Office Rigid Laryngoscopy as a Predictor for Glottic Exposure in Microlaryngoscopy.

Good glottic exposure is a prerequisite for a good microlaryngeal surgery. Often this is difficult to predict preoperatively. This study aims to evaluate the utility of office-based rigid laryngoscopy (70°) as a screening tool to predict laryngeal exposure during micro laryngoscopy. Sixty-nine patients underwent office-based rigid laryngeal examination followed by micro laryngoscopic surgery for benign vocal cord lesions. Office-based laryngoscopy was classified as grade 1 when the entire glottis with anterior commissure (AC) was visualized without undue traction of tongue; grade 2 when AC was visualized only during phonation and with some traction of tongue and grade 3 when there is an inability to visualise the glottis adequately despite moderate traction of tongue and the examination was completed using a flexible scope. These were correlated with laryngeal exposure during micro laryngoscopy. 42 patients were categorized as grade 1 out of which 39 (93%) had a favourable laryngeal exposure (class 1) while only 3 (7%) had a partially favourable exposure (class 2). 18 patients were categorized as grade 2 out of which 12(66%) had a favourable exposure (class 1) as against 6 (33%) who had a partially favourable exposure (class 2). Nine of our patients were categorized as grade 3 out of which all 9 (100%) had an unfavourable exposure (class 3) requiring angled tele laryngoscopy to complete the surgery. A strong correlation between office-based laryngoscopic grading and exposure during operative laryngoscopy was obtained statistically (Cramer's V test, V = 0.746). Office examination with a 70° telescope is a good predictor of glottic exposure during micro laryngoscopy. We believe that the ease of performing a micro laryngoscopy in the operating room is directly proportional to the ease of doing laryngoscopy in the office.

Idiopathic Ulcerative Laryngitis (IUL): An Indian Perspective.

Idiopathic ulcerative laryngitis (IUL) is characterized by bilateral ulceration of vocal cords which is followed by a protracted course of healing. It is rarely diagnosed, with a paucity of published data in English literature. There is no published data on this topic in the Indian population. Twenty-one patients from 3 centres were prospectively evaluated for clinical presentation, diagnosis, treatment, and follow-up. All patients underwent fibreoptic laryngoscopic evaluation and stroboscopic assessment. They were treated with supportive care and stringent follow-up. 21 patients with a median age of 39 years were included. This condition was commonly seen in males. All patients were treated conservatively except two who underwent a biopsy. The average time for full recovery in 14 of our patients who had compliant follow-ups was 9.24 weeks. GRBAS score improved from 9 to 5.93(p < 0.0001). Self-reported voice outcomes improved in all patients except for one patient who had a biopsy. IUL is uncommon but not rare in the Indian population. It shows full recovery with conservative management that involves at least more than 3-4 weeks.

Killian-Jamieson Diverticulum-A Rare Cause of Dysphagia in an Adult Male.

Killian Jamieson diverticulum is a rare diverticulum of the esophagus that out pouches through the Killian Jamieson's dehiscence. They are relatively rare compared to Zenker's diverticula, although both present similarly. However, both needs to be distinguished separately and treated accordingly given their anatomic variations.

The Chondroma of Arytenoid Cartilage: A Case Report.

The chondromas of laryngeal cartilage constitute less than 1% of common mesenchymal tumors of the larynx. 70-75% of chondroma is located at the endolaryngeal surface of the cricoid cartilage. Here is a case report of the chondroma of arytenoid cartilage-a rare site of occurrence. A middle aged male patient, presented to the outpatient department of otorhinolaryngology with a history of hoarseness of voice. On Flexible laryngoscopy [Pentax, Tokyo, Japan], the right vocal cord was found to be immobile along with a smooth bulge noted over the arytenoid cartilage. The computerized tomography scan of the neck showed a well-defined peripherally calcified lesion arising from the superior aspect of right arytenoid cartilage possibly chondroma. Patient underwent microlaryngeal surgery and sub mucosal excision of the arytenoid mass which was confirmed as chondroma on histopathological examination. High degree of suspicion is required while examining a patient with hoarseness of voice and one should have chondroma as one of the differential diagnosis.

Transoral silastic medialization for unilateral vocal fold paralysis.

BACKGROUND: Medialization laryngoplasty has historically been performed through an external approach. The aim of our work is to demonstrate the feasibility of silastic vocal fold medialization transorally. METHODS: Patients with unilateral vocal fold paralysis requiring medialization laryngoplasty were included in this report. Silastic medialization was done through a transoral approach. A supraglottic laryngotomy is performed followed by dissection and tunneling in the paraglottic space. Silastic implant is inserted into the tunnel to medialize the vocal fold and the ipsilateral arytenoid. The laryngotomy is tightly closed by endoscopic sutures. RESULTS: A consecutive series of 22 patients are reported. All patients had dysphonia with significant glottic insufficiency. After endoscopic silastic medialization, voice and swallowing were significantly improved (P < .001). No postoperative complications or implant extrusion occurred in our series. CONCLUSION: Silastic vocal fold medialization can be safely and effectively performed through a transoral approach with good results on voice and swallowing.

