1
|
Alyousef M, Alromaih S, Aldokheel B, Alroqi A. Bilateral maxillary silent sinus syndrome: A case report and literature review. SAGE Open Med Case Rep 2023; 11:2050313X231211712. [PMID: 38033913 PMCID: PMC10687922 DOI: 10.1177/2050313x231211712] [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: 10/27/2022] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
Silent sinus syndrome refers to a spontaneous enophthalmos caused by maxillary sinus collapse without any symptomatic sinonasal illnesses. Its prevalence is almost entirely unilateral. The authors report a patient with a bilateral silent sinus syndrome managed successfully by middle meatal antrostomies. This case brings attention to recognizing bilateral silent sinus syndrome. Because of its bilateral involvement, the facial disfigurement might be recognized late due to the symmetrical presentation. This article highlights the pathophysiology and reports the detailed course of such a rare disease. The balloon dilatation is promising as a newly described treatment modality in a patient with silent sinus syndrome, although more long-term data on its outcome is needed.
Collapse
Affiliation(s)
| | - Saud Alromaih
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | | | - Ahmad Alroqi
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Alghulikah A, Alseneidi S, Alsaady H, Alhussien A, Al-Dousary S, Alromaih S, AlHumaizi A. Abducens Nerve Neuropraxia due to Acute Bacterial Rhinosinusitis: Case Report and Literature Review. Case Rep Otolaryngol 2023; 2023:5175871. [PMID: 38058534 PMCID: PMC10696470 DOI: 10.1155/2023/5175871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/23/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023] Open
Abstract
Background Acute bacterial rhinosinusitis (ABRS) is a common infection of the paranasal sinuses that can lead to complications such as orbital and intracranial extension. The abducens nerve course is adjacent to the sphenoid sinus. Diplopia is rarely the initial presentation of sphenoid sinus pathology. In this article, we present the case of a middle-aged male who presented with diplopia and abducens nerve palsy secondary to ABRS, and we conducted a literature review in search of similar cases. Case Presentation. A 52-year-old male presented with diplopia secondary to ABRS. Imaging revealed the complete opacification of the bilateral sphenoid and frontal sinuses, with the extension of the inflammatory process to the optic nerve and cavernous sinus. The patient underwent a surgical intervention, which revealed a pyocele collection in the opticocarotid recess inside the sphenoid sinuses. After the surgery, the patient received antibiotics and reported a complete recovery. Conclusions Acute bacterial rhinosinusitis can present with atypical symptoms and lead to serious complications, such as abducens nerve palsy. Early diagnosis, appropriate management, and timely referral to a multidisciplinary team are crucial to preventing residual nerve damage and ensuring favorable outcomes.
Collapse
Affiliation(s)
- Abdulrahman Alghulikah
- Otolaryngology–Head and Neck Surgery Unit, Surgery Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Sarah Alseneidi
- Children's Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hedayah Alsaady
- Department of Surgery, Otolaryngology Division, Security Forces Hospital, Makkah, Saudi Arabia
| | - Ahmed Alhussien
- Otolaryngology–Head and Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Surayie Al-Dousary
- Otolaryngology–Head and Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Otolaryngology–Head and Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman AlHumaizi
- Department of Otolaryngology–Head and Neck Surgery, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Albaharna H, Alqurashi A, Alshareef M, Alromaih S, Alrasheed AS, Alroqi A, Ajlan A, Alsaleh S. Impact of Concurrent Chronic Rhinosinusitis on Complication Rates after Endonasal Endoscopic Skull Base Surgery: A Single-Center Experience. J Neurol Surg B Skull Base 2023; 84:507-512. [PMID: 37671295 PMCID: PMC10477013 DOI: 10.1055/s-0042-1755602] [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: 10/23/2021] [Accepted: 06/20/2022] [Indexed: 10/15/2022] Open
Abstract
Objectives Preoperative planning of endoscopic skull base surgery (ESBS) is essential. The safety of performing surgery before managing sinus pathologies including concurrent chronic rhinosinusitis (CRS) in patients undergoing ESBS has been questioned. The current study aimed to evaluate and compare the complication rates between patients with and without CRS undergoing ESBS. Design This is a retrospective study. Setting Present study was conducted at tertiary referral center. Participants We included all patients who underwent ESBS between March 2015 and March 2021. However, patients who had surgical revision for remnant tumor, primary sinonasal tumor excision, and cerebrospinal fluid (CSF) leakage repair were excluded. The presence of concurrent CRS was determined according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020) criteria by reviewing electronic charts about the preoperative clinical assessment and CT scan images of the paranasal sinuses. Then, the incidence rates of postoperative meningitis, CSF leakage, and surgical site infection were compared between patients with and without concurrent CRS undergoing ESBS. Main Outcome Measures Postoperative complication rates in patients underwent ESBS with and without CRS. Results From a total of 130 ESBS cases, 99 patients were included in this study. Among them, 24 had concurrent CRS. One patient presented with postoperative meningitis, one with CSF leakage, and two with surgical site infections. The incidence rate of postoperative meningitis, CSF leakage, and surgical site infection did not significantly differ between patients with and without concurrent CRS. Conclusion Concurrent CRS is not a contraindication for ESBS. Moreover, simultaneous endoscopic sinus surgery can safely be performed without additional morbidity in ESBS.
Collapse
Affiliation(s)
- Hussain Albaharna
- Department of Otolaryngology, Head and Neck Surgery, Qatif Central Hospital, Qatif City, Saudi Arabia
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ashwag Alqurashi
- Department of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alshareef
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Otolaryngology, Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait City, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz S. Alrasheed
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Department of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Alharbi A, Alhussain F, Alyamani A, Aljohani M, Alsergani A, AbaAlkhail M, Alsayed A, Aloulah M, Alrasheed A, Aldousary S, Alromaih S, Alroqi A, Alsaleh S. Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia. Saudi Med J 2023; 44:601-606. [PMID: 37343994 DOI: 10.15537/smj.2023.44.6.20230911] [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: 12/19/2022] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES To aimed to determine the incidence of complications of endoscopic sinus surgery (ESS) and to investigate the factors associated with the occurrence of complications. METHODS In this retrospective study, we reviewed the medical records of all patients who had undergone ESS at King Saud University Medical City (KSUMC) between January 2015 and March 2022. Patients who underwent ESS for complicated acute sinusitis, sinonasal malignancy, and cerebrospinal fluid leak repair, and those who underwent extended ESS for indications other than chronic rhinosinusitis were excluded. This study was approved by the KSUMC Institutional Review Board. RESULTS We included 1395 patients, 3 of whom had major complications and 28 had minor complications, resulting in an overall major complication rate of 0.2% and a minor complication rate of 2%. The most common major complication was orbital hematoma, and the most common minor complication was synechia. Moreover, the duration of surgery and laterality increased the risk of complications, whereas the use of image guidance had no effect. CONCLUSION The ESS is a safe procedure. The operative start time and laterality were associated with an increased risk of complications and warrant further investigation.
