Search

Background: Subtotal petrosectomy (STP) has attracted massive interest over last two decades. The aim is to present our experience of this uncommon surgery. The indications, outcomes, and our variation in surgical technique would be presented and literature reviewed. Methods: A retrospective observational study of all patients who underwent STP at a tertiary care center in India was analyzed. Results: A total of 9 ears (in 8 patients) underwent STP over last 5 years at our center. The pathological conditions for which STP was done included chronic otitis media squamous (four ears), middle ear tumors (three ears), petrous apicitis (one ear), and traumatic cerebrospinal fluid (CSF) otorhinorrhea (one ear). The indication of STP included disease clearance (eight ears), unserviceable hearing (seven ears), hearing rehabilitation with otological implants (six ears), and intraoperative CSF gusher (one ear). Intraoperative indications included CSF gusher, large tegmen defect with erosion of apical turn of cochlea, and erosion of anterior bony wall of external auditory canal. The mean follow-up period was 36 months (range of 6 months to 60 months). None of the patients had any dehiscence of blind sac closure or secondary acquired cholesteatoma on imaging. Conclusions: STP facilitates disease clearance by providing unmatchable exposure in difficult otological scenarios and additionally isolates middle ear cleft from external environment, thereby eliminating problems of mastoid cavity. Furthermore, it also prepares ear for second stage otological implants. It is a safe surgery with minimal complications. [ABSTRACT FROM AUTHOR]

Cranial measurements have been widely used in various studies in wildlife sciences, ranging from understanding predator ecology to wildlife forensics. However, detailed description of morphometry and sexual dimorphism of the skull of gaur Bos gaurus gaurus is lacking. The present study was undertaken to determine the sexual dimorphism based on the cranial measurements of gaur. A total of 12 individual gaur skulls of male (n = 6) and female (n = 6) were studied in the field from the naturally deceased animals between January 2018 and December 2021 in different ranges of Bandhavgarh tiger reserve (BTR), Madhya Pradesh, India. The skull measurements were analysed using univariate and multivariate statistics to determine whether cranial dimensions could be used to differentiate male and female skulls reliably. A total of 43 morphometrical parameters grouped into nine indices were calculated. Select morphometrical parameters viz PL, GFL, AKI, LBB, LFB, GBEE, GBAN, BPOP and GTCH were significantly different (p < 0.05) between sexes, whereas GBAN were significantly higher in female skulls. The measurements demonstrated that the skull of the gaur was dolichocephalic as the profile length and the otion to otion breath in both male and female were <75% of the length. Overall, 28 linear measurements of both the sexes were statistically significant (p < 0.05; <0.01). The calculated indices revealed that the foramen magnum index in the female gaur were significantly higher. In calculated cranial indices the facial index (a) was higher in female and facial index (b) were higher in males. The two important parameters, facial breadth in facial index (a) and the greatest breadth in facial index (b) were positively correlated, though facial index (a) was statistically not significant between the sexes. The greater inner length of the foramen magnum in female skull resulted in foramen being oval whereas it was circular in males. These parameters were decisive for sexual dimorphism, skull comparison and craniological studies. This study ascertained that the frontal index and skull index had no significant influence and were not good indices for discriminating skulls between male and female. Based on the Principal Component Analysis, it was found that skull of male and female gaurs exhibits differences in cranial morphology viz. cranial profile length or total length (PL) and the least inner height of the temporal groove (LIHT). The findings of the present study provide baseline information on various craniometrical measurements of skull of gaur, indices and parameters for sex identification that can be effectively used in understanding sex biased predation ecology, provide base line information to describe variation across its geographic range, and in identifying skulls recovered in wildlife offence cases. [ABSTRACT FROM AUTHOR]

Background: In otolaryngology outpatient clinics, patients frequently present with unilateral vocal cord paralysis (UVCP). During the pandemic, various new protocols were designed to identify UVCP. An experienced otolaryngologist must conduct a thorough history-taking, examination, and investigation to determine the cause of UVCP. Objectives: To evaluate various causes of UVCP during the pandemic. Methods: Thirty patients with UVCP on 70-degree rigid endoscopy were studied. Detailed general and systemic examinations were done. All COVID-19 precautions were followed during the evaluation, and real-time reverse transcription-polymerase chain reaction was done before the endoscopic procedure. High-resolution computed tomography scan of skull base to mediastinum with contrast was performed for etiology. Patients were treated according to the standard protocols. Follow-up at 1, 3, and at 6 months was performed. Results: The mean age was 42.3 ± 14.83 years. All the patients had presented with a change in voice. Twenty percent had UVCP post a surgical procedure. No cause could be found in 16.67% of patients. Five patients had succumbed to complications relating to their other prevailing conditions. At 6 months, 10 patients continued to have palsy, 9 showed paresis, and 6 showed complete mobility of the cords. Conclusion: During the pandemic, diagnosing and following up such patients were a challenge. Investigating a cause of UVCP, the symptoms of which might be trivial at presentation, leads to discover a much sinister cause. UVCP in post-covid mucormycosis was an entity requiring multimodality management. Pandemic-induced restrictions lead to formulations of newer protocols for tackling this entity. [ABSTRACT FROM AUTHOR]

