Nilam Sathe

Abstract

Introduction: Aspergillus species is a chronic colonizer of paranasal sinuses and ears as well as associated with a variety of different clinical conditions. Fungi are increasingly recognized as a significant cause of morbidity and mortality among the patients because of the wider use of broad-spectrum antibiotics, immuno suppressive therapy, cancer chemotherapy, increased incidence of immunodeficiency diseases and increased use of intensive care interventions. Among the species of Aspergillus, A. flavus is more common in India and Arabian countries while in USA A. fumigatus is the most common Case Report: 32 years old male presented with complaints of headache since 4 months, insidious in onset, progressive, no history of diurnal variation. He developed swelling around right eye since 3 months associated with history of diplopia. He was non diabetic but was hypertensive& was on medication. Ge was suffering from Rheumatoid Arthritis and on immunosuppressive medications for it. CT scan of nose & paranasal sinuses revealed a soft tissue opacification in the right maxillary sinus with right anterior ethmoids and extensive bony erosion of the sinuses and the floor of orbit with intraorbital extension. The eyeball was sinking in the maxillary sinus. Patient was taken up for surgery , Right Total Maxillectomy Surgery with repair of floor of orbit using Titanium plate was done under under general anaethesia using External Weber Ferguson approach. Intraoperative findings suggestive of fungal debris in Right maxilla which was confirmed on final histopathological report. Conclusion: Invasive aspergillosis is mainly seen in immunocompromised individuals likeneutropenia, uncontrolled Diabetes Mellitus, inappropriate use of antibiotics, immunosuppressive drugs and corticosteroids, post viral infections. The mortality and morbidity like vision loss, facial deformity, meningitis,and other intracranial complications can be reduced with early recognition and early intervention. The advanced tools like Titanium plates can prevent the sinking of eyeball into maxillary Sinus & prevent morbidities like diplopia, squint & vision loss. Keywords: Aspergillosis of Nose & Paranasal sinus; Sinking Orbit  

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Abstract

Introduction: Airway injuries are one of the less commonly encountered types of cases in the emergency department Neck lacerations can involve the superficial layers of skin, superficial fascia, deep structures including the airway and less commonly the structures encased in carotid sheath. Airway injuries are potentially life threatening. In this case report we present a cut throat case presented to the emergency services at our institute in an unusual way. And it was challenging case to treat as the trachea has got transacted and sinked into thorax. Case Report: A 35-year-old male, laborer by profession, had sustained multiple injuries while lowering granite slab from a truck. He presented with a cut over his throat, and injury to his leg. He complained of pain in chest while breathing, difficulty in phonation, difficulty and pain while walking. He had a contused lacerated wound over the lower half of his neck .Deeper examination of the wound revealed that the trachea had been transected in half of its circumference. The lower tracheal segment was sinking in thorax due to complete transaction of trachea. Tracheostomy tube was placed in the lower segment. Patient was taken up for emergency airway assessment under general anesthesia and immediately resection and anastomosis surgery of trachea was performed in the same emergency operation theatre on the same day. Patient was taken up for emergency airway assessment under general anesthesia and immediately resection and anastomosis surgery of trachea was performed in the same emergency operation theatre on the same day. The challenge was to search the lower intrathoraccic segment of trachea & to pull it in the neck to perform resection anastomosis surgery. Conclusion : Although airway injuries may not always be present in a case of lacerations of the neck, careful assessment is necessary to evaluate airway integrity even when the patient has no respiratory issues A carefully done & accurately placed tracheostomy helps not only to secure the airway but also makes any possible future airway surgery have a better outcome and thus reduce postoperative morbidity. Timely decision making, careful patient selection and aseptic & meticulous surgical technique reduces intraoperative complications, postoperative morbidity and also makes earlier functional recovery possible.   Keywords: Airway Injury, Sinking Trachea

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