A comparative study of laser posterior cordotomy and vocal cord lateralization

AbstractIntroductionThe treatment of bilateral vocal cord paralysis continues to be a challenge to the otolaryngologist, head and neck surgeon even today. Numerous surgical procedures have been proposed to improve the patient’s airway insufficiency without leaving the patient with a breathy, weak voice or an incompetent larynx. In this study we compared the outcome of laser posterior cordotomy and vocal cord lateralization in a group of bilateral abductor palsy patients.MethodRetrospective as well as a prospective study of 25 patients was carried out. The total of 25 patients was divided into 2 groups, group 1 consisted of 15 patients who underwent vocal cord lateralization with SUTUPAK suture and group 2 consisted of 10 patients who underwent laser assisted posterior partial cordotomy.ResultsThyroidectomy was the commonest cause for bilateral vocal fold paralysis i.e. 80% (20) of cases. Patients who underwent laser posterior cordotomy had 100% successful decannulation rate as compared to 92.8% for vocal cord lateralization patients. Comparison between pre and post operative voice assessment data by WILCOXON SIGNED RANKS test revealed that excepting the parameter of fluctuations/s in F0, all other parameters were statistically not significant.ConclusionLaser cordotomy is a superior, reliable and viable alternative to the other lateralization procedures for bilateral vocal fold paralysis

Schwannoma of the base of tongue – A rare presentation

AbstractIntroductionSchwannomas are benign tumours arising from the Schwann cells. Only 1% of extracranial schwannomas occur intraorally and its pharyngeal presentations are rare.Case reportWe report a rare case of a 50year old lady who presented with frequent hawking sensation since one year. Video laryngoscopy showed polypoidal lesion in the base of tongue. CT imaging was done to know the extent of lesion. Excision biopsy of the lesion was done. To our surprise, the histologic examination and the immunohistochemistry confirmation with S100 proved it to be schwannoma of the base of tongue.DiscussionAbout a quarter of all schwannomas occur in the head and neck region. Only 1% of these occur intraorally, generally in the tongue. Pharyngeal presentations of schwannoma are rare.ConclusionSchwannomas arising in the base of tongue are rare and are not often included in the differential diagnosis. They are usually benign and have excellent prognosis as compared to the usual malignant lesions which occur in the tongue base

Staging of Laryngeal and Hypopharyngeal Cancer: Computed Tomography versus Histopathology

Introduction: Computed tomography (CT) imaging is the choice of investigation for evaluation of extent of tumor under the mucosa, locally and regionally. This study was undertaken to assess the accuracy of preoperative CT imaging in the staging of carcinoma of the larynx and hypopharynx.   Materials and Methods: In this retrospective study, all cases who were clinically (c) staged T3–T4 and who underwent surgery were evaluated. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Ac) of a preoperative CT scan to detect cartilaginous penetration and spread outside the larynx was evaluated. Clinical T-stage by CT imaging was compared with postoperative histopathological T-stage.   Results: There were 22 (96%) male patients and one (4%) female patient. Patients were aged from 48 to 64 years (mean, 56 years). Twenty (87%) patients had laryngeal carcinoma, whereas three (13%) had hypopharyngeal carcinoma. Four (17%) patients had T3 tumors and 19 (83%) had T4a lesions. Preoperative imaging over-staged one of five pathological (p) T3 cases and three out of three pT2 cases, and was accurate in the remaining 19 cases. In a comparison of the results of imaging with histopathological T-classification, T-staging was found to be 82.6% accurate.   Conclusion: CT is a precise and non-invasive imaging method with high sensitivity but relatively lower specificity because of increased false positives. CT imaging may be useful to guide the choice of surgical procedure, which can heavily impact a patients’ quality of life

Microbiological analysis of paranasal sinuses in chronic sinusitis – A south Indian coastal study

Introduction: In contrast with the well established roles of microbes in the etiology of acute sinusitis, the exact roles of all of these microbes in the etiology of chronic sinusitis are uncertain. The objective of the study is to analyze micro-flora present in patients with chronic sinusitis in the coastal belt of India. Methods: A cross sectional study was done to analyze the microorganisms of paranasal sinuses in patients having chronic sinusitis undergoing a functional endoscopic sinus surgery. Biopsy/Swabs were taken from the infected sinus of the patients during surgery and were sent for microbiological analysis within 4 h of collection. Results: Staphylococcus aureus was the most common isolate accounting for 43% of the patients followed by Klebsiella spp., 9% and MRSA, 3%. Fungal organisms identified were Aspergillus and Candida spp. isolated from 9% of the patients, which is very high compared to the other studies. No anaerobes were isolated. Discussion: The possibility of a fungal infection should always be considered in the differential diagnosis of difficult to treat diseases of the paranasal sinuses especially in tropical coastal regions. Conclusion: Based on results we can vary the choice of antibiotics in chronic and acute rhino-sinusitis leading to a better management of the condition

