Jyoti Dabholkar

Wegener's granulomatosis mimicking skull base osteomyelitis.

OBJECTIVE To report a case of Wegeners granulomatosis mimicking skull base osteomyelitis. CASE REPORT A case of Wegeners granulomatosis is reported in a diabetic woman presenting with facial palsy and hearing loss. The clinical course of the disease was very similar to that of skull base osteomyelitis, especially since the patient was diabetic and the ear swab was positive for pseudomonas. The definitive diagnosis was made based on clinical presentation, imaging and serum antineutrophil cytoplasmic antibody testing. The patient was started on immunosuppressants, and her hearing loss and facial palsy recovered. CONCLUSION Wegeners granulomatosis is a systemic disease with various manifestations. A high index of clinical suspicion is required to reach the correct diagnosis. The clinician should be alerted to the possibility of Wegeners granulomatosis in the presence of: systemic upset out of proportion to the apparent intensity of the local lesion; middle-ear disease failing to respond to conventional treatment; and a consistently raised erythrocyte sedimentation rate.

ENT manifestations of Wegeners granulomatosis.

Wegeners granulomatosis is a necrotizing granulomatous vasculitis with multisystemic involvement. We present two cases of Wegeners presenting with otological manifestations as the first symptom. These symptoms are subtle and diagnosis may be easily overlooked. Hence a high index of suspicion is required. Early diagnosis and treatment goes a long way in improving the outcomes and in preventing further complications.

Radical Management of Giant Ameloblastomas: A Case Series

Ameloblastomas are rare, slowly growing and locally invasive tumours with high recurrence rate, if not treated they can grow to enormous size; we report five such cases in our article and discuss their surgical management. We report five cases of giant ameloblastoma presented in our institute between 2007 and 2010, we treated them surgically with wide margin of resection. It is widely reported that recurrence of ameloblastoma in many cases reflects the inadequacy or failure of the primary surgical procedure. We treated all our cases with radical excision with free flap reconstruction with no recurrence in any of our patients in 2 years follow-up. Radical excision of these benign but locally invasive lesions, which grows to giant size with reconstruction using micro vascular free flaps forms the best modality of treatment.

Mastoid cavity obliteration: our experience.

INTRODUCTION A chronic discharging ear has been a challenge for the otologists for centuries. The mainstay of treatment for cholesteatoma is surgery and the surgical treatment of choice is modified radical mastoidectomy. The open mastoidectomy technique has been the mainstay of management of chronic ear disease; however this type of surgery is not without its problem. It results in the formation of a mastoid cavity which has various problems. Mastoid obliteration is done to eliminate the cavity related problems. AIMS AND OBJECTIVES To study surgical results of mastoid obliteration, efficacy of different methods of mastoid obliteration, cavity problems and the need of cavity care. MATERIALS AND METHODS This study was conducted on 30 subjects having evidence of attico-antral type of disease in middle ear cleft. The mastoid cavity was obliterated with either cartilage/bone dust/flaps Scientific design-prospective study. RESULTS AND CONCLUSIONS Incidence of discharge, debris, giddiness, pain was reduced in obliterated cavities. Healing of cavity was better in obliterated ears. Cavity obliterated with bone dust and flap had better and early epithelialisation as compared to cartilage.

Metallic foreign body in the neck: case report.

Penetrating neck injuries constitute 5-10% of all trauma cases. Such injuries are dangerous because of the high risk of injury to the vital structures in the neck and hence demand an immediate surgical exploration. We present a case of a penetrating injury of the neck caused by the broken metallic fragment of a saw.

Benign jaw tumors

The jaw bones may develop the same types of tumors as the other bones of the body but may also develop tumors arising from the alveolar processes (epulis) and the developing teeth (odontomes). They are usually benign in nature and can affect the functions of mastication, swallowing and cause facial deformity. They make about 3% of all bone tumors with a tendency for a local recurrence if a wide excision is not contemplated at the first attempt. Local destruction caused by the tumor can mimic a malignancy; however with imaging we can get a fair idea about the treatment planning. We present a series of 6 cases of such nature for their variety, diagnostic challenge they posed and different reconstruction methods used for better cosmesis.

Primary tuberculous osteomyelitis of the mandible mimicking a parotid fistula

A young girl of 14 years was refer-red to us with a progressively increasing right cheek swelling since 2 months. A simi-lar swelling 3 months back was diagnosed as parotid abscess and drained. 10 days later she started complaining of a discharge from the same site. Patient remembered having undergone a tooth extraction 8 months back.Examination revealed a firm swelling of about 5X5 present in the right parotid region reaching up to the angle of mandible. A discharging sinus was also present.(Fig.1)A plain radiograph of the chest was normal and FNAC from the swelling was inconclusive. Patient tested negative for HIV. Ultrasonography showed osteomye-litis of the mandible with a well defined abscess in the vicinity which was confirmed on CT. The outer cortex of the mandible at the angle and the neck showed a lytic destruction.Patient was taken up for open biopsy. Intraoperatively the outer cortex of the mandible was destroyed. Caseous material was present and the sinus which was probed and found reaching up to the mandible was excised. As the parotid gland was normal, it was left behind.The histopathology showed epithe-loid cell granulomas composed of central area of caseous necrosis surrounded by epitheloid cells, Langhan type of giant cells and peripheral mantle of lymphocytes. A diagnosis of tuberculous osteomyelitis was thus made.Patient was started on anti tuber-cular treatment. Patient completed her treatment with complete resolution of the swelling.

Sphenochoanal polyp - a rare diagnosis in nasal obstruction

One of the most common nasal pathologies to present to an otolaryngologist is polyposis. Two well-recognized forms occur, the common antrochoanal polyp and the rare sphenochoanal polyp. Differentiation between the two is necessary for proper management by endoscopic sinus surgery.

Primary exophytic laryngeal amyloidosis presenting as sudden airway obstruction.

Primary amyloidosis of larynx is an uncommon phenomenon, the precise etiopathogenesis of which is not yet clear. It can present with slowly increasing hoarseness or difficulty in breathing. It presents more commonly as infiltrative lesion, exophytic presentation is a rare occurrence.

A rare case of synovial sarcoma of the neck with review of literature

Synovial sarcoma (SS) is a malignant tumor of pluripotent/undifferentiated cells. Only 3% of all SSs are found in the neck. We present a case of a 16-year-old male presenting neck swelling for 6 months which was diagnosed as biphasic SS of the neck on fine-needle aspiration cytology. Complete surgical resection with lateral partial pharyngectomy was done followed by postoperative radiotherapy. We also present the recent reviews on diagnosis and management on SS of head and neck.