Traumatic facial nerve paresis is an undesired sequel following temporal bone fractures. The choice of surgical approach for this condition is largely dependent on the site of the lesion. A 33-year-old woman presented with delayed facial nerve paresis following a motor vehicle accident, which did not show any improvement with conservative treatment for 3 months. Preoperatively, she had facial nerve paresis House–Brackmann grade V. She underwent endoscope-assisted facial nerve decompression involving the tympanic segment of the facial nerve. A standard postauricular mastoidectomy was performed. The mastoid segment of the facial nerve was identified but there was no obvious fracture or bony spicule seen. An extended posterior tympanotomy was done and endoscope was used by way of this corridor to examine the tympanic segment of the facial nerve until the second genu which appeared to be emaciated with lack of lustre. Finally, neurolysis was done under endoscopic guidance. She regained significant improvement in her facial nerve function 8 months postoperatively to House–Brackmann grade II.
Malignant otitis externa (MOE) is a rare and potentially life-threatening disease of the ear and temporal bone. Bilateral simultaneous MOE is extremely rare. Due to bilaterally symmetrical facial nerve palsy, it can easily be missed at the initial presentation, causing delay in management. Here, we report a case of bilateral MOE managed aggressively with regular ear toileting, ear packing with a ribbon gauze soaked with topical antimicrobials, and long-term intravenous and oral antibiotics. The patient showed good improvement in pain control, facial nerve status, and ear findings.
A 42-year-old male presented with fever and symptoms of impending upper airway obstruction on the day of presentation. He required immediate intubation due to swollen epiglottis. The condition responded to antibiotic and steroids, and he was able to be extubated after 3 days. Two days later, however, the epiglottis started to swell up again, this time with pus discharge. Emergency exploration and drainage of the epiglottic abscess were executed, and the patient was kept intubated for a few days afterwards for the swollen epiglottis to reduce in size. Daily flexible laryngoscopy was commenced to monitor the disease status. After completing the antibiotic therapy the patient was discharged in good general condition.
Soft tissue sarcoma, especially synovial sarcoma, is extremely rare in infancy, with only a few cases reported worldwide. Due to the particularly small size of the head and neck region in infants, with important anatomical structures in close vicinity to one another, surgical resection is very challenging, if the goal is to ensure total disease elimination as well as maintaining function and good cosmetic outcome postoperatively. In the case reported here, following diagnosis, the child was given three cycles of neoadjuvant chemotherapy followed by infratemporal tumour resection via Bramley–Al-Kayat incision incorporated with a modified Blair incision. Postoperatively, the child recovered well, with no recurrence after three months. This case highlights the important role of a multidisciplinary approach in the diagnosis and managing such rare cases. We also discuss the clinical presentation, imaging features, histopathological features, treatment regime, and prognosis of synovial sarcoma of the infratemporal fossa in children, based on cases reported in the literature.
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