Using low level laser therapy to reduce early postoperative airway obstruction following modified Hogan’s flap / El uso de la terapia con láser de baja intensidad para reducir la obstrucción de la vía aérea postoperatoria temprana después del colgajo de Hogan modificado

Introduction and objective: The most common postoperative complications of velopharyngeal insufficiency surgery are postoperative bleeding and airway obstruction or obstructive sleep apnoea. Consequently, the aim of this study was to evaluate the effect of low level laser therapy (LLLT) during the first postoperative days in children undergoing superiorly based pharyngeal flap (SBF) surgery. Materials and methods: A randomized double blind clinical study on 30 children divided on two groups 15 patients each, who underwent SBF. LLLT was used in a group and the other was a control group. The study was conducted in academic tertiary care medical centres between 2013 and 2015. The degree of edema, oxygen saturation, occurrence of obstructive sleep apnoea (OSA) and steroid administration were recorded. Results: The mean of the average oxygen saturation was significantly less in the control group in the 1st and 2nd day as compared to the laser group. The need for oxygen and the incidence of OSA in the first 3 days were significantly higher in the control group as compared to the laser group. The degree of edema showed no significant difference in the first day but was significantly higher in the control group in the 2nd and 3rd days. Hence, the need of steroids was significantly higher in the control group in the first 3 days. Conclusions: Preliminary results showed that low level laser therapy is effective in reducing the incidence of early postoperative airway obstruction after SBF operations (AU)

Introducción y objetivo: La más común de las complicaciones postoperatorias tras la cirugía de la insuficiencia velofaríngea son el sangrado y la obstrucción postoperatoria de las vías respiratorias, o la apnea obstructiva del sueño. Por lo tanto, el objetivo de este estudio fue evaluar el efecto de la terapia láser de baja intensidad durante los primeros días del postoperatorio en niños sometidos a colgajo faríngeo de base superior (SBF). Métodos: Estudio clínico aleatorizado doble ciego en 30 niños, entre el grupo de láser y el grupo control, que fueron sometidos a SBF. El estudio se llevó a cabo en dos centros médicos académicos de atención terciaria, entre 2013 y 2015. Se registró grado de edema, la saturación de oxígeno, la aparición de apnea obstructiva del sueño y la necesidad de esteroides. Resultados: Durante los 3 primeros días, la media de la saturación de oxígeno muestra cambios significativos entre los dos grupos. Por otra parte, la necesidad de oxígeno en los primeros 3 días muestra también cambios significativos entre los dos grupos. Así como la incidencia de apnea obstructiva del sueño. El grado de edema no muestra ningún cambio significativo en el primer día, pero sí en los 2 días siguientes. Por lo tanto, la necesidad de esteroides en los primeros 3 días también muestra cambios significativos entre los dos grupos. Conclusiones: Los resultados preliminares mostraron que la terapia con láser de baja intensidad es eficaz en la reducción de la incidencia de obstrucción de vía aérea en el postoperatorio temprano después de las operaciones SBF (AU)

The value of using loupe magnification and methylene blue dye in intra-operative identification of thyroglossal duct tract.

BACKGROUND: This was a comparative randomised study to find out the value of using loupe magnification and methylene blue dye in identification of the thyroglossal duct and to compare between them. PATIENTS AND METHODS: Twenty-two patients who presented with infrahyoid thyroglossal duct cyst were subjected to excision of the cyst with two methods for identification of thyroglossal duct track during the operation. Data were anlysed for identification of multiple tracts, the tract relation to the hyoid bone, incidence of complications and operative time. RESULTS: We found that multiple tracts were present in 9.1% of the patients in Group I and 36.3% in Group II, with no statistically significant difference between the two groups. The incidence of complications was 27.2% in Group I and 9.1% in Group II, with no statistically significant difference between both groups. However, the incidence of identification of the tract, and its relation to the hyoid bone was higher in Group II (90.9%) than in Group I (45.5%) , with a statistically significant difference between both groups. Also the incidence of identification of the extension level of the tract above the hyoid bone and up to the tongue base was significantly higher in Group II (72.8%) as compared to Group I (9.1%). The operative time was significantly shorter in Group II (54.35 min) and was 76.55 min in Group I, (P = 0.0001). CONCLUSION: Intra-operative identification of the thyroglossal tract is an essential step in the removal of the thyroglossal duct cyst. Both loupe magnification and methylene blue dye help in the tract identification, however, the usage of surgical loupes enhances better and safe results.

The effectiveness of low-level laser on postoperative pain and edema in secondary palatal operation.

