Safe functional endoscopic sinus surgery (FESS) requires that the surgeon has a thorough knowledge of paranasal sinus anatomy and adequate training in endoscopic surgical technique. In an effort to more accurately define sinus anatomy, enhance surgical results, and reduce surgical risk, image-guided navigation systems (IGNS) have been developed for FESS. Image-guided functional endoscopic sinus surgery provides a real time, 3-dimensional link between the preoperative CT information and the intra-operative surgical anatomy. Intra-operatively, the surgeon can place the surgical instrument on intranasal structures and view the precise location on coronal, axial, and sagittal CT images in real time. Many authors feel this technique allows for a more complete surgical resection, while reducing the risk of complications. In this article an overview of image-guided technology is presented, the current literature on image-guided functional endoscopic sinus surgery is reviewed, and the advantages and disadvantages of each technique are compared.

Epithelial myoepithelial carcinoma (EMC) of the parotid gland is difficult to differentiate from pleomorphic adenoma. EMC is a rare entity and there is not much information about this in literature. We review here the diagnosis, clinical behavior, and treatment of EMC .and in the same time , we recmmend to have early surgical excision if there is nodal metastasis on CAT scan and not to depend on FNAC only if it shows pleomorphic adenoma.

Background And Objective: The voice handicap index-10 (VHI-10) questionnaire is widely used and is self-administered by the patient. It saves time for both patient and clinician as it is a 10-item questionnaire compared to the 30-item questionnaire in the original version of VHI. The purposes of the present study were to generate an Arabic version of the VHI-10, and to evaluate its validity, consistency, and reliability in normal and voice-disordered Arabic population. Setting And Design: This is a prospective study that has been carried out at Communication and Swallowing Disorders Unit, King Saud University. Subjects And Methods: The validated Arabic VHI-10 was administered to 100 patients with variable voice disorders and 165 control subjects. Internal consistency and test re-test reliability were evaluated. The results of the pathological and the control groups were compared. Results: The Arabic VHI-10 showed high internal consistency (Cronbach’s α = 0.88). Excellent test–retest reliability was found for the total scores of the Arabic VHI-10 (r = 0.920, P = 0.001). There was a significant difference between VHI-10 scores of the control and the voice disordered group (P < 0.001). Conclusion: This study demonstrated that Arabic VHI-10 is a valid tool for self-assessment of voice disorders that can be used by Arabic language speakers.

Extracranial schwannomas (ECS) of the head and neck are uncommon tumors of peripheral nerve sheath origin. Methods: We reviewed our experience with ECS over the last 12 years with respect to presentation, management and outcome. Results: Thirty-five cases of ECS at three centers were identified from 1992 to 2004 (16 women, 19 men). The mean age at diagnosis was 50.5 years (range 19 – 87 years). Sites of ECS distribution included 7 facial, 6 vagus, 5 sympathetic chain, 5 brachial plexus, 5 cervical plexus, 2 hypoglossal, 2 jugular foramen, 2 trigeminal, and 1 lingual nerve. The most predominant symptoms were a painful mass, and facial nerve or vocal cord paresis. Wide surgical excision was performed in 32 of 35 patients (91%). Median follow-up is 64 months. Post-operative sequelae included vocal cord paralysis, Horner’s syndrome, and facial nerve paralysis for which cable nerve grafting largely achieved partial re-animation. Recurrence occurred in 4 patients. Three were re-operated and one irradiated. They have remained tumour free since. Conclusion: ECS are rare nerve sheath tumors often presenting in late stages at multiple sites in the head and neck. In our experience, surgical excision is the treatment of choice bearing in mind a potential for CN paralysis or sympathetic chain injury. Symptomatology of this tumour is discussed with its investigation and management.

Background and Objectives: The Pediatric Voice Handicap Index (VHI) is a valid tool for assessing self-perceived voice handicap in children. We developed an Arabic abbreviated version of pediatric Voice Handicap Index (pVHI) for future use in Arab pediatric population. Setting and Design: The study was conducted on nondysphonic children at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia. Subjects and Methods: The original English pediatric VHI which is composed of 23-items was shortened to 10-items and translated into Arabic by a committee of two Pediatric Otolaryngologists and one Phoniatrician. The translated Arabic version was administered to the parents of 137 children without voice disorders or communication disorders. Results: The subjects of our study had low scores which were comparable with control groups of different worldwide pediatric VHI studies. Also, there was an insignificant effect of gender on VHI subscales (P > 0.025). Obviously, the validity of these results may be limited by the absence of another dysphonic group. However, the preliminary results have encouraged us to report it and when a dysphonic group is available it will be possible to better validate this pVHI in term of performance. Conclusion: Arabic version of the pVHI is a valuable tool for voice specialists dealing with Arabic speaking children. Future testing of our developed Arabic abbreviated pVHI with dysphonic groups to confirm its reliability in differentiating control subjects from dysphonic subjects is recommended.

