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

We report an unusual case of recurrent parotitis caused by Streptococcus pneumoniae in a 23-year-old female university student with poor oral hygiene and vitamin D insufficiency. Despite multiple antibiotic courses, symptoms persisted, highlighting the complexity of diagnosis and management in such cases. Diagnostic workup included blood tests, which showed normal inflammatory markers, and magnetic resonance sialography, revealing two intraductal stones in the right parotid gland. Microbiological culture of purulent discharge from the parotid duct identified S. pneumoniae. The patient was successfully treated with levofloxacin, guided by culture sensitivity, along with parotid massage and hydration. Pneumococcal vaccination was recommended as a preventive measure, with no reported side effects after the first dose. This case underscores the importance of considering S. pneumoniae, an uncommon pathogen in immunocompetent adults, as a potential cause of parotitis. It emphasises the role of comprehensive diagnostics, including imaging and microbiology, in managing recurrent parotitis, especially when typical treatments fail. The case also highlights the potential interplay between oral hygiene, vitamin D status, and susceptibility to unusual pathogens in parotid infections.

Cutaneous metastasis from laryngeal carcinoma is an uncommon occurrence. We reported a man with laryngeal squamous cell carcinoma developed cutaneous metastasis on his neck and anterior chest wall after undergoing treatment. Thus, new skin lesions in laryngeal cancer patients may indicate cutaneous metastasis and it signifies poor prognosis.

We report a case of recurrence pneumocephalus in a 42-year-old man who underwent transnasal CSF leak repair for left lateral sphenoid meningocele, with thecoperitoneal(TP) shunt. The pneumocephalus was attributed to negative intracranial pressure created by an over draining shunt in the presence of multiple skull base defects.

Surgical techniques that are safe and effective in adults can produce bad results in children. The study was done To present the results of septoplasty and functional septorhinoplasty (FSR) in children in order to restore the anatomy and function of the nose. In a prospective study done in a tertiary care hospital between May, 2016 and November, 2022, twenty-five children (14 males and 11 females) aged 8 to 14 years having significant nasal obstruction due to deviated septum with or without external nasal deviation were included in this study. Septoplasty was done in 16 patients and FSR was done in 9 patients by endonasal technique. Surgical outcomes were evaluated by comparing preoperative and postoperative photographs, NOSE scores, anterior rhinoscopy and subjective satisfaction. The follow-up period ranged from 15 to 90 months with a mean follow-up period of 43 months. Out of the 25 patients, the mean NOSE scores preoperatively and postoperatively were 72 and 22 (a significant improvement of mean 50.00 with p-value of < 0.05). Anterior rhinoscopy postoperatively showed that 19 patients (76%) had a straight septum while 6 patients (24%) had some residual deviation. Subjective patient satisfaction was "much improved" in 13 (52%) patients, and "improved" in 12 (48%) patients. In photographic evaluation of 9 patients with external nasal deviation the result was very good in 3, good in 5 and average in 1 patient. Septoplasty and FSR in children resulted in significant improvements in nasal airway and external nasal deviation.

Segmental resections of the mandible may cause severe functional and aesthetic problems due to continuity loss. The morbidity after mandibular resection can be minimized after microvascular transfer of vascularized bone grafts. Although free flaps have become the gold standard in the past decades for reconstruction of oral cavity defects, regional flaps can also be a reliable option in certain cases, especially for those belonging to the lower socioeconomic corridor and or with coexisting chronic comorbidities which will not allow lengthier procedures. (Milenović A, Virag M, Uglešić V, Aljinović-Ratković N (2006) The pectoralis major flap in head and neck reconstruction: first 500 patients. J Cranio-Maxillofacial Surg 34(6):340-343); (Sabri A (2003) Oropharyngeal reconstruction: current state of the art. Current opinion in otolaryngology & head and neck surgery. 11(4):251-254); (Porcuna DV, Vintró XL, Vilas ML, Olmo AP, Ayala JM, Agustí MQ (2008) Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps. Acta Otorrinolaringologica (English Edition) 59(6):263-268) There are a very few reports of early oral cancers being reconstructed by PMMC flap. In this article, however, we have exclusively reviewed 247 cases of early oral cancer requiring marginal mandibulectomy and their reconstruction with PMMC flap thus justifying the name, the "workhorse flap" even in early oral cancers. This is a retrospective analysis of 5-year patient data collected from our institutional data register of 247 patients undergoing marginal mandibulectomy and reconstruction with PMMC flap between April 2017 to June 2022. No flap loss was reported. No cases were re-explored either for hematoma or for congestion. All patients recovered uneventfully. Although, in this era, free flaps dominate in the soft tissue reconstruction and PMMC is used only in certain advanced oral cancers, our study proves that it can be used safely in effectively in early oral cancer patients as well. Being a quicker procedure, PMMC flap reconstruction should be considered as a valid alternative in early oral cancers requiring marginal mandibulectomy, to overcome the increasing oral malignancy patient load belonging to low socioeconomic regions. To the best of our knowledge, this is the largest data ever published.

