Anterior endoscopic sublabial transmaxillary access to middle cranial base lesions

BACKGROUND

Anterior endoscopic access to middle cranial base lesions becomes feasible in the presence of infratemporal fossa (ITF) involvement. Various approaches, including endoscopic endonasal, transoral sublabial, and transorbital methods, have been described for accessing the ITF through a transmaxillary corridor. Among these approaches, endonasal access is the most commonly preferred, while the transorbital approach is a novel technique gaining popularity. The transoral sublabial approach is considered suitable for selected lesions.

METHODS

Patients who underwent the anterior endoscopic transoral/sublabial transmaxillary approach to middle cranial base lesions at a single institute from 2016 to 2023 were included in this retrospective study. Malignant lesions were excluded from the study. The sublabial approach was exclusively performed in all cases, with the exception of one patient who required a combined approach.

RESULTS

The anterior endoscopic transoral sublabial transmaxillary approach to the infratemporal fossa, upper parapharyngeal space, and middle cranial fossa was performed on 14 patients. The underlying conditions for these patients were as follows: trigeminal schwannomas (n = 8), meningiomas (n = 2), juvenile nasopharyngeal angiofibroma, osteochondroma, arachnoid cyst and encephalocele (n = 1 each). Gross total resection was achieved in 11 cases. The most common complication was numbness in the territory of the maxillary and mandibular nerves (n = 4). Two patients needed endoscopic maxillary antrostomy for persistent suppuration. No wound problems or CSF rhinorrhea occurred. The average follow-up time was 26.6 months.

CONCLUSION

The endoscopic sublabial transmaxillary approach provides direct access to the infratemporal fossa and middle cranial base, enhancing the surgical range of maneuverability while sparing the sinonasal cavity. This procedure is safe, less invasive, and could be used as an efficient corridor for the resection of selected infratemporal fossa lesions with or without extension to the middle cranial base and parapharyngeal space.

Comparison of the Prevalence of Body Dysmorphic Disorder in Rhinoplasty Patients and its Influence on its Surgical Outcomes

Introduction

Body dysmorphic disorder (BDD) in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, is defined as one of pseudo-obsessive disorders; a class of obsessive-compulsive disorders. Whereas BDD has been weakly investigated among the Middle east population and there are little data about the prevalence of BDD in Iran especially in the northern part, in this study we tend to investigate the prevalence rate of BDD and its relationship with demographic factors and post-operative satisfaction in a sample of candidates for cosmetic and non-cosmetic surgery in Rasht.

Method

During an analytical cross-sectional study, we investigated the prevalence of BDD in 100 applicants for cosmetic surgery (rhinoplasty) and 100 applicants for non-cosmetic surgery (including septoplasty and FESS) who were referred to Amir Al-Momenin Hospital in 2022. The modified Yale-Brown Obsessive Compulsive Questionnaire was used to examine BDD. Also, postoperative satisfaction (3 months later) was evaluated and compared in these two groups through telephone calls. SPSS software version 22, Fisher's test, chi-square test, independent t-test, and multiple logistic regression analysis were used for statistical analysis of the collected data.

Results

The frequency of BDD in rhinoplasty applicants is significantly higher than the non-cosmetic surgery applicants (P-value = 0.005). The chance of BDD in rhinoplasty applicants is 4 times more than in non-cosmetic surgery applicants (P-value = 0.001, OR = 4.03). There is no significant difference in post-operative satisfaction between cosmetic and non-cosmetic surgery applicants (P-value = 0.975).

Conclusion

It is recommended that all applicants for cosmetic surgeries be examined with appropriate tools in terms of mental health before being accepted by surgeons so that they can be referred to psychiatrists if needed and unnecessary cosmetic surgery should be avoided.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04355-3.

The effect of injection of 1:100 000 adrenaline solution in the pterygopalatine fossa on intra-operative bleeding during endoscopic sinonasal surgical procedures in chronic sinusitis: a blinded clinical trial

OBJECTIVE

Rhinosinusitis is one of the most common reasons for a visit to otolaryngology clinics. Some patients are candidates for sinus surgery. Infiltration of 1:100 000 adrenaline in the pterygopalatine fossa was studied, with the aim of evaluating the effect on bleeding in the surgical field.

METHODS

This double-blind clinical trial was conducted in 2021-2022 on 40 candidates for endoscopic sinus surgery. For each patient, one side of the pterygopalatine fossa was randomly selected to be infiltrated with a vasoconstrictor. Surgical field bleeding on each side was evaluated.

