Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionIn laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability.ConclusionIn conclusion, the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage LTR.Summary and ConclusionSurgical correction of moderate to high myopia proved to be effective, safe and predictable. The choice of the procedure should be based on the patient’s condition, the surgeon’s expertise as well as the resources of the health care facility. The main procedures for correction of high myopia are Phakic IOLs, LASIK and clear lens extraction. Each of these procedures has its own indications, precautions as well as its most feared complications.Phakic IOLs despite the excellent initial outcome in terms of predictability and quality of vision imply certain risk for endothelial damage therefore should be followed up regularly. Phakic IOL should be removed as soon as serious decline in endothelial cell density occurs. As large proportion of high myopes will develop cataract, care should be taken to interfere before endothelial cell count decreases below safe limit for performing cataract extraction. The younger the patient at time of PIOL implantation, the higher the endothelial cell count required before PIOL implantation.LASIK is less invasive but irreversible procedure. Concerns about LASIK include degradation in quality of vision especially with marked flattening of the cornea which directly increases the higher order aberrations, the compromise between the optical zone and the possible correction respecting the minimal residual stromal bed. At any cost the risk of post LASIK keratectasia, the most devastating complication of LASIK nowadays, should be minimized. It should be kept in mind that theoretical calculations do not make up for the common error in the flap thickness.Clear lens extraction is more appealing in patients over forty five years especially if there is lens sclerosis as phakic IOL may enhance the cataract. LASIK also complicates IOL calculation should cataract progress necessitating removal. CLE should be performed through as small incision as possible to decrease the fluctuation in anterior chamber depth. Complete cortical clean up as well as capsular polishing must be performed to decrease the incidence of posterior capsular opacification and consequently YAG laser capsulotomy which is a very important added risk factor for retinal detachment in high myopes.Finally, due to the possible risks and elective nature of these procedures, they should only be offered to patients who refuse glasses and do not tolerate contact lenses. Clear explanation and proper informed consent is mandatory in every case.SUMMARYAs refractive surgery gets simpler, safer, more predictable and more effective, it becomes more popular. While cases of simple myopia are usually easy to handle and get satisfactory results when corrected with excimer laser, those with high myopia still represent some challenges.To get the best possible outcome, the surgical plan should be tailored individually to suit each particular case with its peculiar characteristics regarding patients age, activities, visual needs, expectations and of course not the least his own eye parameters.In an attempt to better understand this issue, this study was conducted including ninety eyes of 48 patients, 22 males (45.8 %) and 26 (54.2%) females with a mean age of 40.66±12.03 (range 20 to 63) years and mean spherical equivalent of -12.67±4.64 (range -24 to -7.5) diopters. They were divided into three equal groups.The first group (A) underwent phakic intraocular lens implantation namely Kelman duet lens which is an angle supported anterior chamber phakic lens with rigid tripod haptic and foldable optic that can be injected through a self sealed clear corneal incision of as small size as two mm to be assembled to the previously implanted haptic.The second group (B) under went LASIK after doing the necessary investigations to exclude keratoconus suspects and to make sure that the cornea has enough thickness to allow complete correction of the refractive error in an ablation diameter that matches the scotopic pupil size.The third group (C) underwent clear lens extraction using micro-incision cataract surgery followed by implantation of acrylic foldable posterior chamber IOLs.The mean efficacy index three months postoperatively was 0.99, 0.874 and 0.916 in group A, B and C respectively. UCVA of 0.5 (6/12) or better was achieved in 80%, 93.33%, 63.3% of cases of group A, B and C respectively, while UCVA of 1.0 (6/6) was achieved in 16.67% and 33.3% of cases of group A and B.The mean postoperative safety index was 1.268, 1.03 and 1.249 in group A, B and C respectively. BCVA of 0.5 (6/12) or better was achieved in all cases however, 50%, 60% and 26.67% of cases in group A, B and C respectively achieved postoperative BCVA of 1.0 (6/6)Postoperative spherical equivalent within one diopter of emmetropia was achieved in 