The Outcome of Endoscopic Sinus Surgery for Orbital Apex Syndrome Secondary to Sinusitis in a Tertiary Care Center-Our Experience Over 10 Years.

Objective: Orbital apex syndrome (OAS) is a rare condition with multiple cranial nerve involvement caused by varied etiologies. It is not only a threat to the patient's vision but also life-threatening due to the intracranial spread of infection, if not diagnosed early and treated accurately. To study the outcome of endoscopic sinus surgery (ESS) for OAS secondary to sinusitis concerning resolution of ptosis, improvement of ophthalmoplegia, visual prognosis, intracranial spread of infection, and mortality. Methods: A retrospective review of patients with OAS secondary to sinusitis who underwent ESS from 2011 to 2021 was tabulated and analyzed. Results: Twenty-seven patients (mean age: 55.11+/-16 years; male 62%) were included in this study. At presentation, blurring of vision (81%), headache (66%), diplopia (63%) ptosis (63%) were the most common symptoms, and ophthalmoplegia (100%) was the most common sign. Five patients had no perception of light and the rest had various degrees of vision impairment. The most common etiopathology of sinusitis was fungal sinusitis (12 mucormycosis and four aspergillus). The final visual prognosis at three months follow-up post-ESS showed vision stabilization (no improvement or worsening) in 13 (48%) patients, improvement in seven (26%) patients, and vision deterioration in two (7%) patients. There was a significant improvement in ptosis (70%) and ophthalmoplegia (85%). There was no intracranial spread of infection or recurrence with a mortality rate of 3.7% (one patient). Conclusion: ESS coupled with appropriate antimicrobials effectively treats OAS secondary to sinusitis with decreased morbidity and mortality.

Thyroid pyocele with systemic sepsis: a rare clinical scenario.

A late middle-aged woman presented with a large, painful neck mass, with a history of rapid increase of size since 1 week and associated voice change, dyspnoea and odynophagia. Prior radiological investigation showed a multiloculated cystic mass in the left thyroid lobe. Fine needle aspiration revealed a predominant cluster of neutrophils. Blood investigations showed leucocytosis and high blood glucose levels suggestive of sepsis. The patient underwent surgical drainage of the thyroid abscess with total thyroidectomy which was managed through multidisciplinary teamwork between surgeons, haematologists, endocrinologists and anaesthesiologists. In addition, urine culture and thyroid pus culture both showed Escherichia coli growth suggestive of bacterial sepsis. The patient was treated successfully and made a complete recovery following surgery with normalisation of voice.

Transnasal endoscopic drainage of neonatal orbital abscess.

Neonatal orbital complications are rare and potentially fatal, demanding prompt diagnosis and adequate treatment. A 25-day-old neonate presented with rapidly progressive orbital complications as evidenced by proptosis, chemosis, lid oedema and restricted eye movements, developing within 3 days. There was no significant medical history or risk factors for developing infection. An initial conservative approach with antimicrobial therapy failed to show any resolve. An MRI brain, orbits and paranasal sinuses demonstrated that there were features suggestive of right orbital cellulitis with possibility of abscess formation with right ethmoidal mucoinflammatory disease and mass effect on the optic nerve causing stretching and compression by the surrounding inflammation.The patient was treated successfully with transnasal endoscopic drainage and decompression. Endoscopic access was challenging owing to the restrictive anatomy. Postoperatively, the patient showed improvement, with gradual decrease in proptosis and resolve in eye movements.

Pneumosinus dilatans of the spheno-ethmoidal complex associated with hypovitaminosis D causing bilateral optic canal stenosis.

INTRODUCTION: Pneumosinus dilatans (PSD) is a rare disorder of undetermined etiology characterized by expansion of the paranasal sinuses without bony erosion. Of the few cases of PSD described in indexed pediatric literature, there has been no reported case of this disorder presenting with optic canal stenosis in the setting of a vitamin deficiency. CASE MATERIAL: A 12-year-old girl presented with a 3-month history of progressive, painless, and asymmetric visual deterioration in her eyes. MRI showed prominent perioptic CSF spaces bilaterally and mild atrophy of both the optic nerves. CT head showed hyperpneumatization of the sphenoethmoidal air cells and both anterior clinoid processes with the optic nerves contained within narrowed intact bony canals. Blood investigations showed reduced vitamin D levels, and a subsequent skeletal survey showed diffuse osteopenia. She underwent endoscopic sphenoidotomy and bilateral decompression of the optic nerves. Following surgery, she reported improvement of vision in her left eye. She was started on vitamin D supplements for the endocrine abnormality. At a follow-up visit 6 months later, her visual acuity in both her eyes had improved. CONCLUSION: Pneumosinus dilatans is an unusual cause of progressive optic nerve dysfunction in the pediatric population. In the absence of any associated intracranial pathologies, conditions like hypovitamosis D should be ruled out.

Comparison of Elective Minimally Invasive with Conventional Surgical Tracheostomy in Adults.

Minimally invasive techniques were used for tracheostomy including small horizontal skin incision, limited soft tissue dissection and no suturing. A Retrospective analysis of case sheets of patients who underwent elective tracheostomy by the first and second authors at M S Ramaiah Hospitals in Bangalore between 1st May 2010 and 1st May 2015 was done to compare the result of elective conventional open surgical tracheostomy using midline vertical skin incision with minimally invasive tracheostomy using a short horizontal incision. No statistically significant difference in the peri and post operative complication rate was found. The patterns of intra and post operative complications reflected the choice of the surgical technique-the conventional technique had problems associated with wide dissection, whereas the minimally invasive technique had problems associated with limited exposure. Problems of wound gaping, emphysema and peristomal inflammation were reduced with minimally invasive technique with short horizontal skin incision although statistical difference could not be shown. There was also no statistically significant difference with either technique regards death and decannulation rates. Minimally invasive technique of elective open surgical tracheostomy was found to be as safe as conventional open surgical tracheostomy with midline vertical skin incision in the studied groups.