Sanjeev Mohanty

Solitary oncocytoma of the submandibular salivary gland in an adolescent female: A case report

We report a rare presentation of Oncocytoma of the submandibular salivary gland in an young adolescent female who presented with progressive swelling in the left submandibular region since childhood with pain for the past one month. Fine needle aspiration revealed Oncocytoma for which a conventional submandibular excision was done. There are few articles about the rare presentation of submandibular Oncocytoma and literature favors older population for this rarity. This case was unique because of its presentation in a young individual and there were no supporting published articles available till date.

Actinomycosis of faucial tonsil masquerading as oropharyngeal malignancy.

Actinomycosis is a rare inflammatory disease caused by anaerobic gram negative bacterium of actinomyces species. Lesions in the head and neck are characterized by their varied presentation and their propensity to mimic other diseases.[1] Here we present a rare case report of actinomycosis of tonsil in an elderly man masquerading as tumour of oropharynx.

Comparative study of percutaneous dilatational tracheostomy and conventional tracheostomy in the intensive care unit.

Objective: Tracheostomy is a one of the earliest described surgical procedure dating back to 2000 B.C. Percutaneous tracheostomy is becoming increasingly popular as an alternative method for conventional tracheostomy in the intensive care unit. In this study we compare the results of the use of these 2 techniques in 32 patients who underwent elective tracheostomy in the intensive care unit.Study Design: Prospective randomized comparative study.Setting: Tertiary care hospital.Patients: Adult intubated patients selected randomly in the intensive care unit with normal cervical soft tissue, laryngeal framework, palpable cricoid cartilage and normal coagulation parameters.Results: 17 patients underwent conventional tracheostomy and 15 patients underwent percutaneous dilatational tracheostomy. Demographic data and duration of intubation comparable between two groups. The mean operative time, blood loss and complications were lower in percutaneous than in conventional tracheostomy.Conclusions: PDT is quicker to perform and has lower blood loss and complication rates compared to conventional tracheostomy. However percutaneous tracheostomy is not indicated in emergencies and in children. The cost of the percutaneous kit and use of bronchoscopy adds to the cost. It is a good alternative to conventional tracheostomy in properly selected patients.

Management of extra sellar craniopharyngioma masquerading as hypertrophied adenoid tissue in a 6-year-old boy.

Described here is a rare case of a craniopharyngioma of the nasopharynx and the sphenoid sinus and its surgical resection via an endoscopic, transnasal, transphenoidal approach. The study design is case report. Craniopharyngiomas are histologically benign, extra-axial slow growing tumours of the sellar and the supra sellar space. Patients usually present with symptoms of neurologic, ophthalmologic or endocrine dysfunction. Possibility of the occurrence of such rare tumours needs to be always kept in mind while dealing with nasopharyngeal masses. The endoscopic transnasal transsphenoidal approach has been found to be associated with very low morbidity in experienced hands. Long term follow up of these patients is mandatory, because of the tendency of craniopharyngiomas to recur. Here, the patient was a 10-year-old boy, who had none of the above symptoms and was operated upon previously for the same complaints, with no relief in symptoms.

Significance of styloidectomy in Eagle’s syndrome: an analysis

Objectives/hypothesisReported here is a randomized retrospective analysis of 28 cases of elongated styloid process causing nagging cervicofacial pain, both unilateral and bilateral, and the effect of styloidectomy in these cases in relieving the symptom complex of the patient, in situations where conservative management failed in alleviating the symptoms.Study designRandomized retrospective analysis over a period of 25 months.ConclusionElongated styloid process causing glossopharyn-geal neuralgia is beginning to be a frequently encountered clinical entity nowadays. Of the 28 cases of elongated styloid process who underwent unilateral/bilateral styloidectomy, 27 patients had total relief of symptoms. Hence, we advocate styloidectomy, following careful diagnosis of the entity with clinical and radiological correlation, if the patient does not respond to medical therapy. The psychological status of the patient would provide clue to the authenticity of the symptoms in unrelieved cases.

Endoscopic Medial Maxillectomy Breaking New Frontiers

Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management of benign sino-nasal tumours. We present our experience of endoscopic medial maxillectomy in the management of sinonasal pathologies.

