A novel technique with butterfly splint for middle turbinate stabilization in sinus surgery.

OBJECTIVE: To assess the efficacy of newly designed butterfly splint with special technique for middle turbinate stabilization in preventing adhesion following bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). STUDY DESIGN: Prospective, double-blind, randomized controlled. SETTING: University hospitals. METHODS: Following ESS, in cases of traumatized and/or unstable middle turbinates, newly designed butterfly plastic splint was randomly inserted in the middle meatus of one nasal side, while no splint was inserted in the other (control). Patients were followed up on after 1 week, 1 month, and 6 months. Endoscopic examination and a visual analog scale were used to evaluate each side of the nasal cavity for adhesion, crusting, pus, pain, nasal obstruction, and nasal discharge. RESULTS: Thirty patients (60 nasal sides) were included. For all investigated parameters, there was no significant difference between the splinted and non-splinted sides at the first week visit. Adhesion was found significantly less in the splinted sides (3%) than the non-splinted sides (27%) after 1 month (P = 0.038). The adhesion rate in the splinted sides remained 3% at the 3 month follow-up visit, however, in the non-splinted sides, the rate increased up to 30% (P = 0.007). Throughout the follow-up visits, all other investigated parameters remained statistically insignificant between both sides. CONCLUSIONS: The newly designed butterfly plastic splints to avoid middle turbinate adhesion is safe and effective in both reducing middle meatal adhesion with low complication rate in CRSwNP patients undergoing ESS and middle turbinate stabilization in its intermediate position.

Endoscopy-assisted excision of nasoglabellar dermoid cyst.

OBJECTIVE: To assess the endoscopic assisted excision of the nasoorbital dermaoid cyst. DESIGH: Case series. SETTING: Zagazig univesity hospitals. PARTICPANT: The study included patients with nasal dermoid who were operated using a local vertical incision with endoscopic assisted dissection and excision. MAIN OUTCOME MEASURES: Complete removal, complication, recurrence. RESULTS: In all patients, complete excision of the cyst was achieved with negligable blood loss. No recurrence was detected throughout the follow up. CONCLUSION: Endoscopic-assisted resection of the nasal dermoid cyst appears a safe and effective approach with small incision, precise dissection and satisfactory apparent scar with with low incidence of recurrence.

Modified Z-Palatoplasty for Correction of Acquired Nasopharyngeal Stenosis Following Palatal Surgery: A Case Series.

OBJECTIVES: To evaluate the efficacy of a novel surgical technique in management of nasopharyngeal stenosis (NPS), describing its steps and results. Study Design: Prospective clinical trial. SETTING: This study was conducted at the Otolaryngology, Head and Neck Surgery Department, Zagazig University. METHODS: This prospective study was conducted on patients with snoring ± obstructive sleep apnea due to acquired postsurgical NPS of grade Ι and ΙΙ. New surgical repair was employed on the patients and the pre and postoperative results were statistically compared. RESULTS: The grade of NPS improved significantly postoperatively (P = .00136) throughout a follow-up of 1 year. Postoperatively, there was statistically significant improvement of apnea hypopnea index (P = .0005), Visual Analog Scale (VAS) of nasal obstruction (P < .0001) and VAS of snoring (P < .0001). Dysphagia showed early worsening, but it improved completely at 3 months postoperatively. CONCLUSION: The utilized novel procedure appears effective, low cost, and easily applicable, and it does not require implants, special tools, or suture materials. Furthermore, it gives excellent results, with negligible pain, and rapid recovery without significant complications. LEVEL OF EVIDENCE: 4.

Positional awake nasoendoscopic pattern-based surgical decision for correction of retropalatal obstruction in OSA.

