Alaa Gaafar - Academia.edu (original) (raw)

Papers by Alaa Gaafar

Journal of cardiothoracic surgery, Feb 3, 2024

Background Tumor-like lesions of the trachea are rare and challenging in diagnosis and management... more Background Tumor-like lesions of the trachea are rare and challenging in diagnosis and management. Inflammatory myofibroblastoma, also known as Inflammatory pseudo tumors (IPTs), as well as Rosai Dorfman Disease (RDD) are inflammatory lesions that may involve the central airways with variable non-specific clinical features mimicking tumors. Case presentation In this study 2 cases with tumor-like lesions are presented. One case with an inflammatory pseudotumor and the other one with Rosai-Dorfman disease affecting the upper trachea. Both cases were successfully managed with tracheal resection anastomosis. Conclusion Tracheal Inflammatory myofibroblastoma, and Rosai-Dorfman diseases are rare tumor like lesions that present with upper airway obstruction. Despite being benign, these lesions may have features suggestive of malignancy, requiring prompt management. Complete surgical excision by segmental resection and primary anastomosis (if feasible) is the treatment of choice with an optimum outcome.

The Egyptian Journal of Otolaryngology, Jul 1, 2014

No signi cant difference in the acoustic parameters between the two groups was observed, but ther... more No signi cant difference in the acoustic parameters between the two groups was observed, but there was signi cant difference between the preoperative and the postoperative acoustic parameters for each group. Postoperative parameters satisfactorily improved with resolution of the lesions in both groups. Conclusion The microdebrider was determined to be a safe, accurate, and reliable method in removal of benign vocal fold lesions but does not offer major advantages compared with the standard instruments.

The Open Respiratory Medicine Journal

Introduction: Foreign body aspiration is a commonly encountered and challenging emergency. Foreig... more Introduction: Foreign body aspiration is a commonly encountered and challenging emergency. Foreign body aspiration causes significant morbidity and mortality in the paediatric population. In adults, it is usually encountered in patients with impaired consciousness and in young females using pins to secure their veils. We aimed to analyse the incidence, type and site of foreign body, radiological presentation, complications and different modalities used in managing tracheobronchial foreign bodies (FBs). Methods: A prospective single centre cross-sectional study between December 2010 and December 2011 in the Department of Cardiothoracic Surgery at the University of Alexandria, Egypt. Results: Seventy-eight patients were included. The age of the patients ranged between 1.3 and 32 years, with a mean of 13.37± 7.67 years. Inorganic FBs were the most common aspirated FBs (66 patients, 84.62%). FBs were more frequently located in the left versus the right bronchial tree (44.9% vs. 43.6%). ...

Senses and Sciences, Sep 2, 2021

Background: The Functional Oral Intake Scale (FOIS) is a seven-point observer-reliable, valid rat... more Background: The Functional Oral Intake Scale (FOIS) is a seven-point observer-reliable, valid rating scale that can be used without adding to the patient's workload. It was designed for stroke patients but is now used by adults and children. For newborns, a special scale was created. Toddlers are the transition from infant to adult swallowing. So the current study's goal is to assess the screening accuracy of the FOIS as an objective indicator of dysphagia in toddlers. Methods: A cross sectional study of 123 toddlers attending dysphagia clinic in phoniatrics unit, Otorhinolaryngology (ORL) department, Alexandria main university hospital. Swallowing assessment of these patients was conducted by bedside swallowing assessment including functional oral intake scale and instrumental evaluation by videofluoroscopy. Another 123 healthy toddlers were assessed by FOIS as control. Two experienced clinicians scored the toddlers twice for each form of FOIS. VFSS was performed to assess swallowing of these patients. Results: Both Intra rater and inter-rater reliability were high with ICC= 0.984* and 0.946* respectively. Chi-square test showed a statistically significant difference of FOIS scores between cases and control group. There was a strong negative correlation between FOIS and PAS score in fluids with Pearson correlation coefficient (r=0.293 at p<0.001 while for semisolids and solids equally (r=0.424) while no correlation between FOIS score and total residue score. The cut off point for detection of aspiration at ≤5 using FOIS had high sensitivity 71.1 % in predicting aspiration of fluids with 43.6% specificity Adel, Gaafar, Fasseeh et al. Senses Sci (Educ Sci Tech) 2021; 2: 1230-1249 (AUC=0.617), with semisolids and solids 42.1 Positive predictive value (PPV) and 72.3 negative predictive value (NPV), (AUC= 0.754) with higher sensitivity than fluids (84.6%) and lower specificity (40.9 %). On the other hand, FOIS was very poor in predicting pharyngeal residue. It was highly sensitive in detecting the oral phase dysphagia 91.3 but low specificity 19.5, (AUC = 0.715*) (95% CI of 0.618-0.812). Conclusion: FOIS has high screening power of oropharyngeal dysphagia in toddlers, with high prediction of fluids and semisolids aspiration but not pharyngeal residue. It was also highly predictive of oral phase dysphagia.

