Indian Journal of Otolaryngology and Head & Neck Surgery, Jul 1, 1994
Total cheek defects in twenty cases of carcinoma of the buccal mucosa undergoing ablative surgery... more Total cheek defects in twenty cases of carcinoma of the buccal mucosa undergoing ablative surgery were reconstructed. A pectoralis major myocutaneous flap (alone or in combination with another flap) and cervicofacial flap were the most common methods used (ten and eight cases respectively). It was found that neck dissection, bony resection and pre-operative irradiation did not influence the choice of flaps. Patients gender and local soft tissue topography were the most important determinants in flap selection. o rn c')
Indian Journal of Otolaryngology and Head & Neck Surgery, Dec 1, 1990
This commnnlcation is a prospective non-randomised study of 17 cases seen at this centre during 1... more This commnnlcation is a prospective non-randomised study of 17 cases seen at this centre during 1984. Twelve cases which received radiotherapy and radical surgery form the basis of this analysis. Four of five (800/o) cases who received only radiation and surgery survived diseasefree for 4 years as compared to three of seven (43(}/0) who received additional induction chemotherapy. Overall, seven (58°/o) of these are disease-free for more than 4 years. Malignant tumours arising from he paranasal sim,.ses constitute about 0.5 percent of all cancers and 3 percent of aU malignancies arising from the respiratory tract (Sisson and Becker, 1981). Nearly all cases are diagnosed at a late stage when the turnout has already destroyed the bony confines of the sinus and may have spread to the surrounding structure (Bahadtw et al 1983). The fundamental factor m~.derlyir.g the diagnosis is a high degree of suspicion (Harrison, 1973).
Indian Journal of Otolaryngology and Head & Neck Surgery, Dec 1, 1991
i i i i i i i i i i ĩi i i ĩ!i i ĩi i i i i i i i i i i i ĩi i i i ĩĩĩi ĩĩi i ĩi i ĩi i i ĩĩi i i... more i i i i i i i i i i ĩi i i ĩ!i i ĩi i i i i i i i i i i i ĩi i i i ĩĩĩi ĩĩi i ĩi i ĩi i i ĩĩi i i i i i i i i i i ĩ!!!ĩi ĩi ĩi i i i Original/main article
Indian Journal of Otolaryngology and Head & Neck Surgery, Dec 1, 1976
Complete laryngopharyngeal stenosis poses a very difficult problem as to its immediate and long t... more Complete laryngopharyngeal stenosis poses a very difficult problem as to its immediate and long term management. If the stricture is impermeable surgical intervention is imperative. The long term dilatation programme, if and when feasible, is tedious and painstaking for both the patient and the treating physician. The management of complete laryngopharyngeal stenosis by applying Wookey’s technique, with the retention of
During a 10 year period 30 patients with carinoma of the soft palate were treated. There were 22 ... more During a 10 year period 30 patients with carinoma of the soft palate were treated. There were 22 cases in stages I and II. A curative dose of irradiation was used in 25 cases, four of whom required surgical salvage. Another five cases were treated by a combined modality of surgery and postoperative radiation. Seven cases had nodal metastases. A mean two-year disease-free survival of 83 per cent was obtained. The probability of five-year disease free survival was 65 per cent.
The management of sarcoma of the nasalcavity and paranasal sinuses is a challenging problem becau... more The management of sarcoma of the nasalcavity and paranasal sinuses is a challenging problem because o f natural behaviour and evasive diagnosis o f the tumour and the anatomic location. Sarcoma is a malignant tumour of mesenchymal or mesodermal origin, and is therefore o f lymphoid, fibrous, bony or cartilaginous origin. The incidence o f sarcoma in cancers of the nose and paranasal sinuses is 5% (Lewis, 1969). The present paper surveys 11 cases of sarcoma of soft part, bony and cartilaginous origin, treated in our hospital during 1978-84.
