Alterations in Smell During Pregnancy: Myth or Fact?

To compare the olfactory functions of pregnant and non pregnant females draining the tribal tertiary care centre. Odor identification (OI), odor discrimination (OD) and odor threshold (OT) in subjects and control group with no previous Sino-nasal symptoms or pathology were included in the study. Mean scores of all the parameters were calculated in both the groups. Group A being of 60 pregnant females in 1st trimester and Group B constituted 60 non pregnant females as control group. Both the groups were matched for Age and Normal Mucociliary clearance range. Modified Indian Smell Identification Kit was used to assess all parameters. Before doing objective olfactory assessment all the study participants were given questionnaire for subjective assessment of olfaction in which we found significant impairment in drinking beverage and fragrance perception of flowers in pregnant females compared to non pregnant females. We also found there was no significant difference in mean scores of various olfactory parameters in multigravida and non pregnant females. The mean OI score in both groups was 9.54 ± 1.87 and 8.70 ± 1.62 respectively. Mean OD score of the two groups was 8.80 ± 2.61 and 9.80 ± 2.61 respectively and the mean OT score of both the groups was 6.99 ± 4.63 and 4.13 ± 2.48 respectively.

Congenital Symmastia: A Four-Step, Minimally Invasive Approach.

Symmastia is a rare condition in which breasts are unified medially due to aberrant development of mammary tissue in the intermammary region, resulting in the appearance of an intermammary web. There are limited reports on this rare anomaly and hence, no standard protocols on its management. Additionally, creating a normal cleavage in these young patients without scars over or around the breast is a challenge from an esthetic standpoint. In this article, we present a case of congenital symmastia corrected by four steps: liposuction of the intermammary region, use of suction drains along medial breast border, transdermal bolster sutures, and customized compression garment. Esthetic creation of the medial breast footprint and good preservation of breast contours was achieved with considerably less scars. Thus, we propose our four-step approach as an effective, minimally invasive method for treating congenital symmastia.

An Immunohistochemical Study of HIF-1 Alpha in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma.

To evaluate and compare the expression of HIF-1 Alpha (HIF-1α) in oral epithelial dysplasia (OED) and various grades of Oral squamous cell carcinoma (OSCC). 30 cases each of OEDand OSCC were stained with HIF-1α antibody. Quantification of HIF-1α positive cellswas carried out and the data was statistically analysed. The mean % HIF-1α labeling index (HIF-1α LI) increased significantly from mild OED (32.11%), moderate OED (55.07%), to severe OED (64.58%). There was a statistically significant increase in the expression of HIF-1α as grades of OED increased. The mean HIF-1α LI % in well differentiated OSCC was 46.3%, Moderately differentiated OSCC-76.31% and Poorly differentiated OSCC-89.9%. The mean HIF-1α LI was found to increase with increasing grades of OSCC which was statistically significant (P < 0.05). Further a comparison of mean HIF-1α LI in OED with different histologic grades of OSCC by Independent samples t test was performed. We found statistically significant difference between OED and moderately differentiated OSCC and OED and poorly differentiated OSCC (P = 0.000). Progressive increase in expression of HIF-1α was noted from OED to OSCC. It can be postulated that epithelial dysplastic lesions with increased HIF-1α expression are at greater risk of malignant transformation, suggesting that the expression of HIF-1α is an early event in oral carcinogenesis.

Adverse Effect of Mobile Phone on Hearing in Healthy Individuals: A Clinical Study.

The mobile phone is a ubiquitous piece in this modern world. An estimated 85% of Americans, 80% of the British, and perhaps 75% of Indians use it, as of today. Mobile phones communicate by transmitting radio waves through a network of fixed antennas called base stations. Radio frequency waves are electromagnetic fields, and unlike ionizing radiation such as X-rays or gamma rays, can neither break chemical bonds nor cause ionization in the human body. 1000 participants from outpatient department of a tertiary care center over a period of one and a half years, were included in the study and were divided equally into case (> 1 year use) and control (< 1 year use) groups. Out of 500 cases, maximum 233(46.6%) subjects were using mobile since last 4-6 year and 134(26.8%) were using mobile since last 7-9 year and maximum 344(68.8%) subjects were using mobile 1-3 h/day and 145(29.0%) were using mobile 4-6 h/day.

