Effects of type 3 thyroplasty on voice quality outcomes in puberphonia

@#p style=text-align: justify;strongOBJECTIVES:/strong To assess effects of type 3 thyroplasty on outcomes of voice quality in puberphonia.METHODS:br /Design:/strong Prospective cohortbr /strongSetting:/strong Tertiary Referral Hospitalbr /strongParticipants:/strong Six patients with puberphonia who failed voice therapy, aged 16-25 years, who consulted at the ENT Outpatient department between September 2010 and September 2012, underwent type 3 thyroplasty.Pre-operative and 6-month post-operative voice analysis by voice recordings, Voice Handicap Index (VHI), GRBAS score and real time acoustic analysis (perturbation) using Dr Speech software (University version 4.0, Voice Tech Corporation, USA [Tiger Electronics] with habitual fundamental frequency (FO), jitter % and shimmer % as parameters were performed.Results: Mean pre-operative VHI and GRBAS scores were 53 and 75.67, respectively, whereas post-operative scores were 29 and 25.00, respectively. (P-value for VHI was 0.004 and that of GRBAS was 0.00). On acoustic analysis, mean pre-operative habitual fundamental frequency (FO), jitter % and shimmer % was 245.82 Hz, 0.21 and 2.34, respectively, whereas post-operative mean was 140.78 Hz (P=0.00), 0.19 (P=0.04) and 1.52 (P=0.00), respectively.Conclusion: The mainstay of treatment of puberphonia is voice therapy. Thyroplasty provides a suitable management option in those cases who fail to respond by voice therapy./p

Carcinoma ex pleomorphic adenoma in the parapharyngeal space

@#<p><strong>OBJECTIVE:</strong> To present a case of carcinoma ex pleomorphic adenoma in the parapharyngeal space and discuss its management.<br /><br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Teaching Hospital<br /><strong>Patient:</strong> One<br /><br /><strong>RESULTS:</strong> A 40-year-old male patient with dysphagia for three months and a left-sided mucosa-covered oropharyngeal mass was found to have a prestyloid parapharyngeal lesion on CT scans. Fine Needle Aspiration Cytology (FNAC) revealed a pleomorphic adenoma. With a past history of parapharyngeal pleomorphic adenoma excised transorally three years before, the present mass was excised by mandibular swing approach. Post-operative recovery was uneventful but the final histopathological report was carcinoma ex pleomorphic adenoma. <br /><br /><strong>CONCLUSION:</strong> Malignant transformation should be suspected in recurrent salivary tumors in the parapharyngeal space. Provided there was truly no pre-existing malignant focus in the originally-excised tumor, and that early recurrence was not due to inadequate initial excision, this patient had a rare condition where the same tumor underwent malignant transformation within three years only. To the best of our knowledge, such an early transformation to malignancy of a minor salivary gland tumor of the parapharyngeal space has not been reported in the English literature.</p>

Ectopic thyroid tissue- A case series

@#<p><strong>OBJECTIVE:</strong> To describe the clinical presentation and course of seven ectopic thyroid patients. <br /><br /><strong>METHODS:<br />Design:</strong> Retrospective Chart Review<br /><strong>Setting:</strong> Tertiary Government Teaching Hospital<br /><strong>Patient:</strong> Seven patients<br /><br /><strong>RESULTS:</strong> Five patients were female and two were male (ratio of 5:2). Three belonged to the 20 to 30 year-old age group, whereas two were below 10 years of age. All seven were biochemically hypothyroid and ectopic thyroid was found to be the only functioning thyroid tissue. Three patients were managed medically with levothyroxine, while ectopic thyroid was excised in four. Ectopic thyroid tissue was autotransplanted in two cases following excision.<br /><br /><strong>CONCLUSION:</strong> The ages of presentation in the present series correspond with the increased physiological demand of thyroid hormone. Thyroid substitution therapy is a must in the presence of clinical and/or biochemical hypothyroidism. Surgical excision should be avoided as far as possible especially if the ectopic tissue is the only functioning thyroid in the body. Surgery is required in selected cases presenting with obstructive symptoms or hemorrhage which are unresponsive to substitution therapy. Auto transplantation of the ectopic thyroid may not provide significant benefit to the patient and more research is warranted in this aspect.</p>

