RESUMEN

Conventional deltopectoral flap is a two-staged procedure that needs a prolonged hospital stay, adding to treatment cost as well as patient discomfort and may delay adjuvant treatment. A modified deltopectoral flap, as a single-stage procedure, can overcome these shortcomings. This is a retrospective chart review of prospectively collected clinical data from a tertiary care hospital. The patients who had undergone a deltopectoral flap for the reconstruction of the neck defects at our hospital between July 2017 and July 2021 were considered for analysis. We present our results with a single-stage deltopectoral flap that was used to reconstruct medium-to-large-size defects of the neck, along with clinical illustrations as appropriate. This study was approved by the Institutional Ethical Committee (number: IEC 702-2021). A total of six patients received single-stage deltopectoral flap during the study period, of which five were for oncosurgical defects, and one had necrotizing fasciitis. The healing and overall outcome were optimal in all cases, with no flap loss. In two of these cases, the donor site was closed primarily, and in the rest, a split-thickness skin graft was used. Our results reiterate the tremendous practical value of a single-stage deltopectoral flap in the primary reconstruction of medium- to large-sized surgical defects of the neck, even in this era of free tissue transfer. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04641-8.

RESUMEN

Malignant nerve sheath tumors are rare and aggressive soft tissue sarcomas. They contribute to 5-10% of all soft tissue sarcomas. They can be sporadic, occur in patients with NF1 (neurofibromatosis 1) or can occur after radiation therapy. A high rate of recurrence and hematogenous metastasis is seen in these patients. They are also associated with poor prognosis. A case of malignant nerve sheath tumor seen in a 44-year-old male with pre-existing NF1 is being discussed here due to the unique nature of the disease and its rarity.

RESUMEN

Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.

RESUMEN

Angiolipoma is a benign mesenchymal tumor and its occurrence in head and neck region is very rare. Only 2 cases of Laryngeal angiolipomas have been reported in the medical literature. We present one such rare case in a 32-year-old male who presented with complaints of change in voice and foreign body sensation in the throat since past 9 months along with features suggestive of obstructive sleep apnoea and dysphagia. Contrast enhanced CT scan of the neck showed a cystic lesion arising from right ventricle extending superiorly till the vallecula, partially obstructing the airway. Suspecting a supraglottic cyst, trans-oral microlaryngoscopic KTP-532 laser assisted excision was planned, intraoperatively a solid tumor was encountered. We discuss herein the clinical presentation and management of this rare neoplasm with review of literature.

RESUMEN

Abstract Introduction The criteria for the removal of the tracheostomy tube (decannulation) vary from center to center. Some perform an endoscopic evaluation under anesthesia or computed tomography, which adds to the cost and discomfort. We use a simple two-part protocol to determine the eligibility and carry out the decannulation: part I consists of airway and swallowing assessment through an office-based flexible laryngotracheoscopy, and part II involves a tracheostomy capping trial. Objective The primary objective was to determine the safety and efficacy of the simplified decannulation protocol followed at our center among the patients who were weaned off the mechanical ventilator and exhibited good swallowing function clinically. Methods Of the patients considered for decannulation between November 1st, 2018, and October 31st, 2020, those who had undergone tracheostomy for prolonged mechanical ventilation were included. The efficacy to predict successful decannulation was calculated by the decannulation rate among patients who had been deemed eligible for decannulation in part I of the protocol, and the safety profile was defined by the protocol's ability to correctly predict the chances of risk-free decannulation among those submitted to part II of the protocol. Results Among the 48 patients included (mean age: 46.5 years; male-to-female ratio: 3:1), the efficacy of our protocol in predicting the successful decannulation was of 87.5%, and it was was safe or reliable in 95.45%. Also, in our cohort, the decannulation success and the duration of tracheotomy dependence were significantly affected by the neurological status of the patients. Conclusion The decannulation protocol consisting of office-based flexible laryngotracheoscopy and capping trial of the tracheostomy tube can safely and effectively aid the decannulation process.

