Day 2 :
Apollo Cosmetic Surgical centre & V-Graft Hair Transplant centre, India
Dr. M M T Vasan practices at Apollo Spectra Hospitals. Professional qualification of the Doctor is MBBS, MS, Fellowship in Plastic & Cosmetic Surgery and specializes in Plastic and Cosmetic Surgery. Dr. M M T Vasan has expertise in Cosmetic Surgery with an experience of 7 Years.
Introduction: Hair transplant is a common cosmetic surgery. Finer & newer techniques are coming up very often. Identifying and modifying the factors that affect graft survival have received a great deal of attention.
Materials & Methods: Harvesting done by Follicular Unit Transplant (FUT) and Follicular Unit Extraction (FUE). By adding good buffering solution for the graft storage and PRP application during the hair transplantation increases the graft survival. The factors affecting graft survival are discussed under the following headings: A. Follicular trauma – Mainly occurs by transection, dehydration and crushing of the grafts; B. Bio chemical factors – Lack of O2, blood, nutrients and pH shift; C. Vascular factors – Refers to immediate post-operative oxygen supply and revascularization.
Results & Analysis: Suction assisted hair transplant with good buffering storage for the graft survival and PRP application during hair transplant has be done around 350+ cases in past 5 years.
Conclusion: Graft survival can be increased to greater extend by reducing the follicular trauma, storing the grafts in good buffering solution and by PRP application.
Dr. Hans Centre for ENT, Hearing Care & Vertigo, India
Time : 10:45
Padma Shri awardee Prof. (Dr) J. M. Hans, is a topper and medalist from PGI Chandigarh. Dr. Hans has done pioneering work in the field of cochlear implant surgery and has done more than 1500 cochlear implants in his center, centers around the country and also in SAARC countries. He is the Founder Member of the Cochlear Implant Group of India. He is currently Chairman& Director of Dr. Hans Centre for ENT & Cochlear Implant and Chairman of Dept of ENT & Cochlear Implant, Venkateshwar Hospital, Dwarka, New Delhi. He is Honorary Consultant to Ex-Prime Minister of India. Dr. Hans is Government Member to the Ali Yajur Jung National Institute for Deafness, Mumbai. The Government appointed him as Executive Member of the All India Institute of Speech and Hearing, Mysore. He is appointed Member to the National Program on Prevention and Control on Deafness (NPPCD) and Advisor to UPSC and WHO. He pioneered the minimally invasive technique for Cochlear Implantation in India. He is also advisor Cochlear Implant Surgeon to Pingalwara Trust in Amritsar. He is visiting cochlear implant surgeon to the Medical Colleges of Chattisgarh, Andhra Pradesh and Madhya Pradesh, PGI Chandigarh etc., to perform CI surgery on deaf and dumb children.
Member of ADIP, Committee of Cochlear Implant, Govt. of India and Executive Council AIISH Mysore.
Aim: To understand and assess the presence of abnormal cochlear aqueduct and vestibular aqueduct and their presentation during cochlear implant surgery
Methods: The study involved 100 cases of a large cochlear aqueduct and 50 cases of large vestibular aqueduct which were identified on radiological assessment prior to surgery. The cases were operated by the same surgeon and by VERIA technique. The large cochlear aqueducts presented with CSF gushers after cochleostomy and the large vestibular aqueducts presented as pulsatile leak of perilymph. The cochleostomy in large cochlear aqueducts and the large vestibular aqueducts cases were sealed at the time of the CSF leak by the three handed technique in VERIA technique with a dumbbell shaped tissue seal or by using the specially designed electrode array.
Results: Large cochlear aqueducts presented with CSF gushers on cochleostomy which required a better preparedness during surgery to seal the cochleostomy at the time of the gusher to obtain a complete seal and the large vestibular aqueducts presented as a mild pulsatile leak of perilymph which was self-limiting and was easily sealed using tissue. All cases were sealed well at the cochleostomy and did not require any lumbar drain.
