Embryonal Rhabdomyosarcoma: The Diagnostic Dilemma of a Rare Laryngeal Malignancy

The larynx and the remaining components of the upper aerodigestive tract collectively play an important role in undertaking respiration, phonation, and deglutition. Therefore, a variety of pathologies can present with similar symptoms. Systemic diseases, such as rheumatoid arthritis and relapsing polychondritis, may also manifest with laryngeal symptoms and findings, whereas rare pathologies may present with vague presentations. Such scenarios may be attributed to the consequent medical confusion and dilemma in reaching an accurate diagnosis. In this case report, an 11-year-old male presented with airway compromise symptoms, which were later identified and diagnosed as laryngeal embryonal rhabdomyosarcoma.

Nasopharyngeal Mantle Cell Lymphoma: An Extremely Rare Entity

Mantle cell lymphoma (MCL) is a rare, aggressive subtype of non-Hodgkin lymphoma with a poor prognosis and high recurrence rate. It seldom affects the Waldeyer's ring let alone the nasopharynx. Patients usually present at late stages of the disease leading to poor failure-free and overall survival rates. Intensive chemotherapy regimes and autologous stem cell transplantation have reported increased survival rates. We report a relapsed case of nasopharyngeal MCL, which previously occurred in the gastrointestinal tract. The patient had undergone a hemicolectomy for colon intussusception secondary to the intraluminal lymphoma mass. He was unable to complete the treatment regime for MCL due to the adverse side effects. Oropharyngeal mass was discovered during routine outpatient follow-up, which was confirmed as nasopharyngeal MCL. We discuss the prognosis, disease progression, and possible treatments.

Facial Subcutaneous Emphysema As A Rare Complication Of Tonsillectomy

Tonsillectomy is a very common procedure in Otolaryngology practice. Common complications include bleeding, which can be primary or secondary due to infection of the tonsillar bed. Subcutaneous emphysema after a tonsillectomy is very rare. We report a 19-year-old girl who developed cervicofacial subcutaneous emphysema several hours after tonsillectomy with successful conservative treatment outcome.

Identification of Nasal Irrigation Bottle Contamination in Post Sinonasal Surgery

Nasal irrigation is an effective and cheap method in managing post sinonasal surgery patients. It works by improving ciliary clearance and performing mechanical debridement of the thick crust, decreasing mucosal edema and reducing the inflammatory mediators. Presence of nasal irrigation bottle contamination and its effect on patients have been studied. The aim of this study is to prospectively identify the risk of contamination in the nasal irrigation bottle, fluid from the bottle and to correlate with endoscopic findings from the patients who had underwent sinonasal surgery. Swabs will be taken from the nasal irrigation bottle and patient's middle meatus before the surgery and at each post surgery visits (2 and 4 weeks). Patients will be advised to irrigate their nose three times per day post sinonasal surgery. During endoscopic examination of the patient's nasal cavity at 2 and 4 weeks, any evidence of infection will be noted and documented. Additionally, a swab of fluid irrigated from the nasal cavity collected during the clinic follow-ups will also be taken. The specimens will be sent to the Microbiology laboratory for standard culture and sensitivity test. A total of 27 patients completed the study and were divided into case (n = 15) and control (n = 12) groups. The CFU (colony-forming unit) value of the bacteria cultured from the nasal cavity and the nasal irrigation bottle was statistically significantly (P = 0.00) increased from the baseline to the second week follow-up in both groups but not from the second week to the fourth week follow-up. The majority of the swabs from the nasal cavity of the patients and the nasal irrigation bottles were positively cultured for Pseudomonas sp. group. Other groups of bacteria that were cultured were Enterobacter sp., Coagulase Negative Staphylococcus (CONS) and Klebsiella sp. Endoscopically, there was no clinical evidence of infection found in the nasal cavity of the patients. The nasal irrigation bottle that was used in the post sinonasal surgery treatment and for alleviation of symptoms of sinonasal diseases was found to have bacterial contamination from the swabs taken from the bottle. However, despite this finding there was not clinical evidence of infection noted from the nasal endoscopic examination. A simple and effective method of cleaning the bottle would be helpful to reduce the bacterial contamination for this useful treatment method.

Nasal papilloma: A comparison between inverted papilloma and oncocytic schneiderian papilloma

The Schneiderian membrane gives rise to 3 morphologically distinct tumours: septal, inverted (IP) and oncocytic schneiderian papillomas (OSP). OSP, although, almost parallel to IP, still have its own distinct features in the incidence, location, clinical presentation and histological examination. Despite the differences, the standard treatment is still surgical removal of the tumour. External approach is preferred but in view of advanced endoscopic technique, it is feasible to remove the tumour endoscopically with carefully selected tumour presentation. DOI: http://dx.doi.org/10.3329/bjo.v18i2.12033 Bangladesh J Otorhinolaryngol 2012; 18(2): 215-218