Modified lateral rhinotomy for fronto-ethmoid schwannoma in a child: a case report

Schwannoma of frontoethmoid region is a rare presentation. We report a case of 11-year-old girl with a swelling at the root of nose and nasal dorsum. Based on clinical picture and radiological findings it was not possible to establish a definitive diagnosis. But the histopathological picture was suggestive of schwannoma. A novel surgical approach was adopted to facilitate complete removal of the tumor and provide best possible cosmetic results

Study on the Anatomical Variations of the Posterosuperior Bony Overhang of External Auditory Canal

To evaluate the extent of posterosuperior bony overhang required to be removed for proper exposure of the incudo-stapedial complex during stapes surgery. Whether an assessment can be made out about the extent of the posterosuperior bony overhang clinically or not. A prospective study. One hundred patients of Stapedial Otosclerosis were included in this study. The direction of the posterosuperior bony canal wall i.e. straight or sloping type was recorded in every patient. All the patients underwent stapedotomy operation under local anaesthesia. The amount of overhang of the posterosuperior bony canal wall required to be removed for adequate exposure of the incudo-stapedial complex during stapes surgery was recorded by using measured right-angled picks of different sizes in mm. The aim of this study is to find out the extent of posterosuperior bony overhang and to know whether the posterosuperior bony overhang is more in straight or sloping bony canal wall. Fifty-seven percent of our patients had a medially sloping posterosuperior bony canal wall and 43% had a straight canal wall, which was noted clinically before surgery. The extent of posterosuperior bony overhang was divided into 4 groups: Gr. A ≤2 mm, Gr. B 2–2.5 mm, Gr. C 2.5–3 mm, Gr. D ≥3 mm. There were 25 patients in Group A, 55 in Group B, 20 in Group C and none in Group D. So majority (i.e. 55%) patients belonged to Group B i.e. 2–2.5 mm. The posterosuperior bony overhang is more in those patients who had straight bony canal than those who had sloping bony canal. This may be clinically assessed and this observation is statistically significant (P < 0.001)

Aspergilose invasiva do seio esfenoidal e paralisia do sexto nervo

A aspergilose do seio esfenoidal é doença rara e pode se apresentar sob diferentes formas clínicas devido a envolvimento de. diversas estruturas anatomicamente adjacentes ao seio esfenoidal. Relatamos o caso de uma paciente com 74 anos de idade, diabética, com paralisia do sexto nervo esquerdo secundária a aspergilose do seio esfenoidal. Não havia história de cefaléia ou de queixas sugestivas de alergia respiratória. A tomografia computadorizada revelou lesão etmoídeo-esfenoidal à esquerda, com presença de imagem cálcica em seu interior e destruição óssea. A paciente foi submetida a cirurgia com retirada de material necrótico e debridamento da lesão, seguida de tratamento com anfote-ricina B e 5-fluorocitosina. Exame histológico revelou a presença de hifas sugestivas de Aspergilius sp. Após três meses de tratamento a paciente apresentou recuperação total da paresia do nervo abducente. O diagnóstico clínico pré-operatório de aspergilose do seio esfenoidal é difícil. No entanto, a presença de imagem cálcica ou de densidade metálica à radiografia simples de crânio ou à tomografia computadorizada sugere fortemente o diagnóstico. O exame hihstológico revela a presença de hifas dicotomatosas em 45,0 típicas do Aspergilius. O tratamento inclui excisão e debridamento da lesão seguida do uso de anfo-tericina B associada a 5-fluorocitosina ou rifampicina