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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. Conclusions : 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.

Background: Chronic frontal sinusitis as a component of chronic rhinosinusitisis is one of the greatest challenges in rhinology. The endoscopic endonasal approach to the frontal sinus became the standard approach in chronic rhino sinusitis refractory to medical management. Objectives: The aim of this work is to assess different approaches addressing frontal sinus disease in twenty four patients with chronic frontal sinusitis resistant to medical treatment for a period not less than twelve weeks in Otorhinolaryngology Department in Zagazig University Hospitals from March 2018 to November 2018. Patients and methods: Patients' age ranged from 20 to 58 years with a mean of 32.6 ± 10.68. These patients had two different approaches on each nasal side: Zero angled endoscopic approach (to perform standard uncinectomy and anterior ethmoidectomy including resection of ethmoidal bulla with middle turbinate preservation then removal of agger nasi cells accessing frontal sinus) and resection of the superior attachment of uncinate process (with preservation of ethmoidal bulla then using 70 degree angled endoscope to expose the frontal sinus). Results: In both techniques, preservation of ethmoid artery, middle turbinate and lamina papracyae were maintained. Residual mucopurulent discharge in the frontal recess area was found in 4 sides (10%) and managed medically. Endoscopic assessment revealed lateralization of middle turbinate in 6 sides only (15 %) which had ethmoidectomy prior to frontal sinusotomy. Conclusion: Addressing frontal sinus through intact bulla technique is less invasive guarding against anterior ethmoidal artery injury, scarring at frontal recess area and frontal ostium restenosis.

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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).