Dipak Ranjan Nayak

Giant neurofibroma of the tongue

Neurofibroma of the tongue arising from the hypoglossal nerve is rare [7], but a combined neurofibroma of the hypoglossal and lingual nerve is extremely rare in the English literature to our knowledge [4,6]. Here one such case is being presented for its rarity, peculiarity of its clinical presentation and the surgical approach to excise it.

A Comparison of Microdebrider Assisted Endoscopic Sinus Surgery and Conventional Endoscopic Sinus Surgery for Nasal Polypi

Nasal polyposis is often encountered in rhinology practice. Those who fail conservative management, a definitive surgery is essential to achieve sufficient ventilation and drainage of the affected sinuses by using either microdebrider or conventional instruments for functional endoscopic sinus surgery (FESS). A prospective study was conducted on 40 cases of nasal polypi in a tertiary care hospital. 20 cases were operated by conventional endoscopic instruments and 20 using the microdebrider. The study aimed at comparing the intra operative (blood loss, duration of surgery) and post operative results (crusting, scarring, discharge, symptoms, recurrence) between the two groups using Lund–Mackay scoring system and the data was statistically analysed. There was no statistically significant difference in surgical outcome for patients when either conventional endoscopic instruments or microdebrider was used. However, there was a significant symptomatic improvement in cases undergoing microdebrider FESS. Microdebrider assisted polypectomy is precise, relatively bloodless surgery though the precision depends on the surgeon’s anatomical knowledge and operative skills. Study substantiates that these instruments are helpful but not a prerequisite for successful outcomes in FESS. The study re-emphasises the utility of the microdebrider to young learning FESS surgeons.

PAPILLARY SQUAMOUS CARCINOMA OF PARANASAL SINUS-AN UNCOMMON HISTOLOGICAL VARIANT

Papillary Squamous cell carcinoma is an uncommon histological variant Squamous cell carcinoma (SCC) of the upper aero-digestive tract (UADT). It rarely involves the paranasal sinuses. We report an aggressive case of papillary SCC of the left maxillo-ethmoid complex in a 59 year old male, who presented with rapidly progressive left cheek swelling and nose block. Biopsy revealed diagnosis of Papillary Squamous cell carcinoma arising in a transitional papilloma. The contrast enhance CT scan showed heterogeneously enhancing large lobulated soft tissue mass is seen involving the left maxillary sinus, left nasal cavity, left ethmoidal sinuses and left frontal sinus with extensions as.Superiorly, there was destruction of inferior wall of left orbit with loss of fat plane between the inferior oblique and inferior rectus muscles possibly infiltrating and pushing the globe superolaterally. Inferiorly, with destruction of inferior wall of left maxillary sinus and extending along alveolar process of left maxilla is seen.Patient underwent left subtotal maxillectomy (Pre-maxilla preservation) and orbital exenteration with endoscopic fronto-spheno-ethmoidal clearance. The resected margins were found to be free from tumour. The patient underwent postoperative Chemo-radiotherapy. Patient developed recurrence at orbital apex with extension to Middle cranial fossa after four months following post operative radiotherapy with a histopathological diagnosis of well differentiated carcinoma and was advised cyber knife treatment at another center. The patient did not undergo cyber knife treatment and came back after one month and was started on palliative chemotherapy, but expired after 2 months. The case is presented for its rarity and aggressive behavior.

Prevalence of HPV in Oral Squamous Cell Carcinoma in South West India

AbstractThere are inconsistent reports regarding the role of HPV in the origin and progression of oral squamous cell carcinoma (OSCC). The observed heterogeneity was mainly attributed to the social and cultural habits of the enrolled cases, discrepancies in the nature of samples procured and varying sensitivity of the assays employed for detection of HPV. The objective of this study was to assess the prevalence of HPV in OSCC in South West India. This was a cross sectional study conducted over a period extending from October 2015 to June 2017. This study involved Department of ENT-Head and Neck Surgery and Department of Virology, Manipal Academy of Higher Education. Fifty histologically confirmed oral squamous cell carcinoma patients undergoing wide local excision of the tumour were enrolled for the study. Intraoperatively 4–5xa0mm of tissue samples were transported in sterile normal saline at 4–80xa0°C. The primary screening of tissue samples was performed by nested PCR using PGMY09/11 consensus primers and GP5+/6+ consensus primers and TaqMan based real time multiplex PCR for HPV-16, HPV-18, HPV-31 and HPV-45. All samples tested negative for HPV DNA by conventional nested PCR and TaqMan based real-time Multiplex PCR ruling out four common HPV subtypes such as HPV-16, 18, 31, 45. We did not find presence of HPV DNA in the tissues of patients with OSCC from southwest India. However, studies with more geographic representation from other parts of India are required before generalising our findings.n

Usual Suspects: the foreign bodies of the aerodigestive tract

This case series is about four different foreign bodies lodged in different locations of the aerodigestive tract. All four cases had delayed diagnosis due to inconspicuous history. Radiology in the form of computed tomography aided the appropriate diagnosis in most of these cases. Though all four patients have been successfully managed by removal of foreign body, not all of them have identical outcomes. A brief discussion about predictive factors in the fish bone foreign body has been included. The authors also discuss certain critical aspects of the management, which may aid in reducing the morbidity. We emphasise on the high index of suspicion in peculiar cases and on the low threshold for radiological investigation in doubtful clinical scenarios.