This study aims to establish a set of normal values for the objective evaluation of ocular movements using videonystagmography (VNG). Thirty individuals aged between 18 and 50 years, with no history of vestibular symptoms, recurrent headaches, central nervous system (CNS) symptoms, or cochlear symptoms, were selected. The assessment of five types of ocular movements (saccades, pursuit, optokinetic tests, spontaneous nystagmus, and gaze tests) were conducted using VNG. Normal ranges were established for different parameters of saccades, including latency, precision, and velocity in both horizontal and vertical directions for each eye. Pursuit gain was calculated for each eye in all four directions. Optokinetic gain was determined when the stimulation screen moved in all four directions. Symmetric responses were observed in all subjects. No spontaneous nystagmus was observed with fixation, although two participants exhibited nystagmus upon removal of fixation. Gaze tests revealed no abnormalities.

Aim of this paper is to present a literature review among bone conduction hearing aids particularly focusing on their surgical and functional outcomes.

Methods: A detailed review of the English literature to date on bone conduction hearing aids and outcomes have been performed using Pubmed, Scopus, Google Scholar and Medline databases. The literature review was performed using the guidelines proposed by the study "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)" for scoping review.

Results: a total of 30 full text articles were included in this review, collecting 660 patients. All the studies examined reported an improvement, in terms of PTA and speech audiometry, following the implantation of bone-conduction devices. The subjective outcome of patients was also evaluated, which was positive in terms of improved quality of life perception.

Conclusions: Bone conduction devices represent an excellent rehabilitative solution allowing adequate functional gain. Nowadays, the variability of devices consents an appropriate customization of the surgical indication based on the functional and general needs of the patient, to achieve a tailored approach.

Odontogenic Keratocysts (OKCs) are known for their aggressive behavior along with rapid expansion. Subepithelial hyalinization (SEH) is one of the causes of recurrence. The ability to predict this biological behavior histologically may help medical experts choose the best course of action. To investigate the aggressiveness of odontogenic keratocyst caused by SEH and its recurrence tendency in the north Indian population, this study will link differential staining methods with immunohistochemistry biomarkers that can be used in routine investigative procedures. Consequently, the evaluation and grading of SEH were established by measuring from the basement membrane to the extent of connective tissue. The levels were correlated to Ki67, Alcian blue, and O -safranine for validation. Forty OKCs were examined for the histological investigation of SEH using the immunohistochemical marker Ki67 and differential staining with O-safranine and Alcian Blue. The histological trait of separation of epithelium from the connective tissue interface due to SEH was noted. SEH-positive cases that were evaluated with Ki67, had increased proliferative activity. The differential staining techniques were validated with Ki67, cross-tabulations in SPSS, and kappa statistic value was given to analyze the results. Spearman's rank correlation was done between Ki67 vs Alcian blue and O-Safranine. A p value of less than < 0.05 was considered statistically significant. In SEH-positive cases, a higher proliferative index was observed. Additionally, histological metrics were statistically significantly higher in SEH-positive cases. Consequently, SEH is a reliable histopathological indicator in OKC for predicting recurrence. The presence of SEH indicates that OKCs are more likely to recur.

Angiomyxomas, also known as vascular myxolipomas, are a rare type of soft tissue tumor characterized by the proliferation of adipose tissue within a myxoid stroma accompanied by multiple vascular channels. They represent a distinct variant of lipomas and require differentiation from other benign and malignant lipoma subtypes. Despite their rarity, only a few cases of angiomyxolipoma have been documented in medical literature. We present a case of angiomyxolipoma occurring in the cheek of a 40-year-old female patient who presented with a long-standing history of swelling on the left side of her face. Histopathological examination revealed alternating nests of myxoid and adipose tissue containing dilated blood vessels, which confirmed the diagnosis of angiomyxolipoma. This case underscores the importance of recognizing and accurately diagnosing rare soft tissue tumors like angiomyxolipoma to guide appropriate management and follow-up care.

In this study, it was aimed to assess the microstructural changes in the main central auditory pathway in cases with subjective tinnitus. In total, 101 subjects (52 cases with bilateral subjective non-pulsatile tinnitus and 49 healthy cases as the control group) were included in the study. Participants underwent pure tone audiogram and Diffusion Tensor Imaging-Magnetic Resonance Imaging (DTI-MRI) examination with a 3 Tesla MRI device. The number of tracts, tract length, volume, and quantitative anisotropy (QA) and normalized quantitative anisotropy' (nQA) values were calculated by plotting cochleocortical pathways from the cochlear nerve to ipsilateral and contralateral Heschl's gyrus (HG). In pure tone audiometry, the control group had lower hearing thresholds than cases with tinnitus. Fibres and nQA values from the right cochlear nerve to the right HG were significantly lower in the tinnitus group than in the control group. Cochlear nuclei voxel counts were significantly decreased in the tinnitus group. Both cochlear nucleus volumes were higher in the tinnitus group than in the control group. nQA values in both cochlear nuclei were decreased in the tinnitus group. This study showed that the most commonly affected part in subjective non-pulsatile tinnitus cases is the cochlear nucleus. Therefore, the cochlear nucleus should be evaluated more carefully in cases presenting with subjective tinnitus.