Annals of Otolaryngology and Rhinology

Wednesday 30 September 2015

Effect of Intratympanic Dexamethasone in Intractable Unilateral Meniere’s Disease

Pradeep Pradhan, Kanwar Sen and Priti Lal

Abstract:
Objective: To evaluate the effectiveness of Intratympanic dexamethasone in controlling vertigo and sensor neural hearing loss in intractable Meniere’s disease.
Methods: 30 patients with intractable Meniere’s disease were treated with intratympanic dexamethasone injections. Post treatment pure tone audiograms and dizziness scores were compared with the pretreatment audiogram and dizziness scores respectively.
Results: Improvement in mean vertigo score was noticed from 91.58 (range 80 -100) (pretreatment) to 49.295 (p=0.351) at 6 months and to 60.4 (p= 0.974) at the end of 2 years after intratympanic injection. 9 (40.90%) and 5 (25%) patients were found to be free of vertigo at the end of 06 months and 2 years respectively. None of the patients showed any significant improvement in hearing (>10dB) at the end of 2 years of follow-ups. Only one patient was found with a small central perforation at the end of 1 month of treatment.
Conclusion: Intratympanic steroid is a safe and an effective method of treating intractable Meniere’s disease. Although improvement in vertigo was more pronounced in the short term, 25% of the patients were detected free of vertigo at the end of 2 years. No significant improvement in hearing was noticed after 2 years of treatment.]

Endoscopic Assisted Neck Dissection via Retro Auricular Approach Versus Conventional Technique

Phakdee Sannikorn* and Nut Niyomudomwatana

Abstract:
Background Most standard surgical treatment of cervical lymph node metastasis of Head and neck cancer is Conventional neck dissection. Recently, the skin incision has been modified to smaller incision than previous by using a special technique such as Robotic surgery system. In unavailable special system, we have to apply our instruments to do neck dissection via modified incision. The aim of our study was to compare surgical outcomes of Endoscopic assisted neck dissection and conventional neck dissection.
Method From March 2013 to August 2013, 70 patients with cervical lymph node metastasis of head and neck cancer were enrolled in this study. Of these patients, 10 patients desired the endoscopic assist retro-auricular neck dissection, and 60 patients were done conventional approach. Demographic data were recorded. Total excised lymph nodes and total operation time of both groups were compare.
Result The mean total excised lymph nodes was no statistical different between two groups. However, mean total operative time of endoscopic assisted technique was longer than conventional approach, but there was no statistical different between two groups. Patients with retro auricular neck dissection are better aesthetic outcome and less local skin flap swelling.
Conclusion In unavailable Robotic surgery system situation, we can apply existing instrument to do endoscopic assisted retro-auricular which gave us a good aesthetic outcome but do not compromise to the disease control outcome.

Tumor of the Temporal Bone Mimicking Acute Mastoiditis

Julian Küstermeyer*, Helmut Ostertag, Jörg Hattingen and Hans-Jürgen Welkoborsky

Abstract:
Background: Tumors of the temporal bone in general and particular in children are extremely rare. The anatomical conditions of that special anatomic region can cause misleading symptoms. Diagnosis of rare tumor entities of the skull base in children is a challenging interdisciplinary task.
Objective: The purpose of the present article is to describe the diagnostic process of a rare pathologic condition and review the literature with current opinions of diagnostic and therapeutic methods with respect to angiosarcomas.
Methods: We report about a 13 years old boy with an angiosarcoma of the temporal bone. A review of the literature with particular emphasis on the diagnostic procedures was performed.
Results: The clinical and histological characteristics are reported in here. To date less than 20 cases of angiosarcomas of the temporal bone are published in the literature. Although a large variety of diagnostic methods is available, diagnosing and grading of such a rare tumor is still challenging.
Conclusion: Angiosarcoma of the temporal bone is extremely rare. The symptoms are unspecific, and can mimicking, like in this case, an acute mastoiditis. Diagnosis is challenging and only possible by Immunohistochemical examinations. Diagnosis of such rare pathologic conditions requires an interdisciplinary teamwork and collaboration of different institutions. Current technologies allow an easy exchange of knowledge all around the world for characterizing diseases precisely, and getting the experience of specialists together. This is crucial for a targeted and effective treatment.

