Tonsillar Fossa Research Articles

Bilateral Parotid Gland Oncocytoma Mimicking Oropharyngeal Cancer Metastasis: A Case Report from a Radiation Oncologist's Perspective.

Parotid oncocytomas typically present as benign, unilateral, slow-growing, painless, and solitary masses that are histologically firm and multilobulated. They are often misdiagnosed as pleomorphic adenomas, hemangiomas, or other forms of oncocytosis. However, in our case, the parotid oncocytomas initially mimicked bilateral parotid gland metastasis of advanced oropharyngeal cancer. Here, we present a case of oropharyngeal cancer with bilateral parotid oncocytomas treated with chemoradiotherapy (CCRT). We report the case of a 74-year-old man with a sore throat, neck pain, right earache, oropharyngeal cancer, and bilateral parotid gland oncocytoma. Head and neck computed tomography and magnetic resonance imaging (MRI) showed soft-tissue swelling in the right tonsillar fossa and several enlarged level II neck lymph nodes. MRI revealed enhancing masses in both parotid glands, initially suspected to be metastatic lymph nodes. A biopsy of the right palatine tonsil confirmed squamous cell carcinoma with human papilloma virus-16 positivity. A positron emission tomography scan was performed, and biopsy-proven malignant lesions were observed in the right tonsillar region with metastatic lymph nodes in the right and left neck. Focal hypermetabolism was observed in the parotid glands, suspected to be pathological lesions such as metastatic intra-parotid lymph node or Warthin's tumor. An ultrasonography-guided biopsy of the left parotid gland confirmed an oncocytoma. Based on these results, the patient was scheduled for CCRT. After pathological confirmation of parotid oncocytoma, CCRT was administered, excluding the parotid glands within the radiotherapy field. This is a case of bilateral parotid gland oncocytoma mimicking oropharyngeal cancer.

Barbed tonsillectomy.

Although tonsillectomy is a common otolaryngological procedure renowned for its ease and safety, it is associated with various complications such as hemorrhage, dysphagia, pain, and infection. Post-tonsillectomy bleeding, especially secondary bleeding, poses a significant risk, with mortality rates reported as 5% of cases. Various techniques have been proposed to mitigate these risks, including the closure of the tonsillar fossa to prevent hemorrhage. Suturing of tonsil pillars has been suggested to enhance healing by reducing exposed surfaces. However, complications such as arterial injury and infection have been reported. This study aimed to investigate the efficacy of barbed sutures for reducing post-tonsillectomy complications compared to standard techniques. This prospective case-control study included 25 patients to receive a tonsillectomy with silk sutures (n = 11) or a tonsillectomy with barbed sutures (n = 14). Patients underwent either Barbed Tonsillectomy (BT) or standard tonsillectomy with external silk sutures. Pain scores were assessed using a visual analogue scale (VAS), while oropharyngeal dysphagia was evaluated using the Eating Assessment Tool (EAT-10) at two weeks and one month post-operation. BT showed significantly lower postoperative pain scores than standard tonsillectomy at 24 hours (VAS: 2.9 vs. 7.0) and after two weeks (VAS: 0.1 vs. 3.4). Similarly, BT demonstrated lower EAT-10 scores at two weeks (0.6 vs. 8.2) and one month (0.9 vs. 5.3), thus indicating reduced dysphagia. Only one patient in the control group required surgical revision due to bleeding, and none in the BT group. Comparison of all variables showed always a statistically significant (p<0.05). This study showed that barbed sutures in tonsillectomy may be a safe technique with reduced complications and a faster recovery. Initial findings regarding hemorrhage, pain management, and recovery outcomes are highly promising, warranting further investigation with larger sample sizes to endorse these results.

