M. Panduranga Kamath

Cervical thymic cyst: a rare differential diagnosis in lateral neck swelling.

Introduction. Thymic cysts are among the rarest cysts found in the neck. Nests of thymic tissue may be found anywhere along the descent of the thymic primordia from the angle of the mandible to the mediastinum. Mediastinal extension is seen in 50% of cervical thymic cysts. Case Report. We report an uncommon case of a 15-year-old male, who noted a painless, growing mass on left side of his neck of one-year duration. Computerised tomographic scan showed a multiloculated fluid density lesion with enhancing septae in the left parapharyngeal space, extending from the level of mandible up to C7 vertebral level. Here, we discuss the surgical aspect, histopathology, and management of this rare lateral neck swelling. Discussion. Clinically, in most cases, cervical thymic lesions present as a unilateral asymptomatic neck mass, commonly on the left side of the neck, and 75% of patients present before 20 years of age. Conclusion. Thymic cyst should be included as differential diagnosis of cystic neck masses. Greater awareness among the pathologists may decrease misdiagnosis.

A rare complication of an impacted foreign body in the cricopharynx

Foreign body impaction in the gastrointestinal tract is not rare. The majority (up to 90%) of these impacted foreign bodies are passed spontaneously.* Bloom et al2 found that most of the foreign bodies that fail to pass through the gastrointestinal tract lodge in the esophagus. A foreign body impacted in the esophagus should be removed as soon as the diagnosis is made, for the following reasons3: the chance of spontaneous passage is small; edema from local trauma grips the object firmly, making later manipulation difficult; and perforation of the esophagus is a very serious complication, with high mortality and morbidity.

Presentation and management of deep neck space abscess

ObjectiveTo study the presentation, etiology, microbiology and morbidity of deep neck space infections.Study DesignRetrospective study Methods: 29 patients admitted in Kasturba Medical College Hospital, Mangulore, India between January 1997 and December 2002 with deep neck space infections.,were included in the study.RemitsThe most common space involved was the parapharyngeul space. No specific etiology was determined in .38%; an odontogenic cause was discovered in 28% of the patients; tonsillar/pharyngeal infections in 24% of patients and foreign body impaction in 7% of cases. The main morbidity was due to mediastinitis (5 patients). I patient succumbed to the disease. Mixed flora with aerobic and anaerobic infections was identified in most of the cases.

Radiotherapeutic effect on oropharyngeal flora in head and neck cancer.

The effect of radiotherapy on oropharyngeal bacterial and mycotic flora was studied. Thirty five patients were included from whom swabs were taken before and at the end of irradiation. Fifteen controls were included.It was found that Streptococcus pneumoniae was significantly decreased at end of irradiation, while there wan an increase in Staphylococcus aureus. Pseudomonas, Bacteroides and Candida species. There was no change in culture and sensitivity pattern prior to and after radiotherapy.

Role of estimation of arterial blood gases in the management of stridor

AimWe studied the epidemiology and etiology of stridor in our patients along with the role of arterial blood gas (ABG) analysis in their management. We also reviewed their prognostic indices and the clinical outcomes.Materials and methodsIt was a prospective study in a tertiary referral hospital in which 72 patients presenting with stridor, were independently evaluated by 3 different clinicians and clinically classified into mild, moderate and severe. Based on ABG values (pH, PO2, PCO2), we defined 3 groups of patients viz, those in respiratory failure, impending respiratory failure and those with no evidence of failure. Treatment was directed at the cause of stridor. Clinical outcomes were assessed and results classified as resolved, improved, stable and death.ResultsOut of 72 patients, kappa coefficient of agreement between the 3 observers were found to be 0.014, indicating poor interobserver reliability for the working clinical classification. However, ABG analysis indicated otherwise, with 6 patients in respiratory failure, 19 progressing to impending failure. Hence we complied by the more objective ABG analysis in planning management. Laryngomalacia in children and hypopharyngeal malignancies in adults were found to be the most common causes of stridor in our study. As compared to other conditions, laryngomalacia in children had a poorer outcome (p = 0.001).ConclusionEarly detection of impending respiratory failure was instrumental in achieving better clinical outcomes in our patients presenting with stridor. Thus we inferred that ABG analysis is a valuable tool in the effective management of stridor.

Antrochoanal polyps and allergy-A comparative study.

Antrochoanal polyps, are solitary polyps arising from the maxillary autrum. Their aetiology largely remains unknown; allergy has been implicated. The study attempts to define the relation between antrochoanal polyps and allergy and the need for such an investigation by studying 24 cases with antrochoanal polyps and comparing them with 20 cases of sinonasal polyps. Nasal smear cytology, serum total IgE and polyp fluid IgE was evaluated. 52.38% of cases turned out to be allergic. In their presentation, antrochoanal polyps do not significantly differ from other polyps.

Solitary nasal mass: an unusual diagnosis

Solitary nasal mass: an unusual diagnosis Suja Sreedharan, MS⁎, Sonali Ullal, MD, M. Panduranga Kamath, MS, Mahesh Chandra Hegde, MS, Kiran M. Bhojwani, MS, Arathi Alva, MS, K.V. Vishwas, MBBS Department of Otolaryngology, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Manipal University, Karnataka State, India Received 14 February 2010

Histiocytosis of the temporal bone.

Histiocytosis is a rare disease of unknown aetiology which commonly affects the head and neck region. In the ear it can closely mimic acute and chronic ear disease leading to a confusion in diagnosis. It can be easily misdiagnosed unless a high index of clinical suspicion is maintained. We present a case of Letterer Siwe disease of the temporal bone which presented with bilateral mastoid abscesses.

A case of foreign body in the subglottic region

An impacted foreign body in the subglottis is a rare cause of upper airway obstruction in children. More often than not the diagnosis is delayed; especially where proper history is not forthcoming. This peculiar condition can masquade as laryngotracheobronchitis or a croup. Though it is rare, a foreign body in the subglottis should be kept in mind in the investigation of a child with stridor.