Pradeep Pradhan - Academia.edu (original) (raw)

Papers by Pradeep Pradhan

Research paper thumbnail of Columellar Strut in Correcting the Recurrent Vestibular Stenosis

Indian Journal of Otolaryngology and Head & Neck Surgery

Management of vestibular stenosis is always a challenge in rhinology, especially for patients wit... more Management of vestibular stenosis is always a challenge in rhinology, especially for patients with complete vestibular stenosis. Tip plasty (with columella strut) can be supplemented to the primary surgery, can ensure good functional and cosmetic outcomes in patients with complete vestibular stenosis.

Research paper thumbnail of Endoscopic Repair of CSF Rhinorrhea: Our Experience at a Tertiary Centre

Indian Journal of Otolaryngology and Head & Neck Surgery

Research paper thumbnail of Carotid Body Tumors: Institutional Experience of 10 Cases and a Review of Literature

Indian Journal of Otolaryngology and Head & Neck Surgery

Research paper thumbnail of Efficacy of endoscopic repair for CSF otorrhoea in children with recurrent meningitis due to incomplete partition type 1

International Journal of Pediatric Otorhinolaryngology

Research paper thumbnail of Combined Use of Pectoralis Major Myocutaneous Flap and Deltopectoral Flap for the Reconstruction of Advanced Oral Cancers: Our Experience in 29 Cases

Journal of Maxillofacial and Oral Surgery, 2020

Purpose To assess the utility of the combined use of pectoralis major myocutaneous (PMMC) flap an... more Purpose To assess the utility of the combined use of pectoralis major myocutaneous (PMMC) flap and deltopectoral flap (DP) in advanced oral cavity cancers in the Indian population. Materials and Methods It is a retrospective study, considering 29 patients with stage IV carcinoma of the oral cavity, from July 2015 to February 2019. Both pectoralis major Myocutaneous flaps and deltopectoral flaps were used for stage IV oral cancers involving the full-thickness cheek and the mandibular cortex. The reliability of the flaps and clinical outcomes were evaluated in the postoperative period. Results Of the 29 patients, partial necrosis of the skin island was detected in 6 patients, 2 patients presented with wound dehiscence, and one patient had an orocutaneous fistula. Recurrence was detected in 3(10.34%) patients, in one patient, it was at the primary site and in 2 patients, it was in the neck. When different parameters were compared between the patients with complications and without complications, the comorbidities like smoking and alcohol intake adversely affected the flap survival in the postoperative period. Conclusions The combined use of PMMC and DP flap can be a reliable option for advanced oral malignancies, especially in patients with poor performance status with the coexisting chronic illness. Due to the presence of a definite vascular pedicle, ease of harvesting the flap, quick surgical procedure, and the minimal postoperative morbidities, these pedicle flaps can be successfully used alternative to the free flaps in advanced oral cancers, especially patients with a low socioeconomic corridor like India.

Research paper thumbnail of Endoscopic Transcanal Approach to Lateral Skull Base Lesions

Journal of Neurological Surgery Part B: Skull Base, 2018

Research paper thumbnail of Ancient Schwannoma of the Infratemporal Fossa: A Case Report

Iranian Journal of Otorhinolaryngology, 2020

Introduction: Ancient schwannoma of infratemporal fossa arising from the trigeminal nerve is very... more Introduction: Ancient schwannoma of infratemporal fossa arising from the trigeminal nerve is very rare in clinical practice. Case Report: A 65-year old male presented to the outpatient department with a progressive swelling over the left parotid for 5 years and pain during chewing for 6 months which was diagnosed as benign spindle cell tumour on cytology. The tumor was excised with a combined transparotid and transmandibular cervical approach and the final pathology was confirmed to an Ancient Schwannoma. Conclusion: A giant infratemporal fossa Schwannoma extending to the parapharyngeal space masquerading as a parotid swelling is very unusual. Transparotid transmandibular excision of the infratemporal fossa tumor is an effective approach ensuring complete removal of the tumor with minimal postoperative complications and acceptable cosmoses.

Research paper thumbnail of Rhinosporidiosis of the lacrimal sac masquerading as chronic dacryocystitis: a rare presentation

Autopsy & Case Reports, 2021

Rhinosporidiosis is a chronic infection of the mucous membrane caused by the Rhinosporiduim seebe... more Rhinosporidiosis is a chronic infection of the mucous membrane caused by the Rhinosporiduim seeberi, which infects through transepithelial penetration. Although described worldwide, this entity is mostly found in the western hemisphere, afflicting young people, predominantly males, associated in many cases with recreational or professional contact with bath in ponds, rivers, or stagnant waters. The clinical features are varied depending on the affected membrane, in some cases mimicking other diseases postponing the correct diagnosis. Although nasal obstruction and epistaxis are the common clinical presentations in sinonasal rhinosporidiosis, patients with epiphora without a nasal mass often challenge the diagnosis. In the present case, we have documented a case of isolated lacrimal sac rhinosporidiosis masquerading as chronic dacryocystitis, which was successfully managed by endoscopic excision, accompanied by a literature review.

