Early presentation of traumatic pseudoaneurysm of deep lingual artery as a massive oral bleed

Tongue trauma with active bleed is most commonly due to the ruptured lingual artery and its branches, whereas delayed haemorrhage is usually secondary to pseudoaneurysm formation. This case is a unique presentation of traumatic tongue bleeds with early formation of pseudoaneurysm of a lingual artery branch. We present our experience in its management. A contrast-enhanced CT (CECT) with angiography detected right deep lingual artery pseudoaneurysm, which was managed by endovascular gelfoam embolisation followed by tongue laceration repair. Tongue bleed stopped immediately post embolisation; tongue viability and functions restored on postoperative day 1 of repair. No complications like secondary haemorrhage or tongue necrosis were noted at 1-month follow-up. High index of suspicion for lingual artery and/or its branch pseudoaneurysm is crucial in acute and uncontrollable traumatic tongue bleed. A CECT is a minimum norm in early diagnosis. Choice of management is the cornerstone of a successful outcome.

EFFICACY OF STEROID AND PROTON PUMP INHIBITORS IN PATIENTS UNDERGOING TONSILLECTOMY - A COMPARATIVE STUDY

INTRODUCTION: All tonsillectomy techniques share the same characteristics of producing an avulsion wound exposing the underlying tissues which requires extensive healing by secondary intention. our study aims to compare two pharmacological agents and analyze their clinical outcome in post operative recovery of tonsillectomy patients. MATERIALS AND METHODS: Patients were randomly divided into two groups- Group A and Group B. Group A received Injection Dexamathasone, while group B received oral pantoprazole. Post operatively patients were assessed for post operative pain, wound healing and incidence of secondary hemorrhage on Post operative Day (POD) 0, 1, 7, 14. RESULTS: Group A (steroid) had comparatively less pain on POD 0 and POD 1. However there was no significant differnence between both the groups on POD 7 and 14. Incidence of secondary haemorrhage was seen in Group A (2%), but no incidence of haemorrhage was recorded in Group B. Both the groups did not show statistically significant difference in regards to wound healing. DISCUSSION: Tonsillectomy as a surgical procedure has evolved over the years. Our study took into account two pharmacological agents, dexamethasone and pantoprazole which act by different mechanism and measured their clinical outcomes in managing post tonsillectomy patients. CONCLUSION: The study concluded that there was no significant statistical difference between the two drugs in alleviating postoperative pain, wound healing and secondary haemorrhage.

Isolated convergence-retraction nystagmus secondary to intralesional haemorrhage of a pineal cyst: an easily missed neurological finding with potentially life-threatening consequences

This case report describes a patient who presented to the emergency department with intermittent visual disturbance and was found to have convergence-retraction nystagmus. This occurred in the setting of supratherapeutic anticoagulation on warfarin for an aortic dissection graft repair. Urgent imaging demonstrated haemorrhagic transformation of a previously identified incidental pineal cyst. After close monitoring given the risk of secondary hydrocephalus, the patient was discharged in stable condition with symptom resolution and without any further significant complications. This case report highlights the importance of identifying subtle clinical findings and the risk of secondary haemorrhage of pineal cysts when on anticoagulation. While the risk of secondary hydrocephalus is a significant concern, clinically stable patients can be followed without need for neurosurgical intervention.

Comparison of tonsillectomy by coblation and tonsillectomy by conventional method

<p class="abstract"><strong>Background:</strong> Operations on tonsils and adenoids are performed since many years. Tonsillectomy produces an open wound that heals by secondary intention. Tonsillectomy is still a very common surgical procedure. There are various modalities to perform surgery (diathermy, laser, harmonic scalpel, radiofrequency cautery, cryosurgery and coblation). Among these, dissection and snare method are commonly done by ENT surgeons.</p><p class="abstract"><strong>Methods:</strong> We carried out the prospective cross-sectional study to compare intraoperative blood loss, time taken for the surgery, post-operative pain score, degree of slough formation and complications between these two methods. </p><p class="abstract"><strong>Results:</strong> Average time for surgery on coblation side was less (15.1 min) than conventional side (36.04 min). For haemostasis on conventional side, all patients required bipolar cauterization while on coblation side only 8 patients (16%) required hemostasis. Average blood loss on coblation side (left) was 3.40ml while on conventional side (right) 25.57 ml. In my study, mean pain score on 1st day, 2^nd day, 5^th and 10^th day of surgery was 6.18, 4.10, 2.30 and 1.64 on conventional side and 4.36, 3.00, 1 and 0 on coblation side. In my study, only one patient had Secondary haemorrhage on conventional side on 7^th day.</p><p class="abstract"><strong>Conclusions:</strong> The use of coblator reduces the time required for surgery, per-operative blood loss is very much less, chances of damage to surrounding structures are less, charring of tissue is less, post-operative severity of pain after 24 hours is very much less than that of dissection method. Slough formation was more on coblation side as compared to conventional side.</p>