PURPOSE: To evaluate differential surgical interventions for obstructive sleep apnea (OSA) patients with single-level retropalatal based on the preoperative topographical diagnosis using nasoendoscopy with Müller's maneuver during supine position (MM-P). SUBJECTS AND METHODS: This case series included adult patients with OSA who showed a predominant single-level retropalatal collapse on MM-P. An anteroposterior pattern of collapse was managed by an anterior advancement procedure, while a transverse pattern of collapse was managed by lateral/anterolateral advancement procedures (double suspension sutures). A combined procedure was provided to the concentric type of collapse. All patients underwent evaluation of the polysomnography, Epworth Sleepiness Scale (ESS) values and snoring scores both preoperatively and 6-8 months after surgery. RESULTS: Among 102 patients, the most commonly reported pattern of collapse at the retropalatal level was the concentric pattern (48.04%) followed by the transverse pattern (27.45%). The AP-pattern of collapse was reported in 24.51%. In the postoperative follow-up visits, no early or late complications were reported. All included groups showed significant improvement in polysomnographic data (mean AHI and lowest O2 saturation level). Significant improvement of VAS of snoring was reported. The overall success rate was ˃90%. CONCLUSION: Preoperative differential diagnosis of OSA with MM-P allows for tailored surgical management. Tailored procedures could yield good surgical outcomes when patients are properly selected and the technique is chosen according to preoperative topographical diagnostic assessment. This study might provide an available less-costly and effective preoperative planning for OSA intervention. LEVEL OF EVIDENCE: 4.

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency.

OBJECTIVE: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). METHODS: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. RESULTS: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. CONCLUSION: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

Reconstruction of the outer attic wall by cortical bone and bone cement.

OBJECTIVE: To asses using cortical bone and bone pate with and without glass ionomer bone cement (GIBC) for reconstructing the outer attic wall (OAW) defect during cholesteatoma surgery without mastoid cavity obliteration. METHOD: This is a prospective case series of 25 patients who underwent primary surgery for cholesteatoma with presence of OAW defect that was reconstructed by cortical bone graft and bone pate, further fixation of the cortical bone graft in place was done by GIBC in 18 patients. RESULTS: There was significant improvement of persistent otorrhea and hearing loss after surgery (P < 0.001). Recurrence of cholesteatoma was found in 2 patients (8%), residual TM perforation was found in one patient (4%). CONCLUSION: Reconstruction of OAW by cortical bone and bone pate is an effective surgical option to decrease the incidence of recurrence in cholesteatoma surgery. Glass ionomer bone cement can be added safely to fix the cortical bone graft in the OAW defect.

Eustachian Tube: Computed Tomography Analysis.

BACKGROUND: Eustachian tube has a major role in ventilation, drainage, and protection of the middle ear. High resolution computed tomography magnifies the role of preoperative imaging for detailed inner and middle ear anatomical information. The aim of this study was to find an applicable way by computed tomography imaging for assessment of Eustachian tube. The goal was to provide improved understanding of the Eustachian tube measurements and the relationship with middle ear in Egyptian population. Computed tomography measurements for Eustachian tube were done including; length of the bony and cartilaginous portions, Total length of Eustachian tube, as well as the width and height of the tympanic orifice of the Eustachian tube. Also, tubotympanic and Reid plane- Eustachian tube angles were measured. RESULTS: Within 200 studied ears in 100 subjects, the mean total Eustachian tube length was 40.19 ±â€Š3.05 mm, mean length of the bony Eustachian tube was 11.69 ±â€Š1.8 mm with significant longer Eustachian tube on left side, The mean length of the cartilaginous Eustachian tube was 28.5 ±â€Š2.95 mm with significantly longer cartilaginous and total length in male (P < 0.0001). The mean width and height of the tympanic orifice of the Eustachian tube was 5.4 ±â€Š0.79 and 4.85 ±â€Š0.75 mm, respectively. The mean tubotympanic angle of the Eustachian tube was 148.11 ±â€Š2.82°. The mean Reid plane- Eustachian tube angle was 27.69 ±â€Š2.08° with significantly wider angle in males (P < 0.022). CONCLUSION: The Eustachian tube measurements can easily be obtained on computed tomography images, and are representative for the Eustachian tube anatomy. There is importance of extending computed tomography examinations beyond the middle ear cavity and the mastoids to the Eustachian tube in order to have more data on its condition and relations with different pathological conditions. Computed tomography provides improved understanding of the Eustachian tube measurements and relationship with middle ear structures.

