M. Gopinath

Comparative study of percutaneous dilatational tracheostomy and conventional tracheostomy in the intensive care unit.

Objective: Tracheostomy is a one of the earliest described surgical procedure dating back to 2000 B.C. Percutaneous tracheostomy is becoming increasingly popular as an alternative method for conventional tracheostomy in the intensive care unit. In this study we compare the results of the use of these 2 techniques in 32 patients who underwent elective tracheostomy in the intensive care unit.Study Design: Prospective randomized comparative study.Setting: Tertiary care hospital.Patients: Adult intubated patients selected randomly in the intensive care unit with normal cervical soft tissue, laryngeal framework, palpable cricoid cartilage and normal coagulation parameters.Results: 17 patients underwent conventional tracheostomy and 15 patients underwent percutaneous dilatational tracheostomy. Demographic data and duration of intubation comparable between two groups. The mean operative time, blood loss and complications were lower in percutaneous than in conventional tracheostomy.Conclusions: PDT is quicker to perform and has lower blood loss and complication rates compared to conventional tracheostomy. However percutaneous tracheostomy is not indicated in emergencies and in children. The cost of the percutaneous kit and use of bronchoscopy adds to the cost. It is a good alternative to conventional tracheostomy in properly selected patients.

Significance of styloidectomy in Eagle’s syndrome: an analysis

Objectives/hypothesisReported here is a randomized retrospective analysis of 28 cases of elongated styloid process causing nagging cervicofacial pain, both unilateral and bilateral, and the effect of styloidectomy in these cases in relieving the symptom complex of the patient, in situations where conservative management failed in alleviating the symptoms.Study designRandomized retrospective analysis over a period of 25 months.ConclusionElongated styloid process causing glossopharyn-geal neuralgia is beginning to be a frequently encountered clinical entity nowadays. Of the 28 cases of elongated styloid process who underwent unilateral/bilateral styloidectomy, 27 patients had total relief of symptoms. Hence, we advocate styloidectomy, following careful diagnosis of the entity with clinical and radiological correlation, if the patient does not respond to medical therapy. The psychological status of the patient would provide clue to the authenticity of the symptoms in unrelieved cases.

Endoscopic Medial Maxillectomy Breaking New Frontiers

Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management of benign sino-nasal tumours. We present our experience of endoscopic medial maxillectomy in the management of sinonasal pathologies.

Sino Nasal Teratocarcinosarcoma-An Interesting Clinical Entity

Sinonasal teratocarcinoma is a rare tumour of the paranasal sinuses. It was earlier termed as teratoid carcinosarcoma or teratocarcinoma. It is a highly aggressive tumour with a 5 year survival rate of 45 %. Here we report a case of sinonasal teratocarcinoma who was managed excision of tumour by lateral rhinotomy approach followed by radiotheraphy.

Pneumatic Balloon Dilatation of the Trachea: New Hope for Tracheal Stenosis

Post intubation tracheal stenosis is a clinical problem caused by regional ischemic necrosis of the airway. Its treatment options include tracheal resection with end to end anastomosis, laser resection and stenting. Laser resection followed by balloon dilatation of the soft stenosis is an innovative procedure. It is relatively simple and inexpensive procedure to perform. This case report highlights the importance of this innovative surgical procedure to alleviate the suffering of this elderly diabetic male with chronic renal failure and with a poor cardiac status ‘a high risk surgical patient’. Laser ablation of the stenotic segment followed by balloon dilation was performed under direct visualization. Quality of life following this procedure is also good in relation to post-operative morbidity.

Minimally Invasive Endoscopic Surgical Repair of Recurrent Complete Third Branchial Fistula in a Nine Year Old Girl

Congenital anomalies of the branchial arches are well known with fistulas presenting in the head and neck region. A proper diagnosis of this uncommon entity is mandatory for a successful surgical repair in the first attempt itself. In this case report, we profile a patient who was subjected to multiple surgeries only to result in subsequent breakdowns and resurfacing of symptoms. An innovative attempt was made with the use of endoscopes and minimally invasive surgical methods to repair this recurrent fistula and followed up with a repeat fistulogram which showed a complete closure of the tract without any co-morbidity.

Benign tumours of nasopharynx-revisited.

Benign tumours of nasopharynx are extremely rare; seen predominantly in children and young adults. Patients usually present with seemingly innocuous symptoms and an error in judgement can be catastrophic. This is a retrospective analysis of patients diagnosed to have benign tumours of nasopharynx by histopathological examination in our tertiary care referral centre. The period of study is from September 2009 to August 2010. Eight patients with complete clinical data were identified and included in the study. All the patients were males with a mean age of 21.37 years (range 10–43). Following surgical excision patients were followed up for a mean period of 6.5 months (range 3–14). The Clinical profile, investigation modalities, treatment options are being analysed here.