76.67%, 86.67%, 70% of cases in group A, B and C respectively. Postoperative defocus equivalent equal to or less than one diopter was achieved in 50%, 80% and 60% of cases group A, B and C respectively.The contrast sensitivity curves improved in the first postoperative month in all spatial frequencies in cases of group A and C without significant change in the subsequent visits. However; in cases of group B the contrast sensitivity curves decreased in the first postoperative month in all spatial frequencies, then improved at the third month visit to the preoperative level to exceed it in the sixth month without significant change in the subsequent ninth month visit.There was transient rise in IOP in cases of group A and C during the first postoperative week however; in group B IOP showed significant decline all through the follow up period.There was statistically significant loss of endothelial cells at one and nine months postoperatively however, the degree of loss varied in different groups. The loss in the mean endothelial cell count from preoperative level to the first month postoperatively was 6.29%, 1.56% and 9.78% and from the first month to the ninth month postoperatively was 0.99%, 1.28% and 0.92% in group A, B and C respectively.Regarding complications; in group (A), 6.67% of cases developed mild intraoperative hyphaema. Pupil ovalization occurred in 6.67% of cases, In 3.33% of cases rotation of the lens occurred due to too short haptics. In group (B), 3.33% of cases had decentered flap 3.33 % had decentered ablation. Interface deposits as well as bleeding to the interface were observed in 6.67%. The incidence of epithelial ingrowth, DLK and flap stria was 3.33% where as that of pseudoDLK was 6.67%. while in group (C), 3.33% of cases had intraoperative iris trauma while developed 6.67% posterior capsule opacification.CONCLUSIONSurgical correction of moderate to high myopia proved to be effective, safe and predictable. The choice of the procedure should be based on the patient’s condition, the surgeon’s expertise as well as the resources of the health care facility. The main procedures for correction of high myopia are Phakic IOLs, LASIK and clear lens extraction. Each of these procedures has its own indications, precautions as well as its most feared complications.Phakic IOLs despite the excellent initial outcome in terms of predictability and quality of vision imply certain risk for endothelial damage therefore should be followed up regularly. Phakic IOL should be removed as soon as serious decline in endothelial cell density occurs. As large proportion of high myopes will develop cataract, care should be taken to interfere before endothelial cell count decreases below safe limit for performing cataract extraction. The younger the patient at time of PIOL implantation, the higher the endothelial cell count required before PIOL implantation.LASIK is less invasive but irreversible procedure. Concerns about LASIK include degradation in quality of vision especially with marked flattening of the cornea which directly increases the higher order aberrations, the compromise between the optical zone and the possible correction respecting the minimal residual stromal bed. At any cost the risk of post LASIK keratectasia, the most devastating complication of LASIK nowadays, should be minimized. It should be kept in mind that theoretical calculations do not make up for the common error in the flap thickness.Clear lens extraction is more appealing in patients over forty five years especially if there is lens sclerosis as phakic IOL may enhance the cataract. LASIK also complicates IOL calculation should cataract progress necessitating removal. CLE should be performed through as small incision as possible to decrease the fluctuation in anterior chamber depth. Complete cortical clean up as well as capsular polishing must be performed to decrease the incidence of posterior capsular opacification and consequently YAG laser capsulotomy which is a very important added risk factor for retinal detachment in high myopes.Finally, due to the possible risks and elective nature of these procedures, they should only be offered to patients who refuse glasses and do not tolerate contact lenses. Clear explanation and proper informed consent is mandatory in every case.SUMMARYAs refractive surgery gets simpler, safer, more predictable and more effective, it becomes more popular. While cases of simple myopia are usually easy to handle and get satisfactory results when corrected with excimer laser, those with high myopia still represent some challenges.To get the best possible outcome, the surgical plan should be tailored individually to suit each particular case with its peculiar characteristics regarding patients age, activities, visual needs, expectations and of course not the least his own eye parameters.In an attempt to better understand this issue, this study was conducted including ninety eyes of 48 patients, 22 