Ankylosis of the temporomandibular joint.

It studied twenty eight (28) patients with ankylosis of the temporomandibular and , analysed them in terms of age, sex, signs and symptoms. It revealed difficulty in opening the mouth as the common complaint. The detailed history was taken of 96.4 % patients presented in first two decades of life. Right side was found more affected than the left side with bilateral infection in only one patient. Majority of the patients had juxta articular type which followed trauma while as intra-articular ankylosis was seen in 8 patients with secondary infection. Roentgenological examination was found to be useful investigative tool for pre-operative evaluation. After surgical procedures, it was observed that lesser the duration of ankylosis better are the results of surgery. The technique of interposition arthoroplasty using cylindrical acrylic spacer was found safe, simple and inexpensive with uniformly satisfactory in all patients. No complications were observed

Role of fine needle aspiration cytology in the diagnosis of head and neck masses.

It analysed 410 patients in terms of age, sex, signs and symptoms. The commonest presenting symptom was a swelling in head and neck region followed by the pain in the swelling region. A detailed history was taken but routine investigations did not help in arising at a diagnosis but thyroid scintiscan provided a clue to the functional status. FNAC revealed a correct diagnosis in 87.84% patients, case accuracy for thyroid swelling in 90.63% patients, for salivary gland swelling in 82.35% patients, for lymph node swelling in 86.71% patients and miscellaneous swelling in 88% patients. The sensitivity of FNAC observed for diagnosing malignant lesions were in 93.25 % patients. Positive predictive value of FNAC was in 98.06 % patients, FNAC missed 11 malignancies cases. All the cases were subjected to different surgical procedures for detaining tissue specimens to establish the histopathological confirmation of diagnoses and also provided the comparison between cytological and hystopathological diagnosis. It recommends FNAC in the preoperative evaluation of head and neck masses

Results of snodgrass repair.

Objectives: Snodgrass repair is fast becoming the procedure of choice in distal penile hypospadias. Multiple series document excellent cosmetic outcome in conjuction with low complication rates. Study Design: Prospective. Material & Methods: A prospective study of 26 patients in whom Snodgrass repair for distal penile hypospadias was done over a period of two and a half years. All patients with hypospadias other than distal penile were excluded from the study. Results: Mean age of the patients was 6.2±3.2years. Mean operative time was 68.7 minutes. Mean hospital stay was 15.4 days. Wound infection, bleeding/haematoma and urethrocutaneous fistula were the three complications seen in our patients with equal incidence (3.8%). Cosmetic as well as functional outcome was very good in our patients. Conclusions: Snodgrass Repair has revolutionised the management of distal penile hypospadias. Meticulous technique coupled with careful patient selection permit a high rate of success with minimal morbidity

Clinical profile and surgical results with rotation advancement and triangular flap technique in congenital cleft.

It studied 105 patients of congenital cleft evaluated for rotation advancement and triangular flap techniques in 68 patients of unilateral cleft. A detailed history was taken and systematic examination carried out. 78.1% patients had unilateral clefts and left side involvement part of bilateral cleft was observed in 2/3rd of the patient. Clefts were complete in 68.5% patients. Associated nostril deformity was observed in all patients. Millard repair was conducted in 38 cases whereas 30 patients had undergone tennision repair. The short lips were found in 11 patients and long lips in 3 patients .. Scar hypertrophy (increase in size of an organ) was observed after millard repair. Grading was better for incomplete clefts and lip segments in comparison to complete clefts and nose segment. Complications in terms of complete or partial wound disruption were observed in 4 patients, out of which 3 patients needed secondary repair. Follow up period ranged from 3 months to 5 years. It concludes that ultimate outcome of nasal and various secondary deformities need a follow up for many more years

Intralesional corticosteroid therapy in childhood cutaneous heamangiomas.

The study investigates 50 cases with haemangiomas and analyzed in terms of age, sex and site of involvement. The common sites of involvement were head, neck, chest and abdomen. A detailed history was taken and the numbers of lesions found were single, double or multiple and the colour of lesions was brown, bluish, pink and skin coloured. A thorough check up was made in case of haemangiomas around the eye. The patients were subjected to local intralesional corticosteroid therapy through a 26 gauge needle under all aseptic precautions. The procedure was done mostly without anesthesia with assistant immobilizing. The ketamine sulphate was given intravenously to prevent injury to the eye in children with periorbital haemangiomas. The follow up period of patients was six months It revealed that 37.3% patients of the lesions disappeared completely, 25.92 % patients underwent more than 50% reduction in volume while 18.5% showed less than 50 % reduction in vol,18.5 % patients did not show any response to therapy. The results were better in smaller in lesions and younger patients. The complications like ulceration, subcutaneous atrophy and bleeding were seen in 7.96% cases but all resolved after stopping the treatment

Clinical profile and surgical results of platoplasty in congenital cleftplate.

