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Rhinoplasty approaches, closed versus semiopen: a comparative study
Nabil G Zeid, Mahmoud S El Fouly, Ahmed A Kamel, Basim M Wahba, Refaat N Behman, Mohamed Abd Elmottaleb Sabaa
July-December 2016, 6(2):39-44
Background The 'open' (external) and 'closed' (endonasal) rhinoplasty approaches remain a subject for debate. Semiopen approach was proposed by Inchingolo and colleagues in 2012 with the advantages of the open technique without division of the columella. Patients and methods A randomized prospective single-blinded study was conducted. Thirty patients were divided into two groups. In group A, 15 patients underwent rhinoplasty with the endonasal approach, whereas in group B, 15 patients were subjected to rhinoplasty with the semiopen approach. Parameters used for evaluation were recorded intraoperatively, at 1 week, and 3 months postoperatively. Results In group B, the operative time was longer and tip accessibility was better compared with group A, with a high statistical significance. Postoperative edema was more in group B than in group A, with a significant difference in the immediate postoperative period. Conclusion The semiopen approach shows better tip accessibility compared with the ordinary closed approach, with fewer incisions compared with the tip delivery technique and with no need for columellar division as in open approach. However, it has a longer operative time with more postoperative edema compared with the closed approach. Therefore, the best use of this approach is for cases in which tip modification is needed, especially if concomitant nasal dorsum modification is also needed.
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Level of total and specific fungus IgE in allergic fungal sinusitis: how it affects management and follow-up
Nabil Galal, Ahmed Shawky, Mahmoud El-Fouly, Ahmed Kamel, Hisham Lasheen, Mahmoud El-Essawy
July-December 2016, 6(2):45-50
Objective The aim of this study was to evaluate the relationship between the level of total serum IgE and the prognosis of allergic fungal sinusitis, possibility of recurrence and level of aggressiveness. Type of the study This study was a prospective controlled one. Patients and methods Forty patients who were diagnosed as having allergic fungal sinusitis were randomly divided into two equal groups. One group (group A) received postoperative systemic steroids, whereas the other group (group B) received postoperative local steroids only. The patients were followed up for 6 months with endoscopy and IgE level evaluation. Results The total number of patients who had recurrence of the disease 6 months postoperatively was 17. Six of them were from group A (systemic steroids) and 11 were from group B (local steroids only). Conclusion Allergic fungal sinusitis should be treated with minimal surgical or endoscopic procedures, followed by local and more important systemic steroids for a prolonged period. Patients should be followed up at close intervals postoperatively using nasal endoscopy and more importantly serum IgE (total and if available fungus specific) as it is a good indicator to the future possibility of recurrence and thus the possibility of resurgery or further medical treatment.
  2,487 1,751 1
Bilateral antrochoanal polyps: a case report and literature review
Amnah S.A. Alashoura, Nada A Alshaikh, Samuel Yeak
July-December 2016, 6(2):59-63
Antrochoanal polyp (ACP) is a common unilateral benign lesion that originates from the maxillary sinus mucosa and protrudes through the choana into the nasopharynx. Patients usually present with progressive unilateral nasal obstruction. Rarely, bilateral ACPs could be encountered in clinical practice. It is important to recognize such unusual entity to spare patients unnecessary investigations and prolonged medical and aggressive surgical treatment. Generally, ACP is managed surgically with complete excision including the mucosa of origin to reduce the risk for recurrence. In this report, we present a rare case of bilateral simultaneous ACPs that was managed successfully with endoscopic excision. Review of the literature as regards the etiology, pathophysiology, different clinical presentations, and management aspects of ACP is also presented.
