Teratomas of the head and neck due to their obscure origin, bizarre microscopic appearance, unpredictable behaviour and often dramatic clinical presentation are a clinical surprise. This article focuses on pediatric head and neck teratomas and on their diversity and rarity and also reviews the recent terminology of this group of tumours.

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This study was designed to assess the efficacy of functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis (CRS) patients with minimal radiological findings, and based on one centre, prospective randomized controlled study, conducted in the Department of Otorhinolaryngology, Lady Hardinge Medical College, New Delhi. All the CRS out-patients ([18 years) refractory to 3 weeks of medical therapy were radiologically evaluated with computerised tomographic scan (CT) of nose and paranasal sinuses. These patients were grouped based on CT scoring (Lund Mackay staging system): group A (CT score 0-6) and group B (CT score 7-24); with 35 patients in each group. All the patients underwent FESS using Messerklinger technique. Symptom scoring of all the patients was done using visual analog scale preoperatively and postoperatively at 1-, 3-, 6-and 12-month follow-up. CRS patients with minimal evidence of disease on CT showed statistically significant improvement in symptom scores after FESS. There was no significant difference noted in the overall symptom score improvement as well as for improvement in specific symptoms in both the groups. Further, there was no correlation between the pre-operative symptoms and CT scores. A good subjective outcome in terms of symptom improvement can be obtained with FESS in patients with CRS with minimal evidence of disease on CT.

To review the need of emergency recanalization surgical procedure in cases of bilateral choanal atresia. A retrospective analysis was undertaken for the cases of bilateral choanal atresia which were recanalized between January 2000 and February 2010 in a teaching hospital. Out of 135,954 live births (0.004%), six cases of bilateral choanal atresia were diagnosed and operated during this period. Five cases were hospital deliveries from our hospital whereas one case was referred from another hospital. Three cases were recanalized with dilatation procedure whereas the other three were endoscopically recanalized with micro-drill. All the cases were operated in routine operation theatre. All were managed with orogastric tube or oropharyngeal airway during the waiting period for surgery. No neonate required emergency intubation or tracheostomy. The average age at the time of surgery was 10 days (range 5-21 days). As per our observations recanalization surgery for bilateral choanal atresia is not a surgical emergency. Neonates can be managed temporarily with orogastric tube/oropharyngeal airway during waiting period. Subsequently surgery can be done in routine and unhurried operation theater by experienced surgical hands thus minimizing the morbidity.

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Objective: Nebulized intranasal medical therapy (NIMT) is a novel treatment for chronic rhinosinusitis (CR). To determine the role of NIMT in CR, we compared 50 patients treated with NIMT and oral therapy. We present our findings of pre-and posttreatment modified SNOT 20 scores and sinus cultures.Method: Pretreatment nasal endoscopy with culture was obtained, and a modified SNOT 20 questionnaire was completed. Patients were treated with either NIMT or oral antibiotic therapy twice daily for 21 days. Patients were re-evaluated 2 weeks postcompletion of treatment with repeat SNOT 20 questionnaire and endoscopic culture.Results: Pre-and posttreatment sinus cultures were assessed. Bacteriology cultures and sensitivities demonstrated a wide range of organisms, including Staph aureus, H influenzae, Pseudomonas aeruginosa, Pseudomonas fluorescens, Moraxella catarrhalis, Stenotrophomonas maltophilia, Serratia marcescens, Morganella morganii, and Cornybacterium. Both solitary and mixed infections with various degrees of antibiotic resistance were encountered. Early results indicate a change in bacteriology as a result of treatment. Additionally a preliminary review of outcomes demonstrates a reduction in the pre-and posttreatment modified SNOT 20 scores in both groups. Final comparison of the 2 study groups and statistical analysis is pending. Conclusion:The use of NIMT in the treatment of CR is an effective alternative. It is particularly valuable in those patients who cannot tolerate traditional oral therapy and/or whose cultures identify an organism for which an oral antibiotic is not available. Patient compliance and treatment morbidity is favorable.

Invasive trichosporonosis is a rare fungal infection, but this disease has recently increasingly been recognized in patients with hematological disorders. However, little is known about the clinical characteristics of this infectious complication. We evaluated consecutive trichosporon septicemia in 20 patients with hematological disorders at the Mie University Hospital and related hospitals for 5 years between January 2003 and December 2007. All patients were male and age ranged 23-85 years (mean, 60.3). Underlining diseases are acute myelogenous leukemia (AML) in 18, macroglobulinemia in one and aplastic anemia in one. All had a neutrophil count < 500 /l before the diagnosis of septicemia. Seventeen patients developed the sepsis after intensive chemotherapies, one during steroid treatment and two during observation. No patients examined had positive surveillance cultures for trichosporon. Nineteen patients showed breakthrough septicemia during the use of anti-fungal agents such as micafungin (MCFG) in 17, fluconazole (FLCZ) in 5, itraconazole in one and amphotericin-B (AMPH-B) in 3. Only 4 patients, who had an increase of neutrophil > 500 /l, recovered from this infection. Among them, two were treated with AMPH-B, FLCZ and miconazole, one with AMPH-B and FLCZ, and one with voriconazole only. We should pay attention to an occurrence of breakthrough trichosporonemia when we use MCFG as an empirical anti-fungal therapy for male patients with hematological disorders and neutropenia. We need to develop an effective strategy to treat this fungal infection because of rapid onset and high mortality.