Otolaryngology Commons^™

The Rationality Of Prescribing Antibiotics After Tonsillectomy, Maqbool Ahmed Baloch, Shabbir Akhtar, Mubasher Ikram, Hassan Nabeel Humayun

Section of Otolaryngology, Head & Neck Surgery

Objective: To compare the antibiotic therapy with the absence of antibiotic therapy in reducing post-tonsillectomy morbidities
Methods: The quasi-experimental study was conducted at the Aga Khan University Hospital, Karachi, from November 2006 to September 2007. It involved 60 patients fulfilling the criteria for recurrent tonsillitis who were divided in two groups based on the different practice of two sets of surgeons. In one group antibiotics were used, while in the other group, no antibiotic was given. Patients filled a questionnaire about pain, post-operative bleeding, day of normal diet intake, day of normal activity and any consultation received during the first …

Frontal Sinus Osteoma Removal With The Ultrasonic Bone Aspirator., Eric Ehieli, Jaemi Chu, Eli Gordin, Edmund A. Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Osteomas, the most common skull tumors, are typically excised through either an open or endoscopic ostectomy using a high-speed drill, a technically challenging procedure that can result in injury to adjacent soft tissue structures. Osteoma removal through ultrasonic bone emulsification and aspiration (UBA) offers the advantages of decreased blood loss, preservation of adjacent soft tissue structures, and precise bone removal. UBA was used to successfully remove a forehead osteoma without injury to adjacent nerves and with a satisfactory cosmetic outcome. We describe skull osteoma removal with an ultrasonic bone aspirator, which offers potential advantages over conventional bone removal techniques.

Minimally Invasive Endoscopic Selective Parathyroidectomy, Montasir Junaid, Zainul Abedeen Sobani, Maliha Kazi, Mumtaz Junaid Khan

Section of Otolaryngology, Head & Neck Surgery

Primary hyperparathyroidism is a common condition with surgery being the definitive treatment modality. Controversy exists over the extent of optimal neck exploration, whether unilateral or bilateral exploration should be performed, particularly since 85-90% of primary hyperparathyroidism results from single gland disease. Unilateral neck exploration is now considered to be adequate unless a definitive adenoma is not identified on ipsilateral exploration and where the serum intact Parathyroid Hormone (iPTH) level does not show a decline greater than 60% after removal of a suspected adenoma. It also avoids the potential risk of hypocalcaemia, recurrent laryngeal nerve injury along with extended anaesthesia and …

Frontal Sinus Osteoma Removal With The Ultrasonic Bone Aspirator., Eric Ehieli, Jaemi Chu, Eli Gordin, Edmund A Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Osteomas, the most common skull tumors, are typically excised through either an open or endoscopic ostectomy using a high-speed drill, a technically challenging procedure that can result in injury to adjacent soft tissue structures. Osteoma removal through ultrasonic bone emulsification and aspiration (UBA) offers the advantages of decreased blood loss, preservation of adjacent soft tissue structures, and precise bone removal. UBA was used to successfully remove a forehead osteoma without injury to adjacent nerves and with a satisfactory cosmetic outcome. We describe skull osteoma removal with an ultrasonic bone aspirator, which offers potential advantages over conventional bone removal techniques.

Angioembolization In Itractable Epistaxis—A Tertiary Care Experience, Maqbool Ahmed Baloch, Mohammad Sohail Awan, Hassan Nabeel Humayun

Department of Surgery Docs

Objective: To review the role of angioembolization in the control of intractable epistaxis at our institution. Methods: A retrospective review of the charts of the patients between Jan 2001 to June 2010 at Aga Khan University Hospital, Karachi was done. All patients who underwent angioembolization for intractable epistaxis were included in the study. Patients with nasal or nasopharyngeal mass were excluded. Data was analyzed by using SPSS version 16. Results: Total numbers of the patients were 16. Fourteen (87.5%) patients were male and 2(12.5%) were female with mean age 51.2 ± 12.922 years (range 26-71 years). In 11(68.75%) patients there …

Laryngeal Tuberculosis Presenting As Laryngeal Carcinoma, Anwar Suhail, Muhammad Sheharyar Ahmed, Zain-Ul-Abdeen Sobani, Shahzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

Tuberculosis (TB) accounts for the highest number of mortalities among infectious diseases worldwide. Laryngeal TB is an extremely rare presentation of TB. It has many similarities to laryngeal carcinoma, one of the three most common cancers among males in the city, with an age standardized rate of 8.6. The associated risk factors of laryngeal carcinoma i.e. smoking, paan, betel nut usage and alcohol use also tend to be concentrated in the same demographic background as that of TB, creating a diagnostic dilemma. We present a case of granulomatous laryngeal TB, in a 40 year old male, with characteristic presenting features …

