Volume and Location of the Defect as Predictors of Swallowing Outcome After Glossectomy: Correlation with a Classification.

This study aimed to characterize the swallowing outcomes after glossectomy and analyze factors affecting them. An attempt is made to propose a classification system and corroborate it to the results. This is a cross-sectional study to assess swallowing in carcinoma tongue patients treated surgically with or without reconstruction, followed by adjuvant therapy as indicated. One hundred and six patients were evaluated with videofluoroscopy (VFS). Volume defects were classified as I: less than one-third, II: one-third to half, III: half to two-thirds, IV: two-thirds to total glossectomy. Location was assigned as lateral, tip, and sulcus defects. Predictors were T stage, surgical approach, volume, location, and adjuvant radiotherapy. Chi-square and logistic regression were used for statistical analysis. Defects were Class I, II, III, and IV in 36, 42, 16, and 12 patients, respectively. Adjuvant radiotherapy was given in 40% of cases. Mean evaluation time was 14 months from treatment. On, Functional Oral Intake Scale (FOIS) score, as the Class of the defect increased, the percentage of patients with low scores (poor swallowing outcomes) showed an increasing trend (p < 0.001). Defect volume, T stage, approach, and radiotherapy correlated significantly with an abnormality of all VFS parameters (p < 0.001). On multivariate analysis, defect volume remained an independent predictor for oral parameters; radiotherapy emerged as the only independent predictor for pharyngeal parameters. The incremental volume of the defect is a significant independent predictor of swallowing. Based on this, we propose a classification for glossectomy.

Simultaneous quantification of N-butylthiophosphoric triamide and dicyandiamide in urea formulation by liquid chromatography with tandem mass spectrometry.

A new liquid chromatography with tandem mass spectrometry method employing a mixed-mode zwitterionic stationary phase was developed for simultaneous determination of urease inhibitor (N-butylthiophosphoric triamide) and nitrification inhibitor (dicyandiamide) in urea fertilizer. Molecular modeling based on density functional theory calculations was employed to provide an insight into the interaction mechanism of urea, dicyandiamide, and N-butylthiophosphoric triamide with zwitterionic stationary phase in chromatographic separation system. The detection of analytes was performed on a triple quadrupole tandem mass spectrometer in multiple reaction monitoring mode using positive electrospray ionization. The ion transitions monitored were m/z 85→68 for dicyandiamide and m/z 168.2→74 for N-butylthiophosphoric triamide, respectively. The standard calibration curves of dicyandiamide and N-butylthiophosphoric triamide were linear over the range of 1.0 ̶ 15 ppm (coefficient of determination = 0.9984), 0.05 ̶ 1 ppm (coefficient of determination = 0.9995), with limit of detection of 25 and 5 ppb, respectively. The recoveries of low, middle, and high concentrations were from 96.7 to 105.8% for N-butylthiophosphoric triamide and 94.4 to 105.8% for dicyandiamide with accuracy (relative error %) of ≤5.8% and ≤5.8%, the precision (coefficients of variation) was ≤2.0% and ≤2.9%, respectively. The validated method was successfully applied on real urea samples to determine N-butylthiophosphoric triamide and dicyandiamide simultaneously.

Cricotracheal reconstruction with free radial forearm flap and titanium mesh.

BACKGROUND: Reconstruction after partial cricotracheal resection is technically demanding and is seldom reported in literature. The purpose of this study was to report a technique of reconstruction of such a defect with a radial forearm flap supported by a titanium mesh. METHODS: A 75-year-old man who was diagnosed with a case of papillary carcinoma thyroid, underwent excision of the tumor with a partial cricotracheal resection. The defect was reconstructed with a free radial forearm flap with fascia suspended on a titanium mesh. RESULTS: At a follow-up of 6 months after treatment, the patient has normal nasal breathing and an acceptable voice. CONCLUSION: This reconstructive technique enabled us to maintain the integrity of the subglottic airway. Our technique was unique in that we used the skin-lined part of the radial forearm flap to line the airway and the fascia to cover the titanium mesh outside, thereby preventing plate exposure.

Verrucous lesions of the oral cavity treated with surgery: Analysis of clinico-pathologic features and outcome.

OBJECTIVE: Verrucous lesions of the oral cavity can be of varied histopathology. The present study evaluates the clinico-pathological features of verrucous lesions of the oral cavity and analyzes the treatment outcomes. MATERIALS AND METHODS: This is a retrospective study of 15 consecutive patients who presented with verrucous lesions of the oral cavity, during the 5-year period from January 2006 to December 2010. Demographic, clinico-pathological features, treatment details, and outcomes were analyzed. RESULTS: Fifteen patients with verrucous lesions of the oral cavity were treated with surgery as the primary modality. The mean age was 62.8 years (range 35-85 years). Wide excision of the primary lesion with adequate mucosal and soft-tissue margins was carried out. Free-flap reconstruction was done in eight patients. All patients remain loco-regionally controlled with good functional speech and swallowing outcome. CONCLUSIONS: Verrucous lesions of the oral cavity are a distinct clinical entity with varied histopathology. A surgical excision with wide margins and appropriate reconstruction is necessary to optimize the disease and functional outcome.

Pre-Operative and Post-Operative Assessment of Hearing following Tympanoplasty.

Tympanoplasty is one of the ever evolving surgical procedures mainly aimed at restoring the hearing loss and eradication of middle ear disease. We have made an attempt to assess the hearing improvement of various types and techniques of tympanoplasty. A prospective observational study was done on 50 cases of CSOM, of which 45 cases were tubotympanic type, and 5 cases were attico-antral. Patients of only pure conductive component with good cochlear reserve and good Eustachian tube function were considered for the study. This study aims at assessing the hearing improvement with various types of tympanoplasty.

A randomized control trial to verify the efficacy of pre-operative intra venous tranexamic Acid in the control of tonsillectomy bleeding.

Tonsillectomy is an age old surgery which is still very commonly done. Bleeding related to surgery is the major problem. This study is done to verify by randomized control trial the efficacy of preoperative intravenous tranexamic acid in the control of tonsillectomy bleeding. Hundred cases undergoing tonsillectomy were randomized into two groups, one of which received pre-operatively intra venous tranexamic acid, 10 mg kg(-1). The other group patients were given a placebo. Amount of bleeding was assessed in each case. The study group had statistically highly significant reduction in bleeding. There were no side effects of the drug. This finding is similar to that in other studies for tonsillectomy, other surgeries and other hemorrhagic conditions. Tranexamic acid in the dose of 10 mg kg(-1) given intra venous pre-operatively is effective in the control of tonsillectomy bleeding.