males (45.8 %) and 26 (54.2%) females with a mean age of 40.66±12.03 (range 20 to 63) years and mean spherical equivalent of -12.67±4.64 (range -24 to -7.5) diopters. They were divided into three equal groups.The first group (A) underwent phakic intraocular lens implantation namely Kelman duet lens which is an angle supported anterior chamber phakic lens with rigid tripod haptic and foldable optic that can be injected through a self sealed clear corneal incision of as small size as two mm to be assembled to the previously implanted haptic.The second group (B) under went LASIK after doing the necessary investigations to exclude keratoconus suspects and to make sure that the cornea has enough thickness to allow complete correction of the refractive error in an ablation diameter that matches the scotopic pupil size.The third group (C) underwent clear lens extraction using micro-incision cataract surgery followed by implantation of acrylic foldable posterior chamber IOLs.The mean efficacy index three months postoperatively was 0.99, 0.874 and 0.916 in group A, B and C respectively. UCVA of 0.5 (6/12) or better was achieved in 80%, 93.33%, 63.3% of cases of group A, B and C respectively, while UCVA of 1.0 (6/6) was achieved in 16.67% and 33.3% of cases of group A and B.The mean postoperative safety index was 1.268, 1.03 and 1.249 in group A, B and C respectively. BCVA of 0.5 (6/12) or better was achieved in all cases however, 50%, 60% and 26.67% of cases in group A, B and C respectively achieved postoperative BCVA of 1.0 (6/6)Postoperative spherical equivalent within one diopter of emmetropia was achieved in 76.67%, 86.67%, 70% of cases in group A, B and C respectively. Postoperative defocus equivalent equal to or less than one diopter was achieved in 50%, 80% and 60% of cases group A, B and C respectively.The contrast sensitivity curves improved in the first postoperative month in all spatial frequencies in cases of group A and C without significant change in the subsequent visits. However; in cases of group B the contrast sensitivity curves decreased in the first postoperative month in all spatial frequencies, then improved at the third month visit to the preoperative level to exceed it in the sixth month without significant change in the subsequent ninth month visit.There was transient rise in IOP in cases of group A and C during the first postoperative week however; in group B IOP showed significant decline all through the follow up period.There was statistically significant loss of endothelial cells at one and nine months postoperatively however, the degree of loss varied in different groups. The loss in the mean endothelial cell count from preoperative level to the first month postoperatively was 6.29%, 1.56% and 9.78% and from the first month to the ninth month postoperatively was 0.99%, 1.28% and 0.92% in group A, B and C respectively.Regarding complications; in group (A), 6.67% of cases developed mild intraoperative hyphaema. Pupil ovalization occurred in 6.67% of cases, In 3.33% of cases rotation of the lens occurred due to too short haptics. In group (B), 3.33% of cases had decentered flap 3.33 % had decentered ablation. Interface deposits as well as bleeding to the interface were observed in 6.67%. The incidence of epithelial ingrowth, DLK and flap stria was 3.33% where as that of pseudoDLK was 6.67%. while in group (C), 3.33% of cases had intraoperative iris trauma while developed 6.67% posterior capsule opacification.CONCLUSIONSurgical correction of moderate to high myopia proved to be effective, safe and predictable. The choice of the procedure should be based on the patient’s condition, the surgeon’s expertise as well as the resources of the health care facility. The main procedures for correction of high myopia are Phakic IOLs, LASIK and clear lens extraction. Each of these procedures has its own indications, precautions as well as its most feared complications.Phakic IOLs despite the excellent initial outcome in terms of predictability and quality of vision imply certain risk for endothelial damage therefore should be followed up regularly. Phakic IOL should be removed as soon as serious decline in endothelial cell density occurs. As large proportion of high myopes will develop cataract, care should be taken to interfere before endothelial cell count decreases below safe limit for performing cataract extraction. The younger the patient at time of PIOL implantation, the higher the endothelial cell count required before PIOL implantation.LASIK is less invasive but irreversible procedure. Concerns about LASIK include degradation in quality of vision especially with marked flattening of the cornea which directly increases the higher order aberrations, the compromise between the optical zone and the possible correction respecting the minimal residual stromal bed. At any cost the risk of post LASIK keratectasia, the most devastating complication of LASIK nowadays, should be minimized. It