Comparative Survival Function in Patients with Positive Surgical Margins Following Laryngectomy.

Aims: This study aims to make a comparative analysis of disease-free survival (DFS) and overall disease-specific survival (OS) in patients with laryngeal carcinoma. Materials and methods: The study was designed retrospectively. Sixteen patients with postoperative PSM and 30 with negative surgical margins (NSM) were included. Survival analysis and Long-Rank comparisons was performed for DFS and OS between groups. Results: PSM was a significant independent risk factor for loco-regional recurrence and disease-related mortality (p = 0.004, HR: 1.6, p = 0.002, HR: 3.2, respectively). DFS and OS were significantly longer in NSM group (p = 0.001 and 0.003, respectively). For PSM group, 2- and 5-year DFS rates were 57%; OS rates were 80% and 34% respectively. In NSM group, 2- and 5-year DFS rates were 96% and 83%; OS rates were found to be 96%. Conclusion: PSM had significant relation with poor prognosis.

The critical period for development of secondary restenosis following post-intubation tracheal stenosis surgery.

BACKGROUND: Determining a predictable duration to restenosis very essential for reducing mortality and morbidity for tracheal stenosis surgery. OBJECTIVES: The aim of this study was to determine the critical periods for secondary restenosis risk for operated patients with post-intubation tracheal stenosis (PITS) during the initial healing period. METHODS: A total of 61 patients with a diagnosis of surgically treated PITS were included in the study. Treatment groups were carbon dioxide (CO2) laser and tracheal resection with primary anastomosis (TRPA). Duration to restenosis was compared with Kaplan-Meier curves between study groups. RESULTS: Restenosis developed in 11 (18.0%) patients and was diagnosed after a mean of 39.3 ± 38.5 (range, 22 to 155) days. Gender or Cotton-Myer grade of the PITS was not found to be risk factors for the development of stenosis. Restenosis rate was 33.3% in CO2 laser group and 10% in the TRPA group (p = .036). Duration to restenosis was detected at a median of 28 days in patients treated with CO2 laser, and a median of 30 days in patients treated with TRPA (p = .024). CONCLUSIONS: The most critical period for the development of restenosis after PITS treatment is the third and fourth weeks, especially in patients treated with CO2 laser.

The Role of Serum Adhesion Molecules s-ICAM-1 and s-VCAM-1 in Chronic Otitis Media Pathogenesis: A Prospective Controlled Study.

The aim of this study was to determine the levels of soluble intracellular adhesion molecule-1 (s-ICAM-1) and soluble vascular cell adhesion molecule- 1 (s-VCAM-1) in patients with chronic otitis media (COM) according to the disease profile and to compare with ears without otitis media. Eighty-nine patients had ear surgery were included in the study prospectively. 78 patients who underwent tympanomastoidectomy included in the study group and 11 patients who underwent exploratory tympanotomy included in the control group prospectively. The level of s-ICAM-1 and s-VCAM-1 measured with ELISA technique. s-ICAM-1 and s-VCAM-1 levels compared between COM specific diseases group and with the control group. Levels of s-ICAM-1 and s-VCAM-1 measured as 584.5 ± 165.3 ng/ml and 541.1 ± 237.3 ng/ml in patients with COM, 384.4 ± 99.6 ng/ml and 551.7 ± 336.4 ng/ml in the control group respectively. The mean of s-ICAM-1 detected significantly higher in the COM group (p < 0.001). But the mean of s-VCAM-1 in the COM and control group was similar (p = 0.895). Also, s-ICAM-1 was significantly higher in patients with cholesteatoma, ossicular chain defects and tympanic membrane retraction (p = 0.037, 0.045 and 0.032, respectively). Although s-VCAM-1 level was not affected by cholesteatoma, ossicular chain defect and tympanic membrane retraction (p = 0.178, 0.243, p = 0.164, respectively). While the mean of s-ICAM-1 was detected significantly higher in COM and related pathologies therefore, increased serum levels may reflect the severity of the disease. But, s-VCAM-1 was not affected by COM and COM-specific diseases.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer / Valor prognóstico de parâmetros de PET/TC com 18F-FDG e variáveis histopatológicas em câncer de cabeça e pescoço

