Sphenochoanal polyp

Sphenochoanal polyp are rare tumours arising from sphenoid sinus. The main presenting complain is gradually progressing nasal obstruction. Sphenochoanal polyp mimics antrochoanal polyp clinically. To differentiate it from antrochoanal polyp, diagnostic nasal endoscopy, computer tomography and magnetic resonance imaging of the paranasal sinuses are the investigation of choice. Functional endoscopic sinus surgery is the line of treatment.: A 33years old female presented with right nasal obstruction since 2 years. On Diagnostic nasal endoscopy polypoidal mass was seen partially obliterating the right nasal cavity not arising from middle meatus. CT scan showed polypoidal mass obliterating the nasal cavity, choana and Sphenoid sinus. It was completely excised by functional endoscopic surgery.We present this rare case to highlight the use of diagnostic nasal endoscopy and Computed Tomography in the diagnosis and treatment of Sphenochoanal polyps

New Nasopharyngeal Flap for Posterior Skull-Base Reconstruction: The Upper-Tongue Flap

Introduction Reconstructions of clival resection are still challenging, and additional reconstructive methods may be necessary to achieve full coverage of the skull-base defect in patients with middle- and lower-clivus disease. Objective To describe a new nasopharyngeal flap for the middle and lower clivus. Methods Using nasal endoscopy in a cadaver dissection, we demonstrated a new nasopharygeal flap to cover the lower and middle clival resection. Results We described a new nasopharyngeal flap capable of covering the lower and middle portion of the clivus. Discussion The new nasopharyngeal flap, called the upper-tongue flap, is particularly adequate as an alternative for the reconstruction of middle and lower clivus defects, and it is better used in association with a nasalseptal flap in cases in which the nasalseptal flap alone does not provide enough mucosal coverage. Conclusion The new nasopharyngeal flap can be used in the reconstruction of clival resection.

EVALUATION OF DIAGNOSTICNASAL ENDOSCOPY AND CTSCAN IN VARIOUS SINONASAL DISEASES

Objective:To evaluate role of Diagnostic Nasal Endoscopy and CT scan in various Sinonasaldiseases with regards to diagnosis and surgical intervention. Patient and methods:This prospective study was carried out in Department of ENT, A.N.M.M.C.H., Gaya on 200 patients with clinical evidence of sinonasal disease who had presented between March 2016 to February 2019. All patients were evaluated with DNE using 0 degree 4mm endoscope and CT scan with 3 mm coronal cuts. Result: Female patients(56%) were more as compared to male(44%) with majority between 21 - 40 yrs. Most common finding on Diagnostic Nasal Endoscopy(DNE) was mucopurulent discharge in middle meatuswhile on CT Scan was maxillary sinusitis(60%). Sinonasal polyp detection was better with DNE.CT has better detection rate of anatomical variation of osteomeatal complex. Conclusion : DNE has become initial tool for diagnosis as it is cost effective and office based procedure. In patients where surgical intervention is required, CT scan has advantage as it provides detailed understanding of anatomical variations. So bothDNE and CT scan should be used in collaborative fashion. Source Of Support:Patients of A.N.M.C.H., Gaya. Conflict Of Interest:None.

Four unusual sinonasal and sinorbital lesions: a case series

<p class="abstract">Presentations of Sino nasal lesions may be indistinguishable and therefore represent diagnostic and therapeutic dilemma due similarities of non-neoplastic and neoplastic lesions at initial presentation may lead to a significant delay in the diagnosis. This case series has been reported to through light on four different case scenarios that presented to us, their diagnosis and management. This was a case series of four unusual cases of the sinonasal and sinoorbital region that presented with symptoms of nasal obstruction, rhinnorhea, epistaxis, radiological and diagnostic nasal endoscopy was performed. Using functional endoscopic sinus surgery and lynch Howarth method the lesions were excised. As sino nasal and sinoorbital lesions present with similar clinical features accurate diagnostic procedures such as nasal endoscopy and radiological investigations, histopathological investigations play an important role in the management of the lesions. </p>

Diagnostic accuracy of nasal endoscopy and contrast magnetic resonance imaging in COVID-19 associated mucormycosis (CAM)

Key Points 1. COVID-19 associated mucormycosis (CAM) is a life-threatening fungal disease that has become an epidemic and notifiable disease after the second wave of COVID-19 in India 2. The target group for CAM includes severely immunocompromised individuals either by COVID-19, or corticosteroid therapy, or uncontrolled glycemic index. 3. With an intention to find out the sensitivity and specificity of diagnostic nasal endoscopy (DNE) and contrast-enhanced magnetic resonance imaging (CEMRI), one hundred two consecutive patients of target group with clinical features of CAM were enrolled in the study. 4. The sensitivity and specificity of DNE as compared to KOH mount were 73.4% and 94.7% respectively. The sensitivity and specificity of CEMRI as compared to KOH mount were 87.5% and 50% respectively. 5. CEMRI misses fewer cases than DNE. In cases of normal endoscopy in the target group, imaging and biopsy should be advised to reduce false-negative results. Nasal endoscopy, biopsy, and imaging can reliably detect the majority of cases of CAM.

