Cerebrospinal fluid rhinorrhoea—Transnasal endoscopic repair

The recent advances in nasal endoscopic surgery in anterior skull base area have made it the procedure of choice for repair of cerebrospinal fluid rhinorrhoea (CSFR). The aim of the present study is to analyze the technique and efficacy of endoscopic repair of CSFR.     

Cerebrospinal fluid rhinorrhoea and otorrhoea: extracranial repair

Cerebrospinal fluid otorhinorrhoea is a well recognized problem. The otolaryngologist has a major role to play in the diagnosis and management of this condition. Five cases are described which illustrate the problems involved; four presented as leaks and one as pneumoencephalus and meningitis. Of the various methods of diagnosis and localization non-invasive techniques, i.e. tomography, CT and flexible endscopy are preferred. The extracranial extradural approach for anterior, middle and posterior fossa leaks allows a direct assault on the fistula. It may be usefully augmented by temporary lumbar drainage.     

Protein energy malnutrition revealing an esophageal foreign body

It is not unusual for a foreign body to be swallowed and be lodged in the esophagus. It is however, very unusual for such a foreign body to remain lodged for a period of 8 months. This particular case, a 15-month-old male infant, is under focus because of the time length the foreign body remained in the esophagus without local complications, what is unusual is a protein energy malnutrition complication. The neck and chest X-ray permitted the foreign body identification. The management of esophageal foreign body requires a multidisciplinary approach among otorhinolaryngologist, radiologist and pediatrician.     

An unusual laryngeal foreign body in an infant

A case is presented of laryngeal impaction in an infant by a cervical vertebra of a toad. Symptoms were mild initially but became progressive later with secondary laryngeal edema. Early diagnosis was not made, which resulted in considerable difficulty in management. Computerized tomography (CT) scan was found to be useful in identifying the foreign body and thereby facilitating management. CT is recommended for suspected foreign bodies in the air and food passages where more conventional methods fail to make a diagnosis.     

Toothbrush: an unusual foreign body in ENT practice

The toothbrush is an unusual foreign body in ENT practice. Three cases of impacted toothbrushes are presented.     

Cerebrospinal fluid rhinorrhoea as a complication of endoscopic endonasal reduction of blowout fractures

Background: Unless the orbital contents are supported, the insertion of nasal packing material during endoscopic endonasal surgery may cause serious intracranial complications such as cerebrospinal fluid leakage. Methods: Case report and literature review. Results: We report a patient with iatrogenic cerebrospinal fluid rhinorrhoea caused by intracranial entry of a Silastic sheet inserted into the nasal cavity. This skull defect and the surrounding skull base were successfully reconstructed in a multilayer fashion via an endoscopic endonasal approach. Conclusion: This case highlights the need for caution when inserting nasal packing material. During endoscopic endonasal reduction of blowout fractures, great care must be taken to support the orbital contents, in order to avoid serious intracranial complications such as cerebrospinal fluid leakage.     

Management of an unusual presentation of foreign body aspiration.

Foreign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.     

Bronchial foreign body: an unusual form of child abuse

Bronchial foreign bodies are common in pediatric population. Some times these events may be a form of child abuse. A rare case of child abuse in a 4-month-old boy is reported who presented with a nail in right bronchus. Rigid bronchoscopy was planned and nail was successfully removed. It is suggested that any non-ambulant infant with a foreign body must be viewed with suspicion.     

An unusual oronasal foreign body.

An unusual case of oronasal foreign body in a child is reported. A plain lateral X-ray of the head was carried out to show the shape and position of the foreign body; it was also useful in planning removal. Ribbon gauze impregnated with vaseline was packed around the sharp end of the metal in the nostril to protect the nasal mucosa from further trauma while removing it. We recommend this technique.     

An unusual parotid gland foreign body

A foreign body in the parotid gland is extremely uncommon. It can penetrate to the parotid gland through the skin or from the oral cavity via the Stenonís duct. A case of 23-years-old man with the several pieces of glass within the superficial lobe of the right parotid gland was described. The surgical removal was performed and the diagnosis of the foreign body was quite easy.