Primary subglottic carcinoma is rare with a uniformly poor prognosis. We present our experience o... more Primary subglottic carcinoma is rare with a uniformly poor prognosis. We present our experience of eight such cases treated over a period of ten years. One patient had a mucoepidermoid carcinoma while the rest had a squamous cell carcinoma. A combination of surgery and radiotherapy was employed in five cases, while one case each underwent radiotherapy only, surgery only and salvage surgery following radical irradiation. Three cases died of locoregional failure within a year. The remaining five patients have been disease-free for six months to 3.5 years.
Thirty patients with nasal and paranasal sinus lesion involving anterior cranial fossa, underwent... more Thirty patients with nasal and paranasal sinus lesion involving anterior cranial fossa, underwent craniofacial resection over a three year period were analysed. Nasal mass causing obstruction was the most frequently encountered symptom. Half of the patients had either unilateral or bilateral proptosis. A similar number had history of visual deterioration. Ocular nerve palsies were recorded in over a third of the cases. All the patients had CT scans of Head along with coronal cuts for anterior cranial fossa. A wide range of lesions were encountered, which included malignant lesions in 20 (66 percent) patients, 2 patients had extensive fibrous dysplasia of the sphenoethmoid complex and 3 patients had large osteomas of the anterior skull base. Mucarmycosis, aneurysmal bonecyst, and miningioma were noticed one case each. Two patients had giant cell tumour. Anterior cranial fossa floor was radically excised, posteriorly up to tuberculum orbits. In 9 patients orbital exenteration was also carried out. Total maxillectomy and partial medical maxillectomy was carried out in 8 cases each. Patients had a good cosmetic results, thus justifying the need for extensive cranio facial resection.
Mucosal melanoma of the upper aerodigestive tract is a rare disease with a relentless inexorable ... more Mucosal melanoma of the upper aerodigestive tract is a rare disease with a relentless inexorable course. This lesion involved the nasal cavity, maxillary sinus and palate in two cases each all of whom underwent a radical excision. The disease did not respond to radiotherapy in two patients with nasopharyngeal involvement. One other patient died of distant metastasis within five weeks of diagnosis. Despite surgery offering variable disease free periods, the prognosis remains guarded.
Hypopharyngeal carcinoma is an aggressive cancer with a guarded prognosis. Results of 64 patients... more Hypopharyngeal carcinoma is an aggressive cancer with a guarded prognosis. Results of 64 patients with-hypopharyngeal cancer, 59 of whom were in stage III or IV, undergoing curative therapy during a six-year period were analysed. A combined modality resulted in a 62% and 38.4% 2-year disease free survival incases with pyriform sinus and postcricoid tumours respectively. Results of radiotherapy failed salvage surgery were much poorer for either site.
Indian Journal of Otolaryngology and Head & Neck Surgery, Jul 1, 1996
A muscle flap was utilized for repair of pharyngocutaneous fistulae following total laryngectomy ... more A muscle flap was utilized for repair of pharyngocutaneous fistulae following total laryngectomy after irradiation in ten cases. A sternocleidomastoid flap was used in four cases with a type I fistula. In two of these the investing fascia over the muscle was utilized for supplementing mucosal closure. A pectoralis major muscle flap was utilized in six patients with a type II or Ill fistula. The fistula healed in all cases. Technical details and one illustrative case are described.
Indian Journal of Otolaryngology and Head & Neck Surgery, 1997
Clinical, radiological and CT findings for each adjacent subsite were tabulated and compared in 2... more Clinical, radiological and CT findings for each adjacent subsite were tabulated and compared in 25 consecutive cases undergoing surgery for malignant lesions of the maxillo-ethmoid complex. It was found that tumour extensions into nose, palate, cheek and orbit were identified correctly in a high proportion of cases clinically and radiologically. Posterior extensions into infratemporal or pterygopalatine fossae were evident clinically in only one out of 5 cases. Clinical assessment failed to detect orbital invasion in 3 out of 7 cases, while CT missed orbital periosteal involvement in one case. CT overestimated spheno-ethmoidal extensions of tumour in 44% (8/18) cases.
