Primary Mucinous Eccrine Carcinoma in Nasomaxillary Region: a Rare Case Report and Management Insights.

Primary Mucinous eccrine carcinoma (MEC) is a rare malignant neoplasm of skin believed to arise from eccrine sweat gland commonly with periocular involvement. Here we report a case of 60-year male with a recurrence of unilateral nasomaxillary mass and epiphora. Imaging suggested nasolacrimal duct as probable site of origin. Histopathology and immunochemistry confirmed the diagnosis and managed surgically. This case report emphasizes the significance of including primary MEC in the differential diagnosis of nasomaxillary mass for its recurrence nature and histological similarity with metastasis from other viscera.

A Prospective Study of Management of Neck Trauma and its Complications : An Institutional Approach.

Background: Assessment and immediate surgical management of laryngotracheal injuries is essential to minimize the risk of perioperative and long term complications [1]. The present study was conducted at tertiary care centre to assess the proportions of complications following neck injuries. Methodology: The study was conducted as a prospective study on 19 patients presenting with laryngotracheal injuries at Emergency department in NSCB Medical College, Jabalpur, India during the study period of 2 years. History was obtained in detail and depending upon the extent and nature of injury, patients were managed. Patients were followed up till discharge for assessment of any postoperative complications. Results: A total of 19 cases with neck trauma were enrolled during our study period with mean age of 27.37±8.88 years. Tracheal breach was noted in 78.9% cases. The most common site of airway injury was tracheal wall (47.3%), followed by Laryngeal trauma with unilateral or bilateral thyroid cartilage (15.8%). Major vessels injury was noted in 26.3% cases and injury to minor blood vessels was observed in 68.4% cases. Wound exploration followed by wound repair was done in 36.8% of the cases whereas emergency tracheostomy along with wound repair was done in 31.6% of the cases. During surgery, brachial plexus injury and surgical site infection were the surgical complications in 1 case each. However, anemia psychiatric tendency and symptoms due to alcohol withdrawal were the complications in 1 case each. Among postoperative complications, persistence of psychiatric symptoms, recurrent laryngeal nerve palsy, withdrawal symptoms, and complications due to brachial plexus injury persisted. Conclusion: Neck injuries and laryngotracheal injuries are rare but life threatening injuries, timely management of which is essentially important to avoid the occurrence of complications. Management often requires multidisciplinary approach due to associated complications. The complications may be immediate or remote which can be prevented if patients are managed timely. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03533-7.

Comparative Study of Injection Triamcinolone and Hyaluronidase Combination with Injection Platelet Rich Plasma (PRP) in Management of Oral Submucous Fibrosis (OSMF).

This study aimed to compare the results of injection triamcinolone and hyaluronidase combination with injection Platelet Rich Plasma (PRP) in management of Oral Submucous Fibrosis (OSMF). Present study was carried out in randomly divided two groups of 30 patients each of OSMF who all are presented with chief complain of reduced mouth opening. Group A patients were given 1 ml of injection triamcinolone and hyaluronidase combination. Group B patients received 1 ml of injection Platelet Rich Plasma. Both injections were given intralesionally once a week for 6 weeks. Results of ANOVA shows significant better results in improving mouth opening in group B patients receiving injection Platelet Rich Plasma as a treatment. In Group A, patients shows improvement in Maximum interincisal distance (MIID) of mean 6.51 ± 1.02 mm as compared to the patients in group B shows improvement in MIID of mean 9.53 ± 1.06 mm (p value < 0.05). Treatment of OSMF with injection Platelet Rich Plasma is a novel method and found to be more efficient than treatment with injection triamcinolone and hyaluronidase combination.

Primitive Myxoid Mesenchymal Tumour of Nose.

Primitive Myxoid Mesenchymal Tumour of Infancy (P.M.M.T.I.) is a locally aggressive myofibroblastic tumour, occurring mostly in the first year of life. Grossly, it occurs as a non-encapsulated, multi-nodular tumour with focal infiltrative growth with a size ranging from 2 to 15 cm. It is composed of primitive spindled cells in a myxoid background. It is a low-grade fibroblastic malignancy with low metastatic potential with a high local recurrence rate. On immunohistochemistry, it stains positive for Vimentin. no reactivity for smooth muscle actin, muscle specific actin, desmin, S-100 protein, or myogenin. Electron microscopy documented a poorly differentiated fibroblastic proliferation. The present case is of a P.M.M.T. occurring in the nose of a 3 ½ years old female child. This is the first case reported from Central India. The child had recurrent nasal growth and the excision biopsy was suggestive of intermediate grade fibroblastic neoplasm. The biopsy, on IHC staining, was positive for Vimentin and CD99 and negative for S-100, CD-34 and Desmin, favouring the diagnosis of P.M.M.T. The child had a total of three recurrence of growth after local excision before diagnosis was established. In the prior two surgeries, the histopathological analysis reported it as a benign nasal polyp. After the third surgery, the specimen was sent for IHC. Immunohistochemical stains helped in differentiating it from congenital infantile fibrosarcomas, a similar type of mesodermal tumour. The present case of Primitive myxoid mesenchymal tumour following IHC stains were positive for Vimentin, CD-99, CD-117 and NESTIN, pointing to the primitive nature of the tumour. It was negative for the neural marker. Since it is chemo resistant, the preferred method of treatment is wide surgical excision.

