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

Oral Rhabdomyosarcoma (RMS) are rare accounting for 10-12% of all head and neck tumors. In this case report we highlight the importance of combining the clinical, radiographic, and histopathologic examination to obtain a definitive diagnosis in sarcomas of the head and neck region, especially rhabdomyosarcoma.

Carcinoma ex pleomorphic adenoma (Ca ex PA) is a malignant epithelial salivary gland neoplasm that arises from or within a pleomorphic adenoma. It has been named Carcinoma ex mixed tumor, Carcinoma ex adenoma, and Carcinoma ex benign pleomorphic adenoma. Ca ex PA is rare and accounts for approximately. 3-6% of all salivary gland neoplasms and 11% of all malignant salivary gland tumors. Ca ex PA of the maxillary sinus is rare and has occasionally been reported as part of a large series. The present article reports two cases of maxillary sinus Ca ex PA.

Grisel's syndrome is a rare condition characterized by non-traumatic atlantoaxial subluxation, typically secondary to inflammatory processes or surgical interventions in the head and neck region. The literature suggests a rare incidence of approximately 1:100,000,000 per year without gender predilection.The syndrome is often associated with an abnormal head posture and can lead to serious neurological complications if not diagnosed and treated promptly. This paper reviews the pathophysiology, clinical presentation, diagnostic approach, and management strategies for Grisel's syndrome, emphasizing the importance of early recognition to prevent morbidity. A 7-year-old boy presented with torticollis, head tilt to the left, nasal obstruction, purulent nasal discharge, headache, and fever for 3 days. Examination showed painful head tilt to left, with neck rotation to the right and no neurological deficits. Nasopharyngoscopy revealed inflamed adenoid tissue with purulent discharge. CT scan showed a Fielding type I rotatory atlantoaxial subluxation. He was treated with intravenous antibiotics, analgesics, and a cervical collar. He became symptomatically better after 7 days of treatment and on follow-up, he had fully recovered and returned to normal activities. We performed a systematic review of the literature following the preferred reporting items for Systematic reviews. Literature searches were conducted in web-based search engines using MeSH terms and key words. Grisel's syndrome, though rare, should be considered in pediatric patients presenting with painful torticollis following upper respiratory infections or head and neck procedures. Prompt diagnosis through radiographic imaging and early intervention can prevent severe complications and improve patient outcomes.

Variations in the origin of the superior laryngeal artery hold significant clinical relevance in head and neck surgery. The current dissection report presents a rare common origin of the superior laryngeal artery and the lingual artery (in the form of a trunk) from the external carotid artery in coexistence with a superior thyroid artery variant origin from the common carotid artery (level of bifurcation). While such variants are uncommon, they highlight the necessity for precisely understanding their exact topography and morphological anatomy to prevent intraoperative complications.

Introduction: Obturator prostheses and removable prostheses still represent a valid option in head and neck cancer patients. The aim of the present article is to briefly review the current literature about the use of a digital workflow in the intraoral prosthetic rehabilitation of head and neck cancer patients.

Methods: The review included articles in English published from January 2010 to February 2023. Articles regarding patients who had undergone head and neck cancer treatment and intraoral prosthetic rehabilitation by a CAD-CAM techniques in at least 1 of the prosthetic treatment stages (scanning, design, and/or fabrication) were included.

Results: Nineteen articles with 72 described patients met the inclusion criteria and were included. Three types of removable prosthetic treatments were reported: 52 maxillary obturators, 19 provisional maxillary obturators, and 1 maxillary complete denture. As for 3-dimensional image capture, the most common method was intraoral scanner, followed by conventional CT scan. As for prosthetic procedures, all treatments incorporated at least a digital workflow in 1 of the stages, either in design or fabrication. Concerning the CAM phase, definitive cast printing was performed in 69 patients. Only 3 patient was rehabilitated by using a completely digital workflow.

Conclusions: A completely digital workflow was rarely used in the intraoral prosthetic rehabilitation of patients with head and neck cancer. The reduced laboratory working time, the avoidance of the risk of aspiration of impression materials, and the possibility of performing an adequate digital impression in spite of the trismus are important advantages associated with the digital workflow.

Background: Median palatine cysts are uncommon nonodontogenic lesions found in the midline of the hard palate with only 22 cases reported in literature hitherto. Often asymptomatic, they are frequently discovered incidentally during routine clinical examination. We report a case of large median palatine cyst with a novel technique to mitigate the risk of oronasal fistula and give a brief review on the current literature on the entity.

Case presentation: A 29-year-old male presented with recurrent purulent nasal discharge, right-sided nasal obstruction, fever, and headaches persisting for six months. Clinical examination revealed a mucosa-covered bulge obstructing the right nasal cavity and partially affecting the left. Intraoral examination identified a soft, fluctuant midline palatal swelling communicating with the nasal cavity. Computed tomography revealed a well-circumscribed midline opacity involving the hard palate and nasal cavity. Surgical excision was performed using a U-shaped mucoperiosteal flap. Intraoperatively, a breach in the nasal mucosa was noted, necessitating reconstruction with a buccal fat pad to prevent oronasal fistula formation.

Result: Histopathological examination confirmed the diagnosis of median palatine cyst, characterised by a fibro-collagenous cyst wall lined by stratified squamous epithelium. Postoperatively, the patient exhibited wound contracture with intact mucosa over the palate.

