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A COMPARATIVE STUDY ON THE EFFECT OF TOPICAL MITOMYCIN C AND NORMAL SALINE ON GRANULATION TISSUE IN TRACHEOSTOMISED PATIENTS

2024-07-01T00:00:00Z

Title: A COMPARATIVE STUDY ON THE EFFECT OF TOPICAL MITOMYCIN C AND NORMAL SALINE ON GRANULATION TISSUE IN TRACHEOSTOMISED PATIENTS Authors: SREELEKSHMY, S Abstract: BACKGROUND Tracheostomy is a surgical procedure performed to secure airway which can be in emergency or in elective setting. Granulation tissue is a late complication of tracheostomy which may cause airway occlusion, haemorrhage, difficulty in changing the tracheostomy tube, delayed decannulation, obstruction of tracheostomy tube, and can induce tracheal stenosis. Stomal granulation tissue can form at various sites like peristomal area, within the trachea, in the trachea at the distal end of the tube. The incidence of stomal granulation in tracheostomised patients ranges from 10%-80%. Ideal treatment for granulation tissue is not yet known but, various treatment modalities have been used to control and treat granulation tissue which includes topical application of corticosteroid creams, antibiotic preparations, silver nitrate, polyurethane foam dressings. Surgical interventions may at time be needed when granulation tissue becomes obstructive which includes laser ablation, electro cautery, resection, which may not be available in all centres. Mitomycin C (MMC) has been used in other airway surgeries to reduce stenosis and to reduce formation of granulation tissues as it is known to reduce fibroblast proliferation which is a key component of granulation tissue. In this study we intend to find the efficacy of topical MMC in preventing or minimizing granulation tissues in tracheostomised patients. OBJECTIVES: 1. To study the effect of Mitomycin C on granulation tissue in tracheostomised patients 2. To study the effect of Normal saline on granulation in tracheostomised patients xvii 3. To compare the dimensions of granulation tissue formed in tracheostomised patients administered Mitomycin C with a placebo group. METHODS:  This comparative study was done on 68 patients satisfying the inclusion criteria who underwent tracheostomy in our institution during the study period July 2022 to May 2024. Patients were randomly allocated by block randomization into two groups, each with 34 patients. The study group was Group A- MMC and placebo group was Group B-NS.  The patients in Group A (MMC) and Group B(NS)were subjected to three topical applications of 1 ml of MMC (0.4mg/ml) and 1 ml of normal saline respectively for 2 minutes intra-operatively during tracheostomy and repeated again on post-operative day 5 and day7. The patients were followed up every week to see for the presence of granulation tissue in and around the tracheostoma.  Using vernier callipers the length and thickness of granulation tissue were measured 2nd week, 4th week, and 6th week post tracheostomy and was documented and outcomes compared. RESULTS: The mean age of patients in Group A was 54.5±13.3 years and in Group B was 57.26±12.4 years with majority of the patients were males (Group A-70.6%, Group B- 76.5%). The overall incidence of granulations in Group A(MMC) was 35.3% compared to 82.4% in Group B (NS) and was statistically significant (p value <0.001). Delayed xviii onset of granulation tissue was observed in our study in Group A (end of second week) compared to group B (end of first week). At six weeks follow up Group A exhibited higher number of Grade II (14.71%) stomal granulation compared to Grade IV (14.71%) in Group B. When compared to the normal saline-treated group, (Grade I -14.71% Grade III – 11.76% and Grade IV - 14.71%) the Mitomycin treated group had minimal peristomal granulation, (Grade II, 5.88%) with P value of 0.003. Also Group B (NS) exhibited a higher incidence of Grade IV granulation) compared to Group A. When compared to placebo group (19 patients,55.8%) there was less incidence of stomal stenosis in patients treated with mitomycin C (6 patients,17.64%) and was statistically significant (p value 0.001) CONCLUSION: MMC does not completely arrest the development of granulations but leads to delay in the onset and progression of granulation and thereby reduces the risk of stomal stenosis.

