1
|
Nofal A, El-Anwar MW. Endoscopy-assisted excision of nasoglabellar dermoid cyst. Clin Otolaryngol 2024; 49:320-323. [PMID: 38311981 DOI: 10.1111/coa.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/20/2022] [Accepted: 12/04/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE To assess the endoscopic assisted excision of the nasoorbital dermaoid cyst. DESIGH Case series. SETTING Zagazig univesity hospitals. PARTICPANT The study included patients with nasal dermoid who were operated using a local vertical incision with endoscopic assisted dissection and excision. MAIN OUTCOME MEASURES Complete removal, complication, recurrence. RESULTS In all patients, complete excision of the cyst was achieved with negligable blood loss. No recurrence was detected throughout the follow up. CONCLUSION Endoscopic-assisted resection of the nasal dermoid cyst appears a safe and effective approach with small incision, precise dissection and satisfactory apparent scar with with low incidence of recurrence.
Collapse
Affiliation(s)
- Ahmed Nofal
- Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
2
|
Abdelhamid HI, Awad AMM, Albadea AMA, Khaled IA, El-Anwar MW, El-Ahl MAS. A novel technique with butterfly splint for middle turbinate stabilization in sinus surgery. Eur Arch Otorhinolaryngol 2024; 281:1325-1330. [PMID: 37966539 DOI: 10.1007/s00405-023-08322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To assess the efficacy of newly designed butterfly splint with special technique for middle turbinate stabilization in preventing adhesion following bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). STUDY DESIGN Prospective, double-blind, randomized controlled. SETTING University hospitals. METHODS Following ESS, in cases of traumatized and/or unstable middle turbinates, newly designed butterfly plastic splint was randomly inserted in the middle meatus of one nasal side, while no splint was inserted in the other (control). Patients were followed up on after 1 week, 1 month, and 6 months. Endoscopic examination and a visual analog scale were used to evaluate each side of the nasal cavity for adhesion, crusting, pus, pain, nasal obstruction, and nasal discharge. RESULTS Thirty patients (60 nasal sides) were included. For all investigated parameters, there was no significant difference between the splinted and non-splinted sides at the first week visit. Adhesion was found significantly less in the splinted sides (3%) than the non-splinted sides (27%) after 1 month (P = 0.038). The adhesion rate in the splinted sides remained 3% at the 3 month follow-up visit, however, in the non-splinted sides, the rate increased up to 30% (P = 0.007). Throughout the follow-up visits, all other investigated parameters remained statistically insignificant between both sides. CONCLUSIONS The newly designed butterfly plastic splints to avoid middle turbinate adhesion is safe and effective in both reducing middle meatal adhesion with low complication rate in CRSwNP patients undergoing ESS and middle turbinate stabilization in its intermediate position.
Collapse
Affiliation(s)
- Hoda Ismael Abdelhamid
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Mohammad Mohammad Awad
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amany Mohamed Abd Albadea
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ibrahim Ahmed Khaled
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Magdy Abdalla Syed El-Ahl
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
3
|
El-Anwar MW, Fouad YA, Elgohary AF, Saber S, Mobasher MA. External Auditory Canal: Computed Tomography Analysis and Classification. Int Arch Otorhinolaryngol 2023; 27:e565-e570. [PMID: 37876695 PMCID: PMC10593536 DOI: 10.1055/s-0042-1758213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Computed tomography (CT) details of the external auditory canal (EAC) are not fully covered in the literature, so building up base for the CT evaluation and description is important. Preoperative details of the EAC are mandatory before any approach or procedure involving the canal. Objective To determine the different dimensions, measurements, and grading of the EAC by CT scan that were not previously published. Methods The CT scans of 100 temporal bones (200 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Results At the EAC entry, the mean vertical length (height) was 7.75 ± 1 mm, and its mean horizontal length (width) was 6.1 ± 0.8. At the bony cartilaginous junction of the EAC, the mean vertical length was 7.88 ± 1 mm, and its mean horizontal length was 6.22 ± 0.9. At the EAC isthmus, the mean vertical length was 6.8 ± 0.97 mm, and its mean horizontal length was 5.2 ± 0.76. At the medial end of the EAC, the mean vertical length was 7.1 ± 0.9 mm, and its mean horizontal length was 5.4 ± 0.85. There were no reported significant differences between right and left sides in all dimensions. Males showed significantly longer vertical and horizontal dimensions of the EAC entry, vertical dimension of the isthmus, and vertical dimension of the medial end of the EAC than females. Conclusion This study improves otologists and radiologists' awareness of EAC variations in the ear field and can be of help to residents in training.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yasser Ahmed Fouad
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Fouad Elgohary
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Saber
- Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Adel Mobasher
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
4
|
Nofal AAB, El-Anwar MW. The Frontal Sinus Drainage in Relation to Frontal Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:661-667. [PMID: 37206767 PMCID: PMC10188813 DOI: 10.1007/s12070-022-03230-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 10/03/2022] [Indexed: 05/21/2023] Open
Abstract
In order to perform a successful endoscopic frontal sinus surgery, prevent complications, and lower the recurrence risk, it is essential to understand the anatomy of the frontal sinus (FS) and frontal recess cells with many variations in frontal sinus drainage (FSD). Preoperative assessment of the FSD in three levels in order to find prognostic factors in the decision process regarding the kind and the extent of surgery when required. Three FSD levels were assessed by computed tomography in two dimensions; antero-posteriorly and laterally in 100 consecutive patients with chronic sinusitis symptoms. The first level represents the proper drainage of FS. The second level is the drainage of FS without the effect of the frontoethmoidal cells. The third level is the maximum drainage that can be achieved in a single FS. The relation of FSD levels to FS and frontoethmoidal cells pathology were assisted. Within 100 patients (200 sides, 186 FSs), for the proper FSD, antero-posterior (AP) length was 5.94 ± 3.42 mm in opaque FS and 5.32 ± 2.87 mm in clear FS and its lateral length was 3.04 ± 1.6 mm in opaque FS and 2.30 ± 1.25 mm in clear FS. For the functional FSD, AP length was 8.97 ± 2.7 mm in opaque FS and 8.05 ± 2.7 mm in clear FS and its lateral length was 7.51 ± 1.69 mm in opaque FS and 7.58 ± 1.75 mm in clear FS. In the anatomical FSD, AP length was 11.25 ± 3.07 mm in opaque FS and 10.01 ± 2.87 mm in clear FS and its lateral length was 11.1 ± 2.6 mm in opaque FS and 10.95 ± 1.7 mm in clear FS. This study offers essential data for preoperative assessment in order to improve surgeons' awareness of the frontoethmoidal region for optimal safe EFSS with lower incidence of complications and recurrences.
Collapse
Affiliation(s)
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
5
|
Hendawy E, El-Anwar MW, Elghamry RM, Abdallah AM, Ibrahim AM. Anosmia in COVID-19 Patients: Can We Predict the Severity of Chest Manifestations? Int Arch Otorhinolaryngol 2023; 27:e143-e151. [PMID: 36714889 PMCID: PMC9879642 DOI: 10.1055/s-0042-1758716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/22/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Anosmia is one of the common symptoms of COVID-19, the link between severity of chest infection and anosmia was investigated by few studies. Objectives To find an association between anosmia and severity of chest infection. Methods An analysis of patients admitted to isolation hospital of our university with confirmed polymerase chain reaction positive testing for COVID-19, between March 2021 until September 2021. We called all patients who reported anosmia during their time of illness and asked them about anosmia. We examined their chest CT. A statistical analysis was done. Results A total of 140 patients completed the study; 65% were female and 56.4% had complete anosmia. Anosmia was significantly associated with loss of taste. Smell returned in 92.5% of anosmic patients. Duration of smell loss was ∼ 2 weeks in 40.5%. The most common symptoms associated with anosmia were running nose, sore throat, fever, and cough. Loss of smell was significantly associated with mild chest disease. 73.4% of anosmic patients had mild chest infection, 21.5% of them had moderate infection, and 5.1% had severe chest infection. Conclusion The pattern of anosmia in COVID-19 patients has some common similarities in general; the way it starts, the associated symptoms, the time until smell returns and, the most important, the severity of chest infection. As anosmia is significantly associated with mild chest infection. the presence of anosmia could be an independent predictor of good COVID-19 outcome as reflected by a lower disease severity and less frequent ICU admissions.
