Rare Causes of Unilateral Vocal Fold Paralysis: Report of 3 Cases with Review of Literature.

Unilateral vocal fold paralysis is a common finding with a variety of underlying causes. The six main etiologic groups include neoplastic, traumatic (iatrogenic, accidental) neurological, inflammatory, congenital, and idiopathic. Various unusual causes have been described including foreign body ingestion, mediastinal lymph nodes, large pleural blebs, tracheal diverticulum, etc. It is therefore essential, that a thorough evaluation and methodical approach be undertaken to ascertain the etiology, before labelling it as idiopathic and offering any treatment. This review article focuses on the uncommon and rare causes of unilateral vocal fold paralysis that are presented through 3 representative case reports; a cardio-vocal (Ortner's) syndrome, Zenker's diverticulum and diffuse idiopathic skeletal hyperostosis. These examples are discussed with radiological findings in the context of current literature.

Papillary Carcinoma of Thyroglossal Cyst with Thyroid Hemiagenesis: Is Conservative Surgical Management Enough?

We describe a case of papillary carcinoma in a thyroglossal cyst with left hemiagenesis of the thyroid gland in a 24-year-old female patient. We opted not to perform a total thyroidectomy as the patient was at low risk for aggressive disease. In this article we review the criteria for selection of thyroidectomy in incidentally discovered papillary carcinomas after thyroglossal cyst excision and management protocol in case of coexisting thyroid hemi-agenesis. To our knowledge, this case represents the second case report of an association between left thyroid hemiagenesis and thyroglossal duct cyst papillary carcinoma.

Diverse clinical presentations of tubercular parotitis in children: case series with review of literature.

Tuberculosis of the parotid gland is a rare entity in children. Manifestations can vary from acute parotitis to indolent benign parotid lesions, abscesses and fistulas in the parotid region. Diagnosis is challenging in the absence of constitutional symptoms and essentially non-contributory test reports. We discuss a series of six cases of parotid tuberculosis in children with different clinical presentations and management and review the literature on the subject.

DLBCL of bilateral submandibular glands and MALToma of thyroid-A rare coexistence.

Involvement of the bilateral submandibular glands and thyroid by the same lymphoma simultaneously has been reported in the literature. However, two different types of lymphomas presenting simultaneously at different sites have never been reported. This case report highlights this rare occurrence. A 65-year-old female, a known case of Hashimoto's thyroiditis with raised anti-TPO antibodies, presented with thyroid swelling for 1 year and bilateral submandibular swelling for 3 years. FNAC and flow cytometry showed features of mucosa-associated lymphoid tissue lymphoma in the thyroid gland, whereas the bilateral submandibular glands showed features of diffuse large B cell lymphoma. Histopathology and immunohistochemistry from the submandibular swelling led to similar diagnoses as the flow cytometry.

Medullary carcinoma of thyroid mimicking Hurthle cell neoplasm on cytology: a diagnostic dilemma.

Medullary carcinoma of thyroid (MCT) is a neuroendocrine neoplasm derived from the parafollicular cells or C cells. It constitutes 5% of thyroid carcinomas. We present a case of 36-year-old female with a left lower lobe thyroid swelling since 8 to 9 years. Swelling was smooth, nontender, and moving with deglutition. Contrast-enhanced computed tomography (CECT) findings were suggestive of malignant thyroid nodule. Fine-needle aspiration cytology (FNAC) smears were highly cellular comprising predominantly Hurthle cells arranged in sheets, clusters, and follicles with few singly scattered cells. Background was hemorrhagic with scant colloids. An impression of follicular neoplasm or suspicious of follicular neoplasm was given with an additional note mentioning that the possibility of Hurthle cell neoplasm could not be excluded. Left hemithyroidectomy was done and sections showed a well-circumscribed tumor suggestive of MCT, which was confirmed based on immunohistochemistry for calcitonin and carcinoembryonic antigen. It is difficult to differentiate MCT from Hurthle cell neoplasm. There may be cellular pleomorphism within a single aspirate, but the presence of mixed cell population is a diagnostic pointer for MCT. In the presence of predominant Hurthle cell population, distinguishing these entities by cytomorphology alone is difficult. Hence, clinical findings and histopathology with immunohistochemistry are mandatory in such cases to reach to a correct diagnosis to ensure proper management.

Encapsulated Follicular Variant of Papillary Thyroid Carcinoma Arising in a Follicular Adenoma: a Diagnostic Dilemma.

