BACKGROUND We used the irradiated homograft rib cartilage as an augmentation tip support and Medpore alloplast for reconstruction of the dorsum in patients with saddle nose deformities. Thereafter, the safety and efficiency of this method was evaluated to determine if this can be a safe and efficient technique for patients with saddle nose deformities. METHODS A total of 32 patients who suffered from saddle nose deformities due to past trauma or aggressive rhinoplasty underwent reconstruction using the Medpor prosthesis for dorsum reconstruction and irradiated rib cartilage as acolumellar strut during the same technique. After at least one year follow up, patients' satisfaction and their aesthetic indexes were evaluated and compared with preoperative results. RESULTS More than 84% of patients were satisfied from the results of the surgery and only one patient had a complication of the infection which resulted in removal of the prosthesis. There were statistically significant differences between most of the pre- and postoperative aesthetic indexes. CONCLUSION Despite the superiority of autogenous material in nose reconstruction, lack of such materials in revision rhinoplasty cases present challenges to surgeons. This study proposes the safety and efficiency of the Medpor alloplast for reconstruction of the dorsum and irradiated rib cartilage for the tip, at least for a short period of time.

OBJECTIVE To compare the effects of routine nasal packing with polyvinyl acetal sponge (Merocel) versus no packing, after endoscopic sinus surgery for nasal polyposis. SUBJECTS AND METHODS This clinical, randomised, controlled trial was performed in an academic tertiary referral centre between 2008 and 2011. Sixty patients with resistant nasal polyposis underwent endoscopic sinus surgery, and were then randomly divided into two groups: packed and non-packed. The amount of bleeding and pain in each group during pack removal was documented. RESULTS There was no significant difference between the two groups in the outcome of surgery and complications. One patient in each group needed extra packing. In the packed group, the mean ± standard deviation pain score on pack removal was 61 ± 3 (using a visual analogue scale in which 0 = no pain and 100 = worst pain imaginable). CONCLUSION This study found no significant difference between polyvinyl acetal packed and non-packed groups, following endoscopic sinus surgery for nasal polyposis. This confirms the findings of similar studies, and supports the reconsideration of routine post-operative packing in selected cases.

OBJECTIVE: To determine the presence of common bacterial agents of otitis media with effusion (OME), together with investigation these agent in the adenoid tissue and antimicrobial susceptibility pattern of isolated bacteria in Iranian children with OME. METHODS: Polymerase chain reaction (PCR) and bacterial culture methods were used for detection and isolation of Alloicoccus otitidis, Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae in 63 middle ear fluid samples and 48 adenoid tissues from 48 OME patients. Fifteen patients were bilaterally affected. Antimicrobial susceptibility of all bacterial isolates were determined by disk agar diffusion (DAD) method. RESULTS: Bacteria were isolated from 47%(n=30) of the middle ear fluid samples and 79%(n=38) of the adenoid tissue specimens in OME patients. A. otitidis was the most common bacterial isolated from the middle ear fluid 23.8% by culture and 36.5% by PCR method. S. pneumoniae was the most prevalent pathogen (35.5% and 31.2% by culture and PCR) in the adenoid tissues. In 10 patients the same organisms were isolated from the middle ear fluid and adenoid tissue. Antimicrobial susceptibility pattern showed taht most isolates of bacteria were sensitive to ampicillin, Amoxicillin/Clavulanate and fluoroquinolones. CONCLUSION: The present study, being the first report on the isolation of A. otitidis by culture method in Iran and Asian countries, shows that A. otitidis is the most frequently isolated bacterium in Iranian children having otitis media with effusion. In this study A. otitidis, S. pneumoniae, H. influenzae and M. catarrhalis are the major bacterial pathogens in patients with OME and we found that ampicillin and Amoxicillin/Clavulanate have the excellent activity against bacterial agents in Iranian children with OME.

HASH(0x2ba594f4c600)

OBJECTIVE Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis. SUBJECTS AND METHODS Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered. RESULTS The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome. CONCLUSION Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.