Collapse
Affiliation(s)
- Ehsan Hendawy
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt,Address for correspondence Ehsan Hendawy, MD Department of Otorhinolaryngology, Head-Neck SurgeryUniversity of Zagazig, Zagazig, Egypt, Postal Code: 44511
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reda M. Elghamry
- Department of Chest Disease, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amany M. Abdallah
- Department of Family Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amin M. Ibrahim
- Department of Diagnostic Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
6
|
Nofal A, El-Anwar MW, Al Shawadfy MA, Fouad YA. Drain-Less Submandibular Gland Excision With Preserved Facial Artery. Ear Nose Throat J 2022:1455613221142735. [PMID: 36453599 DOI: 10.1177/01455613221142735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES To describe our experience in excision of the submandibular gland (SMG) without drain insertion and with preservation of the facial artery as a day case surgery as well as evaluation of the surgical outcomes of this procedure. METHODS Prospective case series study of 42 cases of chronic calcular submandibular sialadenitis that underwent SMG excision by the same surgical team during the period from 2017 to 2021. The initial surgical plan in all cases was to excise the SMG with preservation of the facial artery and without drain insertion. RESULTS SMG excision without drain insertion was successfully achieved in 28 patients who were discharged on the same day. In the remaining 14 patients, the surgical dissection was difficult and a suction drain was inserted at the end of the surgery; consequently, they were discharged on the next day. In all cases, facial vessels were preserved, and complete gland excision was achieved. Among the 28 patients who had no drain insertion, 1 patient had a postoperative seroma and no patient had wound related complications. Among the 14 patients who had drain insertion, 2 patients had postoperative seroma and 3 patients had wound related complications in the form of obvious scar formation. There were no other significant complications in all patients. CONCLUSIONS Submandibular gland (SMG) excision with facial artery preservation and without drain insertion as a day case surgery could be safely done in cases of chronic calcular inflammation provided that meticulous surgical dissection and complete hemostasis were achieved.
Collapse
Affiliation(s)
- Ahmed Nofal
- Department of Otolaryngology, Head-Neck Surgery, University of Zagazig, Zagazig, Egypt
| | | | - Mohamed A Al Shawadfy
- Department of Otolaryngology, Head-Neck Surgery, University of Zagazig, Zagazig, Egypt
| | - Yasser Ahmed Fouad
- Department of Otolaryngology, Head-Neck Surgery, University of Zagazig, Zagazig, Egypt
| |
Collapse
|
7
|
El-Anwar MW, Elshiekh E, Awad A, Elsayed AM, Alshawadfy M. Pediatric versus adult maxillofacial fractures. Egypt J Otolaryngol 2022. [DOI: 10.1186/s43163-022-00354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objective
To study, compare, and analyze the differences and the detailed features of the maxillofacial fractures in adults versus children.
Patients and methods
This prospective comparative study was conducted on patients who had traumatic maxillofacial fractures. Patients were categorized into 2 groups: the pediatric group and the adult group. History taking including the type of trauma, examination, computed tomography (CT) maxillofacial, fracture management, and outcome evaluation was done for all patients.
Results
Within included 82 patients (42 adults, 40 children), males were the most affected in adult and pediatric groups and the most affected age was between 19 and 27 years (29.2%). Motor vehicle accident (MVA) was the most common cause in both the adult group (66.66%) and the pediatric group (60%). But fall represents a significant cause in children (17.5%) with a significant difference between the two groups (p = 0.038). The mandibular fracture was the most common fracture in pediatric (65%) and adult (38.1%) groups with a significant difference between both groups regarding different sites of trauma (p = 0.017). Surgical intervention was performed in 80% of pediatric patients and 92.23% with a significant difference (p = 0.035).
Conclusion
MVA is the main etiology of maxillofacial fractures in children and adults, but fall is an important cause of pediatric trauma. Pediatric maxillofacial fractures below school age are a rare event with increasing incidence with age. Mandibular fractures are the most common site in the adult and pediatric populations. Most cases of maxillofacial fractures are surgically treated with OR/IF with good results but conservative management is used more in pediatric than adult fractures.
Collapse
|
8
|
El-Anwar MW, Elnashar I, Hussein A, Nofal AA. Trans-antral Endoscopic Assisted Excision of Dentigerous and Radicular Maxillary Cyst; our Experience. J Maxillofac Oral Surg 2022; 22:470-475. [PMID: 37122784 PMCID: PMC10130242 DOI: 10.1007/s12663-022-01772-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 07/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background maxillary cysts of dental origin are not common diagnosis. There is still debate about their perfect treatment method. There are many approaches to manage the odontogenic maxillary cysts; either intraoral, sublabial, or transnasal endoscopic approach. In this study, we present our technique of trans-antral endoscopic assisted excision of maxillary cysts of dental origin with assessing feasibility, results, and complications. Results Thirty-two patients were reported; 14 dentigerous cysts (43.75%) and 18 dental (radicular) cysts (56.25%). Complete cyst removal could be achieved in all cases without jeopardizing the maxillary sinus drainage through its natural ostium to the nasal cavity. Postoperative pain and facial swelling were mild in all cases and resolved within few days. No tooth loss, Sino nasal symptoms, infection or recurrence was reported throughout follow-up period ranging from 2 to 6 years. Conclusion Trans-antral endoscopic assisted approach for excision of odontogenic maxillary cyst is a reliable, safe, and effective procedure without recurrence, or permanent negative sequels over the long-term follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-022-01772-9.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ismail Elnashar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atef Hussein
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Abdelfattah Nofal
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
9
|
Abstract
Background We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, nose, anosmia, hyposmia, smell, olfactory, ORL, different ENT related symptoms. We reviewed published and peer-reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. Main text Within the included 2549 COVID-19 laboratory-confirmed positive patients, smell affection was reported in 1453 patients (57%). The other reported ENT manifestations were taste disorder (49.2%), headache (42.8%), nasal blockage (26.3%), sore throat (25.7%), runny nose or rhinorrhea (21.3%), upper respiratory tract infection (URTI) (7.9%), and frequent sneezing (3.6%). Conclusion Smell affection in COVID-19 is common and could be one of the red flag signs in COVID-19 infection. With a sensitivity of utilized questionnaire in smell identification, a homogenous universal well-defined COVID-19 questionnaire is needed to make the COVID-19 data collection more sensible.
Collapse
|
10
|
El-Anwar MW, Gaid K, Nasr MH, Ahmed NAEA. Transoral per punctum excision of an impacted parotid duct stone of unfavorable direction: a case report. Egypt J Otolaryngol 2021; 37:43. [DOI: 10.1186/s43163-021-00112-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/21/2021] [Indexed: 09/02/2023]
Abstract
Abstract
Background
In the literature, the reported parotid duct stones that did not respond to the conservative measures are few. The present work reported and described the diagnosis and treatment of a case of impacted parotid duct stone that was surgically removed through minimally invasive transoral per punctum approach.
Case presentation
On examination of a 27-year-old male with left intermittent parotid swelling and pain for 1 year, a stone was palpated in the left buccal mucosa region near the orifice of the parotid duct. Ultrasonography (US) showed left Stensen’s duct distal stone. Under general anesthesia and oral intubation, the stone measuring about 1 cm in length was felt transversely located (directed at a right angle with the orifice of the duct). A small mucosal incision was done at the upper lateral part of the punctum; pus came out, and then the stone bulged from the orifice and was pushed outside. Recovery was event-less; postoperative paracetamol was sufficient to relieve pain, and the patient was discharged a few hours after the surgery.
Conclusion
The transoral per punctum excision of an impacted parotid duct stone appears to be a reliable minimally invasive effective and safe procedure. The unfavorable direction of the parotid duct stone might be a cause of failure of the conservative treatment for this stone.
