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A woman in her 70s reported to the outpatient department of our tertiary care hospital with chief complaints of painless swelling in the right cheek and palatal area. The patient was a known case of diabetes mellitus and hypertension on medications with controlled sugars and blood pressure. The swelling was 10×8 cm in size extending from right infraorbital region up to the lower mandible. CT demonstrated a permeative lytic pattern of bone destruction noted involving the hard palate and maxillary bone.Using the Weber Ferguson approach, a surgical resection was carried out under general anaesthesia. Resection included from right total maxillectomy (excluding roof of maxilla), nasal septum up to left medial maxillectomy including hard palate and the tumour was resected en bloc. The palatal obturator was fixed. On the basis of histopathology, grade 1 well-differentiated chondrosarcoma was diagnosed. The patient received postoperative radiotherapy and had a good recovery.
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Condrossarcoma , Maxila , Feminino , Humanos , Maxila/cirurgia , Septo Nasal/cirurgia , Palato Duro , Bochecha , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/cirurgiaRESUMO
Apart from complete surgical clearance of the malignancy, reducing morbidity and improving quality of life of the patient is also considered. One of the morbidities linked with neck dissections is shoulder dysfunction. The aim of our study is to analyse the functional outcomes in patients operated for various neck dissections with preservation of the Spinal accessory nerve. A single centre prospective observational study was conducted in a total of 45 patients with oral cancers. These patients underwent Wide local excision of the primary tumour along with neck dissection. Tests for assessing spinal accessory nerve function was elicited in all these patients preoperatively and postoperatively. Patients were examined for shoulder pain and shoulder disability using Arm abduction test. All 45 patients underwent spinal accessory nerve preserving neck dissection. On post operative day 10, 89% of patients showed arm abduction test score of 1 and 47% of patients had a pain score of 6 whereas 13% had a pain score of 8. After 6 months of rehabilitation and regular follow up, 62% of the patients had improved arm abduction test score of 4 and above and all 45 patients had pain score improved to score of 4 and less. Variable amount of shoulder dysfunction is seen even in spinal accessory nerve preserving neck dissections. But active rehabilitation and regular follow up of these patients reduces the morbidity associated with shoulder syndrome.
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Teachers are the backbone of any civilized society as they are the keepers of knowledge, wisdom and values. Lack of infrastructure, manpower and resources makes voice the most important tool for a teacher. Teachers need to speak loudly for long periods often under unfavourable circumstances. Increased vocal effort and incorrect phonation techniques can lead to vocal fold tissue damage and vocal fold pathologies and hence voice problems producing adverse effects on teaching performance. To study the prevalence of voice disorders in Indian female secondary school teacher population. To identify the risk factors for the development of voice disorders. A multicentric, cross-sectional observational study of 200 teachers were conducted in 4 schools over a period of 2 years. Female teachers who gave consent and were willing for follow up were included in the study. Details were collected using a structured questionnaire. Subjective analysis by VHI, perceptual analysis by GRABS score, acoustic analysis and direct visualization using Hopkins 70° rigid laryngoscope were done.The prevalence of voice disorders was 18.5%. Risk factors identified were age group 41-60 years, repeated respiratory allergies, comorbidities, constitutional symptoms, increased number of years of teaching and number of lecture hours per week. VHI, GRABS, Acoustic analysis findings were consistent with Rigid Laryngoscopic finding making them effective tools in the assessment of voice.
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The novel coronavirus disease 2019 is an ongoing pandemic and a global health emergency. Since the main portal of entry for the virus is the nose, olfactory and taste dysfunction have gained attention as important symptoms in COVID-19. The primary objectives are to assess the prevalence of olfactory and taste dysfunction in patients affected with COVID-19. And to determine whether anosmia and ageusia are early predictors of COVID-19. A prospective study was conducted on 300 patients who were laboratory diagnosed cases of COVID-19 admitted in tertiary care centre and a covid care centre. A written informed consent was taken. All patients underwent olfactory and taste examination and the details were noted in a case-record proforma. The prevalence of olfactory dysfunction in COVID-19 patients was 21% and that of taste dysfunction was 26.6%. Majority of the affected individuals were males and mainly of the younger age group. These symptoms lasted for a duration of 7-9 days and 97% of the patients showed complete recovery. Acute sudden onset olfactory and taste dysfunction seems to be a useful indicator for early diagnosis of patients thus helping in early isolation, timely management of the illness and controlling the spread of the disease.