Abstract Introduction 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. Objective To investigate the prognostic value of these parameters in patients with head and neck cancers. Methods We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. Results The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63 cm3 (0.6-34.3), 68.9 g (2.58-524.5 g), 13.89 (4.89-33.03 g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. Conclusion Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Resumo Introdução Os parâmetros da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose, como os máximos valores de captação padronizados, o volume metabólico tumoral padrão e a glicólise total da lesão são importantes biomarcadores prognósticos de câncer. Objetivo Investigar o valor prognóstico desses parâmetros em pacientes com câncer de cabeça e pescoço. Método Fizemos um estudo retrospectivo que incluiu 47 pacientes com câncer de cabeça e pescoço e que foram submetidos à tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose antes do tratamento. Volume metabólico tumoral, glicólise total da lesão e valores de captação padronizados foram aferidos em cada paciente. O valor prognóstico de parâmetros quantitativos da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose e das variáveis clínico-patológicas sobre a sobrevida livre de doença e a sobrevida geral foi analisado. Resultados A média (intervalo) de volume metabólico tumoral e glicólise total da lesão e valores de captação padronizados foram 7,63 cm3 (0,6-34,3), 68,9 g (2,58-524,5) e 13,89 g/mL (4,89-33,03), respectivamente. Metástase nos nódulos linfáticos e diferenciação tumoral foram variáveis significativas de sobrevida livre de doença e sobrevida geral; contudo, nenhum parâmetro da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose estava associado a sobrevida livre de doença e sobrevida geral. Conclusão As quantidades dos parâmetros da tomografia por emissão de pósitrons pré-tratamento não previram a sobrevida em câncer de cabeça e pescoço.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer.

INTRODUCTION: 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. OBJECTIVE: To investigate the prognostic value of these parameters in patients with head and neck cancers. METHODS: We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. RESULTS: The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63cm3 (0.6-34.3), 68.9g (2.58-524.5g), 13.89 (4.89-33.03g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. CONCLUSION: Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Risk factors for decannulation failure after single-stage reconstruction of adult post-intubation tracheal stenosis: 10-year experience at a tertiary center.

Background: Although the risk factors for decannulation failure have been discussed in the literature, there are many unclear points on this issue.Aims and objectives: To identify risk factors for developing decannulation failure after single-stage surgical reconstruction of post-intubation tracheal stenosis (TS).Material and methods: A total of 45 adult patients with post-intubation TS admitted to our institution and underwent single-stage surgical reconstruction between April 2008 and May 2018. Nine patients developed decannulation failure by postoperative 6 months (Failed Decannulation Group), and 36 patients were decannulated successfully (Successful Decannulation Group). Causal factors of intubation were noted. Patient-related risk factors of decannulation failure were compared between two groups.Results: Failed Decannulation Group had a significantly higher body mass index (p = .034) and were more likely to have diabetes (p = .025). Patients who were previously intubated for more than 48 h (p = .043) were significantly more likely to have decannulation failure. The presence of comorbid diseases did not place a patient under statistically significant risk of decannulation failure.Conclusion: Patients with high body mass index, the ones with diabetes, and patients who were previously intubated for more than 48 h were more likely to develop decannulation failure.

Risk Factors for Adult Postintubation Tracheal Stenosis.

BACKGROUND: To identify risk factors for developing adult postintubation tracheal stenosis (TS) and determine if there were patient characteristics that could serve as prognostic indicators of clinical outcomes in this patient population. METHODS: A total of 55 patients with postintubation TS admitted to our institution between February 2009 and March 2017 (TS group) and randomly selected 86 patients admitted to the intensive care unit and intubated over the same period in whom TS was ruled out (control group) were compared. Causal factors of intubation were noted. Patient-, treatment-, and procedure/cuff site-related risk factors of TS were compared. RESULTS: Both groups did not differ from each other by means of age and gender (P = 0.640, and P = 0.724, respectively). Compared to controls, patients with TS had a significantly higher BMI (32.8 ±â€Š7.64 kg/m versus 25.9 ±â€Š6.68 kg/m; p = 0.002) and were more likely to have diabetes (28.4% vs 9.82%; p = 0.0011). Patients who were previously intubated for more than 48 hours (P = 0.016) and patients treated with irradiation (P = 0.028) were significantly more likely to develop TS than control patients. CONCLUSION: Patients with TS had a significantly higher BMI, and were more likely to have diabetes compared to controls. Patients who were previously intubated for more than 48 hours and patients treated with irradiation were more likely to develop TS than control patients.

Internal Nasal Valve Expanding Graft for Middle Vault Reconstruction.

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre- and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P < 0.05). Based upon pre- and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P < 0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.

Superficial Parotidectomy Versus Partial Superficial Parotidectomy: A Comparison of Complication Rates, Operative Time, and Hospital Stay.

