A Cadaveric Study of Occurrence of Extralaryngeal Branches of the Recurrent Laryngeal Nerve with Reference to its Importance in Thyroid Surgery

Introduction Recurrent Laryngeal Nerve Palsy (RLNP) is the most common complication of thyroid surgery. Patients complain of hoarseness of voice and sometimes variable amount of respiratory distress due to palsy of recurrent laryngeal nerve (RLN), extra laryngeal branches of which are often ligated along with Inferior Thyroid Artery (ITA) during thyroidectomy. So prevalence and variable pattern of extra laryngeal nerve branches (ELNB) of RLN should be known to the thyroid surgeon to avoid post operative complications. Materials and Methods   Dissection was carried on the neck of properly embalmed 25 adult cadavers including both sexes in the dissection hall to study extra laryngeal nerve branches (ELNB) of 50 RLN specimens. Results Out of 50 RLN, 13 nerves (26%) have ELNBs. Only in 4 cadavers (16%) they are bilateral. In 9 cases RLN branches were surrounding either single trunk of ITA or branches of the artery. In rest of the 4 cases ELNBs were passing entirely either in front or behind the ITA Conclusion The gold standard for preservation of the RLN during thyroid surgery is still visual anatomical identification. Proper dissection and anatomical identification of the RLN and all its branches is very important prior to the clamping of the ITA and all its branches

Chronic Draining Ear and Cholesteatoma Recidivism: A Retrospection from Clinical, Imaging, and Surgical Perspectives

Objective:To evaluate the reasons for persistent draining ear and cholesteatoma recidivism following canal wall down (CWD) tympanomastoidectomy by studying the sensitivity of high-resolution computed tomography (HRCT) scanning in different potential etiologies, corroborating through appropriate surgical intervention, and thereby, to suggest proper preventive measures.Methods:In this observational study, 32 chronic, refractory draining ears were subjected to revision surgery following a radical or a modified radical mastoidectomy. Besides disease (cholesteatoma/granulations) eradication, pitfalls of the primary surgeries were addressed. Data were interpreted for studying the epidemiologic profile, the clinical presentation at recurrence, the type of primary surgery, the sites of recidivism, the probable causes, and the best possible management at revision.Results:Of the 32 patients/ears, 23 had residual/recurrent cholesteatoma. Major reasons were inadequate disease clearance, contracted/inadequate conchomeatoplasty, no cavity obliteration, and inappropriate bone work. HRCT predicted persistent bridge and lateral semicircular canal dehiscence with 100%, and ossicular integrity and bony overhang with >80% sensitivity. Sinus tympani and oval window niche were the commonest sites of recurrence. At revision, radical/modified radical mastoidectomies were associated with cavity obliteration and appropriate revision of conchomeatoplasty in 28 patients.Conclusion:Recurrence of cholesteatoma/granulations is an important cause for chronic drainage from post-CWD cavities. Revision surgery explores the surgical pitfalls, and ensures clearance of disease from hidden areas, adequate bone work, and optimum conchomeatoplasty following cavity obliteration to provide a safe, dry ear with hearing improvement whenever feasible

Non-malignant Oral Ulcer: A Diagnostic Challenge to Otorhinolaryngologists

Introduction Apart from the malignant ulcers a wide variety of dermatological and other systemic conditions can affect oral cavity and often be a diagnostic challenge due to their similar presenting features and appearance. Despite being benign, some of them may be fatal if not diagnosed and treated timely. This study aims to assess the incidence of different non malignant ulcers in oral cavity and to estimate the need for histopathological examination for confirmation of the condition for proper management. Materials and Methods  An institution based observational study was conducted over a time period of 16 months at a tertiary care institute. Total 172 cases were included in the present study irrespective of age, sex and duration. Malignant lesions were excluded from the study. Results The present study shows a slight male preponderance (M:F = 1.48:1) with majority of cases were in age group 20-40 years of age (43.02%). Most commonly encountered were recurrent aphthous stomatitis (27.9%) followed by erosive lichen planus (16.28%), oral candidiasis, angular stomatitis, traumatic ulcers and others. 78.5% were treated successfully on the basis of clinical diagnosis while 21.5% cases needed further histopathological or other investigation for confirmation of diagnosis. Conclusion Though the otolaryngologists are more concerned about malignant ulcer, there are many non malignant ulcers which can cause significant morbidity and can even be fatal and should be given similar importance like malignant lesions. Majority of them can be treated successfully on the basis of clinical diagnosis but histopathological examination may be required in some cases for proper diagnosis and appropriate management