Research paper thumbnail of Isolated Primary Rhinosporidiosis of the Parotid Duct: A Rare Presentation

Iranian Journal of Otorhinolaryngology, 2020

Introduction: The primary involvement of the parotid duct in rhinosporidiosis is very rare in cli... more Introduction: The primary involvement of the parotid duct in rhinosporidiosis is very rare in clinical practice. Here, we present a case of rhinosporidiosis primarily involving the parotid duct, which was successfully excised through transparotid and transoral approaches. Case Report: A 51-year-old male presented with a painless progressive swelling over the left cheek for nine months. It was diagnosed as a parotid cyst or a mucous retention cyst based upon the radiological and cytological features. The cyst was completely excised with transparotid and transoral approaches, and the final diagnosis was confirmed to be rhinosporidiosis. Conclusion: Although the nose and the paranasal sinus are the common sites to be involved in rhinosporidiosis, the affection of the parotid duct is very unusual in clinical practice.

Research paper thumbnail of Efficacy of Balloon Tamponade Versus Merocel Nasal Packs in Endoscopic Sinonasal Surgery: A Randomized Controlled Study

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Although absorbable nasal packings have been abundantly used in the recent time, the conventional... more Although absorbable nasal packings have been abundantly used in the recent time, the conventional packings are still used in different sinonasal surgeries in the various parts of the globe due to their lower cost. To compare the effectiveness of the balloon tamponade (Rapid Rhino) with Merocel nasal pack in sinonasal diseases. This study was conducted from July 2018 to July 2019 in a tertiary care referral hospital. Rapid Rhino and Merocel were put in 30 patients and 31 patients, respectively. Pain, bleeding, and mucosal healing was evaluated and compared between two groups postoperatively. The reduction in the pain and postoperative bleeding was significant with balloon tamponade (Rapid Rhino) compared to the Merocel (p \ .05). Although insignificant (p [ 0.05), patients with balloon tamponade nasal packs had less crusting and synechia in the postoperative period. Balloon tamponade (Rapid Rhino) nasal pack can be a better alternative to the Merocel nasal pack in reducing postoperative pain, bleeding, and mucosal damage.

Research paper thumbnail of Predisposing factors of rhino-orbital-cerebral mucormycosis in patients with COVID 19 infection

Indian Journal of Otolaryngology and Head & Neck Surgery, 2021

The predisposing factors of invasive fungal disease in COVID 19 infection are still debatable bec... more The predisposing factors of invasive fungal disease in COVID 19 infection are still debatable because of the limited human understanding of the virus with the current literature. In this study, we have tried to correlate the various predisposing factors influencing the clinical profile and treatment outcomes in patients with covid associated mucormycosis (CAM). It is a retrospective analysis of cases of CAM during the second wave of COVID 19 infection, which was managed in the department of Otorhinolaryngology from Dec 1, 2020, to June 10, 2021. The detailed clinical, radiological and management of patients with CAM were collected, recorded, evaluated and correlated with the predisposing factors. Of the total, 46 patients, 44(95.65%) were diabetic and 41 patients had a previous history of steroid intake. When clinical parameters were compared between blood sugar \ 200 mg/dl and [ 200 mg/dl, the old and newly diagnosed diabetes mellitus in patients with CAM, there was no significant differences in any of the above clinical parameters (p [ 0.05), except the hospital stay (p = 0,004). Steroid intake in patients with coexisting DM associated with CAM is considered the most important factor for the development of the CAM. There was are no significant difference in any of the clinical/treatment outcomes in patients with CAM with respect to the initial blood sugar, except for the hospital stay. A large sample size with a long-term follow-up period may be needed for a better understanding of common predisposing factors for the development of CAM.

Research paper thumbnail of Giant epidermal inclusion cyst of the thyroid: a rare occurrence

Autopsy Case Reports, 2021

Epidermal inclusion cyst (EIC) of the thyroid is extremely rare in the clinical practice. A handf... more Epidermal inclusion cyst (EIC) of the thyroid is extremely rare in the clinical practice. A handful of cases have been documented in the past in the world literature. A giant EIC of the thyroid is hitherto unreported. This lesion may arise from the squamous metaplasia of the thyroid follicular cells. Though non-neoplastic, giant forms can cause compression of the vital structures of the neck. In the present case, we have described a giant epidermal inclusion cyst successfully managed with surgical management.

