Presentation, management and outcome of surgery PF thyroid swellings by ENT and head and neck surgeons at civil hospital Karachi

Objective: to assess the presentation, management and outcome of surgery of thyroid swellings

Design: retrospective study

Place and duration of study: department of Otorhinolaryngology-Head and Neck Surgery, Dow Medical College and Civil Hospital Karachi [CHK], from Jan 2004 to June 2010

Patients and methods: retrospective review of 184 consecutive cases of thyroid swellings admitted and operated, irrespective of age, sex and socioeconomic status. Physiological goiter and previously operated thyroid swellings were excluded from the study. Demographic data, clinical features, investigations, surgical management details and complications were assessed

Result: among 184 cases of thyroid swellings 62.5% were between 21 to 40 years of age, with female preponderance [79.9%]. Majority [71.7%] cases belonged to lower socioeconomic status. Right lobe was involved in 32.60%, left in 15.7% while both lobes were involved in 51.5% cases. Multinodular goiter was seen in 54.8% cases while 39.1% cases had solitary nodule. Total thyroidectomy was performed in 23.3% cases, near total thyroidectomy in 9.8%, subtotal thyroidectomy in 31% and lobectomy [with isthemectomy] in 35.9% cases. In postoperative period, hoarseness was seen in 0.5% cases; while other complications like bleeding due to slipping of ligature, wound infection and hypoparathyroidism was seen in 1.6%, 2.2% and 2.2% cases respectively

Conclusion: with female preponderance and low socioeconomic status, thyroid swellings are mostly seen between the ages of 21 to 40 years. Solitary nodule and multinodular goiter are common findings. Surgical management performed by ENT - Head and Neck surgeon's ranges from total thyroidectomy to lobectomy, gives good results and few complications

Frequency, presentation and management of juvenile nasopharyngeal angiofibroma

To determine frequency, clinical presentation and management of juvenile nasopharyngeal angiofibroma [JNA] at Civil Hospital Karachi. A descriptive study. Department of Otorhinolaryngology - Head and Neck Surgery, Dow Medical College, Civil Hospital Karachi and Dow University of Health Sciences from, January 2002 to December 2008. This study included 54 cases of nasopharyngeal angiofibroma over a period of 7 years. Follow up period ranges from 1 month to 7years. All patients were male with an age range of 14 - 17yrs. Epistaxis and nasal obstruction were the two most common presenting symptoms. Majority of our patients 39 [72%] had stage III a disease, stage II disease as seen in 13 [24%] cases while 2 [4%] cases presented in stage I disease according to Fisch classification. Surgery was done in all patients. Tumor recurrence was seen in 4 [7%] of cases. Angiofibroma usually presents in adolescent males. The triads of nasal obstruction, nasopharyngeal mass and recurrent epistaxis indicate the presence of the neoplasm. Surgery is the treatment of choice. Lateral rhinotomy is the most common approach. The sublabial endoscopic assisted approach is cosmetically better than other approaches and has definite advantages. Long term outcome for our patients treated by endoscopic assisted sublabial technique is required to further strengthen our view

Juvenile nasopharyngeal angiofibroma: stage and surgical approach

Objective: to study various surgical approaches and the outcome of surgery in juvenile nasopharyngeal angiofibromas [JNA]

Design: a descriptive study

Setting: department of Otorhinolaryngology - Head and Neck Surgery, Civil Hospital Karachi

Method: this study included 40 consecutive cases of nasopharyngeal angiofibroma over a period of 4 years. Patients were regularly followed up for any recurrence up to 3 years

Results: majority of our patients had stage III [72.5%] disease [Chandlers staging] i.e. extension in pterygopalatine fossa, maxillary antrum, nose and sphenoid sinuses; and infratemporal fossa in 72.5% patients, tumor was removed through lateral rhinotomy approach while Weber Fergusson in 17.5% , mid facial degloving in 7.5% and only in 2.5% patient transpalatal approach was used. Tumour recurrence were seen only in 5% of cases

Conclusions: angiofibromas usually present at the late stage. Surgery is the treatment of choice. Most of the tumours are excisable by a lateral rhinotomy approach, with minimal chance of recurrence