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Papers by Dr.Ashraf Elmalt
Zagazig university medical journal, Oct 20, 2023
International journal of pediatric otorhinolaryngology, 2018
Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to corre... more Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision. To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed. This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the poste...
Zagazig university medical journal, Jun 22, 2019
Background: Nasal septal perforation is an anatomical defect of the cartilaginous and/or bony nas... more Background: Nasal septal perforation is an anatomical defect of the cartilaginous and/or bony nasal septum. There are many causes for septal perforaton including prior nasal surgery ,nasal trauma , cocaine abuse ,inflammatory disorders ,infection , cancer. The mechanical closure with a prosthesis such as the septal button. Silicon buttons can alleviate epistaxis, whistling and nasal obstruction, but these prostheses cannot control the production of crusting around the margins of the button which causes discomfort for patients. Objectives: the aim of this study was to evaluate endonasal endoscopic repair of cartilaginous nasal septal perforation. Patients and Methods: The study included 24 Patients; they were 16 males and 8 females, their age ranged from 18 to 53 years to 50 years underwent endoscopic repair for the perforation of cartilaginous septum with alloderm and rotational flap. Results: The study, showed that 23 cases had complete healing after endoscopy with success rate (95.8%) and one case failed due to flap necrosis (4.2%). Conclusions: Endoscopic repair for the perforation of cartilaginous septum with alloderm and rotational flap approach can be considered as an effective technique for septal perforation. The use of Alloderm, has the advantage of decreasing morbidity and suitable for all perforations sizes, acting as an excellent scaffold for re-epithelization, but is associated with high costs and the septal flap provide a good vascularity for good healing .
American Journal of Otolaryngology
Ear, nose, & throat journal, 2017
Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. ... more Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. Postnasal packing and cautery of the adenoid bed are the most popular methods of controlling postadenoidectomy bleeding. Many hazards and complications may arise from traditional nasopharyngeal packing and nasopharyngeal cautery. In this case series, oxidized regenerated cellulose (Surgicel Nu-Knit; Ethicon; Somerville, N.J) was inserted and used as postnasal packing to control primary postadenoidectomy bleeding in 9 cases after conventional curettage adenoidectomy. All patients underwent nasophayngoscopic examination with a 0° rigid telescope to re-curette if any remnant was still present, and were repacked with appropriate size ribbon gauzes for at least 15 minutes before applying Surgicel. Surgicel succeeded in controlling primary postadenoidectomy bleeding in all cases, with no need for any further intervention. At the 1-month follow-up, no complications were reported. We conclude th...
Laryngoscope Investigative Otolaryngology, 2021
Assessment the effect of topical application of mitomycin‐C (MMC) after endoscopic removal of ant... more Assessment the effect of topical application of mitomycin‐C (MMC) after endoscopic removal of antrochoanal polyp (ACP) on its recurrence rate.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2021
This study describes a simple extraendolaryngeal technique to apply laryngeal keel in dealing wit... more 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 anterio...
Research and Opinion in Anesthesia and Intensive Care, 2017
Background Satisfaction for patients and surgeons during the perioperative functional endoscopic ... more Background Satisfaction for patients and surgeons during the perioperative functional endoscopic sinus surgery (FESS) remains an anesthetic challenge. We compared FESS under local anesthesia (LA) with monitored anesthesia care (MAC) and LA after induction of general anesthesia. Patients and methods One hundred patients scheduled for FESS were randomly recruited in this randomized controlled study. Fifty of them received LA after induction of general anesthesia (G group), while the rest of the patients received LA with MAC (M group). The outcome measures included satisfaction for the patient and surgeon, cost, surgical, and postoperative profiles. Results Surgeon’s satisfaction was comparable in both groups, while patient’s satisfaction was significantly higher in the M group (P<0.001). Total operative time and time to postanesthetic care unit discharge were significantly shorter in the M group (70.65±4.3 and 13.3±2 vs. 95.8±4.4 and 47.3±5.8 min in the G group, respectively; P<...