Background and objective: Dysphonia is considered a relatively common disorder among pediatric population. Proper diagnosis for voice disordered children is essentially required for proper therapeutic plans. Subjects and Methods: A prospective study was designed to involve children presented to the voice clinic with either airway or voice problems. Children included in the study were typically examined using rigid 70° laryngoscope. Those who could not tolerate the rigid endoscopy were examined by flexible fiber-optic endoscopy. Results: Forty-nine children with variable voice and airway complaints were included in the study. Rigid laryngeal stroboscopic examination was successfully performed in 42 children (85.7%) of the total included pediatric population. Conclusion: Rigid laryngeal stroboscopic examination appears to be a feasible technique for laryngeal stroboscopic examination in children at or below the age of 6 years.

Objectives: Tonsillitis is a common infection in all age groups, especially under the age of five. Organisms causing this condition vary from place to place. Our aim was to find out the main causative agents of this condition in our hospital. Patients and Methods: Fifty-two consenting patients who needed tonsillectomy in Khamis civil Hospital, Khamis Mushait Kingdom of Saudi Arabia, between September 2006 and April 2007, were enrolled for the study. Tonsils removed at surgery were sent immediately to our Microbiology laboratory where they were aseptically sliced into 2, swabs were taken from their inner surfaces and cultured for anaerobes and aerobes according to standard microbiological techniques. The data generated was analyzed using the SPSS version 10. Results: Fifty-two patients, consisting of 30 males and 22 females were enrolled. Their ages were 3-27 years, mean age 9.81 ± 6.47. Thirty-four of the 52 patients, (65.38 %), had positive cultures while 18/52, 34.62 %, were negative. The commonest bacteria isolated were Staphylococcus aureus 15/34 (44.1 %); and group B Streptococcus 12/34 (35.3 %). Two Gram-negative bacteria, Klebsiella pneumoniae, (3/34, 8.82 %), and Pseudomonas aeruginosa (1/34, 2.94 %), were also isolated. No anaerobe was isolated. Conclusion: Gram-positive cocci, consisting of Staphylococcus aureus and group B Streptococcus (Streptococcus agalactiae), are the major causes of tonsillitis requiring surgery in our hospital. Antibiotic treatment of this condition should be directed largely against these organisms.

Chronic fungal rhinosinusitis caused by Aspergillus terreus is rare. We report a case of 22-year-old immunocompetent Saudi female presented to ENT clinic complaining of right nasal obstruction accompanied by rhinorrhoea, intermittent headache and recurrent attack of epistaxis for the previous two years. On examination large nasal polyps obstructing the whole nostrils were found. Computed tomography (CT) revealed sinonasal polypoidal disease involving right ethmoid and right sphenoid sinuses together with large polyps obstructing the right nasal cavity and osteomeatal complex with partial mucosal thickening of both maxillary sinuses. Nasal polyps were surgically removed during functional endoscopic sinus surgery (FESS). Histopathology showed the presence of acute and chronic inflammatory cell infiltrates (rich in eosinophils) in the covering epithelium and the sub-epithelial layer. Microbiology identified Aspergillus terreus as the causative agent. Patient made good recovery and discharged home on oral itraconazole 100mg for one month. A two-year follow-up did not reveal any recurrences.

Background: Tuberculosis is a common infectious disease. Nasopharyngeal involvement is a rare finding. Results: We present a case of 25-year old female with primary nasopharyngeal tuberculosis. The manifestation of disease was right neck mass for two months with allergic symptoms and nasal obstruction. There were no tuberculosis lesions in other organs. Diagnosis was made based on result of pathological examination of biopsy. Improvement was obtained by anti tuberculosis therapy. Conclusion: Tuberculosis must be considered in differential diagnosis of nasopharyngeal mass.

A rare case of lingual thyroid is being reported in a 25-year-old female patient who presented with submental swelling persistant pain and history of constipation and loss of appetite. CT was done and lingual thyroid was discovered incidentally. Submental abscess was draind and antibiotics, thyroxin and regular follow up were given to the patient.

The objective of this study is to highlight the embryological development of cervical remnants and to report a case of thymocervical duct cyst. Cervical ectopic thymic tissue is rarely reported. However, it should be included in the differential diagnosis of neck masses especially in children and young adults