Mangal Singh

Comparative study of the underlay and overlay techniques of myringoplasty in large and subtotal perforations of the tympanic membrane

Myringoplasty is an established procedure. However, the quest is on to improve the results further by studying the different influencing factors, that could possibly affect the outcome. In the present randomized prospective study of one years duration, 60 patients having dry, large and subtotal perforations of the tympanic membrane were subjected to myringoplasty, 30 by the overlay technique and 30 by the underlay technique keeping all other influencing factors constant. The graft take-up rate was found to be the same (93.3 per cent) in both techniques but the underlay technique was judged to be better because of its technical ease, better assessment of ossicular chain integrity and mobility, less time consumption (55 minutes vs 90 minutes), earlier healing of graft (four to six weeks vs six to eight weeks), hearing gain in more patients (92.8 per cent vs 57.1 per cent) and fewer minor complications (6.6 per cent vs 33.3 per cent).

Comparative study between the Hybrid Capture II test and PCR based assay for the detection of human papillomavirus DNA in oral submucous fibrosis and oral squamous cell carcinoma

BackgroundOral malignancy is a major global health problem. Besides the main risk factors of tobacco, smoking and alcohol, infection by human papillomavirus (HPV) and genetic alterations are likely to play an important role in these lesions. The purpose of this study was to compare the efficacy of HC-II assay and PCR for the detection of specific HPV type (HPV 16 E6) in OSMF and OSCC cases as well as find out the prevalence of the high risk HPV (HR-HPV) in these lesions.Methods and materialsFour hundred and thirty patients of the potentially malignant and malignant oral lesions were taken from the Department of Otorhinolaryngology, Moti Lal Nehru Medical College, Allahabad, India from Sept 2007-March 2010. Of which 208 cases were oral submucous fibrosis (OSMF) and 222 cases were oral squamous cell carcinoma (OSCC). The HC-II assay and PCR were used for the detection of HR-HPV DNA.ResultThe overall prevalence of HR-HPV 16 E6 DNA positivity was nearly 26% by PCR and 27.4% by the HC-II assay in case of potentially malignant disorder of the oral lesions such as OSMF. However, in case of malignant oral lesions such as OSCC, 32.4% HPV 16 E6 positive by PCR and 31.4% by the HC-II assay. In case of OSMF, the two test gave concordant result for 42 positive samples and 154 negative samples, with an overall level of agreement of 85.4% (Cohens kappa = 66.83%, 95% CI 0.553-0.783). The sensitivity and specificity of the test were 73.7% and 92.05% (p < 0.00). In case of OSCC, the two test gave concordant result for 61 positive samples and 152 negative samples, with an overall level of agreement of 88.3% (Cohens kappa = 79.29, 95% CI 0.769-0.939) and the sensitivity and specificity of the test were 87.14% and 92.76% (p < 0.00).ConclusionThis study concluded that slight difference was found between the positivity rate of HR-HPV infection detected by the HC-II and PCR assay in OSMF and OSCC cases and the HC II assay seemed to have better sensitivity in case of OSCC.

Correlation of histopathological diagnosis with habits and clinical findings in oral submucous fibrosis.

BackgroundOral submucous fibrosis is a common oral health problem in India. This study was conducted to correlate the histopathological diagnosis with habits and clinical findings in patients suffering from oral submucous fibrosis (OSF).MethodsPatients suffering from oral submucous fibrosis from the Departments of Otorhinolayngology and Pathology, Moti Lal Nehru Medical College, Allahabad, India were studied from 2004–2008. Detailed information was gathered in a pretested proforma. Emphasis was given to the various addictions, clinical findings and histological examination was done.ResultsTwo hundred and thirty nine patients were studied, yielding a male to female ratio of 6.8:1. Maximum patients were in the 21–30 years age group with a marked male predominance. Of these, 197 (82.4%) patients chewed areca nut/dohra, 14 (5.8%) were smokers and 2 (0.8%) patients were habituated to alcohol. 89(37.2%) patients reported difficulty in opening of the mouth (trismus). 51 (57.4%) patients were found to have stage II (2–3 cm) trismus while rest had stage I and III. The buccal mucosa was found to be the most commonly involved site. On the basis of histopathological examination, 52(21.7%) were classified as OSF grade I, 75(31.3%) patients as grade II and 112(46.8%) had grade III disease.ConclusionThe widespread habit of chewing dohra/paan masala is a major risk factor of OSF, especially in the younger age group. In this study, an increase in histopathological grading was found with severity and duration of addiction habit. However no significant correlation was found between clinical staging and histopathological grading.

