Otorhinolaryngology Head and Neck Surgery

Fibrolipoma of the nasopharynx Mohammad H Shaheen, Heba Z Kufiah Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):41-44 Nasopharyngeal fibrolipoma is exceedingly rare. This review article aims to recognize the characteristics of this rare tumor along with a favorable way to diagnose and treat it. We reviewed six cases of nasopharyngeal fibrolipoma. This lesion involves both sexes at any age. It is tremendously rare with only six case reports in the English literature and should be considered in the differential for nasopharyngeal masses. Nasopharyngeal fibrolipoma can be diagnosed by radiological investigations as a hypodense, well-defined nonenhancing lesion on the computed tomography and confirmed histologically, and endoscopic or transoral surgical excision approach is the most accepted management. However, no cases reported recurrence for this lesion.

Sensible awareness for otolaryngologist in managing aerodigestive foreign bodies in time of COVID-19 Muneera Abdulla Al Khalifa, Noor Yousif Abdulkarim Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):45-49 Background: In the time of COVID-19, the world came to a cease, however medical emergencies are ceaseless. Aerodigestive tract foreign bodies are one of the frequent emergencies in otolaryngology. Within the era of COVID-19, otolaryngologists have been documented to be at high risk of infection. Due to high viral load in the respiratory epithelium, the examination and extraction of foreign bodies in the aerodigestive tract places the otolaryngologist at high risk. Objective: The objective was to highlight the appropriate way of handling aerodigestive foreign bodies in the time of COVID-19 pandemic to insure safety of all involved medical staff. Methods: This was a systematic review of related international published guidelines. Results: A simplified flowchart is suggested to help guide the triaging of emergency patients with aerodigestive foreign body in the COVID-19-affected area. Conclusion: COVID-19 is a highly contagious infection that places health-care workers, especially the workers dealing with the aerodigestive tract at high risk. An appropriate management of these cases is essential to protect the health-care workers.

Oral ranulas: A 15-year retrospective clinico-surgical evaluation in a major referral hospital in the Southern Province of the Kingdom of Saudi Arabia John Spencer Daniels, Ibrahim AlBakry, Ramat Oyebunmi Braimah, Mohammed Ismail Samara Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):50-56 Background: A ranula is a mucous extravasation phenomenon involving the sublingual gland. The main objective of the current study was to present a clinic-surgical evaluation of ranula in our center. Materials and Methods: This is a 15-year retrospective analysis of ranulas in the main referral hospital in the Najran Region of the Kingdom of Saudi Arabia. Data collected includes demographics, type of ranula, modality of occurrence, laterality, surgical approach, and type of treatment. Data were stored and analyzed using IBM SPSS Statistics for IOS Version 25(IBM Corp., Armonk, NY, USA). Results were presented as simple frequencies and descriptive statistics. Results: Fifty-five cases of oral ranula were recorded out of a total of 75 ranulas during the study with a prevalence rate of 0.14 cases/1000 persons. There were 27 males and 28 females with a male-to-female ratio of 1:1.03. Their ages ranged from 2 years to 45 years with mean ± standard deviation (22.2 ± 10.7). The age group from 11 to 20 years had the highest frequency with 19 cases, representing 34.5% followed by the age group of 21–30 years with 16 cases, representing 29.1%. Of the total of 55 cases of oral ranula, 53 (96.4%) had the lesions excised together with the sublingual gland through intraoral approach, while only 2 (3.6%) cases were marsupialized. Conclusions: We have reported that oral ranulas represent about 73.3% of the ranulas. Surgical removal of the lesion and the sublingual gland is essential for the prevention of recurrence. Loose intraoral suturing in the floor of the mouth is advised to prevent saliva refilling.

Nasal bone measurements in the middle eastern population based on radiological analysis: A cross-sectional retrospective study Salma Saud Al Sharhan, Maha I Al Somali, Fahad S Al Zahrani, Mona M Ashoor, Sawsan F Almarzouq, Afnan F Almuhanna, Adnan T Samarah Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):57-62 Objectives: Performing septorhinoplasty surgery requires comprehensive knowledge of nasal morphology. The effect of racial differences on nasal bone morphology has gathered increasing interest. However, previous studies have primarily focused on the Western population with a few studies assessing the Middle Eastern participants. We aimed to provide itemized measurements of the nasal bone morphology as the baseline data for the Middle Eastern population. Study Design: This was a retrospective cross-sectional single-center study. Materials and Methods: We included patients who underwent maxillofacial computed tomography between February and August 2019 at King Fahad Hospital of University. The Kolmogorov–Smirnov test was used to check the assumption of data normality. The Mann–Whitney U-test and Student's t-test were used for nonsymmetrical and symmetrical variables, respectively. One-way analysis of variance was used for symmetrical data. Chi-square test was used to compare the categorical variables. Results: We included 276 cases. The mean right and right nasal bone length was significantly larger in men than in women. Moreover, patients with severe nasal septal deviation angle had significantly lower left and right medial bone thickness, as well as the internasal angle. Conclusion: There were significant between-sex differences in the nasal bone morphology. There was no side predilection for deviated nasal septum and nasal bone thickness. However, severe cases of deviated nasal septum presented a lower medial nasal bone thickness, which could be attributed to ethnic variations in the Middle Eastern population.