CORRELATION OF SYSTEMIC IMMUNE INFLAMMATORY INDEX WITH DEPTH OF INVASION AND LYMPH NODE METASTASIS IN ORAL CANCERS

2024-07-01T00:00:00Z

Title: CORRELATION OF SYSTEMIC IMMUNE INFLAMMATORY INDEX WITH DEPTH OF INVASION AND LYMPH NODE METASTASIS IN ORAL CANCERS Authors: SREEJITH BOBAN Abstract: BACKGROUND: Oral squamous cell carcinoma is a leading cause of mortality in India. It is observed that 30% of all malignancies are involving head and neck, out of which 20 per 1 lakh individuals are affected by oral cancer. The main etiology of addiction to tobacco quid chewing females in our region have a high prevalence of oral squamous cell cancer. Majority of these individuals present with locally advanced illness which will definitely need extensive surgery and adjuvant therapy. SII has observed to play a significant role in the prognosis and outcome of the surgery. This index involving the blood parameters like neutrophils, lymphocytes and platelets counts obtained preoperatively. In this study we intend to find out whether there is a correlation between systemic immune inflammatory index and depth of invasion and lymph node metastasis in oral cancers and its reliability in preoperatively predicting the outcome of surgery and treatment. OBJECTIVES: 1. To document the systemic immune inflammatory index in patients planned for curative treatment comprising composite resection and adjuvant therapy in oral cancers staged T2 – T3. 2. To document the depth of invasion and lymph node metastasis on histopathological examination of the respected specimen in the above mentioned patients. 3. To correlate the systemic immune inflammatory index with depth of invasion and lymph node metastasis. xvii MATERIAL & METHODS: A prospective observational study, involving 41 patients with biopsy proven OSCC staged T2-T3, was carried out at Sri Devaraj Urs Medical College, R.L. Jalappa Hospital & Research Centre, Kolar from July 2022 to May 2024. A full blood count (CBC) was performed, and SII was approximated prior to surgery. Following surgery (primary excision of tumour with neck dissection and reconstruction), the resected specimen was histopathologically evaluated to determine the size, depth of invasion, and number of metastatic lymph nodes. The cut-off limit for SII was 484.5. RESULTS This prospective observational study conducted in Kolar included 58.5% female patients, with the majority of patients being over the age of 60. SII was found to be statistically significant for depth of invasion, lymph node metastases, complications, TNM stage, adjuvant treatment, hospital stay, and disease-free survival. CONCLUSION From the discussion it showed that SII can be used as a prognostic marker for survival for patients treated for OSCC. Mainly the features of easy access, cheaper and easy calculation has helped to prognosticate these patients. However, we still need larger prospective and well-structured studies to confirm the conclusion in the future.

COMPARISON OF INTRAORAL ULTRASOUND, COMPUTED TOMOGRAPHY AND HISTOPATHOLOGY IN ASSESSMENT OF DEPTH OF INVASION IN BUCCAL MUCOSA CANCERS – A CROSS-SECTIONAL STUDY

2024-07-01T00:00:00Z

Title: COMPARISON OF INTRAORAL ULTRASOUND, COMPUTED TOMOGRAPHY AND HISTOPATHOLOGY IN ASSESSMENT OF DEPTH OF INVASION IN BUCCAL MUCOSA CANCERS – A CROSS-SECTIONAL STUDY Authors: MONESHA, B Abstract: BACKGROUND: Head and neck cancers account for 30% of malignancies in India among which oral squamous cell carcinoma is the most common. Among the oral squamous cell carcinomas, the buccal mucosa cancers and lower gingivobuccal sulcus complex cancers are more common in our region due to addiction to tobacco and betel quid chewing. The majority of patients presenting here are females belonging to low socioeconomic status with locally advanced diseases that require major surgery and adjuvant treatment with significant morbidity. Depth of invasion shows the true infiltrative potential of a tumor. Following the study by Ebrahimi, the 8th edition of the American Joint Committee on Cancer (AJCC-TNM) staging incorporated depth of invasion as one of the features for preoperative tumor staging.1 Depth of invasion is usually measured preoperatively using imaging technique by Contrast enhanced Computed Tomography Scan or Magnetic resonance imaging and postoperatively from resected specimens by histopathological examination which is the gold standard method. Ultrasound evaluation is widely being used for assessment of thyroid nodules and metastatic lymph nodes in neck. Imaging also has limitations in assessing cancers involving the alveoli, palate and retromolar trigone as the periosteum is just deep to the mucous membrane. xviii OBJECTIVES: 1) To perform Intraoral ultrasound and contrast enhanced Computed Tomography preoperatively on patients with squamous cell carcinoma of the buccal mucosa and document the depth of invasion by using these modalities. 2) To document depth of invasion in resected specimens of these patients with squamous cell carcinoma of Buccal mucosa by Histopathological examination. 3) To compare depth of invasion documented by Intraoral ultrasonography and computerized tomography with depth of invasion assessed by Histopathological examination and thereby evaluate the reliability of these preoperative imaging modalities. METHODS: The study included 42 patients with biopsy proven squamous cell carcinoma of Buccal mucosa staged T2 or T3 planned for composite resection and adjuvant treatment at R.L. Jalappa Hospital And Research Centre, Kolar from July 2022 – May 2024. The pre-operative depth of invasion was documented by using intraoral ultrasound and Contrast enhanced computed tomography. All these patients underwent composite resection of the oral cavity tumor (including marginal or hemimandibulectomy) with neck dissection and reconstruction. The resected specimen was subjected to Histopathological examination where the tumor thickness, depth of invasion, bony involvement, perineural involvement, lymph node involvement and extracapsular spread were documented. The patients were administered adjuvant treatment in the form of post-operative radiotherapy or radiotherapy plus chemotherapy. The patients were followed up for a minimum of 6 months after xix completion of the treatment and any local, regional or loco-regional recurrence was documented. RESULTS: In our study, the majority of patients were females (79%) aged more than 60 years, and the most common site was left buccal mucosa. Out of the 19 patients staged T2 clinically, 5 patients were down-staged to T1 and 4 patients who were staged T3 by clinical and radiological examination were down-staged to T2, whereas 2 patients were upstaged to T4a due to skin involvement on histopathology. The DOI assessed by intraoral ultrasound correlated with that measured on histopathology in 71.5% of cases whereas in CECT it was 26.2 % with a Karl Pearson correlation coefficient of 0.929 between intraoral ultrasound and histopathology. The intraoral ultrasound overestimated DOI in 21.4% of cases. Nodal staging of the patient was also compared and 4 patients were upstaged to N3b due to ENE in histopathology. 13 patients were down-staged to N0 since it turned out to be reactive lymph nodes. Patients underwent surgery, followed by adjuvant radiotherapy in 61.9 % and adjuvant chemoradiotherapy in 21.4 %. Disease-free survival was seen in 81 % of the patients and locoregional recurrence was seen in 16.6% of the patients. CONCLUSION: There is a high prevalence of Oral squamous cell carcinoma in the region of Kolar, with the majority of the patients being female (79%) due to addiction to tobacco. There may be a significant difference in the DOI assessed radiologically when compared to histopathology, thereby affecting treatment planning and outcome. The depth of invasion assessed by intraoral ultrasound correlates much better with that measured on histopathology when compared to that measured by CECT in buccal mucosa cancers staged T2 or T3. Intraoral ultrasound is a better preoperative imaging modality for determining the depth of invasion in buccal mucosa cancers compared to CECT.

