Extensive cutaneous malignant melanoma of head and neck

Management of extensive cutaneous malignant melanomas of head and neck is usually a challenging problem especially if the tumour has nodal metastasis. A young female presented with fungating growth of right side of face extending up to the neck. Two months after surgery, she developed brain and lung metastasis. The oncological control at this advance stage is far difficult with surgical excision. In such cases, reconstruction of head and neck becomes questionable at times

Clinical manifestations and risk factors of otitis media with effusion in children presenting in tertiary care hospital

This study was conducted to find out the pattern of presentation and the risk factors associated with otitis media with effusion, in three major tertiary care hospitals of Karachi. Prospective descriptive study. This study was conducted at three major tertiary care hospital of Karachi including Civil Hospital Karachi, Lyari General Hospital and Abbasi Shaheed Hospital, Karachi, over a period of two years from November 1998 to October 2000. Two hundreds and fifty patients diagnosed as otitis media with effusion have been included in this study. Otoscopic examination, tympanic membrane mobility with Siegel's pneumatic speculum, examination of the nose and throat, pure tone audiogram and tympanometry were done in all the cases. There were 140 male and 110 female patients with mean age incidence was 7.3 [ +/- 1.2] years. Hearing impairment was the commonest symptom present in 98% of the cases. Retracted tympanic membrane was noted in 151 cases [60.4%]. Enlarged adenoids were present in 115 cases [46.0%]. Average hearing loss on pure tone audiogram was found to be 23.4 dB. Myringotomy was required in 84 cases [33.6%]. The peak age incidence of otitis media with effusion in this study was impairment with retracted tympanic membrane was the commonest clinical presentation. Enlarged adenoids was the most common and important risk factor

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

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

Cochlear and vestibular toxicity by the use of ototoxic drugs - the regional experience

The objective of the study is to find out the common pharmacologic agents causing ototoxicity in our region with their pattern of presentation and effects on the inner ear. This study was conducted at department of Ear, Nose, Throat, Head and Neck Surgery, Civil Hospital Karachi, over a period of three years from January 1998 to December 2000. A total of 44 patients were included who presented at ENT department with the diagnosis of ototoxicity. The diagnosis was established in each case by taking detailed history, through ENT examination and related investigations. All these patients were followed up regularly for a maximum of six months. Out of44 patients, 32 were male and 12 were female patients with mean age of 42.2 years. Majority of the patients had some form of cochleotoxicity with symptoms of deafness in 95.4% and tinnitus in 36.6% of the cases. Vestibular toxicity with symptoms of vertigo and sense of imbalance were presented in 29.5% of the cases. 26 patients received only one ototoxic drug while 18 patients had received more than one ototoxic drug at one time. Gentamycin was the commonest offending agent for ototoxicity in 40.9% of the cases. In this study no patient of ototoxicity was found due to macrolide antibiotics, salicylates or any non-steroidal anti-inflammatory drugs. Sensori-neural hearing loss in majority of the patients was moderate to severe in nature

Endoscopic removal of bullet from orbital apex

Penetrating injuries of face are not uncommon. Bullets or pallets may be lodged anywhere in the cavities of skull as a result of firearm injury. Lodgment of a bullet within the orbit through nose is uncommon. An eighteen 18 years old married woman sustained a bullet injury, which entered through lateral wall of the nose and lodged at left orbital apex area. The bullet was removed endoscopically via left nostril without any damage to the eye or disturbance in vision

Plexiform neurofibroma of external auditory canal - a rare entity

We present a case of plexiform neurofibroma of external auditory canal [EAC] in a 43 years old male. Neurofibroma of EAC presents in rare cases. It is a benign tumor arising from the connective tissue of the nerve sheath, now thought to arise from schwann cells rather than fibroblasts. This tumor causes a fusiform enlargement of a nerve. This rare case is reported in a 43 years old male, who presented with pain in the left ear, found to have a polypoidal mass in [L] external auditory canal. Histological examination of the excised specimen revealed the features suggestive of plexiform neurofibroma of external auditory canal

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

giant pleomorphic adenoma of parotid gland.

Pleomorphic adenoma is the most common benign neoplasm of parotid gland, generally presenting as slowly enlarging firm painless mass. The vast majority are 2-6 cm in size, when resected. We report a case of big water-melon sized parotid mass measuring 22 x 16 cm. It proved to be a pleomorphic adenoma. To the best of our efforts and literature search, this is the largest parotid mass ever resected in Pakistan. The mass was resected successfully without post-operative complications

Laryndeal Cancer Surgery Techniques, Management and Complications

Management of laryngeal cancer experienced a vital change during the last few decades. Indeed laryngeal cancer is a significant malignancy as it also has high cure rate. Surgery is an effective economical mode of treatment in our country, where facilities of time duration of study other modalities such as radiotherapy and chemotherapy are not uniformly available. This study evaluates the different surgical techniques, management and post operative complications of 50 cases of laryngeal carcinoma. Total laryngectomy was the commonest operation i.e. in 31 cases [62 percent]. The commonest complication was found to be pharyngocutaneous fistula [18 percent]. 72 percent patients were living disease free, 20 percent patients were living with disease and 8 percent patients expired in follow up period, of 3 years. It was concluded that radical surgery is still the most suitable modality of treatment in our environment where we deal advanced pathology

Nasopharyngeal angiofibroma: experience at civil hospital Karachi

Juvenile nasopharyngeal angiofibroma [JNA] is a common clinical entity seen in adolescent males in our country. JNA is although benign histologically but the clinical course and behaviour is comparable to malignant lesions. Surgical ablation has remained the treatment of choice. Our current approach in its management include computerized tomographic scan, digital subtraction angiography, super selective embolization and excision through lateral rhinotomy and medial maxillectomy approach. Presented here is our recent experience with 25 patients of nasopharyngeal angiofibroma treated surgically at the ENT Department, Civil Hospital, Karachi