In a retrospective and prospective study of 5 years clinical profile of 102 patients of congenital cleft plate was studied. 81 patients attending the follow up were assessed for anatomycal results and 60 patients were above the age of 4 years were assessed for speech development. A detailed history was taken. The most common complaints were regurgitation of feeds, defect in plate, defective speech etc. Males were more affected than females. The type III cleft was seen more than type II clefts. Associated anomolies were seen in 3.92% patients. ENT problems including serous otitis media, perforations and deafness was seen in 11.69% patients out of 102 patients V-Y pushback operation was done in 72 patients and four flap technique in 30 patients. Post operative complications were seen in 6.68% patients including 2 patients of wound disruption and 4 patients of palatal fistula. Nasopharyngeal competence was achieved in 75 of patients. It revealed that best speech results were observed in patients operated before the age of 2 years

Clinical profile and outcome of surgical treatment of dermatofibrosarcoma protuberans (DFSP).

Abstract Objectives: The main objective of the present study was to study the clinical pattern and outcome of surgical treatment of Dermatofibrosarcoma Protuberans. Material & Methods: This study included 45 patients both retrospective and prospective from Dec. 1995 to Dec. 2008. Results: In total, 45 patients were studied. Out of 45 patients, 30 were males and 15 females with the male to female ratio of 2:1. Mean age of presentation was 38.4±13.2 years. Commonest mode of presentation was raised firm multinodular lesion with fixity to overlying skin. Site distribution was 42.22% trunk, 58.88% extremities and head & neck. All the patients underwent wide local excision. Split thickness skin graft (STSG) was used in 37 (82.22%), pedicled flap in 3 (6.66%) & primary closure in 5 patients. On histological examination, 8 patients had positive margins and adjuvant post operative radiotherapy was used in these 8 patients. The rate of recurrence following surgery was 18.91% and after adjuvant postoperative radiotherapy, recurrence rate was 37.50%. Overall recurrence rate was 22.22%. Only 2 patients developed metastasis to lungs in the course of their follow-up. None of the patients had lymph node involvement. Out of 45 patients, 35 remained recurrence free over a varying period of 5 months to 13 years (mean 68 months). 10 patients developed one or more local recurrences. Out of 10 patients with local recurrence, 7 had single recurrence, 1 had 2 recurrences and 2 had more than 2 recurrences. Average time from initial treatment to recurrence was 32 months. All patients with recurrent tumours were subjected to salvage treatment i. E. re-excision. Average recurrence free period was 36±44 months within a mean follow up of 68 months. Conclusions: Because of the potential of local recurrence, therapy for DFSP should be directed towards adequate local excision of the primary lesion. Minimal resection should include a surrounding margin of 2-3cm of normal skin. and removal of underlying deep fascia is essential. Compromising on margins invites higher chances of local recurrence. Addition of adjuvant postoperative radiotherapy may decrease likelihood of local recurrence

Soft tissue defects of the ankle and foot: Clinical profile and management.

Objectives: To study the etiologies and distribution of soft tissue defects over the ankle and foot, reconstructive procedures employed to provide cover of these defects, outcome, and the complications of various reconstructive procedures. Study Design: Retrospective and prospective Materials & Methods: All patients with soft tissue defects of ankle and foot, treated in the Department from Jan 1995 to July 2006, were evaluated for the etiology, site, histopathology of the lesions, size of the defects, any underlying illness and the reconstruction planned accordingly. Outcome of the reconstruction was assessed by regular follow-up. Results: Overall, 213 patients were studied with mean age of 37 years (range, 1-75 years). Male: female ratio was 2:1. Majority of the defects were on the weight bearing heel (35%); other predominant sites were dorsum of the foot (12%), dorsum of ankle (9%), forefoot (18%), posterior heel (8%) and circumferential foot & ankle (5%). Motor vehicular accidents accounted for the most common cause of the defects (38%); other causes were post tumor excision (25%), diabetes (16.7%), and burns (8.3%). Among the 55 patients with tumorous defects, 54.5% were squamous cell carcinomas, and 38% were malignant melanomas. Various modalities of the reconstruction were Distally based sural artery flap in 85 (40%) patients, Microvascular transfer of Latissimus dorsi, rectus abdominis and anterolateral thigh free flaps in 8 (3.7%) patients, flexor digitorum brevis muscle turnover flap with grafting in 12 (5.6%) patients, instep island flap in 3 patients, posterior tibial flap in 8 (3.7%) patients and instep rotation flap in 11 (5.1%) patients. Vacuum assisted closure (VAC) as a new modality of treatment was applied for reconstruction in 10 patients. There were only one complete flap necroses each in free flap and sural artery flap groups, 10 marginal/ partial necrosis and only two graft losses. They were managed by dressings, VAC and regrafting. Long-term results of the reconstruction were satisfactory. 90% of the patients were able to ambulate in their normal footwear. Half of the patients had protective sensations reconstruction was aesthetically acceptable to them. Conclusions: These reconstructive measures give the sufferers a good quality of life in the form of ambulation in a normal footwear and esthetically acceptable shape of the foot