Thornwaldt Cyst: Case Report

Thornwaldt cyst is benign, mucosal congenital cyst which is located in upper nasopharynx. It developed in nasopharyngeal bursa if opening of bursa is occluded due to infection or inflammation. It is rare congenital cyst present in nasopharyngeal bursa. Its incidence is 3% in adults [1]. The usual age of presentation is 2nd and 3rd decade [1]. It is usually asymptomatic and incidental finding on MRI but it can present as nasal obstruction, post nasal drip, halitosis, occipital headache, foreign body sensation in throat [1] [2]. Here we are presenting a case report of 23 years old male presented with foreign body sensation in throat since 5 months. On oral and nasal endoscopic examination cystic mass in nasopharynx seen, bulging in oropharynx. MRI shows cystic mass arising from left side of nasopharynx popping up in oropharynx. Cyst then excised with diode laser with both endonasal and transoral approach with zero degree rigid endoscope. Histopathology confirmed the cyst as thornwaldt cyst.

An Unusual Maxillary Sinus Foreign Body and Its Endoscopic Assisted Removal

Foreign bodies in maxillary sinuses are uncommon. But the incidence is on a rise. Herewith we present a case of foreign bodies (glass pieces) in left maxillary sinus and bilateral nasolacrimal ducts, which is managed endoscopically.

Plexiform Neurofibroma of Nasal Tip

Neurogenic tumor is the name given to any tumor that arises from the nerve tissue or its coverings. Neurogenic tumors of Sino-nasal cavity are a very rare entity. The most common types are Schwannomas and Neurofibromas and the plexiform subtype is one form of these neuroendocrine tumors. We report the case series of two such cases of a plexiform neurofibroma of the nasal tip, which were excised via an open rhinoplasty approach.

Post-Stapedectomy Granuloma: A Rare Case Report

Reparative granuloma in the oval window region is an uncommon complication of stapes surgery, which usually develops within one to eight weeks after operation and causes a sudden hearing loss and disturbance of balance. It may also cause otalgia. Because of its rarity, no single centre would be able to give conclusive evidence regarding this complication. Hence we would like to report our experience and hope to get a better understanding regarding the stapes surgery induced granulation.

Intratympanic Injections: An Unsolved Mystery

Aims: The aim of this study was to test the effectiveness of intratympanic dexamethasone injections as a treatment for severe disabling tinnitus and also observe its effect on hearing loss if any. Materials and Methods: Thirty patients with severe disabling tinnitus in the age group 20 to 60 years were selected and randomly assigned to receive intratympanic injections of a dexamethasone solution 4 mg/ml (0.5 ml) or isotonic saline (0.5 ml) solution under topical anaesthesia, once per week for 4 weeks using a zero degree endoscope. Improvement in tinnitus was assessed using a visual analog scale, considering 2-point improvement as significant and alteration in hearing if any was noted by pure tone audiometery before and after the therapy. Results: The improvement in tinnitus was not significant, with no alteration in audiometery reports. Conclusions: Intratympanic therapy is an attractive mode of treatment because of its highly targeted delivery, low concentration of the drugs required and a very good patient tolerance. Although there has been no breakthrough in intratympanic therapy for tinnitus or other otological conditions, accessibility to the inner ear through the semipermeable round window membrane holds many promises in the near future.

Squamous Cell Carcinoma of the Middle Ear Mimicking CSOM with Intracranial Complications: A Diagnostic Dilemma

Cancer of the external auditory canal (EAC) and middle ear (ME) is rare, accounting for less than 1% of all head-and-neck malignancies [1] [2] of which squamous cell carcinoma (SCC) is the most common. Even though squamous cell carcinoma [SCC] of the middle ear and chronic suppurative otitis media (CSOM) co-exist, no definitive correlation has been proven. Here we are presenting a case of squamous cell carcinoma of the middle ear who presented with headache, fever and vomiting with a background history of chronic suppurative otitis media since childhood. A provisional diagnosis of mastoid abscess with intracranial complications secondary to chronic suppurative otitis me dia was made and modified radical mastoidectomy was done but histology of the mastoid specimen revealed well differentiated keratinizing squamous cell carcinoma, which was treated with radical radiotherapy. Objective of this presentation is to bring attention to the coexistence of CSOM and squamous cell carcinoma ear and also the importance to detect these lesions at an early stage. This report also highlights the requirement of histopathological analysis in mastoidectomy and discusses the aetiology and management of squamous cell carcinoma of the middle ear with review of literature.

