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

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

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

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

diagnostic value of fine needle aspiration cytology in masses of the salivary glands

To determine the sensitivity and specificity of fine needle aspiration cytology in masses of the various salivary glands. The study included 49 cases. It was conducted at the Departments 0f ENT, Hayatabad Medical Complex, Peshawar and Saidu Teaching Hospital, Saidu Sharif, Swat from January 1, 2002 to December 31, 2009. Patients undergoing Fine Needle Aspiration Cytology followed by open biopsy were included in the study. The results obtained on FNAC were compared with those obtained on biopsy findings of the respective specimens and the specificity and sensitivity of FNAC were calculated from the data. The FNAC findings in salivary glands were; Benign 38, Malignant 7 and Suspicious 4. The biopsy findings were; Benign 33 and Malignant 16. Comparison of FNACs and biopsy in the salivary glands taken as True Negative, True positive, False Negative and False Positive respectively was; 32, 10, 6 and 1. The Sensitivity and Specificity for FNAC were calculated at 62.50% and 96.97% respectively. The results of this study show that FNA cytologic diagnoses in the salivary gland tumours are reliable and treatment can be planned on its basis. However, owing to a higher number of false negative cases occurring in this study, it is recommended that a negative cytology report should be viewed with suspicion. The diagnosis should be confirmed by open biopsy if clinical suspicion persists