RESUMEN

BACKGROUND: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. METHODS: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. RESULTS: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. CONCLUSIONS: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

Asunto(s)

RESUMEN

The current consensus in the management of hypopharyngeal cancers favors the non-surgical management. However, many studies have reported relatively better oncological and functional outcomes with the surgical approach in locally advanced hypopharyngeal cancers. In here, we report a tertiary care center's experience with total laryngopharyngoesophagectomy with gastric pull-up done for such cases. We also describe a slight modification of the procedure that has been followed at our institute, and discuss its advantages. It is a retrospective study of patients who have undergone the surgical procedure between the September 2016 and the March 2019. The primary objective was to analyze the surgical complications and the benefits in terms of disease clearance, survival duration, and functional outcomes. Study consisted of 15 patients, mostly men, with mean age of 56 years. 12/15 had stage IV disease and 7/15 were failed chemoradiotherapy. Most common complication of surgery was anastomotic failure (33%). Perioperative mortality rate was 13.3%. Higher complications could probably be attributed to poor nutrition and tension over the anastomosis. Mean survival duration and disease free interval were 12.1 and 11 months, respectively. Oral feeds was restored in 77%, and the average time to restore oral feeds was 17 days. Most of our results were comparable with the literature, which supports the surgical excision of larynx-pharynx-esophagus and reconstruction by pull-up, in all those medically fit cases of radio-recurrent/residual tumors, and also in primary cases of locally advanced hypopharyngeal cancers with non-functional larynx. In these scenarios, the radical surgical treatment would atleast serve as palliative if not curative.

RESUMEN

OBJECTIVE: Dysphonia is one of the most common side effects of long-term inhaler therapy containing corticosteroids in asthma or asthma-chronic obstructive pulmonary disease overlap (ACO) patients. This common, often reversible side effect is due to the structural changes in the vocal folds resulting from steroid deposition. This study determines the structural changes and voice profile of patients on long-term inhaler therapy by videostroboscopy and perceptual voice profile analysis. It also determines the duration, formulation, and drug delivery system producing the least side effects during therapy. STUDY DESIGN: Prospective case-control study. SETTING: Tertiary care hospital. METHODS: In total, 196 patients diagnosed with moderate to severe asthma or ACO were divided into cases (patients on at least 6-month combination inhaler therapy) and controls (newly diagnosed patients not on inhaler therapy) and recruited in the study. They were assessed by videostroboscopy for structural changes and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and strain) perceptual scale for voice profile changes. RESULTS: The prevalence of dysphonia was significantly higher in cases (62.2%) than controls (27.6%). Prevalence of laryngeal structural changes and voice profile changes were higher in cases. The prevalence of dysphonia and structural changes among cases was much lower when a spacer was used (P < .001). CONCLUSION: This study adds evidence to the long-term side effects of combination inhaler therapy containing corticosteroids on the larynx as demonstrated by videostroboscopy and perceptual voice profile analysis. It also propagates the use of spacers in drug delivery to reduce the prevalence of side effects during long-term inhaler therapy.

Asunto(s)

RESUMEN

Ingested fish bone at times can migrate extraluminally into the surrounding soft tissue, leading to complications. Conventionally, these migrated fish bones are retrieved by open procedures, which could add to the morbidity. We successfully retrieved one such foreign body by a minimally invasive transcervical approach in a 64-year-old female patient. The method offered an easy identification of the foreign body with minimal soft-tissue dissection, which ultimately aided in the early post-operative recovery. This is the first report of a minimally invasive approach to explore the retropharyngeal space, and we propose the technique even for sampling retropharyngeal lymph node.