Sphenopalatine Foramen Computed Tomography Landmarks.

OBJECTIVE: The aim of the study was to assess different radiologic bony landmarks for endoscopic localization of the sphenopalatine foramen (SPF). METHODS: Paranasal computed tomography (CT) scans of adults without sinonasal pathology were included. On axial cuts, the anteroposterior distances from the SPF to maxillary line, anterior head of the middle turbinate, basal lamella of the middle turbinate, choanal arch, and posterior fontanel of the maxillary sinus ostium were measured. While on coronal cuts, the vertical distances from the SPF to the nasal floor was measured. The registered measurements were then studied and statistically analyzed. RESULTS: In 70 patients (140 sides, 840 measurements), the mean distances from the SPF to nasal floor, choanal arch, maxillary line, anterior head of the middle turbinate, basal lamella, and posterior fontanel were 25.6 ±â€Š2.4, 8.5 ±â€Š1.38, 36.4 ±â€Š2.6, 34.6 ±â€Š4.26, 8.1 ±â€Š1.27, and 13.7 ±â€Š1.7 mm, respectively, without significant differences between right and left sides. Females showed significantly shorter mean distances between SPF and the nasal floor (P = 0.0011), choanal arch (P = 0.0459), and posterior fontanel (P < 0.0001) than males. While no significant differences were detected between both sexes as regard distances from SPF to maxillary line (P = 0.5579), anterior head of middle turbinate (P = 0.8581), and basal lamella (P = 0.0638). CONCLUSION: Preoperative CT can provide multiple easily detected, reliable, and simple bony landmarks that can help SPF endoscopic localization. Thus the authors recommend adding these measurements to the preoperative CT checklist for patients scheduled for sphenopalatine artery ligation and/or excision of vascular lesions.

Hyoid Periosteum Sutures: A Modified Tissue-Preserving Hyoid Suspension Technique for Obstructive Sleep Apnea.

OBJECTIVE: To present and assess a new, simple, conservative modification of hyoidthyroidpexy using 2 sutures between hyoid periosteum and thyroid lamina. METHODS: Included patients had obstructive sleep apnea with apnea hypopnea index >20. Through a small midline neck incision, 2 Vicryl sutures were applied between the hyoid periosteum and thyroid cartilage. Infrahyoid and suprahyoid muscles were not traumatized. RESULTS: In 19 patients, the mean apnea hypopnea index significantly dropped (P < 0.0001) from 51.5 ±â€Š11.9 preoperatively to 10.1 ±â€Š4.9 postoperatively. The mean lowest oxygen saturation significantly increased from 79.2 ±â€Š10.2 to 89.5 ±â€Š8.1 (P = 0.0015). Moreover, Epworth sleepiness scale showed significant improvements (P < 0.0001) as its mean diminished from 13.8 ±â€Š2.9 to 5.3 ±â€Š2.9. CONCLUSION: The hyoid periosteum sutures technique (simple modification of hyoidthyroidpexy) is considered effective easily applicable, less costly with limited tissue dissection. It could be combined with other procedures in multilevel surgery for obstructive sleep apnea.

Bioglass reconstruction of posterior meatal wall after canal wall down mastoidectomy.

BACKGROUND: Canal wall down (CWD) mastoidectomy has many drawbacks including chronic otorrhea, granulations, dizziness on exposure to cold or hot water and tendency of debris accumulation in the mastoid cavity demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). OBJECTIVES: To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using bioactive glass (BAG) that is fabricated and built up intraoperatively. PATIENTS AND METHODS: This study was applied on 20 patients had atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by BAG that was prepared and built up intraoperatively. All patients were exposed to full preoperative evaluation and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. RESULTS: During a follow up of 12 to 36 months, postoperative appearance of external auditory canal contour was found smooth without hidden pouches, irregularities nor stenosis in all cases. No registered granulation, foreign body reaction, nor extrusion and/or displacement of the BAG material. No reported facial palsy or recurrent cholesteatoma. Significant hearing improvement was statistically reported (p = 0.0006). CONCLUSION: Surgical reconstruction of the PMW using BAG that operatively fashioned immediately after CWD mastoidectomy appears to be reliable without considerable complications giving smooth appearance of the PMW and improving the hearing.