Giant cell tumor of the maxilla

@#OBJECTIVE/strong: To present a rare case of maxillary swelling; its investigation and management.br /br /strongMETHODS/strong:br /strongDesign/strong: Case Report br /strongSetting/strong: Tertiary Government Teaching Hospital br /strongPatient/strong: One br /br /strongRESULTS/strong: A 45-year-old female presented with a right maxillary swelling of six months duration. Radiological investigation revealed a radiolucent lesion arising from the inferior aspect of the right maxilla with no areas of calcification. Incisional biopsy report was consistent with giant cell tumor. The mass was excised via a Weber Ferguson incision under general anesthesia.CONCLUSION/strong: Though rare, giant cell tumor should be considered as one of the differential diagnosis in cases of maxillary swelling. Adequate surgical excision with long-term follow-up should be the treatment of choice for managing a giant cell lesion of the maxilla./p

Sino nasal malignant melanoma: a case series

To present a retrospective case series of Sino-nasal malignant melanoma cases consisting of eight cases, their clinical presentation, management protocol and treatment outcome.: Retrospective review of 8 sino-nasal melanoma patients with their clinical profile, investigation result and treatment outcome with comprehensive review of literature. The 5-year survival rate in this small series was nil. Local failure with skull base invasion was noticed in 3 cases. Distant metastasis was noticed in 4 cases. Advanced sino nasal malignant melanoma carries a poor prognosis as seen in the present series. Early diagnosis and adequate surgical excision is beneficial in managing these lesions

Supernumerary nostril - an unusual case report

Developmental anomalies of the nose encompass a diverse group of conditions. Embryologic development anomalies of the nose include nasal dermoids, gliomas, encephaloceles, nasal clefts, proboscis lateralis, arhinia, polyrrhinia, nasopharyngeal teratoma, and epignathus. Supernumerary nostril is a very rare congenital anomaly. We report such a case with review of literature. Embryology of nasal development and embryogenesis of duplication anomalies are discussed in this review

Management of salivary gland tumours: a 10 years institutional experience

A retrospective longitudinal study was conducted on 166 patients of clinically evident salivary gland tumours over a period of l0years with the main aim to assess the prognosis of the various surgical techniques used in the management of salivary gland tumours. All the patients underwent detailed clinical examination and FNAC. CECT and MR scan were done whenever indicated. After meticulous assessment of the extent and establishment of the cytopathological diagnosis, these cases underwent surgical excision of the tumour. Various surgical approaches were described for the excision of the tumours of various size, type and extension, with or without nodal metastasis. Neck dissection was done in 54% cases of salivary gland malignancies. Excisional biopsy was done in all of the cases. Post-operative radiotherapy was given in 26% cases. 6% cases of malignant salivary gland tumours showed recurrence

Malignant peripheral nerve sheath tumour of parapharyngeal space

Sarcomas account for only 1% of all head and neck primary cancers. Of all soft tissue sarcomas only 5% are neurogenic sarcomas [malignant peripheral nerve sheath tumour] and upto 20% of these lesions occur in the head and neck region.[1,2] About 50% of these tumours are associated with neurofibromatosis type I. Sporadic cases usually occur during the 4[th], 5[th] or 6[th] decades of life with equal sex predisposition[1]. Painless enlarging neck mass with or without neuropathy is the usual presenting feature [3]. Differentiating neurofibrosarcoma from other spindle cell sarcomas, e.g., malignant fibrous histiocytoma, fibrosarcoma or leiomyosarcoma can be very difficult without immunohistochemistry. Wide local excision is the treatment of choice [3, 4] but prognosis is poor for high grade tumours, tumours larger than 5 cm in diameter, if surgical margins are not free from tumour and in patients with neurofibromatosis[1, 4]

Capillary hemangioma of the sphenoid sinus

Hemangiomas of the paranasal sinuses are rare, particularly those of the sphenoid and ethnioid sinuses. Although imaging of the sinuses is key to determining the extent of involvement, the diagnosis is based on the lesions histologic appearance. We describe a new case of sinonasal hemangioma originating in the sphenoid sinus and we discuss the diagnostic and therapeutic interventions