Produl Hazarika

Endoscopic repair of cerebrospinal fluid rhinorrhea - Manipal experience

Otolaryngologists play a major role in the management of cerebrospinal fluid (CSF) rhinorrhea. A thorough understanding of the underlying pathophysiology and the various treatment options available is essential to achieve the best possible results.In this paper, we are highlighting the pathophysiology, diagnosis and surgical technique involved in the repair of cerebrospinal fluid rhinorrhea. A retrospective study conducted in the department of ENT and Head and Neck Surgery, Kasturba Hospital, Manipal is presented to highlight our experience with cerebrospinal fluid rhinorrhea.Eleven patients were managed in the department of otolaryngology between 1999 and 2005. Seven had spontaneous CSF rhinorrhea, three were due to trauma and one iatrogenic, following surgery. Commonest anatomic site of leak was the cribriform plate in 4 cases. Other sites included sphenoid [2], lateral lamella [2], fovea ethmoidalis [2] and olfactory groove [1]. Onlay technique was performed in 10 out of 11 patients. Closure was successful in 10 out of 11 cases in the first attempt. One patient underwent revision surgery. Patients were followed up for a period ranging from 3 months to 3 years.CSF rhinorrhea is a potentially fatal condition which requires precise and urgent treatment. The transnasal endoscopic repair of CSF leak has a high success rate with low morbidity when performed by experienced endoscopic sinus surgeons. Our experience in managing this condition is presented.

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.

Deep and Unusual Sialolithiasis of Submandibular Duct and Gland: A Surgical Dilemma

Giant solitary submandibular duct calculus and multiple calculi of the gland are extremely rare. This occurrence along with more deep and proximally placed common calculi in submandibular gland may occasionally cause a dilemma in selection of the appropriate surgical approach in the present era of sialoendoscopic surgery. There is a high chance of fracture of the stone in a proximally placed stone in the gland followed by likely dissemination of fragments of the stone into the gland parenchyma during the procedure of sialoendoscopy which is a matter of grave concern. We authors believe that excision of the submandibular gland with the stone in such a situation should still be preferred as the gold standard of treatment leaving the ductal stone for endoscopic removal.

Avulsion of malleoincudal complex with dislocation: A rare ossicular chain injury by using an indigenous claw-like ear hook with review of literature

Direct ear trauma through external auditory canal causing an avulsion injury of malleoincudal complex is a grievous injury that can happen during ear cleaning with indigenous ear hook. One such case of avulsion injury is presented here with its symptomatology, investigation, and management with the review of available literature because of its rarity. Various locally designed indigenous ear hooks are available in street side markets and even online for purchase and used by many without knowing its ill effects on health. Injury caused by these types of hooks may lead to a severe hearing disability, if not properly treated. This presentation is to highlight the fact that indigenous ear hooks; rampantly available online for purchase can cause a potentially major injury leading to hearing disability and thereafter poor quality of life. Reporting and highlighting of such incidents among the ENT community can help increase the public awareness; thereby, eliminating such disastrous consequences. Wikipedia, PubMed, and Google search engine has been used for our data collection and analysis.

Sequential pictorial account of results of sealant gel-aided cable nerve grafting in a case of iatrogenic facial nerve palsy

The uniqueness of this surgical case report is in the use of a stitchless anastomosis of the harvested greater auricular nerve cable graft with the sealant gel to the stump ends of the facial nerve. A liberal use of the gel was done in the full length of the cable graft and a folded hammock support by the temporalis fascia was used to reinforce the stability of the nerve. The restoration of the grafted facial nerve has been documented in different stages in its course of the recovery. Our review of medical literature in PubMed and Medscape search engines failed to show such a sequential pictorial account of documented nerve grafting with the use of sealant gel in the Indian perspective.

Endoscopic KTP532 Laser Resection of Early Laryngeal Cancer

study is to assess the feasibility of endoscopic CO2 laser cricopharyngeal myotomy and/or stricture ablation in the setting of prior radiotherapy. METHOD: A retrospective review of patients who underwent endoscopic CO2 laser cricopharyngeal myotomy with or without stricture ablation for dysphagia after radiation for squamous cell carcinoma of the head and neck (SCCHN). Pre and postoperative barium swallow studies were performed as well as formal speech pathology evaluation before and after surgery. Outcomes and complication rates were examined. RESULTS: Between July 2008 and November 2009, 9 patients with prior treatment for SCCHN with chemoradiation were identified with dysphagia as a result of cricopharyngeal stenosis/stricture by barium swallow. Endoscopic CO2 laser cricopharyngeal was performed on all patients. No complications were observed. Documented resolution of stenosis was observed on barium swallow in 8 of 9 patients, with partial resolution in the other patient. Swallowing improved from liquid diet to a regular diet in 4 patients, and from gastrostomy tube dependence to a soft diet in three patients, including the patient with partial resolution. Additional dilation was necessary only in the one patient with incomplete stricture ablation, who declined additional endoscopic surgery. CONCLUSION: Endoscopic CO2 cricopharyngeal myotomy can be performed safely in the setting of prior chemoradiation, with significant improvement in swallowing in select patients. Indications and technical considerations will be discussed.

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®

Solitary malignant schwanoma of para pharyngeal space-a case report and review of literature.

Malignnant Schwannom is an aggressive tissue tumor that is more cnmitutnh found m assoiiatiun with Ion Recklinghausens disease. The solitary tumors although rarer have a better prognosis when compared to those associated witk tan Recklinghausens disease. Parupharyngeui tumors are rare and a majority af these are benign salivary or neurogenie tumors, A malignant Schwannoma at this site is very infrequent with only four earn reported so far. The tase of a 16 year old girl with a parapharynccal malignant Schwnnaomu is presented Jor its rarity and our experience in dealing with it. .A combined modallty oftretument with surttery, radiotherapy and chemotherapy Was used. Pertinent literature h revlewed

A case of foreign body in the subglottic region

An impacted foreign body in the subglottis is a rare cause of upper airway obstruction in children. More often than not the diagnosis is delayed; especially where proper history is not forthcoming. This peculiar condition can masquade as laryngotracheobronchitis or a croup. Though it is rare, a foreign body in the subglottis should be kept in mind in the investigation of a child with stridor.