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Cryosurgery in Otolaryngology Practice

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Cryosurgery technique Cryosurgery technique
Cryosurgery technique is an established clinical modality which offers ENT surgeons a unique tool to eradicate many benign as well as pre–malignant lesions in the ENT spectrum. Its special role in chronic vasomotor rhinitis is well established.

Cryosurgery technique Tissue destruction by local application of a refrigerant offers clear advantages over other invasive methods. Its inherent anesthetic and haemostatic properties make it suitable for outpatient use. The tissue destruction is essentially well circumscribed, leaving a cryolesion characterized by healing without scarring and complications.

Distinct benefits to patients
  • Cryo applications under local anesthesia.
  • No scarring.
  • No bleeding during and after the procedures.
  • Palliation of painful neoplasms.
  • Minimum pain controlled with non–narcotic analgesics.
  • Well accepted by elderly and debilitated patients.
  • No unpleasant odor of burning tissue.
  • Excellent response, low costs, and minimum hospitalization requirements make cryotherapy a popular modality in ENT surgery.
  • Crysurgery in Otorhinolaryngology.
Nasopharyngeal rhabdomyosarcoma
Abstract
Nasopharyngeal Rhabdomyosarcoma, a common soft tissue sarcoma in children, is a rare identity, so far only four–cases have been reported as per the review of literature. Ours is the fifth case presented exclusively in the nasopharnx, which is, hereby reported. The prognosis of this clinical entity is always gloomy and the modality of the treatment is always surgery, chemotherapy and radiotherapy.

Case report
A 5 year old boy was referred to ENT department of K.E.M. hospital with the complaints of nasal obstruction, noisy breathing and mouth breathing for over four months. There was no history of bleeding from the nose or any other significant ENT problems. Clinical examination revealed both nostrils clear with no evidence of any nasal mass occluding the nasal passage. Airways were blocked. Posterior rhinoscopy revealed huge polypoidal and grape like mass arising from the nasopharynx and hanging in the oropharynx pushing the soft palate downward and forward. Palatal movements were normal and there was no neurological involvement. Rest of the ENT examination was insignificant. Rest of the ENT examination was insignificant. Routine hematological tests and urine exam was normal. X–ray nasopharynx and compromising the nasal airway. Provisional diagnosis of nasopharyngeal malignancy was made. CT scan could not be done because of poor economical status of the patient. He was advised surgery and was subjected to excision under G. A. with routine tonsillectomy position. With Boyle–Davis gag, mouth was opened and with adenoid curette the whole mass was curetted. Bleeding was not alarming and controlled with post nasal packing. Postoperative recovery was uneventful. The mass sent for histopathology revealed rhabdomyosarcoma. Patient was advised post–op radiation and chemotherapy. Post operative recovery was uneventful and his symptoms of mouth breathing noisy breathing and nasal obstruction was cleared.

Dissussion
Rhabdomyosarcoma is a highly malignant tumor of childhood arising from the rhabdomyosarcoma of mesenchymal connective tissue. It frequently involves the head and neck region as orbit, nasopharynx, cheek, external ear, maxilla, tonsillar area and soft palate.

The presentation in the nasopharynx is very rare. Only four cases so far have been reported in the literature. Ours is another rare case which exclusively presented in the nasopharynx.

The first mention of this pathological entity was made by Weber (1855), Mason and Soule (1956). The histological classification was made by Wills R. A. (1967). Histologically, the tumor is characterized by round or spindle cells with distinct granular vacuolated cyto plasm.

The Rhabdomyosarcomas can be divided into four subtypes
  • Embryonal and embroyonal botryoid.
  • Alveolar.
  • Pleomorphic.
  • Mixed.
The embryonal is most frequently encountered rhabdomyosarcoma of childhood (80%). The disease usually runs a rapid course unless diagnosed and treated promptly. Clinically, it may be mistaken as antrochoanal polyp or angiofibroma or hypertrophic adenoid. The tendency of lymph node metastasis is more in embryonal rhabdomyosarcoma. Hemotogeneous spread to lung and bones are also not uncommon. Prior and Stoner (1957), Vieta et al (1962). Mason and Soule (1963).

The prognosis of rhabdomyosarcoma is very gloomy with less than 10% long time survival. The treatment modality adopted is a nutimodality therapy. This entails surgery, chemotherapy and radiotherapy.

References
  • Horn R. C. Jr. Enterline HT (1958). Rhabdomyosarcoma a clincopathological study and classification Cancer11, 181.
  • Masson J. K. and Soule EH (1965). Embryonal rhabdomyosar coma of Head and Neck. American Journal of Surgery 110,585.
  • Stout A. D. (1946). Rhabdomyosarcomas of the skeletal muscles. Annals of Surgery 123,447.
  • Vieta L. R. Guraieb SR and Obregon MA (1962) Archives of Otolaryngology 75,248.
  • Wilis R. A. (1967) Pathology of Tumors 4th edition. Editorial Butterworth, London.
Contributed by Dr. K. K. Desarda

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