THE EFFECT OF PLATELET RICH PLASMA ON POST OPERATIVE WOUND HEALING FOLLOWING ENDOSCOPIC SINUS SURGERY-A PROSPECTIVE STUDY

2024-07-01T00:00:00Z

Title: THE EFFECT OF PLATELET RICH PLASMA ON POST OPERATIVE WOUND HEALING FOLLOWING ENDOSCOPIC SINUS SURGERY-A PROSPECTIVE STUDY Authors: KRITHIGA, SRIDAR Abstract: Background: Chronic rhinosinusitis (CRS), is the persistent inflammation of the mucosal lining of the nose and paranasal sinuses, affecting approximately 11% of individuals. Functional endoscopic sinus surgery (FESS) is the primary treatment for CRS unresponsive to medical management. Despite its efficacy, FESS can result in complications such as bleeding, crusting, adhesions, and infections, which can impair wound healing and mucociliary clearance, potentially leading to disease recurrence. Effective postoperative care is crucial to improve surgical outcomes. Platelet rich plasma, is an autologous compound rich in platelets and growth factors. It provides an environment conducive to wound healing and has anti-inflammatory, haemostatic, and antimicrobial properties. This study evaluates the effectiveness of platelet rich plasma in enhancing postoperative recovery following FESS. Objectives:  To perform anterior nasal packing after topical application of platelet rich plasma in one nasal cavity and without platelet rich plasma in the other nasal cavity following endoscopic sinus surgery and document the outcome in each nasal cavity in terms of wound healing and post operative complications like bleeding, crusting, adhesion, infection, and pain.  To determine the effect of platelet rich plasma in reducing post operative bleeding, crusting, adhesion, infection, and pain after endoscopic sinus surgery for chronic rhinosinusitis by comparing the outcome between the two nasal cavities in the above mentioned patients. xvii Study type: Prospective comparative study Methods: 42 patients diagnosed with bilateral CRSwNP and CRSsNP who underwent FESS at RL Jalappa hospital were included in the study. Following FESS, platelet rich plasma was instilled in one nasal cavity and normal saline in the other nasal cavity and nasal packing was done. Patients were assessed for the presence of bleeding, crusting, infection, adhesion and postoperative pain and grading was done at 1week, 2weeks and 3months post operatively. Results: Our study has shown that in the 1st postoperative week, platelet rich plasma shows significant reduction in bleeding, adhesion, crusting and postoperative pain. Postoperative infection rates were comparable between the PRP side and saline side in the first week. In the second week, there was significant decrease noted on the side of PRP for adhesion and infection. At the 3rd month there was significant decrease in crusting alone on the side of PRP. Thereby showing that PRP has a positive effect on wound healing in the initial post operative period and its long-term effect must be looked in detail in further studies. Conclusion: Our study demonstrated that platelet--rich plasma (PRP) significantly improves postoperative outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Platelet rich plasma has found to effective in decreasing bleeding, crusting, postoperative pain, and adhesion. These benefits can be attributed to PRP's biostimulatory properties, which facilitate wound healing and reduce inflammation. It is a minimally invasive and inexpensive. Therefore, it can be advocated as an effective treatment following endoscopic sinus surgery, potentially leading to better recovery, and improved quality of life.