A novel way of identification of recurrent laryngeal nerve during thyroid surgeries

Background: This was a report of a movement of the recurrent laryngeal nerve which can be demonstrated during thyroid surgeries which can be used for locating the nerve, or identifying it if already exposed and causing confusion with other nearby structures or when alone too.Methods: The nerve is located by observing for a superior-inferior movement of the recurrent laryngeal nerve transmitted by the loose areolar tissue over it and dissecting over this site to locate the nerve right underneath it. This was by direct observation of the movement which will be there so long as the thyroid is held retracted to the opposite side and is not separated from the thyroid at the tissues that constitute the condensation of pre-tracheal fascia called the Berry’s ligament.Results: The recurrent laryngeal nerve originates from the vagus and loops posteriorly and then upwards around the arch of aorta on the left side and the subclavian artery on the right side. When the thyroid gland is retracted away and thus the nerve put on slight stretch, a superior-inferior to and fro- movement of the nerve can be seen. This movement can be used for identification and dissection of the nerve along its course.Conclusions: A review of literature has been done and it is clear that this movement has not been hitherto identified or published

STUDY OF DIFFERENT TYPES OF GRAFT MATERIALS USE IN TYPE - I TYMPANOPLASTY AT ENT DEPARTMENT OF SKMCH, MUZAFFARPUR, BIHAR

Background: The present study was undertaken to compare the results of various autogenous tissues as grafting materials for the repair of the tympanic membrane defect. As all the materials used previously were not easily available. So the present study comprised of the materials, which were easily available in adequate amount. These were temporalis fascia, tragalperichnodrium, areolar tissue and Ear lobule fat. Methods: In 100 subjects tympanoplasty operation was performed in 100 ears. The age of subjects ranged from 11 years to 50 years with mean age being 28.9 years. 33 cases were male and 67 cases were female. Majority (62%) of them were residing in rural areas and rest (38%)were from urban population. The period of study was from May 2019 to April 2020 starting from the pre-operative assessment to post– operative follow up all findings were noted in specific proforma. All of them attended ENT outpatient department of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, with the chief complaints of discharging ear of varying duration. Slight impairment of hearing of varying degree was also complained of. Few of them presented with active stage of the disease and they were treated conservatively so that they attained the criteria as mentioned previously for myringoplasty operation of the present study. Results: Temporal fascia – None of the operated case reached the excellent result of post operative A-B gap closure by 0 – 10 dB. 23 cases showed good A-B gap closure of 11 – 20 dB followed by 9 cases with fair A – B gap closure of 21 – 30 dB and 5 cases showed poor result of >30 dB A-B gap closure. Tragal perichondrium –None of the operated case reached the excellent result of post operative A-B gap closure by 0 -19 dB 5 cases showed good A-B gap closure by 11 -20 dB, followed by 3 cases of fair A-Bgap closure 21 – 30 dB and 1 case of poor result with >30 dB A- B gap closure. Areolar tissue – None of the operated case reached the excellent result of post operative A-B gap closure by 0 -10 dB. 6 cases showed good A-B gap closure by 11 – 20 dB, followed by 2 cases of fair i.e. 21 – 30 dB A- B gap closure. Ear Lobule fat – 8 out of 45 cases showed excellent result with post operative A-B gap closure by 0 – 10 dB followed by 32 cases with good A-B gap closure by 11 – 20 dB, followed by 5 cases of fair i.e. 21 – 30 dB A-B gap closure. Conclusion: Tympanoplasty using Fat from ear lobule has high success rate of 90% for tiny small perforations. It is an office procedure which is cost effective with minimum post operative morbidity. But it is an underused procedure. We should practice it more for the benefit of our patients. Further long term study with more number of patients and verities of graft materials are necessary to achieve detailed and accurate results.

Efficacy of Skin, Connective Tissue, Aponeurosis Galea, Loose Areolar Tissue, and Pericranium Acupuncture Techniques in Stroke Patients in Improving Muscle Strength of Motion Limbs

BACKGROUND: Nowadays, more than 650,000 stroke survivors needed further therapy and treatment related to mild or severe relief caused by stroke. Defects that cause stroke lesions require more serious and longer handling and will be very burdensome for patients and health insurance. Acupuncture method in the head skin, connective tissue, aponeurosis galea, loose areolar tissue, and pericranium (SCALP) was known to be related to the function of the cerebral cortex known as Zhu’s scalp acupuncture. Stimulation on this point was believed can open blood vessels, and provides better blood flow so it could improve repair in stroke patient. AIM: This research aimed to prove the effectivity of needle sticking on SCALP to strengthen limb muscle in stroke patients. MATERIALS AND METHODS: This research used a quasi-experimental design, pre-test-post-test without control group. The subjects of this study were stroke patients who were in the recovery phase (after the critical period had passed) and who had an stroke attack <1 year. Sampling method of this study was consecutive sampling, namely, recovery post-stroke patients who were hospitalized or outpatient of all over hospitals in Palembang, Indonesia. In this study, needle pricking was performed in the cerebral motor cortex which is located in the anterior central sulcus. Stimulation is done 10 times for 2 weeks. Assessment of muscle strength in the upper and lower limbs was performed using manual muscle testing measurement before and after therapy. Analysis of muscle strength before and after cerebral cortex stimulation through needle pricking on the SCALP of the head was analyzed by t-test dependent using SPSS 18. Data were displayed in tabular form, with a significance of p < 0.05. RESULTS: Subjects of this study were eight people consisting of four men (50%) and four female patients (50%) who had passed the critical stroke and were in the recovery phase within a period of recovery <1 year after stroke attack. The number of subjects who experienced improvement in joint motion of each joint was much greater than the frequency of the number of subjects who had no improvement. About 90% of the study subjects felt improvement in joint motion of each joint. The improvement in muscle strength score almost doubled after being treated with SCALP acupuncture better than before treatment. CONCLUSION: SCALP acupuncture technique was effective in improving muscle strength of motion limbs on stroke patients.