A Clinicopathological Study of OSMF to Evaluate the Response After Treatment with Intralesional Steroid Versus Intralesional Steroid Plus Hyaluronidase.

Oral submucous fibrosis (OSMF) is a chronic debilitating and a well-recognized potentially malignant condition of the oral cavity, sometimes involving oropharynx associated with trismus and burning sensation. Apart from medical management and counselling, local injection of hyaluronidase mixed with triamcinolone acetonide has been used at our centre for the last 20 years with satisfactory clinical results and without any significant side effects. The problem with the treatment was that the doses and duration of treatment has not been standardized. Therefore, in this study, authors aim to evaluate and compare the efficacy of Triamcinolone alone versus Triamcinolone acetonide plus Hyaluronidase at weekly interval and improvement in Clinical and Histopathological staging of disease after 6 weeks of treatment. This study was conducted in Department of Otorhinolaryngology & Head Neck Surgery, with a total sample of 80 participants divided into two Groups, group A received Inj. Triamcinolone acetonide and group B received Inj. Triamcinolone Acetonide and Hyaluronidase 1500 IU at weekly interval. Pre-treatment and post-treatment clinical and histopathological profile of the patients were recorded and analyzed using SPSS 16 software. According to pre-treatment status, the proportion of clinical grades I, II and III were found in proportion 12.5%, 18.8% and 15.0% respectively. No significant difference was found in proportion of various grades between the groups (p = 0.388). At post treatment, the grading was reduced with changed proportion of grades I, II and III cases as 33.8%, 41.3% and 7.5% respectively. There was no significant difference in proportion of various grades between the groups (p = 0.681). Further, the intragroup comparison showed significant improvement Pre to post in group A (p = 0.002), Group B (p < 0.001) and overall, as well (p < 0.001). The inj. Triamcinolone acetonide and Inj. Hyaluronidase showed a better improvement on post treatment histopathological grading although the difference between the two groups was not significant statistically.

Clinico-pathological profile of parotid gland tumors at a tertiary care center in North India.

Aim of the Study: The objective of this study was to know the various types of parotid tumors and their clinical presentations, surgical management, and post-operative outcome. Material and Methods: Data of 102 patients assessed from hospital records who underwent parotid surgery between the years 2013 and 2018 were obtained. Parameters included age, sex, socio-demographic profile, presenting complaints, examination findings, and cytopathology. Surgical techniques, post-operative complications such as a facial scar, retro-mandibular and pre-auricular depression, facial palsy, Frey's syndrome, and numbness over the ear lobule were analyzed. Result: Out of a total of 102 patients, 54.0% of patients were male, and 45.1% were female. The mean age of patients was 33.30 ± 13.87 years ranging from 7 to 65 years. The most common clinical presentation was swelling in the parotid region (95.1%), and associated symptoms with swelling were pain (17.5%), facial palsy (4.9%), discharging sinus (4.9%), and ulcerative lesions (1%) at the time of presentation. Pleomorphic adenoma was the most common benign neoplasm (76.5%), followed by Warthin's tumors (2.9%). Mucoepidermoid carcinoma was the most common malignant neoplasm (3.9%). After parotid surgery, 35% of patients had a sensory impairment or hypoesthesia of the ear lobule, and 23.28% had temporary facial nerve weakness. 5.0% of patients had permanent facial weakness, and 2.06% of patients had weakness of the marginal mandibular nerve. Conclusion: Pleomorphic adenoma and mucoepidermoid carcinoma are the most common benign and malignant tumors, respectively, and parotidectomy is the treatment of choice, depending on the tumor location. Successful treatment depends on early diagnosis and histopathological and radiological investigations. Sensory impairment and temporary facial nerve paralysis are the most common post-operative complications, which are minimized by proper knowledge of anatomy and meticulous dissection of the facial nerve during parotid surgery.

Extended cervicomastoid approach with sternocleidomastoid flap reconstruction for parotid surgery: A better esthetic technique.

Aim of the Study: The aim of the study is to compare the esthetic outcome of extended cervicomastoid approach with reconstruction with conventional approach (modified Blair's incision) for parotid surgery. Materials and Methods: 48 patients were enrolled and grouped into A: surgery through extended cervicomastoid incision with sternocleidomastoid reconstruction and B: surgery through modified Blair's incision. After parotid surgery, patients were followed up to 6 months on the basis of flap ischemia, patient satisfaction, and cosmesis (visual analog scale [VAS]). Results: In our study, preauricular depression over the face was present in 4.2% and 95.8% patients Group A and B at 6 months, respectively (P < 0.001) and retromandibular depression (70.8%) in Group B (P < 0.001). Subjective Frey's syndrome was present in 8.3% of patients of Group B (P > 0.05). The mean value of VAS between the two groups was 1.08 ± 0.28 and 3.29 ± 0.62 at 6 months (P = 0.001) while mean change was significantly (P = 0.03) higher in Group A (1.00 ± 0.00) as compared to Group B (0.20 ± 0.72) from postoperative to 6 months, respectively. Patient of Group A had good satisfaction level (62.5% and 91.7%) at 6 weeks and 6 months while Group B patients had fair satisfaction level (87.5%) at 6 weeks and poor satisfaction level 79.2% at 6 months. Conclusion: Parotidectomy through extended cervicomastoid incision with sternocleidomastoid flap reconstruction experienced lower rates of postoperative complications, flap necrosis, and gustatory sweating in comparison to cervicomastoid facial approach, and thus, the previous incision is esthetically superior that allows cheek contour reconstruction with no increase in operative time or postoperative complications.

