Posterior ethmoidal artery bleed

Posterior ethmoid all artery bleed is more dangerous than anterior ethmoid all artery because of its proximity to optic nerve.

Swinging flashlight test is the test to diagnose this as this tests the compression on Optic nerve.

Frontal sinus

Agger nasi is pneumatization of lacrimal bone.

For frontal sinus , u require 0.6 mm axial cuts with Sagittal and coronal reconstructions in 3D mode. 

Frontal recess is like hourglass appearance. 

As long as we see the floor of frontal sinus , it is sinus.  When floor not seen, it is frontal recess. 

Supra orbital cell is lateral and posterior to frontal sinus. 

Good suction like liposuction unit suction increases the life of microdebrider three times.  

PJ wormald suggested minimum size of 4 mm of frontal sinus opening but ideal is 8mm. 

Balloon sinuplasty may not create this much size.  

Fungal infection of face and orbit in a young Indian boy

Superior laryngeal nerve palsy

This patient presented with four day history of hoarseness of voice.  He was being treated for acute laryngitis by a physician.  He was prescribed voice rest, antibiotics and antacids.  He did not have any relief.

His laryngoscopy showed that his leafy vocal cord was bowing on adduction and did not have full tension.  It was moving well but didn't close fully producing a significant vocal gap.  A working diagnosis of left superior laryngeal nerve palsy was made and treatment started.  

Left superior laryngeal nerve palsy

Same patient showing vocal cords in full abduction

X ray Mastoids



X Ray Mastoid air cells. Rt side x rays shows hazy mastoid air cells with some sclerosis while on left shows a very well pneumatized mastoid air cell system.

Contact Granuloma of the vocal cords

These are the two pictures of before and after giving steroids in a case of Contact granuloma of the vocal cord. Blue arrow shows an active granuloma. the paler counter part is shown in next photo after treatment. This patient does not have any significant history of trauma or intubation.



Blue arrow shows an active contact granuloma

How common are symptomatic adenoids causing otitis media witheffusionin adult patients. ?

This 39 year gentleman presented with recurrent right side otitis media with effusion. Nasal endoscopy showed a mass in Nasopharynx blocking right side Eustachian tube. A MRI was done which suggested it to be Adenoids.a biopsy was also done which showed it to be reactive hyperplasia of lymphoid tissue.  

Right side Grommet was put.