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  • ISSN: 2379-948X
    Volume 3, Issue 1
    Review Article
    Caterina Solda*, Davide Pastorelli and Alessio Bridda
    Primary malignant neoplasms of the trachea are very rare, making up only 0.1-0.4% of all respiratory malignancies. Limited data exists on management and evidences guiding the treatment are gained from single-institution reports and a few epidemiologic studies. Surgical resection combined with postoperative radiotherapy is the main treatment option. Early diagnosis, access to interventional bronchoscopy, and surgical treatment in specialist units may improve survival.
    At present, no clear knowledge exists on the role of chemotherapy, chemo radiation and targeted therapy in the postoperative and advanced setting. Therefore, collaborative effort and multicenter studies are needed.
    Research Article
    Shireen Samargandy, LujainBukhari, Talal Al-Khatib*, Hani Marzouki and Khaled I. Al-Noury F
    Background: Tympanoplasty (TP) is a surgical procedure that aims to repair a persistently perforated eardrum via grafting. Different surgical techniques and graft materials were used for TP with variable success rates.
    Purpose: This study aims to determine predictors of failure of TP and compare different graft materials used.
    Materials and Methods: Retrospective review of all the medical records of patients that underwent tympanoplasties at King Abdulaziz University Hospital from 2011 to 2013. Predicting factors included smoking, associated comorbidities, past ear surgeries, symptoms, anatomy and cause of perforation, primary or revision, type of TP, technique, approach, usage of packing and graft materials (fascia, cartilage or allograft). Outcome of success was measured clinically by graft take-up and degree of air-bone gap (ABG) closure.
    Results: A total of 80 cases were reviewed, and analysis showed no difference between graft types' success rate. The underlay surgical technique had a statistically significant better success rate (85.7%) compared the overlay technique (55.6%) (p=0.03). No other risks for failure were identified from our variables. ABG closure was best at hearing frequencies 250, 500 and 1k Hz. ABG closure at 2k and 4k Hz was not statistically significant.
    Conclusions: Graft type has no significant effect on clinical outcome. Underlay technique is superior to overlay with a higher success rate. Functional hearing improvement after TP can be expected after surgery.
    Ali Özdek, Ömer Bayir*, Kemal Keseroğlu, Emel Cadalli Tatar, Bülent Öcal and Mehmet Hakan Korkmaz
    Objectives: To present our preliminary results of endoscopic stapedectomy surgeries and also to discuss possible advantage and disadvantage of endoscope in otosclerosis surgery.
    Methods: 29 patients who were conducted fully endoscopic stapedectomy procedure were involved and analyzed retrospectively in the study. Preoperative and postoperative pure tone averages and air-bone gaps were compared. Perioperative and postoperative complications were investigated.
    Results: Audiologic improvement was achieved in 27 of 29 patients. Postoperative air-bone gap was within 10 dB in 23 years and between 10–20 dB in the 4 ears. Unfortunately, sensorineural hearing loss (not total) was observed in 2 patients.
    Conclusion: Endoscopic transcanal stapedectomy seems a feasible and relatively safe surgical procedure. The main advantage of endoscope is that; it allows the better visualization of middle ear structure. It is possible to perform surgery completely by transcanal approach, even in narrow ear canals. The main disadvantages are that; it is a one handed surgery, lack of stereoscopic vision and it requires a learning curve.
    Case Report
    Cristiano Tonello, Mauricio Yoshida, Marco Antonio Ferraz de Barros Baptista* and Nivaldo Alonso
    Negative pressure pulmonary edema following tracheal extubation is an uncommon and life-threatening complication of patients undergoing endotracheal intubation and general anesthesia for surgical procedures. The common pattern in these cases is the occurrence of an episode of airway obstruction upon emergence from general anesthesia, usually caused by laryngospasm. Patients who are predisposed to airway obstruction may have an increased risk of airway complications upon extubation after general anesthesia. This paper presents the case of a young male with repaired cleft lip and palate submitted to aesthetic nasal surgery under general anesthesia, who exhibited sudden respiratory insufficiency and pulmonary hemorrhage immediately after tracheal extubation. Prevention and early relief of upper airway obstruction may decrease the incidence of pulmonary edema and hemorrhage after surgery.
    Ramya Bharathi, Frank Sullivan*, Babak Aliarzadeh and Michelle Greiver
    Previous studies have showed a significant proportion of Bell's palsy patients are left untreated and suffer from lifelong complications. The study objectives were: 1) to assess the feasibility of finding Bell's palsy patients in large EMR databases and 2) measure the level of completeness and accuracy of recorded data in Canadian Family Practice EMRs about Bell's palsy; we used a primary care EMR based database to identify patients with a diagnosis of Bell's palsy. Nine practices with at least 4 cases of Bell's palsy per physician participated; 33 patients identified with Bell's palsy were selected as cases and 220 age and sex matched patients with no indication of Bell's palsy diagnosis were selected as controls. We identified 30 true positive Bell's palsy cases, 3 false positive cases, and 220 true negative cases. Approximately 44.8% of patients were not treated with steroids; they had antivirals alone, had other treatments, or were untreated. Bell's palsy patients could be reliably identified in EMR derived large health databases.
    Yasmina Zoghbi, Ralph Abi Hachem, John W. Wood and David E. Rosow*
    Purpose: To report successful management of complete supraglottic stenosis using suspension microlaryngoscopy and an endoscopic technique.
    Methods: A 51 year-old female with complete supraglottic stenosis was referred for consideration of decannulation. She had been radiated for oropharyngeal carcinoma several years prior, and had gradually developed progressive supraglottic and glottic stenosis requiring tracheotomy. Several endoscopic procedures had previously been done by another surgeon using local tissue flaps or balloon dilation, with only temporary short-term improvement in airway patency. Combined transoral and transstomal visualization was utilized to open a posterior glottic airway with a microlaryngeal spear and KTP laser. A silastic keel sheet was placed in the newly opened supraglottis and glottic aperture and left in place for 3 weeks.
    Results: Following keel removal in the office, the patient experienced significant improvement in the patency of her supraglottic and glottic airway and was decannulated after one month. Her post-operative voice and breathing have been markedly improved, with no regression seen 3 months post-operatively.
    Conclusion: Endoscopic management of complete Supraglottic cicatrization is feasible and yields excellent voice and airway results. This technique can potentially be applied to other complex cases of laryngeal stenosis.
    Short Communication
    Jin Keat Siow*
    Objective: To describe the anatomy of the bony mesentery of the anterior ethmoid artery.
    Study Design: Descriptive anatomy based on coronal and sagittal CT sections, endoscopic images of a post-surgical case and a cadaveric dissection specimen.
    Methods: A short review of medical literature in textbooks and journals to show past and current assumptions. A descriptive presentation based on images above illustrating an important detail in surgical anatomy.
    Results: The presence of the medial aspect of a supraorbital ethmoid cell dictates the length of the bony mesentery and the vertical distance of the anterior ethmoid artery from the skull base. This part of the skull base is not the ethmoid roof as previously presumed in early teachings but refers to the roof of the supraorbital ethmoid cell, which is continuous with the posterior table of the frontal sinus.
    Conclusion: The bony mesentery of the anterior ethmoid artery projects horizontally forward from the skull base and may confer more bony protection posteriorly against inadvertent injury during surgery than previously thought. When clearing the posterior outflow tract of the frontal sinus in a posterior to anterior direction, an instrument should not be pushed simultaneously in a superior direction as this could cause anterior ethmoid artery damage.
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