Hesham A Saleh

Imperial College London | Imperial · Department of Surgery and Cancer

Objective In this multicentric study involving three London hospitals, we compared ANCA‐positive and ANCA‐negative cocaine‐induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around...

Corrective septal surgery for children with nasal obstruction has historically been avoided due to concern about the impact on the growing nose, with disruption of midfacial growth. However, there is a paucity of data evaluating complication and revision rates post nasal septal surgery in the paediatric population. In addition, there is evidence to...

Objective This pilot study aimed to assess the feasibility of using a high-definition intra-operative exoscope in teaching septorhinoplasty. Methods The exoscope was used in septorhinoplasty cases with different trainers and trainees. A high-definition screen displayed real-time, magnified images. Post-procedure, a questionnaire was completed by t...

Introduction: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for endoscopic sinus surgery (ESS). The aim of this study was to investigate the safety of day-case ESS in England. Design: Secondary analys...

Severe concavity of the lateral crura can lead to an unsightly aesthetic deformity of the nasal tip and narrowing of the external nasal valve. Concurrently if the lateral crura are structurally weak, this can lead to a functional issue. We report a previously undescribed technique of combining a lateral crural reversal with a turn-in flap. This ach...

Purpose of Review Rhinoplasty has traditionally been considered an elective procedure for younger patients. However, increasingly older patients are undergoing nasal surgery for both functional and aesthetic indications. We provide an overview of the common problems with rhinoplasty in the elderly and the surgical techniques that can be reliably ut...

Introduction Success in septorhinoplasty surgery can be difficult to assess, due to a lack of objective and measurable outcomes. If patients’ expectations are not met, this places surgeons performing septorhinoplasty at risk of litigation, which can be stressful and costly. Methods NHS Resolution is a government funded organisation in the UK, which...

Background: As elective surgical services recover from the COVID-19 pandemic a movement towards day-case surgery may reduce waiting lists. However, evidence is needed to show that day-case surgery is safe for many ENT operations including endoscopic sinus surgery (ESS). We aimed to investigate the safety of ESS in England. Methods: This was an obse...

Postoperative pain following a septoplasty is expected to be mild and limited to a few days after the operation. Chronic pain following the procedure is rare. No cases of delayed-onset neuropathic pain or allodynia have been described in the literature. This paper presents a case of delayed-onset neuropathic pain after septoplasty in a previously p...

Recent advances in image-guided techniques allow endoscopic surgery to extend beyond the sinonasal cavity to the pterygopalatine fossa, orbit, anterior skull base and petrous apex. These techniques reduce complication rates compared with traditional open surgery (craniotomy or trans-facial) and require a multidisciplinary team review of imaging and...

Purpose SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This...

Introduction The aim of this study was to assess UK otorhinolaryngology trainees’ perceptions of their septorhinoplasty training. The possible effects that the COVID-19 pandemic may have on current and future training opportunities are also discussed. Methods A cross-sectional survey of members of the Association of Otolaryngologists in Training w...

Background: Dorsal preservation rhinoplasty (DPR) has recently received significant academic attention in part due to theoretical benefits over excisional surgical methods. The purpose of this study was to assess the global practice patterns regarding this technique. Materials and Methods: An 11-item questionnaire was electronically distributed to...

Purpose: SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This...

Ever since the introduction of the concept of Procedures of Limited Clinical Value (PoLCV), procedures such as functional septorhinoplasty have been subject to additional funding restrictions within the British National Health Service. Recent publications have suggested that 10% of Clinical Commissioning Groups in the United Kingdom no longer fund...

Accurate assessment of facial symmetry is a key component of successful rhinoplasty surgery but is often overlooked by both surgeon and patient. Up to three-quarters of patients with a significantly crooked nose have been found to have concurrent marked facial asymmetry. Whilst not a contraindication to rhinoplasty, provided that facial asymmetry i...

Background The association between spontaneous cerebrospinal fluid (CSF) leak/rhinorrhea and idiopathic intracranial hypertension (IIH) has been increasingly recognized over the last years. However, considerable variability of opinion regarding the assessment, investigations, and management of patients with spontaneous CSF rhinorrhea remains. Meth...