RESULTS

Blood loss was 35.8 ± 20.9 ml in the study group and 38.4 ± 23.7 ml for the control group, with no statistically significant difference between groups (p = 0.49). In addition, there was no difference between the two groups in terms of the surgical field based on Boezaart scores.

CONCLUSION

Although there are some recommendations on the usage of vasoconstrictors via the pterygopalatine foramen, debate remains.

Investigation of the effects of intranasal desmopressin on the bleeding of the patients during open septorhinoplasty: A randomized double-blind clinical trial

Objectives

Rhinoplasty is one of the most common cosmetic surgeries in the world. Lack of adequate local homeostasis may lead to excessive bleeding during the operation, which increases the time of operation and recovery period, and the prevalence of complications. This study investigated the effects of nasal desmopressin on the quality of the surgical field and the volume of bleeding during rhinoplasty.

Materials and methods

This double-blind randomized clinical trial was performed on 120 patients aged 18-40 years who were candidates for rhinoplasty. Patients were randomly divided into three groups: low-dose desmopressin group and high-dose desmopressin group and placebo group. Hemodynamic changes and surgical field based on BOEZAART criteria, and the volume of bleeding were calculated.

Results

In this study 115 women (95.8%) and 5 men (4.2%) participated. The mean age of patients was (27 ± 6.8). Bleeding volume in high dose desmopressin group was (21.7 cc ± 12.3), (27.7 cc ± 12.3) in low dose group, and (38.3 cc ± 12.3) in the placebo group, The difference in blood volume among the three groups was statistically significant with p < 0.005. Clean surgical field according to BOEZAART classification was marginally significant in both desmopressin groups. The differences in blood pressure, heart rate, blood and urine sodium, and hemoglobin before and after surgery between groups there not statistically significant.

Conclusion

Based on the results of the present study topical nasal spray desmopressin can reduce surgical field bleeding during rhinoplasty. To generalize the results to other surgeries in the ENT field it is recommended to conduct studies.

Skull base osteomyelitis: A case report of Garcin syndrome due to mucormycosis in COVID pandemic

Garcin syndrome is characterized by progressive unilateral multiple cranial nerve palsy without the presence of intracranial hypertension. In this case, we present a patient who experienced lower cranial nerve (CN 9-12) involvement attributed to post-mucormycosis osteomyelitis of the skull base. The osteomyelitis resulting from mucormycosis led to the development of Garcin syndrome, which manifested as progressive paralysis of the cranial nerves. It is important to recognize this rare complication and consider it in the differential diagnosis when evaluating patients with lower cranial nerve palsy following mucormycosis-related skull base osteomyelitis.

Neonatal Hearing Screening and Prevalence of Hearing Impairment in the Time Period of COVID-19 Epidemic in the North of Iran

Background and Aim: COVID-19 is an acute respiratory disease, caused by a coronavirus named SARS-CoV-2. Previous reports suggest an association between COVID-19 infection and Hearing Loss (HL). We have investigated the Universal Newborn Hearing Screening (UNHS) results in the time period of COVID-19 epidemic in Guilan Province, north of Iran. Methods: We analyzed UNHS results from10 major obstetrics hospitals from 20th Mar 2020 to 19th Mar 2021, and compared the total UNHS positive/“refer” and total neonatal HL reports with the same time periods of recent three years. The prevalence of risk factors for HL were analyzed during the same period. Results: The total number of childbirth was decreased significantly from 27735 birth cases  in Mar 2017-2018 to 18216 births in Mar 2020-2021 (p<0.001), but the total “refer” rate was significantly increased from 63.0 per 1,000 births in Mar 2019-2020 to 79.8 in Mar 2020-2021 (OR=1.29, 95% CI: 1.19-1.39, p<0.001), and also increased from 74.7 per 1,000 births in Mar 2017-2020 to 79.8 in Mar 2020-2021 (OR=1.07, 95% CI: 1.01-1.14, p=0.020). The HL rate increased from 10.3 per 10,000 births in Mar 2019-2020 and from 11.4 per 10,000 births in Mar 2017-2020 to 18.7 in Mar 2020-2021 (OR=1.81 and 1.63, 95% CI: 1.06-3.09 and 1.10-2.44, p=0.028 and 0.015, respectively). The prevalence of preterm birth (p=0.039) and neonatal intensive care unit stay (p=0.016) was increased significantly during Mar 2020-2021. Conclusion: The chance of “refer” results and neonatal HL, found in the UNHS program, increased during the COVID-19 epidemic in comparison to the past years. Keywords: Newborn; hearing screening; hearing loss; COVID-19

