Nepalese Journal of ENT Head & Neck Surgery

LETS TALK: SURGEONS HEALTH & ERGONOMY

Yogesh Neupane — 2023-06-13

RELATION BETWEEN CHRONIC RHINOSINUSITIS AND SERUM VITAMIN D3 LEVEL

Om Prakash Yadav — 2023-06-13

Objectives:
To explore the relation between Chronic rhinosinusitis (CRS) and serum Vitamin D3 level.
Materials and methods:
A prospective, observational study consisting of 115 patients with CRS was carried out at Department of ENT & HNS in Bir Hospital from March 2018 to March 2019. Patients were divided into two groups: ‘CRSwNP (Chronic rhinosinusitis with polyp)’ and ‘CRSsNP (Chronic rhinosinusitis without polyp).’ Vitamin D3 levels were measured by Chemiluminescent Immunoassay method and compared between the two groups. Receiver operating characteristic (ROC) curve analysis was also performed to evaluate the role of vitamin D3 in discriminating between the two groups.
Results:
Out of 115 cases, 54 (47%) had CRSwNP and 61 (53%) had CRSsNP. Mean age of the patients was 34.7 years. Sixty six (57%) were female. Mean vitamin D3 level of all patients was 23.86 ng/ml. Only 17 (14.8%) patients had normal vitamin D3 level. CRSwNP patients had significantly lower vitamin D3 levels compared to CRSsNP patients (21.42 ng/ml vs. 26.01ng/ml respectively; p value <0.001). Higher proportion of patients with CRSwNP had Vitamin D3 deficiency compared to CRSsNP cases (35.2% vs. 16.4%). On ROC curve analysis of Vitamin D3 to discriminate CRSsNP from CRSwNP, area under the curve (AUC) was 0.718 and accuracy was 67.83% at a cutoff value of ≥ 23.15 ng/ml.
Conclusion:
The mean vitamin D3 levels in CRSwNP patients was significantly lower than CRSsNP patients. A cut off level of vitamin D3 level ≥23.15ng/ml had a fair ability to discriminate CRSsNP patients from CRSwNP patients.
Keywords: Chronic Rhinosinusitis (CRS), Polyp, Task force criteria, Vitamin D3.

INITIAL EXPERIENCE OF RECONSTRUCTION OF SURGICAL DEFECT IN HEAD AND NECK WITH FREE FLAP AT DEDICATED CANCER CENTER IN NEPAL

Deepak Yadav — 2023-06-13

Background:
Due to the complexity of surgery, fear of flap failure and lack of resources, free flap reconstruction is rarely performed at most centers in Nepal. Recently free flap reconstruction following ablative surgery for head and neck cancer has been started at Kathmandu cancer center. This study aims to determine the short-term outcomes and success rates of free flap reconstruction following ablative surgery for head and neck cancer at Kathmandu Cancer Center.
Materials and methods:
This is a retrospective chart review of all patients who required free flap reconstruction following head and neck surgery for cancer from July 2021 to December 2022. Various characteristics of patients and details of treatment were extracted from the records.
Results:
During the study period, 38 patients with a median age of 50 underwent surgery for head and neck cancer and required reconstruction with free flap. Primary cancer was the indication for surgery in 32 patients whereas one had undergone surgery for residual tumor and five had undergone surgery for recurrence or second primary. Free radial artery forearm flap (FRAFF) was utilized in 20 patients, free anterolateral thigh flap (FALTF) in 11 patients and free fibula osteocutaneous flap (FFOCF) in 7 patients. Median duration of surgery was 540 minutes. Reexploration within 24 hours was required for two patients, one for hematoma and other for ischemia. One patient experienced free flap failure due to arterial ischemia, resulting in an overall success rate of 97%.
Conclusion:
Dedicated, skilled teams can achieve comparable success and acceptable short-term outcomes in free flap reconstruction.
Keywords: Anastomosis, FALTF, FFOCF, FRAFF, ischemia, oral cavity, neck dissection, Squamous cell cancer.

OUTCOME OF AUGMENTED CARTILAGE TYMPANOPLASTY FOR THE MANAGEMENT OF TYMPANIC MEMBRANE RETRACTION POCKET IN PATIENTS WITH INACTIVE SQUAMOUS CHRONIC OTITIS MEDIA

