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Volume-II
JanuaryJune,2008
The Official Publication of the Association of Otolaryngologists of India, Orissa State Branch
All rights owned by the Association of Otolaryngologists of India, Orissa State Branch (O.S.B.)
OSB
Editorial :
Chairman
Number-I
Editorial Board
CHAIRMAN:
The views expressed in the articles are entirely of individual author. The Journal bears no responsibility
about authenticity of the articles or otherwise any claim howsoever.
This Journal does not guarantee directly or indirectly for the quality or efficiency of any product or services
described in the advertisements in this issue which is purely commercial in nature.
ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
Place of Publication
Periodicity of Publication
Nationality of Publisher
Publisher & Editorial
Chairman, Name & Address
:
:
:
:
5.
6.
I, Prof. Abhoya Kumar Kar hereby declare that, the particulars given above are true to the best
of my knowledge & belief.
Date : 10.6.2008
ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
Sign. of Publisher
Number 1
CONTENTS
EDITORIAL :
A reminiscence of Joseph Toynbee
(1815 - 1866) - The Philanthropic &
Humanitarian Otologist
Abhoya Kumar Kar, & G. C. Sahoo
MAIN ARTICLE :
Whats new in Obstructive Sleep Apnoea
Syndrome ?
Mohan Kameswaran
2-4
Semi-automated Digital Model Of Ciliary
Beat Analysis
Ashutosh Kacker & Vijay Anand
5-7
Facial Nerve Monitor - Our experience
K. K. Ramalingam, Ravi Ramalingam,
T. M. Sreenivasa Murthy, Uttam Agarwal,
Sriram Nathan, Chandrakala G R.
8-11
25-27
28-29
23-24
Recurrent Rhinosporidiosis
N. K. Goyal, Viplav Dutta,
Varsha Mungutwar & Reema Nair
43-45
Otoplasty in TCS
S. N. Mishra & G.C. Sahoo
46-47
for the most severe cases of OSAS with RDI above 50,
lowest O2 saturation below 60% or cardiac arrhythmias.
Uvulopalatopharyngoglossoplasty (UPPGP)
combines UPPP with limited resection of the tongue base.
CONCLUSION :
A detailed history, clinical examination & simple overnight
observation will usually help to clinch the diagnosis of
obstructive sleep apnoea syndrome. Polysomnography is
the gold standard investigation to help diagnose the type
and severity of sleep apnoea. Sleep MRI (dynamic MRI)
with F.O. nasoendoscopy has obviated the need for
cumbersome cephalometric measures to establish the site
of obstruction. CPAP & Tracheotomy form the gold standard
of management but are not accepted by a majority of
patients. In properly selected cases, UPPP, LAUP, RAUP and
procedures to enlarge the retrolingual airway have all
yielded gratifying results.
Repose tongue suspension intraoral approach tongue base is pulled forward and secured anteriorly by a
titanium screw placed at the lingual cortex of genial tubercle
of mandible.
REFERENCES :
1.
2.
3.
4.
Robert J. Troell, Daid J. Terris. Sleep apnea and sleepdisordered breathing. Cummings Otolaryngology &
Head and Neck Surgery. 2005: Vol. 2, 1707
5.
6.
Ashutosh Kacker, MD
RESULTS :
CBF analysis was performed in 10 healthy human
volunteers specifically those without a history of nasal/
sinus or lung pathology. CBF ranged from 7-10 Hz with
a mean of 8 Hz.
DISCUSSION :
Many techniques to measure ciliary beat frequency in
respiratory epithelium have been described since the
REFERENCES
The 30th Sate Conference of AOI, Orissa State Branch with workshop on
Sinus Endoscopy, Head & Neck Surgery and Thyroplasty will be held on 8th & 9th
November, 2008 at Berhampur.
Kindly contact Prof. R. N. Samal, Organising Secretary, Dept. of E.N.T., M.K.C.G.
Medical College, Berhampur (Gm.)-760 004 or Prof. Abhoya Kumar Kar, Chairman
Organising Committee for registration & accomodation
Prof.
1.
2.
Vestibular neurectomy.
