A well-differentiated liposarcoma of the prevertebral space: A case report

Liposarcoma is common in adults; however, it very rarely occurs in the retropharyngeal space, and to date, no cases of liposarcoma in the prevertebral space have been reported. A 78-year-old man presented at the Otolaryngology Department with a 1-month history of dyspnea and dysphonia. Magnetic resonance imaging of the neck reveled a retropharyngeal mass extending from the superior margin of the axis to the level of the 7thcervical vertebra. A computed tomography scan of the patient’s neck uncovered the relationship between the mass and its’ surrounding structures. Based on the above examinations, a diagnosis of retropharyngeal liposarcoma was made initially. The patient underwent transoral surgical excision with the assistance of a nasal endoscope. During surgery, the tumor was located in the prevertebral space. Combined with pathology and immunohistochemistry examinations, the diagnosis was modified to well-differentiated liposarcoma of the prevertebral space. At the 1-year follow-up, the patient was well and there was no evidence of recurrence. The long-term outcomes are not yet known. Liposarcoma of the prevertebral space may sometimes be misdiagnosed as retropharyngeal liposarcoma; however, in our view, it is not necessary to focus on differentiating between enormous retropharyngeal and prevertebral tumors. In relation to the short-term outcome, complete excision using the transoral approach with the aid of nasal endoscope may present a better choice than the cervical approach in treating these tumors, especially in old people.

Use of Vandenberg and Kuse Mental Rotation Test to Predict Practical Performance of Sinus Endoscopy

Objectives: The aim of this study was to assess the predictive value of the Vandenberg and Kuse Mental Rotation Test (MRT) on performance of novice medical students for manipulation of a nasal endoscope on a cadaveric model. Material and Method: We randomly selected 39 medical students who had never handled a nasal endoscope and subjected them to the MRT. General information including experience in manual, technical, or surgical activities and testing of anatomical knowledge were collected to exclude possible confounding factors. They were then asked to perform series of cadaveric model exercises using a nasal endoscope. Their cadaver performance was evaluated by 2 blinded observers, using a standardized scale. Results: We found that medical students with higher mental rotation skills had significantly increased endoscopic sinus performance ( P = .0002 using multivariate regression adjusted for specialty choice, previous surgical exposure, and anatomy knowledge). Higher anatomy knowledge was also associated with better endoscopic sinus performance ( P = .0141). Other parameters had no impact on endoscopic sinus performance measured by the endoscopic scale ( P > .05). Conclusion: The score obtained on the MRT was correlated with the practical performance of manipulating the nasal endoscope in cadaver. It could therefore be a useful spatial ability tool for directing targeted training in rhinology.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

A Well-differentiated Liposarcoma of the Prevertebral Space: A Case Report

Background: Liposarcoma is common in adults. However, its occurrence in the retropharyngeal space is extremely rare, and no cases of liposarcoma in the prevertebral space have been reported before.Case presentation: A 78-year-old man presented to the Otolaryngology Department with a 1-year history of progressive dysphagia and a 1-month history of dyspnea and dysphonia. A computed tomography scan of his neck demonstrated a large retropharyngeal mass. Magnetic resonance imaging was performed to further characterize this mass. Based on the above examinations, retropharyngeal liposarcoma was first made. The patient underwent transoral surgical excision with the help of nasal endoscope. During surgery, the tumor was found to lie in the prevertebral space. Combine with histological examination, the diagnosis was modified to liposarcoma of the prevertebral space. Conclusions: It’s difficult to distinguish the enormous retropharyngeal tumors and prevertebral tumors using imaging. Complete excision via transoral approach maybe enough for these tumors.

A OBSERVATIONAL STUDY OF ENDOSCOPIC REPAIR OF CSF RHINORRHOEA

Background: Intrathecal fluorescein may be used to visualize CSF fistulas using a nasal endoscope. This allows the examiner to directly visualize the size of the defect, its location, and its rate of flow. The first repair of CSF leak was performed by Dandy in 1926 using a frontal craniotomy. This technique had a 60-80% success rate and was the gold standard for decades. In 1964Vrabec and Hallberg described the endonasal approach of CSF leak repair. AIMS: This study aims to establish the success rate of endoscopic surgical repair of CSF rhinorrhoca. MATERIALS AND METHODS: The study was conducted in Department of ENT IPGMER and SSKM Hospital. During the study period of 18 months, 30 patients have been admitted in our department with CSF leak (most of them were referred from neurosurgery). RESULTS: Fat and fascia lata and temporalis fascia were used to repair CSF leak in 24 patients. Bath plug technique was applied for 3 patients. Repair with vascularised flap such as Hadad flap or middle turbinate graft were used in case of 3 patients. CSF rhinorrhoea repair was successful in 28 out of 30(94%) patients after primary surgery whereas recurrence occurred in 2(6%) cases. Among them 1 patient underwent second surgery which achieved definitive closure of the leak. But one case lost follow up and did not come for second surgery. Interval between surgery and recurrence was varied and so were the causes. CONCLUSION: CSF rhinorrhoea cases can be repaired by an endoscopic approach with a high success rate. Radiological investigation of PNS and brain are equally important for selection of cases for endoscopic repair. Spontaneous leak must be checked cautiously to exclude features of raised ICT. Relapse occurs mainly for failure to delineate actual site or sites of leak and inadequate size or faulty placement of graft. Success depends not only on surgical skill but also on baseline intracranial tension, cause & site of leak and postoperative care.

Comparison of marsupialization under nasal endoscopy versus lacrimal probing for treatment of congenital dacryocystoceles: a report of 40 cases

Background: This study was performed to compare the efficacy of marsupialization under nasal endoscopy versus lacrimal probing for the treatment of congenital dacryocystocele. Methods: A prospective randomized controlled study. Forty neonates (43 eyes) diagnosed with congenital dacryocystoceles were divided into Group A (nasal endoscopic marsupialization) and Group B (lacrimal probing). The patients were followed up for 1 year after surgery. The efficacy, incidence of complications, and reoperation rate were compared between the two groups. Results: The male:female ratio was 25:15 patients (27:16 eyes). In Group A, the success rate was 100%, the incidence of complications was 5%, and the reoperation rate was 0%. In Group B, the success rate was 90%, the incidence of complications was 20%, and the reoperation rate was 30%. There was no significant difference in the success rate between the two groups, but the incidence of complications and the reoperation rate in the lacrimal probing group(Group B) were significantly higher than those in the nasal endoscopic marsupialization group(Group A). Conclusion: In the treatment of congenital dacryocystoceles, nasal endoscope marsupialization has the same success rate as lacrimal duct probing, but the former is more effective and safer in clinical practice.