Cerebrospinal fluid rhinorrhea: etiology, site of leakage and endoscopic management

To determine the etiology and site of leak of cerebrospinal fluid [CSF] rhinorrhea and the surgical efficacy of Functional Endoscopic Sinus Surgery [FESS], in closing the defect of CSF leak by different graft materials. Case series. Department of ENT-Head and Neck Surgery, Dow University of Health Sciences, Karachi, from September 2005 to December 2008. Clinical and pathological records of 23 patients who were diagnosed to have cerebrospinal fluid leak and managed by endoscopic approach were studied. Different graft materials alone or in combination were used endoscopically to seal the CSF leak. Results were obtained in terms of successful closure of the CSF leak, as evidenced by cessation of CSF rhinorrhea. Iatrogenic trauma, due to previous surgery, was the commonest cause in [n=9, 39%] patients. Lateral lamella of cribriform plate [fovea ethmoidalis] was the commonest site of leak [n=10, 43.5%]. The leak was closed solely by fat in 15 [65.2%] cases, combination of fat and middle turbinate mucosa [two layered] in 7 [30.4%] patients and temporalis fascia only in one patient [4.3%]. Successful closure of the CSF leak in the first attempt was achieved in 22 [95.6%] patients. Success rate achieved by endoscopic approach in this study was high. However, more data is required to prove the superiority of FESS over intracranial approach for management of CSF rhinorrhea

incidence of foreign bodies and its management in E.N.T. practice

To evaluate foreign body [F.B.] cases in the upper aerodigestive tract and to find out the outcome in their management, in children and adults. On going prospective study. This study was carried out in the department of ENT-Head and Neck Surgery, Lyari Gen. Hospital, Karachi for a period of one year from 1st August 2005 to 31st July, 2006 Patients who visited the Emergency Department or Department of ENT -Head and Neck Surgery, Lyari General Hospital, Karachi, from 1st August 2005 to 31st July, 2006 with a history of F.B. in ear, nose throat, esoghagus or bronchus. Out of 786 patients registered in the study, 652 [83%] were children [age 0-15 years], while 134 [17%] were adults [age above 15 years. The male to female ratio was 1.1:1 The commonest site of impaction of FB was ear in 45.67%, followed by nose. Among children, betel nut was the commonest FB found in 124 [15.77%], followed by rubber pieces in 89 [11.32%], plastic beads in 79 [10.09%], stones in 63 [8%] etc. Coin was found in 38 [4.83%] in the region of cricopharynx and upper oesophagus. The commonest FB among adults was the fish bone in 52 [6.61%], Betel nut is the commonest FB found in children in our region, in this study. 17% of all FB occur in adult age groups. The commonest FB found in adult Age group is fish bone found in 52 patients [6.61% of all FB] Rhinolith was the only FB found in adult noses

giant pleomorphic adenoma of parotid gland.

Pleomorphic adenoma is the most common benign neoplasm of parotid gland, generally presenting as slowly enlarging firm painless mass. The vast majority are 2-6 cm in size, when resected. We report a case of big water-melon sized parotid mass measuring 22 x 16 cm. It proved to be a pleomorphic adenoma. To the best of our efforts and literature search, this is the largest parotid mass ever resected in Pakistan. The mass was resected successfully without post-operative complications