PURPOSE: The type and extent of surgery for benign parotid tumors are a subject of debate. We aimed to measure and compare hospital stay, operative time, and complication rates associated with superficial parotidectomy (SP) and partial superficial parotidectomy (PSP). MATERIALS AND METHODS: This retrospective cohort study included all patients who underwent surgery for benign parotid gland tumors in our tertiary center between January 2006 and March 2014 and were followed up for at least 3 years. The predictor variable was the type of parotidectomy, and the main outcome parameters were operative time, hospital stay, and postoperative complications. The demographic characteristics (age and gender), clinical history, and preoperative findings were obtained from patient records. The Kolmogorov-Smirnov test, Mann-Whitney U test, and χ2 test were used to analyze the data. P < .05 was considered statistically significant. RESULTS: The sample was composed of 321 patients (184 men and 137 women) with a mean age of 54.0 ± 14.7 years (range, 18 to 87 years). Of these, 190 underwent SP and 131 underwent PSP. Pleomorphic adenoma was the most common tumor (83 patients, 53%), followed by Warthin tumor (50 patients, 32%). The mean hospital stay was 6.7 ± 2.3 days in the SP group and 4.8 ± 2.4 days in the PSP group (P < .001). The mean operative times in the SP and PSP groups were 134.0 ± 24.6 and 92.1 ± 21.9 minutes, respectively (P < .001). The overall complication rates were 21.6% and 12.2% in the SP and PSP groups, respectively (P = .031). No tumor recurrence was observed in either group. CONCLUSIONS: Compared with the SP group, the PSP group had shorter operative and hospital stay durations and fewer postoperative complications with a comparable recurrence rate. Therefore, PSP should be considered in suitable cases.

Endoscopic Repair of Persistent Oroantral Communications Using the Caldwell-Luc Approach.

In this article, a novel endoscopic technique used to close oro-antral fistulas will be described. In the technique described here, 24 cases were surgically treated between May 2011, and November 2014. Under endonasal endoscopic examination following partial inferior uncinectomy, the natural ostium of the maxillary sinus was identified; through this tract, a curved aspirator was advanced into the sinus. If present, we extracted endoscopically tissues causing obliteration of the ostium through the Caldwell-Luc antrostomy, taking care to preserve the integrity of the natural ostium. In the technique described here, endoscopic examination using the Caldwell-Luc approach, the inside of the maxillary sinus is explored fully, existing infection and polyps are eliminated locally, and natural patency of the maxillary sinus ostium can be achieved. The graft used to obliterate the oroantral fistula can be easily harvested from the bone of the anterior wall of the maxillary sinus by accessing the surgical entry tract.

Application of Sal classification to parotid gland fine-needle aspiration cytology: 10-year retrospective analysis of 312 patients.

BACKGROUND: The accuracy of fine-needle aspiration biopsy (FNAB) is controversial in parotid tumors. We aimed to compare FNAB results with the final histopathological diagnosis and to apply the "Sal classification" to our data and discuss its results and its place in parotid gland cytology. METHODS: The FNAB cytological findings and final histological diagnosis were assessed retrospectively in 2 different scenarios based on the distribution of nondefinitive cytology, and we applied the Sal classification and determined malignancy rate, sensitivity, and specificity for each category. RESULTS: In 2 different scenarios FNAB sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 81%, 87%, 54.7%, and 96.1%; and 65.3%, 100%, 100%, and 96.1%, respectively. The malignancy rates and sensitivity and specificity were also calculated and discussed for each Sal category. CONCLUSION: We believe that the Sal classification has a great potential to be a useful tool in classification of parotid gland cytology.

Analysis of Recurrence after Frontolateral Laryngectomy.

OBJECTIVE: This study aimed to evaluate the recurrence and survival of patients treated with frontolateral laryngectomy for T1 and T2 glottic laryngeal carcinoma. METHODS: Patients who underwent frontolateral laryngectomy for glottic laryngeal carcinoma at a tertiary hospital between March 2009 and June 2014 were included. Patient demographics, tumor stage, treatment and histopathological examination data, and adjuvant therapy details were evaluated. RESULTS: Thirty patients with T1aN0, T1bN0, and T2N0 vocal fold carcinoma were examined. The mean follow-up duration was 40 months. Of the 30 patients, nine (30%) were stage T1 and 21 (70%) were in stage T2. Twenty-nine patients were males and one was female, and the mean age was 59 (range, 42-81) years. During follow-up, local recurrence was observed in four patients following frontolateral laryngectomy. Six patients continued smoking after frontolateral laryngectomy, of which three developed tumor recurrence. The local control rate was poor in patients with anterior commissure involvement (66.6%) compared with those with no involvement (95.2%). Two of four patients with local recurrence were treated with salvage total laryngectomy and adjuvant postoperative radiotherapy; the remaining two were treated with only radiotherapy. One patient who was treated with only radiotherapy developed lung metastasis during follow-up and died because of distant metastasis. CONCLUSION: Frontolateral laryngectomy is an efficient choice of treatment for selected cases of T1 and T2 glottic laryngeal carcinoma.