The United Kingdom has been hit hard by the COVID‐19 pandemic with the highest death toll in Europe exceeding 40,000. London has been the epicentre of the UK outbreak, with more than 1600 positive recorded cases in our institution alone. Consequently, hospital specialities have had to adapt rapidly to the challenges COVID‐19 has posed.

Background The novel coronavirus (COVID‐19) pandemic is expected to last for an extended time, making strict safety precautions for office procedures unavoidable. The lockdown is going to be lifted in many areas, and strict guidelines detailing the infection control measures for aesthetic clinics are going to be of particular importance. Methods A...

Despite the well documented increased risk of thrombosis in patients with cancer and during chemotherapy, cerebral venous sinus thrombosis (CVT) remains a rare entity. We present a rare case of cerebrospinal fluid (CSF) rhinorrhoea secondary to a left transverse sinus thrombus which occurred 2 years previously during chemotherapy for breast cancer....

The impact of the COVID-19 pandemic has resulted in widespread disruption to routine surgical services across the globe. As the peak of the initial pandemic passes, surgeons will increasingly resume elective work to address the backlog. Whilst urgent cases such as cancer work will be prioritized, the safe resumption of facial plastic surgery will r...

Allergic rhinitis affects more than 20% of the population of Westernized countries and has a significant impact on quality of life and school/work performance. Important environmental factors include tree and grass pollens (seasonal allergic rhinitis); house dust mite and domestic pets, most often cats (perennial allergic rhinitis); and a variety o...

Objectives To evaluate the level of undergraduate and post-graduate ENT exposure amongst general practitioners and their perceived quality of this training. A secondary aim was to examine whether general practitioners believe ENT department based rotations should remain in the undergraduate curriculum. Method An online questionnaire-based survey w...

Background Chronic rhinosinusitis (CRS) is one of the commonest chronic health problems among adults in the UK. Around 15% of CRS patients undergo functional endoscopic sinus surgery (FESS) annually after failing medical treatment. However, as incomplete resolution of symptoms or complications post-operatively is common, the post-operative manageme...

Purpose The aim of this national survey is to assess the current practice of functional septorhinoplasty (SRP) surgery in the UK and better inform future practice. Methods An ENT-UK approved questionnaire was sent out to all 135 consultant members of the British Society of Facial Plastic Surgery (BSFPS). Data was collected on numbers of functional...

Background: Cerebrospinal fluid (CSF) leak is a very rare complication of rhinoplasty that typically occurs secondary to improper handling of the perpendicular plate of the ethmoid bone. If left untreated, it can lead to devastating intracranial sequelae. Case report: We report a previously unrecognized cause of CSF leak attributed to injudicious...

The internal nasal valve (INV) is bound by the nasal septum, inferior turbinate and the upper lateral cartilage (ULC). It is the most important determinant of nasal airflow, and critical for nasal breathing. The normal internal nasal valve angle is 10‐15o.¹ Even a small change in the INV angle can have a significant impact on nasal airflow. This ar...

In recent years, there is an increasing trend to use health-related quality of life questionnaires after surgical procedures. The idea is to prove the success of an operation by objectively measurable parameters. Rhinoplasty is by far the most frequently performed surgery of facial plastic surgery. One of the most difficult parts of rhinoplasty is...

The full British Thoracic Society Guideline for Bronchiectasis in Adults is published in Thorax . The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline. The appendices are available in the full guideline.

After rhinoplasty, during the first 24 hours, the patients should be closely monitored for pain and discomfort, nausea and vomiting, and cool compresses must be applied regularly to decrease edema and ecchymosis. In the early postoperative period of the first month, the sutures, cast, and splints are usually removed during the first week. Then the...

A 72-year-old man presented with epistaxis on two occasions requiring admission. Prior to performing a bilateral sphenopalatine artery ligation diathermy, anaesthetic concern was raised regarding what the patient described as a ‘congenital aortic aneurysm’, with an overlying scar secondary to explorative surgery as a child. The abnormality was a ce...