Adverse Drug Reaction of Antifungals in the Management of Black Fungus: A Tertiary Care Centre Experience.

In India, COVID-19 has led to a surge in cases of a potentially fatal fungal infection called mucormycosis, popularly known as "black fungus." Intravenous amphotericin B is the only available drug for salvage therapy. Efforts to improve its therapeutic efficacy and decrease its nephrotoxicity have focussed on the reformulation of AmB in three new lipid formulations such amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). The aim of this study is (1) to evaluate the adverse drug reaction of various formulations of amphotericin B used for the treatment of rhinooculocerebralmucormycosis in Indian population. (2) to evaluate the adverse drug reaction of injectable form of posaconazole. This prospective observational study was done on a random sample of 110 patients who got admitted for the management of rhinooculocerebral mucormycosis in a tertiary care centre of middle india… The patients were assessed for the adverse reactions following the administration of various antifungal medication and the findings were analysed. All the 110 patients had received two forms of Amphotericin B (liposomal Amphotericin B and Amphotericin B lipid complex) and Posaconazole injection. 60 patients had received all three forms of Amphotericin B. Out of the 110 patients who received Liposomal amphotericin B, only 2 patients developed adverse drug reaction while in 110 patients who received Amphotericin B Lipid complex, 7 patients had adverse drug effects. Lyophilised amphotericin B had been administered to 60 patients in which 51 patients developed adverse drug reaction and in them one patient went to congestive cardiac failure. Injection posaconazole had been administered to 110 patients in which 72 patients developed drug reaction. In spite of its proven track record of Amphotericin B, its well-known side effects and toxicity will sometimes require discontinuation of therapy despite a life-threatening systemic fungal infection. Lipid formulations of AmB are better tolerated than AmB deoxycholate but infusional drug reactions have been reported in lipid formulation too. So improved strategies for the management of infusion related adverse events are required.

A Prospective Study to Evaluate the Role of Narrow Band Imaging and Toludine Blue in the Screening of Premalignant and Malignant Lesions of the Oral Cavity in a Tertiary Referral Centre.

In India cancer patients come at a very advanced stage with many of them being crossed the stage of resection. A wide range of non invasive techniques like toludine blue staining, methylene blue staining, Narrow band imaging have been developed for the early detection of malignant and premalignant lesions in the mucosa including oral cavity and gastrointestinal tract. However it is difficult for the clinicians to decide which diagnostic tool is most appropriate and useful for screening, resulting in failure to pick up the lesions at an early stage. Various online journals have been reviewed and no journal was found to support this point. This study here by describes Toludine blue and narrow-band imaging (NBI), diagnostic tools already proven independently as a useful screening method in many fields, and demonstrate its usefulness in the early detection of premalignant and malignant lesions of the oral cavity, as reported by previous studies in the otolaryngologic literature and compare both screening tools which has not been done till now. This study was done in a tertiary referral centre in middle India from March 2018 to August 2019 in order to evaluate the role of different screening tools (NBI and Toludine blue).44 patients with suspicious oral cavity lesions (premalignant and malignant) who had given consent for both NBI and toludine blue screening techniques were selected from the suspected (premalignant and malignant lesions) who had visited the OPD during the study period. Patients with proven malignancy were excluded from the study. A detailed history of the patient taken and standard Ear, nose, throat, oral cavity and neck examination of patient carried out. After subjecting the patients to screening tools like NBI and toludine blue, the efficacy of these techniques in helping us to take a representative biopsy was evaluated. In present study the sensitivity (to correctly identify all patients with disease), specificity (to correctly reject healthy patients without disease) of older technique toludine blue in detecting premalignant lesion was 66.6%, 87.8% while for NBI was 66.6%, 95%. For malignant lesion sensitivity and specificity of toludine blue was 94.3%, 100%, while the same for NBI was 100%, 88.8% respectively. Both NBI and toludine blue staining can be adopted for screening and the accurate detection of biopsy site and in the follow up of premalignant lesions to look for malignant transformation. Time tested is Toludine blue which is cheap and easily available. But being a better tool and having an upper hand in evaluating the lesions, NBI should be made available in all the secondary and tertiary care centres as a screening method.