Collapse
|
11
|
El-Anwar MW, Askar S, Abou Shab YA, Abou Sharkh AAM. Could mandibular fractures lead to obstructive sleep apnea? Cranio 2021:1-4. [PMID: 34623227 DOI: 10.1080/08869634.2021.1989178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To detect and assess obstructive sleep apnea (OSA) before and after repair of different types of mandibular fractures. METHODS In patients with traumatic isolated mandibular fractures who were indicated for open reduction and internal fixation (OR/IF), polysomnography (PSG) was done before and 3 months after surgery. RESULTS Of 51 patients (80 mandibular fractures), fractures were unilateral in 29 patients (56.9%) and bilateral in 22 patients (43.1%). PSG was normal in 33 patients (64.7%), and OSA was detected in 18 cases (35.3%); all had bilateral fracture. Mild OSA was reported in 9 cases (17.65%), and moderate OSA was detected in 9 cases (17.65%). Three months after OR/IF of the fractures, successful reduction was obtained, and PSG was within normal limits in all patients. CONCLUSION Bilateral mandibular fractures often lead to OSA, which could be cured with proper OR/IF of the fractures. OSA is not encountered in unilateral fractures.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherif Askar
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Yehia Aly Abou Shab
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | |
Collapse
|
12
|
El-Anwar MW. Authors' reply to: Comment on the article by Dr. W. Narożny: ENT manifestation in COVID-19 patients. Auris Nasus Larynx 2021; 48:799. [PMID: 33622579 PMCID: PMC7888249 DOI: 10.1016/j.anl.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mohammad Waheed El-Anwar
- Professor of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
| |
Collapse
|
13
|
El-Anwar MW, Eesa M, Mansour W, Zake LG, Hendawy E. Analysis of Ear, Nose and Throat Manifestations in COVID-19 Patients. Int Arch Otorhinolaryngol 2021; 25:e343-e348. [PMID: 34377166 PMCID: PMC8321632 DOI: 10.1055/s-0041-1730456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/14/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has dramatically spread all over the world, crossing the borders of all countries. It is presented mainly by lower respiratory tract symptoms such as fever, cough, dyspnea, and chest tightness. However, COVID-19 causes different upper respiratory tract-related symptoms including nasal congestion, sore throat, and olfactory dysfunction. Objective To discuss different ear, nose and throat (ENT) manifestations in COVID-19-positive patients and their relation to other manifestations and to the severity of COVID-19. Methods We detected ENT manifestations in polymerase chain reaction (PCR)-confirmed positive COVID-19 patients at Zagazig Isolation Hospitals (Zagazig University hospitals, Zagazig Chest hospital, Al-Ahrar hospital, and Zagazig Fever hospital) with proportional allocation in the period from April 15 to June 15, 2020. All patients were subjected to full history taking and COVID-19 was categorized into 4 classes of severity after all patients underwent computed tomography (CT) of the chest. Afterwards, the collected data was analyzed and compared. Results Among the included 120 COVID-19 patients, the most frequent reported ENT manifestations were; sore throat (30%), nasal congestion (28.3%), nasal obstruction (26.7%), sneezing (26.6%), headache (25%), smell and taste dysfunction (25%), rhinorrhea (20%), upper respiratory tract infection (URTI) (15%), and tonsil enlargement (10%). The most common non-ENT manifestations were fever (88.3%), cough (63.3%), and dyspnea (45%). Conclusion Fever and cough are the dominant symptoms of COVID-19, but ENT manifestations for COVID-19 are common and should be a part of the suspected clinical criteria for COVID-19, particularly if the nasal examination was nonsignificant. The most common symptoms are sore throat, followed by nasal congestion and obstruction, headache, and lastly, olfactory dysfunction.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Eesa
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Waleed Mansour
- Department of Chest Disease, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Lamia G. Zake
- Department of Chest Disease, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ehsan Hendawy
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
14
|
Eesa M, Hendawy E, El-Anwar MW. Modified Z-Palatoplasty for Correction of Acquired Nasopharyngeal Stenosis Following Palatal Surgery: A Case Series. Cleft Palate Craniofac J 2021; 59:774-778. [PMID: 34155921 DOI: 10.1177/10556656211021702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the efficacy of a novel surgical technique in management of nasopharyngeal stenosis (NPS), describing its steps and results. Study Design: Prospective clinical trial. SETTING This study was conducted at the Otolaryngology, Head and Neck Surgery Department, Zagazig University. METHODS This prospective study was conducted on patients with snoring ± obstructive sleep apnea due to acquired postsurgical NPS of grade Ι and ΙΙ. New surgical repair was employed on the patients and the pre and postoperative results were statistically compared. RESULTS The grade of NPS improved significantly postoperatively (P = .00136) throughout a follow-up of 1 year. Postoperatively, there was statistically significant improvement of apnea hypopnea index (P = .0005), Visual Analog Scale (VAS) of nasal obstruction (P < .0001) and VAS of snoring (P < .0001). Dysphagia showed early worsening, but it improved completely at 3 months postoperatively. CONCLUSION The utilized novel procedure appears effective, low cost, and easily applicable, and it does not require implants, special tools, or suture materials. Furthermore, it gives excellent results, with negligible pain, and rapid recovery without significant complications. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Mohamed Eesa
- Department of Otorhinolaryngology, Head and Neck Surgery, 68865Zagazig University, Zagazig, Egypt
| | - Ehsan Hendawy
- Department of Otorhinolaryngology, Head and Neck Surgery, 68865Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology, Head and Neck Surgery, 68865Zagazig University, Zagazig, Egypt
| |
Collapse
|
15
|
Askar SM, El-Anwar MW, Quriba AS. Positional awake nasoendoscopic pattern-based surgical decision for correction of retropalatal obstruction in OSA. Eur Arch Otorhinolaryngol 2021; 278:901-909. [PMID: 33386971 DOI: 10.1007/s00405-020-06559-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate differential surgical interventions for obstructive sleep apnea (OSA) patients with single-level retropalatal based on the preoperative topographical diagnosis using nasoendoscopy with Müller's maneuver during supine position (MM-P). SUBJECTS AND METHODS This case series included adult patients with OSA who showed a predominant single-level retropalatal collapse on MM-P. An anteroposterior pattern of collapse was managed by an anterior advancement procedure, while a transverse pattern of collapse was managed by lateral/anterolateral advancement procedures (double suspension sutures). A combined procedure was provided to the concentric type of collapse. All patients underwent evaluation of the polysomnography, Epworth Sleepiness Scale (ESS) values and snoring scores both preoperatively and 6-8 months after surgery. RESULTS Among 102 patients, the most commonly reported pattern of collapse at the retropalatal level was the concentric pattern (48.04%) followed by the transverse pattern (27.45%). The AP-pattern of collapse was reported in 24.51%. In the postoperative follow-up visits, no early or late complications were reported. All included groups showed significant improvement in polysomnographic data (mean AHI and lowest O2 saturation level). Significant improvement of VAS of snoring was reported. The overall success rate was ˃90%. CONCLUSION Preoperative differential diagnosis of OSA with MM-P allows for tailored surgical management. Tailored procedures could yield good surgical outcomes when patients are properly selected and the technique is chosen according to preoperative topographical diagnostic assessment. This study might provide an available less-costly and effective preoperative planning for OSA intervention. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Sherif Mohammad Askar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Othman Bin Affan St., Zagazig, Sharkia Governorate, Egypt.
| | - Mohammad Waheed El-Anwar
- Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Othman Bin Affan St., Zagazig, Sharkia Governorate, Egypt
| | - Amal Saeed Quriba
- Phoniatric Unit, Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
16
|
El-Anwar MW, Ali AH, Almolla RM, Abdulmonaem G, Raafat A, Hassan ME. Radiological middle turbinate variations and their relation to nasal septum deviation in asymptomatic adult. Egypt J Radiol Nucl Med 2020. [DOI: 10.1186/s43055-020-00222-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Middle turbinate (MT) is one of the important anatomical and physiological structures of the nasal cavity. After the widespread use of nasal endoscope and paranasal sinus computed tomography (CT), many MT variations have been described. This study aimed to determine the incidence of MT variations by computed tomography (CT) in asymptomatic adult, their relation to each other, and to deviated septum (DS).
Results
In the included 86 subjects (172 MTs), pneumatized MT was the most common MT variation followed by paradoxical MT (PMT). Septal deviation did not appear to affect occurrence of pneumatized or PMT. Fifty-nine percent of the reported bilateral PMT were associated with pneumatized MT, while 35.7% of unilateral PMT were associated with pneumatized MT with non-significant difference.
Conclusion
MT variations in adults are common mainly pneumatized MT then PMT with no apparent relation to septum deviation.
Collapse
|
17
|
El-Anwar MW, Elsheikh E, Alnemr MA, Quriba AS, Hassan E, Bahgat AY. Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency. Cleft Palate Craniofac J 2020; 58:244-250. [PMID: 32808547 DOI: 10.1177/1055665620950150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). METHODS This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. RESULTS Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. CONCLUSION The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, 68799Zagazig University, Egypt
| | - Ezzeddin Elsheikh
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, 68799Zagazig University, Egypt
| | - Mohamed Abdelmohsen Alnemr
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, 68799Zagazig University, Egypt
| | - Amal Saed Quriba
- Phoniatric Unit, Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, 68799Zagazig University, Egypt
| | - Elham Hassan
- Phoniatric Unit, Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, 68799Zagazig University, Egypt
| | - Ahmed Yassin Bahgat
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, 54562Alexandria University, Egypt
| |
Collapse
|
18
|
Abstract
OBJECTIVE to detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures. METHODS We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. RESULTS within the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%). CONCLUSION ENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Professor of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
| | - Saad Elzayat
- Professor of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Kafrelsheikh University, Egypt
| | - Yasser Ahmed Fouad
- Assistant professor of Otorhinolaryngology, Head and Neck Surgery, Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| |
Collapse
|
19
|
El-Anwar MW, Khazbak AO, Eldib DB, Algazzar HY. Anterior Ethmoidal Artery: A Computed Tomography Analysis and New Classifications. J Neurol Surg B Skull Base 2020; 82:e259-e267. [PMID: 34306947 DOI: 10.1055/s-0039-3400225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Abstract
Objective to determine the anterior ethmoidal artery (AEA) anatomy and variations by computed tomography (CT) in adult and their relations to and presents new AEA classifications. Methods One hundred and fifty paranasal CT scans (300 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes. Results One hundred and forty-four AEAs canal (48%), 293 AEAs foramen (97.7%), and 229 AEAs sulcus could be detected (76.3%). The mean AEA intranasal length was 6.7 ± 1.27 mm (range: 4.24-10.6 mm). The mean angle between AEA and lamina papyracea was 105.49 ± 9.28 degrees (range: 76.41-129.76 degrees). Of them, 95.8% AEAs had an angle with lamina >90 degrees, while 4.2% had angle <90 degrees. The mean angle between AEA and lateral lamella of cribriform plate was 103.95 ± 13.08 degrees (range: 65.57-141.36 degrees). Of them, 87.5% AEAs had an angle >90 degrees and 12.5% had an angle <90 degrees. The mean distance between AEA and skull base was 1.37 ± 1.98 mm (range: 0-8.35 mm). The AEA types in relation to skull base was type 1 (0-2 mm from skull base; 64.6%), type 2 (2-4 mm; 22.2%), type 3 (4-6 mm; 11.1%), and type 4 (>6 mm; 2.1%). The mean distance between the AEA and frontal sinus ostium was 9.17 ± 4.72 mm (range: 0-25.36 mm). AEA classification according to distance from AEA to frontal sinus ostium was 17.4% type 1 (<5 mm), 41.7% type 2 (5-10 mm), 31.9% type 3 (10-15 mm), and 9% type 4 (>15 mm). Conclusion Provided AEA details improve surgeons' awareness of AEA variations in the endoscopic field and can help residents in training.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology Head and Neck, Faculty of Medecine, Zagazig University, Zagazig, Egypt
| | - Alaa Omar Khazbak
- Department of Otorhinolaryngology Head and Neck, Faculty of Medecine, Zagazig University, Zagazig, Egypt
| | - Diaa Bakry Eldib
- Radiodiagnosis Department, Faculty of Medicine, Benha University, Department of Radiodiagnosis, Faculty of Medicine, Benha University, Benha, Egypt
| | - Hesham Youssef Algazzar
- Radiodiagnosis Department, Faculty of Medicine, Benha University, Department of Radiodiagnosis, Faculty of Medicine, Benha University, Benha, Egypt
| |
Collapse
|
20
|
El-Anwar MW, Eldib DB, Elmalt A, Khazbak AO. Supratubal recess and sinus tympani: CT analysis of middle ear hidden areas. Egypt J Radiol Nucl Med 2019. [DOI: 10.1186/s43055-019-0056-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
High-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed middle ear anatomy particularly its hidden area. The purpose of the current study was to assess the sinus tympani (ST) and supratubal recess (STR) by HRCT, to create CT classification of the STR depth, and to study the relationship between ST types and the new STR grades.