Coblation Reduced Post-operative Pain Over Bipolar Diathermy in Tonsillectomy Operation

Background: Tonsillectomy is a common surgical procedure performed for conditions like chronic tonsillitis and obstructive sleep apnea. Coblation and Bipolar Diathermy are advanced techniques that offer potential benefits over traditional methods; however, comparative studies evaluating these techniques in Bangladesh are scarce. Methods: A prospective analysis of 750 tonsillectomy cases (420 Coblation, 330 Bipolar Diathermy) was conducted at the Department of ENT, Rajshahi Medical College Hospital and Metropolitan Hospital, Rajshahi, Bangladesh, from January 2021 to June 2024. Data were collected on primary outcomes (pain duration, post-operative bleeding rates, healing time) and secondary outcomes (operation time, analgesic use, intra-operative bleeding, diet, and healing degree). Statistical analysis included chi-square and t-tests. Results: Coblation tonsillectomy significantly reduced post-operative pain duration compared to Bipolar Diathermy. In the pediatric group (ages 3-15 years), 85% of Coblation patients reported pain resolution within 5-7 days, while only 60% in the Bipolar group achieved resolution within 8-12 days. In adults (&gt;15 years), 70% experienced pain resolution within 8-10 days with Coblation versus 55% with Bipolar Diathermy. Coblation was associated with lower reactionary hemorrhage rates (pediatric: 0.24% vs. 1.21%; adult: 0.1% vs. 0.61%) and secondary hemorrhage rates (pediatric: 1.67% vs. 3.33%; adult: 2.17% vs. 3.57%). Healing times were shorter with Coblation, with reduced analgesic use, lower intra-operative bleeding (average 1.5 ml vs. 3.5 ml), earlier return to a normal diet, and faster healing in the tonsillar fossa. Conclusion: Coblation tonsillectomy provides superior outcomes in terms of pain management, bleeding complications, and healing time compared to Bipolar Diathermy. These findings support Coblation as a preferred tonsillectomy technique for both pediatric and adult patients in a tertiary care setting in Bangladesh.

Comparison of Surgical Complications between Cold Steel Dissection Method and Bipolar Electro Dissection Method in Tonsillectomy

Objectives: To assess whether bipolar electro dissection tonsillectomy has better surgical outcome compared to traditional cold steel dissection followed by silk ligature. Methodology: A Randomized Control Trial (RCT) was conducted at Department of ENT and Head-Neck surgery, Dhaka Medical College Hospital, from 1st January, 2020 to 30th July, 2021 Total 100 patients were enrolled through non- probability consecutive sampling and according to the selection criteria, who were admitted for elective tonsillectomy. They were randomly allocated into two groups of 50 persons each Bipolar electro dissection' (BED) and 'Cold Steel Dissection (CSD) group according to surgical method applied on them. The parameters of comparison were-duration of surgical technique, intraoperative blood loss, post-operative hemorrhage, pain, time taken returning to solid diet and healing rate of tonsillar fossac. Results: The mean operative time was 23.7±4.4 minutes in BED whereas 47.2±48.1 minutes in CSD method (p&lt;0.0001). Mean intra operative blood loss was less in BED (16.4±6.6ml) than in CSD (37.8±6.6ml) technique (p&lt;0.001). Overall reactionary hemorrhage rate was 12% and overall secondary hemorrhage rate was 18%. There was no statistically significant difference in post-operative hemorrhage incidence between two methods (p=0.373). Moderate to severe post- operative pain is more common bipolar method (68% &amp; 12%) than dissection method (46% &amp; 6%) which was significant (p=0.012). Mean time taken to return to solid diet for BED group was 8.12 days (range 3-16 days) and for the CSD group was 4.23 days (range 3-15 days) (p&gt;0.05). Regarding aspect of the tonsillar fossa in the CSD group healing was faster than BED group (p&gt;0.05). Conclusion: Operative time and intraoperative blood loss was significantly less in the bipolar electro dissection tonsillectomy (BED) group. Postoperative pain was significantly less in cold steel dissection tonsillectomy (CSD) group. Time taken to return to solid ......

Should paediatric tonsillar asymmetry be an indication for tonsillectomy? A single centre experience.

