Effect of Lateral Osteotomy in Subperiostal Plan in Reducing Severity of Periorbital Edema and Ecchymosis after Rhinoplasty.

Introduction: Osteotomy is the main reason of periorbital edema and ecchymosis after rhinoplasty due to damage of angular vessels and fracture of the nasal bones and frontal process of maxilla. Several methods are suggested for reducing periorbital edema and ecchymosis. The main purpose of this study was to determine the effect of internal lateral osteotomy in subperiosteal plan in reducing periorbital edema and ecchymosis after rhinoplasty. Methods: This double-blinded clinical trial was conducted on 30 patients. Internal lateral osteotomy was performed in one side in subperiosteal plan and opposite side used as a control without elevation of periostium from the bone. The degree of edema/ecchymosis on both sides was compared on the 1st and 7th day postoperatively. Results: The severity of periorbital edema was more significant in one side with periosteal elevation 24 hours after operation (P. value=0.006). However, no significant difference was found in periorbital edema between both sides 7 days after the surgery (P. value=0.098). The severity of periorbital ecchymosis was also more significant in the side with periosteal elevation 24 hours (P. value= 0.023) and seven days after operation (P. value=0.004). Conclusion: Since lateral osteotomy in subperiosteal plan increased periorbital edema and ecchymosis after rhinoplasty, performing lateral osteotomies without subperiosteal tunneling during rhinoplasty operation is suggested.

Effect of adenotonsillectomy on adhd symptoms of children with adenotonsillar hypertrophy

Adenotonsillar hypertrophy and obstructive sleep disordered breathing can lead to attention deficit/hyperactivity disorder [ADHD]. The purpose of this study was to evaluate effect of adenotonsillectomy on improvement of ADHD symptoms in a quasi-experimental [before and after] study. The efficacy of adenotonsillectomy on improvement of ADHD symptoms of 35 children aged 5-12 years with adenotonsillar hypertrophy and ADHD was evaluated six months after surgery. Diagnosis of ADHD was based on the DSM-IV criteria in three subtypes [predominantly inattentive type, predominantly hyperactiveimpulsive type and combined type]. Seventeen boys [49%] and eighteen girls [51%] with mean [ +/- SD] age of 7.4 +/- 3.8 years [range: 1-10 years] were evaluated. Frequency of combined type of ADHD decreased significantly six months after adenotonsillectomy [54.3% versus 22.9%, P=0.003]. ADHD inattention score [2.26 +/- 1.93 versus 0.96 +/- 0.45, P=0.005], hyperactivity score [4.23 +/- 3.57 versus 3.57 +/- 8, P=0.03] as well as ADHD combined score [9.66 +/- 2.58 versus 7.2 +/- 3.67, P=0.0001] improved significantly after surgery. Upper air way obstruction due to adenotonsillar hypertrophy might be an important and treatable cause of ADHD and should be considered in evaluation of affected children. Adenotonsillectomy in these children is associated with improvements in ADHD symptoms.

Hearing status in neonatal hyperbilirubinemia by auditory brain stem evoked response and transient evoked otoacoustic emission

Hyperbilirubinemia at neonatal period is one of the major deteriorating factors of the auditory system. If left untreated, it may cause certain cerebral damage. This study aims to evaluate the impact of hyperbilirubinemia on the hearing of neonate. This study was conducted on 35 newborn babies with jaundice [bilirubin more than 20 mg/dL]. Auditory brainstem response [ABR] and transient evoked otoacoustic emission [TEOAE] tests were performed, after treatment and one year after. ABR test results indicated that 26 children [74.3%] had normal hearing but 9 [25.7%] suffered from an impairment. As for TEOAE test, 30 children [85.7%] passed whereas the remaining [14.3%] seemed to be failures. The comparative results of the two tests pointed to autonomic neuropathy /autonomic dysreflexia symptoms in 5 babies. Due to the high incidence of Autonomic neuropathy/autonomic dysreflexia among hyperbilirubinemic babies, screening in this regard seems reasonable. Our result emphasizes the necessity of more experiments on the afflicted areas

Lymphatic metastasis in head and neck squamous cell carcinoma

Squamous cell carcinoma is the common type of malignancy in head and neck area and it metastasis into the regional lymphnodes. The objective of this study was to evaluate the detection of this metastasis via lymphatic channels around the tumor or via newly formed lymphatics inside the tumor. This case series included twenty patients specimens with head and neck squamous cell carcinoma. They were evaluated for lymphangiogenesis by using Vascular Endothelial Growth Factor 3 and KI67 immunohistochemical markers and then the data was correlated with clinicopatological criterias. High intratumoral and peritumoral lymphatic densities were both found significantly associated with the poor histological differentiation [Exact test p= 0.023]. There was no association between intratumoral lymphatic density, peritumoral lymphatic density and the presence of lymph node metastasis, location of the tumor, age, and sex. There was however a significant association between intratumoral lymphatic density and peritumoral lymphatic density [Fisher exact test p=0.001]. This study reveals the existence of intratumoral and peritumoral proliferating lymphatics, but these lymphatics have no correlation with the lymph node metastasis in all the head and neck squamous cell carcinoma cases such as larynx and oral cavity