A Comparative Study of Endoscopic Endonasal Dacryocystorhinostomy Using an Inferiorly Based Flap Versus a Posteriorly Based Flap.

To evaluate the outcome and complications of Endoscopic endonasal Dacryocystorhinostomy (DCR) using an inferiorly based mucosal flap as compared to a conventional posteriorly based mucosal flap with flap preservation and no stenting. 36 patients presenting with nasolacrimal duct obstruction were divided into two groups: the first group underwent endoscopic DCR using an inferiorly based mucosal flap, and the other group used a posteriorly based mucosal flap. In both groups, the mucosal flap was preserved, and bone was removed using Kerrison's punch. No stenting was done in any of the cases. The patency of the ostia was determined by syringing, and nasal endoscopy was done to look at the neo-ostium at follow-up visits to determine success and complications in each group. All 18 cases in the inferiorly based flap group had patent ostia with good mucosalization of the neo-ostium at 6-month follow-up. 3 of the 18 cases in the conventional posteriorly based flap group had failure due to granulation tissue formation around the neo-ostium. The use of an inferiorly based mucosal flap is easy to fashion and reposition at the end of the surgery. This technique has a good outcome with patent ostia during the follow-up period of 6 months.

Prevalence of Tonsilloliths in Chronic Rhinosinusitis: A Retrospective CT PNS Study.

To determine the prevalence of tonsilloliths in CT PNS (Computed Tomography ParaNasal Sinuses) of patients with and without features of chronic rhinosinusitis. 97 CT PNS of the patients with features of chronic rhinosinusitis were included in the study group, and 124 CT PNS of cases without features of chronic rhinosinusitis were taken as the control group. All 221 CT PNS were then evaluated for the presence of tonsillar calcifications indicative of tonsilloliths and the prevalence of the same in the study and control groups. 97 of the 221 CT PNS evaluated showed features of chronic rhinosinusitis. 60 of these 97 CT PNS showed features of tonsillolith in one or both tonsils. Of these 60 cases, 58 had maxillary sinusitis, and 17 had pansinusitis. Most of the cases had small tonsilloliths (1-3 mm), and only one case had a large tonsillolith (> 6 mm). At the same time, 27 out of the remaining 124 CT PNS without chronic rhinosinusitis showed the presence of tonsilloliths in one or both tonsils. The prevalence of tonsilloliths is significantly higher in patients with chronic rhinosinusitis than in the control group. The presence of tonsilloliths in patients with chronic rhinosinusitis indicates repeated inflammation of the tonsils due to sinusitis. Such chronic inflammation of the mucosa of the pharynx should prompt more aggressive treatment of chronic rhinosinusitis.

"Penetrating Neck Injuries: A Comprehensive Study".

Penetrating neck injuries are defined as injury to the neck associated with breach in the platysmal muscle layer. All penetrating neck injuries are potentially dangerous and require emergency intervention due to its proximity to airway, important blood vessels, nerves and other organs in the neck. A complete evaluation, rapid airway intervention and proper surgical repair are highly essential to prevent complications. Clinical evaluation and management of penetrating neck injuries at a tertiary care hospital. In this study, 66 cases of penetrating neck injuries who presented to the emergency department from October 2018 to September 2020 were included. The particulars of the insult like type of instrument causing injury and zone of injury were compared. An analysis of the management of penetrating neck injury with respect to exploration and wound repair and the need for tracheostomy, vascular repair, esophageal repair, laryngeal framework repair and pharyngeal repair was made. The maximum incidence was observed for the age group between 21 and 30 years. The object causing the maximum number of neck injuries was knife, in 36 cases. The distribution of cases according to zone of injury revealed that the zone II was most commonly affected in 43 cases. The structures injured in the study indicated that platysma was involved in all the cases, followed by thyroid cartilage in 33 cases. Wound exploration and repair was done in all cases and tracheostomy was done in 44 cases. Complications were vocal cord palsy in 19 patients, 15 had tracheal stenosis, 13 had hoarseness of voice, 7 developed pharyngocutaneous fistula and 1 developed pharyngeal stenosis. There were 2 deaths. 16 patients who attempted suicide had depression. All penetrating neck injuries are potentially dangerous and require emergency treatment because of the presence of important vessels, nerves andorgans in the neck. Thorough knowledge of the anatomy of neck, clinical assessment and diagnostic and therapeutic interventions are necessary for appropriate management.

