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   Table of Contents - Current issue
July-December 2019
Volume 3 | Issue 2
Page Nos. 55-90

Online since Monday, November 25, 2019

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Safer dissection of spinal accessory nerve from sternocleidomastoid muscle during neck dissection p. 55
Akhlak Hussain, Ashish Singhal, Nida Siddiquee, Bimlesh Thakur
Background: The spinal accessory nerve (SAN) may damage during its dissection from the sternocleidomastoid (SCM) muscle during modified neck dissection type II due to their intimate relation. Routinely, it is dissected from the anterior aspect of the SCM. The aim of this study is to describe and simplify the safer dissection of the SAN from the SCM muscle. Objectives: We proposed a different method of dissection describing it to be posterior approach. Materials and Methods: Posterior dissection of SAN was done as routine. Conclusion: Although more studies are required to depict the superiority of one over another, we found this method to be easier and time-saving approach.
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Mucormycosis in head-and-neck region – Our experiences at a tertiary care teaching hospital of Eastern India p. 58
Santosh Kumar Swain, Ishwar Chandra Behera, Jatindra Nath Mohanty
Introduction: Mucormycosis is a rare clinical entity and often affects immunocompromised patients. It is caused by the fungus of the order Mucorales. Rhizopus species are the most common causative organism associated with mucormycosis. It is an emergency situation and has poor prognosis.Materials and Methods: A retrospective study included eight patients with head-and-neck mucormycosis diagnosed over a 3-year period from December 2016 to March 2019. Results: There are five male and three female patients, aged from 29 to 65 years. Out of eight patients, four were diabetic and the rest were with hematological disorders. There were five sinonasal mucormycosis and three nonsinonasal involvement. Diagnoses were confirmed by histopathological examination. Two cases were fatal due to cerebral involvement.Conclusion: Prompt diagnosis with tissue biopsy, local control of the disease by aggressive surgical debridement, and appropriate systemic antifungal treatment improve the prognosis and survival of the patients. Treatment of mucormycosis needs antifungal agents such as amphotericin B and wide surgical debridement. Early diagnosis and treatment is often needed for survival of the patients.
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Effectiveness of isolated septal surgeries in nasal septal deviations: A prospective study with reference to the nasal obstruction symptom evaluation scale p. 63
Saai Ram Thejas, Sindu Mohan
Introduction: Nasal septal deviation is a common diagnosis made by an otorhinolaryngologist, and septoplasty or submucous resection is among the most common daycare procedures practiced in the clinic. Aims and Objectives: The aim of this study was to assess clinically if at all, there is any change in the symptoms of a person post an isolated septal surgery without dealing with the external contour and cosmetic appeal. Materials and Methods: One hundred patients with complaints of nasal obstruction, trouble breathing through the nose, and headache were selected for the study. The initial preoperative assessment was done based on a symptomatic score (Nasal Obstruction Symptom Evaluation Scale [NOSE]). The presence of a septal deviation (cartilaginous or bony) was confirmed with a computed tomography of the paranasal sinuses and a diagnostic nasal endoscopy. Surgery was then performed to correct the pathology based on the location of the deviation. The postoperative assessment was done after 12 weeks based on the NOSE Scale. The results were analyzed and documented. Observations and Results: It was found that the symptomatic picture was better post surgery. Conclusion: The conclusion obtained from the study was that septoplasty and submucous resection as isolated surgical procedures are still relevant in today's world for symptomatic betterment and a healthier lifestyle.
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A dreadful complication of peritonsillar abscess drainage managed endovascularly p. 69
Apratim Chatterjee, Anshu Mahajan, Vinit Banga, Gaurav Goel
A 11 year female presenting with sorethroat and diagnosed as peritonsillar abscess ,drained outside under aseptic precautions lead to bleeding, later presented with hemiparesis with DSA revealing a large pseudoaneurysm formation in ipsilateral carotid with patchy infarcts on CT. At emergency repeat bleeding occurred and patient started deteriorating following which the patient was managed by endovascular parent vessel occlusion following which she recovered gradually with regaining normal strength in paretic limbs within a few days . The case highlights the dreadful complication of peritonsillar abscess drainage as well as its endovascular management.