Collapse
Affiliation(s)
- Abdulmajeed Alharbi
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Fahad Alhussain
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abduljabbar Alyamani
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Majed Aljohani
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah Alsergani
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mashal AbaAlkhail
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Alsayed
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammad Aloulah
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz Alrasheed
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Surayie Aldousary
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Saud Alromaih
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Ahmad Alroqi
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Saad Alsaleh
- From the Department of Otolaryngology-Head & Neck Surgery (Alharbi, Alsayed, Aloulah, Alrasheed, Aldousary, Alromaih, Alroqi, Alsaleh), College of Medicine, from the College of Medicine (Alhussain, Alyamani, Aljohani, Alsergani, AbaAlkhail), King Saud University, from the Department of Otolaryngology-Head & Neck Surgery (Alharbi), East Jeddah General Hospital, Jeddah, Kingdom of Saudi Arabia
| |
Collapse
|
5
|
Alroqi A, Abaalkhail MB, Albuhayjan N, Alorainy J, Jomah M, Alromaih S, Binkhamis K. Evaluation of Chronic Rhinosinusitis Symptoms' Severity Following COVID-19 Infection: A Retrospective Analysis. Cureus 2023; 15:e38517. [PMID: 37288207 PMCID: PMC10241694 DOI: 10.7759/cureus.38517] [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] [Accepted: 04/30/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives This study aims to compare the severity of chronic rhinosinusitis (CRS) symptoms pre- and post-COVID-19 infection and estimate the impact of the COVID-19 pandemic on the use of intranasal corticosteroids (ICS) among adult CRS patients. Methods This was an observational retrospective cohort study conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between July 2022 and October 2022. Adult CRS patients with sino-nasal outcomes test-22 (SNOT-22) scores documented prior to March 2020, marking the occurrence of Saudi Arabia's initial reported case of COVID-19, were requested to complete the SNOT-22 questionnaire following COVID-19 infection. A comparison was subsequently made between the two scores obtained. Results The study enrolled a total of 33 patients, with 16 assigned to the control group and 17 with a history of COVID-19 infection. The mean age of the patients was 43 years, and the majority (52%) were males. Statistical analysis did not reveal any statistically significant differences in the total SNOT-22 scores or domain-level scores between the two groups. Furthermore, the use of ICS during the COVID-19 pandemic did not show any significant associations, except for patients with asthma, where 80% of them used ICS during the pandemic (p=0.0073). Conclusion There was no statistically significant disparity observed in the SNOT-22 scores between patients who tested positive for COVID-19 and those who did not. The use of corticosteroids during the COVID-19 pandemic was found to be more prevalent in this study compared to previous studies conducted before the pandemic, particularly among patients with asthma. The use of ICS during the pandemic was not associated with the presence of polyps, functional endoscopic sinus surgery (FESS), allergic rhinitis, or eczema.
Collapse
Affiliation(s)
- Ahmad Alroqi
- Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, SAU
| | | | - Nawaf Albuhayjan
- Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, SAU
| | - Jehad Alorainy
- Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, SAU
| | - Mohammed Jomah
- Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, SAU
| | - Saud Alromaih
- Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, SAU
| | | |
Collapse
|
6
|
Alfallaj R, Obaid SB, Almousa H, Ismail D, Mahjoub S, Alanazy F, Dousary SA, Alromaih S, Aloulah M, Alrasheed A, Alroqi AS, Alsaleh S. Demographic and clinical profile of patients with chronic rhinosinusitis in Saudi Arabia. Saudi Med J 2023; 44:401-405. [PMID: 37062559 PMCID: PMC10153620 DOI: 10.15537/smj.2023.44.4.20220947] [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: 01/02/2022] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVES To determine the clinical features of patients with chronic rhinosinusitis at a tertiary hospital in Riyadh, Saudi Arabia. METHODS A cross-sectional study was carried out at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. We enrolled 660 male and female participants with medical records indicating a history of chronic rhinosinusitis between 2021 and 2022. Quantitative and descriptive analyses of age, gender, nationality, presence of polyps, aspirin sensitivity, presence of urticaria, asthma, and allergies were performed. RESULTS Of the 660 enrolled patients, 60% (n=396) were male and 40% (n=264) were female. Additionally, 67.7% (447) had nasal polyps, 32% had a history of asthma, 10% had hypersensitivity to aspirin, 1.4% reported a history of urticaria, 9.7% reported allergies to medications, 7.9% reported food allergies, 26% reported multiple allergies, and 1.8% reported environmental allergies. CONCLUSION Our study revealed the following: Samter's triad was present in 6.9% of participants with chronic rhinosinusitis; the greatest prevalence of chronic rhinosinusitis with nasal polyps was observed among those older than 50 years. The prevalence of urticaria was not significantly different among groups; a higher rate of environmental allergies was observed among those with CRSwNP than among those without nasal polyps; and a higher prevalence of aspirin hypersensitivity was observed among those with CRSwNP than among non-polyps group.
Collapse
Affiliation(s)
- Rayan Alfallaj
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Sultan bin Obaid
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Hisham Almousa
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Dawood Ismail
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Saleh Mahjoub
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Fatma Alanazy
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Surayie Al Dousary
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Saud Alromaih
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammad Aloulah
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Abdulaziz Alrasheed
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmad S. Alroqi
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Saad Alsaleh
- From the Department of Otolaryngology – Head And Neck Surgery Department (Alfallaj, Alanazy, Al Dousary, Alromaih, Aloulah, Alrasheed, Alroqi, Alsaleh) College of Medicine; and from the College of Medicine (bin Obaid, Almousa, Ismail, Mahjoub), King Saud University, Riyadh, Kingdom of Saudi Arabia.
| |
Collapse
|
7
|
Alqurashi A, Albaharna H, Alshareef M, Noor Elahi B, Alromaih S, Alrasheed A, Alroqi A, Alsaleh S, Ajlan A. Classification of Endoscopic Transnasal Lateral Skull-base Approaches: Anatomical Study. World Neurosurg 2023; 173:e559-e570. [PMID: 36842530 DOI: 10.1016/j.wneu.2023.02.093] [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: 12/17/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVES Endoscopic Transnasal Approaches (ETA) to the ventrolateral skull-base is commonly classified according to coronal plans or anatomical structures. Our goal is to simplify the description of the ETA to lateral skull-base regions in a sequential dissection with correlation to computed tomography, helping in pre-operative planning, efficient surgical exposure, and exposing the surgical anatomy limitations. METHODS Five fresh injected cadaver heads were dissected using an extended ETA to lateral skull-base. Each specimen underwent a high-resolution computed tomography scan. A classification of the lateral skull-base based on well-defined zones was proposed. RESULTS We divided the lateral target into four different zones, in a craniocaudal orientation. • Zone 1 is the space lying between the orbital floor superior and the level of the sellar floor inferior. • Zone 2 On a coronal plane, located between the level of the sellar floor and vidian canal. • Zone 3 is the area lateral to the anterior limb of the petrooccipital fissure, located between the vidian canal and the carotid canal. • Zone 4 is the space located between the carotid canal and extracranial opening of the hypoglossal canal, lateral to the anterior part of the posterior limb of petrooccipital fissure. CONCLUSION Multiple previous works are described and classified the coronal plan and its lateral extensions. Our classification system for the proposed lateral zones enables preoperative planning to select a suitable approach. The craniocaudal orientation facilitates the understanding of surgical corridors and tailored exposure.
Collapse
Affiliation(s)
- Ashwag Alqurashi
- Division of Neurosurgery, Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hussain Albaharna
- Department of Otolaryngology-Head & Neck Surgery, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Mohammad Alshareef
- Department of Otolaryngology-Head & Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait, Saudi Arabia
| | - Basim Noor Elahi
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alrasheed
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Ahmad Alroqi
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| |
Collapse
|
8
|
Alromaih S, Aloraini N, Alrasheed A, Alroqi A, Alsaleh S. Temporary Submucosal Inferior Maxillary Antrostomy: A Modification of the Inferior Antrostomy. Cureus 2023; 15:e34530. [PMID: 36879690 PMCID: PMC9984911 DOI: 10.7759/cureus.34530] [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] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Complete removal of maxillary sinus pathology can be challenging in specific locations. In the past, the Caldwell-Luc procedure was used for maxillary sinus disease. Currently, the endoscopic middle meatal antrostomy (EMMA) approach is used. However, it can often be difficult to reach certain locations of lesions by EMMA alone, requiring an endoscopic inferior meatal antrostomy (EIMA), which has been reported in the literature to have numerous complications. Furthermore, multiple techniques have been suggested for a combined bi-meatal approach to remove such lesions. We present a case of a 17-year-old with a challenging antrochoanal polyp (ACP) location requiring EIMA. The patient underwent our modified technique of submucosal inferior antrostomy with mucosal flap with no observed intra-operative and post-operative complications. Maxillary sinus pathology can be challenging due to limited access to specific regions. In this case report, we present a novel technique to achieve a temporary inferior antrostomy through a minimally invasive approach with a promising post-operative course.
