A. K. Rai

Computed Tomography in Chronic Suppurative Otitis Media: Value in Surgical Planning

The present study was conducted prospectively to evaluate how accurately high resolution computed tomography scanning could define the extent and severity of the underlying disease in patients with chronic suppurative ear disease, thus, helping convert a surgical exploration into a planned procedure. Sixty adult consecutive cases of chronic suppurative otitis media underwent a detailed high resolution computed tomography by a single radiologist. The recorded radiological findings in various heads were then compared to the surgical findings during mastoid exploration of these patients by a single otologist and the two statistically compared. The presence and distribution of soft tissue in the middle ear cleft and mastoid could confidently be predicted using this modality. The malleus, body and short process of incus were well visualized, but not the long process of incus and the stapes suprastructure. Lateral semicircular canal fistulae could be demonstrated with an acceptable degree of accuracy. It was possible to detect facial nerve dehiscence and defects in tegmen tympani in significant number of cases although, statistical values were low for these structures. High resolution scanning is a modality which can accurately image the pathological anatomy in unsafe chronic suppurative otitis media. Otologists should use it more often, especially in complicated cases as an adjunct to better preoperative assessment, and thus, the surgical outcome. Its accuracy is likely to improve with larger studies and better experience, wherein its routine use may become justifiable.

Teratoma tongue: Case report and review of literature

Teratomas are true neoplasms composed of tissues from all three germinal layers and may exhibit variable levels of maturity. They have an unknown origin and eccentric microscopic appearance. Teratomas arising from the oral cavity are rare in the newborn; only 22 cases have been reported in the literature. We describe a female neonate with an oral teratoma originating from the tongue that was successfully treated with surgery.

Primary Thyroid Tuberculosis

In India, it is estimated that more than 40% of the adults are infected with tuberculosis bacilli and every year 2 million people develop tuberculosis and nearly 500,000 die from it1. But, tuberculosis of the thyroid gland occurs only rarely. Since extra-pulmonary tuberculosis is now seen relatively more frequently, the existence of this condition should be recognized when goitres are being treated. We present a case of right thyroid nodule associated with low grade fever and weight loss. No signs and symptoms of hypothyroidism or hyperthyroidism were present. Patient did not have any other tuberculosis focus. Routine investigation and chest X-ray were normal. Sputum for Acid Fast Bacilli was negative. Fine Needle Aspiration Cytology and Contrast Enhanced Computed Tomography led to a diagnosis of Primary Thyroid Tuberculosis in a euthyroid patient. Patient responded well to Anti tubercular Drug Therapy along with repeated aspiration.

Role of autografts in the reconstruction of ossicular chain in intact canal wall procedures.

Improvement of hearing in ossiculoplasty depends on the efficiency of the methods to reestablish the ossicular continuity and the connection with the tympanic membrane. While various prostheses have been used to bridge the ossieular defect, we have used autogenous bone (incus remnant & cortical bone ) and autogenous cartilage (frugal & conchal) for reconstruction of ossicular continuity.Hearing results at I8 months follow up have been fairly good i.e., 84% patients had closure of air bone gap within 20 dB and 37% had closure of air bone gap within 10 dB.

Bilateral nasal vestibular stenosis: a case of rhinoscleroma and review of surgical techniques

Vestibular stenosis is an uncommon but debilitating cause of nasal obstruction. It is caused by disruption of the nasal vestibular lining with secondary proliferation of granulation and fibrous tissue. A number of techniques have been described for repair of the stenotic segment. Correction can be difficult because of the tendency of wound contracture and recurrence. We present a surgical technique that employs the concept of excision of the stenotic segment, enlargement of the vestibule and placement of a full thickness skin flap. Its ability to resist contracture obviates the need for post-operative stenting and gives good result.

Nasopharyngeal glioma: A unique presentation in infants

Despite the complex embryological development of the nose and surrounding structures, significant developmental nasal anomalies are rare. Of the various anomalies like-nasopharyngeal cysts, hairy polyps, dermoids, haemangiomata, fibromas, mucocoeles, lipoma, aplasias. We are presenting a rare case of Heterotopic Brain Tissue in the nasopharynx. This 1.5-month-old patient was operated through transpalatal route and mass excised. Histopathologicaly it consisted of various central nervous tissue elements. Seven months post surgery patient is thriving well.

Synchronous cystic teratomas of the craniofacial region.

A case of synchronous cystic teratomas presented with the complaints of a slow-growing facial mass and forward protrusion of the right eye since birth. The patient was examined thoroughly and subjected to magnetic resonance imaging (MRI) scan. The MRI scan revealed the presence of two separate cysts in the right orbit and right temporal fossa. The patient was operated by a combined effort of ophthalmologists and otorhinolaryngologists. The cysts were excised and subjected to pathological examination. The histopathological survey revealed both the cysts to be mature cystic teratomas similar to each other. This coexistence of a primary temporal fossa teratoma with an orbital teratoma is the first of its kind and to the best of our knowledge has not been reported before.