The efficacy of botulinum toxin injection on adductor spasmodic dysphonia Hatem Ezzeldin, Gamal Youssef Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):63-68 Background: Adductor spasmodic dysphonia (ASD) is a voice disorder characterized by strained, stuttering-like voice (involuntary disruptions of voice). Botulinum toxin (BT) injection of the vocal folds (VFs) is the treatment of choice, however, the doses and method of injection are variable. Objectives: The aim of this study is to assess the effect of BT injection on the voices of the patients having ASD. Patients and Methods: Twelve patients with ASD treated bilaterally with VF BT injection in the office under local anesthesia. Each patient evaluated by laryngoscopic examination, acoustic analysis, and voice handicap index. Results: All patients improved markedly regarding laryngoscopic, acoustic, and self-assessment parameters. Conclusion: BT can be used effectively for the treatment of ASD and improving phonatory (voice) and quality of patients' life.

Accuracy of fine-needle aspiration in diagnosing of well-differentiated thyroid cancer at a tertiary care center Mazin A Merdad, Zahra'a I Alghafli, Sarah M AlSharif, Marwah S AlQathmi, Ghazi M Sindi, Hani Z Marzouki Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):69-72 Background: Thyroid cancer is the third-most common cancer in Saudi females and males. The Bethesda System for Reporting Thyroid Cytopathology provides a diagnostic framework that can be used in surgical decision-making that allows the use of standardized treatment algorithms for each category. The present study aims to assess the accuracy of fine-needle aspiration (FNA) in diagnosing well-differentiated thyroid cancer in comparison to the corresponding final histopathological results. Methodology: This was a retrospective review of 404 patients who underwent FNA cytology, followed by thyroid surgery during 2010–2018. Data were collected from the medical records of these patients. Results: Based on the final histopathological examination results, 63% of the tested nodules were benign and 36% were malignant. The tested thyroid nodules with Bethesda categories II, III, IV, V, and VI were diagnosed as malignant in 8.7% 33.3%, 50%, 60%, and 94.4%, respectively. FNA (Bethesda categories II and VI) for benign and malignant lesions revealed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value of 79.69%, 97.84%, 94.44%, and 91.28%, respectively. Conclusion: FNA is a reliable diagnostic tool for diagnosing thyroid nodules with a high specificity and PPV. The capability of the relatively high overall malignancy rate can be explained by the nature of our institution, being a major regional tertiary and cancer center. The size of the nodule and its location, body mass index, and age had no significant effect on the accuracy of the FNA.

Laryngeal pathology requiring microlaryngoscopy a retrospective descriptive study of a single tertiary center in bahrain Maryam Isa Khalifa, Fatema Mohamed Alasfoor, Tasabeeh Ahmed Qareeballa Yousif, Fatema Sayed Ali Mohamed Alhashimi Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):73-77 Background: Laryngeal pathologies are commonly encountered in otolaryngology practice, and more benign lesions have been described than malignant ones. Microlaryngoscopy and biopsy are used to obtain a definite diagnosis in such cases. Aim: The aim was to study laryngeal pathologies requiring microlaryngoscopy in our tertiary care center during the period of 2014–2018. Study Design: This was a retrospective cohort study. Materials and Methods: Data were retrospectively extracted from the records of patients who had a suspected diagnosis of laryngeal pathology based on history and clinical examination and eventually underwent microlaryngoscopy procedures under general anesthesia. Results: There were 51 participants who underwent 58 microlaryngoscopic examinations. Males accounted for 61% of the participants. The mean age was 45 years. The most frequently presenting complaint was voice change. Benign lesions were more common than malignant ones. The most frequently described lesions were vocal fold polyps. Conclusion: We believe this is the first epidemiologic study to investigate laryngeal pathologies requiring microlaryngoscopy in Bahrain. The study provides insight into our population presenting with laryngeal pathology requiring microlaryngoscopy and could provide a basis for future research.

