Carotid blow out syndrome

This is an extremely high risk condition associated with significant degrees of morbidity and mortality. This condition commonly results from invasion and destruction of cervical carotid vasculature from head and neck squamous cell carcinomas. Prompt diagnosis of this condition and active intervention will help in saving lives of these patients.


Causes of carotid blow out syndrome:


1.Aneurysms
2.Infections – cause vasovasorum thrombosis leading on to necrosis of carotid walls.
3.Secondary carcinomatous deposits in cervical lymph nodes
4 Following irradiation for secondary carcinomatous deposits in the neck – Free radicals caused during irradiation causes thrombosis of vasovasorum leading on to breakdown of carotid artery wall. Patients develop fibrosis and thinning of the cartotid arterial wall leading on to blow out.


Read the full article from here.

Avoiding pitfalls in endoscopic skull base surgery

Introduction:

The advantages of endoscopic approach to skull base are many. They include:

1. It is the most direct route to anterior skull base. This approach provides access to the following areas Sella, Cribriform plate, Planum sphenoidale, suprasellar cistern, Clivus, Pterygopalatine fossa and adjacent parasellar areas.
2. In this approach there is decreased retraction of brain and cranial nerves when compared to that of conventional neurosurgical apporaches.
3. Endoscope offers excellent visualization of the tumor and the surrounding neurovascular structures
4. Post operative recovery time is short when compared to that of conventional neurosurgical approaches
   

As with any other procedure this method also has its flip side, which includes a steep learning curve, and need to collaborate with neurosurgeon. A cohesive collaboration with neurosurgeon is a must for successful endoscopic skull base surgical procedures.The complicated anatomy of skull base has managed to bridge these two specialities. In a nut shell an otolaryngologist navigates the pathway to the intracranial lesion while the neurosurgeon removes the tumor.

Dangers of endoscopic skull base surgery:

Since the skull base has many vital structures it should be performed with the highest degree of deligence and skill. The potential complications of any endoscopic skull base surgery include:

1. CSF rhinorrhoea
2. Injury to great vessels (internal carotid artery and its branches inside the skull)
3. Injury to optic nerve
4. Injury to other cranial nerves
   
5. Bleeding from cavernous sinus
6. Meningitis
   
   
   
   Click on the image below to read the  e book.http://www.drtbalu.co.in/skull_base.html
   
   
   
   
   
   
   
   
   

Gradenigo's syndrome E module

In continuation with my effort in creating learning modules I have come out with a module titled "Gradenigo's syndrome".

Nasal topical therapeutics

Intranasal drug delivery systems for the management of local and systemic
ailments have caught up recently. Initially this route of drug administration
was attempted for the management of allergic rhinosinusitis. Now inflammatory sinusitis is also managed by intranasally administered drugs. The reasons for interest in this route of drug administration because of its high vascularity, porous endothelial basement membrane and a high total blood flow per volume of tissue. Since first pass metabolism is avoided in this drug delivery method the drug is metabolized slowly thus helping in reducing the dosage of the drug. This also goes a long way in reducing the potential toxicity of the administered drug even if it has a very low therapeutic index. The complex nasal anatomy and the varying dynamics of nasal air flow make this drug delivery modality a little bit unpredictable. This is more so especially in patients with nasal cold which is associated with congestion of nasal mucosa and turbinates.







You can read the complete e book by clicking  the link below:

http://www.drtbalu.co.in/nasal_thera.html

Unique e module on chronic tonsillitis by drtbalu

I have given a unique e learning module on chronic tonsillitis.

This will be very useful for exam going students of otolaryngology.

You can expect more such modules in future: