Post COVID-19 Head and Neck Mucormycosis: MR Imaging Spectrum and Staging.

OBJECTIVE: To develop a systematic approach for magnetic resonance imaging (MRI) analysis, imaging spectrum, and classification system for the staging of post-COVID-19 head and neck mucormycosis. METHOD: The study included 63 post-COVID-19 patients with pathologically proven mucormycosis who underwent head and neck MR imaging. Three independent radiologists assessed the imaging spectrum of mucormycosis, MRI characteristics of sino-nasal mucormycosis, and extra-sinus extension, and submitted a final staging using a systematic approach and a proposed categorization system. A consensus reading was considered the reference imaging standard. The kappa statistics were used to assess the categorization system's diagnostic reliability. RESULTS: The overall interreader agreement of the MR staging system was very good (k-score = 0.817). MR imaging spectrum involved localized sino-nasal mucormycosis (n = 7 patients, 11.1%), sino-nasal mucormycosis with maxillo-facial soft tissue extension (n = 28 patients, 44.5 %), sino-nasal mucormycosis with maxillo-facial bony extension (n = 7 patients, 11.1%), sino-naso-orbital mucormycosis (n = 13 patients, 20.6%), and sino-nasal mucormycosis with cranium or intracranial extension (n = 8 patients, 12.7%). Extra-sinus extension to the orbit and brain did not have significant association with involvement of the posterior ethmoid/sphenoid sinuses and maxillo-facial regions (p > 0.05). MRI-based staging involved four stages: stage 1 (n = 7, 11.1%); stage 2 (n = 35, 55.6%), and stage 3 (n = 13, 20.6%), and stage 4 (n = 8, 12.7%). Involvement of the bone and MR-based staging were significant predictors of patients' mortality p = 0.012 and 0.033, respectively. CONCLUSION: This study used a diagnostic-reliable staging method to define the imaging spectrum of post-COVID-19 head and neck mucormycosis and identify risk variables for extra-sinus extension.

Simple Endoscopic Application of Laryngeal Keel Stent.

This study describes a simple extraendolaryngeal technique to apply laryngeal keel in dealing with anterior commissure web/fibrosis. Standard extraendolaryngeal punctures were applied via 20-gauge needles, 30° from the skin surface, in midline through the cricothyroid and thyrohyoid membranes. These needles were used as a conduit for the passage of 2/0 Prolene threads, which were retrieved through the laryngoscope by crocodile forceps. Both laryngoscopic ends of the Prolene threads were passed through a fabricated silastic sheet (keel stent) via a 22-gauge free needle, and these ends were tied to have a secure internal knot. Steady traction was applied on the other 2 external threads until there was appropriate application of this keel stent within the vicinity of anterior commissure. Finally, these external ends were tied to have a secure external knot. A keel stent could be applied without the need for special instrumentation and with reasonable outcomes (proper healing of anterior commissure, satisfied voice outcome, and patent airway).

Linear Measurements of Vocal Folds and Laryngeal Dimensions in Freshly Excised Human Larynges.

INTRODUCTION: Understanding the morphology of the larynx, one of the most complex organs of the human body, is an important step toward understanding the detailed laryngeal anatomy, and physiology. Different studies have described the linear measurements of the larynx in different measuring methods, but no studies have been structured to describe vocal fold length in freshly excised larynges. OBJECTIVES: The aim of this study was to describe exact anatomical measurements of vocal folds and some laryngeal structures in freshly excised larynges, and to compare such measurements between males and females. This can help improve the diagnostic and therapeutic procedures in the laryngology field. SUBJECTS AND METHODS: This study was applied on 21 patients having different types of laryngeal carcinoma: 11 males and 10 females with the age range 41-75 years old. Every patient was assessed using laryngeal endoscopy and photography, and the length of the membranous vocal fold was measured using a millimeter-graded ruler that was photographed with focus with the same magnification used in the video laryngoscopy of the glottis. Then patients were exposed to total laryngectomy, and excised larynges were used for a direct measuring of the membranous and cartilaginous vocal folds. Then measures of men and women were compared statistically. Measures of excised larynges were also compared with those of the video endoscopy using a video-printed ruler. CONCLUSION: Freshly excised larynges can be used for accurate quantitative measuring of the vocal fold length and laryngeal dimensions. There are considerable differences in all measured dimensions between males and females.