Rare Case of Nasal Tip Schwannoma - A Case Report.

Schwannoma is a benign neurogenic neoplasm which is arising from schwann cells of peripheral nerve sheath. It can occur in anywhere in the body. Schwannoma of sinonasal tract is extremely rare. Here we report a rare case of schwannoma of nasal tip. A 45 year old male presented with a swelling of tip of the nose, causing cosmetic deformity with no other associated symptoms. Surgical excision of the mass done by using external rhinoplasty approach. Histolopathology report of specimen showed a well circumscribed schwannoma with Antoni A and Antoni B areas.

Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft / Timpanoplastia endoscópica com enxerto de cartilagem tragal de espessura parcial ou total

Abstract Introduction: Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Objective: The present study was carried out to report a personal experience with "tragal cartilage shield" tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. Methods: Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. Results: Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. Conclusion: This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.

Resumo Introdução: A cartilagem é o material de enxerto de escolha no tratamento cirúrgico de certas condições clínicas da orelha média. Devido ao possível efeito prejudicial na audição pós-operatória, as indicações para seu uso rotineiro ainda são controversas. Objetivo: Relatar a experiência dos autores com a timpanoplastia tipo 1 endoscópica usando cartilagem tragal e comparar os resultados entre a cartilagem tragal com espessura parcial e espessura total, em termos de integração do enxerto e melhoria da audição. O estudo também buscou apresentar sugestões para cirurgia endoscópica de orelha média com uma única mão (single-handed endoscopic ear surgery). Método: Foram selecionados 50 pacientes com otite média crônica supurativa, atendidos neste ambulatório entre fevereiro de 2014 e setembro de 2015, alocados aleatoriamente em dois grupos: 25 pacientes foram incluídos no grupo A, no qual uma cartilagem tragal de espessura total foi usada e outros 25 pacientes foram incluídos no grupo B, no qual foi usada uma cartilagem tragal de espessura parcial. Em todos os casos, uma audiometria foi feita dois meses após a cirurgia; os pacientes foram acompanhados por um ano. Resultados: Dos 50 pacientes, o enxerto foi bem-sucedido em 39 (78%), entre os quais 22 pertenciam ao grupo A e 17 pertenciam ao grupo B. A melhoria da audição em ambos os grupos foi muito semelhante. Conclusão: O estudo indicou que a timpanoplastia endoscópica com cartilagem tragal é uma técnica confiável, com alto grau de integração do enxerto e bons resultados de audição, independentemente da espessura usada. Além disso, a cartilagem tragal é facilmente acessível, adaptável e resistente à reabsorção; a cirurgia endoscópica é minimamente invasiva, sem sutura e proporciona uma visão panorâmica da orelha média.

Butterfly tragal cartilage for repair of focal canal wall defects / Cartílago tragal en mariposa para reparar los defectos focales de la pared del conducto auditivo externo

BACKGROUND: Meato-mastoid fistula is a connection between the external auditory canal and the mastoid cavity. It may be iatrogenic or pathological. The repair of these focal canal wall defects is necessary to prevent retraction pockets or sequential cholesteatoma and attain relief from otorrhoea. AIM/OBJECTIVE: To study the effectiveness of an innovative technique for repair of meato-mastoid fistula (less than or equal to 10 mm in size) in the bony external auditory canal. MATERIAL AND METHODS: We performed a retrospective review of 5 surgeries performed in our hospital between January 2017 and December 2017 for the repair of posterior bony canal wall defects. Active ear disease was ruled out before the repair. We used full-thickness butterfly tragal cartilage graft for the repair of these fistulae. All our surgeries were endoscopic and sutureless. RESULTS: The butterfly tragal cartilage graft was in situ at the repair site and viable on examination at 2 years follow-up, in all our cases. CONCLUSION AND SIGNIFICANCE: Small posterior canal wall defects can be successfully repaired using this technique. The method is minimally invasive and cosmetic, with good patient compliance. The curling property of the cartilage graft is exploited effectively in this method of repair

INTRODUCCIÓN: La fístula meato-mastoidea es una conexión entre el canal auditivo externo y la cavidad mastoidea. Puede ser iatrogénica o patológica. La reparación de estos defectos focales de la pared del canal es necesaria para evitar las bolsas de retracción o el colesteatoma secuencial, y aliviar la otorrea. OBJETIVO: Estudiar la eficacia de una técnica innovadora para reparación de fístula meato-mastoidea (inferior o igual a 10 mm de tamaño) en el hueso del canal auditivo externo. MATERIAL Y MÉTODOS: se realizó una revisión retrospectiva de 5 cirugías en nuestro hospital de atención terciaria entre enero y diciembre de 2017 para la reparación de defectos de la pared ósea del canal posterior. Se descartó la enfermedad activa del oído antes de la reparación. Utilizamos injerto de cartílago tragal en mariposa de espesor completo para la reparación de estas fístulas. Todas las cirugías fueron endoscópicas y sin sutura. RESULTADOS: El injerto de cartílago tragal en mariposa se realizó in situ en el sitio de reparación, siendo viable durante el examen de seguimiento a los 6 meses, en todos nuestros casos. CONCLUSIÓN: Los defectos de la pared del canal posterior pequeños pueden repararse exitosamente con esta técnica. El método es mínimamente invasivo y cosmético, con buena aceptación del paciente. La propiedad ondulada del injerto de cartílago se aprovecha eficazmente en este método de reparación

Butterfly tragal cartilage for repair of focal canal wall defects.