Adult Laryngeal Haemangioma; A Rare Entity, Shabbir Akhtar, Adeel Ahmed Shamim, Shehzad Ghaffar, Muhammad Sheryar Ahmed, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Laryngeal haemangioma is commonly seen in children. Adult laryngeal haemangiomas are rare and usually involve the supraglottic region. Most common symptom includes dysphagia, dysphonia and shortness of breath. Detailed history, fiberoptic laryngoscopy and computerized scanning may suggest benign nature of the lesion but diagnosis is only confirmed by a biopsy. In comparison to infantile haemangiomas which usually respond to propronolol, the treatment of adult laryngeal haemangiomas is always surgical removal. We present a case report of a supraglottic haemangioma in an adult male, who was treated surgically without any complications.

Nasal Encephaloceles Presenting At Later Ages: Experience Of Otorhinolaryngology Department At A Tertiary Care Center In Karachi, Pakistan, Montasir Junaid, Zain-Ul-Abedeen Sobani, Adeel Ahmed Shamim, Maliha Kazi, Mumtaz Jamshed Khan

Section of Otolaryngology, Head & Neck Surgery

Encephaloceles are anomalous herniations of the meninges, with or without brain matter. Globally the incidence of encephalocele is about 1 per 35,000 births, but it is more frequently reported in Southeast Asia. As the defect is more pertinent to embryological development, an encephalocele is a more common entity in an infant with a mean age of presentation ranging between 15.5 and 21 months; making an encephalocele presenting for the first time in a relatively, older individual a rare occurrence. Consequently a surgeon might not consider an encephalocele among his differentials. Here we present a series of encephaloceles that presented at …

A Case Report: Giant Cystic Parathyroid Adenoma Presenting With Parathyroid Crisis After Vitamin D Replacement, Ali Asghar, Mubasher Ikram, Najmul Islam

Section of Otolaryngology, Head & Neck Surgery

Background: Parathyroid adenoma with cystic degeneration is a rare cause of primary hyperparathyroidism. The clinical and biochemical presentation may mimic parathyroid carcinoma. Case presentation: We report the case of a 55 year old lady, who had longstanding history of depression and acid peptic disease. Serum calcium eight months prior to presentation was slightly high, but she was never worked up. She was found to be Vitamin D deficient while being investigated for generalized body aches. A month after she was replaced with Vitamin D, she presented to us with parathyroid crisis. Her corrected serum calcium was 23.0 mg/dL. She had …

Detection Of Evolving Injury To The Brachial Plexus During Transaxillary Robotic Thyroidectomy., Adam Luginbuhl, Daniel M Schwartz, Anthony K Sestokas, David Cognetti, Edmund Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: Continuous intraoperative neuromonitoring (IONM) of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) has gained universal acceptance as an efficacious method for detecting emerging positional brachial plexopathy or peripheral nerve compression during spinal and shoulder surgery. This has implications for transaxillary thyroid surgery.

STUDY DESIGN: Case report with literature review.

METHODS: The patient underwent robotic transaxillary thyroid surgery with continuous tceMEP and SSEP monitoring of brachial plexus function. We present detailed IONM data depicting the emergence of positional brachial plexopathy.

RESULTS: Significant amplitude loss of both IONM modalities were identified during an evolving positional plexopathy, which …

Cerebrospinal Fluid Rhinorrhea: An Institutional Perspective From Pakistan, Muhammad Zubair Tahir, Muhammad Babar Khan, Muhammad Umair Bashir, Shabbir Akhtar, Muhammad Ehsan Bari

Section of Neurosurgery

Background:The management of cerebrospinal fluid (CSF) rhinorrhea has evolved over the last two decades. We present here a review of our 11-year data on CSF rhinorrhea and its management at a tertiary care hospital in a developing country, with particular reference to the diagnosis, surgical management and outcome of the disease.
Methods: The medical charts of all Patients with a diagnosis of CSF rhinorrhea over an 11-year period were reviewed. The etiology of CSF rhinorrhea was classified into three categories: spontaneous, iatrogenic and traumatic. All the Patients were divided into three categories based on the type of management as …

Use Of The Anterolateral Thigh In Cranio-Orbitofacial Reconstruction., William J Parkes, Howard Krein, Ryan Heffelfinger, Joseph Curry

