Bengal Journal of Otolaryngology and Head Neck Surgery

Airway Fire During Tracheostomy

Murali T.V. — 2023-07-29

Introduction

Airway fire is a life-threatening complication in the operation table which is preventable. We report an incident of airway fire that occurred during a tracheostomy and discuss what went wrong.

Case report

A 48-year-old gentleman with carcinoma tongue and multinodular goiter underwent modified radical neck dissection, hemithyroidectomy, tracheostomy, hemi glossectomy, and free radial forearm flap reconstruction. During tracheal hemostasis with cautery, a flame appeared, and airway burns resulted. It was extinguished in a few seconds with wet mops, but the resultant combustion injury of the tracheobronchial tree and later bilateral pneumonia required multiple sittings of bronchoscopic toileting and intensive airway management for recovery.

Discussion

This report is to make anesthetists and surgeons aware of such a rare but life-threatening complication, its prevention, and early therapeutic steps which can prevent long-term complications and death.

Unusual Intra-Orbital Foreign Body Removed by a Unique Surgical Approach

Shriyash Sinha — 2023-07-29

INTRODUCTION

A retained intra-orbital foreign body can give rise to serious complications. This case report highlights an interesting case where a metallic foreign body remained lodged inside the orbit for over a year, unbeknownst to the patient, and was eventually detected and surgically extracted.

CASE REPORT

We report a case of a 57-year-old female who presented with mild pain of the left orbit following an injury with an umbrella after a fall one year ago. Following a near normal physical examination, on radiological evaluation we found a linear, presumably metallic foreign body lodged into the orbit, without piercing the globe. An inferolateral orbitotomy approach was used to gain adequate exposure and facilitate the removal of a 3.5 cm metallic remnant of an umbrella stick.

DISCUSSION

The management of intra-orbital foreign bodies poses several challenges. The choice between conservative and surgical management is one of them. CT scan is the diagnostic tool of choice. When surgical removal is indicated, a suitably planned approach facilitates extraction of the foreign body with minimal morbidity. This rare case is testament to the fact that although it may not be part of their conventional realm, carefully selected intra-orbital foreign bodies can be efficiently managed surgically by ENT professionals.

Clinical Pearls of Branchial Cleft Cyst Management in an Adult

Niya Joseph Neelamkavi — 2023-07-29

INTRODUCTION: Second branchial cleft anomalies most commonly present as cysts followed by sinuses and fistulae. They have been classified into four different sub-types by Bailey. Type II is most common type where the branchial cleft cyst (BCC) lies anterior to the sternocleidomastoid muscle, posterior to the submandibular gland, adjacent and lateral to the carotid sheath. In this article, a case of type II second branchial cleft anomaly is presented.

CASE REPORT: This article aims to portray how to evaluate a patient with second branchial cleft cyst focussing, focusing on how its diagnosed and its appropriate management. A young woman who had chief complaint of swelling of left side of the neck visited our outpatient department. She underwent complete excision of the lesion. There was no recurrence at 1year follow-up visit.

DISCUSSION: Most branchial anomalies arise from the second branchial apparatus. Most second BCCs are located in the submandibular space. Patients with BCCs are usually older children or young adults. MR imaging provide the surgeon adequate preoperative information. Treatment for these lesions is complete surgical excision.

Primary Thyroid Lymphoma: An Interesting Case Emphasising Early Diagnosis

Bipin Kishore Prasad — 2023-07-29

Introduction: Primary thyroid lymphoma is defined as a lymphoma involving only the thyroid gland, or thyroid gland with regional lymph nodes without contiguity or metastasis to other areas at the time of diagnosis. Hashimoto’s thyroiditis is a known risk factor for the disease. It responds well to chemotherapy but since it is a rare clinical entity, the diagnosis is often missed, thereby subjecting the patient to extensive surgery.

Case report: A 69 years old male presented with rapidly progressive swelling in front of neck for 10 days associated with dysphagia, odynophagia and dyspnoea. He had right lobe thyromegaly with multiple cervical lymphadenopathy with ultrasonographic risk stratification of TIRADS 5. Diagnosis was clinched by core biopsy report on immunohistochemistry as Diffuse Large B Cell Non-Hodgkin’s Lymphoma. Positron emission tomography computerized scan revealed 18-fluorodeoxyglucose avid grossly enlarged thyroid lobes and isthmus with multiple bilateral cervical lymph nodes. Documenting the stage of disease as III E, he was managed with Chemo-immunotherapy consisting of RCVP regime with complete remission.

