Selective Neck Dissection for Node-Positive Oral Cavity Squamous Cell Carcinoma: A Retrospective Cohort Study

Abstract Introduction Selective neck dissection inclinically node-negative neckisconsidered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevailsinnode-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease. Objective To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC. Methods This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study. Results During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively (p = 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group (p = 0.703). Conclusion Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.

To assess the accuracy of fine needle aspiration cytology [FNAC] for diagnosis of malignancy in solitary thyroid nodule at civil hospital Karachi

Objective: To assess the accuracy of fine needle aspiration cytology [FNAC] for the diagnosis of malignancy in solitary thyroid nodule

Study Design:Observational / Descriptive study

Place and Duration of Study: This study was conducted in the department of otolaryngology and Head and Neck Surgery at Civil Hospital Karachi from January 2007 to July 2008

Materials and Methods: This study comprises of 70 cases in one and half years. We have included all cases of solitary nodule of either sex more than 10 years and excluded those patients who were exposed to radiation or underwent any sort of neck surgery previously. All Patients with solitary thyroid nodule were investigated with routine hematological and biochemical tests, thyroid profile, thyroid Scan, ultra sound neck and FNAC in outpatient department. At admission all risks/benefits of surgical procedures were explained to patients. Postoperative histopathological report of specimen was compared with preoperative fine needle aspiration cytology

Results: In our 70 cases study 59 patients were diagnosed with benign and 11 with malignant disease. Sensitivity, specificity, accuracy was also recorded which were 72.72%, 99.20% and 94.20% respectively. Papillary carcinoma was found most common tumor in 63.63%

Conclusion: FNAC is valuable investigation for the preoperative assessment of solitary thyroid nodule and also has high diagnostic accuracy in its evaluation

Sinonasal polyposis and fungus: a growing relationship

To determine the frequency of underlying fungus in nose and paranasal sinuses in patients present with nasal polyposis. A total of 324 patients presented with nasal polyps were included in this study. Data collected from all the patients admitted in ENT department with diagnosis of nasal polyposis. All the relevant information about their presenting symptoms was recorded in a proforma. Post operatively the removed material was sent for histopathology and fungal culture. Later the findings of biopsy and culture reports were also recorded and analysed. Out of 324 patients 159 were males and 165 were females. Underlying fungus was present in 226[69.75%] and out of them, 102[45.13%] were males and 124[54.86%] were females with a P value of 0.039. The mean age was 25.95 +/- 9.32 [15-45] years for the patient with fungus. Aspergillus was the commonest organism found. Underlying fungus was found in a significantly high number of patients presented with nasal polyps and Aspergillus was the commonest organism found

Hepatitis 'B' and 'C' seropositive cases in the practice of ENT-head and neck surgery, where do we stand?

To determine the frequency of hepatitis 'B' and 'C' virus in patients admitted with pathologies of Ear, Nose, Throat or Head and Neck for surgery,: Non intervention, descriptive. Department of ENT-Head and Neck Surgery Dow University of Health Sciences and Civil Hospital Karachi, from September2006 to August 2008. Sampling was done by probability stratified technique. A total number of 832 patients admitted in department of ENT. Civil Hospital Karachi were screened by ELISA method before surgery. All the subject were unaware of their serological status regarding hepatitis B surface antigen [HBs Ag] and hepatitis C antibody [HCV Ab]. Patients admitted through emergency department, those admitted for conservative management and those under 10 years of age were not included in this study. Age, gender and risk factors like history of blood transfusion, dental treatment, any surgical intervention, home deliveries and shaving by barbers were taken as variables. Statistical analysis was done on SPSS, Out of 832 patients screened, 126 [15.14%] were seropositive out of whom 52 [41.26%] were males and 74 [58 73%] were females. HBV was positive in 31 [24.60%] [M=12; F=19] and HCV was positive in 95 [75. 39%] patients [M: 38, F: 57]. Variables did not show any statistically significant effect over the results. Universal screening rather than selective screening for HBV and HCV infection of all pre surgical cases should be exercised to prevent spread of infection among healthcare workers as well as community

Endoscopic removal of bullet from orbital apex

Penetrating injuries of face are not uncommon. Bullets or pallets may be lodged anywhere in the cavities of skull as a result of firearm injury. Lodgment of a bullet within the orbit through nose is uncommon. An eighteen 18 years old married woman sustained a bullet injury, which entered through lateral wall of the nose and lodged at left orbital apex area. The bullet was removed endoscopically via left nostril without any damage to the eye or disturbance in vision