Conclusion: Better access provided by VERIA technique provides the surgeon a complete access to the cochlea which enables a three handed control of the gushers for better sealing of cochleostomy. Knowing the aqueducts radiologically prior to surgery is a must for every cochlear implant surgeon.
ASUR- AV2 Senigallia, Italy
Time : 11:00
Muhs nashik university, india
Currently working as associate professor in ent deprtment at JIIU's Indian Institute of Medical Science and Research (IIMSR). Previously worked as Senior Resident at Kem Hospital, Mumbai and DR. R. N. Cooper Hospital, Mumbai.
Background HRCT is found to be extremely useful for evaluating the ear diseases involving the external auditory canal, middle ear cavity, vertical segment of facial nerve canal, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint . our main objective was to correlate the clinical presentation and operative findings of ear diseases with HRCTmastoid
METHODS This study is done in our institute otorhinolaryngology dept. From april 2014 to april 2016. This is prospective study involves 36 patient belonging to different age and sex groups with high suspicious of ear diseases . we have taken detail history of each patient with complete ear nose throat examination done and after that all patient were investigated with routine blood investigation , x-ray and HRCT mastoid to correlate clinical finding and subjected for operation to compare operative findings with HRCT finding.
RESULTS:, Determined using pearson chi square test indicated a statistically significant correlation between HRCT temporal bone with clinical presentation and operative findings of ear diseases [P<0.05].
CONCLUSION With the advent of modern high-resolution CT scanners, detailed demonstration of temporal bone anatomy is practically possible now. We have been able to identify many significant structures not demonstrated by any of the known imaging modalities. The improved contrast and soft tissue a definition possible with HRCT has resulted in production of excellent images of soft tissue lesions in air spaces. Hence HRCT appears to be the diagnostic modality of choice for cholesteatomas and other soft tissue lesions in middle ear
- Head and Neck Oncology
Location: Bunga Anggerik
University Putra Malaysia, Malaysia
Associate Professor Dr.Sethu Thakachy Subha Current Appointment:,Head of Unit ENT Head & Neck Surgery ,Department of Surgery/Otorhinolaryngology Faculty of Medicine & Health Sciences University Putra Malaysia Serdang,Malaysia. Associate Professor Dr.Sethu Thakachy Subha ,obtained her MBBS degree from the University of Kerala India in 1989 and MS degree in ENT Head & Neck Surgery from University Malaya,Kuala Lumpur Malaysia in 2002.she has published articles in local and international peer reviewed journals. She has also presented her research papers in various international conferences. She has been serving as reviewer for many reputed medical Journals.
Nasopharyngeal carcinoma (NPC)representing about 0.7% of global burden of cancers where as NPC is the most common cancer of head and neck in Malaysia,South Eastern China ,Hong kong and Singapore.Nasopharyngeal carcinoma has typically metastases to cervical lymphnodes.Majority(>75%) of NPC patients have advanced locoregional disease with cervical metastases at the time of initial presentation. The common sites of distant metastases are bone,liver,lung and rarely metastases to axillary nodes.We report the rare presentation of recurrent NPC with axillary lympnode metastases.Our patient , 44 years old chinese gentleman who was diagnosed to have NPC with initial staging T2N3bM0 could not complete neoadjuvant chempradiotherapy due to severe oral mucositis.subsequent surveillance assessments were unremarkable and after 3 years he has presented with right axillary lymph nodes.Clinical examination revealed radiotherapy changes at the nasoharynx and absent cervical lymphadenopathy.Fine needle aspiration of nodes showed as metastatic carcinoma.CT scan showed obliteration of right fossa of Rosenmuller and axillary nodes.PET CT demonstarted right supraclacicular , axillary and mediatinal lymphnodes and patient has been subsequently referred for palliative chemotherapy.