Orofacial clefts, including cleft lip with or without cleft palate (CL (P)), are common congenital malformations, second only to clubfoot in frequency of occurrence. The epidemiology and genetics of this disorder have been studied extensively in various countries by several investigators. The objective of this study is to assess the epidemiology and some genetic aspects of orofacial clefting at Imam Khomeini Hospital in Tehran. This study was a 7-year case series (retrospective) study from 1999 to 2006. The setting for the study was Imam Khomeini Hospital in Tehran, and the participants were all consecutive surgical cases with orofacial clefts referred to this hospital. One hundred and 77 cases of cleft lip and/or cleft palate were recorded during these 7 years. Seventy four of them (41.8%) were female and 103(58.2%) were male (M/F Ratio=1.39). Of all patients, 40 persons (22.6%) had isolated CP, 45 (25.4%) had cleft lip without cleft palate, and 92 (52%) had cleft lip with cleft palate (CL+P). Their M/F ratios were 1.66, 0.6 and 1.96 respectively. Of all CL (P) probands, 41 patients (29.9%) were bilaterally affected. In unilateral cases, the left side was affected nearly twice as frequently as the right side. Among the patients, 23 cases (13%) had other malformations; most commonly head and face abnormalities and then congenital heart disease. Fifty-four patients (30.5%) had consanguine parents; 33 (18.6%) were first cousins, 7 (4%) were second cousins, and 14 (7.9%) were distant relatives. There was a positive family history for cleft syndrome in 23 cases; most commonly CL-P. Our study reveals that the epidemiologic aspects of oral clefts in Iran are very similar to other Caucasian populations. It also suggests that a routine screening such as echocardiography and ruling out skeletal, hearing and visual problems may be necessary in cleft patients especially in children. It seems that genetic counseling and karyotyping can be very useful in patients with multiple malformations.

OBJECTIVE: This study was designed for better understanding of the role of different methods of nasal endoscopy in the assessment of adenoid hypertrophy and comparing them with lateral neck radiography and patients' symptoms. SUBJECTS AND METHOD: From August 2007 until January 2009, in the otolaryngology ward of a tertiary referral center, 89 patients who had symptoms related to chronic mouth breathing participated in this study. History of the symptoms related to adenoid hypertrophy was obtained from them. In addition, all patients underwent nasal endoscopy and lateral nasopharynx x-ray. The clinician who did nasal endoscopy was blinded to information about clinical data and x-ray and vice versa. Afterward, the relationship between symptoms and each diagnostic procedure was evaluated. RESULTS: Patients had a mean age of 9.47 +/- 4.68 years. In the evaluation of the relationship between symptoms grading and grading in lateral neck radiography, this relationship was significant about snoring. Furthermore, there was a significant relationship between the endoscopic size of adenoid and number of the episodes of acute otitis media. The sum of symptoms grading had a significant relationship with the size of adenoid in lateral neck x-ray, but not in nasal endoscopy. CONCLUSION: The results of the present study indicated that both radiography and nasal endoscopy could define the relationship between adenoid hypertrophy and associated symptoms and therefore are complementary. Between them, despite the popularity of nasal endoscopy, radiography can serve as a better planning tool.

Objective:To determine the effect of embolisation on endoscopic resection of angiofibroma.Subjects and method:A partially blinded trial was undertaken. Twenty-three patients with angiofibroma (nine embolised and 14 not embolised) underwent endoscopic resection between January 2007 and August 2008 in two tertiary referral centres. Demographic data were collected, the pre-operative tumour extent was assessed by computed tomography, and tumours were staged according to their computed tomography appearance (Radkowski scale). In addition, we evaluated the duration of surgery, amount of haemorrhage, blood pressure during surgery, duration of hospitalisation, complications of surgery and embolisation, cost of treatment, and number of post-operative recurrences, as well as the angiographic characteristics in the embolisation group.Results:There was no significant difference between the general characteristics of both groups. At the end of the study period, we could find no significant difference between the two groups regarding haemorrhage, number of recurrences or complications. The only significant difference was cost of treatment, which was significantly higher in the embolisation group.Conclusion:Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolisation in every case of endoscopic angiofibroma resection.

BACKGROUND: Rhinoplasty is one of the most challenging esthetic surgeries. The ability to achieve precise and predictable changes in the shape and position of the nasal tip is still among one of the demanding areas of rhinoplasty. Columellar strut is one of many techniques to ensure an adequate nasal tip projection and rotation; however, there is little evidence to support long-term efficacy of this technique.METHODS: In a clinical trial, 93 patients who were rhinoplasty candidates were studied prospectively. They were randomly divided into two groups according to the use of columellar strut. The outcome measures were gaining and maintaining tip projection and rotation in the long term. Standardized photographsbefore and 3, 6, and 12 months after surgery were the measurements to compare the results between two groups.RESULTS: The mean age was 23.3 +/- 4.8 years. In 47 cases, surgery was performed using columellar strut and in 45 cases this method was not used.Preoperatively, nasolabial angle and tip projection were not significantly different between the two groups. In addition, postoperatively, the mean of nasolabial angel and tip projection were not significantly different in the two groups 3, 6, and 12 months after surgery. The decreasing of these parameters was not significantly different during follow-up in the two groups.CONCLUSION: It seems that columellar strut is not an essential technique to enhance and maintain tip projection and/or rotation in rhinoplasty. Using good techniques in qualified hands give the best results in the long term even without columellar strut.