International journal of pediatric otorhinolaryngology, 2018
Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to corre... more Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision. To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed. This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the poste...
Egyptian Journal of Radiology and Nuclear Medicine, 2019
BackgroundHigh-resolution computed tomography (HRCT) magnifies the role of preoperative imaging f... more BackgroundHigh-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed middle ear anatomy particularly its hidden area. The purpose of the current study was to assess the sinus tympani (ST) and supratubal recess (STR) by HRCT, to create CT classification of the STR depth, and to study the relationship between ST types and the new STR grades.ResultsIn HRCT of non-pathological temporal bones of 100 subjects (200 ears), measurements of the STR and ST were calculated, registered, and analyzed. The depth of the STR was classified into grade 1 with depth less than 3 mm, grade 2 with depth ranged between 3 and 5 mm, and grade 3 with depth more than 5 mm. The mean STR length, width, and height were 4.17 ± 0.86, 3.55 ± 0.65, and 3.64 ± 0.7 mm, respectively, while the ST mean length and width of were 2.52 ± 0.5 and 1.82 ± 0.78 mm, respectively, without significant differences between either sexes or sided. The ST types were found to be type A in 56 ears (...
Ear, nose, & throat journal, 2017
Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. ... more Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. Postnasal packing and cautery of the adenoid bed are the most popular methods of controlling postadenoidectomy bleeding. Many hazards and complications may arise from traditional nasopharyngeal packing and nasopharyngeal cautery. In this case series, oxidized regenerated cellulose (Surgicel Nu-Knit; Ethicon; Somerville, N.J) was inserted and used as postnasal packing to control primary postadenoidectomy bleeding in 9 cases after conventional curettage adenoidectomy. All patients underwent nasophayngoscopic examination with a 0° rigid telescope to re-curette if any remnant was still present, and were repacked with appropriate size ribbon gauzes for at least 15 minutes before applying Surgicel. Surgicel succeeded in controlling primary postadenoidectomy bleeding in all cases, with no need for any further intervention. At the 1-month follow-up, no complications were reported. We conclude th...
Zagazig university medical journal, Oct 20, 2023
International journal of pediatric otorhinolaryngology, 2018
Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to corre... more Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision. To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed. This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the poste...
Zagazig university medical journal, Jun 22, 2019
Background: Nasal septal perforation is an anatomical defect of the cartilaginous and/or bony nas... more Background: Nasal septal perforation is an anatomical defect of the cartilaginous and/or bony nasal septum. There are many causes for septal perforaton including prior nasal surgery ,nasal trauma , cocaine abuse ,inflammatory disorders ,infection , cancer. The mechanical closure with a prosthesis such as the septal button. Silicon buttons can alleviate epistaxis, whistling and nasal obstruction, but these prostheses cannot control the production of crusting around the margins of the button which causes discomfort for patients. Objectives: the aim of this study was to evaluate endonasal endoscopic repair of cartilaginous nasal septal perforation. Patients and Methods: The study included 24 Patients; they were 16 males and 8 females, their age ranged from 18 to 53 years to 50 years underwent endoscopic repair for the perforation of cartilaginous septum with alloderm and rotational flap. Results: The study, showed that 23 cases had complete healing after endoscopy with success rate (95.8%) and one case failed due to flap necrosis (4.2%). Conclusions: Endoscopic repair for the perforation of cartilaginous septum with alloderm and rotational flap approach can be considered as an effective technique for septal perforation. The use of Alloderm, has the advantage of decreasing morbidity and suitable for all perforations sizes, acting as an excellent scaffold for re-epithelization, but is associated with high costs and the septal flap provide a good vascularity for good healing .