Tuberculous parotitis: A series of eight cases and review of literature.

Although tuberculosis is a common health problem in developing countries such as India, tuberculous parotitis (tubercular involvement of parotid gland) is rarely encountered. Because of very low incidence and nonspecific symptoms, it is often misdiagnosed as parotid neoplasm. Ultrasonographic and computed tomographic findings are also noncontributory for this entity. Hence, to increase awareness about this rare entity, here, we report a series of eight cases of tuberculous parotitis which were diagnosed on fine-needle aspiration cytology (FNAC) and successfully treated with antitubercular drugs. Majority of our cases (five cases) presented as asymptomatic unilateral swelling or acute tender painful swelling (two cases) in the parotid region. FNAC smears showed caseous necrosis, epithelioid granulomas along with variable amount of mixed inflammatory exudates, and few benign ductal or acinar cell clusters. One case had unilateral recurrent swelling in the preauricular region with fistula. Superficial parotidectomy was done and histological examination revealed the diagnosis of tubercular parotitis. Following diagnosis, all patients were kept on antitubercular treatment and responded well to treatment with no evidence of recurrence on 9-month regular follow-up.

Current molecular profile of juvenile nasopharyngeal angiofibroma: First comprehensive study from India.

OBJECTIVE: An attempt is made to analyze the molecular behavior of juvenile nasopharyngeal angiofibroma (JNA). STUDY DESIGN: Case Series METHODS: Quantification of mRNAs expression was undertaken through real-time polymerase chain reaction in JNA (9-24) samples for VEGF-A, basic fibroblast growth factor (b-FGF), platelet-derived growth factor PDGF-A, KIT proto-oncogene receptor tyrosine kinase (c-Kit), Avian myelomatosis viral oncogene homolog (c-Myc), Harvey rat sarcoma viral oncogene homolog (H-Ras), tumor suppressor gene TP53, and androgen receptor and interleukin 6 (IL-6). The ß-catenin expression was evaluated by western blot in 16 samples. Nasal polyp was taken as control. RESULTS: A significantly increased (P < 0.01) expression of c-myc, VEGFA, bFGF, PDGFA, c-kit, and TP53 was seen, along with enhanced expression of ß-catenin. A massive enhancement of H-Ras expression was seen for the first time. Androgen receptor expression was no different, whereas IL-6 despite showing upregulation trend was not significant. CONCLUSION: The enhanced expressions of various markers suggest their potential role in JNA. Although the biological significance of c-kit, c-myc, and one of the novel markers H-Ras has yet to be defined, their significant expression may have a therapeutic importance. LEVEL OF EVIDENCE: NA. Laryngoscope, 127:E100-E106, 2017.

Clinical Predictors of Streptomycin-Vestibulotoxicity.

The Global tuberculosis control is challenged with a growing resistance to antitubercular treatment (ATT) culminating in resistant (MDR/XDR) strains; an important factor being premature withdrawal of streptomycin owing to its morbidity particularly nephrotoxicity and cochleotoxicity as guidelines for their prevention exist. An attempt is made here to address the least recognized and most debilitating vestibular toxic effects of streptomycin and defining a vestibular-protocol for its early detection and progression. Thirty two prospective patients (treatment-failures, relapse and default cases) undergoing ATT (24 shots of IM streptomycin 15-20 mg/kg over 8 weeks) underwent complete vestibular workup including vestibulo-ocular and vestibulo-spinal reflex assessment with an attempt to closely follow them. Four categories (I: No-, II: Occult-, III: Delayed-Manifest- and IV: Manifest-vestibulotoxicity) were defined. The DHI and casual gait abnormality clearly differentiated III/IV from I/II. The occilopsia and head thrust tests significantly differentiated II from I. Rotation and bithermal calorics significantly differentiated I from II and II from III/IV. The Fukuda, Rhomberg, Tandem-Rhomberg and CTSIB were significant in differentiating I from II and II from III/IV. Dix-Hallpike and Positional tests were of no significance in the entire study. The Occilopsia and Head-Thrust tests that showed 100 % positivity for II to IV are more likely to better predict 'manifest' or 'occult' -vestibulotoxicity while DHI and casual gait assessment may be carried out by a paramedic at a peripheral center to suspect vestibulotoxicity. Since we found absolute compliance with our series we feel that vestibulotoxicity may not be a deciding factor for termination of streptomycin provided an in-built mechanism for patient support/counseling be incorporated in management schedule.

Stridor: an unusual presentation of juvenile nasopharyngeal angiofibroma.

Nasopharyngeal angiofibroma is a rare and benign disease, which is mainly found in adolescent male subjects. It is usually diagnosed on clinical grounds on the basis of its presenting symptoms of nasal obstruction, nasal mass and most importantly unprovoked recurrent moderate to severe epistaxis. Imaging studies are only needed to confirm the diagnosis and formulate the management plan. A case of juvenile nasopharyngeal angiofibroma is presented here, which presented to us with severe respiratory distress and stridor. Urgent tracheostomy had to be performed before definitive management could be started. Definitive treatment was excision through modified transpalatal with sublabial route, which resulted in successful outcome.