Imaging Modalities for Identifying Causes of Vocal Fold Paralysis: A Systematic Review and Meta-Analysis.

BACKGROUND: Vocal fold paralysis (VFP), involving one or both vocal folds, often indicates underlying pathologies. Identifying VFP causes is vital for excluding malignancies and focusing on treating the cause. While various imaging methods are used to investigate VFP causes, their detection abilities remain unclear. This study aims to assess the detection prevalence of different imaging techniques in determining the causes of VFP. METHODS: In September 2023 a comprehensive search was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines across multiple databases, including Web of Science, PubMed, Scopus, Cochrane CENTRAL, and EMBASE. Following the search, the retrieved studies were screened based on the predefined eligibility criteria. Data extraction from the included studies was carried out independently by two authors. Outcomes were analyzed using pooled proportions and 95% confidence intervals. RESULTS: Our meta-analysis encompassed 14 studies with 1492 VFP patients included. Malignant causes for VFP identification were most prevalent in F-fluorodeoxyglucose Positron Emission Tomography (PET)/Computed Tomography (CT) (41.5%) followed by Magnetic resonance imaging (MRI) (40%), with CT being the lowest (17.1%). Conversely, benign causes had the highest prevalence in F-fluorodeoxyglucose PET/CT (10.8%), followed by MRI (6.7%) and CT (4%). In the VFP cause identification, MRI had the highest detection prevalence (58.1%), followed by CT (30.1%), and Ultra Sound (US) had the lowest (26.8%). In chest lesion detection, CT had the highest prevalence (17.6%), followed by Chest X-ray (CXR) (6.5%). Head lesions were detected with CT at a prevalence of 15%, while neck lesion detection showed CT prevalence at 38.9% and US at 20.6%. CONCLUSION: Our study revealed varying prevalence rates for the identification of malignant and benign causes across different imaging modalities. MRI demonstrated the highest overall detection prevalence for VFP causes, while CT was most commonly used and had the highest prevalence for specific lesions detection in various regions. These findings provide valuable insights into the diagnostic utility of different imaging techniques in the evaluation of VFP.

A novel method for evaluating mastoid defect regrowth after cochlear implantation.

This retrospective study examined mastoid defects resulting from cochlear implant (CI) surgery and their potential for spontaneous regrowth across different age groups. Spontaneous closure of mastoid defects has been observed in certain CI patients during revision surgery or through post-operative temporal bone computer tomography (TB-CT). The analysis encompassed 123 CI recipients, comprising 81.3% children and 18.7% adults, who underwent post-operative TB-CT scans. Using image adjustment software, the study measured mastoid defect areas and found a significant reduction in children's defects between the initial and subsequent scans. Notably, mastoid defect areas differed significantly between children and adults at both time points. Furthermore, the analysis revealed significant correlations between mastoid defect areas and the age at implantation as well as the time elapsed since the CI surgery and the first CT scan. This study provides valuable insights for evaluating CI patients scheduled for revision surgery by assessing potential surgical challenges and duration. Furthermore, it may have a pivotal role in evaluating patients who experience postauricular swelling subsequent to CI surgery.

Papillary thyroid microcarcinoma with and without nodal metastasis: A comparative analysis.

OBJECTIVES: To assess the demographics and clinical factors of papillary thyroid microcarcinoma (PTMC) patients in Saudi Arabia and compared and analyzed the differences between the patients with and without lymph node metastasis (LNM). Papillary thyroid microcarcinoma (PTMC) is a common thyroid cancer and is not usually detectable clinically but found incidentally after pathologic evaluation of thyroid tissue following surgery for benign thyroid disorders. However, these tumors have a significant risk of LNM. METHODS: All PTMC patients who underwent surgery at King Abdulaziz University Hospital, King Fahad Medical City, and King Abdulaziz Medical City from 2012 to 2022 were included. The incidence rate of LNM was 9.17%. The patients' average age was 44.05. Most of the patients were female. RESULTS: Prevalence of LNM among PTMC patients is 9.17% (n=31). The PTMC patients showed the following significant risk factors for LNM: higher Bethesda class, type of pathology, extrathyroidal extension, extracapsular extension, lymphovascular invasion, and residual tumors in patients who had received radioactive iodine. Presence of thyroiditis, multifocality, goitrous thyroid, neural invasion, and tumor size were unrelated to the LNM in the PTMC patients. CONCLUSION: Higher Bethesda class, pathology type, extrathyroidal extension, extracapsular extension, lymphovascular invasion, and RAI-treated residual tumors were strongly linked to LNM.

Acute Vision Loss in Patients With Allergic Fungal Rhinosinusitis: A Case Series.