3.
4.
5. Parotid surgeries.
As more and more surgeons realize the usefulness of
intraoperative monitoring of facial nerve, the indications
will broaden.
Nerve monitor
[Neurosign 100]
Interpretation
There are four basic sounds from the instrument when
used correctly. These are :
Description Causes
Pulses
Electrical
stimulation
Burst
Direct surgical
manipulation
Clicks synchronized
with surgical
manipulation of the
nerve or tissue
to which the nerve is
attached; often
sounds like the
rustling of tissue
paper.
Train
Stretching of the
nerve.
Compression of
the nerve.
Irrigation.
Heating [LASER
or
diathermy].
Continuous clicks
lasting several
seconds or even
minutes after the end
of surgical action.
Except for irrigation,
a train response is a
warning that the
nerve has been
irritated significantly
and the surgeon
should wait until the
response dies down.
Stimulation probes:
There are different types of probes available
1.
2.
3.
Silence
BIPOLAR PROBE
Typical sound
MONOPOLAR PROBE
2.
3.
4.
5.
6.
LARYNGEAL ELECTRODE
OUR EXPERIENCES
Special uses
The facial nerve monitor can be useful not only for acoustic
neuroma, mastoid or middle ear surgery, but also for
extratemporal course of facial nerve as in parotidectomy
and selective peripheral neurectomy.
The monitor can also be useful for :
1.
Parotid
sialography
showing
intraductal and intraparenchymal
sialolithiasis involving deep lobe of
gland
Parotid sialography
showing sialectesis
1. Professor & Head of Dept., 2. Asst. Professor, 3. P.G. Student, Dept. of E.N.T.,
M.K.C.G. Medical College, Berhampur (Gm.) Pin-760004
ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
TABLE
Symptoms
No. of cases
Percentage
Headache
83
69.16
Nasal obstruction
57
47.50
Chronic hawking
51
42.52
Sneezing
42
35.00
Heaviness in head
31
25.83
Nasal discharge
26
21.66
Epistaxis
09
7.50
No. of cases
Percentage
66
55.00
Sinus tenderness
58
48.33
23
19.16
Associated polyp
13
10.83
D.N.S. (Gross)
36
30.00
OF
No. of Sinuses
Percentage
Type - 1
10
4.16
Type - 2
104
43.33
Type - 3
66
27.50
Type - 4
54
22.50
Type - 5
2.50
No. of cases
Percentage
Gross opacity
Bony erosion
Mucosal thickening
Bony thickening
12
1
11
1
48.00
4.00
44.00
4.00
Percentage
Clear
37
15.42
Mucoid
48
20.00
Mucopurulent
118
49.16
Purulent
37
15.42
Total
240
100.00
No. of cases
Percentage
No growth
106
88.34
Isolated fungi
14
11.66
No. of cases
Percentage
Aspergillus fumigatus
42.86
Aspergillus flavus
21.43
Aspergillus niger
7.14
10
71.43
Candida albicans
14.29
Cladosporium
7.14
Penicillium
7.14
No. of Cases
Percentage
Non-invasive
13
92.85
Invasive
7.15
Pencillium
Candida
albicans
Cladosponum
Mucor
Present study
71.43%
7.14%
14.29%
7.14%
__
Grigoriu et al
(1975)
66.60%
2.00%
8.30%
__
__
Laskownick et
25.20%
16.80%
41.10%
__
__
75.00%
12.50%
12.50%
__
__
4.00%
2.00%
__
__
66.00%
__
33.00%
__
__
67.47%
4.82%
26.51%
__
1.20%
al (1978)
Grewal et al
(1990)
Chakrabarti et 86.00%
al (1992)
Aher et al
(2000)
GPS Gill et al
(2004)
Number
Male
23
Females
17
Total
40
canal was noted. The mucosa over the bony fallopian canal
was removed using a needle. Using a small diamond burr
& a right angled hook, the entire bony shell was removed
exposing the sheathed horizontal segment of the VII nerve.
