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

Desmoid tumors affecting vital structures can be life-threatening despite their non-malignant behavior. The lack of standardized treatment poses a therapeutic challenge, particularly regarding the sequelae in pediatric patients. A one-month-old male patient presented with respiratory distress and stridor. Endoscopic exploration and computed tomography revealed a laryngeal tumor, which was confirmed as a desmoid tumor via biopsy. Systemic chemotherapy in combination with imatinib was initiated, leading to stabilization of the tumor size. A surgical approach for desmoid tumors may be unsuitable for pediatric patients due to excessive morbidity. In such cases, targeted therapies like tyrosine kinase inhibitors can effectively control the disease.

Adverse listening environments in the classroom can pose difficulties in listening for children with normal hearing (NH) and even more for children with hearing loss (HL). Listening difficulty in the classroom environment can be assessed using a culturally sensitive questionnaire in one's native language. Currently, no questionnaires are available in Malayalam, the language spoken in Kerala, India. Development and validation of Malayalam questionnaires to assess listening difficulties among children (6-12 years) with hearing loss from self, peer and teacher perceptions. Cross sectional study design was used. Items representing the construct for self, peer, and teacher perception were generated by deductive literature search. Simple, unambiguous sentences were constructed and logically sequenced; leading or biased, double-barrelled questions were avoided. Content validation was done by six experts, followed by a pilot study and cognitive interview, before administering the developed questionnaire to 60 participants. Content validation was done following Yusoff (2019) guidelines. Internal reliability and consistency were calculated using the split-half method and Cronbach's alpha. Item content validity index for self, peer, and teacher perception was 1.00, 0.97, and 1.00, respectively. Split-half method and Cronbach's alpha scores for self, peer, and teacher perception were 0.978, 0.819, 0.815, 0.791, 0.734, and 0.822, respectively. The developed questionnaire for self, peer, and teacher perception has good content validity, internal reliability, and consistency. Understanding classroom listening difficulties will facilitate devising measures for a favourable listening environment.

Objective: Determine the rate of occult lymph node metastasis in advanced laryngeal squamous cell carcinoma and identify its predictive factors.

Methods: A retrospective study including 98 patients with laryngeal cancer classified as T3-T4 N0, who underwent bilateral lymph node dissection in sectors II, III and IV.

Result: The median age of our patients was 61. The main symptom was dysphonia (96%). On CT scan, the thyroid cartilage was invaded in 53.5% of cases, and the HTE space in 50% of cases. It was essentially laryngeal squamous cell carcinoma of high grade in 6.1% of cases and of low grade in 93.9% of cases. We found lymph node involvement in 33 lymph node dissections (33.6%) in 24 patients (24.4%) with extranodal extension in 4 cases. Level IIA and III were the most commonly affected, with 28.6% and 21.4% of cases respectively. We noted a vascular emboli and perineural invasion in 5 patients. The predictive factors for MGO in our present study were age over 65, invasion of the subglottic stage, involvement of the thyroid cartilage, the hyo-thyro-epiglottic space, peri-neural invasion and limits of resection.

Conclusion: The criteria for performing lymph node dissection in cases of laryngeal cancer are becoming more restricted for patients with clinically negative lymph nodes (cN0). Nevertheless, for cases of locally advanced tumors, proactive lymph node dissection is advocated, particularly when certain predictive factors for hidden lymph node metastases are present.

Bone wax is a waxy substance used for mechanical control of bleeding from bone surfaces during surgical procedures. Bone wax can cause local inflammatory reactions like granuloma formation, infection, impaired bone healing, osteo-hypertrophy and rarely rhinosinusitis. Bone wax is widely used in neurosurgical and ENT procedures. Complications secondary to bone wax are difficult to ascertain on clinical grounds as it is largely thought to be inert. It can be challenging to diagnose this in imaging studies as bone wax can be mistaken for air or soft tissue. We report a case of unilateral nasal polyp secondary to the herniation of bone wax through the frontal recess into the nasal cavity.

Castleman's disease is rare lymphoproliferative disorder mostly seen in the mediastinum. We report a case of Castleman's disease involving a single lymph node at the left level II A in a 27-year-old female whose definitive diagnosis was made only on histological examination. Isolated Castleman's disease of the level II A lymph node is rare and a thorough clinical and histological examination is necessary to rule out the systemic form of the disease. Clinically two types of the Castleman's disease are seen, a unicentric variety where either a single lymph node or region is involved microscopically and multicentric variety where various lymph node regions are involved. Surgical excision is the standard of management for the unicentric Castleman's disease and has good prognosis, whereas the multicentric type is associated with systemic symptoms and has a poor prognosis. Although, microscopically, they can be classified as-hyaline vascular, plasma cell, transitional and stromal rich type, but their clinical significance is not clear.

