Skull base osteomyelitis typically occurs most often as a complication of malignant otitis externa secondary to pseudo monas infection. Common risk factors are increasing age, diabetes mellitus and immunosuppression. If it happens in the absence of external otitis it is called atypical or central type. Medical management is the mainstay of treatment. Sur gical management is for a diagnostic biopsy and in some for debridement. Described below is a case report of a 75 years old male patient who was diagnosed to have skull base osteomyelitis and was started on intravenous antibiotics. Following an initial improvement of symptoms, after 4 weeks he developed ear and oropharyngeal bleed. Imaging revealed a massive aneurysm of petrous internal carotid artery with multiple brain infarcts and before we could intervene the patient expired. This case emphasizes a rarity in skull base osteomyelitis and the need for early diagnosis and aggressive treatment.
Actinomycosis is a gradually evolving infection caused by bacteria of genus Actinomyces. Cervicofacial involvement is the most common presentation and palatal involvement is very rare. Presented below is the case report of a 79-year-old diabetic and hypertensive female who presented with nonhealing ulcer over the hard palate for 10 months, which enlarged and formed a large oroantral fistula within 4 months. Following the diagnosis of actinomycosis by histology, complete debridement and removal of necrotic tissue was done. She was treated with intravenous crystalline penicillin 6th hourly for 4 weeks and was discharged on oral amoxicillin for 12 months with regular follow-up. Only four cases of actinomycosis hard palate have been reported in English literature so far. How to cite this article: Dahiya V, George BR, Ramachandran K, et al. Actinomycosis Hard Palate: A Rare Presentation. Int J Otorhinolaryngol Clin 2019;11(3):73–75.
Drug-induced airway hematoma is a very rare condition. The incidence of hemorrhage with anticoagulants is 6.8%. We hereby present the case reports of two such cases. Both patients presented with dysphagia and throat pain. One was on warfarin and the other was on aspirin. Examination revealed laryngeal and retropharyngeal hematoma respectively. Discontinuation of drugs and reversal of anticoagulation improved the symptoms. In the second case, retropharyngeal hematoma was drained. These cases highlight the importance of suspecting this entity in patients on drugs, especially anticoagulants who present with upper aerodigestive tract symptoms. Timely intervention and reversal of coagulopathy can save the patients. How to cite this article Divya GM, Dahiya V, Ramachandran K, Muhammed F. Drug-induced Airway Hematoma. Int J Head Neck Surg 2015;6(4):187-189.
Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of neonatal respiratory distress. We report a case series of four infants with similar radiological dimensions but while two needed surgery, two could be managed conservatively. The clinical presentation of the child and the response to conservative treatment, rather than the radiological dimensions were the main predictors for surgical intervention.
INTRODUCTION:Tracheostomy is a common procedure performed in critically ill ventilator-dependent patients to provide long-term airway access. About 10% of the ICU patients require prolonged mechanical ventilation and hence a tracheostomy is needed. Early bedside tracheostomy in such patients reduces the length of stay in ICU and number of days on ventilator by facilitating weaning. AIMS AND OBJECTIVES: This prospective clinical study aims to study the results of early versus late Tracheotomy in critically ill patients of ICU and other Emergency wards. This study also aims to observe and analyze the outcomes of bedside open tracheostomy, in relation to its safety, complications, and duration of hospital stay; mortality and problems of decannulations. MATERIALS AND METHODS:This is a prospective study done in Govt. Medical College, Calicut from Jan 2013 to June 2014 and includes all the patients in ICU's and wards who underwent bedside tracheostomy by open surgical method during the study period. Results: The study sample consisted of 60 patients in the age group of 15-75 years. 41(68%) males and 19(32%) females. The main indication for tracheostomy is prolonged ventilation (90%). Patients with head Injury fared better than with neurological diseases in our study, with a statistical significance. (P value-0.02).Mortality is 53.33%. One patient died directly as a result of the procedure. Remaining patients recovered from primary disease and decannulated. There was significant relationship between early tracheostomy with early weaning, early decannulations and shorter ICU and overall hospital stay (P value <0.05). All complications were managed conservatively without any sequelae. CONCLUSION: Operative complications of bedside tracheostomy are less. Most of these develop in the first week and can be managed without morbidity. Majority of deaths in our study are related to the primary disease rather than the procedure. There was no significant relationship between timing of tracheostomy with laryngotracheal stenosis and overall mortality.
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