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Sewing Needle Migrating from Esophagus into Prevertebral Space: A Challenging Case
Get PDFOesophageal foreign body presents as a medical emergency and requires immediate evaluation and treatment. We are reporting a rare case of sewing needle in esophagus migrating into the prevertebral space at thoracic inlet level. A 13-year-old mentally retarded female child was brought in emergency at midnight with complaint of accidental ingestion of sewing needle with the thread. Patient was posted for rigid esophagoscopy under general anaesthesia, no needle could be visualised and only thread of the sewing needle was removed. So patient was taken up for neck exploration along with gastroenterologists. Further careful dissection confirmed the needle in the pre vertebral space, which was removed successfully with artery forceps. Patient was given IV antibiotics for 10 days. Patient had an uneventful recovery and was discharged after 10 days. Pointed metallic slender foreign bodies can perforate and migrate very fast in the neck or chest and can lead to morbidity and mortality. Multidisciplinary approach offers a great advantage in surgical planning and proper patient management
True Orthodontic Intrusion Using Three-Piece Intrusion Arch for Correcting Excessive Gingival Exposure
Get PDFThe combination of proclined upper anteriors with high gingival exposure is challenging for the orthodontist. Correction of proclined upper anteriors sometimes leads to deepening of the bite and loss of posterior anchorage resulting in worsening of gingival exposure. Routinely correction of high gingival exposure was done prior to space closure resulting in increased treatment duration. However, application of sound biomechanical strategies can help us overcome these challenges without compromising treatment time. This presentation will describe the meticulous orthodontic biomechanics using a 3-piece intrusion arch to simultaneously correct excessive gingival exposure as well as accomplish space closure. The patient presented with Class I malocclusion with proclined upper anterior teeth, crowding in upper and lower arches and an excessive gingival exposure. Fixed orthodontic therapy was initiated with first premolar extractions and the primary strategies after correcting of the crowding was the effective use of a 3-piece intrusion arch for simultaneous intrusion and retraction of proclined anterior teeth. Biomechanics strategies utilizing the 3 piece intrusion arch effectively aided in closure of spaces, correction of high gingival exposure, intrusion of the upper anteriors and controlling posterior anchorage. All desired treatment outcomes were achieved without prolonging treatment time. Proper biomechanics strategies can effectively bring about true intrusion of the upper anteriors as well as correct the upper incisor proclination without prolonging treatment time. The use of threepiece intrusion arch to achieve orthodontic correction assures the attainment of predictable treatment results. Loss of anchorage is seldom observed because of the tip back moment on the posterior teeth. Another advantage of intrusion mechanics is the control of the vertical dimension
Comparison of Electrocautery and Plasmablade on Ischemia and Seroma Formation after Modified Radical Mastectomy for Locally Advanced Breast Cancer
Get PDFThe aim of this study was to compare postoperative drainage volumes and IMA levels in patients who underwent modified radical mastectomy (MRM) with using PlasmaBlade (PB) or electrocautery (EC). A total of 36 patients who underwent MRM with PB or EC in our clinic between August 2012 to February 2013 were enrolled. Number of removed and positive lymph nodes, duration of drainage and total drainage volume was recorded. Seroma formation after drain removal and number of aspirations were also recorded. Serum ischemia modified albümine (IMA) levels were analysed before surgery, 1 h and 24 h after surgery. In total, 36 patients were treated with MRM in the study period. Of the 36 patients, 16 underwent MRM with PB, and 20 underwent MRM with EC. The patients demographics were similar in both groups. The mean drainage volume and seroma formation were significantly higher in the PB group when compared with EC group (p < 0.05). Number of aspirations due to the seroma were also high in PB group. The total aspiration volume of seroma was not different in both groups. IMA levels 24 h after surgery in the PB group was significantly higher than EC group. There was no statistical significance between the groups for IMA levels at 1st hour. PB is a monopolar energy device and is associated with increased levels of ischemia. This situation resulted with an increased volume of total axillary drainage and elevated risk of seroma formation
Minimal Access Thyroid Surgery in Children: A Retrospective Study and Literature Review
Get PDFMinimal access thyroid surgery (MATS) is a technique whereby a part of or whole of a thyroid lobe is removed through a small (3–4 cm) neck incision. Its use in the surgical management of thyroid disease in children has not been well elucidated. We present a retrospective case study of 12 patients over the period of 2007 to 2010 to assess the feasibility of MATS in the management of thyroid disease. Minimal access thyroid surgery is a safe and feasible approach for hemithyroidectomy/lobectomy in selected patients. There were no associated adverse events, complications or disease recurrence. We also reviewed the literature and discussed the use of MATS as a routine procedure in selected pediatric patients
Broken Metallic Tracheostomy Tube Migrating into the Tracheobronchial Tree
