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   2019| October-December  | Volume 35 | Issue 4  
    Online since October 16, 2019

 
 
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ORIGINAL ARTICLES
Impact of site and size of pars tensa tympanic membrane perforation on the success rate of myringoplasty
Ezzat M Saleh, Mohammed A.M Salem, Suzan H.A Nemr
October-December 2019, 35(4):339-346
DOI:10.4103/ejo.ejo_69_18  
Objective This article is intended to investigate the impact of size and site of tympanic membrane (TM) perforation on the outcome and success rate of myringoplasty. Patients and methods This prospective study was conducted at Assiut University Hospital, between September 2015 and November 2017. Video-otoscopy was done to all cases, the images were registered on the computer and analyzed by using Universal Desktop Ruler V.3.5.3364 program, as the area of TM perforation (P) and the entire area of TM (T) were calculated. Thereafter, the percentage area of the perforation (P/T×100%) for the perforated ear was revealed. Site of perforation was also authenticated. Preoperative and postoperative A–B gap was carried out through audiogram for hearing results. Results The overall success rate of myringoplasty was 78.8%. According to size of TM perforation; the highest success rate of myringoplasty established between small perforations was 93.3% and the lowest found between subtotal perforations was 42.9%; in medium and large perforations, the success rate of myringoplasty was 87.5 and 71.4%, respectively. As regards the site of TM perforation, the success rate of myringoplasty was highest (90%) for posterior perforations and lowest (70%) for anterior perforations; in central and inferior perforations, the success rate of myringoplasty was 79.8 and 75%, respectively. After myringoplasty, the amount of closure of A–B gap was 21.82 dB. Conclusion The size of TM perforation has a great influence on the success rate of myringoplasty, while the site of TM perforation has no impact on the success rate of myringoplasty, and myringoplasty is an effective operation for sealing off TM perforations, resulting in improvement of quality of life.
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An algorithm for management of nasal caudal septal deformities
Ahmed Younes, Rasha El-Dsowkey, Sameh M Ragab, Hosam E Romaih, Mohamed N Elsheikh
October-December 2019, 35(4):352-356
DOI:10.4103/ejo.ejo_24_19  
Introduction Caudal end septal deformities are common deformities. Trauma is a main cause of these deformities. there is lack of an algorithm for choosing the suitable technique for the type of deformity. The aim of this retrospective study was to put an algorithm for approaching different caudal end deformities. Patients and methods Retrospective review of 136 patients underwent surgical correction for caudal end deformities. Data collection included functional breathing outcomes and drawbacks of different techniques as postop caudal end sublaxation and firm nasal tip sensation. Results Patients were divided into 4 groups (according to the technique by which the caudal end of nasal septum was managed) as following: Group A: 90 patients who had undergone surgeries with swinging door or modified swinging door techniques with fixation to anterior nasal spine technique, Group B: 26 patients who had undergone surgery with tongue in groove technique, Group C: 10 patients who had undergone surgery with caudal end splinting using septal bone, Group D: 10 patients who had undergone surgery with septal extension graft with tongue in groove technique. Conclusion An algorithm was obtained to help in deciding a methodology for correcting the caudal end deformities according to preoperative patient data.
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Assessment of the role of otoendoscopy in evaluating Eustachian tube and middle ear status during myringoplasty
Essam A Behiery, Ibrahim A Abdel-Shafy, Hosam A Hussien, Mahmoud F Hassan
October-December 2019, 35(4):347-351
DOI:10.4103/ejo.ejo_48_19  
Objective To assess the role of otoendoscopy in evaluating Eustachian tube and middle ear status during myringoplasty. Background Eustachian tube function has been the center of focus as a prognostic factor for middle ear surgery success because of its primary role in the middle ear aeration and in the pathogenesis of otitis media. Otoendoscopic evaluation of Eustachian tube allows visualization of the protympanic segment of the Eustachian tube and hidden recesses of the middle ear. Patients and methods In this prospective study, patients with a persistent dry central tympanic membrane perforation were operated at Otorhinolaryngology Department of Menoufia University Hospital in the period from March 2017 to February 2019. All patients were divided into two groups: group A included 50 cases that underwent otoendoscopic-assisted microscopic myringoplasty, and group B had 50 cases that underwent microscopic myringoplasty. Results This study included 100 patients, with a mean age of 30.2 years. Overall, 42% of the patients were male and 58% of the patients were female. Otoendoscopic examination of middle ear in group A showed 20% of cases with adhesions and secretions at tympanic orifice of the Eustachian tube opening plus 8% of cases with congested mucosa at middle ear apparatus. The success of graft uptake was 94% in group A and 84% in group B. Conclusion The result of this study supports the use of otoendoscopy in traditional microscopic myringoplasty. Endoscopy could be utilized efficiently to improve the visibility of the Eustachian tube opening and middle ear apparatus and then dealing with any pathology affecting them.
