Bilateral Karapandzic Flap, a Saviour for Subtotal Lower Lip Reconstruction

Lip plays an essential role in facial esthetic, food intake, and speech. Lip defect due to trauma or surgical excision needs proper reconstruction to preserve their function. Carcinoma lip is one of the common malignant lesions in the head and neck, which needs wide local excision with proper margin with neck clearance. When the size is more than two-thirds, it becomes a challenge to reconstruct and preserve its functionality and aesthetic issues. Bilateral karapandzic flap plays an important role in this case scenario. We have two cases of subtotal lower lip defect following squamous cell carcinoma of the lower lip excision, which was reconstructed with a bilateral karapandzic flap with reasonable functional outcome and cosmesis. Thus, bilateral karapandzic flap can be an alternative option to free flap in resource-constrained scenarios with acceptable functional outcomes.

Seroprevalence of ToRCH Pathogens among Children Admitted to a Tertiary Care Hospital in Eastern India for Cataract Surgery and Cochlear Transplantation

AIMS

The study aims to investigate the presence of TORCH infections in a child with bilateral cataracts and deafness and report the ToRCH-serology screening profile (Toxoplasma gondii (TOX), rubella (RV), cytomegalovirus (CMV), and herpes simplex virus (HSV-I/II)) in pediatric cataract and deafness.

METHODS

Cases that had a clear clinical history of congenital cataracts and congenital deafness were included in the study. The study population consisted of 18 bilateral cataracts and 12 bilateral deafness child who was admitted to AIIMS Bhubaneswar for cataract surgery and cochlear implantation, respectively. Sera of all children were tested qualitatively and quantitatively for IgG/IgM-antibodies against ToRCH agents in a sequential manner.

RESULTS

Anti-IgG antibodies against the torch panel were detected in all cataract and deafness patients. Anti-CMV IgG was detected in 17 of 18 bilateral cataract children and 11 of 12 bilateral deaf children. The rates of anti-CMV IgG antibody positivity were significantly higher. In the cataract group, 94.44% and in the deafness group, 91.66% of the patient was Anti-CMV IgG positive. Besides this, 77.7 % of the patient from the cataract group and 75% from the deafness group was anti- RV IgG antibody positive. In bilateral cataract patients, IgG-alone seropositive cases were mostly attributed to CMV (94.44%; 17/18), followed by RV (77.70%; 14/18), HSV-I (27.70%; 5/18), TOX (27.70%; 5/18), and HSV-II (16.60%; 3/18). In bilateral deafness patients, the spectrum of IgG alone seropositive cases was almost the same except for TOX (0/12).

CONCLUSION

The current study recommends interpreting ToRCH-screening in pediatric cataracts and deafness with caution. Interpretation should include both serial qualitative and quantitative assays in tandem with clinical correlation to minimize diagnostic errors. The sero-clinical-positivity needs to be tested in older children who might pose a threat to the spread of infection.

Endoscopic stapedotomy: A comparison between the conventional approach versus CO2 laser-assisted surgery

Background

Although the utility of laser fiber in microscopic stapes surgery has been documented in the past, their role can be highly emphasized in endoscopic stapes surgery, especially in difficult anatomical situations.

Methods

This is a retrospective analysis of cases where a total of 46 patients (22 in conventional stapedotomy and 24 in CO2 laser-assisted stapedotomy) were included in the study. The clinical parameters were assessed both in the preoperative and postoperative periods in the respective groups and later compared 12 weeks after stapedotomy.

Results

A total of 90.90% (20/22) of the patients in the conventional stapedotomy and 95.83% (23/24) of patients in laser-assisted stapedotomy had <20 dB of AB gap in the postoperative period (P = 0.71). Canaloplasty was required in six patients in the conventional stapedotomy and none of the patients in the laser group needed the same (P = 0.01). Chorda tympani nerve was manipulated in 59.09% (13/22) and 25.00% (6/24) of cases in the conventional group and in the CO2 laser group, respectively (P = 0.01).

Conclusion

Although the audiological outcomes with fiber-enabled CO2 laser in endoscopic stapedotomy are comparable to conventional surgery, it is a better tool in a narrow auditory canal, requiring minimal manipulation of the chorda tympani nerve.