Infraorbital foramen localization in orbitozygomatic fractures: a CT study with intraoperative finding.

OBJECTIVE: The aim of this study was to assess the infraorbital foramen (IOF) using CT in patients with Zygomaticomaxillary complex (ZMC) fractures (midface fracture). PATIENTS AND METHODS: This prospective study was carried out on 49 patients had ZMC fractures (98 sides) and 27 patients (54 sides) with craniomaxillofacial fractures rather than fractured ZMC as a control. Using CT, position of IOF was documented on 3D view in relation to inferior orbital rim, tooth root relation and finally with a novel imaginary line passing between anterior nasal spine and whitnall tubercle. RESULTS: Position of IOF had fixed anatomical landmark: just lateral to a line drawn between the anterior nasal spine to whitnall tubercle (clinically between nasal tip-lateral canthal ligament) and lateral to vertical plane to root of maxillary canine also with variable distance from inferior orbital rim ranged from 4.56 to 18.03 mm with a mean of 7.9 ± 2.447 mm. CONCLUSION: Even though ZMC fractures disturb the anatomical location of the ZMC bones, there are still preserved reliable fixed landmarks maxillofacial surgeons can depend on to identify and preserve ION.

Single-Stage Repair of Palatal Fistula and Velopharyngeal Incompetence by the New L Flap.

OBJECTIVE: To describe and assess the results of use of the new L-shaped posterior pharyngeal flap for repair of both palatal fistula and velopharyngeal incompetence. METHODS: This study included 10 patients who were diagnosed to have soft palate fistula and persistent velopharyngeal insufficiency (VPI). L-shaped superiorly based pharyngeal flap was harvested from oropharynx and inserted into the soft palate closing the fistula after fistula trimming. The palatal part of the flap (transverse limb) was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate at fistula site closing it without tension. Prior to and after surgery, patients were assessed by examination, video-nasoendoscopy, and speech assessment. RESULTS: Closure of the palatal fistula could be achieved in all patients. Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported. CONCLUSION: The new used L-shaped pharyngeal flap could properly close palatal fistula and correct velopharyngeal functions (closure and speech) in patients with persistent VPI with no reported significant complication and without the need for palatal dissection or flaps.

Could Nasal Surgery Affect Multilevel Surgery Results for Obstructive Sleep Apnea?

OBJECTIVE: To study the role of nasal surgery as a part of multilevel surgery for management of obstructive sleep apnea (OSA). METHODS: All patients underwent multilevel surgery for relieving OSA symptoms and they were classified according to type of surgical intervention into: group A (20 patients), who underwent hyoid suspension (Hyoidthyroidpexy), tonsillectomy, suspension (El-Ahl and El-Anwar) sutures and nasal surgery (inferior turbinate surgery). Group B (20 patients), who underwent hyoid suspension (Hyoidthyroidpexy), tonsillectomy and suspension sutures. Pre and postoperative sleep study, Epworth sleepiness scale, snoring score were reported and compared. RESULTS: Apnea hypoapnea index (AHI) dropped significantly in both groups. The mean preoperative AHI was significantly less in patients who had no nasal obstruction (P = 0.0367), while the difference in postoperative values was nonsignificant (P = 0.7358).The mean Epworth sleepiness scale improved significantly in both groups, but the difference between pre and postoperative values in both groups was nonsignificant. The lowest oxygen saturation elevated significantly in both groups, but the difference between pre and postoperative values in both groups was nonsignificant. As regards snoring scores, they dropped significantly in both groups. The preoperative snoring score was reported to be significantly more in patients who had associated nasal obstruction (group A) (P = 0.0113). But after surgery the difference in postoperative values was nonsignificant (P = 0.1296). CONCLUSION: Treatment of nasal obstruction should be considered a crucial component in the comprehensive management plan for OSA patients as it has significant impact on the patients' AHI and snoring.

