Sphenoid sinus mucocele with blindness: a rare presentation.

Isolated sphenoid sinus mucocele is a rare entity. Here we report a case of isolated sphenoid sinus mucocele in a 9 years old girl presenting with unilateral blindness and without any sinonasal complaints. C.T. scan revealed an isolated sphenoid sinus mucocele which was managed endoscopically. A brief review of literature is also included.

Myiasis infestation in postoperative mastoid cavity.

This is a case report of myiasis in modified radical mastoidectomy cavity in a 48 years old male presented in the Department of ENT and Head and Neck Surgery, T.U.Teaching Hospital, Katmandu, Nepal. Around 50 maggots were removed from his mastoid cavity. Patient was managed with turpentine oil and antibiotics which was given to prevent secondary infection. Literature search revealed only one case report of Myiasis infestation in a postoperative mastoid cavity.

OK-432: an effective sclerosing agent for the treatment of lymphangiomas of head and neck.

OBJECTIVE: The basic objective of this study was to find out the efficacy of OK-432 for the conservative treatment of lymphangiomas of head and neck regions at the Department of ENT-Head & Neck Surgery of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. METHODS: It was a hospital based prospective, cross-sectional, case series, conducted among the patients suffering from different lymphangiomas of head and neck regions and treated with intra-lesional injection of OK-432, from March, 2005 to September 2006. Altogether eleven patients were enrolled in this modality of treatment out of which one patient was excluded from the study, which was treated surgically due to very ugly scar at the site of lesion resulting from previous surgery for the same. The data were analyzed by using simple mathematical tools like percentage and frequency. RESULTS: Out of ten patients treated with intralesional injection of OK-432, absolute response, i.e. total resolution of swelling was found in nine patients (90%) after the first dose. Remaining one patient also responded well on the treatment but some residual swelling was in situ for which second dose was given. After the second dose it was also totally resolved. In this way we achieved 100% response after the second dose of OK-432. CONCLUSION: The results of this study so far indicate that OK-432 is an effective and safe tool for the treatment of lymphangioma of head and neck region. As the procedure can be done in an out patient department, without hospitalization and has got minimal side effects, it can be proposed as the first line treatment of lymphangiomas of head and neck.

Hearing results after myringoplasty.

BACKGROUND: Myringoplasty is one of the various surgical techniques for the management of chronic supurative otitis media of tubotympanic type (CSOM-TT). The presence of a perforation of tympanic membrane with intermittent discharge and hearing loss of conductive nature are the indications of myringoplasty. It is a beneficial procedure done for closing tympanic membrane perforation and improving hearing. OBJECTIVE: The aim of this study was to assess hearing improvement after myringoplasty within ten weeks following surgery. MATERIAL AND METHODS: The study population consisted of 50 patients who were suffering from CSOM-TT. Preoperative and postoperative examinations of the patients were conducted clinically as well as audiologically. Pre and postoperative air-bone (A-B) gap were calculated by taking the averages of bone conduction and air conduction at the frequencies of 500, 1000 and 2000 Hz. Myringoplasty was performed with underlay technique under local anaesthesia by either permeatal or endaural approach. Temporal muscle fascia was used as grafting material for reconstruction of the tympanic membrane. RESULTS: Preoperatively, air-bone gap of 30 db or more was observed in 39 (76%) patients whereas post operatively A-B gap of 30 db or more was observed in only one patient. Using hearings gain exceeding 15 dB as the criterion, thirty-nine (78%) patients had their hearing gain exceeding 15 dB. Using postoperative A-B gap within 20 dB as the criterion, 42 (84%) patients had their A-B gap within 20 dB. CONCLUSION: Myringoplasty is a beneficial procedure for hearing improvement. Using the proportion of patients with a postoperative A-B gap of 30 dB as the criterion, in this study, 98% of patients achieved their A-B gap closer within 30 dB. Using hearing gain exceeding 15 dB as the criterion, 78% patient had their hearing gain exceeding 15 dB.

Distribution of malignancies in head and neck regions and their management.

A retrospective, cross sectional, series of cases were currently studied in the department of ENT-Head & Neck Surgery of Tribhuvan University Teaching Hospital (TUTH) Kathmandu, Nepal to find out the distribution of different malignancies in head and neck regions and to identify their treatment modalities during the period of one year from January 2003 to December 2003. Altogether 159 new cases of histopathologically/cytopathologically confirmed malignancies of head and neck regions and their treatment modalities were analyzed. Out of 159 cases, malignancies of larynx (41), pharynx (31) and oral cavity (30) were found to be the commonest head and neck malignancies where as malignancies of ear (1), and salivary glands (4) were found to be the least common. Likewise surgery with or without radiotherapy and/or chemotherapy was found to be the commonest treatment modality. Of the 159 cases seven were occult primary. As the laryngo-pharyngo-oral malignancies are the commonest malignancies and surgery with or without radiotherapy and/or chemotherapy the commonest treatment modalities for these head and neck malignancies. A well equipped head and neck unit is needed at TUTH along with proposed radiotherapy and medical oncology support for better management of these malignancies.

Lipoblastoma in head and neck--a rare childhood tumour.

Lipoblastoma is an uncommon benign mesenchymal tumour that occurs primarily in children younger than 3 yrs of age. Despite the lesions being benign, great difficulty can be encountered in its management because of its tendency to invade the different fascial planes. A rare case of huge lipoblastoma diagnosed in a 22 months old child, involving various spaces of face and skull base has been reported. This huge tumour was completely and successfully removed through cheek incision without any postoperative complications.