NBE CME programme for DNB consultants - National Board Of ...

NBE CME programme for DNB consultantsNasopharyngeal angiofibromaHistory-Unprovoked torrential bleeding from nose; Nasal obstruction/Snoring/Mouth breathing;Anosmia/Hyposmia; Nasal intonation of voice; Headache denote coexisting sinusitis or duralcompression; Blocked ears due to ET orifice block; Rarely diplopia & proptosisor or failing visiondue to tenting of optic nerve; Recurrence after earlier incomplete surgery; H/O earlier surgery orradiotherapyClinical examination - Adolescent male; Red or pink or purplish smooth, lobulated/nodular masspushin the septum to opposite side in the midst of secretion sin the nasal cavity & nasopharynx;Soft palate may be bulged with restricted movement; Fullness of cheek/temple or frog faced deformity;Proptosis; features of Sec’ otitis media & conductive deafness; Trismus; Anaemia; Palpation canbe done using soft palate as a curtain- Fibroangioma if very frim/Angiofibroma if softer; Intraoralpalpation in the interval between the ascending ramus & the side of maxilla reveals diseaseextension to pterygopalatine fossaInvestigations - X’Ray-Paranasal sinuses, Lat’ view nasopharynx & Base of skull; Tomogram; CT;MRI; DSA; Complete hemogram & Blood grouping with work uo for G.A.; Ophthalmologist’s opinion;Neurologist’s opinion(SOS); Excision biopsyDifferential diagnosis- Antrochoanal polyp with squamous metaplsia; Hypertrophic turbinate &adenoids; rathke’s pouch or Thomwaldt’s cyst; Nasonasopharyngeal rhinosporidiosis; Othertumours of nasopharynx such as- Chordomas/Fibromas/Teratomas/Hemangiomas/Condromas/Gliomas/Rhabdomyomas/Fibrous dysplasia/Lymphomas NPCManagement - Surgery - Prior embolisation, Approaches- Endoscopic approach for smalltumors(Stage I) - Transfacial approach- Moure’s lateral rhinotomy, Medial maxillectomy,Midfacial soft tissue degloving, Weber Fergusons incision transnasoantral approach,Transmaxillary, Maxillary swing; Oral approach to nasopharynx- Transoral, Transpalatal; Hormonetherapy - Primary or adjunctive treatment(Diethylstilbestrol & flutamide)- To reduce vascularity; T.(30-40Gy) – reduces vascularity- Primarily for intracranial extensions & inoperable tumoursCancer LarynxHistory- Hoarseness of voice; Difficulty in breathing; Difficulty in swallowing; Pain, radiating pain toear; Selling in the neck; H/O aspiration & cough; H/o smoking & alcohol consumptionClinical examination–General-Comfortable/ in stridor;Cachexia; Throat-Dental/oral hygiene; IDLmasdescription, cord mobility, airway adequacy; Neck-Lymphadenopathy – level; Laryngeal contour;Laryngeal crepitus; Laryngeal tenderness; Thyroid gland; Trachea; Abdomen; Respiratory system;Spine; Provisional diagnosis-TNM staging.Investigations –DL scopy & biopsy; X-ray soft tisdsue neck-AP & lateral; X-ray chest; CT scan neck;Blood investigations; USG abdomen; Whole body bone scanDifferential Diagnosis-Tuberculosis of larynx; Squamous cell ca; Sarcoidosis; Scleroma of larynx;Basloid sq. cell ca; Verrucous ca; Scarcomatod caNon surgical management-Palliative/curative radiotherapy; Cobalt-60/linear accelerator; Irradiationfield perimetes; Dose 60Gy-70Gy; Duration 6-7 weeks; Complications of radiotherapy; Preparationof patient for RT; Role of chemotherapySurgical management-Micro laryngeal laser surgery; Conservation laryngectomy; Subtotallaryngectomy; Near total laryngectomy; Total laryngectomy; Extended total laryngectomyCarcinoma laryngopharynxHistory- Difficulty in swallowing; C/o stickin of food in the throat on swallowing; Pain radiatin pain toear; Hoarseness of voice; Difficulty in breathing; Swelling in the neck; H/o aspiration & cough;70