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic noninvasive sinusitis accounting for 7.8% (0.2%-26.7%) of all chronic rhinosinusitis cases. A definitive diagnosis is usually made after sinus surgery. Successful treatment requires a combination of surgical and medical management. Although orbital involvement is relatively common, reports on optic neuropathy and acute vision loss are limited. Herein, we present a series of 3 patients with AFRS who presented with acute visual loss as the chief complaint. All 3 patients were otherwise healthy adults in their early 20s with extensive nasal polyps on endoscopic nasal examination and bone erosion in the bilateral orbits and lateral wall of the sphenoid sinus on the affected side on imaging. One of the 3 patients had bilateral cranial nerve IV defects in addition to cranial nerve III defects. All patients underwent endoscopic sinus surgery with orbital decompression and were followed up postoperatively by both otolaryngology and ophthalmology services with endoscopic and radiologic evaluation. Unfortunately, no meaningful improvement in vision was observed in any patient despite successful nerve decompression. Prompt diagnosis and early medical and surgical intervention are warranted to prevent complications in patients with AFRS with orbital extension.

Translation and Cross-Cultural Adaptation of an Arabic Version of the Summated Xerostomia Inventory.

OBJECTIVE: We aim to assess the validity and reliability of the Arabic language translation of the Summated Xerostomia Inventory (SXI). METHODS: A cross-sectional, self-administered, electronic Arabic SXI was sent to 79 patients with thyroid nodules (female: n = 34, 57%; male: n = 45, 57%) who visited the Otolaryngology-Head and Neck Surgery clinic at King Abdulaziz University Hospital and King Fahad Medical City between June 2023 and July 2023. RESULTS: Dependability was assessed using Cronbach's alpha coefficients at two distinct instances (first: α = 0.824, second: α = 0.932), which reaffirmed the SXI's reliability and consistency. Legitimacy was ascertained using a test-retest method and correlation analysis between the two measurements. CONCLUSION: All SXI items displayed a potent positive correlation (between 0.746 and 0.871, p < 0.001), exhibiting remarkable consistency in responses over time. The outcomes of the paired t-tests showed nonsignificant differences for all queries, indicating that the responses were stable over time.

Intramuscular Hemangioma of the Sternocleidomastoid: A Rare Tumor in an Unusual Location.

Intramuscular hemangiomas (IMH) are benign vascular tumors of the skeletal muscles. These tumors are uncommon in the head and neck region and usually affect the trunk and extremities. IMH of the masseter and trapezius muscles have been reported in the head and neck region. However, the sternocleidomastoid is extremely rare. In the current case report, we described a 25-year-old man with a rare case of intramuscular hemangioma involving the sternocleidomastoid muscle and reviewed the relevant literature. Contrast-enhanced computed tomography was initially obtained and showed a slightly hyperdense soft tissue mass. Head and neck magnetic resonance imaging (MRI) demonstrate a well-delineated hyperintense lesion on the T2 sequence suggestive of a soft tissue hemangioma. Subsequently, angioembolization using onyx was performed, followed by surgical excision of the mass under general anesthesia. Histopathological examination of the mass showed vascular proliferation within the skeletal muscles, and fatty tissue with an abundance of capillaries, which are consistent with capillary type intramuscular hemangioma. The patient was followed up in the clinic until the wound healed. Three months after surgery, no recurrence was observed. Preoperative angioembolization contributed to the success of IMH surgery by reducing morbidity, facilitating complete excision, and decreasing the risk of recurrence.

Patterns of treatment failure in patients with nasopharyngeal carcinoma and salvage treatment outcome: A retrospective analysis study.

INTRODUCTION: In Saudi Arabia, head and neck cancers represent 6 % of all malignancies. 33 % of these are nasopharyngeal. Thus, we aimed to distinguish patterns of treatment failure and salvage treatment outcomes among patients with nasopharyngeal carcinoma (NPC). METHODS: A retrospective review of patients treated for NPC in a tertiary care hospital. From May 2012 to January 2020, we retrospectively reviewed 175 patients that fit our inclusion criteria. Those who did not complete their treatment, started treatment in another institution, or did not complete a 3-year follow-up were excluded. In addition, the primary treatment outcome and the salvage treatment for those who failed initial treatment were collected and analyzed. RESULTS: Patients were predominantly stage 4 disease. 67 % of the patients were alive without evidence of disease during their last follow-up. However, 75 % of failure occurs in the first 20 months of completing the treatment regimen. Neoadjuvant therapy and delays in referral play a significant role in treatment failure. For failed cases, concurrent salvage chemoradiotherapy showed the best survival. CONCLUSION: Advanced stage 4A and T4 nasopharyngeal carcinoma should receive the maximum treatment, with a close follow-up, particularly during the first 2 years after treatment. Furthermore, the excellent outcome from salvage chemoradiotherapy and radiotherapy alone would make physicians aware of the importance of aggressive primary treatment.

Basal Cell Adenoma of the Parotid Gland: A Rare Disease Entity.

Neoplasms of the salivary glands are of rare incidence, have a vague presentation, and follow a complex long-term clinical course. Both minor and major salivary glands have been implicated in dysplastic transformation, with parotid gland tumors being the most notable. Most of these tumors are benign in nature and are typically diagnosed and classified based on their histopathological presentation. In this report, we exhibit a rare case of basal cell adenomas (BCA), localized to the right parotid gland, in a 69-year-old male patient. Volume acquisition computed tomography (CT) imaging of the region was obtained with and without contrast, with relative reconstruction in both the coronal and axial planes. A soft tissue mass of 5 cm in diameter was detected in the superficial lobe of the right parotid gland. Fine needle aspiration (FNA) with ultrasound guidance revealed a population of basaloid cells that is monomorphic with minimal nuclear atypia and scattered fibrillary matrix. Thereafter, the patient was treated with partial excision of the right parotid gland under general anesthesia, and the post-operative pathology report confirmed the diagnosis of basal cell adenoma. The patient was doing well post-operatively with no complaints and maintained routine clinic follow-ups.

