Long term outcome of chondromesenchymal hamartoma of sinonasal cavity: a rare entity.

Nasal chondromesenchymal hamartoma in the sinonasal cavity is an unusual entity mostly found in young infants and children. We present the case of a nasal chondromesenchymal hamartoma in a young female. NCMH has a favourable outcome that shows neither recurrence nor any malignant behaviour.

Chondrosarcoma of hyoid bone: a case report.

Chondrosarcoma of hyoid bone is a rare malignant tumour, with only a few cases reported in literature. We present the case of a 28-year-old male with grade I hyoid bone chondrosarcoma.

Thyroid gland neoplasms; histopathological pitfalls as a consequence of FNAC: A tertiary care hospital experience.

Fine-needle aspiration cytology (FNAC) is one of the useful procedures for the investigation of thyroid swellings. FNAC is a minimally invasive procedure, is cost effective, and a gold standard for diagnosing thyroid lesions. Haemorrhage, thrombosis, and infarction are known common complications of FNAC. Post FNAC infarction in thyroid gland has been known as a rare phenomenon. Here, we report the case of a young female who underwent FNAC that showed Hurthle cell neoplasm (Bethesda 3). Four weeks later, she underwent right thyroid lobectomy and the final histology showed extensive necrosis and haemorrhage which is a diagnostic dilemma and hampered our diagnosis.

Bilateral simultaneous primary Oral Squamous Cell Carcinoma: A rare presentation.

Introduction: and Importance: Oral Squamous Cell Carcinoma (OSSC) is one of the most common malignancies of the oral cavity and is one of the ten most prevalent tumours in the world. Control of this tumor is difficult and challenging as its propensity to spread is embedded in the cancer field of epithelial cells which alter these cells and induce a malignant potential within them. Simultaneous bilateral primary tumours are a rare presentation in the oral cavity which highlights the significance of early diagnosis and treatment. Case presentation: Here we present a case of 50-year-old gentleman known case of diabetes, hypertension and chronic history of beetle nut chewing who developed a simultaneously growing bilateral primary OSSC in the buccal mucosa. CT scan revealed a heterogeneous enhancing thickening in the bilateral buccogingival mucosa. A wide local excision of bilateral buccal mucosa with bilateral marginal mandibulectomy with neck dissection was planned. Clinical discussion: The majority of the case report emphasises the relevance of simultaneously developing bilateral primary oral cavity tumours in a patient who had a history of consuming beetle nuts. The independent incidence of bilateral primary OSSC in individuals without a history of tobacco, beetle nut, or alcohol use has also been documented in a small body of research. Due to the considerable clinical variety in its presentation, it is necessary to include bilateral primary OSSC when making a differential diagnosis of OSSC. Conclusion: Multiple bilateral primary tumours of the oral cavity are typically on the rise. The prognosis and survival of these individuals are considerably improved by close surveillance and early, expectant management of these cancers. This case study emphasises the value of thorough screening techniques used at an early stage to find these lesions and treat them appropriately.

Comparison of Endoscopic Versus Microscopic Tympanoplasty.

Introduction: Tympanoplasty is a common surgery for chronic otitis media and has conventionally been performed with a microscope for decades. The trend of endoscopic minimally invasive surgeries has been increasing worldwide for the last few decades. Few studies have discussed the outcomes of tympanoplasty with microscope and tympanoplasty with endoscope . This study aims to compare results of tympanoplasty done with microscope vs endoscope in terms of graft take rate and improvement in conductive hearing loss. Materials and Methods: We did a retrospective review of 120 patients (54 male and 66 female) who underwent Type I tympanoplasty at Liaquat National Postgraduate Medical Center from January 2019 to January 2020. We included 60 patients who underwent tympanoplasty with microscope and 60 patients who underwent tympanoplasty with endoscope. Postoperative graft uptake and hearing improvement were studied. Results: Overall mean preoperative hearing loss was 30.24 (±9.61) dB as compared to mean postoperative hearing loss, which was reduced to 19.36 ( ±8.54) dB, and the difference was significant (P-value <0.001. No statistically significant difference was found for air-bone gap closure between the two groups (P-value 0.78). Out of 120 patients, overall successful graft uptake was seen in 109 (90.8%). In tympanoplasty with microscope, graft take was 90.0%, compared to 91.6% in endoscope group. There was no significant difference in graft take in the two groups. Conclusions: The tympanoplasty with endoscope is comparable to tympanoplasty with microscope in terms of graft uptake and hearing improvement.

Incidence and Recurrence of Allergic Fungal Sinusitis at Tertiary Care Facility.

