Otolaryngology Commons^™

Composition Of The Adult Digestive Tract Bacterial Microbiome Based On Seven Mouth Surfaces, Tonsils, Throat And Stool Samples, Nicola Segata, Susan Kinder Haake, Peter Mannon, Katherine P. Lemon, Levi Waldron, Dirk Gevers, Curtis Huttenhower, Jacques Izard

Department of Food Science and Technology: Faculty Publications

Background: To understand the relationship between our bacterial microbiome and health, it is essential to define the microbiome in the absence of disease. The digestive tract includes diverse habitats and hosts the human body’s greatest bacterial density. We describe the bacterial community composition of ten digestive tract sites from more than 200 normal adults enrolled in the Human Microbiome Project, and metagenomically determined metabolic potentials of four representative sites.

Results: The microbiota of these diverse habitats formed four groups based on similar community compositions: buccal mucosa, keratinized gingiva, hard palate; saliva, tongue, tonsils, throat; sub- and supra-gingival plaques; …

Post-Traumatic Pseudoaneurysm Of Internal Carotid Artery: A Cause Of Intractable Epistaxis., Mohammad Adeel, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

In this case report, the authors are presenting a case of a 35-year-old lady who presented to our clinic with recurrent episodes of massive epistaxis and loss of right eye vision for last 6 months following road traffic accident. There was no other significant medical and surgical history. Bleeding episodes were sometimes very severe with loss up to 400-500 cc and would stop spontaneously. She was given multiple blood transfusions after these episodes. A complete otorhinolaryngological examination including rigid endoscopy and coagulation investigation did not reveal any abnormality. CT with contrast of paranasal region showed blood within the right sphenoid …

Daycare Adeno-Tonsillectomy: Is It Safe In Developing Countries, Aria Masoom, Shabbir Akhtar, Hassan Nabeel Humayun, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To determine the safety of daycare adeno-tonsillectomy in a tertiary care centre.

METHOD: A retrospective chart review of 207 patients who had undergone tonsillectomy and/or adenoidectomy as daycare procedure in Aga Khan University Hospital, Karachi, between January 2008 to March 2009 was done. Demographic data as well as complications requiring unplanned admissions were recorded. Any emergency room visit in the first 24 hours was also noted. Telephonic calls were then made to collect the first 24-hour, postoperative data in order to know if there were any complications requiring visit to some nearby health facility. All data was analysed using …

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.

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 …

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.

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 …

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 …

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 …