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Nasalance measures outcome in vasomotor rhinitis patients after treatment with intranasal corticosteroids versus hypertonic saline irrigation
Hesham Fathy, Ahmed Hussein, Wael Wageeh, Hesham Lasheen
July-December 2016, 6(2):51-55
Objective The objective of this study was to evaluate the effect of intranasal corticosteroid versus hypertonic saline irrigation on the nasalance scores in patients with vasomotor rhinitis (VMR). Patients and methods The study was conducted on 71 patients recruited from the Otolaryngology Department, Kasr El-Aini Hospital, Cairo University, with a history of nasal obstruction for at least 6 months, clinical and endoscopic evidence of VMR, and negative skin prick test. The patients were subjected to nasometric evaluation to obtain their nasalance scores before treatment. The patients were then randomly classified into two groups: group A, which included 33 patients who were instructed to apply mometasone furoate nasal spray two puffs in each nostril once per day for 3 months, and group B, which included 38 patients who were instructed to apply hypertonic saline nasal spray three times per day for 3 months. Patients of the two groups were re-evaluated by means of nasometry to assess the change in their nasalance scores after each treatment plan. Results The mean pretreatment nasometry score for group A was 34.55 ± 7.71, the minimum score was 18.7, and the maximum score was 48. The post-treatment nasometry score for the same group showed a mean of 46.44 ± 7.76 and ranged from a minimum of 29.9 to a maximum of 58.2. The difference between the two scores was found to be statistically significant (P = 0.014). As regards group B, the mean pretreatment nasometry score was 36.04 ± 7.36, the minimum score was 17.4, and the maximum score was 47.3. The post-treatment nasometry score for the same group showed a mean of 45.57 ± 7.4 and ranged from a minimum of 29.3 to a maximum of 55. The difference between the two scores was found to be statistically highly significant (P = 0.001). Conclusion It appears that intranasal hypertonic saline is highly effective in the treatment of VMR and approaches the effect of intranasal corticosteroids.
  2,441 472 -
How I do it: direct transnasal endoscopic posterior ethmoidectomy with the intact bulla technique
Reda Kamel, Hesham Mansour
July-December 2016, 6(2):64-66
In lesions affecting both anterior and posterior ethmoids where surgery is indicated, total ethmoidectomy as part of functional endoscopic sinus surgery is the state of the art. In solo posterior ethmoid lesions, there is still controversy in terms of the most direct and least destructive approach. In these cases, it is not justified to disturb the integrity of the bulla ethmoidalis and/or the middle turbinate. In this article, a novel approach to the posterior ethmoid is presented that does not disrupt the integrity of the ostiomeatal complex.
  2,524 293 -
Endoscopic nasopharyngectomy for nasopharyngeal carcinoma
Reda Hussien Kamel, Mohamed Salah Eldeen Hassan, Ahmed Elfarouk Abdelfattah, Ahmed Selim Fouad, Sameh Medhat Zamzam
January-June 2016, 6(1):5-10
Background The radiosensitivity of nasopharyngeal carcinoma has led to effective primary treatment using radiation with or without chemotherapy. Despite modern radiotherapy techniques, recurrent or persistent disease remains challenging. Materials and Methods This study included 10 patients who underwent endoscopic nasopharyngectomy: two primary cases of nasopharyngeal carcinoma, five cases recurrent after finishing treatment with chemoradiation by 7–14 months, and three patients showed residual disease just after finishing therapy using chemoradiotherapy confirmed with biopsy. The average age was 43.5 years. Chemoradiotherapy was performed postoperatively for all patients. Margin status and complications were evaluated. Repeated nasopharyngeal endoscopic assessment plus computed tomography and MRI imaging with contrast were carried out, with a mean follow-up period of 17.5 months. Results One patient showed recurrence (10%) and was managed with resurgery. No deaths were recorded due to the disease (overall survival rate, 100%) until the end of this study, and there were no major complications. Conclusion Endoscopic nasopharyngectomy is a feasible, direct, effective, and safe surgical procedure. Long-term follow-up is necessary for better assessment.