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described …

Neuronavigation Assisted Endoscopic Sinus Surgery, Masaud Mohyuddin, Zain A Sobani, Montasir Junaid, Shehzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

In the past two decades, endoscopic sinus surgeries (ESS) have been widely advocated as a safe and effective treatment for disorders of paranasal sinuses that are refractory to medical therapy. ESS caters surgeons with two-dimensional visualization of the anatomical structures; however in scenarios where there is a close anatomical relation between the disease and delicate intracranial or intraorbital structures drastic complications can occur. Hence, endoscopic procedures had to be converted into open surgical procedures if the extent of the disease could not be visualized or cleared thoroughly. Recently however; neuronavigation systems have been combined with ESS to yield better results …

Comparison Of Outcomes Of Enteral Feeding Via Nasogastric Versus Gastrostomy Tubes In Post Operative Patients With A Principle Diagnosis Of Squamous Cell Carcinoma Of The Oral Cavity, Zain-Ul-Abedeen Sobani, Shehzad Ghaffar, Beenish Nisar Ahmed

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVES: Squamous cell carcinoma of the oral cavity has a profound impact on a patient's nutritional intake, 40-50% of head and neck cancer patients have a markedly impaired nutritional status at the time of their initial presentation. Studies show that patients who have better nutritional status have fewer complications and a better survival rate. Therefore, enteral nutritional support plays an important part in their management. Due to the lack of relevant data, surgeons help patients make informed decisions regarding their mode of nutritional support and perform gastrostomy or place nasogastric tube depending on the patient's preference. This study addresses the …

Mucoepidermoid Carcinoma Of The Base Of Tongue, Zain-Ul-Abedeen Sobani, Montasir Junaid, Shehzad Ghaffar, Anwar Suhail

Section of Otolaryngology, Head & Neck Surgery

Mucoepidermoid carcinomas are thought to arise from the reserve cells of salivary gland ducts. Minor salivary glands are located all around the oral cavity and base of the tongue; however few cases of MEC of the base of the tongue have been reported in literature and no guidelines are available for its management. Here we would like to present the case of a 71 year old male with mucoepidermoid carcinoma of the base of the tongue successfully treated with surgical excision and neck dissection. Regular clinical follow up showed no signs of recurrence at 9 months post excision.

Novel Irradiated Axial Rotational Flap Model In The Rodent, Adam J. Luginbuhl, Mara Modest, Bs, Kaiguo Yan, Joseph Curry, Ryan N. Heffelfinger

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Abstract

Objectives: To design an easily reproducible rodent rotational skin flap and to evaluate the effects of radiation on flap viability.

Methods: Ten rats received 40 Gy irradiation to the abdominal wall. Following a recovery period of one month, a 3 X 8 cm fasciocutaneous flap based axially on the inferior epigastric vessel, was raised and rotated 60 degrees into a contralateral deficit. Five non-irradiated rats underwent the identical procedure as a control. Animals were sacrificed seven days postoperatively, areas of flap necrosis were documented, and histological specimens were taken to compare flap viability and vessel density.

Results: 60% of …

Tp53 As A Biomarker In Head And Neck Squamous Cell Carcinoma, Thomas J. Ow Md

Dissertations and Theses (Open Access)

Currently, there are no molecular biomarkers that guide treatment decisions for patients with head and neck squamous cell carcinoma (HNSCC). Several retrospective studies have evaluated TP53 in HNSCC, and results have suggested that specific mutations are associated with poor outcome. However, there exists heterogeneity among these studies in the site and stage of disease of the patients reviewed, the treatments rendered, and methods of evaluating TP53 mutation. Thus, it remains unclear as to which patients and in which clinical settings TP53 mutation is most useful in predicting treatment failure.

In the current study, we reviewed the records of a cohort …

Malignant Peripheral Nerve Sheath Tumour Of Maxilla, Naeem Sultan Ali, Montasir Junaid, Kanwal Aftab

Section of Otolaryngology, Head & Neck Surgery

Malignant peripheral nerve sheath tumour (MPNST) is a very rare entity in head and neck with high rate of recurrences and local invasiveness. This tumour is usually found in lower extremities and only 10-12% occur in head and neck region. The diagnosis is considered as the most elusive and difficult among soft tissue sarcomas because of its non specific presentation, both clinically as well as pathologically. This difficulty has now been overcome by immunohistochemistry. We report here a case of MPNST in a 50 years old male with a localized right maxillary growth.