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The giant cell tumour is a benign but locally aggressive tumour accounting for 5% of all bone tumours typically seen at the metaphyseo-epiphyseal ends of long bones with 1% incidence in skull bones. We are presenting a case report of 40 year old female with GCT of hard palate. An initial pre-operative plan was hard palate removal with complete tumour clearance trans-orally with iatrogenic oro-nasal fistula with rehabilitation to be done with obturator for closure of fistula and dentures to aid chewing. However, intra-operatively the surgical plan was revised and the tumour was removed with preservation of party wall mucosa. Thus, we present this case due to its clinical rarity and academic interest.
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PURPOSE: To report a series of 13 immunocompetent patients who developed new-onset uncontrolled diabetes mellitus (DM) following COVID-19 infection and presented as rhino-orbital mucormycosis (ROM). METHOD: Retrospective study. RESULTS: A total of 127 patients of COVID-19 Associated Mucormycosis (CAM) were evaluated at four centres in India. All patients underwent endoscopic sinus debridement surgery and received systemic amphotericin-B therapy. Five patients (5/13; 38.4%) received retrobulbar amphotericin-B injections. Orbital exenteration was performed in advanced orbital involvement or progression of orbital disease in spite of maximal medical therapy. In his cohort, 13/127 (10.2%) patients presented with new onset DM, where one patient had bilateral disease. The mean age was 35.9 years (range: 20-51 years) and the mean duration from diagnosis of COVID-19 to the diagnosis of mucormycosis was 14.2 days. While 7/13 (53.8%) of the patients received systemic corticosteroids during the course of their treatment for COVID-19, six patients received no steroids or immunomodulators. The mean follow-up period was 9.2 weeks (range: 3-18 weeks) following discharge. Life salvage was possible in 100% of the cases. While overall globe salvage was possible in 42.8% (6/14 eyes), the globe could be preserved in 4/5 patients who received retrobulbar amphotericin-B injections. CONCLUSIONS: Those involved in the care of COVID-19 patients should be aware about the possibility of recent-onset DM, even in patients without a history of corticosteroid therapy. Rarely, recent-onset DM following COVID-19 may present as rhino-orbital mucormycosis, which requires aggressive surgical and medical intervention.
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COVID-19 , Infecções Oculares Fúngicas , Mucormicose , Doenças Orbitárias , Adulto , Antifúngicos/uso terapêutico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/etiologia , Estudos Retrospectivos , SARS-CoV-2RESUMO
PURPOSE: To report clinical presentations and factors affecting outcomes in rhino-orbital-cerebral mucormycosis following COVID-19. METHODS: Retrospective multi-centric interventional case series of 58 eyes with rhino-orbital-cerebral mucormycosis. Demography, clinical parameters and management outcomes were noted. Factors affecting outcome and mortality were analyzed. Outcome was defined as favorable when complete resolution or stabilization without further progression of the infection was noted at last visit. RESULTS: Mean age was 55 ± 11 years (median 56). The mean HbA1c value was 10.44 ± 2.84 mg% (median 10.5). The duration between the diagnosis of COVID-19 and rhino-orbital-cerebral mucormycosis was 16 ± 21 days (median: 8 days). Thirty-six eyes (62%) had no vision at presentation. Imaging revealed paranasal sinus involvement (100%), orbital apex involvement (41%), cavernous sinus involvement (30%), and central nervous system (CNS) involvement (33%). All the patients were treated with systemic Liposomal amphotericin-B and sinus debridement. Twenty-two eyes (38%) underwent exenteration. One eye underwent transcutaneous retrobulbar amphotericin-B. The mean follow-up duration was 5.62 ± 0.78 months (median 6). Favorable outcome was seen in 35 (60%) cases. Presence of uncontrolled diabetes (p = 0.001), orbital apex involvement (p = 0.04), CNS involvement (p = 0.04), and history of steroid use (p < 0.0001) resulted in unfavorable outcome. CNS involvement was the only factor predicting mortality (p = 0.03). Mortality was seen in 20 (34%) patients. CONCLUSION: Over a third of patients with rhino-orbital-cerebral mucormycosis following COVID-19 have an unfavorable clinical outcome. Uncontrolled diabetes mellitus at presentation, involvement of the orbital apex, CNS, and the usage of steroids were associated with poorer outcomes. CNS involvement was a factor determining mortality.