Papillary thyroid carcinoma (PTC) arising within follicular adenoma is a rare histological subset of papillary carcinoma. A 24-year-old female (euthyroid and asymptomatic) presented with a solitary mass in the right lobe of thyroid for 2 years. Fine-needle aspiration cytology (FNAC) suggested features of hyperplasia of thyroid. Hemithyroidectomy was performed. Histopathological examination revealed two distinct areas and was reported as encapsulated variant of papillary carcinoma along with follicular adenoma. Papillary carcinoma was confirmed by positive immunohistochemistry for HBME-1. CT head and neck region ruled out metastasis and the patient was kept on follow-up. There have been reports of medullary and papillary carcinomas occurring together; however, there is a paucity of literature on co-existing follicular neoplasm and papillary carcinoma. We hereby report a rare case of follicular variant of papillary carcinoma arising within follicular adenoma of the thyroid.

Teeth in Rare Locations with Rare Complications: An Overview.

Ectopic presence of teeth within the dentate region is common in clinical practice. However, the presence of teeth in non-dentate areas such as the nasal cavity or the maxillary sinus is rare. These may remain asymptomatic for years, may be misdiagnosed as foreign bodies, or may present with some serious complications involving the nose and paranasal sinuses. Complications such as nasal obstruction, epistaxis, headaches, rhinolith formation, epiphora, sinusitis and oro-antral fistula have been well described in literature, however, very few cases of antro-cutaneous fistulas have been reported. We discuss three cases of ectopic eruptions of teeth, all occurring in children. The clinical and radiographic findings of the cases, possible etiology, complication, diagnosis and treatment are discussed.

Unusual presentations of intracranial meningiomas: Report of two cases and review of the literature.

Meningiomas at extracranial sites are uncommon clinical presentations. They may present in the form of benign, slow.growing masses or may exhibit aggressive malignant behavior. We report two cases of intracranial meningiomas presenting at extracranial sites that are, at the sinonasal tract/external auditory canal and as a neck mass. The clinical presentations, histopathological features and appropriate management are discussed.

Esthesioneuroblastoma: Good Local Control of Disease by Endoscopic and Endoscope Assisted Approach. Is it Possible?

To present a short report on nine patients of esthesioneuroblastoma, managed endoscopically or endoscope assisted. To describe the technique and discuss the results at an average of 36.7 months of follow up. A retrospective study in a tertiary care centre. The present communication describes a series of 9 cases harbouring esthesioneuroblastoma, 6 managed endoscopically and 3 endoscope assisted between January 2005 and December 2009. All the nine patients remained free of disease at the primary site by endoscopic and radiological evaluation on an average of 36.7 months of follow up. One of the patients developed cutaneous and systemic metastasis for which she received chemotherapy and another one died during post-operative period due to unrelated causes. None of the patients showed recurrence or residual disease locally. Endoscopic and endoscope assisted approach provides a cosmetically better and surgically comparable outcome for local control of disease in early stages of esthesioneuroblastoma in expert hands without significant complications.

Schwannoma of the nasal septum: an unusual finding.

Schwannomas of the nasal cavity are rare benign tumors, and those that arise from the nasal septum are even rarer. When they do occur, they usually become symptomatic early because of the close confines of the nasal cavity. We describe a case of nasal septal schwannoma that was noteworthy in that the patient-a 28-year-old woman-waited 8 months after the onset of symptoms to seek medical care. Her symptoms included complete right-sided nasal obstruction, occasional epistaxis, and hemifacial pain. The tumor was completely removed via an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.

Functioning thyroglossal cyst and concurrent ectopic thyroid in the floor of the mouth without an orthotopic thyroid gland.

We report the case of a 20-year-old man with a constellation of anomalies - a functional thyroglossal cyst and concurrent ectopic thyroid in the floor of the mouth, without an orthotopic thyroid gland. To our knowledge, this is the third such report in the otolaryngology literature. It is important to be aware of the possibility of concurrent ectopic thyroid and thyroglossal cyst in the absence of an orthotopic thyroid gland. The majority of reported cases of thyroid ectopy occur at the base of the tongue. The occurrence of an ectopic thyroid in the floor of the mouth is both unusual and not amenable to clinical examination. Even if there is good uptake on nuclear imaging, the ectopic thyroid may be hypofunctioning. We discuss the importance of thyroid imaging, as well as the need for preoperative imaging and an appropriate management strategy in the treatment of patients with this triad of anomalies.

Dynamic Morphological Changes Induced By GM1 and Protein Interactions on the Surface of Cell-Sized Liposomes.