Research paper thumbnail of Primary endoscopic stapedotomy using 3 mm nasal endoscope: Audiologic and clinical outcomes

Journal of Otology, 2020

Objective: To report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy an... more Objective: To report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy and clinical and audiological outcomes. Materials and methods: Thirty patients diagnosed with primary otosclerosis underwent endoscopic stapedotomy that was performed using a 3 mm nasal endoscope (Karl Storz). At 6 months follow-up, the patients were evaluated for intraoperative findings, postoperative hearing outcomes and complications. Results: Canaloplasty was performed in 2 (6.66%) patients, and no curettage of the canal wall was required in 12 (40%) patients. Transposition of the chorda tympani nerve was conducted in 11 (36.66%) patients. The average duration of surgery was 36 min (range 31e65 min). The air-bone gap (ABG) was 35 dB (range 24e50 dB) preoperatively and 14.63 dB (range 9e20 dB) postoperatively (p ¼ 0.00). At 6 months follow-up, <20 dB ABG was achieved in 93.33% of the patients. No major intraoperative/postoperative complications were detected. Conclusion: A 3 mm rigid nasal endoscope can be effectively used in stapedotomy to obtain adequate audiological outcomes. It can be considered as a better alternative to the standard microscope or 4 mm endoscope in preserving the posterior canal wall and chorda tympani nerve while minimizing operative time without causing significant complications.

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

Journal of Otology, 2020

Introduction: Majority of petrous bone and lateral skull base pathologies are benign in nature. T... more 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.

Research paper thumbnail of Analysis of Pattern of Laryngotracheal Invasion by Papillary Thyroid Carcinoma and Their Management: Our Experience

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

To analyse the pattern of laryngotracheal invasion (LTI) by papillary-thyroid-carcinoma (PTC) and... more To analyse the pattern of laryngotracheal invasion (LTI) by papillary-thyroid-carcinoma (PTC) and outcomes of their management. We undertook a retrospective chart review to study patterns of LTI by PTC and to evaluate outcomes of surgical modalities used to treat PTC with LTI. Out of 246cases of PTC, 26-cases had LTI (male-12, female-14, mean-age-55.6 years, range 42-73 years). Common clinical presentation were neck swelling, respiratory distress/stridor and vocal cord paralysis in 100%, 8 (30.8%) and 10 (38.5%) cases respectively. PTC was staged according to AJCC-TNM staging system (T4a-24, T4b-02, N1a-12, N1b-14, M0-25, and M1-01). CT-scan showed obvious LTI and tracheal narrowing in 11(42.3%) and 18(69.2%) cases respectively. All cases underwent total thyroidectomy with central-compartmentclearance. Unilateral and bilateral lateral-neck-dissection was performed in 08 and 06cases respectively. Pattern of Intra-operative LTI were as follows: trachea-13cases, trachea and cricoid-05cases, thyroid cartilage-6cases, trachea, cricoid and thyroid cartilage-2 cases and intra-luminal involvement in 4cases. Modified Shin's staging was used to stage LTI. LTI were superficial, deep-extra-luminal and intra-luminal in 13, 09 and 04cases respectively. LTI was managed by shave-excision, window-resection of trachea, sleeve-resection of trachea and anastomosis, partial laryngectomy and total-laryngectomy in 13,02,04,05 and 2 cases respectively. All patients received radioactive iodine (RAI) and TSH-suppression-therapy post-operatively. Mean follow-up period was two-years (range 18-30 months). One-case had radio-iodine non-avid local recurrence with lung metastases one-year post-operatively. Shave-excision is adequate for tumours not infiltrating into outer perichondrium. Tracheal-resection and total/partial laryngectomy may be required in cases with laryngo-tracheal cartilage or intra-luminal involvement. Adequate surgical excision along with postoperative RAI and TSHsuppression-therapy gives good loco-regional disease control in PTC with LTI.

