Current Issue Volume 9, Number 2 , May-August 2017

EDITORS’ SPEAK
Bachi T Hathiram, Vicky S Khattar

Pathologies of the Nose and Paranasal Sinuses-I

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:vi]



The frontiers of endonasal surgery continue to expand at a rapid pace. The last three decades have seen a sudden surge in nasal endoscopic work on the sinuses and adnexae.


ORIGINAL ARTICLE
Sumitha Ramanathan, Nisha A Joseph

Microdebrider-assisted Inferior Turbinectomy: Improving Quality of Life in Patients with Nasal Allergy

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:39-41]



Objective: To assess the effectiveness of resection of inferior turbinate with assisted powered instrumentation in patients with nasal allergy.

Study design: A total of 50 patients presenting to the outpatient Department of Otorhinolaryngology in Sree Balaji Medical College & Hospital, Chennai, India, with nasal allergy with turbinate hypertrophy on examination between the age of 19 to 45 years were included in the study during the period between December 2014 and July 2015.

Materials and methods: All patients were assessed subjectively by a questionnaire regarding their symptoms and objectively graded by the size of turbinate hypertrophy as grades I, II, and III. Patients with grade II and III turbinate hypertrophy were subjected to inferior turbinectomy using microdebrider and followed up for postoperative outcome and any complications.

Results: The advantage of the microdebrider technique is the precise control of the amount of tissue and location of tissue, i.e., removed on a submucosal plane. There are very less complications. There was no crusting or excessive bleeding during the procedure.

Conclusion: The results show that submucous resection of inferior turbinates with a microdebrider is a safe method of achieving turbinate size reduction with minimal morbidity.

Keywords: Microdebrider, Submucous resection, Turbinate.

How to cite this article: Ramanathan S, Joseph NA. Microdebrider-assisted Inferior Turbinectomy: Improving Quality of Life in Patients with Nasal Allergy. Int J Otorhinolaryngol Clin 2017;9(2):39-41.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Punnoose Philip, Deepika Pratap, Aroor Rajeshwary, Vadisha Bhat

Subjective Assessment of Outcomes of Septoplasty

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:42-46]



Septal deviation is the leading cause of chronic nasal obstruction. The procedure of choice for treating these patients is septoplasty. We aimed at assessing the disease-specific qualityof- life outcomes of septoplasty by means of a questionnaire.
Ours was a retrospective study where 100 patients who underwent septoplasty between 2014 and 2015 in the Department of Otorhinolaryngology were analyzed. A modification of the nasal obstruction symptom evaluation (NOSE) scale was used to compare the pre- and postoperative symptoms.
We found that nasal obstruction was seen in all patients. A significant improvement was seen in all symptoms of the modified NOSE scale. An improvement in the general condition of the patients was seen postsurgery.
The modification in the NOSE scale addresses a wider range of symptomology and is a good tool for subjective assessment of septoplasty.

Keywords: Nasal obstruction, Nasal obstruction symptom evaluation scale, Septoplasty.

How to cite this article: Philip P, Pratap D, Rajeshwary A, Bhat V. Subjective Assessment of Outcomes of Septoplasty. Int J Otorhinolaryngol Clin 2017;9(2):42-46.

Source of support: Nil

Conflict of interest: Nil


RESEARCH ARTICLE
Shruti Tandon, Vijay Giridher, Akash Juneja

Symptomatic Septal Deviation: Its Nasal Endoscopy and Computed Tomography-aided Correlation with Chronic Rhinosinusitis

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:47-51]



Aim: To evaluate the nasal septal deviation by measuring the angle of deviation and study its relation with sinus diseases and lateral nasal wall anomalies, by diagnostic endoscopy (DNE) and computed tomography (CT), in patients with chronic rhinosinusitis (CRS).

Materials and methods: A prospective study was carried out on 90 patients with nasal complaints and deviated septum, attending the Department of Otorhinolaryngology, from January 2015 to August 2016. Patients diagnosed to have CRS clinically were subjected to DNE and CT scans. The maximum angle of septal deviation was calculated in coronal cuts. The side and sites of rhinosinusitis and lateral wall anatomical variants were identified.

Results: The prevalence of CRS was 73%, with males more affected than females (1.8:1). Left-sided and C-shaped deviated nasal septum (DNS) was most common. About 52% patients suffering from CRS had septal angle of deviation between 7° and 12°, 46% had more than 12°. Maxillary sinus was the most commonly involved sinus. Concha bullosa (32%) was the most common variant noted. Occurrence of medialized uncinate process was found to be increasing on the ipsilateral side of deviated septum with increasing angle of deviation.