American Journal of Otolaryngology
Ear, nose, & throat journal, 2017
Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. ... more Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. Postnasal packing and cautery of the adenoid bed are the most popular methods of controlling postadenoidectomy bleeding. Many hazards and complications may arise from traditional nasopharyngeal packing and nasopharyngeal cautery. In this case series, oxidized regenerated cellulose (Surgicel Nu-Knit; Ethicon; Somerville, N.J) was inserted and used as postnasal packing to control primary postadenoidectomy bleeding in 9 cases after conventional curettage adenoidectomy. All patients underwent nasophayngoscopic examination with a 0° rigid telescope to re-curette if any remnant was still present, and were repacked with appropriate size ribbon gauzes for at least 15 minutes before applying Surgicel. Surgicel succeeded in controlling primary postadenoidectomy bleeding in all cases, with no need for any further intervention. At the 1-month follow-up, no complications were reported. We conclude th...
Laryngoscope Investigative Otolaryngology, 2021
Assessment the effect of topical application of mitomycin‐C (MMC) after endoscopic removal of ant... more Assessment the effect of topical application of mitomycin‐C (MMC) after endoscopic removal of antrochoanal polyp (ACP) on its recurrence rate.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2021
This study describes a simple extraendolaryngeal technique to apply laryngeal keel in dealing wit... more 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 anterio...
Research and Opinion in Anesthesia and Intensive Care, 2017
Background Satisfaction for patients and surgeons during the perioperative functional endoscopic ... more Background Satisfaction for patients and surgeons during the perioperative functional endoscopic sinus surgery (FESS) remains an anesthetic challenge. We compared FESS under local anesthesia (LA) with monitored anesthesia care (MAC) and LA after induction of general anesthesia. Patients and methods One hundred patients scheduled for FESS were randomly recruited in this randomized controlled study. Fifty of them received LA after induction of general anesthesia (G group), while the rest of the patients received LA with MAC (M group). The outcome measures included satisfaction for the patient and surgeon, cost, surgical, and postoperative profiles. Results Surgeon’s satisfaction was comparable in both groups, while patient’s satisfaction was significantly higher in the M group (P<0.001). Total operative time and time to postanesthetic care unit discharge were significantly shorter in the M group (70.65±4.3 and 13.3±2 vs. 95.8±4.4 and 47.3±5.8 min in the G group, respectively; P<...
International journal of pediatric otorhinolaryngology, 2018
Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to corre... more Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision. To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed. This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the poste...
Egyptian Journal of Radiology and Nuclear Medicine, 2019
BackgroundHigh-resolution computed tomography (HRCT) magnifies the role of preoperative imaging f... more BackgroundHigh-resolution computed tomography (HRCT) magnifies the role of preoperative imaging for detailed middle ear anatomy particularly its hidden area. The purpose of the current study was to assess the sinus tympani (ST) and supratubal recess (STR) by HRCT, to create CT classification of the STR depth, and to study the relationship between ST types and the new STR grades.ResultsIn HRCT of non-pathological temporal bones of 100 subjects (200 ears), measurements of the STR and ST were calculated, registered, and analyzed. The depth of the STR was classified into grade 1 with depth less than 3 mm, grade 2 with depth ranged between 3 and 5 mm, and grade 3 with depth more than 5 mm. The mean STR length, width, and height were 4.17 ± 0.86, 3.55 ± 0.65, and 3.64 ± 0.7 mm, respectively, while the ST mean length and width of were 2.52 ± 0.5 and 1.82 ± 0.78 mm, respectively, without significant differences between either sexes or sided. The ST types were found to be type A in 56 ears (...
Ear, nose, & throat journal, 2017
Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. ... more Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. Postnasal packing and cautery of the adenoid bed are the most popular methods of controlling postadenoidectomy bleeding. Many hazards and complications may arise from traditional nasopharyngeal packing and nasopharyngeal cautery. In this case series, oxidized regenerated cellulose (Surgicel Nu-Knit; Ethicon; Somerville, N.J) was inserted and used as postnasal packing to control primary postadenoidectomy bleeding in 9 cases after conventional curettage adenoidectomy. All patients underwent nasophayngoscopic examination with a 0° rigid telescope to re-curette if any remnant was still present, and were repacked with appropriate size ribbon gauzes for at least 15 minutes before applying Surgicel. Surgicel succeeded in controlling primary postadenoidectomy bleeding in all cases, with no need for any further intervention. At the 1-month follow-up, no complications were reported. We conclude th...