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Endoscope-assisted excision of recurrent frontotemporal dermoid: A case report p. 73
Renu Rajguru, Anubhav Singh, TS Lingaraju
Craniofacial dermoids develop as a result of sequestration of epidermal and adnexal components within mesodermal and neuroectodermal structures during embryonic development. Frontotemporal dermoids are the most common of these and usually present as slow-growing masses without discharging sinus or deep bone or intracranial extension. We present a case of recurrent frontotemporal dermoid with discharging sinus and invasion into the sphenoid bone with bone erosion and intracranial extradural extension of dermoid. The patient was managed with surgical excision and clearance of dermoid. Complete surgical excision was ensured with the help of angled nasal endoscopes. Endoscopes provide a wide angle of view and are available in various angles, hence helping in complete visualization of bony cavity and clearance of its contents. The use of endoscopes in surgeries of craniofacial dermoids can help in reducing chances of residual lesion and requirement of subsequent revision surgery and ensure a better cosmesis.
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Congenital hypofibrinogenemia – A cause for neck swelling p. 76
Kartikesh Gupta, Amit Kumar, Amit Kumar Tyagi, Saurabh Varshney, Manu Malhotra
Congenital hypofibrinogenemia is a rare condition which can present as spontaneous hemorrhage. We present a case of a 7-year-old male who presented with complaints of sudden swelling over the cheek and neck after an episode of fever and upper respiratory tract infection. The diagnosis was delayed as the initial diagnosis of deep neck space infection was suspected, and the patient was treated in that line. The diagnosis was suspected when the child developed swelling in the knee joint and workup was done for hypofibrinogenemia. The child was transfused with cryoprecipitate and he has complete recovery by day 7.
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Pseudodiverticulum formation by metallic foreign body in esophagus: A concealed presentation p. 79
Anshuman Darbari, Neeraj Kumar, Ashikesh Kundal, Anil Pandey, Saurabh Varshney
Foreign body (FB) ingestion is a common problem in children, and coins are the most frequently ingested FB all over the world due to easy availability in household area. In the majority of these cases, coins usually pass through the esophagus without any complication, but rarely impacted coins can cause complications due to pressure necrosis of wall. Hereby, we report a case of pseudodiverticulum formation due to retained metallic FB (coin) and later successful surgical management.
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An unusual cause of long-standing foreign body sensation in throat p. 82
Santosh Kumar Swain, Biplob Bhattacharyya, Mahesh Chandra Sahu
Foreign body (FB) sensation in the throat is often a common symptom encountered in clinical practice. FB sensation in throat has numerous causes. Long-standing FB in the soft tissue of the neck is sometimes asymptomatic and presents only with throat irritation or FB sensation, although it is an extremely rare incidence. The diagnosis of this clinical event is based on the clinical presentations and imaging. The treatment is done by securing the airway, removal of FB, and antibiotic coverage. Here, we report the case of a 16-year-old boy presenting with chicken bone embedded in the soft tissue of the posterior pharyngeal wall and retropharyngeal space for 2 months in the throat without any major symptoms except FB sensation. Imaging confirmed the diagnosis of chicken bone in the retropharyngeal space with mild abscess formation, which was removed by transoral approach.
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Thyroglossal duct cyst papillary carcinoma: A treatment puzzle yet to be solved! p. 85
Neha Shakrawal, Bharti Varshney, Aman Kumar Verma, Sudeep Khera, Amit Goyal, Sourabha Kumar Patro
Thyroglossal duct cyst (TGDC) is the most common congenital aberration of the thyroid gland. On the contrary, TGDC malignancies are rare events constituting <1% of all cases of thyroid carcinoma reported in the world. The rarity of the lesion precludes the formulation of clear guidelines and makes management decisions difficult. We describe a case of a young male who presented with a midline neck swelling and underwent radical Sistrunk's procedure and total thyroidectomy for primary papillary carcinoma in a TGDC. The need of total thyroidectomy in high-risk cases needs clinical suspicion and careful consideration of this differential.
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Orbital apex syndrome due to invasive aspergillus flavus sinusitis p. 89
Mansoor C Abdulla
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