Research paper thumbnail of Outcome of temporalis fascia myringoplasty with and without use of platelet rich plasma: A randomized control trial

Objectives: To compare the efficacy of temporalis fascia myringoplasty using platelet rich plasma... more Objectives: To compare the efficacy of temporalis fascia myringoplasty using platelet rich plasma(PRP) {MP-PRP} and conventional temporalis fascia myringoplasty(MP-C) in treatment of moderate to large central tympanic membrane(TM) perforation. STUDY DESIGN: Randomized-Control-Trial SETTING: Tertiary-Health-Centre SUBJECTS AND METHODS:We randomly assigned eighty patients with COM-mucosal-type with medium to large central TM perforation and conductive hearing loss planned for primary myringoplasty to receive either MP-PRP orMP-C. Myringoplasty was performed through post-auricular approach underlay graft using temporalis fascia. Primary outcome was graft uptake (an intact TM) at 6 months postoperatively. Secondary outcome was the post-operative hearing improvement measured by pure-tone-audiometry (PTA). RESULTS: Eighty myringoplasties (MP-PRP group-40, MP-C group-40) done for 80 patients (male=41; female=39,age-group=18-45years) were included in analysis. At 6months postoperatively graft uptake rate was 94.4% in MP-PRP and 92.1%% in MP-C group. There was no statistically significant difference in graft uptake between the two groups(p=0.358).Success in terms of hearing gain ([?]10dB) was achived in 34 patients (89.5%) in MP-C and 37 patients (94.9%) in MP-PRP group.At 6months follow-up; mean-PTA-average improved from 35.10±5.401dB to 27.74±5.660dB and mean ABG improved from 24.00±5.204dB to17.42±5.559dB in MP-C group. At 6months follow-up; mean-PTA-average improved from 37.00±6.144dB to 26.65dB and mean air bone gap(ABG) improved from 25.98±5.736dB to 16.21±4.318dB in MP-PRPgroup. No statistically significant differences in improvement in PTA-values were observed between both groups. (p=0.336).Postoperative complications were similar in both groups. Conclusion: Graft uptake, hearing outcomes and complications of MP-PRP were similar to MP-C. MP-PRP offers no advantages over MP-C for treatment of TM perforation.

Research paper thumbnail of Submental Ectopic Thyroid Cyst: An Atypical Presentation

Indian Journal of Otolaryngology and Head & Neck Surgery, 2018

Research paper thumbnail of Vallecular Neurofibroma Successfully Managed with Endoscopic Assisted Coblation: A Novel Technique

Indian Journal of Otolaryngology and Head & Neck Surgery, 2018

Research paper thumbnail of Surgical management of extracranial nerve sheath tumours in a tertiary care center

World Journal of Otorhinolaryngology - Head and Neck Surgery, 2019

Objective: Excision of the nerve sheath tumours of head and neck is always a challenge to the sur... more Objective: Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structures. Methods: It is a retrospective study contained 13 consecutive patients of nerve sheath tumours involving the head and neck from March 2013 to February 2017 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. The retrospective clinical data, diagnostic procedures, surgical approaches and their complications are analyzed after 12 months of surgery. Results: Total 13 patients, 7 were females and 6 were males. Painless neck swelling was the most common presentation found in 6 and the most common site of origin was the vagus nerve in the parapharyngeal space (6 patients). Transcervical excision of the tumour was performed in 7 patients. Six needed combined surgical approach for the excision of the tumours. Neurovascular injury was detected in 3 patients, and one patient had recurrent disease during the follow-up period. Conclusions: Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structure. Although the transcervical approach is commonly practiced for the majority of the tumours, combined approaches can be effectively applied for extensive nerve sheath tumours with the satisfactory clinical outcome.

Research paper thumbnail of Submental island flap reconstruction for carcinoma of the oral cavity: Experience in 30 cases

World Journal of Otorhinolaryngology - Head and Neck Surgery, 2019

The submental flap can be utilized for soft tissue reconstruction in oral cavity malignancies bec... more The submental flap can be utilized for soft tissue reconstruction in oral cavity malignancies because due to its close approximation to the surgical site, fewer donor site morbidity and the cost effectiveness of the procedure. Methods: A total of 30 patients with squamous cell carcinoma of the oral cavity were included in the study from July 2012 to August 2015 in a tertiary care referral hospital. Patients with clinical staging I/II/III (T1/T2/T3, N0) oral malignancy were included in the study. Patients with nodal metastasis irrespective of the stage of disease and patients with chronic medical illness/revision cases were excluded from the study. Submental island flap was utilized for the reconstruction of the soft tissue defect in each patient. Patients were followed at monthly interval till 6 months in the postoperative period. Results: The buccal mucosa (12 patients), tongue (10 patients) and floor of mouth (8 patients) were the subsites in the oral cavity. Partial and complete skin necrosis was found in 4 and 2 patients respectively. Postoperative chemoradiation was required in 5 patients. None of the patients had loco regional recurrence till 6 months of follow-up. Conclusion: The submental island flap is considered to be the reliable option for the soft tissue reconstruction in oral cancer because of dependent vascular pedicle, less donor site morbidity and the lower cost compared to the free flaps, often preferred in patients with a lower socioeconomic condition.

