Glomus Tumor of the Pterygopalatine Fossa: A Rare Case Report.

The pterygopalatine fossa (PPF) is a challenging space and pathological processes in this anatomical space are uncommon. This report presents a case of glomus tumor right PPF in a 65 years old female patient who underwent tumor removal by endoscopic transnasal-transmaxillary approach with preoperative selective embolization of the right internal maxillary artery.

Tranexamic acid has no advantage in head and neck surgical procedures: a randomised, double-blind, controlled clinical trial.

OBJECTIVE: To assess the effect of tranexamic acid in head and neck surgical procedures. METHODS: A prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients' group allocation (case or control). RESULTS: Patients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant. CONCLUSION: Although this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.

Killian's polyp mimicking malignant tumor.

Killian polyp is predominantly found in children and any sinonasal tumor in elderly presenting with epistaxis and pain usually indicates malignant growth until proved otherwise. We present an unusual case of Killian polyp in an elderly patient that behaved as a malignant tumor. This case report reminded us that paranasal sinuses are still dark hollow mysterious cavities, and we should take utmost clinical acumen in managing such cases.

Volumetric CT perfusion assessment of treatment response in head and neck squamous cell carcinoma: Comparison of CT perfusion parameters before and after chemoradiation therapy.

BACKGROUND AND PURPOSE: World Health Organization estimated that there were 600,000 new cases of head and neck cancers and 300,000 deaths each year worldwide. Scientific modalities to predict the treatment outcomes are not available yet. We conducted this study to (1) compare CT perfusion parameters before and after chemoradiation among patients with head and neck squamous cell carcinoma and (2) to evaluate the prognostic value of each perfusion parameter in predicting the response to chemoradiation. MATERIALS AND METHODS: We conducted a prospective study among all patients with head and neck squamous cell carcinoma registered for chemoradiotherapy (CRT) at Regional Cancer Research Center, Shimla, Himachal Pradesh, India during the period June 2012 through June 2013. CTp data were acquired on a 64-slice CT scanner (Light speed VCT Xte; GE Healthcare) with 14 cm z-axis coverage using Volume Helical Shuttle (VHS) feature at baseline, on completion of 40 Gy and 66 Gy of chemoradiation. We dichotomised the treatment outcome as complete response and non-response (partial responders/stable disease/progressive disease) using RECIST 1.1 criteria. We compared all perfusion parameters at baseline, 40 Gy and 66 Gy of CRT between responders and non-responders. We dichotomised the perfusion parameters as high (>median value) and low (≤median value) to analyze association between perfusion parameters and treatment outcome. We calculated the sensitivity, specificity, predictive values, and likelihood ratios for each dichotomized perfusion parameter using Wilson Score method. RESULTS: We followed 24 patients (23 of them men) from start of the treatment till completion of it. All had Stage III or Stage IV of the disease. Blood flow (BF) and blood volume (BV) decreased and Mean Transit Time (MTT) increased significantly (p < 0.05) at 66 Gy among responders to CRT as compared to non-responders. Patients with high BF (>106 ml/100 g/min) at baseline were five times more likely (p = 0.004) to respond to treatment as compared to those with low BF. BF was found to be 83.3% predictive of complete response. Other perfusion parameters were not significantly predictive of outcome (p > 0.05) Combination of high BF (>106 ml/100 g/min) and low (≤47 ml/100 g/min) permeability surface (PS) was 100% predictive of response to CRT irrespective of the stage of tumor. CONCLUSIONS: High BF at baseline is the single best predictor of response to chemoradiaton. A combination of high BF and low PS was found to be 100% predictive of complete response irrespective of the stage of the tumor.

Primary schwannoma of maxillary sinus masquerading as malignant tumour.

Polyp and mucocele are the commonest sinonasal tumours and schwannoma is rarely found in the paranasal sinuses. We report a case of a 64-year-old man presenting with progressive nasal obstruction and numbness on left cheek for the past 2 months. High-resolution CT found a soft tissue mass in the maxillary antrum with bony destruction. Clinical features, radiological scan and nasal endoscopic examination were suggestive of a malignant tumour. Tumour was excised through Caldwell-Luc's approach and histopathological examination found a mixed schwannoma.

Alternating extra medullary plasmacytoma of maxilla.

Plasmatytomas of maxilla are rare lesions. Alternating plasmacytoma of maxilla is still rare. A case of maxillary extra medullary plasmacytoma is reported in a patient, who presented with same lesion in the opposite maxillary sinus within one year of initial presentation. On review of available literature we could not find bilateral medullary plasmacytoma involving both maxilla one after another.

An autogenous foreign body in tracheobronchial tree.

Foreign body in the trachea is not uncommon but foreign body of autogeneous origin is rare with stray dog bite.

Study of auditory brainstem responses in presbyacusis.

The results of auditory brainstem evoked responses in 25 subjects of presbyacusis are compared with 25 age and sex matched controls. Absolute latent periods of wave I through V were significantly prolonged in presbyacusis group. Delayed wave I and no significant change in interwave interval latencies of I-V, III-V and mild shortening of interwave interval of I-III in presbyacusis is observed.