Septal repositioning in septo‐columelloplasty and septorhinoplasty requires anchoring of the caudal septum to the anterior nasal spine. 1,2 Failure to do this securely may result in recurring dislocation of the caudal septum and further symptoms of nasal blockage. However, passing a standard appropriate sized suture needle through the anterior nasa...

Key points • Rhinoplasty is a technically challenging procedure for which both the aesthetics and function of the nose must be considered. • Meticulous planning is essential to ensure the best surgical outcomes. • Successful surgery requires realistic patient expectations, careful consideration of facial aesthetics and a detailed examination of the...

Aim: Onodi cells (sphenoethmoidal cells) are anatomical variants of the posterior most ethmoid air cells which pneumatise superiorly or laterally to the sphenoid sinus. They can be intimately related to the optic nerve and so thorough pre-operative evaluation of the anatomy is essential to avoid potentially devastating complications. Although usual...

Nasal examination should be obligatory in any patient who is being considered for lacrimal surgery. Preoperative assessment should include nasal endoscopy to allow evaluation of anatomical variations or any concurrent intranasal pathology. Furthermore, lacrimal surgery itself is now widely practiced via an endoscopic approach, and therefore ophthal...

Patients with lacrimal obstruction require a comprehensive ophthalmologic assessment to confirm the diagnosis. However, in addition, nasal examination should be considered obligatory in such patients, for evaluation of any concurrent intranasal pathology or anatomical variations, and therefore ophthalmologists practicing lacrimal surgery should fam...

Antrochoanal polyps (ACP) are benign, large, inflammatory polyps which originate from within the maxillary sinus and extend through the natural or accessory ostia, into the nasal cavity, with extension into the choana. They are relatively uncommon, accounting for just 3 – 6% of all nasal polyps, although they are much more frequently encountered in...

Rapidly absorbable skin sutures have been found to be of use in numerous settings including for the closure of the columellar incision following open rhinoplasty. Its removal does not routinely require trimming, and the sutures tend to fall off with minimal intervention 10–14 days postoperatively. This practice has a good acceptance by patients and...

Objective This study aimed to develop a multidisciplinary coded dataset standard for nasal surgery and to assess its impact on data accuracy. Method An audit of 528 patients undergoing septal and/or inferior turbinate surgery, rhinoplasty and/or septorhinoplasty, and nasal fracture surgery was undertaken. Results A total of 200 septoplasties, 109...

Objectives: When performing septoplasty or septorhinoplasty, we have observed that patients blink on injection of local anaesthetic (lidocaine 1 per cent with adrenaline 1:80 000) into the nasal mucosa of the anterior septum or vestibular skin, despite appropriate general anaesthesia. This study sought to quantify this phenomenon by conducting a p...

This article explores current recommendations for the safe and efficient running of outpatient clinics, why non-adherence exists, the consequences of non-adherence, and what can be done to improve standards. It promotes adherence to recommendations by both clinical and managerial staff.

Purpose of Review The goal of this paper is to present a detailed up-to-date overview of sinonasal benign neoplasms by reviewing their clinical and pathological characteristics, their diagnosis and their treatment. Recent Findings Traditionally, excision of larger benign neoplasms required invasive open approaches; however, due to advances in endo...

Objective: Body dysmorphic disorder (BDD) is defined as having a preoccupation with a perceived flaw in one's appearance, which appears slight to others and significantly interferes with a person's functioning. When undetected in septorhinoplasty patients, it will often lead to poor outcomes. Design: We performed a prospective cohort study to de...

Objective: The endoscopic modified Lothrop procedure is mainly used for refractory frontal sinusitis. However, we have used it as an access procedure to facilitate treatment for an extended range of additional frontal sinus pathologies. Methods: A retrospective review of patients who underwent the endoscopic modified Lothrop procedure for 'alter...

Little data on UK prescribing patterns and treatment effectiveness for allergic rhinitis (AR) are available. We quantified unmet pharmacologic needs in AR by assessing AR treatment effectiveness based on the prescribing behaviour of UK general practitioners (GP) during two consecutive pollen seasons (2009 and 2010). We conducted a retrospective obs...

