Avoiding granulations and accidental decannulation in paediatric tracheostomy

Tracheal access, accidental deccannulation, peristomal granulation, stenosis and difficult weaning are the laryngologist’s dilemma, wherever tracheostomy has been resorted to, in the paediatric age group. These major problems necessitate a modification in the procedure of tracheostomy where ‘stay’ and ‘maturation’ sutures are utilized. The stay sutures facilitate a quick midline tracheotomy and the maturation ones minimise parastomal granulation and easy tracheal recannulation.

Results of Tragal Perchondrium and Cartilage in Middle Ear Reconstructive Surgery

Introduction: There will always be never ending quest tofind ideal graft material in middle ear reconstructive surgery.Of all the graft materials used till date the temporalis fasciastill enjoys the otologist’s favour. This study was an attempt tofind the results of the tragal perichondrium and cartilage in themiddle ear reconstructive surgery in terms of the graft uptakeand the hearing results in patients of the chronic suppurativeotitis media.Material and Methods: The present study was done inpatients of chronic suppurative otitis media patients. Thetragal perichondrium was used as a graft material for repair.The complete demographic and clinical data was collected.Following surgery, graft survival was studied and audiologicalassessment was carried out. The follow up of the patient wasfor atleast one year.Result: 30 patients were included in the study with 31 earsoperated. The overall graft uptake obtained in our study was80.65% and the hearing improvement that is 10dB air boneclosure was seen in 7 of the 12 ears (58.33%).Conclusions: The results of this study emulate the earlierdone tragal perichondrium and cartilage studies world over.The hearing results may not show the improvement as in otherstudies due to small number of patients studied. But overall,tragal perichondrium and cartilage serves as a good substituteavailable in adequate amounts in the vicinity of the surgicalfield.

Pneumocephalus after Ventriculoperitoneal Shunt: Diagnostic Dilemma and its Endoscopic Management.

Pneumocephalus, a common entity in neurosurgical practice is a very rare phenomenon after ventriculoperitoneal shunt insertion and generally is result of long-standing hydrocephalus causing bony erosion. Defect may remain completely plugged by gliotic brain tissue and meningeal scarring but lowering of intracranial pressure following shunt placement causes opening up of fistula and pneumocephalus. We report a case of a 55-year-old male with pineal region tumor with hydrocephalus who presented to us with severe headache after ventriculoperitoneal shunt insertion for hydrocephalus. Computed tomography (CT) head revealed tension pneumocephalus and pneumoventricle. Thin cut coronal CT images localized the air leak to left basifrontal region and patient underwent successful endoscopic transnasal skull base repair using fat and fascia lata graft. Pneumocephalus, a well-known condition in neurosurgery practice is extremely rare after shunt operations. Air can gain access to the intracranial cavity only when there is a break in basal structures in connection with the paranasal sinus, and when the nasal air pressure exceeds the intracranial pressure. Most cases resolve spontaneously but recurrent cases require definite repair. Thin axial CT cuts are used to localize the defect in the skull base. We add a new dimension to the treatment of this rare complication via endoscopic transnasal skull base repair technique.