Simple Percutaneous Transbuccal Approach for Management of Mandibular Angular Fracture.

OBJECTIVE: To describe a relatively simple, easy, and safe technique for open reduction and internal fixation of the mandibular angle fracture using the combined modified percutaneous and oral approach with no special instrumentation. PATIENTS AND METHODS: This study was carried out on 10 patients who had traumatic mandibular angle fractures. All patients were managed by open reduction and internal fixation. Intraoral exposure and reduction of the fracture was performed through the gingivolabial incision. Then, a modified percutaneous-transbuccal way was utilized for conduction of the microdrill shaft and screw driver to permit screws fixation with perpendicular relations between plate and inserted screws. RESULTS: There were no registered soft tissue infections, wound dehiscence, occlusal defects, or facial nerve paresis. The mean surgical duration was 39.7 ±â€Š11.5 minutes. No patients were recorded to have unsatisfactory external scar and further intervention was not required. CONCLUSION: The described percutaneous approach to mandibular angle fracture can be done effectively and safely using available and operatively fabricated disposable tools.

Normal Nasopharyngeal Measurement by Computed Tomography in Adult.

BACKGROUND: This study aims to investigate the detailed computed tomography (CT) measurement of the nasopharynx (NP) in normal adult detecting mean of its dimension and relation of that measurement to that of the sphenoid sinus. METHODOLOGY/PRINCIPAL: A normal paranasal CT scan and a straight nasal septum of 128 individuals (256 sphenoid sinuses) were included in the study. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes for all subjects. Measurement of the width, length, and anteroposterior dimensions of the NP and sphenoid sinuses were taken separately. RESULTS: In 128 studied CT of adult subjects, the mean height of the NP was 19.4619 ±â€Š4.52661 and mean depth was 21.80714 ±â€Š4.62324 while the mean width was 25.31951 ±â€Š3.80521. No significant relations between diameters of NP and sphenoid sinuses were found. CONCLUSION: The detailed CT measurement of the NP in normal adult is an easy and reliable measurement. This study put the base of CT measurement of NP for further work to describe changes in such measures in patients with nasal and paranasal sinus anomalies.

Cilostazol Effect on Amikacin-Induced Ototoxicity: An Experimental Study.

OBJECTIVES: To find out the possible protective effect of cilostazol against amikacin-induced ototoxicity. METHODS: This study was carried out on 24 adult male rats classified into 4 equal groups of 6 animals each. (1) The control group was administered saline (1 ml/day, p.o.) for 14 days. (2) The amikacin group was administered amikacin (200 mg/kg, i.m.) once daily for 14 days. (3) The cilostazol-amikacin (14 days) group was administered cilostazol (30 mg/kg, p.o.) once daily and amikacin (200 mg/kg, i.m.) once daily for 14 days. (4) The cilostazol (28 days)-amikacin (14 days) group was administered cilostazol (30 mg/kg, p.o.) once daily for 28 days and amikacin (200 mg/kg, i.m.) once daily for 14 days. Changes in the transient evoked otoacoustic emissions (TEOAEs) in the 4 groups were interpreted statistically. RESULTS: No reported significant differences in TEOAE levels were detected between the groups at the start of the study. In all frequency bands, TEOAEs disappeared after amikacin treatment in the amikacin-alone group and remained absent in the amikacin-cilostazol (14 days) group, while TEOAEs reappeared in the amikacin-cilostazol (28 days) group. CONCLUSION: Cilostazol treatment for 28 days had a protective effect against amikacin-induced ototoxicity in rats.

Thyroglossal duct cyst excision with hyoid bone preservation.

