Can anyone explain what this means?

[Guderian]

My lady friend's been suffering on and off from dizzy spells, throat pains and noises in one ear for quite a while now. When they happen they can be quite incapacitating. I'm in the UK at the moment and her English is as bad as my Thai, but she's evidently been for a scan at Pattaya City Hospital. The results, or diagnosis, are below. Can anyone explain what this means to me as a layman?

What I read is that most things are OK, but she's got some problems with her right eye orbit being deformed, and also with some deviation to the nasal septum, as well as an absence of the frontal sinus. Presumably this is due to the protrusion of the frontal lobe of the brain downward to the right orbit, as noted? So what does this mean, is it serious, or minor, or even just cosmetic? Does it need treatment, and if so what would that imply? Is it likely to be the source of her problems?

Grateful for any help/insights, I'd like to understand what she's up to exactly and what the problem is, but the language barrier makes it difficult to ask her directly. I tried Googling it but didn't find anything relevant.

Edited May 19, 2016 by Guderian

[Sheryl]

This sort of problem usually occurs in people with a past history of facial injury, what is called a "blowout" fracture of the orbit. Did she have an accident in the past year or two?

Reconstructive surgery may be required. Pattaya City Hospital is not up to this, she needs to be treated by specialists and it would run to big money to do this privately. She should go to whatever hospital she is eligible for free care from (under wither Social Secuirty is she is employed, or else the "30 baht" scheme) and get referred onward from there - it will ultimately need to be a regional level facility.

[johnatong]

This might also be a congenital defect and an incidental finding.

However, without specialist evaluation it is impossible to say whether any surgical intervention is required.

[Guderian]

This sort of problem usually occurs in people with a past history of facial injury, what is called a "blowout" fracture of the orbit. Did she have an accident in the past year or two?

Reconstructive surgery may be required. Pattaya City Hospital is not up to this, she needs to be treated by specialists and it would run to big money to do this privately. She should go to whatever hospital she is eligible for free care from (under wither Social Secuirty is she is employed, or else the "30 baht" scheme) and get referred onward from there - it will ultimately need to be a regional level facility.

Thanks Sheryl, that's most helpful.

I just had a chat with her via Skype.She says that the problem is with her nose (jamuuk is one Thai word I do know!), whereas from the hospital report I get the impression that it's more to do with the orbit of the right eye. She says that when she was very young she had a bad accident, and that damaged her nose. Presumably that led to the problems with the nasal septum and maybe also the missing sinus, and probably also to the eye and brain issues? I'm guessing that she ran into something, or got hit in the face somehow, and that caused damage to both her nose and the right eye. Like a classic black eye/broken nose in a boxer?

She has an appointment next week in Chon Buri hospital, which is a big one with everything she says, and although she's registered in Pattaya for free treatment use of Chon Buri hospital will also be free (thank Buddha!).

Since she had the accident, I'm guessing, some 25 to 30 years ago will surgery still be an option? She's also long complained of throat pain, sometimes so severe that she can't swallow, which seems to be associated with the dizziness and other symptoms. Do you think that's also something to do with the 'blowout fracture'?

[Guderian]

This might also be a congenital defect and an incidental finding.

However, without specialist evaluation it is impossible to say whether any surgical intervention is required.

Thanks for the reply, please see my reply to Sheryl above. She had a bad accident when she was very young, it seems, and next week she'll get specialist evaluation (I hope) at Chon Buri hospital.

[Sheryl]

Chonburi Hospital is a regional level facility and should have the necessary specialists to evaluate this.

I cannot say whether her symptoms are related, but they could be if the protruding brain tissue is compressing key nerves. It will need to be evaluated by a neurologist among others.

[Guderian]

Chonburi Hospital is a regional level facility and should have the necessary specialists to evaluate this.

I cannot say whether her symptoms are related, but they could be if the protruding brain tissue is compressing key nerves. It will need to be evaluated by a neurologist among others.

Thanks. I'll see what they say on the 26th, though trying to figure it out from 6000 miles away is a bit of a pain.

[Guderian]

Back again, in Thailand as well as on this forum.

My friend went to Chon Buri hospital as I mentioned above, and she was immediately referred from there to Chulalongkorn hospital in Bangkok. She has some sort of 'elephant syndrome' which does appear to need a pretty big operation to fix it. The Thai name for the problem is โรคงวงช้าง which seems to translate as elephant trunk syndrome. At the moment it's just a small swelling on the bridge of her nose, or maybe just above it, but I suppose it may get worse over time? Some of the pictures she showed me are not very attractive, so It seems that it needs to be sorted out.

She showed me some Thai websites about it, including a You Tube video of an operation to fix it (I'm a bit squeamish and had to close my eyes when they started peeling back the face), but I can't find the right English name for this problem to read up on it. When I search I mainly seem to get elephant man syndrome, as in the Merrick guy a long time ago, aka proteus syndrome, but that seems to affect the whole body rather than just the nose.

Can anyone tell me the correct English name for this problem, or else direct me to a source that explains the nasal version of the proteus syndrome, if that is what this is? Thanks for any help.

[Sheryl]

Can't say for sure since the Thai term you give is lay slang, not medical terminology.

Possibly it is neurofibromatosis - but you really need to find out the medical name for her condition from her doctors.

If she got a medical certificate, or has any of the referral papers with her, these would likely say.

[Guderian]

Can't say for sure since the Thai term you give is lay slang, not medical terminology.

Possibly it is neurofibromatosis - but you really need to find out the medical name for her condition from her doctors.

If she got a medical certificate, or has any of the referral papers with her, these would likely say.

Hi Sheryl, thanks for the reply. Not much chance of speaking to her doctors as they're in Bangkok and I'm in Pattaya. Her family are taking her to the hospital, which is much better for her than me doing it. She's staying with them in Laem Chabang so any paperwork will be up there.

If you Google the Thai term, โรคงวงช้าง, then the images show what the problem is. Something like this one, for example:

At the moment all she has is a minor swelling just above the bridge of her nose, you can hardly even see it though I expect to her it feels enormous. I'm guessing that this is progressive and if left untreated she might end up looking something like the picture?

You mentioned neurofibromatosis but from what I can tell that seems to be mainly a skin disorder, this isn't the skin, it's a problem with the bones in her skull as far as I can tell.

[Sheryl]

Neurofibromatosis is not a skin disorder. These are tumors that form on nerve tissue.

There is a specific type of neurofibromatosis that is seen in adults whereby tumors develop on the skull and nerves (Schwannomatosis).

[Guderian]

Neurofibromatosis is not a skin disorder. These are tumors that form on nerve tissue.

There is a specific type of neurofibromatosis that is seen in adults whereby tumors develop on the skull and nerves (Schwannomatosis).

OK, thanks. I'll see if I can get her to bring something from Chula next time she comes that might say what the correct medical term is for her condition.