Nasal Septal Cartilage as Anterior Cap-Graft for Open Tracheoplasty in Cases for Laryngotracheal Stenosis: Our Initial Experience.

The aim of our study is to analyze the efficacy of nasal septal cartilage as cap-graft in laryngo-tracheoplasty in cases of Laryngotracheal stenosis. This was a prospective observational study carried out at a tertiary care hospital from March 2020 to March 2023. Total 8 patients who underwent laryngo-tracheoplasty using nasal septal cartilage as anterior Cap-graft were included in the study. Detailed history and clinical evaluation followed by diagnostic Flexible Fiber-optic Laryngoscopy and radiological investigations were done for all patients with post operative follow up for at least 1 year. Our study had maximum patients in age group of 11-30 years with male predominance, unknown compound ingestion being most common cause of intubation which was followed by tracheostomy. All patients had Cotton Mayer Grade III or IV subglottic stenosis. Out of 8 patients, 5 patients are decannulated, 1 patients still have T-tube in-situ whereas 2 patients didn't tolerate decannulation and required re-exploration. No donor site complication was seen during the study period. Nasal septal cartilage is a viable option for being used as anterior cap graft in laryngo-tracheoplasty. It can be a game changer, as can be done by E.N.T surgeon himself. No separate learning skills are required. It's cosmetically better with minimal complications; compared to life threatening complications like pneumothorax on using costal cartilage. Laryngeal framework is preserved as opposed to thyroid alar cartilage graft. Faster healing along with better postoperative donor site recovery are significant advantages.

Our Experience in Trans Nasal Endoscopic Repair of Anterior Skull Base Defects Reinforced with Multiple Layers of Graft Materials.

Aims: To determine the best technique to repair anterior skull base defects using various grafts. Materials & Methods: This Ambi-directional cohort study was carried out at a tertiary care hospital from May 2019 to October 2021. A total of 17 patients who underwent Endoscopic Repair of Anterior Skull Base Defects using various grafts were included in the study. Detailed history and clinical evaluation followed by Diagnostic Nasal Endoscopy, Biochemical and Radiological investigations were done for all patients with postoperative follow-up for at least 6 months. Results: Most common site of anterior skull base defect in our study group was the posterior wall of the sphenoid sinus. Various graft materials used in our study were fascia lata, thigh fat, Hadad flap, Septal cartilage, nasal septal bone chip, septal mucosal free flap, surgicel and fibrin glue. The most commonly used sequence of graft materials used is the fat(underlay) - fascia lata - fat(overlay). Various complications that occurred were nasal bleeding, residual CSF leak, localized collection of pus in the Septal region, cerebral oedema and Alar trauma. Conclusions: The success of Anterior skull base defect repair depends on watertight Dural closure with multiple layers of grafts to prevent postoperative CSF leak. Although dependent on the Surgeon's preference, usually the sequence of an underlay fat - fascia lata - overlay fat followed by glue/gel foam/Hadad flap works well. Even after discharging the patient, regular follow-up and evaluation ensure that the graft is in situ and there is no CSF leak or other complication.

Causes of Failure of Canal Wall down Mastoidectomy.

AIMS: To identify the causes of failure of the canal wall down mastoidectomy and evaluate the causes for discharging mastoid cavity and to address the causes of failure of previous surgery to minimize the Revision surgery. MATERIALS AND METHODS: This was a prospective and retrospective observational study conducted at a tertiary care hospital from May 2019 to December 2021. Total 20 Patients (11 male & 9 female) with age group (0-60 years) who previously underwent canal wall down mastoidectomy and presented with complaints of persistent ear discharge were included. All patients underwent otoscopic, oto-endoscopic and microscopic examination. RESULTS: Out of 20 cases,13 cases had residual/recurrent cholesteatoma, 11 cases had narrow meatoplasty and 9 cases had high facial ridge.Other causes for failure are graft defect, incomplete removal of anterior and posterior buttress. CONCLUSION: Recurrent/residual cholesteatoma and Narrow meatoplasty are most common cause for failure of previous surgery. Persistent granulation at un-exenterated area was the most common cause for suppuration. Regular follow up and cleaning of the debris from cavity enhances the epithelialization and healing of the cavity.

Comparative Study Between Conventional Curettage Adenoidectomy Versus Endoscopic Microdebrider Assisted Adenoidectomy: Our Experience.