Bifid Inferior Turbinate: A Prospective Study.

With the wide spread use of nasal endoscopes and paranasal sinus computed tomography, many variations of nasal turbinates has been described. Bifid inferior turbinate was initially described by Aksungur et al. and very few cases of bifid inferior turbinate have been reported in the literature. Bifid inferior turbinate is a very rarely encountered anomaly and can be easily recognized in paranasal tomography but can be overlooked by endoscopic examination. In the present study 1000 patients with sinonasal disease who underwent nasal endoscopy, were evaluated for rare inferior nasal turbinate anomalies. There were five patients with bifid inferior turbinate. This is the first prospective study on bifid inferior turbinates.

Osteomas of Temporal Bone: A Retrospective Study.

Osteomas of temporal bone are rare, slow growing benign tumours and they are reported in all parts of temporal bone. This study is a retrospective study of the clinical presentation, management and complications of temporal bone osteoma done from January 1999 through January 2017. The study population is thirteen patients, all who has been radiologically and histopathologically proven to be a case of osteoma. Total number of patients were 13 of which 7 were females and rest 6 were male. Presenting complaints included swelling behind the ear (6 cases), reduced hearing in 4 cases, 2 cases had ear discharge, 3 of them were asymptomatic in whom it was diagnosed accidently. The duration of symptoms ranged from 1 month to 10 years. Of total 13 patients 7 had external auditory canal involvement and 4 cases had mastoid region. Two patients were managed conservatively, one refused surgery and rest ten cases underwent excision. The specimen was sent for histopathological examination and diagnosis of osteoma was confirmed. The decision regarding whether to operate or not depends on each case depending on its size, symptoms and more importantly the complications. Excision of osteoma remains the treatment of choice.

Otological Manifestations of Nonseptic Lateral Sinus Thrombosis: A Review.

Nonseptic lateral sinus thrombosis differs from septic lateral sinus thrombosis in that it is not associated with ear or sinus infection. Etiologies of these conditions are different and management of these conditions are different. Nonseptic lateral sinus thrombosis requires medical line of management and anticoagulant therapy where as septic lateral sinus thrombosis treatment involves surgical exploration of the mastoid cavity, sinus decompression, and long-term antibiotic therapy. Mastoid changes are frequently detected on computed tomography or magnetic resonance imaging in cases of nonseptic lateral sinus thrombosis. An otolaryngologic evaluation is usually required to exclude coexisting mastoiditis. An otologist should be familiar with the septic lateral sinus thrombosis and existence of nonseptic variant lateral sinus thrombosis for early recognition and initiation of appropriate treatment.

Caldwell Luc Surgery: Revisited.

Caldwell Luc surgery (CWS) is almost 120 years old now and it still enjoys an important place in ENT Surgeons armamentarium. The logic behind this surgery is to replace the diseased and scarred mucosa from maxillary sinus with new mucosa. In the initial period of this long journey the surgery gained many other important indications which also includes approach to surrounding structures which makes us to think if it's really a radical surgery as it is used just an approach to other structure. This was a retrospective study of CWS done during period of 2002-2014 in Sri Venkateshwara ENT Institute and Bowring & Lady Harding Hospital both of these attached to Bangalore Medical College & Research Institute. In this study we have tried to analyze the indications and surgical procedure adapted and complications. Even though it has synonym of radical antrostomy the complications were minor and temporary, except for permanent tooth anesthesia and nasal vestibular stenosis. With reasonable expertise if this surgery is done for proper indication: its worth to face these complications and it's a versatile surgery even today.

Powered Endoscopic Endonasal Dacryocystorhinostomy with Mucosal Flaps and Trimming of Anterior End of Middle Turbinate.

