Suresh Pillai

Hyalinizing clear cell carcinoma of the base of the tongue

Hyalinizing clear cell carcinoma is a rare, low-grade neoplasm of the minor salivary glands. It is composed exclusively of epithelial cells with optically clear cytoplasm. There are only a few isolated cases reported in the literature involving the base of tongue. The treatment of choice is wide excision and selective neck dissection, with or without radiotherapy. The prognosis of these tumours is good. A 57-year-old male patient presented with a lesion in the base of tongue, which was well enhanced on contrast computerized tomography scan. Once confirmed by biopsy, the hyalinizing clear cell carcinoma was resected via a transcervical approach. The patient underwent postoperative radiotherapy. There was no evidence of locoregional recurrence or distant metastasis at 18 months of follow up.

Malignant oncocytoma of the nasal cavity: A case report

Malignant oncocytoma is a rare clinical entity and is most commonly seen in the salivary glands. Its occurrence in the nasal cavity is extremely rare, and only 4 such cases have been reported in the literature. The authors report one such case in a 60-year-old woman, which presented as a slow-growing nasal mass arising from the nasal septum, with no lymph node metastasis, which was successfully managed by a combined modality of treatment-surgery followed by radiation therapy. The relevant literature has been reviewed. The case is discussed as a possible differential diagnosis for a mass in the nose.

Role of KTP-532 laser in management of oral submucous fibrosis

INTRODUCTION Oral submucous fibrosis is a chronic disease characterised by progressive inability to open the mouth. Various treatment modalities are available for its management, but these have largely been ineffective. MATERIALS AND METHODS Nine cases of oral submucous fibrosis underwent a release procedure using a KTP-532 laser, from March 2005 to January 2006, within the ENT-head and neck surgery department of a tertiary centre. RESULTS Pre- and post-operative mouth-opening was compared using the Wilcoxon signed rank test, and a significant difference observed (Z = -2.690, p = 0.007). Follow up over an average period of 12 months showed encouraging results. CONCLUSION This preliminary study indicated that adequate release of oral submucous fibrosis can be achieved by using a KTP-532 laser release procedure, with minimal morbidity and satisfactory results. These promising results should encourage more widespread use of this technique in the management of this condition.

Rhinofacial zygomycosis caused by conidiobolus coronatus

Fungal infections are common in a tropical country like India. Among the Zygomycosis infections, those caused by Mucorales are more prevalent. However, there exists another order of zygomycetes, the Entomophthorales, which rarely cause clinical disease. We report a rare cause of fungal infection of the maxillo-facial region and the oropharynx in a previously healthly male adult caused by Conidiobolus coronata of the order Entomophthorales to highlight the clinical presentation and treatment of this rare, chronic, indolent form of fungal infection.

Acute prevertebral abscess secondary to infected pancreatic pseudocyst

We report a case of a middle aged, man with diabetes who presented with dysphagia and odynophagia. On evaluation, he was diagnosed to have an acute prevertebral abscess with an unusual aetiology, an infected pseudocyst of pancreas. Contrast-enhanced CT revealed an enhancing collection in the prevertebral space extending to the retrogastric space and communicating with the body of the pancreas via the oesophageal hiatus. Transoral incision and drainage of the prevertebral abscess were performed. Nasogastric tube was placed in the prevertebral space for continuous drainage and daily irrigation. Supportive intravenous broad spectrum antibiotic therapy along with the surgical intervention led to the resolution of the prevertebral abscess and the infected pancreatic pseudocyst.

Epididymal and prostatic histoplasmosis in a renal transplant recipient from southern India.