Traumatic loss of total lower lip and chin: The anterolateral thigh flap provides an optimal solution.

BACKGROUND: Young female presented 15 days after traumatic avulsion of total lower lip and chin. Considering the functional and aesthetic needs of the lower lip and chin, it is indeed challenging for the reconstructive surgeon to provide aesthetically appealing lower facial subunit with maintenance of good oral seal and competence. The authors present this case of total lower lip and chin loss reconstructed as a single aesthetic unit with free anterolateral thigh flap followed by secondarily defining the aesthetic subunits into lower lip and chin by selective liposuction. METHOD: Free anterolateral thigh flap was harvested. The fascia lata, harvested separately, was divided to form slings over which distal part of the flap, designated to form the lower lip, was hung over and inset into the remnant gingivolabial sulcus mucosa. This folded distal part of the flap formed the lining and cover of the lower lip. RESULT: After resurfacing with free ALT flap, she was able to attain lip seal and resume oral feeds within 3-4 days. She presented six weeks after the first surgery with severely reduced mouth opening. This was due to excessively tight perioral slings. Slings were released and flap was selectively debulked using liposuction so as to define the lower lip and chin subunits. CONCLUSION: Free anterolateral thigh flap is an extremely versatile option in the armamentarium of free flaps available. Primary thinning and good colour match along with negligible donor site morbidity makes it meritorious over the radial forearm flap.

A Comparative Study of Various Office Procedures for the Management of Small to Medium Size Tympanic Membrane Perforations.

A hospital based prospective study to compare and evaluate the efficacy and convenience of various office procedures like chemical cauterization, fat plug myringoplasty and butterfly cartilage tympanoplasty. This interventional, prospective, longitudinal study carried out on 300 patients in the ENT department of a tertiary care medical college hospital in central India between January 2009 and January 2015. The success rate was found to be 94.54, 91.12 and 97% in chemical cauterization, fat plug and butterfly cartilage tympanoplasty respectively (p value 0.246). In all the groups there were significant improvement in terms of hearing in decibels and AB gap postoperatively. No statistically significant association was found in between the failure rates in all the groups. From this study we conclude that all the procedures were simple, rapid, reliable, cost effective, takes less time and minimum hospital stay (day care) than conventional tympanoplasty. We strongly recommend these procedures in place of tympanoplasty in small to medium size central tympanic membrane perforations according to condition and convenience of the patients.

Presentation of Lesions of Nose and Paranasal Sinuses at a Tertiary Care Center in Central India.

A variety of non-neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinus and are fairly common presentation encountered in clinical practice. Sinonasal lesions are a common finding in all age groups. The lesion of nose and paranasal sinuses are very deceptive so, the presenting features, clinical examination, nasal endoscopy, radiodiagnosis and histopathology are employed conjointly to reach a diagnosis. This cross sectional study was conducted between November 2014 and September 2016. 150 patients with nasal or paranasal sinus lesions attending ENT OPD were included. Among 150 patients there was a male predominance in all lesion except malignant lesions and most of the patients 72 (48%) were in the age group 11- 30 years. Mean age of presentation for benign lesions was 33.64 years and of malignant lesions was 49.14 years. The study showed that 96 (64%) of the nose and PNS lesions were of inflammatory nature followed by 22 (15%) benign, 18 (12%) granulomatous and 14 (9%) malignant, Inflammatory polyp being the most common diagnosis. Haemangioma was the most common benign neoplastic lesion whereas in granulomatous lesions most common diagnosis was tuberculosis. The maximum lesions 74 (49%) were in maxillary antrum. The most common clinical presentation was nasal obstruction, with unilateral nasal obstruction seen in 84 (56%) cases and bilateral nasal obstruction in 50 (33.3%) cases. Angiofibroma 6 (4%) was exclusively seen in adolescent males. Olfactory neuroblastoma 4 (2.6%) was diagnosed in females with mean age of presentation of 30 years. Sinonasal lesions display a complex and interesting spectrum of clinical, radiological and histopathologic features. The non-neoplastic lesions are numerous, the morphologic variants of neoplasms are many and most of them present as polypoid masses which are impossible to distinguish clinically. Hence a proper workup including histopathological and radiological categorization is essential in the management of these lesions.

