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To study and analyse the variations in ethmoid roof anatomy and estimate the anatomical location and variations of AEA on CT scans. The study is conducted on 200 patients for detailed analysis of the olfactory fossa (OF) depth, supraorbital pneumatisation, and AEA location and distance from the skull base. In our study, Keros type II was predominant type seen followed by type I. Asymmetry was noted in 32/200 subjects (16%). The anterior ethmoidal artery (AEA) canal was seen in 341/400 sides (85.2%). We found Keros type II was the most common type in our study. We also found grade I anterior ethmoidal artery as the most common variant and the dangerous grade III anterior ethmoidal artery was least common type found in this study, and there was a significant association of Keros type II with increasing anterior ethmoidal artery grading.
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Abstract Introduction The Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis. Objectives The purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years. Methods Between 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year. Results The majority of patients in the study were in the age group of 21-30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result. Conclusion Management of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later.
Resumo Introdução O tubo T de Montgomery é um dispositivo usado como stent traqueal combinado com tubo de traqueostomia para evitar estenose traqueal pós-operatória. Objetivo Avaliar o resultado do procedimento cirúrgico feito para lesões no pescoço e nas vias aéreas em pacientes com trauma laringotraqueal contuso agudo e o resultado da colocação do tubo T de Montgomery nesses pacientes por 12 anos. Método Entre 2005 e 2017, 19 pacientes com trauma laringotraqueal contuso agudo foram submetidos ao implante do tubo T de Montgomery. Todos os 19 pacientes com trauma laringotraqueal foram submetidos a uma traqueostomia pré-operatória no pronto-socorro por um cirurgião otorrinolaringologista. O implante do tubo T de Montgomery foi feito posteriormente através de uma abordagem externa. O período de seguimento variou de dois a 10 anos. O tubo T de Montgomery foi removido após um período que variou de seis meses a um ano e meio. Resultados A maioria dos pacientes do estudo estava na faixa de 21 a 30 anos. A traqueostomia pré-operatória foi feita em todos os 19 pacientes. Todos, exceto três, tiveram decanulação bem-sucedida e resultado satisfatório em longo prazo. Conclusão O tratamento do trauma laringotraqueal contuso agudo é um desafio que exige uma abordagem multidisciplinar. A opção de tratamento ideal deve ser individualizada de acordo com a condição do paciente e as características da lesão. De acordo com nosso estudo, sugerimos que os casos de pacientes com trauma laringotraqueal contuso agudo sejam tratados de acordo com o protocolo mencionado em nosso estudo e enfatizamos fortemente que o implante do tubo T de Montgomery deve ser mantido por pelo menos um ano completo nas vias aéreas, pois resulta em chances insignificantes de posterior estenose pós-traumática das vias aéreas.
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INTRODUCTION: The Montgomery T-tube is a device used as a combined tracheal stent and tracheostomy tube to prevent post-operative tracheal stenosis. OBJECTIVES: The purpose of this retrospective study is to evaluate the outcome following Montgomery T-tube stenting performed in for neck and airway injury in patients with acute blunt laryngotracheal trauma over a period of 12 years. METHODS: Between 2005 and 2017, 19 patients with acute blunt laryngotracheal trauma underwent Montgomery T-tube stenting. All 19 laryngotracheal trauma patients had undergone a preoperative tracheostomy in the emergency department by an ENT surgeon. Montgomery T-tube stenting was done later through an external approach. The follow up period ranged from 2 to 10 years. The Montgomery T-tube was removed after a period ranging from 6 months to 1½ year. RESULTS: The majority of patients in the study were in the age group of 21-30 years. A preoperative tracheostomy was done in all 19 patients. All patients except 3 underwent successful decannulation, and experienced long-term satisfactory result. CONCLUSION: Management of acute blunt laryngotracheal trauma is a challenging problem that demands a multidisciplinary approach. The ideal treatment option should be individualized according to the patient's condition and characteristics of injury. According to our study we suggest that cases of acute blunt laryngotracheal trauma patients should be managed following the protocol as mentioned in our study, and we strongly emphasize that Montgomery T-tube should be left for at least 1 complete year in the airway as it results in negligible chances of post-traumatic stenosis of airway later.
