Management of temporomandibular joint dislocation at mayo hospital Lahore

For the management of TMJ dislocation, controversies always surround to the various conservative and surgical modalities. Hence a retrospective study was planned to audit the demographics, etiology and patterns of occurrence and to enumerate the treatment modalities of TMJ dislocation at the De-partment of Oral and Maxillofacial Surgery/Mayo Hospital Lahore, fifty two cases of TMJ dislocation were retrospectively studied from 2013 to 2017. Patient records contained information about age, sex, type of dislocation, immediate event preceding the dislocation, treatment modality used and reported complications regarding dislocation. Thirty two patients [62%] were males and 20 [38%] were females. Their ages ranged from 1-80 years with a mean of 37 years. 23/52 patients were presented with acute dislocation which were managed by manual reduction and analgesics. 19/52 patients were presented with chronic recurrent dislocation in which 7 patients were injected with autologous blood, 9 patients were treated with intermaxillary fixation and three patients were given STD injection. Chronic long standing TMJ dislocation in 10 patients were managed by eminectomy in 7 patients and condylecto-my in 3 patients. This study concluded that male sex, middle age, yawning, and low socio-economic status appeared to be associated with TMJ dislocation; however, this observed relationship was not statistically significant. Different treatment modalities exist. This study highlighted the advantages and effectiveness of conservative methods of treatment

Bipolar electrofulguration with endoscopic approach in allergic hypertrophied turbinate

Background: Allergic hypertrophied turbinate, is managed by different treatment modalities, with variable outcome

Objective: To evaluate the result of bipolar electrofulguration with endoscopic approach in allergic hypertrophied turbinate

Patients and Methods: Study design: Descriptive, cross sectional study. Place: ENT department of Jaber AL - Ahmed Forces Hospital, Kuwait from 1[st] January 2008 to 31[st] December 2010. Fifty five cases of hypertrophy of Inferior turbinate were selected. Forty patients were females and 15 were males. They presented mainly with history of nasal blockage. Endoscopic bipolar diathermy was used to decrease the size of inferior turbinate. The variables included were nasal obstruction, post nasal drip, itching and sneezing. The patient were followed up on one, three and 6 month. The data was entered and analyzed by SPSS version 12

Results: Endoscopic bipolar diathermy showed good results after follow upto two six months duration. We found that 89% of the patients reported subjective improvement and 65% of the patients have objective improvement as well

Conclusion: Bipolar diathermy of inferior turbinate using zero degree endoscope is a good technique for excellent view of inferior turbinate. This procedure gives good results to the patients

Suction cleaning of the external auditory canal in otomycosis: is it really helpful?

OBJECTIVE: This study was conducted with the objective to find out whether suction cleaning of the external auditory canal in cases of otomycosisis helpful or not

STUDY DESIGN: Prospective, randomized comparative study

PLACE AND DURATION OF STUDY: This multi-center study conducted at the departments of ENT, head and neck surgery of Liaquat University Hospital, Hyderabad, Sheikh Zayed Hospital, Rahim Yar Khan and Zubaida Medical Centre, Karachi. The study was conducted from March 2013 to February 2014 for a period of one year

PATIENT AND METHODS: A total of 200 patients were included in this study. These patients were serially divided into two groups A and B. Both groups received topical antifungal solution of 1% clotrimazole, 3 to 4 drops three time per day..In group A at the time of first consultation suction cleaning of the fungal debris was also done while in group B only above mentioned treatment was given without suction cleaning of the external auditory canal. All these patients were followed up regularly till the complete resolution of the disease

RESULTS: The minimum time duration for group A was 5 days and for group B was 9 days. The maximum time duration for group A was 18 days while for group B was 23 days. The mean time duration for complete resolution in group A was 9.6 days while in group B was 15.2 days [p<0.05]

CONCLUSION: Suction cleaning of the external auditory canal for removal of fungal debris is very helpful and it reduces the time duration for complete resolution. So it should be performed in every patient of otomycosis to remove fungal debris

Audit of patients of epistaxis: treatment modalities and relation with blood groups

Background: Epistaxsis in one of the common condition faced in emergency

Objective: To evaluate the pattern of epistaxis, treatment, modalities and relation of epistaxis with blood groups

