Mainak Dutta

Primary laryngeal aspergillosis in the immunocompetent state: a clinical update.

Laryngeal aspergillosis is known to occur in immunocompromised states, particularly in diabetes mellitus, tuberculosis, and human immuno-deficiency virus (HIV) infection, and is associated with use of inhalational steroids and cytotoxic drugs. Primary laryngeal aspergillosis is rare, especially in immunocompetent patients, with very few reported cases to date. It often mimics the pre-malignant and malignant conditions of larynx, and responds well to antifungals. This report presents a case of primary laryngeal aspergillosis in an immunocompetent middle-aged woman, and explores the current pool of evidence regarding its pathogenesis and clinical aspects. To date, this represents the only comprehensive review on the topic.

The ectopic accessory parotid system with congenital cheek fistula: An overview and current update

This review attempts to provide a comprehensive, updated overview of the ectopic accessory parotid system (EAPS) from clinical and developmental perspectives and investigates its eligibility to be included in the oculo‐auriculo‐vertebral spectrum (OAVS).

The ectopic accessory parotid system: A new patient, studied through magnetic resonance imaging

The ectopic accessory parotid system (EAPS) connotes an extra parotid tissue with its ductal outlet that is morphologically distinct from the main parotid gland and its drainage system. Clinically presenting as a saliva-draining cheek fistula near the oral commissure, this rare congenital anomaly is almost always associated with ipsilateral preauricular appendages and occasional mandibular hypoplasia, and is considered a variant of the oculo-auriculo-vertebral spectrum. This report discusses the embryology, clinical details, and management aspects in a new patient, highlighting the role of magnetic resonance imaging in, for the first time, tracking the ectopic salivary system, and establishing its independent existence.

A lesson learnt: retrospection in a case of pilomatricoma mimicking as parotid neoplasm

Department of Pediatric Surgery, Medical College and Hospital, Kolkata, India.Corresponding author: Mainak Dutta – Department of Otorhinolaryngology and Head-Neck Surgery – Medical College and Hospital, 88, College Street – Zip code: 700073 – Kolkata, West Bengal, India Phone: +91 9830737587 – E-mail: duttamainak@yahoo.comReceived on: Mar 4, 2014 – Accepted on: Aug 20, 2014DOI: 10.1590/S1679-45082015AI3096

Ameloblastic carcinoma of mandible: facts and dilemmas

Ameloblastic carcinoma is a rare malignant odontogenic tumor and is considered as the malignant counterpart of ameloblastoma with features of both benign and malignant histology. It may arise de novo or from a long-standing ameloblastoma and is locally aggressive with a propensity for metastasis. With limited documentation, little is known about its pathobiogenesis, with no universal guidelines for management. For clinicians, differentiating ameloblastic carcinoma from ameloblastoma and malignant ameloblastoma in a patient presenting with a suspicious jaw tumor is a challenge due to overlapping clinical features, inconclusive cytology/biopsy reports, different management approaches and inadequate follow-up. Proper knowledge of the disease entity and a high index of suspicion are essential. Here we elaborate the dilemmas in diagnosis and management of ameloblastic carcinoma through presentation of a representative case in a 56-year-old man presenting with a tumor in the mandible.

Socio-demographic Correlates of Rhinosporidiosis: A Hospital-Based Epidemiologic Study in Purulia, India

The present paper attempts toxa0explore the socio-demographic profile of patients with rhinosporidiosis in an endemic area. A cross-sectional study was carried out in a tertiary-care hospital in Purulia district, India, including consecutive patients with histologically-proved rhinosporidiosis. Their socio-demographic profiles were obtained through a pre-designed proforma with given epidemiologic parameters. Data was statistically analyzed with inputs from literature review. Of the 39 patients included, 87xa0% were fresh/new cases. The age-group of 10–20xa0years was mostly involved, with multiple peaks around 50. About 82xa0% were from rural background, commonly involved in cattle farming and agriculture, with a universal habit of pond-bathing. There was a male preponderance; however women were being increasingly affected. Nasal cavity was the predominant site involved; nasal obstruction and epistaxis were the primary complaints. About 13xa0% had recurrent lesions that were statistically related to higher age-group (≥15xa0years) and occupation (agriculture, labor). Rhinosporidiosis is predominantly the disease of young rural adults engaged in field activities and habituated to pond-bathing. A bimodal age distribution was noticed. The present article provides an update on the socio-demographic perspectives of rhinosporidiosis in an endemic zone. It also summarizes the factors that would identify the vulnerable population and help formulate preventive measures.

Encountering Chronic Sore Throat: How Challenging is it for the Otolaryngologists?