Results
In HRCT of non-pathological temporal bones of 100 subjects (200 ears), measurements of the STR and ST were calculated, registered, and analyzed. The depth of the STR was classified into grade 1 with depth less than 3 mm, grade 2 with depth ranged between 3 and 5 mm, and grade 3 with depth more than 5 mm. The mean STR length, width, and height were 4.17 ± 0.86, 3.55 ± 0.65, and 3.64 ± 0.7 mm, respectively, while the ST mean length and width of were 2.52 ± 0.5 and 1.82 ± 0.78 mm, respectively, without significant differences between either sexes or sided. The ST types were found to be type A in 56 ears (28%), type B in 142 ears (71%), and type C in 2 ears (1%). The STR grading was grade 1 in 12 ears (6%), grade 2 in 160 ears (80%), and grade 3 in 28 ears (14%) without significant relationship between ST types and STR grading (P = 0.3).
Conclusion
The current study provided reliable and applicable methods of CT assessment of STR and ST that can help to predict the degree of surgical visibility of the ST and STR during ear surgery.
Collapse
|
21
|
Emara TA, El-Anwar MW, Omara TA, Anany A, Elawa IA, Rabea MM. Submental intubation versus tracheostomy in maxillofacial fractures. Oral Maxillofac Surg 2019; 23:337-341. [PMID: 31093795 DOI: 10.1007/s10006-019-00771-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare submental intubation with tracheostomy in patients with maxillofacial fractures who were operated under general anesthesia and nasotracheal intubation was contraindicated. PATIENTS AND METHODS This prospective comparative study was conducted on 32 patients undergoing maxillofacial operations. All patients had a panfacial trauma (including naso-ethmoid orbital fracture combined with mandibular fracture). Patients who had unstable cervical vertebra, laryngeal trauma, urgent tracheostomy, and patients with expected prolonged postoperative ventilation were excluded from the study. Patients were randomly assigned to elective tracheostomy and submental intubation groups. The patients were evaluated according to the time required to do elective tracheostomy or submental intubation, the operation comorbidity and complications, and the postoperative scar. RESULTS The average time required to do submental intubation was 8.35 min versus 30.75 min required to do elective tracheostomy with significant difference (p < 0.0001). No complication was reported with submental intubation while in elective tracheostomy group, surgical emphysema was registered in two patients. The submental scar was acceptable in all patients while the tracheostomy scar needs scar revision in four cases (p = 0.0325). CONCLUSION Submental endotracheal intubation appeared to be a simple, safe, and significantly faster reliable alternative to tracheostomy during surgical reconstruction of selected cases of maxillofacial fractures without indication for prolonged postoperative ventilation support with significantly lower morbidity.
Collapse
Affiliation(s)
- Tarek Abdelzaher Emara
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | | | - Ahmed Anany
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohamed Mohamed Rabea
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
22
|
Elsheikh E, El-Anwar MW. Soft palate bi-pedicle flaps: A modification of VY repair of cleft soft palate in twenty-six patients. Clin Otolaryngol 2019; 44:442-446. [PMID: 30729715 DOI: 10.1111/coa.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/08/2019] [Accepted: 02/03/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ezzeddin Elsheikh
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
23
|
El-Anwar MW, Askar S, El-Sinbawy AH, Salem AMH. Single versus double suspension sutures for selected cases of obstructive sleep apnea. Auris Nasus Larynx 2019; 46:754-757. [PMID: 30626548 DOI: 10.1016/j.anl.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the results of expansion pharyngoplasty using bilateral single palatal suspension sutures (SSS) versus double suspension sutures (DSS) for the treatment of selected cases of obstructive sleep apnea (OSA) with retropalatal collapse. METHODS Patients were randomly categorized into two groups: the first group for whom bilateral SSS were performed and a second group for whom bilateral DSS were done. Snoring on the basis of the visual analog scale (VAS), Epworth Sleepiness Scale (ESS), apnea hypopnea index (AHI), lowest O2 saturation were assessed preoperatively and 6 months postoperatively in all patients. RESULTS DSS provided significantly more retroplatal space (p = 0.0137) and less snoring score (p = 0.0005). While no significance difference between SSS and DSS as regard inter pillar distance (p = 0.0985), AHI (p = 0.1677), ESS (p = 0.4094), and lowest O2 saturation (p = 0.0839). CONCLUSION Both SSS and DSS are simple, rapid, bloodless and effective procedures for treating OSA (in patients with retropalatal collapse) with no temporary or persistent postoperative complications. Adding the second suture in DSS could significantly enlarge more retropalatal space and reduce more snoring scale than SSS.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
| | - Sherif Askar
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Amr Hassan El-Sinbawy
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | | |
Collapse
|
24
|
El-Anwar MW, Abdelmonem S, Nada E, Galhoom D, Abdelsameea AA. Protective effect of pentoxifylline on amikacin-induced ototoxicity. Ear Nose Throat J 2018; 97:E8-E12. [PMID: 30138519 DOI: 10.1177/014556131809700802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We conducted an animal experiment to assess the effect of adding pentoxifylline to amikacin to prevent amikacin-induced ototoxicity. This research was conducted on 24 rats arranged in four groups of 6. One group was injected with 200 mg/kg of intramuscular amikacin once daily for 14 days (AMK-only group). Another received 25 mg/kg of oral pentoxifylline and 200 mg/kg of intramuscular amikacin once daily for 14 days (PTX-AMK 14/14 group). A third group received 25 mg/kg of oral pentoxifylline for 28 days and 200 mg/kg of intramuscular amikacin once daily for 14 days on days 15 through 28 of the pentoxifylline regimen (PTX-AMK 28/14 group). Finally, a control group was administered 1 ml/day of 0.5% carboxymethyl cellulose for 28 days. Transient otoacoustic emissions (TOAEs) were statistically analyzed and serum urea and creatinine levels were measured before and after treatment. We found no significant differences in TOAEs among the groups at the study's onset, but after the experiment, TOAEs disappeared in all frequency bands in the AMK-only and PTX-AMK 14/14 groups. However, TOAEs were preserved in the PTX-AMK 28/14 group. In addition, the serum urea and creatinine levels in the PTX/AMK 28/14 group were significantly lower than the levels in the other two treatment groups (p < 0.05 for all), but not significantly different from those of the control group. We conclude, therefore, that 28 days of pentoxifylline treatment exerted a protective effect against amikacin-induced ototoxicity in rats.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | | | | | | | | |
Collapse
|
25
|
Askar SM, El-Anwar MW, Awad A. Expansion Hyoidthyroidpexy: Combined Hyoid Surgery Techniques for Obstructive Sleep Apnea: All in One. Otolaryngol Head Neck Surg 2018; 160:355-358. [DOI: 10.1177/0194599818815658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We provide expansion hyoidthyroidpexy as a novel surgical procedure for obstructive sleep apnea (OSA) that could combine different techniques of hyoid bone surgery in 1 procedure. This case series included patients with OSA who had an apnea-hypopnea index (AHI) >15 and showed predominant lateral wall hypopharyngeal collapse. In 21 patients, the procedure was performed smoothly without technical difficulties or operative adverse events, resulting in lateral expansion of each horn of the hyoid bone by ≥1 cm without early or late complications. At 6 months postoperatively, both AHI and the mean lowest oxygen saturation level were significantly improved ( P < .0001). The new expansion hyoidthyroidpexy technique is a reliable, easy, and effective procedure with good surgical outcomes in patients with OSA. It is feasible to be employed in the protocol of multilevel surgery for OSA.
