Preliminary report--near total laryngectomy for SCC larynx

A retrospective analysis was performed on patients subjected to near-total laryngectomy at Aga Khan University Hospital Karachi from September 2006 and May 2010, to evaluate the functional outcome of Near Total Laryngectomy and its effect on disease control. In all of these advanced stage laryngeal-hypopharyngeal squamous cancer patients, the disease was limited to one side of the larynx-hypopharynx. Four patients were staged as T3 and rest were T4; near total laryngectomy was done in all 07 patients. Post operative adjuvant radiotherapy was given to 06 patients. All of these patients are on regular oral diet and maintaining their body weight. Six patients are using their preserved hemi larynx effectively. Mean follow up of these patients was 15 months. Three patients developed regional recurrence whereas the remaining four patients were well till their last follow-up. Near total laryngectomy is a safe surgical option even for advanced laryngeal-hypopharyngeal cancer without compromising oncological clearance. It gives patients their own physiological voice that does not require maintenance but at the expense of permanent tracheostomy

A case of otogenic tetanus.

The authors are presenting our experience of managing an interesting case of a 12-year-old girl who presented to our clinic with otorrhea for 3 months and trismus for 1 week. Examination showed bilateral ear discharge with central perforations in tympanic membranes, palatal paralysis and trismus. Systemic examination revealed only mild stiffness of hand muscles. CT-scan head and neck was done to look for intracranial complications of otitis media. However, it revealed only decreased pneumatisation of mastoid cells. She was admitted in the hospital and started on intravenous and local antibiotics after sending ear swab and blood cultures. But she showed no improvement in 48 h. So on the clinical suspicion (trismus and stiffness of hands) remote possibility of otogenic tetanus was considered and she was given tetanus toxoid and immunoglobulins. She gradually showed improvement in her symptoms. Thereafter, culture from ear discharge was also reported positive for Clostridium tetani

Ameloblastoma : Management and outcome

Introduction Ameloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. Management of ameloblastoma poses a challenge for all involved in the field of head and neck surgery because successful treatment requires not only adequate resection but also a functional and aesthetically acceptable reconstruction of the residual defect. Methods Patients who had histologically proven ameloblastoma between 1991 and 2009 were identified from the database of Aga Khan University Hospital. A review of all medical records, radiological images, operative reports and pathology reports was undertaken. Results A total of 15 patients with histologically confirmed ameloblastoma were identified. Out of 15 patients nine were males and six were females with age range from 20 to 60 years (mean age 43 years). The most common symptom found in our patient group was painless facial swelling. In 13 patients the origin of tumor was mandible and in the remaining two the tumor originated from maxilla. Eleven out of 15 patients underwent segmental mandibulectomy, two had maxillectomy and two had enucleation. All patients who underwent segmental mandibulectomy required reconstruction. Reconstruction was done with microsurgical free tissue transfer in eight patients, non-vascularized iliac crest bone graft was used in one patient and two had plating only. All free flaps survived with no evidence of flap loss. The mean follow-up was eight years. There was no evidence of graft failure which was used in one patient. Complication was seen in only one of our patients in the form of plate exposure. Recurrence was seen in two of our cases who primarily underwent enucleation. All patients had satisfactory speech, cosmesis and mastication. Conclusion The management of ameloblastoma still poses a big challenge in spite of being the most common odontogenic tumor. In our study we have found that segmental mandibulectomy with disease-free margin of around 1 cm and immediate reconstruction with free tissue transfer have shown good results

Harmonic scalpel versus electrocautery tonsillectomy: a comparative study in adult patients

OBJECTIVE: To compare harmonic scalpel (HS) tonsillectomy with electrocautery (EC) tonsillectomy in terms of operating time, intra-operative blood loss, post-operative pain and secondary haemorrhage.METHODS: Sixty adult patients subjected to tonsillectomy only, were evaluated in this prospective study. The patients were stratified into 2 groups (30 each) based on the dissecting instrument used (HS vs. EC) at Aga Khan University Hospital Karachi Pakistan from June, 2006 to August, 2008.RESULTS: The mean operative time was less in electrocautery group (EC 3.57 +/- 0.85 minutes Vs HS 4.20 +/- 1.37 minutes;