The base of skull forms the first line of barrier to be breached in the transition of rhino-orbito-palatal forms of mucormycosis to intracranial forms with various neurological deficit. The pattern of base of skull erosion has prognostic implications in overall recovery and survival of the patient. The aim of the study was to assess the pattern of skull base involvement in cases of rhino-orbital-cerebral mucormycosis (ROCM) in terms of clinical presentations, radiological findings, intraoperative illustrations and post operative recovery. This is a retrospective single centre study of Covid associated Mucormycosis (CAM) patients with skull base involvement at a tertiary referral centre of central India from May 2021 to October 2021. Amongst a total of 248 patients of CAM, 54 patients with skull base involvement were included in our study. The cases were stratified into basifrontal-BF (15%), basisphenoid-BS (20%), orbital apex-OA (15%), basiocciput-BO (26%), frontal bone osteomyelitis-FBO (22%) and sphenoid bone osteomyelitis-SBO (2%), based on their pattern of involvement of skull base and intracranial spread. Early ethmoid and cribriform plate involvement progressed to frontal lobe abscess while early maxillary disease progressed to developed temporal lobe abscess. The orbital apex lesions had early onset cavernous sinus thrombosis. Analysis of clinical manifestations and postoperative follow up revealed an emerging pattern where Posterosuperior lesions of paranasal sinuses (Ethmoid, roof of maxilla and orbit) progressing to BF, BS, OA, FBO and SBO had poorer treatment outcome than Anteroinferior (Floor of maxillary sinus, palate) based lesions which involved BO of skull base. The inferiorly located diseases had better prognosis, less duration of hospital stay, lesser mortality and decreased need for second surgery. There exists a temporal relation of the initial site of fungal load in sinonasal region to their subsequent intracranial spread. Classification into subtypes helped in disease stratification which helped in prognostication and surgical planning. Early intervention by multidisciplinary team improved survival outcome. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to evaluate the magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) at presentation and on follow-up imaging when patients receive treatment with systemic antifungal therapy and surgical debridement. Material and Methods: This is a retrospective analysis of imaging data from a cohort of patients diagnosed with AIFRS during the second wave of COVID-19 in single tertiary referral hospital in South India between March 2021 and May 2021 (n = 68). Final diagnosis was made using a composite reference standard which included a combination of MRI findings, clinical presentation, nasal endoscopy and intraoperative findings, and laboratory proof of invasive fungal infection. Analysis included 62 patients with “Definite AIFRS” findings on MRI and another six patients with “Possible AIFRS” findings on MRI and laboratory proof of invasive fungal infection. Follow-up imaging was available in 41 patients. Results: The most frequent MRI finding was T2 hypointensity in the sinonasal mucosa (94%) followed by mucosal necrosis/loss of contrast-enhancement (92.6%). Extrasinosal inflammation with or without necrosis in the pre-antral fat, retroantral fat, pterygopalatine fossa, and masticator space was seen in 91.1% of the cases. Extrasinosal spread was identified on MRI even when the computed tomography (CT) showed intact bone with normal extrasinosal density. Orbital involvement (72%) was in the form of contiguous spread from either the ethmoid or maxillary sinuses; the most frequent presentation being orbital cellulitis and necrosis, with some cases showing extension to the orbital apex (41%) and inflammation of the optic nerve (32%). A total of 22 patients showed involvement of the cavernous sinuses out of which 10 had sinus thrombosis and five patients had cavernous internal carotid artery involvement. Intracranial extension was seen both in the form of contiguous spread to the pachymeninges over the frontal and temporal lobes (25%) and intra-axial involvement in the form of cerebritis, abscesses, and infarcts (8.8%). Areas of blooming on SWI were noted within the areas of cerebritis and infarcts. Perineural spread of inflammation was seen along the mandibular nerves across foramen ovale in five patients and from the cisternal segment of trigeminal nerve to the root exit zone in pons in three patients. During follow-up, patients with disease progression showed involvement of the bones of skull base, osteomyelitis of the palate, alveolar process of maxilla, and zygoma. Persistent hyperenhancement in the post-operative bed after surgical debridement and resection was noted even in patients with stable disease. Conclusion: Contrast-enhanced MRI must be performed in all patients with suspected AIFRS as non-contrast MRI fails to demonstrate tissue necrosis and CT fails to demonstrate extrasinosal disease across intact bony walls. Orbital apex, pterygopalatine fossa, and the cavernous sinuses form important pathways for disease spread to the skull base and intracranial compartment. While cerebritis, intracranial abscesses, and infarcts can be seen early in the disease due to the angioinvasive nature, perineural spread and skull base infiltration are seen 3–4 weeks after disease onset. Exaggerated soft-tissue enhancement in the post-operative bed after debridement can be a normal finding and must not be interpreted as disease progression. [ABSTRACT FROM AUTHOR]