Hand Dominance and Blood Group: Association in Epistaxis.

The present work was undertaken to study the association of epistaxis with hand dominance and blood group. The present cross sectional study was conducted among 360 cases of epistaxis who reported to the E.N.T outpatient department of tertiary care centre in central India during the period of July 2014 to July 2015. Examination was carried out by self prepared Performa which included demographic information, detailed history and clinical examination findings. Total of 360 patients were included in the study, the mean age being 31.2 years of which there were 208 males and 152 female. Most of the patients (48.9 %) presented with 4-6 episodes of nasal bleed per year. In present study, local trauma (22.2 %) followed by nose picking (16.7 %) were the commonest local etiological factors while Idiopathic thrombocytopenic purpura, pancytopenia etc. (15.6 %) being the commonest of general causes followed by hypertension (13.4 %). The study showed highly significant association of A+ve blood group with epistaxis (p = 0.002). Most of the patients (54.8 %) presented bleeding episodes mainly in summer season. In our study we found statistically significant (p = 0.0001) association of hand dominance and side of nasal bleeding. Anterior nasal bleeding was significantly more presenting symptom in all epistaxis patients. This study underlines the importance of epistaxis as the most frequent emergency diagnosis in ENT. The observed association of A+ve blood group and Hand dominance in epistaxis provokes to have further large scale studies in this area.

Medial femoral condyle vascularised corticoperiosteal graft: A suitable choice for scaphoid non-union.

INTRODUCTION: Scaphoid fractures are not very common and frequently remain undiagnosed, presenting in non-union and persistent wrist pain. Options for scaphoid fracture treatment have been described over several decades, however, none with an optimal solution to achieve union along with good hand function. We describe here, the use of vascularised corticoperiosteal bone grafts from the medial femoral condyle (MFC) as a solution for the difficult problem of scaphoid fracture non-union. MATERIALS AND METHODS: This series has 11 patients with non-union following a scaphoid fracture treated over 18 months ranging from January 2014 to January 2016 using a vascularised corticoperiosteal graft from the MFC. Bone graft fixation was done using K-wires and anastomosis was done with the radial vessels. RESULTS: There were no cases of flap loss. Time of union was an average 3 months. All patients had a full range of movements. DISCUSSION: MFC is an ideal site for harvesting vascularised corticoperiosteal grafts providing a large surface of tissue supplied by a rich periosteal plexus from the descending genicular artery. No significant donor site morbidities have been reported in any series in the past. The well-defined anatomy helps in a rather simple dissection. Corticoperiosteal grafts have a high osteogenic potential and hence, this vascularised graft seems ideal for small bone non-unions. CONCLUSION: Thin, pliable and highly vascularised corticocancellous grafts can be obtained from the MFC as an optimal treatment option for scaphoid non-unions.

A Clinical Study of Oral Mucosal Lesions in Patients Visiting a Tertiary Care Centre in Central India.