Collapse
Affiliation(s)
- Saud Alromaih
- Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, SAU
| | - Nouf Aloraini
- Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, SAU
| | | | - Ahmad Alroqi
- Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, SAU
| | - Saad Alsaleh
- Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, SAU
| |
Collapse
|
9
|
Assiri K, Alroqi A, Alromaih S, Alzarei A. Impact of Preoperative Steroids Administration on Endoscopic Sinus Surgery: Systematic Review of Literature, and a Survey in Saudi Arabia. Indian J Otolaryngol Head Neck Surg 2022; 74:4612-4622. [PMID: 36742850 PMCID: PMC9895580 DOI: 10.1007/s12070-021-02888-z] [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: 05/15/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023] Open
Abstract
There is limited knowledge in the literature and lack of clear protocols among practitioners regarding preoperative steroids administration for patients undergoing endoscopic sinus surgery (ESS). This study aimed to identify the practice patterns of rhinologists in Saudi Arabia as well as systematically review all health-related evidence regarding the use of preoperative steroids for ESS. A previously used questionnaire was modified and distributed in Saudi Arabia among rhinologists who finished their residency training. It entailed questions about their qualifications and preoperative steroids use, preferred regimen, and possible benefits. Also, a systematic literature review using four major databases was conducted to build a scoping view of the current evidence. A total of 94 subjects responded to the mailed survey. Of them, 72(76.6%) used preoperative steroids; 40 subjects believed that there is a strong supporting evidence while 32 reported that there is no solid evidence. The commonest indication was chronic rhinosinusitis with nasal polyp followed by allergic fungal rhinosinusitis. More than half of subjects (54.2%) preferred medium-dose prednisone (30-40 mg/day). A considerable number believed that steroids decreased surgical bleeding (n = 57, 79.2%), improved surgical field visualization (77.8%), decreased surgical time (77.8%), and decreased mucosal inflammation (61.1%). Thirteen studies including 1028 patients were eligible for the systematic review. Only three studies reported a statistically significant effect of steroids in reducing intraoperative hemorrhage, while only two studies revealed that steroids significantly improved surgical field quality. In two studies, steroids showed a significant effect in reducing eosinophil infiltration. There is a major number of rhinology experts using preoperative steroids for patients undergoing ESS but there is a wide variation among their practice patterns. The current potential advantages of steroids need to be supported by further large randomized clinical trials to establish clear guidelines.
Collapse
Affiliation(s)
- Kholood Assiri
- Rhinology and Skull Base Surgery Consultant, Otorhinolaryngology, Head and Neck Surgery, King Faisal Medical City, P.O Box 10031, Abha, 61431 Saudi Arabia
| | - Ahmad Alroqi
- Rhinology and Skull Base Surgery Consultant, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Rhinology and Skull Base Surgery Consultant, Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alzarei
- Rhinology and Skull Base Surgery Consultant, Department of Otolaryngology, Head and Neck Surgery, Aseer Central Hospital, Abha, Saudi Arabia
| |
Collapse
|
10
|
Alromaih S, Alsagaf L, Aloraini N, Alrasheed A, Alroqi A, Aloulah M, Alsaleh S, Alhawassi T. Drug-Induced Rhinitis: Narrative Review. Ear Nose Throat J 2022:1455613221141214. [PMID: 36377650 DOI: 10.1177/01455613221141214] [Citation(s) in RCA: 1] [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: 12/22/2023] Open
Abstract
OBJECTIVES Rhinitis, one of the most common inflammatory conditions of the nasal mucosa, is known to affect a large proportion of people worldwide. It is generally classified into allergic and non-allergic types and both are associated with several unpleasant symptoms. Several medications prescribed for different medical conditions can cause unpleasant rhinitis as an adverse effect, which is known as drug-induced non-allergic rhinitis. The aims of this article were to review the literature to identify drugs that could induce rhinitis, prevalence of drug-induced rhinitis, and the associated pathogenic mechanisms if known. METHODS Literature search screening for eligible papers published up to December 31st, 2021, in Medline (via PubMed) and Embase was conducted. The search included the following combination of keywords and terms: rhinitis, sneezing, congestion, allergic, non-allergic, rhinorrhea, vasomotor, medication, drug-induced. RESULTS The review findings suggest that 12 subtypes of drugs potentially could induce rhinitis. Based on their mechanisms of action, the pathogenic causes for the induction of rhinitis have been recognized for some drugs, while others remain unknown. CONCLUSION Awareness of the list of drugs that reportedly induce non-allergic nasal symptoms, along with taking the patient's medication history, is important in the diagnosis of rhinitis.
Collapse
Affiliation(s)
- Saud Alromaih
- Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Lamya Alsagaf
- Pharmaceutical Science - College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Aloraini
- Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alrasheed
- Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Alhawassi
- Department of Clinical Pharmacy - College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
11
|
Aldajani A, Alroqi A, Alromaih S, Aloulah MO, Alsaleh S. Adverse events of biological therapy in chronic rhinosinusitis with nasal polyps: A systematic review. Am J Otolaryngol 2022; 43:103615. [DOI: 10.1016/j.amjoto.2022.103615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
|
12
|
Alromaih S, Yaghmoor F, Alarifi I, Alsaleh S, Alroqi A, Aloulah M, Almusa A, Ajlan A, Sumaily I. Graft-Extended Nasoseptal Flap for Endoscopic Anterior Skull Base Reconstruction: A Novel Technique. Indian J Otolaryngol Head Neck Surg 2022; 74:1344-1347. [PMID: 36452736 PMCID: PMC9701919 DOI: 10.1007/s12070-021-02490-3] [Citation(s) in RCA: 1] [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] [Received: 12/09/2020] [Accepted: 02/22/2021] [Indexed: 11/27/2022] Open
Abstract
Reconstruction of the anterior part of the anterior skull base with a nasoseptal flap (NSF) is technically demanding. This challenge is mainly related to the real possible length of the flap. Herein, we describe a new technique for extending the NSF such that it can sufficiently cover the far anterior part of the anterior skull base. Three cadaveric heads were used for mucosal graft extension of the NSF. The graft was harvested from the other side, sutured to the NSF, then repositioned over the skull base after opening all the paranasal sinuses. Each head was operated by a rhinologist and a skull base surgeon. The study variables were the initial length of the NSF, the length of the graft harvested, the new length of the graft-extended NSF, and the length of the new graft-extended NSF from the nasal spine. The average length of the NSFs was 6.4 cm (± 0.2); that of the harvested grafts was 2.93 cm (± 0.1); that of the graft-extended NSF was 9.33 cm (± 0.4); and that of the graft-extended NSF from the nasal spine was 3.93 cm. The graft-extended NSF is an easy and extremely useful technique for the reconstruction of the far anterior parts of the skull base. However, further prospective studies on the clinical usefulness of this technique and its long-term results are yet to be performed. Level of evidence: IV.