should be kept in mind that theoretical calculations do not make up for the common error in the flap thickness.Clear lens extraction is more appealing in patients over forty five years especially if there is lens sclerosis as phakic IOL may enhance the cataract. LASIK also complicates IOL calculation should cataract progress necessitating removal. CLE should be performed through as small incision as possible to decrease the fluctuation in anterior chamber depth. Complete cortical clean up as well as capsular polishing must be performed to decrease the incidence of posterior capsular opacification and consequently YAG laser capsulotomy which is a very important added risk factor for retinal detachment in high myopes.Finally, due to the possible risks and elective nature of these procedures, they should only be offered to patients who refuse glasses and do not tolerate contact lenses. Clear explanation and proper informed consent is mandatory in every case.SUMMARYAs refractive surgery gets simpler, safer, more predictable and more effective, it becomes more popular. While cases of simple myopia are usually easy to handle and get satisfactory results when corrected with excimer laser, those with high myopia still represent some challenges.To get the best possible outcome, the surgical plan should be tailored individually to suit each particular case with its peculiar characteristics regarding patients age, activities, visual needs, expectations and of course not the least his own eye parameters.In an attempt to better understand this issue, this study was conducted including ninety eyes of 48 patients, 22 males (45.8 %) and 26 (54.2%) females with a mean age of 40.66±12.03 (range 20 to 63) years and mean spherical equivalent of -12.67±4.64 (range -24 to -7.5) diopters. They were divided into three equal groups.The first group (A) underwent phakic intraocular lens implantation namely Kelman duet lens which is an angle supported anterior chamber phakic lens with rigid tripod haptic and foldable optic that can be injected through a self sealed clear corneal incision of as small size as two mm to be assembled to the previously implanted haptic.The second group (B) under went LASIK after doing the necessary investigations to exclude keratoconus suspects and to make sure that the cornea has enough thickness to allow complete correction of the refractive error in an ablation diameter that matches the scotopic pupil size.The third group (C) underwent clear lens extraction using micro-incision cataract surgery followed by implantation of acrylic foldable posterior chamber IOLs.The mean efficacy index three months postoperatively was 0.99, 0.874 and 0.916 in group A, B and C respectively. UCVA of 0.5 (6/12) or better was achieved in 80%, 93.33%, 63.3% of cases of group A, B and C respectively, while UCVA of 1.0 (6/6) was achieved in 16.67% and 33.3% of cases of group A and B.The mean postoperative safety index was 1.268, 1.03 and 1.249 in group A, B and C respectively. BCVA of 0.5 (6/12) or better was achieved in all cases however, 50%, 60% and 26.67% of cases in group A, B and C respectively achieved postoperative BCVA of 1.0 (6/6)Postoperative spherical equivalent within one diopter of emmetropia was achieved in 76.67%, 86.67%, 70% of cases in group A, B and C respectively. Postoperative defocus equivalent equal to or less than one diopter was achieved in 50%, 80% and 60% of cases group A, B and C respectively.The contrast sensitivity curves improved in the first postoperative month in all spatial frequencies in cases of group A and C without significant change in the subsequent visits. However; in cases of group B the contrast sensitivity curves decreased in the first postoperative month in all spatial frequencies, then improved at the third month visit to the preoperative level to exceed it in the sixth month without significant change in the subsequent ninth month visit.There was transient rise in IOP in cases of group A and C during the first postoperative week however; in group B IOP showed significant decline all through the follow up period.There was statistically significant loss of endothelial cells at one and nine months postoperatively however, the degree of loss varied in different groups. The loss in the mean endothelial cell count from preoperative level to the first month postoperatively was 6.29%, 1.56% and 9.78% and from the first month to the ninth month postoperatively was 0.99%, 1.28% and 0.92% in group A, B and C respectively.Regarding complications; in group (A), 6.67% of cases developed mild intraoperative hyphaema. Pupil ovalization occurred in 6.67% of cases, In 3.33% of cases rotation of the lens occurred due to too short haptics. In group (B), 3.33% of cases had decentered flap 3.33 % had decentered ablation. Interface deposits as well as bleeding to the interface were observed in 6.67%. The incidence of epithelial ingrowth, DLK and flap stria was 3.33% where as that of pseudoDLK