Iranian Journal of Otorhinolaryngology
Volume:30 Issue: 6, Nov - Dec 2018

The aim of this study was to compare the functional outcomes of swallowing act detected by videofluoroscopy of two different techniques in the treatment of laryngeal carcinoma. This study was conducted on 41 patients undergoing two supraglottic laryngectomy techniques. The research population was assigned into two groups of open and laser supraglottic laryngectomy, including 21 and 20 patients, respectively. Food residue was present in most of the patients in the open laryngectomy group. Aspiration of the liquid and solid contrasts was observed in 16 and 4 patients, respectively. In the laser laryngectomy group undergoing a partial supraglottic laryngectomy via carbon dioxide (CO2) laser, aspiration was recorded in only six patients. There was a statistically significant difference between these two groups regarding the presence of aspiration as a marker of a bad functional outcome. Techniques that include the endoscopic removal of the tumor via CO2 laser result in good oncologic and functional outcomes, along with reduced postoperative morbidity and mortality.

Different approaches have been developed to find the position of the internal auditory canal (IAC)in middle cranial fossa approach. A feasibility study was performed to investigate the combination of cone beam computed tomography (CBCT), optical coherence tomography (OCT), and laser ablation to assist a surgeon in a middle cranial fossa approach by outlining the internal auditory canal (IAC). A combined OCT laser setup was used to outline the position of IAC on the surface of the petrous bone in cadaveric semi-heads. The position of the hidden structures, such as IAC, was determined in MATLAB software using an intraoperative CBCT scan. Four titanium spheres attached to the edge of the craniotomy served as reference markers visible in both CBCT and OCT images in order to transfer the plan to the patient. The integrated erbium-doped yttrium aluminum garnet laser was used to mark the surface of the bone by shallow ablation under OCT-based navigation before the surgeon continued the operation. The technical setup was feasible, and the laser marking of the border of the IAC was performed with an overall accuracy of 300 μm. The depth of each ablation phase was 300 μm. The marks indicating a safe path supported the surgeon in the surgery. The technique investigated in the present study could decrease the surgical risks for the mentioned structures and improve the pace and precision of operation.

The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) on the quality and quantity of bone formation in unilateral maxillary alveolar cleft reconstruction using cone beam computed tomography. This study was conducted on 10 non-syndromic patients with unilateral cleft lip and palate within the age group of 9-12 years. The study population was randomly assigned into two groups of PRF and control, each of which entailed 5 cases. In the PRF group, the autogenous anterior iliac crest bone graft was used in combination with PRF gel. On the other hand, the control group was subjected to reconstruction only by bone graft. The dental cone beam CT images were obtained immediately (T0) and 3 months (T1) after the operation to assess the quality and quantity of the graft. Independent and paired sample t-tests and analysis of covariance were used to analyze and compare the data related to the height, thickness, and density of the new bone. The mean thickness difference of the graft in both PRF and control groups at T0 and T1 was not significantly different (P>0.05). Furthermore, the reduction changes of bone height at the graft site from T0 to T1 were not statistically significant for both groups (P=0.78). The mean total bone loss of the regenerated bone from T0 to T1 was lower in the control group than that in the PRF group; however, this difference was not statistically significant. The usage of PRF exerted no significant effect on the thickness, height, and density of maxillary alveolar graft.

Eagle’s syndrome is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle. The syndrome includes symptoms ranging from stylalgia (i.e. pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia, or even increased salivation or giddiness. We describe a clinical study of 12 patients with Eagle’s syndrome, along with their clinical profile and the treatment offered. Patients were diagnosed based on history and clinical examination, as well as the Xylocaine 2% tonsillar fossa injection test. A visual analog scale (VAS) was used for comparison of pain before and up to 3 months after treatment. Radiology (orthopantomogram or three-dimensional computed tomography) was used for further exploration. Nine patients underwent tonsillo-styloidectomy surgery and three underwent medical treatment with pregabalin (75 mg/day). The majority of surgically-managed cases (88%) achieved a definitive benefit by tonsillo-styloidectomy surgery, whereas all medically managed cases achieved only short-term pain relief. Besides the common throat diseases, the symptoms associated with Eagle’s syndrome may be similar to those due to cervicofacial neuralgias, dental, or temporo-mandibular joint diseases. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations, and should not be missed. Treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia.

The recurrence rate after tympanoplasty is variable between 0% and 50%. The causes of failure may be different and frequently interrelated, making the surgical choice difficult and the prognosis not always favourable. In this study, we analysed recurrence rate and the possible causes of failure of tympanoplasty in the treatment of tympanic perforations. This prospective case-control study was carried out on patients undergoing tympanoplasty. The main outcome was closure of the tympanic membrane. Among the studied 72 patients, the overall recurrence rate was 19.4%. The average follow-up was 28 months; no recurrence was observed over 12 months of follow-up. We observed a recurrence of 30.7% (OR 2.9) in near total perforations. In 32 subjects with a perforation of over half size of the membrane, a recurrence rate of 31.2% was noted (OR 4.09; P< 0.05). In 22 out of the 72 patients, there was a bilateral chronic otitis where the rate of recurrence was 27.2% (OR 1.9). During the postoperative period, 10 patients contracted infection of the middle/external ear, and in all of these cases failure of the surgical intervention was recorded (P<0.01). The rate of recurrence is closely related to several factors that may be concomitant and therefore, worsen the prognosis. Perforations that affect more than 50% of the tympanic surface are related to a higher rate of failure and are often associated with one of the two conditions previously described. Postoperative infection is the most significant risk factor for recurrence.

