ATLANTOAXIAL SUBLUXATION-A CHALLENGE!
Dr.Himanshu Kulkarni,
Consulting Spine Surgeon
A 45 years old female suffered a fall from height. After the fall, she was unable to stand up and walk and also had loss of power in both her upper limbs. She was rushed to Bharati Hospital, Sangli and was examined by Dr Himanshu Kulkarni at the same place where he is working as a Super speciality panel consultant for spine
surgery.
On examination, patient was unable to stand because she was not able to maintain her balance. Her neck movements were painful. She was not able to pass urine and her bladder was distended, for which self-retaining catheter was passed. Power was grade 5 in all lower limb joints, but it was grade 0 in all upper limb joints.
MRI and CT scan showed C1-C2 subluxation with ADI of 4.5 mm and ruptured Transverse Atlantal ligament. Cord oedema was present at CV junction. Keeping the radiological and clinical findings in mind, diagnosis of C1-C2
subluxation with central cord syndrome was confirmed. Decision to fuse C1 and C2 was taken. Guarded nuerological prognosis and very high risk nature of surgery was explained to the relatives. In Prone position, C1 lateral mass screw and C2 Pedicle screw was inserted. Subluxation was reduced, graft was inserted in burred facets and
posterolaterally.Posterior decompression was done in form of C1 arch removal and foramen magnum decompression. Patient had excellent neurological recovery post operatively with rapid motor recovery of
upper limbs. At the end of 3 weeks, patient was also able to walk with the help of walker.
This goes on to show that early intervention in an incomplete cord injury can be immensely helpful in terms
of recovery.
Rhino-orbitocerebral Mucormycosis – a rarity in itself!
DR. SANIKA KULKARNI
Maxillifacial and Oral Surgeon,
DR. APPASAHEB SANDI
Maxillifacial and Oral Surgeon
A 45 year old male presented with h/o pain and mild swelling over right side of face for last one and half year. He had consulted local dentist couple of times during last 1 and half year where he was prescribed antibiotics which used to reduce swelling and pain temporarily.
After careful clinical examination swelling was noticed over the palate. The incisional biopsy was taken from the same region which gave the diagnosis of Rhino-orbitocerebral Mucormycosis. MRI of head and neck was advised. MRI revealed extensive hyperdense mass involving right maxillary sinus extending from alveolous to orbital
floor and posteriorly eroding the posterior wall of maxillary sinus. Lesion was seen to be extended in soft tissue eroding the buccinator. Lateral wall of nose and nasal cavity were intact.
Right total maxillectomy was planned. Weber- ferguson incision with Dieffenbach extension was placed. Necrosed maxillary bone was seen. Left maxilloectomy was carried out with removal of inferarobital rim. Maxillary mandibular disjunction was carried out and stripping of medical and lateral ptyrigoid muscles was out using 1.5 mm titanium orbital plate. Interim obturator was placed to minimize nasal regurgitation. Patient was continued with Inj. Amphotericin B for next 15 days. The incidence of this opportunistic fungal infection has been increasing since last decade in immunocompetent patients. With prolonged antifungal therapy an extensive surgical debridement has to be carried out in management of mucormycosis.