Implants displaced into the maxillary sinus, an endoscopic approach - a report of two cases

Accidental implant displacement into the maxillary sinuses and accompanying complications are well documented in the literature. Two surgical approaches have been suggested to remove the displaced implants and to handle the related complications: an intraoral approach and the nasal endoscopy. The intraoral approach is preferred in cases of absence of local infection, ostium obstruction, and oroantral communication needing to be closed. The nasal approach, besides retrieval of displaced implants, allows the treatment of any associated pathology and reestablishment of the mucociliary clearance as well as the natural ventilation through the ostium. This article reports two clinical cases of implant displacement in the maxillary sinus treated with a nasal endoscopy through the middle meatal meatotomy. This article reports two clinical cases of implant displacement in the maxillary sinus treated with a nasal endoscopy through the middle meatal meatotomy. Implants accidentally displaced can be avoided by a proper exploration of the preoperative x-ray, selecting an appropriate treatment plan, and esteeming the surgical skills. The most appropriate approach to handle these complications is close cooperation between oral surgeons and otolaryngologists.

Identifying the Clinical Pattern of Eosinophilic and Non-Eosinophilic Asthma subtype in adult patients with Bronchial Asthma

Background Context:- Asthma is a heterogenous disease with various phenotypes, it is the most common chronic disease characterized by airway limitation due to bronchospasm and airway inflammation associated with excessive mucus secretion from agitated mucus gland that occur due to air way hyper responiveness. Purpose of the study Comparison between eosinophilic and non-eosinophilic asthma patients. Patients and Methods 100 bronchial asthma patients of age ≥ 18 years old divided into2 groups according to blood eosinophilia. All patients were subjected to: history. Total Asthma Control Test. Spirometry. Sputum eosinophil count. IgE levels 6-Skin prick testing (SPT). Nasal endoscopy. Results the mean age of all patients was (35.4 ± 12.8) years, majority (61%) of patients were males,; the mean ACT score was (18.7 ± 2); 39% of cases have obstructive pattern by spirometry, 39% of cases had abnormal nasal endoscopy, SPT had significant relation with asthma, there is significant correlation between total IGE,sputum eosinophilia with eosinophilic asthma. Conclusion Blood eosinophils had the highest accuracy in the identification of sputum eosinophilia in asthma. Total IgE values and sutum eosinophilia were markedly increased in patients with eosinophilic asthma more than patients with non-eosinophilic asthma.

Diagnosing chronic rhinosinusitis: a comparative study between diagnostic nasal endoscopy and computed tomographic scan paranasal sinuses

<p class="abstract"><strong>Background:</strong> The term ‘rhinosinusitis’ refers to a heterogenous group of disorders characterized by inflammation of mucosa of the nose and paranasal sinuses. The National Institute of Allergy and Infectious Diseases (NIAID) have recently mentioned that 136 million people of India suffer from chronic rhino sinusitis.</p><p class="abstract"><strong>Methods:</strong> A total 50 patients with symptoms of rhinosinusitis were investigated with both diagnostic nasal endoscopy and CT scan paranasal sinuses and their findings were scored with particular scoring system and compared with each other. </p><p class="abstract"><strong>Results:</strong> Out of 50 patients, 90% patients were diagnosed on CT scan and 84% patients were diagnosed on nasal endoscopy. By considering CT scan as accurate procedure and correlating nasal endoscopy with CT scan, sensitivity was 88.88%, specificity was 60%, positive predictive value was 95.23%, negative predictive value was 37.5%, and p value was 0.004671, which was significant at p&lt;0.05, indicates that CT paranasal sinuses is more accurate than diagnostic nasal endoscopy in diagnosing chronic rhinosinusitis.</p><p class="abstract"><strong>Conclusions:</strong> Both diagnostic nasal endoscopy and CT paranasal sinuses are important pre-operative evaluation tools in detecting pathology and both are complementary to each other. But CT paranasal sinuses are more convenient than endoscopy according to this study.</p>