Dipendra Gautam — 2023-06-13

Objectives:
To evaluate the outcome of augmented cartilage tympanoplasty for the treatment of tympanic membrane retraction pocket in patients with inactive squamous COM.
Materials and methods:
This Prospective, interventional study was conducted in the Department of ORL& HNS, NAMS, Bir Hospital, over a period of 3 years, between July 2017 to December 2000. Twenty-five consecutive patients having tympanic retraction pocket of early symptomatic charachon stage II without otorrhoea, keratin debris or cholesteatoma of age above 5 years were taken for the study. Augmented cartilage tympanoplasty was done after excision of the retraction pockets. The outcome of surgery in terms of graft uptake, hearing improvement and recurrence of disease were noted 12 weeks after the surgery. The patients were kept for continued follow up every three monthly thereafter. Follow-up ranged 3-18 months.
Results:
Out of 25 patients operated, 23 (92%) had successful graft uptake in one and half year observation period. One (4%) had small residual perforation without otorrhoea and one (4%) had mild re-retraction at postero-superior quadrant. The air-bone gap (ABG) improved in 12 (48 %), remained almost similar in 10(40%) and mild deterioration in three (12 %) patients.
Conclusion:
Augmented cartilage tympanoplasty in the early symptomatic patients of charachon stage II retraction pockets do not have significant hearing loss and recurrence of retraction after the surgery with advantage of prevention of choleasteatoma formation and ossicular erosion.
Keywords: Augmented cartilage tympanoplasty, Air bone gap, Tympanic membrane retraction, Inactive squamous COM

EFFECT OF EUSTACHIAN TUBE OBSTRUCTION IN GRAFT UPTAKE RATE IN MYRINGOPLASTY

Bikram Budhathoki — 2023-06-13

Objectives:
To observe the effect of eustachian tube obstruction in graft uptake/rejection rate in myringoplasty.
Materials and methods:
This study was done in Nepalgunj Medical College Teaching Hospital, Kohalpur, Nepal over the period of one year including patients with COM mucosal inactive with age more than 10 years. Standard underlay myringoplasty technique with temporalis fascia graft was used.
Results:
There were total 60 cases, divided in two groups, 30 cases in each. Group 1 consists of patent eustachian tube and Group 2 consists of patients with eustachian tube dysfunction. Graft uptake was seen in 49 patients (81.7%) and rejected in 11 patients (18.33%). Out of 11 rejected cases 5 were from ET patent (GROUP 1) and 6 from ET obstructed (Group 2). Among 49 graft uptake cases, 25 (51.03%) were from Group 1 and 24 (48.97%) were from Group 2. In Group 1 graft uptake was 83% and was rejected in 17%, whereas in Group2 graft uptake was seen in 80% and rejected in 20% which was not statistically significant (p value 0.739).
Conclusions:
There was no significant difference between two groups regarding the graft uptake.

ENT HEAD AND NECK PROBLEMS AT REFERRAL REHABILITATION CENTER OF SHREE BIRENDRA HOSPITAL

Sarita KC — 2023-06-13

Objectives:
The objective of this study was to find out the burden of ENT-HNS problem of differently abled patients at a residential physical rehabilitation center in Nepal. Though people at a residential physical rehabilitation center have many medical problems alike general population, they are known to less emphasize them since the problems related to their primal condition, spinal cord injury (SCI), overshadows others.
Materials and methods:
This retrospective cross-sectional study was conducted at the department of Ear Nose Throat- Head and Neck Surgery, Shree Birendra Hospital. Recorded data were reviewed of clinical examination findings, pure tone audiometry, and speech and language evaluation of 22 residential differently abled patients and were analysed.
Results:
There were total 22 male patients with the mean age of 42 years (ranged 26 -74). Majority had spinal cord injury. Deviated nasal septum was the commonest ENT-HNS finding followed by hearing loss. Five of them (22.72%) had speech and language disorder.
Conclusions:
Patients of physical rehabilitation center have ENT-HNS related problems like DNS, hearing loss, speech and language disorders. However, these problems take less precedence compared to their primary and its associated conditions. Comprehensive check-up and treatment of ENT-HNS problems can contribute to enhance patients’ quality of life.
Keywords: ENT-HNS problems, Physical rehabilitation center, Spinal cord injury

EXOPHYTIC THYROID NODULE

Abha Kuran K.C. — 2023-06-13

ABSTRACT
An exophytic tissue grows outside towards the surface of an organ and the connecting tissue has similar functional features as the mother organ. A case of exophytic thyroid tissue in the submandibular area connected to the normal thyroid by a fibrous stalk has been described. However, the fibrous connecting band did not contain functional thyroid tissue, and hence questions the true exophytic nature of the swelling. We present a rare case of subplatysmal solitary thyroid nodule in lower anterior neck connected to the superior pole of right thyroid lobe by functional thyroid tissue.

Keywords: Exophytic, Thyroid

INFLAMMATORY NASAL POLYP (ANTROCHOANAL POLYP) ASSOCIATED WITH CAVERNOUS HEMANGIOMA

Nagendra Prasad Shah — 2023-06-13

ABSTRACT
Sinonasal cavernous hemangioma, a very rare entity, though congenital appears in third to fourth decade of life and presents with unilateral nasal obstruction and recurrent epistaxis. Bleeding nasal lesion despite typical clinical and histological presentation of antrochoanal /inflammatory nasal polyp, coexisting cavernous hemangioma should be considered when the presenting symptom is epistaxis. Appropriate surgical modality based on the expertise and anticipation to completely remove the mass should be planned. Caldwell Luc surgery is appropriate to remove such lesion when endoscopic surgery cannot proceed due to bleeding.
Keywords: Caldwell Luc surgery, cavernous hemangioma, inflammatory nasal polyp