Salivary gland tumours: a tertiary care hospital experience

To study demographic, clinical and histopathological features of salivary gland tumours in a tertiary care hospital. Prospective cross sectional study. This study was carried out in the Department of ENT, Head and Neck surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from June 2010 to May 2014. This prospective cross sectional study of 4 years was carried out in the Department of ENT, Head and Neck surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar. All the patients qualifying inclusion criteria were evaluated in terms of detailed history, thorough examination and relevant investigation. After performing required surgery specimen was examined for histopathology. In this study 123 patients were included with mean +/- SD age of 40 +/- 5.1 years [age range 7–76 years]. Males were 81 and females were 42 with male: female ratio of 1.9:1. Most of the patients presented in 4th decade [28.45%, 35]. Lump was the commonest clinical feature lasting for 1-5 years [66.66%, 82]. Among the tumours 77.23% were benign while 22.76% were malignant. Benign tumours were commonly noticed in parotid gland [53.65%]. Pleomorphic adenoma was the commonest benign tumour [65.04%, n-80], affecting parotid gland in 52.03%. Mucoepidermoid carcinoma is the commonest malignant tumour [12.19%] predominantly found in minor salivary gland of palate [6.50%]. Salivary gland tumours predominantly affecting middle aged male population. Benign tumours are the commonly occurring salivary gland tumours. Pleomorphic adenoma is commonly occurring benign tumour affecting predominantly parotid gland while mucoepidermoid carcinoma is the commonest malignant tumour of salivary glands

Interval tonsillectomies; comparison of per and post operative complications in patients undergoing early and delayed after peritonsillar abscess

Peritonsillar abscess is a common clinical problem faced by otorhinolaryngologist all over the world. There are different schools of thoughts regarding tonsillectomy after peritonsillar abscess due to its expected complications. This comparative study was conducted to know about frequency of complications in each of the techniques. To compare per and post operative complications in patients undergoing early and delayed interval tonsillectomy after peritonsillar abscess. This was randomized control trial. Department of ENT, Head and Neck surgery, PGMI/HMC, Peshawar. From Jan 2012 to Dec 2013. After taking detailed history, thorough examination, relevant investigations and informed written consent peritonsillar abscess was drained and then interval tonsillectomy was performed. The complications were noted on predesigned proforma. Chi square test was used to compare the complications in both the groups while keeping P < 0.05 as significant. Out of 60 patients males were 38 and females were 22 with male to female ratio of 1.31:1. Average age was 24.7 years + 7.63 SD with a range of 13-45 year in Group-A, while Group B has average age of 23.97 year + 7.07 SD with a range of 13-46 years. Findings of per-operative and post operative hemorrhage showed that there was insignificant difference in both the groups [P=0.601]. However pain and hospital stay in both the groups was significantly different with P value of 0.004 and 0.000 respectively. Early interval tonsillectomy is an easy and safe procedure for peritonsillar abscess

Pattern of causes and management of permanent loss of voice studied at a tertiary care hospital

To determine the frequency of causes of hoarseness leading to permanent loss of voice and discuss their management. This descriptive study was carried out at the department of ENT, Head and Neck Surgery, Lady Reading Hospital Peshawar from January 2009 to December 2011. All these patients were evaluated in terms of detailed history, thorough examination and relevant investigations. Biopsy from laryngeal mass was taken in case of tumours. Total laryngectomy was performed in patients with advanced laryngeal tumours provided with preoperative counseling regarding postoperative handicaps. The patients with laryngeal narrowing due to trauma were subjected to laryngeal stenting. The data was analyzed using SPSS 15. Out of 16 patients 10 were male and 6 were female with male: female ratio of 1.6:1. The ages ranged from 09-75 years with mean age of 43.68 +/- S.D 18.65 years. Majority of patients [68.75%] had low socioeconomic status. Main presentation of these patients was hoarseness [100%]. The commonest cause of change of voice was laryngeal carcinoma [n-6, 37.5%], followed by blast injury [25%].Endolaryngeal stenting was the commonest [43.75%] procedure performed for traumatic laryngeal stenosis followed by total laryngectomy. Most of the patients gained good esophageal speech. It is concluded that beside laryngeal cancer, trauma to the larynx is a common cause of permanent loss of voice resulting due to increased incidence of violence in our set up. Esophageal speech can be easily and successfully instituted in laryngectomized patients among other voice rehabilitative options

