Laser versus radiotherapy in the treatment of early glottic carcinoma

Background: Laryngeal cancer is one of the most common types of head and neck malignancy, although its optimal primary treatment is still a matter of debate. Methods: Typical patients with laryngeal SCC (90% at least) are males, over 45 years and heavy smokers. Hoarseness, voice changes, dysphagia, odynophagia, neck mass, dyspnea, referred otalgia and aspiration are the symptoms seen in laryngeal carcinoma. Glottic carcinomas are usually diagnosed earlier and hoarseness is the most common typical symptom. Results: All patients had completed the study. After comparison of the result between the 2 treatment groups, transoral laser excision shows better results than radiotherapy. There is significant difference between laser and radiotherapy in post-operative complications regarding granuloma tissue formation, tumor recurrence and web formation. In laser excision of laryngeal carcinoma, 10% of cases have post-operative granuloma while in radiotherapy, 66.6% of them have post-operative granuloma, but no cases has tumor recurrence while in radiotherapy, 33.3% of them have tumor recurrence. In laser excision of laryngeal carcinoma, 10% of cases have post-operative web formation while in radiotherapy, 22.3% of them have post-operative web formation. There is statistically significant difference between laser and radiotherapy in post-operative satisfaction about the voice (voice quality). Radiotherapy shows better results than laser in voice satisfaction. Conclusions: As regard the study, transoral laser excision of early glottic carcinoma shows better control rate and decrease recurrence and complications than radiotherapy. Keywords

Two- versus Three-Point Internal Fixation of Displaced Zygomaticomaxillary Complex Fractures.

Despite the high frequency of the zygomaticomaxillary complex (ZMC) fractures, there is no consensus among facial reconstructive surgeons regarding the best surgical management; thus, surgical choice for ZMC fractures is still challenging. This study included 40 patients with displaced ZMC fracture. Twenty patients were treated with open reduction and internal fixation (OR/IF) using two-point fixation technique (at infraorbital margin and zygomaticofrontal buttress region) and the remaining 20 patients were treated with OR/IF using three-point fixation technique (at frontozygomatic suture, infraorbital margin, and zygomatico maxillary buttress). The results of both types of ZMC fractures repair were then statistically compared. No statistical differences between the two types regarding malar eminence asymmetry; projection (forward displacement) and width (medial displacement) in axial CT; inferior displacement; superior displacement and width (medial displacement) in coronal CT; angle of displacement (outward displacement) in 3D CT; masseter and temporalis muscles power electromyography; actual duration of surgery; and patient satisfaction. On the other hand, the total cost of the used plates and screws was significantly higher with three-point repair than two-point repair ( p = 0.003). Moreover, postoperative CT lateral zygoma displacement was statistically significantly better in three-point fixation. Two-point fixation modality for displaced ZMC fractures is as effective as three-point method in fixation and prevents postreduction rotation or clinical displacement with significantly lower cost.

MRI as an Alternative to Second Look Mastoid Surgery.

The main goal of surgery of cholesteatoma is eradication of the disease and revision surgery is indicated when a dry and safe ear has not been achieved. Residual cholesteatoma usually occurs at the sites that are difficult to reach with an operating microscope, such as posterior tympanum and anterior epitympanic recess. Computed tomography can be performed to delineate the extent of disease. High-resolution computed tomography scanning is important for planning for surgery and is indicated for all revision mastoid operations. Magnetic resonance imaging is superior to computed tomography in tissue characterization for diagnosis of recurrent cholesteatoma. To evaluate the cases of recurrent cholesteatoma comparing the intraoperative surgical findings with the preoperative MRI radiological findings and if the preoperative MRI can replace the second look surgery for cholesteatoma. This study was applied on 60 patients that have a recurrent cholesteatoma after previous mastoid surgery. A preoperative radiological evaluation was done by Magnetic resonance, surgical management was done by canal wall up or canal wall down mastoidectomy to exclude residual disease. Then, radiological, and surgical findings correlation was done. Diffusion-weighted MRI successfully detected 42 cases out of the 45 cases of surgically proved cholesteatoma, it has accuracy 95%, sensitivity 93.33%, specificity 100%, PPV 100% and NPV 83.33%. MRI is better than CT in tissue characterization for diagnosis of recurrent cholesteatoma, and can replace the unnecessary second look surgery of cholesteatoma.

Platelet-Rich Plasma in Reconstruction of Posterior Meatal Wall after Canal Wall Down Mastoidectomy

Abstract Introduction Canal wall down (CWD) mastoidectomy has many drawbacks, including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). Objectives To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using titanium mesh and platelet-rich plasma (PRP) mixed with bone pate. Methods This study was conducted with 20 patients that have atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by titanium mesh and the mixture of PRP with bone pate. All patients were exposed to a full preoperative evaluation and full postoperative assessment of the complications, the appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results The PMW reconstructed by titanium mesh and the mixture of PRP with bone pate showed a smooth contour. During the follow-up of 12 to 36 months, the postoperative appearance of the external auditory canal contour was found to be smooth without hidden pouches, irregularities or stenosis in all cases. No granulation, foreign body reaction, or extrusion and/or displacement of the titanium mesh were registered. No facial palsy or recurrent cholesteatoma was reported. Conclusion The surgical reconstruction of the PMW using PRP, bone pate and titanium mesh after CWD mastoidectomy appears to be reliable without considerable complications, giving a smooth appearance to the PMW.