Patients and Methods: This retrospective the study was conducted at department of Ear, Nose, Throat, Head and Neck Surgery, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] January to 31[st] December 2010. Patients with spontaneous severe epistaxis who require hospitalization for control were included in this study and those who were with obvious cause like trauma, rhinolith, foreign bodies, granulomatous condition, tumours, blood dyscrasia and age below one year were excluded from this study. Data regarding age, gender, mode of presentation, under lying cause, blood groups and treatment modalities of consecutive 160 admitted cases of epistaxis was collected and analyzed by manual method and with the help of SPSS version 19. Sixty patients were excluded from this study because of blood dyscrasia, granulumatous disease and tumours. Trauma was not included in this study. To determine the association of blood grouping with opistaxsis 100 controls were also included in the study

Results: Hypertension above 50 years was the most common cause. It was more common in male patients [72%] as compared to in female. Sixty patients [60%] were above 50 years, twenty [20%] patients were in between [30 to 49] years, nine patients [9%] were in between [10 to 29] years and seven patients [7%] were in between [01 to 09] years of age. Hypertension was observed in sixty [60%] patients, chronic rhino sinusitis in twenty [20%]. Eighty five patients [85%] were managed by anterior nasal pack and in fifteen patients [15%] posterior nasal packing was done. Blood group [O] distribution was present in [47%], while in control group it was 38%

Conclusion: In adult admitted patients, hypertension was the major cause when trauma, granulomatous disease and blood dyscrasia was excluded. Anterior nasal packing is still valuable in control of epistaxis. Patients with blood group O was found in majority of patients of epistaxis

Pattern of hearing loss on pure tone audiogram in heavy industrial workers

Background: Hearing loss in industrial worker may be devastating for the workers, with poor quality of life

Objective: This study was conducted to find out the degree of hearing loss and audiometric pattern of hearing loss in local industrial workers

Patients and method: This cross sectional study was conducted at department of ENT, head and neck surgery, Kulsoom Bai Valika Social Security Hospital, SITE, affiliated hospital of Hamdard University, Karachi, from 1[st] January, 2010 to 31[st] December, 2010. A total of 100 persons were included in this study who were industrial workers for more than 15 years and came to hospital for some reasons other than hearing loss or any ENT problem. The data was entered and analyzed by using SPSS version 15

Results: Majority of the subjects were male [96%] while only 4% were females. 18 patients were below the age of 35 years, 29 were between 36-45 years, 32 were between 46-55 years and 21 were above the age of 55 years. 74% of the workers were not using any protective device or method against loud machinery noises. Mean hearing threshold of all the subjects was above 25 dB in all frequencies tested i.e. from 250 to 8000 Hz. Mean hearing loss was maximum at the frequency of 4000 Hz

Conclusion: All of the workers included in this study has some degree of hearing loss at least in some frequencies [more pronounced at 4000 Hz], although majority were not aware of this hearing loss

audit of the emergency tracheostomies in a tertiary care hospital

Background: Emergency tracheostomy remains a vital life saving procedure in advanced upper airway obstructive pathologies and in various other clinical settings where urgent alternative air passage is needed. Ingestions of hair dye powder containing PPD for self harm purpose or accidentally, is emerging as its new indication especially in young female patients

Objective: To evaluate the demographic and etiological factors underlying emergency tracheostomies in consecutive one hundred patients presenting in a tertiary care hospital

Subjects and Methods: In this case descriptive study, records of one hundred consecutive cases of emergency tracheostomies were collected and analyzed from demographic and etiologically point of view, from 1[st] January, 2012 to 30[th] September, 2013 manually as well as by using SSPS version 17

Results: Etiologically we found thirty five [35%] cases of severe respiratory distress due to kala pathar ingestion, thirty [30%] cases due to advanced laryngopharyngeal growths, twenty one[21%] due to trauma of head neck region or for assisting ventilation, four [4%] due to foreign bodies in laryngotracheal region, four[4%] cases were due to acute pharyngolaryngeal edema due to corrosive in take, four[4%] cases were due to post thyroidectomy bilateral abductor paralysis, one [1%] case was due to laryngomalacia and one [1%] case was due to acute epiglottitis male to female ratio was 1 to 1.5

Conclusion: Upper air way obstruction secondary to kala pathar ingestion is emerging as a new indication for emergency tracheostomy secondly, late presentation of upper airodigestive tract tumors, along with head neck trauma, remains a dominant indication for emergency tracheostomy

