Our Experience at Tertiary Medical College-Intralesional Injection of Triamcinolone Acetonide Versus Injection Verapamil Following Keloidectomy with Fillet Flap in Auricular Keloids

Keloid, which forms as an excessive tissue response to trauma to the skin, is a benign, hyperproliferative, recurrent growth of dermal collagen without a quiescent or regressive period throughout the process of wound healing. The aim of this study was to evaluate patient satisfaction with treatment and to compare the efficacy of intralesional injection of triamcinolone acetonide against verapamil after keloidectomy with fillet flap in auricular keloids. Our study was Duration based prospective observational study with a Duration of two years from June 2021 till May 2023 with study population inclusive of 50 patients aged between 20 and 70 years having recurrent keloid(s) over the pinna of any size or site. Keloidectomy with fillet flap and intralesional injection of trimcinolone acetonide was performed on 25 patients (30 keloids) in Group A, and keloidectomy with fillet flap and intralesional injection of verapamil was performed on 25 patients (30 keloids) in Group B. With a recurrence rate of 27%, eight keloids in Group A patients had an early recurrence three months following surgery. At nine months, nine more mixed-type cases with a 30% recurrence rate resurfaced. Recurrence seen in eight keloids out of 28 showed a 28.57% recurrence rate 12 months following surgery. Three people in Group B with three sessile keloids experienced an early recurrence at three months after surgery, with a recurrence rate of 10%. At nine months, four more cases of mixed kind returned, with a recurrence rate of 13%. A recurrence rate of 14.28% was found in 4 of 28 keloids at 12 months postoperatively. The Patient and Observer Scar Assesment Scale scores (POSAS scores) were consistently higher than Beausang scores at 1 year, indicating high patient satisfaction compared to physician assessment in both groups A and B. A keloid recurrence-free interval of 11.36 months was obtained by the Kaplan-Meier survival test (p < 0.05) in group A. Keloid recurrence-free interval of 10.98 months was evaluated by the Kaplan-Meier survival test (p < 0.05) in group B. Among Keloidectomy with fillet flap surgery with intralesional injection of triamcinolone acetonide (group A) and keloidectomy with fillet surgery with intralesional injection of verapamil (group B), at each follow-up the success rate of group B was higher than group A indicating better trend of success in this group in terms of both absence of recurrence and absence of complications without statistically significant difference between them which shown both procedures more or less similar.

Our Experience at Tertiary Medical College: Excision with Sublabial Approach Versus Marsupialization with Transnasal Endoscopic Approach in Patients with Nasolabial Cyst

Rare non-odontogenic cysts of the soft tissue of the midface that form between the nasal vestibule and upper lip are known as nasolabial cysts. Treatment can be accomplished by surgical removal, injection of sclerosing material into the cyst, and endoscopic marsupialization. The aim of this study is to compare the effectiveness of Excision with sublabial approach versus Marsupialization with Transnasal Endoscopic approach in patients with Nasolabial cyst in terms of operating time, recurrence rate, postoperative pain and complications. Our study was Duration based prospective observational study with a Duration of four years from August 2018 till July 2022 with study population inclusive of 30 patients aged between 20 and 70 years who were diagnosed with a unilateral nasolabial cyst on the basis of clinical presentation, anatomical location, and computed tomography (CT) findings at ENT Department of our Tertiary Institution. The study used a randomized, single blind, parallel design with a total of 30 patients, which were randomly allocated to undergo Excision with sublabial approach (group A) in 15 patients (15 nasolabial cysts) and Marsupialization with Transnasal Endoscopic approach (Group B) in 15 patients (15 Nasolabial cysts). In the sublabial approach group, the mean operating time was 91.28 ± 3.1 min, whereas in the transnasal marsupialization group, it was 29.7 ± 3.2 min. These differences were statistically significant (P = 0.003). In the excision with sublabial approach and transnasal endoscopic marsupialization groups, the visual analogue scale (VAS) for postoperative pain was 5.9 ± 1.4 and 3.2 ± 0.6, respectively (P = 0.001). Ten patients in the sublabial approach group and five patients in the transnasal marsupialization group had one or more problems during the follow-up period which disappeared spontaneously within 4 weeks without long lasting issues. There were no recurrence lesions or obstructions of the marsupialized cyst opening in either group, according to physical, endoscopic and computed tomography examinations. Nasolabial cysts can be marsupialized transnasally, which offers many advantages over the more traditional sublabial excision method. Transnasal endoscopic marsupialization has the benefits of a shorter operating time, less postoperative pain, and a low complication rate. Therefore, we propose that Transnasal Endoscopic marsupialization be the treatment of choice for nasolabial cyst, replacing the conventional Excision with sublabial approach.