Conclusion: In patients with chronic sinusitis, most of the angles were deviated between 7° and 12°. The mean deviation was 12.92°. Majority of patients with chronic rhinosinusitis had a concurrent variation along with DNS. No correlation was found between the side of DNS and side of maxillary sinusitis. No corelation was noted between the anatomical variants of lateral nasal wall with increasing angle of deviation.

Clinical significance: Our study emphasizes the multifactorial etiology behind CRS with plausible role of genetic factors, environmental influence, allergic factors, hormonal influence, etc., in its causation.

Keywords: Angle of septal deviation, Deviated nasal septum, Lateral wall variant, Prevalence of chronic rhinosinusitis, Prospective study, Rhinosinusitis.

How to cite this article: Tandon S, Giridher V, Juneja A. Symptomatic Septal Deviation: Its Nasal Endoscopy and Computed Tomography-aided Correlation with Chronic Rhinosinusitis. Int J Otorhinolaryngol Clin 2017;9(2):47-51.

Source of support: Nil

Conflict of interest: Nil


CASE REPORT
Mayashankar B Vishwakarma, Sanket D Vakharia, Vidhyadhar R Borade, Pooja S Nagare, Shubhalaxmi A Jaiswal

Nasopharyngeal Schwannoma

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:52-54]



Schwannoma is a rare benign solitary, slowly growing, encapsulated neural tumor arising from the nerve sheath of Schwann cells of the nerves.1 They can occur throughout the body with only a handful reported originating in the nasopharynx. These lesions are quiet asymptomatic and malignant transformation rate is negligible. Their clinical presentations are varied and depend on the nerve of origin. Its diagnosis is quite difficult as fine needle aspiration cytology, computerized tomography, and magnetic resonance imaging are of little use. The nasopharynx is, however, a notoriously difficult area to access surgically due to its central location, surrounding facial skeleton and skull base, great vessels, and cranial nerves. Complete surgical excision is treatment of choice and postoperative histopathological examination establishes the final diagnosis. Here we present a rare case of a 25-year-old male with nasopharyngeal mass whose postoperative histopathological and immunohistochemistry of excised lesion showed a nasopharyngeal schwannoma and discuss the treatment and differential diagnosis for the same.

Keywords: Benign nerve cell tumor, Neurilemmoma, Schwannoma.

How to cite this article: Vishwakarma MB, Vakharia SD, Borade VR, Nagare PS, Jaiswal SA. Nasopharyngeal Schwannoma. Int J Otorhinolaryngol Clin 2017;9(2):52-54.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Kamalika P Roy, Deepeshkumar R Maurya

A Case of Isolated Sphenoid Sinusitis with Orbital Complication and Maxillary Osteomyelitis

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:55-57]



Aim: One should have a high index of suspicion to diagnose cases of isolated sphenoid sinusitis.

Background: Isolated acute sphenoid sinusitis is a rare clinical entity and accounts for less than 3% of all cases of sinusitis. Sphenoid sinusitis usually occurs in conjunction with infections of the other paranasal sinuses. Here, we report a case of acute isolated sphenoid sinusitis leading to orbital cellulitis and maxillary osteomyelitis.

Case report: Patient presented with history of sudden pain behind the right eye that progressed to loss of vision within 3 weeks. Within the next week, a draining sinus appeared in the cheek.

Treatment: Treatment included intravenous antibiotic, endoscopic ethmoidosphenoidotomy, and right total maxillectomy with orbital exenteration.

Outcome: Patient is performing his daily activities normally.

Conclusion: Isolated sphenoiditis with maxillary osteomyelitis is uncommon. It usually presents with subtle symptoms and illusive physical findings and, hence, a high index of suspicion is necessary. Nasoendoscopy with aid of computed tomography/ magnetic resonance imaging (CT/MRI) sinuses allows for early diagnosis. Complications arise due to the close proximity of optic nerve to sphenoid.

Clinical significance: Early recognition of the disease is necessary to prevent persistence and progression of disease and avoid morbid complications.

Keywords: Complication, Headache, Isolated sphenoid sinusitis, Maxillary osteomyelitis.