The objective of this study is to assess complete removal of the thyroglossal duct cyst (TGDC) and its tract(s) to the base of the tongue with sparing of the hyoid bone. This is a prospective cohort study. Tertiary hospital (Zagazig university hospital). This prospective study was carried out on 21 patients who had been diagnosed preoperatively as TGDC or fistula. All patients were managed by dissection and removal of the TGDC and its tract(s) to the base of the tongue with sparing of the hyoid bone. The study was conducted on 12 males (57.14 %) and 9 females (42.85 %) with mean age 6.8 years (4-20 years). After histopathological examination; 16 patients (9 male and 7 female) were proved to have TGDC and 5 patients (3 male and 2 female) were proved to have dermoid cyst. The hyoid bone could be preserved in all cases except in two cases for whom the middle third of the hyoid bone was removed with the specimen. Multiple tracts were found in three cases and could be identified and dissected successfully with sparing of the hyoid bone. Identification, dissection, and complete excision of the TGDC with its attaching tract(s) could be performed without hyoid bone resection with no recurrence and minimal minor complication. The impacts of this hyoid bone preservation versus removal on the pattern of swallowing and retroglossal space need to be studied.

Posterior Pharyngeal Flap for Velopharyngeal Insufficiency Patients: A New L-Shaped Flap.

OBJECTIVE: To describe and assess the results of central inset L-shaped posterior pharyngeal flap (PF) for treatment of velopharyngeal incompetence. METHODS: This study included 12 patients who were diagnosed as persistent velopharyngeal insufficiency. L-shaped central inset superiorly based PF was harvested from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm behind the posterior margin of the hard palate, then the flap was spread 1 cm horizontally and 1 cm in the anteroposterior direction in soft palate. Before and after surgery, patients were assessed by examination, video: nasoendoscopy, and speech assessment. RESULTS: Postoperative speech assessment showed significant improvement in the nasal emission, resonance, intraoral pressure, and articulation defects. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in all patients. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea reported. CONCLUSIONS: The new used L-shaped PF could properly correct velopharyngeal functions (closure and speech) in patients with persistent velopharyngeal insufficiency with no reported complication.

Relation of Lower Last Molar Teeth With Mandibular Fractures.

OBJECTIVES: The objectives of this study were to study and investigate the relation between the state of the lower last molar teeth eruption and the site of the mandibular fractures. METHODS: Adult patients with traumatic mandibular fractures were included in this study. Panorama and computed tomography was performed for all patients. The relation between the state of the lower last molar eruption and criteria of the fracture was analyzed. RESULTS: In 106 patients who had 168 mandibular fractures, impacted lower third molar teeth were found to significantly increase the incidence of mandibular angle fracture while they had nonsignificant effect on incidence of other sites of mandibular fractures. CONCLUSION: Impacted lower third molar teeth significantly increase the incidence of mandibular angle fracture but did not have the same effect on other sites of mandibular fractures.

Mental Foramen Relation to Mandibular Fracture.

OBJECTIVE: To detect site of the mental nerve foramen in patients of mandibular fracture and study its relation to mandibular fracture site using radiology and operative findings during open reduction and internal fixation. PATIENTS AND METHODS: This study was carried out on 46 patients who had traumatic mandibular fractures. All patients were managed by open reduction and internal fixation during which mental foramen site and fracture site were reported and analyzed and compared to preoperative radiography. RESULTS: By both radiology and operative findings, the mental foramen was found in 78.3% between the first and second premolar, and in 21.7% below the first premolar. While no other mental foramen sites were reported. There were no statistically significant differences between both detected sites as regard age and sex. By operative dissection, mental foramen and neurovascular bundle could be detected, dissected, and preserved in all patients. CONCLUSION: To the best of the authors' knowledge, this is the first operative and radiological work that highlights the site and relation of mental foramen site to mandibular fracture in Arab people. The authors' study provides useful data of mental foramen among Arab population for the surgeons, anesthetists, and dentists to carry out procedures without complications.