Coblation Tonsillectomy our experience

Tonsillectomy happens to be the commonly performed surgery these days. Like any other surgical procedure this surgical procedure has also undergone tremendous technological changes. One suchevolving change happens to be coblation tonsillectomy. Coblation technology is actually an offshoot of radiofrequency surgery. This technique involves passing radiofrequency energy througha conductive medium like isotonic sodium chloride or potassium chloride solution. This produces a plasma field which is composed of sodium and hydroxyl ions which ablates tissue. This tissueablation takes place at (60-70° C) which is much lower than that achieved during other electro surgical techniques (400 – 600° C). This article attempts to discuss the use of this technology toperform tonsillectomy with special emphasis on sharing our experience with the system. This study involves critical appraisal of 25 coblation tonsillectomy surgeries performed at Stanley Medicalcollege during the year 2013.

Skin Metastasis in a case of Oropharyngeal Cancer

Distant metastasis from oropharyngeal cancers usually occur in the lung, liver or bone. We present here a case of skin metastasis from primary cancer of the oropharynx (right tonsil extending up to the soft palate and adjacent base of tongue) in 56 year old male smoker initially staged as T3 N2c M0. After completion of definitive chemoradiation, the patient was in disease free locoregionally but developed secondaries in lung and bone and multiple skin nodules whichwere confirmed as metastatic deposits. Skin metastasis from oropharyngeal cancers are very rare (about 1%) and need careful evaluation because they portend a poor prognosis.

MALIGNANT PERIPHERAL NERVE SHEATH TUMOR OF THE NECK

Malignant peripheral nerve sheath tumors are highly aggressive tumors characterized by rapid growth with infiltration of surrounding tissue and hematogenous metastases. Wedescribed a 32-old male patient with malignant peripheral nerve sheath tumor of the head and neck. Surgery was the chosen method of treatment by the dissecting the mass.Even chemotherapy were administered after surgery, local recurrence occurred in the second month of the follow-up period. Then the patient underwent radical neck dissection under general anesthesia. Close follow-up was made, at first year disease hadno recurrence. We reported this case and reviewed the literature regarding malignant peripheral nerve sheath tumor by reason of this case.

TEFLON VS TITANIUM PROSTHESES IN STAPES SURGERY

BACKGROUND: Otosclerosis is one of the most leading causes of conductive hearing loss with intact tympanic membrane in adults. Stapes prostheses have seen many changes in its shape, design and material. Both Teflon and Titanium prostheses used in this study having different method of application are reviewed in detail.OBJECTIVE: To compare the outcomes of use of Teflon and Titanium prostheses instapedotomy surgery in patients with conductive hearing loss.STUDY DESIGN: Prospective studySETTING: Tertiary referral centreMETHODS: A prospective study of 50 patients of otosclerosis, who underwent stapedotomy at B.J.Medical College, Civil Hospital, Ahmedabad, with Teflon/Titanium prostheses, from June 2009-February 2012 was done. Follow up was done for a minimum period of 6 months.Revision cases were excluded. A comparison of prostheses was concluded by differences in AB (Air Bone) Gap.RESULT: Postoperative ABG of 20db or less was seen in 96% in both groups. The mean postoperative ABGap was 8.2 dB and 11.5 dB for Teflon and Titanium group respectively.There was no statistically significance difference noted in ABGap between Teflon and Titanium pistons at 95% confidence limit at P<0.05. There was significant improvement of AC thresholds at each frequency except for above 4 kHz, in postoperative period.CONCLUSION: Both prostheses provide equal benefit to patients and there is no statistically significant difference between the uses of Teflon/Titanium prostheses. Long term results are still to be analyzed.

PRIMARY B CELL LYMPHOMA OF TONGUE- A RARE CASE REPORT

Malignant lymphoma of the oral cavity is rare (2-3%). The gingival vestibule andWaldeyer’s ring seem to be the most frequent sites of occurrence whereas the lingual and buccal mucosa is rarely involved. We here present a case of B- cell lymphoma in a 55 year old male who presented with a mass lesion primarily involving the tongue.Although lymphoma of tongue is very uncommon, it should always be considered indifferential diagnosis of various benign and malignant lesions in this region. A properclinical evaluation, histopathologic as well as immune histochemical evaluation of biopsy specimen may aid in the diagnosis and thus, help in proper management.

STYLALGIA BILATERAL: A CASE REPORT

Calcified stylohyoid ligament may presents in the form of recurrent throat pain unilateral or bilateral, foreign body sensation or sometimes dysphagia and rarely referred otalgia. In adults the styloid process is approximately 2.5 cm in length, in our case it was nearly 4 to 5cm in length with its tip just lateral to tonsil in tonsillar bed area.

CASE REPORT A CASE OF EPIDERMOID INCLUSION CYST IN THE NASAL VESTIBULE

ABSTRACT                                                                                                                                                    Introduction:  Epidermal inclusion cyst are formed due to trauma or they may be congenital. They are unusual in head and neck region. Epidermal inclusion cyst is rare in nasal vestibular region.                                                                                                                                                                     Case report: To present a case of Epidermal inclusion cyst in the right nasal vestibular region with no history of trauma. Patient had no allergic symptoms. The swelling was non fluctuant and cystic.  All routine investigation normal. The swelling was excised via elliptical incision and sent for histopathological examination. Histopathological finding consistent with epidermal inclusion cyst.                                                                                                                                       Conclusion: Epidermal inclusion cyst in nasal vestibular region is rare. In the absence of history of trauma, only clinical examination and histopathology will help in diagnosis.

BILATERAL PERICHONDRITIS OF PINNA FOLLOWING PIERCING OF HELIX – A CASE REPORT

Piercing of Helix of pinna is a social custom of certain communities in Northern Tamil Nadu. Sucha “high helical” piercing is well known to cause Perichondritis of Pinna. Most of the times such aPerichondritis is unilateral. Here we present a case of Bilateral Perichondritis of pinna, followingear piercing, first time from India subcontinent. We also highlight some practical points onmanagement of such cases.

Kashima's Posterior cordectomy using coablator our experience

Aim:To study the effectiveness of coblation technology in performing Kashima's procedure for bilateral abductor vocal fold paralysis.Methodology:Managing patients with bilateral vocal fold abductor paralysis is rather tricky one. It calls for delicate balance between airway and phonation. Various endolaryngeal techniques have been usedto manage this problem. Here the authors describe their experience with posterior cordectomy using coablator. This study includes 10 patients who presented with stridor following bilateralabductor paralysis. All our patients were on tracheostomy tubes. They were very anxious with the tube and wanted decannulation done. All of these patients were operated by the same seniorsurgeon. These patients were managed with posterior cordotomy using coablation. Laryngealwands were used in all these patients. These patients underwent spiggoting of their tracheostomy tube on the first post operative day. Decannulation was completed on the third post operative day.Early decannulation was made possible because there was negligible soft tissue oedema as these patients underwent coblation procedure.Observation:On discharge all of them had a good voice and adequate airway.These patients were able to climb two flights of stairs without discomfort.Although the causes of bilateral abductor paralysis of vocal cords are multifactorial post traumaticparalysis formed a large majority of our patients ( 8 who developed bilateral vocal fold paralysis following total thyroidectomy).

Coblation wands

This article discusses the architecture of coblation wands used in otolaryngological surgeries.Wand happens to be the most important consumable of the coblation system. These wands are also expensive and meant only for single use. Hence this technology has a built in recurring cost factor.