Successful Management Of Aggressive Fibromatosis Of The Neck Using Wide Surgical Excision: A Case Report., Zain A. Sobani, Montasir Junaid, Mumtaz J Khan

Section of Otolaryngology, Head & Neck Surgery

Introduction:Aggressive fibromatosis is a benign tumor, thought to arise from deep musculoaponeurotic structures, rarely found in the head or neck. However, when it does occur in the head and neck region, it tends to be more aggressive and associated with significant morbidity, which may be attributed to the vital vascular, neurological or anatomical structures in close proximity. Case Presentation: We report the case of a 39-year-old Pakistani man who presented with a two-month history of a lump on the right side of his neck. The mass was excised and histopathological analysis revealed a case of aggressive fibromatosis.

Conclusions:

Due …

Preliminary Report--Near Total Laryngectomy For Scc Larynx, Asif Arain, Shehzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

A retrospective analysis was performed on patients subjected to near-total laryngectomy at Aga Khan University Hospital Karachi from September 2006 and May 2010, to evaluate the functional outcome of Near Total Laryngectomy and its effect on disease control. In all of these advanced stage laryngeal-hypopharyngeal squamous cancer patients, the disease was limited to one side of the larynx-hypopharynx. Four patients were staged as T3 and rest were T4; near total laryngectomy was done in all 07 patients. Post operative adjuvant radiotherapy was given to 06 patients. All of these patients are on regular oral diet and maintaining their body weight. …

Diagnostic Accuracy Of Fine Needle Aspiration Cytology In Parotid Lesions, Naeem Sultan Ali, Shabbir Akhtar, Montasir Junaid, Sohail Awan, Kanwal Aftab

Section of Otolaryngology, Head & Neck Surgery

Objective:Histopathology of parotid gland tumors is extremely varied and complex due to heterogeneous cellular composition. Preoperative diagnostic tools include fine needle aspiration cytology, the role of which remains controversial. The aim of this paper is to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of parotid gland tumors.

Methods:

We retrospectively reviewed charts of 129 Patients who underwent parotidectomy for parotid lesions at Aga Khan University Hospital from 2002 to 2010. We compared the results of preoperative FNAC with final histopathological diagnosis.

Results:

Concordance with histological results was observed in 86%, specificity was …

Extracranial Meningioma: An Unusual Presentation Of A Mass Over Inner Canthus Of Left Eye, Nasir Ali, Mubasher Ikram, Tahir Shafi Khan, Syed Athar Enam, Abdul Qadir Jangda, Farrok Karsan

Section of Otolaryngology, Head & Neck Surgery

ABSTRACT Meningiomas are commonly encountered as intracranial brain tumours, but extracranial meningiomas do occur although seen rarely. Here we present a case of extracranial meningioma presenting as a mass over the medial canthus of left eye and the glabella with extension into the left ethmoid sinuses, without any neurological symptoms or signs. The patient underwent surgical excision, plastic surgical reconstruction and adjuvant radiotherapy after 3-dimensional conformal treatment planning.

Rhinocerebral Zygomycosis In Pakistan: Clinical Spectrum, Management, And Outcome, Mubasher Ikram, Moghira Iqbal, Muhammad Aslam Khan, Erum Khan, Mahnaz Shah, Raymond A., Jr Smego

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To study the disease spectrum and salient management features of 36 patients with histopathologically-confirmed rhinocerebral zygomycosis seen at our academic center over a 16-year period.

METHODS: Retrospective review of patients admitted to the Aga Khan University Hospital in Karachi, Pakistan from January 1991 to December 2006 with histopathologically-confirmed zygomycosis of the head and neck.

RESULTS: Mean patient age was 40 +/- 5.0 years (range, 34-63 years), and 23 (64%) patients were male. Thirty-two (89%) patients were referred from clinical services other than otolaryngology. Underlying predisposing conditions included diabetes mellitus (21 patients), haematologic diseases (9), and renal failure (6). Twenty …

Harmonic Scalpel Versus Electrocautery Tonsillectomy: A Comparative Study In Adult Patients, Naeem Sultan Ali, Mubasher Ikram, Shabbir Akhtar, Iqbal Moghira, Ahmad Nawaz, Asif Arain