How to cite this article: Roy KP, Maurya DR. A Case of Isolated Sphenoid Sinusitis with Orbital Complication and Maxillary Osteomyelitis. Int J Otorhinolaryngol Clin 2017;9(2):55-57.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Hitendra P Singh, Sunil Kumar, Veerendra Verma, Nitika Gupta, Shahab A Usmani

Lacrimal Gland Fistula: Report of a Rare Case

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:58-60]



Congenital fistula of lacrimal gland is a rare condition. These are usually located just lateral to the lateral canthus of the eye. Authors encountered a case of lacrimal gland fistula that was present around 2 cm lateral to the lateral canthus of the right eye. The condition was appropriately managed with surgical excision, which resulted in successful outcome both cosmetically and functionally.

Keywords: Congenital lacrimal gland fistula, Lacrimal gland, Lacrimal gland fistula, Magnetic resonance imaging sinogram.

How to cite this article: Singh HP, Kumar S, Verma V, Gupta N, Usmani SA. Lacrimal Gland Fistula: Report of a Rare Case. Int J Otorhinolaryngol Clin 2017;9(2):58-60.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Deepak Verma, Naveen Sharma, Uma Garg, Saurabh Makkar, Parnav Bansal, Saru Singh

Accidental Partial Middle Turbinectomy: A Rare Complication of Nasal Intubation

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:61-63]



We report a case of accidental partial avulsion of the middle turbinate during nasotracheal intubation while inducing anesthesia at the time of an elective surgery. This is a rare complication with very few cases reported until date in the literature. This case report demonstrates the importance of early detection and management of this potentially dangerous complication. Traumatic avulsion of turbinate secondary to nasal intubation may mimic presence of an abnormal nasopharyngeal mass as experienced in this case.

Keywords: Anesthesia, Epistaxis, Nasotracheal intubation, Turbinectomy.

How to cite this article: Verma D, Sharma N, Garg U, Makkar S, Bansal P, Singh S. Accidental Partial Middle Turbinectomy: A Rare Complication of Nasal Intubation. Int J Otorhinolaryngol Clin 2017;9(2):61-63.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Sanajeet K Singh, Kamal D Joshi, Shilpi Saxena

Rare Case of Spindle Cell Carcinoma in Inverted Papilloma

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:64-67]



Aim: The aim of this case report is to sensitize about the possibility of early malignant transformation in an inverted papilloma (IP) and presence of rare spindle cell carcinoma (SPCC) in IP, which can masquerade as a benign lesion.

Background: Inverted papillomas are benign tumors of sinonasal tract with characteristic histological features. Though benign, these lesions show recurrence, are locally aggressive, and have potential for malignant transformation.

Case report: A case of IP is described, which recurred following wide local excision and underwent malignant transformation into aggressive spindle cell variant of squamous cell carcinoma. A 48-year-old male presenting with unilateral nasal obstruction and serosanguinous discharge was detected to have reddishgray nasal mass arising from lateral wall of right nasal cavity. The histopathological examination was suggestive of IP. A medial maxillectomy and excision was done. However, recurrence was detected within 6 months. There was subsequent rapid malignant transformation into SPCC, which is a rare type of squamous cell carcinoma and even rarer in malignant transformation of IP.

Conclusion: The patient was managed promptly with radiotherapy after diagnosis of malignant transformation was made and is under follow-up. The case highlights the importance of follow-up care in IP, as early recurrence can be there. Moreover, malignant transformation, especially rarer type of SPCC, made the case more challenging.

Clinical significance: The diagnosis of SPCC required a high index of suspicion as it is a rare variety of squamous cell carcinoma arising as malignant transformation of IP and mimics many other reactive or mesenchymal lesions.

Keywords: Inverted papilloma, Malignant transformation, Maxillectomy, Spindle cell carcinoma, Squamous cell carcinoma.

How to cite this article: Singh SK, Joshi KD, Saxena S. Rare Case of Spindle Cell Carcinoma in Inverted Papilloma. Int J Otorhinolaryngol Clin 2017;9(2):64-67.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Boon C Gan, Ramiza R Ramli

Sinochoanal Polyp of Sphenoidal Origin: Diagnostic and Surgical Approach in Two Cases of Large Sphenochoanal Polyp

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:68-71]



The diagnosis of sinochoanal polyp (SP) with the origin of either maxillary or ethmoidal sinuses may not be uncommon for any otorhinolaryngologist. We report two rare cases of large sphenochoanal polyp (SCP) that underwent complete excision using endoscopic transnasal approach, debulking with microdebrider, and subsequent evacuation of polyp through the oral cavity under image-guided surgery (IGS) protocol. Due to the rarity of SCP, this condition may sometimes be mistaken for antrochoanal polyp (ACP) and lead to unwarranted exploration of other sinuses and incomplete removal of SCP from the sphenoid sinus. In this report, we also discuss on the diagnostic confusion with ACP, the surgical approach, as well as the usage of endoscopic and imaging techniques in managing SCP.