Outcomes in Managing Vascular Tinnitus: Institutional Experience and Review of 6-Year Literature

To evaluate the outcomes in patients of vascular tinnitus managed at our institute. The clinical data of all patients diagnosed with pulsatile tinnitus from January 2014 to April 2022 and managed at AIIMS, Bhubaneswar, was retrospectively reviewed. The diagnosis, treatment and outcomes were analyzed. A 6-year literature review was performed from March 2015 to April 2021. Our series discusses managing eleven cases of vascular tinnitus with varied aetiology and their outcomes. Out of the eleven cases, eight patients underwent surgical or radiological intervention, and seven had complete resolution of symptoms. Of the eleven patients, three had partial resolution. The 6-year literature review revealed sigmoid and transverse sinus as the most common causative anatomical sites for pulsatile tinnitus. Amongst those who received an intervention, 83.56% of the patients had complete resolution of symptoms. Vascular tinnitus can be cured if the exact vessel causing it is localized. Clinical suspicion is based on the character of tinnitus and patient history. A careful evaluation of the head and neck sites for any vascular anomaly that can cause pulsatile tinnitus must be done. Radiology demonstrates treatable causes of it. It delineates the aberrant anatomical variations that can lead to this disturbing aetiology. Treatable causes are best addressed, and pathology should be taken care of. A multidisciplinary team comprising ENT surgeons, audiologists and interventional radiologists must identify and treat the pathology.

To evaluate the efficacy of topical anti-fungal therapy in postoperative cases of COVID Associated Mucormycosis (CAM): A single-blinded randomized control trial

PURPOSE

To compare the efficacy of 0.1 % w/w Liposomal Amphotericin-B gel with 10 % w/w Povidone-Iodine and saline nasal douching in preventing revision surgery in patients with CAM.

STUDY DESIGN

Multi-arm, parallel randomized control trial.

STUDY SETTING

The trial was conducted in the Department of ENT, All India Institute of Medical Sciences (AIIMS) Bhubaneswar.

METHODS

Participants: Microbiologically and histologically proven cases of mucormycosis who underwent surgical debridement were included in the study.

INTERVENTIONS

Postoperatively, patients were randomized into three groups based on the type of topical intervention received, in the form of Lipid-based Amphotericin B gel, povidone‑iodine ointment or saline nasal douching.

OUTCOME

Requirement of revision surgery in postoperative cases of CAM.

RANDOMIZATION

Participants were allotted to one of the three arms by block randomization.

BLINDING

Single-blinded trial.

RESULTS

Numbers randomized: 15 participants were randomized to each group. Recruitment: Completed recruiting. Numbers analyzed: 15 participants were analyzed in each group.

OUTCOMES

Control arm's risk of revision surgery was 4.50 (95 % CI: 1.16-17.44) times than Lipid-based Amphotericin B gel arm and 1.50 (95 % CI: 0.71-3.16) times that of the Povidone- Iodine arm. The difference was statistically significant (p = 0.02) for Amphotericin but not for Povidone-Iodine.

CONCLUSIONS

Topical Amphotericin-B gel application in the postoperative cavity can decrease the need for revision surgery and help in early recovery.

TRIAL REGISTRATION

CTRI/2021/10/037257. Clinical Trials Registry of India.

In vivo appraisal of oxidative stress response, cell ultrastructural aberration and accumulation in Juvenile Scylla serrata exposed to uranium

In vivo studies were performed to evaluate the organ specific tissue accumulation and cellular toxicity of uranium to mud crab Scylla serrata. The specimens were acclimated in natural seawater and the exposure to 50-250 μg/L uranium was investigated up to 60 days. The present study examined the effects of concentration and duration of uranium exposure in the tissue of S. serrata at cellular and subcellular level using scanning electron microscopy and bright field transmission electron microscopy in addition to histological analysis. The results indicated that accumulation of U in S. serrata was organ specific and followed the order gills > hepatopancreas > muscle. The response of key antioxidant enzyme activities such as SOD, GPx and CAT in different organs of crabs indicated oxidative stress due to U in the ambient medium and tissue. At 50 and 100 μg/L of U exposure, individuals were able to acclimate the oxidative stress and withstand the uranium exposure. This acclimation could not be sustained at higher concentrations (250 μg/L), affecting the production of CAT in the tissues. Cellular and subcellular changes were observed in the hemocytes with reduction in their number in consonance with the antioxidant enzymes. Histological aberrations like lamellar disruption of gill, necrosis of hepatopancreas, disruption and rupture of muscle bundles were observed at different concentrations and were severe at higher concentration (250 μg/L). Necrosis was observed in the electron micrographs of tissues shortly after 15 days of exposure. SEM micrograph clearly shows disrupted lamellae, folding of marginal canal and reduction of inter lamellar spaces in the gills of crab exposed to high concentration of uranium. Mitochondrial anomalies are reported for the first time in the present study in addition to the subcellular changes and vacuoles on exposure uranium in the cells of gill and hepatopancreas.

Exclusive endoscopic transcanal approach to lateral skull base lesions: Institutional experience of 3 cases

Introduction

Majority of petrous bone and lateral skull base pathologies are benign in nature. The complex anatomy usually warrants an extensive approach with associated morbidity.

Case summary

Two cases of petrous bone cholesteatoma (1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma) and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach. The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches. The mean operative time was approximately 140 min. No CSF otorrhoea was noticed in the post-operative period. The average period of hospital stay was 3.7 days.

