Efficacy of Single Transverse Neck Incision for Modified Radical Neck Dissection.

BACKGROUND: To assess the viability of the single transverse neck incision (STNI) for modified radical neck dissection and to analyze the yield of lymph nodes using this approach. MATERIALS AND METHODS: We conducted a prospective observational study in the Department of Head and Neck Surgical Oncology at our Tertiary Cancer Care Centre from November 2013 to May 2017. RESULTS: A total of 257 patients underwent surgical treatment for malignant tumors of the head and neck which included 265 modified radical neck dissections (eight bilateral and 249 unilateral). Average of total dissected nodal yield was 37.07. Average yield of positive neck nodes was 2.78. CONCLUSION: Single transverse neck incision is an acceptable technique for modified radical neck dissection as it provides adequate surgical exposure for achieving optimal nodal clearance with little technical difficulty.

Non-compliance With Neonatal Hearing Screening Follow-up in Rural Western India.

OBJECTIVE: The reasons of failure to follow-up for the Universal Neonatal Hearing Screening (UNHS) program were delineated. METHODS: Review of case records for data related to follow-up of neonates who underwent the UNHS between February 2012 - January 2015. RESULTS: 2534 neonates underwent primary screening with Distortion Product Oto-acoustic Emission (DPOAE). 14 (26.9%) were lost to follow-up between the first and second DPOAE screenings. 275 neonates (including high-risk cases) were to undergo confirmatory Brain Evoked Response Audiometry testing out of which 201 (73.4%) came for follow-up. Out of 74 who failed to follow-up (including those lost between first and second DOPAE screenings), unwillingness and non-compliance was the commonest reason. CONCLUSION: Increasing awareness and counseling of the caretaker are important interventions for ensuring good follow-up in hearing screening programs.

Eye Inside Out: Endonasal Endoscopic Reposition of Eye from Nose with Complete Vision Regainment.

Faciomaxillary and ocular trauma is a common entity in most emergency and trauma units. We came across a 68-year-old female patient with a history of bull horn injury over the right eye. Examination revealed an empty orbital socket with unreliable perception of light present. Imaging showed that the eye had displaced posteroinferomedially to be lying in the ethmoid air cells in the nasal cavity. Under nasal endoscopic guidance, the eye was reposited back into the orbital socket and conjunctival sutures were taken to stabilize the position. The patient had vision of counting fingers at 1.5 m on the first postoperative day which improved to 6/24 on last follow-up. Such is the rarity that never before has such a case been described in literature where traumatic displacement of eyeball into the nose has been successfully repositioned by an endonasal endoscope with appreciable regaining of vision. It also further promotes endonasal endoscopic approach in the management of orbital blow out injuries.

Novel Program of Using Village Health Workers in Early Detection and Awareness of Head and Neck Cancers: Audit of a Community Screening Program.

Head and neck cancers together (oral cavity, pharynx and larynx) are sixth commonest worldwide and are the commonest cancers in developing countries. The Cancer Project was started in Kheda/Anand, Gujarat, a harvest land of tobacco. The objective of this programme was to indoctrinate the most vulnerable and the least tended upon; the basics of head and neck cancers via the medium of their own kins. Voluntary village health workers were educated and trained to pick up the early signs of head and neck cancers. Oral self examination was taught to them and they went to peripheral villages to screen the population. They would refer suspicious cases to tertiary healthcare centre. The population was enlightened upon the basics of preventable measures, treatment options and rehabilitation facilities for head and neck cancer patients. Knowledge, attitude and practice analysis was done in the population which showed widespread disbelief and false practices. A population of 26,10,432 was surveyed in 1862 villages of which 10,522 (1.1%) individuals successfully quit the habit. The minimally educated workers referred 3309 suspicious individuals to higher centre of which 1890 (57.11%) tested positive for cancer. A lot of resource is put in research and development of rapid diagnosis and complete cure; however such a minimally costing program may help the most in primordial, primary and secondary level of prevention. Such programs should be advocated on the global platform on lines of Breast Self Examination.

Comparison of Partial Thickness and Full Thickness Tragal Cartilage Graft During Modified Cartilage Shield Tympanoplasty for Type I Procedures.

To compare the results, in terms of graft uptake and hearing improvement, of modified cartilage shield technique of tympanoplasty using either partial thickness tragal cartilage or full thickness tragal cartilage for type I procedures. 35 patients were included in group A where a partial thickness tragal cartilage was used and 27 patients included in group B where a full thickness tragal cartilage was used for modified cartilage shield tympanoplasty. Audiometry done at 4 months after surgery and the results compared. The graft take up rate for both these techniques is excellent. There had been no statistically significant difference in hearing gain between these two groups, except at 4,000 Hz, where hearing gain had been more in group A than group B with P value being 0.027. The modified cartilage shield tympanoplasty is a good technique for closure of tympanic membrane perforations. Hearing gain is very much similar between thin and thick cartilage groups, except at 4,000 Hz.

Neonatal Hearing Screening Programme (NHSP): At A Rural Based Tertiary Care Centre.

Deafness is the most common curable childhood handicap. It is a well recognised fact that unidentified hearing impairment can adversely affect optimal speech and language development and therefore academic, social and emotional development. Universal neonatal hearing screening programmes are implemented in many developed countries. However it is still in its early stage in India. The incidence of hearing impairment in India is 1-6 per thousand newborns screened (Paediatrics 19:155-165, 1998; Indian J Paediatr 74(6):545-549, 2007; Status of Disability in India, pp 172-185 2000). To determine the incidence of permanent hearing loss of moderate to evere variety in neonates taking care in a tertiary care rural based hospital in Gujarat. It was a non randomised observational study done for duration of 3 years. All neonates born in Shri Krishna Hospital underwent screening using two stage protocols with DPOAE test and final confirmation done with BERA. Total 2534 neonates were screened out of them 52 failed and 2482 (97.94 %) neonates passed in the 1st DPOAE test with 2.05 % refer rate. Total 7 (2 per 1000) neonates were detected with hearing impairment. 10 % neonates had one or other high risk factor. Out of high risk neonates, 1.8 % were diagnosed with hearing impairment in high risk group. Overall the follow-up rate was 72.7 %. Hospital based universal hearing screening of new born before discharge is feasible at a rural based tertiary care centre. Non specialist staff is invaluable in achieving a satisfactory referral rate with two stage hearing screening protocol. However, more efficacious tracking and follow up system is needed to improve the follow up rate for diagnosis.