Inflammatory Myofibroblastic Tumor: Two Cases in Head and Neck Region

Previously described as inflammatory pseudotumor, inflammatory myofibroblastic tumors (IMT) are now considered as distinct tumors of specific histopathologic features. This rare mesenchymal tumor consists of spindle shaped fibroblasts associated with various amounts of inflammatory cells. Head and neck region, is an unusual site of involvement. In this article, we will introduce two separate cases with the diagnosis of IMT involving the nasopharynx and the temporal bone which are both rare locations of presentation. Inflammatory myofibroblastic tumor should be considered in the differential diagnosis list of every mass in head and neck region.

Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial

OBJECTIVE

The present study was conducted to compare the rates of recovery from idiopathic sudden deafness after the treatment with oral and intratympanic corticosteroids in both mono and combination therapies.

STUDY DESIGN

Triple-blind randomized clinical trial.

SETTINGS

Tertiary referral hospital.

SUBJECTS AND METHODS

A total of 112 patients who were admitted to the ENT emergency department randomly divided into three groups: an oral corticosteroid plus intratympanic placebo (systemic corticosteroid monotherapy group); an intratympanic corticosteroid plus oral placebo group (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with antiviral and proton pomp inhibitor. An audiometry was performed once before beginning the therapies and again at the end of the therapy.

RESULTS

Of the total of 112 patients, 32 received intratympanic (IT) corticosteroids, 45 were receiving systemic corticosteroids, and 35 were receiving a combination of the two. A total of 74 patients (66.1%) responded positively [response to treatment was calculated as gain of at least 10 dB in 10 dB in average threshold or with the minimum improvement of 15% in speech discrimination scores (SDS)] to corticosteroid therapy. No significant differences were observed between the three groups (IT, systemic group, and combination therapy group) in their overall response to treatment (p = 0.5). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (p < 0.002). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (p < 0.001). The response to treatment was not related to the pattern (p = 0.04) and initial severity of hearing loss (p = 0.9).

CONCLUSION

This study did not find any difference in the rate of hearing improvement between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss.

LEVEL OF EVIDENCE

1b.

Esophageal Foreign Body: A Case Report of a Refractory Croup in a 20-Month-Old Boy

INTRODUCTION

Foreign body ingestion is common among children and more common in boys and in children under the age of 3. It can present with a wide variety of symptoms like dysphagia and drooling or symptoms related to the upper aerodigestive tract.

CASE REPORT

A 20-month-old male presented with refractory croup and poor feeding since 2 weeks. Bronchoscopy and esophagoscopy was performed due to suspicious history of eating loquat. The core of the fruit was found in the esophagus.

CONCLUSION

Physicians should be aware of the variability of esophageal foreign body presentations to prevent serious complications due to delay in diagnosis.

Dermoid Cyst Within Concha: A Case Report

Dermoid cysts are congenital anomalies derived from ectoderm. They are rare in head and neck region and especially in pinna. We presented an 8-year-old girl with a dermoid cyst in the conchal region of auricle which was treated with complete surgical resection.

Frequency of Congenital Heart Diseases in Prelingual Sensory-Neural Deaf Children

INTRODUCTION

Hearing impairment is the most frequent sensorial congenital defect in newborns and has increased to 2-4 cases per 1,000 live births. Sensory-neural hearing loss (SNHL) accounts for more than 90% of all hearing loss. This disorder is associated with other congenital disorders such as renal, skeletal, ocular, and cardiac disorders. Given that congenital heart diseases are life-threatening, we decided to study the frequency of congenital heart diseases in children with congenital sensory-neural deafness.

MATERIALS AND METHODS

All children who had undergone cochlear implantation surgery due to SNHL and who had attended our hospital for speech therapy during 2008-2011 were evaluated by Doppler echocardiography.

RESULTS

Thirty-one children (15 boys and 16 girls) with a mean age of 55.70 months were examined, and underwent electrocardiography (ECG) and echocardiography. None of the children had any signs of heart problems in their medical records. Most of their heart examinations were normal, one patient had expiratory wheeze, four (12%) had mid-systolic click, and four (12%) had an intensified S1 sound. In echocardiography, 15 children (46%) had mitral valve prolapse (MVP) and two (6%) had minimal mitral regurgitation (MR). Mean ejection fraction (EF) was 69% and the mean fractional shortening (FS) was 38%.

CONCLUSION

This study indicates the need for echocardiography and heart examinations in children with SNHL.