Lincoln ’S Highway - A Forgotten Abscess

Introduction: Carotid space is a deep neck space within the carotid sheath. .Mosher called carotid sheath as the Lincoln Highway of the neck. Abscess in this space is rare to be seen by young Ear, Nose and Throat (ENT) surgeons in this era of early diagnosis and good antibiotics. We are reporting a case of isolated carotid space abscess in a 20 year old male to familiarize young surgeons with this abscess. Case report: A 20 year old young boy came to our Outpatient Department (OPD) with complaints of fever, painful neck swelling, progressive difficulty in swallowing from the last 7 days. Contrast Enhanced Computed Tomography (CECT) was done which revealed abscess located adjacent to carotid artery in the carotid sheath. Incision and drainage was done and carotid sheath was opened and pus drained .Patient was discharged after few days on oral antibiotics. Conclusion: Carotid space abscesses are rarely seen in developed countries. Tender and fluctuating swelling over the carotid artery area points towards it. CECT is the investigation of choice. Needle aspiration should be avoided especially by less trained persons. Small abscesses may respond to intravenous antibiotics but when frank and large abscess is formed, incision and drainage is the treatment of choice

Lincoln ’S Highway - A Forgotten Abscess.

ABSTRACT Introduction: Carotid space is a deep neck space within the carotid sheath. .Mosher called carotid sheath as the Lincoln Highway of the neck. Abscess in this space is rare to be seen by young Ear, Nose and Throat (ENT) surgeons in this era of early diagnosis and good antibiotics. We are reporting a case of isolated carotid space abscess in a 20 year old male to familiarize young surgeons with this abscess. Case report: A 20 year old young boy came to our Outpatient Department (OPD) with complaints of fever, painful neck swelling, progressive diffi culty in swallowing from the last 7 days. Contrast Enhanced Computed Tomography (CECT) was done which revealed abscess located adjacent to carotid artery in the carotid sheath. Incision and drainage was done and carotid sheath was opened and pus drained .Patient was discharged after few days on oral antibiotics. Conclusion: Carotid space abscesses are rarely seen in developed countries. Tender and fl uctuating swelling over the carotid artery area points towards it. CECT is the investigation of choice. Needle aspiration should be avoided especially by less trained persons. Small abscesses may respond to intravenous antibiotics but when frank and large abscess is formed, incision and drainage is the treatment of choice

A study of outcome of ossiculoplasty using autologous cartilage, refashioned incus, and polytetrafluoroethylene (Teflon) prosthesis in patients of chronic suppurative otitis media

Abstract Aim To find out the mean air conduction thresholds (ACT) and air–bone gap (ABG) closure across the treatment groups at the end of 3 and 6 months of follow-up. Material and methods Sixty patients diagnosed with COM with conductive hearing loss were included in the study. Air conduction threshold (ACT) and air–bone gap were calculated and recorded pre-operatively. Surgery was done with clearance of disease followed by reconstruction of hearing in single-stage operation using autologous conchal cartilage, refashioned incus, and polytetrafluoroethylene (Teflon) prosthesis (PORP, TORP) depending upon the intraoperative findings during surgery. Patients were followed for up to 6 months for assessing the hearing outcome in terms of the mean air conduction threshold and mean air–bone gap closure for each group separately. Results The outcome of each ossiculoplasty material was calculated in terms of mean air conduction threshold and mean AB gap closure. Preoperative and postoperative air conduction threshold (ACT) at 3 months and 6 months follow-up of each group was as follows: for the autologous conchal cartilage group, 41.3 (± SD 6.69), 29.2 (± SD 5.39), and 21 (± SD 4.66); for autologous refashioned incus group, 40.4 (± SD 5.43), 28.4 (± SD 6.73), and 20.8 (± SD 4.33); for the Teflon PORP group, 42.9 (± SD 5.68), 31.4 (± SD 6.86), and 34.9 (± SD 6.37); and for the Teflon TORP group, 43.1 (± SD 5.40), 32.5 (± SD 5.91), and 36.2 (± SD 5.31). The mean air–bone gap preoperatively and postoperatively at 3 months and 6 months respectively were as follows: for autologous conchal cartilage, 40.6 (± SD 4.57), 23.7 (± SD 4.48), and 20 (± SD 5.28); for autologous refashioned incus, 39.3(± SD 4.92), 21.9 (± SD 5.61), and 19.4 (± SD 5.82); for Teflon PORP 43.0 (± SD 4.48), 32.8 (± SD 4.84), and 36.3 (± SD 5.56); and for Teflon TORP, 44.5 (± SD 5.56), 33.2 (± SD 5.53), and 35.2 (± SD 5.10). Conclusion The hearing outcome of ossiculoplasty varies with the type of ossiculoplasty material used. Most favorable results were obtained with refashioned autologous incus followed by autologous conchal cartilage. Teflon prosthesis has a significant improvement in hearing outcomes although the results are less favorable