Conclusion: This case illustartes the fact that ,eventhough NPC is highly radio and chemo sensitive ,these patients needs close follow up for early detection of recurrence and distant metastases.Despite the effectiveness of radiation and chemotherapy in the mangement of npc ,local or regional failure still occurs.Knowledge of potential mode of spread is not only vital to surgeons and also must be conveyed to patients for self examination.FDG-PET CT is better than CT in detecting residual or recurrent disease in NPC.
Liaquat National Hospital & Medical College, Pakistan
Dr. Shakeel Uz Zaman completed his MBBS from King Aga Khan University, Later he joined for specialization of Otorhinolaryngology at Liaquat National Hospital & Medical College, Karachi, Pakistan.
Objective: The purpose of this study was to identify the significant predictors of locoregional recurrence in early stage SCCA of buccal mucosa with pathologically clear surgical margins and negative neck.
Materials & Methods: We retrospectively reviewed records of 73 patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCCA between 2007 and 2011 with clear surgical margins (>5 mm margins each) and negative neck (N0). None of the patients received postoperative radiotherapy or chemotherapy. The primary endpoint of the study was local, regional or locoregional recurrence. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence.
Results: Recurrence was observed in 22 of 73 (30%) patients at the end of this study. Twelve (54.5%) had local, seven (31.8%) had regional and three (13.6%) developed locoregional recurrences. Sixteen patients (72.2%) had recurrence within the first 2 years of primary treatment. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control.
Conclusion: Our results demonstrate that LVI and non-T4MI significantly increased the locoregional recurrence rate in early stage buccal SCCA with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present.
Mohamed Saleh Elarbi is a renowned Professor in Ali Omar Askar Neurosurgery Centre, Libya. He has many publications to his credit.
Aim: To review medical records from patients who had maxillofacial infections between january2008-January 2016.
Methods: Retrospective analysis of 91 patients ,51 males(56%) and 40 females(44%) admitted in Ali Omar Askar(AOA) University hospital for Neurosurgery ,Oral &Maxillofacial surgery department, Esbea ,Tripoli Libya. Epidemiology, causes of infection treatment carried out and complications were discussed.
Results: A total of 91 patients with maxillofacial infection of which 51 were male (56%) , 40 females (44%), 85 patients had Odontogenic infections (93%) , 45 males (52,9%) & 40 females (47,1%)and 6 had non-Odontogenic infections(7%). The Odontogenic infections occurred mostly at the mandible and its associated spaces 74 cases (87%) involving the posterior teeth (82%). The main cause was dental caries 80 cases (94%). The most commonly affected facial anatomic region was the submandibular 39 cases (45,9%)Surgical treatment was required in all the cases.
Conclusions: Maxillofacial infections require proper urgent treatment, to avoid complications, which can be serious. Their Management is primarily surgical (incison ,drinage with extraction of offending tooth as required which require skilled anaesthetic airway management. Immedate admision, monitoring vital signs and high doses of antibiotics ,with intravenous fluids for rehydration .
Early diagnosis and national oral health preventive programme required in all age groups with emphasis on younger age group will reduce the incidence of Odontogenic infections and its serious consequences.
Complications; Mediastinitis, Cavernous sinus thrombosis were reported in two cases.
Keywords: Odontogenic infection, non-Odontogenic;, epidemiology, retrospective analysis.
Aga Khan University, Pakistan
Dr. Awan did his MBBS from Nishtar Medical College in 1990. He did his residency training at Pakistan Institute of Medical Sciences, Islamabad and Aga Khan University Hospital, Karachi and got his post graduate degree (FCPS) from College of Physicians and Surgeons, Pakistan in Otolaryngology and Head and Neck Surgery in 1998. He got his further training in the field of Otology (Ear diseases and surgery) from Wurzberg University, Germany and Portmann Institute, France. Dr. Awan has special interest in Cochlear Implant surgery and started a CI program at AKU in 2005 first of its kind in the country. Dr. Awan has keen interest in research activities and has 50+ national and international publications to his credit. Currently Dr. Awan is working as Associate Professor and Consultant Otolaryngologist at AKUH, he is head of ENT department and also leading the Cochlear Implant Program at Aga Khan University.