Paediatric tonsillar lymphoma (TL) is a rare diagnosis. Historically, the presence of clinical features such as tonsillar asymmetry, grossly abnormal tonsil appearance and cervical lymphadenopathy raise concern for this diagnosis. Tonsillar asymmetry is considered to be the most concerning clinical feature; however, asymmetry is often apparent due to differences in depth or shape of tonsillar fossa and tonsillar pillars, rather than a true difference in volume. There is debate whether a tonsillectomy is required in all cases of tonsil asymmetry to exclude lymphoma, and what clinical features should raise concern. The aim of this study was to establish whether the presence of clinical asymmetry can be deemed a reliable marker for genuine tonsil size discrepancies. We also sought to evaluate the clinical and examination characteristics that are concerning for lymphoma. Retrospective review of clinical records for paediatric tonsil specimens sent for histological evaluation between 1 January 2012 and 1 January 2023 driven by a clinical suspicion of lymphoma at Starship Children's Hospital, New Zealand. Patient demographics and clinical data were recorded. A comparison was made between tonsil size asymmetry on clinical examination (Brodsky criteria) and tonsil volume difference based on dimensions given in pathology reports. One hundred and forty-three patients had tonsillectomies between 2012 and 2022 at Starship Children's Hospital due to concern for lymphoma. Of these, three were positive for lymphoma. Presence of pain and abnormal tonsil appearance were predictors for lymphoma (p<0.02). Interrater reliability agreement between clinical size difference and tonsil volume was poor, Kappa= -0.13 p<0.05. Clinical size difference is a poor predictor for true tonsil volume difference. We advise that assessment of tonsil size should be performed in conjunction with the examination of gross visual abnormalities and lymphadenopathy to guide clinical decision making.

Prevalence and Causes of Blindness and Visual Impairment in Sudur Paschim Province of Nepal

Tonsillectomy is the complete removal of a tonsil from its bed and is one of the most common procedures in Otorhinolaryngology. The intensity of post-operative pain is severe enough to cause dysphagia which subsequently leads to infection of the fossa and other complications. Several studies on pain management have been conducted but not a single standard protocol currently exist. This study aims to evaluate the intensity of post tonsillectomy pain and to assess the efficacy of infiltration of Bupivacaine on the tonsillar fossa following tonsillectomy. A comparative study was conducted at Kathmandu Medical College, ENT-HNS department for a period of 18 months (January 2018 to June 2019). Ninety three patients were included. 2.5 ml of 0.5% Bupivacaine was infiltrated in right tonsillar fossa after tonsillectomy in all patients. The lateralization and intensity of pain at various post-operative period was assessed using visual analogue scale. The requirement of extra analgesics at various post-operative period was recorded. The pain score on the Bupivacaine side on the first and second post-operative day was decreased as compared to the other side. The pain score on the fourth hour and third post-operative day on Bupivacaine side was more than that of the other side. Infiltration of Bupivacaine over the tonsillar fossa has provided a good result with a significant reduction of pain in first post-operative day and in early post-operative period. However, other multi-centered and double blinded study is requires to provide better results.

Comparison of Post-operative Pain with and without Infiltration of Bupivacaine Hydrochloride in Tonsillectomy

Tonsillectomy is the complete removal of a tonsil from its bed and is one of the most common procedures in Otorhinolaryngology. The intensity of post-operative pain is severe enough to cause dysphagia which subsequently leads to infection of the fossa and other complications. Several studies on pain management have been conducted but not a single standard protocol currently exist. This study aims to evaluate the intensity of post tonsillectomy pain and to assess the efficacy of infiltration of Bupivacaine on the tonsillar fossa following tonsillectomy. A comparative study was conducted at Kathmandu Medical College, ENT-HNS department for a period of 18 months (January 2018 to June 2019). Ninety three patients were included. 2.5 ml of 0.5% Bupivacaine was infiltrated in right tonsillar fossa after tonsillectomy in all patients. The lateralization and intensity of pain at various post-operative period was assessed using visual analogue scale. The requirement of extra analgesics at various post-operative period was recorded. The pain score on the Bupivacaine side on the first and second post-operative day was decreased as compared to the other side. The pain score on the fourth hour and third post-operative day on Bupivacaine side was more than that of the other side. Infiltration of Bupivacaine over the tonsillar fossa has provided a good result with a significant reduction of pain in first post-operative day and in early post-operative period. However, other multi-centered and double blinded study is requires to provide better results.

Absorption and pharmacokinetics of bupivacaine after bilateral topical administration in tonsillar fossae for posttonsillectomy pain relief.

