Free Flap Reconstruction in Head and Neck Surgery: Experience in Bangabandhu Sheikh Mujib Medical University.

Free flap reconstruction after surgical ablation of head & neck cancer greatly improve the surgical outcome. Microvascular anastomosis is an important part of Microsurgery and it is not widely practiced in every center. A retrospective review was conducted in the Head & Neck Division of Otolaryngology-Head & Neck Surgery Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from May 2016 to June 2017. Total 20 patients with head & neck cancer had been treated surgically between this period and 14 patients were reconstructed with free flap. The focus of this study is to establish the surgical outcome, which is more with free flap reconstruction in the patients previously diagnosed as head & neck cancer. We reconstructed 14 cases of oral cavity carcinoma (Stage IV) with the free flap. Majority cases were carcinoma involving the buccal mucosa with retromolar trigone (36%) followed by buccal mucosa (22%), buccal mucosa with lower alveolus (21%), carcinoma tongue with floor of the mouth (14%) and floor of the mouth (7%). Radial forearm freflap (RFFF) were commonly used in 10 cases (71.4%) and Anterolateral thigh flap (ALT) used in four cases (21.5%). Partial flap loss was seen in one case and wound infection occurred in another case but both were managed successfully with postoperative dressing and debridement. Microvascular free flap reconstruction can be a good choice after surgical removal of the head & neck cancer diseases and it should be practiced in every well-equipped tertiary medical center with the help of properly trained surgeon.

Management Outcome with Occurrence and Predisposing Factors of Pharyngocutaneous Fistula.

To establish the frequency, risk factors and its relation with the outcome of the management of Pharyngocutaneous fistula (PCF) was aimed. This is an observational, cross-sectional study which was conducted in the Department of Otolaryngology and Head-Neck surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh since 2006-2018. Duration of this study was 13 years (2006-2018). Total number of patients was 252. Total PCF developed in 49 participants. PCF developed more in irradiated patients with multiple co-morbidities. Number of PCF healed spontaneously was 40. There were 9 PCF which required surgical interventions and among them 3 recurred. High incidence of pharyngocutaneous fistula mostly due to advanced stage of disease, positive margin, various levels of surgical expertise and post irradiated patients with multiple co-morbidities.

Parathyroid failure following thyroid surgery.

This cross-sectional study was done to see the association of post thyroidectomy parathyroid failure with thyroid disease and type of surgery. It was carried out in the Department of Otolaryngology-Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of July 2008 to June 2010. Total 50 cases of thyroid malignancy and multinodular goiter who had undergone total or near total thyroidectomy with or without neck dissection were studied. In this study highest number of cases were found in 3rd decade of age (28%) and there was female predominance (M:F=1:3.54). Overall frequency of post operative hypocalcaemia was 30% (26% was temporary hypocalcaemia and 4% was permanent). Hypocalcaemia revealed clinically in 20% cases and remained subclinical in 10% cases. Hypocalcaemia developed in 42.30% cases of malignant thyroid disease and 16.66% cases of benign thyroid disease (p<0.05). It was found in 54.54% cases with neck dissection and 23.07% cases without neck dissection (p<0.05). Hypocalcaemia developed in 62.5% cases where parathyroid gland were not identified and 23.8% cases where parathyroid gland was identified. Hypocalcaemia developed most commonly on the 2nd post operative day (73.33%). There is a significance difference with development of parathyroid failure after thyroid surgery between benign and malignant thyroid disease and also between thyroid surgery with or without neck dissection.

Comparative study of radical neck dissection vs. modified radical neck dissection in metastatic neck gland.

Treatment of metastatic neck gland is an integral part of management of Head and Neck cancers, because this is the single most important prognostic determining factor. Although surgery and radio therapy with or without chemotherapy are the modalities available for treating neck gland, wide surgical excision of the whole regional lymphatic chain enblock is mostly favored. Radical Neck dissection is the operation for such disease, designed in the early part of twentieth century, still has got the validity, but a modification of that (modified radical neck dissection) is becoming popular for last few decades to reduce morbidity. In this study we compared 15 cases of radical neck dissection and equal number of modified radical neck dissection to observe the selection criteria of these two types of operations, their complications and therapeutic success. Neck deformity, shoulder pain and restricted shoulder movement are the major morbidities which are less in modified radical neck dissection. The oncologic efficacy appears as same in both procedures.

Head and neck squamous cell carcinoma (HNSCC) 5 year study at BSMMU.

Head and Neck Squamous Cell Carcinoma (HNSCC) are generally similar in their clinical features, epidemiology and etiology although their natural and clinical history and treatment differ. Despite lot of improvement in diagnostic and management technique, there is little improvement in survival rate over the last few decades. This study was carried-out in a multidisciplinary tertiary level hospital (BSMMU), with a country-wide catchment area to see the burden of HNSCC existing in our country and their clinical pattern. The overall incidence rate of HNSCC in this study was (0.15%) i.e. 150 person in 1,00,000 population. Male incidence (0.19%) was higher than female (0.12%). This study revealed that carcinoma of the larynx (25.22%) and pyriform fossae (20.57%) were the main culprit, whereas buccal carcinoma was the main component (37.70%) in the female series. Highest incidence was found in the 6th decade in both sexes. As the treatment of HNSCC may be time consuming, requires multidisciplinary approach, demands lot of clinical, social and financial consideration, therefore, the best treatment can be offered through a combined board consisting of Surgical, Radiation, Medical oncologists, Histopathologist and Speech therapist as required.

Prevalence of CSOM among rural school going children.

A prospective study was carried out from January 2001 to December 2002 to find the prevalence of CSOM among rural school going children. Altogether 225 students aged 4-13 years from five primary schools and junior high schools of Magura district were interviewed and examined. 28 (12.44%) children were found to have CSOM. Out of these 28 cases, 25 came from lower and 3 from middle income group families. No case of CSOM was found in higher income group family. In this study 73.33% mothers were not aware of CSOM. 60% mothers had no knowledge about treatment and sequelae of CSOM. Only (5.78%) people use cotton bud to clean ear while majority use unhygienic materials like matchstick, cloth with stick and chicken feathers. Treatment seeking pattern was observed in our study. 10.71% cases did not receive any treatment and remaining 89.29% received treatment of which 25% from MBBS doctor or Hospital and 7.14%, 35.71%, 10.71%, 10.71% received it from Kabiraj, Quack, Homeopathy doctor, and salesman of pharmacy respectively.