Mucoceles expand by the process of bone resorption and new bone formation, which leads to local destruction and displacement of adjacent structures. We present the case of a 47-year-old woman who presented with recurrent headaches, nausea, and vomiting, all of which were believed to have occurred secondary to a mucocele of the crista galli. To the...

Nasal examination should be obligatory in any patient who is being considered for lacrimal surgery. Preoperative assessment should include nasal endoscopy to allow evaluation of any concurrent intranasal pathology or anatomical variations. Furthermore, lacrimal surgery itself is now widely practiced via an endoscopic approach and therefore ophthalm...

Dacryocystorhinostomy via an endoscopic approach is now widely favored and considered to result in comparable outcomes to similar surgery via an external approach. Such surgery is usually done jointly between ophthalmologists and otolaryngologists. If endoscopic surgery is to be considered, patients should have a complete preoperative assessment to...

To demonstrate a novel and effective surgical technique for the treatment of refractory cerebrospinal fluid rhinorrhoea after skull base surgery. The novel surgical technique is described and the findings of a review of relevant world English-language publications are reported. A 44-year-old woman, otherwise fit and well, presented with more than a...

Objectives Antrochoanal polyps (ACP) are benign lesions originating from maxillary sinus mucosa extending into the nasal cavity and choana. They are typically unilateral and rarely arise from other sinus groups. Their treatment is surgical, with various approaches reported. We aimed to evaluate the following outcome measures: 1) Report the first UK...

Background: Scytalidium dimidiatum is a soil and plant pathogen that frequently affects fruit trees, but can also cause human infection. There are only two reported cases of invasive fungal sinusitis involving this rare micro-organism. Objective: This paper reports the first case of invasive fungal sinusitis caused by Scytalidium dimidiatum occu...

Nasal vestibular stenosis can result in a challenging cosmetic deformity, for which a variety of techniques have been described, including scar excision and replacement with local flaps, composite or cartilage grafts, with or without stents. We describe the Z-plasty technique to widen the alar base and assess patient satisfaction from the surgery....

Septal reconstruction is challenging. Autologous cartilage may be thin or deviated and traditional techniques are often inadequate or technically difficult. The use of an absorbable scaffold material for support during healing can improve results. Polydioxanone (PDS) plate can be used for this purpose. We describe our use of PDS plate in both open...

Objectives: This case report describes the endoscopic transsphenoidal management of a cholesterol granuloma situated in a technically challenging part of the petrous apex, and the associated peri- and post-operative complications that arose. The literature on diagnosis and management of petrous apex cholesterol granulomas is reviewed. Method and...

Introduction: Craniofacial fibrous dysplasia commonly affects the larger mandible and the maxillary bones. Although involvement of the frontal, temporal and sphenoid bones has been described, fibrous dysplasia of the nasal bone has not been previously described; the two cases reported here have been made rarer by their isolated involvement. Clinic...

To describe our experience of the management of spontaneous cerebrospinal fluid (CSF) rhinorrhoea in a large case series focusing on surgical approach, peri-operative management and outcomes; to evaluate the efficacy of endoscopic CSF leak repairs. Retrospective chart review was performed for all patients with spontaneous CSF rhinorrhoea managed fr...

Objectives Nasal vestibular stenosis results in significant functional impairment and cosmetic deformity. Various techniques can be used, including excision of the deformed segment and replacement with healthy tissue using local flaps, composite or cartilage grafts, with or without stents. W-plasty, Z-plasty, and double-cross plasty techniques have...

Objectives 1) Explore developments in endoscopic techniques and their application in the management of Sinonasal Inverted Papilloma (SNIP). 2) Describe 0% recurrence rates with aggressive endoscopic resection of complex SNIP. Methods Retrospective single-center patient cohort analysis of twenty-one cases of SNIP treated by endoscopic resection at...

Background: The management of frontal sinus disease in cystic fibrosis patients represents a challenge for many surgeons. Procedures can vary from the minimally invasive to those involving extensive open surgery. Objective: This study describes the outcomes of the endoscopic modified Lothrop procedure, in terms of safety and morbidity, for cysti...

Objective To describe our experience of cerebrospinal fluid (CSF) rhinorrhea management. Design Retrospective. Setting Charing Cross Hospital, London, a tertiary referral center. Participants Fifty-four patients with CSF rhinorrhea managed from 2003 to 2011. Main outcome measures Surgical technique; Recurrence. Results Etiologically, 36 were sponta...

