Endoscopic Transnasal Repair of Cerebrospinal Fluid Leakage: Experience in BSMMU

Endoscopic transnasal repair of CSF rhinorrhoea is gaining popularity around the world because of its tremendous success rate but it depends on defect site, size, technique of repair, experiences of surgeon and also patient's profile. Aim of this study was to analysis of surgical outcome of endoscopic transnasal repair of CSF rhinorrhoea. A retrospective study carried out in the department of ENT and Head neck surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU) from January 2018 to December 2019. Of the total of 24 patients 16(66.0%) were female and 8(33.0%) males. The commonest site of the leak was in the cribriform plate in 18(75.3%) followed by 5(20.8%) in the fovea ethmoidalis, and 1(4.0%) in the sphenoid sinus, the overall success rate of this series with first surgical procedure was 95.83% and 100.0% with a second procedure. Meticulous pre-operative evaluation, proper identification of leakage site, choice of graft materials and surgical technique are keys to attaining excellent results.

A Modified Technique in Submandubular Salivary Gland Excision: Preservation of Facial Artery

Cutting and ligation of facial artery is the conventional practice for excision of submandibular gland. Facial artery is the main arterial supply to the lower face. Its preservation results in preservation of large proportion of vascularity to the lower face, preserves vascularity of platysma myocutaneous flap, allows repair of lower lip using Bernard's technique; facial artery is one of the most important recipient artery for microvascular free flap in modern reconstructive surgery in head and neck oncology. This prospective study was carried out in Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University Hospital (BSMMU), Dhaka, Bangladesh from October 2005 to October 2012 on 31 cases. Chronic submandibular sialoadenitis, benign submandibular gland tumours and cases of neck dissection where level I cervical lymph nodes were not involved by metastasis were included in this study. The facial artery was identified proximal to the gland and was dissected free from the gland by ligating or cauterizing its glandular branches to mobilize the gland. Appropriate anatomical aspects were noted and the time required for separation of the artery from the gland was recorded. Thirty-one consecutive cases were studied. The indications were chronic sialoadenitis (67.7%), pleomorphic adenoma (12.9%) and as a part of neck dissection for oncologic clearance of neck (19.4%). The mean duration of time for separation of the artery from the gland was 10.26 minutes. In two cases the facial artery could not be safely separated due to excessive adhesion from chronic inflammation. No significant complications were noted. Preservation of facial artery in submandibular gland excision is a simple procedure. So it should not be routinely sacrificed during this surgery.

Complications of endonasal endoscopic sinus surgery for management of nasal polyp and chronic sinusitis

Sinusitis is defined as a condition manifested by inflammation of the mucous membrane of the nose & paranasal sinuses, fluid within this cavities and or underlying bone. Chronic rhinosinusitis is diagnosed by the presence of two or more of the following factors facial congestion/fullness, nasal obstruction, nasal discharge or discolored post nasal drainage, hyposmia/anosmia or one major and two of the following minor factors, headache. Halitosis, fatigue, dental pain, cough, ear pressure, fullness. The use of endoscope during surgery of nose & para nasal sinuses improves visualization enable greater preservation of normal structures and reduces the necessity for wide exposure. This cross-sectional study on 50 cases of chronic rhinosinusitis carried out during a period of 6 months. All the cases of both endonasal endoscopic sinus surgery (EESS) group and conventional group assessed clinically endoscopicaly and by imaging both pre and post-operative period. Twenty five cases were EESS group. Twenty five cases of conventional group. Follow-up frequencies are 1st week, 2nd week, 3rd week, 1st month, 3rd months, 6th months. In both type majority of patients in between 21-40 years, most of the cases were male, majority of patients present with headache (80)%, nasal discharge (70%), nasal obstruction (62%), major indication incase of EESS group were ethmoidal polyp 52% & conventional surgery group were chronic sinusitis (56%). Commonest complications were cheek swelling 10(40%) incase of conventional group, crusting 12(84%) in EESS group. Complete recovery incase of EESS were in 21(84%) cases and conventional surgery group 16(64%). Endonasal endoscopic sinus surgery has provided a safe & efficient method for dealing with different sinonasal diseases.

Comparative study of outcome of the endoscopic sinus surgery and conventional surgery for nasal polyposis

This is a cross-sectional study done in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College & Hospital (DMCH) & Bangladesh Institute of Research and Rehabilitation of Diabetic Endocrine and Metabolic Disorder (BIRDEM), Dhaka during the period of January 2009 to August 2010. This study included 60 cases of nasal polyposis, among them in 30 cases Functional Endoscopic Sinus Surgery (FESS) was done and in 30 cases conventional surgical procedure was done as treatment procedure. Here mean age of patient in FESS was 45.43 years and in conventional surgery was 45.13 years and male female ratio was 3.3:1. In this study postoperative complication of FESS were found in 07(23.33%) cases whereas in conventional surgery it were in 16 (53.33%) cases (p = <0.01, df = 1, Chi-squire = 7.65). In case of outcome, complete relief of symptoms occur in 22(73.33%) cases by FESS and 14(46.66%) cases by conventional procedure (p = <0.05 df = 2, Chi-squire = 9.29). In FESS 22(73.33%) cases and in conventional technique 14(46.67%) cases discharged within 24-48 hours (p = <0.05, df = 1, Chi-squire = 4.44). Recurrence after FESS was 6.67% cases and conventional surgery was 30% cases. The results of this series reveled that FESS had the combined advantages of precise removal of the disease with minimal complication.