Adenoidectomy is one of the commonest surgical procedures performed by otolaryngologists however; its recurrence rates are very high. Our objective in this study was to compare safety and efficacy between conventional curettage and endoscopic assisted microdebrider adenoidectomy. This was a prospective comparative parallel randomized control trial conducted at a tertiary care hospital from April 2017 to December 2018. We divided patients (N = 42) into two groups i.e. conventional adenoidectomy (group A) (n1 = 21) and endoscopic microdebrider assisted adenoidectomy (group B) (n1 = 21) groups using the lottery method of randomization. Among 42 patients, 33 (79%) were male and 9 (21%) were female. The average operative time in group A was 16.15 min and in group B was 22.9 min with p value < 0.05. Average blood loss in group A was 35.57 ml and in group B was 37.14 ml. In group A, 1 (4.76%) of 21 patients developed temporary velopharyngeal insufficiency which was relieved after 4 weeks of surgery whereas in group B, 5 (23.8%) patients developed nasal bleed and 2 (9.52%) patients presented with nasal synechiae on follow-up. Eight (38%) patients in group A showed grade I adenoids after 3 weeks of surgery while group B showed complete clearance in all patients (p < 0.05). Conventional adenoidectomy has less intra-operative blood loss and shorter surgical time duration as compared to endoscopic assisted microdebrider adenoidectomy but with higher chances of residual adenoid tissue.

Is Cartilage a Better Option than Temporalis Fascia for Grafting in Type 1 Tympanoplasty?: An Institutional Study.

Chronic suppurative otitis media (CSOM) is one of the important health problems in our country. The present study was conducted to compare Cartilage and Temporalis Fascia as graft material for Type 1 Tympanoplasty for CSOM. The study was conducted to assess hearing outcome as average AB Gap closure respect to age of the patient and size of perforation, to evaluate Graft uptake with both grafting material and with respect to size of perforation and to find the complication rate. Prospective Comparative study was conducted on 60 patients of CSOM divided in two groups and randomly selected for cartilage Typanoplasty and Temporalis Fascia Tympanoplasty. Hearing result are compared pre and post operative. Group 1(cartilage): Average AB Gap closure was 55% for Small CP, 50% for Moderate CP, 40% for Large CP, 38% for Subtotal CP. In Group 2(Temoralis Fascia): Average AB Gap closure was 81% for Small CP, 72% for Moderate CP, 64% for Large CP, 52% for Subtotal CP. In Group 1, 46% and in Group 2, 69% Average closure of AB gap observed at 12 weeks post operatively. The p value for our study was found to be < 0.05, which statistically indicates better hearing outcome with TF graft. Cartilage is an excellent grafting material because of its accessibility, resistance to negative pressure and high graft uptake rate. Temporalis Fascia is easily available with similar thickness to TM. It showed inferior morphological uptake rate compared to cartilage though functional gain was better.

Pediatric E.N.T. emergencies during COVID-19 pandemic: our experience.

Our aim is to analyze effect of covid-19 pandemic in management of pediatric emergencies in E.N.T. and to provide recommendations for management of pediatric emergencies in E.N.T. during pandemic. In this retrospective study we included emergency pediatric cases required early intervention during covid-19 pandemic. Pre operative radiological investigation x-ray was done in all aero digestive foreign body patients. Pre operative HRCT neck and chest with virtual bronchoscopy in foreign body inhalation & compromised airway patients was done only in cases where patient's clinical condition was stable. Similarly RT PCR for covid-19 screening done only in cases where patient's clinical condition was stable. Adequate personal protective equipment was used during all the procedures. Total 29 Pediatric patients age ranging from 1 day to 13 years underwent procedures due to history of foreign body inhalation; ingestion, insertion and compromised airway in form of immediate endotracheal intubation were included. Comprehensively we recommend intervention only in emergency procedures during pandemic, use of personal protective equipment during all procedures, preoperative investigations for diagnosis and modifications in operation theatre, anesthesia and surgical techniques to reduce aerosols generation will minimize risk of infection transmission to health care workers.

Comparative Study of CO2 LASER Assisted and Electrocautery Assisted Tonsillectomy with Conventional Tonsillectomy.

Tonsillectomy is the most common surgical procedure performed since many years. Various methods of tonsillectomy (Electrocautery, LASER, Harmonic scalpel, Coblation) have been practiced over the last century aiming for reducing intra and postoperative morbidity. We carried out prospective randomized control study using retrospective data as secondary data to compare blood loss, excision and hemostasis time, pain, recovery time and complication between CO2 LASER and Electrocautery assisted with conventional method. Average time for surgery with CO2 LASER (82.17 min) was more than conventional (77.77 min) and electrocautery (21.40 min) was least. The postoperative pain and recovery time was more in CO2 LASER and Electrocautery group than conventional. The blood loss was more in conventional group compared to other two group. We concluded that CO2 LASER group has longest operative time but least blood loss. Postoperative pain was more and lasted longer in Electrocautery group. Conventional method had least recovery time, least tissue reaction and least hospital stay.