Get PDFForeign body aspiration can be a life-threatening emergency. Broken tracheostomy tube in tracheobronchial tree is one of the rarest types of foreign body reported. Here we report two cases of fracture of metallic tracheostomy tube, leading to foreign body in tracheobronchial tree. A 14-year-old girl presented to our Emergency Department with history of respiratory distress and violent bouts of cough since 2 days. Chest X-ray showed that the broken part of the tube was lodged in the right main bronchus. The presence of Parkinson’s disease in the patient and restricted neck flexion offered a challenge both for the anaesthetist and the surgeon. We were successful in removing the broken tube in 13 small pieces. Check bronchoscopy was clear and the procedure went uneventful. We would like to conclude that broken tracheostomy tube presenting as foreign body bronchus is infrequent but it is a preventable complication of tarcheostomy. The patient must be kept on regular follow up to check for signs of wear and tear. Timely and periodic replacement of tracehostomy tube should also be done, otherwise such life-saving surgery can become lifethreatening
Echinococcus in the Orbit: An Unusual Hideout
Get PDFIsolated involvement of the orbit by hydatidosis is extremely rare. It is a parasitic infestation due to a tapeworm called Echinococcus Granulosus. It is an uncommon disease in head and neck region as it commonly manifests in the lungs and liver. When seen in head and neck, it has been found in the orbit, paranasal sinuses and salivary glands. Orbital hydatidosis per se forms only 1% of all types of hydatid disease. It is endemic in Africa, Middle East and Southeast Asian countries including India. In orbital hydatid disease, patients usually present with unilateral proptosis and diminution of vision. Proptosis is classically painless. Total surgical removal remains the mainstay of treatment. A 30-year-old female belonging to lower socio-economic status, presented with left eye proptosis since 2 years. There was a gradual increase in proptosis associated with diminution of vision over the last 4 months. This finally led to complete loss of vision in a period of two months. Computed tomography scan showed two soft homogenous non-enhancing cystic structures present in the orbit abutting the optic nerve without any intracranial extension; most likely differentials are a developmental cyst, hydatid cyst, epidermoid cyst, rhabdomyosarcoma or a nerve sheath tumor. Magnetic resonance imaging showed two T1 hypointense non-enhancing, T2 hyperintense soft cystic capsulated space-occupying lesions present in the extraconal compartment of orbit abutting the optic nerve, likely to be lymphangioma or a hydatid cyst. Surgery was planned and endoscopic orbital decompression was done. Sago grain-like granules were seen pouring out of the cysts. Cyst walls were completely removed in piecemeal and the specimen was sent for histopathology. Immediate intra-operative reduction of proptosis was seen. The final histopathological report was suggestive of hydatid cyst
A Rare Case of Nasal Schwannoma of Middle Turbinate
Get PDFSchwannoma is a benign, slow-growing nerve sheath tumor derived from the Schwann cells. Cases with nasal schwannoma arising from nasal septum and inferior turbinate have been reported, though being rare. A 32-yearold male patient presented to our hospital with left side progressive nasal blockage since 4 months and multiple episodes of epistaxis. Anterior rhinoscopy revealed left side smooth spherical nasal mass, which was bleeding on touch. Computed tomography was done, which was suggestive of right side deviated nasal septum. Left nasal cavity soft tissue lesion extended into anterior ethemoid cells, causing widening of the osteomeatal complex. The patient underwent endoscopic excision of nasal mass. Histopathology of nasal mass suggested nasal schwannoma. Though nasal schwannoma is rare, it should be considered as a differential diagnosis in case of unilateral nasal mass with epistaxis. Definitive diagnosis of schwannoma can be considered only after final histopathological reporting of the surgical specimen
Chemoport Anchoring—The In Situ Technique
Get PDFChemoports are subcutaneously placed long term central venous access devices usually inserted under local anaesthesia. Rare complications include port inversion or flip over. These can be prevented by anchoring the port to the tissues at its base. We describe an in-situ technique of port anchoring. Here, the port is first ‘fixed’ temporarily to the overlying skin by Huber needle, thus facilitating placement of fixing sutures without port manipulation. The described technique is safe and we have not encountered complications. In addition, explanting the port was easier due to the use of delayed absorbable sutures. It is safer to anchor the port even if the port pocket ensures that the port fits in snugly. This described technique results in minimal manipulation of portcatheter system thereby ensuring that the catheter tip which is properly placed remains unaltered
Light at the End of the Tunnel: A Technical Note on Thoracoscopic Repair of Congenital Diaphragmatic Hernia
Get PDFThoracoscopic repair of congenital diaphragmatic hernia (CDH) has been described by a number of authors and is increasingly widely practiced. We present a technical learning point. CDH is associated with the presence of a hernia sac in around 20% of all cases. In this case the presence of a ruptured hernia sac complicated the thoracoscopic repair of a left sided CDH, as it was initially difficult to recognise. Once the anatomy was clarified the repair was satisfactorily completed and the child made a rapid postoperative recovery. This technical note is to warn other surgeons that a tunnel like appearance of the diaphragmatic defect may in fact be due to the presence of a torn hernia sac, which requires excision before closure of the defect
Single Port Paediatric Heminephrouretectomy
Get PDFWe present a 4-year-old girl who underwent a single incision laparoscopic surgery (SILS) heminephrouretectomy. The procedure was completed without intra-operative complications or conversion. The operative time was 162 min. At 3 month follow up there is no evident scar and the patient is asymptomatic. SILS upper moiety heminephrouretectomy for duplex kidney is safe and technically feasible in children