Indian Journal of Otolaryngology and Head and Neck Surgery最新文献

Manipulation of the collagen membrane has always been cumbersome in the oral cavity because of its rolling tendency. We present a new technique for easy handling and manipulation of the collagen membrane.

Chronic rhinosinusitis (CRS) is one of the most prevalent conditions in medicine causing a considerable amount of healthcare expenditure. This study was performed to clinically diagnose chronic rhinosinusitis with or without polyps and to measure the intensity of patients' symptoms and treatment outcomes. This was a prospective cohort study, which included 70 patients diagnosed with CRS according to the EPOS-2012 and were given SNOT-22 questionnaire preoperatively, which was repeated on 1st, 4^th, and 12th weeks post-op to determine the treatment outcome. Patients were divided into three groups according to their predominant histopathological features and the treatment outcomes were assessed based on SNOT-22 scoring system. According to our study, ESS effectively raised the quality of life for CRS patients, and one week after surgery, there was a significant improvement in total symptoms (from 49.01 ± 14.83 to 21.91 ± 8.88). it was noted that there was a decrease in SNOT-22 scores at various intervals from baseline to week 12. The four subscales of the SNOT-22 test (rhinological symptoms, ear and facial symptoms, sleep function, and psychological difficulties) showed significant improvements in quality of life across all groups, and this relationship extended beyond the relationship with rhinological symptoms. These improvements were statistically significant after three months of post operative medical therapy. SNOT-22 is determined to be reliable and convenient to use. After ESS, all of the symptoms in our study showed a drop in SNOT-22 scores from week 1 to week 12, indicating an improvement in overall symptoms. Therefore, it can be used to monitor the success of surgical intervention in addition to medicinal therapy.

The aim of the study was to evaluate and compare the efficacy of Endoscopic Adenoidectomy with Microdebrider over Conventional technique by Curettage using Impedance Audiometry findings. In this prospective, randomised, comparative study patients were divided into two groups to undergo one of the above adenoidectomy surgeries. Patients with symptoms of Adenoid hypertrophy after failed maximal medical therapy (12 weeks) were selected after due consideration of the inclusion and exclusion criteria. Baseline Impedance Audiometric assessment was done one week prior to surgery which was compared to Impedance Audiometric values 12 weeks post operatively in each group. This study enrolled 50 patients with adenoid hypertrophy, 25 patients of group A underwent Conventional adenoidectomy and the other 25 patients of group B underwent Endoscopic Adenoidectomy with Microdebrider. Significant difference in type of tympanogram before and after adenoidectomy was found in both the groups (p = 0.0008 in group A & p < 0.0001 in group B). In Group A Percentage of abnormal tympanograms becoming normal (Type A), 12 weeks after adenoidectomy was 80%. In Group B Percentage of abnormal tympanograms becoming normal (Type A), 12 weeks after adenoidectomy was 88%. A statistically significant improvement (p < 0.0001 in both the groups) in the percentage of ears with absent stapedial reflex was observed in both groups postoperatively, with no difference between the two groups suggestive of improvement in eustachian tube function. Association of Preoperatively & Postoperatively Eustachian tube function in each group undergoing adenoidectomy was statistically significant (p < 0.0001). Both forms of adenoidectomy are effective in managing adenoid hypertrophy with tubal dysfunction causing mild conductive hearing loss and prone for OME. However, the audiological and endoscopic evaluation seems to favor Endoscopic Adenoidectomy with microdebrider over conventional adenoidectomy, and it should be therefore considered in the therapeutic management of young patients with adenoidal disease.