Synergistic effect of stromelysin-1 (matrix metalloproteinase-3) promoter (-1171 5A->6A) polymorphism in oral submucous fibrosis and head and neck lesions

BackgroundMatrix metalloproteinases (MMPs) are enzymes that degrade all the components of extra cellular matrix and collagen. Various types of MMPs are known to be expressed and activated in patients with oral submucous fibrosis (OSMF) as well as head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to asses the association of the single nucleotide polymorphism (SNP) adenosine insertion/deletion polymorphism (-1171 5A->6A) in the MMP-3 promoter region in these lesions.MethodsMMP-3 SNP was genotyped by polymerase chain reaction-restriction fragment polymorphism (PCR-RFLP) analysis in a case control study consisting of 362 participants; 101 cases of OSMF, 135 of HNSCC and 126 controls, compared for age, sex and habits. ROC distribution was plotted to assess the contributions of genetic variation in MMP-3 genotypes with relation to age.ResultsAnalysis of MMP 3 (-1171 5A->6A) polymorphism revealed the frequency of 5A allele in OSMF, HNSCC and controls to be 0.15, 0.13 and 0.07, respectively. A significant difference was found in 5A genotype frequency between OSMF (5A genotype frequency = 0.15, p = 0.01, OR = 2.26, 95% CI = 1.22-4.20) and in controls (5A genotype frequency 0.07) as well as HNSCC (5A genotype frequency 0.13, p = 0.03,95%CI = 1.06-3.51) and controls (5A genotype frequency = 0.07) In this study, 5A genotype had greater than two fold risk for developing OSMF (OR = 2.26) and nearly the same in case of HNSCC (OR = 1.94) as compared to controls. In patients with OSMF as well as HNSCC, the ROC analysis between the MMP-3 genotype and age, 6A/6A allele was found to be significant in patients both over and under 45 years of age; while the 5A/5A carrier alleles showed an association only in patients less than 45 years of age.ConclusionsThis study concluded that the expression of MMP-3 genotype associated with the 5A alleles, it may have an important role in the susceptibility of the patients to develop OSMF and HNSCC.

Role of functional polymorphism of matrix metalloproteinase-2 (-1306 C/T and -168 G/T) and MMP-9 (-1562 C/T) promoter in oral submucous fibrosis and head and neck squamous cell carcinoma in an Indian population

The aim of this study was to explore the association of MMP-2 (-1306 C/T and -168 G/T) and MMP-9 (-1562 C/T) promoter polymorphisms in oral submucous fibrosis (OSMF) and head and neck squamous cell carcinoma (HNSCC) cases. These SNP were genotyped by PCR-RFLP. Total of 1260 individuals were recruited, of which 412 OSMF, 422 HNSCC and 426 were controls. In HNSCC, MMP-2 (-1306 C/T) and MMP-9 (-1562C/T) polymorphism, T allele showed strong association (p < 0.00 and p < 0.01) as compared to healthy control respectively, but not in case of OSMF and showed significant association with increasing progression of clinico-pathological grading. We concluded that SNPs in the MMP-2 and -9 promoter region may be associated with susceptibility to HNSCC not in OSMF.

Intranasal endoscopic DCR (END-DCR) in cases of dacryocystitis.

A prospective study on 27 cases of chronic dacryocystitis was done to see the outcome of management by End-DCR in Indian population and to look for advantages or disadvantages over Ext-DCR from available datas in literature All cases were diagnosed clinically by regurgitation test and lacrimal syringing In selected cases Jones dye test, dacryocystogram and CT scan of nose and paranasal sinuses (PNS) was done to confirm the site of obstruction and find out the cause Cases having hyperlacrumation due to other causes and epiphora due to presaccal stenosis were excluded Cause of NLD obstruction was atrophic rhinitis (4 cases), chronic sinusitis (4 cases), enlarged agger nasi cells (4 cases), faciomaxillary injury (1 case) and unknown in rest of cases All cases were treated by End-DCR under local anaesthesia Concommitent nose and PNS surgeries were done in selected cases where it was supposed to be the cause Average follow-up was from 3 months to 1 year Primary success rate was 92 6% and after revision in two cases final success was 96% Success rate was 100% in cases of atrophie rhinitis Major complication was not found in any case Our result of End-DCR was as good as Ext-DCR Our results of End-DCR are better than those who had used lacnmal stent, lasers, microdebriders, dacryoendoscope and electrocautery It was finally concluded that end-DCR by using simple instruments is a safe and effective procedure

Histological changes to palatal and paratubal muscles in oral submucous fibrosis

Oral submucous fibrosis (OSMF) is prevalent in the Indian subcontinent. In a large number of patients conductive deafness due to eustachian tube dysfunction has been found. The present study was, therefore, planned to assess the histopathological changes in palatal and paratubal muscles in oral submucous fibrosis. Incisional biopsy from the soft palate was taken in clinically proven cases of OSMF. In most of the cases, signs of chronic inflammation and fibrosis were seen in the submucosa. Dysplasia was noticed in seven (13.2 per cent) patients. Degenerative changes in palatal/paratubal muscles were found in the form of loss of cross striations in seven (13.2 per cent), oedematous muscle fibres in five (9.4 per cent) and atrophy in five (9.4 per cent) cases. It was concluded that there was definite involvement of palatal and paratubal muscles in OSMF. This could explain the eustachian tube dysfunction in these patients.