Cushing's reflex secondary to neck haematoma following thyroidectomy

Neck haematoma following thyroid surgery can present with respiratory distress which is generally attributed to airway obstruction. We recently had a 63-year-old female patient who underwent total thyroidectomy for toxic nodular goitre. However, within 4u2009hours of surgery, she developed sudden respiratory distress which was managed by prompt evacuation of the neck haematoma. Just before the haematoma evacuation, the patient had hypertension and bradycardia along with the distress. The arterial blood gas analysis sampled at that time was normal. Intraoperatively, the tracheal framework was found rigid and non-pliable. Considering the various clinical–biochemical findings observed, we think that the cause of the respiratory distress in the index case was transiently elevated intracranial pressure, secondary to bilateral internal jugular veins compression. We hypothesise that in many patients with immediate postoperative neck haematoma, the Cushing’s reflex would at least contribute partly, if not solely to the respiratory distress.

Phonomicrosurgery for benign vocal fold lesions using medial-microflap technique with cold instruments in a teaching hospital of India

Background: Phonomicrosurgery is a challenging and evolving field. One of the key techniques used for this is nmicro-flap technique used along with cold micro instruments. nObjective: To convey the role of Microflap technique in phonosurgery and the role of basic microlaryngeal instrumnets in such surgery when sophisticated phonomicrosurgical instruments are not available. nMethods: This is a retrospective study of 33 patients of benign vocal fold lesions who have undergone phonomicrosurgery using microflap technique from the year January 2011 to January 2016. Majority of these cases were vocal nodules (16cases) followed by Cyst in the vocal cord (10 cases) and 5 cases of polyps. nResults: Cases were analyzed using GRBAS scoring and stroboscopic findings. A significant improvement was noted in the voice outcome of these patients except two cases where endoscopic paraglottic fat injection was done along with hyaluronic acid with steroid infiltration into the Reinke’s space, after which there was improvement in voice. nConclusion: Microflap technique for vocal fold lesion is a unique surgical procedure that allows preservation of nvocal cord morphology and at the same time prevents post surgical scarring with excellent voice outcome. nThisThis surgery can be performed with good quality regular microsurgical instruments.

Paranasal Sinus Malignancies – A 6 Year Tertiary Hospital Experience

AIMS AND OBJECTIVES:To illustrate our experience in the demographics,tumour characteristics and man-agement of paranasal sinus malignancies during an 6-year time period.MATERIALS AND METHODS:This is a retrospective, observational study where clinical data of 41 patients diagnosed and treated for paranasal sinus malignancies were analysed.RESULTS: The male:female ratio was 1.6:1 and the median age of presentation was 48 years. The most common presenting symptom was epistaxis (46.4%). The median time gap between the onset of symptoms and presentation was 3 months.The maxillary sinus was the most commonly affected site (68%) and the most common malignancy was squamous cell car- cinoma(39%). 90% of the patients underwent surgery as part of a multimodality curative treatment plan or alone as curative treatment. CONCLUSION:Advanced T stage, regional and distant metastasis of paranasal sinus malignancies are highly predictive of poor survival. Hence early diagnosis and treatment is of immense value in decreasing the morbidity and mortality due to these tumors

Implants in Medialization Thyroplasty: Silastic vs Gore-Tex

Dr. ROHIT SINGH MS,DNB Kasturba Medical College, Manipal, INDIA Email: rohit.singh.dr@gmail.com Phone: 91-9900405817 Website: www.manipal.edu Objectives : To compare the results of Medialization thyroplasty using silastic and Gore-Tex® implants. Methods : A prospective study was conducted on 20 cases of unilateral vocal cord palsy, who under went Medialization Thyroplasty at our tertiary care center between August 2003 and October 2008 using Silastic implant in 10 cases and Gore-Tex® implant in 10 cases. All cases presented with hoarseness and underwent videolaryngoscopy to establish the diagnosis. Glottal gap was assessed in all cases. All cases were subjected to preoperative and post-operative (at six months) voice assessment objectively using the computerized VAGHMI diagnostic module and subjectively using the audio recorder. The parameters studied using VAGHMI Diagnostic Module included mean fundamental frequency, intensity, jitter, shimmer, harmonics to noise ratio & number of visible harmonics. Subjective judgments were made by speech-language pathologists who assessed hoarseness, loudness, pitch and maximum phonation duration. The data obtained was statistically analyzed using Wilcoxon Signed rank sum test. Results : Age groups: 21-40yrs (10 cases) , 41-60 yrs (10 cases). The most common cause for unilateral vocal cord paralysis was idiopathic in 14 cases and post thyroid surgery in 6 cases. Statistically significant improvement in glottal gap closure (p = .018) and loudness (p = .013) was seen in Gore-Tex® group. Conclusion : Gore-Tex® implant showed significant improvement in glottal gap closure and loudness on 6 month follow up when compared to silastic. However, a long term follow up is warranted to evaluate whether deterioration in voice outcomes ensue over time. IMPLANTS IN MEDIALIZATION THYROPLASTYSILASTIC Vs GORE-TEX®