Research paper thumbnail of Columellar Strut in Correcting the Recurrent Vestibular Stenosis

Indian Journal of Otolaryngology and Head & Neck Surgery

Management of vestibular stenosis is always a challenge in rhinology, especially for patients wit... more Management of vestibular stenosis is always a challenge in rhinology, especially for patients with complete vestibular stenosis. Tip plasty (with columella strut) can be supplemented to the primary surgery, can ensure good functional and cosmetic outcomes in patients with complete vestibular stenosis.

Research paper thumbnail of Endoscopic Repair of CSF Rhinorrhea: Our Experience at a Tertiary Centre

Indian Journal of Otolaryngology and Head & Neck Surgery

Research paper thumbnail of Carotid Body Tumors: Institutional Experience of 10 Cases and a Review of Literature

Indian Journal of Otolaryngology and Head & Neck Surgery

Research paper thumbnail of Efficacy of endoscopic repair for CSF otorrhoea in children with recurrent meningitis due to incomplete partition type 1

International Journal of Pediatric Otorhinolaryngology

Research paper thumbnail of Combined Use of Pectoralis Major Myocutaneous Flap and Deltopectoral Flap for the Reconstruction of Advanced Oral Cancers: Our Experience in 29 Cases

Journal of Maxillofacial and Oral Surgery, 2020

Purpose To assess the utility of the combined use of pectoralis major myocutaneous (PMMC) flap an... more Purpose To assess the utility of the combined use of pectoralis major myocutaneous (PMMC) flap and deltopectoral flap (DP) in advanced oral cavity cancers in the Indian population. Materials and Methods It is a retrospective study, considering 29 patients with stage IV carcinoma of the oral cavity, from July 2015 to February 2019. Both pectoralis major Myocutaneous flaps and deltopectoral flaps were used for stage IV oral cancers involving the full-thickness cheek and the mandibular cortex. The reliability of the flaps and clinical outcomes were evaluated in the postoperative period. Results Of the 29 patients, partial necrosis of the skin island was detected in 6 patients, 2 patients presented with wound dehiscence, and one patient had an orocutaneous fistula. Recurrence was detected in 3(10.34%) patients, in one patient, it was at the primary site and in 2 patients, it was in the neck. When different parameters were compared between the patients with complications and without complications, the comorbidities like smoking and alcohol intake adversely affected the flap survival in the postoperative period. Conclusions The combined use of PMMC and DP flap can be a reliable option for advanced oral malignancies, especially in patients with poor performance status with the coexisting chronic illness. Due to the presence of a definite vascular pedicle, ease of harvesting the flap, quick surgical procedure, and the minimal postoperative morbidities, these pedicle flaps can be successfully used alternative to the free flaps in advanced oral cancers, especially patients with a low socioeconomic corridor like India.

Research paper thumbnail of Endoscopic Transcanal Approach to Lateral Skull Base Lesions

Journal of Neurological Surgery Part B: Skull Base, 2018

Research paper thumbnail of Ancient Schwannoma of the Infratemporal Fossa: A Case Report

Iranian Journal of Otorhinolaryngology, 2020

Introduction: Ancient schwannoma of infratemporal fossa arising from the trigeminal nerve is very... more Introduction: Ancient schwannoma of infratemporal fossa arising from the trigeminal nerve is very rare in clinical practice. Case Report: A 65-year old male presented to the outpatient department with a progressive swelling over the left parotid for 5 years and pain during chewing for 6 months which was diagnosed as benign spindle cell tumour on cytology. The tumor was excised with a combined transparotid and transmandibular cervical approach and the final pathology was confirmed to an Ancient Schwannoma. Conclusion: A giant infratemporal fossa Schwannoma extending to the parapharyngeal space masquerading as a parotid swelling is very unusual. Transparotid transmandibular excision of the infratemporal fossa tumor is an effective approach ensuring complete removal of the tumor with minimal postoperative complications and acceptable cosmoses.

Research paper thumbnail of Rhinosporidiosis of the lacrimal sac masquerading as chronic dacryocystitis: a rare presentation

Autopsy & Case Reports, 2021

Rhinosporidiosis is a chronic infection of the mucous membrane caused by the Rhinosporiduim seebe... more Rhinosporidiosis is a chronic infection of the mucous membrane caused by the Rhinosporiduim seeberi, which infects through transepithelial penetration. Although described worldwide, this entity is mostly found in the western hemisphere, afflicting young people, predominantly males, associated in many cases with recreational or professional contact with bath in ponds, rivers, or stagnant waters. The clinical features are varied depending on the affected membrane, in some cases mimicking other diseases postponing the correct diagnosis. Although nasal obstruction and epistaxis are the common clinical presentations in sinonasal rhinosporidiosis, patients with epiphora without a nasal mass often challenge the diagnosis. In the present case, we have documented a case of isolated lacrimal sac rhinosporidiosis masquerading as chronic dacryocystitis, which was successfully managed by endoscopic excision, accompanied by a literature review.

