Attic reconstruction techniques in cholesteatoma surgery: a comparative analysis of cartilage versus bone pate.

BACKGROUND: Cholesteatoma surgery involves canal wall down (CWD) and canal wall up (CWU) mastoidectomy. CWU is associated with higher cholesteatoma recurrence, often linked to attic retraction pockets. Attic reconstruction with cartilage or bone pate lacks comparative evidence. AIMS/OBJECTIVES: To compare the effectiveness of cartilage and bone pate in attic reconstruction during CWU mastoidectomy for cholesteatoma. MATERIAL AND METHODS: We conducted a retrospective study at King Abdullah University Hospital (KAUH) in Jordan, analyzing surgeries performed from 2011 to 2021. Patients who underwent CWU mastoidectomy with attic reconstruction using tragal cartilage with perichondrium or bone pate were included. RESULTS: Of 48 patients analyzed, 26 had cartilage graft attic reconstruction, and 22 received bone pate. Recurrent cholesteatoma occurred in 19.23% of the cartilage group but none in the bone pate group (p = .001). Ear discharge was observed in 19.23% of the cartilage group and 18.18% of the bone pate group, while tympanic membrane perforations and external auditory canal cholesteatoma were more prevalent in the cartilage group. CONCLUSIONS AND SIGNIFICANCE: Our study indicates that bone pate results in significantly lower cholesteatoma recurrence than cartilage grafting in CWU mastoidectomy attic reconstruction. Bone pate offers stability and favorable long-term outcomes for outer attic wall repair.

Does open reduction internal fixation using a volar locking plate and closed reduction percutaneous pinning using K wires provide similar functional and radiological outcomes for unstable distal radius fractures?

BACKGROUND: Distal radius fractures (DRFs) are a common orthopedic injury, with open reduction internal fixation (ORIF) and closed reduction percutaneous pinning (CRPP) being the two most frequently used methods for treating unstable DRFs. The optimal treatment approach for DRFs is still a matter of debate. Therefore, this retrospective analysis aimed to compare the functional and radiological outcomes of ORIF and CRPP to determine the most effective approach for treating unstable DRFs. MATERIAL AND METHODS: A total of 89 patients were included in this retrospective study; 34 underwent CRPP and 55 underwent ORIF (61 males and 28 females, mean age: 35.5). Radiographic measurements of radial inclination, radial height, and volar tilt, as well as patient-rated wrist evaluation (PRWE) scores for pain and function, were used to evaluate the functional and radiological outcomes during the final follow-up period, ranging from 1 to 4 years. RESULTS: There were significant improvements in the radiographic measurements for both groups, indicating a good reduction. However, the two fixation methods had no significant difference in radiographic measurements during the entire follow-up period. Regarding PRWE scores, there was a significant difference between the two groups, with patients in the CRPP group reporting better wrist function and less pain. CONCLUSIONS: Both CRPP and ORIF are effective methods for treating unstable DRFs. Achieving an acceptable reduction did not correlate with better pain management, function, or the ability to carry out day-to-day activities. However, patients treated with CRPP had better wrist function and less pain during follow-up. Radiographic measurements did not differ significantly between the two groups. Clinicians should consider closed-reduction percutaneous pinning as a viable and effective treatment option for distal radius fractures, particularly when optimal wrist function and pain management are important considerations.

[Successful laparoscopic robot-assisted surgical treatment of bilateral ureterosciatic hernias (Lindbom's hernia) and pelvic kidney]. / Erfolgreiche laparoskopische roboterassistierte operative Therapie bei beidseitigen ureteroischialen Hernien (Lindbom's Hernie) und Beckenniere.

Ureterosciaic hernia is a rarely described pathology that represents a diagnostic and therapeutic challenge for the treating physician. In this case report, we present a patient with symptomatic bilateral ureteroschial hernias and a pelvic kidney on the left. The definitive surgical treatment of the hernias was performed in the robotic-assisted laparoscopic technique.This is the second case describing bilateral intestinal sciatic hernia, in combination with its diagnosis and robotic surgical repair.In this paper we present the fourth known case of a robotic approach to the surgical treatment of ureterosciaic hernia with detailed presentation of diagnostic and therapeutic measures, as well as postoperative results and literature research on this rare pathology.

An Overview of the Effect of Age at Time of Cochlear Implantation on Language Outcomes in Jordan: A Retrospective Cohort Study.

INTRODUCTION: Cochlear Implantation (CI) surgery has long been used as an effective treatment for children with bilateral profound sensorineural hearing loss who failed to benefit from the use of hearing aids. Among other factors, the age at which implantation is done is thought to have an effect on the speech progression outcome of patients postoperatively. OBJECTIVES: The Jordanian CI Program has limited resources, and Jordan has an underdeveloped early screening and intervention program for deafness. In this study, we aimed to explore the effect of age at time of implantation on receptive and expressive language outcomes in Jordan, to guide funding and focus efforts on patient groups who would benefit most, thus reducing unnecessary longterm morbidity and disability, and improving cost efficiency. METHODS: Data was gathered from all major sectors in Jordan on patients who underwent CI from 2006 to 2018 (a total of 1815 patients). We compared the language outcome 2 to 4 years after implantation for patients aged below 3 years, 3 to under 6, 6 to under 9 years, and 9 and older at the time of implantation. RESULTS AND CONCLUSION: We found a statistically significant difference in language outcomes between patients aged below 6 years vs those 6 and older, with better receptive and expressive language outcomes in the younger age groups.

