Search

Objective: To isolate and identify various bacterial pathogens in positive ear swab cultures of CSOM cases and to determine the antibiotic sensitivity pattern of different bacterial species identified. Study design: Prospective study Setting: J. L. N. Hospital & Research Centre, Bhilai (C.G). Materials and Method: The study was done on the population of Bhilai and surrounding region. A sample size of 120 cases attending the ENT OPD with the diagnosis of Chronic Suppurative Otitis Media and active ear discharge were included in the study. Detailed history, general physical examination, local systemic examination was done along with aural swab for Gram’s staining and aerobic bacterial culture and drug sensitivity . The data were then compared with the relevant & available literature. Results: Most of the patients were in the age group of 11-20 years (38.33%), followed by 21-30 years age group (31.67%). More males (60%) were affected by the disease than females (40%). Unilateral (59.16%) infection was more common than bilateral (40.83%). Incidence of monobacterial (90%) etiology was more common than polymicrobial (9.1%). Staphylococcus aureus 67 (51.53%) was the most commonly isolated bacteria followed by the Pseudomonas 26 (20%). Antibiogram showed the most effective drugs in the present study are clindamycin, cotrimoxazole, ciprofloxacin, amikacin, chloramphenicol and ceftazidime Conclusion: Staphylococcus aureus is the most common pathogen isolated, followed by Pseudomonas. Clindamycin was the most effective antibiotic followed by cotrimoxazole, ciprofloxacin, amikacin, chloramphenicol and ceftazidime. Antibiotic sensitivity of the organisms varies according to geographical area and local practice regarding the choice of antibiotics. A continuous and periodic evaluation of microbiological pattern and their antibiotic sensitivity pattern in local area is helpful in prescribing empirical antibiotics for successful treatment of otitis media and thus minimi

Objective: The objective of the study is to study the efficacy of ultrasonography (USG) and fine- needle aspiration cytology (FNAC) in the evaluation of neck masses and differentiating between cystic, inflammatory, benign, and malignant neck masses with a histopathological correlation. Study Design: Prospective study and observational study. Setting: J. L. N. Hospital and Research Centre, Bhilai (C. G). Study Period: June 1, 2016–May 30, 2017. Materials and Methods: Sonographically, neck masses were evaluated final diagnosis was made on the basis of FNAC and histopathology of excised specimens. Finally, the USG findings were correlated with FNAC report and histopathology reports (wherever possible) to evaluate their sensitivity, specificity, and accuracy by statistical methods. Results: Most of the cases clustered between 31 and 60 years of age group. Among all patients, males outnumbered the females with the M:F ratio 1.5:1. Hyperechoic and anechoic lesions suggested benign pathology, whereas chances of malignancy were highest with hypoechoic lesions. As diagnosed by USG, the majority was benign lesion (36.4%), followed by inflammatory neck masses (27.08%), then cystic neck masses (20.83%) and least was malignant masses (15.63%). FNAC impression diagnosed benign mass (32.29%), inflammatory mass (26.04%), cystic mass (19.79%), and malignant mass (15.63%). The diagnostic accuracy of USG, FNAC, and Histopathological Examination (HPE) was comparable as P ≤ 0.05 for inflammatory, cystic, benign, and malignant neck masses. Conclusion: High-resolution grayscale ultrasound can differentiate inflammatory, cystic, benign and malignant neck masses. FNAC can be considered highly efficacious in distinguishing benign and malignant neck masses. A team work between a cytopathologist, radiologist, and clinician maximizes the diagnostic utility of USG and FNAC.

AimTo highlight a rare case of a congenital midline cervical cleft (CMCC) in context with embryological theories/hypothesis, presentation, and management along with review of literature.IntroductionCongenital midline cervical cleft is a rare but interesting anterior neck anomaly with controversial theories/ hypothesis regarding its embryogenesis.Case reportWe describe here a classical case of midline cervical cleft that presented at birth with a cephalocaudal orientation, extending from the level below the hyoid bone to the suprasternal notch with a length of 3 cm and width of 0.5 cm. At 6 months of age, the lesion was excised and closure was done by multiple Z-plasty, with satisfactory results.DiscussionAlthough the diagnosis is clinical, it is frequently misdiagnosed. The associated clinical features could include thyroglossal duct cysts, cleft lip/mandible/sternum, cervical contractures, mandibular spurs, microgenia, and/or bronchogenic cysts. If it is not treated at an early age, it can result in complications like webbing of the neck, dental malocclusion, and restricted neck movements.ConclusionEarliest recognition of CMCC and proper intervention can provide better esthetic and functional prognosis.Clinical significanceA correct earlier recognition of the lesion and appropriate surgical management are key to avoid longterm complications.How to cite this articleJaiswal AA, Behera BK, Membally R, Mohanty MK. Congenital Midline Cervical Cleft: A Case Report with Review of Literature. Int J Head Neck Surg 2017;8(1):25-30.