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COVID-19 , Infecções Oculares Fúngicas , Mucormicose , Doenças Orbitárias , Adulto , Idoso , Antifúngicos/uso terapêutico , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Mucormicose/terapia , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/terapia , Estudos Retrospectivos , SARS-CoV-2RESUMO
INTRODUCTION: A long-standing retained foreign body in the bronchus is unusual. In majority of cases, an adequate history is not obtained, the clinical picture is usually clouded by superadded pathological changes. CASE SERIES: We report three cases of long-standing foreign body in the airway who presented with recurrent lower respiratory tract infection. Examination of respiratory system revealed no significant abnormality. Chest radiograph was normal. CT scan of the chest was useful to indicate endobronchial opacity in the airway suggestive of a foreign body. The patients underwent rigid bronchoscopy under general anesthesia for successful removal of the foreign body. CONCLUSION: So the patients with non-resolving or recurrent lower respiratory symptoms in spite of medical treatment and without any obstructive findings must undergo diagnostic bronchoscopy evaluation and imaging.
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Corpos Estranhos , Infecções Respiratórias , Brônquios/diagnóstico por imagem , Broncoscopia , Corpos Estranhos/diagnóstico , Corpos Estranhos/diagnóstico por imagem , Humanos , Lactente , Infecções Respiratórias/diagnóstico , TraqueiaRESUMO
The possibility of a retained foreign body should always be considered when a patient presents with a history of orbital trauma, especially when the patient is unresponsive or temporarily responsive to treatment. Not all cases of retained foreign body present with decreased vision or restricted mobility or fever. The entry wound is also not apparent on examination in all cases. In summary, meticulous history-taking, thorough examination, high index of suspicion along with a low threshold for imaging studies are essential to make a timely diagnosis of a retained intraorbital foreign body. The prompt removal with the appropriate approach may not only save the eye but also the life of the patient.
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Endoscopia , Corpos Estranhos no Olho/etiologia , Corpos Estranhos no Olho/cirurgia , Traumatismos Faciais/complicações , Granuloma de Corpo Estranho/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Feminino , Humanos , Órbita/diagnóstico por imagem , Madeira , Adulto JovemRESUMO
Spontaneous onset pneumomediastinum, pneumothorax and subcutaneous emphysema are rare presentations of a foreign body in the airway. The possible mechanism for unexplainable and non traumatic subcutaneous emphysema can be attributed to "Air leak syndrome" following inhalation of foreign body in the airway.
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Respiratory epithelial adenomatoid hamartoma (REAH) is a rare lesion in nasal cavity first reported by Wenig and Heffner in 1995. Most commonly seen in men in third to ninth decade of life. Majority of cases presents as a polypoidal mass in one or both nasal cavities. We experienced such a case of REAH originating from the nasal septum, in posterior aspect, treated by endoscopic approach. It is important to differentiate REAH from other sinonasal pathologies like inverted papilloma and low grade sinonasal adenocarcinoma. Complete surgical resection is the treatment of choice.
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Adenoma/diagnóstico , Hamartoma/diagnóstico , Pólipos Nasais/diagnóstico , Neoplasias Epiteliais e Glandulares/diagnóstico , Neoplasias Nasais/diagnóstico , Adenoma/patologia , Diagnóstico Diferencial , Hamartoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/patologia , Pólipos Nasais/complicações , Neoplasias Epiteliais e Glandulares/etiologia , Neoplasias Nasais/etiologiaRESUMO
Mucormycosis is an uncommon, rapidly progressive, angio-invasive, commonly fatal, opportunistic fungal infection. The most critical decision in the management of rhinoorbital mucormycosis is whether the orbit should be exenterated. (1) To layout the indications of orbital exenteration in patients with rhino-orbito-cerebral mucormycosis. (2) To devise a scoring system that predicts the stage at which the exenteration needs to be carried out. A scoring system was devised by a team of experienced Otorhinolaryngologists and Ophthalmologists from prior experience in managing mucormycosis. All patients of mucormycosis visiting our hospital were admitted and included in the study. A total of 15 patients were included. The scoring system is based on 3 main criteria, namely: (1) clinical signs and symptoms. (2) Direct and Indirect Ophthalmoscopy. (3) Imaging. The Sion Hospital Scoring System is an accurate and promising measure to solve the dilemma that is associated with orbital exenteration in orbito-rhino-cerebral mucormycosis.
