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Objectives: To evaluate the incidence, presentations and different treatment outcomes of orbital complications secondary to sinusitis.Methods: We conducted a retrospective chart review of patients with orbital complications secondary to sinusitis seen at Ain-Shams University Hospitals (Department of OtoRhinoLaryngology, Cairo, Egypt) over a period of three years. Data obtained from the charts included clinical presentations, contrast enhanced computed tomography data, type of treatment, surgical approaches used and their outcomes.Results: Thirty-five patients (35) presented to Ain Shams University Hospital over the three year period with orbital complication secondary to sinusitis. Medical treatment was successful in 15 patients; surgical drainage was done in 19 cases (13 cases were done endoscopically and 6 were drained externally) including orbital exenteration and Caldwell Luc procedure which were done in the same patient (fungal infection). One case developed coma and passed away the same day of presentation despite aggressive management and neurological consultation.Conclusion: Orbital complications of sinusitis have a good prognosis when detected early and managed appropriately. The key point here should be increasing physician awareness towards this problem as well as encouraging early referral to specialized centers for the proper management of these cases.

Background: The principal aims of a tympanoplasty operation are to create an intact tympanic membrane and to restore an optimal hearing improvement. Many surgeons have used cartilage for grafting due to its increased stability and resistance to negative pressure. Cartilage has been criticized because of concerns regarding hearing results.Objectives: The aim of this study is to present the experience of using cartilage for grafting central perforations in type I tympanoplasty procedure with some novel modifications and evaluate its take rate and audiologic results.Methods: This is a prospective study including 40 patients (45 ears) who underwent type I cartilage tympanoplasty. All patients are primary cases of chronic suppurative otitis media of tubotympanic type. The following parameters were evaluated at least after 3 months from surgery: graft take and change between the pre-and post-operative pure-tone average air-bone gap (PTA-ABG).Results: Thirty-nine patients included in the study underwent 45 cartilage tympanoplasty type I operations. The mean age of the patients was 24.9 ± 9.5 years (range, 15-51 years). The mean follow up period was 6.2 months (range, 3-9 months). All perforations were found to be closed with a 100% graft take rate. The overall mean pre-operative PTA-ABG was 26.0 ± 4.4 dB, whereas the postoperative PTA-ABG was 13.8 ± 5 dB (p < 0.0001) which is highly significant. The percent of reduction of PTA-ABG was about 46.6%.Conclusion: Bi-island chondroperichondrial type I tympanoplasty is an effective and reliable technique with a high success rate and minimal complications.

BackgroundSpontaneous cerebrospinal uid (CSF) rhinorrhea from the lateral recess of the sphenoid sinus is surgically challenging. Sternberg's canal has stirred great controversy as the potential source. The aim of this study was to present our experience with endonasal endoscopic repair, the possible etiopathology, and the outcomes. Study designThis prospective study comprised 10 patients (seven female and three male) with spontaneous CSF rhinorrhea from the lateral recess of the sphenoid sinus, which was not related to trauma, previous surgery, tumors, irradiation, or meningitis. CSF rhinorrhea was con rmed with 2 transferrin test and high resolution CT scan (HRCT) and MRI cisternography. All patients were treated with the endonasal endoscopic conservative retrograde trans-sphenoidal approach. ResultsThe mean BMI was 35.55 ± 2.84 kg/m 2 . Elevated intracranial pressure was present in all cases con rmed directly (with a mean intraoperative lumbar drain pressure of 27.5 ± 3.84 cm H 2 O), and indirectly [with the presence of primary empty sella (100%), arachnoid pits (30%), and attenuated skull base (40%)]. Osteodural defect was constantly present in the superior wall of the lateral recess, lateral to the foramen rotundum, none above the foramen rotundum or below the vidian canal ori ce. The mean follow-up was 46.9 ± 8.26 months. ConclusionThe endonasal endoscopic repair is a safe and effective method. The etiopathology is multifactorial. The management of elevated intracranial pressure is crucial. The potential source is not Sternberg's canal but persistent cartilaginous vascular channels at the ossi cation center of the alisphenoid, cartilaginous precursor of the greater wing of the sphenoid bone.

Background: Dural injury and CSF otorrhea is a serious complication during mastoidectomy especially in low level dura.Objectives: Aim of the study is to determine a reliable landmark for the middle fossa dura to minimize risk of dural injury and CSF otorrhea during mastoidectomy. By answering the question which is considered as a more fixed landmark for the dura; the supramastoid crest or the lower border of the zygomatic arch?Methods: A cadaveric study was done on 204 temporal bone specimens in the temporal bone lab at the Ain Shams University Specialized Hospital.A correlation between the level of the supramastoid crest and the level of the zygomatic arch was done.A correlation between the level of the dura and the level of the supramastoid crest in the area of mastoid antrum was done.A correlation between the level of the dura and the level of the zygomatic arch was done.Results: In 20.6% of specimens, the dura lies at a lower level than the level of the supramastoid crest but in 2.9% of specimens the dura lies at a lower level than the lower border of the zygomatic arch.Conclusion: It is better to consider the lower border of the zygomatic arch as a reliable landmark of the middle fossa dura in the area of the antrum than to consider the supramastoid crest as a landmark for the dura. It is better to consider imaginary line directed posteriorly from the lower border of the zygomatic arch as a superior limb of the Macewen triangle.