was 6.67%. while in group (C), 3.33% of cases had intraoperative iris trauma while developed 6.67% posterior capsule opacification.CONCLUSIONSurgical correction of moderate to high myopia proved to be effective, safe and predictable. The choice of the procedure should be based on the patient’s condition, the surgeon’s expertise as well as the resources of the health care facility. The main procedures for correction of high myopia are Phakic IOLs, LASIK and clear lens extraction. Each of these procedures has its own indications, precautions as well as its most feared complications.Phakic IOLs despite the excellent initial outcome in terms of predictability and quality of vision imply certain risk for endothelial damage therefore should be followed up regularly. Phakic IOL should be removed as soon as serious decline in endothelial cell density occurs. As large proportion of high myopes will develop cataract, care should be taken to interfere before endothelial cell count decreases below safe limit for performing cataract extraction. The younger the patient at time of PIOL implantation, the higher the endothelial cell count required before PIOL implantation.LASIK is less invasive but irreversible procedure. Concerns about LASIK include degradation in quality of vision especially with marked flattening of the cornea which directly increases the higher order aberrations, the compromise between the optical zone and the possible correction respecting the minimal residual stromal bed. At any cost the risk of post LASIK keratectasia, the most devastating complication of LASIK nowadays, should be minimized. It should be kept in mind that theoretical calculations do not make up for the common error in the flap thickness.Clear lens extraction is more appealing in patients over forty five years especially if there is lens sclerosis as phakic IOL may enhance the cataract. LASIK also complicates IOL calculation should cataract progress necessitating removal. CLE should be performed through as small incision as possible to decrease the fluctuation in anterior chamber depth. Complete cortical clean up as well as capsular polishing must be performed to decrease the incidence of posterior capsular opacification and consequently YAG laser capsulotomy which is a very important added risk factor for retinal detachment in high myopes.Finally, due to the possible risks and elective nature of these procedures, they should only be offered to patients who refuse glasses and do not tolerate contact lenses. Clear explanation and proper informed consent is mandatory in every case.SUMMARYAs refractive surgery gets simpler, safer, more predictable and more effective, it becomes more popular. While cases of simple myopia are usually easy to handle and get satisfactory results when corrected with excimer laser, those with high myopia still represent some challenges.To get the best possible outcome, the surgical plan should be tailored individually to suit each particular case with its peculiar characteristics regarding patients age, activities, visual needs, expectations and of course not the least his own eye parameters.In an attempt to better understand this issue, this study was conducted including ninety eyes of 48 patients, 22 males (45.8 %) and 26 (54.2%) females with a mean age of 40.66±12.03 (range 20 to 63) years and mean spherical equivalent of -12.67±4.64 (range -24 to -7.5) diopters. They were divided into three equal groups.The first group (A) underwent phakic intraocular lens implantation namely Kelman duet lens which is an angle supported anterior chamber phakic lens with rigid tripod haptic and foldable optic that can be injected through a self sealed clear corneal incision of as small size as two mm to be assembled to the previously implanted haptic.The second group (B) under went LASIK after doing the necessary investigations to exclude keratoconus suspects and to make sure that the cornea has enough thickness to allow complete correction of the refractive error in an ablation diameter that matches the scotopic pupil size.The third group (C) underwent clear lens extraction using micro-incision cataract surgery followed by implantation of acrylic foldable posterior chamber IOLs.The mean efficacy index three months postoperatively was 0.99, 0.874 and 0.916 in group A, B and C respectively. UCVA of 0.5 (6/12) or better was achieved in 80%, 93.33%, 63.3% of cases of group A, B and C respectively, while UCVA of 1.0 (6/6) was achieved in 16.67% and 33.3% of cases of group A and B.The mean postoperative safety index was 1.268, 1.03 and 1.249 in group A, B and C respectively. BCVA of 0.5 (6/12) or better was achieved in all cases however, 50%, 60% and 26.67% of cases in group A, B and C respectively achieved postoperative BCVA of 1.0 (6/6)Postoperative spherical equivalent within one diopter of emmetropia was achieved in 76.67%, 86.67%, 70% of cases in group A, B and C respectively. Postoperative defocus equivalent