Diathermy tonsillectomy vs conventional dissection tonsillectomy

To compare the conventional method of tonsillectomy, the dissection snare method with that of the newer procedure, bipolar electrodissection method. We studied 200 cases in two groups, hundred in each. In the first group the patients underwent tonsillectomy by dissection-snare method and in the second by electrodissection method. The results of the two groups were studied regarding the time taken in the procedure, blood loss during the procedure, postoperative analgesia required, reactionary hemorrhage, postoperative diet toleration and secondary hemorrhage. The average operation time was 14.2 minutes for diathermy group and 35 minutes for the dissection-snare group. Regarding the postoperative diet taken and reactionary heamorrhage the bipolar diathermy method is better, but there is no significant difference regarding the postoperative analgesia, postoperative pain and secondary hemorrhage. We concluded that bipolar electrodissection [diathermy] method is the superior method regarding the time taken during the procedure, the intra operative blood loss was lower and there was no need of ties [ligating the bleeding vessels] in the diathermy method

Outcome of myringoplasty

The out come of graft acceptance and rejection in myringoplasty were evaluated in patient of 16-45 year of age, having dry central perforation. Admitted patients in ENT unit Post-Graduate Medical Institute Lady Reading Hospital, Peshawar. Myringoplasty was done in 60 patient admitted in ENT unit with dry central perforation. Age limit was 16 - 45 years. All patients were admitted in door a night before. All the relevant investigation including clinical examination, pure tone audio gram, x-ray mastoid and para nasal sinuses were done. Examination under microscope was carried out a day before admission. Operations were done under local anaesthesia graft was taken from temporalis fascia. After weeks the tympanic membrane were evaluated under Microscope, to assess the result of Myringoplasty. Myringoplasty was successful in 35 patients [60%] and in 24 patients [40%] graft was rejected due to infection. Myringoplasty is a beneficial procedure to protect the middle ear and inner ear for future hearing deterioration. The improvement of hearing is an added benefit. Overall 2/3rd of patients get their graft accepted. In absence of meddle ear cleft infection, the reason of high graft rejection is due to improper sterilization of instruments and environment

Hydatid disease of the submandibu;ar gland

Echinococcosis is a tissue infection of the human caused by the larval stage of Echinococcus granulosus or E. multilocularis. Hydatid cyst of the head and neck region is uncommon and the involvement of salivary glands, especially the submandibular gland, is very rare. A case of submandibular gland hydatid cyst is reported in this article, in a patient who was presented with swelling of this area of three months' duration. Examination revealed a soft, non-tender, mobile mass measuring 6x4 cm. Chest X-ray and abdominal ultrasonography were normal. Excision of the whole mass was performed and pathological examination confirmed the fine needle aspiration cytology report. A 7 years old female child was admitted in ENT unit, Lady Reading Hospital, Peshawar, with a swelling on the right side of her neck in the submandibular region of a duration of three months, prior to which the patient had no complaints. The swelling had increased in size, but had remained painless and without any other significant problem. She had a course of conservative management, but there was no response. No history of cough, hemoptysis or jaundice was reported, and examination revealed her to be afebrile. The skin overlying the mass was soft, non-tender, mobile and showed no redness or warmth. The size of the mass was 6x4 cm and intraoral examination revealed no stones in the right submandibular gland duct. Milking of the submandibular glands showed decreased saliva production on the involved side, which was clear and examinations of her chest and abdomen proved normal. X-ray of the submandibular region, however, showed a soft mass with no radiopaque shadow or erosion of the mandible. Ultrasonography of the submandibular area revealed a large non-vascular predominantly cystic mass having some internal solid components with a few enlarged lymph nodes. Fine needle aspiration cytology [FNAC] of the mass showed many scolyces and hooklets along with some inflammatory cells. Complete blood count and sedimentation rate were normal except mild eosinophilia. The tuberculin test [PPD] was also normal. With the impression of hydatid cyst of right submandibular gland, surgery was performed via a horizontal incision about 4 cm below the lower edge of the mandible. After dissection of the surrounding tissue, the submandibular gland was exposed and completely removed without rupturing the cyst. The submandibular gland was incised and a 4x4 cm sized cyst containing a whitish-yellow fluid was seen. The patient was discharged from the hospital with no complications.5 The pathologic report showed a hydatid cyst. Periodic check-ups, including abdominal ultrasonography and x-ray examination, were performed during the first six months postoperatively which revealed no pathological findings