Collapse
Affiliation(s)
- Saud Alromaih
- Department of Otorhinolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faris Yaghmoor
- Neurosurgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Alarifi
- Otorhinolaryngology Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otorhinolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otorhinolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otorhinolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Almusa
- Neurosurgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- ENT Department, King Fahd Central Hospital, Jazan, Saudi Arabia
| |
Collapse
|
13
|
Alshareef M, Alroqi A, Albaharna H, Alsayed A, Alromaih S, Alrasheed AS, Ajlan A, Alsaleh S. Nasoseptal flap and rigid reconstruction in endoscopic endonasal skull base surgeries: The longitudinal experience of a single center. Ear Nose Throat J 2022:1455613221099483. [PMID: 35603535 DOI: 10.1177/01455613221099483] [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: 11/16/2022] Open
Abstract
BACKGROUND Recently, endoscopic endonasal approaches (EEA) have been used for skull base defect reconstruction surgeries. The nasoseptal flap (NSF), a vascular pedicled flap, was introduced to decrease postoperative cerebrospinal fluid (CSF) leakage. PURPOSES This study aimed to outline the authors' institutional experience using NSF and rigid implants in anterior skull base defect reconstruction surgeries following EEA. DESIGN A retrospective cohort review of patients who underwent NSF reconstruction following EEA in the Otorhinolaryngology and Neurosurgery Departments at King Saud University Medical City, Riyadh, Saudi Arabia, from January 2015 to May 2021, divided into 2 time periods according to the reconstruction technique. RESULT Out of the 106 patients who underwent EEA, 77 underwent NSF reconstruction. The majority had expanded EEA (94.8%). The mean age was 40.21 ± 17.7 years, and the female gender represented 61% of the sample. More than half of the sample underwent right NSF (57.1%). Meningioma was the most common diagnosis (45.5%). The clivus was the most frequent site of lesions (23.4%). The overall rate of postoperative CSF leakage and lumbar drainage (LD) insertion was 15.6% and 51.9%, respectively. The duration of LD was a median of four days. The overall failure rate was 13%, declining from 20% in the first period to 5.4% in the second period. Rigid implants were used significantly more in the first period than in the second period (67.5% versus 16.2%, P < 0.001). Meningitis, the highest postoperative complication, was reported in 6 patients (7.8%). One patient died three weeks postoperatively after massive nasal bleeding. No significant difference was found between either side of the NFS regarding the CSF leakage and failure rate. CONCLUSION In the authors' experience, there has been an overt decline in failure rates and complications of EEA over the last three years due to increased experience among surgeons and a standardization of reconstruction techniques. Minimal reconstruction may provide satisfactory results by decreasing the use of rigid implants. An endoscopic endonasal approach with an NSF for anterior skull base defect reconstruction is considered a safe procedure with no significant difference between the sides of the flap.
Collapse
Affiliation(s)
- Mohammad Alshareef
- Department of Otolaryngology-Head and Neck Surgery, Khamis Mushait General hospital - Khamis Mushait City, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 191082King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 191082King Saud University, Riyadh, Saudi Arabia
| | - Hussain Albaharna
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 191082King Saud University, Riyadh, Saudi Arabia
- Department of Otolaryngology-Head and Neck Surgery, 48070Qatif Central Hospital - Qatif City, Saudi Arabia
| | - Ahmed Alsayed
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 191082King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 191082King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz S Alrasheed
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 191082King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Department of Neurosurgery, 191082College of Medicine King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 191082King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
14
|
Sumaily I, Jomaah M, Alarifi I, Alromaih S, Aloulah M, Ajlan A, Alroqi A, Alsaleh S. Extent of Nasal Irrigation in Non-operated Sinuses: A Cadaveric Trial. Ear Nose Throat J 2022:1455613221081567. [PMID: 35220780 DOI: 10.1177/01455613221081567] [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: 11/15/2022] Open
Abstract
BACKGROUND Nasal irrigation is among the most widely used treatment modalities for sinonasal diseases. The extent of irrigation is well studied in operated sinuses but not for non-operated sinuses. Moreover, the preferred head positioning during irrigation is not known. Herein, we studied the extent of nasal irrigation in cadaveric heads with non-operated sinuses. METHODS Nine cadaveric heads were used. Normal saline solution mixed with radiological contrast material was used to irrigate the nasal cavities with the heads in 2 different positions: standing-leaning-forward (SLF) and Head-down forward (HDF). After each irrigation, computed tomography images of the head were acquired. The extent of irrigation was assessed for each subunit of the sinonasal cavity. RESULTS Irrigation was performed twice on a total of 18 sides, each time in 1 position. Nine subunits were evaluated: inferior, middle, and superior meati; the olfactory cleft; and the frontal, maxillary, anterior, and posterior ethmoid and sphenoid sinuses. The extent of irrigation was significantly better in the HDF position for the olfactory cleft (100% vs 33%), P-value=.001, frontal sinus (33% vs 11%), P-value=.002, maxillary sinus (78% vs 17%), P-value=.001, and anterior ethmoid sinus (89% vs 17%), P-value=.001. There was no significant difference in the extent of irrigation between the 2 positions for the other evaluated subunits. The overall extent of irrigation was 70.37% of the subunits in HDF position and 45.06% of the subunits for SLF position, P-value= .001. CONCLUSIONS Nasal irrigation reached the cavities of non-operated paranasal sinuses. However, while the extent of irrigation was limited in the SLF, it was well achieved in the HDF position. Studies on the clinical efficacy of irrigation in this position are recommended.
Collapse
Affiliation(s)
- Ibrahim Sumaily
- Department ENT, 48134King Fahd Central Hospital in Jazan, Saudi Arabia
| | - Mohammad Jomaah
- Department Otolaryngology, 191082King Saud University College of Medicine, Saudi Arabia
| | - Ibrahim Alarifi
- Department Otorhinolaryngology, 48061Security Forces Hospital in Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department Otolaryngology, 191082King Saud University College of Medicine, Saudi Arabia
| | - Mohammad Aloulah
- Department Otolaryngology, 191082King Saud University College of Medicine, Saudi Arabia
| | - Abdulrazag Ajlan
- Neurosurgery Division, 191082King Saud University College of Medicine, Saudi Arabia
| | - Ahmad Alroqi
- Department Otolaryngology, 191082King Saud University College of Medicine, Saudi Arabia
| | - Saad Alsaleh
- Department Otolaryngology, 191082King Saud University College of Medicine, Saudi Arabia
| |
Collapse
|
15
|
Albaharna H, Alshareef M, Alromaih S, Aloulah M, Alsaleh S, Alroqi A. Topical Intranasal Fluorescein to Diagnose and Localize Cerebrospinal Fluid Leak: A Systematic Review. Turk Arch Otorhinolaryngol 2021; 59:223-229. [PMID: 34713008 PMCID: PMC8527542 DOI: 10.4274/tao.2021.2021-3-12] [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: 03/31/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: This study evaluates the available evidence regarding using topical intranasal fluorescein (TINF) to diagnose and localize nasal cerebrospinal fluid (CSF) leak. Methods: A literature search was conducted through PubMed, the Cochrane Database, Scopus, and Ovid to identify the articles providing insight into using TINF to diagnose CSF leak preoperatively or to localize the leak intraoperatively. The articles from the database were screened and filtered by two authors according to the selection criteria. A spreadsheet was created to collect the data including demographic characteristics, the sensitivity and specificity of TINF for diagnosing and localizing a CSF leak, the protocol of applying TINF, and the complications. Results: After excluding duplicates and articles that did not meet our selection criteria, we included five reports in the final analysis. The average age of the 94 participants was 39.5, and there was an equal distribution of males and females. The sensitivity of TINF to make a preoperative diagnosis of CSF leak was 100%, and it was 97% to localize the site intraoperatively. Complications associated with TINF were not reported in any of the reports. This review showed a grade C recommendation based on five case series. Conclusion: Based on the current evidence, TINF cannot be recommended for standard clinical practice. It can, however, be considered in situations where other gold standard tools are unavailable since it is feasible and easy to use. A standardized control trial should be conducted to yield additional unbiased evidence.