Platelet Rich Fibrin in Management of Complex Endoperio Cases.

Endo-perio lesions have been a dilemma to the dental practitioner. Both tissues share the same anatomical origin. Sometimes exact etiological passage of disease process cannot be traced; nevertheless traditional and newer treatment modalities must be employed to ensure best treatment possibilities. Patient reported with pain and pus exudates in upper left anterior region. Past dental history revealed no history of trauma. Initial examination revealed draining sinus with respect to 22. However, no Caries and pockets could be detected. Tooth was nonresponsive to vitality test. Patient symptoms did not relieve even two months after completion of RCT. Apical surgery was planned. Apicectomy was done and osseous defect was filled with PRF coagulum. Patient was followed up every three months and showed complete resolution of all symptoms. Radiographs showed complete resolution of osseous defect in nine months. PRF can be used to enhance bone augmentation in treatment of periapical defects as a potential treatment alternative for faster healing.

Conservative Management of Horizontal Root Fracture - A Case Series.

Root fracture has been defined as a fracture involving dentin, cementum, pulp and periodontal ligament. Depending on the level of the fracture line various treatment modalities may be employed by the clinician to promote healing. The following case reports highlight how changes in technique allow for conservative management of horizontal root fractures at different levels. This approach allows the patient to retain their natural dentition at an affordable cost and provide a viable alternative to the use of more invasive and expensive alternatives. These patients presented with complaints of pain and mobility in upper front tooth region following trauma. Diagnosis was confirmed on the basis of intra-oral periapical radiographs following which non-surgical root canal treatment was performed.

Comparative evaluation of sealing ability of glass ionomer-resin continuum as root-end filling materials: An in vitro study.

BACKGROUND AND OBJECTIVES: Root-end filling is a prudent procedure aimed at sealing the root canal to prevent penetration of tissue fluids into the root canals. An ideal root-end filling material should produce a complete apical seal. Therefore, the aim of this study is to compare the leakage behavior of four different root-end filling materials. MATERIALS AND METHODS: Sixty-eight maxillary central incisors were obturated with laterally condensed gutta-percha and AH plus sealer. The roots were resected at the level of 3 mm perpendicular to the long axis of the tooth. Root-end cavities were prepared with straight fissure stainless steel bur. The teeth were then divided into four experimental and two control groups, and cavities restored as per the groupings. The teeth were immersed in methylene blue for 48 h, split longitudinally, and dye penetration was measured. RESULTS: A highly significant difference existed in the mean dye penetration of Group I (conventional glass ionomer) and the other groups (resin-modified glass ionomer, polyacid-modified composite, and composite resin). There was no statistically significant difference among the three groups. CONCLUSIONS: (1) Significant difference was found in the dye penetration values of conventional glass ionomer cement and other groups. (2) No statistically significant difference was found in the dye penetration values of groups II, III, and IV.

An In-vitro Evaluation of the pH Change Through Root Dentin Using Different Calcium Hydroxide Preparations as an Intracanal Medicament.

CONTEXT: The aim of the study was to evaluate the pH variation in the surrounding medium after the use of two different vehicles of Calcium hydroxide - Saline (aqueous), Propylene glycol (viscous) and Calcium hydroxide containing guttapercha points over a period of 7 days as an intracanal medicament. MATERIALS AND METHODS: Sixty single rooted premolars were decoronated at the cementoenamel junction and cleaned and shaped uptil size 40 master apical file. External defects were made on the mesial surface in the coronal third of the roots and divided randomly into 4 groups. One control and three experimental. In the control - group I the root canals were left empty. In the experimental groups - group II was filled with Ca(OH)2 + saline, group III was filled with Ca(OH)2 + propylene glycol and group IV the root canals were filled with Calcium hydroxide points. The coronal accesses were sealed with 3mm of Cavit G and all the surfaces of the root except the defect were covered with 3 coats at Nail varnish. The samples were then placed in air tight vials containing 2ml of distilled water. The vials were kept in an incubator and the pH of the surrounding medium was measured using a digital pH meter after 1,3,5 and 7 days respectively. RESULTS: A statistically significant difference (p<0.05) existed between the experimental groups over the observation period. At day 1, a high pH was recorded by the calcium hydroxide points and saline groups and a lower pH by the propylene group. At day's 3 and 5, the maximum pH was recorded by the propylene glycol group and minimum by the calcium hydroxide points and saline groups. At day 7, the pH of all the groups had dropped, with propylene glycol recording the maximum pH followed by saline and lastly calcium hydroxide points. CONCLUSION: Within the limitations of this study, a viscous vehicle is better among other vehicles, calcium hydroxide paste of propylene glycol provided the highest 7 days release of hydroxyl ions.

Impact of low level magnification on incipient occlusal caries diagnosis and treatment decision making.