Fibrous dysplasia (FD), commonly known as Lichtenstein-Jaffe disease, is a benign fibro-osseous bone disease. Clinical symptoms often include bone pain, deformities, pathological fractures, or nerve compression. Fibrous dysplasia (FD) in the cranio-facial region presents major management concerns because to the risk of deformity, loss of function, and recurrence. The purpose of this study is to demonstrate a single institution's experience managing cranio-facial FD with zolendronic acid, as well as an extensive review of the available literature on the subject. This retrospective study was conducted in the Orthopedic Oncology unit of the Department of Surgical Oncology with a study duration between January 1, 2019, and January 1, 2022. There were seven patients with cranio-facial fibrous dysplasia in the current study. The effects of zolendronic acid were evaluated using clinical assessment, data, radiological findings, biochemical indicators. Furthermore, a comprehensive literature review was conducted in order to compile the current data of cranio-facial FD. The study included seven individuals (five men and two females), four with polyostotic FD and three with cranio-facial FD. The average follow-up duration was 18.75 months. The study found that all parameters improved: the mean VAS score increased from 7 to 1, mean serum calcium levels increased from 8.75 to 8.46 mg/dL, mean serum phosphorus levels increased from 4.46 to 4.17 mg/dL, and serum alkaline phosphatase levels increased from 152 to 93.25 IU/L.A comprehensive literature review was conducted using PubMed and Google Scholar with the following keywords: "Fibrous dysplasia," "Cranio-facial bones," "Bisphosphonate," and "Zolendronic acid." The search included 24 studies published between 2000 and 2022, incorporating all relevant studies available to date. Our study demonstrated the effectiveness of zolendronic acid in the treatment of cranio-facial fibrous dysplasia. Zolendronic acid offers potential as a feasible treatment options in treating cranio-facial FD, with possible advantages including alleviating symptoms, disease progression stabilisation, and morbidity reduction. However, multi-centre prospective randomised study with larger sample numbers and longer follow-up periods are needed in future.

Myiasis is a disease caused by fly larvae from the Diptera order settling in various tissues and organs of humans or animals. To report the diagnosis of myiasis larvae invading the oral and nasal cavities of patients in the management of intensive care units and to draw attention to the poor hygiene situation. A 78-year-old male patient diagnosed with cancer and a 93-year-old male patient diagnosed with ischemic cerebrovascular disease were followed up in the intensive care unit. On the 21st day of the cancer patient's hospitalization, eight larvae were removed from the oral cavity. In the first month of the other patient's hospitalization, six larvae were seen in the patient's nasal osteum near the feeding tube. A clinical diagnosis of myiasis was made and the larvae were initially manually removed for treatment, followed by medication. In conclusion, myiasis is a rare condition, but good hygiene, correct diagnosis, and treatment are necessary to prevent further harm to those who have risk factors such as immunosuppression, poor hygiene, malnutrition, diabetes, and peripheral vascular disease, particularly those who are hospitalized.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-024-04767-9.

Mucoepidermoid carcinoma (MEC) is a malignant locally invasive tumour of salivary glands, presumed to arise from reserve cells of salivary gland ducts. It accounts approximately 35% of all malignancies of major and minor salivary glands [1]. MEC arising in minor salivary glands can be located in different areas such as palate, retromolar trigone, floor of mouth, buccal mucosa, lips and tongue. MEC of tongue base are not common but they constitute around 50% of malignant lesions of salivary glands in this region. It presents in fifth and sixth decades of life mostly [1]. We present a rare case of 29 year old woman with low grade mucoepidermoid carcinoma of base of tongue operated by the Trotter procedure with harmonic scalpel - median labio-mandibular glossotomy approach. It's an interesting approach first described by William Trotter in 1920s. It's used by head and neck surgeons for accessing tongue base lesions, pharyngeal wall and cervical spine.

Nasopharyngeal cysts are rare benign entity, smaller in size and usually asymptomatic. They are mostly diagnosed incidentally on MRI. Larger cysts commonly presents with spasmodic and obstructive symptoms. Thornwaldt cysts are congenital cysts originating from the mid- line of the nasopharynx just above the upper border of the superior constrictor muscle. They represent primitive communication between notochord remnants and the pharyngeal endoderm. We report this case because of its unique presentation in a 35 year old male. Patient presented with nasal blockage, nasal discharge, snoring, ear pain and aural fullness, intermittent neck pain and neck stiffness. Preoperative evaluation included diagnostic nasal endoscopy (DNE) and Magnetic resonance imaging (MRI-scan). A large cystic mass of size 2.8 cm × 3 cm was diagnosed on DNE and MRI. Transnasal Marsupialisation and excision of the cyst was planned using powered instruments. Post operatively, patient noticed marked improvement in the obstructive symptoms. Regular follow up was done 6 monthly for 2 years. No recurrence was noted on DNE. Although a rare pathology in adulthood, it should be kept as a differential diagnosis for cervical pain and neck stiffness.