The aim of this study was to find the frequency of various oral mucosal lesions in relation to age, sex, site and associated addiction habits. This retrospective study was done in tertiary care centre including 1280 patients of oral mucosal lesions. Clinical findings and detailed history of their addiction habits with frequency and duration was noted from the existing data. Cytological and histopathological diagnosis of various lesions was recorded to conclude diagnosis. The most common lesion in this study was found to be aphthous ulcers (44.5 %), followed by leukoplakia (12.9 %). The most common site of involvement was tongue in aphthous ulcers and buccal mucosa in leukoplakia. In the present study 66.46 % cases were non malignant, 21.2 % cases were premalignant and the remaining 11.9 % cases were found to be malignant. Oral lesions are common finding in patients presenting to ENT OPD. Aphthous ulcers are common oral lesions. A patient with oral mucosal lesion should be examined for dietary deficiency, systemic disease or premalignant state with simultaneous counseling to quit addiction.

Challenges Posed by Delayed Presentation of Mutilating Hand Injuries.

Management of mutilating hand injury is a challenge for any hand surgeon. Delay in presentation makes management even more challenging, usually because of inadequate initial assessment, inadequate debridement leading to infection, and secondary loss of tissues from exposure and desiccation. The aim is to obtain a functional hand by radical debridement, adequate assessment of the injury, appropriately timed reconstruction, and physiotherapy and rehabilitation. The hand surgeon must pay attention to the appearance of the hand by elimination of deformities, unsightly scars and bulky flaps to help to restore confidence in the patient to face the demands of daily living.

Evaluation of CT and MRI Findings among Patients Presented with Chief Complaint of Headache in Central India.

INTRODUCTION: Headache is one of the most common presenting complaints in day to day medical practice however the secondary causes of headache are uncommon. Thus, appropriate selection of headache patient (Pt) is important to determine those that require neuroimaging due to likely secondary cause. Red flags and Clinical warning criterion (CWC) act as a screening tool to help in identifying those who may get benefit from neuroimaging. AIM: To evaluate the findings of computed tomography (CT) and Magnetic Resonance Imaging (MRI) among patients presented with the chief complaint of headache and to compare the findings between two groups of patients. MATERIALS AND METHODS: This retrospective observational study was carried out in 500 selected patients, who underwent CT or MRI scan of head in Peoples College of Medical Sciences and Research centre, Bhopal, MP during the period of 2 year in between Jan 2013 to Dec 2014. Siemens Somatom sensation 40 slice MDCT and Siemens magnetom 1.5T MRI scanner were used for imaging. Five hundred patients of 10 to 70 year age were selected for the study based on our criterions of selection. RESULTS: All 500 patients were divided in to two groups A and B based on presence or absence of red flag signs and CWC signs. Group A consists of 48 patients having one or more red flag or CWC signs and group B consists of 452 patients those don't have any above signs. 29 cases (60.4%) out of total 48 cases of group A is suffering from chronic headache as compared to 97 cases (21.5%) out of total 452 patients of group B is having positive findings (p-value<0.05). Out of 500 patients, only 29 cases (5.8%) revealed some form of brain parenchymal pathology whereas other associated findings were seen in 97 cases e.g. sinusitis in 58 (11.6%), bone related pathology in 26 (5.2%) and chronic suppurative otitis media (CSOM) in 13 (2.6%) patients. CONCLUSION: CT/MRI in patients without red flag or CWC sign yields very low percentage of clinically significant positive findings in neuroimaging. In the absence of these, the only reason for CT or MRI scan seems to reassure the patients and their loved ones. CT or MRI as a screening tool in these patients has limited value in term of cost effectiveness.

Pre and Post Operative Status of Contralateral Ear in Unilateral Chronic Otitis Media.