Introduction: The caroticoclinoid ligament extends from the Anterior Clinoid Process (ACP) to the Middle Clinoid Process (MCP). Occasionally, it gets ossified and forms the caroticoclinoid foramen. Anterior clinoidectomy is a common surgical procedure to treat internal carotid artery aneurysms or pituitary tumours. Abnormal ossification of the caroticoclinoid ligament may lead to intraoperative or postoperative complications as it is not normally present. Aim: To find out the incidence of ossification of the caroticoclinoid ligament in adult human skulls. Materials and Methods: This was an observational crosssectional study that included 100 dry adult human skulls collected from the Department of Anatomy, Gandhi Medical College, Secunderabad; Osmania Medical College, Hyderabad; Bhaskar Medical College, Moinabad, Telangana, India, from January 2021 to February 2023. Adult human skulls with open vault were included. All the skulls were observed and skulls damaged in the clinoid regions were excluded from the study. The skulls were observed for the presence of any ossifications of the caroticoclinoid ligaments and the observations were noted. The qualitative data was presented as number and percentage was calculated. The data was recorded in MS excel version 2021. Results: The incidence of ossification of caroticoclinoid ligament was 8 (8%). The incidence was higher on right-side when compared to the left-side. Bilateral complete ossification of the caroticoclinoid ligament was observed in 2 (2%) skulls; bilateral incomplete ossification was observed in 3 (3%) skulls, unilateral complete ossification was observed in 2 (2%) skulls on the right-side. In one skull 1 (1%), complete ossification was observed on the right-side and incomplete ossification was observed on the left-side. Conclusion: Knowledge of the ossification of the caroticoclinoid ligament is important for neurosurgeons while performing anterior clinoidectomies or skull base surgeries. Radiological confirmation of the ossification of the caroticoclinoid ligament is essential to avoid complications. [ABSTRACT FROM AUTHOR]

Introduction: The vertical dimension of a face is crucial in determining facial aesthetics and harmony. It is important for the orthodontist to understand the relationship between dental arch width and facial morphology for correct diagnosis and proper treatment plan. Aim: To determine the relationship between the vertical face pattern, dental arch width and also, to compare arch widths among both untreated female and male adults. Materials and Methods: This quantitative cross-sectional study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics, at Sharad Pawar Dental College, Sawangi, Wardha, Maharashtra, India. The duration of the study was 1 month, from June 2019 to July 2019. Dental casts and lateral cephalograms were collected from 50 untreated adults (25 males and 25 females), aged between 18 to 30 years, who had minimal spacing, crowding and no crossbite. On every patient's cephalogram, the angle between the plane of the mandible to the cranial base anterior Sella Nasion (SN) angle was calculated. Intercanine, intermolar, and interpremolar widths were measured on dental casts. Females and males arch width were compared. The significance of the differences was assessed using Student's t-test, one-way Analysis of Variance (ANOVA) test and regression analysis. Results: The mean age of male study participants in the study was 24.44±5.04 years, whereas, mean age of females was 24.88±3.08 years. There were 25 males and 25 females of 18-30 years with mean age of 24 and 25 years, respectively. Arch widths of males were found to be significantly greater than, those of females (p<0.05) and it was observed that, interarch width decreased significantly as the Sella Nasion-Mandibular Plane (SN-MP) angle increased. Regression analyses of male subjects revealed a significant positive relationship between the SN-MP angle. Whereas, the SN-MP angle and width of maxillary first premolar's buccal cusp tip and the width of the second premolar (most buccal and buccal cusp tip), was found to have a strong correlation in female subjects. Conclusion: It was found that, the width of the dental arch is related to vertical face morphology and gender. During orthodontic therapy, it is recommended to use individualised archwires based on each individual's pretreatment arch shape and width. [ABSTRACT FROM AUTHOR]

Background: Diameter of carotid canal is very much important because hypo-plastic of CC leads to multiple of neuro vascular complications, passing through these CC. Method: 45 male, 30 female adult non-pathological, dried crania were studied. The cranial Index was measured by winged calliper and diameter of CC by digital verniercalliper. The obtained values were correlated statistically. Results: Mean value of CI 64.09 (± 0.35) in male, 70.06 (± 0.98) in females crania Diameter of rt. Cc 0.76 (± 0.14) in male, 0.67 (± 0.09) in female crania, 0.74 (± 0.10) diameter of cc in males, 0.54(± 0.08) in cc of females crania and correlation coefficient of both male and female with CI and CCwere highly significant (p<0.001). Conclusion: Correlative coefficient study of CI and CC in both gender crania will be useful neuro-physician, neuro-surgeon,radiologist, medico-legal expert, anthropologist and anatomist because morpho-metric values of mesodermal derivatives are uncertain. [ABSTRACT FROM AUTHOR]

