ABSTRACT
OBJECTIVE: A non-surgical approach for managing rhinosinusitis associated with chronic oroantral fistula resulting from tooth extraction was evaluated. METHODS: Twenty-six consecutive patients (15 males and 11 females) aged 28-72 years (mean, 49.81 years) were administered local decongestion therapy for 2 weeks and antibiotics for 10 days. Patients showing a reduction in Sino-Nasal Outcome Test 22 scores after two weeks continued to receive local decongestion therapy weekly for up to six weeks, while those not showing any improvement underwent surgical management. RESULTS: At 2 weeks, 17 patients (65.38 per cent) showed an improvement in rhinosinusitis (33.39 per cent mean reduction in Sino-Nasal Outcome Test 22 scores). The primary determinant of response was fistula size. At 6 weeks, sinusitis resolved completely in all 17 patients, and the fistula closed in 16 of these. Final Sino-Nasal Outcome Test 22 and Lund-Mackay scores showed no significant difference between the surgically treated and non-surgically treated groups. CONCLUSION: Local decongestion therapy along with antibiotics may promote resolution in this subset of rhinosinusitis patients.
Subject(s)
Anesthetics, Local/therapeutic use , Anti-Bacterial Agents/therapeutic use , Imidazoles/therapeutic use , Lidocaine/therapeutic use , Nasal Decongestants/therapeutic use , Oroantral Fistula/drug therapy , Postoperative Complications/therapy , Rhinitis/drug therapy , Sinusitis/drug therapy , Tooth Extraction , Administration, Topical , Adult , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Oroantral Fistula/complications , Oroantral Fistula/diagnostic imaging , Rhinitis/diagnostic imaging , Rhinitis/etiology , Sinusitis/diagnostic imaging , Sinusitis/etiology , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: To determine anatomical variations in the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle, and to propose a rational approach for the preservation of the nerve in thyroid surgery based on anatomical principles. METHOD: A cadaveric dissection study of the anatomy of the external branch of the superior laryngeal nerve in relation to the inferior constrictor muscle was conducted. Twenty-nine formalin-fixed cadavers of both sexes (age 50-70 years), with normal necks, were examined. RESULTS: In relation to the Friedman classification, three anatomical variations of the external branch of the superior laryngeal nerve were found. Type 1 variation was found in 57.1 per cent of cases, type 2 in 26.8 per cent and type 3 in 16 per cent. CONCLUSION: The prevalence of type 3 variation of the external branch of the superior laryngeal nerve suggests that the nerve will not be encountered in a certain percentage of individuals as it lies under the cover of the inferior constrictor. Therefore, there is no justification for attempting to identify the nerve in all cases.
Subject(s)
Laryngeal Nerves/anatomy & histology , Pharyngeal Muscles/anatomy & histology , Thyroidectomy/methods , Aged , Cadaver , Female , Humans , Laryngeal Muscles/innervation , Laryngeal Nerve Injuries/prevention & control , Laryngeal Nerves/surgery , Male , Middle AgedABSTRACT
A 45 year old man presented with persistent pain in throat and otalgia. Clinical and radiographic evaluation confirmed the diagnosis of elongated styloid process syndrome. Surgical shortening of the styloid processes gave relief. The etiopathogenesis, presentation and management of the condition is discussed.
