Angioembolisation for the Treatment of Pseudo-aneurysm of Internal Maxillary Artery.

Pseudo-aneurysm of internal maxillary artery, following a road traffic accident, is a rare clinical scenario. The consequence of pseudo-aneurysm may be spontaneous rupture of the arterial wall, which may eventually lead to life-threatening hemorrhage. We report a case of a 20-year male who presented with recurrent epistaxis. CT scan was performed, which revealed a pseudo-aneurysm of the internal maxillary artery; this was successfully treated by angioembolisation. Similar cases of traumatic pseudo-aneurysms have been reported, however, none presented with recurrent epistaxis after management of pan-facial fractures. Key Words: Epistaxis, Pseudo-aneurysm, Angioembolisation, Pan-facial fracture.

Post parotidectomy facial nerve palsy: A retrospective analysis.

BACKGROUND &OBJECTIVES: Transient paralysis of facial nerve is seen to vary from 15 % to 66 % in post-parotid surgery. The objective of this study was to find out the complications in post-parotidectomy with regards to facial nerve dysfunction since it is a vital structure encountered in parotid surgeries. METHODS: This was a retrospective study through non probability convenient sampling technique carried from September 2010 to January 2019 in the Department of Otorhinolaryngology, Dow University of Health Sciences, Dr. Ruth K.M.Pfau Civil Hospital, Karachi. Clinical data were recorded from 75 patients and out of them 70 patients had undergone surgery with parotid gland tumours and were reported on the morphology, age, sex, surgical procedure and complications, particularly facial nerve dysfunctions. In most cases ante-grade technique was performed to identify the facial nerve, whereas retrograde technique was used in recurring tumours, and in difficult cases. The stimulator of the nerve has not been used. The nature or severity of Facial nerve dysfunction was assessed in terms of either it is, permanent or temporary, total or incomplete in respect to its branches. RESULTS: Among total 75 patients; the mean age was 38.75 ± 9.26 years with male to female ratio of 1:1. Majority of the patients were diagnosed as pleomorphic adenoma, i.e. 78.6% after which 12% were diagnosed as mucoepidermoid carcinoma. 88.6% of patients had superficial parotidectomy and 11.4% of patients had total parotidectomy. About 75% of patients had no complications. 5(7.1%) patients had complete facial nerve palsy. Damage to the mandibular, buccal and temporozygomatic branch was observed in 10(14%), 2(3%) and 1(1.4%) patients respectively. CONCLUSION: The most prevalent benign parotid tumour in this study was pleomorphic adenoma. After performing parotid surgery, it was predicted that the rate of complications related to the facial nerve injury was reduced as compared to the previous studies.

Apprehensions and problems after laryngectomy: Patients' perspective.

OBJECTIVE: To evaluate the apprehensions, social, sexual and financial problems in patients with advanced laryngeal cancer after total laryngectomy and the impact of attending laryngeal club on these problems. METHODS: The analytical study was conducted at the Dow Medical College and Civil Hospital Karachi from January 1996 to December 2011. Patients with total laryngectomy, operated for advanced laryngeal cancer at various centres of Sindh and Balochistan, attending Laryngeal Club of Pakistan, situated at Civil Hospital Karachi, were included. All the patients were evaluated through a questionnaire covering their apprehensions regarding social, sexual and financial impact on their lives after total laryngectomy. Data was analysed using SPSS 16. RESULTS: Of the 125 patients, 120(96%) were males, and 5(4%) were females; all housewives. The overall mean age was 54.8±0.5 years (range: 31-65 years). Further, 92(74%) participants were worried about financial uncertainty, while 84(67%) had regrets over loss of their voice; patients worried about losing family support and facing social rejection were 23(18%) and 15(12%) respectively. Only 7(5%) patients feared losing sexual relationship with their spouse. All these apprehensions were subdued after attending the Laryngeal Club of Pakistan. Severe financial impact was faced by 55(44%) patients due to loss of job, while 05(4%) had moderate impact due to change of job with lower income and 60(48%) patients had no financial problem. A good 102(82%) participants thought the support from their friends and family was upto their expectations; 98(78%) enjoyed satisfactory sex life although with reduced frequency of 1 to 2 intercourses per month; 21(17%) were having the frequency of 3-10 per month; and 3(2%) had more than 10 per month. Only 16(13%) patients were not involved in sexual relations with their spouses due to various reasons. CONCLUSIONS: Majority of laryngectomised patients expressed apprehensions and showed some social problems after laryngectomy, especially in the initial phase which improved either with passage of time or after attending Laryngectomy Club. The main problem was financial constraints; majority had good friends and family support and enjoyed satisfactory sexual relationship with their spouse.