Acoustic Neurinoma with Synchronous Ipsilateral Cerebellopontine Angle Lipoma: A Case Report and Review of the Literature

Lipomas of the cerebellopontine angle (CPA) and internal auditory canal (IAC) are relatively rare tumors. Acoustic neurinoma is the most common tumor in this location, which often causes hearing loss, vertigo, and tinnitus. Occasionally, this tumor compresses the brainstem, prompting surgical resection. Lipomas in this area may cause symptoms similar to neurinoma. However, they are not considered for surgical treatment because their removal may result in several additional deficits. Conservative therapy and repeated magnetic resonance imaging examinations for CPA/IAC lipomas are standard measures for preserving cranial nerve function. Herein, we report a case of acoustic neurinoma and CPA lipoma occurring in close proximity to each other ipsilaterally. The main symptom was hearing loss without facial nerve paralysis. Therefore, facial nerve injury had to be avoided. Considering the anatomical relationships among the tumors, cranial nerves, and CPA/IAC lipoma, we performed total surgical removal of the acoustic neurinoma. We intentionally left the lipoma untreated, which enabled facial nerve preservation. This report may be a useful reference for the differential diagnosis of similar cases in the future.

THYROID SURGERY: A COMPARISON OF COMMON COMPLICATIONS BETWEEN EXPERTS AND SURGEONS IN TRAINING

Objective: To determine the frequency of common complications of thyroid surgery by two types of surgeons. Study Design: Comparative cross sectional. Place and Duration of Study: Combined Military Hospital Rawalpindi & Combined Military Hospital Peshawar, from Jan 2013 to Dec 2017. Methodology: This study was conducted to assess the role of surgical skills in complications of thyroid surgery. Surgeons performing surgery for more than 5 years were considered expert and less than 5 years of experience were considered trainee for this specific surgery. Complications by both were analyzed by SPSS-21 and descriptive statistics were applied. Results: A total of 482 surgeries were performed. Out of 407 were female and 75 were males. Mean age was 43.55 ± 10.9 years. Expert surgeons performed 300 cases and 16 (5.3%) experienced some complication in 6 months of follow up.182 cases were performed by surgeons with lesser experience and 14 (7.5%) cases developed complications over the period of follow up. Recurrent laryngeal nerve paralysis occurred in 2 (0.67%) of experienced surgeons cases while 6 cases (3.2%) of less experienced surgeons had the similar complication. Conclusion: While the overall complication rates are not much different between experienced and lesser experienced surgeons, the rate of recurrent laryngeal nerve paralysis is significantly more, though still within the acceptable international complication rate for this particular surgery.

Penerapan Latihan Range Of Motion (ROM) aktif pada pasien pasca stroke di Desa Sampangan Pekalongan

Stroke is a brain functional disorder characterized by nerve paralysis due to obstruction of blood flow to the brain. The frequent impact if a post-stroke client is not carried out with rehabilitation immediately will result in mobility disorder that can impede daily physical activity. One pratice in the rehabilitation process is to prevent disability in a client with post-stroke physical mobility disorder that is, by performing a Range Of Motion rope. The case study is intended to illustrate application of roma exercises to boost muscle strength. The method of writing the case study USES a descriptive design and case studies reported in narration. The instrumrnts used are observation sheets and structured observation sheets covering the assessment of muscle strength. The resulth of the case study have been after the six-meeting application of roma that the roma can increase muscle strength in subject. I the average muscle strength 3.31 to 3.50 and subject II average muscle strength 3.68 to 3,93. The conclusion of the case study increased muscle strength after the practice of roma. Suggestions for the family in order to train ROM for family members who had suffered stroke. Keywords: Stroke, muscle strength, ROM AbstrakStroke adalah penyakit nerulogis terbanyak yang dapat mengakibatkan disfungsi motorik dan sensorik.Dampak yang sering muncul jika klien pasca stroke tidak dilakukan rehabiltasi dengan segera maka akan mengalami gangguan mobilitas yang dapat menghambat aktivitas fisik sehari-hari. Saalah satu bentuk latihan dalam proses rehabilitasi untuk mencegah terjadinya kecacatan pada klien dengan gangguan mobilitas fisik pasca stroke yaitu dengan melakukan latihan Range Of Motion ROM. Studi kasus ini bertujuan untuk menggambarkan penerapan latihan ROM untuk meningkatkan kekuatan otot. Metode penulisan studi kasus ini menggunakan rancangan deskriptif dan hasil studi kasus dilaporkan dalam bentuk narasi. Instrumen yang digunakan yaitu lembar pengkajian dan lembar observasi terstruktur meliputi penilaian kekuatan otot. Hasil studi kasus setelah dilakukan penerapan ROM selama 6 pertemuan bahwa ROM dapat meningkatkan kekuatan otot pada Subyek I nilai rata-rata kekuatan otot 3,31 menjadi 3,50 dan Subyek II nilai rata-rata kekuatan otot 3,68 menjadi 3,93. Simpulan studi kasus ini terjadi peningkatan kekuatan otot setelah dilakukan latihan ROM. Saran bagi keluarga agar dapat melatih ROM pada anggota keluarga yang mengalmi stroke. Kata kunci: Stroke, kekuatan otot, ROM