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To compare harmonic scalpel (HS) tonsillectomy with electrocautery (EC) tonsillectomy in terms of operating time, intra-operative blood loss, post-operative pain and secondary haemorrhage.METHODS: Sixty adult patients subjected to tonsillectomy only, were evaluated in this prospective study. The patients were stratified into 2 groups (30 each) based on the dissecting instrument used (HS vs. EC) at Aga Khan University Hospital Karachi Pakistan from June, 2006 to August, 2008.RESULTS: The mean operative time was less in electrocautery group (EC 3.57 +/- 0.85 minutes Vs HS 4.20 +/- 1.37 minutes; p

Intelligibility Of Electrolarynx Speech Using A Novel Hands-Free Actuator, Brian Madden, Mark Nolan, Ted Burke, James Condron, Eugene Coyle

Conference Papers

During voiced speech, the larynx provides quasi-periodic acoustic excitation of the vocal tract. In most electrolarynxes, mechanical vibrations are produced by a linear electromechanical actuator, the armature of which percusses against a metal or plastic plate at a frequency within the range of glottal excitation. In this paper, the intelligibility of speech produced using a novel hands-free actuator is compared to speech produced using a conventional electrolarynx. Two able-bodied speakers (one male, one female) performed a closed response test containing 28 monosyllabic words, once using a conventional electrolarynx and a second time using the novel design. The resulting audio recordings …

Heat Shock Protein Induced Protection Against Cisplatin-Induced Hair Cell Death, Tiffany Gray Baker

MUSC Theses and Dissertations

Cisplatin is a highly successful and widely used chemotherapy for the treatment of various solid malignancies in both adult and pediatric patients. Side effects of cisplatin include nephrotoxicity and ototoxicity. Cisplatin's ototoxic effect results in part from damage to and death of cochlear hair cells. Mechanisms underlying cisplatin-induced hair cell death are poorly understood and have been attributed to DNA damage, oxidative stress, and inflammation. This study was designed to determine the role of p53 in cisplatin-induced hair cell death and to investigate heat shock proteins (HSPs) as potential protectants against cisplatin-induced hair cell death using adult mouse utricle as …

Aggressive Embryonal Rhabdomyosarcoma Presenting As Schwanoma : A Case Report, Mohammad Sohail Awan, Montasir Junaid, Zain A. Sobani

Department of Radiology

Rhabdomyosarcomas (RMS) are thought to arise from pluripotent muscle cell precursors intended to form the bodyís future striated muscle. Due to the wide distribution of striated muscle across the body these tumors may appear anywhere and cause symptoms accordingly. Presenting symptoms are highly variable and based on the tumor size and location making clinical diagnosis difficult. The diagnosis of RMS is based on histological examination; however they express varying cytologic pictures representing the different stages of rhabdomyoblasts and their development into skeletal muscle presenting pictures from highly to poorly differentiated neoplasms. Therefore their histological diagnosis also requires the use of …

Supernumerary, Ectopic Tooth In The Maxillary Antrum Presenting With Recurrent Haemoptysis., Taimur Saleem, Umair Khalid, Anam Hameed, Shehzad Ghaffar

Section of Otolaryngology, Head & Neck Surgery

Ectopic eruption of teeth in non-dental sites is a rare phenomenon and can present in a variety of ways such as chronic or recurrent sinusitis, sepsis, nasolacrimal duct obstruction, headaches, ostiomeatal complex disease and facial numbness. However, presentation of such Patients with recurrent haemoptysis has not been described in the literature so far. We have described a case of an ectopic, supernumerary molar tooth in the maxillary antrum in a Patient who initially presented with haemoptysis. A 45-year-old male presented with a 2-month history of episodic haemoptysis. A pedunculated growth from the inferior nasal turbinate was seen with fibre-optic visualization. …

Congenital Bilateral Choanal Atresia, Ali Faisal Saleem, Shabina Arif, Nadeem Aslam, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Abstract: Congenital choanal atresia (CCA) is the developmental failure of the nasal cavity to communicate with nasopharynx. Surgical repair is recommended in the first weeks of life in bilateral cases because this is a life-threatening situation in newborns. This is a case report of a full term, healthy newborn baby presenting with intermittent attacks of cyanosis and respiratory distress soon after birth. On examination, alternating cyanosis and normal colour was observed in the infant. The insertion of nasal catheters in both the nares revealed the diagnosis of bilateral CCA. For this rare condition, conservative management was followed with elective transnasal …

The Challenge Of Head & Neck Squamous Cell Carcinoma Control In Pakistan, Syed Mohammad Asad Zaidi, Nauman Fazal Manzoor, Shabbir Akhtar

Section of Otolaryngology, Head & Neck Surgery

No abstract provided.