Chronic invasive aspergillosis of the paranasal sinuses in immunocompetent hosts from Saudi Arabia.

In immunocompetent patients, paranasal invasive aspergillosis is rare and has a high recurrence rate. Twenty-three cases of paranasal invasive aspergillosis, involving 14 male and nine female immunocompetent patients were reviewed. All patients were cancer-free, HIV-negative, with normal WBC, and none of the patients had received immunosuppressive therapy or corticosteroids. Mean duration of symptoms before diagnosis was 18 months. Aspergillus flavus was the species most frequently isolated. Surgical debridement was performed in all patients followed by antifungal therapy in 18 patients. Mean follow-up duration was 30 months. Fourteen patients relapsed after a mean of 13 months and required an average of 4.3 admissions for repeat surgical evacuation. In a logistic regression model, relapse was not associated with age, duration of symptoms, clinical findings, extent of disease, or mode of therapy. However, patients who were relapse-free tended to have had complete surgical evacuation followed by antifungal therapy.

Multiple bilateral orbital abscesses secondary to nasal furunculosis.

Orbital inflammation secondary to sinus inflammation is a well known entity and has been widely reported. However, nasal furunculosis resulting in orbital inflammation is a rare occurrence. We present a case of a 2-year-old boy who developed multiple bilateral orbital abscesses secondary to nasal furunculosis. To our knowledge such a case has not been reported before.

Laryngotracheoplasty using the Medpor implant: an animal model.

OBJECTIVE: The Medpor implant (Porex Surgical, College Park, GA) is a porous polyethylene that has been used safely in areas in the head and neck. Medpor allows the in-growth of capillaries and soft tissue and reduces the risk of infection and extrusion. This study was undertaken to evaluate the use of the Medpor implant in laryngotracheal reconstruction and to compare epithelialization of the trachea following two different methods at various intervals. METHODS: Eight beagles were divided into two groups. The first group underwent laryngotracheoplasty using the Medpor implant only, whereas the second group had the Medpor implant lined with a strap muscle flap. One animal from each group was sacrificed at 5-, 7-, 9-, and 12-month intervals. The degree of stenosis, inflammation, and epithelialization were compared. RESULTS: The Medpor implant can safely be used to reconstruct the trachea in this animal model. There is less stenosis and better epithelialization when the Medpor implant is lined with a strap muscle flap. CONCLUSION: The Medpor implant can safely be used in laryngotracheal reconstruction in beagles.

A pilot study of the relationship between Down's syndrome and hearing loss.

OBJECTIVE: Hearing loss is one of the most common disabilities in children with Down's syndrome. The objective of this study is to investigate the incidence and types of hearing loss in Down's syndrome patients. METHODS: Twenty-six subjects with Down's syndrome aged between 2 and 17 year old were evaluated during the year 1998, referred randomly by the Pediatric Department and the Down's Syndrome Centre. Screening audiological procedures were used to evaluate these patients, which include behavioral audiometry, play and pure tone audiometry, tympanometry and ABR, which is the measurement of the activity of the auditory pathway structures from the distal auditory nerve to the midbrain using clicks or tonepips. RESULTS: The study showed that 35% were found to have normal hearing compared to 4% found to have sensorineural hearing loss, while the majority of patients were found to have a conductive hearing loss (50%). CONCLUSION: Hearing evaluation of children with Down's syndrome revealed a high prevalence of conductive hearing loss. This study proposed that this might be attributed to eustachian tube dysfunction and middle ear ciliary malfunction. Further diagnostic studies need to be carried out.

Transverse sinus thrombosis and venous infarction of the brain following unilateral radical neck dissection.

Radical neck dissection is one of the commonest procedures performed in any unit dealing with head and neck surgery. Intracranial complications following this procedure are uncommon. Transverse sinus thrombosis and venous infarction of the brain following unilateral radical neck dissection have not been reported in the literature. We present a case in which this complication occurred following an uneventful radical neck dissection.

Leiomyoma of the esophagus and bronchus in a child.

Leiomyomas of the esophagus and/or the bronchus have rarely been reported in children. To our knowledge, the simultaneous presence of this tumor in both the esophagus and a bronchus in a child has not been previously reported. A 7-year old boy presented with respiratory and esophageal symptoms and was found to have a leiomyoma of the esophagus and right main bronchus. The esophageal leiomyoma was treated with limited myotomy, but bronchoscopic resection was possible for the bronchial lesion. The postoperative result was excellent, with normal swallowing and no residual respiratory problems at 1-year follow-up.

Inflammatory myofibroblastic tumour of the tonsil.

Inflammatory myofibroblastic tumours are aetiologically enigmatic, nosologically confusing and biologically unpredictable lesions. The lungs are the organs of apparent predilection. These tumours have also been documented in a number of extrapulmonary sites including the head and neck. So far only two cases of inflammatory myofibroblastic tumour of the tonsil have been reported in the English literature. We document another case, occurring in a 41-year-old man with history of cadaveric renal transplant nine years ago. A comprehensive review of the literature is also presented.

Hypopharyngeal carcinoma: King Faisal Specialist Hospital and Research Centre experience.

From 1975 to 1985, 202 patients with hypopharyngeal cancer were seen at King Faisal Specialist Hospital and Research Centre (KFSH&RC). The endoscopic investigation showed that 28.3% of these patients had postcricoid carcinoma; 19.85% had pyriform fossa carcinoma and 52.9% had involvement of both sites. The pathological diagnosis of all cases was squamous cell carcinoma type. The majority of the patients (62.98%) had T4 lesions, which showed a late presentation to KFSH&RC. Information related to survival was available for a smaller number of patients due to many "lost-to-follow-up" cases. The overall median survival time was 8.5 months (1-110 months). The survival rate for each site was calculated, as well as the staging of the disease and treatment modality used. It appeared that pyriform fossa (median 21 months) had the best survival rate. In addition, the earlier the lesion was detected and the more aggressive the treatment applied, the better the survival rate. Fifty percent of the patients receiving radiation therapy and surgery had a five-year survival rate. Factors other than smoking and/or drinking should be looked for in our community as predisposing to this disease in our population.

Superiorly based osteoplastic flap for frontal sinus disease.

The osteoplastic flap is a widely used technique as an approach to frontal sinus disease. All current textbooks describe the technique with basing the flap inferiorly along the orbital rim and across the naso-frontal suture line. Since 1977, we have had occasion to base the flap superiorly in eight cases with good results. We feel that the superiorly based flap is ideally indicated in unilateral disease, particularly in the balding male, where a coronal incision would be very obvious. It is also a more direct approach. The skin incision itself can be parallel to the brow or almost identical to a blepharoplasty incision. After the floor of the frontal sinus has been removed (as in a Lynch or Howarth approach), cuts in the anterior wall of the frontal sinus are made under direct vision, and the bone is fractured at the superior extent of the sinus. This is certainly quicker and simpler than the standard approach, where a template is required. The risks of CSF leak are greatly diminished. The surgeon has the option of obliterating the sinus, removing the intersinus septum, or creating a mucoperiosteal flap. Details of the technique and two illustrative cases are presented.