TRATAMENTO FISIOTERAPÊUTICO DE PARALISADO FACIAL PERIFÉRICO

A paralisia facial periférica gera diminuição ou perda das funções sensitivas e motoras do paciente e para acelerar a recuperação e evitar complicações é necessária a intervenção fisioterapêutica. Este estudo de revisão de literatura investigou os procedimentos de fisioterapia para tratar pessoas com paralisia facial periférica. Constatou-se que a cinesioterapia associada a massoterapia tem sido recomendada com sucesso. Palavras-chave: facial nerve paralysis; fisioterapia e paralisia facial; paralisia facial.

Corticosteroid Use in Otolaryngology: Current Considerations During the COVID-19 Era

Objective To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. Data Sources PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. Review Methods Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell’s palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19–specific findings. Conclusions Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell’s palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. Implications for Practice SCS use for SSNHL, Bell’s palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.

An Experience of Superficial Parotidectomy in Tertiary Care Teaching Hospitals

Background: Superficial parotidectomy is associated with a decreased incidence of transient facial nerve paralysis compared with that of total parotidectomy. Aim: To analyze the clinical presentation, histopathology and complications following superficial parotidectomy performed for benign parotid tumors. Methods: Two center study data was collected from the Surgical Unit I, Department of Surgery AIMC/Jinnah Hospital Lahore (1st January 2012 to October 2018) and Surgical Unit II, Department of Surgery, Sir Ganga Ram Hospital Lahore (November 2018 to 31st December 2020). All patients who underwent superficial Parotidectomy surgery for benign parotid tumors, from 1st January 2012 to 31st December 2020 were assessed for intra-operative and post-operative complications. Demographic data, intraoperative details, and postoperative outcomes of all patients who underwent superficial parotidectomy were collected. Patients with benign parotid tumors on FNAC were included while patients with malignant cells on histopathology were excluded. Results: A total of 50 patients having benign parotid tumors on FNAC underwent superficial parotidectomy during this study period. There were 35 female patients (70%) and 15 male (30%), with female to male ratio of 2.3:1. The age range was 23-70 years with mean age of patients 35.6 years (5.65±SD). In 48% cases the tumor was on left side of face and in 52% cases it was on right side. Amongst 50 cases, on postoperative histopathology, 2 patients had malignant change. Key words: Superficial parotidectomy, pleomorphic adenoma, facial nerve paralysis.

Bell’s Palsy Caused by SARS-CoV-2

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to major healthcare and everyday life challenges. Every day, new disease associations and systemic manifestations are being explored and reported. Peripheral facial nerve paralysis or Bell’s palsy has been reported to be caused mainly by viral infections. This case represents a COVID-19-positive patient with Bell’s palsy making SARS-CoV-2 as the most likely culprit of his condition.