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Objective Assessment the effect of topical application of mitomycin‐C (MMC) after endoscopic removal of antrochoanal polyp (ACP) on its recurrence rate. Methods This prospective study was done on patients with ACP. Endoscopic nasal surgery has been done to remove the polyp after wide middle meatal antrostomy. The patients were categorized into two groups. In MMC group, after endoscopic ACP removal, MMC on a piece of cotton was topically applied inside the maxillary antrum in the suspected site of ACP origin. A second group was used as a control group without MMC application. Results The study included on 40 patients; 20 patients in each group. Topical MMA application was easily performed. No granulation, crust, infection, or bleeding was reported in all cases of both groups. Recurrent polyp was not reported in MMC group, while recurrent polyp was detected in four cases (20%) in control group without MMA application with statistically significant difference (P = .035). Conclusion Topical MMC application inside the maxillary sinus after endoscopic removal of the ACP is safe, easy, and effective. Level of evidence 2c. Patients with antrochoanal polyp (ACP) were categorized into Mitomycin‐C (MMC) group for whom MMC was topically applied inside the maxillary antrum after endoscopic ACP removal and a control group without MMC application.‐ the recurrent polyp was not reported in the MMC group and was detected in 20% of the control group with a statistically significant difference (P= 0.035).‐ so topical MMC application inside the maxillay sinus after endoscopic removal of the ACP could effectively decrease the recurrence.

Background Retro-maxillary recess of the nasal cavity is an area that has not yet described in the literature. Objective To report, present, and describe a previously non-reported case which has bilateral retro-maxillary nasal recess by multi-slices computed tomography (MSCT). Case presentation A CT of a 22-year-old male showed bilateral retro-maxillary nasal recess extends beyond the posterior maxillary sinus wall and anterior to the pterygopalatine fossa as an extension of the middle meatus laterally and bounded by the maxillary sinus anterior, the orbital floor superior, the inferior turbinates lateral attachment inferior, and the pterygopalatine fossa anterior. The retro-maxillary nasal recess anteroposterior, lateral, and vertical dimensions were 11.53, 8.24, and 11.6 mm respectively at the left side and 5.6, 4.61, and 6.16 mm respectively at the right side. Conclusion This study reports and describes a new retro-maxillary nasal recess that could represent a new hidden challenging area for ESS.

Objective To evaluate using computed tomography dacryocystography (CT-DCG) and its importance in the lacrimal drainage system (LDS) blockage diagnosis. Methods It is a prospective study of 30 patients: 29 females and 1 male with age range from 20 to 65 years (34.5) presenting with symptoms with epiphora assessed by CT-DCG. Results Different levels of LDS blockage were evaluated: Canalicular obstruction in 3 patients (10%), lacrimal sac obstruction in 4 cases (13.3%), proximal NLD obstruction in 15 cases (50%), and distal NLD obstruction in 8 (26.7%) cases. The most common CTDCG finding was blockage of the proximal part of the nasolacrimal duct (NLD) in 50% of cases. Conclusion CTDCG seems to be a minimal-invasive, fast, procedure for evaluation of nasolacrimal duct obstruction (NLDO) that could add benefit in diagnosis and preoperative decision-making.

Background The computed tomography (CT) details of the dimensions of the trachea and the subglottic area are not fully covered in the literature, so it is important to build up a database for the CT measurements of that area. Preoperative details of the trachea are crucial prior to any approach or procedure involving the trachea . So, the aim of this study was to determine the different dimensions of the trachea and subglottic area by computed tomography (CT). Methods From 100 CTs of the trachea acquiring the axial images via the multiplanar reformates for all subjects to get the delicate details measuring the transverse diameter (width) and the anteroposterior diameter (depth) of the trachea and subglottic area. Results The mean tracheal width was 15.5 ± 2.1 mm (range = 11.5–21.7), and its mean anteroposterior diameter was 16.56 ± 2.77 mm (range = 11.8–25.1), while the mean width of the subglottic area was 15.1 ± 1.86 mm (range = 12.3–21.1), and its mean anteroposterior diameter was 17.75 + 2.76 (range = 12.9–25.2). All the dimensions of the trachea and the subglottic area were found significantly smaller in female than males. There was positive correlation between anteroposterior and transverse diameters of the trachea with the subglottic area with more tendency for more subglottic area dimension with increase tracheal dimensions and vice versa. Conclusion The current work updates the CT knowledge about the tracheal and subglottic area dimensions enhancing the surgeons, anesthetist, and radiologists data and orientation of the tracheal dimensions and could aid effective and safe tracheolaryngeal surgery.