Basal Cell Adenoma of the Minor Salivary Glands in the Buccal Mucosa: A Rare Entity Arising in an Unusual Location.

One of the rare tumors of the salivary gland is known as basal cell adenoma (BCA). Only a small percentage of salivary gland tumors affect the minor salivary gland of the oral cavity while the majority are found in the parotid gland. We present a rare case of BCA involving the left buccal mucosa of a 45-year-old female. Magnetic resonance imaging (MRI) showed well defined solid mass measuring 1.9 x 1.5 cm in the left buccal space inseparable from the buccinator muscle. The T2-weighted image demonstrates a hyperintense signal post-contrast. Ultrasound-guided fine needle aspiration cytology revealed cellular basaloid neoplasm of uncertain malignant potential. Thereafter excision of the mass was performed through a transoral approach under general anesthesia. Histopathology of the mass showed encapsulated basal cell neoplasm in favor of BCA. The patient was doing well after the surgery and has intact facial nerve and adjacent nerves such as the auriculotemporal nerve and great auricular nerve with no complications then she kept on routine clinic follow-ups, and the surgical site recovered successfully. Therefore, we conclude that MRI and biopsy provide useful information to differentiate between benign adenoma and malignant adenocarcinoma. BCA should be considered in a differential diagnosis of an isolated neck mass. Surgical excision demonstrates an excellent prognosis.

Demographic and clinical profile of patients with chronic rhinosinusitis in Saudi Arabia.

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.

Perceptions and attitudes toward unusual complications following breast implant surgeries among Saudi female patients: How knowledgeable are our patients?

Background: The number of breast implant-related procedures has rapidly increased. Given the current increase in social media coverage and its influence on the decision to undergo breast implant surgeries, it is critical to identify patients' misinformation about unusual complications related to breast implants. Therefore, the present study aimed to assess the perceptions and attitudes toward unusual complications related to breast implants among patients who underwent breast implant surgeries. Methods: In the present cross-sectional study, a questionnaire was distributed between April 2021 and May 2021 among patients who had undergone breast implant surgeries between 2016 and 2021 at King Saud University Medical City in Riyadh, Saudi Arabia. The 26-item questionnaire was distributed online to assess the participants' perceptions about breast implant illness (BII), capsular contracture, and breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Data were analyzed using Statistical Package for the Social Sciences (SPSS), version 23.0. Results: In total, 106 patients who underwent breast implant surgeries were included in the present study (response rate: 73.6%). Their mean age was 43.68 ± 10.69 years. The reason for undergoing breast implant surgery was cosmetic in 41.5% of the participants and reconstructive in 58.5%. Moreover, 22.6%, 23.6%, and 24.5% of the participants had knowledge about BIA-ALCL, BII, and capsular contracture, respectively. Conclusions: The present findings indicate that it is important for plastic surgeons to discuss unusual complications related to breast implants with patients on a regular basis. Despite the obscurity of these complications, such discussions are important to provide best available information to patients.

The Prevalence of Depression and Anxiety in Post-bariatric Surgery Patients at King Khalid University Hospital, Riyadh.

Background Obesity negatively impacts mental and physical health and is a leading cause of disease worldwide. Obesity affects 33% of Saudi adults, with 10% being morbidly obese (body mass index, BMI >40 kg/m2). This study explored the association between bariatric surgery (BS) and a predisposition or exacerbation of depressive and anxiety symptoms. Material and methods A cross-sectional study of patients who underwent bariatric surgery at the King Khalid University Hospital in Riyadh, Saudi Arabia, was conducted between February 2016 and December 2021. The patients were contacted by phone to complete a self-administered questionnaire on demographic information, chronic medical diseases, psychiatric diseases, body mass index, and type of bariatric surgery. In addition, they completed the patient health questionnaire-9 (PHQ-9) and general anxiety disorder-7 (GAD-7) questionnaire to screen for patients' depression and anxiety symptoms. Results The findings of the 367 BS patients showed that 20.7% of the patients were considered to have mild anxiety, 11.2% had moderate anxiety, and 8.7% had high anxiety levels. However, regarding depression, 46.9% had extremely low levels of depression, followed by mild depression in 29.4% and moderate depression in 11.2%. Furthermore, another 8.2% of BS patients had moderately high depression levels, and 4.4% had severe depression. The anxiety and depression levels of the patients in this study did not show any statistically significant changes postoperatively in the short, medium, or long term. On the other hand, almost all of the patients 97% who underwent bariatric surgery were satisfied with the outcome of their surgery. Conclusion Few BS patients had high symptoms of depression and anxiety. We recommend pre- and postoperative psychiatric assessment for all bariatric surgery patients as surgical protocol.