To analyse and report various aspects of lateral skull base surgery by describing the incidence and demographic variables, diagnostic and management challenges, surgical choices along with complications and their management and the long term morbidity and survival outcomes in our experience of 15 years. Retrospective review of complete records of all cases operated for lateral skull base tumors at a tertiary care teaching institution in India between timespan of 15 years from 2003 to 2018 was undertaken. 53 cases were selected and analysed. Those having follow up of less than 6 months were excluded. Outcomes were assessed in terms of incidence of types of tumors, benign or malignant, age and sex variation of the patients, staging status at presentation, status of facial and other lower cranial nerves pre-operatively, surgical techniques with complications if any, recurrences and survival. Of 35 benign tumors, tympanojugular paragangliomas were most common. Average age for these was 53 years with 19 females and 14 males. All were non-functional. Tinnitus and hearing loss were most common presentations. Class B2 and C1 tumors were most commonly encountered and the ITF A approach was most commonly used. Hearing loss and Facial palsy were commonest complication post-operatively. There were 2 recurrences. 18 malignancies were observed. Most were stage IV at presentation. Otorrhea and otalgia were most common presenting symptoms followed by hearing loss. 5 year survival was 55%. Successful treatment of lateral skull base lesions requires a multimodality therapy with team approach. Surgical resection is the primary management choice with variable approaches. ICA status related to the tumor is the most important consideration. Malignancies require more aggressive treatment for obtaining clear margins along with pre/post-op chemoradiation. Good results with acceptable complications can be obtained even with advanced tumors. [ABSTRACT FROM AUTHOR]

Introduction: There is a significant degree of anatomical variation at the level of the sphenoid sinus and sella turcica and a wide range of these values have been reported in literature and ethnic variation has also been found to contribute to this. Thus preoperative imaging of the central skull base with a knowledge of the normal anatomy and measurements in a specific population is imperative to identify these variations and prevent avoidable intraoperative complications. Aim: To assess the normal intracranial measurements of the intercarotid distance, pituitary fossa width, optic chiasm height, optic chiasm width and the pituitary to optic chiasm distance in healthy subjects of the South Indian population aged between 10 to 80 years and to establish normal reference ranges across the various age groups. Materials and Methods: This retrospective study was conducted in the Radiology Department at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India, from July 2021 to December 2021. The study included normal Magnetic Resonance Imaging (MRI) brains of 700 healthy subjects (378 males and 322 females) in the age range of 10 to 80 years. Subjects were divided into seven groups of 100 subjects for each decade. The variables that were measured included the intercarotid distance, pituitary fossa width, optic chiasm height, optic chiasm width and the pituitary to optic chiasm distance. RStudio version 1.2.1093 was used for statistical analysis and p-value<0.05 was considered statistically significant. Association between age and outcome variables were assessed by Pearson’s correlation coefficient at 95% confidence interval. Results: The overall mean age was 45.4 years. The overall mean intercarotid distance was 16.2±3.7 mm, optic chiasm width was 13.1±1.6 mm, optic chiasm height was 2.18±2.7 mm, pituitary width was 12.1±2.3 mm, pituitary to optic chiasm distance was 5.7±1.84 mm. The overall pituitary fossa width and pituitary to optic chiasm distance was found to be higher in males (p-value <0.001; p-value=0.03, respectively) than females while there was no significant difference between genders in the rest of the parameters. A low and positive correlation was found between age and the pituitary width, age (r-value=0.175, p-value<0.001) and the pituitary to optic chiasm distance (r-value=0.342, p-value<0.001) and pituitary width and optic chiasm width (r-value=0.236, p-value <0.001). A strong and positive correlation was found between the pituitary width and the intercarotid distance (r-value=0.736, p-value<0.001). Conclusion: Establishment of normal reference values across various age groups of the South Indian population may prove useful for future reference and improving diagnostic accuracy. [ABSTRACT FROM AUTHOR]

In recent times, India has been in the midst of a notifiable epidemic of mucormycosis (a rare angio-invasive fungal infection), within the ongoing global coronavirus disease 2019 (COVID-19) pandemic. Epidemiological studies have reported the estimated prevalence of mucormycosis to be around 70 times higher in India as compared to the global data, even in the pre-COVID era. However, in the last 3 months, our city witnessed an unprecedented surge in cases of post-COVID-19-associated rhino-orbital-cerebral (ROC) mucormycosis. This pictorial review aims to illustrate the entire imaging spectrum of mucormycosis in the head-neck-face region. Along with the usual sites (nose, paranasal sinuses, orbits), this disease also involves the skull base, palate, temporal bone, and deep neck spaces. Many cases also demonstrated morbid and, at times, fatal intracranial and neurovascular complications. This review also aims to provide a structured reporting template that will prove useful to the radiologists interpreting imaging studies of ROC mucormycosis. [ABSTRACT FROM AUTHOR]

