ABSTRACT
Image guidance is best suited to paranasal sinus surgeries as these demand a high degree of anatomical precision because of close proximity to orbit and cranial cavity which at times is challenging in patients with frequent anatomical variations. This study is aimed to describe our first experience of using image guided endoscopic sinus surgery in Kashmir valley in terms of real time correlation between the operative field and the preoperative imaging; to evaluate its utility in disease clearance and to evaluate patient reported outcome measures using (pre and post-op) VAS, SNOT-22, Lund Mackey endoscopic and radiological scores. This prospective observational study was conducted from September 2016 to August 2018. Patients with the specific inclusion and exclusion criteria were operated using image guidance system. Pre and post operative SNOT-22, VAS, Lund Mackey endoscopic and radiological scoring were compared. Operative time, Instrument accuracy and complications were noted. Out of twenty cases enrolled in this study majority (14) patients (70%) were cases of uncomplicated chronic rhinosinusitis with nasal polyposis. Mean number of sinuses operated were 7.8 ± 2.14. Set up time for installing navigation system in first 10 cases was on an average 17 ± 1.67 min and in second 10 cases it was 12 ± 1.42 min. Mean operative time recorded was 112 ± 17.32 min. Accuracy of our system was 1.25 ± 0.73 mm (0.50-1.80) and average blood loss was 100 ± 23.54 ml. There was statistically significant reduction in postoperative VAS score, SNOT-22 score, Lund Mackey endoscopic and radiological scoring. Revision FESS was done in 12 cases and most common intraoperative absent nasal landmark was middle turbinate in these cases. No orbital or intracranial complication was seen. Minor complications were seen. Image guided surgery is a valuable tool worth use in difficult and revision cases. It makes the surgeon comfortable and saves patient from any major complication.
ABSTRACT
This case series of 5 patients of rigid bronchoscopy done for tracheobronchial foreign bodies is presented to readers to share my experience of doing rigid bronchoscopy during Covid Times from March to July 2020 specifically sharing experience on personal protection with local innovations during the procedure. Indications, intra-procedure modifications and other relevant things are also presented. The observations and experience are purely personal gained during these months and may be subjected to further research and in no way substitute the well established facts.
ABSTRACT
Rigid bronchoscopy is the gold standard treatment for pediatric tracheobronchial foreign bodies. This procedure gives jitters to young ENT surgeons. The only aim of this study is to aware young ENT surgeons of different challenges they may face during bronchoscopy and their subsequent management. Clinical and demographic presentations of airway foreign bodies are also presented. This prospective observational study was conducted from Jan 2013 to Jan 2020 on patients with tracheobronchial foreign bodies. Patients were divided in four Groups (A, B, C and D) on the basis of mode of presentation. Rigid bronchoscopies using basic instruments without the use of telescope/telescopic forceps in patients fulfilling the inclusion/exclusion criteria were done by first author under the supervision of senior authors. The challenges and difficulties encountered and their subsequent management were noted. Out of seventy cases, maximum patients (50) were in the age group of 2-6 years. Majority of patients (76.2%) in Group A and B in total reported to hospital within 0-2 days. Majority of patients in Group A and B as a whole were educated as per our criteria while majority in group C were uneducated. Cough was the most common symptom seen in all groups at the time of examination. Decreased air entry abnormal breath sounds on examination were seen in 75%, 73%, and 100% of (patients in) Group A, B and C, respectively while it was normal for Group D. Most common X-ray finding was Hyperinflation followed by normal X-ray in group A and B. Most common Grade of modified Cormack-Lehane on direct laryngoscopy was Grade 1. Most common foreign body was nuts/legumes/pulses. Difficulty in inserting appropriate size rigid bronchoscope through vocal cords, Intraoperative drop in oxygen saturation, breakage of foreign bodies into pieces, stucking of forceps into tracheal mucosa, stucking of foreign body in sub glottis while removing and bleed/edema in old foreign bodies were main problems encountered. Rigid bronchoscopy is a life saving procedure. The sophisticated telescopes/forceps and other gadgets may not be always available. The young ENT surgeon should be well acquainted with basic instruments and their usage. The common difficulties/challenges faced should not cause panic as these challenges can be easily overcomed with simple maneuvers.
