.7%]. The most common spaces involved in 141 patients with head and neck space infection following dental infections, were: simultaneous involvement of submandibular, sub mental and sublingual space bilaterally [Ludwig's angina] in 53 patients [37.6%] followed by sumbandibular space in 45 patients [31.9%] and Para pharyngeal space in 37 patients [26.2%]. Culture has been performed in only 34 patients from which bacterial growth occurred in 18 cases. The most common organism was non hemolytic streptococci [11 cases]. Head and neck space infection are dangerous and life threatening conditions that occur most commonly following dental infections so it seems that escalating the general knowledge about oral health, increasing dentistry centers and early and proper management of dental infections have a major role in reducing the incidence of head and neck abscesses

[ effect of dexamethasone on decreasing nausea and vomiting following tympanomastoid surgery]

Nausea and vomiting are common after general anesthesia. Nausea and vomiting are also common after tympanomastoid surgery that may endanger the results of middle ear reconstruction. Medications like dexamethasone have been used to prevent nausea and vomiting. In this study, the effect of dexamethasone on decreasing nausea and vomiting following tympanomastoid surgery has been evaluated. This study is a case control, double blinded, clinical trial that was performed in Dastgheib Hospital affiliated to the Shiraz University of Medical Sciences during 1381-1383. Eighty patients candidate for tympanomastoid surgery who were in physical status I [according to the classification of the American Anesthesiology Association] were selected randomly. These patients were divided into two control and study groups [each group consisting of 40 patients]. Just before induction of anesthesia, 2 ml normal saline was given intravenously to the patients in control group and 2 ml dexamethasone [8 mg] was given to the patients in the study group. The data were collected by a special form, and SPSS software and Chi Square test were used for statistical analysis. There was no significant difference between the study and control groups regarding the mean of age, male to female ratio, and length of anesthesia. Use of dexamethasone resulted in 32.5% decrease in post operative nausea [p=0.002] and 22.5% decrease in vomiting [p=0.04]. It seems that 8 mg intravenous dexamethasone is effective in reducing nausea and vomiting following tympanomastoid surgery and can be used routinely during tympanornastoid surgery

efficacy of Epley manoeuver in the treatment of posterior canal paroxysmal positional vertigo

Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. Canalith repositioning manoeuvers are an established method for treatment of this disorder but efficacy of these maneuvers, including Epley canalith repositioning manoeuver are reported differently in various studies. In this study the efficacy of the Epley canalith repositioning maneuver has been evaluated in 43 patients. 43 patients with a history and physical examination consistent with posterior canal benign paroxysmal positional vertigo were studied. Patients were treated with a modified Epley canalith repositioning manoeuver. Patients were provided with a preprinted diary in which they had to circle the answers most relevant to their symptoms for 7 days after the manoeuver. Patients were reevaluated at one week after the manoeuver, The Hallpike manoeuver was performed at this time to corroborate the response to therapy. The mean duration of the BPPV before treatment was 7 weeks. A resolution of vertigo as a result of the manoeuver was obtained during the first 24 hours in 59% of the patients after one canalith repositioning manoeuver. 20% of patients had a resolution of vertigo during the first week however it is not evidently possible to conclude that these patients definitely benefited from the canalith repositioning manoeuver. In 21% of the patients vertigo persisted after the first week. Residual symptoms of lightheadedness, imbalance or both, were frequent [55% of cases] but rarely required any intervention. Epley canalith repositioning manoeuver resulted in immediate resolution of vertigo in 59% of our cases after one treatment. This manoeuver is safe and requires no special equipment or investigations; and it should be regarded as the treatment of choice for BPPV

Evaluation of the causes of upper airway obstruction leading to tracheostomy in Shiraz

To determine the causes of upper airway obstruction leading to tracheostomy; endoscopic evaluation was done in Khalili Hospital, Iran. During a 2 year period, 47 patients who underwent tracheostomy, were evaluated endoscopically to determine the causes of airway obstruction leading to tracheostomy. Forty-seven cases were included in the study including 40 males and 7 females with mean age of 31.9 years. The most common cause of obstruction was subglottic stenosis [40.%] and laryngeal carcinoma [38.3%]. The cause of subglottic stenosis in the majority of the patients was prolonged endotracheal intubations [95%]. Other less common causes were direct laryngeal trauma [4.5%], vocal cord paralysis [2.1%], supraglottitis [2.1%], tracheal foreign bodies [2.1%], severe trismus [2.1%], and status asthmaticus [2.1%]. Subglottic stenosis secondary to prolonged intubations is the major cause of upper airway obstruction leading to tracheostomy. Converting endotracheal intubations to tracheostomy in patients who need prolonged ventilator support may prevent subglottic stenosis and decrease the rate of serious complications following prolonged endotracheal intubations

Investigation of H pylori colonization in adenotonsillectomy specimens by means of rapid urease [CLO] test

This prospective clinical study was performed to investigate the colonization of H pylori in adenoid and tonsil tissues by using the Campylobacter-like organism [CLO] test. Included in the study were 56 patients aged 3 to 43 yrs who had undergone adenoidectomy, tonsillectomy or adenotonsillectomy procedures under general anesthesia. Two-mm diameter tissue pieces of adenoid and tonsil specimens were placed in urease solution. Color changes were noted after 30 min and 24 hrs. 27 [48.2%] of the patients were shown to be H pylori positive and 29 [51.8%] were negative, regardless of the type of specimen. There was a high rate of H pylori colonization in tonsil and adenoid tissues. The cause of recurrent H pylori infections of the gastric mucosa may be the result of colonization in the adenotonsillar tissues. Prevention of H pylori colonization may reduce the recurrences of the disease

Evaluation of anatomic variations of lateral nasal wall in functional endoscopic sinus surgery

Sinus endoscopic surgery requires sufficient anatomical knowledge of the area. The objective of this study was to determine the variations of anatomic landmarks in patients undergoing functional endoscopic sinus surgery. This retrospective study was based on reviewing the recorded video tapes obtained during operation of 100 patients with chronic sinusitis or other sinonasal diseases who underwent endoscopic sinus surgery. At the beginning of each operation, both nasal cavities were reviewed by 0 and 30 degrees, 4 millimeter telescope. Anatomic structures of the lateral nasal wall was viewed and findings were recorded on VHS videotapes. These videotapes were re-evaluated later. The following data were obtained by reviewing these anatomic variations in 170 nasal cavities in 100 patients: Middle turbinate: typical [70%], concha bullosa [10%], sagittal cleft [4.5%], lateral displacement [5%], lateral bending [4.5%], medial bending [3%], medial displacement [3%] and transverse cleft [0%]. Uncinate process: typical [82%] and medially rotated [18%]. Bulla ethmoidalis: balloon shaped [typical] [60%], sausage shape [22%] and flat [18%]. Accessory ostium: round [67%] and oval [33%]. Sphenoid sinus ostium: oval [50%], slit [35%] and round [15%]. This study attempted to determine the anatomic variations of the lateral nasal wall. Knowledge of these variations is important for differentiating pathologic conditions from normal anatomic variations and offers a safer and more effective endoscopic sinus surgery with less complications

Metastasizing pleomorphic adenoma of the tongue: a case report

A 19-year-old girl referred to our clinic complaining of a painless lump on the left side of her tongue. The patient had no history of dysphagia, lingual paresthesia or bleeding. Physical examination revealed the presence of multiple enlarged lymph nodes on the left side of her neck. Histopathology of lingual mass and lymph nodes showed pleomorphic adenoma. To our knowledge, this is the first case of pleomorphic adenoma of the tongue with metastasis to the cervical nodes