Missed Maxillary Sinus Ostium Syndrome and its Management.

Unlabelled: The inflammatory process involving the maxillary sinus is often exacerbated by a functional obstruction due to laterally displaced uncinate process which obstructs the infundibulum and the natural ostium. Physiologically the drainage pathway may be adequate but during periods of inflammation resulting in nasal oedema, the ostium/infundibulum interface is inadequate, preventing adequate ventilation and drainage of the maxillary sinus. Incomplete removal of the uncinate process without including the natural ostium may result in failure and recurrence.

Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet.

Unlabelled: Endoscopic Ear surgery is evolving day by day and there is need for constant improvement in terms of instrumentation with efficient, quicker, with clear bloodless surgical field and good postoperative outcome and results. The application of Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet are presented. This innovation will provide limited and adequate bone removal in a faster way than drill in endoscopic mastoidectomy and stapedotomy surgeries.

"Fizz Sign" in Acute Sinusitis-A CT Scan Finding.

To study the Computerized Tomography (CT) Paranasal Sinus findings in patients with acute bacterial sinusitis and the clinical symptom associated with it. 120 patients were examined over 2 years with coronal CT images of paranasal sinus with clinical symptoms of acute sinusitis of 2 weeks duration from the onset. Patients with symptoms of more than 2 weeks and patients with chronic sinusitis, immunocompromised status were excluded.

How I do it:- Endoscopic Reverse Denker's Approach.

: Endoscopic Denker's approach involves complete exposure of the anterior, inferior and lateral walls of the maxillary sinus providing access to both infratemporal and pterygopalatine fossa. Open approaches to maxillary sinus may lead to a high chance of cranial nerve dysfunction, trismus and wound healing issues. Surgical methods differ based on pathology, exposure, visualization and extent of clearance of the pathology.

Local Anaesthetic Nerve Blocks in Endoscopic Nasal and Sinus Surgery.

In the present era, Hemostasis in Endoscopic nasal and sinus surgeries are challenging even with appropriate use of instrumentation and surgical skills. This can be addressed with appropriate local anaesthesia and nerve blocks. Expertise in performing surgery under local anaesthesia can be acquired over years of surgical training.

Supra Maxillary Cell (SMC): An Anatomical variant of Ethmoid Sinus.

65 year old female presented with complaints of Right sided nasal obstruction of 1 year duration, intermittent nasal discharge for the past 6 months, without much significant improvement in medical management. Computerized tomography of paranasal sinuses revealed presence of supra maxillary cell (SMC) which was infected, along with sphenoid sinus (Heterodense lesion-suggestive of probable Fungal sinusitis). Patient underwent Functional Endoscopic Sinus Surgery with Septoplasty under local anesthesia.

Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs.

Cribriform plate is the commonest site of Cerebrospinal fluid (CSF) leak, its fragility and juxtaposition of arachnoid's investment to the bone, where the olfactory nerve pierces the skull, is a vulnerable site for CSF leak. Endoscopic transnasal approach has been the main stay for CSF leak repair over the past 2 decades. The technique and surgical steps of Endoscopic Surgical Repair of Cribriform CSF Leak using Free Septal Mucosal Graft without Postoperative Nasal packs are presented.

Ropivacaine: A Novel Local Anaesthetic Drug to Use in Otorhinolaryngology Practice.

Ropivacaine is a long-acting amide local anaesthetic agent which has a significant vasoconstrictive property, long duration of action, least central nervous system and cardiac complications due to the pure (S)-enantiomer property by reversible inhibition of sodium ion influx in nerve fibres. By using additives the duration of analgesia may be prolonged. Ropivacaine has been used routinely in our otorhinolaryngology procedures since 2010 (10 years).

Dr. Ahila's Conchal Crusher for Concha Bullosa.

Endoscopic Sinus Surgery is evolving day by day, there is a constant need for improvisation in terms of instrumentation with clear bloodless surgical field and good postoperative results. The applications of Dr. Ahila's Conchal Crusher for managing Concha bullosa in Functional Endoscopic Sinus Surgery  (FESS) Surgery are presented.

Newer Surgical Options for Nasal Allergy.

Allergic rhinitis is a common disorder that affects several patients annually and the hallmark symptoms are nasal obstruction, rhinorrhea and sneezing which significantly impacts the quality of life. Many surgical options exist for the treatment of allergic rhinitis which is directed primarily addressing the nasal obstructive component. The purpose of this review article  is to highlight newer surgical options in the management of patients with nasal allergy.

Infra-auricular Sinus: A Very Rare Case Presentation.

A 22-year-old male patient presented with right infra-auricular sinus since birth with preauricular swelling and discharge on and off since age of 3 years. He had no history of previous surgery. Patient noted frequent swelling and foul smelling discharge inferior to right tragus through a small puncta every 3-6 monthly, resulting in abscess formation and scaring around 1-1.

[Endoscopic posterior nasal neurectomy].

Background: Surgical techniques for resistant chronic rhinitis (rhinorrhoea) vary, ranging from vidian neurectomy to post-nasal neurectomy. The techniques vary mainly on the basis of instrumentation, and the avoidance of post-operative epistaxis, transient hypoesthesia of the soft palate and dryness of the eye. Endoscopic visualisation, and cauterisation or resection of posterior nasal nerve branches, can prevent such complications.

Mini Inferior Turbinoplasty-Tunneling Technique.

Techniques for inferior turbinate reduction vary with various surgical methods, which differ in the approach of preservation of tissue from total turbinectomy to limited submucosal cauterization. Our preferred method to address hypertrophic inferior turbinate by mini turbinoplasty-tunneling technique are presented. Critical steps include creation of window in the inferior turbinate with a 4 mm microdebrider blade and removal of both inferior turbinate mucosal hypertrophy and bony component to convert a convex looking inferior turbinate to concave shape.

Ahila's Diathermy Round Knife for Endoscopic Ear Surgery.

As endoscopic ear surgery is evolving day by day there is a constant need for improvisation in terms of instrumentation, visualization and clear bloodless surgical field. The applications of Ahila's Diathermy Round Knife for Endoscopic Ear Surgery are presented. The development of Ahila's diathermy round knife will prevent shifting to two handed ear surgery or the need for Endo holders.