Otomycosis is a commonly encountered otological disorder in otorhinolaryngology practice. It has several predisposing factors such as habitual use of cotton buds, water in the ear, hot humid atmospheric condition or high temperature. Diagnosis of otomycosis frequently relies on the patient's history, otoscopic examination and ascertained clinical features and therefore posing diagnostic and therapeutic challenges. Data on otomycosis in Tanzania are scarce. A hospital based descriptive cross-sectional study was conducted at a private hospital from January to June 2022 in Dar es Salaam, Tanzania. All the clinically diagnosed cases were enrolled in the study with typical symptoms and characteristic fungal debris in the external auditory canal. Data was collected using semi-structured questionnaires and analyzed using Statistical Package for Social Sciences version 23. A total of 250 patients were recruited in this study. Majority were females, 153(81.2%) while males were 97(38.8%). Otomycosis was found to be predominantly unilateral in 203 (81.2%) patients. The commonest presenting complaint was ear itching (94.0%) followed by earache (78.6%), hearing loss (75.6%), ear fullness (74.4%), ear discharge (61.2%) and ringing sensation (14.0%). Based on the type of fungal debris on Otoendoscopy, whitish debris was more predominant in 191 (76.4%) patients followed by yellowish debris, 37 (14.8%), blackish debris, 15 (6.0%) and mixed (whitish-black) debris in 7 (2.8%) patients. The commonest risk factor was earbud use (40.8%) and the least one was comorbid conditions (4.4%). Females were more affected by otomycosis. The commonest otological complaint was ear itching while the least one was ringing sensation. Unilateral presentation of otomycosis predominated and the left ear was more affected. The commonest type of fungal debris was whitish debris and the least one was the mixed type (whitish-black). The commonest risk factor for otomycosis was earbud use and the least was comorbid conditions.

Angiectatic nasal polyps (ANP) are rare pseudo-neoplastic lesions that might raise intriguing pathophysiological issues and present a significant diagnostic challenge. They are also referred to as inflammatory granuloma telangiectaticum, vascular granuloma, pseudo-angioma, and angiomatous/angiectatic polyp. However, the name angiectatic polyp refers to the fact that the lesion is not a true tumour and is clinically distinguished by ectatic vasculature, haemorrhage, and persistent proliferation. The most confusing aspect of this polyp is its clinical appearance, which resembles a juvenile nasal angiofibroma. Despite its typical imaging characteristics, this lesion is difficult to differentiate radiologically. Hence, histopathology is paramount for establishing diagnosis. We report a rare case of a young adult who presented with complaints of nasal block and epistaxis. Examination revealed a vascular nasal mass and CT scan demonstrated the lesion to be epicentred in right nasal cavity extending to multiple sinuses with adjacent bone erosion. Patient underwent endoscopic excision of the mass with JNA as the predominant differential and only following histopathological examination, the final diagnosis was confirmed.

Previous research has reported high occult nodal metastases rates for T3/T4 mucoepidermoid carcinoma (MEC) of the oropharynx (OP) and oral cavity (OC). Our study evaluates if there is a benefit of neck dissection (ND) in these patients. The 2004-2016 National Cancer Database was queried for cases of adult MEC of the OC and OP. Patients with clinical T3/T4 disease were included while those with metastatic disease were excluded. Patients were divided into two cohorts: those treated with and without ND. Univariate chi-square, Kaplan-Meier, and multivariable Cox regression analyses were implemented. A total of 243 patients met inclusion criteria, of which 79 (32.5%) underwent ND. The majority of patients were less than 60 years old (60.1%), White (76.2%), and male (53.5%). 92 (37.9%) patients had clinically node-positive (cN+) disease. ND patients had higher rates of cN + disease (53.2% vs. 30.5%, p = 0.002). Of patients undergoing ND, 35 (44.3%) had cN0 disease while 42 (53.2%) had cN + disease. ND patients more commonly had grade III/IV tumors (45.1% vs. 23.4%, p = 0.002). Upon examination of dissected nodes, 20.3% of cN0 patients undergoing ND were found to have occult nodal metastases. There was no significant difference in 5-year overall survival between patients with and without ND (61.8% vs. 53.6%, p = 0.610), even on multivariable Cox analysis (hazard ratio: 1.52, 95% confidence interval: 0.73-3.18, p = 0.269). Our study found patients with cN0 MEC of the OC and OP have a high rate (20.3%) of occult nodal metastasis. In this cohort, patients with ND were not found to have improved survival, possibly due to statistical underpowering. Further research is needed to evaluate the indications and benefit of ND for this rare tumor presentation.