Lymph Node Density in Node-Positive Laryngeal Carcinoma: Analysis of Prognostic Value for Survival.

OBJECTIVE: We investigated the value of lymph node density (LND) as a predictor of survival in patients with laryngeal squamous cell carcinoma (SCC) and positive neck node (pN+) after laryngectomy. STUDY DESIGN: Case series with chart review. SETTING: Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECTS AND METHODS: We reviewed the records of 289 patients with newly diagnosed primary laryngeal carcinomas who underwent partial or total laryngectomy and combined neck dissection at a tertiary referral center between June 2006 and December 2014. Patients with pN+ laryngeal SCC (n = 101) were included in the study. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of LND. RESULTS: In 101 patients with pN+ laryngeal SCC, LND ≥0.09 and number of metastatic lymph nodes >4 were significantly associated with OS and DFS but not the overall tumor, node, and metastasis stage. Forward stepwise Cox regression analysis revealed that LND ≥0.09 was the only independent predictor of both DFS and OS. Furthermore, the odds ratio of LND ≥0.09 was 10 times higher in patients with regional recurrence when compared patients without regional recurrence. CONCLUSIONS: LND was the only independent prognostic predictor of OS and DFS in patients with pN+ laryngeal SCC. Moreover, patients with LND ≥0.09 were significantly associated with high risk of regional recurrence. Thus, patients with LND ≥0.09 are at high risk of regional recurrence and death and may be considered for adjuvant chemoradiation.

Is T-tube treatment effective in Meyer-Cotton grade 3 tracheal stenosis: long-term outcomes.

OBJECTIVES: To present retrospective experience in Meyer-Cotton grade 3 tracheal stenosis of 17 patients treated by T-tube, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS: All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS: The aetiology of the tracheal stenosis was intubation-related in all cases. The duration of intubation ranged between 1 hour to 40 days. According to the Myers-Cotton classification, all patients were at stage 3. Mean length of the stenosis was 26.58 ± 12.02 (range =15-70) mm. Mean follow-up for the study group was 60.16 ± 34.10 (range =18-137) months. Two patients died during follow-up, one due to stroke, one due to chronic lymphocytic leukemia; no deaths were attributable to TS. The remaining 15 patients could be evaluated up to the present time. Post-operative decannulation was achieved in three of 15 patients (20%), and decannulation was not achieved in 12 of 15 patients (80%). CONCLUSION: T-tube is not an effective treatment of tracheal stenosis.

The effects of hypotensive anaesthesia on otoacoustic emissions: a prospective, randomized, double-blind study with objective outcome measures.

The aim of the present study was to compare pre- and post-operative otoacoustic emission examinations of patients who experienced surgery under hypotensive anaesthesia using distortion product otoacoustic emission (DPOAE) and transient evoked otoacoustic emission (TEOAE). Forty-one patients, admitted to our tertiary centre for nasal valve surgery, were prospectively and randomly assigned into two groups. Hypotensive group included 20 patients, while control group included 21 patients. All investigators and patients were blinded to anaesthesia assignment throughout the course of the study. DPOAEs and TEOAEs were performed before surgery and repeated after 15 days in both groups. In control group, DPOAE-DP1 levels per frequency increased significantly in the post-operative period when compared with the pre-operative values in all patients. However, DPOAE-DP1 levels decreased significantly in hypotensive group. Similarly, DPOAE-SNR levels per frequency decreased significantly in hypotensive group. In conclusion, we have observed that under the influence of hypotensive general anaesthesia, the amplitudes of OAEs are affected.

Transection of Nasolacrimal Duct in Endoscopic Medial Maxillectomy: Implication on Epiphora.