W.W. Baig, R.P. Attur, A. Chawla, S. Reddy, S. Pillai, L. Rao, G. Rao, K. Ashok, P. Yegneswaran. Epididymal and prostatic histoplasmosis in a renal transplant recipient from southern India.
Transpl Infect Dis 2011: 13: 489–491. All rights reserved

Endonasal endoscopic dacryocystorhinostomy: our experience

ObjectivesTo study the outcome of endonasal endoscopic dacryocystorhinostomy (DCR) with or without mucosal flap preservation, without mitomycin local application, silicon tube stenting or laser assistance. To determine the duration of the surgical procedure of DCR, influence of simultaneously performed endonasal endoscopic procedures for concomitant sinonasal diseases.MethodsCombined retrospective and prospective study in our tertiary referral center. 24 patients with chronic dacryocystitis underwent 25 standard endonasal endoscopic DCR procedures, 10 with and 15 without mucosal flap preservation. 6 of these had concomitant sinonasal diseases for which they underwent septoplasty or functional endoscopic sinus surgery (FESS) or both, simultaneously or as staged procedures. Relief from epiphora and patency of the nasolacrimal fistula was assessed by nasal endoscopy and syringing of the lacrimal apparatus at 1 week, 3 weeks and 3 months postoperatively.ResultsOut of 18 patients who underwent only DCR, 17 patients (94.44%) had complete relief from epiphora. Out of 6 patients who underwent 7 DCRs with concomitant sinonasal surgery, 5 patients (85.71%) had complete relief from epiphora. Overall 23 out of 25 DCRs (92%) had complete relief. In 15 of the 25 procedures, mucosal flap was excised completely. In remaining 10 procedures, flap was trimmed, repositioned to cover exposed bone around the newly created nasolacrimal fistula. In either situation, only one patient each had partial block of the nasolacrimal fistula. Average duration of the surgical procedure of DCR was 18 min.ConclusionEndonasal endoscopic DCR is a viable alternative to external DCR, co-existing sinonasal diseases can be managed simultaneously, as may be required in 25% of cases. It can be performed under 20 min without mucosal flap preservation, mitomycin local application, silicon tube stenting or laser assistance and can still provide a good success rate (92%) with less complications.

Role of Le Fort type I osteotomy approach in juvenile nasopharyngeal angiofibroma

Le Fort type I osteotomy is a fracture that extends from the pyriform aperture to each of the pterygoid plates, resulting in the detachment of the upper jaw from the cranial base. A retrospective study was conducted on 12 patients with juvenile nasopharyngeal angiofibroma (JNA) who underwent the Le Fort type I approach. Preoperatively, all cases were investigated with computed tomographic scans with contrast and angiography with embolisation. This paper highlights the surgical technique, results and treatment morbidity. The average age of the patients was 21 years, average duration of surgery was 3.2h and average blood loss was 550 ml. All cases had significant symptomatic improvement postoperatively. At 1 year follow up, the authors encountered dental malocclusion in one case and no recurrence of JNA. The Le Fort I osteotomy approach is an excellent approach for the excision of JNA because it allows good surgical exposure, better haemostasis, is cosmetically more acceptable and has a very low morbidity.

Benign lymphoepithelial cyst of the parotid in HIV negative patient

Benign lymphoepithelial cysts are slow growing tumours commonly seen in HIV positive adults. It is rare to find them in non HIV individuals. In this article we discuss an uncommon presentation of a parotid swelling occurring in a 49-year-old non HIV male, which was diagnosed as benign lymphoepithelial cyst. The various investigative modalities and treatment options are outlined in this article.

Ancient schwannoma mimicking a thyroid mass with retrosternal extension

We report the case of a middle-aged hypothyroid woman presenting with a neck swelling, voice change and breathing difficulty. On evaluation, she was diagnosed to have goitre with retrosternal extension. The mass was surgically excised and a histopathological report of ancient schwannoma was obtained. A review of literature on schwannomas of the head and neck was carried out. An ancient schwannoma should be considered as one of the differential diagnosis of a cervical mass, even though the clinical presentation point towards a thyroid swelling. At 6 months follow-up, the patient was found to be asymptomatic except for a hoarse voice.