Wednesday, December 19, 2012

Isolated fracture of lamina papyracea.

Note fracture of medial wall of right orbit wall (known as Lamina payracea because this bone is as thin as paper).
Same case as above in different axial cuts of CT Scan. Fortunately this patient does not have any diplopia.

Tuesday, December 11, 2012

Low grade adenocarcinoma of Parotid

This was a very large tumour which was abutting the external auditory canal. The whole EAC cartilage became bare and so fascia was kept over the bare cartilage while closing the wound. A radical parotidectomy was done for full clearance of tumour. The patient received Radiotherapy after.

Saturday, December 8, 2012

Submandibular duct calculus

A 60-year Female presented with uncontrolled diabetes mellitus with cellulitis of floor of mouth. She responded to oral clindamycin. When the swelling subsided, a left side submandibular calculus was discovered which was confirmed with CT Scans. Despite insulin treatment, her sugar levels remains highly uncontrolled. Her stone was removed under local anesthesia and the duct was marsupialized.

Here is a view of marsupialized submandibular duct few months after surgery. Clear saliva can bee seen coming from it.


Tongue tie

Monday, October 8, 2012

Vestibular Schwannoma presenting as hearing loss.

This 40 year gentlemen presented with gradually deteriorating hearing loss over 1 month in left ear. PURE TONE AUDIOMETRY showed left moderate Sensorineural hearing loss. MRI findings are given below.
Coronal cuts showing left CPA tumour
Axial cuts showing left CPA tumour

Though such findings are rare and this tumour is rare, It's advisable to get  MRI in cases of  nerve deafness especially if  this is unilateral and patient is young. 12 % of cerebellopontine angle tumour may present as sudden deafness which may respond to steroids. All such cases warrants MRI study. 

Friday, June 29, 2012

Young boy with no history of addiction to tobacco or smoking presented with such a lesion over right side of tongue for last 10 weeks. A biopsy is taken and result is awaited.

I wonder in a city like Delhi, it takes 10 weeks to reach ENT Doctor. Does lesion have to be this big then it came for biopsy. It is such a pity to see lesion grow this much. 

Thursday, June 21, 2012

Chest Tuberculosis

This young female present with persistent cough, evening rise of fever, loss of appetite for last 2 weeks. Chest examination shows multiple added sounds. Chest X ray showed multiple lesions especially in right lung field. She was referred to Chest specialist and later started on ATT. 

Cancer Larynx

This patient had progressive hoarseness of voice for last six months. Direct Laryngoscopy showed this growth and biopsy revealed it to be a squamous cell carcinoma. Now he is receiving radical Radiotherapy.


Balloon Sinuplasty™ FAQs

What is sinusitis?Sinusitis is an inflammation of the sinus lining. If the sinus opening becomes swollen shut, normal mucus drainage may not occur, and this may lead to infection and inflammation of the sinuses.
What are the common symptoms of sinusitis?Common symptoms include:
  • Facial pain, pressure, congestion or fullness
  • Difficulty breathing through the nose
  • Discharge of yellow or green mucus from the nose
  • Teeth pain
  • Loss of the sense of smell or taste
  • Headache
  • Fatigue
  • Sore throat
  • Bad breath
What types of doctors treat sinusitis?Many types of doctors treat sinusitis, including general and family practice physicians, pediatricians, and allergists. However, if you have chronic sinusitis or do not respond to medical treatment, you may be referred to a specialist - an Ear, Nose, and Throat (ENT) physician, or Otolaryngologist.
How is sinusitis treated?Various approaches have emerged for surgeons to consider when treating sinusitis patients:
  • Medical therapy
  • Endoscopic sinus surgery with cutting instruments
  • Endoscopic sinus surgery with balloon catheters
Medical Therapy
Sinusitis is typically treated first with medication. Treatment with antibiotics or topical nasal steroid sprays is successful for many sinusitis sufferers. Inhaling steam or use of saline nasal sprays or drops can also help. However, at least 20% of patients do not respond adequately to medications.1,2,3,4