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CASE REPORTS
An unusual presentation of cervical necrotizing fasciitis in an immunocompetent adult patient: a case report and literature review
Jyan M Bhati, Abdulmonem M Al-Shwareb, Shahd M AlKhunaizi, Zeinab A AlQudehy
October-December 2019, 35(4):370-374
DOI:10.4103/ejo.ejo_109_18  
Necrotizing fasciitis is a sever and potentially fatal soft tissue infection, but its presentation in head and neck region is rare. Few reported cases of cervical necrotizing fasciitis secondary to tonsil infection were found in literature, which were proven to be dangerous life threatening condition. In this short communication, we are presenting a 35-year-old, immune-competent Saudi female patient. She was presented to our hospital with ill looking picture of right peritonsillar abscess with mild degree of trismus. Patient was admitted, IV antibiotic was started and CT scan neck showed pus in the left tonsil parenchyma and in right peritonsillar region, with cellulitis in right parapharyngeal region with no clear collection noticed within the neck spaces. Patient was taken to OR where pus in the left tonsil surface was noted and cleaned, and incision and drainage of right peritonsillar fossae was done, pus came out and gas bubbles noted along with necrotic fleshy tissue in the lower pole of the right tonsil from which multiple biopsies were taken. Patient had postoperative bleeding after 24 hours. CT scan was repeated and patient was taken for OR for debridement of necrotic tissue from right tonsil, and right neck exploration and debridement. Necrotic tissues medial to the right submandibular gland was seen and removed. The cultured swab and aspirated pus showed coagulase-negative staphylococcus, antibiotic was changed based on sensitivity results and she responded very well. She was discharged home post operatively in stable condition and was followed up for 18 months with no history of recurrent tonsillitis.
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Temporomandibular joint septic arthritis: A rare manifestation of melioidosis
Lorna Ting KN, Loong Siow Ping, Ahmad Nordin, Ong Cheng Ai, Halimuddin Sawali
October-December 2019, 35(4):364-366
DOI:10.4103/ejo.ejo_88_18  
Melioidosis is a community-acquired infectious disease that is caused by the Gram-negative bacillus, Burkholderia pseudomallei. It is endemic in Southeast Asia countries, and its clinical spectrum is broad, often mimicking other illnesses, which make diagnosis challenging. The hallmark of its presentation is formation of abscess most commonly in the lungs. The overall mortality rate owing to melioidosis is extremely high especially in the bacteremia form. A 54-year-old woman presented with fever, limited mouth opening, and painful left preauricular swelling for 3 months. Premorbidly, she was well without underlying medical illnesses particularly diabetes or autoimmune disease. Local examination revealed a tender diffuse swelling at the left preauricular region. Her mouth opening was limited to two fingerbreadths. Hematological test showed raised total white cells, erythrocyte sedimentation rate and C-reactive protein. Computed tomography and MRI showed presence of significant left masseteric collection with erosion of left temporomandibular condyle. Other incidental findings from the imaging were multiple liver abscesses and right lower lung abscess. Her indirect immunofluorescence enzyme-linked immunosorbent assay and enzyme-linked immunosorbent assay diagnostic test was positive with significant titre ratio of 1 : 320, which established the diagnosis of melioidosis. Full recovery was attained following surgical drainage of the abscess, together with antibiotics for 6 months (intravenous ceftazidime for a month, followed by oral augmentin for 5 months). Melioidosis involving the TMJ joint is a rare entity. This is the second reported case of melioidosis affecting TMJ joint worldwide, from extensive literature search. This case highlights the importance of suspecting melioidosis in individual presenting with abscess at uncommon and atypical site. Enzyme-linked immunosorbent assay is a rapid test as compared to the gold standard blood culture, and it helps in reaching the diagnosis early with its advantages of high sensitivity and specificity.