No previous studies have investigated the systemic absorption of bupivacaine when used topically for posttonsillectomy pain. The present study was undertaken to investigate the pharmacokinetics of bupivacaine after administration by a swab in the tonsillar fossae over 4 min after tonsillectomy. Eleven adult patients undergoing elective tonsillectomy were recruited. After removal of both tonsils, each of the two tonsillar fossae was covered with a swab moistened with 2 mL of bupivacaine 5 mg/mL, that is, a total of 20 mg bupivacaine. Blood samples were drawn after 0, 5, 10, 20, 30, 45, and 60 min. Bupivacaine was analyzed with an ultra-high-performance liquid chromatography-tandem mass spectrometry method. The highest single measured bupivacaine serum concentration was 23.2 ng/mL and took place 10 min after drug administration. Mean (±SD) Cmax was 11.4 ± 6.0 ng/mL and mean tmax was 11.3 ± 4.7 min. Mean t1/2 was 31.6 ± 9.3 min. As the toxic concentration threshold has been reported to be in the interval 1500-4500 ng/mL, the concentrations measured were well below 2% of the lowest cited toxic threshold. In conclusion, this study shows that applying 4 mL of bupivacaine 5 mg/mL by a swab in the tonsillar fossae posttonsillectomy yields very low plasma concentrations, suggesting its safe application without any risk of systemic toxic effects.

Anaplastic Thyroid Carcinoma versus Metastatic SCC: A Diagnostic Dilemma in a Rare Presentation of Post-Radiation Thyroid Swelling

AbstractA 71-year-old male with type 2 diabetes and hypertension was diagnosed with carcinoma of the pyriform fossa in 2019. The biopsy was reported as a moderately differentiated squamous cell carcinoma, and positron emission tomography-computed tomography (PET-CT) scan showed an fluorodeoxyglucose (FDG)-avid lesion in the pyriform fossa and the aryepiglottic fold with few nodes in level II and level III. The paitent was treated with radical chemoradiotherapy. A follow-up PET-CT scan done in 2022 revealed an FDG-avid soft tissue thickening in the left palatine tonsillar region and an uptake in the thyroid that was reported as not significant. A punch biopsy from the tonsillar fossa lesion revealed squamous cell carcinoma. The lesion was treated as a second primary and treated with radiotherapy with curative intent. The patient was complaining of dysphagia, difficulty in breathing, and weight loss around 6 months after treatment that were addressed medically. There was a significant reduction in size and FDG activity of the ill-defined thickening in the left tonsillar region which was seen in the response-assessment PET done 6 months after RT. A heterogeneously enhancing nodules were seen in both lobes of the thyroid in which the largest one measured 3.5 × 3.1 cm seen in the right lobe. The patient underwent a biopsy from the thyroid that revealed a benign thyroid gland infiltrated by clusters and nests of poorly differentiated malignant cells. The histomorphology was suggestive of a poorly differentiated carcinoma, likely anaplastic carcinoma thyroid, or metastasis of the squamous cell carcinoma. Curative treatment was ruled out in this case due to his comorbidities, pulmonary symptoms, and radiation delivered to the neck.

Posttonsillectomy Pain Relief and Wound Healing by Applying Bismuth Iodoform Paraffin Paste (BIPP) to Dissected Tonsillar Beds.

Introduction Tonsillectomy is one of the most common operations performed by otorhinolaryngology surgeons worldwide; however, the insufficient quality of the postoperative pain management and effective posttonsillectomy pain relief remain a clinical dilemma. Objective To evaluate the efficacy of applying bismuth iodine paraffin paste (BIPP) to the dissected fossa as an adjuvant therapy for a better outcome in terms of posttonsillectomy pain management and due to its wound healing properties. Methods The present is a prospective randomized control pilot study with 44 patients aged > 7 years who underwent tonsillectomy. The patients were divided into two groups: the control group and the group that had BIPP applied to the dissected tonsillar fossa. The visual analogue scale score and the post-onsillectomy percentage of tonsillar fossa epithelization were recorded and evaluated. Results Both subjectively and objectively, there a was statistically significant pain-relieving effect in the BIPP group within the first 5 postoperative days ( p < 0.05). From postoperative day 3 onward, the dissected area of the tonsillar fossa healed significantly faster in the BIPP group compared with the control group, and it became stable on day 14. Conclusion The topical application of BIPP showed a better pain-relieving effect, it was safe, and hastened wound healing after tonsillectomy.

Clinical manifestations, endoscopic findings and outcomes of tonsillar fossa foreign bodies in dogs: seven cases (2020-2023).

