Ashwani Sethi

Study of Sphenoid Sinus Anatomy in Relation to Endoscopic Surgery

En las cirugias radicales del pasado, la definicion precisa de las hendiduras de los senos paranasales fueron de importancia limitada. En los ultimos anos, el abordaje transesfenoidal de la hipofisis y las relaciones del seno esfenoidal han tenido en la practica y en el estudio de la anatomia quirurgica, un significativo incremento. Para definir mejor esta anatomia, 20 senos esfenoidales fueron disecados en cadaveres para revelar importantes relaciones anatomicas, dimensiones, volumen y neumatizacion del seno esfenoidal. Los resultados de este estudio son discutidos con referencia particular para la anatomia quirurgica del seno esfenoidal. Los resultados tambien apuntan hacia la posibilidad de variaciones raciales, en terminos de relaciones del seno esfenoidal con la arteria carotida interna y el nervio optico, en la poblacion de la India

Primary tuberculosis of the tongue: a rare nodular presentation.

We report a case of a 38-year-old male who presented to us with a nodular swelling of the tongue with cervical lymphadenopathy suggestive of a malignancy. The lesion was diagnosed to be of tuberculous origin and the patient responded well to anti-tubercular chemotherapy.

Primary tuberculous petrositis

Tuberculous osteomyelitis of the temporal bone is a rare and dangerous entity that should be included in the differential diagnosis of infectious processes of the base of the skull. We present the case of an 11-year-old child who presented with diplopia, ear discharge and hearing loss. The radiological and histopathological findings revealed tuberculous otitis with osteomyelitis and an abscess in the petrous apex. The child responded to anti-tuberculous chemotherapy. The diagnosis and management of tuberculous osteomyelitis are discussed and a brief review of the literature is presented.

Pilonidal sinus of the neck

A pilonidal sinus is most commonly seen in the sacrococcygeal region. Here we describe a rare case of pilonidal sinus of the neck following trauma due to shaving. Excision of the sinus with primary repair resulted in complete healing of the lesion with no recurrence. The possible pathogenesis of this acquired condition is also discussed.

Pharyngeal perforation with deep neck abscess secondary to isolated hyoid bone fracture.

We report the case of a 26-year-old man who presented to us with dysphagia secondary to blunt trauma to the neck. The patient was found to have a hyoid bone fracture with pharyngeal perforation and resultant neck abscess. The patient responded to prompt surgical and medical management. We believe this to be the first report of such a case.

Intraparotid facial nerve neurofibroma: an uncommon neoplasm

Los neurofibromas intraparotideos del nervio facial son una entidad poco frecuente, macroscopicamente e histopatologicamente diferentes de los comparativamente mas frecuentes schwannomas. Se presenta un caso raro de un neurofibroma del nervio facial con extension intraparotidea intratemporal en una mujer de 48 anos de edad. El tumor se extirpo quirurgicamente con injerto del nervio facial. La electroneurografia puede llegar a ayudar en el diagnostico preoperatorio. La reseccion del nervio facial debe ser realizada con mayor facilidad en un paciente con neurofibroma que en un paciente con schwannoma, sin embargo, la preservacion del nervio facial con electroneurografia de seguimiento y tomografia computarizada sigue siendo una opcion viable en pacientes con pequenos neurofibromas del nervio facial, cuando las pruebas electricas revelan minima evidencia de degeneracion neuronal progresiva. Una estrecha vigilancia, especialmente en los neurofibromas asociados con la enfermedad de Von Recklinghausen es fundamental debido al aumento del riesgo de degeneracion sarcomatosa.

Pneumatization of mastoid air cells: role of acquired factors

El mecanismo exacto de la neumatizacion del sistema de celulas mastoideas y los factores que influencian este proceso es pobremente comprendido. Factores geneticos, como tambien adquiridos, han sido implicados en el proceso de neumatizacion del sistema de celulas mastoideas. Esta neumatizacion es considerada un factor de importante pronostico en la conduccion de las cirugias reconstructivas de oido. Hemos llevado a cabo un estudio para explicar el rol de dos importantes factores adquiridos en la duracion de las otitis media cronica y el status funcional de la tuba auditiva en la neumatizacion de las celulas mastoideas. En 50 individuos, con otitis media cronica unilateral, se estudio su sistema de celulas aeriferas mastoideas usando la planimetria y las funciones de la tuba auditiva usando fluorescina, via nasofaringoscopia. Los resultados concuerdan con estudios previos, indicando una influencia definida de enfermedades cronicas del oido medio en el proceso de neumatizacion, aunque la duracion de la enfermedad no fue significativa. En contraste con los estudios previos, no se encontro influencia del status funcional de la tuba auditiva en la neumatizacion mastoidea

Tuberculosis: An Extremely Unusual Cause of Orbital Wall Erosion

We present the case report of a 10-year-old girl who presented to us with a painless swelling involving the left infraorbital region. The swelling was diagnosed to be tubercular in origin with erosion of the zygomatic, maxillary and frontal bones constituting the inferior and lateral walls of the left orbit. The patient responded well to antitubercular chemotherapy. A discussion of the case and a literature review of causes of orbital erosion is presented.

Acute Suppurative Otitis Media: An Unusual Cause of Orbital Apex Syndrome

We report the case of a 40-year-old female who presented to us with earache and a rapidly progressive painful ophthalmoplegia involving the right eye with right temporal swelling. A clinical and radiological assessment revealed it to be temporal cellulitis with orbital apex syndrome secondary to acute otitis media. In spite of prompt initiation of treatment, the patient died within 30 hr of presentation. The case is discussed in detail with a brief review of medical literature.

Tubercular and chronic pyogenic osteomyelitis of cranio-facial bones: a retrospective analysis.

AIM To analyse current trends in our population with respect to the presentation, diagnosis and management of tubercular and chronic pyogenic osteomyelitis of the cranio-facial bones. DESIGN Retrospective study. SETTING Tertiary healthcare centre. PATIENTS AND METHODS The study population comprised 14 patients with tubercular and chronic pyogenic osteomyelitis who were managed in the otorhinolaryngology department between May 2002 and December 2005. RESULTS Odontogenic infections, sinus infections and aural infections were the most commonly identified aetiological factors. Most of the patients presented with swelling, pain and discharging sinus. The diagnosis was established on the basis of clinical evaluation, radiological investigations and histopathological analysis, with six cases diagnosed with tubercular osteomyelitis and eight cases with chronic pyogenic osteomyelitis. All the patients were initially commenced on oral antibiotics, which were continued for two weeks in all cases with chronic pyogenic osteomyelitis. All the patients with pyogenic osteomyelitis underwent surgical management, with one patient requiring repeated surgical interventions. All the patients with tubercular osteomyelitis received anti-tubercular chemotherapy, with complete cure. CONCLUSIONS Osteomyelitis of the cranio-facial bones is an uncommon entity which requires a high index of clinical suspicion along with radiological and histopathological investigations in order to establish the diagnosis. Tubercular osteomyelitis is clinically and radiologically indistinguishable from pyogenic osteomyelitis, and the two conditions can be differentiated only on the basis of histopathological evaluation of involved tissue.