Nitish Virmani

Secondary laryngeal tuberculosis revisited.

Introduction: Laryngeal tuberculosis is often misdiagnosed and is a highly contagious public health problem. The changing pattern of the clinical involvement of this disease poses a diagnostic challenge. The authors report four cases of laryngeal tuberculosis encountered in a short span of one month. Materials and Methods: All the four patients who presented to us with hoarseness had underlying active lesions in the lung. In spite of that they presented with mainly laryngeal symptoms and a multitude of findings on laryngeal examination. A diagnosis could be established owing to a high index of clinical suspicion, and due consideration given to the chest findings and positive sputum examination. The patients showed an excellent response to antituberculous therapy. Results and Conclusions: This study underlines the varied nature of laryngeal tuberculosis and the importance of addressing the hoarseness of a patient at the earliest, for the prompt diagnosis of this infectious condition.

Medullary carcinoma of thyroid: Case report and a review of literature

Medullary thyroid carcinoma (MTC) constitutes around 5% of all thyroid cancers. It accounts for as much as 13% of all thyroid cancer-related deaths. MTC usually arises from parafollicular C-cells that normally secrete a number of peptide hormones such as calcitonin, serotonin, and vasoactive intestinal peptide; thus, it is widely accepted as a neuroendocrine tumor. Both sporadic and familial forms are seen, the sporadic form being responsible for 70% of the cases and familial form for 10-20% of the cases. Here, we present a case report of two patients with sporadic MTC. The first patient underwent total thyroidectomy with central compartment neck dissection and right lateral neck dissection, and also in the second patient, total thyroidectomy with central compartment neck dissection was done. Final histopathology came out to be medullary carcinoma of the thyroid. Postoperative serum calcitonin at 2 months following the surgery came out to be normal. Both the patients are on regular follow-up, and there has been no recurrence. Genetic screening and the evaluation of familial syndromes should always be considered in preoperative work-up in MTC patients. Early diagnosis offers a higher likelihood of cure and long-term survival. Total thyroidectomy plus central compartment neck dissection is the mainstay of treatment. All patients must be kept on regular follow-up to avoid recurrence.

A clinicopathological study of oral potentially malignant disorders

Introduction: Oral cancer is the leading cause of cancer in India accounting for approximately 40% of the cancer burden. A significant number of these are preceded by precancerous lesions and conditions, together referred to as potentially malignant disorders (PMDs). It is important to screen patients for these conditions as they allow physicians to intervene early for prevention as well as early diagnosis of oral cancer. Aims: To study the demographic profile, etiology, clinical profile, and histopathology of oral PMDs. Materials and Methods: Patient evaluation was done in the outpatient department of a tertiary referral center, and those who complained of oral mucosal lesions were examined between March 2011 and March 2012. They were evaluated and treated according to their diagnosis and were observed for 1½ years, with minimum of 4 follow-ups. Results: Of the 23,380 patients who attended the outpatient department between March 2011 and March 2012, 70 (0.29% incidence) patients had oral potentially malignant lesions. Age group most commonly affected was 21–30 years (28.57%). Males were affected more than females (m = 50; f = 20). Smokeless tobacco was the most common risk factor (58.57%). Among single site lesions, buccal mucosa was most commonly affected. Based on histopathology, “leukoplakia without atypia” was the most common lesion followed by oral submucous fibrosis. Conclusions: There is a change in the trend of the age distribution of the oral potentially malignant lesions with younger generation and females being involved more and also a definite relation between tobacco-related abuses and oral lesions.

Laser-assisted posterior cordotomy for bilateral vocal fold paralysis: Our experience

Introduction: Bilateral vocal fold paralysis (BVFP) is a relatively uncommon cause of respiratory distress. The goals of surgical treatment are an improvement in airway size by enlarging the glottis, thus, eliminating the need for tracheostomy, while at the same time avoiding a breathy voice and aspiration. Striking this balance is extremely important. Unilateral laser-assisted posterior cordotomy provides sufficient airway at posterior glottis while preserving phonatory and protective functions of the larynx. Aims: To evaluate long-term acoustic, aerodynamic and functional results of laser-assisted unilateral posterior cordotomy in BVFP. Materials and Methods: The prospective study includes seven patients of BVFP who underwent unilateral laser-assisted posterior cordotomy. Surgical success was evaluated regarding decannulation rate, time to decannulation and need for the second procedure. Voice assessment was done using voice handicap index (VHI), grade, roughness, breathiness, asthenia, strain and measurement of maximum phonation time (MPT). Effect of deglutition was assessed by the presence or absence and duration of aspiration. Observations and Results: Of seven patients, four had been tracheostomized at some time during their treatment. They were successfully decannulated within an average of 1 week after the surgery. The postoperative respiratory function was adequate for more than routine activity in all patients. None of the patients required a second procedure. VHI values demonstrated that while four patients had no/mild degree of voice handicap, two had moderate and one had a severe degree of handicap. While five patients had a normal MPT, two had a reduced MPT. Perceptual rating by a speech pathologist revealed that while two patients had mild dysphonia, four had moderate dysphonia. None of the patients complained of aspiration postoperatively. Conclusion: Unilateral CO2laser posterior cordotomy is a simple, safe and short surgical technique that creates a satisfactory glottic airway to improve respiration while avoiding aspiration and having minimal to the mild effect on the voice.

Tensor fascia lata interposition for treatment of Frey’s syndrome: a forgotten surgical technique?

Frey’s syndrome which manifests clinically as unilateral facial sweating and flushing on salivary stimulation and mastication, is postulated to result from aberrant regeneration of sectioned autonomic nerve fibers. Many surgical and non-surgical treatment modalities have been described with varying degrees of success to relive the symptoms. In this case report, we describe the surgical technique of tensor fascia lata interposition as a simple and reliable treatment option for Frey’s syndrome.