Endoscopic dacryocystorhinostomy

Dacryocystorhinostomy (DCR) is the treatment of distal nasolacrimal duct blockage. It has got many advantages of over external DCR with higher patient's acceptance. Twenty one consecutive cases of endoscopic DCR were studied during the period of two and a half years with a mean follow up period of 13.12 months (SD=7.05). The mean age of cases was 42.95 years (SD=14.49). In most of the cases the cause was either idiopathic (71.43%) or inflammatory (23.81%). The techniques used for making bony window were chisel-hammer (19.50%), powered drill (23.81%), Kerrison punch forceps (14.29%) or combination of powered drill and Kerrison punch forceps (42.86%). Silicon stent was used in 71.43% cases. There was no significant peroperative complication; premature extrusion of stent (4.76%), synaechia (9.52%), excessive granulation tissue formation (9.52%) and stomal stenosis with recurrence of symptoms (9.52%) were the complications noticed here. Anatomical success with patent stoma was observed in 90.48% cases but symptomatic improvement with dry comfortable eyes were seen in 86% cases. There was no statistically significant difference of outcome between this study and that of recently published studies (p>0.05). Some comparative studies showed both higher and lower success rates of endoscopic DCR than external procedure but there was no significant difference (p>0.05).

Outcome of management of differentiated thyroid carcinoma

A prospective study was done on 93 cases of differentiated thyroid carcinoma to find out the outcome of management according to the protocol followed in the Department of ENT-Head and Neck Surgery of Bangabandhu Sheikh Mujib Medical University Hospital. Here Papillary carcinoma is more common (76.35%) than follicular carcinoma. Papillary carcinoma affected in the younger patients more commonly than the follicular carcinoma with a mean age of 34.37years (SD=12.81) for papillary carcinoma and 44.93 years (SD=16.01) for follicular carcinoma; but age as a risk factor showed no significant difference between two histological types (p>0.05). Female was the predominant sex with a ratio of 3.04:1. In this series majority of patients were categorized as high risk group (75.27%). There is strong association between histological type & risk group (P<0.05). High risk group is more common in follicular carcinoma (95.45% Vs 69.01%). There was a significant differences between the two histological types for extrathyroidal extention and distant metastasis as risk factors (p<0.01 and p<0.001); but tumour size and lymphatic metastasis showed no significant difference (p>0.05). All low risk patients were treated by hemithyriodectomy followed by life long thyroxine. All high risk cases were treated with total thyroidectomy with (35.71%) or without (62.86%) different types of neck dissection (according to the degree of lymph node involvement) followed by radioiodine ablasion and lifelong thyroxine therapy routinely. Overall rate of complication of thyroid surgery was 23.08%. The commoner complications were vocal cord palsy (5.5%), hypoparathyroidism (5.5%) and haemorrhage (4.4%). Less common complications were laryngeal oedema (2.2%), wound infection (2.2%), tracheal injury (1.1%) and death (2.2%). Many cases lost to follow up. Sixty seven cases (73.64%) responded well for follow-up. Mean duration of follow up was 3.40 years (SD=1.41). There was recurrence in thyroid remnant in 9.09% of hemithyroidectomy cases and were treated by completion thyroidectomy followed by radioiodine ablasion. Regional lymphatic metastasis was seen in six cases and was treated by different types of neck dissection. Recurrence at distal site was seen in 4 cases (18.18% of follicular carcinoma). These were treated by radioiodine ablation; two of them died during the period of follow-up.

Pattern of lymph node metastasis in supraglottic carcinoma

Objectives: To find out the frequency and distribution of lymph node metastasis in supraglottic carcinoma. Study Design: Cross sectional study. Methods: 50 cases are included in this study (male-45 and female-5) between the ages of 40- 80 years who were treated from September 2007 to February 2008. Study based on history, clinical, radiological, laboratory and histopathological examination. Results: Highest number of patients was in the age group 50-60 years. Male and female ratio was 9:1. Commonest occupational group was cultivators and most patients come from poor socio-economic class. Smoking was commonest (70%).Out of 50 patients 20 (40%) had their regional lymph node involved. Level-II lymph nodes were involved in higher number of cases. Nodes in advanced stage of involvement were found in most cases. Homolateral involvement of nodes was in most cases (84.21%). Most of the patients present with more than one symptom and the commonest presenting symptoms of supraglottic carcinoma was cough and irritation (90%) followed by dysphagia (76%) and change of voice (72%). Most of the supraglottic growth was exophytic in appearance. The common site involve (50%) in the study were aryepiglottic fold and arytenoids. 80% of patients were present with T2 tumours. Patients were staged according to the TNM feature. Most of the patients (40%) were in stage-III followed by stage-II (24%). Conclusion: Lymphadenopathy is present much higher frequency in supraglottic carcinoma than glottic carcinoma. Key words: Supraglottic Carcinoma; Lymph node DOI: http://dx.doi.org/10.3329/bjo.v17i2.8850 BJO 2011; 17(2): 110-116