In all 40 cases studied, none of the nerve showed any
evidence of neuroma, hematoma, oedema or areas of
demyelination. Using a straight fine microsurgical pick,
taking care not to displace incus or stapes, four to six
punctures were made in the horizontal segment of the facial
nerve by pushing it medially through the thickness of the
nerve to hit the medial wall of fallopian canal. The puncture
site was covered with a small gelfoam. The tympanomeatal
flap was reposited and antibiotic impregnated pack was
placed in the external canal. Postoperatively, the patients
were given amoxycilline-clavulinic acid combination,
analgesics & multivitamin capsules for 5 days, following
which the patients were discharged from hospital. No ear
drops or steroid (systemic or local) was prescribed. None
of the complications (as reported elsewhere) viz.
L
L
L
L
L
L
L
No. of patients
Complete
35
Partial
None
No. of cases
Facial paresis
Conductive deafness
2.
3.
4.
5.
6.
7.
8.
9.
Address correspondence & reprint requestsDr. S. B. Ogale, MS, DORL, FCPS, MNAMS
B 523, Dhanwantari CHS,
Deonar Municipal Colony, Sector II
Mumbai, India-400043
Phone-*919820542962
Fax-*9122-24143435
Email: dr_sbogale@yahoo.com
Prof. Abhoya Kumar Kar has been appointed as Honorary Visiting faculty of Annamalai
University for the year 2007-08.
Prof. G. C. Sahoo has been appointed as Hon. Editor of International Profiles
Accomplished Leaders published by American Biographical Institute, Inc.
ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
of
INTRODUCTION :
Headache is not a disease, but a symptom reflecting the
presence of myriad disease spectrum. When it is recurrent,
it becomes a source of misery to the sufferers as well as to
those who venture to treat it. Research has reported about
300 causes of secondary headaches. About 20% of the
headache cases get referred to ENT department from
various other disciplines of medical science to rule out rhinosinusogenic headaches. CT scans & diagnostic endoscopy
resolve most of the puzzles in rhino- sinusogenic headaches
& offer solutions.
METHODS :
This study includes referred patients from Medical, Neuro,
Ophthalmic, Dental or other departments for opinion
regarding headache. All the cases were subjected to
diagnostic endoscopy & CT scans to detect the cause.
Neoplastic lesions of nose & PNS were excluded from the
study. Frank sinusitis cases were identified and treated
appropriately. For the rest of those who walked in with
headache, patch test was done. 4% xylocaine nasal packs
were applied as patches over the contact nasal mucosal
area of the meati, turbinates and septum. Disappearance
of headache & reappearance after the lapse of action of
local anaesthetic identified headaches due to contact areas
from this patch test. Probe test by probing the suspected
areas of contact triggered and aggravated the headache1.
Application of a local anaesthetic patch over that area
relieved headache & confirmed the cause of headache.
Such of those patients with rhinologic headaches due to
contact areas were treated with FESS beneficially. We
reviewed those, who were accessible for 6 months to 2
years follow up in treatment. Total of such number of
compliant patients were 128 in this study of past 5years.
RESULTS :
Contact areas within nasal cavity that is responsible for
headache as confirmed during diagnostic nasal endoscopy
by the patch and probe test revealed the following sites.
Large Ethmoidal bulla with contact area & headache 18%
Aggernasi causing
rhinologic headache
(Endoscopic View)
(Endoscopic View)
(CT View)
(Endoscopic View)
(CT View)
2)
3)
4)
Date
Audiometer
Ident
Age of
Tested
Side
left/right
Transuducer
Air/Bone
PT0250
PT0500
PT1000
PT2000
PT4000
PT8000
13.12.07
25
Blue
Air
-5
10
Frequency
cases
mean
Stderr
Air
500
2388
1.9
0.2
1000
2580
3.0
0.2
2000
2364
5.1
0.2
4000
2371
2.7
0.2
8000
2640
11.0
0.2
500
1104
-1.7
0.5
1000
1218
-0.3
0.4
2000
1099
0.4
0.4
4000
1060
0.2
0.5
8000
946
2.2
0.8
Bone
Lacrimal sac syringing was done with normal saline & free
flow of fluid was observed endoscopicaly. Nose was
packed with ribbon gauze smeared with neosporin
ointment. Patient was put on prophylactic antibiotics and
anti inflammatory drugs. Saline irrigation and nasal
douching was done.