A salivary gland fistula occurs when there is abnormal communication between the skin and the salivary gland or duct. Most of the cases are due to complications of head and neck surgery such as parotidectomy or trauma. At the moment, there are no consensus treatment guidelines for managing salivary gland fistulas. Most cases are treated conservatively; however, the management of ductal fistula can be challenging and typically requires more aggressive measures than conservative ones. We report a case of an elderly with a neck abscess complicated with a parotid fistula after incision and drainage. He presented with wound breakdown and persistent saliva leakage from the wound. The fistulogram showed communication between the Stensen's duct and the external fistula opening. We performed sclerotherapy by injecting Sodium Tetradecyl Sulphate into the fistula tract and ultrasound-guided intraparenchymal Botulinum Toxin type A injection over the affected parotid gland. The management of salivary gland fistula is discussed, focusing on the role of Botulinum Toxin type A injection and Sodium Tetradecyl Sulphate for the management of the fistula.

Extranodal peripheral T-cell lymphomas (PTCLs) are rare and commonly affect patients with immunosuppression or systemic autoimmune disorders. The involvement of oral cavity is extremely rare, and the chances of missing the initial diagnosis are high. A case of 38-year-old, previously healthy male presented with whitish ulcerative lesion (3 × 1.5 cm) over the soft palate crossing the midline with uvula involvement and nasal stuffiness for the last 4- and 8-months, respectively. Initial investigations were unremarkable, and the case was discharged following conservative management. However, 1-month later, the case returned with difficulty in swallowing and a destructive ulcer over the soft palate causing palatal perforation (1 × 3 cm), resulting in the formation of an oro-nasal fistula and destruction of uvula. Various investigations, including CECT brain and thorax, serology, and inflammatory markers, as well as those for autoimmune disorder were unremarkable. CECT face revealed soft palate erosion with complex deviated nasal septum. Nasal mucosal biopsy revealed atypical lymphoid cells with high anaplasia, and angiocentric spread in certain tumor cells suggesting lymphoproliferative disorder. Immunohistochemistry was positive for CD3, CD5, and CD7. Thus, diagnosis of extranodal aggressive PTCL was reached, and chemotherapy with CHOP regimen was initiated. However, following second cycle, the patient succumbed.

A case of a 10-year-old girl with rare association of temporomandibular joint anomaly with external and middle ear anomalies. It emphasizes on the importance of evaluating temporomandibular joint, mandibular condyle, temporal & petrous bone on HRCT in cases of external or middle ear anomalies for categorization, effective management, and reducing the overall childhood disability burden.

Background: Anaplastic thyroid carcinoma (ATC) is a rare, undifferentiated thyroid malignancy with a poor prognosis and rapid clinical progression. It accounts for less than 10% of thyroid cancers but contributes disproportionately to thyroid cancer-related mortality. Histologically, ATC exhibits significant pleomorphism and can present with diverse morphological patterns, often coexisting with differentiated thyroid carcinoma.

Case presentation: We report a case of a 39-year-old female with a 20-year history of anterior neck swelling, which rapidly progressed over six months. Imaging revealed a heterogeneously enhancing lesion in the right thyroid lobe with extrathyroidal extension and cervical lymphadenopathy. The patient underwent total thyroidectomy with central and lateral neck dissection. Histopathological examination demonstrated a high-grade malignant tumor composed of spindle-shaped, pleomorphic, and multinucleated giant cells with focal osteoid formation, consistent with ATC. A coexistent focus of papillary thyroid carcinoma was also identified. Immunohistochemistry revealed PAX8 negativity and SATB2 positivity, supporting its emerging role as a diagnostic marker for ATC.

Conclusion: This case highlights an unusual presentation of ATC in a relatively young patient. The presence of osteoclast-like giant cells and osteoid formation adds to the histological complexity. Accurate diagnosis requires a multidisciplinary approach integrating clinical, radiological, histopathological and immunohistochemical findings. Early recognition and surgical intervention are crucial given the aggressive nature and rapid progression of ATC. Emerging biomarkers like SATB2 may enhance diagnostic sensitivity, especially in challenging morphological variants.