Incidence and risk factors of inadvertent parathyroidectomy during thyroid surgery: A single-center retrospective study Abdulaziz Rajeh Alanzi, Abdullah Ghafouri, Wael Khalifa, Hassan Hawsawi, Suzan Alzaidi Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):78-81 Context: Thyroidectomy is considered a relatively safe surgery with morbidity of <5% when undertaken by experienced surgeons. Inadvertent parathyroidectomy (IP) means pathology report has found parathyroid tissue in the thyroid specimen, and it was reported to range from 2.9% to 31%. Aims: The aim of this study is to measure the incidence rate and to evaluate the significant relationship between risk factors and IP during thyroid surgery. Settings and Design: A retrospective chart review study was carried out in King Fahad Armed Forces Hospital, Jeddah, between June 2015 and December 2019. Subjects and Methods: All consecutive patients undergoing unilateral or bilateral thyroidectomy were enrolled in this study. Histopathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid disease, and these were compared to patients with no parathyroidectomy in terms of gender, pathological features, re-operation, Hashimoto thyroiditis, extrathyroidal extension, and central neck dissection. Statistical Analysis Used: Statistical analysis was carried out using the Statistical Package for the Social Sciences. Results: Retrospective analysis of 181 consecutive thyroidectomy cases reveals that 34 (18.7%) patients had IP. Significant risk factors for IP included extra-thyroid extension (P = 0.008), total thyroidectomy (P = 0.017), and Hashimoto thyroiditis (P = 0.021). Other risk factors, including gender, malignancy, central neck dissection, and re-operation, were not statistically significant in this study. Conclusions: IP during thyroid surgery is not uncommon (18.7%). Total thyroidectomy, hashimoto thyroiditis, and extrathyroidal extension of the tumor were found to be significant risk factors. We recommend more meticulous intra-operative identification of parathyroid glands, particularly for patients with these risk factors.

Skeletonizing the facial nerve underwater: A pilot study Eman Hajr, Laila Hajr, Fida Almuhawas, Farid Alzhrani, Abdulrahman Hagr Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):82-85 Objective: Drilling of the facial recess represents an important step in cochlear implant (CI) surgery. It is crucial for the next step of exposing the round window. This study sought to evaluate the efficacy of underwater drilling (UWD) during the opening of the facial recess for CI surgery. Materials and Methods: This was a prospective clinical pilot study performed at a quaternary care center. We included adult and pediatric patients who underwent bilateral simultaneous CI surgeries. Any patients with facial nerve anomalies or previous ear surgery were excluded from the study. Drilling of the facial recess on one side was performed using UWD (case side); on the other side (control side), drilling was performed by minimal water drilling (MWD). Drilling was performed by the same surgeon on both sides. The time differences between the procedures were recorded. Results: A total of 21 patients were included in this study; 66% (14/21) were males, and the mean age was 8.25 years (standard deviation ± 12.00 years) at the time of surgery. UWD was completed, and the results of a normal facial nerve examination were documented postoperatively. The time needed for UWD (12 ± 6.72 min) was slightly shorter than the time needed for MWD (13 ± 6.15 min), but that difference was not significant (P = 0.71). Conclusion: The drilling of facial recess is one of the most stressful steps during CI surgery, we recommend the use of UWD because of its good safety profile and protective measures.

Left thyroid agenesis case study Bayan Osama Besharah, Haddad Hussin Al-Kaf, Sherif Kamel Abdelmonim, Mohammad Ali Al-Essa Saudi Journal of Otorhinolaryngology Head and Neck Surgery 2020 22(2):86-88 Thyroid hemiagenesis is a rare congenital anomaly, more commonly affecting the left lobe of the thyroid. There is only one case reported in Saudi Arabia in Annals Saudi journals 1997, and this will be the second case to be reported in Saudi. Here, we present a 67-year-old woman with the left thyroid lobe agenesis and multinodular goiter in the right thyroid lobe. The condition was discovered during preoperative preparation for tracheostomy, which showed euthyroid (in laboratory measurements) and an enlarged right large thyroid lobe extending up to cervical vertebra 2 and the retrosternal area (in computed tomography images). The patient underwent total thyroidectomy and tracheostomy. Postoperative thyroid scan and histopathology results confirmed the diagnosis. It is a rare anomaly, with most patients asymptomatic. Consequently, cases may not be readily diagnosed.

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