Italian Journal of Pediatrics, 2021

Background Cases of foreign body aspiration in children may be encountered in emergency departmen... more Background Cases of foreign body aspiration in children may be encountered in emergency departments. A suggestive history is important in diagnosing aspirated foreign body owing to the difficulty in making a diagnosis on the basis of an abnormal physical examination or chest radiography alone. The aim of this study was to examine the sensitivity and specificity of the presenting symptoms, physical examination, and radiologic findings as predictors of foreign body aspiration in children. In addition, a feasible simple algorithm with a scoring system was generated to indicate bronchoscopic investigation. Methods In a retrospective cohort, medical records of patients aged less than 16 years with suspected foreign body aspiration who underwent flexible or rigid bronchoscopy were included. Data including age, sex, symptoms, physical examination findings, radiological features, nature and location of the foreign body, and outcome of the bronchoscopy were collected, and multivariable binar...

Folia Phoniatrica et Logopaedica, 2016

Background and Objectives: The Eating Assessment Tool (EAT-10) is a 10-item self-administered que... more Background and Objectives: The Eating Assessment Tool (EAT-10) is a 10-item self-administered questionnaire. It is a noninvasive tool to measure patients' perception of their swallowing problems. The purposes of the present study were to develop an Arabic version of the EAT-10 and to evaluate its validity, consistency, and reliability in the Arabic-speaking population with oropharyngeal dysphagia. Setting and Design: This was a prospective study carried out at the Communication and Swallowing Disorders Unit, King Saud University, Riyadh, Saudi Arabia. Subjects and Methods: The Arabic EAT-10 was administered to 138 patients with oropharyngeal dysphagia and 83 control subjects. Internal consistency and test-retest reliability were evaluated. Content and clinical validity were studied, and the EAT-10 results were compared across patients and control groups. Results: The Arabic EAT-10 showed excellent internal consistency (Cronbach's α = 0.92). Also, good test-retest reliability...

Otolaryngology -- Head and Neck Surgery, 2012

Objective: 1) To determine the efficacy of the powered endoscopic microdebrider as a tool in the ... more Objective: 1) To determine the efficacy of the powered endoscopic microdebrider as a tool in the management of obstructive laryngeal tumors. 2) To compare the histopathological diagnosis between a biopsy taken using the laryngeal forceps and the resected tissue from the microdebrider. Method: This study is a prospective randomized study. Eighteen patients presented with obstructive laryngeal tumors to the outpatient clinic or emergency room of Alexandria Main University Hospital in 12 months duration starting from November 2010 till November 2011. Tumor debulking was done using laryngeal microdebrider.

Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 2011

Background: Thyroglossal duct cysts are the most common cause of midline congenital cyst formatio... more Background: Thyroglossal duct cysts are the most common cause of midline congenital cyst formation in the neck that may present at any age. Classically, it presents as an anterior midline neck swelling that moves with deglutition and protrusion of the tongue. Occasionally, thyroglossal duct cyst presents in atypical manner either clinically or radiologically, which may pose a diagnostic challenge. Objective: The aim of this study is to review cases diagnosed with thyroglossal duct cysts as regards clinical and radiological presentation, focusing on cases with atypical presentation. Patients and methods: The medical records of patients who were diagnosed with thyroglossal duct cysts from January 2004 till October 2007 were retrospectively reviewed. A total of 22 patients were included in the study. They were classified as typical and atypical according to the clinical and radiological presentation. Results: There were 10 males (45.5%) and 12 females (54.5%) with mean age of 17.3 years. The site of the cyst was infrahyoid in 20 cases (91%), suprahyoid in one case (4.5%) and intralingual in one case (4.5%). Clinically, 16 cases (72.7%) showed typical presentation and six cases (27.3%) were atypical in the form of: thyroglossal duct cyst with intralaryngeal extension, intralingual cyst, 2090-0740

Skull Base, 2008

Objective: To evaluate the use of the temporalis myofascial flap in primary cranial base reconstr... more Objective: To evaluate the use of the temporalis myofascial flap in primary cranial base reconstruction following surgical tumor ablation and to explain technical issues, potential complications, and donor site consequences along with their management. Design: Retrospective case series. Setting: Tertiary referral center. Participants: Forty-one consecutive patients receiving primary temporalis myofascial flap reconstructions following cranial base tumor resections in a 4-year period. Main Outcome Measures: Flap survival, postoperative complications, and donor site morbidity. Results: Patients included 37 males and 4 females ranging in age from 10 to 65 years. Two patients received preoperative and 18 postoperative radiation therapy. Patient follow-up ranged from 4 to 39 months. The whole temporalis muscle was used in 26 patients (63.4%) and only part of a coronally split muscle was used in 15 patients (36.6%). Nine patients had primary donor site reconstruction using a Medpor 1 (Porex Surgical, Inc., Newnan, GA) temporal fossa implant; these had excellent aesthetic results. There were no cases of complete flap loss. Partial flap dehiscence was seen in six patients (14.6%); only two required surgical débridement. None of the patients developed cerebrospinal leaks or meningitis. One patient was left with complete paralysis of the temporal branch of the facial nerve. Three patients (all had received postoperative irradiation) developed permanent trismus. Conclusions: The temporalis myofascial flap was found to be an excellent reconstructive alternative for a wide variety of skull base defects following tumor ablation. It is a very reliable, versatile flap that is usually available in the operative field with relatively low donor site aesthetic and functional morbidity.

Otolaryngology–Head and Neck Surgery, 2010

Objectives. To review cases of deep neck infections with underlying congenital etiology with spec... more Objectives. To review cases of deep neck infections with underlying congenital etiology with special emphasis on their clinical presentations and the computed tomographic findings and to discuss the various therapeutic modalities employed for such lesions. Study Design. Case series with chart review. Settings. Alexandria University Hospital, Egypt. Subjects and Methods. The authors retrospectively reviewed the clinical, imaging, and operative records of deep neck infection cases presented to their department in the past 10 years. Deep neck infection cases due to congenital causes were included in the study. Results. Of the 249 cases of deep neck infections admitted to the authors’ department in the past 10 years, 39 patients were diagnosed with deep neck infections due to congenital causes. Patients were classified into 2 groups. In group 1 (29 patients), computed tomography revealed the presence of infected cystic swelling in the neck that was classified as second branchial cyst (1...

The Journal of Laryngology & Otology, 2007

Background:The management of laryngotracheal stenosis is still a serious surgical challenge. The ... more Background:The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment.Study design:Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic®stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken.Results:Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation...