OBJECTIVE: The postoperative period after palatal surgery is usually very painful, requiring the use of pain-relieving drugs. Hence, the aim of this study was to evaluate the efficacy of Low-level laser therapy (LLLT) in post-operative pain control and edema after secondary palatal operations. METHODS: A randomized double blinded clinical study on 20 children undergoing secondary palatal operations between 2013 and 2015 was done. Patients were randomly divided on two groups 10 patients each. In one group patients received local application of therapeutic laser immediately after surgery while patients received nothing in the control group. The mean age was 5.22 years ± 2.53 SD in the laser group and 6.42 years ± 0.76 in the control group. Postoperative pain was assessed by using visual analog scale scores and by recording the need of analgesics. The degree of postoperative edema was also recorded. RESULTS: The pain scale showed significantly less postoperative pain in the laser group than in the control group from the first day (P-value = 0.006) to the 6th day (P-value = 0.014). The number of postoperative analgesic doses needed were significantly less in the laser group in the second and third days (P-value = 0.014). The postoperative edema was significantly higher in the control group from the 2nd (P-value = 0.004) to the 7th (P-value = 0.014) postoperative days. CONCLUSIONS: Preliminary results showed that low-level laser therapy is effective in the reduction of postoperative pain and edema, and minimizing the need of analgesic medication after secondary palatal operations.

Using low level laser therapy to reduce early postoperative airway obstruction following modified Hogan's flap.

INTRODUCTION AND OBJECTIVE: The most common postoperative complications of velopharyngeal insufficiency surgery are postoperative bleeding and airway obstruction or obstructive sleep apnoea. Consequently, the aim of this study was to evaluate the effect of low level laser therapy (LLLT) during the first postoperative days in children undergoing superiorly based pharyngeal flap (SBF) surgery. MATERIALS AND METHODS: A randomized double blind clinical study on 30 children divided on two groups 15 patients each, who underwent SBF. LLLT was used in a group and the other was a control group. The study was conducted in academic tertiary care medical centres between 2013 and 2015. The degree of edema, oxygen saturation, occurrence of obstructive sleep apnoea (OSA) and steroid administration were recorded. RESULTS: The mean of the average oxygen saturation was significantly less in the control group in the 1st and 2nd day as compared to the laser group. The need for oxygen and the incidence of OSA in the first 3 days were significantly higher in the control group as compared to the laser group. The degree of edema showed no significant difference in the first day but was significantly higher in the control group in the 2nd and 3rd days. Hence, the need of steroids was significantly higher in the control group in the first 3 days. CONCLUSIONS: Preliminary results showed that low level laser therapy is effective in reducing the incidence of early postoperative airway obstruction after SBF operations.

The effects of palatal lengthening on the functional and speech outcomes after submucous cleft palate repair.

UNLABELLED: This study was designed to compare intravelar veloplasty with and without V-Y pushback palatoplasty regarding postoperative functional and speech outcomes. THE AIM: is to find out the importance and influence of palatal lengthening on the functional and speech outcomes after SMCP repair. STUDY DESIGN: This is a prospective randomized comparative study of 20 patients divided into 2 equal groups. The study was conducted between February 2008 and January 2015. METHODS: Radical Intravelar Veloplasty (RIVVP group): included 10 patients with a mean age of 5.539±1.335 years and V-Y Pushback Pharyngoplasty and Radical Intravelar Veloplasty (VYP+RIVVP group): included 10 patients with a mean age of 5.688±1.341 years for non-syndromic SMCP. SETTING: Academic tertiary care medical centres. RESULTS: In both groups there was a significant change in Eustachian tube function, nasal emission and nasal tone of voice postoperatively than preoperatively, while there was no significant difference between both groups in the postoperative outcomes as regards the same parameters (ET function, nasal emission and resonance) (p=0.558, 0.563 and 0.164 respectively). However, there was a significant difference between both groups as regards palatal lengthening, no statistically significant difference was present between both groups as regards the postoperative mean pharyngeal gap, using videoendoscopic analysis. In conclusion, RIVVP and VYP+RIVVP are both effective methods to repair non-syndromic SMCP. Moreover, the lengthening of the palate in non-syndromic SMCP is an unnecessary process.

Analytic hierarchy process as module for productivity evaluation and decision-making of the operation theater.

The analytic hierarchy process (AHP) is a theory of measurement through pairwise comparisons and relies on the judgments of experts to derive priority scales, these scales that measure intangibles in relative terms. The aim of the article was to develop a model for productivity measurement of the operation theater (OT), which could be applied as a model for quality improvement and decision-making. AHP is used in this article to evolve such a model. The steps consist of identifying the critical success factors for measuring the productivity of OT, identifying subfactors that inflauence the critical factors, comparing the pairwise, deriving their relative importance and ratings, and calculating the cumulative effect according to the attributes in OT. The cumulative productivitycan be calculated by the end and can be compared Ideal productivity to measure the productive of OT in percentage fraction. Hence, the productivity could be calculated. Hence, AHP is a very useful model to measure the productivity in OT.

Repair of cleft alveolar bone with bioactive glass material using Z-plasty flap.

