ObjectiveTo determine the accuracy of transoral flexible laryngoscope (TFL) biopsy and also to identify the safety as office based procedure in terms of complications.MethodsThis is a diagnostic study; the type of intervention is outpatient department based biopsy of laryngeal lesions. All patients seen in ENT outpatient department of Lyari General Hospital with suspicious lesions of Larynx were referred for Transoral Flexible Laryngoscopy Biopsy under local anesthesia. The specimens were sent for histopathology. The patients with benign pathology or carcinoma in situ were referred for direct laryngoscopy and biopsy. The sensitivity and specificity were calculated and the frequencies of complications were monitored to determine the complication rate.ResultsDuring the course of study a total of 47 patients underwent TFL biopsy in office settings. Out of these patients 16 patients were referred for direct laryngoscopy biopsy. The study population included 32 men and 15 women with ages ranging from 28 to 52 years and mean of (39 ± 6) years. Among 43 patients squamous cell carcinoma was the final diagnosis in 31 patients. In the rest of 12 patients’ dysplasia and benign lesion was the diagnosis in 9 and 3 patients respectively. These 12 patients underwent direct laryngoscopy biopsy and 10 of them diagnosed with invasive carcinoma rest had benign lesions. Hence the specificity was 75.6% and sensitivity was 100%. None of the patients developed any serious complication.ConclusionsAll patients with a suspicious lesion diagnosed by TFL biopsy as being benign or carcinoma in situ should have direct laryngoscopy for verification of the findings. But the results positive for carcinoma are reliable. In addition, this is a safe procedure.
Sinonasal malignancies are said to be a highly heterogeneous group of cancers, accounting for less than 1 % of all cancers and less than 3 % of all upper aerodigestive tract tumors. Originating from any histologic components of the sinonasal cavity, the histopathology of these tumors is diverse. Accordingly, treatment options vary, surgery being the mainstay in most of them. Recurrence rates differs with each histological type of tumor, dependent on various factors. In this article, we have tried to identify the prevalent characteristics of sinonasal malignancies and to outline the prognostic factors affecting the outcome. It is a retrospective study design with a total number of 102 patients. Patients diagnosed with sinonasal malignancies were included and any patient previously operated outside our institute or having received prior radiation or chemotherapy were excluded. The patients were selected over a period of 10 years, from 2000 to 2010. Data was analyzed using SPSS 17. Majority of the sinonasal tumors were squamous cell carcinomas involving the maxillary sinus. Locoregional recurrence was found to be more frequent in patients with positive neck nodes on final histopathology. Sinonasal malignancies are mostly squamous cell in variety and recurrence of these rare entities is dependent on the histological variety and the presence of positive neck nodes.Keywords Sinonasal malignancy Á Locoregional recurrence Á Squamous cell carcinoma Á Positive neck nodes Malignant lesions involving the sino-nasal tract account for 0.2-0.8 % overall and 3 % of all head and neck malignancies [1]. Approximately 55 % of these lesions are carcinomas with involvement of neck nodes in 7-15 % of the conditions. Treatment involves a wide variety of modalities, including surgery, radiotherapy, and chemotherapy, alone or in combination, however, there is still great controversy about the ideal treatment [1,2]. In 2003, the American Joint Committee on Cancer (AJCC) published the sixth edition of the sino-nasal tumor staging system [3]. This was in contrast to the fifthedition staging system of sino-nasal cancer in which the surgically resectable tumors and non-resectable tumors were all grouped together in the T4 stage [4]. As a result it was difficult to evaluate the results of surgery and a newer staging system was introduced.Despite these improvements, the fact is that there is no widely accepted staging system for tumors of the nasal cavity and ethmoid/sphenoid sinuses. The AJCC tumor stage classification only includes the maxillary sinus [5]. As obvious, this proves difficulties in tumors involving multiple sites in which the primary originating site is difficult to identify.We analysed retrospectively our 10 years experience of managing sino-nasal tumors, with a series of 63 patients.
Variations in thyroglossal duct cysts (TGDCs) between children and adult are mentioned very little in literature. The lesion mostly found in children but adult population also possesses this anomaly. The aim of this study was to determine the differences in clinical presentations and surgical outcomes of TGDC between children and adults. A retrospective chart review of all patients with TGDCs managed in our hospital from July 2004 to June 2014. All records were reviewed for age, sex, location of cyst in neck and with relation to hyoid bone, size, postoperative complication and recurrence rates. Differences between children and adults were assessed. A total of 39 patients (21 children and 18 adults) were treated for TGDC. Of the pediatric group, 71.4% were male and 28.5% were female, whereas 72.2% of the adults were male and 27.7% were female. Adults were more likely to develop other complaints like neck pain, dysphagia and dyspnea. Position was almost similar in both age groups with midline and infrahyoid location while laterality was seen in adult only. Size of Cyst was found to be larger in adults. The recurrence and post operative complication rates between children and adults were not significantly different. TGDC has male predominance. Clinical presentations were almost similar in both age groups. Although lateral deviation, increase size of cyst and recurrences were seen in adults only, Sistrunk procedure is recommended as a safe and standard surgical treatment in both age groups.
Objective: Background: Surgical management of cerebrospinal fluid (CSF) rhinorrhea can be done through a transcranial approach or endoscopically using a transnasal approach. The endoscopic technology is relatively fresh in developing countries. Keeping this in mind we conducted an audit of patients undergoing endoscopic repair of CSF leaks to review their outcome in terms of recurrence and complications and compare them with the patients had transcranial repair. The objective of the study is to review the management of patients who underwent repair of CSF rhinorrhea at Lyari General Hospital, Aga Khan University Hospital and Memon Medical Institute Hospital – 10 years experience. Study design: Cross-sectional observational study Place and duration of Study: Lyari General Hospital, Aga Khan University Hospital and Memon Medical Institute Hospital, from January 2005 to December 2014 Patients & methods: A review of patient charts having undergone surgical repair for CSF rhinorrhea in the last 10 years at our institution was conducted. Thirty eight patients meeting the inclusion criteria of having undergone a surgical procedure for the repair of CSF rhinorrhea with a minimum post operative follow up of 6 months were included in the study. Results: Skull base defects were repaired with the help of minimally invasive transnasal endoscopic approach with a success rate of 80% in comparison to transcranial repair success rate of 29%. Post-operative complications were seen in only 10% of endoscopic group and 53% of transcranial group. Conclusion: Although endoscopic management is associated with better outcomes there is room for improvement in the approach in developing countries and training programs and detailed internal audits need to be conducted to improve the situation to the level of developed countries.
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