Injection Laryngoplasty for the Treatment of Type 1 Laryngeal Clefts: A Single Institution Experience.

OBJECTIVE: Standards for treatment of laryngeal clefts remain poorly defined. There are no large case series that report the efficacy of injection laryngoplasty (IL) in the treatment of pediatric Type 1 laryngeal clefts (LC-1). The objective of this study is to measure the effect of IL in young children with LC-1. METHODS: A retrospective case series of 130 patients was completed over 3 years at a at a single institution included patients aged 1 month to 8 years, diagnosed with aspiration and penetration issues during swallowing based on a Videofluoroscopic Swallow Study (VFSS). Patients underwent surgical evaluation and intervention using carboxymethylcellulose gel injection. Collected data points included age in months at time of first injection, gender, race, pre- and post-operation VFSS scores, number of injections, co-morbidities and post-operative complications. VFSS scores were evaluated pre- and post-operatively to assess efficacy of intervention. A secondary outcome was efficacy in patients with aspiration compared to those with penetration alone. RESULTS: This study included 77 male and 53 female patients. Sixty-two patients (48%) demonstrated a significant post-operative improvement in their swallowing function (P < .05). There were no statistical differences in age, number of injections, or the volume of the first injection. Patients that showed a post-operative improvement in swallowing function were on average 5 months older and had more severe aspiration and penetration compared to those who did not demonstrate a post-operative benefit and underwent less injections. The volume of injection did not appear to play a role in the success rate. CONCLUSION: Injecting the inter-arytenoid area in patients with LC-1 appears to confer some benefit to close to half of our patient population. Successful procedures seemed to occur in patients with more severe aspiration and penetration and older age.

Assessing effects of modification of middle meatal silastic splint after endoscopic sinus surgery for nasal polyps: A randomized controlled study.

PURPOSE: To investigate the efficacy of middle meatal silastic splint in preventing adhesions after bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP), and to assess nasal symptoms and endoscopic findings in splinted and non-splinted sides. METHODS: After completion of ESS, silicon silastic splints were randomly inserted in the middle meatus of one nasal side, while no stent in the other side (control). The surgeon was blinded to the side selection, and splint insertion until removal after 1 week. Patients were followed -up after 1 week, 1 and 6 months. Each side of the nasal cavity was assessed for adhesions, crusting, pus, pain, nasal obstruction, and nasal discharge by endoscopic examination and visual analogue scale. RESULTS: Forty-nine patients (98 nasal sides) were included. At the 1st week visit, there was no significant difference between the splinted and non-splinted sides for all investigated parameters.After 1- month, adhesions were seen in 10% of the splinted sides, while it was in 26% of the non-splinted sides (P = 0.037).At the 6 -month follow-up visit, the adhesions rate remained 10% in the splinted sides, however the rate increased to 32% in the non-splinted sides (P = 0.007). All other examined parameters remained statistically insignificant between both sides throughout the follow -up visits. CONCLUSIONS: Middle meatal silastic splint is significantly reducing middle meatal adhesions with low complication rate in CRSwNP patients undergoing ESS. Our results support its usage when the middle turbinate is unstable or traumatized during surgery.

Correlation between Xerostomia index, Clinical Oral Dryness Scale, and ESSPRI with different hyposalivation tests.

BACKGROUND AND OBJECTIVE: Xerostomia is a subjective measure of dry mouth, while hyposalivation is an objective measure of reduced saliva flow rate. In this study, we aim to assess the association between commonly used xerostomia scoring systems, with different hyposalivation measures among Sjogren Syndrome (SS) patients. METHODS: In a cohort of SS patients, we assessed xerostomia using Xerostomia index, clinical oral dryness scale (CODS), and the European League Against Rheumatism SS Patient-Reported Index (ESSPRI), and we assessed hyposalivation using unstimulated whole saliva flow (UWS), stimulated whole saliva flow (SWS), and stimulated parotid flow (SPF). We analyzed the association between xerostomia and hyposalivation using association tests in SPSS. RESULTS: We included a total of 49 patients in this study, of which 34 (68%) had primary SS, and 15 (32%) had secondary. CODS was significantly correlated with SWS (P=0.048), with a negative correlation coefficient of 0.216, and with SPF (P=0.009), with a negative correlation coefficient of 0.291. The dryness domain of ESSPRI was significantly correlated with UWS (P=0.031) with a negative correlation coefficient of 0.233. CONCLUSION: CODS is the scoring system with the highest correlation with hyposalivation, particularly SWS and SPF, followed by ESSPRI dry domain, which is correlated with UWS. Xerostomia index is not correlated with hyposalivation.