Anatomical Features of Intratemporal Course of Facial Nerve and its Variations.

Introduction Facial nerve has the longest and complex course in its bony canal. The anatomical variations make the nerve prone to injury during mastoid surgeries. Having a thorough anatomical knowledge and its variations is must for the surgeons to avoid injury to this vital structure and for the safe surgery. The objective of the study was to describe the anatomical variations of intratemporal portion of facial nerve. Materials and methods The study was conducted in the department of otorhinolaryngology in the temporal bone dissection laboratory of a tertiary health care centre. Fifty wet temporal bones were dissected by the same team of surgeons for the duration of one year to study the various anomalies of the intratemporal course of the facial nerve and its relations with the other important middle ear structures. Results The mean length of the labyrinth, tympanic and mastoid segment of the facial nerve was 4.1 mm (±0.6 mm), 9.34 mm (±1.12 mm) and 12.8 mm (±1.8 mm), respectively. The mean distance between the horizontal segment and posterior edge of the oval window was 3.1 mm (±1.03 mm). Dehiscence in the tympanic segment was observed in three temporal bones (6%). Two (4%) specimens had bifurcation of the mastoid segment of the facial nerve. In all dissected temporal bones, the chorda tympani travelled in an ascending path. Conclusion The most common site for facial nerve anomaly is the tympanic portion. Anomalous conditions that can place the nerve at risk of being injured by the surgeons are highlighted here.

Role of Heparin Irrigation in the Management of Superficial Burns with Special Reference to Pain Relief and Wound Healing: A Pilot Study.

Introduction The objective of this study was to assess the effect of heparin irrigation in the management of superficial first and second degree burns with special reference to pain relief and wound healing. Materials and methods This pilot study was carried out over a period of 12 months in a tertiary care centre in South India. The study patients were divided into two groups: the heparin group and the saline control group. In the control group, the burn wound was irrigated with 100 mL of normal saline before the conventional dressing with silver sulfadiazine. In the heparin irrigation group, the wound was irrigated with heparin solution before the conventional dressing. Wound healing was assessed in terms of necrotic tissue score and granulation tissue score. Patient satisfaction in terms of patient satisfaction score, visual analogue scale (VAS) score, and length of hospitalization were compared between the two groups. Results A total of 40 patients were analysed in the study, 20 patients in each group. Both the groups were comparable with respect to age, gender, co-morbidities, body mass index (BMI), and degree of burns. Wound healing parameters like necrotic tissue score of six [40% vs. 50%; p = 0.024] and granulation tissue score of four [85% vs. 65%; p= 0.06] were significant in the heparin group compared to the control group. However, the difference was not statistically significant. The mean length of hospitalization between the two groups [10.5 days vs. 12.6 days; p = 0.74] were not statistically significant. Similarly, there was no statistically significant difference between the two groups with respect to the VAS pain score on the seventh dressing day [6.9 vs. 7.3; p= 0.321]. Conclusion In comparison to saline irrigation, heparin irrigation would result in better wound healing in superficial first and second-degree burns. The length of hospital stay in days and VAS pain score on the seventh dressing day were not statistically significant between the two groups.

Influence of External Chromophore on Cutting Efficacy of 940 nm Diode Laser: An In vitro Animal Tissue Study.

BACKGROUND: High-power level lasers used in health sciences have important photothermal effect. The maximum absorption of the diode laser correlates with the absorption range of hemoglobin, suggesting that red color may be the required chromophore. Hence, we hypothesized that by providing artificial external red chromophore, we can improve the cutting efficiency of diode laser in noninflamed tissue. The aim of the present study was to assess the efficacy and collateral thermal damage produced by a 940 nm diode laser on stained and unstained porcine tissue sample. MATERIALS AND METHODS: Eight porcine meat samples of specific dimensions were divided into four groups of two pieces each. Group I was stained with beetroot extract, Group II stained with 3% erythrosine dye, Group III stained with hibiscus extract, and Group IV left unstained. A 940 nm diode laser was used at 1.2 W in an intermittent wave mode, to make a standardized dimension incision in all the samples. One sample from each group was stored in 10% formalin and sent for histopathological examination to evaluate the depth and width of incision and amount of lateral thermal damage. The other sample from each group was observed under video profilometer to evaluate the surface characteristics. RESULTS: Staining of tissues with external chromophore using 3% erythrosine dye improved the efficacy of 940 nm diode laser, as evidenced from the sharper, wider cuts and clean incision with minimal charring as compared to beetroot, hibiscus, and saline. CONCLUSION: The use of staining can be an adjunct to the lasers in improvement of efficacy.