Collapse
Affiliation(s)
- Sherif M. Askar
- Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Ali Awad
- Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| |
Collapse
|
26
|
Affiliation(s)
- Mohammad Waheed El-Anwar
- Deparment of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
27
|
Khater A, El-Anwar MW, Nofal AAF, Elbahrawy AT. Sudden Sensorineural Hearing Loss: Comparative Study of Different Treatment Modalities. Int Arch Otorhinolaryngol 2018; 22:245-249. [PMID: 29983762 PMCID: PMC6033594 DOI: 10.1055/s-0037-1605376] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 07/03/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction
Idiopathic sudden sensorineural hearing loss (ISSNHL) is hearing loss of at least 30 dB in at least 3 contiguous frequencies within at least 72 hours. There are many different theories to explain it, and many different modalities are used for its management, such as: systemic steroids (SSs), intratympanic steroid injection (ITSI), hyperbaric oxygen therapy (HOT), antiviral drugs, and vasodilators or vasoactive substances.
Objectives
This study aims to evaluate the efficacy of the combination of the most common treatment modalities of ISSNHL and to compare the results if HOT was not one of the treatment modalities administered.
Methods
The study was conducted with 22 ISSNHL patients with ages ranging from 34 to 58 years. The patients were divided into 2 groups; group A included 11 patients managed by SSs, ITSI, antiviral therapy, and HOT simultaneously, and group B included 11 patients exposed to the aforementioned modalities, with the exception of HOT.
Results
After one month, all of the patients in group A showed total improvement in hearing in all frequencies, with pure tone average (PTA) of 18.1 ± 2.2, while in group B, 5/11 (45.5%) patients showed total improvement, and 6 /11 (54.5%) patients showed partial improvement, with a total mean PTA of 28.1 ± 8.7.
Conclusion
The early administration of HOT in combination with other clinically approved modalities (SSs, ITSI, antiviral therapy) provides better results than the administration of the same modalities, with the exception of HOT, in the treatment of ISSNHL.
Collapse
Affiliation(s)
- Ahmed Khater
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmad Abdel-Fattah Nofal
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atef Taha Elbahrawy
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
28
|
El-Anwar MW, Elnashar I, Foad YA. Platelet-rich plasma myringoplasty: A new office procedure for the repair of small tympanic membrane perforations. Ear Nose Throat J 2018; 96:312-326. [PMID: 28846786 DOI: 10.1177/014556131709600818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a prospective study to assess the effectiveness of a platelet-rich plasma hourglass graft in the repair of small tympanic membrane perforations as an office-based procedure. Our study population was made up of 25 patients-10 men and 15 women, aged 19 to 45 years (mean: 30.4 ± 7.2)-who each underwent repair of one eardrum. After administration of topical anesthesia, a single piece of platelet-rich plasma approximately double the size of the perforation was obtained from each patient's intravenous blood sample. After the margin of the perforation was freshened, the platelet-rich plasma was placed in an hourglass configuration, with equal portions lying medial and lateral to the perforation. Successful perforation repair was achieved in 21 of the 25 ears (84%). No patient developed an infection, hearing impairment, tinnitus, vertigo, bleeding, taste disturbance, or hyperkeratosis. We conclude that office-based platelet-rich plasma myringoplasty is a safe and effective minimally invasive procedure that is suitable for repairing small tympanic membrane perforations.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otolaryngology-Head and Neck Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt.
| | | | | |
Collapse
|
29
|
Sorour SS, Mohamed NN, Abdel Fattah MM, Elbary MESA, El-Anwar MW. Bioglass reconstruction of posterior meatal wall after canal wall down mastoidectomy. Am J Otolaryngol 2018. [PMID: 29526381 DOI: 10.1016/j.amjoto.2018.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Canal wall down (CWD) mastoidectomy has many drawbacks including chronic otorrhea, 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 bioactive glass (BAG) that is fabricated and built up intraoperatively. PATIENTS AND METHODS This study was applied on 20 patients had 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 BAG that was prepared and built up intraoperatively. All patients were exposed to full preoperative evaluation and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. RESULTS During a follow up of 12 to 36 months, postoperative appearance of external auditory canal contour was found smooth without hidden pouches, irregularities nor stenosis in all cases. No registered granulation, foreign body reaction, nor extrusion and/or displacement of the BAG material. No reported facial palsy or recurrent cholesteatoma. Significant hearing improvement was statistically reported (p = 0.0006). CONCLUSION Surgical reconstruction of the PMW using BAG that operatively fashioned immediately after CWD mastoidectomy appears to be reliable without considerable complications giving smooth appearance of the PMW and improving the hearing.
Collapse
|
30
|
Askar SM, El-Anwar MW. Double suspension sutures: A simple surgical technique for selected cases of obstructive sleep apnoea: Our experience with twenty-two patients. Clin Otolaryngol 2018; 43:753-757. [PMID: 29288566 DOI: 10.1111/coa.13056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S M Askar
- Faculty of Medicine, Head and Neck Surgery Department, Zagazig University, Zagazig, Egypt
| | - M W El-Anwar
- Faculty of Medicine, Head and Neck Surgery Department, Zagazig University, Zagazig, Egypt
| |
Collapse
|
31
|
Tantawy AA, Askar SM, Amer HS, Awad A, El-Anwar MW. Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome. Int Arch Otorhinolaryngol 2017; 22:266-270. [PMID: 29983767 PMCID: PMC6033602 DOI: 10.1055/s-0037-1607227] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/03/2017] [Indexed: 10/29/2022] Open
Abstract
Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly ( p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O 2 ) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 ( p < 0.0001). In addition, the snoring score significantly decreased ( p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements ( p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.
Collapse
Affiliation(s)
- Abd Alzaher Tantawy
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Sherif Mohammad Askar
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hazem Saeed Amer
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali Awad
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
32
|
El-Anwar MW, Khazbak AO, Eldib DB, Algazzar HY. Lamina papyracea position in patients with nasal polypi: A computed tomography analysis. Auris Nasus Larynx 2017; 45:487-491. [PMID: 28942101 DOI: 10.1016/j.anl.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/09/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to describe the positions of the lamina papyracea (LP) in patients who had nasal polypi, by computed tomography (CT) analysis. METHODS Paranasal CT scans of patients diagnosed to have nasal polypi were included in the study. CT images were acquired with multiplanar reformates to obtain delicate details in coronal planes for all subjects. Positions of the LP were registered then analyzed in relation to nasal polypi grading. RESULTS Forty seven subjects (94 nasal sides) were included in the current study. Grade I lamina detected in 50% or more of all cases. Patients who had larger polypi (polyp grade 3, 4) were associated with significantly more medial LP (grade II) than smaller polypi (polyp grade 0, 1, 2) (P=0.00386). CONCLUSION The current study improves surgeons' awareness of LP position in different grades of nasal polypi and highlights that larger polypi are significantly associated with more medial LP than smaller polypi. This may be one of the causes of the higher incidence of complication in larger polypi and can help for safer surgery.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
| | - Alaa Omar Khazbak
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Diaa Bakry Eldib
- Radio Diagnosis Department, Faculty of Medicine, Benha University, Egypt
| | | |
Collapse
|
33
|
El-Anwar MW, Nofal AA, Elmalt A. Surgicel use in control of primary postadenoidectomy bleeding. Ear Nose Throat J 2017; 96:372-375. [PMID: 28931191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. Postnasal packing and cautery of the adenoid bed are the most popular methods of controlling postadenoidectomy bleeding. Many hazards and complications may arise from traditional nasopharyngeal packing and nasopharyngeal cautery. In this case series, oxidized regenerated cellulose (Surgicel Nu-Knit; Ethicon; Somerville, N.J) was inserted and used as postnasal packing to control primary postadenoidectomy bleeding in 9 cases after conventional curettage adenoidectomy. All patients underwent nasophayngoscopic examination with a 0° rigid telescope to re-curette if any remnant was still present, and were repacked with appropriate size ribbon gauzes for at least 15 minutes before applying Surgicel. Surgicel succeeded in controlling primary postadenoidectomy bleeding in all cases, with no need for any further intervention. At the 1-month follow-up, no complications were reported. We conclude that Surgicel postnasal pack effectively controls primary postadenoidectomy bleeding. Its many advantages make it superior to other traditionally used material. It is readily available, tolerable, relatively inexpensive, hemostatic, adhesive, freely reshaped, bactericidal, causes no granulation reaction, has no need to be removed, and the patient does not need to be in the ICU or sedated.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | |
Collapse
|
34
|
Nasr WF, ElSheikh E, El-Anwar MW, Sweed AH, Bessar A, Ezzeldin N. Two- versus Three-Point Internal Fixation of Displaced Zygomaticomaxillary Complex Fractures. Craniomaxillofac Trauma Reconstr 2017; 11:256-264. [PMID: 30574268 DOI: 10.1055/s-0037-1604199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Wail Fayez Nasr
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Ezzeddin ElSheikh
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Ahmed Hassan Sweed
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Awad Bessar
- Department of Radio Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Nillie Ezzeldin
- Department of Rheumatology and Rehabilitation, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| |
Collapse
|
35
|
Abstract
Introduction Recent advances in surgical techniques and electrode design have made residual hearing preservation during cochlear implantation (CI) possible, achievable, and desirable. Objectives The objective of this study was to review the literature regarding methods used for hearing preservation during CI surgery. Data Synthesis We performed a search in the LILACS, MEDLINE, SciELO, PubMed databases, and Cochrane Library, using the keywords CI, hearing preservation, CI electrode design, and CI soft surgery. We fully read about 15 studies that met the criteria described in "study selection". The studies showed that several factors could contribute to possible cochlear damage during or after CI surgery and must be kept in mind; mechanical damage during electrode insertion, shock waves in the perilymph fluid due to implantation, acoustic trauma due to drilling, loss of perilymph and disruption of inner ear fluid homeostasis, potential bacterial infection, and secondary intracochlear fibrous tissue formation. The desire to preserve residual hearing has led to the development of the soft-surgery protocols with its various components; avoiding entry of blood into the cochlea and the use of hyaluronate seem to be reasonably supported, whereas the use of topical steroids is questionable. The site of entry into the cochlea, electrode design, and the depth of insertion are also important contributing factors. Conclusion Hearing preservation would be useful for CI patients to benefit from the residual low frequency, as well as for the children who could be candidate for future regenerative hair cell therapy.