UNLABELLED: Multiple literature addresses cleft alveolar bone, with little consensus on the preferred surgical technique. Hence, we described a transoral approach for repair of cleft alveolar bone with Z-plasty and using bioactive glass. STUDY DESIGN: Case presentation and surgical technique description. In conclusion, transoral mucosal repair cleft alveolar bone Z-plasty using bioactive glass demonstrated an alternative easy and simple approach for augmentation of unilateral alveolar cleft patients.

COMPARISON OF NATURAL AND SYNTHETIC MATERIALS TO IMPROVE HEARING AFTER OBLITERATION OF THE MASTOID CAVITY.

BACKGROUND: Indications for removal of mastoid air cells and obliterating the mastoid cavity vary considerably from surgeon to surgeon. Various obliteration techniques have been recommended to eliminate open cavity problems. Here we investigated the difference between natural and synthetic filling materials to improve hearing after obliteration of the mastoid cavity. SETTING: Academic tertiary care medical centers (Al-Azhar and Ain-Shams University Hospitals). STUDY DESIGN: Retrospective comparative study included 60 patients divided into 2 equal groups. METHODS: The study was conducted over 6 years from 2008-14. The mean follow-up time was 3.5 years. RESULTS: We found that serviceable hearing (≤30 dB) was obtained after surgery in 52 patients (86.6%). In cases where natural materials were used in reconstruction, the average gain in AC was 25.5 dB and in BC it was 1.1 dB, while in cases where synthetic materials were used the average gain in AC was 26 dB and in BC it was 0.5 dB. There was significant improvement in the mean postoperative AC compared to the mean preoperative AC. However, there was no statistically significant difference between the use of natural and synthetic materials in improving postoperative hearing. CONCLUSIONS: Both natural and synthetic materials help in improvement of hearing after obliteration of the mastoid cavity. There is no statistically significant difference between the materials.

Functional and speech outcomes of superiorly based flap pharyngoplasty combined with radical intravelar veloplasty.

OBJECTIVE: The aim of this study was to evaluate functional and speech outcomes of superiorly based pharyngeal flap (SBF) pharyngoplasty combined with radical intravelar veloplasty (RIVVP) for the management of velopharyngeal insufficiency (VPI) following surgically repaired cleft palate. DESIGN: A case series with chart review. The study was conducted in academic tertiary care medical centre. PATIENTS AND METHODS: Fifteen patients with VPIs following surgically repaired cleft palate were managed between May 2011 and August 2014, with SBF pharyngoplasty combined with RIVVP. RESULTS: We found that the speech defects improved by a success rate of 93.4%; the VP function became normal (circular pattern of closure) in 80% of patients and the postoperative overall success rate of VP competence grades was 93.4%. Moreover, we found that the overall incidence of complications were 33.3%. CONCLUSION: By doing SBF pharyngoplasty combined with RIVVP the surgical procedure was satisfactory in both functional and speech outcomes.

Palatopharyngeus the missing palatal muscles: Anatomical and physiological review.

The first true anatomical descriptions of the normal anatomy of the palate and pharynx were published by Von Luschka in 1868, and then in 1935 anatomist James Whillis described pharyngeal sphincter. Later, in 1941 Michael Oldfield noted that the muscular elements of the soft palate have a sling-like function. Although there have been conflicting descriptions of the role of the palatopharyngeus, multiple function such as speech, swallowing, and respiration, it could role in all this function. Although, the palatopharyngeus muscle has many important functions, but it remains the missing muscle that we need to know more about it.

Evaluation of using Bioglass® in obliteration of mastoid cavity.

BACKGROUND: A mastoid cavity resulting from a canal wall down mastoidectomy can result in major morbidity for patients due to different open cavity problems. Mastoid obliteration with reconstruction of the bony external ear canal recreates the normal anatomy to avoid such morbidity. METHODS: This retrospective observational study was conducted for 4 years (between 2008 - 2013) to determine if mastoid obliteration with bioactive glass (Bioglass®) following mastoidectomy overcomes the open cavity problems or not. Patients with cholesteatoma had subjected tomastoidectomy with primary or secondary mastoid obliteration, by using bioactive glass (Bioglass®),then our primary outcome measure. RESULTS: Forty patients were interviewed. Forty of them were primary or secondary obliteration after canal wall down mastoidectomy of a primary cholesteatoma. The most frequent fate of obliteration or reconstruction of mastoid was Grade 1 (47.5%) then Grade 0 (30%). Postoperative hearing assessment showed that the average (mean) air conduction (0.5-4 KHz) was 31.1 dB and the average (mean) bone conduction (0.5-4 KHz) was 15.5 dB. The gain average in air conduction was 26 dB and in bone conduction it was 0.5 dB. Ear discharge was found in 36 patients (90%) preoperative and it was found only in 6 patients (15%) postoperative, in 4 patients (10%) cholesteatoma recidivism or recurrences was present. CONCLUSION: This study shows that the bioactive glass (Bioglass®) is one of the beat materials used in mastoidectomy with obliteration of open mastoid cavity.