Lobular capillary hemangioma of the nasal septum – A case report

Lobular capillary hemangioma is a benign, rapidly growing lesion of the skin and mucous membranes. It may rarely present as a mass that entirely fill the nasal cavity with an unknown etiology. Although it has no predilection for age, it is more common in the third decade and in females. Lobular capillary hemangioma usually involves the gingiva, lips, tongue, and buccal mucosa. The nasal cavity is a rare location. The most common symptoms are nasal obstruction and epistaxis. The treatment is nasal endoscopic surgery even for large lesions as it does not require embolization preoperatively. We present a case report of a 45-year-old male patient with lobular capillary hemangioma who presented with epistaxis and nasal obstruction. The diagnosis of capillary hemangioma must always be kept in mind when discussing the differential diagnosis of a rapidly growing bleeding mass of the nasal cavity even though it is a rare entity

Hemangiopericytoma: A rare sinonasal tumor

AbstractIntroductionHemangiopericytomas are rare, vascular neoplasms that are derived from Zimmerman’s capillary pericytes. They are found most commonly in the retroperitoneum/pelvis and lower extremities and are known to have malignant biological behavior. Of the paranasal sinuses, ethmoid and sphenoid sinuses are most commonly involved.Case ReportWe report an uncommon case of a 77-year-old man, who presented with history of nasal block, nasal discharge and epistaxis since 10years. On examination, there was a fleshy polypoidal mass seen filling the entire right nasal cavity. CT scan of the osteomeatal complex revealed a soft tissue density lesion occupying the entire right nasal cavity, projecting through the posterior choanae into the nasopharynx. An endoscopic excision of the entire mass was done. Histopathological examination and immunohistochemistry confirmed the diagnosis of Hemangiopericytoma.DiscussionHemangiopericytoma is a rare vascular tumor. These lesions are more frequently reported in the seventh decade of life, and the usual presentation includes epistaxis and nasal obstruction. While corticosteroid use, hypertension and pregnancy have been proposed as etiological factors in the development of HPC, this is not widely accepted. It exhibits low malignant potential and distant metastasis is exceedingly rare.ConclusionHemangiopericytomas of the nasal cavity and paranasal sinuses exhibit low malignant potential and distant metastasis. The treatment of choice is wide surgical resection which is the only curative modality

Neck swelling: Unusual manifestation of Pott’s spine

Tuberculosis (TB) of the skeletal system constitutes only 1–3% of extrapulmonary TB and usually involves the thoracic spine. These patients usually present with malaise, weight loss, night sweats, muscle spasms, paraspinal swellings or neurological deficits. We report a case of tuberculosis of the spine, which had an unusual presentation only as a painless neck swelling, without any neurological complications. The patient did not respond well to antitubercular therapy (ATT), necessitating thoracotomy and drainage of pus. Then his ATT was continued for 1 year and is asymptomatic during 1 year of follow up thereafter

Maltoma of Thyroid: A Rare Thyroid Tumour

Introduction. Primary thyroid lymphomas constitute up to 5% of all thyroid malignancies and can be divided into non-Hodgkin’s lymphomas (NHLs) of B- and T-cell types, as well as Hodgkin’s lymphomas. Mucosa-associated lymphoid tissue (MALT) lymphomas are a relatively recently recognized subset of B-cell NHLs, and they are listed as extranodal marginal zone lymphomas according to the revised European-American lymphoma classification. Case Report. We report an uncommon case of a 44-year-old man, who noted a painless, growing mass on right side of his neck of the three-month duration. Thyroid profile was within normal limits. FNAC showed lymphocytic thyroiditis. The patient underwent a right hemithyroidectomy. The histologic examination and the immunohistochemistry showed an extra nodal marginal B-cell type maltoma (malt lymphoma). CHOP chemotherapy with rituximab was given. The clinical course has been favourable in the first year of followup, with no evidence of local or systemic recurrence of the disease. Discussion. Marginal zone lymphoma encompasses a heterogeneous group of B-cell tumours that variously arise within the lymph nodes, spleen, or extranodal tissues. A case of maltoma of thyroid is presented for its rarity and diagnostic dilemmas. Conclusion. Maltomas are slow-growing lymphomas. The optimal treatment and followup of patients with thyroid maltomas remain controversial at present