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

Retrosternal goitre, presentation and treatment outcome

To assess the clinical presentation, surgical out come and complications of retrosternal goitre [RSG]. A descriptive retrospective study. Departments of Ear Nose Throat and Head and Neck Surgery, Fatima Hospital Baqai Medical University and Civil Hospital Dow University of Health Sciences Karachi, between January 2002 to March 2008. Twenty seven patients of both gender and different ages of retrosternal goitre who under went for thyroidectomy between January 2002 to March 2008 were studied regarding their clinical presentation, and surgical outcome. Only two [7.4%] of our patients were presented with acute air way obstruction. Six [22.2%] patients were complained of dsypnoea only in supine posture, dysphagia and hoarseness were noticed in 3[11.1%] and 1 [3.7%] patients respectively while fifteen [51.5%] were asymptomatic apart from the obvious neck swelling. Total thyroidectomy was performed in twenty two [81.4%] cases and lobectomy with isthemectomy was done in five [18.1%] patients. CT scan was done in seven [25.9%] cases. Majority of our cases i.e. twenty five [92.6%] were benign while malignancy was noted in only two [7.4%] cases. Complications noted was haematoma formation in one [3.7%], recurrent laryngeal nerve injury in four [14.8%], hypoparathyroidism [transient] was recorded in three [11.1%] patients, and wound infection was observed in two [7.4%] patients. There was no mortality pre and post-operatively and no case of permanent hypoparathyroidism was noted where as only one patient had permanent unilateral recurrent laryngeal nerve injury. Retrosternal goitre is often asymptomatic and thyroidectomy is the treatment of choice with very low mortality and morbidity

Audiolgical results of type I tympanoplasty by underlay technique with temporalis fascia graft

To determine subjective hearing improvement experienced after closing perforation of various sizes with temporalis fascia grafts by underlay type I tympanoplasty. Prospective study. This study was conducted at the department of Ear, Nose, Throat, Head and Neck Surgery, Jinnah Postgraduate Medical Center Karachi from 01.04.2004 to 31.10.2006. 100 consecutive cases of either sex, age ranging from 18 to 40 years [mean age 31.2] of tubo-tympanic type of chronic suppurative otitis media, with dry central tympanic membrane perforation for last six weeks, having good cochlear reserve and air bone gap between 30dB to 40dB, admitted for tympanoplasty were included for this study. Patients with active ear discharge, frequently or recently discharging ear [history of ear discharge of less than 6 weeks] were excluded. Patients associated with upper respiratory tract pathologies including deviated nasal septum, sinusitis, chronic tonsillitis or pharyngitis and patients with only hearing ear were also omitted from the study. Out of the 100 patients tested, the mean air conduction threshold was 40dB preoperatively and 28dB post-operatively, while the mean bone conduction threshold remained the same pre and post-operatively i.e. 15dB. On post-operative audiometric analysis 51 ears had a post -operative air-bone gap of 10dB or less, air bone gap closed completely in 4 patients, reduced upto 15dB in 26 patients, while in the remaining 19 ears there was no improvement noted. Type-I tympanoplasty underlay technique using the temporalis fascia graft has good functional results in young patients with dry central perforation. For good hearing results, selection of cases has prime importance

Comparative study between intranasal antrostomy and antral lavage

This study was conducted to carry out comparison between intranasal antrostomy and antral lavage and comparison of gross appearance of sinus mucosa and any pus/secretion during operation and pre-operative radiological findings. To establish the following facts: i] Improve the aeration and draining of maxillary sinus to prevent the complications of maxillary sinusitis. ii] Gross appearance of sinus mucosa and any pus/secretion in patients not responding to conservative management, Prospective study. This study was conduded in the departments of ENT, Chandka Medical College Hospital, Larkana and Civil Hospital, Karachi from Dec 2004 to Dec 2007. Total no of 150 cases were selected in this study with non febrile, acute, sub-acute and chronic maxillary sinusitis, divided into two groups. First group was treated with antral lavage under general anaesthesia. The second group was treated by intra nasal antrostomy under general anaesthesia. The comparison data between 1st and 2nd and between 2nd and 3rd lavage nearly the same with minor degree of improvement. Most of the patients undergoing for intra nasal antrostomy [including 33 patients who were not responding to antral lavage] were relieved from their symptoms by this procedure