Conclusion: Primary thyroid lymphoma with extra-thyroid involvement can be rapidly progressing and life threatening. However, timely investigation leads to correct diagnosis, appropriate curative medical management and can avoid unwarranted surgery.

A Rare Case of Sino-Nasal Rosai Dorfman Disease

Anushree BajaJ — 2023-07-29

ABSTRACT :
Introduction: Rosai-Dorfman disease (RDD) is a very rare nonneoplastic lymphoproliferative disease with unknown etiology and pathogenesis. It was originally described as sinus histiocytosis with massive lymphadenopathy(SHML). Approximately 43% of Rosai-Dorfman disease show extra nodal involvement wherein the possible sites are skin, CNS, ear, orbit and rarely nose and paranasal sinuses. Definitive diagnosis can be performed by histopathological examination, which shows emperipolesis. The sinus histiocytes are strongly reactive for S-100 protein and CD68, but negative for CD1a.
Case Report: The current study presents the case of a 29 year old male patient who had complaints of nasal obstruction since 5 months. Diagnostic Nasal Endoscopy showed mass completely filling both nasal cavities. Histopathological examination concluded the diagnosis of Rosai-Dorfman Disease and Immunohistochemistry (IHC) stained positive for S-100 and CD68, while negative for CD1a, of the surgical specimen after surgical excision by Functional Endoscopic Sinus Surgery. Follow up was done after a week, monthly for 6 months and a year for recurrence
Discussion: Extranodal RDD, although rarely seen, should be considered in nasal cavity. Even though there is no ideal protocol in the treatment, surgical excision should be considered if there is a functional disorder.

Correlation between Hypothyroidism and Type 2 Diabetes Mellitus

Santosh U. P — 2023-07-29

Introduction:

Hypothyroidism is the most common thyroid disorder in India with prevalence of 10.95% ⁽¹⁾. Type 2 Diabetes (T2DM) is the most common endocrine disorder with prevalence of 8.9% ⁽²⁾ in India. Studies showed that there is prevalence of T2DM in hypothyroidism. We consider FBS (Fasting blood sugar) and HbA1c (Glycated hemoglobin) to diagnose diabetes in our study as per to American diabetes association. The aim is to assess the incidence of T2DM in biochemically proven hypothyroidism.

Materials and methods:

50 patients of either sex between the ages 18-60 years, who are biochemically proven newly diagnosed case of hypothyroidism, are taken for the study. A detailed clinical history of the patient including history of presenting complaints, past history and other relevant history is taken. A detailed general examination, systemic examination and ENT examination is done. Patients underwent screening for T2DM using FBS and HbA1C as per American diabetes association. This is used to calculate the incidence of T2DM in biochemically proven hypothyroidism.

Results:

The number of cases diagnosed as diabetic is, 13 (26.0%) cases with high FBS (fasting blood sugar) and 16 (32.0%) cases with uncontrolled HbA1C values. Showing a total of 16 cases among the 50 cases of hypothyroidism found as newly diagnosed diabetes, showing a prevalence of 32% among the study group.

Conclusion:

Our study agrees with the various studies showing a similar relationship between hypothyroidism and T2DM. As such we would also like to propose that in cases of hypothyroidism, T2DM to be evaluated for as well for early detection and management.

Comparative Study of Graft Placement Between Medial and Lateral to Malleus in Tympanoplasty

Somnath Ray — 2023-07-29

Abstract

Introduction

Tympanoplasty is a surgical method, to eradicate middle ear infection and improve its function. In tympanoplasty graft can be by overlay or underlay technique. In underlay technique the graft material can be placed either medial or lateral to the handle of malleus.

Objective: To compare the outcome of the surgery when the temporalis fascia graft is placed medial or lateral to the handle of malleus, in terms of complete take up of the graft and hearing improvement after the surgery.

Materials & methods

A prospective and comparative hospital-based study was done in the Otorhinolaryngology (ENT) department of a tertiary referral hospital of Kolkata, from 1st January, 2021 to 30th June, 2022 (18 months). 60 patients were included in the study.

Results

We found that association of tympanic membrane status with group was not statistically significant after 1 month of surgery (p=1.0000) and after 3 months of surgery (p=0.6711). Distribution of mean postoperative hearing gain after 3 months of surgery with group was not statistically significant (p=0.3020).

Conclusion

We found both the techniques are equally effective in terms of complete graft take up and post operative hearing gain after 3 months follow up.

Septoplasty- Does It Change the Quality of Life in Patients Having Nasal Obstruction?

