Free Flap Reconstruction in Head and Neck Surgery: Experience in Bangabandhu Sheikh Mujib Medical University.

Free flap reconstruction after surgical ablation of head & neck cancer greatly improve the surgical outcome. Microvascular anastomosis is an important part of Microsurgery and it is not widely practiced in every center. A retrospective review was conducted in the Head & Neck Division of Otolaryngology-Head & Neck Surgery Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from May 2016 to June 2017. Total 20 patients with head & neck cancer had been treated surgically between this period and 14 patients were reconstructed with free flap. The focus of this study is to establish the surgical outcome, which is more with free flap reconstruction in the patients previously diagnosed as head & neck cancer. We reconstructed 14 cases of oral cavity carcinoma (Stage IV) with the free flap. Majority cases were carcinoma involving the buccal mucosa with retromolar trigone (36%) followed by buccal mucosa (22%), buccal mucosa with lower alveolus (21%), carcinoma tongue with floor of the mouth (14%) and floor of the mouth (7%). Radial forearm freflap (RFFF) were commonly used in 10 cases (71.4%) and Anterolateral thigh flap (ALT) used in four cases (21.5%). Partial flap loss was seen in one case and wound infection occurred in another case but both were managed successfully with postoperative dressing and debridement. Microvascular free flap reconstruction can be a good choice after surgical removal of the head & neck cancer diseases and it should be practiced in every well-equipped tertiary medical center with the help of properly trained surgeon.

Acute invasive fungal rhinosinusitis: our experience in immunocompromised host.

Acute invasive fungal rhinosinusitis (AIFRS) is a potentially fatal infection that usually affects immunocompromised patients. Early diagnosis and treatment, including aggressive surgical debridement, antifungal medication and correction of underlying predisposing factors are essential for recovery. The records of 13 patients histopathologically diagnosed with invasive fungal rhinosinusitis were retrospectively reviewed. Demographic data, presenting symptoms and signs, underlying diseases, and outcomes of the patients are presented. The most common underlying disease was diabetes mellitus. Mucoraceae (n-8) and aspergillus (n-5) were the main fungi found in AIFRS. Mucosal biopsy confirmed fungal invasion to the nasal mucosa in all cases. Computed tomography and endoscopic findings showed a predominance of unilateral disease, with various stages of nasal involvement. All patients underwent surgical debridement and systemic antifungal therapy immediately after diagnosis. Four patients died due to AIFRS. A poor prognosis was detected to the extensiveness of AIFRS and to the underlying disease (patients with diabetes and haematological diseases had the worst outcomes), but not to fungus isolated. Invasive fungal rhinosinusitis is discussed in light of the current literature.

Parathyroid failure following thyroid surgery.

This cross-sectional study was done to see the association of post thyroidectomy parathyroid failure with thyroid disease and type of surgery. It was carried out in the Department of Otolaryngology-Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of July 2008 to June 2010. Total 50 cases of thyroid malignancy and multinodular goiter who had undergone total or near total thyroidectomy with or without neck dissection were studied. In this study highest number of cases were found in 3rd decade of age (28%) and there was female predominance (M:F=1:3.54). Overall frequency of post operative hypocalcaemia was 30% (26% was temporary hypocalcaemia and 4% was permanent). Hypocalcaemia revealed clinically in 20% cases and remained subclinical in 10% cases. Hypocalcaemia developed in 42.30% cases of malignant thyroid disease and 16.66% cases of benign thyroid disease (p<0.05). It was found in 54.54% cases with neck dissection and 23.07% cases without neck dissection (p<0.05). Hypocalcaemia developed in 62.5% cases where parathyroid gland were not identified and 23.8% cases where parathyroid gland was identified. Hypocalcaemia developed most commonly on the 2nd post operative day (73.33%). There is a significance difference with development of parathyroid failure after thyroid surgery between benign and malignant thyroid disease and also between thyroid surgery with or without neck dissection.

Presentation of primary hyperparathyroidism due to adenoma.

This descriptive study was done to evaluate the clinical, biochemical and radiological findings of primary hyperthyroidism (pHPT) patients with parathyroid adenoma. This study was done in the department of Otolaryngology and Head-Neck surgery, BIRDEM, Dhaka from July 2000 to June 2007. We retrospectively reviewed the clinical presentation, biochemical and radiological features from the case records from the last 7 years of 32 patients at a tertiary care centre in Dhaka who had documented pHPT due to adenoma. Of them 18 were male and 14 were female. Mean age±SD of the patients was 42.16±11.64 years. Median preoperative serum calcium, serum phosphate and serum parathyroid hormone (PTH) levels were 11.42 mg/dL (range 8.4-14.0mg/dL), 3.11 mg/dL (range 2.5-4.5) and 293.22 pg/mL (range 65-700 pg/mL), respectively. Of all patients 75% had raised serum calcium level and 100.0% had raised serum PTH levels but all had normal serum phosphate level. Common radiological features were nephrocalcinosis, renal calculi, osteopenic changes in finger and toe, Brown tumour in forearm, 'Salt and pepper' appearance in skull, fracture of femur, fracture radius. pHPT due to adenoma in Bangladesh continues to be a symptomatic disorder with skeletal and renal manifestations.