Chronic otitis media (COM) is one of the oldest disease affecting ears and undoubtedly represents the main area of interest within modern otology. As the main cause of COM is malfunction of Eustachian tube, it is probable that a patient with COM will have a disorder in contralateral ear (CLE) as suggested by the Minneapolis group- called as Continuum Theory. This prospective, observational study was conducted in department of ENT at a tertiary care centre of central India from Sep 2012 to May 2015. Study consisted of 537 patients of unilateral COM who fulfilled the eligibility criteria. After careful history and thorough examination of diseased ear and CLE, findings of diseased ear, CLE and 6 months postoperative findings CLE were entered into performa. The data was entered into SPSS software and further analysis was performed. Out of 740 patients of COM operated in our department, 535 (72.9 %) patients had unilateral COM which were included in the study. The mean age was 24.3 (SD ± 10.63) ranging from 11 to 55 years, of these 51.4 % were females and 48.6 % were males. Out of 535 unilateral COM, 365 (68.2 %) had mucosal while 170 (31.8 %) had squamous type of disease and 30.9 % of total CLE had abnormal findings. The pre and post-operative findings were compared which came out to be statistically significant and there was significant difference in pre and post-op PTA also (0.001). The significant improvement in postoperative status of CLE achieves our objective and also strongly supports the theory of Continuum. The unilateral COM should not be taken as a static phenomenon but as a continuous process in other ear too. We could also shows a significant improvement in the CLE after treatment of diseased ear, this knowledge can be effectively used in therapeutic planning of diseased ear, counselling of patient regarding other ear and if necessary providing therapeutic intervention in the other ear at the earliest.

Thoracodorsal artery perforator flap: Indeed a versatile flap.

INTRODUCTION: The thoracodorsal artery perforator (TDAP) flap has emerged as one of the ideal perforator flaps. We, hereby, describe its versatility in indications (free/pedicled), methods of harvest (patient position and paddle orientation) and perforator consistency. MATERIALS AND METHODS: We have performed a total of six TDAP flaps-five free and one pedicled, over a period of 1-year from March 2014 to February 2015 at a single centre. Our indications have been: Reconstruction of oral cavity, breast and upper and lower extremities. RESULTS: We had neither any failures nor any re-explorations. The average perforator length is about 6 cm and the pedicle length can be extended to 12-14 cm by including the thoracodorsal artery. There is inconsistency in perforator position; however, the presence of a perforator is certain. It can be harvested in lateral, prone or supine position, thus, does not require any position change allowing a two-team approach to reconstruction. The paddle can be oriented vertically or horizontally, both healing with scars in inconspicuous locations. Apart from providing a good colour match for extremities, this flap can be thinned primarily. CONCLUSION: The versatility of TDAP has several advantages that make it a workhorse flap for most reconstructions requiring soft tissue cover. Further, the ease of harvest makes it a good perforator flap for beginners. Its use in chimerism with the underlying latissimus dorsi muscle provides reconstruction for coverage and volume replacement.

A novel 3D template for mandible and maxilla reconstruction: Rapid prototyping using stereolithography.

INTRODUCTION: Replication of the exact three-dimensional (3D) structure of the maxilla and mandible is now a priority whilst attempting reconstruction of these bones to attain a complete functional and aesthetic rehabilitation. We hereby present the process of rapid prototyping using stereolithography to produce templates for modelling bone grafts and implants for maxilla/mandible reconstructions, its applications in tumour/trauma, and outcomes for primary and secondary reconstruction. MATERIALS AND METHODS: Stereolithographic template-assisted reconstruction was used on 11 patients for the reconstruction of the mandible/maxilla primarily following tumour excision and secondarily for the realignment of post-traumatic malunited fractures or deformity corrections. Data obtained from the computed tomography (CT) scans with 1-mm resolution were converted into a computer-aided design (CAD) using the CT Digital Imaging and Communications in Medicine (DICOM) data. Once a CAD model was constructed, it was converted into a stereolithographic format and then processed by the rapid prototyping technology to produce the physical anatomical model using a resin. This resin model replicates the native mandible, which can be thus used off table as a guide for modelling the bone grafts. DISCUSSION: This conversion of two-dimensional (2D) data from CT scan into 3D models is a very precise guide to shaping the bone grafts. Further, this CAD can reconstruct the defective half of the mandible using the mirror image principle, and the normal anatomical model can be created to aid secondary reconstructions. CONCLUSION: This novel approach allows a precise translation of the treatment plan directly to the surgical field. It is also an important teaching tool for implant moulding and fixation, and helps in patient counselling.