Endoscopic endonasal dacryocystorhinostomy (DCR), when compared to external techniques, has always had guarded acceptance primarily due to inconsistent success rates. The most common cause of surgical failure in endoscopic DCR is very high/very low mucosal incision, obstruction of neo-ostium by granulation tissue, infolding of flap or formation of synechiae between middle turbinate and the neo-ostium site post-operatively. Several techniques and modifications have been suggested by various authors over the years since the first introduction of endoscopic endonasal DCR. With the newer techniques and advancements, the success rates have become comparable or even higher than external DCR. The aim of our study was to determine the success of endoscopic endonasal DCR using the classical Wormald technique with a few modifications. A total of 37 cases of epiphora secondary to nasolacrimal duct obstruction were operated using endoscopic endonasal DCR technique. The surgical technique included classical Wormald principle of mucosal flap, removal of the overlying bone using Kerrisons punch & chisel-hammer followed by vertical incision on the sac. The medial wall of lacrimal sac was then trimmed using microdebrider, thus apposing it to the nasal mucosal flaps. The anterior end of middle turbinate was also trimmed prophylactically to prevent synechiae formation. The outcome and long term patency of the cases were evaluated. Of the 37 cases, 35 cases (94.6 %) had complete resolution of the epiphora at the end of 1 year follow up period. The two cases of failure were due to canaliculitis in one patient and extensive granulation around the neo-ostium in another. Thus the above method has very good success rate comparable to previous studies and very less chances of granulation tissue formation and blockage of neo-ostium by synechiae/flap infolding.

Nonseptic and septic lateral sinus thrombosis: a review.

Thrombosis of the lateral sinus can be classified into nonseptic lateral sinus thrombosis and septic lateral sinus thrombosis. Nonseptic lateral sinus thrombosis differs from septic lateral sinus thrombosis in that it is not associated with ear or sinus infection. Etiologies of these conditions are different and hence the management of these conditions is different. Nonseptic lateral sinus thrombosis requires medical line of management and anticoagulant therapy, where as septic lateral sinus thrombosis needs surgical treatment along with antibiotics therapy. An otologist should be familiar with the septic lateral sinus thrombosis existence and nonseptic variant lateral sinus thrombosis for early recognition and initiation of appropriate treatment.

Mastoid cholesteatoma: a result of metaplasia.

Presence of cholesteatoma in the middle ear of the patients with chronic mucosal otitis media has been reported in the literature. But presence of cholesteatoma only in the mastoid, in the absence of cholesteatoma in the middle ear of a patient with chronic mucosal otitis media, is not reported in the literature. In this article three cases of mastoid cholesteatoma, in patients with a clinical picture of chronic mucosal otitis media is reported along with the literature review.

Maxillary sinus osteoma: two cases and review of the literature.

Osteomas are benign tumours characterized by proliferation of compact or cancellous bone. The most common site is the mandible, followed by the sinuses. These tumours are slow-growing, usually asymptomatic, and are generally discovered as incidental radiological findings. Osteomas occur commonly in frontal sinus, followed by the ethmoid and maxillary sinus, and very rarely in the sphenoid sinus. Symptoms arise when osteomas obstruct the ostium of the sinus or impinge on adjacent orbital or intracranial structures. Two cases of maxillary sinus osteoma are presented along with a review of the literature.

Unilateral attico antral ear disease with bilateral intracranial complications.

A 12 year old female patient, who had attico antral type of ear disease on right side, was brought to tertiary care centre for the management of fever, vomiting and headache. Patient had unilateral attico antral type of ear disease with bilateral intracranial complication. Along with the right attico antral type of ear disease and right lateral sinus thrombosis, patient had brain abscess in the left occipital lobe. Brain abscess was drained first and later mastoidectomy was done to eradicate the source of infection and to prevent further complications due to ear disease. Patient recovered well and patient was free from any problem during follow up period of 6 months. Bilateral intra cranial complications occurring simultaneously in a patient with a unilateral attico antral type of ear disease is not reported in the literature.

Conservative management of otogenic brain abscess with surgical management of attico antral ear disease: a review.

Otological intra cranial complications are still a major problem in developing countries. Otogenic brain abscess is a serious, life-threatening complication of otitis media and it usually occurs due to attico antral ear disease. Treatment of otogenic brain abscess is immediate surgical drainage, and mastoidectomy is done to remove the source of infection. This article describes three cases of otogenic brain abscess secondary to attico antral ear disease, which were less than 1.6 cm in size and were treated conservatively with antibiotic therapy. All the patients were started on intravenous antibiotic therapy and serial CT scan was done to monitor the progression of the brain abscess. Canal wall down mastoidectomy was done for the removal of otogenic source of infection. Antibiotic therapy was continued for 6 weeks. Post operative CT scan was done after 8 weeks and it showed complete resolution of the abscess. This study showed that small otogenic brain abscess, which are less than 1.6 cm in size responded to treatment with antibiotics, could be managed by medical therapy. Surgery was required only for the management of attico antral ear disease. To best of our knowledge this is the first review on conservative management of small otogenic brain abscess secondary to attico antral ear disease.