RESUMEN

OBJECTIVES: Preserving the External Branch of Superior Laryngeal Nerve (EBSLN) and Internal Branch of Superior Laryngeal Nerve (IBSLN) is essential during thyroidectomy. However, due to potential distortions caused by large goitres, the present anatomical landmarks used to identify these nerves are flawed. Although under such circumstances, bony landmarks may offer more stable reference points, not much has been explored in this regard. This study measures the distance between the most vulnerable points of the EBSLN and IBSLN and their relatively unexplored bony landmarks, such as the hyoid bone and thyroid notch as well as soft-tissue landmarks like the origin of the Superior Thyroid Artery (STA) and carotid bifurcation. METHODS: An exploratory cadaveric study was conducted in a medical school affiliated with a tertiary care hospital. The detailed analysis included 13 sides from 8 cadavers. RESULTS: The average distance from the EBSLN piercing site to the greater cornua of the hyoid bone, thyroid cartilage prominence, origin of the STA, and carotid bifurcation was 35.1(±7.2) mm, 33.3(±3.8) mm, 25.7(±6.3) mm, and 31.5(±5.0) mm, respectively and from the IBSLN piercing site was 15.9(±5.9) mm, 32.9(±4.7) mm, 16.3(±4.2) mm, and 20.7(±5.9) mm, respectively. For most cadavers, the distal EBSLN had Cernea type 2a-like relationship with the STA. Certain variations were also observed in the way these nerves branched with respect to the origin of the STA. CONCLUSIONS: This study provides metric information (linear measurements) regarding the distance between the branches of SLN and certain unique landmarks. This could potentially aid in minimising intraoperative trauma to these branches.

RESUMEN

BACKGROUND: Social media has become an integral part in the life of every individual in the 21st century. Social media addiction in the younger age group is a major problem. The objective of this study was to find a correlation between academic performance and social media use. METHODS: This was a cross-sectional questionnaire-based study conducted in a medical school over a period of 3 months (Nov 2018-Jan 2019), where 400 medical undergraduates who use social media participated in the study. Data collected from the questionnaire included the academic performance in terms of university examination marks, the duration of social media use per day and the social media addiction score. Data correlation was done using the Pearson's correlation factor. RESULTS: 41.5% of students used social media for upto 3 h per day. Whatsapp (98.25%) and Youtube (91.75%) were the most commonly used social media applications. 73.5% used social media to read health-related news, 71.5% used it to complete assignments and more than 50% used it for seminar preparation, test preparation and research-related purposes. Academic performance of female students was better than male students. There was a significantly higher use of social media among academically low-performing medical students compared with high-performing medical students. There was a weak negative correlation between academic performance and social media usage and a strong positive correlation between social media usage and the social media addiction score. CONCLUSIONS: Social media has a negative impact on the academic performance of 21st-century undergraduate medical students.

RESUMEN

ABSTRACT: Repeated bouts of nose blowing can at times lead to orbital emphysema due to stress fracture in the medial or the inferior wall of the orbit. Very rarely, this can result from paranasal sinus osteoma rendering the orbital wall weak. We report only the fifth case of literature to have such an association. Also, we managed our case non-surgically, as against the previous reports treated surgically. In discussion, we highlight the nuances related to principles of management, including the role of computed tomography, and surgical intervention.

Asunto(s)

RESUMEN

OBJECTIVES: Budesonide nasal irrigation is currently widely used in the treatment of chronic sinusitis typically following endoscopic sinus surgery to improve inflammatory control. Its application in treatment of allergic rhinitis has not been previously studied. This study assesses the subjective and clinical response to budesonide buffered hypertonic saline nasal irrigation and hypertonic saline nasal irrigation in patients with allergic rhinitis. STUDY DESIGN: This is a prospective, single-center, double-blind, randomized placebo-controlled trial. SETTING: Tertiary care hospital. SUBJECTS AND METHODS: Fifty-two patients diagnosed with allergic rhinitis were randomized into 2 groups to receive either buffered hypertonic saline nasal irrigation with a placebo respule or buffered hypertonic saline nasal irrigation with a budesonide respule. Patients were assessed at baseline and 4 weeks subjectively using the Sino-Nasal Outcome Test-22 (SNOT-22) questionnaire and visual analog scale (VAS). Clinical assessment was done using the modified Lund-Kennedy score. RESULTS: The average SNOT-22, VAS, and modified Lund-Kennedy scores improved in both groups (P < .001). The budesonide irrigation group was found to have significantly better improvement than the saline nasal irrigation group with the SNOT-22 scores (P = .012) and VAS scores (P = .007). However, the difference in the clinical response between the 2 groups was not significant (P = .268). CONCLUSION: This study adds evidence to the use of saline nasal irrigation in allergic rhinitis but also demonstrates efficacy of the addition of budesonide to irrigations. Budesonide nasal irrigation thus appears to be a viable treatment option for allergic rhinitis.