International Congress Series, 2003

This study has pursued the development of animal model to assess the efficacy and safety of admin... more This study has pursued the development of animal model to assess the efficacy and safety of administrating mitomycin-C (MMC) by inhalation route for management of laryngeal fibrosis with the potential of human application. Glottic trauma was created in 10 mongrel dogs aiming at scaring and web formation. Eight dogs were randomized to receive a single daily dose of inhalation MMC using a mixture of 1 cm 3 of 0.5 mg/ml MMC and 2 cm 3 of normal saline. The remaining two dogs were left untreated and assigned as controls. A blood sample was withdrawn from the MMC group before trauma, on the 14th, and 28th day. Direct microlaryngoscopy (DML) was performed in all animals on the 14th and 28th day to allow clinical evaluation and photodocumentation. Immediately after 28 days, all animals were painlessly euthanized. The larynx, trachea, lung, liver, kidney, and spleen were harvested and studied for possible pathologic changes. Vocal granuloma and glottic webbing were documented in the controls. The inhalation MMC group demonstrated significant inhibition of fibrosis and scar formation. No local or systemic toxic effects were documented. Our study submits the technique of inhalation MMC as a simple, non-invasive adjuvant to the therapeutic tool for the management of laryngeal stenosis.

European Journal of Radiology, 2010

Functional imaging by means of dynamic multiphase contrast-enhanced magnetic resonance imaging (D... more Functional imaging by means of dynamic multiphase contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion weighted magnetic resonance imaging (DW-MRI) is now part of the standard imaging protocols for evaluation of the female pelvis. DCE-MRI and DW-MRI are important MR imaging techniques which enable the radiologist to move from morphological to functional assessment of diseases of the female pelvis. This is mainly due to the limitations of morphologic imaging, particularly in lesion characterization, accurate lymph node staging, assessment of tumour response and inability to differentiate post-treatment changes from tumour recurrence. DCE-MRI improves the accuracy of T2WI in staging of endometrial cancer. It also helps differentiate tumour recurrence from radiation fibrosis in patients with cervical cancer. DCE-MRI improves characterization of cystic adnexal lesions and detection of small peritoneal implants in patients with ovarian cancer. DW-MRI is valuable in preoperative staging of patients with endometrial and cervical cancer, especially in detection of extra-uterine disease. It does increase reader&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s confidence for detection of recurrent disease in gynaecological malignancies and improves detection of small peritoneal implants in patients with ovarian cancer. In this review article we give an overview of both DCE-MRI and DW-MRI techniques, concentrating on their main clinical application in the female pelvis, and present a practical approach of the added value of these techniques according to the main pathological conditions, highlighting the pearls and pitfalls of each technique.

European Archives of Oto-Rhino-Laryngology, 2011

A l a a G a a f a r-M D , A h m e d Y o u s s e f-M D , M o h a m e d E l h a d i d i-MD A l e x ... more A l a a G a a f a r-M D , A h m e d Y o u s s e f-M D , M o h a m e d E l h a d i d i-MD A l e x a n d r i a F a c u l t y o f M e d i c i n e , E g y p t