OBJECTIVE: Management of the nasolacrimal system is usually recommended during medial maxillectomy via external approach because of reported higher rates of postoperative epiphora. Association of the endoscopic medial maxillectomy (EMM) with epiphora, however, is not clearly stated. In this study, we attempted to evaluate whether patients develop epiphora after simple transection of the nasolacrimal duct during EMM. PATIENTS AND METHODS: Medical records of 26 patients who underwent endoscopic tumor resection for inverted papilloma (IP) were retrospectively reviewed. Patients who underwent EMM with nasolacrimal canal transection were included and recalled for lacrimal system evaluation. Twelve patients were eligible for inclusion and fluorescein dye disappearance test (FDDT) was performed for each patient. Patient demographics, tumor data, surgical procedures, and follow-up time were recorded. RESULTS: Of the 12 patients included in the study, 6 underwent canine fossa transantral approach concurrently with EMM. The mean duration of follow-up was 21.1 months (range, 6-84 months). Eight patients were graded as 0, whereas 4 patients were graded as 1 according to FDDT. All test results were interpreted as negative for epiphora. All patients were completely symptom free of epiphora. CONCLUSIONS: Epiphora after EMM with nasolacrimal canal transection among patients with sinonasal tumors appears to be uncommon. Therefore, prophylactic concurrent management of nasolacrimal system including stenting, dacryocystorhinostomy (DCR), or postoperative lacrimal lavage are not mandatory for all patients.

Tracheal Resection With Primary Anastomosis.

The aim of our study was to present our retrospective experience in the single-stage surgical reconstruction of 21 tracheal stenosis (TS) patients during the last 17 years, considering the characteristics of the treated stenosis, surgical procedures performed, and postoperative outcomes and complications. All demographic and clinical data were collected retrospectively. Chest and neck computed tomography (CT) scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Myer and Cotton grading scale. The aetiology of the (TS) was intubation related in 18 patients and idiopathic in three patients. The duration of intubation was 13.00 ±â€Š6.83 days (range, 1 hour to 27 days). According to the Myers-Cotton classification, mean stage of stenosis for the study group was 3.33 ±â€Š0.66 (range, 2-4). Mean length of the stenosis was 2.05 ±â€Š0.80 (range, 1-3.5) cm. The mean number of stenotic segment involved was 3.67 ±â€Š1.24 (range, 2-6). Mean follow-up for the study group, excluding two patients who died in the postoperative period, was 57 (range, 12-326) months. Of the 19 patients who survived, postoperative decannulation was achieved in 16 patients (76.19%), and decannulation was not achieved in 3 patients (14.29%) who are still on a T-tube. Of the 16 patients who are decannulated successfully, additional procedures were applied in 9 patients. Segmental resection with primary anastomosis is an effective method and can be used as the first option in selected patients of (TS).

Rhino-orbital Mucormycosis: Clinical Findings and Treatment Outcomes of Four Cases.

In this case report, we present the clinical findings and therapeutic outcomes of four rhino-orbital mucormycosis patients. The four patients (1 female, 3 male; age range, 55-77 years) all had diabetes mellitus and two also had chronic renal failure. All patients exhibited proptosis, sinusitis, and dark-colored lesions on the nasopharynx and/or hard palate; three patients had ipsilateral peripheral facial paralysis. Visual acuity was no light perception in the two patients with severe orbital involvement and 0.8 in two patients with limited orbital involvement. Histopathological examination of the hard palate, nasopharynx or sinus biopsy revealed typical Mucor hyphae. Systemic liposomal amphotericin B was initiated in all patients. The patients with limited ocular involvement received amphotericin B both intravenously and by local irrigation; both patients had complete recovery. The other two patients underwent orbital exenteration; one patient died after declining systemic treatment postoperatively. Rapid diagnosis and treatment are important for the survival of rhino-orbital mucormycosis patients. With orbital involvement, surgical debridement and systemic and local treatment with antifungal agents may help avoid mutilating surgery like exenteration.

CO2 laser treatment of tracheal stenosis.

CONCLUSION: Delivery of a carbon dioxide laser is an effective method and can be used in selected cases of tracheal stenosis. OBJECTIVES: To present retrospective experience in tracheal stenosis of 16 patients treated by bronchoscopic delivery of carbon dioxide laser, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS: All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS: The aetiology of the tracheal stenosis was intubation-related in 14 cases, and idiopathic in two cases. The duration of intubation ranged between 1 hour to 26 days. According to the Myers-Cotton classification, mean stage of stenosis for the study group was 3.3 ± 0.5. Mean length of the stenosis was 23.75 ± 6.95 (range = 15-40) mm. Mean follow-up for the study group was 23.81 ± 7.11 (range = 12-38) months. Postoperative decannulation was achieved in 13 patients (81.3%), and decannulation was not achieved in three patients (18.7%).