Functional study of nasal mucosa in endoscopic sinus surgery and its correlation to electron microscopy of cilia

The effect of functional endoscopic sinus surgery (FESS) was evaluated in 20 patients with chronic sinusitis. The physiological function of sinus mucosa and its mucociliary transport mechanism was assessed pre and post operatively in patients undergoing FESS by performing Saccharin clearance test. The effect of functional sinus surgery on nasal mucosa was evaluated using scanning electron microscopy and study of the ultrastructure of cilia in pre and post operative patients and correlation with histopathological examination. The mucociliary transport mechanism of the sinus mucosa improved 6 weeks following surgery. Histopathologically there was evidence of improvement in the ciliary population and decrease in inflammation, ulceration, fibrosis, vascular congestion, edema, squamous cell metaplasia, basement membrane thickening and polyp formation in comparison to the diseased mucosa sampled preoperatively. Scanning electron microscopic examination revealed considerable increase in the ciliary area as well as the orientation of cilia. Subjective improvement 6 weeks following surgery was confirmed by decrease in saccharin test time. This study revealed that FESS is an effective surgical procedure in chronic sinusitis and improves the overall function of the sinuses

Endoscopic cartilage versus temporalis fascia grafting for anterior quadrant tympanic perforations — A prospective study in a tertiary care hospital

OBJECTIVE Management of anterior perforations of tympanic membrane is a surgical challenge. The objective of this study is to analyse and compare the results of composite cartilage perichondrium island (CCPI) graft and temporalis fascia graft by endoscopic technique in anterior quadrant perforations. METHODS A prospective study was conducted in a tertiary care centre from 2012-16. A total of 187 ear drums(n) in 168 patients with perforations involving anterior quadrant were included in the study. All the patients were operated completely by endoscopic technique. Tragal Composite cartilage perichondrium island (CCPI) graft was used in 87 ears and temporalis fascia in 100. Each group was categorised into A and B depending on perforation size. The outcome parameters assessed include graft success with regard to perforation size, pre- and postoperative ABG, mean improvement in ABG, ABG closure ratio and graft medialisation/lateralisation status. RESULTS Cartilage group had 91.95% (80/87) success rate overall, while fascia had 79% (79/100). In category 1, the success rate for cartilage and temporalis fascia were 89.6% (26/29) and 68.9% (20/29) respectively (p=0.51788). In category 2, the success rates were 93.1% (54/58) and 83.1% (59/71) respectively (p=0.86356). The mean improvement in ABG for both groups were 17.52±3.84dB and 15.26±5.56dB respectively (p=0.04). ABG closure ratio for both the groups were 62.84±11.87 % and 53.6±19.6 % respectively (p=0.0008). CONCLUSION Endoscopic composite cartilage perichondrium island graft is an effective technique in managing perforations of anterior quadrant barring the expertise required for endoscopic ear surgeries.

Role of Autologous Costal Cartilage Grafts in Otolaryngology Practice: A Surgical Review.

Aim: The aim of this article is to describe the advantages and disadvantages of the costal cartilage grafts in reconstruction from the otolaryngologist’s perspective and have an analysis of the surgical review of the use of this autologous graft in reconstructive procedures. Materials and methods: A retrospective case series was conducted from 2010–2015. A total of 23 patients were selected and they were categorized depending on the defects and reconstructive procedures performed; 6th, 7th, and/or 8th rib grafts were harvested and carved according to the nature and site of the defect. The remodeled grafts were used for augmentation rhinoplasty (14 patients), laryngotracheal reconstruction (7 patients), and microtia repair (2 patients). Results: The age group of study population was 8 to 57 years. All patients had improved outcomes, barring a minimal warping effect in recipient area. Conclusion: High viability, good texture, and availability in large sum make rib grafts ideal for reconstruction in otolaryngological procedures. Clinical significance: Knowledge of various grafts and reconstruction techniques is important for otolaryngologist practice. This study describes briefly about the techniques and role of costal cartilage grafting in the esthetically complex head and neck region.

Management of Laryngo Tracheal Injury Our Experience

Laryngotracheal trauma is life-threatening. It is considered to be a rare occurrence but now it is more common due to high speed vehicle accident. Failure to recognize such injuries and promptly secure an airway may have fatal consequences [1]. We are reporting 3 cases of blunt trauma following which they developed absolute dysphagia, difficulty in breathing and difficulty in phonation. These patients were promptly and appropriately managed. Two patients were surgically managed and one patient was conservatively managed. They are on regular follow up and are doing well. Here we highlight a successful management of such rare cases.