Asunto(s)

RESUMEN

INTRODUCTION: Rhabdomyosarcoma is the most frequently occurring intrusive soft tissue sarcoma in the pediatric age group. Orbit is the most common location for a pediatric rhabdomyosarcoma, but it can occur in the oral cavity, pharynx, face and neck in the descending order of incidence. Rhabdomyosarcoma in the ear is extremely rare. CASE REPORT: A 5-year-old girl presented to the outpatient department of our tertiary care hospital with complaints of foul smelling, non-blood stained right ear discharge of one-month duration and deviation of angle of mouth to the left side of acute onset. Investigations revealed a diagnosis of embryonal rhabdomyosarcoma. Multimodal therapy was carried out, and the child was rendered disease-free after two years. CONCLUSION: Embryonal rhabdomyosarcoma of the head and neck mimics chronic otitis media. Early diagnosis is essential to deliver prompt treatment and prevent locoregional spread and metastasis.

RESUMEN

Renal cell carcinoma is usually slow growing with delayed vague symptoms and may not be detected until an advanced stage. In only 9% of the cases the classical triad of "haematuria, costovertebral pain and abdominal mass" is seen. Less commonly, sinonasal metastasis may also be the presenting feature of RCC. So, in any case of sinonasal mass, possibility of metastasis from renal malignancy should be considered. Sinonasal metastasis from renal malignancy can occur even several years after the primary is treated with nephrectomy. In sinonasal region maxillary sinus is the most commonly affected. Isolated metastasis to the nose is extremely rare. Malignancies from various other sites of the body can also metastasize to sinonasal region. Epistaxis is the most common symptom. This is because of vascular stroma of the metastatic deposit. A 45 year old male with history of right nephrectomy 1 year back presented with intractable epistaxis. A 66 year old male presented with profuse epistaxis without any history of previous malignancies. Both the cases were evaluated resulting to the diagnosis of sinonasal metastasis from Renal Cell carcinoma. In the first case, metastasis occurred 1 year post surgery whereas in second case sinonasal metastasis was the presenting feature of Renal Cell carcinoma. Epistaxis is the most common symptom. This is because of vascular stroma of this metastatic deposit. In renal cancer, symptoms of metastasis often precede the symptoms of primary tumor.

RESUMEN

To evaluate the anatomical variations in computed tomographic (CT) images of paranasal sinuses and to investigate association between them. DESIGN: Retrospective study. SETTING: Tertiary care center in the southern part of India. SUBJECTS: Radiological images of paranasal sinuses belonging to chronic rhinosinusitis patients managed between June 2016 and November 2018. METHODS: The studied characteristics in the CT images included the deviated nasal septum (DNS), concha bullosa (CB), Haller cell (HC), Onodi cell (OC), pneumatization of anterior clinoid process (ACP), pterygoid base (PB), superior turbinate, inferior turbinate, crista galli (CG), and nasal septum. The height of the lateral lamella of the cribriform plate, the sphenoid pneumatization pattern, and the optic nerve relationship with sphenoid sinus were studied separately. The associations between these factors, and with maxillary sinus opacifications were also investigated. A total of 151 adult patients' CT images were analyzed. The most common manifestations noted were DNS, CB and pneumatized PB, seen in 83.4%, 49% and 47% of the patients respectively. The rates of HC, OC, pneumatized septum, pneumatized CG, and pneumatized ACP were 39%, 23%, 27%, 43% and 27% in that order. Rates of most of these variations were within the range reported in the literature. Chi square test revealed that the OC was independently associated with pneumatized CG and pneumatized septum. The maxillary sinus opacification was related to DNS and CB, but not with protrusion of tooth root into the sinus. Most of the anatomical variations were comparable with the reports across the globe, however, the associations between these variations weren't common in our cohort.