Clinical presentation and outcomes of dogs with tonsillar foreign bodies are not described in the literature. The objective of this case series is to describe the presence, clinical manifestations, endoscopic findings and outcomes of foreign bodies in the palatine tonsillar fossa of dogs. Medical records of dogs in which tonsillar fossa foreign bodies were removed by endoscopy between 2020 and 2023 at a referral centre were reviewed. Dogs were included if complete medical records were available. Seven dogs were included. Among all clinical signs reported, acute onset of throat clearing occurred in all dogs. Palatine tonsil enlargement and protrusion from the tonsillar fossa were observed in four of seven dogs. Foreign bodies were removed under endoscopic guidance in all dogs; a vegetal foreign body was found in all but one dog (6/7). Complete resolution of clinical signs was reported in the five dogs for which follow-up information was available. The tonsillar fossa is a rare but possible location for foreign bodies in dogs and should be explored even in the absence of macroscopic lesions of the tonsils, since some dogs could have a normal palatine tonsil appearance. Acute throat clearing should raise the suspicion of tonsillar fossa foreign bodies. The prognosis appears good after removal.

Analgesic Efficacy of Ropivacaine Infiltration on Early Post-Tonsillectomy Pain in Pediatrics.

To assess the analgesic efficacy of ropivacaine infiltration in the tonsillar fossa among pediatric patients undergoing tonsillectomy. PubMed, Scopus, Web of Science, and CENTRAL. Eligible randomized controlled trials (RCTs) were assessed for bias using Cochrane's risk of bias tool (version 2). Our primary outcome was postoperative pain within 24 h, and secondary outcomes included operative time, intraoperative blood loss, time to first analgesia, bleeding, and nausea/vomiting. Data were pooled as mean difference, standardized mean difference, and risk ratio with a 95% confidence interval. Our review included 11 RCTs, with a total of 712 patients. The quality of studies varied and included low risk (n = 8 RCTs), some concerns (n = 2 RCTs), and high risk (n = 1 RCT) of bias. The primary endpoint of postoperative pain across all time points was significantly reduced in the ropivacaine group compared with the placebo group. Trial sequential analysis (TSA) of the postoperative pain depicted conclusive evidence and unnecessity for further RCTs. The mean operative time was significantly reduced in the ropivacaine group compared with the placebo group. However, there was no significant difference between both groups regarding additional clinical (i.e., mean intraoperative blood loss and mean time to first analgesia) and safety (i.e., rates of bleeding and nausea/vomiting) outcomes. This systematic review and meta-analysis demonstrated the safety and postoperative analgesic efficacy of ropivacaine versus placebo among pediatric patients undergoing tonsillectomy. There was no significant difference between both groups regarding intraoperative blood loss, time to first analgesia, and rate of postoperative bleeding. 1 Laryngoscope, 134:3018-3029, 2024.

Surgical Innovation: Advanced Strategies in the Treatment of Pathologies in the Oropharynx and Parapharyngeal Space

Transoral surgery has evolved and its indications for treating diseases of different regions of the head and neck have increased. Pathologies that affect different sectors of the oropharynx and parapharyngeal space can be treated in selected patients through a transoral approach, significantly reducing the morbidity of surgery and the adjuvant treatments. Objectives: To determine the effectiveness of transoral surgery of the oropharynx and parapharyngeal space in patients treated with transoral surgery with microscope (TOMS) for tumors and other pathologies. Methods: Patients treated via transoral approach with the assistance of endoscopes or using a microscope for benign or malignant tumors, as well as other pathologies affecting different regions of the oropharynx (tonsillar fossa, tongue base, and pharyngeal walls) and the parapharyngeal space, between March 2004 and April 2022, were included in the study. To perform the surgeries, cautery, ultrasonic scalpel and CO2 laser were used. Results: Twenty patients with different lesions affecting various regions of the oropharynx and parapharyngeal space were treated using a transoral approach. Ten patients underwent surgery for lesions located at the base of the tongue, two were treated for tumors located in the tonsillar fossa, four patients had lesions located in the posterior and lateral walls of the oropharynx and four patients had lesions located in the parapharyngeal space. Conclusions: Transoral surgery of the oropharynx and parapharyngeal space assisted with endoscopes was highly effective, allowing adequate exposure and complete resection of various benign and malignant tumors, as well as the resolution of other diseases treated using this approach. There was no need to convert the transoral approach to an open procedure. The use of microsurgical technique was infrequent, and we found it to be more suitable for small tumors at the base of the tongue or lesions located in the lower sector of the posterior pharyngeal wall.