  2,259 262 -
Outcomes of the three-layer technique of nasal alar defect repair
Abdelrahman E. M Ezzat, Marwa M El-Begermy, Mustafa I Eid, Mohamed O Ouf
January-June 2016, 6(1):1-4
Background Nasal defects are usually defined as 'partial' or 'full' thickness. The main role of reconstructive surgery is replacement of the defective tissues with nearly similar tissues. Design This study was a retrospective case series with chart review. The study was conducted at academic tertiary care medical centers. The aim of this study was to evaluate a three-layer reconstruction (functional and esthetic evaluation). Patients and methods Nine patients presented to our office with a defect in the lower third of the nose after an accident or secondary to nasal lesion removal. In our technique, we described a single-stage, three-layer reconstruction. This technique was used to repair the full thickness alar and lower lateral cartilage defects. We designed the new three-layer repair based on the normal anatomy and histology using bilobed skin flap and lateral nasal wall mucosal rotational flaps with septal cartilage graft. Results Aesthetically acceptable results were obtained without the compromise of the nasal valve function, which was assessed using acoustic rhinometry. The acoustic rhinometric evaluation for the nasal valve (1.5–2 cm from the nostril) function showed that the cross-sectional area on the repaired side was 0.46–0.78 cm2 and it was 0.52–0.81 cm2 on the other site (P = 0.670), with a normal nasal cycle and without compromising the airway. Moreover, minimal donor site morbidity was observed. Conclusion The bilobed skin flap and rotational mucosal flap with septal cartilage graft for full thickness alar defect, is a novel technique with minimal donor site morbidity, acceptable postoperative shape and good functional results.
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Case report of a rare case of primary sinonasal meningioma
Sharfi Abdelgadir Omer Ahmed
July-December 2016, 6(2):56-58
The aim of this study was to report a case of sinonasal meningioma in Sudan. Meningiomas account for nearly 20% of all intracranial neoplasms and are the second most common tumor of the central nervous system. Primary meningiomas of the nose and paranasal sinuses are extremely rare. The clinical and radiological features of these tumors are nonspecific, and consequently an accurate diagnosis requires histologic evaluation. A 62-year-old woman from North Sudan presented to our hospital in May of 2016 complaining of right nasal obstruction associated with bloody nasal secretion and proptosis. Endoscopic endonasal examination revealed a soft mass in the right nasal cavity between the septum and the middle and superior turbinates posteriorly. MRI revealed the presence of a lobulated mass with soft-part density in the right nasal cavity (middle meatus) and the right ethmoid sinus invading the orbital contents and extending intracranially. The biopsy of the lesion revealed nodular neoplasm composed of regular cells arranged in whorled pattern. One psammoma body was noted and there was no evidence of pleomorphism or necrosis. The features are consistent with sinonasal meningioma. The patient was referred to the oncological department because it was an unresectable malignant meningioma and surgery was not feasible and would create more complications. Meningiomas involving the nasal cavity and paranasal sinuses are rare. The mortality is low, and its lethality is due to the complications of the surgery and injury of vital structures. Complete surgical extirpation of sinonasal tract meningiomas has an overall good prognosis. Hence, endoscopic nasal approach is an excellent surgical option in these cases, due to its low morbidity and satisfactory lesion resection.
  1,919 355 -
Impact of resection of the head of the middle turbinate in endoscopic sinus surgery
Hamza El-Shafaai A Ahmed, Mohamed M Osman
January-June 2016, 6(1):11-15
Aim The aim of the present study was to evaluate the effects of middle turbinate head resection (MTR) on the outcome of endoscopic sinus surgery. Patients and methods Patients with bilateral nasal polyps were bilaterally operated upon. From one side, the polyps were removed with preservation of the head of the middle turbinate. From the other side, polyps were removed with MTR. Patients were followed up at 1, 2, 4 weeks, 6 months, 1, and 2 years postoperatively for the presence of crusts, adhesions, polyp recurrence, smell affection, frontal sinus drainage pathway obstruction, and overall nose patency. Moreover, the duration of surgery for both sides was compared. Results No statistically significant differences were observed in the presence of crusts, adhesions, polyp recurrence, smell affection, frontal sinus drainage pathway obstruction, or overall nasal patency between the findings on the two operated sides. The operative time was significantly shorter for the group with MTR. Conclusion MTR carries no adverse effects and can be carried out safely in endoscopic sinus surgery.