To assess the incidence and recurrence of patients of allergic fungal sinusitis after administration of topical steroids for 24 months this is a cross-section study. Total 90 patients diagnosed with nasal pathology were enrolled from January 2011 to December 2015 at Liaquat National Hospital, various sign and symptoms were tabulated. Patients clinical, radiological and histopathological reports were analyzed. Post operative steroid dose and recurrence rate was noted. Post stratification, Chi-square test and Fisher's exact test was applied to see the association between CT Scan and endoscopic findings and recurrence considering P value ≤ 0.05 as significant. Total 90 patients of either sex aged between 12 and 63 years fulfilled the inclusion criteria and were enrolled in the study. The results showed that among all study patients, 53(58.9%) were male and 37(41.1%) were female. Common presenting symptoms included nasal obstruction, nasal discharge & headache followed by proptosis. From 90 cases, 73(81.2%) had chronic rhinosinusitis and 17(18.9%) cases had Aspergillus. Postoperatively patients were given topical steroids and recurrence was seen in twelve (17.8%). All were aspergillus positive. The incidence of AFRS is (17) 18.9% of CRS which is slightly higher as reported in previous literature. Endoscopic finding may differ from CT scan finding. Patients presented with CRS should receive steroids for at least 2 years to prevent recurrence.

Neuroendocrine Adenoma of Middle Ear Causing Acute Onset Facial Palsy- A Rare Case Report.

INTRODUCTION: Acute facial nerve palsy secondary to neuroendocrine adenoma of the middle ear (NAME) is a rare disorder. There is only one case report in the literature describing similar findings. CASE REPORT: A 50-year-old man initially presented to ENT clinic with a right-sided middle ear mass and normal facial nerve function. Over the next six days, he developed House-Brackmann grade II facial paralysis. He underwent urgent surgical exploration of the tympanic cavity and excision of the middle ear mass via a post-auricular approach. Histopathological and immunohistochemical analysis revealed NAME. Three weeks after the surgery, facial nerve function returned to normal. No recurrence was found at a 3-year follow-up. CONCLUSION: Acute onset facial palsy induced by NAME is an extremely rare disorder. For a patient already affected by hearing impairment resulted from middle ear mass, facial weakness can have a significant additional detrimental impact on their wellbeing. The early complete excision of tumor is recommended not only as a curative treatment but also restoration of facial function.

Readmissions After Day Care Surgery In Ent: A Tertiary Care Experience.

BACKGROUND: Re-admission following day care surgery in ENT (Ear, Nose & Throat) results in significant morbidity to patient & massive load to hospital & also raises the question on the safety of day care surgery. Only a small number of published studies emphases on return to hospital within 30 days following day care surgery in otorhinolaryngology especially from our region. This study was carried out to determine the frequency of re-admission after day care surgery in ENT. METHODS: We prospectively studied consecutive patients who underwent ENT procedures [i.e., septoplasty, tympanoplasty type I & functional endoscopic sinus surgery (FESS) for deviated nasal septum (DNS), chronic suppurative otitis media tubotympanic (CSOM TT) variety & ethmoidal nasal polyposis (ENP) respectively] as day care surgery case under general anaesthesia at the Section of Otorhinolaryngology and Head & Neck Surgery, Aga Khan University Hospital & Liaquat National Hospital, Karachi from January 2015 to December 2016. All patients aged 20- 60 years of both genders were included in the study. SPSS software version 20 was used for data compilation and analysis. p-value less than or equal to 0.05 was taken as significant. RESULTS: In the phase of 24 months, total 317 cases met the inclusion criteria & were included in the study. There were 205 males & 112 females in the study population. One hundred & twenty-two patients having DNS, 128 having CSOM TT & 67 suffering from ENP & underwent septoplasty, tympanoplasty type I & FESS respectively. Complications were observed in a total of 7 (2.2%) patients in our study group & required re-admission within 1 month of surgery. Stratification was done between re-admission & all effect modifiers, with all showing insignificant results. CONCLUSIONS: Our results demonstrate that ENT surgeries (septoplasty, tympanoplasty type I & FESS) are safe procedures which can be performed as a day care case with acceptably low readmission rates.

Predictors of locoregional recurrence in early stage buccal cancer with pathologically clear surgical margins and negative neck.

OBJECTIVE: To identify the significant predictors of locoregional recurrence in early stage squamous cell carcinoma (SCC) of buccal mucosa with pathologically clear surgical margins and negative neck. METHOD: Seventy-three patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCC with clear surgical margins (>5mm margins each) and negative neck (N0) were included. None of the patients received postoperative radiotherapy or chemotherapy. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence. RESULTS: Recurrence was observed in 22 of 73 (30%) cases. Twelve had local, seven had regional and three developed locoregional recurrences. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control. CONCLUSION: Lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) significantly increased the locoregional recurrence rate in early stage buccal SCC with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present.