RESUMEN

INTRODUCTION: The incidence of cholesteatoma occurring as a result of tympanoplasty is extremely rare. Understanding the cause and preventing its occurrence in the future is the main intention of highlighting this peculiar presentation. CASE REPORT: A 25-year-old woman presented with progressive hearing loss and blocked sensation in the left ear of one and a half months duration. Past history revealed a history of left myringoplasty six years prior to presentation. Clinical examination of the ear revealed a smooth, soft epithelium covered bulge in the lateral one-third of the floor and posterior wall of the left external auditory canal. HRCT and MRI of the temporal bone confirmed the presence of a soft tissue density in the mastoid. Pure tone audiometry revealed conductive hearing loss. She underwent mastoid exploration, removal of sac with soft wall reconstruction. CONCLUSION: Proper placement of the vascular strip with the skin lining the external auditory canal with approximation of the incision margins is essential to prevent iatrogenic cholesteatoma formation. Close follow-up is essential to prevent any recurrence and diffusion weighted MRI plays a vital role in detection of recurrence.

RESUMEN

OBJECTIVE: The prognosis of patients with malignant external otitis (MEO) depends on the extent of the inflammatory changes in the temporal bone and skull base. The efficacy of high-resolution computed tomography (HRCT) imaging in accurately assessing the extent of disease is compared with that of single-photon emission computed tomography/computed tomography (SPECT/CT) scan. STUDY DESIGN: A clinical chart review was conducted with medical records and radiologic images. SETTING: Tertiary care medical college hospital. SUBJECTS AND METHODS: This study involved patients with clinically diagnosed MEO who underwent both modalities of imaging of the skull base. Staging of the disease extent was compared between the imaging systems among patients. Symptom control and survival rates were analyzed with respect to the SPECT/CT staging of MEO. RESULTS: Out of 28 patients included in this study, 72% had SPECT/CT scans showing higher staging than the HRCT imaging. Four patients had mild uptake (stage 1), and 15 had disease confined to the mastoid/temporal bone, not reaching midline (stage 2). All patients in stages 1 and 2 were surviving with good symptom control. Five patients with petrous involvement reaching midline (stage 3) had persistent symptoms, and all 4 cases with SPECT/CT showing sphenoid involvement and crossing midline (stage 4) died within a year of diagnosis. CONCLUSIONS: SPECT/CT scan is more sensitive than HRCT imaging in detecting the extent of disease and is a better prognosticator for patients with MEO.

Asunto(s)

RESUMEN

The most cost-effective test is fine needle aspiration cytology (FNAC). Many surgeons use intraoperative frozen section to confirm the FNAC findings and to guide the extent of thyroid surgery. Though it is a valuable tool in the diagnosis of the thyroid lesion and determining the extent of thyroid surgery, still in certain cases diagnosis can be incorrect or inconclusive, so histopathology of the excised specimen remains the most reliable test. The purpose of this study will be to compare the result attained by FNAC and frozen section of the thyroid to the final histopathological diagnosis, in order to establish their role in thyroid surgery today. A retrospective study with a total of 140 patients who underwent thyroid surgery at the ENT department, of a tertiary hospital in coastal Karnataka. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for FNAC and frozen section. The sensitivity, specificity, positive predictive rate, and negative predictive rate of frozen section was found to be 66.7%, 88.4%,76.6%, 82.4% respectively for detecting malignancy. This was found to be higher than the results of FNAC for the same which were 64.4%, 77.8%, 64.4%, 77.8% respectively. As the sensitivity of FNAC is similar to frozen section in detecting malignant cases, FNAC is a good tool for screening the patient for determining malignancy in thyroid, but frozen section is more specific in confirming the malignancy.

RESUMEN

Entomopthoromycosis is a rare subcutaneous fungal infection caused by onidiobolus coronatus affecting mainly the upper respiratory mucosa in immunocompetent people.The manifestations of this disease masquerades other clinical entities.Hence, high index of suspicion is required for prompt diagnosis.Histopathological examination and culture are the gold standard diagnostic tools, however no standard treatment protocols ha been mentioned in literature.We present a case of rhinofacial entomopthoromycosis in a yearold ma with a leftsided rhinofacial swelling to highlight the presence of this unusual fungal infection and its treatment.

Asunto(s)