Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study.

Background: Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by a saprophytic fungus that predominately affecting immune-compromised patients. Early diagnosis of ROCM is of utmost importance to start the treatment as early as possible to prevent early and horrible complications of the disease. Materials and methods: This retrospective study evaluated the imaging findings of 21 patients with biopsy and KOH mount-based evidence of invasive ROCM. The imaging was obtained from a Siemens Magnetom Amira 1.5T system with a strength of 1.5T or more. The spectrum of findings was evaluated for the sites of involvement, signal intensity, contrast characteristics, necrotic component as well as orbital, infratemporal, and intracranial extensions, especially cavernous sinuses, Meckel's cave, and the brain parenchyma. Results: The mean age of the patients was 55.8±10.9 years and included 71% male. All the patients were positive for COVID-19 and the majority were diabetic. MRI showed predominant involvement of the maxillary sinus (17, 81%) and the ethmoidal sinus (15, 71.4%). The orbital extension was present in 18 cases (86%). T1-weighted imaging showed iso to low signal intensity in involved sinuses in the majority of the patients (9, 42.9%). Heterogeneously high signal intensity was observed in T2-weighted and short tau inversion recovery images in all the patients. Heterogenous contrast enhancement was present in 20 (95.2%) patients. Conclusion: The imaging spectrum of ROCM is variable. Multiplanar MRI with postcontrast images is a very useful complementary tool to the clinical evaluation to assess the extent of disease and its complications, which has a high mortality. Clinicians and radiologists should be aware of the imaging spectrums of ROCM.

A Large Follicular Adenomatoid Odontogenic Tumor Occupying the Maxillary Sinus: A Case Report.

Adenomatoid odontogenic tumour is a rare benign, odontogenic tumour with uncertain histogenesis. Whether it is a hamartoma or a neoplasm is still a controversial topic. It is usually associated with an unerupted maxillary canine. Here, we discuss a follicular adenomatoid odontogenic tumour in a young girl with uncommon features such as it arose from two unerupted teeth and partial resorption of the roots of other normal teeth. The tumour was large enough to completely occupy the maxillary sinus. It was treated with enucleation and curettage by lateral rhinotomy approach. Keywords: adenomatoid tumor; case reports; hamartoma; odontogenic cysts.

Antibiotic Resistance Pattern in Pediatric Deep Neck Space Infection

Abstract Introduction Neck space infection in the pediatric age group is common but can be life-threatening if not diagnosed properly. Since it is a polymicrobial disease, antibiotic usage should be guided by culture sensitivity pattern. Objectives To assess the microbiology, antibiotic resistance pattern and the outcome of the medical and surgical management of deep neck space infection in children. Methods This was a prospective study of children admitted for management of neck space infection from August 2017 to August 2018. The age, gender, organisms isolated, sensitivity and resistance to antibiotics, length of hospital stay, complications, and recurrence were noted. The descriptive data were analyzed. Results Out of 108 cases, there were 51 males (47.2%) and 57 females (52.8%) ranging from 1 month to 15 years, with a mean age of 5.32 +/- 4.35 years. The mean period of hospitalization was 6.98 days. Staphylococcus aureus was the most common organism isolated with less coagulase-negative staphylococci and streptococci. Clindamycin was the most sensitive drug (82.35%) followed by vancomycin and cloxcillin, while amoxicillin/ampicillin, a commonly used drug, was the least sensitive (20.58%). The abscess recurrence rate was 9.28%. The outcomes of either medical treatment or a combined medical or surgical treatment in properly selected cases were comparable. Conclusion Clindamycin or cloxacillin can be used as a first-line option for neck infection in children. Ampicillin/amoxicillin alone has a small role in neck abscess because of high resistance to this type of antibiotic.

Antibiotic Resistance Pattern in Pediatric Deep Neck Space Infection.

Introduction Neck space infection in the pediatric age group is common but can be life-threatening if not diagnosed properly. Since it is a polymicrobial disease, antibiotic usage should be guided by culture sensitivity pattern. Objectives To assess the microbiology, antibiotic resistance pattern and the outcome of the medical and surgical management of deep neck space infection in children. Methods This was a prospective study of children admitted for management of neck space infection from August 2017 to August 2018. The age, gender, organisms isolated, sensitivity and resistance to antibiotics, length of hospital stay, complications, and recurrence were noted. The descriptive data were analyzed. Results Out of 108 cases, there were 51 males (47.2%) and 57 females (52.8%) ranging from 1 month to 15 years, with a mean age of 5.32 +/- 4.35 years. The mean period of hospitalization was 6.98 days. Staphylococcus aureus was the most common organism isolated with less coagulase-negative staphylococci and streptococci. Clindamycin was the most sensitive drug (82.35%) followed by vancomycin and cloxcillin, while amoxicillin/ampicillin, a commonly used drug, was the least sensitive (20.58%). The abscess recurrence rate was 9.28%. The outcomes of either medical treatment or a combined medical or surgical treatment in properly selected cases were comparable. Conclusion Clindamycin or cloxacillin can be used as a first-line option for neck infection in children. Ampicillin/amoxicillin alone has a small role in neck abscess because of high resistance to this type of antibiotic.

Prevalence of Post Tonsillectomy Haemorrhage at a Tertiary Care Centre in Nepal.