Objective: To analyze the clinical presentation, histopathology, complications and outcomes of parotidectomy.
Material and methods: Retrospective chart review was performed of 193 patients who underwent parotidectomy from January 2005 to December 2015 at the Aga Khan University Hospital, Karachi. Data collected included age, gender, comorbid, signs and symptom, perioperative facial nerve function, details of surgery, FNA, histopathology and complications.
Results: Out of 193 patients undergoing parotidectomy, 110(57 %) were males and 83 (43%) were females, mean age being 48.21 and 43.76 years respectively. Mean duration of symptoms was 41.33 months and most common symptom was pre-auricular swelling present in all patients followed by pain present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). FNAC was performed preoperatively and results were compared with final histopathology. 158 patients (81.86 %) underwent superficial parotidectomy while 35 patients (18.14 %) underwent total parotidectomy. The final histological diagnosis showed benign lesion in 147 (76.2%) patients and 46 patients (23.8%) had malignant lesions. 23 (11.9%) patients had transient nerve paralysis while 11 (5.7%) had complete facial nerve paralysis after surgery and majority of them were seen after total parotidectomy. 6 (3.1%) patients developed post-operative hematoma and 2 (1%) developed frey’s syndrome. 33 (71.73%) patients were sent for adjuvant radiation therapy out of 46 patients with malignancy and 9 (19.6%) patients with malignancy developed recurrence.
Conclusion: Parotidectomies are performed for almost all parotid masses and are usually associated with good postoperative outcomes. Malignancies of the parotid are rare with most of the masses benign in nature. FNA can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis. With modern day procedures facial nerve can be saved in most of the surgical interventions.
- Ear Disorders and Treatment
Location: Bunga Anggerik
Bangabundhu Sheik Mujib Medical University, Bangladesh
Md Monjurul Alam has been working as Professor of Otolaryngology & Head - Neck Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka since 2010. He Passed MBBS from Rajshahi Medical College, FCPS (ENT) from Bangladesh College of Physicians & Surgeon, Qualified MS in Otolaryngology from Dhaka University,obtained FICS from USA. He got advanced training in Micro-ear Surgery, FESS & RhynoPlastic Surgery, Snoring & Sleep Surgery, LASER Surgery, Skull-Base surgery from USA, UK, Australia, India, Singapore, Bangkok, Malaysia & different countries of Europe. He is a pioneer of Endoscopic Ear surgery in Bangladesh. He activly perticipated in workshop, seminer, conference, Congress in different countries. He has more than 80 articles published in different national & international journals.More than 5 research works has been going on under his supervision in BSMMU.
Background: Endoscopic ear surgery is an emerging technique with recent advancement highlighting advantages over the traditional microscopic approach. In Bangladesh we started doing myringoplasty since 2005 with otoendoscope and stopped due to few problems But again, since 2007, all types of middle ear surgeries with nasal endoscopes has been being done with bright , wide & clear view. We did different types of Transcanal Tympanoplasties, ossicluplasties, stapedotomies, also few cholesteatoma surgeries by endoscope.As Rigid endoscopy allows for wide-field view of the surgical field improved resolution with high magnification, and the ability to look around corners , enabling direct visualization of the hidden recesses including the retrotympanum, epitympanum, supratubal recess, peritympanum and hypotympanum, granulation tissue or cholesteatoma matrix can be removed easily.
Methods: A cross sectional study done during March,2010 to June,2014 in otolaryngology & Head-Neck surgery dept of Bangabundhu Sheik mujib Medical University (BSMMU) after having permission from Ehethical review board of the University.
