Choanal atresia; diagnosis and simple endoscopic repair at remote primary care centers

Choanal atresia [CA] is a rare, congenital malformation resulting as a failure in communication between the posterior nasal cavity and the nasopharynx. The clinical course is often asymptomatic in unilateral CA leading to higher rates of misdiagnosis, in comparison to bilateral CA, which manifests itself as a surgical emergency at birth. Most cases present as isolated malformations, but it may also be associated with other congenital anomalies in 20-50% of cases. Currently, the most important diagnostic tool for CA is computerized tomography [CT] and confirmatory diagnosis is usually achieved with the help of nasoendoscopic examination. Although, different surgical approaches have been used in the past, transnasal endoscopic repair is currently preferred over others. Herein, we describe our experience of three cases and share our simple stentless endoscopic technique, to facilitate physicians working in low facility units for a timely diagnosis and prompt treatment

Endoscopy in rhinolithiasis

Rhinolith is a stone like nasal mass uncommon in children and adolescent. Diagnosis of rhinolithiasis may be difficult because of the possibility of varying clinical presentations. We report 2 cases in adults. The first was 23 years old female having unilateral nasal obstruction, cacosmia and occasional blood stained nasal discharge. The second case was that of a 47 years old male having unilateral foul smelling nasal discharge, progressive unilateral nasal obstruction, anosmia and atypical facial pain. Both were diagnosed on anterior rhinoscopy and rigid endoscopic examination of nose. Radiological evaluation of nose and paranasal sinuses were performed to confirm the diagnosis. These rhinoliths were removed using zero degree rigid nasal endoscope. Salient features of such large rhinoliths and the role of rigid endoscope in the diagnosis and treatment are discussed briefly enabling the attending physician to be aware of this infrequent entity in adults which requires high index of suspicion

Rhinosporidiosis

Rhinosporidiosis is chronic granulomatous parasitic infection caused by Rhinosporidium seeberi. The organism is now classified under mesomycetozoa as a parasite. It predominantly affects mucous membrane of nose and nasopharynx but other sites are also involved. It is non-contagious sporadic disease which is notorious for its high rate of recurrence and vascularity. We report a 32 years old Indian male who presented in outpatient department of Rafha Central Hospital with complaint of recurrent epistaxis, intermittent left nasal obstruction and pedunculated fragile mass coming out from left nostril after forceful blowing of nose. Diagnosis was established by histopathology of partially excised lesion with high index of suspicion for rhinosporidiosis due to strawberry-like appearance of fragile polypoidal mass. The treatment involved total surgical excision of the lesion with electrocoagulation of the base using rigid nasal endoscope. This case is reported due to its rarity and high recurrence after surgical excision

Management of pleomorphic adenoma of salivary glands

By far the most common benign neoplasm of salivary origin is the pleomorphic adenoma. It is often poorly capsulated and has bosselated surface hence more chances of recurrence after excision

Objectives: to find out the recurrence rate after superficial or total conservative parotidectomy and in case of minor salivary tumours, wide surgical excision

Design of study: prospective study

Setting: Department of ENT Allied/DHQ Hospital Faisalabad

Period: apr 1994 to Dec 1998

Material and methods: 25 cases of benign salivary swellings [22 male and 3 females] were selected after confirming FNAC report to be pleomorphic adenoma. These patients were subjected to surgical excision of the tumour by superficial/total conservative parotidectomy or excision with healthy cuff of tissue

Results: only one patient having tumour spillage during excision has recurrence in scar incision during five years follow up

Conclusions: it seems reasonable to advocate superficial parotidectomy for benign pleomorphic adenoma of parotid and excision with a wide cuff of healthy tissue in case of minor salivary gland adenoma and to avoid capsular rupture at all costs

Malignant otitis externa

Malignant external otitis is a serious pseudomonas infection of the external ear which when untreated may extend towards the base of the skull. To find out the results of conservative treatment and compare it with previous studies. To diagnose this condition at its earlier stage to improve the prognosis. Design: Case study. Setting: ENT Department Punjab Medical College Hospital Faisalabad. Period: Mar 86 to March 1996. Subjects: Fifteen patients, 9 females, 6 males between the ages of 20-26 years, all diabetics presented during the period Mar 86 to Mar 1996. Diagnosis was based upon clinical findings and positive pseudomonas aeruginosa in culture of ear swab. Local debridement, cleansing local drops and systemic use of aminoglycoside with third generation cephalosporin in resistent case used for treatment. 9 Females and 6 Males all between 20-26 years of age presented with pain, discharge, edema, granulations and fever. All were confirmed diabetics and ear swab revealed pseudomonas aeruginosa. Local cleansing with local and systemic aminoglycoside was sufficient in 10 cases but in 5 cases Ceftazidime was also added. Antibiotics were continued 4 weeks after control of symptoms. 13 patients [86.6%] cured without any long term complications, 2 patients [13.3%] died due to MEO. Malignant otitis externa through a dangerous infection can be cured on conservative treatment if diagnosed early