Clinical outcome of orbital apex syndrome in COVID associated mucormycosis patients in a tertiary care hospital.

AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month post-surgical outcome of rhino-orbito-mucormycosis (ROCM) cases. METHODS: All COVID associated mucormycosis (CAM) patients underwent comprehensive multidisciplinary examination by ophthalmologist, otorhinolaryngologist and physician. Patients with clinical and radiological evidence of orbital apex involvement were included in the study. Appropriate medical and surgical intervention were done to each patient. Patients were followed up one-month post intervention. RESULTS: Out of 89 CAM patients, 31 (34.8%) had orbital apex syndrome. Sixty-six (74.2%) of such patients had pre-existing diabetes mellitus, 18 (58%) patients had prior documented use of steroid use, and 55 (61.8%) had no light perception (LP) presenting vision. Blepharoptosis, proptosis, complete ophthalmoplegia were common clinical findings. Seventeen (19.1%) of such patients had variable amount of cavernous sinus involvement. Endoscopic debridement of paranasal sinuses and orbit with or without eyelid sparing limited orbital exenteration was done in most cases, 34 (38.2%) patients could retain vision in the affected eye. CONCLUSION: Orbital apex involvement in CAM patients occur very fast. It not only leads to loss of vision but also sacrifice of the eyeball, orbital contents and eyelids. Early diagnosis and prompt intervention can preserve life, vision and spare mutilating surgeries.

COVID-19 associated rhino-orbital-cerebral mucormycosis: An observational study from Eastern India, with special emphasis on neurological spectrum.

AIMS: 1: Describe the epidemiology and determine risk factors for COVID-19 associated mucormycosis. 2: Elaborate the clinical spectrum of Rhino-Orbital-Cerebral Mucormycosis (ROCM), pattern of neuroaxis involvement and it's radiological correlates. METHODS: Observational study. Consecutive, confirmed cases of mucormycosis (N = 55) were included. A case of mucormycosis was defined as one who had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological examination (HPE). Data pertaining to epidemiology, risk factors, clinico-radiological features were analysed using percentage of total cases. RESULTS: Middle aged, diabetic males with recent COVID-19 infection were most affected. New onset upper jaw toothache was a striking observation in several cases. Among neurological manifestations headache, proptosis, vision loss, extraocular movement restriction; cavernous sinus, meningeal and parenchymal involvement were common. Stroke in ROCM followed a definitive pattern with watershed infarction. CONCLUSIONS: New onset upper jaw toothache and loosening of teeth should prompt an immediate search for mucormycosis in backdrop of diabetic patients with recent COVID-19 disease, aiding earlier diagnosis and treatment initiation. Neuroaxis involvement was characterized by a multitude of features pertaining to involvement of optic nerve, extraocular muscles, meninges, brain parenchyma and internal carotid artery.

Intraoperative Image-Guided Retrieval of Foreign Body from Infratemporal Fossa: A Rare Case Report.

Entrapped foreign bodies in the head and neck region pose a challenge for surgeons, especially when present in areas like infratemporal space. In this case report, a bomb splinter entered through skin below the right infraorbital rim, traversed the maxillary antrum and got entrapped in the infratemporal fossa of the patient, which was initially localized using preoperative two-dimensional and three-dimensional radiographs. The foreign body was exposed via Alkayat Bramley approach and finally retrieved with the help of intraoperative C-arm fluoroscopy.

Efficacy and safety of oesophageal coins removal using a Foley balloon catheter without fluoroscopic control (blind method).

Although previously reported the method is not widely used despite its significant economic advantages. We evaluate safety and efficacy of the procedure of removing coins from the upper oesophagus in children by Foley catheter without fluoroscopic control (blind method). A retrospective case series study was undertaken among 58 consecutive paediatric patients in a district level medical college hospital during the period of 2009-2010. A total of 58 cases of coins impacted in oesophagus were divided into two groups. In group A (n=27), all the impacted coins were in upper oesophagus and they were subjected to Foley catheter removaL In group B (n=31), the patients were selected for endoscopic removal under anaesthesia. Coins were successfully removed in 24 cases in group A and 28 cases in group B. The results between both the groups were compared using Chi-square test. There was no statistically significant difference (p<0.05) between the two groups. Upper oesophageal coins can be safely removed by Foley balloon catheter without fluoroscopic control. This blind technique is cost effective, avoiding the need for hospital stay and anaesthesia. It is worth trying before resorting to endoscopy.

Three years audit of the emergency patients in the department of ENT of a rural medical college.