Collapse
Affiliation(s)
- Hussain Albaharna
- Department of Otolaryngology-Head and Neck surgery, Qatif Central Hospital, Qatif, Eastern province, Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alshareef
- Department of Otolaryngology-Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait City, Saudi Arabia.,Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology-Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
16
|
Al Abdulsalam HK, Aldahish AK, Albakr A, Hussain S, Alroqi A, Alromaih S, Alsaleh S, Ajlan AM. Endoscopic Transnasal Resection of Midline Skull Base Meningiomas: Tumor Consistency and Surgical Outcomes. J Neurol Surg B Skull Base 2021; 82:500-505. [PMID: 34513555 DOI: 10.1055/s-0040-1714111] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/18/2020] [Indexed: 10/23/2022] Open
Abstract
Background The endoscopic transnasal approach (ETA) has proven to be of great value in the resection of midline skull base meningiomas when compared with traditional approaches. Our objective was to assess tumor consistency in relation to surgical outcomes for midline meningiomas (MMs) resected using ETA. Methods Radiological preoperative features, including the tumor to cerebellar peduncle T2-weighted magnetic resonance imaging (MRI) ratio (TCTI), were evaluated. The intraoperative consistency assessment was performed by the surgeon, which determined if the tumor was soft (resectable by suction) or firm (required a cavitation ultrasonic aspirator). Surgical resection and postoperative complications were evaluated in relation to tumor consistency. Results Twenty patients were evaluated; 6 were classified as firm and 14 were classified as soft. The mean TCTI ratio was 1.7 and the median was 1.7 (range: 1.3-2.4). Three firm tumors had a ratio of <1.6. All soft tumors had a ratio of ≥1.6 with three outliers. Additionally, 66.7% of patients with firm tumors had complications compared with 35.7% of patients with soft tumors. Only 33.3% of firm tumors underwent gross total resection (GTR) in comparison to 79.0% of tumors with a soft consistency. Conclusion In our analysis, we found that tumor consistency was significantly related to short-term surgical outcomes in MMs resected using the ETA. The TCTI ratio was found to be the most reliable predictor with a sensitivity of 76.9% and a specificity of 40.0%. Our findings suggest that traditional cranial approaches should be considered as the first surgical option for managing firm MMs.
Collapse
Affiliation(s)
| | - Aljohara K Aldahish
- Department of Surgery, Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Albakr
- Department of Surgery, Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sajjad Hussain
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Otolaryngology-Head and Neck Surgery Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Otolaryngology-Head and Neck Surgery Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Otolaryngology-Head and Neck Surgery Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag M Ajlan
- Department of Surgery, Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Neurosurgery, Stanford School of Medicine, Palo Alto, California, United States
| |
Collapse
|
17
|
Alromaih S, Aloraini N, Alqaryan S, Sumaily I. Isolated intramaxillary sinus cell causing long-standing facial pain: A case report. Int J Surg Case Rep 2021; 85:106188. [PMID: 34265587 PMCID: PMC8282953 DOI: 10.1016/j.ijscr.2021.106188] [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: 05/30/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Sinus pneumatization by definition is a cystic enlargement within the paranasal sinuses, and that expansion causes clinical symptoms. Importance This case highlights the importance of identifying clinically significant sinus pneumatization and the significant role of surgical treatment. Case presentation This case report describes a clinical presentation of intramaxillary sinus cell affecting the patient's quality of life. Despite the rare location of the cyst, it was diagnosed by computed tomography and managed by Functional Endoscopic Sinus surgery (FESS). Clinical discussion This case discussion describes the nomenclature, classifications, location and the treatment of sinus pneumatic dilatations. Conclusion Our case demonstrates the importance of managing the underlying cause of the patient symptoms by a thorough history and physical examination and it can be confirmed by imaging. Symptomatic maxillary air cysts, albeit controversial in its nomenclature and mechanism, should be addressed surgically as it carries high levels of success. A unique symptom of intramaxillary sinus cell is facial pain, which is due to irritation of the trigeminal nerve. CT is considered the gold standard for diagnosis of this entity. This case highlights the importance of Surgery for severe symptoms with excellent prognosis and no reported recurrence.
Collapse
Affiliation(s)
- Saud Alromaih
- Department of Otolaryngology - Head & Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
| | - Nouf Aloraini
- Otolaryngology - Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia.
| | - Saleh Alqaryan
- Otolaryngology - Head and Neck Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- Otolaryngology - Head and Neck Surgery, King Fahad Central Hospital in Jazan, Saudi Arabia
| |
Collapse
|
18
|
Alshareef M, Alsaleh S, Albaharna H, Alghulikah A, Aloulah M, Alroqi A, Alromaih S, Alanazy FH, Al-Dousary S. Utilization of telemedicine in rhinologic practice during COVID-19 pandemic. Am J Otolaryngol 2021; 42:102929. [PMID: 33508591 PMCID: PMC7817525 DOI: 10.1016/j.amjoto.2021.102929] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The only two preventive interventions available for COVID-19 have been social distancing and quarantine. These preventive measures challenge health care providers by causing cancelations of elective in-person outpatient clinic visits in many hospitals, particularly in otolaryngology clinics. OBJECTIVES To assess the applicability and feasibility of telemedicine in rhinology cases with a study of outcomes to guide rhinologists on indications of in-office visits. Assessment of patient satisfaction with telemedicine in the rhinology clinic was also investigated. METHODS A retrospective review of electronic charts of all adult patients (>18 years) who were scheduled in the rhinology clinics of King Abdulaziz University Hospital, Riyadh, Saudi Arabia, and received a phone call as a part of telemedicine care from April through June 2020. Demographics (including age and gender), diagnosis, plan of treatment, and status of the visit (either new or follow-up) were collected. In addition, we used a special questionnaire to measure the satisfaction rate among patients who received telemedicine services. RESULTS A total of 339 patients were included. The mean age was 41 years with 60.2% males. Only 5 cases (1.48%) were asked to attend to the clinic. The vast majority of cases were given a follow-up (n = 311, 91.7%). The most common diagnosis among the follow-up cases was chronic rhinosinusitis with nasal polyposis (n = 130, 38.3%). The satisfaction telephone survey had a total of 41 respondents out of 80 cases selected randomly. Most respondents (83.3%) were satisfied with telemedicine services. CONCLUSION We conclude that telemedicine proved its effectiveness in the efficient management and screening of rhinology cases during public health emergencies while providing sufficient protection for patients and medical practitioners. Telemedicine as a modality of care during the pandemic faced minor or no opposition given patients' understanding of the importance of social distancing.
Collapse
Affiliation(s)
- Mohammad Alshareef
- Department of Otolaryngology-Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait City, Saudi Arabia; Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Hussain Albaharna
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Otolaryngology-Head and Neck Surgery, Qatif Central Hospital, Qatif City, Saudi Arabia
| | - Abdulrahman Alghulikah
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatma H Alanazy
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Surayie Al-Dousary
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
19
|
Alromaih S, Sumaily I, Alarifi I, Alroqi A, Aloulah M, Ajlan A, Yaghmoor F, Alsaleh S. Seeker Uncinectomy: A Randomized Controlled Cadaveric Trial. Allergy Rhinol (Providence) 2020; 11:2152656720971262. [PMID: 33240562 PMCID: PMC7672718 DOI: 10.1177/2152656720971262] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Endoscopic sinus surgery is a common surgery, in which the uncinate process of the ethmoid is removed as the first surgical step. There are multiple techniques for uncinectomy. Herein we describe a new and simple uncinectomy technique. Methods We performed a randomised controlled trial with blinded assessors. Eight cadaveric heads were used to compare the new technique to the commonly used technique; retrograde uncinectomy. The procedures were performed by 2 rhinologists, and the findings were evaluated by 2 senior rhinologists blinded to the technique and the surgeon who did. They assessed the final view of the procedure and the complications. Thereafter, they assessed the procedure for the duration and ease of each technique for teaching purposes. Results Fifteen uncinectomies were performed, 7 using the retrograde technique, and 8 using the new technique. The mean durations were 5.64 min using the seeker uncinectomy and 7.57 min using the retrograde uncinectomy, p-value = 0.017. The completion was better in seeker uncinectomy; however, not significant statistically, p > 0.05. The complications with the new technique were inferior turbinate injury in 12.5% and natural ostium non-identification in 12.5%, p > 0.05. With retrograde uncinectomy, lacrimal injury occurred in 14.3%, p > 0.05. The ease of teaching scores was higher for the seeker uncinectomy. Conclusion Based on this cadaveric trial, seeker uncinectomy seems to be a safe and easy to perform technique. However, injury to the inferior turbinate and missing the natural ostium must be taken into consideration. These warrant further studies on the clinical application of this procedure.