Foreign-body Impaction in Oropharynx Region

Abstract Fish bone impaction in the oral cavity and oropharynx region involving the palatopharyngeus, tonsillar fossa, base of the tongue, and migration into the gastrointestinal tract has all the possibilities of causing no symptoms or life-threatening outcomes. Foreign-body impaction is very common in adults, especially in coastal areas and the eastern region of the India. The delay in the removal of fish bone can cause serious complications and rarely life-threatening consequences. Radiographs and conventional computed tomography may be needed in migrated fish bone in deeper soft tissue and further downward displacement in the gastrointestinal tract.

Primary Small Cell Neuroendocrine Carcinoma of the Tonsil: A Rare Case Report and Review of Literature

Neuroendocrine tumors of the head and neck region are extremely infrequent. Small cell neuroendocrine carcinoma (NEC) of the tonsil is almost unheard of and carries a poor prognosis. There is no standard treatment protocol with regard to this tumor type. We present a 74-year-old male with complaints of odynophagia and swelling on the right side of the neck for one month. Physical examination showed a right neck level II lymph node with an ulceroproliferative mass involving the (R) tonsillar fossa, uvula, soft palate, and obstructing the oropharynx. MRI showed a right tonsillar mass measuring 3.4 × 3.3 × 1.4 cm with an ipsilateral level II lymph node measuring 2.7 × 1.9 cm. PET-CT scan showed a metabolically active right tonsillar lesion with a right level II lymph node. Histopathological examination revealed small cell NEC. On immunohistochemistry, tumor cells were strongly positive for PanCK, synaptophysin, chromogranin, CD56, and p16. Tumor cells were negative for CD45, CK7, CK20, and EBV-LMP. Ki-67 was 80%. The patient was treated with cisplatin and etoposide-based chemotherapy, and the tumor showed a very good response.

An unusual case of excessive angulation of styloid process and ossified stylohyoid complex causing Eagle’s syndrome: a case report

BackgroundEagle’s syndrome or stylalgia is a relatively rare condition that usually presents with throat pain and dysphagia. Most cases are asymptomatic, and diagnosis is difficult owing to the vague nature of the symptoms. There is a female preponderance. In most cases, the bony tip of the styloid process (SP) is palpable upon careful palpation of the ipsilateral tonsillar fossa. X-ray (Towne’s view) or an orthopantomogram indicates the length of the styloid process or the ossified stylohyoid complex (OSHC). Computerized tomography (CT) of the skull base, apart from measuring length, provides additional details such as medial or ventral angulation and relation to the surrounding neurovascular structures.Case presentationA 40-year-old female patient who presented to our hospital with left-sided throat pain and pricking sensation. After workup, she was diagnosed with left-sided stylalgia. X-ray (Towne’s view) showed that the left styloid process was 27 mm long, and the right styloid process was 24 mm long. CT of the skull base measured the length and angulation of the styloid process on both sides (sagittal and transverse angles), which were found to be 60° and 61° on the left and 64° and 60° on the right side, respectively. The patient underwent left styloidectomy under general anesthesia. Postoperatively, the symptoms were completely relieved by day 7.ConclusionStylalgia is usually diagnosed on the basis of the elongated styloid process. Solely using the length of the styloid process as a parameter for diagnosis leads to misdiagnosis of cases that present with normal length of the styloid process. This article highlights the importance of CT scans in measuring the angulation of the ossified stylohyoid complex in such cases for accurate diagnosis.

Dissection Method and Diathermy Cauterization in Tonsillectomy- A Hospital Based Comparative Study

Tonsillectomy is one of the most common procedures performed by otolaryngologists. It is a surgical operation that removes both palatine tonsils from the tonsillar fossa. It is typically performed in youngers for recurrent tonsillitis and tonsillar hypertrophy. This study was done to compare the dissection and diathermy methods of tonsillectomy and evaluate their advantages and disadvantages during surgery and convalescence. This study was a retrospective analysis of 400 patients from January 2015 to January 2020 in Otorhinolaryngology and Head-Neck Surgery department of Bangabandhu Sheikh Mujib Medical College Hospital, Faridpur. Out of 400 patients 200 patients underwent tonsillectomy by dissection method and rest 200 patients underwent electrocautery method. Total 400 patients were analyzed separately their hospital stay, blood loss per-operatively, complications in each method and overall outcome of the patients. The overall hospital staying in both types was 1-3 days. The average intra operative blood loss was 5-7 ml in cautery and average 50 ml in dissection method. The average operative time was 25-30 minutes in dissection method and 10-15 minutes was in electrocautery. We found higher amounts of blood loss and intra - operative time in dissection method than electrocautery. The chance of secondary haemorrhage was more in electrocautery method than dissection method. Pain, scar formation, odynophagia were more in cauterization method. Complete healing time was more in cauterization method than dissection method. There was no death in both methods. Although per-operative blood loss, operation time were less in cauterization method but post operative bleeding, pain, odynophagia and infection were more in electro cauterization method. In both methods, there were some advantages and some disadvantages. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 40-44