Patient was asked to come for review weekly once for Ist
month and then monthly once.
OBSERVATION AND RESULT :
In our study, patients of age from 20 years to 70 years
were taken.
It was found that majority of patients were in 3rd and 4th
decades of life (34% in 3rd decade and 30% in 4th
decade).
A female preponderance was noticed, 30% were males
compared to 70% females.
In intra operative complications 30% i.e. (15 cases) had
moderate bleeding and in 8% i.e. (4 cases), there was
difficulty in doing bony window.
Post -operative complications include synechiae and
granulation. Synechiae was found is 6% i.e. (3 cases)
and granulation in 10% i.e (5 cases).
Success rate was defined as no complaint of epiphora and
presence of patency of duct on syringing. Success rate of
endoscopic DCR was 90% i.e. (Lacrimal drainage system
was patent in 45 cases).
DISCUSSION :
The present study was conducted from Sept., 2005 to Sept.,
2007, during which 50 cases were studied & they under
went endoscopic endonasal dacryocystorhinostomy.
Chronic dacryocystitis was more common in adults &
highest incidence was seen in 3rd & 4th decades. In
CONCLUSION
Endoscopic DCR is simple & safe. The surgical duration
is short. Intranasal pathologies like grossly deviated nasal
septum can be corrected in same sitting.
Endoscopic DCR avoids scar formation & injury to
adjacent structures like medial palpebral ligament and
angular vessels. The lacrimal pump mechanism is not
disturbed as the orbicularis muscle is not incised. The
procedure is cost effective & patient friendly.
Thus endoscopic DCR is a better procedure for treatment
of chronic dacryocystitis. With wide spread use of nasal
endoscopic techniques, this surgery is gaining popularity
all over.
Infiltration
Bone Nibbling
Sac Incision
FOLLOW UP PHOTOGRAPHS
1 st Week
1 st Month
6. Shun shin GA, Thunrairajan G. 1998. "External DCRan end of an era?". British journal of Ophthamology,
south Asia. 1: 11-12.
7. Seppa, Grenman R. 1994. "Endonasal CO2 - Nd: YAG
laser dacryocystorhinotomy". Acta ophthalmologic. 72:
703-706.
6 th Month
1 Year
REFERENCES :
1. Whittet et al. 1993. "Functional endoscopic transnasal
dacryocystorhinotomy" Eye, 7: 545-549.
2. Cokkeser Y. evereklioglu C. Er. H comparative external
versus endosopic dacryocystorhinostomy: results in 115
patients (130 eyes). Otolaryngol head neck surg. 2000;
123(4): 488-91.
3. Sprekelsen
MB
1996
"Endoscopic
dacryocystorhinostomy: Surgical techniques and
results". Laryngoscope 106: 187-189.
4. Hartikainin, Jounko et al. 1998. "Prospective
randomized comparison of endonasal endosopic
dacryocystohinostomy
&
external
dacryocystohinotomy". Larynogoscope 108: 18611866.
5. Rice DH. 1990.
"Endoscopic intranasal
dacryocystorhinostomy: Results in 4 patients".
Achieves of oto laryngology 116: 1061.
NORMAL ANATOMY :
The parathyroids vary in numbers and various authors
report varying numbers and their incidences could be as
follows.
Number
1-12
Normally
87%
Fig. 1
2 Superior
Fig. 2
2 Inferior
3 glands
6%
5 glands
0.2%
6 glands
0.6%
Fig. 3
compartment.
Our experience of parathyroid dysfunction:
Duration
1. Total Thyroidectomies - 55
2. Onset of Hypocalcemia
Day 1
8
2
12
6 wks
5
Longer
15
4. Metabolic deaths
3
--
Acknowldgements :
I am extremely thankful to Prof. (Dr.) Ramanathan,
Dean, Faculty of Medicine and Prof. (Dr.) N. Chidambaram,
Medical Seperintenant, RMMCH for their kind permission
to publish this article.
