This study proposes a grading system based on a 10-point scoring chart of high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) imaging findings in patients being assessed preoperatively for cochlear implantation. This system helps in objectively assessing the degree of difficulty of the surgical procedure and alerts the surgeons to any potential intraoperative complications. This is a prospective study carried out at a tertiary referral center where 55 patients with bilateral profound sensorineural hearing loss were evaluated by HRCT and MRI and subsequently underwent cochlear implantation. HRCT examinations were performed on a 64 slice multidetector CT scanner. MRI examinations were performed on a 3.0 Tesla MRI scanner. A 10-point scoring chart was devised based on specific imaging findings and all patients were assigned potential difficulty scores (PDS) based on HRCT and MRI findings. Surgical times were documented in each case and each imaging point on the scoring chart was correlated with the surgical times. Eight out of theó ten points in the scoring chart proved to be statistically significant in predicting the degree of difficulty of the surgical procedure. After grading the pre-operative imaging examinations based on the 10-point scoring chart we concluded that patients who have PDS between 0 and 3 (Grade 1) have uneventful and uncomplicated surgery with the lowest intraoperative times. Patients with PDS between 4 and 7 alert the surgeon to moderate surgical difficulty and longer intraoperative times. PDS of 8 and above indicate prolonged and difficult surgery.
A nodular lesion of the tongue incorporates a spectrum of entities from reactive to malignancy. A diagnostic dilemma arises when a nodular, solitary, and firm submucosal mass appears in the oral cavity of a patient. To reach a definitive diagnosis, a crucial investigation protocol needs to be followed. Leiomyomas are benign tumors that rarely occur in the oral cavity. They usually affect patients within the fourth to fifth decades of life. We report a rare case of leiomyoma of the tongue in a 12-year-old child patient. Immunohistochemical analysis revealed the positivity of tumor cells for alpha-smooth muscle actin (SMA). Surgical excision of such lesions is the treatment of choice, with a low recurrence rate. Our patient was asymptomatic and tumor-free at the follow-up visit after two years.
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