A comparative study of endoscopic myringoplasty versus microscopic myringoplasty at tertiary care center

BACKGROUND AND OBJECTIVES

Myringoplasty is a surgical procedure performed to repair tympanic membrane perforation which can be performed either using a microscope or an endoscope. The aim of this study is to compare the graft uptake, hearing outcome and operative time of endoscopic myringoplasty (EM) versus microscopic myringoplasty (MM) by underlay cartilage island graft technique.

SUBJECTS AND METHODS

In this prospective comparative study of sixty patients divided into two equal groups with small to medium sized tympanic membrane perforation were included. Tragal cartilage was used as graft material. Both the groups underwent myringoplasty by underlay cartilage island graft using endoscope (n = 30) and microscope (n = 30). The study was conducted between February 2022 to May 2023 after taking ethical approval from IRC of Nepalese Army Institute of Health Sciences. All patients were followed up on 7th postoperative day (POD), 1 and 3 months after surgery.

RESULTS

Graft uptake in was 90 % (27/30) in MM group and 93.33 % (28/30) in EM group. Mean operating time was more in MM group (66.46 ± 6.78min) than EM group (64.53 ± 6.6 min). The improvement in Air Bone Gap (ABG) was better in EM group (12.46 ± 6.58 dB) compared to MM group (10.9 ± 9.01 dB). The differences in graft uptake, operating time and improvement in ABG were not statistically significant.

CONCLUSION

The study concludes that it does not matter which approach is used, good results are predictable and choice of the tool used is up to the individual surgeon.

Giant Cell Tumor of Mandible : A Case Report

Giant cell tumor is locally aggressive primary benign neoplasm of bone with tendency of frequent recurrence, metastasis and malignant transformation. Because of the rarity of the disease involving mandible, no definite treatment guideline is established. Surgical treatment is the treatment of choice for giant cell tumor. Due to its proximity to vital structures including skull base, the recurrent disease associated with less invasive procedure could be difficult to manage while more invasive procedure will result in higher morbidity and complex reconstruction. Medical management with denosumab or zoledronic acid has been advocated in surgically unresectable disease. We present a rare case of giant cell tumor of mandible. Patient was a 33 years old lady who presented with gradually progressive painful swelling in chin. After exclusion of distant metastasis by F-18 FDG PET scan, she underwent en-bloc resection of the tumor with free fibula flap reconstruction. During 6 months of follow up visit patient had no recurrence.

Giant Parathyroid Adenoma: A case Report

Giant parathyroid adenoma (GPA) is a large tumor weighing more than 3.5 g but can weigh as much as 110 g as compared to parathyroid adenomas which usually weigh in the vicinity of 1 g and measure around 1-2 cm. These mainly present with primary hyperparathyroidism. We describe an interesting case and clinical course of a young woman with giant parathyroid adenoma. A 30-year-old Indian female presented with acute pancreatitis and acute kidney injury and was found to have hypercalcemia and hyperparathyroidism on further evaluation. Her physical examination revealed firm, non-tender, and mobile swelling of size 5 × 2 cm on the left side of her neck. USG neck showed a large heterogenous hypoechoic lesion in the left lower pole region of the left thyroid gland measuring 50 × 24 × 29 mm with a volume of 18 ccs. A parathyroid scan was performed using 99Tc Sesta MIBI tracer which was suggestive of a large adenoma in relation to the left lobe of the thyroid gland. She underwent minimally invasive parathyroidectomy with excision of left parathyroid adenoma under general anesthesia. Intraoperative frozen section confirmed the specimen to be parathyroid tissue. Her parathyroid hormone (PTH) level decreased from 1900 pg/ml in the pre-operative level to 242 pg/ml in the immediate postoperative period.

Comparison Between Harmonic scalpel and Cold dissection in Tonsillectomy at Shree Birendra Hospital: A Retrospective Study

Introduction: Tonsillectomy is the most common surgery performed by otorhinolaryngologist worldwide. It is a surgical procedure of removing tonsil with commonest indications for recurrent tonsillitis and tonsillar hypertrophy. The two most important complications of this surgery are bleeding (intraoperative, postoperative) and postoperative pain. Various surgical techniques have been developed to minimize this complication. Harmonic scalpel is an ultrasonically activated surgical device which can coagulate and cut vessels and tissues at a very low temperature. This study was conducted to compare the operative time, intraoperative blood loss and early post-operative pain between Harmonic scalpel and cold dissection tonsillectomy. Methods: This was a retrospective study conducted in ENT and Head and Neck Surgery department of Shree Birendra Hospital, Chhauni, Kathmandu from July 2018 to July 2019. Each patient was assessed by ENT Head and Neck Surgeon. Clinically diagnosed recurrent tonsillitis and tonsillar hypertrophy were included in the study. Those with age < 14 years, acute infection, obstructive sleep apnoea syndrome, adenoid hypertrophy, nasal pathology, cleft, history of bleeding disorders, inability to give informed consent, individual who would have difficulty communicating their pain levels, any chronic illness was excluded. Results: Out of 50 patients, 33(66%) were males and 17(34%) were females. The operative blood loss in harmonic scalpel was lesser (21.89 ± 8.89 ml) than in cold dissection group (49.74 ± 19.69 ml) which was statistically significant (p value = 0.000). The operating time in harmonic scalpel group was longer (8.48 ± 4.58 minutes) than in cold dissection group (8.14 ± 2.01 minutes). Pain on the early postoperative period (3 hours post-surgery, 1st and 2nd postoperative day) was lesser in harmonic scalpel group 68% (34/50) than in cold dissection group 32% (16/50). Conclusion: Harmonic scalpel is easy to use instrument which reduces intra-operative blood loss and post-operative pain as compared with cold dissection method.