ABSTRACT
OBJECTIVE: Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken. METHODS: Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance. RESULTS: Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa-Hunt syndrome cases. CONCLUSION: A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.
Subject(s)
Image-Guided Biopsy/methods , Imaging, Three-Dimensional , Orbit/surgery , Skull Base Neoplasms/diagnostic imaging , Skull Base Neoplasms/surgery , Adult , Age Factors , Aged , Endoscopy/methods , Female , Humans , Male , Middle Aged , Nasal Cavity/diagnostic imaging , Nasal Cavity/pathology , Nasal Cavity/surgery , Orbit/diagnostic imaging , Orbit/pathology , Pain Measurement , Prognosis , Prospective Studies , Retrospective Studies , Risk Assessment , Sex Factors , Skull Base Neoplasms/pathology , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
OBJECTIVE: We report a rare case of tuberculosis presenting with bilateral vocal fold palsy. METHOD: Case report and discussion of ENT manifestations of tuberculosis. CASE REPORT: A 39-year-old man presented with stridor and bilateral vocal fold palsies, and underwent an emergency tracheostomy. Intra-operatively, a mass was identified overlying the thyroid cartilage. Fine needle aspiration cytology of this mass showed well formed granulomas but negative Ziehl-Nielsen staining. Computed tomography showed the mass to be surrounding the thyroid cartilage, causing airway occlusion; pulmonary infiltrates were also seen. The patient was commenced on tuberculosis treatment. Subsequent sputum samples from the tracheostomy confirmed the diagnosis. The patient responded very well to treatment, and was successfully decannulated after one week. CONCLUSION: The incidence of tuberculosis in the UK is increasing, particularly in urban areas. The otolaryngologist may encounter a wide variety of presentations. Diagnosis requires a high index of clinical suspicion.
Subject(s)
Antitubercular Agents/therapeutic use , Otorhinolaryngologic Diseases/diagnosis , Thyroid Cartilage/pathology , Tuberculosis, Pulmonary/diagnosis , Vocal Cord Paralysis/diagnosis , Adult , Biopsy, Fine-Needle , Drug Resistance, Multiple, Bacterial , Granuloma/diagnosis , Granuloma/therapy , Humans , Male , Otorhinolaryngologic Diseases/microbiology , Otorhinolaryngologic Diseases/therapy , Respiratory Sounds/etiology , Risk Factors , Somalia/ethnology , Tracheostomy , Treatment Outcome , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/therapy , United Kingdom/epidemiology , Urban Population , Vocal Cord Paralysis/microbiology , Vocal Cord Paralysis/therapyABSTRACT
OBJECTIVE: We report an extremely rare case of laryngeal lichen planus. METHOD: A case report and literature review of the aetiopathogenesis, clinical features and management of laryngeal lichen planus are presented. RESULTS: A male patient presented with hoarseness and a history suggestive of squamous cell carcinoma of the larynx. However, characteristic histopathological findings demonstrated lichen planus. The patient responded very well to oral steroids, and at the time of writing had remained symptom-free for two years. CONCLUSION: This is the first English language report of laryngeal lichen planus. Lichen planus is a diagnosis of exclusion and responds well to steroids. However, patients should be followed up regularly as malignant change is known to occur.
