Retrospective study of descending cervical mediastinitis.

OBJECTIVE: Descending cervical mediastinitis can occur as a complication of oropharyhgeal and cervical space that spread to the mediastinum vis cervical space. Descending mediastinitis represent a virulent form of mediastinal infection requiring prompt diagnosis and treatment to reduce high morality associated with the disease. Surgical management and a particularly optimal form of mediastinal drainage remain controversial. METHOD: From 1998-2004, eighteen patients were treated in our institution. Surgical treatment consisted more than 2 times. Cervical drainage associated with drainage of the mediastinum through a thoracic approach in 11 patients with pleural drainage in 8 patients. RESULT: The outcome was favorable in eleven patients who had mediastinum drained through thoracotomy. One patient who was not drained died with tracheo-oesophageal fistula. Main culprit neck space is pre and para tracheal space which lead to anterior, superior and posterior mediastinal collection in our series. The tracheostomy is of immense help not only in opening cervical space collections and also to secure a partially compromised airway.

Actinomycosis of the parotid gland.

- Actinomycosis is a slowly progressive infection caused by anaerobic bacteria with relatively decreasing incidence now-a-days. The Parotid gland is a quite rere site to be involved in cervico-facial actinomycosis as compared to the other sites in the face & neck region. We report a successfully managed case of Actinomycosis involving the parotid gland.

Metronidazole ototoxicity--report of two cases.

Two cases of bilateral moderate to severe sensorineural hearing loss due to oral administration of metronidazole are reported. There has been only one case report of deafness following metronidazole therapy in the world literature. The hearing loss recovered gradually in a period of four to six weeks following withdrawal of drug and oral steroid therapy. The possible mechanism of ototoxicity is discussed. Awareness by the treating physician of ototoxicity due to any drug is stressed.

Malignant fibrous histiocytoma of ethmoid sinus.

Malignant Fibrous Histiocytoma (MFH) is a rare tumour to involve ethmoid sinuses. So far only 7 cases have been reported in the literature to our best of knowledge. The disease predominantly affected younger people with no significant sex prediliction. The aggressive behaviour of the tumour clinically is an important parameter to clinch the malignant nature of the disease. Wide surgical resection is the accepted method of treatment. Local recurrences are frequent and distant metastasis are not known from ethmoid sinus.

Dumb-bell schwannoma of brachial plexus.

A rare case of extradural dumb-bell schwannoma of brachial plexus, arising from C6 root is reported along with review of literature. The clinical and radiological features useful in diagnosing the lesion are presented. The treatment policy to be adopted and the importance of adequate surgical exposure is discussed.

Giant parotid calculus--an unusual presentation.

We describe a case of a giant sialolith of Stensen's duct in a 48-year-old woman. The patient was investigated and treated with a mistaken diagnosis of chronic inflammation until the clue to the diagnosis was provided by plain radiography. This is an unusual presentation of a salivary calculus and to our knowledge such a huge parotid calculus has not been reported so far in the literature.