Use of Diode Laser in Excising Bilateral Inverted Papilloma of Paranasal Sinuses

The inverted papilloma is an uncommon unilateral benign unilateral tumor of the nose & paranasal sinuses. Although a benign pathology, it is associated with aggressive local destruction and recurrence after removal and malignancy. The clinical picture presents non-specific signs and symptoms, such as unilateral nasal obstruction, anosmia and headache. Treatment is essentially surgical. This report has the objective of presenting an uncommon bilateral nasal inverted papilloma and the use of diode laser in surgical excision & making a literature review. The uniqueness in our case was the use of diode laser in excision of inverted papilloma.

Palatal Cyst: An Unusual Case Report

Cyst is a fluid accumulated in a cavity lined by epithelium. Cyst over the hard palate is very infrequent. Cyst is commonly seen along nasoalveolar duct or midline palatal cyst which are congenital. Only few cases of palatine cysts have been reported in literature. We present here a case of 21 years old male with a cystic lesion over the hard palate since 2 years.

CSF Rhinorrhoea with Encephalocele through Sternberg’s Canal: Our Experience

Spontaneous cerebrospinal fluid rhinorrhoea with encephalocele restricted to the sphenoid sinus is rare clinical finding. As of today, only 17 cases encephalocele protruding through the Sternberg’s canal and extending into the lateral recess of sphenoid sinus, have been described in literature. Patients presenting with this special clinical entity usually do not have any history of trauma, tumour or iatrogenic injury. Thus the lesions are considered to originate from a congenital bony defect in the lateral wall of the sphenoid sinus, first described by Sternberg in 1888 as the lateral craniopharyngeal canal (Sternberg’s canal). In our experience each patient of spontaneous CSF rhinorrhea should have suspicion of intrasphenoid encephalocele though cribriform plate is a common site. Endoscopic tranasnasal approach is one of the best modalities for such cases.

Our Experience with Embryonal Rhabdomyosarcoma Presenting as Aural Polyp

Aural polyps are a common clinical entity encountered by otorhinolaryngologist in daily practice. Polyps are frequently seen in paediatric patients, usually inflammatory in nature. In children rhabdomyosarcomas (RMS) can mimic all the cinical features of chronic suppurative otitis media which usually present as external auditory canal mass or polyp. Here we present a case where a male child presented with recurrence of polyp in left ear which was finally diagnosed as embryonal rhabdomyosarcoma which is a rare and invariably fatal disease in children. Through this article we intend to highlight the failures and delay committed in attaining diagnosis in this patient in spite of multispecialty evaluation involving repeated imaging and histopathological correlation. Our experience with embryonal rhabdomyosarcoma throws light on the high vigilance required in handling the aural polyps in pediatric population as early diagnosis and treatment are the key elements for successful outcomes.

Osteoma of Temporal Bone—A Rare Case Report

Osteoma is a slow-growing tumor formed by mature bone tissue. In the temporal bone, intracanalicular osteomas are more frequent while extracanalicular ostemoas are rare. They very rarely occur over the mastoid region. They are treated mainly for cosmetic purposes. These are readily excised and recurrence is rare after complete excision. In this case report, we want to revisit this rare mastoid osteoma and discuss the differential diagnosis and treatment. We believe that this report will be of interest to otolaryngologists when dealing with temporal bone osteomas.

An Unusal Case of Epidermal Cyst in Submandibular Space

Epidermal cysts are very common skin lesions and 1.6% are seen in oral cavity. But epidermal cyst in submandibular region is extremely rare with only 3 such reported cases in last 25 years. Here we present a rare case of epidermal cyst in left submandibular space in a 53-year-old female.

Technicality of Managing Cut Throat Injury

Cervical tracheal injuries are relatively uncommon and are frequently associated with esophageal, vascular or spinal injuries. We hereby report a case of cut throat injury with complete transection of trachea and its management.

Myoepithelioma of Tongue

Myoepithelioma is a rare neoplasm of the salivary glands, generally occurring in the parotid gland and less often in the minor accessory salivary gland of the oral cavity. The histological appearance includes solid, myxoid and reticular growth patterns. Vimentin and S-100 protein are very sensitive but non-specific immunohistochemical markers of neoplastic myoepithelium. Conservative surgery is the treatment of choice. A case of myoepithelioma of the minor salivary gland of tongue is described, focusing on clinical behaviour, histopathological and immunohistochemical features.