Priyanka Debbarma — 2023-07-29

Introduction: Deviated nasal septum (DNS) is one of the most common causes of nasal obstruction. However, there are several other etiologies which cause difficulty in nasal breathing. The definitive treatment of symptomatic DNS is septoplasty. The efficacy of septoplasty remains controversial as there are no solid tools for clinical evaluation of patients for establishment of reliable statistical data. Our aim was to evaluate patients who have undergone septoplasty for symptomatic DNS, by following them up with the NOSE questionnaire for predicting the surgical efficacy of septoplasty.

Materials and Methods: This was a prospective observational study, conducted over 1 year. 50 cases of either sex of 18-65 years, having symptomatic DNS not relieved by medical management, and corrected by isolated septoplasty were included. The primary outcome was measured by the NOSE questionnaire, applied before surgery, and 6^th week and 12^th week after the procedure from which the 12^th week nasal score was taken into consideration.

Results: The paired T test done among the variables showed a clear significance, proving the efficacy of the NOSE score in predicting the symptom reducing efficiency of septoplasty

Conclusion: The NOSE score can be used as a regular quality scoring system in analysing the outcomes of septoplasty.

Cross Sectional Study on Thyroid Arteries with Clinical Correlations

Ankita Saha — 2023-07-29

Introduction- Thyroid gland is a highly vascular endocrine gland. The aim of our study is to explore thyroid arteries to escape eventual iatrogenic complications.

Materials and Methods- Both sides of neck of total 60 adult embalmed cadavers were dissected in West Bengal (2020-2021).

Results- We found Superior Thyroid Arteries in 100% cases originating from External Carotid Artery in 77.5% cases, Carotid Bifurcation in 11.67% cases, Common Carotid Artery in 7.5% cases, as well as a common trunk with Lingual artery in 1.67% cases, Lingual and Facial arteries in 1.67% cases. Source of origin of Superior Thyroid Artery when compared with level of origin and between male and female cadavers, the result was found statistically significant (p< 0.05). Inferior Thyroid Artery was present in 90% cases and absent in 10% cases. Inferior Thyroid Artery originated from Thyrocervical Trunk in 92.5% cases, Common Carotid Artery in 1.67% cases, Subclavian Artery in 0.83% cases. Thyroidea Ima Artery was found in 3.33% cases arising from Arch of Aorta and Brachiocephalic Trunk.

Conclusion- Knowledge of thyroid arterial variations will help to prevent loss of patient life due to hemorrhage during surgery.

Complications of neck dissection: Our initial experience

Debabrata Das — 2023-07-29

Abstract:

Introduction:

Neck dissection is an important surgical procedure to treat head-neck cancers. It also helps to stage the disease as well as denotes further treatment plan.

Materials and Methods:

A retrospective analytical study is done between August 2017-July 2021 in tertiary care hospital to identify methods and practices to reduce complications of neck dissection. 104 patients who met the selection criteria were reviewed. Any intraoperative as well as post-operative complication was carefully assessed and managed as per protocol.

Results:

62.5% were in the age group of 49-59 years. 66.35% were male. Maximum patient (65.38%) presented with oral cavity squamous call carcinoma. 51.92% had N1 neck node while 44.23% had N0 neck node. Internal jugular vein injury, spinal accessory nerve and marginal mandibular nerve injury, post-operative hematoma, seroma formation, chyle leak were found as significant complications in initial days. They were less in number or managed well with experience.

Conclusion:

Detailed knowledge of head-neck anatomy, meticulous dissection technique, early detection of any complication and its management can decrease the long-term morbidity and improve patient’s quality of life.

Keywords: Neck dissection, head-neck cancer, complication, meticulous haemostasis.

A Comparison between Cold Steel Method and Bipolar Diathermy Method of Tonsillectomy

Mohammad Naksh Kamar — 2023-07-29

Introduction

It is generally accepted that the ideal method of tonsillectomy should have less operative time, blood loss, post-operative haemorrhage and morbidity.¹

Objective: To compare post-operative pain, intra-operative blood loss and duration of surgery between cold dissection and bipolar diathermy dissection method of Tonsillectomy.

Materials and Methods

This study was a prospective and comparative hospital-based study. It was conducted from January 2021 - June 2022 at the Department of ENT of a tertiary referral hospital, Kolkata. 90 patients were included in this study fulfilling the inclusion and exclusion criteria.

Results

In bipolar diathermy method, the mean total blood loss (in ml) (mean±s.d.) of patients was 15.0778±4.6011 and in cold steel method it was 33.0000±5.8737. Post-operative pain for cold dissection on day 1, day 3 and day 10 was [4.4889±.6613], [2.0222±.7830] and [.3778±.4903] respectively. Post-operative pain for bipolar diathermy on day 1, day 3 and day 10 was [4.9556±.2084], [2.5778±1.0111] and [1.6222±.7474] respectively. Duration (in minutes) for bipolar diathermy dissection was [15.2889±1.9612] and for cold dissection it was [24.0444±2.3351].