Stercoral Ulcer Not Always Indolent: A Rare Complication of Fecal Impaction.

Stercoral sigmoid perforation is a dangerous surgical emergency. It is also a life-threatening situation because the spillage of fecal contents into the abdominal cavity leads to sepsis with many postoperative complications. Chronic, intermittent constipation can lead to fecal impaction, especially in older patients. An 80-year-old male patient presented with intestinal abdominal pain and distention for three days. His chest X-ray showed air under the diaphragm. On laparotomy, a small rent was discovered in the rectosigmoid junction with fecal contamination. The presence of a fecaloma is the speculated reason for the perforation. Primary closure of the defect with a diverting transverse colostomy was performed, and subsequently, the patient recovered well. A colostomy closure was performed six weeks after the primary surgery. It is imperative to understand the incidence of stercoral perforation in a normal bowel. Early treatment and intervention are the important aspects of stercoral pathology. We report a rare case of stercoral sigmoid colonic perforation with fecal peritonitis.

Role of Thermography in the Diagnosis of Chronic Sinusitis.

Introduction Thermography is a form of radiography that images the skin surface temperature. Thermograms are pictorial representations of thermal maps of the entire body's outer surface. Thermography was applied as an attempt to evaluate its usefulness in the diagnosis of chronic sinusitis (CS). Hence, this study was done to determine the diagnostic value of thermography for patients suffering from CS. Methodology Patients attending the Department of Otorhinolaryngology and Head and Neck Surgery over a two years' duration with symptoms suggestive of CS were included in this diagnostic evaluation study. X-ray paranasal sinuses (PNS) and nose, thermography of head and neck, and computed tomography (CT) of PNS and nose (axial and coronal sections) were performed on them. The thermograms and X-ray sinuses obtained were compared with the computed tomography of PNS findings. Results The study population consisted of 167 patients (75 males and 92 females) and the mean age of the study population was 38.6 years. The sensitivity and specificity of thermography of the head and neck in diagnosing frontal, ethmoidal, maxillary, and sphenoidal sinusitis were 92.59% and 68.58%, 100% and 66.32%, 70.06% and 85.88%, 99.18% and 0%, respectively. Whereas the sensitivity and specificity of the X-ray PNS and nose in diagnosing frontal, ethmoidal, maxillary, and sphenoidal sinusitis were 92.59% and 77.88%, 73.61% and 81.05%, 89.19% and 98.92%, 74.44% and 99.18%, respectively. Conclusion Thermography is better than X-rays in diagnosing frontal and ethmoidal sinusitis and as good as X-ray PNS and nose in diagnosing maxillary sinusitis. Thermography failed to pick up sphenoidal sinusitis. The advantages of thermography are that it is a radiation-free, non-invasive, and cost-effective method for diagnosing CS.

Efficacy of Homologous, Platelet-rich Plasma Dressing in Chronic Non-healing Ulcers: An Observational Study.