Collapse
Affiliation(s)
- Saud Alromaih
- Rhinology Unit, Otorhinolaryngology Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- ENT Department, King Fahd Central Hospital, Jazan, Saudi Arabia
| | - Ibrahim Alarifi
- ENT Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Rhinology Unit, Otorhinolaryngology Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Rhinology Unit, Otorhinolaryngology Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Neurosurgery Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Faris Yaghmoor
- Neurosurgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Rhinology Unit, Otorhinolaryngology Department, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
Endam LM, Alromaih S, Gonzalez E, Madrenas J, Cousineau B, Renteria AE, Desrosiers M. Intranasal Application of Lactococcus lactis W136 Is Safe in Chronic Rhinosinusitis Patients With Previous Sinus Surgery. Front Cell Infect Microbiol 2020; 10:440. [PMID: 33154953 PMCID: PMC7586919 DOI: 10.3389/fcimb.2020.00440] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 02/05/2020] [Accepted: 07/16/2020] [Indexed: 12/21/2022] Open
Abstract
Objective: Modulation of the dysbiotic gut microbiome with “healthy” bacteria via a stool transplant or supplementation is increasingly practiced, however this approach has not been explored in the nasal passages. We wished to verify whether Lactococcus lactis W136 (L. lactis W136) bacteria could be safely applied via irrigation to the nasal and sinus passages in individuals with chronic rhinosinusitis (CRS) with previous undergone endoscopic sinus surgery, and whether this was accompanied by bacterial community flora modification. Study Design: Prospective open-label pilot trial of safety and feasibility. Setting: Academic tertiary hospital center. Subjects and Methods: Twenty-four patients with CRS refractory to previous medical and surgical therapy received a 14-day course of BID sinus irrigations containing 1.2 × 109 CFU live L. lactis W136. Patients were monitored for safety using questionnaire, sinus endoscopy, otoscopy, UPSIT-40 smell testing, and endoscopically-obtained conventional sinus culture and a swab for 16S microbiome profiling. Results: All 24 patients receiving at least one treatment successfully completed treatment. L. lactis W136 probiotic treatment was safe, with no major adverse events or new infections. Treatment was associated with improvement in sinus symptoms, QOL, and mucosal scores, which remained improved during the subsequent 14-day observation period. Microbiome changes associated with treatment were limited to an increase of the pathobiont Dolosigranulum pigrum, a bacteria identified as potentially beneficial in the upper airways. Subgroup analysis suggested differences in microbiomes and responses for CRSsNP and CRSwNP phenotypes, but these did not attain significance. Conclusion: Intranasal irrigation of live L. lactis W136 bacteria to patients with refractory chronic rhinosinusitis was safe, and was associated with effects on symptoms, mucosal aspect and microbiome composition. Intranasal bacteria may thus find a role as a treatment strategy for CRS. Clinical Trials Registration:www.ClinicalTrials.gov. identifier: NCT04048174.
Collapse
Affiliation(s)
- Leandra Mfuna Endam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Saud Alromaih
- Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Emmanuel Gonzalez
- Department of Microbiology and Immunology, Microbiome and Disease Tolerance Centre (MDTC), McGill University, Montreal, QC, Canada
| | - Joaquin Madrenas
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Benoit Cousineau
- Department of Microbiology and Immunology, Microbiome and Disease Tolerance Centre (MDTC), McGill University, Montreal, QC, Canada
| | - Axel E Renteria
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Martin Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| |
Collapse
|
21
|
Maniakas A, Asmar MH, Renteria AE, Nayan S, Alromaih S, Endam LM, Sampalis JS, Desrosiers M. Azithromycin in high-risk, refractory chronic rhinosinusitus after endoscopic sinus surgery and corticosteroid irrigations: a double-blind, randomized, placebo-controlled trial. Int Forum Allergy Rhinol 2020; 11:747-754. [PMID: 32929891 DOI: 10.1002/alr.22691] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Refractory chronic rhinosinusitis (CRS) remains a significant burden for patients, often leaving them with few therapeutic options that provide low-morbidity, long-term, and meaningful symptomatologic and endoscopic disease improvement. Macrolides have long been thought to offer both an immunomodulatory and antimicrobial effect. Our objective was to evaluate the efficacy of low-dose, long-term azithromycin in a carefully selected high-risk population failing appropriate medical therapy of budesonide nasal irrigations (BNIs) and endoscopic sinus surgery (ESS). METHODS A double-blind, randomized, placebo-controlled trial was completed in a single tertiary-care center assessing the addition of 250 mg azithromycin, 3 times per week for 16 weeks, in adults failing ESS and high-volume BNIs. Associated comorbidities, as well as symptomatologic, microbiologic, and serologic values, were systematically collected. RESULTS A total of 128 patients were enrolled and underwent ESS followed by BNI. At the 4-month post-ESS visit, 48 patients showed disease persistence and were randomized to azithromycin or placebo. Overall, azithromycin, when compared with placebo, did not show a statistically significant difference in disease clearance (54% vs 33%, respectively; p = 0.146), although patients with disease clearance who were on azithromycin showed significantly better 22-item Sino-Nasal Outcome Test score improvements than patients on placebo (18 vs -0.9, respectively; p = 0.046). In a subgroup analysis excluding aspirin-exacerbated respiratory disease (AERD) patients, azithromycin significantly improved disease clearance when compared with placebo (71% vs 35%, respectively; p = 0.031), with a number needed to treat of 3 (2.8). CONCLUSION Low-dose azithromycin is a therapeutic option with few side effects. Its use can show favorable clinical outcomes in this difficult-to-treat population, especially if patients are AERD-negative.
Collapse
Affiliation(s)
- Anastasios Maniakas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Division of Experimental Surgery, McGill University, Montréal, Québec, Canada
- Division of Otolaryngology-Head & Neck Surgery, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - Marc-Henri Asmar
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Axel Eluid Renteria
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Smriti Nayan
- Division of Otolaryngology-Head & Neck Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Cambridge Memorial Hospital, Cambridge, Ontario, Canada
| | - Saud Alromaih
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Leandra Mfuna Endam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - John Sam Sampalis
- Division of Experimental Surgery, McGill University, Montréal, Québec, Canada
- Medical Affairs, JSS Medical Research, Montréal, Québec, Canada
| | - Martin Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
22
|
Alromaih S, Alqaryan S, Alabood S, Alabaishi S, Ajlan A, Alsuhaibani A, Sumaily I, Alsolami A. Alveolar Soft-Part Sarcoma in Olfactory Cleft: A Case Report and Clinicopathological Review. Ear Nose Throat J 2020; 101:336-341. [PMID: 32931333 DOI: 10.1177/0145561320955134] [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: 11/15/2022] Open
Abstract
Sinonasal alveolar soft-part sarcoma (ASPS) is a rare malignant disease that comprises 0.4% to 1.2% of all soft-tissue sarcomas. Alveolar soft-part sarcoma is usually difficult to diagnose because it has many clinical and pathological mimickers. In this case study, ASPS occurred in the olfactory cleft, representing the second case in this location in the literature. This article presents the clinical presentation, radiologic, and histopathological case, and reviews the literature regarding the differentials.
