Hearing Improvement in Tympanoplasty, with and Without Canalplasty.

Primary objective of this study was to compare the role of canalplasty in tympanoplasty, with that of only tympanoplasty, in patients of chronic suppurative otitis media with narrow external auditory canal and moderate to large central perforation, in terms of hearing improvement, graft uptake, intra operative ease. This study included 60 patients with chronic mucosal otitis media with narrow external auditory canal, with moderate to large central perforation, presenting to our institution from September 2019 to August 2021. Group A consisted of 30 patients, who underwent tympanoplasty with canalplasty and Group B consisted of 30 patients, who underwent tympanoplasty without canalplasty. Both the groups were followed up for 3 months, compared and analysed for hearing improvement and graft uptake. The results of our study indicated that Group A achieved 93.3% graft uptake rates compared to group B which achieved 80%. In Group A gain in air bone gap was 12.43 dB, whereas in Group B it was about 9.50 dB. Group A had significant hearing improvement and better graft uptake compared to Group B. It is advantageous to perform canalplasty prior to tympanoplasty in patients with narrow external auditory canal in whom the entire rim of annulus is not visible in one microscopic view. It yields better hearing improvement and graft uptake and prevents lateralization of the graft.

Variations of Retromandibular Vein and Its Relation to Facial Nerve Within Parotid Gland.

Maxillary vein and superficial temporal vein unite to form the retromandibular vein in the parotid gland. The facial nerve lies lateral to external carotid artery and retromandibular vein. Identifying and preserving the facial nerve is the prime motto during parotidectomy. So the variations of facial nerve and the retromandibular vein should be known so as to avoid injury to both. The variations we encountered during parotid surgery will be helpful in avoiding unexpected bleeding and injury to facial nerve.

Pyramidal Artery: An Artery to Pyramidal Lobe-A New Nomenclature.

Thyroid lobes are supplied by superior and inferior thyroid arteries. We dissected out a specific arterial pattern always present along with a well developed pyramidal lobe. Authors named this as "Pyramidal Artery". This may be a common unnoticed bleeding site during surgery. Thyroid anomalies are commonly observed as incidental finding during surgery. Presence of pyramidal lobe is the most common finding among other thyroid anomalies due to persistence of thyroglossal duct. Present study reported incidence of pyramidal lobe in 41.46% cases and pyramidal lobe branches off more frequently from left lobe than right. Special attention has to be paid during total thyroidectomy in order not to leave the thyroid tissue. Few such anatomical variations and surgical importance of vascular pattern in such cases is discussed in paper.

The study of higher origin of facial artery and its surgical significance.

Facial artery plays a key role in blood supply of the face. Facial artery one of the anterior branches of the external carotid artery originates within the carotid triangle. Variation in the origin of the facial artery was observed on two sides out of 60 sides in 30 cadavers. Facial artery was observed originating at the level just below the maxillary artery within the parotid gland. Facial artery may originate as linguo-facial trunk or thyro-linguo-facial trunk. Other developmental variations have also been described in the literature like, agenesis of facial artery, enlarged facial artery, hypoplastic facial artery. Variability in situation may complicate the surgery. Therefore maxillofacial surgeon, plastic surgeons and head & neck surgeon should be aware of such variation.

Study of a unique 'inverted u' shaped thyroid gland and its clinical importance.

Thyroid anomalies are not uncommon. Two lobes are usually connected by isthmus at the level of 2-4 tracheal rings. We encountered a unique variation in which thyroid lobes were connected near upper pole by an isthmus at the level above the cricoid cartilage giving an 'inverted U' shape to the thyroid gland. Such unusual variation in thyroid gland has not been reported earlier in the literature. The sound knowledge of such variation should be important to the surgeon while operating on thyroid.

Management of tracheobronchial foreign bodies: a retrospective and prospective study.

(1) To study the presenting complaints or complaints suggestive of foreign bodies in the tracheobronchial tract. (2) To study the clinical findings. (3) To study the correlation between clinical and radiological findings. (4) To study different types of foreign bodies. (5) To study the complications caused by foreign bodies. A total of 115 patients presenting with foreign body aspiration in the tracheobronchial tract were included in the study. Patient characteristics, history, clinical, radiographic and bronchoscopic findings were noted. Foreign bodies in trachea and bronchus were removed by rigid bronchoscopy under general anaesthesia. Jackson rigid bronchoscope with a fibre optic light source and venturi technique anaesthesia was used. In the present study, foreign body aspiration was found to be maximum in the 1-3 year old age group. The average time lapse between aspiration of symptoms and presentation was found to be 1-3 days. Positive history was given in only 68% cases. Cough and breathlessness were the most common presenting symptoms. The commonest clinical signs were decreased chest movement and air entry on the affected side. Collapse of the affected side was the most common radiological finding. The commonest site of impaction was the right main bronchus. Majority of the foreign bodies were vegetative, peanut being the most common. The commonest complication following foreign body aspiration was atelectasis of the affected lung. Successful removal of foreign bodies was possible in all the patients. In paediatric respiratory compromise, the presence of unilateral diminished breath sounds, a pathological chest X-ray and a clinical triad of cough, choking and wheezing, is a powerful indicator of tracheobronchial foreign body aspiration. Since no single or combined variables can predict foreign body aspiration with full certainty, bronchoscopic exploration must be performed if tracheobronchial foreign body aspiration is suspected.

Study of thyro-lingual trunk and its clinical relevance.

Every surgery is planned on the anatomical arrangement of the structures. Any variation in the arterial arrangement may lead to haemorrhagic episodes during intraoperative procedures. In this study, variations in the branching pattern of external carotid artery were noted. In two of the cases, thyrolingual trunk was observed. In the first case, thyrolingual trunk was arising from the common carotid artery, 17 mm below carotid bifurcation and in the second one at the carotid bifurcation. The knowledge of anatomical variation is necessary during intra-arterial chemotherapy and to prevent haemorrhagic accidents during intraoperative procedures.