Anagha Joshi

Vocal outcomes following subepithelial infiltration technique in microflap surgery: a review of 30 cases

Understanding of the anatomy and physiology of the vocal folds, availability of better diagnostic tools and precise instruments has spurred the development of newer techniques for the management of benign lesions arising in the vocal folds. As the propensity of the superficial lamina propria to regenerate is minimal, it is of paramount importance to maximally preserve it. Microflap surgery of the vocal folds is based on this principle. There exists a dichotomy in opinion regarding the role of subepithelial infiltration in microflap surgery; the disadvantages cited being possible confusion of the surgical plane following infiltration and hydrodissection of the normal basement membrane from the superficial layer of the lamina propria. A prospective study was therefore carried out in 30 cases of benign glottic lesions and microflap surgery was performed with and without infiltration in similar pathologic lesions. The vocal outcomes i.e. fundamental frequency, jitter, shimmer and maximum phonation time were audited. The advantages of this technique with a review of the literature are discussed.

Radiological correlation between the anterior ethmoidal artery and the supraorbital ethmoid cell.

AbstractThe anterior ethmoidal artery is an important landmark in functional endoscopic sinus surgery.AimsWe undertook this study to determine the reliability of identification of the artery on the coronal CT scan and to determine whether a correlation exists between the pneumatisation of the suprabullar recess and the vertical distance of the artery from the base skull.Materials and Methods50 randomly selected CT scans were studied. The anterior ethmoidal artery was identified on each side and the vertical distance between the artery and the base skull was measured. The orbital beak and the superior oblique muscle were used as landmarks to identify the artery. The CT scans were divided into two groups based on whether the supraorbital cell was present or absent. These groups were each further subdivided into 3 groups depending on the vertical distance between the anterior ethmoidal artery and the base skull.ResultsThe anterior ethmoidal artery was reliably identified in 97% of the cases. When the supraorbital cell was absent, the mean distance between the artery and the base skull was 1.5 mm; while when the cell was present, the mean distance was 4.86 mm. When these groups were evaluated for statistical significance, the p value was 0.000 (highly significant).ConclusionThe orbital beak and superior oblique muscle are reliable landmarks to identify the anterior ethmoidal artery. There exists a strong correlation between the vertical distance of the artery from the base skull and the presence of the supraorbital ethmoid cell.

Transcutaneous Endoscopic Orbital Surgery: A Less Morbid Alternative to Lateral Orbitotomy

Abstract Background: Retrobulbar lesions of the orbit situated lateral to the optic nerve are difficult to access. In this article, the authors would like to present a new perspective to approach these lesions where the goals of surgery are met with minimal complications. Methods: A retrospective analysis of patients’ charts was performed. Results: For approaching retrobulbar lesions an endoscopic technique was developed. Four patients (2 male and 2 female patients) presenting with retrobulbar lesions lateral to the optic nerve have been included in this study. Two patients underwent endoscopic drainage for orbital abscess and two patients were successfully biopsied endoscopically. No intra-operative complications were noted. Open procedures such as lateral orbitotomy were avoided in all the cases. Conclusion: Transcutaneous orbital endoscopy is a safe and a versatile technique to approach retrobulbar lesions lateral to the optic nerve. It can be used as an effective alternative to lateral orbitotomy for well selected cases. One can obtain adequate material for histopathological examination and also drain deep-seated orbital abscess using this technique. It would be possible with increasing experience to use this technique for extended applications.

Endoscopic excision of Juvenile nasopharyngeal angiofibroma — A comprehensive approach

ObjectiveEndoscopie excision of Juvenile Nasopharyngeal Angiofibroma (JNA) was carried out with (he objective of minimizing blood loss and attempting a complete excision of the tumor under direct vision with the help of Hopkins telescopes.Study DesignA prospective 4 year study of 23 cases of JNA treated by endoscopie excision is presented. Of these, 18 were treated by endoscopie excision alone. The remaining 5 were treated with a two staged approach either by mid-facial degloving followed by endoscopy or by 2 endoscopie procedures.ResultsThe tumor was excised completely in 17 out of the total 18 cases that were treated exclusively by endoscopy. One case has shown a recurrence. The 5 cases treated by the staged approach represented very large tumours or tumours with intra-cranial extensions. In I of these cases, inoperable tumor remnant engulfing the internal carotid artery was treated by radiotherapy post-operatively. Conclusion: With successful excision of JNA in all but one case, we could reasonably conclude, that endoscopie excision of JNA could become a safer and a more precise alternative to open surgery provided it is practiced judiciously by surgeons who have considerable experience in endoscopie surgery and the necessary backup to convert to open surgery should the need arise.