Research paper thumbnail of Isolated Primary Rhinosporidiosis of the Parotid Duct: A Rare Presentation

Iranian Journal of Otorhinolaryngology, 2020

Introduction: The primary involvement of the parotid duct in rhinosporidiosis is very rare in cli... more Introduction: The primary involvement of the parotid duct in rhinosporidiosis is very rare in clinical practice. Here, we present a case of rhinosporidiosis primarily involving the parotid duct, which was successfully excised through transparotid and transoral approaches. Case Report: A 51-year-old male presented with a painless progressive swelling over the left cheek for nine months. It was diagnosed as a parotid cyst or a mucous retention cyst based upon the radiological and cytological features. The cyst was completely excised with transparotid and transoral approaches, and the final diagnosis was confirmed to be rhinosporidiosis. Conclusion: Although the nose and the paranasal sinus are the common sites to be involved in rhinosporidiosis, the affection of the parotid duct is very unusual in clinical practice.

Research paper thumbnail of Efficacy of Balloon Tamponade Versus Merocel Nasal Packs in Endoscopic Sinonasal Surgery: A Randomized Controlled Study

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

Although absorbable nasal packings have been abundantly used in the recent time, the conventional... more Although absorbable nasal packings have been abundantly used in the recent time, the conventional packings are still used in different sinonasal surgeries in the various parts of the globe due to their lower cost. To compare the effectiveness of the balloon tamponade (Rapid Rhino) with Merocel nasal pack in sinonasal diseases. This study was conducted from July 2018 to July 2019 in a tertiary care referral hospital. Rapid Rhino and Merocel were put in 30 patients and 31 patients, respectively. Pain, bleeding, and mucosal healing was evaluated and compared between two groups postoperatively. The reduction in the pain and postoperative bleeding was significant with balloon tamponade (Rapid Rhino) compared to the Merocel (p \ .05). Although insignificant (p [ 0.05), patients with balloon tamponade nasal packs had less crusting and synechia in the postoperative period. Balloon tamponade (Rapid Rhino) nasal pack can be a better alternative to the Merocel nasal pack in reducing postoperative pain, bleeding, and mucosal damage.

Research paper thumbnail of Predisposing factors of rhino-orbital-cerebral mucormycosis in patients with COVID 19 infection

Indian Journal of Otolaryngology and Head & Neck Surgery, 2021

The predisposing factors of invasive fungal disease in COVID 19 infection are still debatable bec... more The predisposing factors of invasive fungal disease in COVID 19 infection are still debatable because of the limited human understanding of the virus with the current literature. In this study, we have tried to correlate the various predisposing factors influencing the clinical profile and treatment outcomes in patients with covid associated mucormycosis (CAM). It is a retrospective analysis of cases of CAM during the second wave of COVID 19 infection, which was managed in the department of Otorhinolaryngology from Dec 1, 2020, to June 10, 2021. The detailed clinical, radiological and management of patients with CAM were collected, recorded, evaluated and correlated with the predisposing factors. Of the total, 46 patients, 44(95.65%) were diabetic and 41 patients had a previous history of steroid intake. When clinical parameters were compared between blood sugar \ 200 mg/dl and [ 200 mg/dl, the old and newly diagnosed diabetes mellitus in patients with CAM, there was no significant differences in any of the above clinical parameters (p [ 0.05), except the hospital stay (p = 0,004). Steroid intake in patients with coexisting DM associated with CAM is considered the most important factor for the development of the CAM. There was are no significant difference in any of the clinical/treatment outcomes in patients with CAM with respect to the initial blood sugar, except for the hospital stay. A large sample size with a long-term follow-up period may be needed for a better understanding of common predisposing factors for the development of CAM.

Research paper thumbnail of Giant epidermal inclusion cyst of the thyroid: a rare occurrence

Autopsy Case Reports, 2021

Epidermal inclusion cyst (EIC) of the thyroid is extremely rare in the clinical practice. A handf... more Epidermal inclusion cyst (EIC) of the thyroid is extremely rare in the clinical practice. A handful of cases have been documented in the past in the world literature. A giant EIC of the thyroid is hitherto unreported. This lesion may arise from the squamous metaplasia of the thyroid follicular cells. Though non-neoplastic, giant forms can cause compression of the vital structures of the neck. In the present case, we have described a giant epidermal inclusion cyst successfully managed with surgical management.

