Ravi Meher

Deep neck abscess: a prospective study of 54 cases

Deep neck abscesses (DNAs) continue to be commonly encountered in developing countries like India. This study was conducted to determine the changing trends within our population with respect to presentation, aetiology, location and microbiology of DNAs. Fifty-four patients with DNAs who were managed at the Department of ORL and H&N Surgery in our hospital between May 2002 and December 2002 formed the basis of the study. We observed that the high incidence of DNAs could be attributed to lack of awareness, illiteracy and poverty among patients, along with the poor primary health infrastructure. We also recommend early surgical intervention in these cases to decrease the prevalence of complications.

Endoscopic transcanal myringoplasty—A study

Aim of this study was to evaluate the role of rigid endoscope in the management of dry central perforation of the tympanic membrane and to compare the results of endoscopic myringoplasty with that of conventional myringoplasty using microscope. In endoscopic group there was 90% graft uptake rate as compared to 85% in microscopic group. The results of endoscopic myringoplasty are comparable to the conventional myringoplasty done under operating microscope and there is no significant difference between the gain in A-B gap in either group

Sutureless tympanoplasty using acellular dermis

OBJECTIVE A prospective randomized unblinded controlled trial was conducted by comparing acellular dermis with temporalis fascia as graft materials in tympanoplasty (type 1) in terms of operative time, postoperative pain, graft success rate, and audiologic outcome. STUDY DESIGN Forty-two patients with (inactive) chronic suppurative otitis media of tubotympanic type were randomized, matched, and divided equally into 2 groups of 21 each. One group underwent tympanoplasty (type 1) via transcanal route using temporalis fascia graft and the other using acellular dermis. Both groups were compared for operative time, postoperative pain, graft success rate, and audiologic improvement in hearing. RESULTS There was a statistically significant reduction in operative time (P < .05) and postoperative pain (P < .05) in the acellular dermis group. However, there was no statistical difference in graft success rate (P > .05) and hearing improvement (P > .05) between both the groups. CONCLUSION Results of tympanoplasty using acellular dermis as graft material are comparable to that using temporalis fascia in terms of graft uptake and hearing improvement. However, tympanoplasty using acellular dermis has the advantage of shorter operative time and lesser postoperative pain.

Duplication cyst of oesophagus: a case report.

Duplication of the oesophagus is the second most common duplication of the gastrointestinal tract. Children with oesophageal duplication cyst usually present with dysphagia or as asymptomatic thoracic mass found o incidental chest x‐ray. We report a case of oesophageal duplication cyst that presented with inspiratory stridor and dyspnoea in a 6 month old boy. Bronchoscopy revealed an external compression on the trachea. Duplication cyst arising from the oesophagus was suggested on CT and MRI. The cyst was surgically excised with resolution of symptoms.

Unusual complication of ingestion of a foreign body

Foreign bodies of the upper aerodigestive tract are common problems dealt with by the otolaryngologist. Among all foreign bodies in the oesophagus, an open safety pin still presents a challenge for the ENT specialists because of its propensity to pierce the oesophagus and surrounding structures. We present an interesting case of a long-standing foreign body i.e. an open safety pin, which, after piercing the hypopharynx, caused fatal common carotid artery rupture.

Primary tuberculosis of oral cavity: a rare entity revisited.

Oral lesions of tuberculosis though uncommon, are seen both in the primary as well as the secondary stages of the disease. In secondary tuberculosis, the oral manifestations are accompanied by lesions in the lung, lymph nodes, or any other organ system of the body. This can be detected by the usual clinical history and systemic examination. Primary oral tuberculosis may thus present as a diagnostic challenge to the clinician. Amongst the oral lesions also, tongue is the usual site for tubercular infection, with the upper lip and soft palate being the least affected. The authors report two rare cases of children with isolated primary tuberculosis of the lip and uvula. Interestingly, the first case presenting just as a diffuse swelling of the upper lip, and the second as pain in throat with congestion and granulations on the uvula. We suggest a distinct Indian social habit which predisposes to primary lip and uvular tuberculosis, sites not common in the rest of the world. The habit of doing “datoon” i.e. brushing of the teeth with neem twigs in rural India, which at times causes trauma on the palate and thus predisposing to seedling of the wound with mycobacterium tuberculosis.

Tubercular otitis media in children.

Tubercular otitis media rarely is seen these days. Five cases of tubercular otitis media in children are reported. Four cases presented with postaural fistula, 2 of these after incision and drainage by general practitioners. One case presented with facial palsy. None of the cases showed any improvement with antibiotics. The diagnosis was confirmed by cytopathology following modified radical mastoidectomy in all cases. Clinical features, complications, and management of such cases are discussed. Otitis media in children that is refractory to antibiotics should arouse a high degree of suspicion of tuberculosis, and granulations should be submitted for cytopathological examination.

Pilonidal sinus of the neck

A pilonidal sinus is most commonly seen in the sacrococcygeal region. Here we describe a rare case of pilonidal sinus of the neck following trauma due to shaving. Excision of the sinus with primary repair resulted in complete healing of the lesion with no recurrence. The possible pathogenesis of this acquired condition is also discussed.

Carotid artery erosion in a 4-year child

The carotid erosion occurs most commonly in patients receiving radiotherapy for head and neck cancer and is associated with high mortality. We report a case of carotid blow out in a 4-year-old child who presented with massive parapharyngeal space abscess. The common carotid artery (CCA) was ligated and child recovered without any neurological sequel.

Uma nova abordagem para a dacriocistorrinostomia endoscópica

AIM To compare a composite technique of endoscopic dacrocystorhinostomy with the conventional technique. METHODS A randomised prospective study was carried in the department of Otolaryngology Maulana Azad Medical College. Thirty patient selected for Endoscopic DCR were divided into two groups, one of which underwent conventional endoscopic DCR and the other group were treated with a newer technique using cautery, cold instrumentation and laser at different steps of endoscopic DCR. The patients were followed up for nine months. RESULTS/CONCLUSION By using cautery, cold instrumentation and laser at different steps of endoscopic DCR we were able to achieve a success rate of around 94% with this composite technique as compared to 83.3% in conventional endoscopic DCR surgery.AIM: To compare a composite technique of Endoscopic Dacrocystorhinostomy with the conventional technique. METHODS: A randomised prospective study was carried in the department of Otolaryngology Maulana Azad Medical College. Thirty patient selected for Endoscopic DCR were divided into two groups, one of which underwent conventional Endoscopic DCR and the other group were treated with a newer technique using cautery, cold instrumentation and laser at different steps of Endoscopic DCR. The patients were followed up for Nine months. RESULTS/CONCLUSION: By using cautery, cold instrumentation and laser at different steps of Endoscopic DCR we were able to achieve a success rate of around 94% with this composite technique as compared to 83.3% in conventional Endoscopic DCR surgery.