Eosinophilic mucin rhinosinusitis is a type of chronic rhinosinusitis (CRS). Diagnosis and treatment of this condition play a significant role in reducing the patients’ clinical symptoms. This type of rhinosinusitis has a higher relapse rate, compared to the other types. This disease is more resistant to treatment and more dependent on corticosteroid therapy, compared to the other types of rhinosinusitis. Regarding this, the present study was designed to evaluate the frequency of eosinophilic mucin rhinosinusitis in patients undergoing sinus surgery in a tertiary referral center and examine some clinical and laboratory characteristics regarding this type of rhinosinusitis. This cross-sectional observational study was performed on patients over the age of 16 years, who were diagnosed with CRS in the otolaryngology clinic of a referral tertiary-level hospital, and were candidates for endoscopic sinus surgery. Based on the detection of eosinophilic mucin, the subjects were divided into two groups of eosinophilic mucin and non-eosinophilic mucin rhinosinusitis (controls). The groups were compared in terms of sino-nasal outcome test (SNOT-22) scores, Lund-Mackay staging scores, osteitis status, immunoglobulin E (IgE) level, and eosinophilia. In this study, 46 subjects participated, 29 (63%) cases of whom had eosinophilic mucin. The SNOT-22 score and serum IgE level were significantly higher in the eosinophilic mucin group, compared to those in the control group. Osteitis and Lund-Mackay scores were also higher in the eosinophilic mucin group than those in the control group; however, this difference was not statistically significant. Patients with eosinophilic mucin rhinosinusitis showed a more severe clinical involvement. Seemingly, the Iranian patients have a lower and higher frequency of eosinophilic mucin rhinosinusitis, compared to the patients from the Western countries and East Asia, respectively.

Teratomas are neoplastic tumors derived from totipotent germ cells containing a wide assortment of tissues originating from all three germ cell layers. Teratomas can be mature or immature depending on the presence of immature tissues; typically neuroepithelial tissue. Immature teratomas can be oncologically benign or malignant, and can be divided into three grades with increasingly aggressive biological behavior. The most common site for this tumor is the sacrococcygeal region. The nasal septum is an exceptionally rare site for immature teratomas, with very few cases reported.

Case Report: We discuss a 14-year-old male patient with a left nasal mass which, on histopathological examination, turned out to be a Grade-3 immature teratoma. Imaging revealed the mass to be confined in the left nasal cavity with erosion of the anterior skull base. During endoscopic excision, the tumor was seen extending intracranially but remaining extradurally. Complete resection was achieved, albeit with mild cerebrospinal fluid (CSF) leakage, which was closed successfully. The patient was subjected to adjuvant chemotherapy. A regular follow-up of 2 years showed no recurrence. The purpose of this report is to document the first case of a high-grade immature teratoma arising from the nasal septum with intracranial extension, as well as the efficacy of combined endoscopic resection and adjuvant chemotherapy for this pathology.

Metastatic tumors of the temporal bone are extremely rare. Collet-Sicard syndrome is an uncommon condition characterized by unilateral palsy of the lower four cranial nerves. The clinical features of temporal bone metastasis are nonspecific and mimic infections such as chronic otitis media and mastoiditis.

Case Report: This report describes a rare case of metastatic adenocarcinoma of the temporal bone causing Collet-Sicard syndrome, presenting with hearing loss, headache and ipsilateral cranial nerve palsies. The patient was a 68-year old woman initially diagnosed with extensive mastoiditis and later confirmed as having metastatic adenocarcinoma of the temporal bone, based on histopathologic findings. Clinical presentation of metastatic carcinoma of the temporal bone can be overshadowed by infective or inflammatory conditions. This case report is to emphasize the point that a high index of clinical suspicion is necessary for the early diagnosis of this aggressive disease which carries relatively poor prognosis. This report highlights that it is crucial to suspect malignant neoplasm in patients with hearing loss, headache and cranial nerve palsies.

Diagnosis of orbital foreign body (FB) penetration is usually obvious when part of the FB is still attached at the entry wound (1). However, the depth and course of the FB in this case was not visible.

Case Report: A 5-year old female presented with a pencil penetrating the left orbit. A computed tomography (CT) scan showed that the pencil penetrated the left orbit (extraseptal) through the lacrimal bone to the left nasal cavity, then perforated the nasal septum, crossing the right nasal cavity. Finally, the pencil penetrated the lamina paperatea to the right orbit and stopped near the right optic nerve. The pencil was gently removed under general anesthesia with close observation of the eyes. A case of a pencil penetrating both orbits and nasal cavities was reported, and the pencil was safely removed. This draws attention to the possible penetration power of a pencil, with the possibility of injury to the orbit and optic nerve on the opposite side of the penetration. It also demonstrates the feasibility of safe removal.

Literature regarding the different degrees of hearing loss in patients with Cornelia de Lange syndrome (CDLS) reports that half of the affected patients exhibit severe to profound sensorineural hearing loss. We present the first pre-school child with CDLS who underwent cochlear implantation for congenital profound sensorineural hearing loss.

Case Report: A 3-year-old boy with CDLS underwent unilateral cochlear implantation for bilateral profound sensorineural hearing loss. He had characteristic facial features, bushy eyebrows and synophrys, limb anomalies, growth and mental retardation. Based on the results of postoperative speech perception and production tests, his gain in language skills and expressive vocabulary was modest. However, a cochlear implantation had a significant effect on auditory development, in terms of making him aware of sound localization and the different types of environmental sound. Criteria for cochlear implantation are expanding and now include children with disabilities in addition to deafness, such as those with CDLS. Profoundly hearing-impaired children affected by borderline mental retardation should be considered as potential candidates for cochlear implantation.