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Laringoestenosis , Estenosis Traqueal , Adulto , Humanos , Laringoestenosis/etiología , Laringoestenosis/cirugía , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Tráquea/cirugía , Estenosis Traqueal/etiología , Estenosis Traqueal/cirugía , Traqueostomía , Resultado del Tratamiento , Adulto JovenRESUMEN
To evaluate the synergistic occurrence of facial asymmetry and craniofacial deformities in cases of Congenital muscular torticollis (CMT) and to assess the outcome of surgical correction on these deformities. Twenty-three cases of CMT presenting in ENT OPD from January 2015 to December 2019, 9 cases requiring surgical intervention were included. Facial asymmetry and craniofacial deformities were evaluated and quantified by measuring gaze angle, translational deformity and orbito-alar distance. All cases underwent a bipolar tenotomy using harmonic scalpel. In all cases on comparison with preoperative status there was significant improvement (p < 0.05) in surgical outcomes in terms of gaze angle, translational deformity and orbito-alar asymmetry. (1) There is overall excellent outcomes after surgery even when performed for the cases of neglected torticollis. (2) Timely intervention results in near normal improvement of craniofacial deformities. (3) Bipolar tenotomy using harmonic scalpel is safe, effective and complication-free method.
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BACKGROUND: It is a complete objective and subjective comparative study between two techniques of septorhinoplasty in patients undergoing primary rhinoplasty for crooked nose deformity. METHODS: Forty patients having crooked nose deformity were randomly divided into 2 groups exhibiting two different techniques of correction. Patients were randomly divided into 2 group: Group 1: 20 patients underwent correction of crooked nose by performing bilateral triple osteotomies + Septoplasty Group 2: 20 patients underwent correction of crooked nose by performing bilateral triple osteotomies as well as placement of spreader grafts + Septoplasty Objective and subjective assessment of patients in preoperative and postoperative period was done by various scales and scores. RESULTS: Both the groups showed improvement in facial angles, ROE score, nasal airflow, and NOSE score. But, group 2 patients were more satisfied than group 1 patients in terms of both aesthetic appearance of nose and breathing function. CONCLUSION: It is very well known to the authors that aesthetic result of rhinoplasty is not just dependant on one technique. Keeping this in mind, we conclude that as group 2 patients were more satisfied with their overall results, the additional step of spreader graft placement helped these patients with the complaints associated with crooked nose deformity. However, we also emphasize that additional studies on larger numbers of patients should be performed to compare and know other intricacies of each technique that may play minor or major roles in deciding the success of each technique. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Deformidades Adquiridas Nasales , Enfermedades Nasales , Rinoplastia , Estética , Humanos , Tabique Nasal/cirugía , Deformidades Adquiridas Nasales/cirugía , Osteotomía/métodos , Rinoplastia/métodos , Resultado del TratamientoRESUMEN
Foreign body ingestion is common in infants and children, but they can pose a difficult situation and a diagnostic problem if the foreign body is embedded in the soft tissues of the pharynx. To the best of our knowledge, this is the first case reported with such an unusually shaped foreign body having three sharp ends embedded at two different locations in the hypopharynx of a kid such small in age giving rise to respiratory as well as feeding problem. Secondly, a sharp foreign body penetrating arytenoid causing its swelling and inflammation, thus compromising the glottic opening and producing stridor is a rare phenomenon. We present a case of a 9 months old male infant who presented in ENT emergency with complaints of vomiting, refusal to accept solid as well as liquid feed for 5 days and sudden onset of abnormal grunting sounds on breathing for 1 day. Chest examination revealed intercostal retractions with decreased air entry bilaterally and conducted sounds in chest on auscultation. Abdomen examination revealed no abnormalities, and routine blood and urine investigations were also within normal limits. A metallic foreign body with three sharp ends was visualized in the neck X-ray, the retrieval of which by rigid hypopharyngoscopy relieved the symptoms.
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We performed a prospective interventional study to evaluate correlations between hearing thresholds determined by pure-tone audiometry (PTA) and auditory steady-state response (ASSR) testing in two types of patients with hearing loss and a control group of persons with normal hearing. The study was conducted on 240 ears-80 ears with conductive hearing loss, 80 ears with sensorineural hearing loss, and 80 normal-hearing ears. We found that mean threshold differences between PTA results and ASSR testing at different frequencies did not exceed 15 dB in any group. Using Pearson correlation coefficient calculations, we determined that the two responses correlated better in patients with sensorineural hearing loss than in those with conductive hearing loss. We conclude that measuring ASSRs can be an excellent complement to other diagnostic methods in determining hearing thresholds.