INTRODUCTION: Tonsillectomy is one of the common ENT surgical procedures. Post-tonsillectomy haemorrhage remains a frequent complication which can be potentially life-threatening. The objective of the present study was to calculate the prevalence of haemorrhage following a tonsillectomy at a tertiary care centre. METHODS: It was a descriptive cross-sectional study performed by medical chart review of the patients who underwent tonsillectomy from January 2018 to December 2019 at the department of ENT- Head and Neck Surgery of Tribhuvan University Teaching Hospital. Ethical approval was obtained from the institutional review committee (Ref:-282(6-11) E2 076/077). Convenient sampling method was used. All patients of any age who had tonsillectomy for recurrent tonsillitis or tonsillar hypertrophy with or without obstructive sleep apnoea and no missing information on chart review were included in the study. Data were entered in MS-Excel 2007 and analyzed in rate and percentage. RESULTS: Ten (5.18%) out of a total of 193 patients who underwent tonsillectomy had a post tonsillectomy haemorrhage. All 10 (100%) were adults patients, operated for recurrent tonsillitis, and used electrocautery. It was common in male patients 7 (70%). All of the haemorrhages was between a third and sixth postoperative day and were mild in severity. CONCLUSIONS: The prevalence of post-tonsillectomy haemorrhage was high at our centre during the study period of two years. It was common in adults, males and surgery done for recurrent tonsillitis using electrocauterization.

Mucormycosis: An unanticipated progeny of COVID-19.

The rapid surge of COVID-19 cases in the second wave of the pandemic has crippled the healthcare delivery system in Nepal and neighboring countries. Unlike in the first wave of the pandemic, several cases of mucormycosis have been reported in patients with COVID-19 from Nepal and India. In this report, we briefly describe the clinical presentation, diagnosis, and risk factors for mucormycosis and explore why patients with COVID-19 are at an increased risk for developing the infection. As treatment of mucormycosis is challenging and consumes a lot of resources, prevention of mucormycosis is pivotal in low-income countries like Nepal. We also highlight some basic steps that are easy to perform and important to reduce the risk of infection.

Complications of Acute and Chronic Otitis Media in a Tertiary Referral Center in Nepal.

OBJECTIVE: The aim of this study was to report the incidence of complications in otitis media and to determine the frequencies of various extracranial and intracranial complications at a tertiary care hospital. METHODS: We retrospectively reviewed the clinical records of patients of all ages and genders who were treated in a tertiary care hospital in Nepal from May 2015 to May 2020 for complications of acute and chronic otitis media. The complications were broadly classified as extracranial and intracranial. The details of patient profiles, histories, examination findings, investigations and treatments were reviewed from the charts. RESULTS: The mean age of 164 patients with complications of otitis media was 47.44±18.58 years. There were 79 (48.2%) male and 85 (51.8%) female patients. The overall incidence of otitis media complications was 0.78%. The incidences of the complications from acute otitis media, chronic otitis media without cholesteatoma, and chronic otitis media with cholesteatoma were 0.5%, 0.06% and 5.6%, respectively. Extracranial complications, intracranial complications and combined extracranial and intracranial complications were seen in 80%, 11% and 9% of the patients, respectively. The most common extracranial and intracranial complications were subperiosteal abscesses and brain abscesses, respectively. There was one mortality due to complication. CONCLUSION: The incidences of complications and mortality from otitis media have declined with the availability of suitable antibiotics, improved imaging, and multidisciplinary management. Antibiotic resistance and masking of signs and symptoms, however, could pose challenges in the future.

Lacrimal sac rhinosporidiosis: case report and review of literature with a new grading system to optimize treatment.

Rhinosporidiosis is a chronic granulomatous disease affecting the mucous membrane primarily and is caused by Rhinosporidium seeberi, an aquatic protistan parasite. The nose is the most common site of involvement and is seen in 83.3% cases, followed by ocular involvement in 11.2% cases and other sites like larynx, trachea and bronchus in 5.5% cases. In various oculosporidiosis case series, lacrimal drainage system involvement was seen to vary from 14.3% to 59.6% cases. Isolated lacrimal sac involvement in rhinosporidiosis was found in 45.8% (72 out of 157) cases of the lacrimal drainage system in a review of 31 studies. A variety of surgical procedures have been used to treat rhinosporidiosis of lacrimal sac like dacryocystorhinostomy, Dacryocystectomy, lateral rhinotomy and local lesion excision with a success rate varying from 28.5% to 92.3%. This wide variation in the success rate was due to the fact that a uniform surgical procedure was performed in all the cases of a particular series irrespective of the extent of disease. Grading the lacrimal sac rhinosporidiosis to decide the extent of surgical excision may help achieve better results. We present a grading system based on our own experience in a case of extensive rhinospodiosis of lacrimal sac and review of 31 studies published in the literature. A 24-year-old male from Nepal presented with the complaints of watering from his right eye of 13 years duration, swelling in the right medial canthal area with an extension to the inferior part of the orbit for 12 years and nasal blockage for 1.5 years. The patient had a history of previous intervention in which biopsy was taken from the nose and sent for histopathology that confirmed rhinosporidiosis. An extended intranasal endoscopic dacryocystectomy was done along with debridement and coblation of the lesion over the septum and nasopharynx. Intraoperatively a large rhinosporidiosis mass was seen filling the sac and was removed in toto along with the sac and nasolacrimal duct. Recurrence of a tiny lesion after 6 months in our case despite wide excision with the drilling of bony nasolacrimal duct and coblation, made us review the literature.