Keywords: Antrochoanal polyp, Image-guided surgery, Nasal polyp, Natural orifice endoscopic surgery, Sinochoanal polyp, Sphenoid sinus.

How to cite this article: Gan BC, Ramli RR. Sinochoanal Polyp of Sphenoidal Origin: Diagnostic and Surgical Approach in Two Cases of Large Sphenochoanal Polyp. Int J Otorhinolaryngol Clin 2017;9(2):68-71.

Source of support: Nil

Conflict of interest: None


CASE REPORT
David Temmermand, Andriy Pavlenko, Mark Friedel

Metastasis of a Poorly Differentiated Endometrioid Carcinoma to the Maxillary Sinus: A Rare Report

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:72-75]



In this case report, we present a rare case of an endometrial carcinoma metastasizing to the maxillary sinus. It is the fourth reported case of an uterine malignancy with metastasis to the sinonasal cavities; however, this is the first described in the maxillary sinus. This case demonstrates a rare lesion for a common cancer. Unfortunately, metastatic lesions to the sinonasal cavities are often associated with advanced disease and confer a poor prognosis.

Keywords: Cancer, Endoscopic sinus surgery, Maxillary sinus tumor, Metastatic lesion.

How to cite this article: Temmermand D, Pavlenko A, Friedel M. Metastasis of a Poorly Differentiated Endometrioid Carcinoma to the Maxillary Sinus: A Rare Report. Int J Otorhinolaryngol Clin 2017;9(2):72-75.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Dhaneshwor N Singh, Kanwar Sen, Arun K Sharma, Meenakshi Bharadwaj

Sinonasal Teratocarcinosarcoma: Is Minimally Invasive Resection followed by Adjuvant Histology-directed Chemoradiation a Better Alternative to Radical Excision?

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:76-78]



Sinonasal teratocarcinosarcoma (SNTCS) is a rare, highly malignant tumor arising from the primitive embryonic sinonasal tissue or immature pluripotent cells occurring almost exclusively in the sinonasal tract. It is an aggressive tumor with high propensity for locoregional recurrence and mortality. Local recurrence of SNTCS after excision has been reported as high as 45% with a mean recurrence time of 21.3 months. Even though distant metastasis is rare, local recurrence frequently leads to treatment failure and subsequent death. In view of its aggressive behavior, radical excision with or without chemoradiation is advocated as the optimum treatment. Here, we share our experience of SNTCS in a 23-year-old male managed with endoscope-assisted craniofacial resection followed by histocytology-directed chemotherapy with external beam radiation. He remains disease-free in last 3 years of follow-up.

Keywords: Nasal mass, Olfactory neuroblastoma, Sinonasal teratocarcinosarcoma, Teratoid carcinosarcoma.

How to cite this article: Singh DN, Sen K, Sharma AK, Bharadwaj M. Sinonasal Teratocarcinosarcoma: Is Minimally Invasive Resection followed by Adjuvant Histology-directed Chemoradiation a Better Alternative to Radical Excision? Int J Otorhinolaryngol Clin 2017;9(2):76-78.

Source of support: Nil

Conflict of interest: None


PHOTO ASSAY
Abhinav A Ranwaka, Arya S Mehta

Tension Pneumocephalus after Frontal Sinus Fracture: Mount Fuji Sign

[Year:2017] [Month:May-August] [Volumn:9 ] [Number:2] [Pages:41] [Pages No:79-80]



A 6-year-old child developed head injury and nasal bleeding and showed poor respiratory effort. The computed tomography scan of brain revealed frontal sinus fracture and pneumocephalus, which was causing mass effect on the frontal lobes leading to flattening of their convexity. There was widening of interhemispheric fissure with presence of air within. This mass effect on frontal lobes with separation of the frontal poles has been called “the Mount Fuji sign,” and is suggestive of tension pneumocephalus.

Keywords: Frontal sinus fracture, Mount Fuji sign, Tension pneumocephalus.

How to cite this article: Ranwaka AA, Mehta AS. Tension Pneumocephalus after Frontal Sinus Fracture: Mount Fuji Sign. Int J Otorhinolaryngol Clin 2017;9(2):79-80.

Source of support: Nil

Conflict of interest: None


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