A Cadaveric Study of Occurrence of Extralaryngeal Branches of the Recurrent Laryngeal Nerve with Reference to its Importance in Thyroid Surgery

Introduction Recurrent Laryngeal Nerve Palsy (RLNP) is the most common complication of thyroid surgery. Patients complain of hoarseness of voice and sometimes variable amount of respiratory distress due to palsy of recurrent laryngeal nerve (RLN), extra laryngeal branches of which are often ligated along with Inferior Thyroid Artery (ITA) during thyroidectomy. So prevalence and variable pattern of extra laryngeal nerve branches (ELNB) of RLN should be known to the thyroid surgeon to avoid post operative complications. Materials and Methods   Dissection was carried on the neck of properly embalmed 25 adult cadavers including both sexes in the dissection hall to study extra laryngeal nerve branches (ELNB) of 50 RLN specimens. Results Out of 50 RLN, 13 nerves (26%) have ELNBs. Only in 4 cadavers (16%) they are bilateral. In 9 cases RLN branches were surrounding either single trunk of ITA or branches of the artery. In rest of the 4 cases ELNBs were passing entirely either in front or behind the ITA Conclusion The gold standard for preservation of the RLN during thyroid surgery is still visual anatomical identification. Proper dissection and anatomical identification of the RLN and all its branches is very important prior to the clamping of the ITA and all its branches

Non-malignant Oral Ulcer: A Diagnostic Challenge to Otorhinolaryngologists

Introduction Apart from the malignant ulcers a wide variety of dermatological and other systemic conditions can affect oral cavity and often be a diagnostic challenge due to their similar presenting features and appearance. Despite being benign, some of them may be fatal if not diagnosed and treated timely. This study aims to assess the incidence of different non malignant ulcers in oral cavity and to estimate the need for histopathological examination for confirmation of the condition for proper management. Materials and Methods  An institution based observational study was conducted over a time period of 16 months at a tertiary care institute. Total 172 cases were included in the present study irrespective of age, sex and duration. Malignant lesions were excluded from the study. Results The present study shows a slight male preponderance (M:F = 1.48:1) with majority of cases were in age group 20-40 years of age (43.02%). Most commonly encountered were recurrent aphthous stomatitis (27.9%) followed by erosive lichen planus (16.28%), oral candidiasis, angular stomatitis, traumatic ulcers and others. 78.5% were treated successfully on the basis of clinical diagnosis while 21.5% cases needed further histopathological or other investigation for confirmation of diagnosis. Conclusion Though the otolaryngologists are more concerned about malignant ulcer, there are many non malignant ulcers which can cause significant morbidity and can even be fatal and should be given similar importance like malignant lesions. Majority of them can be treated successfully on the basis of clinical diagnosis but histopathological examination may be required in some cases for proper diagnosis and appropriate management

Tetracycline uptake and metabolism by vetiver grass (Chrysopogon zizanioides L. Nash)

Environmental contamination by antibiotics not only perturbs the ecological balance but also poses a risk to human health by promoting the development of multiantibiotic-resistant bacteria. This study focuses on identifying the biochemical pathways associated with tetracycline (TC) transformation/degradation in vetiver grass that has the potential to be used as a biological remediation system in TC-contaminated water sources. A hydroponic experimental setup was used with four initial TC concentrations (0, 5, 35, 75 ppm), and TC uptake was monitored over a 30-day period. Results show that TC transformation in the media occurred during the first 5 days, where a decrease in the parent compound and an increase in the concentration of the isomers such as epitetracycline (ETC) and anhyrotetracycline (ATC) occurred, and TC disappeared in 20 days in tanks with vetiver grass. However, the isomers ETC and ATC remained in the control tanks for the duration of the trial. Transformation products of TC in plant tissue were analyzed by using ultra HPLC high-resolution Orbitrap mass spectrometery (HRMS/MS), which indicates amide hydrolysis of TC in vetiver roots. Metabolic profiling revealed that glyoxylate metabolism, TCA cycle, biosynthesis of secondary metabolites, tryptophan metabolism, and inositol phosphate metabolism were impacted in vetiver root by TC treatment