INTRODUCTION: This in-vitro study aimed to test the accuracy and reproducibility in detection of incipient occlusal caries and treatment decision making using unenhanced visual-tactile technique and low level magnification by the use of loupes and surgical operating microscope (SOM). METHODOLOGY: Sixty extracted human posterior teeth were assessed by two examiners using ICDAS- II index and CPI- TN probe, with and without magnification. Histopathology was used as gold standard for diagnosis of caries and treatment decision making. Inter and intra examiner reproducibility was determined using Kappa statistics. RESULTS: Intraobserver reproducibility for caries detection using surgical operating microscope ranged from average to good (0.4-0.63). Inter-examiner reproducibility values for treatment decision making using experimental techniques such as unaided (0.40), Loupes (0.51) & SOM (0.63) were similar.

Reaction of rat subcutaneous tissue to mineral trioxide aggregate and Portland cement: a secondary level biocompatibility test.

OBJECTIVES: This secondary-level animal study was conducted to assess and compare the subcutaneous tissue reaction to implantation of white mineral trioxide aggregate (MTA) and white Portland cement. STUDY DESIGN: Polyethylene tubes filled with either freshly mixed white MTA (Group I) or white Portland cement (Group II) were implanted subcutaneously into 12 Wistar Albino rats. Each animal also received an empty polyethylene tube as the control (Group III). After 7, 14, 21 and 30 days, the implants, together with surrounding tissues were excised. Two pathologists blinded to the experimental procedure, evaluated sections taken from the biopsy specimens for the severity of the inflammatory response, calcification and the presence and thickness of fibrous capsule surrounding the implant. Statistical analysis was performed using the Cross-tabs procedure, Univariate analysis of the variance two-way and the Pearson product moment correlation to assess inter-rater variability between the two evaluators. RESULTS: At 7 days, there was no significant difference in the severity of inflammation between the control group, white MTA, and white Portland cement groups. In the 14 day, 21 day and 30 day test periods, control group had significantly less inflammation than white MTA and white Portland cement. There was no significant difference in the grading of inflammation between white MTA and white Portland cement. All materials exhibited thick capsule at 7 days and thin capsule by 30 days. CONCLUSION: Both white MTA and white Portland cement were not completely non-irritating at the end of 30 days as evidenced by the presence of mild inflammation. However, the presence of a thin capsule around the materials, similar to the control group, indicates good tissue tolerance. White MTA and white Portland cement seem to be materials of comparable biocompatibility.

Factors influencing delayed presentation of congenitally hearing impaired children in rural India.

A study was conducted to determine why there was a delay in detection of hearing loss in congenitally hearing impaired children in rural India. It was found that although the parents of these children visited a primary care physician, relevant information regarding investigation and rehabilitation of hearing loss was not available to the patient. In the absence of a universal hearing screening programme in this country, it is a matter of importance to strengthen this aspect of community otolaryngology in the undergraduate ENT programme. There is also a need for continuing medical education programmes for primary care physicians regarding available methods of investigation and rehabilitation for a hearing impaired person.

Myringosclerosis: an indication of a blocked aditus.

Tympanoplasty has been the mainstay of treatment in chronic otitis media. In a non cholesteatomatous chronic otitis media, there has been much debate whether a cortical mastoidectomy is required or not. Creating an aerating mastoidectomy in cases of blocked aditus ad antrum helps in reducing the recurrence. However, the status of aditus is not always known unless a mastoidectomy is performed. In this study we try to find out if there is any clinical clue regarding a blocked aditus ad antrum by looking at the tympanic membrane. Fourty-three cases of cortical mastoidectomies were retrospectively studied in this series. Patency of aditus ad antrum was analyzed with respect to presence of myringosclerosis and the status of middle ear mucosa. In this study myringosclerosis was found to be significantly associated with a blocked aditus while no such association was found with the status of middle ear mucosa. The presence of myringosclerosis may indicate a blocked aditus ad antrum and performing a cortical mastoidectomy in such cases may help in creating an aerated mastoid, thereby possibly reducing the recurrence rate.

Significance of free radical injury in laryngeal and hypopharyngeal cancers.

BACKGROUND AND OBJECTIVES: Laryngeal and hypopharyngeal cancer is a multifactorial disease caused by various carcinogens such as tobacco, alcohol and viruses. Likewise, oxidative stress is known to cause aberrations in the cell membrane and DNA, leading to cancer. We conducted this prospective study in order to evaluate the level of oxidative stress in laryngeal and hypopharyngeal cancer patients. METHODS: Fifty patients with laryngeal and hypopharyngeal cancer and 40 control subjects were selected. Serum malondialdehyde concentrations and ferric reducing antioxidant power were assessed, in order to evaluate oxidative stress. Results were analysed by Student's t-test. RESULTS: Malondialdehyde levels were significantly higher and ferric reducing antioxidant power lower in the cancer patients, compared with the controls, indicating higher oxidative stress in the former. There was no statistically significant difference in malondialdehyde concentration or ferric reducing antioxidant power, comparing patients with versus without neck secondaries, and patients with early stage versus late stage tumours. CONCLUSION: Oxidative stress may have a role to play in the initiation of laryngeal and hypopharyngeal cancers, especially in patients with other risk factors such as tobacco and alcohol use.