Correlation of addictive factors, human papilloma virus infection and histopathology of oral submucous fibrosis.

BACKGROUND Oral submucous fibrosis (OSMF) is a widely prevalent, potentially malignant disorder of the oral cavity in the Indian subcontinent. Areca nut has been incriminated as the main causative factor. However, other factors, including viruses may also play a role in the initiation/development of these lesions. This study was designed to assess the correlation of addictive factors, human papilloma virus infection and histopathology of OSMF. METHODS One hundred and thirteen cases of OSMF were studied. Demographic information of each patient, including the patients age, sex, addiction habits and histopathological grading was obtained. Presence of high-risk human papilloma virus (HR-HPV) DNA was detected using the Hybrid Capture II assay. RESULTS Of 105 cases finally included in the study, 33 (31.4%) patients were found to be positive for HR-HPV, while 72 (68.6%) were negative. A total of 52/105 (49.5%) patients chewed areca nut, of whom 18 (34.6%) patients were found to be positive and 34 (63.5%) were negative (P = 0.08). A total of 18/105 (17.1%) patients were addicted to smoking, of whom five (27.7%) were positive (0.69). Only one (11.1%) patient, who was only habituated to alcohol, was positive (1.08). Of the 105 patients 26 (24.7%) chewed as well as smoked tobacco, of whom, nine (34.6%) were positive and 17(65.3%) were negative (P = 0.67). Thus, there was no significant association between the various addiction habits and the presence of HR-HPV. On correlating the various histopathological grades of the disease with HR-HPV positivity a Pearson correlation of 0.053 was obtained (P = 0.588). Thus, again no significant correlation was observed between the different histopathological grades and HR-HPV positivity. CONCLUSION In conclusion, it was found that there is neither significant correlation between HR-HPV infection and the various addiction habits nor with the different histopathological grades of the disease. To the best of our knowledge, a study of these different factors has never been attempted before in patients with OSMF.

Autofluorescence—an important ancillary technique for the detection of Mycobacterium tuberculosis: Revisited

Tuberculosis is one of the oldest diseases known to affect humans and is caused by Mycobacterium tuberculosis. Lymph nodes are the most common site of extrapulmonary involvement. Tuberculous lymphadenitis can be presumptively diagnosed morphologically on fine‐needle aspiration biopsy of lymph nodes. Additional tests like Ziehl‐Neelsen (ZN) stain for detection of acid fast bacilli, fluorescence, and molecular markers are often employed for confirmation of diagnosis. However, culture is essential for obtaining a definitive diagnosis. Unfortunately, culture is time consuming and expensive. Newer investigative methods are required. The efficacy of autofluorescence in the diagnosis of tuberculous lymphadenitis was evaluated for this purpose. Fine‐needle aspiration biopsies were collected from patients with a clinical diagnosis of tuberculous lymphadenitis. Cytomorphological examination, ZN staining, autofluorescence, and culture were performed on all specimens. ZN staining was positive in 37.5% (30/80) of cases, while autofluorescence was positive in 57.5% (46/80) of patients and was found to have 81.8% specificity, 95% sensitivity, and a positive predictive value of 82.6%. This technique allowed rapid and early diagnosis of tuberculous lymphadenitis in a number of patients, permitting early institution of appropriate therapy. Diagn. Cytopathol. 2013;41:330–334.

Our experiences with parapharyngeal space tumors and systematic review of the literature

ObjectivesTo find out the geographical distribution, age, sex, mode of presentation, diagnostic modalities, surgical approaches, postoperative complications, follow-up and histopathology of parapharyngeal space tumors (PFT) through world wide web search (WWWS) and PFT of our series.Materials and methodsA retrospective study of all PFT seen and treated in S.R.N Hospital, Allahabad between 1990 and 2006 was done. A systematic review of the literature was done through WWWS.ResultsPFT were commonest in the Asian zone. Incidence was highest in the 3rd and 4th decade. Oropharyngeal (100%) and cervical (91.6%) swelling were the commonest presentation. MRI is better than CT scan in evaluating fat plane. Transcervical approach was the commonest. In our series, benign tumors (83.4%) were common, constituting 50% of neurogenic and 16.6% of salivary gland origin.ConclusionPFT were more prevalent in the Asian zone. Neurogenic tumors were commonest in our study which contradicts the WWWS of having maximum PFT of salivary gland in origin.