Sanjeev Bhagat

Anterior craniofacial resection — for paranasal sinus tumors involving anterior skull base

Management of anterior skull base tumors is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Currently, the “gold standard” for surgery is the anterior craniofacial approach. Craniofacial resection represents a major advance in the surgical treatment of tumors of the paranasal sinuses involving anterior skull base. It allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. This study presents a series of 18 patients with anterior skull base tumors, treated by a team of head-neck surgeons and neurosurgeons. The series included 15 malignant tumors of the nose and paranasal sinuses and 3 extensive benign lesions. All tumors were resected by a combined bi-frontal craniotomy and rhinotomy. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of wound infection, cerebrospinal fluid-leakage or meningitis. Recurrent tumor growth or systemic metastasis occurred in 3 out of 15 patients with malignant tumors, 6 months to 2 years postoperatively. Craniofacial resection was thus found to give excellent results with low morbidity in malignant lesions and can also be adapted for benign tumors of anterior skull base.

Pre and post operative evaluation of hearing in chronic suppurative otitis media

Aim: To evaluate pre- and postoperative hearing status in patients of chronic suppurative otitis media (CSOM) undergoing mastoidectomy with tympanoplasty. Study type- Prospective. Materials and Methods: Eighty cases of CSOM were included. All patients underwent a pre-operative pure-tone audiometry (PTA) to find out the hearing status and to obtain documentary evidence for the same, and X-ray mastoid (bilateral Schullres view) to assess the pathology and surgical anatomy of the mastoid. All patients included in the study were categorized into three groups according to the surgery planned: Group-A: Tympanoplasty, Group-B: Canal wall up (CWU) mastoidectomy with tympanoplasty, and Group-C: Canal wall down CWD mastoidectomy with reconstruction. Post-operatively, after 10 weeks and 6 months, audiological examination (PTA) was carried out to compare pre- and post-operative hearing status. Results: In this study we found that postoperative hearing results were better in the case of safe CSOM as compared with unsafe CSOM and of tympanoplasty as compared with tympanoplasty with mastoidectomy.

Endoscopic Trans-Nasal Trans-Sphenoidal (TNTS) Approach For Pituitary Adenomas: Our Experience

Advances in optics, miniaturization, and endoscopic instrumentation have revolutionized surgery in the past decade. Current progress in the field of endoscopy promises to further this evolution: endoscopic telescopes and instruments have improved upon the optical and technical limitations of the microscope, and require an even less invasive approach to the sella. Pituitary surgery is traditionally within the realm of the neurosurgeon. However, since the reintroduction of the transseptal transsphenoidal approach and endoscopic transnasal transsphenoidal approach to the sella turcica for resection of pituitary adenoma, otolaryngologists have been active partners in the surgical management of these patients. Otolaryngologists have lent their expertise in nasal and sinus surgery, assisting the neurosurgeon with the operation. The otolaryngologist has the advantage of familiarity with the techniques and instruments used to gain exposure of the sella turcica by transnasal approach. Hence, the otolaryngologist provides the exposure, and the neurosurgeon resects the tumour. Such collaboration has resulted in decreased rates of complication and morbidity. We hereby discuss our experience of treating 54 cases of pituitary tumour by endoscopic transnasal approach at our hospital.

Clinico-pathological profile of sinonasal masses: An experience in tertiary care hospital of Uttarakhand

Background: The purpose of this study was to classify various types of non-neoplastic and neoplastic lesions presenting as sinonasal mass and characterize their clinico-pathological profile in a tertiary care center in the state of Uttarakhand. Materials and Methods: This was a prospective study where 110 cases of sinonasal masses were included over a period of 12 months. Clinico-pathological study was carried out in these cases. A provisional diagnosis was made after clinical assessment and radiologic investigations, but final diagnosis was made after histopathologic examination. Observations: The number of non-neoplastic lesions were more than the neoplastic lesion, 60% versus 40% respectively. In the neoplastic group, 19.8% and 23.76% patients presented with benign and malignant lesion, respectively. The incidence was more predominant in the age group of 11-20 years (22.72%) with male to female ratio of 1.08:1. In our study, among non-neoplastic lesions the occurrence of sinonasal polyps was highest seen in 80.30% cases. In neoplastic lesions, angiofibroma was most common benign lesion seen in 35% cases. Carcinoma nasal cavity was the commonest malignant lesion seen in 45.83% cases. In 3.63% patients, clinical and radiologic diagnosis was not correlated with histopathologic diagnosis. Only two cases required immuno-histocytochemistry to confirm the final diagnosis. Conclusion: We concluded that for proper evaluation of a sinonasal mass, clinical, radiologic, and histopathologic evaluation should be carried out conjointly in all the cases. Histopathology always gives a confirmatory diagnosis but in few cases immuno-histocytochemistry becomes the ultimate diagnostic technique for correct and timely intervention.