Background Chronic non-healing ulcers are a frequent problem in developing countries and represent a heavy burden to the patients because they lack the necessary growth factors (GFs) to maintain the healing process and are frequently complicated by super, added infections. Traditional therapies, such as regular dressings and wound debridement, cannot provide satisfactory results since these treatments are not able to provide the necessary GFs. Platelet-rich plasma (PRP) helps in enhancing the wound healing by releasing various GFs. The aim was to evaluate the efficacy of PRP dressing in the treatment of chronic non-healing ulcers. Methods Patients attending the outpatient department on a regular basis and those admitted as inpatients for chronic wound management were included in the study. It was an observational study done in a tertiary health center for a period of one year. All patients with eligible criteria were treated with PRP at twice-weekly intervals for a maximum of 10 dressings. At the end of the five weeks period, the reduction in the size of the ulcers (area and volume) was assessed. Results A total of 104 cases with chronic non-healing ulcers of various causes were treated with homologous PRP twice weekly for a maximum of 10 dressings. In those 104 patients, non-healing ulcers in 85 patients (81.73%) were healed at the end of the last dressing. Non-healing ulcers in 13 patients (12.5%) were healed with skin grafting. Among those patients, the baseline mean ulcer area was 5.03 cm2. For each visit, there was a reduction in the ulcer area. At the end of the last visit, the mean ulcer area was 1.69 cm2, which was significant in this study. Conclusion Due to the lack of necessary GFs in chronic non-healing ulcers, PRP is safe and enhances the healing rates of chronic wounds, thereby reducing overall hospital stay and morbidity.

Penile Epidermal Cyst: A Case Report.

Epidermal cysts also known as epidermoid cysts, is one of the common benign tumours presenting anywhere in the body. However, epidermal cyst in the penis is very rare. This condition in children is usually congenital due to abnormal embryologic closure of the median raphe; hence, it is termed as median raphe cysts (MRCs). Penile epidermal cysts may occur in adults following trauma or surgery due to epidermal elements being trapped within closed space. During wound healing, trapped squamous epithelium, undergoing keratinisation leads to cyst formation. Here, we report a rare case of patient with a penile epidermoid cyst whose main complaints was discomfort during coitus.

Ainhum - A Rare Case Report.

The term 'AINHUM' is derived from the African word meaning 'to saw or cut'. True ainhum otherwise called dactylolysis spontanea is a condition involving soft tissue or digits with constricting rings commonly presenting in fifth toes, usually bilateral. It is to be differentiated from Pseudo-ainhum that occurs secondary to some hereditary and nonhereditary diseases that lead to annular constriction of digits. We report a rare case of true ainhum involving the left fourth toe only. It is a very rare case and a very few were reported worldwide. The highest incidence of ainhum has been reported in South Africa and South America. It is rarely reported in India. Ainhum when diagnosed and treated in early stages can be prevented from progressing to mutilating deformities.

Analysis of local perspectives on sustainable forest management: an Indonesian case studyThis study was funded through a collaborative project between the University of Illinois and the Center for International Forestry Research (CIFOR). The ideas contained herein are solely of the authors and do not necessarily reflect official views of CIFOR.

Despite widespread acceptance of sustainability as the ultimate goal of forest management, perspectives about its meaning, significance, and relevant indicators may still differ. This paper examines local perspectives on sustainability, and evaluates their similarities and differences. A systematic procedure based on criteria of proximity, pre-existing rights, dependency, knowledge of forest management, forestry spirit, daily activity, and legal rights was used to identify a small group of relevant stakeholders representing different groups, institutions, and organizations. Using participatory action research (PAR), stakeholders were asked to identify relevant indicators of sustainable forest management. The indicators identified by each stakeholder were then compared to a consolidated list assembled by field facilitators with respect to whether relevant indicators are present or not. Based on the resulting presence/absence matrix, a statistical tool called the simple matching coefficient was used to estimate the similarity measures among the stakeholders' perspectives. In addition, cluster analysis was used to classify groups of stakeholders depending on their similarities to each other. Finally, hypotheses related to the 'closeness' of perspectives among local communities, non-governmental organizations, a timber company, and government organizations, as revealed by their selection of indicators, were tested. Results show that: (a) local communities have different perceptions in terms of what they consider to be important indicators compared to the NGOs, (b) there are significantly different perceptions between the government and the timber companies, and (c) there are also different perceptions between urban and field-based personnel of the same organization.