Surgical audit is a systematic, critical analysis of the quality of surgical care provided, with the aims of improving quality of care, continuing education for surgeons, and guiding appropriate use of health resources. Emergency service is an integral part of any discipline of clinical medicine and it is considered as an indicator of quality of healthcare system. A three years record based, retrospective, cross-sectional study was carried out in the department of ear, nose and throat (ENT) of Midnapore Medical College, Paschim Medinipur,West Bengal to identify the total attendance of various emergency patients, diagnosis made thereafter, the mode of interference and outcome and the potential problems in the quality of care provided to the community. A total of 9051 patients had been admitted/attended in the ENT emergency from January 2008 to December 2010 who were included in this audit. Detailed statistical analysis of the data showed male: female (2.38:1) with the peak in the first decade of life. Majority of the patients were from Medinipur sadar (58.43%). The total otological cases were maximum (42.41%) in comparison to nose (28.98%) and throat (28.60%). The most common ear emergencies were earache due to impacted wax, acute suppurative otitis media, foreign body ear and the trauma/injury. Chronic suppurative otitis media with complications were the least. Amongst the sinonasal emergency, the most common aetiology was the epistaxis and foreign body nose in children. The different types of foreign body impaction in the throat and the inflammatory condition of throat or the inspiratory stridor due to upper airway obstruction were the main emergency situation recorded. Some cases were fatal. The overall mortality was 0.44%.

Fine needle aspiration cytology of thyroid nodules--evaluation of its role in diagnosis and management.

Thyroid swelling is a common problem in India. Early and systematic evaluation of a nodular thyroid swelling is necessary as it is a frequent presentation of thyroid neoplasia. The objective of this study was to evaluate the efficacy of fine needle aspiration cytology (FNAC) in diagnosis and management of thyroid nodules. With the help of statistical parameters, the significance of FNAC in surgical decision making protocol has been evaluated. A comparison between final histopathological findings with initial FNAC findings is done and sensitivity, specificity, positive and negative predictive value and accuracy of FNAC is calculated and compared to already existing studies. A total of 120 cases of nodular thyroid were included, among which 12 cases were excluded from statistical analysis as they were managed conservatively. Total operated cases were 108 and study period was from November 2006 to October 2009. Analysis revealed sensitivity, specificity and accuracy of FNAC as 90%, 84.6% and 86.1% respectively. There were 12 FNAC false positive cases among which 9 were follicular neoplasm and 3 were Hurthle cell neoplasm which ultimately came as benign in histopathology. Only 3 cases of adenomatous nodule as per FNAC report proved to be papillary carcinoma on histology (ie, false negative). This study concludes that FNAC is an important diagnostic tool in early and cost effective evaluation of thyroid nodules. It helps in decision making for appropriate surgical/non-surgical management.

Anhidrotic ectodermal dysplasia presenting as atrophic rhinitis.

Ectodermal dysplasia is a complex group of familial disorders with numerous clinical characteristics, with an incidence of 7 in 10000 born alive children. Ectodermal dysplasia affects structures of ectodermal origin like the skin and its appendages as well as other non-ectodermal structures. The most common sites of involvement are the defects in the skin, hair, teeth, nails and sweat glands,which are of ectodermal origin. Though the dermatologists and paediatricians often manage such cases, we report one case of ectodermal dysplasia presenting with atrophic rhinitis.

Neurofibroma of the external ear - a case report.

Neurofibromas are relatively common tumours of the nervous system, but only a few cases involving the external ear have been reported. We are reporting here a case of a 20-year-old female with neurofibroma of the external ear. The primary complaint was cosmetic deformity. There was partial occlusion of the external auditory canal. The swelling was excised by postauricular approach. Surgery resulted in an excellent functional and cosmetic outcome.

Chondrosarcoma of the arytenoids- a rare laryngeal malignancy.

Even though laryngeal malignancies are the most frequent primary malignancies of the upper aero digestive tract except for oral cavity cancers, laryngeal chondrosarcomas are rare tumors, constituting less than 1% of all laryngeal tumors. We present a rare case of chondrosarcoma arising from the right arytenoid cartilage with sub glottic extension. The mode of presentation and management of the case is presented along with a review of the literature.

Bilateral hamartoma of tonsils bearing ectopic teeth: a case report.

Ectopic teeth presenting in bath the tonsils with hatnartomatous lesion has not been reported earlier. We present here a case of benign hamartoma of both the tonsils bearing 7 teeth in a 13 year old girl and also discuss about unusual Ectopic sites of tooth eruption as well as benign lesions of tonsil.