A Retrospective Review of Seasonal Patterns of Idiopathic Facial Nerve Paralysis in a Tertiary Care Center.

Background The objective of this retrospective study was to investigate the seasonal patterns of idiopathic facial nerve paralysis, specifically Bell's palsy, in Riyadh, Saudi Arabia. The study aimed to determine if there is a correlation between cold weather and the incidence of Bell's palsy, as well as to examine the relationship between age, gender, comorbidities, and the development of the disease. Methodology Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2016 and 2021. Electronic medical records of adult patients diagnosed with idiopathic facial paralysis were reviewed. Patients with facial paralysis caused by known illnesses were excluded. Demographic information, clinical characteristics, and the course of the disease were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results The study included 136 Bell's palsy patients, with a mean age of 39.9 years. Males represented 58.1% (79) of the sample, and the right side of the face was more commonly affected in 71 (52.2%) patients. The majority of patients had House-Brackmann grade III (51, 37.5%). The monthly distribution showed a higher number of Bell's palsy cases during the winter months, particularly December, October, and November, but the seasonal distribution did not yield a statistically significant difference in incidence. Conclusions While this study observed a higher incidence of Bell's palsy during the winter months, it did not establish a statistically significant correlation between cold temperatures and the onset of Bell's palsy in Riyadh, Saudi Arabia. Furthermore, the study found that Bell's palsy predominantly affects middle-aged males, and comorbidities did not appear to be significant risk factors for the development of the disease. This research lays the groundwork for future investigations into the relationship between weather and the pathogenesis of Bell's palsy in the region.

Awareness and Attitude of Physicians on the Role of Dentists in the Management of Obstructive Sleep Apnea.

Background: Efforts to evaluate physicians' awareness and attitude toward dentists' comprehensive role in OSA management are relatively negligible. Therefore, this study aimed to assess physicians' awareness and attitude toward the role of dentists in OSA management in Saudi Arabia. Methods: In a multi-center cross-sectional study, a total of 358 physicians in Saudi Arabia were subjected to an e-questionnaire composed of three sections: (1) physicians' demographic data, (2) physicians' general and specific knowledge of OSA and its management [using 29 factual statements to be responded by "True, False, or I don't know" responses], and (3) physicians' attitude towards dentists' role in OSA management [using 12 attitude statements to be responded by a Likert scale of "Never, Rarely, Sometimes, Usually, Always" responses]. A scoring system was applied for both knowledge and attitude, total and percentage mean scores (PMS) were calculated, and knowledge and attitude levels were categorized accordingly. Predictors of correct knowledge and favorable attitude were identified using multiple regression analyses. Results: Physicians had an overall average knowledge level (PMS = 56% ± 19.4%), with 35.5% and 5.9% reporting good general and specific knowledge levels, respectively (χ2 = 143.0, p < 0.001). Physicians had an overall neutral attitude level (PMS = 64.4% ± 17.5%), with about one-half reporting a neutral attitude level (48.9%) and only one-fourth reporting a positive attitude level (27.7%). Higher levels of knowledge were a significant predictor of favorable attitudes (t = 5.71, p < 0.001). Higher training levels were a significant predictor of correct knowledge (t = 3.60, p < 0.001) and favorable attitude (t = 3.15, p = 0.002). Conclusions: Physicians showed insufficient knowledge about OSA and a less than favorable attitude towards dentists' role in its management. Enhancing medical curricula and clinical protocols and guidelines on the dentists' role in OSA management is recommended.

Multiple Sclerosis Masquerading as Post Septorhinoplasty Complication: A Case Report.

