Modified Stennert's Protocol in Treating Acute Peripheral Facial Nerve Paralysis: Our Experience.

The aim of this study was to know the effect of modified Stennert's protocol on Bell's palsy and delayed onset post traumatic facial nerve paralysis. Retrospective study method which included 26 patients was done. Of this 19 patients had Bell's palsy and seven patients had delayed onset post traumatic facial nerve paralysis. All patients started on modified Stennert's protocol. Nineteen patients were observed and had idiopathic facial nerve paralysis. Fifteen patients showed clinical improvement by the 10th day and by the end of 1 month, 18 patients showed significant symptomatic improvement. One patient had residual defects at 6 months. Of the seven patients with delayed onset post traumatic facial nerve paralysis, three patients had to undergo facial nerve decompression, the remaining four receiving only modified Stennert's protocol. Improvement was seen in three patients by the 10th day. By the end of 1 month a total of five patients showed significant symptomatic improvement. Our experience suggests that regardless of the cause, sudden onset facial paralysis responds favorably to administration of modified Stennert's regimen, resulting in faster recovery and lesser sequelae.

Customised acrylic nasal stents following recanalisation of modified Young's procedure.

INTRODUCTION: Maintaining the patency of the nasal vestibule following recanalisation of a modified Young's procedure can be a difficult task, as restenosis is quite common. MATERIALS AND METHODS: Sixteen patients underwent recanalisation of a modified Young's procedure, between January 2005 and December 2007, in the ENT--head and neck surgery department of a tertiary centre. Three different stent types were used following recanalisation: silicone suction tube tips, dental wax plate stents and customised acrylic stents. RESULTS: The silicone suction tube stents prevented restenosis. They were visible in the post-operative period, and there appeared to be some blunting of the nasal valve region, with no functional impairment. Dental wax plates had a high rate of restenosis and were uncomfortable and unsightly. The customised acrylic stents were more acceptable in the post-operative period, and enabled nasal valve angulation to be maintained. CONCLUSION: The customised acrylic stent described was a superior alternative to such stenting methods as repeated packing, silicone suction tubes and dental wax plates, following recanalisation of a modified Young's procedure.

Role of KTP-532 laser in management of oral submucous fibrosis.

INTRODUCTION: Oral submucous fibrosis is a chronic disease characterised by progressive inability to open the mouth. Various treatment modalities are available for its management, but these have largely been ineffective. MATERIALS AND METHODS: Nine cases of oral submucous fibrosis underwent a release procedure using a KTP-532 laser, from March 2005 to January 2006, within the ENT-head and neck surgery department of a tertiary centre. RESULTS: Pre- and post-operative mouth-opening was compared using the Wilcoxon signed rank test, and a significant difference observed (Z = -2.690, p = 0.007). Follow up over an average period of 12 months showed encouraging results. CONCLUSION: This preliminary study indicated that adequate release of oral submucous fibrosis can be achieved by using a KTP-532 laser release procedure, with minimal morbidity and satisfactory results. These promising results should encourage more widespread use of this technique in the management of this condition.

Endonasal endoscopic dacryocystorhinostomy: our experience.

OBJECTIVES: To study the outcome of endonasal endoscopic dacryocystorhinostomy (DCR) with or without mucosal flap preservation, without mitomycin local application, silicon tube stenting or laser assistance. To determine the duration of the surgical procedure of DCR, influence of simultaneously performed endonasal endoscopic procedures for concomitant sinonasal diseases. METHODS: Combined retrospective and prospective study in our tertiary referral center. 24 patients with chronic dacryocystitis underwent 25 standard endonasal endoscopic DCR procedures, 10 with and 15 without mucosal flap preservation. 6 of these had concomitant sinonasal diseases for which they underwent septoplasty or functional endoscopic sinus surgery (FESS) or both, simultaneously or as staged procedures. Relief from epiphora and patency of the nasolacrimal fistula was assessed by nasal endoscopy and syringing of the lacrimal apparatus at 1 week, 3 weeks and 3 months postoperatively. RESULTS: Out of 18 patients who underwent only DCR, 17 patients (94.44%) had complete relief from epiphora. Out of 6 patients who underwent 7 DCRs with concomitant sinonasal surgery, 5 patients (85.71%) had complete relief from epiphora. Overall 23 out of 25 DCRs (92%) had complete relief. In 15 of the 25 procedures, mucosal flap was excised completely. In remaining 10 procedures, flap was trimmed, repositioned to cover exposed bone around the newly created nasolacrimal fistula. In either situation, only one patient each had partial block of the nasolacrimal fistula. Average duration of the surgical procedure of DCR was 18 min. CONCLUSION: Endonasal endoscopic DCR is a viable alternative to external DCR, co-existing sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. It can be performed under 20 min without mucosal flap preservation, mitomycin local application, silicon tube stenting or laser assistance and can still provide a good success rate (92%) with less complications.

Conidiobolus coronata granuloma of left inferior turbinate: a rare presentation.

OBJECTIVE: To report a rare genus of a fungal family commonly affecting the sinonasal region, which presented as a fungal granuloma of the inferior turbinate in an immunocompetent host. Such a case has not previously been reported. CASE REPORT: A 49-year-old man presented with nasal conidiobolus limited to the left inferior turbinate, despite pre-operative fungal culture and tissue biopsy being negative for any fungal growth. On computed tomography scanning of the paranasal sinuses, and peri-operatively, the left inferior turbinate was seen to be enlarged and a bony, cartilaginous spur was found to impinge deep into the inferior turbinate. The spur may have caused microtrauma suitable for spore implantation, leading to fungal granuloma development. This unusual presentation highlights the fact that excision biopsy is diagnostic and therapeutic in such cases. CONCLUSION: Conidiobolus coronata of the inferior turbinate is rare. Such a fungal granuloma may be large enough to be confused with a benign or malignant lesion of the nasal cavity.

Oncocytic variant of a ductal retention cyst in the interarytenoid region.

Laryngeal cysts are a mixed group of benign lesions that have been classified as per their site of origin and histopathology. We report a case of an interarytenoid cyst in a 56 year old male with hyperparathyroidism. The cyst was resected under an operating microscope using KTP532 laser. It was reported on histopathology as an oncocytic variant of a ductal retention cyst.

Anterior pneumatization of the maxillary sinus - Presenting as a facial swelling.

Over pneumatization of the paranasal sinuses is a fairly common finding on computerized tomography; but involvement of a small segment of the maxillary sinus especially the anteromedial aspect is very rare. We report a case of a twenty year old male who presented with a facial swelling. On CT scan, the swelling was found to be due to pneumatization of the anterior part of the maxillary sinus. Surgical treatment was carried out for cosmetic reasons.