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ORIGINAL ARTICLES
Endoscopic evaluation of completeness of conventional curettage adenoidectomy: a single-blinded observational study
Milind M Navalakhe, Dilesh A Mogre
October-December 2019, 35(4):357-360
DOI:10.4103/ejo.ejo_28_19  
Background Conventional curettage adenoidectomy is a blind procedure, which performed in a confined postnasal space produces surgical challenges. The aim was to examine the completeness of conventional adenoidectomy and compare it with surgeon satisfaction and to identify the need to objectively assess the residual tissue at the end of procedure. Aim The primary aim was to objectively assess the residual adenoid mass after curettage adenoidectomy and compare it with surgeon satisfaction using digital palpation. Settings and design A prospective single-blinded observational study was conducted at a tertiary care hospital between February 2015 and September 2015. Patients and methods A total of 45 cases that underwent conventional curettage adenoidectomy were included in the study. Intraoperative images of the postnasal space were recorded and compared with surgeon satisfaction score by a single-blinded observer. Statistical analysis Statistical analysis of interobserver correlation was performed using Cohen’s κ statistics using Graphpad Prism, version-6.07 (trial). Results The 45 cases had a mean±SD age of 8.45±2.47 years, and female to male ratio was 1.4 : 1. The kappa analysis of surgeon satisfaction in relation to the presence of residual adenoid tissue showed that the strength of agreement was worse than that expected by chance (κ=−0.383, SE=0.129). Conclusion The study showed that surgeon satisfaction via digital palpation alone fails to assess residual adenoid tissue, and we recommend endoscopic visualization of the nasopharynx to assess completeness of adenoidectomy.
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CASE REPORTS
Squamous cell carcinoma paradox in thyroid
Deviprasad Dosemane, Meera Niranjan Khadilkar, Rigzing Chophel Dadul
October-December 2019, 35(4):361-363
DOI:10.4103/ejo.ejo_67_18  
Squamous cell carcinoma (SCC) in the thyroid is extremely unusual, contributing to less than 1% of all primary thyroid carcinomas. It may be primary SCC of thyroid gland or secondary spread to the gland, owing to direct extension of SCC from neighboring structures or distant metastases. Most of the cases of thyroid malignancy present as a rapidly expanding mass in the neck, followed by symptoms of invasion and compression of nearby structures. This case report presents an atypical presentation of SCC in the thyroid gland. In this study, the patient presented with a huge thyroid swelling, with minimal dysphagia, mimicking a primary thyroid malignancy; unusually, the primary lesion in the esophagus was much smaller and found on endoscopic evaluation.
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Frontal sinus nasopharyngeal carcinoma recurrence masquerading as chronic frontal sinusitis: a case report
Liew Yew Toong, Lott Pooi Wah, Adzreil Bakri, Narayanan Prepageran
October-December 2019, 35(4):375-378
DOI:10.4103/ejo.ejo_91_18  
Recurrence of nasopharyngeal carcinoma (NPC) is still a worrying issue despite the advent and advancement of treatment strategies. Presentation of recurrent NPC is different from primary NPC and indicates poor prognosis. Frontal sinus metastasis without any involvement of other sinuses is very rare and could be mistaken as sinusitis or mucocele. Owing to its rare occurrence, it presents a great challenge for clinicians to make a prompt diagnosis. The background chronic rhinosinusitis symptoms as a result of irradiation for NPC may masquerade the underlying paranasal sinus recurrence.
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Dermoid cyst of the parotid gland: report of a rare entity with radiological findings and treatment approaches
Fatih Arslan, Hamdi Tasli
October-December 2019, 35(4):367-369
DOI:10.4103/ejo.ejo_68_18  
Dermoid cysts (DCs) are uncommon masses of the head and neck region, and they account for only 7% of all such cysts. They usually arise in the orbit, the floor of the mouth, and nasal regions, and they are rarely seen in the parotid gland. This study reports a case of a 21-year-old man, presented with a parotid mass on left side, with the pathology consistent with ‘DC’. The discussion includes the clinical presentation, imaging findings, gross pathology, histologic features, and differential diagnosis of parotid DCs.
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