Address for Correspondence :
B-4, R.S.A. Housing Complex, Annamalai Nagar 608002,
Chidambaram, Tamil Nadu.
Prof. Abhoya Kumar Kar was felicitated as Eminent Otolaryngologist of National Stature
by the Organising Committee of Diamond Jubilee AOICON, Agra, 2008.
ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
all the abstracts are free and the full-text articles can be
purchased online. The site offers an evaluated Medline
Service with full-text links, expert annotations and
connections to over 1000 libraries.
Cliniweb (http://www.ohsu.edu)
The Cliniweb site is an index and table of contents of clinical
information on the world-wide web. It has recently been
expanded to include nearly 10,000 URLs indexed by terms
from the Medical Subject Headings (MeSH) Anatomy and
Disease trees.
Doctors Guide to the Internet
www.pslgroup.com/docquide.html)
(http://
Mednets (http://www.internets.com/mednets/)
Mednets sets out to provide a complete informationgathering service for the patient, physician and healthcare
providers. The site offers several search engines including
Medline and links to resources on over 40 specialist
subjects. For patients, the site offers pages of links covering
medical information and advice. For general interest, Mednet
has included links to most of the major online news services
1.
2.
3.
4.
5.
6.
7.
8.
9.
For Correspondence
Dr P Mishra,
Prof of Ophthalmology
RMMCH
Annamalai University
Tamilnadu, PIN- 608002
e mail: dr_pmishra@dataone.in
The book MCQs in ENT written by Prof. G. C. Sahoo, published by Jaypee Brothers
came to market in Jan/Feb, 2008. It is an excellent book.
Prof. Abhoya Kumar Kar delivered Guest Lecture on Laryngeal Cancer on the eve of
Inauguration of Cuddalore & Pondicherry Chapter of AOI on 18.11.07.
ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
Osteosarcoma.
Ewing sarcoma.
Smooth-muscle tumors are rare in the head and neck.
Leiomyosarcoma is a malignant smooth-muscle (soft
tissue) tumor, that has a predilection for the
gastrointestinal tract and the female genital tract,
perhaps because of the preponderance of smooth
muscles at these sites. Leiomyosarcomas of the head
and neck are believed to originate in the tunica media
of the blood vessels or in pluripotential mesenchymal
cells. Clinically, these tumors are very aggressive and
the prognosis is poor.
Case Report :
A 38-years-old male patient from the North-east India
gave history of right-sided nasal obstruction and
epistaxis in 2004. He had undergone a sub-labial
Fig. 4 & 5 : CT
PNS, (axial and
coronal views) of
the mass filling the
right maxillary sinus
and nasal cavity
involving the floor
and medial wall of
the right orbit and
eroding the nasal
septum and the
antero-lateral wall of the maxilla.
Clinical features
Sinonasal leiomyosarcoma is a highly aggressive tumour.
On gross examination, leiomyosarcomas appear smooth
and well circumscribed5. They are unencapsulated and
are greyish or pink in colour. They may be polypoid or
sessile. Regional lymph node involvement is rare, but
cervical node metastasis has been reported in a few
cases6.
Histopathology
On histologic examination, the tumor is made up of
interlacing fascicles of spindle-shaped cells that have
elongated, blunt-ended nuclei and eosinophilic cytoplasm.
Numerous mitotic figures are seen. The cytoplasm of
the tumor cells stains red in Masson's trichrome
medium7.
Radiology
On CT scan, leiomyosarcomas appear as bulky masses
associated with extensive necrotic and cystic changes
with surrounding bony destruction. On MRI,
leiomyosarcomas show intermediate enhancement with
contrast and intermediate to high signal intensity on T2weighted imaging.
Differential diagnosis
Differential diagnosis consists of malignant schwannoma,
malignant fibrous histiocytoma, fibrosarcoma, amelanotic
melanoma, malignant lymphoma, squamous cell
carcinoma, extramedullary plasmacytoma, metastatic
tumor, glandular tumor, chondroma, chondrosarcoma,
osteogenic sarcoma and inverted papilloma.
