Outcome of Thyroid Surgeries at Patan Hospital

Objective: To assess the outcome of thyroid surgeries at Patan HospitalMaterials and Methods: It is a retrospective study of in-patient records of patients undergoing thyroid surgeries for various indications from April 2013 to January 2015 at Patan Hospital, Lalitpur.Results: During the period of 21 months, 75 patients underwent thyroid surgeries. Majority of patients underwent hemithyroidectomy (35) followed by total thyroidectomy (28), subtotal thyroidectomy (7) and completion thyroidectomy (5). Out of 28 patients undergoing total thyroidectomy (TT), 11 underwent central compartment clearance (CCC), 5 underwent CCC and lateral neck dissection. Among 5 patients undergoing completion thyroidectomy, CCC was performed in all cases and in one patient lateral neck dissection was also performed. A total of 13 patients developed unilateral recurrent laryngeal nerve palsy (RLN), among them 5 had permanent palsy. Tracheostomy had to be done in immediate postoperative period for stridor following total thyroidectomy (TT) in one case. Temporary hypocalcaemia was observed in 10 (10/28) cases following TT, out of which 8 had undergone CCC. Permanent hypocalcaemia was observed in 7 (7/28) cases following TT out of which 3 had undergone CCC. Chylous leak occurred in one of the patient undergoing left level II-IV neck dissection which was managed conservatively. None of the patient had to be transfused postoperatively.Conclusion: Complications to thyroid surgery are not uncommon. Visualization of recurrent laryngeal nerve alone in our context is adequate in experienced hands. Identification of parathyroid during thyroidectomy is recommended to avoid hypocalcaemia. Meticulous dissection can reduce the complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Comparison of corrected serum calcium changes following thyroid and non thyroid neck surgeries

Objective: To compare the corrected serum calcium changes following thyroid and non thyroid neck surgeries.Material and Methods: It was a prospective, longitudinal and comparative study, done in Ganesh Man Singh Memorial Academy of ENT and Head and Neck Studies, Tribhuvan University, Teaching hospital, Kathmandu, Nepal. Convenient sample size was taken of patients undergoing thyroid and non thyroid neck surgeries under general anaesthesia, between 1st November 2009 to 30th April 2011.Result: Total 87 cases were included which comprises 41 cases of thyroid and 46 cases of non thyroid neck lesions. Total females in thyroid cases were 39 out of 41 and in non thyroid cases 25 out of 46. The mean corrected calcium in thyroid cases were 2.04 ± 0.07, 1.75 ± 0.26, 1.92 ± 0.16 and 2.00 ± 0.07 in pre-operative, recovery room (immediate post-operative), post-operative day-1(POD 1) and post-operative day-4(POD- 4) respectively. The mean calcium changes in non thyroid cases were 2.04 ± 0.09, 1.89 ± 0.19, 1.94 ± 0.13 and 1.99 ± 0.04 in pre-operative period, recovery room (immediate post-operative), post-operative day-1(POD-1) and post-operative day-4 (POD- 4) respectively. In both thyroid and non thyroid group, the calcium drop was statistically significant (< 0.05) in recovery. Rest were not significant statistically. The mean differences from pre-operative to recovery and preoperative to POD-1 corrected calcium changes were also significant in both thyroid and non thyroid groups. The mean difference between preoperative to POD-4 was not significant in both groups.Conclusion: After comparing the corrected serum calcium changes following thyroid and non thyroid neck surgeries, the transient post-operative hypocalcaemia is not a thyroid surgery dependent phenomenon. Haemodilution is the main factor for hypocalcaemia in immediate postoperative period in all major neck surgeries.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Drug Allergy