Conclusions: This case highlights the importance of timely diagnosis and appropriate surgical management of median palatine cysts to prevent complications such as oronasal fistula. The described surgical approach effectively addressed the cyst while minimizing the risk of postoperative complications, highlighting its efficacy in managing this rare entity. Long-term follow-up is essential to monitor for recurrence and ensure favourable outcomes.

Ewing Sarcoma, which is classified as an undifferentiated blue small round cell tumour, has been found to originate inside the bone, yet it can also develop in soft tissues as well (extraosseous type). These lesions are part of the round cell tumour group, which encompasses a wide variety of cancer types. Despite being present in other limbs and the thoracic region, this category has been shown to have less cancers in the head and neck area. It usually affects patients between the ages of five and twenty-five. Early diagnosis is facilitated by presentation in the jaw, yet the literature is sparse on the existing as well as reported cases of Ewing's Sarcoma of the Head and Neck Region. Thereby, this present case report one such unusual and rare presentation in 33-year-old-female, who reported to the department with the chief complaint of swelling on right side of the face for the past 6 months, which was then diagnosed to be a case of Extra skeletal Ewing's Sarcoma. Since the presentation of the lesion was similar to Oral Squamous Cell Carcinoma (OSCC), therefore such lesions should always be provided with a differential of Soft tissue Tumour. Therefore, such rare cases are needed to be documented in literature so that the diagnosing clinicians whether of head and neck and otolaryngologists, can consider this to be one of the differentials. The present case thus contributes to the limited pool of head and neck Extraskeletal Ewing Sarcoma reports.

To evaluate the clinical presentations and management outcomes in patients with extracranial head and neck schwannomas (ECHNS). This retrospective single-centre study included 16 patients diagnosed with ECHNS from 2017 to 2023. A comprehensive evaluation of patient demographics, clinical presentations, and radiological findings, followed by a detailed assessment of treatment modalities, was done. For analytical purposes, cases were stratified into two categories: major and minor nerve schwannomas, enabling systematic evaluation of both immediate surgical outcomes and long-term nerve function status with rehabilitative measures. Patient mean age was 42 years, with a male-to-female ratio of 9:7. The predominant clinical presentation was a painless, slow-growing neck swelling (n = 9), with two patients exhibiting pre-existing neurological deficits. Surgical resection was undertaken in 15 of 16 cases. Among patients with major nerve schwannomas, postoperative nerve palsy occurred in 88% (8 patients). In contrast, patients who underwent resection of minor nerve schwannomas experienced immediate symptomatic improvement without postoperative complications. Despite rehabilitation and follow-up periods ranging from 1 month to 5 years, complete neurological recovery was not observed in any patient with major nerve involvement. Surgical resection of minor nerve schwannomas had favourable outcomes. In major nerve schwannomas, there is a significant risk of postoperative nerve dysfunction, and hence, a more conservative approach is recommended. Further studies to understand the natural history of these neoplasms and to optimise patient selection and timing of surgery are required.

Septoplasty is a frequently performed procedure to address symptomatic deviated nasal septum (DNS). To minimize bleeding and stabilize the nasal septum after surgery, nasal packing is often utilized; However, it can cause considerable discomfort for patients. This study aimed to evaluate the outcomes of septoplasty with and without nasal packing, specifically examining postoperative pain, bleeding, and patient satisfaction. A prospective comparative study was conducted at a tertiary care institute, from September 2023 till October 2024, duration of 13 months. A total of 64 patients, aged 18 to 50 years, diagnosed with symptomatic DNS were included in the study. They were divided into two groups: Group A, comprising 32 patients who underwent septoplasty with nasal packing, and Group B, consisting of 32 Patients who Had Septoplasty Without Nasal Packing, using quilting sutures instead. Postoperative outcomes, including Pain (evaluated Using a Visual Analog Scale, VAS), bleeding, and patient satisfaction, were monitored during follow-up Visits at 2, 4, and 12 Weeks. Group B experienced significantly less postoperative pain and discomfort compared to Group A. Only two patients in Group B reported minor bleeding, which was managed conservatively. By the 3-month follow- up, all patients expressed satisfaction with the outcomes of their surgery. Septoplasty without nasal packing, utilizing quilting sutures, is a safe and effective alternative to traditional packing methods. This approach reduces postoperative discomfort and does not compromise surgical outcomes. Nasal packing should be reserved for patients at higher risk of postoperative bleeding.

Chronic rhinosinusitis is essentially the inflammation of the nasal passage and sinuses and is diagnosed as per the diagnostic criteria of European position paper on Rhinosinusitis and nasal polyps 2020 (EPOS2020). Eosinophilic and non-eosinophilic Chronic rhinosinusitis are defined based on the presence of greater than 10 eosinophils per high power field. This study aimed to study whether the use of preoperative steroids for surgical field preparation actually impacted our diagnosis of eosinophilic vs non-eosinophilic CRS contemplating eosinophils > 10/HPF as the cutoff in accordance with the EPOS2020 guidelines and whether any pathological parameter could be noted to predict recurrence. In this retrospective study a total of 53 patients were included and separated into steroid and non steroid groups based on whether they had received any pre-operative oral steroid preparation. We found that the use of pre operative steroid had no influence on the diagnosis of eosinophilic or non-eosinophilic chronic rhinosinusitis. The study also revealed that lack of neutrophilic infiltrates was a prognosticator for recurrence. Questions about pre-operative steroid preparation and tissue diagnosis have been addressed in some detail in Japan, China and even Korea; our study hints towards a similar truth for the Indian populace and in our review of literature we could not find any other study ascertaining the same for the Indian subcontinent.