Introduction: Cerebrospinal Fluid (CSF) leak is a serious complication in base of skull fractures with high probability of complications like meningitis. Aim: To find out incidence and duration of CSF leak, occurrence of meningitis, type of organism and antibiotic sensitivity and incidence of those requiring surgery among the head injury patients with base of skull fracture. Materials and Methods: A prospective cohort study was conducted in the Neurosurgery and General Surgery Ward, Government Medical College, Kozhikode, Kerala, India. All patients with clinically evident CSF leak in base of skull fracture from 15th April 2017 to 30th November 2018 were included in the study. Incidence of CSF leak, incidence of meningitis and patients requiring surgery were noted. Results were expressed in terms of frequency and percentages. Results: A total of 167 patients were included in the study. Total 81 (48.49%) patients was between 21-40 age group (years). The most common mode of injury was road traffic accidents, accounting to 83.23%. Of the total 167 patients, 35 patients (20.95%) developed post traumatic CSF leak. Of these 30 (85.71%) had CSF rhinorrhea and 6 (17.14%) had CSF otorrhea. Duration of CSF leak was 1 day in 18 patients (51.42%), 2-10 days in 10 patients (28.57%), more than 10 days in 7 patients (20.00%). Meningitis occurred in 9 out of 35 (25.7%) patients. Most common organism was Streptococcus, found in 2 patients (22.2%), followed by resistant Klebsiella. Cultures were sterile. Two Streptococcus infected patients were found to be sensitive to penicillin. Of the total 35 only 7 patients (20%) needed surgical interventions. Conclusion: The incidence of CSF leak in patients with base of skull fractures is approximately 20%. Most of the cases resolve spontaneously. With persistent leak, there is significant morbidity and mortality in the form of meningitis and requirement of surgery for repair of defect. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively analyse surgical management of clinico-radiologically proven nasal meningoencephalocele amongst children and results of repair with single-layer septo-mucosal flap at a tertiary skull base surgery centre in north India. Methods: Fifteen children with clinic-radiological nasal meningoencephaloceles with or without CSF rhinorrhoea were included. Radiological scans included CT scans and MRI scans for all cases to delineate soft tissue and bony architecture. All children underwent endoscopic excision of encephaloceles and repair of the skull base defect. Results: The authors were successful in fourteen cases. Successful cases included 4 children less than 6 months of age who underwent single-layer rotated septo-mucosal flaps, thereby avoiding donor site morbidity. Conclusion: As endoscopic excision of nasal encephalocele is an established management approach, the authors take the concept of minimally invasive surgery a step further by successfully managing these lesions with single-layer repair. Vascularized septo-mucosal flap seems to be the only determining factor for a successful repair for congenital meningoencephalocele. However, a prospective study comprising a larger subset of patients would substantiate the assumption. [ABSTRACT FROM AUTHOR]

Skull base osteomyelitis (SBO) is difficult to diagnose due to a wide array of clinical presentations. It can be life threatening if not treated promptly. The objective of this study is to identify the various neck spaces involved in skull base osteomyelitis, correlate them with the possible source of infection and identify the related complications. Eighty nine consecutive either culture proven cases of skull base osteomyelitis, or culture negative cases with inflammation on histopathology responding to antibiotic therapy, presenting at a single non-government hospital in south India between January 2016 and December 2018 were included in this study. Images were reviewed by two radiologists and imaging findings were documented by consensus. Involvement of the parotid space, retromastoid space and (temporomandibular) TM joint was associated with otogenic source of infection (p value < 0.05); while, retropharyngeal/prevertebral involvement was associated with sphenoid and nasopharyngeal sources (p value < 0.05). Complications such as cavernous sinus thrombosis (p value = 0.023) and ICA involvement (p value = 0.014) were more commonly seen with central skull base osteomyelitis. Abscess formation was seen in all three groups of patients without a significant difference between the groups. Imaging plays an important role in determining the possible source of infection by identifying the involved neck spaces and this in turn can guide the clinician to a site for biopsy. Complications related to SBO can also be identified on imaging and can guide appropriate management. • Skull base osteomyelitis is a fairly common entity, sometimes masquerading as tumor and is often misdiagnosed. • Imaging is crucial in understanding the pattern of spread of infection and identifying drainable abscesses, if any. • Proper sampling is essential to provide early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Despite academic efforts to study the Indus Valley Civilization (IVC), there have as yet been no successful attempts to unveil the IVC people's craniofacial appearance. We investigated the IVC cemetery area of Rakhigarhi site, which was estimated to be of 2273 ± 38 and 2616 ± 73 years BCE. By craniofacial reconstruction (CFR) procedure using computed tomography (CT) data of two Rakhigarhi skulls (A1 BR02 and A2 BR36), we successfully reconstructed the faces of the IVC individuals who were buried about 4500 years ago. This is the first attempt to unveil scientifically accurate representations of IVC people's actual facial morphology. [ABSTRACT FROM AUTHOR]