equal to or less than one diopter was achieved in 50%, 80% and 60% of cases group A, B and C respectively.The contrast sensitivity curves improved in the first postoperative month in all spatial frequencies in cases of group A and C without significant change in the subsequent visits. However; in cases of group B the contrast sensitivity curves decreased in the first postoperative month in all spatial frequencies, then improved at the third month visit to the preoperative level to exceed it in the sixth month without significant change in the subsequent ninth month visit.There was transient rise in IOP in cases of group A and C during the first postoperative week however; in group B IOP showed significant decline all through the follow up period.There was statistically significant loss of endothelial cells at one and nine months postoperatively however, the degree of loss varied in different groups. The loss in the mean endothelial cell count from preoperative level to the first month postoperatively was 6.29%, 1.56% and 9.78% and from the first month to the ninth month postoperatively was 0.99%, 1.28% and 0.92% in group A, B and C respectively.Regarding complications; in group (A), 6.67% of cases developed mild intraoperative hyphaema. Pupil ovalization occurred in 6.67% of cases, In 3.33% of cases rotation of the lens occurred due to too short haptics. In group (B), 3.33% of cases had decentered flap 3.33 % had decentered ablation. Interface deposits as well as bleeding to the interface were observed in 6.67%. The incidence of epithelial ingrowth, DLK and flap stria was 3.33% where as that of pseudoDLK was 6.67%. while in group (C), 3.33% of cases had intraoperative iris trauma while developed 6.67% posterior capsule opacification.CONCLUSIONSurgical correction of moderate to high myopia proved to be effective, safe and predictable. The choice of the procedure should be based on the patient’s condition, the surgeon’s expertise as well as the resources of the health care facility. The main procedures for correction of high myopia are Phakic IOLs, LASIK and clear lens extraction. Each of these procedures has its own indications, precautions as well as its most feared complications.Phakic IOLs despite the excellent initial outcome in terms of predictability and quality of vision imply certain risk for endothelial damage therefore should be followed up regularly. Phakic IOL should be removed as soon as serious decline in endothelial cell density occurs. As large proportion of high myopes will develop cataract, care should be taken to interfere before endothelial cell count decreases below safe limit for performing cataract extraction. The younger the patient at time of PIOL implantation, the higher the endothelial cell count required before PIOL implantation.LASIK is less invasive but irreversible procedure. Concerns about LASIK include degradation in quality of vision especially with marked flattening of the cornea which directly increases the higher order aberrations, the compromise between the optical zone and the possible correction respecting the minimal residual stromal bed. At any cost the risk of post LASIK keratectasia, the most devastating complication of LASIK nowadays, should be minimized. It should be kept in mind that theoretical calculations do not make up for the common error in the flap thickness.Clear lens extraction is more appealing in patients over forty five years especially if there is lens sclerosis as phakic IOL may enhance the cataract. LASIK also complicates IOL calculation should cataract progress necessitating removal. CLE should be performed through as small incision as possible to decrease the fluctuation in anterior chamber depth. Complete cortical clean up as well as capsular polishing must be performed to decrease the incidence of posterior capsular opacification and consequently YAG laser capsulotomy which is a very important added risk factor for retinal detachment in high myopes.Finally, due to the possible risks and elective nature of these procedures, they should only be offered to patients who refuse glasses and do not tolerate contact lenses. Clear explanation and proper informed consent is mandatory in every case.SUMMARYareEustachian tube dysfunction and middle ear infections,The main symptom of SOM is hearing loss. The importantsigns of the tympanic membrane are altered mobility andcolour changes. Air-bone gap of 20-40 dB was observed in theaudiogram of most cases. Tympanogram was flat in most ofcases.Various methods of treatment had been tried eithermedically or surgically. The medical management includesI~antibiotics, mucolytics, corticosteroids,decongestants,antihistaminics and inflation of the ET. The surgicaltreatment includes, myringotomy, tympanostomy tube andadenoidectomy. Other procdures, including tonsillectomy andantral lavageIn this study we try to evaluate the response of SOM tolocal medication with mucolytics. Bromhexine (Bisolvon) was