A Retrospective Comparative Study on the Outcome of Microscope-Assisted Technique and Supra-Auricular Approach in Preauricular Sinus Surgery in a Tertiary Care Hospital.

Context: Preauricular sinus (PAS) can lead to severe complications such as facial paralysis, and squamous cell carcinoma may develop from this sinus later in life. Asymptomatic sinus needs no intervention, but symptomatic sinus needs surgical interventions. Aims: This study compares the surgical outcome of microscope-assisted sinus tract excision technique with the supra-auricular sinectomy technique. Settings and Design: This was a retrospective, observational study conducted at a tertiary care hospital in Purulia District, West Bengal, India. Subjects and Methods: Records of patients operated on for PAS were included following the proper inclusion and exclusion criteria. These patients were categorized and followed up based on disease pathology and the type of intervention received. Statistical Analysis Used: Data were collected, tabulated, and analyzed using the standard statistical software. Results: Fifty-two patients were included in our study. About 48.07% of patients were found in the age group of 11-15 years. In the microscope-assisted sinectomy category, recurrence of the disease was seen in 2 out of 15 operated patients compared to 1 patient among 13 in the supra-auricular sinectomy approach for uncomplicated cases. In complicated cases, the supra-auricular sinectomy approach had a nil recurrence rate compared to three patients out of ten operated in microscope-assisted technique (Fisher's exact test - 0.0593). Both the outcomes are not statistically significant. Conclusion: Supra-auricular sinectomy technique has the lowest recurrence rate for preauricular sinus surgery.

Endoscopic Endonasal Trans-Sphenoidal Minimally Invasive Pituitary Surgery with Image Guided Navigation System (Igns): Learning Experience of Ent Surgeon: First Author.

Introduction- Endoscopic minimally invasive pituitary surgery (MIPS) is advantageous over microscopic technique, as it provides superior close up, wide angle view of surgical target area. Image guided navigation system (IGNS) guides the surgeon to localize the lesion. In the present study we analyzed the Image Guided Surgical procedure and outcome of Endoscopic minimally invasive pituitary surgery and shared our experiences regarding disease clearance. MATERIALS AND METHODS: During the period of April 2015 to August 2022 a total 104 patients, diagnosed with pituitary adenoma underwent surgery and further followed up in a multidisciplinary team approach in a tertiary care hospital of Kolkata, India. The data obtained were reviewed statistically to satisfy the study objectives. RESULTS: Total 104 operations were done on 98 patients and total cases taken for calculation and analysis was 98, which consist of 11 microadenomas, 81 macroadenomas. Among 35 patients with normal preoperative hormonal assay, one patient developed postoperative hypopituitarism. Among 6 patients with preoperative hypopituitarism 4 patients (66.6%) recovered after surgery. Overall, 85 cases had total disease clearance as detected on post-operative MRI. In functioning pituitary adenoma (FPA) clinical and endocrinological improvement occurred after primary surgery in 85.36% (n = 35) and after revision surgery it was 84.44% (n = 38). Macroadenomas, giant adenomas were found to have statistically significant higher risk of incomplete disease clearance but large adenomas do not have statistically higher risk of incomplete clearance. CONCLUSION: IGNS requires extra time for setup, but with proper registration of tracker instruments it adds precision to the surgery. IGNS supplements endoscopic visualization with localization of target lesion by real time stereotactic feedback using preset preoperative imaging data, thus increasing accuracy, safety and effectiveness of minimally invasive surgery.

An Epidemiological Study of Hearing Loss in a Peripheral Tertiary Care Hospital.