Our Experience in Facial Paralysis.

Facial nerve paralysis is one of the most common symptom an otology surgeon comes across. Aim of this article is to review the literature, to study the important causes, pathogenesis and to know the common sites of involvement in different types of facial paralysis with importance of imaging in identifying the site of lesion and role of surgery and outcome of conservative management in case of infranuclear facial paralysis. This is a prospective study of 23 cases of infranuclear facial paralysis in case of post-head injury, post-mastoidectomy and otitis media. Facial paralysis due to post head injury is more common in adult males due to their active life and road traffic accident is the main cause. Longitudinal Fracture of temporal bone is a common fracture and it accounts for more number of facial paralysis. Decompression of the Facial nerve has beneficial effects. HRCT delineates the status of facial nerve in intratemporal part. Cholesteatoma and granulation tissue both play equal causative role for facial paralysis in otitis media.

Endoscopic Endo-nasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Prospective Study.

The surgical approach for hypophysectomy has undergone sweeping revolution in the past three decades. With the advent of endoscopes, better instrumentation, better illumination and viewing cameras, endoscopic endo-nasal trans-sphenoidal approach to sella has now largely become the norm. The aim of this study is to present our experience, analysing the surgical outcomes of this approach in patients with pituitary adenoma, pertaining to entirety of tumor removal, alleviation of symptoms and rate of complications. This prospective  study was conducted at our tertiary health care  centre from June 2012 to June 2015. A total of 14 patients, meeting the inclusion criteria, underwent endoscopic trans-sphenoidal hypophysectomy for pituitary adenoma. Age of presentation ranged from 19 to 73 years (mean 43.6 years). 9 patients were female and 5 were male. The most common presenting symptom was headache, followed by visual disturbances. Amongst those with hormonal imbalance, most common were prolactinomas and growth hormone secreting adenomas. Preoperative MRI brain showed macroadenomas in all 14 patients. 7 (50%) patients had suprasellar extension, while 5 (36%) patients had intracavernous extension too. CT paranasal sinuses provided the roadmap for surgery by identifying anatomical variations. Alleviation of headache occurred in all cases. Normalization of altered hormonal profile was seen in all cases. 83.3% of our patients with visual field defects on perimetry showed improvement post-surgery. Recidivism was directly related to the size and extent of adenoma. Transient diabetes insipidus was seen in 4 (28%) cases. Persistent diabetes insipidus occurred in 1 (7%) patient. CSF leak was seen in 2 (14%) patients, 1 (7%) patient developed postoperative meningitis. Most common nasal complication was excessive crusting. There was no incidence of any vascular complications, focal neurological deficit or hypopituitarism in our study. The pure endoscopic approach is a safe, efficacious, and minimally invasive technique for the removal of pituitary adenomas. The results have been encouraging in our prospective study. However, the importance of learning curve in endoscopic skull base surgery and use of a multi-disciplinary collaboration cannot be overemphasized.

Micronuclei in Exfoliated Oral Epithelial Cells in Tobacco Users and Controls with Various Oral Lesions: A Study from Gujarat, India.

To assess and compare cytogenic damage in the form of micronuclei in various oral lesions according to duration and frequency of tobacco use. The present cross sectional study was carried out from October 2015 to October 2016. We included total 420 cases with 60 cases in each of the following subgroups, no tobacco habit with no obvious oral lesion (control) and tobacco habit with no obvious oral lesion, oral sub mucous fibrosis, leukoplakia, melanoplakia, erythroplakia, oral squamous cell carcinoma. Oral mucosal cells were collected from both sides of cheek; slides were prepared and examined for cells with micronuclei. The mean micronuclei index distribution in control group, potentially malignant group, and malignancy group was 1.14, 2.63, and 4.88 respectively and was statistically significant. The mean micronuclei index in control group, smoking tobacco and smokeless tobacco group was 1.14, 2.64, and 2.76 and was statistically significant. The mean micronuclei index was significantly higher in those using tobacco, for longer duration and with frequent tobacco use. The mean micronuclei index can be used as a potential screening tool of genotoxic damage and biomarker for epithelial carcinogenesis. The method has practical utility for warning tobacco users that higher than range has a danger of malignant event and therefore this in future can be used as reinforcement to advice of avoiding tobacco before malignancy develops.

Evaluation of auditory brainstem responses for hearing screening of high-risk infants.