Olfactory neuroblastomas are seldom encountered in otolaryngologic practice. Eleven such patients... more Olfactory neuroblastomas are seldom encountered in otolaryngologic practice. Eleven such patients were treated by combined therapy over a nine year period. Two cases who initially underwent surgery only required salvage for a local recurrence by a combined modality. Nine patients were disease-free at the end of two years, with four of them being so for five years. Adjuvant chemotherapy was used in four cases, one of whom developed distant cutaneous metastasis after two years. Craniofacial resection was performed on three patients. A combined therapy is recommended for all stages of olfactory neuroblastoma.
Indian Journal of Otolaryngology and Head & Neck Surgery, Apr 1, 1996
ABSTRACT Malignant external otitis is an indolent osteitis seen in elderly diabetics. Eight patie... more ABSTRACT Malignant external otitis is an indolent osteitis seen in elderly diabetics. Eight patients with malignant otitis externa underwent surgical debridement and a 6–9 week course of antibiotics. Multi-drug therapy was used in all cases. The disease extent as determined on CT and at surgery dictated the nature of surgery. One patient expired of persistent disease. A staging system based on disease extent that correlates with the kind of surgery required and subsequent prognosis is presented.
Indian Journal of Otolaryngology and Head & Neck Surgery, Jun 1, 1983
A rare case of p r i m a r y aspergiiiosis of t h e larynx is presented w h i c h w a s successfu... more A rare case of p r i m a r y aspergiiiosis of t h e larynx is presented w h i c h w a s successfully t r e a t e d w i t h m i c r o l a r y n g oscopic excision and p o t a s s i u m iodide t h e r a p y .
Four regimens of prophylactic antibiotics were utilized in 122 consecutive patients of stages III... more Four regimens of prophylactic antibiotics were utilized in 122 consecutive patients of stages III and IV carcinoma of the upper aero-digestive tract undergoing major resections in a randomized single-blind study. Ampicillin, gentamicin, cephalexin and metronidazole were used in different combinations for periods of 5 or 10 days. A cephalexin-metronidazole protocol for 10 days was associated with lowest post-operative infection rate. Oral-oropharyngeal resection and use of pectoralis major myocutaneous flap were the most important factors contributing to infection.
Indian Journal of Otolaryngology and Head & Neck Surgery, Jul 1, 1994
Total cheek defects in twenty cases of carcinoma of the buccal mucosa undergoing ablative surgery... more Total cheek defects in twenty cases of carcinoma of the buccal mucosa undergoing ablative surgery were reconstructed. A pectoralis major myocutaneous flap (alone or in combination with another flap) and cervicofacial flap were the most common methods used (ten and eight cases respectively). It was found that neck dissection, bony resection and pre-operative irradiation did not influence the choice of flaps. Patients gender and local soft tissue topography were the most important determinants in flap selection. o rn c')
Indian Journal of Otolaryngology and Head & Neck Surgery, Dec 1, 1990
This commnnlcation is a prospective non-randomised study of 17 cases seen at this centre during 1... more This commnnlcation is a prospective non-randomised study of 17 cases seen at this centre during 1984. Twelve cases which received radiotherapy and radical surgery form the basis of this analysis. Four of five (800/o) cases who received only radiation and surgery survived diseasefree for 4 years as compared to three of seven (43(}/0) who received additional induction chemotherapy. Overall, seven (58°/o) of these are disease-free for more than 4 years. Malignant tumours arising from he paranasal sim,.ses constitute about 0.5 percent of all cancers and 3 percent of aU malignancies arising from the respiratory tract (Sisson and Becker, 1981). Nearly all cases are diagnosed at a late stage when the turnout has already destroyed the bony confines of the sinus and may have spread to the surrounding structure (Bahadtw et al 1983). The fundamental factor m~.derlyir.g the diagnosis is a high degree of suspicion (Harrison, 1973).