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Difficult laryngeal exposure during suspension microlaryngoscopic surgeries is a common situation encountered by the phonosurgeons nowadays. It leads to unnecessary trauma, incomplete surgery and even abortion of the procedure. Although various methods have been described to counter the situation, they might not be adequate in some cases with very anteriorly placed larynx. This study is intended to determine the utility of angled rigid endoscope along with malleable endoscopic instruments to improve surgical access in cases with inadequate glottic exposure during suspension microlaryngoscopy. In this cross sectional study conducted at Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai, 50 patients of voice disorders who underwent Suspension Microlaryngoscopy from July 2014 to December 2017 were included. Out of these patients, 5 patients (10%) presented with difficult laryngeal exposure that were operated using readily available angled rigid endoscope along with malleable endoscopic instruments, without requirement of any specially designed instruments. There was improvement in laryngeal exposure in all the cases following utilisation of angled endoscopes. The surgeries were carried out under video monitor guidance with complete excision of the vocal cord lesions. Our study concluded that the cases in which the laryngeal exposure cannot be improved even by various external procedures, can be enhanced by application of angled rigid endoscopes and the vocal cord lesions can be excised completely by using malleable endoscopic instruments.
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The aim of this study is to emphasise the importance of preserving the anterior facial skeleton in angiofibroma surgery and to introduce a new approach by which tumors with far lateral extensions can be operated upon successfully without disruption of the anterior facial skeleton. This is a prospective study conducted at a tertiary referral academic centre. Two patients with extensive juvenile nasopharyngeal angiofibroma with far lateral extensions were recruited and they underwent surgery between July and August 2016. Both patients were not embolised prior to surgery. Complete tumor removal was achieved in both cases without any evidence of recurrence of disease. The facial contour was well maintained. They are under regular follow-up at our centre, having completed their third 3 monthly follow-up. The main outcome measures are preservation of the anterior facial skeleton and complete tumor removal. The Four-Port Bradoo Technique allows for maximum access to the angiofibroma whilst maintaining the anterior facial skeleton, thus ensuring complete removal with minimal morbidity to the patient.
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To evaluate treatment response in patients with laryngopharyngeal reflux (LPR). A prospective study of 100 patients with voice disorders was conducted. Patients were evaluated using reflux symptom index (RSI) and reflux finding score (RFS) by 70° rigid laryngoscope. Patients with RFS score of 7 or more were diagnosed of having LPR and were started with anti-reflux therapy for a period of 6 months. Patients were assessed at regular intervals using RSI and RFS. The prevalence of LPR in patients with voice disorders was found to be 25%. The mean RSI score improved gradually and significantly over a period of 6 months from 11.84 at presentation to 2.04 after 6 months of treatment (p value <0.001). The mean value of RFS improved from 7.92 at entry to 1.52 after 6 months of treatment (p value <0.001). However, it was found that the improvement was not significant at end of first month of treatment, and improvement in RSI and RFS scores was found only after 2 months of treatment. RSI and RFS improve significantly after treatment for 6 months with PPI like Omeprazole. But the improvement starts from the 2nd month from the onset of treatment. Treatment of LPR for at least 6 months may be indicated to attain a full resolution of physical findings.
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BACKGROUND: Retrobulbar lesions of the orbit situated lateral to the optic nerve are difficult to access. In this article, the authors would like to present a new perspective to approach these lesions where the goals of surgery are met with minimal complications. METHODS: A retrospective analysis of patients' charts was performed. RESULTS: For approaching retrobulbar lesions an endoscopic technique was developed. Four patients (2 male and 2 female patients) presenting with retrobulbar lesions lateral to the optic nerve have been included in this study. Two patients underwent endoscopic drainage for orbital abscess and two patients were successfully biopsied endoscopically. No intra-operative complications were noted. Open procedures such as lateral orbitotomy were avoided in all the cases. CONCLUSION: Transcutaneous orbital endoscopy is a safe and a versatile technique to approach retrobulbar lesions lateral to the optic nerve. It can be used as an effective alternative to lateral orbitotomy for well selected cases. One can obtain adequate material for histopathological examination and also drain deep-seated orbital abscess using this technique. It would be possible with increasing experience to use this technique for extended applications.