Parapharyngeal And Retropharyngeal Space Abscess: An Unusual Complication Of Chronic Suppurative Otitis Media

Parapharyngeal and retropharyngeal abscess as a complication of cholesteatoma is an uncommon entity. We present the unusual case of a 32-year-old man with chronic suppurative otitis media, presenting with parapharyngeal and retropharyngeal abscess. This was treated with incision and drainage of the abscess followed by modified radical mastoidectomy for chronic suppurative otitis media.

Extranasopharyneal angiofibroma in an adult: a rare presentation.

Juvenile nasopharyngeal angiofibromas are benign but locally aggressive tumors of nasopharynx seen exclusively in adolescent males. Angiofibromas arising in sites other than nasopharynx is very rare. Maxilla is the most frequent site of origin. Extra nasopharyngeal angiofibromas of adult is extremely rare. We present a case of extra nasopharnygeal angiofibroma arising from maxillary sinus in an adult patient which was excised successfully.

Clinicopathological study of tumous of hypopharynx

Thirty cases of tumors of hypopharyiix were admitted in EST department ofRujendra Hospital, Patiala for ciinicopathological study. Peak age incidence of tumours was seen in 6th decade of Life. Males were affected more than females (23:7), Alcohul consumption, smoking and poor orodental hygiene were important predisposing factors responsible for the disease. Maximum number of cases the growth was seen in pyrifarm fossa (80%). Dysphagia, neck mass and throat pain were commonest symptoms. AU cases were found to be Mstologicalty squamous cell carcinoma. Most of the patients presented in advanced stage with cervical lymphnode metastasis in 60% of cases

A Study of Lateral Nasal Wall: Anatomical Variants,Radiological And Endoscopic Appearance And Role in Symptomatology in Chronic Rhinosinusitis

It is assumed that the anatomical variations of lateral wall of nose contribute to various disease symptoms by blocking normal sinus drainage.This prospective study was conducted on hundred patients suffering from chronic rhinosinusitis, to study the various anatomical variations of lateral wall of nose by CT scan and diagnostic nasal endoscopy.A statistically significant correlation was found between concha bullosa and maxillary sinusitis (right and left concha bullosa with ipsilateral maxillary sinusitis p value was 0.033 and 0.01, respectively which are < 0.05), right and left agger nasi cell and ipsilateral frontal sinusitis (p value is. 01 and. 0006 which are <.05), right and left paradoxical middle turbinate and ipsilateral maxillary sinusitis (p value is. 000 and. 000 which are <.05).Considering the results obtained, we conclude that anatomical variations of the nose and paranasal sinusescan play an important role in the pathogenesis of chronic rhinosinusitis, and thus may increase the risk of sinus mucosal disease.

Primary external auditory canal cholesteatoma presenting as cerebellar abscess

External auditory canal cholesteatoma (EACC) is an uncommon disease and its pathogenesis remains unclear. Clinically, patients usually present with symptoms like chronic dull pain and otorrhea, but many patients can be astonishingly silent or even asymptomatic. The intracranial complication with extensive mastoid cavity from primary EACC is extremely rare. Early diagnosis is imperative to facilitate best possible intervention and to relieve patient symptoms and to prevent further complications. We present the first report in the English literature of a case of primary EACC presenting as cerebellar abscess. We experienced a rare case of a 55-year-old female patient admitted in our hospital with cerebellar abscess complicated by a cholesteatoma in the external auditory canal. The patient was first managed conservatively with systemic antibiotics by neurosurgeon, and then the disease was removed successfully by canal wall down mastoidectomy and no recurrence had occurred in the first 4 months post-operatively.

Intractable Sneezing: Case Report and Literature Review

Sneezing is usually the physiologic response to nasal irritation but intractable paroxysmal sneezing is very uncommon. Various causative factors have been identified in the literature; these include psychologic problems, cervical lymphadenitis, epilepsy, and allergy. Majority of cases of intractable sneezing are reported among adolescents and are psychogenic in origin. We report one young lady with intractable paroxysmal sneezing in whom the removal of psychogenic stressors resulted in complete remission. The sneezing was continuous but did not occur while talking or sleeping, and did not respond to antihistamines, steroids and bronchodilators. The authors discuss the patients’ treatment and outcomes and the pathophysiology of intractable paroxysmal sneezing.