Collapse
Affiliation(s)
- Saud Alromaih
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, 37850King Saud University, Riyadh, Saudi Arabia
| | - Saleh Alqaryan
- Department of Otolaryngology-Head and Neck Surgery, 37850King Saud University Medical City, Riyadh, Saudi Arabia
| | - Saleh Alabood
- Medical Intern, College of Medicine, 48061Qassim University, Buraydah, Saudi Arabia
| | - Somaya Alabaishi
- Department of Anatomical Pathology, 48061Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Department of Neurosurgery, Faculty of Medicine, 37850King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alsuhaibani
- Oncology Center, University Medical City, 37850King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- ENT Department, King Fahd Central Hospital in Jizan, Jazan, Saudi Arabia
| | - Afaf Alsolami
- Department of Pathology, 534884King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
23
|
Abstract
BACKGROUND Endoscopic transnasal surgery has gained rapid global acceptance over the last two decades. The growing literature and understanding of anterior skull base endoscopic anatomy, in addition to new dedicated endoscopic instruments and tools, have helped to expand the use of the transnasal route in skull base surgery. OBJECTIVE Report our early experience in expanded endoscopic transnasal surgery (EETS) and approach to skull base neoplasms. DESIGN Descriptive, retrospective case series. SETTING Major tertiary care center. PATIENTS AND METHODS A retrospective case review was conducted at King Saud University Medical City between December 2014 and August 2019. Cases with skull base neoplasms that underwent EETS were included. EETS was defined as endoscopic surgical exposure that extended beyond the sellar margins (prechiasmatic sulcus superiorly, clival recess inferiorly, cavernous carotid lines laterally). Routine transsphenoidal pituitary neoplasms, neoplasms of sinonasal origin and meningoencephaloceles were excluded. MAIN OUTCOME MEASURES Preoperative clinical assessment, imaging results, surgical approach, and hospital course were all retrieved from the patient electronic charts. Clinical follow-up, perioperative complications, and gross residual tumor rates were documented and reviewed. SAMPLE SIZE AND CHARACTERISTICS 45 cases of EETS, 13 males and 32 females with mean age of 39.0 (17.7) years (range 2-70 years). RESULTS The series comprised a wide range of pathologies, including giant pituitary adenoma (8 cases), meningioma (23 cases), craniopharyngioma (4 cases), chordoma (4 cases), optic pathway glioma (2 cases), epidermoid neoplasms (2 cases), astrocytoma (1 case), and teratoma (1 case). For the entire series, gross total resection was achieved in 25/45 operations (55.5%). Postoperative cerebrospinal fluid leak was the most common complication observed in 9 patients (20%) which were all managed endoscopically. Major vascular complications occurred in 2 patients (4.4%) and are described. Other complications are outlined as well. No mortality was observed. CONCLUSIONS EETS to the skull base can be done with results comparable to traditional approaches. More work is needed to expand our experience, improve outcomes, and educate the public and medical community in our region about the usefulness of this approach. LIMITATIONS Sample size and study design. CONFLICT OF INTEREST None.
Collapse
Affiliation(s)
- Saad Alsaleh
- From the Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Albakr
- From the Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- From the Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alatar
- From the Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Salman Alroqi
- From the Department of Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- From the Division of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
24
|
Alarifi I, Alsaleh S, Alqaryan S, Assiri H, Alsukayt M, Alswayyed M, Alromaih S, Aloulah M, Alroqi AS, AlQahtani A, Sumaily I. Chronic Granulomatous Invasive Fungal Sinusitis: A Case Series and Literature Review. Ear Nose Throat J 2020; 100:720S-727S. [PMID: 32077324 DOI: 10.1177/0145561320904620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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
Chronic granulomatous invasive fungal sinusitis (CGIFS) is a peculiar disease of the paranasal sinuses due to its rarity, patient subset, and disease course. We describe 7 cases of histopathologically confirmed CGIFS with different treatment plans and varying outcomes. Of particular note was that one of these patients developed allergic fungal rhinosinusitis after complete resolution of his primary invasive disease, a finding that has never been reported in the literature. Another patient had an atypical fungal species (Aspergillus nidulans) on fungal stain and culture, while one immunodeficient patient had a large intracerebral disease component and died after 2 months of treatment. We also present a review of the pertinent literature investigating this rare disease.
Collapse
Affiliation(s)
- Ibrahim Alarifi
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Saleh Alqaryan
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Hassan Assiri
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alsukayt
- Department of Otorhinolaryngology, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alswayyed
- Department of Pathology and Laboratory Medicine, College of Medicine, 37850King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Salman Alroqi
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz AlQahtani
- Department of Otorhinolaryngology, 37849King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- Department of Otolaryngology, College of Medicine, 37950King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
25
|
Alhedaithy R, Alhussien A, Alroqi A, Alromaih S, Aloulah M, Alsaleh S. Intranasal endoscopic identification of the nasal septal L-strut: a cadaveric study. Int Forum Allergy Rhinol 2019; 9:934-938. [PMID: 30884203 DOI: 10.1002/alr.22335] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/04/2019] [Accepted: 02/27/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preserving the L-shaped strut during septoplasty is a crucial step in the prevention of several types of postoperative nasal deformities. In this study, we aimed to identify the intranasal anatomic landmarks to establish reliable and feasible measurements to preserve an adequate L-strut during an endoscopic septoplasty. METHODS A prospective study was conducted on 20 cadaver heads. Three measurements were studied within each side of the nasal cavity. The dorsal strut (DS) was measured from the dorsal line to the septal dorsum edge. Then, the caudal strut was measured from 2 different landmarks: the axilla of the inferior turbinate (CSIT) and the pyriform aperture (CSP). RESULTS We examined a total of 40 nasal cavities from 20 cadavers. The DS showed an average length of 15.1 mm (standard deviation [SD], 3.2 mm). The average lengths of the CSIT and CSP were 23.6 (SD, 3.6) mm and 19.4 (SD, 2.7) mm, respectively. CONCLUSION Suggested landmarks to identify the dorsal and caudal struts in endoscopic septoplasty are the axilla of the middle turbinate and pyriform aperture bone, respectively. The utilization of the inferior turbinate axilla as a caudal strut landmark showed larger variability and would potentially leave excessive caudal cartilage that could be manipulated if deviated.
Collapse
Affiliation(s)
- Riyadh Alhedaithy
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alhussien
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Rhinology & Endoscopic Skull Base Surgery Unit, Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saud Alromaih
- Rhinology & Endoscopic Skull Base Surgery Unit, Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Aloulah
- Rhinology & Endoscopic Skull Base Surgery Unit, Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Rhinology & Endoscopic Skull Base Surgery Unit, Otolaryngology-Head & Neck Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
26
|
Maniakas A, Asmar MH, Renteria Flores AE, Nayan S, Alromaih S, Mfuna Endam L, Desrosiers MY. Staphylococcus aureus on Sinus Culture Is Associated With Recurrence of Chronic Rhinosinusitis After Endoscopic Sinus Surgery. Front Cell Infect Microbiol 2018; 8:150. [PMID: 29868506 PMCID: PMC5962714 DOI: 10.3389/fcimb.2018.00150] [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] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/20/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives: Identify whether identification of S. aureus on conventional culture is a predictor of success or failure after ESS followed by budesonide nasal irrigations (BUD) in chronic rhinosinusitis (CRS) patients at high risk of recurrence. Methodology: Prospective clinical trial including 116 patients from a tertiary care center at high-risk of disease recurrence following ESS+BUD. Blood samples, microbial swabs, and SNSS/SNOT-22 were taken on the day of surgery (Visit-1) and 4 months postoperatively (Visit-2). Outcomes were evaluated using symptoms and mucosal status as assessed by the Lund-Kennedy endoscopic score. Results: Seventy-five patients (69.4%) attained SNOT-22 MCID or higher. (Mean = 33.4, range 9–75). Objective documentation of recurrence of disease, as defined by combined endoscopic/symptomatic criteria, was noted in 58/116 patients (50%). Revision surgery was associated with a significantly higher rate of disease recurrence (60.0 vs. 28.0%; p < 0.001). Culture for Staphylococcus aureus was associated with disease recurrence, preoperatively and at 4 months post-surgery (p = 0.020; p < 0.001). This was restricted to post-operative cultures in the revision group (10.0 vs. 48.8%; p < 0.001). Other factors associated with poor outcome included intolerance to non-steroidal anti-inflammatory drugs (NSAID) (p = 0.036). Significantly higher Lund-Kennedy scores in the recurrence groups despite similar symptom intensity, emphasizing the importance of considering objective outcome in addition to patient-reported ones. Conclusion: Patients undergoing revision ESS are at high risk of disease recurrence, even when budesonide irrigations are used post operatively. Presence of S. aureus on culture pre-operatively or at 4 months post-ESS is associated with a negative outcome. This suggests that S. aureus negatively influences outcome, possibly via a number of mechanisms, including interactions with the (i) immune system, (ii) regeneration and repair of the sinus epithelium, or (iii) via interference with the sinus microbiome. This suggests that S. aureus may be a simple and inexpensive biomarker for disease severity and indicates a clear need to better appreciate S. aureus on how it contributes mechanistically to disease development and persistence in order to develop targeted therapeutic strategies.