Comparative study on Post Tonsillectomy use of Antibiotics and Placebo

Tonsillectomy is the most frequently performed surgical procedure in Otolaryngological practice. We included 110 patients and divided into antibiotic group and placebo group, and followed up upto 7th POD. Parameters of observation were pain, fever, nausea & vomiting, reactionary & secondary haemorrhage, duration of hospital stay and return to normal diet. The result of this study showed that post operative pain and return to normal diet improved in antibiotic treated group than those who received placebo, but there is no statistically significant difference between two groups in respect of fever, nausea & vomiting, reactionary & secondary haemorrhage and duration of hospital stay. Bangladesh J Otorhinolaryngol; October 2017; 23(2): 153-158

Comparison of postoperative complications of tosillectomy, adenoidectomy and adenotonsillectomy

Tonsillectomy with or without adenoidectomy is a commonly performed ENT operation over the world, also in our country. Though the operation takes less time and postoperative complication is uncommon but its postoperative complication specially the reactionary haemorrhage as well as secondary haemorrhage is life threatening which heralds immediate appropriate and adequate intervention. So, not only the meticulous surgical procedure rather each and every surgeon should not leave any stone unturned regarding preoperative, peroperative and postoperative care to prevent postoperative complication. More and more study regarding postoperative complication(s) of tonsillectomy or adenoidectomy or adenotonsillectomy operation should be carried out to increase awareness and consciousness among the ENT surgeons. Bangladesh J Otorhinolaryngol; April 2016; 22(1): 40-47

Bloodless Medicine and Surgery: A Review of Practice and Consideration of Jehova Witnesses

Blood transfusion plays important role in medical and surgical practice and has been employed in varying medical and surgical procedures. An increasing amount of literature concerning blood conservation, restrictive transfusion strategies, pharmacological manipulation of the haemostatic and fibrinolytic systems, minimal invasive surgery, local haemostatic agents and guidelines for blood transfusion, is being published each year. This review aims to summaries the key concepts of bloodless medicine and surgery, offer a practical guide on how to approach such cases and outline currently available approaches to manage anemia or bleeding in patients. The standard practice is to keep vigilance to the possibility of reactionary or secondary haemorrhage. Continued bleeding is aggressively managed by postoperative blood salvage, or surgical intervention to stop haemorrhage. A multidisciplinary effort therefore has to be made through the entire chain, from the outpatient clinic through discharge from the hospital, with the utmost exertion of all team members in which surgeons play a key role and the medical laboratory scientist in the adaptation of bloodless surgery program.

Immediate and delayed complications of adenotonsillectomy

<p class="abstract"><strong>Background:</strong> Tonsillectomy with or without adenoidectomy is the commonest pediatric otorhinolaryngological procedure. The aim of the present study was to compare the intraoperative (immediate) and postoperative (delayed) complications between in conventional and coablation tonsillectomy in children.</p><p class="abstract"><strong>Methods:</strong> This observational study was conducted among 100 children between 5 and 15 years who had conventional tonsillectomy and 50 children who had coblation tonsillectomy. Intraoperative and postoperative complications were observed and compared between two groups. </p><p class="abstract"><strong>Results:</strong> Of the total 150 children, 64 (42.7%) were males and 86 (57.3%) were females with mean age of 9.42±2.67 years. Common preoperative symptoms were odynophagia (96.0%), throat pain (95.3%) and difficult swallowing (89.3%). Among the intraoperative anesthetic complications, compression of endotracheal tube was observed in 19 (12.7%), accidental extubation in 10 (6.7%) and dislodging of loose tooth in 9 (6.0%) patients. Regarding intraoperative surgical complications, primary hemorrhage was seen in 43 (28.7%), edema uvula in 39 (26.0%) and pillar injury in 33 (22.0%) patients. Commonest postoperative complication was oropharyngeal pain (18.7%) followed by primary hemorrhage (14.0%) and nausea, vomiting (13.3%). Immediate complications like primary haemorrhage (p value 0.0001) and uvula edema (p value 0.018) were significantly associated with conventional tonsillectomy group while delayed complications like secondary haemorrhage (p value 0.011) and referred otalgia (p value 0.0001) were with coblation tonsillectomy group.</p><p class="abstract"><strong>Conclusions:</strong> Compression of endotracheal tube and primary hemorrhage were the commonest intraoperative anesthetic and surgical complication respectively. Immediate complications were significantly associated with conventional tonsillectomy group while delayed complications were with coblation tonsillectomies.</p>