The present study is an observational case series study of 50 cases of patients in the age group of 5–15 years for a period of 2 years. The age range was chosen, where issue of tonsillar and adenoid hypertrophy is very common. The objective of this case series is to establish that adenoidectomy is not a requirement while performing adenotonsillectomy unless and until the patient suffers from genuine adenoid hypertrophy symptoms.
Aim and objective: The present report describes an atypical presentation of a lacrimal gland mass in a young male patient. Symptomatology favored a benign mass that was proven to be malignant on histopathology.
Background: Adenoid cystic carcinoma is the most common epithelial malignancy of the lacrimal gland. The usual presentation of adenoid cystic carcinoma is in either sex at about an average 40 years of age with range from 6 to 79 years. The patient usually complains of a superotemporal orbital mass with rapid progression usually within a year. Uncommonly, these masses may present with longer history as is described in present case report.
Case description: A 17-year-old male patient of Indian origin presented with a mass in the superotemporal part of the right orbit for the last 5 years and 6 months. A firm and smooth orbital mass, approximately 20 mm × 15 mm, was present in superotemporal orbit that was nontender and nonpulsatile. A clinical diagnosis of lacrimal gland pleomorphic adenoma was strongly suggested by the clinical as well as radiological features. The orbital mass was excised en bloc by a right transseptal anterior orbitotomy. Histopathological examination of the excised mass revealed features characteristic of lacrimal gland adenoid cystic carcinoma.
Conclusion: Lacrimal gland adenoid cystic carcinoma can simulate pleomorphic adenoma and can present with history over 5 years. Hence, it should always be kept as a clinical possibility in patients with the painless superotemporal orbital mass and early excision of such orbital masses for appropriate diagnosis and management is vital.
Clinical significance: The duration of 5½ years at presentation in well-localized lacrimal gland adenoid cystic carcinoma is the longest period ever reported. The present article recommends keeping the differential diagnosis of adenoid cystic carcinoma in all patients with the clinically benign superotemporal orbital mass.
Nikhil M John,
R Anil Kumar,
Hosaagrahara Subbegowda Satish
Background: Mucormycosis is a group of invasive infections caused by filamentous fungi of the Mucoraceae family. Most commonly seen in immunocompromised individuals. Sinonasal mucormycosis is a rare infection, difficult to treat, and can also be fatal.
Aims and objectives: To highlight the importance of early detection of disease, early initiation of antifungal therapy, surgical debridement, and adequate management of immunosuppressive conditions.
Materials and methods: In this prospective study, 46 cases of sinonasal mucormycosis with different courses of illness and comorbidities who presented to the ENT OPD at Bengaluru Medical College and Research Institute from July 2015 to June 2018 were included. They were subjected to a common standardized treatment protocol and outcomes were assessed and discussed.
Results: Most of the patients in our study were in the 4th decade of life. Diabetes mellitus was seen in 94% of our patients. Imaging studies were non-specific with features suggestive of sinusitis. Nasal endoscopy helps in arriving at a provisional diagnosis and knowing the extent of the lesion. Biopsy of tissue showing fungal hyphae with invasion is confirmatory. In our study, 22 (47.8%) patients expired during the time period. Among the expired patients, only 7 had got combined modality treatment and 20 patients presented after 6 months of the onset of symptoms. In patients with strict glycemic control, no recurrences were seen.
Conclusion: The key to manage mucormycosis is early detection and initiation of antifungal treatment. In any immunocompromised patient presenting with features of sinusitis, mucormycosis has to be ruled out. Liposomal amphotericin B therapy has better compliance. Endoscopic debridement is of vital importance for excellent local control. Control of glycemic status boosts the body\'s immune process and reduces the chance of recurrence.
Aim and objective: To describe the evaluation and management of multiple cases of unilateral proptosis due to various sinonasal pathologies.
Materials and methods: Patients presenting to ENT OPD with unilateral proptosis were evaluated, diagnosed, and treated in this prospective study done over 2 years. All cases underwent complete otorhinolaryngological and ophthalmic examination apart from the endoscopic and radiological examination. Proptosis was measured by Hertel\'s exophthalmometry and readings above 21 mm or a difference of more than 3 mm between the two eyes were taken as positive. The cases were managed with appropriate surgery along with required medical management.
Results: Twelve cases were observed over 2 years. The mean age of patients was 48.08 ± 13.02 years. Male:female ratio was 5:1. The most common cause was maxillary carcinoma with an orbital extension (four cases). Surgery was a mainstay of treatment in all patients, along with required medical treatment.
Conclusion: A good work up and with surgical management resulted in good recovery of the patients with only one mortality. Sinonasal infections accounted for 25% of cases, benign neoplasms and tumor-like conditions 33%, and the rest 42% were constituted by malignant conditions.
Clinical significance: Assessment of proptosis in otorhinolaryngology is of paramount importance as it can be an early and/or only manifestation of nasal or paranasal sinus pathology. Although the incidence of proptosis in everyday ENT practice is exceedingly low, the knowledge of the important causes helps in clinching the correct diagnosis and timely management.
Aim and objective: A rare presentation of intractable massive recurrent epistaxis diagnosed and managed.
Background: Traumatic intracranial pesudoaneurysm is a rare complication of blunt trauma. Intracranial internal carotid artery pseudoaneurysm may rupture leading to delayed onset, massive, recurrent epistaxis, which requires an emergency intervention.
Case description: Here, we present a case of recurrent massive intractable epistaxis due to a sphenoidal prolapse of supraclinoid part of right internal carotid artery, presenting as a pseudoaneurysm, secondary to a post-traumatic fracture dehiscence of roof of sphenoid, diagnosed with the help of a computed tomography angiography. The patient was treated successfully with a primary endovascular coiling.
Conclusion: Intractable epistaxis due to a post-traumatic pseudoaneurysm is quite rare and can be fatal and hence need to be considered in the differential diagnosis of massive recurrent uncontrollable epistaxis and treated at the earliest.
Clinical significance: The reach of presentations of such rare cases should be broadened as these are difficult to be diagnosed and managed. Inadequate and untimely diagnosis and management of such cases can cost the life of the patients.