Facial nerve morbidity following surgery for benign parotid tumours.

OBJECTIVE: To determine the frequency and severity of facial nerve dysfunction following surgery for benign parotid gland tumours. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: ENT Department, Karachi Medical and Dental College and Abbasi Shaheed Hospital and Ziauddin University Hospital, from 1990 to 2010. METHODOLOGY: Data was collected of all patients who were surgically managed for benign parotid tumours from 1990 to 2010. Data was reviewed for presentation of tumour, age and gender of the patient, site of tumour, nature and morphology of the tumour, primary or recurrent, surgical procedure adopted and the complications of the surgery especially the facial nerve dysfunction, its severity, complete or partial paresis and transient or permanent and time of recovery. RESULTS were described as frequency percentages. RESULTS: Out of 235 patients, 159 (67.65%) were female and 76 (32.35%) were male. Age ranged from 18 to 70 years. Pleomorphic adenoma was the most common tumour (n=194, 82.6%), followed by Warthin's tumour. Superficial parotidectomy was done in 188 cases and extended parotidectomy in 47 cases. In the immediate postoperative period facial nerve function was normal in 169 (72%) patients and nerve dysfunction was observed in 66 (28%) patients. Complete paresis involving all the branches of facial nerve was seen in 25 (10.6%) patients and 41 (17.4%) patients were having incomplete dysfunction. Of these, 62 (26.3%) recovered and 04 (1.7%) had permanent facial nerve dysfunction. Marginal mandibular branch of facial nerve was involved in 57 (86.3%) cases. CONCLUSION: The frequency of temporary and permanent facial nerve dysfunction was 26.3% and 1.7% respectively in 235 consecutive parotidectomies for benign parotid gland tumours. Higher frequency of facial nerve dysfunction was found in recurrent and deep lobe tumours.

Follicular dendritic cell sarcoma of tonsil.

Follicular dendritic cell sarcoma is a very rare entity. So far only 12 cases have been reported world wide with involvement of tonsil. We present a new case of follicular dendritic cell sarcoma of the tonsil in a 52 years old woman with no evidence of neck node involvement. She had undergone diagnostic tonsillectomy due to unilateral tonsillar enlargement. The final diagnosis after histological review and immunohistochemical stains was follicular dendritic cell sarcoma. Bone scan showed no metastasis. One year follow-up after postoperative chemotherapy showed no evidence of local or regional recurrence. Follicular dendritic cell sarcoma is a rare and underdiagnosed neoplasm. It should be included in the differential diagnosis of any tonsillar mass in adults. Follicular dendritic cell markers such as SR-100, CD21 and/or CD35 are essential for the diagnosis.

An unusual foreign body in trachea.

We report a very unusual case of foreign body (FB) in the tracheo-bronchial tract of a male child, who presented to us in the Emergency Department at our tertiary care centre with the complaint of FB in throat, cough bouts and choking sensation with pain and difficulty in breathing for whom an emergency rigid endoscopy was carried out after appropriate investigations.