Lateral sinus thrombosis in otology: a review.

Lateral sinus thrombosis (LST) is usually occurs as a complication of middle ear infection. The involvement of lateral sinus during the course of ear infection was a well known complication in preantibiotic days. The decrease in the incidence of LST is due to the introduction of broad-spectrum antibiotics, early diagnosis and surgical treatment. Now, it is a rare complication of otitis media and poses a serious threat that warrants immediate medical and surgical treatment. The classical clinical picture is often changed by previous antibiotic therapy. An awareness of this rare potentially devastating condition and its varied presentations is necessary for early diagnosis and treatment. LST can also occur after head injury.Anticoagulants are recommended in cases LST, where there is propagation of thrombus after surgery. The use of anticoagulants is not apart of standard care of patients with LST and was more common prior to the advent of antibiotics. Anticoagulants arrests the spread of thrombosis but may increase the risk of venous infarctions and should be used cautiously.

A forgotten foreign body in the frontal sinus.

A 46-year-old female patient presented with a discharging wound over the nasal bridge, near the medial end of the right eyebrow of 2 months duration. She did not give any history of trauma or surgery in the past. Wound exploration showed a glass piece in the floor of the right frontal sinus. After showing the glass piece, patient remembered road traffic accident she had at the age of 18 years. Patient was asymptomatic for 28 years.To our knowledge, this is the longest retained case of asymptomatic foreign body in the frontal sinus reported in the world literature. Case report and a review of literature concerning foreign body in the frontal sinus are presented.

Middle turbinate osteoma.

A 14-year-old female patient presented with six months history of progressive nasal obstruction on the left side associated with ipsilateral facial pain. Radiograph of the nose and paranasal sinuses showed a bony mass arising from the left lateral nasal wall. Under general anesthesia left lateral nasal wall is approached through a modifi ed Lynch incision. A bony mass arising from the ant part of the middle turbinate was removed. Histopathological examination of the resected specimen showed picture of an osteoma. The postoperative course was uneventful.

Kimura's disease in children: a 9 years prospective study.

UNLABELLED: Kimura's disease is a rare form of chronic inflammatory disorder involving subcutaneous tissue, predominantly in the head and neck region and frequently associated with lymphadenopathy and/or salivary gland enlargement. The nodular lesions are deep seated in subcutaneous tissue and clinically may mimic a neoplasm. Hence head and neck surgeons need to be aware of clinical presentation of Kimura's disease. OBJECTIVES: To study the clinical presentations, management and complications of Kimura's disease in pediatric age group. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: The duration of study was 9 years (January 1998 to December 2006), comprising of 18 patients. Only histopathologically proven cases were included in this study. Blood eosinophil count and serum IgE estimation were done in all these patients. All the patients underwent fine needle aspiration cytology study. In 15 patients excision biopsy was done and resected specimen was sent for histopathological examination. In three cases, only biopsy was done to confirm the diagnosis. RESULTS: All the patients presented with painless swelling in the head and neck region. Post-auricular region was the commonest site (50%). Sixteen patients (88.8%) had blood eosinophilia and in 15 patients (83.3%) serum IgE level was elevated. Fifteen cases were treated by surgery and three cases were treated with steroids. Out of 18 cases, 15 cases were symptom free at the end of 1 year. Among 15 patients who underwent surgery, only one had recurrence (6.6 %). Out of three patients who were treated with corticosteroids, two came back with recurrence (66.6%). In our study, totally three patients had recurrence (16.6%). One patient had nephrotic syndrome (5.5%). CONCLUSION: Post-auricular region is the commonest site of involvement. Incidence is more common in the second decade of life. Recurrence rate is more with steroid therapy. Surgery is the best modality of treatment. The only systemic complication is nephrotic syndrome.

Lateral sinus thrombosis: A major problem still with us.

Twelve cases of lateral sinus thrombosis, which occurred as a complication of attico antral type of chronic otitis media, are reported. Management includes broad spectrum intravenous antibiotics and surgery. Radical mastoidectomy with incision of the lateral sinus and removal of its content was done for all cases. There were no deaths. The prognosis of lateral sinus thrombosis is good if treatment is instituted early with broad-spectrum antibiotics and surgery.