Etiology, pattern and management of maxillofacial fractures in patients seen at mayo hospital, Lahore - Pakistan

The objective of the study was to determine the varying etiology, pattern and mode of treatment of maxillofacial injuries in a tertiary care centre, Mayo Hospital, Lahore, Pakistan. This was a retrospective study spread over two years and six months i.e. January 2010 to June 2012. 214 consecutive indoor/ outdoor and emergency patients with maxillofacial injuries farmed the study group. Data concerning the patients' demographics, aetiology, occupation, socioeconomic status and pattern of maxillofacial injuries were obtained and analysed. The most frequent bone fractured was the mandible, which accounted for 106 cases 49.5%, followed by 15.4% of pan facial [full house] fractures and 15.4% of Zygomatic complex fracture. The associated mid face fractures were found in 12.6% and isolated nasal bone fractures were found in 1.5% cases. The most common cause of injury was RTA 58.4%, followed by falls 24%, FAIs 6.1%, interpersonal violences 2.8%, sports and other injuries were 8.4%. Employees 49.5% and students 31.3% in age groups 20-40 years were mostly affected by RTA, while falls 14.4% were more common in age group less than 20 years. Open reduction and internal fixation alone 43.9%, maxillomandibular fixation +/- suspension 38.8% and open reduction and internal fixation with maxillomandibular fixation 14.5% were the main mode of treatment in this centre. In this study, mandible was the most commonly fractured facial bone; RTA especially by motorbike and chigchi rikshaw was the most common etiological factor. Results could be influenced by the personal and working environment

Herpes simplex encephalitis presenting with normal CSF analysis

A 28 years old female presented with headache, fever, altered sensorium and right side weakness for one week. She was febrile and drowsy with right sided hemiplegia and papilledema. Tuberculous or bacterial meningitis, tuberculoma and abscess were at the top of the diagnosis list followed by Herpes simplex meningo-encephalitis [HSE]. MRI showed abnormal signal intensity of left temporal lobe without significant post-contrast enhancement and midline shift. CSF examination was normal, gram stain and Ziehl-Neelsen stain showed no micro-organism, or acid fast bacilli. CSF for MTB PCR was negative. PCR DNA for Herpes simplex 1 on CSF was detected. Acyclovir was started and the patient was discharged after full recovery. A high index of suspicion is required for HSE diagnosis in Pakistan where other infections predominantly affect the brain and HSE may be overlooked as a potential diagnosis.

Comparison of emergence time after total intravenous anaesthesia versus inhalational anaesthesia in gynaecological procedures

To compare emergence time after Total Intra-venous Anesthesia [TIVA] using Propofol and Inhalational Anesthesia using Sevoflurane in minor gynecological and obstetric procedures. Randomized controlled study. Department of Anesthesiology, Intensive Care and Pain Management, Combined Military Hospital, Peshawar. Six months from 15[th] March 2010 to 14[th] September 2010. A total of 200 gynecological patients of ASA-I and II were included in this study. Patients were divided randomly in 2 groups of 100 each using random numbers table. Group A patients were administered TIVA- Propofol and group B patients were given inhalational anaesthesia using Sevoflurane. A stopwatch was started when the anesthetic drug was discontinued at the end of surgery and was stopped as soon as the patient opened her eyes spontaneously to record the emergence time. All the data was entered in a patient performa. It was observed that group A patients who were administered Propofol had a faster emergence time as compared to group B patients who were administered Sevoflurane. The mean emergence time of TIVA- Propofol group was 6.24 minutes [SD=0.726] while that of inhalational- Sevoflurane group was 8.52 minutes [SD=1.218]. The shorter emergence time of Propofol group was highly significant when compared with the Sevoflurane group [p<0.001]. The study concluded that Propofol provides rapid emergence than Sevoflurane

Cervical lymph node metastases in squamous cell carcinoma of tongue and floor of mouth