Tympanometry, a Prognostic Indicator of Myringoplasty with Assessment of Eustachian Tube Function

Objective: To determine Eustachian tube function in tubotympanic type of chronic ear disease and to correlate Eustachian tube function with pathological change in middle ear mucosa. Materials and Methods: A prospective study of the cases of tubotympanic type of chronic suppurative otitis media was undertaken. Patients were subjected to clinical examination followed by audiometry tests and impedence audiometry to determine eustachian tube functions. Patients were then subjected to myringoplasty and eustachian tube function were then reassessed post operatively. Results: In our study, out of 30 cases who underwent myringoplasty, 21 cases had successful surgical outcome and 9 cases were failed. Out of 24 cases of good Eustachian tube function, 21 cases had successful surgical outcome intends of taking up graft, absence of otorrhea and improvement in hearing. In remaining 3 cases, there was recurrence of otorrhea with central perforation. All the 6 cases with poor Eustachian tube function had surgical failure. Conclusion: The prognosis of the middle ear reconstructive surgery has direct correlation with Eustachian tube functions and Eustachian tube function tests should be a routine investigation in all the cases planned for surgical reconstruction of the middle ear.

Primary Laryngeal Amyloidosis: A Case Report

Amyloidosis is a benign, indolent condition which presents with an abnormal deposition of extracellular protein in various organs of the body. It usually presents with hoarseness of voice to an otolaryngologist. A sits clinical appearance mimics an early laryngeal cancer. It remains a diagnostic challenge to the clinician. It is essential to differentiate a primary laryngeal amyloidosis from malignancy to have a holistic approach towards the management of the disease. Here in this article, a case is reported in order to have a better outlook about this rare condition and to differentiate it from laryngeal malignancy for an effective management and cure.

Prolonged Middle Ear Ventilation by Cartilage-Grommet Tympanoplasty

In 1994, the American Otological Society reported favourable experience with composite cartilage shield tympanoplasty. The tragal cartilage with a grommet inserted in it was used for tympanoplasty in our patient with unilateral CSOM, supposedly because of severe chronic eustachian tube dysfunction. The marriage of cartilage tympanoplasty with grommet insertion was aimed to add the advantages and abolish the disadvantages of both the procedures. In 1990 Lary Hall first introduced the “long term ventilation of the middle ear” with a T-tube placed in the tragal cartilage perichondrium composite island graft. T-tube insertion in the cartilage has been described. But insertion of the Indian Sheperds grommet (ventilation tube) in the cartilage graft as described in this case and its technique are possibly the first of its kinds in literature. The report is aimed to ignite innovation of newer and better techniques of cartilage tympanoplasty.

Klestadt’s Cyst: Case Report

Klestadt’s cyst, more commonly known as the nasolabial cyst, is an uncommon, non-odontogenic, and soft tissue cyst. It is classified as a fissural cyst, found outside the bone, and on the region corresponding to the nasolabial furrow and alar nose. Following its description first by Zukuerkandl in 1882, only 267 cases have been found in English literature. In spite of the low occurrence of nasolabial cysts, it is important to recognize the clinical characteristics of this lesion. The purpose of this report is to review the literature and discuss the histomorphology and etiology of this condition, and also its management by surgical excision. As per our experience, sublabial approach is the best for complete and scarless excision of this cyst.

Tracheal Leiomyoma: A Rare Entity &Role of Diode Laser in Its Management

Primary leiomyoma of the trachea is a rare disease which is of smooth muscle in origin. Presenting symptoms depend on the location and size of the tumor. Here we are presenting a 45-year-old female, who was misdiagnosed and being treated for bronchial asthma presented to our institution with stridor. Her x-ray and Computed Tomography of neck showed tracheal mass & biopsy reported leiomyoma. Objective of this presentation is to report tracheal leiomyoma which is a rare clinical entity and how endoscopic resection of the tumor with diode laser helped us in attaining complete resection of tumor with minimal intra-operative and post-operative complications.

Chondroma of Tongue: A Rare Case Report &Review of Literature

Chondromas are common benign cartilaginous tumours in the skeletal system usually found in extremities. Extra skeletal chondromas are relatively uncommon of which those in head and neck regions are rarely documented. Although the tongue is one of the most common sites of oral soft tissue chondroma, lingual chondromas are rare as evidenced by the fact that only 33 cases are identified in the review of literature till now. This report has the objective of presenting a rare case of lingual enchondroma in a 26-year-old male which was excised with no evidence of recovery during follow up. We have also tried to present a concise review of the relevant literature.