S. K. Kacker

Nasal septal deviation: Effective intervention and long term follow-up

Nasal septal deviation (DNS) occurs more frequently during childhood although it occurs at any age due to trauma. Recently, it has been increasingly recognized that nasal septal deviation is seen also at birth and a number of explanations for this occurrence is forwarded. Awareness of such occurrence and its recognition at birth both by pediatricians and obstetricians is essential for early interventional management of this condition in close collaboration with the otorhinolaryngologists. Closed surgical intervention of this defect carried out early after it was detected at birth benefitted the afflicted in terms of nasal airway improvement and its maintenance resulting in normalization of its anatomy and physiology in long term follow-up. Septal deviation detected at birth if left alone without interventional procedure continues to persist. It is furthermore accompanied by statistically valied symptoms like upper respiratory infections, cough, earache, ear discharge, fever, mouth breathing and at times feeding difficulty during infancy and childhood. Long term follow-up of children who underwent closed surgical correction of DNS at birth, revealed no untoward effects such as nasofacial disproportion or retardation of facial growth. Early interventional management of DNS detected at birth therefore appears to be a safe procedure. It can even be performed by neonatologists or an obstetrician. Such an intervention procedure early in life can prevent septoplasty surgery at a latter date besides preventing a number of nasal airway-related conditions.

Nasopharyngeal angiofibroma: (A nine-year experience)

In a nine-year period 50 nasopharyngeal angiofibromas, of whom 13 had recurrent tumour, were treated surgically at the All India Institute of Medical Sciences, New Delhi. A new staging system according to the regions involved was used; 31 patients in whom the tumour was limited to the nasopharynx (Stage I) and those with superior spread into the ethmoid or sphenoid sinuses (Stage IIA) had their tumours removed by a transpalatal route, alone or in combination with other approaches. Tumours with lateral extensions into the pterygopalatine or infratemporal fossae or the cheek (Stage IIB), and those with simultaneous superior and lateral spread (Stage III) underwent a transmaxillary excision (19 cases). In two of the three cases with intracranial extension (Stage IV), the tumour was removed successfully from below. There was no mortality. The usefulness of the transmaxillary approach, especially in recurrent cases, is emphasized. No adjuvant modalities were employed in this series and blood loss was acceptable.

Oral malignant melanoma (A case report and review of literature)

Oral malignant melanoma is rare and has a poor prognosis. We report a case of melanoma of the lower alveolus with rapid spread to the cervical lymph nodes and breast. Metastasis was diagnosed by fine needle aspiration cytology. The literature on oral melanoma is also reviewed.

Benign osteoblastoma of the nasal bones (a case report).

A case of benign osteoblastoma of the nasal bones has been described. Osteoblastoma is rare in the facial bones. The present case may be the first case to be reported in the nasal bones.

Need-based undergraduate medical curriculum

There is a growing concern over the quality of medical education for undergraduates in India. This paper is an attempt to define a need-based curriculum and outline the initiatives taken by the Medical Council of India (M.C.I.) in developing a need-based curriculum. The steps include: clear delineation of goals and objectives of education; adoption of innovative teaching and learning methodology, adjustments in the course structure, updating of course content, rationalizing assessment strategy, and emphasis on structured and skill oriented internship.For effective implementation of these measures, strategies such as establishment of Medical Education Unites (MEUs), visible funding of education more recognition to teaching and impetus to staff development activities have been suggested.

Inquiry-Driven strategies for innovation in medical education: Experiences in India

Four medical institutes, viz, AIIMS, New Delhi; CMC, Vellore; JIPMER, Pondicherry and IMS-BHU, Varanasi formed a consortium to introduce reforms in undergraduate medical education. A detailed inquiry was conducted by administering questionnaires to the faculty, recent graduates and patients to identify the deficiencies in the present system. Morbidity patterns prevalent in the community at primary, secondary and tertiary care levels were determined. These were matched with the actual curricula being followed and the assessment patterns. The main findings were: inadequate emphasis on practical skills (including communication), insufficient coverage of common diseases; and neglect of behavioral, social and ethical aspects in the curriculum. Based on these findings certain corrective programmes are being introduced. The content areas in the curriculum have been classified in to ‘must know’, ‘good to know’ and ‘need not know’. A list of essential skills have been identified. Steps are on to ensure that these skills are acquired by the graduates. A modular approach to the teaching was suggested and modules on some of these topics are under preparation.

Nasal septal deviation at birth and its diagnosis

Nasal septal deviation occurs at all ages. It occurs mostly during childhood due to trauma. It is also seen at birth and during early childhood. Hence awareness of this disorder among the pediatricians, the otolaryngologists, and the obstetricians is important, as it can be detected at the earliest possible and thus can be prevented.

Oral-pharyngeal histoplasmosis: (A clinico-pathological study, with a literature survey)

Histoplasmosis is a rare disease in India. We are reporting this disease in a middle-aged non-Caucasian male who has never travelled outside India. Successful treatment was achieved with the nephrotoxic anti-mycotic drug (Amphotericin B), despite a pre-existing renal impairment.

Diagnosis of septal deformities in newborns

The discrepancies in the incidences of septal deformities in the newborns reported in literature have been analysed and discussed. A protocol for the detection of septal deformities in the newborns has been presented.

Surgery for parapharyngeal space tumours

Tumours of the parapharyngeal space are rare lesions. The present paper briefly discusses the preoperative evaluation and surgical approaches used in 36 patients. A C.T. scan is extremely useful adjunct in preoperative diagnosis. It helps to differentiate between parotid from the extra parotid masses and in assessing the extent of tumour and probably histology of the lesion. Angiography is not routinely indicated. Surgical approach can be planned in the basis of C.T. scan findings.