The Role of the Level of Interleukin-33 in the Therapeutic Outcomes of Immunotherapy in Patients with Allergic Rhinitis

Abstract Introduction Allergic rhinitis (AR) affects up to 40% of the population and results in nasal itching, congestion, sneezing, and clear rhinorrhea. Objectives This study aimed to evaluate the changes in the clinical symptoms and in the level of serum interleukin (IL)-33 before and after pollen immunotherapy (IT) in patients with AR. Methods The total symptomscore and the levels of total immunoglobulin E (IgE) and IL-33 were determined in the serum of 10 non-allergic healthy controls and 45 patients with AR who were equally divided into 3 groups: GI (patients did not receive IT), GII (patients had received IT for 6 months) and GIII (patients had received IT for 2 years). Results There was a significantly higher concentration of IgE and IL-33 in the serum of patients with AR than in that of non-allergic patients. Furthermore, serum level of IL-33 decreased significantly after pollen IT. But, there was no significant reduction in the serum level of IL-33 between GII and GIII patients. Conclusion Our results show a clinical improvement associated with a decrease in serum level of IL-33 after pollen IT.

Platelet-Rich Plasma in Reconstruction of Posterior Meatal Wall after Canal Wall Down Mastoidectomy.

Introduction Canal wall down (CWD) mastoidectomy has many drawbacks, including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). Objectives To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using titanium mesh and platelet-rich plasma (PRP) mixed with bone pate. Methods This study was conducted with 20 patients that have atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by titanium mesh and the mixture of PRP with bone pate. All patients were exposed to a full preoperative evaluation and full postoperative assessment of the complications, the appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results The PMW reconstructed by titanium mesh and the mixture of PRP with bone pate showed a smooth contour. During the follow-up of 12 to 36 months, the postoperative appearance of the external auditory canal contour was found to be smooth without hidden pouches, irregularities or stenosis in all cases. No granulation, foreign body reaction, or extrusion and/or displacement of the titanium mesh were registered. No facial palsy or recurrent cholesteatoma was reported. Conclusion The surgical reconstruction of the PMW using PRP, bone pate and titanium mesh after CWD mastoidectomy appears to be reliable without considerable complications, giving a smooth appearance to the PMW.

The Role of the Level of Interleukin-33 in the Therapeutic Outcomes of Immunotherapy in Patients with Allergic Rhinitis.

Introduction Allergic rhinitis (AR) affects up to 40% of the population and results in nasal itching, congestion, sneezing, and clear rhinorrhea. Objectives This study aimed to evaluate the changes in the clinical symptoms and in the level of serum interleukin (IL)-33 before and after pollen immunotherapy (IT) in patients with AR. Methods The total symptom score and the levels of total immunoglobulin E (IgE) and IL-33 were determined in the serum of 10 non-allergic healthy controls and 45 patients with AR who were equally divided into 3 groups: GI (patients did not receive IT), GII (patients had received IT for 6 months) and GIII (patients had received IT for 2 years). Results There was a significantly higher concentration of IgE and IL-33 in the serum of patients with AR than in that of non-allergic patients. Furthermore, serum level of IL-33 decreased significantly after pollen IT. But, there was no significant reduction in the serum level of IL-33 between GII and GIII patients. Conclusion Our results show a clinical improvement associated with a decrease in serum level of IL-33 after pollen IT.

Hypopharyngeal reconstruction: a comparison of three alternatives.

This study aimed to evaluate the operative outcomes of using gastric pull-up (GPU), pectoralis major myocutaneous flap (PMMF), and jejunal free flap (JFF) to reconstruct the hypopharynx after resection of hypopharyngeal and cervical esophageal carcinoma. Retrospective clinical study. Otolaryngology Department, Zagazig University Hospital, Egypt and Surgical Department, National Cancer Institute, Cairo, Egypt. Records of 104 patients who underwent resection of carcinoma of the hypopharynx and cervical esophagus were reviewed to determine the indications for radical resection, location, and stage of the primary tumor, gross and pathological surgical resection margins, operative complications, morbidity, and mortality. Reconstruction was performed using the GPU for group (1) (n = 33), PMMF for group (2) (n = 34), and JFF for group (3) (n = 37). The hypopharynx was the most common primary tumor site for group (2) and group (3) whereas group (1) had lesions more frequently in the cervical esophagus. The overall postoperative morbidity rate was 20.2% with a perioperative mortality rate of 6.7% and there was no significant difference between the three groups. There was no graft necrosis in group (1) compared to 5.9% in group (2) and 5.4% in group (3). Pulmonary complications occurred commonly (30.3%) in group (1) compared to 11.8% in group (2) and 10.8% in group (3) The overall 3 years survival rate was 67.3% and there was no significant difference between the three groups. The outcomes of the three techniques are equally successful when used appropriately. The nature of the defect indicates the method of reconstruction. For short reconstruction above the thoracic inlet, PMMF or JFF are equally effective and in tumors requiring total esophagectomy, GPA is indicated.