One-lung ventilation (OLV) is a challenging task in infants and children as few techniques are possible because of narrow anatomy. The aim of this study is to evaluate and experience lung isolation with Fogarty catheters as a bronchial blocker placed by rigid bronchoscope for OLV in infants and children with lung pathologies requiring surgical management in an industrial hospital. This study is a prospective study carried out in J.L.N. Hospital and Research Centre, Bhilai (CG), from January 2011 to December 2014. The study was designed to place Fogarty catheter for achieving OLV using rigid bronchoscope in children. The patient and anaesthesia characteristics, placement and positioning of Fogarty catheters, intraoperative course, complications and recovery of the patient were studied. The data were then compared with the relevant and available literature. Over the study period of 4 years, 27 cases were included, out of which 22 (81.48 %) cases had suppurative lung disease, three cases (11.11 %) had hydatid cyst of the lung, whereas one case (3.7 %) each of congenital lobar emphysema and congenital cystic adenomatoid malformation of the lung, respectively. In all cases general anaesthesia was provided using single lumen endotracheal tube and one lung ventilation achieved by parallel placement of Fogarty catheter as a bronchial blocker with rigid bronchoscope. The surgical management included thoracotomy with decortication in 21 cases, thoracotomy with excision of hydatid cyst in 3 cases, video-assisted thoracoscopic surgery, thoracotomy with left upper lobectomy and thoracotomy with left lower lobectomy in one case each, respectively. There were no major intraoperative and postoperative complications. There was no mortality in our study. We conclude that rigid bronchoscope can be safely and effectively used to place Fogarty catheter in main bronchus in infants and children for achieving OLV.

Lymphangiomas are rare congenital malformations of the lymphatic system that can appear at any age or site. In majority they are diagnosed at birth and 95% of them are found in the neck, the head, or the axilla. Although benign, and commonly asymptomatic, they can sometimes cause pressure and life threatening complications especially massive lesions involving the neck and mediastinum in newborn infants or cause a diagnostic confusion as a result of sudden enlargement following haemorrhage or infection. Lymphangiomas frequently present surgical difficulties and challenges due to their propensity to infiltrate and extend around neighbouring structures. We report a newborn who presented with a huge congenital cervical swelling involving upper 2/3rd of neck on both sides since birth. Complete surgical excision of the lesion was achieved, without damaging any vital structures. After 9 months of surgery, following an episode of upper respiratory tract infection the child developed a large cystic swelling over the lower 1/3rd of neck. Complete surgical excision of the lesion was done. The final histopathological diagnosis was lymphangioma. One year of further follow up showed a cosmetically acceptable scar and no recurrence was noted. The literature is reviewed and the presentation and management of lymphangiomas are discussed.

Tracheo-oesophageal fistula with oesophageal atresia is common life-threatening congenital malformations with an incidence of 1 in 3500 to 1 in 4500 births. ‘H’ type tracheo-oesophageal fistula is an isolated type with an incidence of 4–5% and least association with congenital anomalies. Its diagnosis is often delayed .We report two cases, one presented as a 3 months female child with ‘nasal regurgitation of feeds, recurrent pneumonia and choking on feeding since 15 days of life, while the other immediately after birth with classic triad of symptoms. A review of the literature is presented, with a focused discussion of presentation and treatment options. Confirmation of diagnosis was done by compiling clinical presentation, high index of suspicion and rigid tracheobronchoscopy findings. Management involved surgery by right transcervical approach. High index of clinical suspicion and early diagnosis can provide a better prognosis.