Management of Difficult Laryngeal Exposure During Suspension Microlaryngoscopy

Difficult laryngeal exposure during suspension microlaryngoscopic surgeries is a common situation encountered by the phonosurgeons nowadays. It leads to unnecessary trauma, incomplete surgery and even abortion of the procedure. Although various methods have been described to counter the situation, they might not be adequate in some cases with very anteriorly placed larynx. This study is intended to determine the utility of angled rigid endoscope along with malleable endoscopic instruments to improve surgical access in cases with inadequate glottic exposure during suspension microlaryngoscopy. In this cross sectional study conducted at Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai, 50 patients of voice disorders who underwent Suspension Microlaryngoscopy from July 2014 to December 2017 were included. Out of these patients, 5 patients (10%) presented with difficult laryngeal exposure that were operated using readily available angled rigid endoscope along with malleable endoscopic instruments, without requirement of any specially designed instruments. There was improvement in laryngeal exposure in all the cases following utilisation of angled endoscopes. The surgeries were carried out under video monitor guidance with complete excision of the vocal cord lesions. Our study concluded that the cases in which the laryngeal exposure cannot be improved even by various external procedures, can be enhanced by application of angled rigid endoscopes and the vocal cord lesions can be excised completely by using malleable endoscopic instruments.

“AIR LEAK SYNDROME”: An Unusual Presentation of Foreign Body in the Airway

AbstractSpontaneous onset pneumomediastinum, pneumothorax and subcutaneous emphysema are rare presentations of a foreign body in the airway. The possible mechanism for unexplainable and non traumatic subcutaneous emphysema can be attributed to “Air leak syndrome” following inhalation of foreign body in the airway.

False Cord Retractor: An important Tool in diagnosing Posterior Laryngeal Cleft

When the tracheoesophageal septum fails to develop or fuse, a laryngeal cleft is formed. It may or may not be associated with a tracheoesophageal fistula. Diagnosing a laryngeal cleft is not straightforward as was found to be in this case. Here, the cleft was masquerading as a laryngeal polyp, which resulted in misdiagnoses and delay in the management. A false cord retractor was of significant help in diagnosing the cleft. We recommend the use of this instrument during evaluation of laryngobronchoscopy in all patients suspected to have a laryngeal cleft.

The Four-Port Bradoo Technique: An Alternative to the Modified Endoscopic Denker’s Approach for Giant JNA

The aim of this study is to emphasise the importance of preserving the anterior facial skeleton in angiofibroma surgery and to introduce a new approach by which tumors with far lateral extensions can be operated upon successfully without disruption of the anterior facial skeleton. This is a prospective study conducted at a tertiary referral academic centre. Two patients with extensive juvenile nasopharyngeal angiofibroma with far lateral extensions were recruited and they underwent surgery between July and August 2016. Both patients were not embolised prior to surgery. Complete tumor removal was achieved in both cases without any evidence of recurrence of disease. The facial contour was well maintained. They are under regular follow-up at our centre, having completed their third 3 monthly follow-up. The main outcome measures are preservation of the anterior facial skeleton and complete tumor removal. The Four-Port Bradoo Technique allows for maximum access to the angiofibroma whilst maintaining the anterior facial skeleton, thus ensuring complete removal with minimal morbidity to the patient.

Factors Affecting the Outcome of Frontal Sinus Surgery: A Prospective Study

Chronic frontal sinus disease has always been a difficult problem to treat. We undertook this study to evaluate our results of frontal recess surgery, to determine the factors which affected the surgical outcome and to determine whether the post-operative findings correlated with the symptomatic improvement in the patients. Twenty-four patients with chronic sinus pathologies involving the frontal sinus were included in this study. After failure of maximal medical treatment, they were subjected to endoscopic surgery. The factors assessed included the pneumatisation of the frontal recess on CT scan, the technique of surgery, the intra-operative frontal glow, the state of the frontal recess at the end of surgery, the appearance of the recess on follow-up endoscopy and the symptomatic relief in the patients. 81.2% of well pneumatised frontal recesses had a good outcome while only 42.1% of the poorly pneumatised frontal recesses had a good outcome. 76.2% of cases with a frontal glow seen intra-operatively had a favourable surgical result while 44.4% of cases without a frontal glow intra-operatively had a favourable surgical result. Two-thirds (66.7%) of cases with mucosa-lined frontal recess did well post-operatively while only 33.3% of cases with a raw frontal recess did well following surgery. Well pneumatised frontal recesses, presence of an intra-operative frontal glow and a mucosa-lined frontal recess corresponded with better post-surgical outcomes. A difference in the intra-operative technique did not influence the result after surgery. Nineteen out of 24 patients (79.2%) were asymptomatic after surgery while 5 patients had residual symptoms.