Clinico-pathological profile of sinonasal masses: study of 90 cases

To determine the clinicopathological profile of sinonasal masses studied at a tertiary care hospital. This descriptive study was conducted at the department ofENT, Head and Neck Surgery, Postgraduate Medical Institute Lady Reading Hospital Peshawar from Sept. 2008 to Aug. 2010, with total duration of 02 years. After admitting the patients'a detailed history was taken and thorough examination of ear, nose, throat and neck was carried out. Necessary investigations were performed. After taking an informed consent all the patients were subjected to proper surgical treatment and specimens were examined by histopathologist. All these patients were followed for minimum of six months duration on monthly basis. This study included 90 cases constituting 49 male and 41 female, with male: female ratio of 1.2:1. The age of the patients ranged from 08-65 years with mean age of 33.13 + S.D 18.67 years. The complaints of these patients were left side nasal obstruction [43.33%], Epistaxis [34.44%] and headache [27.77%]. Incisional biopsy of sinonasal masses was taken in 31 cases [34.44%] while among the surgical procedure antrochoanal polypectomy was the commonest [31.11%]. Histopathological diagnosis was obtained and simple inflammatory polyp was the commonest finding [63.3%] followed by angiofibroma [11.11%]. It is concluded that sinonasal masses mainly present with nasal obstruction, nasal discharge and benign masses predominate. Benign sinonasal masses are best treated with surgical excision

An audit of tracheostomy at a tertiary care hospital

To determine the indications and complications of tracheostomy in a tertiary care hospital. This descriptive study was conducted at the department of ENT, Head and Neck surgery, Lady Reading Hospital Peshawar from January to December 2010. This study included 160 patients fulfilling inclusion and exclusion criteria. All these patients were properly evaluated. After taking well informed consent tracheostomy was performed in all the patients as emergency or elective procedure depending upon the clinical condition of the patient. The data was collected on a prof or ma and it was analyzed using SPSS version 10. A total of 160 patients underwent tracheostomy who constituting 110 male and 50 female, with male: female ratio of 2.2:1. The age of the patients ranged from 01-75 years with mean age of 37.61 +/- S.D 19.99 years. Tracheostomy was performed in 148 cases [92.5%] as emergency and in 12 cases [7.5%] as elective procedure. The commonest indication for tracheostomy was trauma [65.62%] followed by infection [26.25%]. Elective tracheostomy was performed for inoperable tumours. The early complications were 37.5% while late complications were 7.5%. It is concluded that the common etiology of tracheostomy in our part of the world is airway obstruction due to trauma and complications of tracheostomy can be minimized by improving the postoperative care of tracheostomized patients

Reconstruction of nasal alar defect; use of nasolabial skin flap

To assess the outcome of nasolabial flap for ala plasty in patients with alar defect. Descriptive study. Department of E.N.T, Head and Neck Surgery Postgraduate Medical Institute [PGMI] Lady Reading Hospital [LRH] Peshawar. January 2006 to December 2007. In this study we included 35 patients. A detailed history and thorough physical examination regarding general condition of the patient and specifically E.N.T of the patient with emphasis on the alar soft tissue deformity, both from cosmetic and functional aspect was recorded on preformed proforma. Pre-operative and post-operative photographs were taken after taking written consent from all the patients. All procedures were carried out under local infiltrative anesthesia and were covered by intravenous prophylactic antibiotics. These patients were followed at one month, six month and one year intervals. Our study included 35 patients of nasal ala plasty with superiorly based nasolabial flap. Out of 35 patients 26 [74.29%] were males and 9 [25.71%] were female with female to male ratio of 1:2.8. Males dominated nasal deformity as males are more exposed to trauma. Average age in males was 47 years [range 24-70 years] and in females it was 48.5 years [range 27-70 years]. The patients presented with nasal alar deformity in the age range from 25 to 70 years, while 19 patients [54.28%] presented during 31 to 50 years of age. Trauma was dominated [n=28, 80%] among the causative factors for alar soft tissue loss in these 35 patients. Twenty-eight [80.00%] patients were fully satisfied both cosmetically and functionally, 04 patients [11.42%] were partially satisfied only cosmetically and 03 patients [8.57%] were not satisfied with their nasal cosmetic improvement and functional results. Nasal ala plasty with superiorly based nasolabial flap provide good cosmetic result with minimal complications

Rare foreign bodies [pellets] migrating through the gastrointestinal tract spontaneously. report of 2 cases

Foreign body ingestion or insertion in children is a common clinical condition. Foreign body may cause number of complications if not detected and treated in time. Firearm injury is not uncommon. Injury by air gun may cause pellets to retain inside human body. Here we present two cases of air gun injury where pellets entered the esophagus and passed through gastrointestinal tract spontaneously without causing any complication

Pattern of maxillofacial trauma seen at ENT department of a tertiary care hospital