Research paper thumbnail of Primary endoscopic stapedotomy using 3 mm nasal endoscope: Audiologic and clinical outcomes

Journal of Otology, 2020

Objective: To report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy an... more Objective: To report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy and clinical and audiological outcomes. Materials and methods: Thirty patients diagnosed with primary otosclerosis underwent endoscopic stapedotomy that was performed using a 3 mm nasal endoscope (Karl Storz). At 6 months follow-up, the patients were evaluated for intraoperative findings, postoperative hearing outcomes and complications. Results: Canaloplasty was performed in 2 (6.66%) patients, and no curettage of the canal wall was required in 12 (40%) patients. Transposition of the chorda tympani nerve was conducted in 11 (36.66%) patients. The average duration of surgery was 36 min (range 31e65 min). The air-bone gap (ABG) was 35 dB (range 24e50 dB) preoperatively and 14.63 dB (range 9e20 dB) postoperatively (p ¼ 0.00). At 6 months follow-up, <20 dB ABG was achieved in 93.33% of the patients. No major intraoperative/postoperative complications were detected. Conclusion: A 3 mm rigid nasal endoscope can be effectively used in stapedotomy to obtain adequate audiological outcomes. It can be considered as a better alternative to the standard microscope or 4 mm endoscope in preserving the posterior canal wall and chorda tympani nerve while minimizing operative time without causing significant complications.

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

Journal of Otology, 2020

Introduction: Majority of petrous bone and lateral skull base pathologies are benign in nature. T... more 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.

Research paper thumbnail of Analysis of Pattern of Laryngotracheal Invasion by Papillary Thyroid Carcinoma and Their Management: Our Experience

Indian Journal of Otolaryngology and Head & Neck Surgery, 2020

To analyse the pattern of laryngotracheal invasion (LTI) by papillary-thyroid-carcinoma (PTC) and... more To analyse the pattern of laryngotracheal invasion (LTI) by papillary-thyroid-carcinoma (PTC) and outcomes of their management. We undertook a retrospective chart review to study patterns of LTI by PTC and to evaluate outcomes of surgical modalities used to treat PTC with LTI. Out of 246cases of PTC, 26-cases had LTI (male-12, female-14, mean-age-55.6 years, range 42-73 years). Common clinical presentation were neck swelling, respiratory distress/stridor and vocal cord paralysis in 100%, 8 (30.8%) and 10 (38.5%) cases respectively. PTC was staged according to AJCC-TNM staging system (T4a-24, T4b-02, N1a-12, N1b-14, M0-25, and M1-01). CT-scan showed obvious LTI and tracheal narrowing in 11(42.3%) and 18(69.2%) cases respectively. All cases underwent total thyroidectomy with central-compartmentclearance. Unilateral and bilateral lateral-neck-dissection was performed in 08 and 06cases respectively. Pattern of Intra-operative LTI were as follows: trachea-13cases, trachea and cricoid-05cases, thyroid cartilage-6cases, trachea, cricoid and thyroid cartilage-2 cases and intra-luminal involvement in 4cases. Modified Shin's staging was used to stage LTI. LTI were superficial, deep-extra-luminal and intra-luminal in 13, 09 and 04cases respectively. LTI was managed by shave-excision, window-resection of trachea, sleeve-resection of trachea and anastomosis, partial laryngectomy and total-laryngectomy in 13,02,04,05 and 2 cases respectively. All patients received radioactive iodine (RAI) and TSH-suppression-therapy post-operatively. Mean follow-up period was two-years (range 18-30 months). One-case had radio-iodine non-avid local recurrence with lung metastases one-year post-operatively. Shave-excision is adequate for tumours not infiltrating into outer perichondrium. Tracheal-resection and total/partial laryngectomy may be required in cases with laryngo-tracheal cartilage or intra-luminal involvement. Adequate surgical excision along with postoperative RAI and TSHsuppression-therapy gives good loco-regional disease control in PTC with LTI.

