Nasal Myiasis

BACKGROUND: Nasal myiasis is very distressing condition of the nose that occurs among patients with atrophic rhinitis. This condition is frequently found among those belonging to the lower socioeconomic status suffering from bad nasal hygienic conditions. A retrospective study was done of 58 cases of patients admitted for nasal myiasis. All the patients belonged to the lower socio- economic class and suffered from poor hygienic condition. The majority of the patients were over the age of 60 years and male female ratio was 1 : 1.5 .The primary complaints of this condition were epistaxis, foul smelling nasal discharge, passage of worms from the nose and pain. The majority of the patients were suffering from primary atrophic rhinitis and a few from the secondary atrophic rhinitis due to syphilis and leprosy. TREATMENT: As a first step of treatment, the maggots were removed manually and endoscopically. All the patients became maggot free in 2-3 days time. Alkaline nasal douching was then started along with 25% glucose in glycerine nasal drop. Complications such as septal perforation, saddling nose, palatal perforation were observed in a few cases. The incomplete closure of nose (modified Young's operation) was performed in a few cases. CONCLUSION: Manual and endoscopic removal should be done repeatedly. Antimeningitis prophylaxis should be started at once. And, to prevent recurrence, mosquito net should be used while sleeping, and incomplete closure of both the nasal cavity (modified Young's operation) should be carried out.

Choanal Atresia: Surgery by Puncture, Dilation and Stenting

BACKGROUND AND OBJECTIVES: The bilateral choanal atresia is a medical emergency for which surgery is the only and definite treatment. We performed an atretic bone perforation using Hagers dilators. The purpose of this study, then, is to evaluate the efficacy of this simple technique of perforation, dilation and stenting. MATERIAL AND METHODS: We studied five patients who underwent surgery for a complete bilateral bony atresia from 1994 to 2004. All the patients were newborn: two males and three females babies. The male female ratio was 1 : 1.5. Their age varied from 1 day to 4 days. The surgery was performed with Hagers dilators using the puncture and dilation technique. Stenting was carried out in all cases using a non cuffed endotracheal tube. RESULTS: The reestablishment of the nasal passage through a perforating atretic plate was considered a successful criteria of surgery. All the neonates had good nasal air passage after the perforation, dilation and stenting. Two of the patients who were with the CHARGE association died within 7 days due to causes unrelated to surgery. The other three patients had successful removal of stent after six weeks. There was no follow-up afterwards. CONCLUSION: The puncture, dilation and stenting technique by Hagers dilator is safe, quick and simple. It involves minimum blood loss and is without any complications. Stenting, therefore, is essential for preventing restenosis.