Ravi C. Nayar

Malakoplakia of the temporal bone in a nine-month-old infant

A case of malakoplakia, of the temporal bone in a nine-month-old male child is reported. The lesion presented as an aural polyp, associated with a lower motor neuron facial palsy. On exploration, the granuloma was noted to involve the temporal bone, eroding the bony labyrinth. It was successfully treated with surgical debridement, and antibiotics. A review of the relevant literature is presented.

Tracheal resection with end-to-end anastomosis for post-intubation cervical tracheal stenosis: study of 14 cases.

BACKGROUND AND OBJECTIVES The incidence of acquired laryngeal stenosis is increasing. This retrospective study aimed to assess the long term results of circumferential resection with end-to-end tracheal anastomosis for isolated post-intubation stenosis of the cervical trachea, and to review the relevant literature. METHODS Twelve male and two female patients (aged 16-30 years, mean age 24 years) treated between February 2003 and December 2008 were included. Hospital and office records were reviewed and relevant surgical details recorded. RESULTS Indications for tracheal resection anastomosis were post-intubation stenosis (78.57 per cent) and trauma (21.42 per cent). One to five tracheal rings were resected (i.e. 1-2.5 cm of cervical trachea). Tracheal anastomosis was considered successful if the patient remained asymptomatic for 24 months of close follow up (involving regular flexible bronchoscopy and neck X-ray). The anastomotic success rate was 92.85 per cent. CONCLUSION Tracheal resection and end-to-end anastomosis is relatively safe and reliable for definitive treatment of benign tracheal stenosis in appropriate patients. Local application of mitomycin C prevents granulation and aids long term airway patency.

Do patients with allergic rhinitis have a particular personality trait

OBJECTIVES This study investigated the personality traits of patients with allergic rhinitis. It also examined the association between personality type and the type of allergic rhinitis, and compared this with the general population. METHODS A descriptive observational pilot study was carried out on 50 consecutive cases of allergic rhinitis who presented to the allergy clinic between June and October 2010. These patients were compared with a control group comprising 50 individuals from the general population that had no symptoms of allergic rhinitis. Both groups completed the International Personality Disorder Examination questionnaire for the assessment of personality traits. RESULTS Persons falling into cluster C personality type showed a positive correlation with the type and severity of allergic rhinitis. The majority of control group individuals fell into cluster A. This indicated a correlation between allergic rhinitis and a dominant anxious trait compared with the control group. CONCLUSION In psycho-allergological research, the potential relevance of personality factors in the maintenance and exacerbation of atopic symptoms is still a matter of debate. More attention should be paid to the psychological status of allergic rhinitis patients, and appropriate treatment should be provided to improve their symptoms and quality of life.

Plasmacytoma of larynx--a case report.

Plasma cell myeloma, the most common plasma cell neoplasm, is characterized by the presence of multiple lesions in the bone marrow. A single isolated lesion may occur either in bone (solitary plasmacytoma of bone) or in soft tissue (extramedullary plasmacytoma). Most cases of extramedullary plasmacytoma occur in the head and neck region. The diagnosis is established by histopathology and immunohistochemistry. A detailed evaluation for lesions at other sites is recommended as extramedullary plasmacytoma treated by radiation therapy has better survival rates than plasma cell myeloma, which is treated by chemotherapy. A case of plasmacytoma of the larynx is presented highlighting clinical and histological features with a review of literature.

Sublingual hydatid cyst: case report and literature review.

OBJECTIVES To demonstrate the importance of detailed clinical analysis in the differential diagnosis of a cyst in the floor of the mouth, and to provide an update on current knowledge and treatment of sublingual hydatid cyst. CASE REPORT A 23-year-old man presented complaining of a swelling in the midline of the sublingual region, present for four months and progressively increasing in size. Ultrasonography of the neck revealed a well defined, hypoechoic lesion in the sublingual region, containing a calcific focus. Fine needle aspiration cytology showed numerous round to oval structures resembling brood capsules, with scolices and occasional hooklets. T1- and T2-weighted, multiplanar magnetic resonance imaging scans showed a well defined, multiloculated lesion in the sublingual region. CONCLUSION Hydatid disease may present as a slow-growing cyst in the sublingual region. Aspiration cytology should preferably be avoided until radiological imaging studies are complete. A high index of suspicion is necessary to diagnose hydatid disease in an unusual location.