BACKGROUND: Meato-mastoid fistula is a connection between the external auditory canal and the mastoid cavity. It may be iatrogenic or pathological. The repair of these focal canal wall defects is necessary to prevent retraction pockets or sequential cholesteatoma and attain relief from otorrhoea. AIM/OBJECTIVE: To study the effectiveness of an innovative technique for repair of meato-mastoid fistula (less than or equal to 10mm in size) in the bony external auditory canal. MATERIAL AND METHODS: We performed a retrospective review of 5 surgeries performed in our hospital between January 2017 and December 2017 for the repair of posterior bony canal wall defects. Active ear disease was ruled out before the repair. We used full-thickness butterfly tragal cartilage graft for the repair of these fistulae. All our surgeries were endoscopic and sutureless. RESULTS: The butterfly tragal cartilage graft was in situ at the repair site and viable on examination at 2 years follow-up, in all our cases. CONCLUSION AND SIGNIFICANCE: Small posterior canal wall defects can be successfully repaired using this technique. The method is minimally invasive and cosmetic, with good patient compliance. The curling property of the cartilage graft is exploited effectively in this method of repair.

Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft.

INTRODUCTION: Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. OBJECTIVE: The present study was carried out to report a personal experience with "tragal cartilage shield" tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. METHODS: Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. RESULTS: Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. CONCLUSION: This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.

Palatal Schwannoma: An Analysis of 45 Literature Reports and of an Illustrative Case

Abstract Introduction Schwannomas are benign tumors originating from differentiated Schwann cells. Being the least common intraoral neoplasm of neural origin, it is rarely seen in the palate. The literature lacks an extensive review of intraoral schwannoma confined to the palate. Objective To review previously reported cases of palatal schwannoma along with an illustrative case, and to provide a better insight regarding clinicopathological and radiological features of this neural tumor in a rare intraoral site. Data Synthesis We present a case of palatal schwannoma in a 16-year-old female. An additional 45 cases were identified in 2 medical database searches (PubMed and Google Scholar) published fromthe year 1985 onwards, and from13 countries, in the 5 continents. The ages of the patients ranged from3 to 84 years old. Palatal schwannoma showed a slight predilection to females, with a male/female ratio of ~ 1:1.81. Hard palate involvement is almost twice greater than soft palate involvement. Surgical excision was employed inalmost all of the cases, and recurrence was reported only once. Conclusion Palatal schwannomas, although rare, have been reported both over the hard and the soft palate. They mostly present as a painless, firm, well-encapsulated, slow-growing solitary lesion over the lateral palatal aspect. Imaging can add to suspicion and can delineate a differential diagnosis, but the diagnosis is confirmed by pathological examination. Fine-needle aspiration cytology (FNAC) is almost always inconclusive. Immunohistochemistry can assist in confirming a diagnosis, but is more important to rule out close differentials. Complete surgical excision is the treatment of choice, and recurrence or malignant transformation are extremely rare.

Palatal Schwannoma: An Analysis of 45 Literature Reports and of an Illustrative Case.

Introduction Schwannomas are benign tumors originating from differentiated Schwann cells. Being the least common intraoral neoplasm of neural origin, it is rarely seen in the palate. The literature lacks an extensive review of intraoral schwannoma confined to the palate. Objective To review previously reported cases of palatal schwannoma along with an illustrative case, and to provide a better insight regarding clinicopathological and radiological features of this neural tumor in a rare intraoral site. Data Synthesis We present a case of palatal schwannoma in a 16-year-old female. An additional 45 cases were identified in 2 medical database searches (PubMed and Google Scholar) published from the year 1985 onwards, and from 13 countries, in the 5 continents. The ages of the patients ranged from 3 to 84 years old. Palatal schwannoma showed a slight predilection to females, with a male/female ratio of ∼ 1:1.81. Hard palate involvement is almost twice greater than soft palate involvement. Surgical excision was employed in almost all of the cases, and recurrence was reported only once. Conclusion Palatal schwannomas, although rare, have been reported both over the hard and the soft palate. They mostly present as a painless, firm, well-encapsulated, slow-growing solitary lesion over the lateral palatal aspect. Imaging can add to suspicion and can delineate a differential diagnosis, but the diagnosis is confirmed by pathological examination. Fine-needle aspiration cytology (FNAC) is almost always inconclusive. Immunohistochemistry can assist in confirming a diagnosis, but is more important to rule out close differentials. Complete surgical excision is the treatment of choice, and recurrence or malignant transformation are extremely rare.

Impacted Incus Foreign Body in the Eustachian Tube.

INTRODUCTION: Foreign bodies in the external auditory canal are fairly common, and tend to be seeds, toys, or insects. However, foreign bodies in the middle ear are rarer and are generally accidental or iatrogenic. Although there are numerous reports regarding fascinating foreign bodies in the ear, the same cannot be said about foreign bodies in the Eustachian tube (ET). CASE REPORT: A 20-year-old male patient presented with right-sided active squamosal chronic otitis media (COM) persisting for 10 years. An incidental finding of a hyperintense foreign body (FB) located near the isthmus of the right ET was reported on high-resolution computed tomography (HRCT) of the temporal bones. The FB was bony (eroded incus), which was impacted near the isthmus of the ET and was extremely difficult to remove. A natural FB such as an eroded ossicle in the ET which aggravated the adhesive otitis and caused active squamosal COM has not been reported in the literature. CONCLUSION: We have reported this case not only for its rarity but also to make readers aware of such incidental findings which can be found only by imaging, and to suggest how they can be tackled with current equipment and technology.