Low contralateral failure rate with unilateral proton beam radiotherapy for oropharyngeal squamous cell carcinoma: A multi-institutional prospective study from the proton collaborative group

IntroductionUnilateral radiation therapy is appropriate for select patients with oropharyngeal squamous cell carcinoma (OPSCC). The use of proton beam therapy (PBT) in the unilateral setting decreases the dose to the contralateral neck and organs at risk. This study aims to evaluate contralateral recurrences in patients who received ipsilateral PBT. MethodsWe evaluated the Proton Collaborative Group database for patients treated with PBT for head and neck squamous cell carcinoma between the years 2015–2020 at 12 institutions. Dosimetric analysis was performed in five cases. ResultsOur analysis included 41 patients that received ipsilateral PBT with a mean follow-up of 14.7 months. 37% patients (n = 15) were treated for recurrent disease, and 63% (n = 26) were treated for de novo disease. Oropharyngeal sites included tonsillar fossa (n = 30) and base of tongue (n = 11). The median dose and BED delivered were 69.96 CGE and 84 Gy, respectively. Eight (20%) patients experienced at least one grade 3 dysphagia (n = 4) or esophagitis (n = 4) toxicity. No grade ≥ 4 toxicities were reported. There was one (2.4%) failure in the contralateral neck. The 1-year locoregional control was 88.9% and the freedom from distant metastasis was 95.5% (n = 2). The dosimetric analysis demonstrated similar ipsilateral level II cervical nodal region doses, whereas contralateral doses were higher with photon plans, mean: 15.5 Gy and 0.7CGE, D5%: 25.1 Gy and 6.6CGE. ConclusionsOur series is the first to report outcomes for patients with OPSCC receiving unilateral PBT. The contralateral neck failure rate was excellent and comparable to failure rates with photon irradiation.

Comparison of Tonsillectomy Techniques with Reference to their Histopathological Healing Patterns

Background: Various techniques are available for tonsillectomy. Selection of the technique is based on the duration of surgery, intraoperative blood loss, post operative pain, duration and healing pattern of the tonsillar fossa. Objective: To compare the outcome of better healing pattern in dissection ligation technique and electrocautery technique of tonsillectomy. Study Design: Randomized control trial. Settings: ENT Department, Mayo Hospital Lahore Pakistan. Duration: Two years from December 01, 2019 to November 30, 2021. Methods: 106 patients with symptoms of recurrent attacks of sore throat with fever, obstructive sleep apnea, pain and difficulty in swallowing were included. Patients were randomized into two groups by random number table. Group A was operated by dissection-ligation technique and group B was operated by electrocautery technique. On 7th post tonsillectomy day healing score was calculated by taking tissue sample for histopathology from the tonsillar fossa. Results: Mean age of patients in group A was 13.79 ± 2.23 and in group B was 13.54 ± 2.09 years. In group A there were 55% males while 40% females in group B. Statistically significant difference were found in terms of profound inflammation, formation of abundant granulation tissue and collagen fibers reticular pattern between two groups on histopathology. Conclusion: Healing outcomes are better in dissection ligation technique than electrocautery technique of tonsillectomy.

Tonsillar Schwannoma: a rare case report

A Schwannoma is a benign, locally aggressive tumor that occurs due to the proliferation of Schwann cells of the nerve sheath. These tumors may involve any cranial nerve and hence are routinely missed on diagnosis. We report a rare case of a young adult female with unilateral tonsillar fossa mass which was excised by transoral approach, and histopathology reported to be a tonsillar schwannoma. Hence, it is necessary to be aware of these rare benign tumors as they can mimic a tonsillar hypertrophy.