Not available.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

An Overview of Facial and Head and Neck Trauma at Patan Hospital

Objective: To find out the prevalence of various types of head and neck trauma.Material and Methods: This retrospective study was done in the department of ENT and HNS, Patan Hospital, PAHS. Charts were retrospectively reviewed for total 61 inpatients with a diagnosis suggestive of head and neck trauma from August 2013 to January 2015. Data was collected for age, sex, address, type of admission (emergency/OPD), mechanism of injury, site of injury , imaging including X-rays/CT scan wherever applicable and results, surgical therapy, type of anesthesia, hospital admission duration, complications, and follow-up and analyzed.Result: Males were common than females (62.3% vs. 37.7%). Fall was the most common mode of injury (100%) in both pediatric and elderly population and in adults RTA (42.10%) was the most common mode. In the type of injury most common in pediatrics was oral cavity and oropharyngeal injury (47.60%), in adults facial soft tissue injury (STI) and facial fractures (42.10%) were equally common and in geriatrics it was (100%).Conclusion: Adult males were prone to head and neck trauma mostly sustaining soft tissue injury (STI) and fractures due to RTA and physical assult. Injury to oral cavity and oropharynx and STI due to fall is common in extreme of ages. Though the management out comes were good and no grave complications were reported in this study.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Parathyroid Adenoma Presenting with Recurrent Abdominal Pain and Renal Calculi

Introduction: Parathyroid adenoma is the single most common cause of hyperparathyroidism. Reported incidence of parathyroid adenoma varies widely and is 30- 90%. Approximately 80% to 85% of patients with primary hyperparathyroidism were found to have solitary parathyroid adenoma.The hyperparathyroidism due to parathyroid adenoma may progress insidiously over several years and eventually presents as renal colic or symptoms may manifest over a considerably shorter period of time. Greater than 50% of patients present with nephrolithiasis or nephrocalcinosis. The present case report describes a 48 year old male patient with symptoms of abdominal pain.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Primary Squamous Cell Carcinoma of Thyroid: A case Report

Background: The thyroid gland lacks the squamous cell and the primary squamous cell carcinoma (SCC) of the thyroid gland is an uncommon malignancy with less than 1 % of all thyroid malignancy with a very poor prognosis. So far few cases are reported in the literature with very low survival rates.Case report: A 60 years female presented with a rapidly enlarging right lobe of the thyroid with pain, dysphagia and hoarseness of two months duration. She had hard fixed 4cm x 4cm right lobe of thyroid with right vocal cord paralysis. Ultrasound demonstrates 36mm x 36mm right lobe with mixed echogenicity with calcifications. Fine needle aspiration cytology suggested anaplastic carcinoma. Computed tomography showed heterogeneously enhancing soft tissue density in the right lobe of the thyroid gland measuring 51mm x 37mm x 53mm with shifting of the trachea towards the left side with no significant cervical lymph nodes. CT chest, ultrasonography abdomen and pelvis did not reveal any primary lesion or other metastatic disease and stage was made as T4N0M0. Patient underwent total thyroidectomy with center neck clearance with temporary tracheostomy. Histopathology came out to be squamous cell carcinoma and patient was send for chemo-radiotherapy.Conclusion: Primary squamous cell carcinoma of thyroid is a rare and aggressive entity with poor prognosis. Fine needle aspiration cytology is effective confirmatory tool but efforts shall be made to rule out metastatic SCC originating from other sites. Surgery, radiotherapy and chemotherapy alone are ineffective. Aggressive treatment with surgery followed by adjuvant radiotherapy with or without chemotherapy is recommended to achieve better outcome.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Otogenic Intracranial Complications in Bir Hospital; an Eight Years Retrospective Review

Objectives: To review our experiences on intracranial complications secondary to otitis media and to compare the results with other studies.Material and Methods: A retrospective chart review of all patients with intracranial complications secondary to otitis media over eight years period in Bir hospital was done. Clinical presentation, radiological findings, microbiology, surgical management and antibiotics used were studied.Results: Forty eight cases were included in this study of which 23 had meningitis, 15 had brain abscess, 7 had lateral sinus thrombosis and 3 had petrositis. 37 of these were secondary to chronic otitis media and 11 were secondary to acute otitis media. Otorrhoea, headache, earache, fever, vertigo and vomiting were the main symptoms. Staphylococcus aureus was the most common bacteria isolated followed by Pneumococcus, Haemophilus influenzae and Klebsiella.Conclusion: Early recognition, multi drug treatment with broad spectrum antibiotic and multi disciplinary approach are the mainstay of management of otogenic intracranial complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Patterns of Facial Bone Fractures in Western Region of Nepal