To determine the pattern of maxillofacial trauma seen at Dept. of Ear, Nose and Throat Head and Neck Surgery of a tertiary care hospital. This descriptive study was conducted at the Department of Ear, Nose, Throat [ENT], Head and Neck Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from June 2010 to Dec. 2010. It included 108 cases sustaining maxillofacial trauma. The patients of any age and either sex were included while patients having trauma to other systems besides maxillofacial trauma were excluded from study. The universal rule of ABC [Airway, Breathing, circulation] regarding managing emergency was adopted for all the patients. After stabilizing the patient necessary surgical procedure was performed and concerned departments were consulted. Our study included 108 cases of maxillofacial trauma constituting 97 male and 11 female, with male: female ratio of 8.8:1. The age of the patients ranged from 08-60 years with mean age of 30.55 + S.D 19.88 years. Most of the cases were from rural area [59.3%] and 75 cases [69.4%] were received in first 8 hours of incidence. Fire arm injuries 42% was on top followed by road traffic accidents 25% [n=27]. Majority of cases [90.7%] were homicidal and mandiblular fracture was 49.07% followed by maxillary fractures. It is concluded that homicidal firearm injury is the commonest while road traffic accident is second most common causative factor for maxillofacial trauma. These can be minimized by proper implementation of traffic rules, free education of the people, free availability of essential primary health care, best tertiary care at hospital level and spread of weapon amongst public should be banned

Otitis media: comparison of outcome of underlay versus overlay myringoplasty

To compare the outcome of underlay versus overlay myringoplasty procedure in the management of otitis media. This comparative study was conducted at the Department of Ear, Nose, Throat, Head and Neck Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January 2008 to December 2009. It included eighty-six patients with dry ears for at least six weeks and no focus of infection in nose, sinuses or throat were included in the study. Forty three patients underwent underlay technique while other 43 patients were operated through onlay techniques. Myringoplasty was performed in total of 86 patients. Male were 69 [80.02%] and females were 17 [19%]. Thirty-five [40.70%] of them belonged to age group of 10-25 years. Thirty [34.88%] were in the age range of 26-35 years, while 21 [24.42%] aged between 36-45 years with mean age of 27.48 +/- S.D 10.20 years. Overall success rate of graft uptake was noted in 70 [81.40%] out of 86 cases. All 86 cases were equally divided into two group's i.e. 43 patients in each group. Thirty-eight out of 43 perforated drums were treated with underlay techniques having success rate of 88.37% as compared to 32 out of 43 patients with only techniques where the graft uptake was 74.4%. Underlay technique is more successful statistically as compared to overlay technique of myringoplasty in all age groups

Angiofibroma of middle turbinate

We report a rare case of angiofibroma of middle turbinate. A man of 17 years presented to out patient department [OPD] of ENT, Head and Neck Surgery Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan with presenting complaint of progressive obstruction of right side of nasal cavity for last 3 months. On ENT examination there was a reddish fleshy mass in the right nasal cavity. It was firm on probing, arising from the middle turbinate of lateral wall of nasal cavity and was sensitive on touching. On CT scan the mass was limited to lateral wall of right side of nasal cavity which was iso-dense with no bony erosion. The mass was removed in toto intranasally and specimen was sent for histopathology study. The histopathology report was angiofibroma. The patient is followed regularly and he is disease free so far

Diagnostic value of fine needle aspiration cytology in diagnosis of non-thyroidal neck masses

To determine the diagnostic value of fine needle aspiration cytology in the diagnosis of non-thyroidal neck masses. This descriptive study was conducted at the Department of ENT, Lady Reading Hospital Peshawar from January to December 2009. Hundred patients with non-thyroidal neck masses fulfilling the inclusion criteria were included in the study. Fine needle aspirations were performed by the same cytopathologist. The findings were TB 31%, metastatic lymph node 19%, reactive lymphadenopathy 9%, lymphoproliferative disease 11%, pleomorphic adenoma 8%, thyroglossal cyst 5%, carotid body tumour 4%, lipoma and branchial cysts were 3% each, sialolithiasis 2% and one case each of dermoid, sebaceous cyst, adenoid cystic carcinoma, Kikuchi's disease and Ewing's tumour. Correlation of FNAC with biopsy was for TB; true positive, 64.5%, true negative 29.03%, false positive 3.22%, false negative 3.22% and for metastatic lymph node true positive 57.89%, true negative 36.84%, false positive 5.26% and no case of false negative. The diagnostic yield of FNAC was for TB, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 93.54%, 95.23%, 90%, 95.23% and 90% respectively. Metastatic lymph nodes accuracy sensitivity, specificity, positive predictive value and negative predictive value were 94.73%, 100%, 87.5%, 91.66% and 100% respectively. Overall diagnostic value of FNAC in non-thyroidal neck masses with regard to accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 90%, 90%, 77.42%, 90.41%, 90.41%, and 88.89% respectively. Fine needle aspiration cytology for non-thyroidal neck masses has equal diagnostic yield to open biopsy