It is important to understand the physicochemical mechanisms that are responsible for the morphological changes in the cell membrane in the presence of various stimuli such as osmotic pressure. Lipid rafts are believed to play a crucial role in various cellular processes. It is well established that Ctb (Cholera toxin B subunit) recognizes and binds to GM1 (monosialotetrahexosylganglioside) on the cell surface with high specificity and affinity. Taking advantage of Ctb-GM1 interaction, we examined how Ctb and GM1 molecules affect the dynamic movement of liposomes. GM1 a natural ligand for cholera toxin, was incorporated into liposome and the interaction between fluorescent Ctb and the liposome was analyzed. The interaction plays an important role in determining the various surface interaction phenomena. Incorporation of GM1 into membrane leads to an increase of the line tension leading to either rupture of liposome membrane or change in the morphology of the membrane. This change in morphology was found to be GM1 concentration specific. The interaction between Ctb-GM1 leads to fast and easy rupture or to morphological changes of the liposome. The interactions of Ctb and the glycosyl chain are believed to affect the surface and the curvature of the membrane. Thus, the results are highly beneficial in the study of signal transduction processes.

The role of current audiological tests in the early diagnosis of hearing impairment in infant.

This study aims to compare the various audiological tests that are currently available as screening tools for infant hearing assessment. In developing countries, which have limited resources, it is imperative to design a screening programme that is easy to perform, gives accurate results, has good patient acceptability and is cost effective. Fifty infants, 3-12 months of age, were subjected to BOT for hearing, transient-evoked oto-acoustic emissions (TEOAEs), automated auditory brainstem response (AABR) test, auditory brainstem evoked response (ABR) testing and auditory steady state response (ASSR). The sensitivity and specificity of the various tests was calculated, with ABR test as the gold standard. We also compared them for average time taken, cost factors, ease of performance, number of repeat tests required and patient acceptability. All the screening tests, TEOAE, AABR and behavioral observation test had reasonably high sensitivity. Specificity was highest for behavioral observation testing (67.7 %) and AABR (64.5 %), but low for OAE test (48.3 %). The cost and time taken for each test was least for the behavioral observation test, which also did not require any repeat testing. TEOAE and AABR incur a recurring cost of approximately one dollar per test. However, in 12 and 28 % of the babies had to be called back for repeat testing, respectively. ASSR, as a diagnostic test, has a 100 % sensitivity and high specificity but scores down on the cost involved, time taken and the number of repeat tests required. Overall parent acceptability was the highest for behavioral observation test, as it was non-invasive and easy to perform. Behavioral observation combined with TEOAE/AABR, can be fairly accurate as screening tests for hearing loss in infants. Considering its ease of performance and low cost, behavioral observation could be used as a screening test for detection of hearing loss in infants, in those countries/places where universal neonatal hearing screening is not yet available.

Metallic stents for proximal tracheal stenosis: is it worth the risk?

Objective. To demonstrate the risk associated with blocked proximal tracheal stents when a patient presents with acute respiratory distress, with blockage of stent and what is the best management we can offer without damage to the stent and its associated complications. Case Report. A 22-yr-old, male patient, presented in severe respiratory distress. He had history of corrosive poisoning for which he was tracheotomised. A stainless steel wire mesh stent was placed in the trachea, from the subglottis, to just above the carina. One month later, he presented with a critically compromised airway with severe respiratory distress. Emergency tracheostomy was done and the metallic stent had to be cut open, in order to provide an airway. Conclusion. Management of blocked proximal stents with patient in respiratory distress remains a challenge. Formation of granulation tissue is common and fibreoptic bronchoscopic assisted intubation may not always be possible. A regular follow up of all patients with stents is essential. Placement of stents within a few centimetres of cricotracheal junction should not be encouraged for long term indications.

Oral and oropharyngeal squamous cell carcinoma in our population: the clinic-pathological and morphological description of 153 cases / Carcinoma de células escamosas oral y orofaríngeo en nuestra población: descripción clínico-patológica y morfológica de 153 casos

