Schwannoma of nasal inferior turbinate in young male: a rare occurrence

A 12-year old boy presented to the ENT Department of Abbasi Shaheed Hospital, Karachi, with a one year history of progressively increasing unilateral right sided nasal obstruction. He denied any other symptoms like that of rhinorrhea, epistaxis, facial pain, headache and any history of nasal trauma. After routine clinical examination, CT scan nose/PNS with contrast was advised and subsequently biopsy was done that revealed the mass to be as schwannoma. This was then removed via a lateral rhinotomy approach and the postoperative specimen again revealed the same. The boy was followed for 1-year and no recurrence is seen. He is still in the follow-up phase

Facial nerve morbidity following surgery for benign parotid tumours

To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. A case series. ENT Department, Karachi Medical and Dental College and Abbasi Shaheed Hospital and Ziauddin University Hospital, from 1990 to 2010. Data was collected of all patients who were surgically managed for benign parotid tumours from 1990 to 2010. Data was reviewed for presentation of tumour, age and gender of the patient, site of tumour, nature and morphology of the tumour, primary or recurrent, surgical procedure adopted and the complications of the surgery especially the facial nerve dysfunction, its severity, complete or partial paresis and transient or permanent and time of recovery. Results were described as frequency percentages. Out of 235 patients, 159 [67.65%] were female and 76 [32.35%] were male. Age ranged from 18 to 70 years. Pleomorphic adenoma was the most common tumour [n=194, 82.6%], followed by Warthin's tumour. Superficial parotidectomy was done in 188 cases and extended parotidectomy in 47 cases. In the immediate postoperative period facial nerve function was normal in 169 [72%] patients and nerve dysfunction was observed in 66 [28%] patients. Complete paresis involving all the branches of facial nerve was seen in 25 [10.6%] patients and 41 [17.4%] patients were having incomplete dysfunction. Of these, 62 [26.3%] recovered and 04 [1.7%] had permanent facial nerve dysfunction. Marginal mandibular branch of facial nerve was involved in 57 [86.3%] cases. The frequency of temporary and permanent facial nerve dysfunction was 26.3% and 1.7% respectively in 235 consecutive parotidectomies for benign parotid gland tumours. Higher frequency of facial nerve dysfunction was found in recurrent and deep lobe tumours

Fibrous dysplasia of mandible

An elderly male presented to the ENT, Outpatient Department at Abbasi Shaheed Hospital [ASH] with a mass on the left side of the face and lower jaw for 8-9 years. It was of a tennis ball size. No treatment was sought by him during those years. A diagnosis of benign fibro-osseous lesion of the mandible was made. Later the histopathology proved the same. The first occurrence in a male gender and involvement of the mandible is uncommon

Postembolization infarction in juvenile nasopharyngeal angiofibroma

We report the occurrence of cerebro-vascular accident, following selective embolization of internal maxillary artery [IMA] in a young male patient aged 18 years admitted at ENT Department, Abbasi Shaheed Hospital [ASH] with diagnosis of recurrent juvenile nasophayrngeal angiofibroma [JNA]. Angiography and selective trans-femoral embolization was done as an adjunctive measure before the definite surgical removal of this benign tumourous condition. The child developed weakness of the right half of body with slurred speech and drowsiness. CT scan of brain revealed the diagnosis of postembolization infarction. The patient recovered with no obvious signs of clinical residual weakness. Surgical excision after ligation of feeding vessel has been planned

Brown tumor of maxilla - a rare occurrence

We report a case of a middle age male patient who presented in our outpatient department at Abbasi Shaheed Hosptial [ASH] with a swelling at [L] half of face and [L] half of hard palate that histologically proved to be a Brown tumor of Maxilla with normal parathyroid hormone [PTH] levels and an elevated serum Ca[++] levels. The site of brown tumor in our case is a rarity. Our aim for presenting this case report is to highlight the rare site of presentation and to emphasize t he multidisciplinary approach incorporating the maxillofacial surgeons, endocrinologists and radiologists for the optimum patient care and management

Role of antibiotics in the pre and post tonsillectomy period in reducing the morbidity associated with tonsillectomy

The aim of the study is to see the role of pre and post operative antibiotic used in the cases for which tonsillectomy was planned as a primary surgical procedure with or without adenoidectomy, for effects on peroperative blood loss, ease of surgery, postoperative fever and pain, incidence of secondary heamorrhage and return to activities of daily living [ADL]. Department of ENT and Head and Neck Surgery, Abbasi Shaheed hospital, Karachi, from June 2006 - December 2006. Prospective, double blind study. The cases which were selected for tonsillectomy were included in this study. Their full informed and written consent was obtained prior to their inclusion in the study. Two groups were made each consisting of 50 patients. In group I [intervention group] preoperatively antibiotic was used for a period of 3 days and continued for another 5 days postoperatively. The antibiotic used was Amoxicillin-Clavulanic acid according to the weight of the patients [50mg/kg/day]. In the group II [control group] no preoperative or postoperative antibiotic was used. Analgesia was given on the need and demand basis in both the groups. Pain for adult was categorized by using a pain rating scale by the British Pain Society and pediatric age group the modified Toddlers Preschooler Postoperative Pain Scale [mTPPPS]' was used. The questionnaires were given on daily basis to them for 5 days postoperatively, results recorded and then compared. Both of these groups were not aware of each other. The parameters monitored were amount of peroperative blood loss, ease of surgery, whether or not the patients had postoperative fever, secondary heamorrhage rate, pain status and return to activities of daily living. The method for tonsillectomy used was dissection method [cold steel dissection method with ties for hemostasis]. There was a significant reduction in the amount of peroperative blood loss and early return to daily activities in group land also there was an ease of surgery because of less friability of tissue and less infection and bleeding as compared to group II where the patients had a significant amount of bleeding peroperatively and delayed return to activities of daily living with a bit difficulty experienced in dissection. The incidence of post tonsillectomy [secondary] heamorrhage was not found to be of significance suggesting that there might be some other factors that may lead to this complication despite the fact that antibiotics was used in group I in comparison to group II. The level of pain experienced post operatively was not affected in either group suggesting that antibiotics do not help in decreasing or alleviating it, Fever occurred in 3 in group I while 6 had fever in group II. Seeing the results of this study we would recommend the use of pre and post operative antibiotics for the tonsillectomy patients

Surgical management of CSOM in a Tertiary Medical Centre

To determine the surgical outcome of chronic suppurative otitis media [CSOM] in term of anatomical and functional results. This study was conducted in the department of E.N.T. Abbasi Shaheed Hospital, Karachi, over a period of one year from Jan 2002 to Jan 2003. 50 consecutive patients were included in this study presented with chronic suppurative otitis media. All cases were enrolled in previously prepared performa which include pertinent clinical history and examination, results of related investigations, surgical findings, surgical techniques adopted and final out come. Total 50 patients were included in this study, of which 23 were male and 27 female with the ages from 2 years to 53 years. Surgical techniques included the intact canal tympanoplasty in 15[30%] patients and canal wall down tympanoplasty in 20[40%] patients. In the canal wall down technique, cavity problems were observed in 3 [8.5%] patients. Graft takes were good in 33 [94%] patients and functional results in term of gain in hearing were observed in 31 [88.5%] cases. CSOM may associate in some farm of irreversible sequelae or pathological condition of the middle ear. It is the disease of low socioeconomic group. The infection may be mixed and polymicrobial, however complications are rare because of the invention of effective antimicrobial agents. Anatomical and functional results were good in our series and this is due to good pre-operative assessment, use of proper surgical techniques and long term follow up