Collapse
Affiliation(s)
- Ahmed Khater
- Department of Otorhinolaryngology Head and Neck Surgery, Zagazig University, Zagazig, Egypt
| | | |
Collapse
|
36
|
Elsheikh E, El-Anwar MW, Abdel-Aziz HR. Impact of Successful Choanal Atresia Repair on the Nasal Mucosa: A Preliminary Study. Int Arch Otorhinolaryngol 2017; 21:276-280. [PMID: 28680498 PMCID: PMC5495593 DOI: 10.1055/s-0037-1601404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 01/29/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction
The main histological features of the nasal mucosa in choanal atresia are distorted cilia, marked increase of mucous submucosal glands associated with marked reduction of goblet cell density, and lymphocytic cellular infiltration.
Objective
To study the nasal mucosal changes in cases of choanal atresia after successful repair compared with pre-repair mucosal histological features.
Methods
Tissue samples were taken from the inferior turbinate of 3 patients (1 bilateral and 2 unilateral) who were successfully operated. Then, the biopsies were subjected to histopathological, histochemical and immunohistochemical studies. After that, the results were compared with pre-repair findings in the choanal atresia side and in the normal side.
Results
Four biopsies (4 repaired choanal atresia sides) of the mucosa of the inferior turbinate revealed that 1 patient (who had a bilateral choanal atresia repaired), after achieving a patent choana for 8 months, had not completely recovered a normal nasal mucosa. The other 2 patients, after 18 and 23 months of achieving a patent choana, showed normal nasal cavities.
Conclusion
The main histological features of the nasal mucosa in choanal atresia could be reversed by surgery, making the patients regain their choanal patency, with their mucosae changing back to normal gradually with time.
Collapse
Affiliation(s)
- Ezzeddin Elsheikh
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | | |
Collapse
|
37
|
El-Anwar MW, Hamed AA, Abdulmonaem G, Elnashar I, Elfiki IM. Computed Tomography Measurement of Inferior Turbinate in Asymptomatic Adult. Int Arch Otorhinolaryngol 2017; 21:366-370. [PMID: 29018500 PMCID: PMC5629090 DOI: 10.1055/s-0037-1598649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/28/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction
The inferior turbinate (IT) is the most susceptible turbinate to enlargement causing nasal obstruction. The common belief ascribes most of the enlargement of the IT to mucosal elements.
Objective
This study aimed to investigate the detailed computed tomography (CT) measurement of the IT in asymptomatic adult by determining the thickness of both the non-bony (mucosa) and bony parts and their relation to nasal air space in different related areas of the nose.
Methods
We included in the study paranasal CT scans of 108 individuals (216 IT) that had no paranasal pathology. We acquired axial images with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. We took separate measurements of the thickness of the medial mucosa, bones, and lateral mucosa of the IT on the anterior and posterior portions of ITs. We also measured the air space of the nasal cavity between the septum and IT anteriorly and posteriorly.
Results
The difference in the air space between nasal septum, anterior and posterior ends of IT was extremely statistically significant (P < 0.0001). The thickness of the medial mucosa was extremely significantly more than the lateral mucosa width (P < 0.0001). There was no significant difference in length of IT at both sides (
p
= 0.5781).
Conclusion
The detailed CT measurement of the IT in normal adult is an easy and novel measurement. This study lays the foundation for CT measurement of IT for further work that can describe changes in IT measures after turbinate surgery.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Atef A Hamed
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ghada Abdulmonaem
- Department of Radio Diagnosis, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ismail Elnashar
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Inas M Elfiki
- Department of Radio Diagnosis, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
38
|
Abstract
BACKGROUND Choanal atresia is the most common inborn nasal anomaly, and its definitive treatment is surgical to achieve proper bilateral nasal patency. Four main surgical approaches were used for repair: transantral, transpalatal, transseptal, and transnasal. The transnasal endoscopic approach is the most widely accepted nowadays. In this study, we aimed to evaluate the long-term results of a transnasal endoscopic repair of congenital choanal atresia started with resection of the posterior portion of the vomer and was completed without the use of stents in a large series of patients. METHODS Twenty-five patients (age range, 3-15 days) with bilateral congenital choanal atresia had surgery by using stentless endoscopic transnasal repair by starting with resection of the vomer bone. Postoperative control included office fiberoptic nasal endoscopy. RESULTS During the follow-up period of 15-66 months (mean [standard deviation], 35.76 ± 16.8 months), 18 patients (72%) had a wide choana with adequate nasal breathing; Six patients (24%) had narrowing of the choana (<50%), still with adequate and satisfactory airway without feeding difficulties, and one patient (4%) developed restenosis (>50%) after 7 months, which necessitated repeated surgery. One patient (the fourth case) developed a palatal defect, which healed conservatively. No other complications were detected. CONCLUSION The described technique proved to be effective and easier, with good long-term satisfactory results in a large series of patients. This technique allows early use of both nasal passages for simultaneous endoscope and instrument insertion to excise both atretic plates without the use of stents or flaps.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | |
Collapse
|
39
|
El-Gerby KM, El-Anwar MW. Differentiating Benign from Malignant Sinonasal Lesions: Feasibility of Diffusion Weighted MRI. Int Arch Otorhinolaryngol 2017; 21:358-365. [PMID: 29018499 PMCID: PMC5629089 DOI: 10.1055/s-0036-1597323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 10/06/2016] [Indexed: 01/20/2023] Open
Abstract
Introduction
Appearance of nasal masses on routine CT and MRI are not pathognomonic. We utilized the apparent diffusion coefficient (ADC) value obtained from diffusion weighted image (DWI) to detect the differences in the microstructures of tumor and non-tumor tissues.
Objective
The objective of our study was to evaluate the diagnostic role of DWI and ADC values in differentiating between malignant and benign sinonasal lesions and its correlation with histopathological results as the reference standard.
Methods
Patients with nasal and / or paranasal mass underwent CT, MRI, and DWI before any surgical intervention. We used diagnostic sinonasal endoscopy and biopsy to confirm the diagnosis after MRI.
Results
When we used ADC value of (1.2 × 10–3 mm2/s) as a cut-off value for differentiating benign from malignant sinonasal lesions, we achieved 90% accuracy, 100% sensitivity, 88.4% specificity, 77.8% positive predictive value, and 100% negative predictive value. At this cut-off, benign lesions show statistically significant higher ADC value than malignant tumors.
Conclusion
DW MRI and ADC value calculation are promising quantitative methods helping to differentiate between malignant and benign sinonasal lesions. Thus, they are effective methods compared with other conventional methods with short imaging time thus it is recommended to be incorporated into routine evaluations.
Collapse
Affiliation(s)
- Khaled M El-Gerby
- Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
40
|
El-Ahl MAS, El-Anwar MW. Expansion Pharyngoplasty by New Simple Suspension Sutures without Tonsillectomy. Otolaryngol Head Neck Surg 2016; 155:1065-1068. [PMID: 27650805 DOI: 10.1177/0194599816669501] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 06/28/2016] [Accepted: 08/25/2016] [Indexed: 11/15/2022]
Abstract
The aim of this study was to introduce and assess a new minimally invasive expansion pharyngoplasty for obstructive sleep apnea (OSA) using bilateral new advancement sutures without tonsillectomy. Among 24 patients who had OSA with Friedman stage II or III and type I Fujita, bilateral sutures were performed to advance and stabilize palatopharyngeus and palatoglossus muscles anterolaterally. Mean apnea hypopnea index decreased significantly from 28.6 ± 4.2 preoperatively to 8.9 ± 4.9 postoperatively. The lowest oxygen saturation increased significantly from 79.25 ± 4.12 to 89.29 ± 4.12. Moreover, the visual analog score showed statistically significant reduction in the snoring intensity from a preoperative mean of 8.2 ± 1.4 to 2.1 ± 1.4 at 6 months postoperatively. Significant improvements were also documented in the Epworth Sleepiness Scale, as its mean decreased from 11.7 ± 2.9 preoperatively to 5.1 ± 2.2 postoperatively. In conclusion, the described new sutures could significantly correct OSA in patients with retropalatal obstruction and lateral pharyngeal walls collapse with easy applicability and no reported complication.
