Subjective and Objective Outcome Assessment in Patients with Sinonasal Disease After Microdebrider Assisted Endoscopic Sinus Surgery.

Microdebrider is a modern powered instrument which is electrically driven with a shaver and a suction. The present study aims to assess the subjective and objective outcome in patients with sinonasal disease after microdebrider assisted endoscopic sinus surgery. A prospective observational study was carried out among 40 patients with symptoms suggestive of sinonasal diseases willing to undergo microdebrider assisted sinus surgery at our tertiary care hospital from January 2019 to December 2019. All the patients underwent microdebrider assisted endoscopic sinus surgery (ESS). Patients were subjectively evaluated using the Lund and Mackay staging system using visual analogue score and objectively using nasal endoscopy by the Lund and Kennedy scoring system preoperatively and post operatively after 6 weeks. 40 patients were included in the study. A mean age of 37 years were noted. All patients showed significant statistical improvement in Lund Mackay scoring system by visual analogue scoring and Lund Kennedy endoscopic scoring postoperatively. Thus, microdebrider offers a better therapeutic approach for patients with sinonasal diseases when compared to endoscopic surgery with the conventional instruments. The advantage of using microdebrider in ESS remains to be proper removal of the pathology, good surgical field and better postoperative outcome.

Disparate Presentations of Retropharyngeal Abscess: An Experience From a Tertiary Care Centre.

To discuss the varied presentations, diagnosis, and prompt management of retropharyngeal abscess for academic importance. A retrospective study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery in Belagavi district of Karnataka. Six cases of varied age group with diagnosis of retropharyngeal abscess were studied during two-year period from January 2019 to January 2021. Thorough assessment of all cases was done which included symptoms at the time of presentation, clinical examination findings, imaging studies and laboratory results, medical and surgical interventions. Six patients (4 males, 2 females) were diagnosed as having Retropharyngeal abscess. Youngest age of presentation was 2 month infant. The most common symptoms at presentation included fever and odynophagia seen in all six patients. The clinical examination revealed bulge in posterior pharyngeal wall in all cases, cervical lymphadenopathy in one case, drooling of saliva in three and stridor in one patient, diffuse neck swelling in two ptatients, and trismus in two patients. Contrast Enhanced Computerized Tomographic (CECT) scanning was performed in five patients and one patient underwent Magnetic Resonance Imaging (MRI). The abscess was surgically drained in all patients and received intravenous antibiotics after which there was significant improvement. Retropharyngeal space infection if left untreated, they carry the potential to cause life-threatening complications and death. Although with availability of broad-spectrum antibiotics, the mortality rate is low, appropriate and successful management requires a thorough understanding of the anatomy of the neck, knowledge of usual causative organisms and appropriate medical and surgical management.

Relative Topography of Laryngeal Nerves for Surgical Cruciality: An Observational Cadaveric Study.

To observe and evaluate the intricrate relationship of recurrent laryngeal nerve (RLN) and external branch of superior laryngeal nerve (EBSLN) to various anatomical structures in the neck like the inferior thyroid artery (ITA), Berry's ligament (LB), Zuckerkandl's tubercle (ZT) and with the superior thyroid artery (STA) for the knowledge of surgical cruciality during surgeries for thyroid gland diseases. This cadaveric observational study was conducted in the department of Otorhinolaryngology and Head and Neck Surgery with logistic support from Department of Anatomy. Total of 40 fresh frozen latex injected cadavers neck dissection was performed to study anatomical variations of thyroid gland and its related vessels and nerves. All measurements were recorded using digital caliper sensitive to 0.01 mm and photographs were documented. Topography of RLN was studied in relation to ITA, LB and ZT. The RLN was predominantly a posterior relation of the ITA in 86.25%, was deep to LB in 46.25% and was related posterior to ZT in 80% of cadaver dissected. The EBSLN has a variable relation with STA which was observed to lie at a distance of < 1 cm from STA in 66.25%. The difference between left and right side was not found to be statistically significant in all parameters (p > 0.05). The awareness and appreciation of the intricate topographical relations and its variations reinforce the surgeons to be careful when performing surgical procedures in the central compartment of the neck which avoid complications.

Topographic Evaluation of Superior Thyroid Artery-A Terrain to be Well Versed for Surgeon's Knife.

Observing the origin, varied branching configurations of superior thyroid artery (STA) and evaluating morphometric details with its surrounding relations was aimed at in this cadaveric neck dissection study to avoid surgical mishaps and its repercussions. This observational study was conducted on 40 fresh frozen embalmed and colored latex infused cadavers in the Department of Otorhinolaryngology and Head and Neck Surgery in collaboration with Department of Anatomy of our institute, which involved systematic evaluative dissection of both sides of neck especially focusing on superior thyroid artery, its branching variations and morphometric details with its surrounding relations. Details were measured using digital caliper. The collected data was statistically analyzed by applying chi-square test and significance was set at 5% level (p < 0.05). The analysis revealed the location of the origin of the superior thyroid artery of cadavers from carotid bifurcation and above it in 40% and from above the level of superior border of thyroid cartilage in 40% of cases. The distribution patterns of the superior thyroid artery were classified into three types depending on the branching pattern typical and variant glandular branching patterns were observed in 85% and 15% of the specimens respectively. A sound knowledge of the regional anatomy and its possible variations helps the surgeon in isolating and preserving the vital structures and avoid iatrogenic complications.