  2,070 196 -
Pleomorphic adenoma of the nasal septum: a case report and review of the literature
Ali Al Momen, Abdulrahman Al Khatib
January-June 2016, 6(1):36-38
Intranasal pleomorphic adenomas are quite rare and are frequently misdiagnosed . We report a nasal septal pleomorphic adenoma in a 60-year-old man. Rigid endoscopy of the nose revealed a large polypoid mass filling the right posterior nasal cavity. Computed tomography scan of the paranasal sinuses demonstrated well-pneumatized paranasal sinuses and a soft tissue mass in the posterior aspect of the right nasal cavity arising from the posterior part of the septum. A submucous resection was used as an approach to the tumor and as a method of excising the mass with the segment of septum attached to it. After 4 years, the patient had experienced no further problems with the nasal airway, and repeated nasal endoscopic examination revealed no recurrence of the disease.
  1,791 180 -
Desipramine plus levocetirizine as a treatment for persistent allergic rhinitis
Diaa El Din Mohamed El Hennawi, Mohamed Rifaat Ahmed, Ashraf Saad Abou-Halawa, Wael Abdelkafy, Ahmed Geneid
January-June 2016, 6(1):22-26
Background Persistent allergic rhinitis has significant effects on the quality of life (QOL), especially on sleep and work performance, and is associated with specific psychiatric syndromes. Aim The aim of the present study was to verify the efficacy of combined desipramine and levocetirizine in the treatment of psychological stress related to persistent allergic rhinitis, and to thereby improve the QOL of the patient. Patients and methods A total of 132 psychologically stressed persistent allergic rhinitis patients (positive Kessler Psychological Distress Scale scores ≥12) were randomly divided into two groups: the control group, which received levocetirizine, and the study group, which received levocetirizine plus desipramine. QOL for all patients was assessed by using a seven-point scale after the treatment period. Results There was a highly statistically significant better QOL in the study group (6.79) compared with the control group (2.21) (t-test=15.17 and P = 0.0001). Conclusion Desipramine and levocetirizine have a better effect on the QOL outcomes in the treatment of patients with persistent allergic rhinitis, and having psychological stress disorders. Level of evidence: 3b.
  1,715 150 -
Effect of middle turbinate intervention on outcomes of middle meatal endoscopic surgery
Khaled M Bofares
January-June 2016, 6(1):27-32
Background and objective Middle turbinate position, bulk, and shape play a significant role in the determination of drainage and ventilation at the middle meatus. The middle turbinate constitutes the corner stone for the performance of drainage as well as ventilation functions at the area of the ostiomeatal complex. As one of the major aims of middle meatal endoscopic surgery is providing sufficient drainage and ventilation at the level of this complex, the middle turbinate should be assessed properly before the surgery with regard to its position, size, and shape, which may predispose for sinusitis through the obliteration of the ostiomeatal complex as in cases of paradoxical middle turbinate, concha bullosa of the middle turbinate, hypertrophy of the middle turbinate, and double middle turbinate. These varieties of abnormal middle turbinate need to be interfered accordingly to reduce the risk for recurrence of sinusitis after the surgery. In addition, the normal middle turbinate may lateralize postoperatively and subsequently result in the reobstruction of the drainage and ventilation at the middle meatal area. Therefore, for the purpose of maintenance of sufficient drainage and ventilation after middle meatal endoscopic surgery, it is suggested to interfere with the normal middle turbinate either by means of its partial resection at its lower part, its medialization and further fixation of it to the nasal septum with a stitch, or by creating a synechia with the mucoperiosteal flap over the nasal septum. For this reason the serial analytic coherent clinical study was planned prospectively to postulate as to which technique is the best among the previously mentioned three techniques and compared further with noninterfered middle turbinate