Collapse
Affiliation(s)
- Magdy Abdalla Sayed El-Ahl
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
41
|
El-Anwar MW, Nofal AAF, Shawadfy MAE, Maaty A, Khazbak AO. Tracheostomy in the Intensive Care Unit: a University Hospital in a Developing Country Study. Int Arch Otorhinolaryngol 2016; 21:33-37. [PMID: 28050205 PMCID: PMC5205538 DOI: 10.1055/s-0036-1584227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/12/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Tracheostomy is the commonest surgical procedure in intensive care units (ICUs). It not only provides stable airway and facilitates pulmonary toilet and ventilator weaning, but also decreases the direct laryngeal injury of endotracheal intubation, and improves patient comfort and daily living activity. Objective The objective of this study is to assess the incidence, indications, timing, complications (early and late), and the outcome of tracheostomy on patients in the intensive care units (ICU) at a university hospital in a developing country. Methods This study is an observational prospective study. It was performed at the otolaryngology department and ICU new surgery hospital on 124 ICU admitted patients. We collected patients' demographic records, cause of admission, indications of tracheostomy, mechanical ventilation, and duration of ICU stay. We also gathered patientś tracheostomy records including the incidence, timing, technique, type, early and late complications, and outcome. All tracheostomized patients received follow-up for 12 months. Results The indication for tracheostomy in ICU patients was mostly prolonged intubation (80.5%), followed by diaphragmatic paralysis (19.5%). All tracheostomies were done by the open approach technique. Tracheostomy for prolonged intubation was done within 17 to 26 days after intubation with a mean of 19.4 ± 2.07 days. Complications after tracheostomy were 13.9% tracheal stenosis and 25% subglottic stenosis. Conclusion Prolonged endotracheal intubation is the man indication of tracheostomy, performed after two weeks of intubation. Although there were no major early complications, laryngotracheal stenosis is still a challenging sequel for tracheostomy that needs to be investigated to be prevented.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmad Abdel-Fattah Nofal
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad A El Shawadfy
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Maaty
- Department of Anesthesia and Intensive Care Units, School of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaa Omar Khazbak
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
42
|
El-Anwar MW, ElAassar AS. Supra-auricular versus Sinusectomy Approaches for Preauricular Sinuses. Int Arch Otorhinolaryngol 2016; 20:390-393. [PMID: 27746845 PMCID: PMC5063745 DOI: 10.1055/s-0036-1583305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/01/2016] [Indexed: 12/25/2022] Open
Abstract
Introduction Several surgical techniques and modifications have been described to reduce the high recurrence rate after excision of preauricular sinus. Objectives The aim of this study is to review the literature regarding surgical approaches for preauricular sinus. Data Synthesis We performed searches in the LILACS, MEDLINE, SciELO, PubMed databases and Cochrane Library in September, 2015, and the key words used in the search were “preauricular sinus,” “sinusectomy,” “supra-auricular approach,” “methylene blue,” and/or “recurrence.” We revised the results of 17 studies, including 1270 preauricular sinuses that were surgically excised by sinusectomy in 937 ears and by supra-auricular approach in 333 ears. Recurrence with supra-auricular was 4 (1.3%) while sinusectomy was 76 (8.1%) with significant difference (p < 0.0001). There were no reported facial nerve paresis or paralysis in any of the approaches. The sinusectomy approach showed significantly more complications (p = 0.0048). Conclusion Supra-auricular approach had significantly less recurrence rate than tract sinusectomy approaches. Thus, it could be regularly chosen as the standard procedure for preauricular sinus excision. As such, it would be helpful for surgeons to be familiar with this approach.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Shaker ElAassar
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
43
|
Abstract
Introduction Choanal atresia (CA) is a challenging surgical problem defined as a failure in the development of communication between the nasal cavity and nasopharynx. Objective The objective of this study is to describe computed tomography (CT) findings in cases with bilateral choanal atresia. Methods The study involved performing axial and coronal non-contrast CT scanning with 2–3 mm sections on14 neonates that had bilateral CA. We used fiberoptic nasal endoscopy to confirm the diagnosis. We evaluated coronal CT to study the skull base area in such neonates. Results This study included 14 neonates with bilateral CA; with mean age of 7 ± 3.5 days. Mixed atretic plates were found in 12 (85.7%) cases while two (14.3%) had pure bony atresia. Isolated CA was detected in 9 cases (64.3%) and 5 (35.7%) cases had associated anomalies. Coronal CT showed soft tissue density in the nasal cavity that appeared to extend through an apparent defect in the nasal roof (cribriform plate), falsely diagnosed by radiologists as associated encephalocele. At the time of surgical repair, all patients showed thick tenacious mucous secretions in both nasal cavities and revealed no encephalocele. Nasal roof remained intact in all cases. Conclusion The thick secretion of bilateral CA could give a false encephalocele appearance on the CT. It is highly recommended to perform proper suction of the nasal cavity of suspected CA cases just before CT scanning.
Collapse
Affiliation(s)
- Ezzeddin Elsheikh
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
44
|
El-Anwar MW, Nofal AAF, Khalifa M, Quriba AS. Use of autologous platelet-rich plasma in complete cleft palate repair. Laryngoscope 2016; 126:1524-8. [PMID: 27075516 DOI: 10.1002/lary.25868] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/07/2015] [Accepted: 12/15/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate the effect of topical application of autologous platelet-rich plasma (PRP) in primary repair of complete cleft palate and then compare the result with another group of patients using the same surgical technique, without application of PRP with regard to the incidence of oronasal fistula, velopharyngeal closure, and grade of nasality. STUDY DESIGN Case control study. METHODS This study was carried on 44 children with complete cleft palate with age range from 12 to 23 months. The children were divided into two age- and gender-matched groups: All children were subjected to the same technique of V-Y pushback repair of the complete cleft palate. In group A (22 children), the PRP prepared from the patient was topically applied between the nasal and oral mucosa layer during palatoplasty, whereas in group B (22 children) the PRP was not applied. RESULTS All cases were recovered smoothly without problems. In group A, no oronasal fistula was reported, whereas in group B three patients (13.6%) had postoperative fistulae and two patients (9.1%) needed revision palatoplasty. At 6 months postoperative assessment, group A (with PRP application) showed significantly better grade of nasality (P = 0.024) and better endoscopic velopharyngeal closure (P = 0.016) than group B. CONCLUSION Usage of autologous PRP in complete cleft palate repair is simple; effective; can decrease the incidence of oronasal fistula; and also significantly improves the grade of nasality and velopharyngeal closure, which decreases the need of further surgical intervention in cleft palate patients. LEVEL OF EVIDENCE 3b. Laryngoscope, 126:1524-1528, 2016.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department , Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Abdel Fattah Nofal
- Otorhinolaryngology-Head and Neck Surgery Department , Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Khalifa
- Surgery Department , Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amal Saeed Quriba
- Audiology Unit, Otorhinolaryngology-Head and Neck Surgery Department , Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
45
|
El-Anwar MW, Abdelhady M, Amer HS, Ghali MA. Early and Delayed Effect of Functional Endoscopic Sinus Surgery on Intraocular Pressure. Int Arch Otorhinolaryngol 2016; 20:359-363. [PMID: 27746840 PMCID: PMC5063733 DOI: 10.1055/s-0036-1579663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/11/2015] [Indexed: 11/05/2022] Open
Abstract
Introduction Due to the close anatomical relationship between the paranasal sinuses and the orbit, involvement or injury of the orbit from paranasal sinuses procedures may occur. Objectives We aimed to study the early and delayed effect of endoscopic sinus surgery on intraocular pressure (IOP). Methods We included in the study 38 patients with chronic rhinosinusitis (CRS), undergoing FESS. We performed FESS with the standard anterior to posterior approach. We measured IOP at the same time one day before surgery as well as day 1 and 6 weeks after surgery. Results One day after surgery, mean IOP in the right eye was 14.176 ± 1.91 mm Hg and in the left eye was 13.79 ± 2.42 mm Hg with statistically non-significant difference from preoperative values. Six weeks postoperative, the mean IOP in the right eye was 15.14 ± 2.28 mm Hg. The difference between the mean preoperative and postoperative IOP values was found to be statistically significant (p = 0.0012). While in the left eye, mean postoperative IOP was 15.14 + 2.23mm Hg. The difference between the mean preoperative and postoperative IOP values was also found to be highly statistically significant (p = 0.0005). Conclusion Delayed significant increase in IOP can occur after FESS, Thus, special measures must be taken to reduce IOP to protect the patient́s eye from the risk of increased IOP, especially in patients with glaucoma.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Abdelhady
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hazem Saeed Amer
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Manar A Ghali
- Department of Ophthalmology, School of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