Research paper thumbnail of Outcome of temporalis fascia myringoplasty with and without use of platelet rich plasma: A randomized control trial

Objectives: To compare the efficacy of temporalis fascia myringoplasty using platelet rich plasma... more Objectives: To compare the efficacy of temporalis fascia myringoplasty using platelet rich plasma(PRP) {MP-PRP} and conventional temporalis fascia myringoplasty(MP-C) in treatment of moderate to large central tympanic membrane(TM) perforation. STUDY DESIGN: Randomized-Control-Trial SETTING: Tertiary-Health-Centre SUBJECTS AND METHODS:We randomly assigned eighty patients with COM-mucosal-type with medium to large central TM perforation and conductive hearing loss planned for primary myringoplasty to receive either MP-PRP orMP-C. Myringoplasty was performed through post-auricular approach underlay graft using temporalis fascia. Primary outcome was graft uptake (an intact TM) at 6 months postoperatively. Secondary outcome was the post-operative hearing improvement measured by pure-tone-audiometry (PTA). RESULTS: Eighty myringoplasties (MP-PRP group-40, MP-C group-40) done for 80 patients (male=41; female=39,age-group=18-45years) were included in analysis. At 6months postoperatively graft uptake rate was 94.4% in MP-PRP and 92.1%% in MP-C group. There was no statistically significant difference in graft uptake between the two groups(p=0.358).Success in terms of hearing gain ([?]10dB) was achived in 34 patients (89.5%) in MP-C and 37 patients (94.9%) in MP-PRP group.At 6months follow-up; mean-PTA-average improved from 35.10±5.401dB to 27.74±5.660dB and mean ABG improved from 24.00±5.204dB to17.42±5.559dB in MP-C group. At 6months follow-up; mean-PTA-average improved from 37.00±6.144dB to 26.65dB and mean air bone gap(ABG) improved from 25.98±5.736dB to 16.21±4.318dB in MP-PRPgroup. No statistically significant differences in improvement in PTA-values were observed between both groups. (p=0.336).Postoperative complications were similar in both groups. Conclusion: Graft uptake, hearing outcomes and complications of MP-PRP were similar to MP-C. MP-PRP offers no advantages over MP-C for treatment of TM perforation.

Research paper thumbnail of Submental Ectopic Thyroid Cyst: An Atypical Presentation

Indian Journal of Otolaryngology and Head & Neck Surgery, 2018

Research paper thumbnail of Vallecular Neurofibroma Successfully Managed with Endoscopic Assisted Coblation: A Novel Technique

Indian Journal of Otolaryngology and Head & Neck Surgery, 2018

Research paper thumbnail of Surgical management of extracranial nerve sheath tumours in a tertiary care center

World Journal of Otorhinolaryngology - Head and Neck Surgery, 2019

Objective: Excision of the nerve sheath tumours of head and neck is always a challenge to the sur... more Objective: Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structures. Methods: It is a retrospective study contained 13 consecutive patients of nerve sheath tumours involving the head and neck from March 2013 to February 2017 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. The retrospective clinical data, diagnostic procedures, surgical approaches and their complications are analyzed after 12 months of surgery. Results: Total 13 patients, 7 were females and 6 were males. Painless neck swelling was the most common presentation found in 6 and the most common site of origin was the vagus nerve in the parapharyngeal space (6 patients). Transcervical excision of the tumour was performed in 7 patients. Six needed combined surgical approach for the excision of the tumours. Neurovascular injury was detected in 3 patients, and one patient had recurrent disease during the follow-up period. Conclusions: Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structure. Although the transcervical approach is commonly practiced for the majority of the tumours, combined approaches can be effectively applied for extensive nerve sheath tumours with the satisfactory clinical outcome.

Research paper thumbnail of Submental island flap reconstruction for carcinoma of the oral cavity: Experience in 30 cases

World Journal of Otorhinolaryngology - Head and Neck Surgery, 2019

The submental flap can be utilized for soft tissue reconstruction in oral cavity malignancies bec... more The submental flap can be utilized for soft tissue reconstruction in oral cavity malignancies because due to its close approximation to the surgical site, fewer donor site morbidity and the cost effectiveness of the procedure. Methods: A total of 30 patients with squamous cell carcinoma of the oral cavity were included in the study from July 2012 to August 2015 in a tertiary care referral hospital. Patients with clinical staging I/II/III (T1/T2/T3, N0) oral malignancy were included in the study. Patients with nodal metastasis irrespective of the stage of disease and patients with chronic medical illness/revision cases were excluded from the study. Submental island flap was utilized for the reconstruction of the soft tissue defect in each patient. Patients were followed at monthly interval till 6 months in the postoperative period. Results: The buccal mucosa (12 patients), tongue (10 patients) and floor of mouth (8 patients) were the subsites in the oral cavity. Partial and complete skin necrosis was found in 4 and 2 patients respectively. Postoperative chemoradiation was required in 5 patients. None of the patients had loco regional recurrence till 6 months of follow-up. Conclusion: The submental island flap is considered to be the reliable option for the soft tissue reconstruction in oral cancer because of dependent vascular pedicle, less donor site morbidity and the lower cost compared to the free flaps, often preferred in patients with a lower socioeconomic condition.