Intralesional Bevacizumab as Adjuvant Therapy for Juvenile Onset Recurrent Respiratory Papillomatosis: A Systematic Review.

Background: Respiratory papillomatosis is one of the common benign lesions of the airway that is often difficult to treat and carries significant morbidity. Bevacizumab is a monoclonal antibody that acts upon vascular endothelial growth factor receptor and is known to have an effect in respiratory papillomatosis. This study aims to systematically review the literature on efficacy of intralesional Bevacizumab in juvenile onset respiratory papillomatosis. Materials and methods. A systematic search of literature in various databases was conducted. The search was restricted to the English language, however, no restrictions were made regarding the date of publication keeping December 31st, 2020 as the last date of publication. We strictly complied with the PRISMA guidelines. Results. Of 145 articles analyzed, only 3 were selected as eligible and a total of twenty-one cases were evaluated. There was improvement in anatomic Derkay score after initiating intralesional Bevacizumb with reduction in the number of surgeries. Where reported, voice related functional outcomes also were also improved. No adverse effect related to the drug was reported. Conclusion: Intralesional Bevacizumab can be a promising efficacious, and safe adjuvant in the management of JORRP. Well-designed studies are further required in the future to prove its efficacy and safety over other adjuvants available.

Role of Honey and Acetic Acid in Mitigating the Effects of Button Battery in Esophageal Mucosa: A Cadaveric Animal Model Experimental Study.

The objective of our study was to evaluate the role of honey and acetic acid in mitigating the mucosal injury posed by button battery using esophagus specimens from goat cadavers. This was an in vitro experimental cadaveric animal model laboratory study. We used 40 specimens of cadaveric goat esophagus and divided into four groups (A, B, C and D). The first comparison was between group A (specimens with button battery only) and group B (specimens with button battery coated with honey) for the difference in the degree of mucosal injury and change in pH and temperature. The second comparison was between group C (specimens with button battery removed after six hours) and group D (specimens with 5% acetic acid applied following the removal of the battery after six hours) for the difference in the progression of the mucosal injury and change in pH and temperature. The observer was blinded regarding the allocation of the groups. We used Fisher's exact test and independent sample t-test, to evaluate the statistical association. There was a statistically significant reduction in the degree of mucosal injury in specimens applied with button battery coated with honey compared to the specimens applied with button battery only. Similarly, progression of the mucosal injury was halted in specimens with the application of acetic acid following the removal of the button battery. Honey and acetic acid can mitigate the mucosal effects posed by the button battery in cadaveric goat esophageal specimens.

A Laboratory Model and Scope of Three Dimensional Printing in Pediatric Airway Surgery Practice for Developing Nations Like Nepal.

Pediatric airway surgery, one of the complex procedures in otolaryngology, often demands a good surgical dexterity. To improve the surgical skills, a simulation laboratory can be a good option. Here we present a model of an airway surgery laboratory which is very minimalist and can be easily established in any hospital setup. Also, we discuss briefly on how a three dimensional (3D) model of an airway can be generated and printed from the digital imaging and communications in medicine (DICOM) CT imaging data of the patients along with the scope of 3D printing in airway surgery.

Natural expulsion of a sharp iron nail: Right main bronchus to the alimentary tract: A case report.

A young girl inhaled a pointed iron nail into the right main bronchus. However, both rigid bronchoscopy and oesophagoscopy failed to locate the nail. Surprisingly, it was detected in the abdomen by C-arm and was expelled uneventfully while defecating two days later.

Comparison of postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty: A randomized controlled trial.

OBJECTIVES: To compare postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty. METHODS: This is a prospective, randomized controlled study conducted in children of age 6-15 years with chronic otitis media (COM) mucosal, inactive type undergoing myringoplasty. Postoperative infection over a period of 4 weeks and status of graft at or around 3 months after surgery was studied as outcome measure. RESULTS: Fifty five out of sixty children completed follow-up. The overall postoperative infection rate was 5.4%. Postoperative infection rate was 3.5% in children receiving prophylactic antibiotic and 7.4% in children receiving no antibiotic. There was no statistically significant difference in postoperative infection between two groups (P > 0.05). The overall graft uptake rate was 87.27%. It was 85.7% in antibiotic used group and 88.8% in non-antibiotic group with no statistically significant difference (P > 0.05). CONCLUSIONS: Postoperative infection following myringoplasty in children is uncommon as it is a clean type of surgery. There was no statistically significant difference in postoperative infection and graft uptake rate by the use of prophylactic antibiotic in the intraoperative period. This study shows no benefit of a prophylactic antibiotic on postoperative infection or graft success in myringoplasty in children. TRIAL REGISTRATION NUMBER: NCT03700814.