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Audiometría de Respuesta Evocada/estadística & datos numéricos , Audiometría de Tonos Puros/estadística & datos numéricos , Pérdida Auditiva Conductiva/fisiopatología , Pérdida Auditiva Sensorineural/fisiopatología , Estimulación Acústica , Adulto , Audiometría de Respuesta Evocada/métodos , Audiometría de Tonos Puros/métodos , Umbral Auditivo/fisiología , Potenciales Evocados Auditivos/fisiología , Femenino , Humanos , Masculino , Estudios Prospectivos , Estadística como AsuntoRESUMEN
INTRODUCTION: Tracheocutaneous fistula (TCF) is one of the recognized sequelae of a long-term tracheostomy resulting from mucocutaneous overgrowth which prevents closure of the artificial lumen at the site of tracheostomy. Primary closure of TCF has disappointing results and may lead to complications like pneumothorax, pneumomediastinum, cervicofacial subcutaneous emphysema, and depressed scar. OBJECTIVE: To compare TCF repair using fistulectomy followed by rhomboid flap versus fistulectomy followed by Z plasty repair. METHODS: In this prospective study, 40 patients of either sex with persistent TCF were included. All patients were randomly divided into two groups. Group I had 20 patients who underwent TCF repair using a technique in which fistulectomy was done followed by its closure in layers, and finally closing the defect using a rhomboid flap. The remaining 20 were included in group II who underwent TCF repair using a technique in which fistulectomy was done followed by layered closing, and final closure of the defect was done using Z plasty. The follow-up period was 3 months. RESULTS: Out of 40 patients, all but 8 experienced a successful outcome without any complications, and complete aesthetic satisfaction, with improvement in phonation, and no soiling of clothes with mucus or sputum. The 8 unsuccessful patients belonged to group II (Z plasty group). CONCLUSION: Both techniques have been described in the literature and are proven to give good results. Our study emphasizes the fact that in our experience, the rhomboid flap was a better alternative for TCF repair than Z plasty. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Fístula Cutánea/cirugía , Procedimientos de Cirugía Plástica/métodos , Fístula del Sistema Respiratorio/cirugía , Colgajos Quirúrgicos/trasplante , Traqueostomía/efectos adversos , Adulto , Fístula Cutánea/etiología , Estética , Femenino , Supervivencia de Injerto , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Masculino , Persona de Mediana Edad , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/cirugía , Estudios Prospectivos , Fístula del Sistema Respiratorio/etiología , Colgajos Quirúrgicos/clasificación , Enfermedades de la Tráquea/etiología , Enfermedades de la Tráquea/cirugía , Traqueostomía/métodos , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
Eccrine Angiomatous Hamartoma (EAH) is a benign rare skin neoplasm characterised histologically by abnormal proliferation of sweat glands and surrounding capillaries and other dermal elements like fatty lobules and hair. It usually presents at birth or in early childhood in the form of solitary nodules mostly affecting the extremities. Here, we report a case of angiomatous hamartoma over the face which presented as a cystic swelling in preauricular region in a 55-year-old man. The late onset and a rare site for presentation of EAH prompted us to report the case. There is not even a single case of EAH arising in the "preauricular" region, reported.
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Meningioma is known to be an intracranial pathology, but it can also present extracranially. We report a case of a 55-year-old female who presented to the Ear, Nose and Throat (ENT) emergency with a complaint of epistaxis for 1 day. There was a 7-8years history of self-resolving intermittent epistaxis. Nasal examination revealed a mass from which biopsy was taken. The specimen showed meningioma on histopathological examination. The mass was excised by ENT surgeons through lateral rhinotomy incision. It was confirmed to be a meningioma by final histopathological examination. The patient was discharged on 10th post-operative day after suture removal under stable condition and was symptom free on regular follow-ups. Worldwide there have been very less number of cases of primary extracranial meningioma causing symptoms of epistaxis, nasal obstruction and a large sinonasal mass in an elderly.
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We report a case of a 2-month-old male child who presented with sudden onset of vomiting and refusal to breast feed. Chest and abdomen examination were normal. A foreign body (zipper) was visualised in the cervical oesophagus on X-ray of the neck. The retrieval of the zipper by oesophagoscopy relieved the symptoms of the patient.