Search

Abstract Background The surgical management of multinodular goiter is the treatment of choice for the majority of cases. There is controversy between radical resection with the lifelong thyroxine substitution and function-preserving resection with the risk for recurrence, and the complications associated with total thyroidectomy. Objective The aim of the present study was to compare the outcome of total thyroidectomy (TT) in comparison with subtotal thyroidectomy (ST) as regards hypocalcemia, transient nerve injury, and recurrence rate. Patients and methods This study included published English medical articles in the last 20 years, concerning the treatment of multinodular goiter. Results Meta-analysis was for the evaluation of surgical outcomes after surgical management of multinodular goiter including total thyroidectomy versus subtotal thyroidectomy by comparing the TT versus ST in our study including 23 studies included of the total number of patients (4485) who underwent subtotal thyroidectomy versus the total number of patients (7116) who underwent total thyroidectomy; a comparison was done as regards postoperative complications including RLN injury (transient or permanent), rate of recurrence, need for reoperation, and incidence of postoperative hypocalcemia. The incidence of RLN injury is lower in ST compared to TT, and its recurrence is much lower in TT than in ST. Conclusion This meta-analysis showed that the advantages of total thyroidectomy include adequate eradication of the disease, prevention of recurrent goiter, and avoidance of the need for completion surgery in case of occult malignancy, but it is associated with higher morbidity (postoperative thyroidectomy complications: RLN palsy and hypoparathyroidism) and the need for lifelong replacement therapy (L-thyroxin supplementation).

Abstract Background The anatomical variation of the frontal sinus and its intimate relation to the skull base and orbit makes its surgery demanding. The extended endoscopic frontal sinus surgery allows wide better drainage and preventing the recurrence of the disease. Fourteen patients underwent EEFSS from May 2017 to May 2019. These patients are nine patients presented by chronic recurrent frontal sinusitis, three patients presented by chronic recurrent fronto ethmoidal mucocele and two patients with chronic recurrent external frontal fistula. Draff III done for ten patients of them and Draff IIB done for four patients of them. This study is designed for evaluating the efficacy of the extended endoscopic frontal sinus surgery (E E F S S) in management of chronic and recurrent frontal sinus diseases. Results The neo opening of the restored frontal sinus was remained opened with Draff III with high success rate; two patients from four patients with Draff IIb were with closed nasofrontal duct. The main follow-up was 12 months; the patients were followed up post-operatively for many office visits without any other manifestations. Conclusion The chronic recurrent frontal sinus diseases can be treated successfully with extended endoscopic frontal sinus surgery (E E F S S). The extended endoscopic frontal sinus surgery (Draff III) provides good results with low morbidity and less post-operative care.

Abstract Background Myringoplasty operation is the reconstruction of the tympanic membrane (TM) which is performed to prevent recurrent discharge of the ear and to improve the hearing impairment which is caused by TM perforation. Platelets are the key factors in tissue repair mechanisms. They provide essential growth factors, which stimulate fibroblasts to create extracellular matrix deposition and neovascularization. The aim of this study is the assessment of the topical use of autologous platelet-rich fibrin (PRF) in the improvement of myringoplasty success rate. Results Patients were divided to two groups, group A included 20 patients who were submitted to myringoplasty operation with adding of PRF from the same patient, and group B included 20 patients who were submitted to myringoplasty operation without adding of PRF. At 6 months postoperatively, the success rate (graft taking) in case group A (95%) was significantly higher than in the control group (70%) (P value = 0.037). Success in terms of hearing gain of the air-bone gap was more than 10 dB achieved in 19 patients (95%) in case group A, and 14 patients (70%) in control group B were with a statistically non-significant difference (P value = 0.079). There was no effect of PRF use on hearing gain in graft-taken cases because hearing gain is related to the closure of TM. Conclusion Topical PRF application over tragal perichondreal graft during myringoplasty is successful, safe, and highly efficient with no complications. PRF improves healing of chronic TM perforations and prevents postoperative infection.