A Large Follicular Adenomatoid Odontogenic Tumor Occupying the Maxillary Sinus: A Case Report.

Adenomatoid odontogenic tumour is a rare benign, odontogenic tumour with uncertain histogenesis. Whether it is a hamartoma or a neoplasm is still a controversial topic. It is usually associated with an unerupted maxillary canine. Here, we discuss a follicular adenomatoid odontogenic tumour in a young girl with uncommon features such as it arose from two unerupted teeth and partial resorption of the roots of other normal teeth. The tumour was large enough to completely occupy the maxillary sinus. It was treated with enucleation and curettage by lateral rhinotomy approach. Keywords: adenomatoid tumor; case reports; hamartoma; odontogenic cysts.

Comparison of Outcomes Between Mometasone Furoate Intranasal Spray and Oral Montelukast in Patients with Allergic Rhinitis.

BACKGROUND: Allergic rhinitis is a common ailment with rising trend and worldwide prevalence of some 400 million. METHODS: This prospective randomized crosssectional study was done at the Department of Otorhinolaryngology and Head and Neck Surgery, Tribhuvan University, Teaching Hospital, Kathmandu, Nepal from June 2016 to August 2017. They were randomly assigned to two groups by lottery method. Group A received mometasone furoate intranasal spray and Group B received oral montelukast for a total duration of one month. Prior to starting medication and one month after medications, total nasal symptom score was documented. Statistical analysis was done using SPSS version 18. RESULTS: Total of 126 patients between 16 to 52 years were enrolled in the study. The mean duration of symptoms was 3.93 years. The mean value of serum total IgE was 833.49 IU/ml. The mean pre and post medication score for mometasone furoate intranasal spray group was 16.32 and 5.44 respectively, which was significant. Similarly, the mean pre and post medication score for oral montelukast group was 15.24 and 7.87 respectively which was also found to be significant. Comparing the means of scores for both the groups, mometasone furoate was found to be more effective than oral montelukast. CONCLUSIONS: Both mometasone furoate intranasal spray and oral montelukast were effective in the treatment of patient with allergic rhinitis. Oral montelukast can therefore be used as a first line treatment for patients with allergic rhinitis.

Lacrimal sac rhinosporidiosis: case report and review of literature with a new grading system to optimize treatment.

Rhinosporidiosis is a chronic granulomatous disease affecting the mucous membrane primarily and is caused by Rhinosporidium seeberi, an aquatic protistan parasite. The nose is the most common site of involvement and is seen in 83.3% cases, followed by ocular involvement in 11.2% cases and other sites like larynx, trachea and bronchus in 5.5% cases. In various oculosporidiosis case series, lacrimal drainage system involvement was seen to vary from 14.3% to 59.6% cases. Isolated lacrimal sac involvement in rhinosporidiosis was found in 45.8% (72 out of 157) cases of the lacrimal drainage system in a review of 31 studies. A variety of surgical procedures have been used to treat rhinosporidiosis of lacrimal sac like dacryocystorhinostomy, Dacryocystectomy, lateral rhinotomy and local lesion excision with a success rate varying from 28.5% to 92.3%. This wide variation in the success rate was due to the fact that a uniform surgical procedure was performed in all the cases of a particular series irrespective of the extent of disease. Grading the lacrimal sac rhinosporidiosis to decide the extent of surgical excision may help achieve better results. We present a grading system based on our own experience in a case of extensive rhinospodiosis of lacrimal sac and review of 31 studies published in the literature. A 24-year-old male from Nepal presented with the complaints of watering from his right eye of 13 years duration, swelling in the right medial canthal area with an extension to the inferior part of the orbit for 12 years and nasal blockage for 1.5 years. The patient had a history of previous intervention in which biopsy was taken from the nose and sent for histopathology that confirmed rhinosporidiosis. An extended intranasal endoscopic dacryocystectomy was done along with debridement and coblation of the lesion over the septum and nasopharynx. Intraoperatively a large rhinosporidiosis mass was seen filling the sac and was removed in toto along with the sac and nasolacrimal duct. Recurrence of a tiny lesion after 6 months in our case despite wide excision with the drilling of bony nasolacrimal duct and coblation, made us review the literature.

Primary Atypical Meningioma of the Nasal Cavity: A Case Report and Review of the Literature.

BACKGROUND: Meningioma is a central nervous system tumor that typically arises in proximity to meninges. Extracranial primary atypical meningioma of sinonasal tract is a rare one. METHODS: We discuss the clinical, radiological, and histological presentation of an elderly female with primary atypical meningioma of the nasal cavity, which was excised via endoscopic endonasal approach. RESULTS: There was no recurrence even up to 20 months of follow-up after endoscopic excision. CONCLUSION: Extracranial primary atypical meningioma should be kept in mind as one of the differential diagnoses of nasal mass. Histopathological diagnosis along with immunohistochemistry should be used for definitive diagnosis.

Endoscopic Sinus Surgery for Sinonasal Polyposis: Microdebrider or Conventional Instruments.

INTRODUCTION: Sinonasal polyposis is one of the commonest causes of nasal obstruction. Surgical management is treatment of choice. Microdebrider offers more advantage to conventional instruments. We aimed to find out outcome using microdebrider versus conventional instruments in endoscopic sinus surgery of sinonasal polyposis. METHODS: The cross sectional descriptive study carried out in patients aged 13 years and above with diagnosis of sinonasal polyposis. Total of 51 patients were operated on the right side with microdebrider and left side with conventional instruments. Postoperatively each patient assessed for nasal obstruction subjectively and by endoscopic examination to look for mucosal oedema, synechiae and recurrence at 4 weeks and 8 weeks postoperatively. RESULTS: The incidence of mucosal oedema in microdebrider and conventional instruments at 4 weeks and 8 weeks was statistically not significant with P value 0.089, 0.322 respectively. The incidence of synechiae in conventional group was more than microdebrider 1 (2%) versus 4 (7.8%) at 4 weeks follow up but the difference was statistically not significant (P value 0.773). There were 2 (3.9%) recurrences in microdebrider group and 3 (5.8%) recurrences in conventional group with P value 0.532. CONCLUSIONS: Use of microdebrider offered fewer incidences of synechiae and recurrence. But we couldn't find statistical advantage over conventional instruments.

Oncocytoma of maxillary sinus--a rare presentation.

A case of Oncocytoma of maxillary sinus in a 73 years old female is reported along with a brief review of literature. To the best of our knowledge this extremely rare tumor is the first of its kind reported in Nepal. Literature review has revealed only four such cases originating from maxillary sinus.

Prevalence of otomycosis in outpatient department of otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Otomycosis is a not-uncommon clinical problem encountered in our otolaryngology practice. We report 100 diagnoses (107 ears) of otomycosis, of which, on microbiological examination, 87 specimens (81.3%) showed positive fungal cultures. Of these, a single isolate was found in 85 cases (79.4%), mixed isolates were found in 2 cases, and 20 cases (18.7%) had no growth. The most common fungal pathogen found was Aspergillus, followed by Candida albicans. The causative factors for otomycosis were examined. The results of treatment with clotrimazole were analyzed.