Endoscopic Sinus Surgery (with cutting instruments)
Sinus surgery aims to clear blocked sinuses and restore normal sinus drainage. The procedure removes bone and tissue to enlarge the sinus opening. The removal of bone and tissue may lead to pain, scarring, and bleeding.
Endoscopic Sinus Surgery (with Balloon Sinuplasty™ technology)
The technology utilizes a small, flexible, Sinus Balloon that is placed into the nose to reach the sinuses. The Sinus Balloon is gradually inflated to gently restructure the previously blocked sinus opening which helps to restore normal sinus drainage and function. There is minimal bleeding, and many patients have been able to return to normal activities within 24 hours. Clinical research has indicated that the Balloon Sinuplasty™ system is a safe and effective instrument in dilating blocked sinuses.5

What is the Balloon Sinuplasty™ system?
The Balloon Sinuplasty™ system is the name used for a group of medical devices that are used to create openings in your sinuses. The devices use a small, flexible balloon that is placed into the nose to reach the sinuses. The balloon is gradually inflated to gently restructure the previously blocked nasal passage, restoring normal sinus drainage.
What are the Balloon Sinuplasty™ devices?
The Balloon Sinuplasty™ devices are FDA-cleared, endoscopic, catheter-based instruments specifically designed to be used in sinus surgery. The Sinus Balloon Catheter is gradually inflated to gently restructure the previously blocked sinus opening, which restores normal sinus drainage, without damaging the sinus.
Does surgery with the Balloon Sinuplasty™ technology work?
Clinical research has indicated that using Balloon Sinuplasty™ technology is safe and effective in dilating sinus openings.5
How long does symptom relief last after surgery with Balloon Sinuplasty™ technology?
Results vary by individual. Published clinical data has shown the following regarding patients who have had sinus surgery with Balloon Sinuplasty™ technology:
  • A study of 1,036 patients at multiple institutions reported that sinus symptoms improved in 96% of patients at an average follow-up period of 10 months.6
  • Another study followed 65 patients at multiple institutions and reported clinically and statistically significant improvement in patient symptoms out to 2 years.5
How do sinus openings stay open after surgery with Balloon Sinuplasty™ technology?Balloon Sinuplasty™ technology dilates sinus openings, or ostia by pushing aside bones which comprise the sinus ostia. Moving bone remodels the sinus ostia, creating wider openings.
Are the Balloon Sinuplasty™ devices safe?
The Balloon Sinuplasty™ technology is minimally invasive and has been clinically demonstrated to be safe by leading Ear, Nose and Throat doctors. Finally, unlike other surgical methods used to clear blocked sinus openings,Balloon Sinuplasty™ technology does not remove any bone or tissue and some patients return to normal activities quicker – within 24 hours without other co-morbid conditions.
What are the risks of surgery with Balloon Sinuplasty™ technology?Your healthcare provider can best explain the potential risks of surgery with Balloon Sinuplasty™ technology. In all published clinical data, no serious adverse events attributable to the Balloon Sinuplasty™ system have been reported.
How long does surgery with Balloon Sinuplasty™ technology take?The duration of the procedure varies by individual situations. Ask your healthcare provider for the most accurate answer.
In a study of 1,036 patients who underwent sinus surgery with Balloon Sinuplasty™ technology at multiple institutions, an average procedure time was 3 hours, including the surgery and post-anesthesia recovery time. None of the patient required an overnight stay at the hospital.6
Will I require general anesthesia for surgery with Balloon Sinuplasty™ technology?Most patients undergo general anesthesia for sinus surgery with Balloon Sinuplasty™ technology, but some patient have had the procedure under local anesthesia. Your healthcare provider can best advise you on your anesthesia options.
How long does it take to recover from a typical surgery using the Balloon Sinuplasty™ system?Because the system is minimally invasive it is typically used in an outpatient setting. While recovery time will vary from patient to patient, many people can return to normal activities within 24 hours after surgery.
Does surgery with Balloon Sinuplasty™ devices limit my treatment options?
No. Balloon Sinuplasty™ devices are endoscopic tools used within conventional sinus surgery and may be used with other medical therapies. They do not limit future treatment options for patients.
Are Balloon Sinuplasty™ devices right for me?
If you suffer from sinusitis, and medication alone has not been effective in relieving your symptoms, you may be a candidate for surgery using the Balloon Sinuplasty™ devices. To find out if you are a candidate for the Balloon Sinuplasty™ devices, We also encourage you to talk to your doctor about whether use of these FDA-cleared, endoscopic, catheter-based tools is right for you.
Who uses Balloon Sinuplasty™ devices?Ear, Nose, and Throat physicians who have been trained on the Relieva Balloon Sinuplasty™ devices.
Are Balloon Sinuplasty™ devices covered by Medicare?Yes. Medicare covers endoscopic sinus surgery when any combination of tools, including a balloon catheter, is used to perform the procedure.
Are Balloon Sinuplasty™ devices covered by other insurance carriers?Most insurance companies cover sinus surgery with Balloon Sinuplasty™ devices. To be certain of your coverage, contact your insurance provider to find out your specific coverage policy.