Indian Journal of Otolaryngology and Head & Neck Surgery, Dec 1, 1991
i i i i i i i i i i ĩi i i ĩ!i i ĩi i i i i i i i i i i i ĩi i i i ĩĩĩi ĩĩi i ĩi i ĩi i i ĩĩi i i... more i i i i i i i i i i ĩi i i ĩ!i i ĩi i i i i i i i i i i i ĩi i i i ĩĩĩi ĩĩi i ĩi i ĩi i i ĩĩi i i i i i i i i i i ĩ!!!ĩi ĩi ĩi i i i Original/main article
Indian Journal of Otolaryngology and Head & Neck Surgery, Dec 1, 1976
Complete laryngopharyngeal stenosis poses a very difficult problem as to its immediate and long t... more Complete laryngopharyngeal stenosis poses a very difficult problem as to its immediate and long term management. If the stricture is impermeable surgical intervention is imperative. The long term dilatation programme, if and when feasible, is tedious and painstaking for both the patient and the treating physician. The management of complete laryngopharyngeal stenosis by applying Wookey’s technique, with the retention of
During a 10 year period 30 patients with carinoma of the soft palate were treated. There were 22 ... more During a 10 year period 30 patients with carinoma of the soft palate were treated. There were 22 cases in stages I and II. A curative dose of irradiation was used in 25 cases, four of whom required surgical salvage. Another five cases were treated by a combined modality of surgery and postoperative radiation. Seven cases had nodal metastases. A mean two-year disease-free survival of 83 per cent was obtained. The probability of five-year disease free survival was 65 per cent.
The management of sarcoma of the nasalcavity and paranasal sinuses is a challenging problem becau... more The management of sarcoma of the nasalcavity and paranasal sinuses is a challenging problem because o f natural behaviour and evasive diagnosis o f the tumour and the anatomic location. Sarcoma is a malignant tumour of mesenchymal or mesodermal origin, and is therefore o f lymphoid, fibrous, bony or cartilaginous origin. The incidence o f sarcoma in cancers of the nose and paranasal sinuses is 5% (Lewis, 1969). The present paper surveys 11 cases of sarcoma of soft part, bony and cartilaginous origin, treated in our hospital during 1978-84.
Primary subglottic carcinoma is rare with a uniformly poor prognosis. We present our experience o... more Primary subglottic carcinoma is rare with a uniformly poor prognosis. We present our experience of eight such cases treated over a period of ten years. One patient had a mucoepidermoid carcinoma while the rest had a squamous cell carcinoma. A combination of surgery and radiotherapy was employed in five cases, while one case each underwent radiotherapy only, surgery only and salvage surgery following radical irradiation. Three cases died of locoregional failure within a year. The remaining five patients have been disease-free for six months to 3.5 years.
Thirty patients with nasal and paranasal sinus lesion involving anterior cranial fossa, underwent... more Thirty patients with nasal and paranasal sinus lesion involving anterior cranial fossa, underwent craniofacial resection over a three year period were analysed. Nasal mass causing obstruction was the most frequently encountered symptom. Half of the patients had either unilateral or bilateral proptosis. A similar number had history of visual deterioration. Ocular nerve palsies were recorded in over a third of the cases. All the patients had CT scans of Head along with coronal cuts for anterior cranial fossa. A wide range of lesions were encountered, which included malignant lesions in 20 (66 percent) patients, 2 patients had extensive fibrous dysplasia of the sphenoethmoid complex and 3 patients had large osteomas of the anterior skull base. Mucarmycosis, aneurysmal bonecyst, and miningioma were noticed one case each. Two patients had giant cell tumour. Anterior cranial fossa floor was radically excised, posteriorly up to tuberculum orbits. In 9 patients orbital exenteration was also carried out. Total maxillectomy and partial medical maxillectomy was carried out in 8 cases each. Patients had a good cosmetic results, thus justifying the need for extensive cranio facial resection.
Mucosal melanoma of the upper aerodigestive tract is a rare disease with a relentless inexorable ... more Mucosal melanoma of the upper aerodigestive tract is a rare disease with a relentless inexorable course. This lesion involved the nasal cavity, maxillary sinus and palate in two cases each all of whom underwent a radical excision. The disease did not respond to radiotherapy in two patients with nasopharyngeal involvement. One other patient died of distant metastasis within five weeks of diagnosis. Despite surgery offering variable disease free periods, the prognosis remains guarded.
Hypopharyngeal carcinoma is an aggressive cancer with a guarded prognosis. Results of 64 patients... more Hypopharyngeal carcinoma is an aggressive cancer with a guarded prognosis. Results of 64 patients with-hypopharyngeal cancer, 59 of whom were in stage III or IV, undergoing curative therapy during a six-year period were analysed. A combined modality resulted in a 62% and 38.4% 2-year disease free survival incases with pyriform sinus and postcricoid tumours respectively. Results of radiotherapy failed salvage surgery were much poorer for either site.
Indian Journal of Otolaryngology and Head & Neck Surgery, Jul 1, 1996
A muscle flap was utilized for repair of pharyngocutaneous fistulae following total laryngectomy ... more A muscle flap was utilized for repair of pharyngocutaneous fistulae following total laryngectomy after irradiation in ten cases. A sternocleidomastoid flap was used in four cases with a type I fistula. In two of these the investing fascia over the muscle was utilized for supplementing mucosal closure. A pectoralis major muscle flap was utilized in six patients with a type II or Ill fistula. The fistula healed in all cases. Technical details and one illustrative case are described.
Indian Journal of Otolaryngology and Head & Neck Surgery, 1997
Clinical, radiological and CT findings for each adjacent subsite were tabulated and compared in 2... more Clinical, radiological and CT findings for each adjacent subsite were tabulated and compared in 25 consecutive cases undergoing surgery for malignant lesions of the maxillo-ethmoid complex. It was found that tumour extensions into nose, palate, cheek and orbit were identified correctly in a high proportion of cases clinically and radiologically. Posterior extensions into infratemporal or pterygopalatine fossae were evident clinically in only one out of 5 cases. Clinical assessment failed to detect orbital invasion in 3 out of 7 cases, while CT missed orbital periosteal involvement in one case. CT overestimated spheno-ethmoidal extensions of tumour in 44% (8/18) cases.
Olfactory neuroblastomas are seldom encountered in otolaryngologic practice. Eleven such patients... more Olfactory neuroblastomas are seldom encountered in otolaryngologic practice. Eleven such patients were treated by combined therapy over a nine year period. Two cases who initially underwent surgery only required salvage for a local recurrence by a combined modality. Nine patients were disease-free at the end of two years, with four of them being so for five years. Adjuvant chemotherapy was used in four cases, one of whom developed distant cutaneous metastasis after two years. Craniofacial resection was performed on three patients. A combined therapy is recommended for all stages of olfactory neuroblastoma.
Indian Journal of Otolaryngology and Head & Neck Surgery, Apr 1, 1996
ABSTRACT Malignant external otitis is an indolent osteitis seen in elderly diabetics. Eight patie... more ABSTRACT Malignant external otitis is an indolent osteitis seen in elderly diabetics. Eight patients with malignant otitis externa underwent surgical debridement and a 6–9 week course of antibiotics. Multi-drug therapy was used in all cases. The disease extent as determined on CT and at surgery dictated the nature of surgery. One patient expired of persistent disease. A staging system based on disease extent that correlates with the kind of surgery required and subsequent prognosis is presented.
Indian Journal of Otolaryngology and Head & Neck Surgery, Jun 1, 1983
A rare case of p r i m a r y aspergiiiosis of t h e larynx is presented w h i c h w a s successfu... more A rare case of p r i m a r y aspergiiiosis of t h e larynx is presented w h i c h w a s successfully t r e a t e d w i t h m i c r o l a r y n g oscopic excision and p o t a s s i u m iodide t h e r a p y .
Four regimens of prophylactic antibiotics were utilized in 122 consecutive patients of stages III... more Four regimens of prophylactic antibiotics were utilized in 122 consecutive patients of stages III and IV carcinoma of the upper aero-digestive tract undergoing major resections in a randomized single-blind study. Ampicillin, gentamicin, cephalexin and metronidazole were used in different combinations for periods of 5 or 10 days. A cephalexin-metronidazole protocol for 10 days was associated with lowest post-operative infection rate. Oral-oropharyngeal resection and use of pectoralis major myocutaneous flap were the most important factors contributing to infection.
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