Background Blood eosinophil count is significantly correlated with eosinophil infiltration in the nasal polyps; so, it could be a good marker for the nasal polyp eosinophilic inflammation. Objective Assessment of different peripheral eosinophil counts in different nasal polyps grading in allergic rhinitis patients. Methods A study was applied to 160 patients with allergic rhinitis (AR). Computed tomography (CT) was done preoperative then nasal polyps grading was assessed by nasal endoscopy. Peripheral eosinophil counts were checked in a blood sample for all patients. Then, a statistical analysis of the data was done. Results The study included 160 patients. Within 54 AR patients with no nasal polypi, eosinophil counts ranged between 0.001 × 10 3 μl and 0.907 × 10 3 μl with a mean of 0.2399 (SD = 0.2153). While within 106 patients with nasal polyps, eosinophil counts ranged between 0.05 × 10 3 μl and 14.7 × 10 3 μl with a mean of 1.6645 (SD = 3.06) with a significant difference ( p = 0.0008, t = 3.418). The eosinophil counts were statistically significantly more in advanced grades of the nasal polyps ( p < 0.0001, F = 9248). Conclusion Measuring peripheral eosinophil counts is simple, low cost, safe, and directly proportionate with different grades of nasal polyps. It can be used as a reliable marker to predict the severity of nasal polyps and consequently predict the prognosis of sinus disease and quality of life.

Background The retropalatal and retroglossal spaces are the main affected areas in obstructive sleep apnea (OSA) and they are the main targeted regions during OSA surgeries. But the dimensions of these spaces are sparsely referred to in literature. Aim To measure the retropalatal and retroglossal spaces dimensions in an easily measured way on the radiological evaluation to put basic measurements for such areas in normal subjects by multislice computed tomography (MSCT) in adults. Methods MSCT scans of asymptomatic adults were done for all included subjects to obtain delicate anatomical details of the recess using coronal, axial, and sagittal reformatted capability. Each retropalatal and retroglossal space was revised in the CT to find and measure their dimensions Results Within included 100 subjects, the mean transversal diameter (width) of the retropalatal space was 16.7±3 mm axially and the mean anteroposterior diameter (depth) was 6.9±1.4 mm. At the retroglossal area, the mean transversal diameter (width) was 17.7±3.8 mm axially and the mean anteroposterior diameter (depth) was 10.1±1.95 mm. Conclusion The current work describes the measurements of the retroglossal and retroplatal spaces. It is recommended to add the retroglossal and retropalatal space dimensions to the preoperative CT checklist, particularly in OSA.

Background Most of the surgeons tend to avoid exposing and identification the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy. In this study, our aim is to assess sequential steps to ligate superior thyroid vessels safely away from the External branch of superior laryngeal nerve (EBSLN). Methods This prospective case series study was conducted on 60 patients going for either total or hemi thyroidectomy in a tertiary teaching hospital between January 2016 and June 2019 . During thyroidectomy, firstly we skeletonized the upper pole of the thyroid gland by its capsular dissection followed by anterolateral down retraction of the superior pole. Then, entry and opening of the cricothyroid space and lastly clamping and ligating superior thyroid pedicle close to the upper pole away from EBSLN. Results This study included 60 cases; 19 total thyroidectomy and 41 hemi thyroidectomy with 79 superior thyroid vessels ligation and EBSLN at risk. In all patients, no evidence of superior laryngeal nerve (SLN) palsy or bleeding was detected. Postoperative video laryngoendoscopy showed apparently normal mobility, length, level, and position of the vocal folds with symmetry of the larynx. The patients’ voice showed no changes from preoperative evaluation in all studied patients at 3 months postoperative evaluation. No patients complained of any changes in their voice or voice activities. Conclusion The described stepwise approach for preservation of the EBSLN serves to completely remove the superior pole of the thyroid gland and ligate superior thyroid vascular pedicle without risk of SLN injury.