Oral cavity and oropharynx are one of the commonest sites for cancers in our population due to a high prevalence of tobacco use, especially chewing, in our country. The objective of this study was to prospectively assess the clinico-pathological and morphological aspects of the patients presenting to us with these malignancies. We studied 153 patients with oral and oropharyngeal squamous cell carcinoma who were managed in the department of otolaryngology and head and neck surgery between January 2006 and December 2007 at Maulana Azad Medical College and associated hospitals in New Delhi. There were 127 male patients (83 percent) and 26 females (17 percent) with ages ranging from 22 years to 70 years. One hundred and eleven patients (73 percent) presented with oral cavity and 42 patients (27 percent) with oropharyngeal carcinomas. Most common site of presentation in the oral cavity was the buccal mucosa, whereas, base of tongue was the commonest site in the oropharynx. Amongst the oral cavity cancers, 51 each (46 percent each) were well differentiated and moderately differentiated, whereas, 9 (8 percent) were poorly differentiated cancers. However, amongst the oropharyngeal cancers, 27 (64 percent) were moderately differentiated and 15 (36 percent) were poorly differentiated. Overall, 73 patients presented with lymphadenopathy on presentation, out of which, 44 patients were those with oral cavity and 29 with oropharyngeal cancers. There was a significant correlation between the site (i.e. oral cavity or orophaynx) and lymphadenopathy on presentation. Fifty nine patients (39 percent) presented to us with early stage disease (i.e. stage I and II), whereas, 94 patients (61 percent) presented with late stage disease (i.e. stage III and IV). There was a significant correlation between the site (i.e. oral cavity or oropharynx) and stage at presentation.

En nuestro país, la cavidad oral y orofaringe son los sitios más comunmente afectados por cáncer, debido a la alta prevalencia del consumo de tabaco, especialmente, el tabaco de mascar. El objetivo de este estudio fue evaluar prospectivamente los aspectos clínico-patológicos y morfológicos de los pacientes que acuden con estas malignidades. Se estudiaron 153 pacientes con carcinoma de células escamosas de la cavidad oral y orofaringe que fueron tratados en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello entre enero del 2006 y diciembre del 2007 en Maulana Azad Medical College y hospitales asociados en Nueva Delhi. Se evaluaron pacientes de ambos sexos, 127 hombres (83 por ciento) y 26 mujeres (17 por ciento) con edades entre 22 a 70 años. Ciento once pacientes (73 por ciento) presentaron carcinoma de la cavidad oral y 42 (27 por ciento) carcinomas de la orofaringe. El sitio más común de presentación en la cavidad oral fue la mucosa bucal, mientras que la base de la lengua fue el sitio más común de la orofaringe. Entre los cánceres de la cavidad oral, 51 (46 por ciento cada uno) estaban bien diferenciados y moderadamente diferenciados, mientras que 9 (8 por ciento) fueron escazamente diferenciado. Sin embargo, entre los cánceres de la orofaringe, 27 (64 por ciento) fueron moderadamente diferenciados y 15 (36 por ciento) fueron pobremente diferenciados. En total, 73 pacientes se presentaron con adenopatías, de los cuales, 44 pacientes fueron en la cavidad oral y 29 en la orofaringe. Se observó una correlación significativa entre el sitio (es decir, la cavidad oral u orofaringe) y la presentación de adenopatías. Cincuenta y nueve pacientes (39 por ciento) se presentaron con enfermedad en estadio temprano (estadios I y II), mientras que 94 pacientes (61 por ciento) se presentaron con enfermedad en estadio tardío (etapas III y IV). Se observó una correlación significativa entre el sitio (cavidad oral u orofaringe) y la etapa en la presentación.

Treatment delay in oral and oropharyngeal cancer in our population: the role of socio-economic factors and health-seeking behaviour.

The objective is to assess the role of socio-economic factors and health-seeking behavior in treatment delay in oral and oropharyngeal cancer in our population. This article adapts-design: prospective study and setting: tertiary care centre. We studied 153 patients with oral and oropharyngeal squamous cell carcinoma who were managed in the department of otolaryngology and head and neck surgery between January 2006 and December 2007. There were 127 male patients (83%) and 26 females (17%) with ages ranging from 22 years to 70 years. Fifty-nine patients (39%) presented to us with early stage disease (i.e. stage I and II), whereas, 94 patients (61%) presented with late stage disease (i.e. stage III and IV). Of the 59 patients presenting with early stage disease, 20 were illiterate and 39 literate with 28 patients (47%) belonging to low socio-economic status and 32 patients (54%) having an access to primary health centre (PHC). Of the 94 patients presenting with late stage disease, 53 were illiterate and 41 literate with 58 patients (62%) belonging to low socio-economic status and 38 patients (40%) having an access to primary health centre. Literacy, socio-economic status, access to primary health centre and health-seeking behavior of our population has a significant association with the stage of presentation of patients with oral and oropharyngeal cancer.