Crushed Septal Cartilage Graft in Rhinoplasty and Nasal Septal Surgery: Clinical Outcomes and Complications

Deepak Verma and Neeraj Narayan Mathur*

Abstract:
Objectives: To assess clinical outcomes and complications with the use of crushed septal cartilage graft in rhinoplasty and nasal septal surgery.
Method: A prospective clinical study has done at a tertiary referral centre included 32 patients who underwent crushed cartilage grafting during rhinoplasty and nasal septal surgery with autogenous septal cartilage as the graft material. Slight or moderately crushed septal cartilage grafts were used to augment nasal dorsum, nasal tip and for septal correction. Photographic and endoscopic assessment was done preoperatively and postoperatively at 10th day, 1, 3 and 6 months to assess clinical outcomes and complications including graft resorption, warping, extrusion and any postoperative deformity.
Result: Among 32 patients, 19 underwent rhinoplasty and rest 13 nasal septal correction. Complications encountered were postoperative deformity in 3 patients of rhinoplasty and persistent septal deviation in 2 patients of septoplasty. There was no graft resorption, rejection, or extrusion.
Conclusion: Crushed cartilage appears to be a good graft material to conceal nasal irregularities and fill nasal dorsal defects in rhinoplasty and to obtain good functional outcomes in septoplasty.

The Use of Autologous Fascia Lata Graft Aided with Pedicled Muscle Flap in the Repair of Pharyngeal Tears

Tiba M*, Hasaballah M, Askoura A and Kassamy H

Abstract:
Introduction: Management of pharyngo-esophageal tears is challenging as it can end in mediastinitis and/or carotid blow out. Pharyngo-esophageal tears accompanied by suppuration or other neck’s vital structures injuries are more complicated.
Patients and Methods: This study addressed the use of non-vascularized autologous fascia lata graft in addition to a pedicled sternomastoid flap as a second layer in the repair of wide, primary irreparable pharyngeal tears. This was done to four patients with pharyngeal tears at Ain Shams University Hospitals, Cairo, Egypt. Pre and post-operative laryngeal examination, CT scan neck with contrast swallow were done.
Results: All patients showed complete closure of the pharyngeal tear. The harvesting of the grafts produced neither functional deficits nor complications at the donor site.
Discussion: The procedure was found to be effective with complete sealing of the tear as proved clinically and radiologically.

Comparative Histological Analysis of Collagen and Elastic Fibers Present in the Ventricular Folds and the Vocal Folds of Cadaveric Larynges

André Silva Luca, Devandir Antonio de Souza Júnior, Rui Celso M Mamede, Maria Célia Jamur

Abstract:
Introduction: Knowledge of the structural features of the vocal fold and the ventricular fold may help to understand the phonation process, and consequently may facilitate the use of the ventricular fold in phonation after laryngeal damage. Objective: To compare the histology and the distribution of collagen and elastic fibers between the ventricular folds and the vocal folds.
Methods: Hemilaringes from 14 male cadavers were collected, processed for histology, sections stained for collagen and elastic fibers and analyzed.
Results: The major part of the ventricular fold was lined with pseudostratified ciliated columnar epithelium containing goblet cells. In the ventricular folds the collagen fibers are homogeneously distributed in layers. In contrast, in the vocal fold the collagen fibers are unorganized and have a heterogeneous distribution. The percent of total collagen and of type I and type III collagen is similar between the vocal fold and the ventricular fold. However, the percent of type I collagen is increased in the ventricular fold in comparison to type III collagen. In the ventricular fold the elastic fibers are found in all layers of lamina propria, while in the vocal fold these elastic fibers are preferentially found in the deep layer of the lamina propria. The percent of elastic fibers is similar between the vocal folds and the ventricular folds.
Conclusion: The percentage of collagen fibers and elastic fibers is similar between the vocal fold and the ventricular fold. However, in the ventricular fold the percentage of type I collagen is greater than type III collagen.

Complicated Pansinusitis Masquerading Orbital Apex Syndrome

M. Silva*, JC. Ribeiro, J. Romão and A. Paiva

Abstract: Orbital Apex Syndrome is a very rare clinical diagnosis presented to ENT surgeons. Intraorbital extramedullary plasmacytoma is extremely rare and there are a few cases reports in the literature. Very unusually it develops a secondary leukemic transformation to a plasma cell leukemia which is a very rare and aggressive type of acute leukemia (in our tertiary hospital, Hematology Department had previously 3 cases in the last fifteen years).
Orbital apex syndrome is a rare but potentially fatal situation rarely seen initially by ENT surgeons. We report an even rarer case of an intraorbital extramedullary plasmacytoma that caused orbital apex syndrome, initially masqueraded by a complicated pansinusitis.
An immunosuppressed 78-year-old female presented with a progressive left side reduced best corrected visual acuity, pansinusitis and orbital involvement, imaging showed opacification of all paranasal sinuses, cavernous sinus involvement and left intraorbital mass lesion. After an initial improvement with antibiotics, sudden clinical deteriotion occurred. Biopsy of the intraorbital mass showed a monoclonal lymphoid neoplasm and laboratory findings led us to the diagnosis of plasma cell leukemia.
We advocate for a multidisciplinary approach ab initio in all cases of complicated rhinosinusitis to minimize or prevent deterioration of vision and optimize clinical outcomes.