Auris Nasus Larynx, 2008

Isolated sphenoid sinus pathology is a relatively uncommon entity. The present study is a retrosp... more Isolated sphenoid sinus pathology is a relatively uncommon entity. The present study is a retrospective review of 40 patients with isolated sphenoid sinus pathology who were treated at the Department of Otorhinolaryngology, Alexandria University between July 2002 and December 2005. Special emphasis will be given to the role of various endoscopic approaches in the surgical management of isolated sphenoid sinus pathology. Factors that govern the selection of each approach will be discussed. Extracted data included patient demographics, clinical presentation, imaging studies, treatment modalities and complications. Sphenoid sinus was approached through one of the following three approaches: (1) endoscopic transnasal approach, (2) endoscopic transseptal approach and (3) endoscopic transpterygoid approach. Outcome measures were based on assessment of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; symptoms and confirmation of a patent sphenoid sinus by office endoscopy. The pathology spectrum was rather wide and included 26 (65%) inflammatory conditions (acute/chronic sphenoiditis, mucoceles, and fungal sinusitis), 7 (17.5%) neoplasms and 7 (17.5%) miscellaneous conditions (cerebrospinal fluid (CSF) rhinorrhea, sphenochoanal polyp, and fibrous dysplasia). The most common initial symptom was headache (50%) followed by ophthalmological symptoms (22.5%). Other presenting symptoms included CSF leak in five patients, epistaxis in four patients and nasal obstruction and/or rhinorrhea in two patients. Radiological workup included computed tomography (CT) scan of the paranasal sinuses in all patients. Magnetic resonance imaging (MRI) was performed in 21 patients (52.5%). The most common indication was a sphenoid mass based on endoscopic and CT findings. Four patients with acute/chronic sphenoiditis were successfully treated with medical therapy. One patient with fibrous dysplasia did not require any definitive treatment. Thirty-five patients underwent endoscopic surgery under general anaesthesia. An adjuvant radiotherapy with or without chemotherapy was utilized in two patients. A high index of clinical suspicion, routine office nasal endoscopy and radiological imaging are central to making an accurate and timely diagnosis of isolated sphenoid sinus pathology. Surgical treatment of sphenoid pathology can be safely and successfully performed through a variety of endoscopic approaches. Selection of the most appropriate endoscopic approach is governed by the nature and location of sphenoid pathology as well as the anatomical configuration of the sphenoid sinus.

Pediatric Research, 2011

Background: Laryngomalacia is the most common cause of congenital stridor. It usually presents by... more Background: Laryngomalacia is the most common cause of congenital stridor. It usually presents by high pitched inspiratory stridor which is often present at birth and is usually noticed by 2 weeks of age. Aim: The aim of this study was to assess clinical presentation, management and prognosis of infants and children suffering from laryngomalacia presented to our department in the period of 5 years. Methods: Retrospective analysis of the medical sheath records of newborns and infants suffering of laryngomalacia were reviewed regarding demographic data, clinical presentation, diagnosis and management. Results: Fifty eight infant and child were included in the study. They were 33 males (57%) and 25 females (43%). Their age at presentation ranged from 2-13 months. Diagnosis was done using laryngoscopy under general anesthesia with spontaneous breathing in 49 patients (85%) and by using flexible nasopharyngolaryngoscopy under topical anesthesia in 9 patients (15%). Conservative treatment was given for all cases in the form of diet modification, lansoprazole and Domperidone. For mild cases, gradual improvement occurred within 1 to 3 months. For severe cases, surgical intervention was planned. Indications for surgical intervention were severe airway obstruction with attacks of cyanosis, feeding difficulties and aspiration, weight loss and failure to thrive. Conclusion: Laryngomalacia is the most common congenital anomaly of the larynx. It usually presents within 2 weeks after birth. Diagnosis depends on visualization of the larynx during respiration. Conservative treatment is the rule. Surgical treatment is only indicated in 10% of cases

… --Head and Neck Surgery, 2011

Folia Phoniatrica et Logopaedica, 2016

Journal of cardiothoracic surgery, Feb 3, 2024

The Egyptian Journal of Otolaryngology, Jul 1, 2014

The Open Respiratory Medicine Journal

Senses and Sciences, Sep 2, 2021

Italian Journal of Pediatrics, 2021

Folia Phoniatrica et Logopaedica, 2016

Otolaryngology -- Head and Neck Surgery, 2012

Egyptian Journal of Ear, Nose, Throat and Allied Sciences, 2011

Skull Base, 2008

Otolaryngology–Head and Neck Surgery, 2010

The Journal of Laryngology & Otology, 2007

International Congress Series, 2003

European Journal of Radiology, 2010

European Archives of Oto-Rhino-Laryngology, 2011

Auris Nasus Larynx, 2008

Pediatric Research, 2011

… --Head and Neck Surgery, 2011

Folia Phoniatrica et Logopaedica, 2016