Objective: The aim of this study was to determine pattern of facial bones fracture in western region of Nepal.Material and Methods: A descriptive cross sectional study was carried out in department of ENT, Nepalgunj medical college, Nepalgunj. Records from emergency department, inpatient ward and OPD of ENT and dental department of last 3 years (Jan 2012 to Dec 2014) were enrolled in the study and entered into proforma. Comparison was done between mode of injury, demography and types of injuries. Data was analyzed using SPSS 17 software.Results: Out of included 626 cases, there were 410 male patients and 216 female patients. Age ranged from 3 to 68 years with average age being 32.4 years. Most of the male patients sustained trauma due to road traffic accidents (51.7%) followed by physical assault (23.9%). In female also same mode of injuries were common with higher proportion due to physical assault. Majority of cases were from Midwestern Terai region (35.4%). There were 288(46.0%) cases with isolated facial bone fracture. The maximum was that of mandibular fracture (29.1%) followed by nasal bone fracture (27.7%) and maxilla (24.3%). Rest of 338 patients had multiple facial bone fractures with zygomatic bone fracture (79.2%) being commonest. It was followed by maxilla (64.4%) and mandible fracture (36.6%). The overall frequency of fracture is mainly involving zygomatic bone (49.5%) followed by maxilla (46.0%) and mandible (33.2%).Conclusion: Middle aged male patients are usually involved in facial bone fractures with road traffic accident and physical assault being common modes of injury. Zygomatic bone is the commonest bone to get fractured in isolated cases while mandible is commonest bone to get fractured in multiple fracture cases.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Short Term Versus Long Term Graft Uptake Rates Following Myringoplasty in Chronic Otitis Media–Mucosal Type

Objective: The objective of study is to compare overall success rate of myringoplasty after 6 weeks and 4 months following surgery.Materials and Methods: Retrospective analytical study was done at Lahan Ear Hospital, Nepal. All the data were collected from the operative notes of Lahan ear hospital which were done in-between August 2010 to October 2012 for a period of 26 months. All Myringoplasty were done under local anesthesia using either temporalis fascia or Tragal cartilage. Outcome measured was the graft uptake rate at the end of 6 weeks and end of 4 months.Results: Total of 978 patient underwent Myringoplasty during the period of 26 months. The mean age was 24.4 years, minimum age who underwent surgery was 15 years and maximum age was 60 years. 571 patients completed 6 weeks follow up and only 419 patient completed 4 months follow up. The overall graft uptake rate was 82 % and 78 % by the end of 6 weeks and 4 months respectively.Conclusion: The overall graft uptake rate was 82 % by the end of 6 weeks which further decreased to 78% by the end of 4 months.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Otorhinolaryngological Problem in Geriatric Population

Objective: The main objective of the study was to identify various geriatric otolaryngological problems in mid western part of Nepal.Materials and methods: A cross-sectional descriptive hospital based study was done from 1st January 2014 to 1st September 2014 among the all patients 60 years or above visiting the outpatient department of ENT/Emergency department of Nepalgunj Medical College. Data collection was done via interviewing with semi structured Performa with questionnaire. Data was entered in SPSS 17th version and exercised the analysis.Results: Among the total 866 geriatric population, female were 450 while 416 were male. Age ranged from 60 to 96 with average age of 70.3 years. Maximum numbers of elderly were of 60-70 years. Farming was the most common occupation in past. Sixty one percent (289) were smokers or tobacco chewer and 23% (106) consumed alcohol regularly. Majority of elderly had Hypertension as main co morbid condition. Decreased hearing was major complaint (82.6%) which was present for on an average 10.5years. Second leading ear problem was tinnitus (47.7%). Regarding nasal problems, bleeding nose was commonest (21.5%) followed by equal proportion of decreased smelling and nasal blockage (16%, 16.2%). Snoring was the frequent throat problem (58.4%) with average duration of approximately 6 years, followed by day time somnolence (16.6%).Conclusion: Among the ENT problems, hearing problem was the most common problem of these elderly. Nasal bleeding was common nasal problem presented among approximately one fourth of elderly. Among the throat problem snoring was the most prevailing with more than fifty percent occurrence. Occasional aesthetical complaint is very common. Head and neck malignancy was least common in these aged populationsNepalese Journal of ENT Head and Neck Surgery, Vol. 5, No. 2, 2014, Page: 23-25