Establishment of Paediatric Airway Surgery Services in Tribhuvan University Teaching Hospital: A Leap in Otorhinolaryngology in Nepal.

Paediatric airway surgery is an emerging superspeciality for a developing country like Nepal. Thriving in a resource limited environment of the country, Tribhuvan University Teaching Hospital is setting its early steps in this subspecialty of paediatric otorhinolaryngology. With generous support of the experts from USA and a team of very dedicated surgeons in the department, future of paediatric airway surgery in Nepal seems to be promising. Here, we discuss in brief about the establishment of paediatric airway surgery in Tribhuvan University Teaching Hospital, the tertiary referral center of Nepal with short discussion on the cases operated so far and their outcomes.

Comparison of Ultrasonic Device Versus Bipolar Diathermy Tonsillectomy in Children.

BACKGROUND: Intraoperative bleeding and postoperative pain are two commonest concerns for both patient and surgeon in tonsillectomy. This study was aimed to compare intraoperative blood loss and early postoperative pain between ultrasonic device and bipolar diathermy tonsillectomy in children. METHODS: Prospective, interventional, single blinded, comparative study was carried out from September 2016 to September 2017 including children up to age 15 years who underwent tonsillectomy either by bipolar diathermy or ultrasonic device. Intraoperative blood loss was recorded using standard sized gauge technique. Post-tonsillectomy pain on first five postoperative days (early postoperative pain) was assessed using Visual analog scale for children older than 5 years and FLACC score for children up to 5 years respectively.Means were compared. RESULTS: 38 children (76 tonsils) were included in the study out of which 31 were boys (62 tonsils) and 7 were girls (14 tonsils). The mean intraoperative blood loss in ultrasonic dissection group was 13.94 ml and 13.91 ml in bipolar diathermy group. This difference was not statistically significant (p=0.974). Post-operative pain on 1st, 2nd, 3rd and 4th days were significantly less (p<0.05) in ultrasonic device group compared to bipolar diathermy group. Post-operative pain was less also on 5th post-operative day in ultrasonic device but was not statistically significant (p=0.172). CONCLUSIONS: Tonsillectomy in children using ultrasonic device did not differ from bipolar diathermy tonsillectomy in respect to intraoperative blood loss. However, early postoperative pain was significantly lower in ultrasonic device group.

A comparison of two myringoplasty techniques in Nepalese children: a prospective randomized trial.

BACKGROUND: In children, the success of myringoplastywith temporalis fascia is lower compared to adults and cartilage as an alternative graft material has shown higher success rate. OBJECTIVE: To compare results of myringoplasty using tragal cartilage palisades with the use of temporalis fascia in children with large tympanic membrane perforations. MATERIALS AND METHODS: This is a prospective and randomized study conducted in children of age 6-14 years with large tympanic membrane perforation of more than two quadrants. Status of graft at or around 6 weeks after surgery was used as morphological outcome measure. Pre- and postoperative audiograms were compared to evaluate audiological outcome in two groups. RESULTS: Forty seven out of 55 patients completed follow-up. The graft uptake rate in the cartilage palisades and temporalis fascia myringoplasty group was 91.3% (21/23) and 83.33% (20/24), respectively; the difference was not statistically significant (P=0.666). The mean preoperative air-bone gaps (ABG) in cartilage palisades and temporalis fascia group were 36.2±8.9dB and 33.8±7.5dB, the difference was not statistically significant (P=0.412). Similarly, the postoperative ABG in cartilage palisades and temporalis fascia group were 25.1±12.2dB and 17.2±9.2dB, respectively, the difference was statistically significant (P=0.040). The gap closure was 11.0dB in palisades group and 16.8dB in fascia group, but it was not significant (P=0.133). CONCLUSION: In our study of pediatric myringoplasty, the morphological and functional outcomes in both cartilage palisades and temporalis fascia groups were comparable.

Outcome of surgical management of laryngeal carcinoma: a 5-year experience.

OBJECTIVE: To investigate the outcome of surgically managed laryngeal carcinoma patients attending an outpatient clinic over a 5-year period. MATERIAL AND METHODS: This was an analytical, retrospective, cross-sectional study. A total of 36 laryngeal carcinoma patients who were managed surgically with or without radiotherapy were analyzed. RESULTS: A total of 32 patients (89%) were found to be disease-free during follow-up for up to 5 years. Two patients (5.5%) died because of intercurrent infection and recurrence of the disease and two (5.5%) were lost to follow-up 5 and 7 months after surgery, respectively. CONCLUSIONS: The results indicate that the best disease-free rates can be achieved by managing laryngeal carcinoma surgically with or without radiotherapy depending on the advancement and aggressiveness of the disease.