Background We performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, nose, anosmia, hyposmia, smell, olfactory, ORL, different ENT related symptoms. We reviewed published and peer-reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients. Main text Within the included 2549 COVID-19 laboratory-confirmed positive patients, smell affection was reported in 1453 patients (57%). The other reported ENT manifestations were taste disorder (49.2%), headache (42.8%), nasal blockage (26.3%), sore throat (25.7%), runny nose or rhinorrhea (21.3%), upper respiratory tract infection (URTI) (7.9%), and frequent sneezing (3.6%). Conclusion Smell affection in COVID-19 is common and could be one of the red flag signs in COVID-19 infection. With a sensitivity of utilized questionnaire in smell identification, a homogenous universal well-defined COVID-19 questionnaire is needed to make the COVID-19 data collection more sensible.

Background Nasopharyngeal stenosis (NPS) is a rare condition defined as the obstruction of the communication between the oropharynx and nasopharynx owing to scar contracture of the soft palate, tonsillar pillars, and posterior pharyngeal wall. NPS could be primary (attributed to a disease process such as rhinoscleroma) or secondary caused by prior surgery. In this study, we discuss the clinical manifestation of the acquired nasopharyngeal stenosis (NPS) and to investigate if there is a relation between the grade of the acquired NPS and the severity of obstructive sleep apnea (OSA) and patients’ symptoms. So, this cross-sectional study was conducted on patients who had post-surgical NPS of different grades. Then, the severity of snoring ± OSA and VAS of symptoms in those patients was assessed in different grades of the NPS, and the results were also statistically compared. Results Within the included 22 patients, there were no statistical differences between grade 1 and in grade 2 as regards age ( p = 0.0619) or sex ( p = 0.21137). The mean AHI was significantly more ( p = 0.004) in grade 2 NPS than grade 1 NPS. The VAS of difficult nasal breathing and dysphagia were significantly worse ( p < 0.0001) in grade 2 NPS than in grade 1, while the VAS of snoring did not differ significantly ( p = 0.3466) between grade 1 and grade 2 NPS. Conclusion Grade 2 NPS leads to significantly more severe AHI, dysphagia, and difficult nasal breathing than grade 1 NPS. But the difference in the grade of NPS did not cause differences in the snoring intensity.

Background maxillary cysts of dental origin are not common diagnosis. There is still debate about their perfect treatment method. There are many approaches to manage the odontogenic maxillary cysts; either intraoral, sublabial, or transnasal endoscopic approach. In this study, we present our technique of trans-antral endoscopic assisted excision of maxillary cysts of dental origin with assessing feasibility, results, and complications. Results Thirty-two patients were reported; 14 dentigerous cysts (43.75%) and 18 dental (radicular) cysts (56.25%). Complete cyst removal could be achieved in all cases without jeopardizing the maxillary sinus drainage through its natural ostium to the nasal cavity. Postoperative pain and facial swelling were mild in all cases and resolved within few days. No tooth loss, Sino nasal symptoms, infection or recurrence was reported throughout follow-up period ranging from 2 to 6 years. Conclusion Trans-antral endoscopic assisted approach for excision of odontogenic maxillary cyst is a reliable, safe, and effective procedure without recurrence, or permanent negative sequels over the long-term follow-up.