The maxillary sinus may be involved in a wide variety of disorders. Many of these share common presenting symptoms but some have unique features. This article reviews some of the recent publications in this area. The majority of isolated maxillary sinus disease has been previously described. Some recent data on the microbiology of sinusitis have be...

Aims: UK publications base evidence on University of Pennsylvania Smell Identification Test (UPSIT) results, yet UPSIT normative values are not transferrable outside the USA. This study was designed to (a) Estimate normative scores for the UK population and (b) Identify smells causing cultural bias. Methods: The UPSIT test was applied to 44 healthy...

Background: Rhinoplasty and septal surgery often require the use of cartilage grafts. Autologous cartilage may be thin or deviated, and the use of an absorbable scaffold material to support the reimplanted cartilage during healing can improve technique and outcomes. Objective: To describe the use of a polydioxanone plate not only as a template i...

Myxofibrosarcoma (MFS) also known as myxoid variant of malignant fibrous histocytoma is one of the most common soft tissue sarcomas of the extremities in adult and elderly patients with rare occurrences in head and neck region. Low-grade MFS is unusual among low-grade sarcomas because it often recurs relentlessly and multiplies despite wide local r...

Objective: We report the use of triamcinolone injections to correct severe nasal deformity due to sarcoidosis, as an alternative to formal surgical rhinoplasty. Case report: A 30-year-old woman with a long-standing history of sarcoidosis presented to a tertiary referral rhinology clinic complaining of breathing difficulty and nasal deformity. Fl...

Objective: To describe our experience of cerebrospinal fluid (CSF) rhinorrhea in a large case series focusing on etiology, surgical approach, and long-term outcomes alongside perioperative management; to evaluate the efficacy of endoscopic CSF leak repairs and assess the differences between spontaneous and traumatic etiologies. Design: Retrospecti...

Background: Septoplasty is commonly undertaken to improve nasal airways or to correct cosmetic septal deviation. The most difficult areas to correct are the caudal and/or superior regions. Methods: We describe our technique of partial extracorporeal septoplasty using polydioxanone plate to support the cartilage, allowing correction of very anterior...

Cesar Boeck of Christiania, Denmark, was the first to use the word sarcoid and described the multisystem nature of the disease in 1899 (Black 1973). He mentioned the clinical similarity to a previous case described by Jonathan Hutch- inson of London in 1898 as Mortimer’s Malady where a female patient, Mrs Mortimer, had generalized skin lesions and...

To describe the clinical presentation, pathophysiology, and treatment of spontaneous cerebrospinal fluid (CSF) leaks of the sphenoid bone, with an emphasis on a previously undescribed form in this location, in which CSF is trapped under the mucosa of the sinonasal cavity or in the soft tissue of the skull base. Case series and literature review. An...

Nasal tip numbness is a recognized postoperative complication after septorhinoplasty and rhinoplasty. We performed a twin-center retrospective study to determine the incidence of short- and long-term (>6 mo) nasal tip numbness after these procedures, and we studied several variables that might have been associated with this complication. Our study...

Menthol and cold sensation trigger symptoms and reflex responses in the upper airway, but the underlying molecular mechanisms are unknown. We have therefore studied nerve fibres expressing the menthol and cold receptor TRPM8 in normal human mucosa, and in rhinitis. TRPM8 nerve fibres were compared with those expressing other TRP receptors including...

A 65-year-old man with a history of renal transplantation presented with facial pain, purulent nasal discharge, and periorbital swelling. Signs of optic nerve compromise developed and persisted despite medial orbital wall decompression. Further imaging revealed an orbital floor abscess secondary to direct communication of a maxillary pseudomonal si...

Intranasal steroids are effective in preventing or delaying recurrence of nasal polyps. However, their effectiveness in delaying a need for repeat polypectomy in clinical practice is unknown. To compare time to a repeat polypectomy between post-polypectomy intranasal steroid users and non-users. METHODOLOGY/PRINCIPLE: Our cohort consisted of patien...