Oral squamous cell carcinoma has high chances of cervical lymph node metastasis. This case series describes the distribution of cervical lymph nodes in 50 cases of squamous cell carcinoma of tongue and floor of mouth. The mean age was 47.28 +/- 10.5 years. Thirty positive metastatic lymph nodes were found; 90% occurring at level l-ll mostly in T4 size but also in T1 and T2 cases. The distribution of involved lymph nodes in oral cancer affects the neck dissection extent and is, therefore, an important pre-operative feature

low cost digital infant incubator

In modern times the care of new born, especially the premature, the small for dates, or otherwise vulnerable infant has been greatly improved by the invention of the isolette incubator. However the cost of an infant care incubator is prohibitively high for poor and low income countries. We set out to develop an economical machine which should not only have the usual features, but also should have the ability to run, if electrical power fails.Our design required that it should be, safe to use and be run on 12 volt batteries to make it immune to frequent power breakdowns, it should be a sturdy, shock proof and a durable machine. It should have the provision of its own light source to provide for an emergency light for observation of the baby in case of power failure or during transport. Design should be such that it should be easy to repair with conveniently available parts. The design has a microcontroller, at its heart receiving input from Analog to Digital Convertor [ADC]. It provides the efficient functional control of temperature and humidity simultaneously. It will send signals to keep the heating and humidity in control at the same time feeding signals to LCD display.The product has turned out to be a very well functioning machine as shown in the figure. The prototype is economical to make and meets our initial aims. But we intend to improve upon it in our next model and make it a commercially viable and a more useful machine

Epidemiology and management of intra-abdominal injuries due to criminal abortion

To collect data about different aspects of epidemiology of intra-abdominal injuries due to criminal abortions and devise a plan of management for various categories of intra-abdominal injuries. This observational case series study was carried out in Surgical unit 2, Bahawal Victoria hospital, Bahawalpur, from January 2006 to December 2007. A total of 40 consecutive patients were studied. All patients of abdominal injuries due to criminal abortion were included in the study. Patients of criminal abortion having only gynaecological complications i.e. per vaginal bleeding, septicaemia and acute renal failure were excluded from the study and only the patients with abdominal injuries were included. Relevant history and appropriate physical examination was performed and necessary investigations were done. Exploratory laparotomy was performed and injuries were treated accordingly. The most common age group developing intra-abdominal injury due to criminal abortion was of 25-34 years [77.5%]. Most of these abortions were in first trimester [70%], in women belonging to poor socio-economic status [80%]. Sixty five percent of these abortions were induced by semi-skilled persons, mostly by dilatation and curettage [70%]. The most common clinical presentation was painful abdominal distention [57.5%]. On laparotomy, gut injury was found in 20 [50%] cases, out of which 12 [60%] cases underwent gut exteriorisation. Isolated uterine injury was observed in 13 [32%] cases, out of which 12 [92%] patients underwent primary uterine repair. Intra-abdominal injuries due to criminal abortions are a definite entity. They usually present as acute abdomen. Exploratory laparotorny is mandatory; viscera most commonly injured are gut and uterus

Walking epidural with low dose bupivacaine plus tramadol on normal labour in Primipara

To determine the obstetric outcome in terms of duration of labour and mode of delivery between the walking epidural analgesia with 0.1% Bupivacaine + 0.5% tramadol and routine labour practice. Non-randomized controlled trial. Department of Anaesthesia, Military Hospital, Rawalpindi, from August 2004 to July 2007. Consecutive 50 primiparous patients, ASA-I, coming to antenatal clinic for routine delivery were included in control group-A, and consecutive 50 primiparous ASA-I, coming to antenatal clinic and requesting for painless delivery were included in group-B. In group-A, only injection Nalbuphine 10 mg intramuscular was given when pain was unbearable, on patient's request as a routine practice. In group-B epidural analgesia was given with 15 ml of 0.1% Bupivacaine + 0.5 mg/ml Tramadol. First stage, second stage and total duration of labour were noted. Mode of delivery was also recorded in both groups. Patient satisfaction was assessed by interviewing the parturient ast evening round after delivery. In group-A, fist stage duration of labour was 3.72 +/- 1.16 hours and in group-B, it was 4.03 +/- 1.00 hours, [p < 0.001]. Second stage of labour in group-A was 0.55 +/- 0.35 hours and in group-B it was 0.67 +/- 0.33 hours; [p = 0.072]. Total duration of labour, group-A was 7.57 +/- 1.13 hours and in group-B it was 4.77 +/- 1.21 hours, [p < 0.001]. In group-A 46/50 [92%] patients were delivered spontaneously, while 4/50 [8%] required instrumental assistance, In group B 36/50 [72%] patients were delivered spontaneously and instrumental deliveries were 13/50 [26%] [p = 0.015]. One patient developed fetal distress and went through cesarean section in group B. Patient satisfaction was excellent in 88% of group-B parturients. Epidural analgesia with combination of low concentration of Bupivacaine, injection Tramadol and ambulation markedly reduce the duration of labour

