Carcinoma cheek: regional pattern and management

Oral cancer varies globally and regionally, and is closely linked with geographical, social, economical, biological, ethnic, dietary and environmental factors. In western countries it accounts for about 2-5% while in the south-east Asia for about 40% of all cancers. In Pakistan it is second commonest tumour after bronchogenic carcinoma in males and breast carcinoma in females. The objectives of this study were to find out the pattern of carcinoma cheek in our region, its etiological associations, management and prognosis. This study was conducted in the Otolaryngology and Head and Neck Surgery Department of Civil Hospital, Karachi from April 1995 to December 1998. It was prospective study. Forty-five cases of primary carcinoma cheek were diagnosed and investigations including OPG and CT scan were carried out along with other required investigations to evaluate the extension of tumour, bony erosion and metastasis. TNM staging was done. All patients were treated surgically, sent for post-operative radiotherapy or chemoradiation and followed up for 3 years. Among 45 cases of oral cancer, 28 were females and 17 were males. Common presenting symptom was growth or ulcer. It was more common in 41-50 years of age. Squamous cell carcinoma [SCC] was found in 95.5% of the cases. Most of the patients 31[68%] were in T4 stage. Surgical excision was done in all cases with reconstruction in 23 cases and neck dissection in 39 cases. In the follow up for 3 years, 30 patient remained disease free. Carcinoma cheek is a common entity in our region and now it is seen in relatively younger patients. Oral cancer is a self preventable disease. What is required is to develop awareness of oral hygiene and discourage the habit of social carcinogens use. Early diagnosis and treatment offers better chance of cure whereas advance disease has a poor prognosis

Ossicular damages in chronic suppurative ear disease

Ossicular damage is a frequently encountered sequel of chronic suppurative otitis media. It is associated with both chloesteatomous and non cholesteatomous pathologies. In this series of 100 cases, who underwent exploration of tympanomastoid region, 67 cases showed various froms of ossicular damages. We found multiossicular losses to be more frequent than isolated involvement of a single ossicle. Granulations were more frequent [49%] than cholesteatoma [15%]. Central defects of the tympanic membrane dominated

Neurofibroma of the gingiva

Neurofibroma and Schwanoma are the tumors which have their origin from the nerve sheaths of peripheral nerves. Although common in the head and neck region, they are rarely encountered in the oral cavity. Of the oral cavity tongue is the most common site followed by buccal mucosa, floor of mouth, palate, lips and gingival in a descending order of frequency. We present a case of Neurofibroma originating from the gingiva. It apperated as a large encapsulated mass, measuring 10 cm x 8 cm, filling whole of the oral cavity. Surgery was conservative and their was no recurrence

Saw-blade: an unusual foreign body in the facial tissue

A 32 year old man was accidentally hit by a broken saw blade on the face. The blade caused a lacerated wound of entry on the cheek. Its impaction was not recognized initially when the wound was sutured. Subsequent cheek swelling and epistaxis prompted him for an ENT consultation. X-rays showed the saw blade lying in the soft tissue of the cheek. Under general anaesthesia, external manipulation showed the edge of the foreign body visible in the nasal cavity below the inferior turbinate. Intranasal removal was successful

Laryngo tracheal stenosis-diagnosis and management at civil hospital Karachi

Over a period of seven years, 8 patients of chronic laryngotracheal stenosis presented at Civil Hospital Karachi. Road traffic accident was the commonest cause in our series [5 cases]. Various modalities were employed for the diagnosis and treatment. For diagnosis we recommend MRI in preference to conventional X-rays and CT scan. In six cases open surgical method with stenting was used. Good patency and acceptable voice were achieved. Successful decannulation of tracheostomy tube was obtained in all these cases

Current options in the treatment of laryngeal carcinoma

The incidence rate of carcinoma of larynx varies globally. This malignancy is significant as it has a high rate of cure. Beside other factors topography and the clinical stage of the disease is important to decide the modality of treatment. Supraglottic carcinoma is amenable to treatment either by surgery, radiotherapy or by combining both. Radiotherapy is effective in supragloltic carcinoma in superficial growths only. T1 glottic carcinoma can be treated by radiotherapy, excision, laser evaporation with equivocal results. T2 lesions may be treated by either radiotherapy or hemilaryngectomy with similar outcome. T3 glottic lesion is treatable with radiotherapy and salvage surgery for recurrence. Conservation surgery is also possible for T3 lesions in the recent years. In selected cases partial laryngectomy and radiotherapy may permit preservation of laryngeal function. Total laryngectomy is the mainstay of treatment for T4 lesions along with resection of adnexal areas. Subglotlic cancers are only treatable by total laryngectomy. For transglottic growths partial laryngectomy is only feasible when cartilages are spared. Radiorecurrent growths are now considered amenable to conservation surgery. Induction chemotherapy is useful for tumour regression only in advanced cases. For the nodal disease prophylactic neck dissection has no value now in No status. Radical neck dissection is mandatary once the node figures out. For the relief of airway in advanced disease emergency laryngectomy should be avoided for the danger of stomal recurrence. Among the voice restoration procedures oesophageal speech is the most cost affective

Post-tonsillectomy hemorrhage: incidence and management

This is a retrospective study of 300 cases of tonsillectomy for post-tonsillectomy haemorrhage. Overall incidence figure was found to be 2% i.e. 6 cases out of 300. Reactionary haemorrhage occurred in 2 patients while secondary haemorrhage was present in 4 patients. Reactionary haemorrhage was treated by ligation while the secondary haemorrhage was treated conservatively