cases. Patients and methods Sixty patients between 14 and 63 years of age with chronic sinusitis presented with clinical as well as radiological evidence of maxilloethmoidal sinusitis with or without frontal and sphenoidal involvement at ENT OPD, Al-Tarahom Private Center (Elbyda, Libya), during the period between July 2013 and March 2015 and underwent functional endoscopic sinus surgery. The patients were divided into four groups, group A (n = 16), group B (n = 18), group C (n = 6), and group D (n = 20), which included those patients who proceeded after middle meatal endoscopic surgery with the medialization of the ipsilateral middle turbinate and creation of a synechia between it and the nasal septum, partial resection of the ipsilateral middle turbinate at its lower third, medialization and further fixation of the ipsilateral middle turbinate to corresponding nasal septal flap using a vicryl stitch material, or just medialization of the ipsilateral middle turbinate without any further fixations, respectively. The four groups were compared in relation to postoperative patency persistence of the ipsilateral middle meatus and correlated with the incidence of sinusitis recurrence after the surgery. Results and conclusion An overall 49% of the patients who underwent just medialization of the ipsilateral middle turbinate without any further fixations developed recurrence of sinusitis due to reobliteration of the middle meatus either by means of a synechia between the middle turbinate and the lateral wall or by means of extreme lateralization of the middle turbinate compared with the other groups. All patients in other groups achieved complete improvement without any evidence of recurrence of sinusitis after 1 year of follow-up, apart from 12% of patients in group B who presented with evidence of sinusitis recurrence after 3–6 months postoperatively. Broadly speaking, the intervention with the normal middle turbinate can be considered as one of the important steps during the middle meatal endoscopic surgery that may help significantly toward the improvement of outcomes of this commonly performed procedure.
  1,542 179 -
Intravascular papillary endothelial hyperplasia (Masson's tumor) as a nasal mass: a case report and review of the literature
Khalid H Al-Qahtani
January-June 2016, 6(1):33-35
Intravascular papillary endothelial hyperplasia (Masson's tumor) is a rare non-neoplastic vascular proliferative process in a normal blood vessel or vascular malformation. Nose and paranasal sinuses are extremely rare location for this type of tumor. We report a case of Masson's tumor in a 33-year-old female, presented with an obstructing nasal mass in the right side, repeated epistaxis and rhinorrhea for eight months associated with anosmia, frontal headache and proptosis.
  1,505 138 1
The incidence of complications after prelacrimal recess approach versus endoscopic sinus surgery of maxillary sinus lesions
Mohammed A AlAyadi, Sherif A Raafat, Khalid A Ateya, Fadi M Gharib, Abdullah M AlMurtada
January-June 2016, 6(1):16-21
Aim of work The aim of the study was to evaluate the incidence of complications after prelacrimal recess approach (PLRA) and compare it with endoscopic sinus surgery for maxillary sinus lesions. Patients and methods This was a prospective study in which 20 patients were recruited between July 2013 and September 2015 from the otorhinolaryngology outpatient clinic of Kasr Al-Ainy Hospital, Cairo University. Patients with bilateral maxillary sinus lesions underwent endoscopic sinus surgery on one side and PLRA on the other side. Postoperative complications during 2-year follow-up were assessed. Results Two patients had epiphora at the PLRA side; one cured spontaneously, and the other was treated accordingly. Four patients had adhesions at the PLRA side, whereas two patients had adhesions at the middle meatal antrostomy side. Two patients developed numbness at the PLRA side, and one patient had persistent facial pain at the PLRA side. Intraoperatively there was excessive bleeding in three patients and an inferior turbinate destabilization in three patients at the PLRA side. Conclusion Our study demonstrated that, although PLRA is a minimally invasive technique, it still carries a risk for complications.
  1,220 175 -