Exposure to otorhinolaryngology in India has been shadowed by an inadequate curriculum. Our study brings forth the lacunae in medical education setup related to ENT. We introspect why the subject is not a first choice for specialization. 100 medical graduates were assessed at the end of internship postings for: (1) subject knowledge, (2) basic and emergency procedures, (3) diagnosis and investigation of common and emergency conditions. 84% take ENT as a minor subject. Least awareness is seen regarding its relation with skull base, head and neck and plastic surgery. Very few knew about advanced surgeries and instruments in the field. Majority rejected ENT as a primary choice and its upgradation as major subject. Routine and emergency procedures based on ENT were not a matter of ease by majority of subjects. Post internship doctors lagged in doing basic clinical and diagnostic steps. Diagnosis of various pathologies was not a skill of majority of subjects under study. A lack of basic knowledge of important emergency conditions in ENT was noticed. Our study points at inadequate training in ENT and under estimation of its scope. The outcome raises a need to revise the curriculum and methodology to come at par with world standards, reflecting its true expanse and tremendous scope. [ABSTRACT FROM AUTHOR]

Introduction: Necrotizing otitis externa resolves best with antimicrobial treatment. How to care for these patients and monitor their resolution remains a problem. Our protocol in Bangalore can manage these patients inexpensively and well. Materials and Methods: Patients who were referred to our patients became the subjects for this paper. They were managed through our protocol, which consists of IV ciprofloxacin and meropenem, weekly labs, weekly examinations, and photodocumention. Results: Fifty-one people presented with necrotizing otitis externa (NOE) between October 2015 and November 2017 and completed our entire protocol. Forty-six had complete resolution of their disease, while 5 had to undergo surgical removal of necrotic bone. Six of 8 patients with facial weakness had improvement in their House-Brackmann scores. Reduction of self-reported nocturnal pain, dissolution of ear canal granulations, and normalization of the erythrocyte sedimentation rate (ESR) proved to be the most accurate indicators of disease regression. Conclusion: Patients are monitored closely with review of their otalgia, examination of their canal, repeated ESRs, effective control of their diabetes, and radiological imaging. All this can be done in a resource-poor country, which in turn serves as a model for the wealthier nations. [ABSTRACT FROM AUTHOR]

Context: Skull base osteomyelitis (SBO) is an uncommon disease with substantial morbidity and mortality. Aims: The aim of this study is to characterize clinical features, outcomes, and complications of SBO. We also looked at differences in clinical profile in otogenic and non-otogenic SBO. Materials and Methods: This is a single-center retrospective observational study. Patients aged more than 15 years of age with clinical and radiological diagnosis of SBO admitted in general medicine department in a teaching hospital in South India from March 2006 to February 2018 were recruited. Results: A total of 41 patients with SBO were identified and included. Mean age was 56.9 ± 10.7 years. In all, 90% of patients (37/41) had diabetes mellitus and 29% (12/41) had recent head/neck surgery. Only 19% (8/41) needed ICU care, and mortality was 21% (9/41). Most common symptom was headache seen in 73% (30/41) of patients. Majority, 61% (25/41), had otogenic infections. Otogenic infections were associated with longer duration of diabetes mellitus (mean = 11.5 vs. 5 years, P = 0.01), higher creatinine levels (mean = 1.66 vs. 0.9 mg/dL, P = 0.014, odds ratio [OR] = 3.8), and higher incidence of cranial nerve palsy (92% vs. 56%; OR = 8.9) compared to non-otogenic SBO. Cranial nerve palsy (78%), meningitis (63%), and cerebral venous thrombosis (43%) were frequent complications of SBO in this study. The causative organisms for SBO in our cohort was bacterial in 60% (15/25) and fungal in 40% (10/25) of the patients. Surgical debridement for source control was done in 54% of patients (22/41) and was associated with survival at discharge (P = 0.001). Conclusions: Bacterial infections are the most common cause of SBO. Otogenic SBO is associated with longer duration of diabetes mellitus and higher incidence of cranial nerve palsy. Therapeutic surgical debridement plays an important role in treatment of SBO and is associated with improved survival. [ABSTRACT FROM AUTHOR]