Extracranial cysticercosis of the parotid gland: a case report with a review of the literature

OBJECTIVE A case of solitary extracranial cysticercosis of the parotid gland is reported. A discussion concerning the clinical features, imaging modalities, diagnostic methods and management of cysticercosis, along with a review of relevant literature is also presented. CASE REPORT A young female patient presented with features resembling acute parotitis. Solitary cysticercosis of the parotid gland was diagnosed, based on fine needle aspiration cytology and radiological investigations. Medical therapy was effective, consequently surgery was deferred. CONCLUSION This is the first report of solitary extracranial cysticercosis of the parotid gland. A high index of suspicion for such parasitic infestations is essential even in non-endemic areas due to the ease of worldwide travel.

Paraganglioma of larynx

A case of Paraganglioma of Larynx in an elderly female is reported. Its location in the interarytenoid region is noteworthy, as this is not a site of normal aggregation of paraganglionic tissue in the Larynx.

Surgical management of a case of third branchial pouch fistula.

A case of left pyriform sinus fistula in a 20-year-old male is presented. The surgical management of this uncommon condition is discussed. Its embryological and clinical aspects are reviewed.

Isolated sphenoid sinus disease - a retrospective analysis

ObjectiveTo evaluate the etiology, symptoms, signs, imaging, surgical findings and outcomes of isolated sphenoid sinus disease (ISSD).DesignRetrospective study.SettingsTertiary university based referral center.Materials and methodsAll 8 patients aged 17–63, managed surgically in the department of ENT and Head and Neck Surgery at St. John’s Medical College and Hospital, Bangalore from 2006 to 2008 for ISSD. Demographic data, presenting signs and symptoms endoscopic and imaging findings, surgical management, surgical pathology and clinical outcomes were investigated in the above patients.ResultsOf the 8 cases of ISSD, 5 were male; 3 were female, with an age range of 17–63 years. The most common presenting symptom was headache (7 patients [87.5%]), followed by nasal obstruction and recurrent URTI (5 cases [62.5%]). Imaging included CT and/or MRI studies in all cases. Sphenoid sinus pathology was varied and included 5 (62.5%) inflammatory cases, 1 (11.1%) cerebrospinal fluid fistula and 2 (22.2%) cases of sphenoid sinus neop;asms. Of the inflammatory cases 2 (40%) had isolated polyps in the sphenoid sinus [sphenochoanal polyps] and 3 (60%) had fungal sinusitis. Treatment was surgical, endoscopic transnasal sphenoidotomy under general anesthesia in all 5 patients with inflammatory ISSD Two patients with sphenoid sinus tumors underwent endoscopic biopsy.ConclusionISSD is rare. A high index of suspicion is required for diagnosis, which should be an active process and not one of exclusion. Both diagnostic nasal endoscopy and CT imaging are essential for diagnosis. The direct approach to the sphenoid sinus, transnasal endoscopic sphenoidotomy without ethmoidectomy is safe and effective. With early and adequate surgery we were able to avoid the morbidity associated with ISSD.

Correlation Between Retropalatal Collapse as Observed During Muller’s Maneuver to Severity of OSA

Abstract Objective of the study was to evaluate the reliability of Muller’s maneuver (MM) with the severity of obstructive sleep apnea (OSA) at the retropalatal level. Case series of 58 adult patients diagnosed to have OSA. Sleep apnoea clinic in a tertiary referral center in south India. Fifty-eight adult OSA patients underwent outpatient based MM under local anaesthesia. Collapse of hypopharynx and the retroglossal regions were assessed during a maximal inspiratory effort against the closed mouth and sealed nose (reverse valsalva). Correlation co efficient was used to compare MM grade with apnea–hypopnea index (AHI) scores. Severity of OSA based on AHI scores were compared with the results of Muller’s maneuver at the retropalatal level. The correlation coefficient was 0.213, hence no correlation was found, p value was 0.019, which was not statistically significant. MM is an useful tool for evaluation of upper airway collapse. The advantages include simplicity, cost-effectiveness, relatively easy to perform, thorough evaluation of upper airway. The pitfalls of the procedure includes the subjectiveness of the procedure and the fact that it is performed on awake patients and therefore remains an indirect estimation of obstruction that occurs during sleep. In our study, we did not find correlation between the severity of OSA based on the AHI scores and the collapse at the retropalate level assessed by the Muller’s maneuver.