rare case of malignant ameloblastoma with Multicentric presentation

Malignant ameloblastoma accounts for less than 1% tumour of the faciomaxillary region, arising from epithelial odontogenic cells or dental lamina. The commonest site is the ascending ramus of mandible and maxilla. A rare case of malignant ameloblastoma at unusual sites is reported. It is important to identify this condition to offer adequate excision and prevent recurrence. This is a case of 9 years old male child, who presented a mass in left cheek and inguinal mass with amputated right leg. Complete excision of the maxilla and inguinal mass was carried out and confirmed as a metastatic malignant ameloblastoma both in maxilla and inguinal region. There was recurrence of the same growth in the right maxilla and skull bones after one year. This is a unique presentation of ameloblastoma spreading to remote areas in the body that has not been reported in the literature. A 9 years old male child was admitted in our ENT Department at Lady Reading Hospital, Peshawar on May-June 1998 with history of swelling left cheek and right inguinal mass. The cheek swelling appeared 10 months back and rapidly increased in size in the last 3 months. It was progressively pushing the left eye ball upward and medially with a proptosis and intact vision. There was history of nasal obstruction with blood stained nasal discharge. He had epiphora as well. On physical examination patient revealed 8x9 cm irregular solid mass of the left cheek which totally occupied the left nasal cavity with protrusion of the lateral wall, left palate and alveolus resulting in loosening of teeth. The mass was smooth and non-tender. The local temperature over the mass was normal, the overlying skin was intact and freely mobile over the mass. On systemic examination there was a mass 8x9 cm in the right inguinal region. The overlying tissue was normal, in the past patient suffered from the same lesion of the right lower limb which was amputated on October 10,1992. Mass from the right axilia was excised by the general surgeon and reported as adamantinoma on histopathology in November 13, 1996. The lesion of the left maxilla and right groin appeared during the last ten months

Removal of a large frontal sinus osteoma with unilateral osteoplastic flap

A Seventeen years old male presented with right unilateral proptosis and supra-orbital swelling. Routine x-rays sinuses and CT Scan showed opacified mass of the right frontal sinus mainly occupying the lateral part of the sinus extending into the orbit. Excision of the lesion was carried out under general anaesthesia utilizing unilateral osteoplastic flap. The procedure was devised to ensure complete excision of osteoma through frontal sinus, direct examination of the frontonasal duct opening, and to achieve a good post operative cosmesis

unusual presentation of foreign body oesophagus

A case of long standing oesophageal foreign body [coin] in a child is discussed. The patient was unusual in several respects, especially the way it presented: failure to thrive secondary to the under nourishment caused by the foreign body. The foreign body was diagnosed only after it had eroded the walls of the oesophagus and the right main bronchus producing a bronchooesophageal fistula

Preoperative evaluation of eustachian tube function in reconstructive middle ear surgery

A correlation between preoperative eustachian tube functional results with postoperative stability and function of the ears undergoing reconstructive surgery i.e. [Tympano-plasties] is presented from our Institute. The study was conducted on 24 patients with a variety of Chronic middle ear diseases. The ear pathology included both tubo-tympanic and attico-antral diseases with or without cholesteatoma. Preoperatively, patients were divided into three main groups on the basis of tubal functions. The same patients were then followed up postoperatively for a period of three to six months and their ears were evaluated with regards to anatomical and functional stability. It was confirmed that a physiologically functioning eustachian tube in a chronic suppurative Otitis Media results in a successful tympano plasty both from anatomical and functional aspects

Velopharyngeal incompetence: functional evaluation

Evaluation of patients with Velopharyngeal Incompetence were carried out both pre-operatively and post-operatively in 56 patients over the period 1982 to 1985 in Department of E.N.T. at Post Graduate Medical Institute, Peshawar. Different methods were utilized for recording the voice of the patients as well as to see the dynamic action of different articulating structure during speech at Velopharyngeal Port. Voice tape recording on video along with video radiography were carried out to hear voice. Also speech phonography was carried out in form of tracings. These evaluations were carried out both pre-operatively and post-operatively for comparison and record. Most of the operated cases were between the age group of 2 years to 7 years except 9 patients who were above this age group. 22% of these patients under went primary pharyngo-palatoplasty with superiorly based pharyngeal flap. Remaining 78% of cases under went secondary pharyngo-palato-plasty with superiorly based pharyngeal flaps. Improvement in overcoming Hypernasality and nasal escape of air associated with Velopharyngeal incompetence was achieved in all of these cases to a variable degrees. This was noticed both objectively and subjectively