Conclusion

In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach. It decreases operative time, blood loss, chance of meningitis, morbidity and hospital stay. The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery. This approach can create direct access to cochlea/petrous apex/internal auditory canal (IAC)/Supra-geniculate ganglion region.

Genetic diversity and multiple antibiotic resistance index study of bacterial pathogen, Klebsiella pneumoniae strains isolated from diseased Indian major carps

Intensive fish farming systems have led to increase in disease incidence, due to higher stocking density, high organic matter levels, and poor quality of the aquatic environment. Diseased fish samples showing hemorrhages and reddish lesions were collected from different freshwater fish farms located at three different districts of West Bengal, India (Burdwan, North 24 Parganas, and Nadia). The present study was conducted to evaluate the genetic diversity of ten different Klebsiella pneumoniae strains isolated from different infected freshwater fish samples based on 16S rRNA gene sequence analysis. Primarily, Klebsiella-specific media was used for the isolation and characterization of Klebsiella pneumoniae. Further, through a biochemical test, all the strains were confirmed as K. pneumoniae. PCR analysis of 16S-23S internal transcribed spacer (PCR ribotyping) was carried out to study the species variation within different Klebsiella pneumoniae isolates. For all the isolates, a conserved PCR ribotype pattern was observed while differing from other bacterial species. Phylogenetic study showed the high degree of homology with diverse source of other strains. The multiple antibiotic resistance (MAR) values of the present study for the isolates were found to be 0.468. MAR value above 0.2 indicates that the source of isolation was highly contaminated with antibiotics. Based on the 16S rRNA gene sequence analysis, the present study revealed the genetic diversity of Klebsiella pneumoniae isolated from the different diseased fish farms of West Bengal. All the strains were found to be hypermucoviscous and multidrug-resistant, thus making it pathogenic towards the host organisms. Further, the study revealed a high prevalence of K. pneumoniae in aquaculture farms, representing a risk towards successful aquaculture.

A clinicoradiologic analysis of symptomatic craniofacial fibro-osseous lesions

Objective

To outline the clinical and radiologic aspects of symptomatic craniofacial fibro-osseous lesions and to study the appropriate surgical management with follow-up results.

Study Design and Setting

A retrospective review of 11 patients who underwent surgical treatment during 1985 to 2004 in a tertiary health care center.

Results

Most (72.7%) cases were of fibrous dysplasia and were under 25 years of age (72%). Maxilla was the most common bone involved (81%). Lateral rhinotomy was the main approach for surgical resection. One patient underwent bilateral optic nerve decompression (left side therapeutic and on right side prophylactic). Six (54.5%) cases had recurrences that were managed by either radical surgery (total maxillectomy) or by further shaving off the lesion.

Conclusion

Treatment of craniofacial fibro-osseous lesions is highly individualized. A conservative approach may not be able to treat all cases of craniofacial fibro-osseous lesions. A more radical approach that includes a craniofacial resection or a total maxillectomy may be warranted in few cases.

Primary meningioma of the middle turbinate: a case report

Meningioma of the sinonasal tract is a rare entity. Meningioma of the nose and paranasal sinuses may occur in one of two ways: (1) by secondary extension of a primary tumor in the cranial cavity or orbit or (2) primarily in the nose and paranasal sinuses de novo from the ectopic meningocytes derived from pluripotent mesenchymal cells. Primary sinonasal meningiomas are often difficult to diagnose because of their infrequent occurrence. The final diagnosis rests on the histologic examination. We report what is to our knowledge the first case of primary meningioma of the middle turbinate.

Second branchial cleft cyst causing internal jugular vein thrombosis - A case report

The branchial cleft cyst also known as lateral cervical cyst is usually present in the lateral part of neck deep to sternocleidomastoid muscle at the junction of its upper third and lower two thirds. Branchial cysts are known for repeated infection with sudden increase in size and pain and for its recurrence. Thrombosis of major vessels of neck secondary to recurrent infection and inflammation of branchial cyst is extremely rare. Here we present the first case of internal jugular vein thrombosis; a rare complication seen with branchial cyst in a 54-year-old male. The patient was treated initially with antibiotics followed by excision of cyst and ligation of internal jugular vein without any complication.

Syringocystadenoma papilliferum: report of first case on the pinna

Syringocystadenoma papilliferum is a benign adnexal skin tumour, which, in a third of cases, arises from an organoid nevus on the head and neck. We report on a 17-year-old man with a syringocystadenoma papilliferum on his right pinna of three-years duration. The clinical and histopathological features are described. Following excision and skin grafting, the patient remains asymptomatic four years after surgery. This is the first report of a syringocystadenoma papilliferum on the pinna.