Cranionasal fistula in pediatric population: is endonasal endoscopic approach effective?

PURPOSE: To study the efficacy and safety of endoscopic endonasal repair of CSF leak in pediatric population. STUDY DESIGN: A prospective study in a tertiary care center. PATIENTS AND METHODS: All the cases with a age of less than 14 years with a diagnosis of CSF rhinorrhoea were included in the study. These were subjected to detailed examination, radiological evaluation using computed tomographic cisternography and MRI if required. These cases were then subjected to endoscopic endonasal repair of the fistula using the technique described in the text. RESULTS: There were 25 cases in the study with a male predominance and trauma responsible for 22 of these and spontaneous leak in 3 of the cases. The majority of these leaks were from cribriform plate area. After the repair, there was no leak in 24 of these cases and 1 case with recurrence did well after second surgery. DISCUSSION: The prior work on the entity of CSF rhinorrhoea in children consists of a few case reports only and ours is the largest series on endoscopic repair of the CSF leak in children showing it to be safe and effective with a success rate of 96%. CONCLUSION: Endoscopic closure of the cranio nasal fistula is associated with a high degree of success (96% in our series) and has significantly less morbidity and mortality when compared with the craniotomy approach. Hence it can be concluded that it is the standard of care for the pediatric population as well.

Cervical necrotizing fasciitis: Our experience with 11 cases and our technique for surgical debridement.

We conducted a retrospective review of 11 cases of adult cervical necrotizing fasciitis that were treated at our institution over a period of 5-plus years. The most common etiology was a dental infection, which was seen in 7 of the 11 patients (64%). Most cultures were sterile because all of these patients had been referred to us after they had already been treated elsewhere with intravenous antibiotics and without surgical intervention. Under our management, patients spent an average of 21.6 days in the hospital, and they underwent an average of 1.6 debridements under general anesthesia. Aggressive wound care, broad-spectrum antibiotic therapy, and timely surgical intervention resulted in an overall survival rate of 91% (10/11), including a 75% survival (3/4) for patients with thoracic extension.

Pyogenic granuloma of the hard palate: a case report and review of the literature.

We describe the case of a 35-year-old man who presented with a 4 x 4-cm ulcerated swelling over the hard palate that had progressed over 6 months. The lesion was associated with recurrent bleeding and occasional pain. Based on the lesion's clinical appearance and other characteristics (i.e., the slow progression, ulceration, and lack of regional lymphadenopathy), a provisional diagnosis of pyogenic granuloma was made, even though pyogenic granulomas of such size are rare. The mass was excised via a transoral route with a 0.5-cm margin of healthy mucosa, and the base was curetted. Histopathologic examination of the excised specimen confirmed the diagnosis. We discuss the etiopathogenesis of this entity and the various treatment options, and we review the relevant literature.