The estimated prevalence of adult onset hearing deafness in India is 7.6% and childhood onset hearing loss is 2%. But there are very few studies which highlight the prevalence of various types of hearing loss. So a retrospective, cross-sectional study in a peripheral tertiary care hospital was designed to analyze the different types of hearing loss among patients with complaints of hearing disabilities attending and assess the more prevalent type of hearing loss according to severity. Out of total study population of 14,365 patients, Male patients with Mild hearing loss have the maximum correlation coefficient followed by Moderate, Moderately severe, Profound and Severe hearing loss. In the case of female patients Mild Hearing loss has the maximum correlation coefficient. Result of this study may be helpful in planning and management of different programs related to hearing disability prevention. As most of the hearing loss is mild variety and it slowly progress to other form of severe hearing loss, early intervention is very helpful in reducing the severity thus disability.

A Comparative Study of Orbital Blow Out Fracture Repair, Using Autogenous Bone Graft and Alloplastic Materials.

Maxillofacial trauma, a common injury in urban population following road traffic accident or act of interpersonal violence of which orbital floor fractures is common. It impairs the integrity of the extraocular muscles and may be accompanied by enophthalmos, orbital deformity and diplopia. Orbital reconstruction is essential to improve anatomical and visual deformity. Repair of orbital floor is done by autologous bone graft or synthetic implants. Compare outcome of orbital floor reconstruction in blow out orbital fracture using autogenous bone graft from iliac crest, outer table of mandible, alloplastic implant- silastic block and titanium mesh. 30 patients having orbital fractures were considered in study population. All the patients were treated by ORIF and repair of floor by subcilliary incision. Out of 30 patients, repair of orbital floor was done by autologous bone graft from iliac crest in 7 patients (Group A), bone graft from outer table of mandible in 5 patients (Group B), implant using silastic block in 8 patients (Group C) and titanium mesh in 10 patients (Group D). Factors analyzed were age, sex, cause of fracture and treatment outcome in terms of correction of pre operative diplopia and enophthalmos, rate of development of post operative infection, wound dehiscence and implant exposure. All patents were reviewed at 4 weeks and 12 weeks following operation. 71.42% of patients in Group A had early correction of diplopia and enophthalmos. This was 100% in rest of the groups. All patients had complete correction when assessed at 12 weeks post operatively. Post operative complication rate was 20% and 12.5% in Group B and C respectively. There were no complications in the rest of the groups within the follow up period. No statistically significant difference as to the chance of occurrence of complication could be found amongst the groups. Autologous bone graft has no immunological reaction but donor site morbidity. Silastic block may case immunological reaction, infection, poor drainage of orbital floor. But titanium mesh for orbital floor repair has excellent outcome and superior to other modality of treatment.

A Comparative Study of Pharyngeal Repair in Two Layers Versus Three Layers, Following Total Laryngectomy in Carcinoma of Larynx.

Larynx is the second most common site for cancer in the upper aerodigestive tract. One of the dreaded complications following total laryngectomy has been pharyngo cutaneous fistula (PCF). PCF merits special attention due to its significant negative impact on the recovery process. Total laryngectomy profoundly alters speech. Effective voice restoration is essential for the rehabilitation of these patients. Inadequate consensus exists as to the best technique of pharyngeal repair to decrease incidence of PCF and ensure good quality voice following total laryngectomy. 21 patients were included in the study for total laryngectomy with trachea oesophageal voice prosthesis placement. Patients were randomised into 2 groups. Group A had their pharynx repaired in two layers and Group B had it done in three layers. Post operatively the patients were followed up for a period of 12 months to look for incidence of PCF. Subjective and objective evaluation of voice was done. 9.52% of patients developed PCF. All of the cases of PCF were in the group repaired in three layers. In cases with repair by two layers the mean Voice Handicap Index 10 (VHI 10) score was 19.27 and those with three layers pharyngeal repair was 23.20. Average maximum phonation time amongst the study population was 13.09. In three layers and two layers pharyngeal repair the average maximum phonation time was 12.56 and 13.58 respectively. Surgical repair of pharynx in two layers excluding the third layer of pharyngeal musculature reduces the chance of PCF. Two layers pharyngeal repair supplemented by cricopharyngeal myotomy led to significantly better voice outcome.