Conclusion

The blood loss and duration were less in bipolar diathermy method but post-operative pain was more as compared to cold steel method.

Keywords

Tonsillectomy, cold steel, bipolar diathermy, post-operative pain.

An Insight into Usefulness of Anterior Rhinomanometry as Marker in Adenoid Hypertrophy

Vamsi Krishna Teja — 2023-07-29

INTRODUCTION

Prospective Observational Study in 34 Patients from December 2018 till November 2022 in Tertiary Care Hospital to objectively assess diagnostic utility of anterior rhinomanometry in symptomatic patients undergoing Adenoidectomy preoperatively and postoperatively and subjectively compare changes in quality of life.

MATERIALS AND METHODS

Patients with clinical history of adenoid hypertrophy managed clinically for 2 months, posted for adenotonsillectomy were performed Anterior Rhinomanometry using M/s GENESIS MEDICAL SYSTEMS NASOBALANCE – P ⁵ to calculate both baseline and post decongestion resistance values. Postoperatively anterior rhinomanometry is performed after 12 weeks and compared with preoperative nasal resistance values. Quality of Life measured by Visual Analogue Scale.

RESULTS

Comparison of Preop post decongestion and postop pre decongestion of nasal resistance following adenoidectomy revealed nasal resistance significantly reduced (p<0.05). When nasal resistance preoperatively compared with X ray nasopharynx there was proportionate increase in nasal resistance as soft tissue narrowing of airway increases.

CONCLUSION

Visual Analogue Scale reveals improvement of quality of life in 28/34 = 82.35% patients. Comparison of Pre and post decongestion values following adenoidectomy in isolated asymptomatic patients revealed p value is insignificant which is established by anterior rhinomanometry suggesting values of nasal airway resistance remained similar in isolated adenoid hypertrophy patients.

Pott’s Puffy Tumour in Mucormycosis: New Presentation of an Old Disease

Smita Hegde — 2023-07-29

Introduction: Pott’s puffy tumour (PPT) is a rare but grave complication of frontal sinusitis. During the second wave of Covid-19, there was rise in rhino-orbito-cerebral mucormycosis (ROCM) cases in India. There is a paucity of literature reporting association of frontal osteomyelitis with rhino-orbital cerebral mucormycosis. This study elucidates the clinico-epidemiological profile and clinical outcomes of management of frontal osteomyelitis in patients with ROCM.

Materials & Methods: A retrospective, observational study was conducted at a tertiary hospital from May 2021 to May 2022. 350 patients with covid-19 associated ROCM had reported to the hospital. 12 patients presenting either pre- or post-operatively with doughy swelling over the forehead, with/without oedema of the upper eyelid were clinically diagnosed to have frontal osteomyelitis. Minimal localised defects in the frontal bone were subjected to local excision of granulation tissue, evacuation of pus and biopsy. Cases involving extensive erosions of anterior table of frontal sinus underwent osteoplastic flap with obliteration.

Results: 12 patients presented with frontal osteomyelitis. All received systemic antifungals and broad-spectrum antibiotics. It sufficed in only 1 case. 2 required additional local debridement. In 4, endoscopic sinus surgery achieved adequate disease control. 5 with extensive disease required osteoplastic flap with obliteration via either eyebrow or bicoronal incision.

Conclusion: A high index of suspicion is warranted in patients with covid-19 associated mucormycosis who present with a forehead swelling because even though PPT is a rare clinical entity it is associated with potentially life-threatening complications.

Post Covid-19 Mandibular Mucormycosis: A Rare and Deviant Site of Presentation

Ravishankar C — 2023-07-29

Introduction:Mandibular involvement in mucormycosis is rare, and only a few cases of post covid-19 mandibular mucormycosis have been reported to date.
Materials & methods: This is a retrospective descriptive case series study conducted at a tertiary care centre.We report the clinico-epidemiological profile and management of 5 cases of post covid mandibular mucormycosis. All patients received intravenous antifungals at the earliest and underwent surgical debridement of the infected bone.
Results: 4 patients were managed satisfactorily. 1 patient succumbed to the disease. Extent of debridement was based on the clinical, radiological and intraoperative assessment of the mandible.
Conclusion: Mandibular mucormycosis is rare and early recognition of symptoms and treatment is imperative in reducing the spread of disease, decreasing the extent of resection and postoperative reconstruction.

Preface

Editor-in-Chief BJOHNS — 2023-07-29