Treatment
Surgical resection of the tumor with wide margins is
the treatment of choice. Neck dissection is needed if
nodes are involved 8 . Recent studies show that,
combination therapy with mesna, doxorubicin, ifosfamide
and dacarbazine or combination therapy with
cyclophosphamide, doxorubicin, vincristine and
dacarbazine is effective against soft-tissue sarcomas to
a certain extent. Combination chemotherapy and
radiation therapy are used as adjuncts for residual and
recurrent disease.
Conclusions
Discussion
The first case of maxillary leiomyosarcoma was
reported in 19582. Since then, only about 65 cases have
been reported throughout the world3. Leiomyosarcomas
account for 6.5% of all soft-tissue sarcomas and only
3% of them arise in the head and neck4. The most
common sites are the nasal cavity, the maxillary sinus
and the ethmoids.
REFERENCES :
1. Sercarz JA, Mark RJ, Tran L, et al: Sarcomas of
the nasal cavity and paranasal sinuses. Ann Otol
Rhinol Laryngol 1994 Sep; 103(9): 699-704.
2. Konrad HR. Nasal neoplasms. In: English GM, ed.
Otolaryngology. Philadelphia: J.B. Lippincott,
1993:1-11.
3. Ortega JM, Gomez-Angulo JC, Aragones P, et al.
Leiomyosarcoma of the paranasal sinuses with
intracranial involvement: Report of a clinical case
and review of the literature. Neurocirugia (Astur)
2001;12:331-7.
4. Tanaka H, Westesson PL, Wilbur DC.
Leiomyosarcoma of the maxillary sinus: CT and MRI
findings. Br J Radiol 1998;71: 221-4.
MS
Ex - Registrar
Dept. of Otorhinolaryngology & Head & Neck surgery
King Edward VII Memorial Hospital & Seth G. S. Medical College, Mumbai, India
Abstract : Brown tumor is an uncommon focal giant cell lesion, which arises as a direct result of parathyroid hormone
on bone tissue in patients with hyperparathyroidism. Any of the skeletal bone can be affected including maxillo facial
bones. Initial treatment is to correct hyperparathyroidism. This is the case report of a Brown tumor of nasal bone in
22 year old female, who presented with nasal bone mass and femoral fracture. Laboratory values confirmed the
diagnosis. Partial parathyroidectomy was done. Patient has been kept under observation for the regression of tumor.
Key words: Brown tumor, hyperparathyroidism, parathyroid adenoma.
INTRODUCTION :
The Brown tumor is localized form of fibrocystic osteitis,
which occurs as a result of hyperparathyroidism. Brown
tumor can affect any bone, but most commonly affects
mandible, maxilla, clavicle, ribs and pelvis. Histologically,
tumor is made up of cell mass consisting of mononuclear
stromal cells along with multinucleate giant cells, in which
recent hemorrhagic infiltrates and hemosiderin deposits
are often found. That is why it is called as Brown tumor.1
Radiographic and histological features of this tumor are
very much similar to other tumors of face, but whenever
round, radiolucent, bone expanding tumor is found in facial
region along with hyperparathyroidism, one has to think
about Brown tumor as most likely diagnosis.
We report a rare case of brown tumor of nasal bone
in a young woman and discuss the clinical history,
differential diagnosis, diagnosis and treatment of this
type of lesion.
Case Report
A 21 yr old female, presented with right sided external
swelling of the nose since last 8 months, which was
increasing progressively. There was mild pain, but no
complaints of nasal blockage,
epistaxis or orbital problems. She
also had a fracture of right femur,
sustained due to fall 8 months ago,
which was not healing in spite of
adequate treatment.
Fig. 1: Profile showing the
bulge of nasal bone tumor
Otorhinolaryngologic examination
revealed the external nasal mass,
measuring 2 x 3 cm which was
hard in consistansy, nontender ,
nonmobile & not fixed to the
overlying skin. There was no
abnormality found on anterior
rhinoscopy. Oral & Neck examination didnt reveal any abnormality.
2.
3.
4.
5.