Collapse
Affiliation(s)
- Anastasios Maniakas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marc-Henri Asmar
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Axel E Renteria Flores
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Smriti Nayan
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada.,Department of Surgery, Cambridge Memorial Hospital, Cambridge, ON, Canada
| | - Saud Alromaih
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Leandra Mfuna Endam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Martin Y Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
27
|
Aldahish A, Hussain S, Albaker A, Alroqi A, Alromaih S, Alsaleh S, Ajlan A, Alajlan Z. Endoscopic Transnasal Resection of Midline Skull Base Meningioma: Tumor Consistency and Surgical Outcome. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
28
|
Schwartz JS, Al-Mot S, Endam MF, Alromaih S, Madrenas J, Desrosiers M. Bacterial immune evasion via an IL-10 mediated host response, a novel pathophysiologic mechanism for chronic rhinosinusitis. Rhinology 2017; 55:227-233. [PMID: 28315920 DOI: 10.4193/rhin16.199] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Staphylococcus aureus is a frequently implicated pathogen in chronic rhinosinusitis (CRS). S. aureus may promote commensalism by downregulating pro-inflammatory T cell host responses via an IL-10 mediated pathway. This finding, coupled with the observation that S. aureus and CD8+ T cell numbers are inversely correlated in CRS mucosa, suggests that S. aureus may evade immune destruction via IL-10 induction. To support this hypothesis, we evaluated i) whether IL-10 levels differ in CRS compared to controls (CTL) using microarray and immunohistochemistry and ii) whether IL-10 levels correlate with S. aureus and CD8+ T cell levels. METHODOLOGY Sinus epithelial brush samples from 12 patients undergoing ESS for CRS and 10 CTLs underwent microarray analysis of IL-10 gene expression. Microarray results were verified on simultaneously obtained surgical biopsy samples by immunohistochemistry staining for IL-10. Potential mechanisms were assessed by immunohistochemistry for CD8+ T cells and S. aureus. RESULTS IL-10 gene expression was significantly higher in CRS vs CTL subjects at the time of surgery. Immunohistochemistry confirmed increased levels of intraepithelial IL-10. A strong inverse correlation was observed between intraepithelial IL-10 and CD8+ T cell levels as was intraepithelial IL-10 and S. aureus. CONCLUSION Elevated IL-10 levels in sinus mucosa may be a potential pathophysiologic feature of CRS in association with a significant downregulation of host CD8+ T cell levels. While S. aureus is believed to play a role in IL-10 induction, a comparatively weaker relationship between S. aureus and IL-10 levels suggests other bacterial species may also induce IL-10 production as a common survival strategy in CRS.
Collapse
Affiliation(s)
- J S Schwartz
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - S Al-Mot
- Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, Canada
| | - M F Endam
- Centre de Recherche du Centre Hospitalier de l Universite de Montreal (CRCHUM), Montreal, Canada
| | - S Alromaih
- Department of Otolaryngology -Head and Neck Surgery, Faculty of Medicine King Saud University, Riyadh, Saudi Arabia
| | - J Madrenas
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
| | - M Desrosiers
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| |
Collapse
|
29
|
|
30
|
Gabra N, Alromaih S, Endam LM, Brito RM, Larivière F, Al-Mot S, LeDeist F, Desrosiers M. Clinical features of cytotoxic CD8+ T-lymphocyte deficiency in chronic rhinosinusitis patients: a demographic and functional study. Int Forum Allergy Rhinol 2014; 4:495-501. [PMID: 24639246 DOI: 10.1002/alr.21313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 01/04/2014] [Accepted: 01/07/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Identification of Staphylococcus aureus intracellularly in chronic rhinosinusitis (CRS) suggests an underlying cellular immunodeficiency. Supporting this, we have previously reported low CD8+ (cytotoxic) T-lymphocyte levels in a subpopulation of CRS patients and identified polymorphisms in the CD8A gene associated with CRS. In order to better understand the role of low CD8+ in CRS, we wished to determine the phenotype for CRS/Low CD8+ in comparison to that of conventional CRS. METHODS Sixty-seven low CD8+ CRS patients identified during investigation of CRS were compared for demographics, disease evolution, and bacteriology on endoscopic culture were compared with an existing population of 480 patients with CRS with nasal polyposis previously recruited for genetic association studies. RESULTS Mean level of CD8+ in the CRS/Low CD8+ population was 0.15 × 10(9)/L (range, 0.20-1.5 × 10(9)/L). There was no difference between both groups in terms of history of allergy, asthma, eczema, acetylsalicylic acid (ASA) intolerance or smoking. The bacteriology was similar between both groups (S. aureus: CRS/Low CD8+: 35%; CRS 32%, p = 0.643). Evolution of disease was somewhat milder in CRS/Low CD8+, with fewer patients requiring surgery, and first surgery performed at a more advanced age. However, antibiotic use was higher in CRS/Low CD8+. Subgroup analysis restricted to CRS with nasal polyposis (CRSwNP)/Low CD8 or CRS without nasal polyposis (CRSsNP)/Low CD8 phenotypes did not substantially alter these results. CONCLUSION Low CD8+ levels are often identified in CRS patients; however, these patients have disease remarkably similar to those with conventional CRS. This suggests that immune deficiency, whether systemic or locally mediated, is well tolerated and may be present in other forms in CRS. CRS patients with low CD8+ levels may possibly require antibacterial therapies as part of ongoing management.
Collapse
Affiliation(s)
- Nathalie Gabra
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Alromaih S, Mfuna-Endam L, Bosse Y, Filali-Mouhim A, Desrosiers M. CD8A gene polymorphisms predict severity factors in chronic rhinosinusitis. Int Forum Allergy Rhinol 2013; 3:605-11. [DOI: 10.1002/alr.21174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 02/28/2013] [Accepted: 03/19/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Saud Alromaih
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM); Montreal Canada
- Department of Otolaryngology-Head and Neck Surgery; Montreal General Hospital, McGill University; Montreal Canada
- Department of Otolaryngology; Faculty of Medicine, King Saud University; Riyadh Saudi Arabia
| | - Leandra Mfuna-Endam
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM); Montreal Canada
| | - Yohan Bosse
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec; Québec Canada
- Department of Molecular Medicine; Laval University; Québec Canada
| | - Abdelali Filali-Mouhim
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM); Montreal Canada
| | - Martin Desrosiers
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM); Montreal Canada
- Department of Otolaryngology-Head and Neck Surgery; Montreal General Hospital, McGill University; Montreal Canada
- Department of Otolaryngology; Hôtel-Dieu Hospital, Centre Hospitalier de l'Université de Montréal (CRCHUM); Montreal Canada
| |
Collapse
|