Health care providers (HCP) of ENT and Skull base surgery are highly vulnerable and mostly infected by novel coronavirus as they have to examine and perform procedures directly in oral cavity, oropharynx, nose, nasopharynx, where coronavirus remains in plenty. ENT & Skull base surgeons need to do several aerosol generating procedures (AGP). Most of the endoscopic and microscopic ENT & skull base surgery are AGP; like-mastoid surgery, sinus surgery, surgery of pituitary, tympanomastoid paraganglioma, temporal bone malignancy, tracheostomy etc. All of we know, COVID negative by RT-PCR test is not always COVID negative. In COVID-19 pandemic-routine, even cancer surgeries are avoided or postponed for the sake of safety of HCPs. Moreover, in case of surgical emergency there's no way to refuse a patient for not having a report of COVID test. We thought about neutralizing or destroying the novel coronavirus from it's route of entry zone, as well as preventing aerosol to be transmitted in the air of OT. We designed a novel approach, i.e. 'POLIDON' (POLIDON = Polythene ? Povidone Iodine), which can be the solution for these patients as well as surgeons or HCPs of above mentioned specialties. Use of Povidone Iodine as mouthwash and nasal spray or irrigation for both patient and HCPs prior to surgery is proposed. Then, use of simple polythene as barrier drape of patient or operative area for prevention of spread of aerosol in OT during surgery is the other component. With the POLIDON' approach-all these ENT & skull base surgeries can be done with more safety and confidence.
Objectives: This study evaluates the incidence, Frequency and risk factors of complications in patients submitted to thyroidectomy for various benign and malignant lesion and to corroborate the results in relation to the extent of surgery in a Tertiary level hospital. Study design : An analytical study of 100 consecutive patients who underwent thyroidectomy for benign and malignant thyroid lesion. Material s and methods: The study was carried out at Department of ENT and Head-Neck surgery in Dhaka Medical College Hospital over a period of 1.5 years from January 2017 to June 2018. Data were collected from 100 patients who underwent thyroidectomies for various thyroid diseases at this center. Results: There were 80 females (80%) and 20 males (20%) with female-to-male ratio of 4:1, and The age range of the patients were 15 to 80 years, the mean age was 39.29 years. Preoperative diagnosis of benign and malignant pathologies was made in 86% and 14% cases respectively. Most common pathological diagnosis was colloid goiter 46%,nodular of cases, whereas papillary carcinoma accounting for 11% was the commonest malignant lesion .The types of thyroid operations done were as follows (Table-II). The commonest operation performed was hemithyroidectomy (45%). The overall postoperative complication rate was 17%.Temporary and permanent RLNI occurred in 3% and 2% respectively. The less common complications were wound hematoma, seroma formation, and superior laryngeal nerve injury. There was no mortality observed in this study. Conclusion: In conclusion, extent of resection, surgical technique and thyroid pathologic condition had a greater impact on the rates of postoperative complications. By developing understanding of the anatomy and the ways to prevent each complication, the surgeon can minimize each patient’s risk and can handle complications expediently and avoid worse consequence. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 108-113
BackgroundA live foreign body in trachea or bronchus is a very rare as well as life threatening condition. A bigger fish with irregular shape usually impacts at the oropharynx, hypopharynx or inlet of the larynx. But a small or flat, elongated foreign body may cross the glottis and enter into trachea and bronchus. We report a rare type of very long live fish in trachea and bronchus.Case presentationA 16-year-old Bangladeshi boy presented with severe respiratory distress and cyanosis with a history of live fish impaction in the throat. To relieve respiratory distress and secure life an emergency tracheostomy was carried out while a tail fin of a fish was seen through tracheostome directed to the right bronchus which was grasped with an artery forceps and pulled out of the trachea. Respiratory distress was relieved immediately. The fish removed from the trachea was locally known as Guchi Baim Fish (Macrognathus pancalus). It was about 16 cm long and about 2 cm wide at its central region.ConclusionLive fish lodging in the trachea and bronchus is an acute emergency condition. It is very difficult to diagnose and manage because of its presence in critical anatomical location. So a quick short history from accompanying persons especially about the type of fish is crucial to predicting the site of its lodgement in the airway as well as management plan. Avoidance of the tendency of holding the fish between teeth during fishing can prevent this life threatening condition.
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