A Novel Surgical Approach to Nasolabial Fistula.

Infection of hair follicle is commonly called 'boil' or furunculosis. This can result in abscess formation leading to accumulation of pus and necrotic tissue. This can be more common in immunocompromised patients such as uncontrolled diabetes mellitus. Commonest organism to cause furunculosis is believed to be Staphylococcus aureus. We present an elderly patient where multiple nasal vestibular furunculosis suppurated resulting in extensive tissue damage and nasolabial fistula. Reconstruction was delayed to accommodate tissue healing from hyperglycemic insult and necrosis. Alar advancement flap was employed to give a suitable 3 layer closure to the fistula.

Managing Rhinophyma by Trimodal Therapy-Novel Approach.

Rhinophyma is characterized by nodular thickening of the Nasal skin, sebaceous gland hyperplasia, dilated pores, and in its late stage, fibrosis. In severe cases, it results in loss of normal facial contours, significant disfigurement, and social isolation. Treatment options for severe rhinophyma include cryosurgery, partial-thickness decortications with subsequent secondary reepithelialisation, laser ablation, full thickness resection with graft or flap reconstruction, excision by electrocautery or radio frequency. We report a case of severe rhinophyma resulting in marked facial disfigurement treated successfully with trimodal therapy with excellent cosmetic outcome on a long term follow up.

Facial Nerve Paralysis in Acute Suppurative Otitis Media-Management.

Facial paralysis is a rare complication of acute suppurative otitis media which requires early detection and appropriate care. We hereby report a case which we managed conservatively with good outcome. Following our experience and review of literature on the subject, antibiotic therapy and corticosteroid therapy, with or without myringotomy were found to be the first-line procedures. Surgery should be employed in case of acute or coalescent mastoiditis, suppurative complications and lack of clinical regression.

Papillary carcinoma in a lingual thyroid: an unusual presentation.

A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid.

Role of estimation of arterial blood gases in the management of stridor.

AIM: We studied the epidemiology and etiology of stridor in our patients along with the role of arterial blood gas (ABG) analysis in their management. We also reviewed their prognostic indices and the clinical outcomes. MATERIALS AND METHODS: It was a prospective study in a tertiary referral hospital in which 72 patients presenting with stridor, were independently evaluated by 3 different clinicians and clinically classified into mild, moderate and severe. Based on ABG values (pH, PO2, PCO2), we defined 3 groups of patients viz, those in respiratory failure, impending respiratory failure and those with no evidence of failure. Treatment was directed at the cause of stridor. Clinical outcomes were assessed and results classified as resolved, improved, stable and death. RESULTS: Out of 72 patients, kappa coefficient of agreement between the 3 observers were found to be 0.014, indicating poor interobserver reliability for the working clinical classification. However, ABG analysis indicated otherwise, with 6 patients in respiratory failure, 19 progressing to impending failure. Hence we complied by the more objective ABG analysis in planning management. Laryngomalacia in children and hypopharyngeal malignancies in adults were found to be the most common causes of stridor in our study. As compared to other conditions, laryngomalacia in children had a poorer outcome (p = 0.001). CONCLUSION: Early detection of impending respiratory failure was instrumental in achieving better clinical outcomes in our patients presenting with stridor. Thus we inferred that ABG analysis is a valuable tool in the effective management of stridor.