Auditory brainstem responses (ABR) were recorded in 30 normal and 60 high-risk neonates with gestational age between 30 and 45 weeks. The normative data of normal group as regard to age, sex and various parameters of ABR were compared with high-risk group. ABR parameters especially wave V and interwave V-I intervals were significantly prolonged in high-risk infants. An infant was considered to "pass" the ABR test if an identifiable and replicable wave V response was present at 30 dB HL in both ears. All the normal neonates had click thresholds consistent with normal hearing. 12 of the highrisk neonates showed mild to moderate hearing impairment (absent replicable wave V at 30-60 dB HL) and 2 of them showed severe to profound hearing impairment (absent replicable wave V at 70 dB HL). 9 of the "failed" group were reevaluated within 3 months and several times thereafter if the abnormal responses persisted. 2 (3.3%) infants showed persistent hearing loss, which was confirmed later by behavioral audiometry.

Proliferative fascitis of nose.

Rapidly growing soft- tissue lesions in the oral and maxillofacial region can represent a variety of diagnoses involving radically different treatment modalities. Accurate diagnosis is important to avoid unnecessary and often mutilating surgery. Nodular fascitis is a rapidly proliferating fibroblastic lesion that presents as a tumour- like mass. Up to 20% of cases occur in the head and neck region.

Post operative sensorineural hearing loss after middle ear surgery.

Mild Sensorineural hearing loss subsequent to middle ear surgery has till today been an important complication to middle ear surgery inspite of advances in surgical techniques, operative instruments, monitoring devices and better treatment options. Lack of proper knowledge about this problem is because of under reporting of exact magnitude of hearing loss on account of difficulty in measuring hearing threshold of patients in immediate postoperative period as it may lead to post operative infection and discomfort to the patient.In our study of 80 cases carried out at ENT department, Baroda Medical College and S.S.G Hospital, Baroda, we have utilized weber's lateralisation principle and measured bone conduction thresholds of patients undergoing middle ear surgery for evaluation of postoperative Sensorineural loss as a result of middle ear surgery. Probable causes of post operative hearing loss in a patient undergoing middle ear surgery are, noise due to drills, continuous suction irrigation, vibrations, inner ear injury, manipulation of ossicles and a few unknown reasons.

Extranodal non-Hodgkins lymphoma of larynx.

Non-Hodgkins lymphoma is found in the older age group with extranoda involvement more commonly seen than in Hodgkins lymphomna. It isusually of B-cell type which has a better prognosis than T-cell type, Extranodal Non-Hodkin's lymphomas of larynx are rare. they can present as isolated lesions in larynx or associated with multiple involvement. They are usually found in the supraglottic region of the larynx. We present a case of 70-year-old female with extranodal Hodgkins lymphoma of epiglottis with metastasis in the liver.

Nasal manifestations in chromium industry workers.

People working in mines, plating factories, cement industries are mainly exposed to chrome substances, IIexavalent chromium has been implicated for its toxic effect on the nasal mucosa. Hereby we present a rare study of 28 patients who attended out patient department of Otorhinolaryngology at SSG Hospital, Baroda from a nearby chromium industry. This study aims to present various nasal manifestations of toxic effects of prolonged chromium exposure.

Pseudoaneurysm of the facial artery.

Pseudoaneurysm of the facial artery has very characteristic clinical features and radiological findings and can be treated with successful catheter emholisation, thus decreasing the morbidity associated with surgical procedure. A rare case of pseudoaneurysm of the facial artery is presented here for clinical interest.

Benign cementoblastoma - a rare odontogenic neoplasm.

Benign Cementoblastoma is a rare cementum producing tumour of odontogenic origin having very characteristic clinical features and radiological findings. A rare case of Benign Cementoblastoma is presented here for clinical interest.

Nasopharyngeal angiofibroma (a report of 19 cases).

Nasopharyngeal Angiofibroma is a relatively rare benign, but locally aggresive tumor of the nasopharynx afflicting the adolescent males. The management of these tumors has been a subject of much interest and controversy in the past Here we present a series of 19 patients of nasopharyngeal angiofibroma (with CT Scan as the main stay of diagnosis) managed over the last 5 years at ENT and Head & Neck Surgery Department of S.S.G. Hospital, Vadodara, with infraoperative internal maxillary artery ligation via the trans maxillary approach permitting accurate removal of tumor with no major post operative complications, minimal blood loss, good cosmetic result and no recurrence till date. If further experience with this approach to management in a larger series of patients has the same results, surgery should be the gold standard in treatment of Nasopharyngeal angiofibroma.