Balloon Sinuplasty-Result after Left frontal Sinuplasty

Sunday, May 27, 2012

A 2 cm stone was removed from a 73 year old female through the mouth and the duct was marsupialized later. 

Wednesday, April 4, 2012

A tribute to Dr. VP Sood- Sir, We miss you

It is difficult to believe that the man who initiated All India Rhinology society is no more. He was the single most important person to popularize Rhinoplasty in India. He will always be remembered as Father of Indian Rhinoplasties.

Being associated with him for last seven years , I wish to honor him with the title 'MASTER OF CARTILAGES'. He was fine sculpture artist of upper and lower lateral cartilages. He was strong supporter of closed rhinoplasty techniques and He used to do all extensive cases under local anesthesia, which is again an art. His presence in operation theater was good enough to make all things fall in place.

So much confidence he generated among patients that there are generations of families which he had operated. His hands and luck were God gifted. He was a very religious person.

His Rhinoplasty and endoscopic sinus surgery courses were extremely popular in India and abroad and he conducted such courses for 38 years!

His book on Rhinoplasty remained popular for beginners. I realized it`s importance once I assisted him during surgeries. The book was sheer outcome of his vast experience.

He had been president of association of otorhinolaryngologists of India and All India Rhinology society.

He was a true fighter in personal life also. He fought his terminal illness with dignity and grace. He was active in his work till last month. Death is immortal but the way he braved his illness should be lesson for others.

The greatest concern now for me goes to Mrs Sood who was the force behind this man. I pray God to give her strength and the family to overcome his absence.

May God rest his soul in peace.

Dr. Ajay Jain

Wednesday, January 4, 2012

RE: Nose bleeding


Dryness and crusts formation which are picked by kids with fingers causes most of the bleeding from nose in children. See if your child is having cold or cough. Apply any lubricating ointment such as neosporin eye ointment just inside the nose to avoid dryness there. You can also use coconut oil for same. Rarely some serious causes may be there like blood clotting abnormality or abnormal mass or foreign body which should be ruled out if bleeding persists.

with Best Regards,

Dr. Ajay Jain

Date: Mon, 2 Jan 2012 06:48:10 -0800
Subject: Nose bleeding

Visitor Email:
my son is three yers old. ha has a problem of nose bleeding. bleeding come through from nose automaticaly and it happend in sleeping time also i have taken a advise from DR in agra but there is no relief in this problem so kindly advice me.

Message from Dr Ajay Jain

Dear Friends, I hope this message finds you in good health and high spirits. Welcome to my blog, a space dedicated to educating my patients ...