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Objective: Orbital apex syndrome (OAS) is a rare condition with multiple cranial nerve involvement caused by varied etiologies. It is not only a threat to the patient's vision but also life-threatening due to the intracranial spread of infection, if not diagnosed early and treated accurately. To study the outcome of endoscopic sinus surgery (ESS) for OAS secondary to sinusitis concerning resolution of ptosis, improvement of ophthalmoplegia, visual prognosis, intracranial spread of infection, and mortality. Methods: A retrospective review of patients with OAS secondary to sinusitis who underwent ESS from 2011 to 2021 was tabulated and analyzed. Results: Twenty-seven patients (mean age: 55.11+/-16 years; male 62%) were included in this study. At presentation, blurring of vision (81%), headache (66%), diplopia (63%) ptosis (63%) were the most common symptoms, and ophthalmoplegia (100%) was the most common sign. Five patients had no perception of light and the rest had various degrees of vision impairment. The most common etiopathology of sinusitis was fungal sinusitis (12 mucormycosis and four aspergillus). The final visual prognosis at three months follow-up post-ESS showed vision stabilization (no improvement or worsening) in 13 (48%) patients, improvement in seven (26%) patients, and vision deterioration in two (7%) patients. There was a significant improvement in ptosis (70%) and ophthalmoplegia (85%). There was no intracranial spread of infection or recurrence with a mortality rate of 3.7% (one patient). Conclusion: ESS coupled with appropriate antimicrobials effectively treats OAS secondary to sinusitis with decreased morbidity and mortality.
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BACKGROUND: The use of regional anaesthesia as an effective alternative to general anaesthesia in thyroid surgeries is now being accepted in many parts of the world. In this day of computers and technology, there is an increased awareness among the people of the available options of anaesthesia and the adverse effects of general anaesthesia. They thus have an inclination to avoid general anaesthesia wherever feasible. This study dwells on the use of regional anaesthesia as an alternative tool that can be offered to the patients undergoing thyroidectomy. AIMS: This study aims at analysing the effectiveness, safety, ease and patient acceptability of performing thyroidectomies under regional anaesthesia. SETTINGS AND DESIGN: This prospective study was performed at a university - affiliated hospital. MATERIALS AND METHODS: Twenty nine patients who underwent thyroidectomy for benign thyroid diseases under regional anaesthesia were included in this study: 20 patients under deep cervical plexus block and 9 patients under cervical epidural anaesthesia. STATISTICAL ANALYSIS USED: Z-test and validity test. RESULTS: In our study, all the 29 patients who underwent thyroidectomy under regional anaesthesia found the anaesthesia effective and were comfortable throughout the procedure. The surgeon too was at ease while performing the surgery. No complications were recorded. CONCLUSION: In our present study, regional anaesthesia (Cervical epidural anaesthesia and Cervical plexus block) has been used safely and effectively in 29 thyroid surgeries. We conclude that although regional anaesthesia has been reserved for high risk thyroidectomies it may be offered as effective alternative to general anaesthesia even in routine thyroid surgeries.
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INTRODUCTION: Benign thyroid swelling disorders are common conditions, frequently encountered in clinical practice. Though medical management has been useful in treating the hormonal variations, it has not been very significant in reducing the size of the swelling. OBJECTIVE: To study the efficacy of intra thyroid injection of triamcinolone in benign thyroid swelling disorders. MATERIALS AND METHODS: A total of 20 patients were selected for this study. All the patients with thyroid swellings, were evaluated with history and clinical examination followed by routine blood investigations, thyroid function tests (T3,T4,TSH), Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) of the neck. The treatment adopted in this study was intrathyroid injection of triamcinolone acetonide. RESULTS: In this study there were 20 patients, all were females in the age group of 17- 55 years. Four patients did not come for regular follow up, and hence were excluded. Sixteen patients were followed up regularly. Thirteen (81.25 %) patients showed excellent results with no visible swelling, confirmed sonologically. Two patients (12.5%) showed fair results with residual swellings, and one patient did not show any reduction in size of the swelling. CONCLUSION: Intrathyroid injection of triamcinolone acetonide is a safe, minimally invasive technique in reducing the size of benign thyroid swellings with minimal or no side effects.