Chondrosarcoma of the maxilla

A woman in her 70s reported to the outpatient department of our tertiary care hospital with chief complaints of painless swelling in the right cheek and palatal area. The patient was a known case of diabetes mellitus and hypertension on medications with controlled sugars and blood pressure. The swelling was 10×8 cm in size extending from right infraorbital region up to the lower mandible. CT demonstrated a permeative lytic pattern of bone destruction noted involving the hard palate and maxillary bone.Using the Weber Ferguson approach, a surgical resection was carried out under general anaesthesia. Resection included from right total maxillectomy (excluding roof of maxilla), nasal septum up to left medial maxillectomy including hard palate and the tumour was resected en bloc. The palatal obturator was fixed. On the basis of histopathology, grade 1 well-differentiated chondrosarcoma was diagnosed. The patient received postoperative radiotherapy and had a good recovery.

Shoulder Dysfunction Post Spinal Accessory Nerve Preserving Neck Dissections: Our Experience

Apart from complete surgical clearance of the malignancy, reducing morbidity and improving quality of life of the patient is also considered. One of the morbidities linked with neck dissections is shoulder dysfunction. The aim of our study is to analyse the functional outcomes in patients operated for various neck dissections with preservation of the Spinal accessory nerve. A single centre prospective observational study was conducted in a total of 45 patients with oral cancers. These patients underwent Wide local excision of the primary tumour along with neck dissection. Tests for assessing spinal accessory nerve function was elicited in all these patients preoperatively and postoperatively. Patients were examined for shoulder pain and shoulder disability using Arm abduction test. All 45 patients underwent spinal accessory nerve preserving neck dissection. On post operative day 10, 89% of patients showed arm abduction test score of 1 and 47% of patients had a pain score of 6 whereas 13% had a pain score of 8. After 6 months of rehabilitation and regular follow up, 62% of the patients had improved arm abduction test score of 4 and above and all 45 patients had pain score improved to score of 4 and less. Variable amount of shoulder dysfunction is seen even in spinal accessory nerve preserving neck dissections. But active rehabilitation and regular follow up of these patients reduces the morbidity associated with shoulder syndrome.

Effects of Insulin-Like Growth Factor (IGF-1) in Patients with Sensorineural Hearing Loss

Objectives:

(1) To test the effect of local administration of insulin-like growth factor-1 (IGF-1) in patients with sensorineural hearing loss (SNHL). (2) To test the effect of local administration of IGF-1 in patients with ototoxicity.

Methods:

Forty patients with SNHL were included in the study. Their hearing thresholds at different frequencies (0.5, 1, 2, and 4 kHz) along with the average hearing threshold were noted. The patients were then randomly allocated to 2 groups and were treated with IGF-1 via one of the following routes: (1) intratympanic injection and (2) Gelfoam.

Feasibility of Transoral Thyroidectomy by Vestibular Approach

Introduction An open approach to thyroidectomies through neck provides good exposure and safe dissection however, the patient still has a scar. Endoscopic thyroid surgery has been practised since the late 90s. The latest addition is the transoral endoscopic thyroidectomy by vestibular approach. Materials and Methods We at our centre performed this surgery on 3 patients. Here we present our initial experience of transoral endoscopic thyroidectomy by vestibular approach (TOETVA). Results Two of the three patients did not have any complication. Diffuse bleeding was encountered during one instance and decision was taken to convert it into an open procedure. Conclusion The preliminary experience of transoral thyroidectomy by vestibular approach shows it to be a feasible and promising ‘scarless’ and ‘minimally invasive’ surgery.

More to it than meets the eye: a case of retained intraorbital foreign body removed using transcutaneous orbital endoscopic surgery

The possibility of a retained foreign body should always be considered when a patient presents with a history of orbital trauma, especially when the patient is unresponsive or temporarily responsive to treatment. Not all cases of retained foreign body present with decreased vision or restricted mobility or fever. The entry wound is also not apparent on examination in all cases. In summary, meticulous history-taking, thorough examination, high index of suspicion along with a low threshold for imaging studies are essential to make a timely diagnosis of a retained intraorbital foreign body. The prompt removal with the appropriate approach may not only save the eye but also the life of the patient.

Respiratory epithelial adenomatoid hamartoma: a diagnostic challenge in sinonasal lesions

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare lesion in nasal cavity first reported by Wenig and Heffner in 1995. Most commonly seen in men in third to ninth decade of life. Majority of cases presents as a polypoidal mass in one or both nasal cavities. We experienced such a case of REAH originating from the nasal septum, in posterior aspect, treated by endoscopic approach. It is important to differentiate REAH from other sinonasal pathologies like inverted papilloma and low grade sinonasal adenocarcinoma. Complete surgical resection is the treatment of choice.

Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System

Mucormycosis is an uncommon, rapidly progressive, angio-invasive, commonly fatal, opportunistic fungal infection. The most critical decision in the management of rhinoorbital mucormycosis is whether the orbit should be exenterated. (1) To layout the indications of orbital exenteration in patients with rhino-orbito-cerebral mucormycosis. (2) To devise a scoring system that predicts the stage at which the exenteration needs to be carried out. A scoring system was devised by a team of experienced Otorhinolaryngologists and Ophthalmologists from prior experience in managing mucormycosis. All patients of mucormycosis visiting our hospital were admitted and included in the study. A total of 15 patients were included. The scoring system is based on 3 main criteria, namely: (1) clinical signs and symptoms. (2) Direct and Indirect Ophthalmoscopy. (3) Imaging. The Sion Hospital Scoring System is an accurate and promising measure to solve the dilemma that is associated with orbital exenteration in orbito-rhino-cerebral mucormycosis.

The Four-Port Bradoo Technique: An Alternative to the Modified Endoscopic Denker's Approach for Giant JNA

The aim of this study is to emphasise the importance of preserving the anterior facial skeleton in angiofibroma surgery and to introduce a new approach by which tumors with far lateral extensions can be operated upon successfully without disruption of the anterior facial skeleton. This is a prospective study conducted at a tertiary referral academic centre. Two patients with extensive juvenile nasopharyngeal angiofibroma with far lateral extensions were recruited and they underwent surgery between July and August 2016. Both patients were not embolised prior to surgery. Complete tumor removal was achieved in both cases without any evidence of recurrence of disease. The facial contour was well maintained. They are under regular follow-up at our centre, having completed their third 3 monthly follow-up. The main outcome measures are preservation of the anterior facial skeleton and complete tumor removal. The Four-Port Bradoo Technique allows for maximum access to the angiofibroma whilst maintaining the anterior facial skeleton, thus ensuring complete removal with minimal morbidity to the patient.

Transcutaneous endoscopic orbital surgery: a less morbid alternative to lateral orbitotomy

BACKGROUND

Retrobulbar lesions of the orbit situated lateral to the optic nerve are difficult to access. In this article, the authors would like to present a new perspective to approach these lesions where the goals of surgery are met with minimal complications.

METHODS

A retrospective analysis of patients' charts was performed.

RESULTS

For approaching retrobulbar lesions an endoscopic technique was developed. Four patients (2 male and 2 female patients) presenting with retrobulbar lesions lateral to the optic nerve have been included in this study. Two patients underwent endoscopic drainage for orbital abscess and two patients were successfully biopsied endoscopically. No intra-operative complications were noted. Open procedures such as lateral orbitotomy were avoided in all the cases.

CONCLUSION

Transcutaneous orbital endoscopy is a safe and a versatile technique to approach retrobulbar lesions lateral to the optic nerve. It can be used as an effective alternative to lateral orbitotomy for well selected cases. One can obtain adequate material for histopathological examination and also drain deep-seated orbital abscess using this technique. It would be possible with increasing experience to use this technique for extended applications.

Endoscopic excision of Angiofibroma

We present a case of Juvenile Nasopharyngeal Angiofibroma (JNA) managed by endoscopic excision alone. The selection of the case, technical difficulties and the advantages offered by this technique are detailed.

Vocal outcomes following subepithelial infiltration technique in microflap surgery: a review of 30 cases

Understanding of the anatomy and physiology of the vocal folds, availability of better diagnostic tools and precise instruments has spurred the development of newer techniques for the management of benign lesions arising in the vocal folds. As the propensity of the superficial lamina propria to regenerate is minimal, it is of paramount importance to maximally preserve it. Microflap surgery of the vocal folds is based on this principle. There exists a dichotomy in opinion regarding the role of subepithelial infiltration in microflap surgery; the disadvantages cited being possible confusion of the surgical plane following infiltration and hydrodissection of the normal basement membrane from the superficial layer of the lamina propria. A prospective study was therefore carried out in 30 cases of benign glottic lesions and microflap surgery was performed with and without infiltration in similar pathologic lesions. The vocal outcomes i.e. fundamental frequency, jitter, shimmer and maximum phonation time were audited. The advantages of this technique with a review of the literature are discussed.

Sphenoid sinus mucocele with unilateral blindness

Mucoceles of the sphenoid sinus are rare and may frequently remain undiagnosed until symptoms due to compression of surrounding structures set in. In such cases, the optic nerve, because of its close proximity to the sphenoid sinus, is at risk, and pressure exerted by the mucocele may result in visual impairment. A case of a sphenoid sinus mucocele with sudden-onset unilateral blindness as the only presenting symptom has been described. Early diagnosis and prompt surgical intervention enabled the vision to be restored completely.