Anatomical variations of nose and para-nasal sinuses; CT scan review

Objective: To determine the frequency of anatomic variations on computed tomography scan of para-nasal sinuses.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised computed tomography scans of 77 patients who had presented between October 2007 and March 2011. All the scans were reviewed using Picture Archiving Communication System computer software. The scans were reviewed for the presence of deviated nasal septum, paradoxical middle turbinate, Haller cell, Onodi cell, and pneumatisation of the middle turbinate and uncinate process.Results: The mean age of the patients was 31±13.15 years. One or more types of anatomical variants were observed in 40 (51.9%) of the patients; the most frequent being the deviated nasal septum 20 (26%) and the Concha bullosa 14 (18.2%).Conclusion: Considering the wide range of variations in the anatomy, each and every para-nasal sinus case should be planned individually and carefully to avoid dreadful complications and maximise patients’ benefit

The role of integrated offline/online social activity and social identification in Facebook citizenship behaviour formation

Purpose<: Drawing on social identity theory and prosocial behaviour research, this study explores how people's integration of their offline and online social activities through Facebook cultivates their Facebook citizenship behaviour (FCB). It also offers further insight into the underlying mechanism of offline and online social activity integration - FCB relation by investigating people's social identification with their offline and online social groups as possible mediators. Design/methodology/approach: Based on social identity theory (SIT) literature, community citizenship behaviour and offline-online social activity integration through Facebook, we developed a conceptual model, which was empirically tested using data from 308 Facebook users Findings: The results confirm that the participants' offline-online social activity integration via Facebook is positively linked to their FCB. Further, the integration of offline and online social activity through Facebook positively affects how a person identifies with their offline and online social groups, which in turn causes them to display FCB. In addition, offline/online social identification mediates the integration – FCB relation. Practical implications: In practice, it is interesting to see people's tendency towards altruistic behaviours within groups they like to associate themselves with. Those who share their Facebook network with their offline friends can use such network to seek help and support. Originality/value: From a theoretical perspective, unlike past research, this study examines how individuals' offline-online social activity integration via Facebook helps them associate with groups. In addition, this study investigates social identification from an offline and online perspective

Frequency and predisposing factors of pharyngocutaneous fistula after total laryngectomy

AbstractObjectiveThe objective of our study was to determine the frequency and predisposing factors of pharyngocutaneous fistula in postlaryngectomy patients.Materials and methodsCharts of those patients who were treated with total laryngectomy for laryngeal carcinoma in our department from 2000 to 2008 were reviewed. Total 77 patients were included in the study. The variables studied for the development of pharyngocutaneous fistula (PCF) after total laryngectomy were: age and gender, diabetes mellitus, post-operative hemoglobin, ischemic heart disease, chronic obstructive pulmonary disease, tumor characteristics including tumor site, stage, differentiation and extension into pyriform sinus, pre-operative radiotherapy, pre-operative chemotherapy, pre-operative tracheostomy and positive surgical margins.ResultsUnivariate analysis showed diabetes, pre-operative radiotherapy, pre-operative chemotherapy and pre-operative tracheostomy to be significantly associated with the formation of PCF. However, multivariate regression revealed that the only pre-operative radiotherapy was highly associated with the formation of PCF (OR=132.923, P=0.001).ConclusionsWe found 28.6% incidence of pharyngocutaneous fistula mainly because of the number of patients undergoing radiotherapy and chemotherapy as primary treatment for laryngeal cancers is increasing with current approach of organ preservation protocol

Frequency and predisposing factors of pharyngocutaneous fistula after total laryngectomy

Objective The objective of our study was to determine the frequency and predisposing factors of pharyngocutaneous fistula in postlaryngectomy patients. Materials and methods Charts of those patients who were treated with total laryngectomy for laryngeal carcinoma in our department from 2000 to 2008 were reviewed. Total 77 patients were included in the study. The variables studied for the development of pharyngocutaneous fistula (PCF) after total laryngectomy were: age and gender, diabetes mellitus, post-operative hemoglobin, ischemic heart disease, chronic obstructive pulmonary disease, tumor characteristics including tumor site, stage, differentiation and extension into pyriform sinus, pre-operative radiotherapy, pre-operative chemotherapy, pre-operative tracheostomy and positive surgical margins. Results Univariate analysis showed diabetes, pre-operative radiotherapy, pre-operative chemotherapy and pre-operative tracheostomy to be significantly associated with the formation of PCF. However, multivariate regression revealed that the only pre-operative radiotherapy was highly associated with the formation of PCF (OR = 132.923, P = 0.001). Conclusions We found 28.6% incidence of pharyngocutaneous fistula mainly because of the number of patients undergoing radiotherapy and chemotherapy as primary treatment for laryngeal cancers is increasing with current approach of organ preservation protocol