The Clinical Response Time of Epley Maneuvers for Treatment of BPPV: A Hospital Based Study.

The Epley maneuver is one of the most effective canalith repositioning procedures for treatment of posterior canal benign paroxysmal positional vertigo. It was found that response to BPPV varies with various factors such as types, single versus multiple canals BPPV, single or repeated cycles of head maneuvers in each session and duration of follow up of patient. Furthermore, less uniform result exists after treatment of BPPV among studies. Hence, the present study was taken with aim to investigate "The clinical response time of Epley maneuvers in treatment of BPPV: A Hospital Based Study. A total of 132 patients were included in study with age ranging from 30 to 50 years These patient visited department of ENT from 2019 to 2020 with complaint of vertigo. The subjective balancing assessments along with Dix-Hallpike maneuver were done and dizziness handicap inventory were administrated for screening of BPPV. The patients, who were diagnosed as posterior canal BPPV, were treated with Canal repositioning procedure i.e. Epley's Maneuvers during the initial visit. In addition, the same maneuvers were repeated after 1 week of sequential sessions if the patient reported no benefit or partial benefit from first session until the patient became asymptomatic and Dix-Hallpike maneuver were negative. The total number of sessions of Epley maneuver required by each patient was recorded. The findings of present study suggested that 37.69% of cases with posterior canal BPPV were asymptomatic after first CRP session of Epleys maneuver whereas repeated sessions were required in 61.52% of cases of BPPV and 0.76% of cases showed no response to repeated CRP up to 6 months. BPPV involving posterior canals may be easily detected by position test with good response to Epley maneuver. Short-term and long term control of symptoms of unilateral posterior SCC through this easy and simple procedure can be achieved. This cost effective approach requires proper trained and committed professionals. The repeated session may be required as complete recovery may not be immediate. Sometimes partial response can be due to canal switching during BPPV Hence, it is necessary to counsel the patient regarding the importance of follow-up.

Role of Video Laryngostroboscopy in Benign Disease of Larynx.

Benign disease of larynx frequently present with voice disorder. Observing the larynx with high resolution stroboscope and its mucosal wave pattern with greater precision aids in the better understanding of normal/abnormal anatomy and function, which forms the basis of designing treatment strategies.Videolaryngostroboscopy now a days is considered routinely used method of vocal fold examination and evaluation of patients with voice disorders. This valuable imaging tool can also be used to assess the outcomes of therapy of laryngeal diseases or functional result of phonosurgical procedures. Present study, videostroboscopic assessment of 81 cases of different benign vocal cord pathologies was done. Stroboscopic parameters like glottic closure, amplitude, vocal fold edge, symmetry, periodicity and mucosal wave pattern were studied and statistically significant relationship with different vocal pathologies were obtained.

CBNAAT: A Boon for Early Diagnosis of Tuberculosis-Head and Neck.

Tuberculosis of head and neck has been an under diagnosed entity due to large number of smear negative cases, which results in missing out the positive cases, further increasing the burden of TB. The role of cartridge- based nucleic acid amplification test (CBNAAT) with a potential to diagnose TB and rifampicin resistance within 2 h is promising. The study highlights the extended implications of CBNAAT in infectious lesions of head and neck, where the pus or aspirate was subjected to this test, along with other investigations which have been routinely used for detection of extra pulmonary tuberculosis. Twelve patients with infective lesions of head and neck were included in this prospective study, conducted in Department of Otorhinolaryngology, Netaji Subhash Chandra Bose Medical College and hospital, Jabalpur from September 2016 to March 2017. They were investigated for pulmonary and extra pulmonary TB. CBNAAT, microscopy, FNAC and HPR from the site of lesion were done. Nine out of twelve patients were diagnosed positive for Tuberculosis. Microscopy (ZN staining) could detect only two such cases, whereas FNAC showed granulomatous lesion in 3 cases (33.3%). CBNAAT was positive in 77.7% of the total positive cases. Histopathological examination showed 100% results but was feasible only in selected number of cases (4 in this study). CBNAAT provides a promising role in early diagnosis of TB in head and neck. Its high sensitivity and less time taking procedure makes it an excellent tool for timely diagnosis of such cases.