Results: During the study period 1200 different types of transcanal Endoscopic Tympanoplasties like underlay & interlay tympanoplasty using different graft matrials ;temporalis fascia,perichondrium, cartilage with graft taken up rate & hearing gain equivalent with tympanoplasty done by microscope. 517 different types ossicluplasties and stapedotomies were done with similar hearing gain done by microscope.117 cholesteatoma surgery – Atticotomy, attico-antrostomy with reconstruction have been done without any major complication or recurrence. Learning curve of surgery among the residents is higher with endoscope.
Conclusions: Endoscopic ear surgery is a new technique that is gaining momentum in Bangladesh and there is enthusiasm for its incorporation into future practice. Further investment in training courses and guidance for those who looking to start or advance the use of endoscopes in their practice will be vital in the the years to come.
- Chemical Peels
Location: Bunga Anggerik
Masroor Ahmad Wani is Gold Medalist, has done MD from Medical College, Kolkata. He is practicing Aesthetic and Skin Medicine at Health Zone Medicate, Srinagar, India. He has published many articles in newspapers and magazines, has attended more than 22 national and international dermatological conferences.
A chemical peel is used to improve the appearance of the affected skin. A chemical peel solution is applied to the skin that eventually peels off the affected area. The new, regenerated skin is usually smoother and less wrinkled than the old skin. The new skin is temporarily more sensitive to the sun. Three basic kinds of chemical peels are: Superficial peel: Alpha-hydroxy acid or any another mild acid is used to penetrate only the outer layer of skin to gently exfoliate it. The treatment is used to improve the appearance of mild skin discoloration and rough skin as well as to refresh the affected area. Medium peel: Glycolic acid is used to penetrate the out and middle layers of skin to remove damaged skin cells. The treatment is used to improve age spots, fine lines and wrinkles, acne spots, freckles. Deep peel: Phenol or trichloroacetic acid is applied to deeply penetrate the middle layer of skin to remove damaged skin cells. The treatment removes moderate lines, age spots, freckles and shallow scars. Patients feel good improvement in skin appearance. Who is a good candidate for a chemical peel? Generally, fair-skinned and light-haired patients are better candidates for chemical peels. If you have darker skin, you may also have good results, depending upon the type of problem being treated. But you also may be more likely to have an uneven skin tone after the procedure.
- Aging Science
Location: Bunga Anggerik
Cairo University, Egypt
Marwa Mohamed Fawzy has completed her PhD from Cairo University and Postdoctoral studies from Cairo University School of Medicine. She is a Professor of Dermatology, Cairo University (since April 2016). She has got International Board Certificate in Dermatopathology (December 2010) passing successfully the 8th International Board Certifying Examination in Dermatopathology. She has published more than 30 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Background: Alopecia areata (AA) is a common condition causing non-scarring hair loss, yet its pathogenesis is still unclear. Treatment of AA is a difficult challenge. The discovery of epithelial stem cells in the bulge region of the outer root sheath of hair follicles in mice and man has encouraged researchers to utilize the hair follicle as a therapeutic source of stem cells for regenerative medicine.
Objective: The objective of the study is to evaluate the use of follicular stem cells in the treatment of AA.
Patients & Methods: Fifteen patients with AA of the scalp were included in a randomized controlled double blinded clinical trial. Isolation of hair follicle stem cells was done by enzymatic digestion of the bulge areas. Cell tagging using iron oxide particles was performed in order to elucidate the exact fate of the injected cells as a way for in vivo cell tracking. Sham saline injections have been done at control sites on the scalp of the treated patients.
Results: Excellent response was achieved in three patients (20%), good response was achieved in seven patients (47%), while five patients (33%) showed poor response at the end of nine months evaluation. None of the placebo injected sites in all included patients showed any response.
Limitations: Sample size is relatively small. Long-term follow up is mandatory.
Conclusion: It can be concluded that, local follicular stem cell therapy could be a feasible, efficient and safe therapeutic option for Alopecia areata.