Pharynogocutaneous fistula following laryngectomy

Sixty-eight cases of stage III and IV laryngeal cancer were analysed to determine the frequency and management of post - operative pharyngocutaneous fistula [PCF]. The overall incidence in our series is 8.9% [6 cases]. In five patients PCF healed spontaneously without any surgical intervention while one patient expired due to concomitant other medical illness. The longest time taken by the fistula to heal by conservative treatment was 7 weeks. Retaining the NG tube for a longer period [14-16 days] and adequate and appropriate antibiotic cover reduces the incidence of fistula formation

Foreign bodies in the ears: the regional experience

Foreign body in the ear is a common complaint in ENT practice. Between February 1993, and March 1994, 200 cases of foreign bodies in the ears were presented at Chandka Medical College Hospital, Larkana. Our experience of managing these foreign bodies along with the review of literature is reported in the article. One hundred eighteen males [59%] and 82 females [41%], 68% of the patients were below the age of 10 years. In-animate foreign body was present in 160 patient [80%], where the majority were of non-vegetative type. Trauma to the tympanic membrane was found in 42 cases [21%], where healing occurred spontaneously in all the cases without any surgical intervention

Hypertension: a common cause of epistaxis in adults

Epistaxis is a very common event and one of the commonest reasons of emergency admission in ENT wards. In the year 1993, 116 cases of epistaxis in adult age group presented in our departments. Hypertension was the most common cause of epistaxis in our series i.e. 68 cases out of 116 [57.8%]. Majority of these hypertensive patients were between the ages of 40 and 60 years [70.6%]. The mean systolic blood pressure in our series was found to be 197.4 mm of Hg, and mean diastolic blood pressure was 128.3 mm of Hg. In 30 patients [44.1%] there was no previous history of epistaxis. All the cases were managed by anterior nasal packing, antihypertensive drugs and other supportive therapy

Oesophageal foreign bodies

The impaction of foreign body into the upper digestive tract is a common accident, specially in children. Removal of foreign bodies from the oesophagus by oesophagoscopy under general anaesthesia has been considered to be relatively safe and effective. This paper reports 110 cases of oesophageal foreign bodies removed by rigid endoscopy. The common foreign bodies were coins [61%] and bone pieces [20%], 65% were in children under 10 years of age. Upper oesophageal sphincter was the commonest site of impaction

Angiokeratoma tongue

A 4 year old girl from Swat presented with large protruding tongue which has gradually grown in 3 years. The exposed surface was swollen, congested and non tender. A punch biopsy was non diagnostic. Tracheostomy and partial glossectomy was done and revealed it to be a Angiokeratoma;a vascular lesion with hyperkeratosis. Angiokeratoma may be localised or generalised, and may presented in skin, cornea, gingiva and soft palate

Retropharyngeal abscess in adults

Retropharyngeal or prevertebral abscesses are less common in adults than in children. Acute variety is mostly seen in children, while the chronic variety, essentially prevertebral collection of pus resulting from tuberculosis of cervical spine, is seen in adults. Four cases of retropharyngeal or prevertebral abscess in adults are presented. The first one is an acute retropharyngeal abscess due to Staphylococcus aureus, the other case is due to a perforating foreign body while the remaining two cases are due to tuberculosis of cervical spine

Nasal polyposis and fungal sinusitis

Nasal polypi are notorious for their recurrence. Among the inhalant allergens fungal spores can excite aggressive disease with hypertelorism and facial disfiguration. Aspergillus fumigatus is the commonest offending agent. Anterior ethmoid disease is the local anatomical factor which causes secondary sinusitis of the maxillary sinus. The relationship between nasal polypi and fungal sinusitis is highlighted. Twelve patients with aggressive and recurrent nasal polypi were subjected to Caldwell Luc clearance of the sinus combined with polypectomy. Results showed definite reduction in recurrence rate

Parapharyngeal space tumours, clinical presentation, diagnosis and management

A series of 6 cases of Parapharyngeal space tumours is reported. Of the total, 4 [66%] were benign schwanomas. The incidence of malignant tumours in this study is 33%. The commonest mode of clinical presentation was painless mass in the lateral wall of pharynx with or without a contagious swelling below the angle of mandible. Pain, trismus and cranial nerve palsies indicated malignancy. Amongst the investigations M.R.I. is of special interest. In case No. 5 cross-circulation in angiograms helped us in deciding to simultaneously ligate both internal and external carotids. This has been done in some series published elsewhere but not in Pakistan

Traumatic facial paralysis, causes and management

A series of 13 cases of traumatic facial paralysis is presented. The cases are almost equally distributed between temporal bone fractures and iatrogenic causes. Damage is seen in supralabyrinthine part and genicular area in cases with temporal bone trauma. Damage is common at the junction between the horizontal and vertical parts in iatrogenic cases occurring as a complication of mastoid surgery. In follow up of 3 years all showed recovery up to a varying degree except 2 cases

Treatment modality and prognosis as a function of topography and clinical staging in laryngeal carcinoma

Treatment modality and prognosis in laryngeal cancer depends on topography and clinical staging. While conservation surgery is indicated in early supraglottic and glottic cases, total removal of larynx is the choice in subglottic and late supraglottic and glottic tumours. Total laryngectomy is also indicated in failures after conservation operations and D.X.R. We use deep X-ray therapy as a post-operative supplement in advanced cases where we remove larynx as well as some adjoining infiltrated area such as pharynx, tongue base, etc. D.X.R. is also indicated for palliation. As regards prognosis, it is best in early clinical stage-1 and clinical stage-2 tumours, specially in glottic area. Advanced cases where one has to remove extensively do not fare so well. Same is true for cases who require neck dissection

Stapedial fixation, causes and management

Causes and Management of stapedial fixation is discussed in fifty-seven cases of tympanotomy. The commonest condition is otosclerosis for which we advocate stapedectomy. Other causes include congenital fixation, tympanosclerosis and chronic adhesive otitis media