This is a case report of a young woman, who after a successful septorhinoplasty procedure, sustained repeated nasal trauma with a subsequent diagnosis of multiple sclerosis (MS) at a large tertiary hospital in Riyadh, Saudi Arabia. A 24-year-old woman with a history of childhood trauma presented with difficulty in breathing and dissatisfaction with her nasal appearance. After a successful and uneventful septorhinoplasty, she required numerous hospital admissions due to multiple episodes of blunt nasal trauma, culminating in clear nasal discharge and neurological symptoms, including dizziness, right-sided paresthesia and difficulty walking. Cerebrospinal fluid (CSF) leak was ruled out by CT brain; however, magnetic resonance imaging (MRI) of the brain and spinal cord showed demyelinating areas in the brain and cervical region of the spinal cord. CSF examination revealed the presence of oligoclonal bands. A neurologist confirmed the diagnosis of MS and initiated treatment, which was well tolerated. The patient is in remission with mild paresthesia in the right hand. Despite the repeated nasal trauma, the septorhinoplasty procedure had an excellent outcome. In conclusion, repeated nasal trauma, especially in the early postoperative period, in addition to procedure failure, may also point to the presence of an uncommon underlying neurological disorder, hitherto undiagnosed. It is therefore important to have an open mind when it comes to the differential diagnosis in such unusual scenarios. In addition, while investigating recurrent nasal trauma, it is extremely important to keep in mind rare neurological conditions, especially in younger patients.

Endoscopic transorbital management of frontal sinus mucocele: a case report and review of the literature.

The frontal sinus is the most common site for paranasal mucoceles, resulting in potentially threatening intraorbital or intracranial complications. Surgical drainage of mucoceles is the mainstay of treatment, which can be achieved usually through open or endoscopic transnasal approaches. Transorbital endoscopic surgery is a relatively novel approach to selective skull base lesions with limited data in the literature. It could be utilized as a safe and effective alternative approach in managing frontal sinus lesions when the endoscopic transnasal access alone is insufficient or inadequate. Here, we present a case of an isolated lateral left frontal mucocele that was managed successfully using an endoscopic transorbital approach alone with complete resolution of symptoms during a 10-month follow-up period.

Outcomes of tracheostomy in COVID-19 patients in National Guard Health Affairs, Riyadh, Saudi Arabia.

OBJECTIVES: To evaluate coronavirus disease 2019 (COVID-19) patient tracheostomy outcomes. METHODS: All COVID-19 patients at the National Guard Hospital, Riyadh, Saudi Arabia, were retrospectively recruited. Those who had tracheostomies between April and December 2020 were included. RESULTS: The population was 45 patients, of which 30 (66.7%) were males, 15 (33.3%) were females and the mean age was 66.76±12.74 years. The tracheostomy indications were anticipated prolonged weaning in 40 (88.9%) and failed extubation in 5 (11.1%) of the patients. The mean intubation to tracheostomy duration was 20.62±7.21 days. Mortalities were high, with most attributed to COVID-19. Mortality and a pre-tracheostomy C-reactive protein (CRP) uptrend were significantly related (p=0.039). Mortality and intubation to tracheostomy duration were not significantly related. The mean post-tracheostomy time to death was 10.64±6.9 days. Among the survivors, 20 (44.4%) males and 11 (24.4%) females were weaned off mechanical ventilation; 9 (20%) remained on ventilation during the study. The mean ventilation weaning time was 27.92±20 days. CONCLUSION: The high mortality rate was attributed to COVID-19. Mortality and a pre-tracheostomy CRP uptrend were significantly related; uptrend patients experienced far more mortalities than downtrend patients. Unlike previous findings, mortality and intubation to tracheostomy duration were not significantly related.

Fatal rapidly progressive interstitial lung disease in a patient with amyopathic dermatomyositis.

Interstitial lung disease (ILD) is a well-established common manifestation of idiopathic inflammatory myopathies. Yet, till now, the pathogenetic mechanisms are still poorly understood, classification is evolving and prognosis is variable. A refractory and rapidly progressive ILD (RPILD) that is associated with dermatomyositis (DM) with minimal muscle weakness and normal creatine kinase (termed clinically amyopathic DM) is increasingly being recognized, with more incidence in Asians. However, we are not aware of reports of the Arab region. Herein, we present a 38-year-old male with this condition that ended with a fatal outcome despite aggressive therapy, with a review of recent literature.