Outcomes of Newborn Hearing Screening Program: A Hospital Based Study.

Hearing loss is hidden disability and second most common congenital pathology. Prevention, early identification and early intervention of hearing loss can prevent further disability in development of speech, language, cognition and other developmental domains. The prevalence of congenital hearing loss has been estimated to be 1.2-5.7 per thousand in neonates. In these contexts, the aim of study was to determine outcomes of neonates hearing screening program in Hospital. It is a clinical cross-sectional study which was conducted in tertiary care centre from 8th July, 2015 to 31th May, 2016. Total no of 2254 cases were screened. Details case history including high risk register, Pediatric Audiometry, Otoacoustic Emission tests were performed followed brainstem evoked response audiometry. The Prevalence of hearing loss among high risk babies confirmation by BERA was 8.8% per 1000 babies and 16 cases were recommended for Cochlear Implant. The screening protocol with objective test i.e. Distortion Product Otoacoustic Emission and confirmation by Brainstem Evoked Response Audiometry is very useful tool in early identification of congenital hearing loss in neonates. Hence, the results of this study will be used to initiate universal newborn hearing screening in other hospitals. Moreover, this study highlights the relevance of neonatal hearing screening in other states of India and country where this screening is not performed routinely in all hospitals and creating awareness to identify neonatal risk factors associated with hearing loss and understand the importance of early identification and early intervention and among health care professionals.

Neck Trauma: ENT Prospects.

Neck trauma is a very important surgical emergency faced by ENT surgeons in day to day practice. They are potentially life threatening conditions due to the presence of many vital structures in this area. Timely presentation to the referral centre and proper multidisciplinary approach towards management plays a pivotal role in the healing pattern of the wound and prevention of serious complication like shock, sepsis, laryngeal stenosis or fistula formation. A retrospective study was done in ENT Department, NSCB Medical College, Jabalpur, Madhya Pradesh, India during the period of 2014-2016. 17 patients were included in the study. All the records regarding symptoms at presentation, type and mode of injury, level of injury were analyzed. Management plan undertaken were thoroughly studied and post operative complications like hoarseness, stenosis or fistula formation were noted carefully. 14 out of 17 patients were male, all 17 patients belonged to lower socioeconomic status. Most common age group presenting with neck trauma was between 22 and 40 years. 7 case were homicidal, 5 cases were suicidal and 4 were of accidental injury. Most cases reached hospital within 2-6 h of injury except 3 cases which took more than 8 h. Bleeding from wound site was most common symptom at presentation. Most injuries in 13 out of 17 cases were at thyroid cartilage level. Penetrating neck trauma was most common followed by blunt neck trauma. Most cases required emergency tracheostomy along with primary laryngotracheal repair. Most common post operative complication seen was wound dehiscence, subglottic stenosis and fistula formation. Neck trauma and cut throat injuries are potentially life threatening emergency that require multidisciplinary approach. Timely intervention can be crucial in preventing fatal complications and reducing morbidity period of the patient.

Correlation of Radiological and Endoscopic Findings in Patients Presenting with Dysphagia.

Dysphagia is a common symptom with diverse etiology in otolaryngology. In the present study clinicopathological, radiological and endoscopic evaluation of patients was done in a tertiary care hospital in patients presenting with dysphagia. A prospective nonrandomized observational study was carried out on total of 80 cases having dysphagia during March 2015 to August 2016. In the present study, out of 80 patients, youngest case was a three years old child while oldest case was an 85 years old female. The mean age was 48.3 ± 20.3 years. The majority of cases were in age group 41-59 years (35%). Male to female ratio was 2.33:1. The mean duration of illness was 15.44 weeks. 15% of patients had absolute dysphagia. For detecting the lesion, Barium swallow study (BSS) showed a total sensitivity of 49.05% (n = 53), Computerised Tomography (CT) showed a total sensitivity of 85.70% (n = 49), plain skiagram neck & chest showed a total sensitivity of 88.88% (n = 9) and endoscopy was the most sensitive test overall as it showed a total sensitivity of 98.75% (n = 80). No complications were reported with either rigid or flexible endoscopy. Dysphagia is a common presenting complaint in otolaryngology with cases coming directly or being referred from other specialities. Males are more commonly affected than females and incidence of malignancy increases with age. Endoscopy can become the first screening test in dysphagia due to its high sensitivity and low risk of complications, with radiological tests being done in an adjunct manner.

Mutilating Lesions of Face.