46
|
El-Anwar MW, Abdelmonem S, Abdelsameea AA, AlShawadfy M, El-Kashishy K. The Effect of Propolis in Healing Injured Nasal Mucosa: An Experimental Study. Int Arch Otorhinolaryngol 2016; 20:222-5. [PMID: 27413403 PMCID: PMC4942295 DOI: 10.1055/s-0036-1579664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/16/2015] [Indexed: 01/13/2023] Open
Abstract
Introduction
Mechanical trauma to the nasal mucosa increases the risk of synechia formation, especially after chronic rhinosinusitis and nasal surgeries. Objective
This study was carried to assess the effect of propolis administration in healing injured nasal mucosa in rats. Methods
We randomly divided eighteen rats into three equal experimental groups: (1) non-treated group; (2) gum tragacanth (suspending agent for propolis) treated group; and (3) propolis treated group. The non-treated group received no treatment for 15 days. The second group received gum tragacanth administration (5 ml/kg, orally) once daily for 15 days. The third group received propolis suspension orally at a dose of 100 mg/kg once daily for 15 days. At the beginning of this study, we induced unilateral mechanical nasal trauma on the right nasal mucosa of all rats in the three groups using a brushing technique. A pathologist stained tissue samples using hematoxylin and examined eosin by using a light microscope. Results
The severity of inflammation was milder with the absence of ulcerations in the propolis treated group compared with the non-treated and gum tragacanth groups. Goblet cell and ciliated cell loss was substantially lower in patients treated with propolis compared with groups without treatment and those treated with gum tragacanth. Conclusion
Propolis decreased inflammation and enhanced healing of wounds of the nasal mucosa in rats.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Said Abdelmonem
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A Abdelsameea
- Department of Pharmacology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed AlShawadfy
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Kamal El-Kashishy
- Department of Pathology, School of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
47
|
Elsheikh E, Quriba AS, El-Anwar MW. Voice Changes after Late Recurrent Laryngeal Nerve Identification Thyroidectomy. J Voice 2016; 30:762.e1-762.e9. [PMID: 26832828 DOI: 10.1016/j.jvoice.2015.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/07/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess voice changes in patients after thyroidectomy where the recurrent laryngeal nerve (RLN) was found late in the thyroid dissection and where the RLN was not injured (late RLN identification technique). METHODS This study was conducted on 64 patients who underwent thyroidectomy by late RLN identification technique. Voice was assessed preoperatively, 1 week, 3 months, and 6 months after surgery using the voice assessment protocol and Voice Problem Self-Assessment Scale. The study group was divided into two subgroups (hemithyroidectomy: N = 13 and total thyroidectomy: N = 51). Voice assessments of both subgroups were then compared with a control group (N = 20) of patients who recently underwent extracervical surgeries. RESULTS All voice analysis differences between the control group and the individual study subgroup were nonsignificant. Dysphonia in the study group was significantly worse at 1 week and 3 months postoperatively but became nonsignificant at 6 months postoperatively. The deviations from the preoperative acoustic analysis were significant only in the first week postoperative comparison for fundamental frequency, noise-to-harmonic ratio, and maximal phonation time and thereafter became nonsignificant. Significant Voice Problem Self-Assessment Scale mean score increase (worsening) was also detected only at first week postoperatively. CONCLUSION Minimal voice changes were reported early after late RLN identification thyroidectomy in absence of RLN injury and disappeared gradually in a few months. Those changes are comparable with that of other extracervical surgeries, making thyroidectomy with late RLN identification a relatively safe technique as regard voice.
Collapse
Affiliation(s)
- Ezzeddin Elsheikh
- Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Amal Saeed Quriba
- Unit of Phoniatrics, Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt
| | - Mohammad Waheed El-Anwar
- Audiology Unit, Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt..
| |
Collapse
|
48
|
El-Anwar MW, Abdelmonem S, Nada E, Galhoom D, Abdelsameea AA. Cilostazol Effect on Amikacin-Induced Ototoxicity: An Experimental Study. Audiol Neurootol 2016; 21:250-253. [DOI: 10.1159/000446467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
<b><i>Objectives:</i></b> To find out the possible protective effect of cilostazol against amikacin-induced ototoxicity. <b><i>Methods:</i></b> This study was carried out on 24 adult male rats classified into 4 equal groups of 6 animals each. (1) The control group was administered saline (1 ml/day, p.o.) for 14 days. (2) The amikacin group was administered amikacin (200 mg/kg, i.m.) once daily for 14 days. (3) The cilostazol-amikacin (14 days) group was administered cilostazol (30 mg/kg, p.o.) once daily and amikacin (200 mg/kg, i.m.) once daily for 14 days. (4) The cilostazol (28 days)-amikacin (14 days) group was administered cilostazol (30 mg/kg, p.o.) once daily for 28 days and amikacin (200 mg/kg, i.m.) once daily for 14 days. Changes in the transient evoked otoacoustic emissions (TEOAEs) in the 4 groups were interpreted statistically. <b><i>Results:</i></b> No reported significant differences in TEOAE levels were detected between the groups at the start of the study. In all frequency bands, TEOAEs disappeared after amikacin treatment in the amikacin-alone group and remained absent in the amikacin-cilostazol (14 days) group, while TEOAEs reappeared in the amikacin-cilostazol (28 days) group. <b><i>Conclusion:</i></b> Cilostazol treatment for 28 days had a protective effect against amikacin-induced ototoxicity in rats.
Collapse
|
49
|
Waheed El-Anwar M, Elsheikh E, Sweed AH, Ezzeldin N. Electromyography assessment in zygomaticomaxillary complex fractures. Oral Maxillofac Surg 2015; 19:375-379. [PMID: 25934247 DOI: 10.1007/s10006-015-0505-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study was to assess the activity of the masseter and temporalis muscles using surface electromyography (EMG) in patients with zygomaticomaxillary complex (ZMC) fractures. PATIENTS AND METHODS This prospective study was carried out on 25 patients who had ZMC fractures. Fifteen patients were managed by open reduction and rigid fixation (ORIF) using titanium miniplates. This study, using surface electromyography, analyzed the activity of the masseter and temporalis muscles of 25 patients with ZMC fractures; 15 of them were surgically treated under general anesthesia (GA). Evaluations were made before surgery and 6 weeks after surgery by recording the mean of muscle contraction of 20 motor unit action potential (MUAP) against resistance, and statistical analyses were performed. RESULTS A significant EMG difference between the normal and ZMC fracture sides was found (P < 0.0001) for both masseter and temporalis muscles and was significantly improved after ORIF. However, postoperative EMV values of the repaired side was significantly less than measured postoperatively in the normal side (P < 0.0001) for both muscles. CONCLUSION ZMC fractures significantly diminish muscular activity of the masseter and temporalis and even though significant recovery of muscle activity was revealed after 6 weeks, it is still less than normal activity, highlighting the importance of postoperative rehabilitation.
Collapse
Affiliation(s)
- Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Ezzeddin Elsheikh
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Hassan Sweed
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nillie Ezzeldin
- Rheumatology and Rehabilitation department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
50
|
El-Anwar MW, Sayed El-Ahl MA, Amer HS. Open Reduction and Internal Fixation of Mandibular Fracture without Rigid Maxillomandibular Fixation. Int Arch Otorhinolaryngol 2015; 19:314-8. [PMID: 26491477 PMCID: PMC4593909 DOI: 10.1055/s-0035-1549154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/23/2015] [Indexed: 10/25/2022] Open
Abstract
Introduction The ability to treat fracture with open reduction and internal fixation (OR/IF) has dramatically revolutionized the approach to mandible fracture. With OR/IF, the postoperative role of rigid maxillomandibular fixation (MMF) has declined, but it is used to maintain proper occlusion until internal fixation of the fracture is achieved. Objective To assess intraoperative manual MMF during OR/IF of selected cases of mandibular fractures. Methods This prospective study was conducted on 80 patients with isolated mandibular fractures managed by OR/IF using two titanium miniplates. The patients were classified into two groups: a control group (40 patients) treated by OR/IF after intraoperative rigid MMF followed by immediate MMF removal, and a study group (40 patients) treated by rigid MMF, which was replaced by temporary intraoperative manual MMF (3MF) until plate fixation. Results There were no significant differences of the postoperative complication and dental occlusion, although a highly significant reduction of operative time was achieved in the 3MF group. Patient who received the 3MF technique had statistically significantly better average intrinsic vertical mouth opening in the early postoperative period (1 week after surgery), and normal mouth opening could be achieved in all cases in both groups 8 weeks after surgery. Conclusions Intraoperative rigid MMF is not mandatory and can be replaced in selected cases of fracture mandible by manual maintenance of proper dental occlusion until hardware fixation, gaining the advantages of shorter operative time and less risk of blood-transmitted diseases to the surgical team and the patient in addition to the benefits of immediate postoperative mandible mobilization.
Collapse
Affiliation(s)
| | | | - Hazem Saed Amer
- Department of Otorhinolaryngology, Head and Neck Surgery, Zagazig University, Zagazig, Egypt
| |
Collapse
|