The Nasal Tip Rotation After Primary Rhinoplasty Using Columellar Strut Graft.

OBJECTIVE:  In this study, we aimed to investigate the degree of nasal tip rotation three months after rhinoplasty using columellar strut graft. METHODS:  Using photographs of 25 patients who underwent rhinoplasty, we prospectively analyzed nasal tip rotation before, during, and after three months of the surgery. Columellar strut graft was used for all patients for tip support. Standardized left profile images were taken. For evaluation of tip rotation, the nasolabial angle was measured. The results were statistically compared, and a p value less than 0.05 was considered statistically significant. RESULTS:  The mean preoperative nasolabial angle (NLA) for the entire group was 91.44°, and the directly postoperative angle measured 108.84°. The mean of postoperative nasolabial angles measured at three-month follow-up was 97.2°. The preoperative, directly postoperative, and three-month postoperative nasolabial angles were all recorded. CONCLUSION:  Considering the results of this study, a postoperative nasolabial angle is increased compared to preoperative angle. However, an occasional dropping of the angle might be seen in following months, which can be linked to several factors.

Postoperative malodorous smell in open septorhinoplasty: the effect of intradomal suturing with mucosal release.

PURPOSE: The aim of this study was to test a mucosal release method for decreasing the occurrence of malodourous smells after septorhinoplasty by preventing formation of debris pockets after surgery. METHODS: This study included 50 adult patients from 18 to 45 years of age who underwent open septorhinoplasty from January to May 2019. Patients were divided into two groups. The first group had intradomal (transdomal) sutures without submucosal release, while the second group had mucosal release. All patients had scheduled post-op visits at 1, 2, 4, and 8 weeks and 6 months. RESULTS: The overall postoperative rate of malodorous smell in both mucosal release and non-mucosal release patients at 2 weeks, 8 weeks and 6 months was 43.1%, 31.4% and 5.9%, respectively. Patients 36-45 years of age had a higher rate of postoperative malodorous smell with 55.6% at 2 weeks, decreasing to 33.3% at 8 weeks, and to less than 1% at 6 months. At 2 weeks after surgery, only 20% of the mucosal release group reported a malodorous smell compared to 65.4% in the non-mucosal release group. The rate was 8% at 8 weeks, and less than 1% at 6 months in the mucosal release group compared to 53.8% at 8 weeks and 11.5% at 6 months in the non-mucosal release group. CONCLUSIONS: Utilizing absorbable polydioxanone sutures and releasing the vestibular mucosa of the LLC significantly reduced the rate of postoperative malodorous smell for septorhinoplasty patients with intradomal (transdomal) single-dome suturing.

Nasal spindle cell sarcoma: A case report.

BACKGROUND: Synovial sarcoma is a mesenchymal high grade tumor. It is found in soft tissue mostly lower extremities. It is rarely found in the head and neck area with paraspinal neck accounting for the most common location. In rare occasions, it can be found in nasal cavity. CASE PRESENTATION: A 46-year-old female patient presented with recurrent epistaxis for 7 months. A 0-degree rigid scope examination revealed a left nasal cavity mass. A non-contrasted CT scan of the paranasal sinus showed heterogeneous and hypodense lesion in the left nasal cavity. Functional endoscopic sinus surgery was performed and multiple nasal-mass biopsies were taken which showed high grade spindle cell sarcoma favoring synovial type. Further workup and management were done from MRI, cranial tumor resection with skull base reconstruction to adjuvant radiotherapy. Patient has regular follow up with involved specialties and thus far is doing well. CONCLUSION: Spindle cell synovial sarcoma is a rare lesion found in soft tissue. It is unusual to be found in nasal cavity. Thus crucial attention to the clinical, radiographical and histopathological manifestation should be taken for more accurate diagnosis and further appropriate management.