Kalpesh S. Patel

Atlanto-axial subluxation (Grisel's syndrome) following otolaryngological diseases and procedures

Grisels syndrome is a rare condition of uncertain aetiology characterized by atlanto-axial subluxation following an infection in the head and neck region. The condition most frequently affects children and characteristically presents in the post-operative period with cervical pain and torticollis. We describe three cases and discuss the aetiology and pathogenesis. A high index of suspicion may lead to early diagnosis in its natural history thereby preventing potentially serious complications.

The role of computed tomography in the management of peritonsillar abscess

Twenty-four patients who fulfilled the clinical criteria for peritonsillar abscess (PTA) were randomized into two groups over a 6-month period. Group A (n = 13) underwent CT with contrast, whereas group B (n = 11) was managed without radiologic Investigation. In group A, CT with contrast enabled differentiation of PTA from peritonsillar cellulitis in all 13 cases (100%) and demonstrated abscesses in 11 patients (85%), thereby allowing drainage at first attempt. Two patients with peritonsillar cellulitis were successfully managed with antibiotics only. In group B, all patients underwent needle aspiration. In seven patients (64%), pus was found after needle aspiration at first attempt and In one patient after needle aspirations at two locations. In three patients (27%), no pus was found after needle aspirations at three different locations. We conclude that CT enhances diagnostic accuracy, obviating unnecessary drainage procedures, and reduces patient morbidity.

Malignant otitis externa in HIV and AIDS

Malignant otitis externa is a necrotising infection of the external ear canal which may spread to include the mastoid and petrous parts of the temporal bone, leading to skull base osteomyelitis. It is almost exclusively caused by infection with Pseudomonas aeruginosa, and usually occurs in elderly non-insulin-dependent diabetic patients. However isolated cases have been reported in a small number of non-diabetic patients, particularly in children who are immunocompromised due to malignancy, malnutrition and severe anaemia. In 1984 a case of malignant otitis externa was reported in a child with an acquired immunodeficiency syndrome (AIDS)-like illness, prior to identification of the human immunodeficiency virus (HIV). Since that time further sporadic cases of this invasive infection have been reported in HIV and AIDS. We present two further cases and also a review of the current literature.

The Association between Periodontal Disease and Peritonsillar Infection: A Prospective Study:

OBJECTIVE : To study the relationship between periodontal status and peritonsillar disease/recurrent tonsillitis. STUDY DESIGN AND SETTING : A total of 158 patients presenting over a 3-year period with peritonsillar abscess (PTA) confirmed by needle aspiration and a control group of 112 patients booked for elective tonsillectomy for recurrent tonsillitis (RT) were examined in terms of their periodontal status using the WHO Community Periodontal Index of Treatment Needs (CPITN). RESULTS : The mean CPITN index was 2.81 (Standard Deviation [SD], 1.10) in patients with PTA and 1.41 (SD, 0.92) in patients with RT. One hundred seven of 158 patients with PTA had significant periodontal pathology (CPITN, 3 or 4) compared with 12 of 112 patients with RT. These differences were statistically significant. CONCLUSION : Patients with peritonsillar abscess had an increased prevalence of periodontal disease as compared with patients with recurrent tonsillitis. SIGNIFICANCE : There is a need to further explore this correlation and determine its nature, although it could be the result of common pathogenic factors, a causal relation cannot be excluded.

Kikuchi-Fujimoto's syndrome masquerading as tuberculosis.

We report a case of a 27-year-old Asian man presenting with the typical features of tuberculous cervical lymphadenitis who was commenced on anti-tuberculous therapy on the strength of the clinical presentation. Histological examination of an excised cervical lymph node however, revealed the diagnosis of Kikuchis syndrome; a histiocytic necrotizing lymphadenitis which is usually self-limiting.

Foreign body in the tongue: an unusual site for a common problem

Foreign bodies in the upper aerodigestive tract represent one of the commonest ENT emergencies. A case report of a fish bone penetrating the anterior tongue is presented which exemplifies this frequent problem, but at a rare site.

Submucosal squamous cell carcinoma of the subglottis.

noma (SCC) of the larynx is direct laryngoscopy with the patient under general anaesthesia, which allows biopsy of the mucosal lesion. This procedure also allows tumour staging according to American Joint Committee on Cancer guidelines. 1 A small proportion of laryngeal SCCs are submucosal with no mucosal abnormality present. This leads to difficulties in both diagnosis and staging. The first reported case of primary subglottic submucosal SCC is presented.

A systematic review of the surgical techniques for the treatment of internal nasal valve collapse: Where do we stand?

A myriad of interventions have been described to address the restoration or preservation of the internal nasal valve, the narrowest portion of nasal airway.

Recurrent aspergilloma of the frontoethmoid sinus in a non-immunocompromised patient.

Management of invasive aspergillosis of the paranasal sinuses requires sufficient experience to initiate appropriate investigations and then utilize the correct treatment protocol. Computed tomography (CT) or magnetic resonance imaging (MRI) is essential to show the extent of the disease and diagnosis is confirmed by histological analysis. Aspergillus flavus is a ubiquitous soil saprophyte in the Sudan and is responsible for many cases originating from this area. The literature is reviewed and treatment options discussed.

An ingested foreign body: two sides of the same coin?

A 2-year-old child presented to the emergency department with an acute onset of dysphagia and stertor. A plain anteroposterior chest X-ray revealed a single circular opacity in the middle third of the oesophagus consistent with an ingested coin. The child was taken to the theatre for rigid pharyngo-oesophagoscopy and removal of the coin. After the first coin was removed subsequent endoscopic examination revealed a second coin at the same location. This extremely rare case of two ingested coins becoming impacted with perfect radiological alignment emphasises the importance of thorough examination on endoscopy and the potential limitations of an X-ray in initial assessment of an ingested foreign body.