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Endoscopia/métodos , Doenças Orbitárias/cirurgia , Adolescente , Adulto , Biópsia , Diagnóstico por Imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/diagnóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Middle ear ossicular reconstruction is a challenging task for any otologist. Over a period of time, surgeons have tried various types of materials as ossicular prosthesis with varying amount of success. In the last decade, numerous studies have been conducted that have proved that titanium prosthesis is biocompatible. We have conducted this study to investigate the efficiency of titanium middle ear prosthesis (Eon Meditech Pvt. Ltd.) in tympanoplasty. Nineteen patients who underwent tympanoplasty with titanium prosthesis placement from January to October 2010 were included in the study. Fifteen patients underwent reconstruction using titanium PORP while four patients required titanium TORP. The average follow up period was 11.1 months. The pre-operative and post-operative PTAs and the closure of the air-bone gap (ABG) at 0.5, 1, 2, 3 KHz (as per the AAO-HNS guidelines) were analyzed. As per the Indian speech and hearing association (ISHA) guidelines, the patients were classified into groups based on the amount of hearing loss. The improvement in the mean PTA (AC) was 16.21 dB in the PORP group while it was 20.47 dB in the TORP group (P value < 0.05). According to ISHA guidelines, 18 out of 19 (94.8%) patients had either a normal hearing or a mild hearing loss post-operatively. The overall success rate (post-operative ABG ≤ 20 dB) of this series is 68.4%. In this series, there has been no extrusion of the prosthesis. Titanium prosthesis is delicate, easy and quick to handle. They are efficient and suitable implants for middle ear ossicular reconstruction. The use of cartilage between the prosthesis and the graft helps to prevent extrusion of the prosthesis.
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A 26 years old female presented with fever, nasal stuffiness with blood stained purulent discharge, nasal twang in voice along with non-healing palatal ulcers since three months. Examination revealed a paramidline perforation in the hard palate causing oronasal fistula formation. Histopathology and immunohistochemistry suggested a diagnosis of extranodal Natural Killer (NK)/T cell lymphoma. Multi-agent chemotherapy was instituted. We report this extremely rare case of Non-Hodgkin's Lymphoma (NHL) of the extranodal NK/T cell variety presenting as palatal perforation.
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Fístula/etiologia , Linfoma de Células T/complicações , Neoplasias Bucais/complicações , Doenças Nasais/etiologia , Neoplasias Nasais/complicações , Fístula Bucal/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Células Matadoras Naturais , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/patologia , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/patologia , Neoplasias Nasais/tratamento farmacológico , Neoplasias Nasais/patologia , Úlceras Orais/patologia , Palato Duro/patologia , Resultado do TratamentoRESUMO
UNLABELLED: The anterior ethmoidal artery is an important landmark in functional endoscopic sinus surgery. AIMS: We undertook this study to determine the reliability of identification of the artery on the coronal CT scan and to determine whether a correlation exists between the pneumatisation of the suprabullar recess and the vertical distance of the artery from the base skull. MATERIALS AND METHODS: 50 randomly selected CT scans were studied. The anterior ethmoidal artery was identified on each side and the vertical distance between the artery and the base skull was measured. The orbital beak and the superior oblique muscle were used as landmarks to identify the artery. The CT scans were divided into two groups based on whether the supraorbital cell was present or absent. These groups were each further subdivided into 3 groups depending on the vertical distance between the anterior ethmoidal artery and the base skull. RESULTS: The anterior ethmoidal artery was reliably identified in 97% of the cases. When the supraorbital cell was absent, the mean distance between the artery and the base skull was 1.5 mm; while when the cell was present, the mean distance was 4.86 mm. When these groups were evaluated for statistical significance, the p value was 0.000 (highly significant). CONCLUSION: The orbital beak and superior oblique muscle are reliable landmarks to identify the anterior ethmoidal artery. There exists a strong correlation between the vertical distance of the artery from the base skull and the presence of the supraorbital ethmoid cell.
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This communication presents a case report of a parameningeal rhabdomyosarcoma in a young male leading to vision loss which was effectively salvaged using prompt intervention in the form of surgery and high dose systemic steroids. Early debulking was the key in the prevention of complete blindness in our patient.