ABSTRACT
In all head and neck bullet injuries, treatment has to be individualized, as there is no universal protocol for all cases. Five important steps of management should be taken: securing airways, hemorrhage control, recognizing other injuries, foreign body removal when necessary, and repair of facial wounds. In this report, the case of a 28-year-old male patient will be presented and discussed. The patient was referred from a surgery clinic to an ear, nose and throat (ENT) outpatient clinic complaining of right neck pain, throat pain, and foreign body sensation in the throat for 2 months following a firearm injury to his face. The entry wound was observed on the left alar cartilage of his nose, which was almost healed and had left a scar. A sinus computed tomography scan showed a bullet in the right parapharyngeal space about 3 mm in front of the first vertebral body. The bullet was successfully removed using a trans-nasal endoscopic approach with the support of an image-guided navigational system and frequent fluoroscopy. These 2 methods help to replace the old traditional open approaches.
Subject(s)
Firearms , Foreign Bodies , Wounds, Gunshot , Adult , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Humans , Male , Parapharyngeal Space , Vertebral Body , Wounds, Gunshot/diagnostic imaging , Wounds, Gunshot/surgeryABSTRACT
Foreign body neglected in the nasal cavity for many years leads to the formation of a rhinolith, which gradually increases in size. Nasal obstruction and persistent foul smelling nasal discharge usually are the main presenting symptoms, although some might be silent. This paper presents and discuss a case of 19-year-old female patient whose main complaint was nasal obstruction for many years and treated as allergic rhinitis. Diagnosis was confirmed with computed tomography scan, and it was removed endoscopically without complications. We think that proper examination, which includes endoscopic evaluation, should be done to reach the diagnosis. A computed tomography scan confirmed the diagnosis and helped in planning the best treatment option.
ABSTRACT
BACKGROUND: We have conducted this study to evaluate the effect of antibiotics, whether oral or intravenous, compared to no antibiotic protocol on post-tonsillectomy morbidity. METHODS: A total of 270 patients aged 3 - 12 years were included in the study. Patients were assigned into three groups randomly; each group consisted of 90 patients. In the first group (group A), patients were given intravenous injections of ceftriaxone 50 mg/kg/24 hours in divided doses, the second group (group B) received oral co-amoxiclav (dose according to weight) for 5 days post-operatively, and in the third group, patients were not given antibiotics. Patients were evaluated for the incidence of any bleeding, number of days before resuming normal diet, incidence of nausea and vomiting, incidence of abdominal pain, frequency of analgesic use in the first week, and pain. RESULTS: Our study groups were comparable in age, gender, and weight. There were no statistically significant differences between our study groups with regard to the incidence of post-tonsillectomy bleeding, time relapsed to resume normal diet, and pain score scale. Incidence of nausea, vomiting, and abdominal pain was more in the oral antibiotic group, and it was statistically significant. CONCLUSION: We do not recommend the routine use of antibiotics in post-tonsillectomy period in pediatric age group and oral antibiotics prove to have worse outcome with regard to the incidence of nausea, vomiting, and abdominal pain, and these recommendations need to be evaluated by multicenter evaluation.
ABSTRACT
OBJECTIVE: To evaluate the current practice in requesting and performing paranasal sinuses CT scan for patients scheduled for endoscopic sinus surgery, and to describe the current hospitals practice in performing these scans. METHODS: This cross-sectional questionnaire study was conducted in the King Hussein Medical Center, Amman, Jordan between April and May 2010. Three forms were designed to collect data from our study groups, which included: Ear, Nose and Throat (ENT) surgeons, radiologists, and the radiology sections in 3 hospitals. The first was designed for ENT surgeons and aimed at investigating, whether or not they perform endoscopic sinus surgery, and if they have specific requirements for a CT scan of the sinuses. The second was designed for the radiologist to investigate their specifications in performing CT of the sinuses. The last was designed to evaluate the current practice of performing CT of the sinuses at the 3 hospitals. RESULTS: Twenty-four ENT surgeons participated, 83.3% surgeons performed endoscopic sinus surgery, and 83.3% requested specific specifications for the sinuses CT scan, and the most requested specification was coronal plane in 42%. Of the 24 radiologists, 71% prefer the prone position, 71% prefer the coronal plane, and 71% preferred direct coronal. In all 3 hospitals, the axial plane with reconstructed coronal images, the current practice with a slice thickness of 2-3 mm, and the total number of images was 40-50. CONCLUSION: Differences between ENT surgeons, radiologists, and hospitals practice and other hospitals guidelines found in literature are present. Therefore, we are in need of an agreed upon guideline protocol to obtain the best data with the least radiation dose.
