Identification of Significant Anatomical Variations in the Nose and Anterior Skull Base Using Computed Tomography: A Cross-Sectional Study.

Introduction This study is aimed at the identification of anatomic variations in the nose, paranasal sinuses (PNS), and anterior skull base, which are substantially important to ensure safe and complete endoscopic sinus and skull base surgery. Materials and methods This cross-sectional study was conducted at the Dow Institute of Radiology, Dow International Medical College, Dow University Hospital. We included adult patients (i.e., those aged 18 years or older) undergoing a non-contrast CT of the nose and PNS. Two consultant radiologists reviewed the scans on the picture archiving and communication system independently. Any conflict was resolved with consensus. Anatomical variations in the nose, PNS, and anterior skull base of both sides were evaluated. Results We reviewed the CT of the PNS of 130 patients with an age of 35.8 ± 14.48 years (mean ± standard deviation). The proportion of men (64/130; 49.2%) and women (66/130; 50.8%) was equal. All patients had one or more variations. The most common abnormality was a deviated nasal septum (DNS), observed in 115 of 130 participants (88.5%) with unilateral occurrence predominant. It was followed by inferior nasal turbinate hypertrophy and agger nasi cells in 76.2% and 67.7% patients, respectively. Optic nerve variation type I (160/260 sinuses; 61.5%) and Keros type II, for olfactory depth (162/260 sinuses; 62.3%), were most common. Conclusions Here we report anatomical variations in PNS in all patients of our study; the commonest of all anatomical variations was a DNS. A CT scan is instrumental in surgical planning and patient safety in functional endoscopic sinus surgery.

Prevalence of EBV, CMV, and HPV in oral squamous cell carcinoma patients in the Pakistani population.

Many studies have proposed an important role of viruses in the pathogenesis of oral cancer. The present study aimed to find out the prevalence of Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human papillomavirus (HPV) among patients with oral squamous cell carcinoma (OSCC) in a Pakistani cohort. We investigated tissue samples obtained from 58 patients with OSCC using the polymerase chain reaction assay. No sample was positive for HPV. EBV was identified in 15 patients (25.86%), and CMV in three patients (5.17%). Coinfection with one or more viruses was detected in two cases and was coinfection with EBV and CMV. These results suggest a low prevalence of these viruses in OSCC patients in the Pakistani population compared to most other countries where the prevalence of these viruses has been reported in the past. Nevertheless, further studies are necessary to determine the potential role of EBV and the possible importance of CMV as an infection cofactor in oral cancer.

Role of Amphotericin B in Nasal Irrigation for Chronic Rhinosinusitis with Nasal Polyps.

OBJECTIVE: To determine the effect of topical antifungal irrigation fluid containing amphotericin B on nasal polyp and their recurrence pattern, and to study the association of serum IgE in predicting the presence of fungus along with the nasal polyps. STUDY DESIGN: An interventional study. PLACE AND DURATION OF STUDY: Dow University Hospital, Dow International Medical College, DUHS, Karachi, from June 2015 to June 2017. METHODOLOGY: All adult patients having nasal polyps, who had not undergone any previous nasal surgery, were included in the study. Patients aged under 18 years, history of granulomatous diseases, immunosuppression, invasive fungal sinusitis, and pregnant ladies were excluded from the study. The ratio was kept as 1:2; one receiving irrigation with amphotericin B and the other only saline nasal irrigation without the medicine. After surgery, the patients were divided into two groups; 58 patients were in the placebo group and 29 in the amphotericin group. Serum IgE levels were documented before and one month postoperative treatment. Serum IgE level of more than 250 ng/ml was taken as a high value. All the patients were followed for six months. Recurrence was defined as the recurrence of nasal symptoms and recurrence of mucosal thickening based on repeat CT scan. Frequency tables and cross tabulations using Chi-square test were performed with p-values of 0.05 taken as significant were performed on different variables. RESULTS: A total of 87 patients were inducted. Overall 22 (25.3%) patients had recurrence of symptoms at six-month followup visit. Twelve (13.7%) of these were in the placebo group and 10 (11.5%) were in the amphotericin B nasal irrigation group. Serum IgE level preoperatively ranged between 52 - 9344 ng/dl; postoperatively it ranged from 13-1050 ng/dl. When pre and postoperative serum IgE level were compared with each other and CT scan scores, using Chi-square test, the difference was significant (p<0.001). CONCLUSION: Amphotericin B improved the CT scan score of the patients. The nasal irrigation of amphotericin B did not show significant change in the recurrence pattern of chronic sinuses with polyps. Serum IgE can be used as marker for the presence and response to treatment for non-invasive fungal sinusitis.

Relationship of Oral Tumor Thickness with the rate of lymph node metastasis in Neck based on CT Scan.

OBJECTIVE: To determine the relationship of tumor thickness of oral lesions with metastasis in neck based on CT scan. METHODS: A total of 58 oral squamous cell carcinoma patients having the median age of 46 (39-55) years. with either gender presented with malignant tumor of buccal mucosa and tongue were prospectively enrolled. A CT Scan with contrast was performed on all patients. Correlation of tumor thickness level with metastasis in neck was calculated using spearman's rank correlation coefficient test. RESULTS: Median age of the patients was 46 (39-55) years with preponderance of male gender, i.e. 48 (82.8%). Strong positive significant correlation was observed in between transverse dimension (TS) tumor size and stages of tumor (rho 0.673, p-value <0.001), Anterioposterior (AP) tumor size and stages of tumor (rho 0.675, p-value <0.001), and Craniocaudal (CC) tumor size and stages of tumor (rho 0.771, p-value <0.001). CONCLUSION: CT scan of neck with contrast can be used for predicting the positive presence of lymph node in neck with primary tumors having a size of more than 4 mm.

Adenosquamous carcinoma of paranasal sinuses and Kartagener syndrome: an unusual combination.

A 34 years old non-smoker male patient reported with growth of right maxillary region which on histopathology confirmed adenosquamous carcinoma of nose and paranasal sinus. Patient also had total situs inversus including dextrocardia, bronchiectasis and sinusitis. His blood group was AB negative. This association of Kartagener syndrome with adenosquamous carcinoma of paranasal sinuses has never been reported. Carcinoma of paranasal sinuses accounts only 0.3% of all cancers. Adenosquamous carcinoma makes only 2% of the nose and paranasal sinuses tumours. Kartagener syndrome, AB negative blood group and adenosquamous carcinoma of paranasal sinuses all are extremely rare clinical conditions found in populations and the combination of all three in the same patient have never been reported to the best of authors' knowledge.

Extensive cutaneous malignant melanoma of head and neck.

Management of extensive cutaneous malignant melanomas of head and neck is usually a challenging problem especially if the tumour has nodal metastasis. A young female presented with fungating growth of right side of face extending up to the neck. Two months after surgery, she developed brain and lung metastasis. The oncological control at this advance stage is far difficult with surgical excision. In such cases, reconstruction of head and neck becomes questionable at times.