Comparison of haemodynamic changes after laryngeal mask airway insertion with propofol versus sevoflurane

To compare haemodynamic changes on Laryngeal Mask Airway [LMA] insertion using tidal volume induction technique with sevoflurane at high concentration versus an intravenous induction with propofol. Randomized Controlled Trial [RCT]. Place and Duration of study: The study was carried out at Department of Anaesthesiology, Intensive Care and Pain Management, Military Hospital Rawalpindi from May 2006 to April 2007. One hundred patients were enrolled after written informed consent. Patients were divided in two groups. Group A received propofol and group B received sevoflurane for induction of general anaesthesia. Heart rate and mean arterial pressure [MAP] were recorded one minute before induction of anaesthesia and three minutes after induction and LMA placement. Independent sample "t-test" was applied to compare means for MAP and mean heart rate in both the groups and p value was inferred to judge the significance. In group A 20 males and 30 females were enrolled for the study while in group B there were 16 males and 34 females. The mean age of the patients in group A was 30.5 +/- 4.8 years while in group B was 28.4 +/- 5.2 years. Mean weight was 60.5 +/- 5.8 and 62.2 +/- 4.7 kilograms respectively in both groups. Twenty two patients were ASA I and 28 were classified as ASA II in group A while 27 were ASA I and 23 were ASA II in group B. In the group A, MAP was recorded to be 90 +/- 5.3 mmHg before induction and 79.9 +/- 7.5 mmHg after LMA placement following propofol induction. Whereas MAP in Group B before induction of anaesthesia and after LMA placement were 90 +/- 4.8 and 84.2 +/- 7.03 mmHg respectively. The fall in MAP was found to be significant in Group A when compared to Group B after induction and insertion of LMA [p value < .005]. In group A, mean HR was recorded to be 79.1 +/- 4.3 before induction and 82.2 +/- 8 per minute after LMA placement following propofol induction. While mean HR in Group B was 78.1 +/- 7.8 before induction and 83.3 +/- 8.0 per minute after LMA placement following sevoflurane induction. Hence, we found no significant difference in terms of change in mean HR between the two groups [p value > 0.4] before and after LMA insertion. Considering more fall in the MAP following propofol induction in group A and as there was no significant change in MAP and heart rate before and after sevoflurane induction, we conclude that sevoflurane provided better haemodynamic stability than propofol for LMA insertion

Evaluation of the analgesic and adverse effects of tramadol in combination with low dose bupivacaine for painless epidural delivery

To evaluate the analgesic and adverse effects of Tramadol in combination with low dose Bupivacaine for painless epidural delivery. Quasi-experimental study. Place and Duration of Study: The study was carried out at department of anaesthesiology Military Hospital Rawalpindi from August 2004-July 2007. Material and Fifty ASA-I uncomplicated full term primiparous were selected. Epidural analgesia was given with 15ml of 0.1% Bupivacaine plus 0.5% Tramadol when labour was established and was repeated on patient's demand. Pain was assessed by using verbal analogue scale 0-10 in first stage as well as in second stage of labour. Adverse effects on mother and baby were noted. Overall satisfaction about the procedure was also assessed. Forty two [84%] rated first stage of labour pain free [VAS-0] and Eight patients [16%] rated it as good pain relief [VAS-3]. Thirty four [68%] patients in second stage of labour rated it pain free while sixteen [32%] patients rated it as good pain relief [VAS-3]. One patient developed hypotension. Two patients complained of nausea. No patient complained of vomiting and none of them developed sedation. Three [6%] newborns had Apgar score nine and forty seven [94%] had ten after five minutes of delivery. Forty four patients described the experience as excellent; five described it as good and one as satisfactory. Tramadol used in epidural painless delivery in combination with low dose Bupivacaine is very effective analgesic with less adverse effects on mother and baby and can be used as an alternative to fentanyl/pethedine

new supraclavicular approach to subclavian venous catheterization

Supraclavicular approach to access the right subclavian vein is easier and associated with fewer complications as compared to infraclavicular approach. Needle is directed at an angle of 10° medially from the sagittal plane and 35° posteriorly from the coronal plane, just at the clavisternomastoid angle, to locate the subclavian vein