Objective To explore and diagnose the underlying causes of chronic, recalcitrant sore throat. Methodology In this descriptive, cross-sectional study spanning 3xa0years (January 2014–December 2016), 1580 patients with chronic sore throat (>12xa0weeks duration, despite conventional medication) were evaluated for the possible cause(s) in a tertiary care teaching institute of eastern India, through proper history, appropriate investigations, and a self-designed algorithm. Results The common causes for chronic sore throat were chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder, respectively. Allergy, psychiatric illnesses, oral submucous fibrosis, systemic comorbidities (diabetes mellitus, hypothyroidism, uremia, arthritides), stylalgia, Koch’s pneumonitis, recurrent aphthous ulcers, and dietary deficiencies formed the other major causes. There was a minimal female preponderance, the female: male ratio being 1.25. About 39% patients were chronic smokers, and 31% addicted to alcohol. Forty-three (2.72%) patients were reactive to HIV 1/2. Conclusion The study provided with a detailed account of the heterogeneous etiology of chronic sore throat, and an overall structured idea on how to approach to its work-up and diagnosis. Proper history taking and appropriate structured investigations are the keys. Chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder were the chief causes of chronic sore throat.

Optimizing the outcome of transnasal endoscopic sphenopalatine artery ligation in managing refractory posterior epistaxis: A case–control analysis

OBJECTIVEnTo optimize the outcome of transnasal endoscopic sphenopalatine artery ligation (TESPAL) by determining the key surgical steps and applying them accordingly.nnnMETHODSnThis is a case-control study carried out in a tertiary care teaching institution on subjects who underwent TESPAL during the period of October 2010 to September 2015. Their surgical and clinical records were reviewed, and success (no re-bleed) and failure (return with re-bleed) were considered the main outcome measures of TESPAL. Accordingly, depending on whether the subjects returned with re-bleed or not, they were classified as failure and success groups. After appropriate matching in terms of age, gender and a given set of exclusion criteria that could influence per-operative decision-making or contribute to post-operative epistaxis, the groups were considered as cases (subjects undergoing TESPAL and returned with re-bleed; part of the failure group following matching) and controls (subjects undergoing TESPAL and did not return with re-bleed; part of the success group following matching). Per-operative/surgical factors executed or followed in varied combinations in each group that influenced the outcome of TESPAL were then identified from the surgical notes and were subsequently analyzed statistically.nnnRESULTSnIn 89% of cases, the sphenopalatine artery (SPA) pedicle was either clipped or cauterized, whereas in 90% of the controls, it was both clipped and cauterized. The posterior nasal artery (PNA), when found, was cauterized in 25% of the cases, compared to 85% in the controls. Also, the septal artery region was cauterized in only 33% of cases. Both cauterization/clipping of the SPA along with cauterization of PNA was done in 69% of the controls, whereas in 59% the septal artery region was also cauterized. However, there were no cases when all these steps were combined. The results were statistically significant.nnnCONCLUSIONnWhen only the per-operative/surgical factors were considered, the outcome of TESPAL was most favorable when the procedure could be done combining both clipping and cauterization of the SPA, along with cauterization of the PNA and the septal artery region.

Pilomatricoma perforante que se presenta como una úlcera en el hélix del pabellón auricular

A 24-year-old woman presented with a painless swelling in her right pinna which was noticed about four months back and had a recent increase in size. On examination, a 1.5×1 cm, firm, non-tender skin-colored nodule was seen in the helix. A clinical diagnosis of keloid was rendered. Considering chances of recurrence following surgical excision and because the woman was not concerned about cosmesis, we preferred to wait-and-watch. We were skeptical about the provisional diagnosis though, as she gave no history of ear-prick, a custom common among women for wearing earrings, and also because there was a history of transient peri-lesional reddening one month back. She returned two weeks later with the swelling increased in size, erythematous, and covered by crust. The scab was removed and the raw, bleeding, necrotic surface exposed (Fig. 1). At this point, we considered some form of chronic granulomatous disease or pyogenic granuloma as alternative possibilities,

Cystic squamous cell carcinoma of the neck: could a second metastatic focus help?

Squamous cell carcinoma of the neck presenting clinically as predominantly cystic lesion has often been considered as branchiogenic carcinoma in the past. However, such cystic lesions presently constitute a distinct form of head-neck metastasis, and a co-existent second metastatic focus could supposedly help distinguish them from branchiogenic carcinoma. We here present a case where, although the primary remained elusive, the associated spinal metastasis precluded us from diagnosing a cystic squamous cell carcinoma as branchiogenic carcinoma. Thus a second metastatic focus, if found, could add to the existing knowledge to distinguish between a cystic squamous cell carcinoma and the so-called branchiogenic carcinoma, especially when the primary could not be found.