Ashok Verma

Endonasal carbon-dioxide laser assisted dacryocystorhinostomy verses external dacryocystorhinostomy.

This is a prospective, non-randomized study to evaluate and compare the results, morbidity and surgical time for endonasal carbon-dioxide laser assisted dacryocystorhinostomy and external dacryocystorhinostomy. 70 consecutive patients of chronic dacryocystitis with nasolacrimal duct obstruction were selected for the study. 36 patients under went endonasal CO2 laser assisted dacryocystorhinostomy and 34 had external dacryocystorhinostomy. Selection of the type of operation was left to the patients choice. All the patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Patients not willing for the external incision were selected for endonasal laser assisted dacryocystorhinostomy and others were operated via external approach. Silicone tubes were put in all the patients for three months after surgery. The final follow up was 12 months after the removal of silicone tubes. The patency of the lacrimal passage was confirmed by irrigation, and patients were questioned about their symptoms.The success rates, 12 months after removal of silicone tubes were 100% in endonasal CO2 laser assisted dacryocystorhinostomy and 88.24% in external dacryocystorhinostomy. The surgical time of endonasal laser assisted dacryocystorhinostomy was 38 minutes as compared to 62 in external dacryocystorhinostomy. Complication rate in both groups was almost equal.Thus, we came to the conclusion that Endonasal CO2 laser assisted dacryocystorhinostomy is a better surgical option to external dacryocystorhinostomy in cases of chronic dacryocystitis with nasolacrimal duct obstruction, with shorter surgical time.

Adult tonsillectomy and day care surgery.

ObjectiveTo evaluate the safety of adult tonsillectomy as a day care surgeryMethodsRecords of 664 patients above the age of 12 years, who underwent tonsillectomy were analysed. These patients were operated in our department within January 1999 and September 2002. Only 13 patients (1.95%) had post operative bleeding and were readmitted after discharge. The data of these patients were collected from medical records as well from the morbidity meeting proceedings and was reviewed retrospectively. Statistical analysis was done by using ‘one sample t-test’.ResultsOverall incidence of post operative bleeding was 1.95%. None of our pateients bled with 12 hours of Surgery, 0.3% had bleeding between 12 to 24 hours after tonsillectomy and 1.65% encountered bleeding between 24 hours to the 6th post operative day. Bleeding was not major in majority of patients as only 0.45% of the patients required second anesthesia to control the bleeding and only 0.35% of patients required blood transfusion to replace the lost blood volume. In addition, higher incidence of bleeding was seen in males, in the older age group of 31–40 years, patients with obstructive sleep aponea and in patients where tonsillectomy was done by electrocautry dissection.ConclusionBased on these observations, we conclude that Adult tonsillectomy can be safely preformed in our setup.

Cryosurgery in vasomotor rhinitis—an analysis of 156 patients

156 patients of vasomotor rhinitis were treated with cryodestruction of nasal branches of vidian nerve. These patients were divided into two groups A and B. In Group ‘A’ intermittent partial nasal obstruction-was the main symptom (82 patients) and in Group ‘B’ watery nasal discharge was the predominant symptom (74 patients).

Retropharyngeal cystic hygroma

A case of cystic hygroma of retropharyngeal space is being reported in a 5 years male child. The patient presented with a painless swelling on right side of the neck, dysphagia, change in voice and respiratory stridor. Surgical excision was done under general anaesthesia and the histopathology of which was consistent with cystic hygroma.

Laryngeal papillomatosis—Analysis of 20 cases

A study of 20 patients of laryngeal papillomatosis is presented with an analysis of epidemiological factors, results of surgery and systemic use of levamisole. The youngest patient was 6 months old. 9 out of 20 patients presented with stridor. Involvement of bronchus and lung parenchyma was not seen in any of the cases. Repeated surgical excision (14 on average) were needed in majority of patients to achieve cure. Role of levamisole needs further evaluation.

Salivary gland tumours—Analysis of 162 cases

The clinical records of 162 cases of salivary gland tumours were studied. Parotid gland was the commonest site for origin of tumour (110 cases.) Commonest benign tumour was pleomorphic adenoma (42 cases) and the commonest malignant tumour was mucoepidermoid carcinoma (26 out of 162 cases). The next common tumours were adenoidcystic and undifferentiated carcinoma which constituted 23 and 20 cases respectively. Surgery or surgery with radiotherapy were the main modalities of treatment for the primary tumours. Twenty patients had recurrence within three years after the treatment. These patients were treated with either revision surgery or external radiations. Chemotherapy was given to one patient of soft tissue sarcoma. Twenty nine patients had post-operative complications like facial paralysis, parotid fistula, skin necrosis and Frey’s syndrome.

Malignant fibrous histiocytoma

Two cases of malignant fibrous histiocytoma with widely varying clinicopathological behaviour are reported. The treatment employed was combined surgery and radiotherapy.

Laryngo-tracheal trauma (a retrospective study)

Thirty five cases of laryngotracheal trauma in the age group of 1–72 years are being reported in this study. Unilateral vocal cord palsy was noted in 20 cases and left side was involved more commonly than the right. The extent of the injuries varied from simple haematoma in the ventricle to a completely shattered larynx and avulsion of the trachea. All neck wounds were explored and debrided under general anaesthesia. Surgical exploration of laryngotracheal injuries was directed towards an open reduction and stabilization in position of function. Complications like laryngeal stenosis and permanent tracheostomy can be best avoided, if managed at the earliest.