RECURRENT RHINOSPORIDIOSIS
Dr. N. K. Goyal
Dr.Viplav Dutta
Dr.Varsha Mungutwar
Assistant Professor
Resident
Department of ENT, Pt. J.N.M.Medical College & Dr.B.R.A.M.Hospital , Raipur ( C.G.)
Fig -1
ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK
SURGERY
Fig -2 : Rhinosporidiosis of
bones
Fig -3
Rhinosporidiosis of bones
Fig 5
DISCUSSION :
Rhinosporidiosis is the disease caused by Rhinosporidium
Seeberi in humans and animals. In humans, it manifests
as chronic granulomatous polyp predominantly in the nose
and nasopharynx. Extranasal sites are conjunctiva , lacrymal
sac , skin , parotid gland , bones , lip , vulva , palate ,
epiglottis , trachea , bronchi , urethra , vagina and rectum.
Extranasal manifestations of rhinosporidiosis are uncommon
and may not be diagnosed easily, especially in sporadic
cases occurring in non endemic areas.
Rhinosporidium Seeberi has never been successfully
propagated in vitro. Initially it was thought to be a parasite,
but for the past 25 years it has been regarded as a water
2.
3.
4.
5.
6.
7.
8.
9.
Prof. Abhoya Kumar Kar has been elected as Vice-President, IMA, Orissa for
2008-09.
Prof. Abhoya Kumar Kar was felicitated as Otolaryngologist of National Stature by
GSL Educational Trust, Andhra Pradesh.
OBITUARY
Two members of Orissa State Branch of AOI, Dr. Banka Bihari Negi &
Dr. Ajit Kumar Das passed away in recent past.
Let their souls remain in peace.
ORISSA JOURNAL OF OTOLARYNGOLOGY AND HEAD & NECK SURGERY
OTOPLASTY IN TCS
Dr. S. N. Mishra, Professor and Head of Department of Plastic Surgery.
Dr. G.C. Sahoo, Professor and Head of Department of ENT.
Raja Muthiah Medical College & Hospital, Annamalai University.
Abstract
Treacher Collin's syndrome (TCS) or mandibulofacial dystosia is also otherwise known as Franceschettic Zwahlen - Klein syndrome or Berry syndrome, having an autosomal dominant trait with high penetration and marked
variability in expression. A 20 year old female patient with typical facial, otological, oral and ophthalmological features
of TCS reported here for whom otoplasty was performed to treat the cosmetic deformity of the pinna and a hearing
aid was provided which improved her hearing.
Key words : TCS, Otoplasty, Pinna, Flap
Introduction :
Operative procedure:
Case report :
A 20 years old female, presented with H/O inadequacy of
hearing and cosmetic deformity of both the ears to the
division ENT, RMMCH, Annamalai University & on examination
the patient had microtia with meatal atresia, bird like face
with prominent parrot beak nose, macrostomia and
hypoplasia of the maxilla. On investigation PTA showed
moderate to severe mixed hearing loss and 'X' ray mastoid
- Laws view showed sclerosis of the air cells. The patient
i.
Post auricular flap (F) and the pre auricular incision (I) marked.
ii.
Pre auricular defect (D) and the raised post auricular flap (F)
are seen in the field. The ear (E) is rotated medially.
iii. The post auricular flap (F) transposed to the pre auricular
defect.
(b) Left ear :
i.
Post auricular flap (F), release incision (I) and pre auricular
rotation flap (RF) marked.
ii.
The pre auricular defect (D), the raised post auricular flap (F)
and the medially rotated ear (E) are seen.
Dr. S. N. Mishra
Professor and Head of Department of Plastic Surgery
RMMC&H, Annamalai Nagar-608002, T.N.
Mobile : 9894857960.
Ex - Senior registrar
Ex - Registrar
DISCUSSION :
RECOMMENDATIONS :
Certain aspects of domiciliary tracheotomy tube care needs
review & emphasis in order to prevent such mishaps from
occurring. Besides checking for manufacturing defects,
regular inspection of tube for signs of wear & tear & its
periodic replacements should be carried out.
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REFERENCES :
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