A Comparative Study Between Anterior-Posterior and Superior-Inferior Flap Suturing Technique in Endoscopic Dacryocystorhinostomy at our Tertiary Institution

The Nasolacrimal sac inflammation, also known as dacryocystitis, is frequently accompanied by nasolacrimal duct blockage at the confluence of lacrimal sac and duct. Treatment of choice for dacryocystitis is dacryocystorhinostomy (DCR), which can be done through external approach and endoscopic approach. The endoscopic DCR has distinct advantage over the external DCR as there is no facial scar& also it maintains the pump action. We have used flap suturing technique of endoscopic DCR in our study where in lacrimal sac medial flap is sutured to nasal mucosal lateral flap wherein patients were selected into either of the two groups such as Anterior-Posterior type (group A) and Superior-Inferior type (group B) of Flap suturing technique. Aim and objectives of the study were to compare the subjective and objective success rate between group A & B of flap suturing used in endoscopic DCR & to compare the success rate of our techniques with other techniques in literature. Our study was Duration based prospective observational study with a Duration of one year from June 2021 till June 2022 with study population comprised of patients in age group of 20 to 70 years, with complaints of watering of eye (epiphora) attended ENT Department of our institute during this one year. Study population comprised of Total of 86 patients (100 eyes) of which 45 patients (51 EYES) underwent anterior- posterior flap suturing (Group A) and 41 patients (49 eyes) underwent superior- inferior flap suturing (Group B) technique of endoscopic DCR The mean age ± standard error of mean was 45.1765 ± 1.5 and 49.0816 ± 1.9 in group A & B respectively,which was not statistically significant (p value = 0.994). The male and female patients in group A & B was 27.45%,72.54% and 34.69%,65.30% respectively which was not statistically significant (p value = 0.434). At each follow‑up, subjective success rate was more in group A that indicated a better trend of success for that group. However, the difference in the success rate was not statistically significant.The objective success rate between the two groups were more or less similar & was not statistically significant. The subjective success rate in both Anterior-Posterior type (group A)and Superior-Inferior type (group B) of Flap suturing techniques of endoscopic dacryocystorhinostomy were more or less similar with regards to absence of epiphora but objective success rate with regards to the patency, were almost similar with a shift of trend from Group A to group B at 6 months follow up and we also found that complications in both the groups were very few, without statistically significant difference between them. In terms of success rate and complication,The endoscopic DCR with flap suturing technique found to be more or less similar with previous techniques of DCR described in the literature.

Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna

A pseudocyst of pinna is benign, painless, rare and asymptomatic swelling on the lateral or anterior surface of the pinna resulting from intracartilaginous accumulation of fluid. The condition auricular pseudocyst was first described by Engel (Arch Otolaryngol 83:197-202, 1966). Pseudocyst of in majority of cases presents as unilateral lesions, predominantly in 35-40 years mean age group and affecting predominantly males (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). Commonly these cysts shows no symptoms but occasionally, there may be presence of minor discomfort and mild inflammatory signs. The pseudocyst of pinna typically involves in its descending order of involvement as scaphoid fossa, triangular fossa of the antihelix, and the Cymba concha (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). Diagnosis of psuedocyst is based mainly on the clinical characteristics without evidence of infection (Ramadass and Ayyaswamy in Indian J Otolaryngol Head Neck Surg 58:156-192, 2006). There are wide range of treatment modalities described in the literature for this condition ranging from medical line of management including minimally invasive Intralesional steroid therapy, intralesional sclerosant therapy, systemic steroid therapy to surgical line of management including aspiration and pressure dressing, quilting suture with corrugated rubber drain, incision and drainage with mastoid dressing, cartilage curettage with drainage tube, surgical de-roofing and cartilage window procedure. Although multiple treatment options are available for this condition,there is no gold standard option is found In literature as more invasiveness of procedure associated with more complications and less invasiveness is associated with more recurrence (Bhat et al. in J Clin Diagn Res 8:KC05-KC07, 2014). The main aim of treatment is preservation or restoration of normal Anatomy or architecture of the auricle without recurrence or complications in postoperative duration (Schulte et al. in J Am Acad Dermatol 44:285-286, 2001). In our study we are going to compare the surgical deroofing with buttoning technique with Posterior Cartilage window with Pressure Gauze dressing technique in patients with pseudocyst on the basis of recurrence and complications. To compare effectiveness in terms of recurrence and complications between surgical deroofing with buttoning technique and posterior cartilage window with Pressure Gauze dressing technique in patients with pseudocyst of pinna. Prospective observational study done for duration of one year from June 2021 till June 2022 at Ashwini Rural medical college and Hospital, Solapur. Study was done on 30 patients aged between 20 and 70 years with pseudocyst of who are diagnosed on the basis of clinical presentation and characteristics of the aspirated fluids with no signs of infection or inflammation. Among 30 patients with pseudocyst 15 patients were undergone surgical deroofing with buttoning technique and remaining 15 patients were undergone posterior cartilage window with Pressure Gauze dressing technique. The age distribution of patients with psuedocyst of pinna in our study ranged from 20 to 70 years with maximum number of cases (i.e. 16) in the age group of 30-40 years which comprised of about 53% of study population. Among 30 cases in our study 26 were males (86.7%). All cases were of unilateral pseudocyst with left ear involvement more than right ear i.e. 20 and 10 cases respectively which indicates predominantly affecting left ear (66.6%). In our study we observed the site of involvement of pinna by pseudocyst showing maximum number of cases involving combined scaphoid fossa and triangular fossa i.e. 15 cases (50%) and minimum number of cases involving Concha i.e. 2 cases (6.6%). In our study we found that the aspirated fluid from pseudocyst of pinna was sterile in all cases i.e. 30 cases (100%). In our study we observed that the aspirated fluid was serous in majority of cases i.e. 21 cases (70%) and serosanguinous in few of them i.e. 3 cases (10%). Success rate in our study for surgical deroofing with buttoning technique was 66.6% and for posterior cartilage window with Pressure Gauze dressing technique was 100% but in terms recurrence of pseudocyst of pinna, 2 groups were not statistically significant. Success rate in our study for posterior cartilage window with Pressure Gauze dressing technique was 100% with no recurrence. Among patients who have undergone surgical deroofing with buttoning technique 2 cases have minor complications like pressure discoloration of skin i.e. 1 case and thickening of skin of pinna i.e. 1 case. All these complications are temporary one and show recovery in follow up duration. Among patients who have undergone Posterior cartilage window with Pressure Gauze dressing technique 1 case had perichondritis at 1 week follow up which was resolved spontaneously at the end of 2 weeks and 2 cases had painless thicknening of pinna which also resolved spontaneously at the end of 2 weeks. Pseudocyst of pinna occurs commonly in middle aged males as unilateral lesions with left ear involvement in majority of cases. The most common involvement of pinna by pseudocyst is combined scaphoid fossa and triangular fossa, the least common site is concha. Most of the pseudocyst of pinna contain sterile serous fluid. Success rate in our study for surgical deroofing with buttoning technique was 66.6% and for posterior cartilage window with Pressure Gauze dressing technique was 100% but in terms recurrence 2 groups were not statistically significant. Both surgical treatment groups have few and temporary complications but in terms of complications 2 groups were not statistically significant.

A Case Series of Dentigerous Cyst in Paediatric Patients at Our Tertiary Institution

Dentigerous cysts involves erupted or developing teeth in decreasing order of frequency as mandibular third molars, the maxillary canines, the maxillary third molars with rare involvement of the central incisors & are usually asymptomatic but becomes symptomatic with symptoms such as swelling, mild sensitivity, tooth mobility and displacement when it reaches size > 2 cm in diameter. Dentigerous cysts are seen most commonly in 20-30 years age group with relative low frequency in children with proportion of 4-9% of these cysts occur in the first 10 years after birth. Hospital based study conducted in the Department of ENT at Ashwini Rural medical college & Hospital, Solapur in which we have reported a series of three cases of dentigerous cyst in paediatric patients. Dentigerous Cysts in our study were associated with maxillary permanent lateral incisor, mandibular permanent premolar, Mandibular second molar tooth in pediatric age group. Provisional diagnosis of Dentigerous cyst based on clinical, radiological & biochemical study but Histopathological examination confirms the diagnosis. Dental orthopentamogram aids in diagnosing and localizing the Dentigerous cyst and ct face in all views helps to see bony effects and complications due to expansion of Dentigerous cyst. Enucleation of the cystic lesion followed by extraction of the offending teeth is a suitable treatment modality for Dentigerous cyst associated with maxilla and mandible giving adequate balance between complete removal of cyst & giving chance for eruption of unerupted teeth.