Introduction: Anterior and anterolaterally situated foramen magnum meningiomas are a technically complex subgroup of meningiomas. The need for an extensive exposure and bone work and their complex anatomy make them a difficult and challenging group of tumors to resect. The bone work has ranged from an extensive condylar resection to condylar preserving exposures. In this paper, we present our experience with condylar preserving or minimal condylar resection based approaches to these tumors.Materials and Methods: All patients who underwent surgical resection of anterior and anterolaterally situated foramen magnum meningiomas were included in the analysis. The study period was more than 10 years from 2005 to 2015 at our institute; a tertiary referral centre in India. The records along with demographic profile, clinico-radiological features, surgical strategies, outcomes as well as mortality and morbidity were analysed.Results: There were a total of 20 patients (9 males and 11 females) who were operated during the study period. The average age was 36.7 years. In 16 patients, gross-total or near-total resection could be achieved, four patients underwent subtotal resection. Eight patients had fresh morbidity in the form of new motor deficits, pseudomeningocele formation, worsening of the lower cranial nerve functions or post-operative adhesions leading to syrinx formation. The follow-up ranged from 6 months to 140 months.Conclusion: Foramen magnum meningiomas are an eminently treatable group of tumors. Condylar preservation provides a good visualization, while helping to preserve joint stability and in avoiding instrumental stabilization. [ABSTRACT FROM AUTHOR]

Background: Piramys auffenbergi was described as an emydine turtle based on a well-preserved skull retrieved from late Miocene deposits exposed on Piram Island, India. The description and figures provided in the original publication are vague and do not support assignment to Emydinae. This taxon has mostly been ignored by subsequent authors. Material and Methods: We reexamine the holotype specimen, provide an extensive description and diagnosis for Piramys auffenbergi, and include this taxon in a global character-taxon matrix for Pleurodira. Results: The presence of a processus trochlearis pterygoidei conclusively shows pleurodiran affinities for Piramys auffenbergi. Inclusion of this taxon in a phylogenetic analysis retrieves it within Stereogenyini closely related to the Asian taxa Shweboemys pilgrimi and Brontochelys gaffneyi. Discussion: Our reexamination of the holotype of Piramys auffenbergi confidently rejects the original assessment of this taxon as an emydine testudinoid and conclusively shows affinities with the pleurodiran clade Stereogenyini instead. Even though most taxa from this lineage are thought to be coastal turtles, all Asian stereogenyines were collected from continental deposits, suggesting a more diverse paleoecology for the group. [ABSTRACT FROM AUTHOR]

Chordoma and chondrosarcoma are locally aggressive tumors occurring in one-third cases at the base of the skull. These tumors often recur locally with significant morbidity and mortality. The mainstay of treatment is maximal safe tumor debulking. However, in spite of gross total resection, these tumors are likely to recur. Hence, adjuvant radiation is provided to reduce the risk of local recurrence and to improve outcomes. These tumors are considered relatively radioresistant; hence, high doses of radiation are generally required during treatment. However, the presence of several important structures around the lesion poses a major challenge with respect to covering the target with the prescribed high dose. In this regard, protons, for their physical and dosimetric advantages, have become the accepted modality of treatment in these tumors. With the evolution of proton beam therapy (PBT) over the years, especially pencil beam scanning techniques; which result in an extremely high conformal intensity-modulated proton beam therapy (IMPT), robust and Monte Carlo optimization, computational algorithms, and biological modelling are the significant advances which have further enhanced the value of this technology and have improved outcomes. Herein, we would like to report our experience of two cases of skull base tumors treated with intensity-modulated proton therapy at our center along with a review of the literature. [ABSTRACT FROM AUTHOR]

In recent years, several investigations have documented notable secular changes in human skull morphology. The present study is the next link in the series, addressing its possible effects in the cranial base in North Indian populations. The present study aims to examine the sexual dimorphism in cranial base of two temporally different samples of North Indian population to provide updated population specific osteometric standards. The contemporary and the subrecent samples are comprised of 158 (M 110; F 48) and 325 adult crania (M 206; F 119), respectively. Five variables of cranial base were measured, and data were subjected to discriminant function analysis using SPSS 16.0. The t-tests between the two temporally different samples showed significant sexual dimorphism and population variation. Contemporary females showed comparatively greater dimensions than subrecent. Contemporary population exhibited less sexual dimorphism than subrecent population. Factors associated with the changes in sexual dimorphism are likely to be a consequence of improved nutrition and population admixture in last 50 years. The accuracy of sex prediction ranged from 48.1 to 70.0 % in contemporary sample and 60.9 % to 77.2 % in subrecent sample. Overall, these findings support the conclusion that sexual dimorphism shows variation within few decades, so sex discriminating osteometric standards must be updated regularly. [ABSTRACT FROM AUTHOR]