Pleomorphic adenoma is the most common type of all salivary gland tumors, involving more frequently the parotid gland. In most series, it represents 45–75% of all salivary gland neoplasms. We report an unusual case of a huge tumor that measured 9 × 8 cm & 400 g by weight with extensive bone formation, occurring in the parotid gland of a 22 year old man. Thorough clinical examination was done. FNAC was done which showed Myxochondroid matrix with glandular epithelial cells suggesting pleomorphic adenoma. CT scan head & neck revealed a large mass with nodular areas of calcification within soft tissue with marked narrowing of orophayngeal lumen. Total parotidectomy with preservation of facial nerve was done by the Transcervical Transparotid approach. The histopathological findings suggested the possibility of extensive endochondral ossification in pleomorphic adenoma. Preservation of facial nerve functions is a key to successful parotid surgery.

Cervical thymic cysts are among the rarest cysts found in the neck. They may be found at any level of the pathway of normal thymic descent, from the angle of the mandible to the superior mediastinum. Cervical thymic cysts are considered uncommon lesions in the differential diagnosis of paediatric neck masses, their presence is often revealed by pathologic examination of an excised specimen. The main entities to be differentiated are branchial-cleft cysts and cystic hygromas, because of their frequent occurrence and similar clinical presentation. Adolescents and children comprise the majority of the typically asymptomatic patients. We report the clinical presentation, diagnostic evaluation and therapeutic management of one case of multilocular cervical thymic cyst in a 8 year old male child, accompanied by a review of literature.

Cervical teratomas are not reported quite frequently in medical literature, especially from Indian subcontinent. Prenatal diagnosis of this condition is even rarer, making the management protocols difficult. In absence of prompt intervention in the form of airway decompression, morbidity and mortality is very high. Presented here is the case of antenatal diagnosed cervical mass, which was managed successfully in immediate post-natal period with uneventful survival and normalized tumor marker levels.

A 2-year-old female child was referred from a private hospital as a case of recurrent lower respiratory tract infections (LRTI). The chest X ray revealed a hypoplastic right lung and further workup led to the diagnosis of esophageal lung - a rare type of communicating bronchopulmonary foregut malformation. A right posterolateral thoracotomy was done, anamolous bronchial communication with esophagus disrupted, esophageal fistula repaired and the lung resected. Postoperatively, diet was allowed from day 7. The patient tolerated the diet well. Repeat dye study revealed no leak and subsequently the patient was discharged on day 10.

The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.

To determine the incidence of otogenic complications of Chronic suppurative otitis media (CSOM) and its management. The study was conducted at the tertiary referral centre and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patient. The data were then compared with the relevant and available literature. Over the study period of 12 years, a total 45 cases of CSOM with complications were reviewed. Out of these 45 cases, 20 cases had extracranial (EC) while 25 cases had intracranial (IC) complications. The prevalence of each complication was 0.17 and 0.13 %, IC and EC respectively. The commonly encountered IC complications were brain abscess, meningitis and lateral sinus thrombophlebitis. Among the EC complications, mastoid abscess followed by labyrinthitis and facial nerve palsy were encountered. The reliable warning signs and symptoms of IC complications were fever, headache, earache vestibular symptoms, meningeal signs and impairment of consciousness. Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus epidermidis were the common organism isolated. Cholesteatoma and granulation in the middle ear were the major findings in both groups of cases. Surgery was main modality of management of these conditions. We observed that two patients fail to regain full facial nerve function despite of surgery. Mortality rate was zero but morbidity was seen in 15 % (3) and 28 % (7) of cases in EC and IC group respectively. The epidemiological presentation, clinical features and results of treatment are discussed. CSOM complications, despite its reduced incidence still pose a great challenge in developing countries, as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity. In this study we emphasize the importance of the accurate and early diagnosis followed by adequate surgical therapy with multidisciplinary approach.

Pilomatrixoma is a rare, benign, circumscribed, calcifying epithelial neoplasm that arises from the hair follicle on any part of the body. It may present to the otorhinolaryngologist as a palpable mass in the head and neck region. They are usually found in girls during the first two decades of life. These tumors may contain calcification, which, when present, is helpful in suggesting the diagnosis. We present a rare case of ossifying pilomatrixoma in a 15 year old female who presented with a painless hard slow growing swelling over the left cheek region. FNAC could not provide any clue whereas USG and CT scan showed the swelling to be in subcutaneous plane, superficial to the parotid gland. Complete excision of the mass along with the overlying adherent skin in toto with preservation of facial nerve was done. The diagnosis was confirmed after histopathological examination of the excised specimen which revealed pilomatrixoma with extensive ossification and marrow formation.