Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree.

OBJECTIVES: Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children. METHODS: The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy. RESULTS: A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent. CONCLUSION: Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy.

Stylalgia and its surgical management by intra oral route -clinical experience of 332 cases.

Stylalgia is a pain syndrome occurring in connection with on elongated or malpositioned styloid piocess and is more common than generally thought. 332 cases of stylalgia were diagnosed over a period of 15 years. The charcteristic symptoms were chronic throat pain during swallowing with referred otalgia or referred pain to cheek or lower part of neck associated with foreign body sensation in throat. Movements of head or act of deglutition initiates or increases the pain The diagnosis of stylalgia is based on symptoms, palpation of enlarged styloid process mtraorally in the tonsillar region and elicitation of similar nagging throat pain or pain in the neck or foreign body sensation in the throat. Confirmation of enlarged styloid process is always done by radiological examination of styloid process per orbital view. Bilateral enlargement of tyloid process were found in 196 patients (59.03%) and unilateral enlargement was found in 136 (40.96%) patients. All the patients were operated under local anaesthesia by intra oral route without any complications.

Anatomic variations of the bone in sinonasal C.T.

Coronal plane Computed Tomographic (C.T) Scanning of paranasal sinuses is importannt as a preoperative evaluation tool and providing a road map for Functional Endoscopic Sinus Surgrey. The present study wea crried out on 61 patients of chronic sinusitis who underwent C.T. Scan of paranalal sinus, (coronal section) prior to Functional Endoscopic Sinus Surgery.The incidence of anatomical variations of the bone such as Agger nasi cells, Middle turbinate pneumatisation, Heller's Cells,Paradoxically curved middle turbinate, Deviated septum and Uncinate process variations, etc. were investigated in each C.T.Scan. Mucosal abnormalities in each paranasal sinus were also reported.The purpose of this investigation was to determine the background prevalence of bony anatomical variations and mucosal abnormalities of paranasal sinuses and assess the possile pathogenecity of these findings in patients undergoing evalation for Functional Endoscopic Sinus Surgery.

Brush cytology and its comparison with histopathological examination in cases of diseases of the nose.

Nasal cytology is a simple, easy, bloodless and quite reliable investigation. Although its utility was recognized as early as 1927 by Eyerman, it has not yet gained much popularity. Here, an attempt is made to assess its efficacy for the diagnosis of various inflammatory, benign and malignant conditions in 151 cases of common rhinological problems in the M.Y. Group of Hospitals, Indore MP, India. This method can be used as an adjuvant to clinical diagnosis and histopathological diagnosis as an outpatient department (OPD) procedure with the help of a nasal endoscope, as it was found to be a simple, reliable and time-saving procedure for further management. It can also be used as a screening test for the detection of symptomless patients particularly in precancerous lesions.

Concha bullosa: Frequency and appearances on sinonasal CT.

Aeration of the middle turbinate, termed "Concha bullosa", is one of the most common, obstructive, anatomic variants seen in patients with sinusitis. The present study was carried out on 150 patients of chronic sinusitis, who underwent CT scan paranasal sinuses, coronal section prior to Functional Endoscopic Sinus Surgery (FESS). The CT Scans were evaluated to detect the incidence of Concha bullosa and its types, the significance of Concha bullosa in genesis of osteomeatal complex disease and relation between type of Concha bullosa and osteomeatal complex disease. Later the patients were subjected to FESS. In this study we found that the overall incidence of inflammatory disease in the osteomeatal complex in these symptomatic patients was no different between with and without Concha bullosa and osteomeatal complex disease is found to be more frequent if peumatization is localized to inferior part of middle turbinate. Concha bullosa requires specific endoscopic surgical techniques.