The destructive lesions affect midline facial areas causing extensive destruction. These lesions are challenging till date due to peculiarity in presentation and non availability of any single objective test. An attempt has been done to evaluate these different clinical presentations of lesions presenting at a single centre and the challenges faced by us at a tertiary government setup. Prospective study done on 15 patients presenting in department during period of 2006-2016. After a detailed history, hematological and biochemical markers, ESR, radiographical tests, pus culture, C ANCA, CECT PNS and histopathogical evaluation were done. 12 out of 15 patients were male; Most common age group was above 45 years of age. All cases had ulceration of nose, 9 had cartilaginous destruction and 3 had osseocartilaginous destruction. 5 cases of mucormycosis had hyperglycemia with 2 having ketonuria and 4 had nerve palsies. All patients needed multiple biopsies. 3 cases of wegners and 4 cases were suspected of IMDD and immunohistochemistry was advised. C ANCA was negative in wegners cases as they were in limited form. Mutilating diseases of face usually present at an advanced stage with diverse etiology, are slowly progressive and require detailed evaluation. Due to lack of availability of IHC markers and C-ANCA at every centre it is difficult to diagnose them. The treatment is challenging due to incomplete response and frequent relapses. These cases require proper work up plan and perseverance leads to a final diagnosis.

Myxoid Chondrosarcoma of Nasomaxilloethmoid Region with Intracranial Extension.

Chondrosarcoma of the faciomaxillary area constitute only 4 % of non-epithelial tumours of the nasal cavity, paranasal sinuses and nasopharynx, making it one of the rare malignancy (Indian J Otolaryngol Head Neck Surg 60(3):284-286, [1]), with its myxoid variety still rarest. It is a slow-growing tumour, occurring mostly in middle-aged men. Primary chondrosarcoma of the nasal and paranasal sinus region, including the nasal septum, rarely extends into the cranial or intracranial areas unless there is recurrence (Indian J Ophthalmol 41(4):189-191, [2]. When it does occur, early diagnosis is difficult because patients generally present with common, nonspecific sinonasal complaints. A 45 year male patient came to ENT OPD with complaints of epistaxis, diplopia, facial swelling and loosening of teeth. On examination extensive swelling was present involving right maxilla, palate and ethmoid with shifting of Rt eye laterally. FNAC of swelling was non specific infected cystic lesion. On endoscopic examination there was erosion of Rt lateral wall of nose with mucoid material filling maxilla. Its wall was expanded & lined with velvety red mucosa. Maxillary antral biopsy report was myxoid chondrosarcoma. CT scan revealed extensive lesion of maxilla, ethmoid going up to optic nerve and brain. This case of myxoid chondrosarcoma is presented as it is a rare diagnosis. It presented with advanced disease involving nasomaxilloethmoid region and extended up to optic canal and middle cranial fossa. In a thorough review of Indian literature this was a rarely diagnosed tumour.

Rhino-oculo Cerebral Mucormycosis with Multiple Cranial Nerve Palsy in Diabetic Patient: Review of Six Cases.

AIM of the study is to evaluate etiopathogenesis role played by predisposing conditions (Diabetes, Immunosupression), precipitating factors (trauma/surgery/ketoacidosis) and possible role of occupational hazard is discussed briefly. Clinical presentation and management of patients presenting with rhinoorbitocerebral mucormycosis is discussed. The prospective study of patient undergoing treatment of mucormycosis] without control Setting was done in ENT Deptt. NSCB Medical College, Jabalpur (tertiary referral centre of mid India). Subject were patients presenting with invasive fungal rhino sinusitis presenting with orbital involvement and cranial nerve palsies undergoing treatment. The detailed history, clinical examination including cranial nerve examination, blood test, CTscan and biopsy. Nasal endoscopy, CWL surgery and medical management with 6 month follow up. All six patients were diabetic when evaluated on presentation. Two patients had ketoacidosis. Four had history of surgery in recent past. Blood stained nasal discharge and dysaesthesia of face are early warning signs. They had necrotic lesion in nose and infraorbital area with 2, 3, 4, 5, 6 and 7 cranial nerve involvement. Skin necrosis/Mucosal necrosis, facial palsy and diplopia signify advanced disease. Altered sensorium, panopthalmitis & diabetes complicated with ketoacidosis signify bad prognosis. In present study two patients with advanced disease, altered sensorium and ketoacidosis succumbed within 72 hours in spite of anti fungal medicine. Of the four surviving patients, all responded well to treatment but had residual sixth and seventh nerve palsy. One patient defaulted in diabetes control & had recurrence after 6 months. Early diagnosis, aggressive surgical debridement and proper management of underlying metabolic abnormality along with amphotericin B can avert the bad prognosis of rhinoorbitocerebral mucormycosis.