Orbital fractures commonly occur in maxillofacial trauma causing enophthalmos and diplopia. If not properly managed the cosmetic and functional problems can virtually become untreatable. In recent years, management of these fractures has been standardized with special emphasis on methods of treatment, timing and materials used for reduction.
Fibrous dysplasia is abnormal proliferation of fibrous tissue interspersed with normal or immature bone. The records of 11 cases of fibrous dysplasia of paranasal sinuses with skull base involvement were reviewed. Six patients were polyostotic and 5 were classified as monostotic fibrous dysplasia. Four cases were managed endoscopically and only 1 patient had undergone right lateral craniotomy for relief of pressure symptoms. All the patients were regularly followed up to see for any recurrence. It was found that endoscopic clearance of disease in skull base should be reserved for patients with functional compression symptoms.
Transnasal endoscopic repair of CSF rhinorrhea is an effective and safe procedure. A retrospective follow-up of nineteen patients who underwent transnasal endoscopic repair was done. A variety of graft materials and grafting techniques were used. None of the patients had any complications or required revision surgery.
Cancers and granulomatous diseases cause wide spread destruction of nose and reconstruction is a challenge to the surgeon. majority of the surgical defects after BCC excision can be reconstructed by full thickness skin grafts, bilobed and rhomboid local flaps but excision of SCC and large BCC lead to large surgical defects which need regional or distant flaps for reconstruction like median forehead flaps.
The purpose of this study was to determine the prevalence of anatomical variations of the ethmoid sinus in patients with rhinosinusitis. This was done to assess and evaluate the significance of the anatomical variations of the ethmoid in the genesis of inflammatory sinus disease.
Material and methods
We reviewed 50 patients with rhinosinusitis, of which 38(76%) had anatomical variations of ethmoid and the extent of mucosal disease.
Concha bullosa was found to be the most common anatomic variation and was seen in 25(50%) patients closely followed by variations in the uncinate process, paradoxically bend middle turbinate. The most commonly affected paranasal sinus was maxillary sinus (84%) followed by anterior ethmoidal sinus, posterior ethmoidal sinus, frontal sinus and sphenoid sinus in descending order.
Anatomical variations of the ethmoid sinuses are important etiological factors in the genesis of inflammatory sinus disease.
Nasolacrimal duct obstruction is a common disorder which clinically manifests as epiphora. Many procedures have been described to bypass this obstruction, for example external dacryocystorhinostomy (DCR), endoscopic DCR with and without stents, Laser endoscopic DCR. Each of these procedures has its own success rates and complications. We did an analysis of all laser assisted endonasal DCR performed in our department from Feb 2006 to July 2009. In all we had operated 237 total cases out of which 203 were with normal endonasal DCR and 34 cases were Laser transcanalicular endonasal DCR (Laser DCR). Over all success rate was 92%(218 cases). In case of Laser assisted endonasal DCR the success rate was 70.3% (19 cases) with failure rate of 29.7% (8 cases) at three months follow-up. This preliminary study reveals that LASER DCR is associated with higher failure rates as compared to the normal endonasal DCR.
Our study was conducted to assess the advantages and disadvantages of use of endoscopes use in septoplasty. Hundred patients with symptomatic deviated nasal septum were randomly divided into endoscopic septoplasty (ES) group and conventional septoplasty (CS) group of 50 patients each. The two groups were compared for technique, improvement in symptoms and complications. The postoperative symptoms and complications were significantly less in ES group due to better visualization and minimal dissection.
Ashok K Gupta,
Ramandeep S Virk,
Esthesioneuroblastoma is a rare neoplasm of nose & paranasal sinuses and anterior skullbase. Management includes either radiotherapy or surgery or both. Surgical management can be done by external neurosurgical approach (i.e. craniofacial resection) or endoscopic approach. In the present case report we present our experience of the management of an extensive esthesioneuroblastoma kadish stage C treated by endoscopic excision and postoperative radiotherapy.
Inverted papillomas form about 0.4 to 5% of nasal tumors. They usually present as unilateral firm, bulky, red and vascular masses. We present three cases which were initially diagnosed as a maxillary mucocele, pansinusitis and antrochoanal polyp based on clinical and radiological findings. It is important to keep the diagnosis of inverted papilloma in mind in unilateral diseases of the paranasal sinuses as a more radical approach is required.
Extramedullary plasmacytoma is a rare plasma cell proliferative disorder arising outside the bone marrow. It shows a predilection for the head and neck region. They commonly involve the mucosa associated lymphoid tissues of upper airways. Common sites are nasal cavities and paranasal sinuses followed by nasopharynx, tonsils and oropharynx. We report a case of an isolated lesion in the right nasal cavity in an elderly male in which surgical excision is followed by postoperative radiotherapy.
Digvijay S Rawat
Foreign bodies in nose is a very common presentation encountered by the ENT practitioners. A variety of nasal foreign bodies has been described in literature. We present our experience of managing an open safety pin lodged in the nose of a 2 years old child.
We describe an unusual case where we found a broken pen 20 years after trauma causing cicatricial ectropion and mimicking osteomyelitis.
A 60-year-old male presented with 6 months history of epiphora and cheek hypoesthesia after a 3 months old discharging sinus had healed causing cicatricial ectropion of left lower eyelid. He also gave history of road traffic accident 20 years ago with injury at the same site that had healed. Clinical diagnosis of maxillary sinus osteomyelitis was made and computerized tomographic (CT) scan revealed a suspicious foreign body extending from the orbit into the maxillary sinus. Infraorbital incision and endoscopic approach were used to remove the 4 cm long broken pen.
Penetrating injuries, however trivial they may appear, need to be investigated further with a CT scan to detect foreign bodies early and prevent late complications.
Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular tumor of young males. Surgical excision remains the principal modality of treatment. Tumors with intracranial extension may require major surgical resections which are not devoid of complications. We here present a case of JNA with massive intracranial extension with postsurgery huge skull base defect with resultant encephalocele which was repaired successfully using rectus abdominis free flap.
A 30-year-old immunocompetent male presented with progressive painless proptosis with double vision and no visual loss. The patient had a mass lesion in the lateral part of the orbit infiltrating the lateral rectus on computed tomography. Lateral orbitotomy was done and the mass was biopsied revealing it to be aspergillosis. The patient was put on intravenous amphotericin B but did not tolerate it and was therefore started on voriconazole. There was a complete resolution of the symptoms with voriconazole.