Cranioplasty our experience in last 5 years

The incidence of craniofacial deformities in our country is not less than other countries. However the surgical treatment of these deformities is considered either difficult or out of the reach for most people. We present our experience at PNS Shifa in the last 5 yrs. Five cases of craniofacial anomalies were operated at PNS Shifa, Karachi, from 2005 to 2010. Two had hypertelorism; one associated with frontonasal encephalocoele; one with plagiocephaly, one had Scaphocephaly and one with microcephaly. All the cases recovered well from surgery. Average age at surgery was 5 months. One case [20%] developed CSF leakage from nose and had to be re-explored. Cosmetic results were from good to very good. With better facilities of anesthesia and better imaging techniques the surgery for craniofacial deformities is becoming safe and available in our country.

Tympanic membrane disintegration by otomycosis

To report ear drum disintegration in cases of otomycosis. Case series study. E.N.T and Head and Neck Surgery Department PNS Shifa Hospital Karachi and E N T Department of Combined Military Hospital, Quetta Cantt from August 2009 to October 2010. 242 patients with clinical diagnosis of otomycosis were registered over a period of 15 months. On registration ear was meticulously cleaned under microscope removing fungal debris to establish the integrity of eardrum. In the same sitting cream with combination of triamcinolone acetonide, neomycin sulphate, gramicidin, nystatin was applied all around within external auditory meatus [EAM] on effected walls and same drops were advised locally thrice daily for 3 to 5 days. Every patient was advised to report back immediately on occurrence of irritation, earache, ear discharge, blockage of ear and pain. Out of 242patients [140 males and 102 females] 110 [45.45%] were cured after single visit as outpatient adopting a regimen of single application of antifungal cream and thrice daily antifungal ear drops for 5 days after proper cleaning of fungal debris from EAM. 73 [30.16%] cases were cured of otomycosis after two sittings of same regimen. 59 [24%] patients neglected the otomycosis for days to weeks till the time pain became unbearable. In 18 [7.43%] patients ear drum was perforated by otomycosis and all these patients had neglected the disease. Neglected Qtomyeosis has all the potentials to create a defect in ear drum causing chronic disability .Meticulous cleaning and local antifungal therapy still remains the gold standards for curing otomycQsis

Acute parapharyngeal abscess secondary to streptococcal mastoiditis

A rare case of parapharyngeal abscess caused by Streptococcus pneumoniae presenting as neck abscess is reported. The patient had 20 days history of cough, fever and swelling behind right ear. He had not responded to multiple antibiotic treatments given earlier. On the basis of clinical examination and CT scan finding, he was diagnosed as having parapharyngeal abscess pointing in the neck. The abscess was drained and the patient was treated with injectable Ceftriaxone, due to identification of penicillin - resistant Streptococcus pneumoniae

Compartive study of laser and conventional surgery in laryngeal diseases

CO2 Laser in laryngeal disease has been discussed only insufficiently in literature and even those reported were individual case reports with small caseloads. This comparative study was carried out during June 1995 to June 1997 at CMH Rawalpindi involving a total number of 100 patients. Purpose of this study was to compare conventional surgical techniques currently in practice with that of laser. Some advantages and disadvantages of both the techniques are discussed. The financial effects of both the techniques are also compared. The addition of the carbon dioxide laser to the instrumentation available to the laryngeal surgeon has improved the precision of traditional endolaryngeal surgical procedures and has made the endolaryngeal approach possible for operations formerly performed only by external approaches