Monopolar cautery versus cold steel dissection for tonsillectomy in children. a randomized clinical trial

Objective: To compare monopolar cautery with cold steel dissection for tonsillectomy in pediatric age group

Study Design: A randomized clinical trial

Place and Duration of Study: Ear, nose and throat [ENT] department Combined Military Hospital Gujranwala, from Jan 2013 to Jan 2015

Material and Methods: A total of 220 consecutive pediatric patients undergoing tonsillectomy for recurrent or chronic tonsillitis between Jan 2013 to Jan 2015. Both groups were compared with regards to surgery time, intraoperative bleeding, post operative pain and complications

Results: A total of 20 patients were excluded from the study for various reasons while the data of the rest of the patients has been presented. Mean age of the study group was 8.82 years. A total of 58% of the patients were male. Average time of surgery for monopolar cautery was 29.33 [SD 2.77] min as compared to 18.53 min [SD 2.94] for dissection method which was significant [p<0.005]. Average blood loss for monopolar surgery was 11.66 ml and 29.04ml for dissection method [p<0.005]. Average pain scores were less for dissection method at 2nd post op day 3.59 vs. 5.51. Rates of primary and secondary hemorrhage were less for monopolar method although they were not statistically significant

Conclusion: Monopolar cautery though causes decreased intraoperative blood loss however requires longer anesthesia and causes significant post operative pain to the patient

Comparison between the efficacy of topical ciprofloxacin with neomycin in the management of chronic suppurative otitis media

Objective: To compare the efficacy of topical Ciprofloxacin with Neomycin in the management of Chronic Supportive Otitis Media [CSOM]

Study Design: Randomized Clinical Trial [RCT]

Place and Duration of Study: Combined Military Hospital [CMH], Peshawar from Jan 2013 to Dec 2013

Patients and Methods: A total of 186 patients with the diagnosis of chronic suppurative otitis media were included in the study. Patients were randomly allotted to either group I that was treated by topical Ciprofloxacin eardrops [n = 93] or to group II, treated by topical Neomycin eardrops [n = 93]. Outcomes were measured by disappearance of discharge and congestion at follow-up examination. SPSS 16 was used for data analysis .Chi square test was used for analysis and p-values less than 0.05 were considered significant

Results: Topical Ciprofloxacin is more effective in earlier control of congestion and discharge of ear in CSOM; [p value = 0.001 and < 0.005 respectively] as compared to Neomycin

Conclusion: Topical Ciprofloxacin is a better drug for the treatment of CSOM as compared to topical Neomycin

Management of suicidal cut throat-a case report

Suicide is one of the 10 leading causes of death in the world, accounting for more than 400,000 deaths annually1. Hanging, poisoning and fire arm are the most common methods of committing suicide in the world. Knives and razor blades are the common implements used in suicide2. Tentative marks were present in most fatalities3. Suicide by cutting one's own throat without hesitation cuts remains rare. Such life threatening injuries require emergency treatment3,4. Here we present a case of young individual presenting in ENT department Combined Military Hospital [CMH] Quetta with a suicidal cut throat injury, using a long bladed knife

Submandibular gland involvement in early stage oral cavity carcinomas: can the gland be left behind?

To determine the frequency of submandibular gland involvement in early oral cavity tumors. Observational study. ENT Department, CMH, Rawalpindi, from January 2008 to December 2011. Data of 110 oral cavity tumors operated over 2008 - 2011 was retrieved from ENT OPD, tumor registry in AFIP and from Head and Neck Oncology Forum Registry. Cases of oral cavity tumors that had undergone elective neck dissections were retrospectively studied for invasion of the submandibular gland, TNM Staging, perineural, perivascular, lymphovascular invasion, site specific frequency of oral cavity tumors and frequency of lymph node metastasis. Tumors of tongue were the most common constituting 42%, squamous cell carcinoma was the histological diagnosis in 90% cases. Sixty eight [61.8%] cases were node negative. Selective neck dissection was done in 55.5% of the cases. Submandibular gland was involved in 2 cases [1.8%]. Submandibular gland metastasis from early oral cavity tumors is rare; any neoplastic involvement of the gland usually occurs via direct spread

Oral cavity tumours, a clinical experience in a tertiary care center

To determine the age range, gender distribution, histological types, sites, neck node involvement, and surgery as modality of treatment in diagnosed cases of oral cavity tumours in a tertiary care centre. Descriptive Study. The study was carried out in ENT Department, CMH Rawalpindi for the duration from Dec 2008- Dec 2011. Data of 113 biopsy proven cases of oral cavity tumors who underwent surgery at CMH Rawalpindi, were retrieved from Armed Forces Institute of Pathology's Tumour Registry and from Head and Neck Oncology Forum Registry, and were evaluated. Out of 113 patients with oral cavity tumours, 87 [77%] were male, while 26 [23%] were female, the male: female ratio being 3:1. The mean age of the patients was 59.4 years, ranging from 40 to 75 years. Site distribution of the tumours was: Tongue: 61[54%], buccal mucosa 24 [21%], floor of mouth 18 [16%], and hard palate 10 [9%]. The histology of tumours showed Squamous cell carcinoma in 102 [90%] and tumours of Salivary gland origin in 11 [10%]. Sixty four [56%] of these patients had N0 disease, 10 [9%] had N1 disease, 8 [7%] had N[2s] disease, 27 [25%] had N[2b] disease, 3 [2%] had N[2c] disease, while 1 patient [1%] had N[3] disease. Resection of the tumour along with Supra-omohyoid neck dissection was carried out in 64 [56%] patients, while resection with radical neck dissection was done in 49 [44%] patients. Primary closure was carried out in 62 [55%] patients, while secondary reconstruction was done in 51 [45%] patients. Presentation of oral cavity tumours occur at an advanced age with male preponderance in our population. Early presentation results in lesser local spread, leading to less aggressive surgical approach with selective neck dissection