Background: Lateral cephalometric standards of normal Central Indian adults having class I occlusion and acceptable facial profile were studied using the Burstone and Legan comprehensive cephalometric analyses that are specific for orthognathic surgery. Aim: To study normal dentofacial patterns of adult population belonging to Central India. Materials and Methods: Cephalometric radiographs of 76 Central Indian adults (38 males and 38 females) having class I occlusion with acceptable facial profile were analyzed, and the mean values of their hard and soft tissue measurements were compared with those of Caucasian adults as reported in the literature. Results: The Central Indian males demonstrated greater anterior cranial base length and ramal length and a reduced chin depth. The inclination of the upper and lower incisors was also greater. The females demonstrated greater posterior cranial base length, increased upper anterior and posterior facial heights, and an increased maxillary length. Both mandibular body and ramal lengths were increased and there was greater mandibular protrusion and a reduced chin depth. The lower incisors were found to be proclinated. Conclusion: This study reveals that some of the cephalometric parameters in the Central Indian population are significantly different than that of the Caucasian population, especially in the females. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The buccal-complex tumors with masticator space involvement (T4b) have variable outcome and are treated with different protocols ranging from conventional surgery, NACT-surgery, CTRT or palliative care. . PURPOSE: This study focuses on outcome for this group of patients after compartment surgical resection. METHOD: All the advanced buccal-complex cancer patients treated at Narayana Multi-specialty Hospital, India, from March 2009-January 2014 formed the study-group. All these patients underwent compartment surgical resection and adjuvant therapy based on pathology report. Their charts were reviewed to evaluate oncological and functional outcome. The radiological findings were used to classify these tumors into three categories - Category I (low-medial pterygoid), Category II (intermediate-lateral pterygoid and plates) and Category III (high-pterygomaxillary fissure). The statistical analysis was used to correlate outcome (margin control, local control and DFS) between these categories. Results: Total 85 cases had T4b buccal cancer. Fifty-nine (69.4%) patients were alive and disease free at median follow-up of 23.7 months (range 06-56 months). About 21 (24.7%) patients died of disease. Local failure was in 16 (18.8%). Regional failure in 19(22.4%) patients was seen. About five patients were lost to follow up.The local and locoregional control rates were 81 % and 77.6 % respectively. The disease free survival and overall survival were 85% and 84% respectively. All the local recurrences-16 (18.8%) happened at skull base and intra-cranial compartment. 30 patients were classified in category I, 47 patients in category II and 8 patients in category III. 16 (18.8%) patients developed local recurrence, of which 4 were from category III and 10 from category II, only 2 from category I . Of the 80 patients who underwent functional evaluation, 71 had good quality of life. CONCLUSIONS: Compartment surgery concept has potential to improve outcome, all patients should not be put in one group and category I & II have good outcome. The advanced buccal mucosa cancer involving masticator space (T4b): New classification and outcome of newer surgical technique (compartment resection). [ABSTRACT FROM AUTHOR]

Background: Box trainers are ideal simulators, given they are inexpensive, accessible, and use appropriate fidelity., Objective: The development and validation of an open-source, partial task simulator that teaches the fundamental skills necessary for endonasal skull-base neuro-endoscopic surgery., Methods: We defined the Neuro-Endo-Trainer (NET) SkullBase-Task-GraspPickPlace with an activity area by analyzing the computed tomography scans of 15 adult patients with sellar suprasellar parasellar tumors. Four groups of participants (Group E, n = 4: expert neuroendoscopists; Group N, n =19: novice neurosurgeons; Group R, n = 11: neurosurgery residents with multiple iterations; and Group T, n = 27: neurosurgery residents with single iteration) performed grasp, pick, and place tasks using NET and were graded on task completion time and skills assessment scale score., Results: Group E had lower task completion times and greater skills assessment scale scores than both Group N and R (P ≤ 0.03, 0.001). The performance of Groups N and R was found to be equivalent; in self-assessing neuro-endoscopic skill, the participants in these groups were found to have equally low pretraining scores (4/10) with significant improvement shown after NET simulation (6, 7 respectively). Angled scopes resulted in decreased scores with tilted plates compared with straight plates (30° P ≤ 0.04, 45° P ≤ 0.001). With tilted plates, decreased scores were observed when we compared the 0° with 45° endoscope (right, P ≤ 0.008; left, P ≤ 0.002)., Conclusions: The NET, a face and construct valid open-source partial task neuroendoscopic trainer, was designed. Presimulation novice neurosurgeons and neurosurgical residents were described as having insufficient skills and preparation to practice neuro-endoscopy. Plate tilt and endoscope angle were shown to be important factors in participant performance. The NET was found to be a useful partial-task trainer for skill building in neuro-endoscopy., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The article presents an update on the Otology, Neurotology and Lateral Skull Base Surgery Workshop held from December 23 to 25, 2006 at Doctor Balabhai Nanavathi Hospital in Mumbai, India. About 250 representatives from different places of the country attended the event. Professor Mario Sanna have demonstrated various skull base surgical procedures and presented discussions on middle ear, mastoide and facial nerves.