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

Is lateral rhinotomy, an adequate surgical approach for juvenile naso-pharyngeal angiofibroma

The objective of the study was to determine optimal surgical approach in patients with JNA. Retrospective, descriptive. The study was carried out at the department of Ear, Nose, Throat, Head and Neck Surgery, Dow Medical College and Civil Hospital, Karachi from 1996-2007. All the young males who visited out patients department with the history of recurrent intractable epistaxis, nasal obstruction, proptosis, fullness and asymmetry of face and were diagnosed as a case of JNA on the basis of history, clinical examination and CT scan, were included in the study. All the diagnosed cases of recurrent JNA and other causes with similar symptoms were excluded. Almost all the included patients underwent digital subtraction angiography with embolization of main feeding vessel 24-48 hours before surgery. Chandler staging system was used to stage the disease. Lateral rhinotomy approach was employed in majority of the cases for exploration and removal of JNA. The out come were discussed for lateral rhinotomy as an optimal surgical approach in patients with JNA in term of ease of approach, complete removal and recurrence. Total of 53 cases of JNA were included in the study. All were young males between the age group from 8-22 years. Majority of the patients were between 13 to 18 years of age. No female patient was reported. Majority of the patients presented with triad of symptoms with recurrent epistaxis [n-53] nasal obstruction [n-53] and nasal mass [n-41]. Others presented with additional symptoms of nasal discharge [n-46], snoring [n-43] speech defect [n-32], headache [n-23], facial asymmetry [n-20], visual problems, like proptosis and diplopia [n-09] and impairment of hearing [n-19]. Diagnosis was made by clinical examination, C T scan and angiographic findings with embolization 24-48 hour prior to surgery [n-45]. Lateral rhinotomy approach for extirpation of the JNA was employed in 41 cases and Weber-Furguson approach in 07 patients. Midfacial degloving approach was used in 03 patients and in 02 cases transpalatal approach was employed where the extent of the lesion was limited to nasopharynx. Recurrence was found in 03 cases of JNA approached through lateral rhinotomy during 1-2 years follow-up. Lateral rhinotomy approach to nose and nasopharynx gives an adequate exposure in almost all the cases of JNA

Is mallampati scoring relevant in patients with oral cancers?

To assess the feasibility of successful endotracheal intuhation in patients with oral cancer with a Mallampati score of 4 with reasonable mobility of temporo-mandibular and atlantoaxial joints. ENT department, Civil Hospital Karachi, from March 2005 to March 2007. 25 patients, with orofacial cancers were chosen in which the Mallampati score was 4 and tracheal intubation was expected to be very difficult. In this study out of twenty five patients 24 pts [96%] were intubated successfully with Macintosh laryngoscope. Patients having Mallampati class 4 have a reasonable chance of undergoing successful endotracheal intubation provided their temporo-mandibular joints and atlantoaxial joints are mobile. Key Words: .Endotracheal intubation, Mallampati scoring

Ceruminoma of external auditory canal: a rare entity

We present a case of polyp of External Auditory Canal [E.A.C.] in 26 years old male, which turned out to be a ceruminoma on histopathological examination. It is a rare entity arising from the ceruminous glands present in the skin o f outer cartilagineous part o f E.A. C. The most extensive review of the topic lists only 32 cases over a period of 30 years worldwide. Meticulous local medical literature search revealed that this is most likely the first case ever-reported in Pakistan. The wide local excision of the growth was done after Examination Under Microscope [E. U.M.] and tissue sent for histopathological examination, which was reported as 'Ceruminoma'. Tympanic membrane was found intact on E. U.M under general anaesthesia

Unusual pathology presented as neck lump

Neck lump is a common presentation in the outpatient clinics of otolaryngology, Head and Neck Surgery. It can be diagnosed on the basis of history, clinical examination, investigations and categorized according to the age of presentation. We present a case of young adult girl who had rightsided neck lump since four years. On the basis of fine needle aspiration cytology [F.N.A. C], she was diagnosed as a case of cervical chronic granulomatous inflammation consistent with tuberculosis. She was prescribed antituberculous treatment [A.T.T.] for 09 months but the swelling persists without any change. Excisional biopsy of the neck lump was performed and the histopathology revealed Histiocytoma Cutis, a variant of benign fibrous histiocytoma also called Fibrous Xanthoma or Xanthoma Cutis. Extensive English medical literature search on net revealed it to be a rare pathology which, to the best of our knowledge, has never been reported in locoregional literature and very rare over the globe