tracheostomy case report

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SURGICAL AIRWAY PROCEDURES

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Dr. NaushadHouse Officer

ENT Department

Tracheostomy

for impending airway problem in a case of

Carcinoma of Larynx

Case Presentation

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PERSONAL DATAPERSONAL DATA

NameName :: Mohd ArshadMohd Arshad

AgeAge :: 35 Years male35 Years male

BedBed :: E.N.T 10E.N.T 10

D.O.AD.O.A :: 8.01.20048.01.2004

D.O.DD.O.D :: 9.02.20049.02.2004

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HISTORYHISTORY

MAIN COMPLAINTS:MAIN COMPLAINTS: Change in voiceChange in voice 6 months6 months Pain in throatPain in throat 6 months6 months

HISTORY OF PRESENTING HISTORY OF PRESENTING ILLNESS:ILLNESS: According to the patient, he was alright 6 According to the patient, he was alright 6

months back when developed change in months back when developed change in voice and pain on swallowing on the right voice and pain on swallowing on the right side of throat. Both the complaints side of throat. Both the complaints developed slowly and were constantly developed slowly and were constantly progressing. He went to a number of progressing. He went to a number of doctors and received different medications doctors and received different medications with only temporary relief. with only temporary relief.

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PAST HISTORY-PAST HISTORY- No past history of any No past history of any other medical or surgical illness. other medical or surgical illness.

FAMILY HISTORY-FAMILY HISTORY- His father died of His father died of malignancy. Details are not available.malignancy. Details are not available.

PERSONAL HISTORY-PERSONAL HISTORY- Chain Chain Smoker (2 pack per day for last 10 Smoker (2 pack per day for last 10 years) years) with normal bowel habits. with normal bowel habits.

……HISTORYHISTORY

Contd.

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DRUG HISTORY-DRUG HISTORY- Had been taking antibiotics and Had been taking antibiotics and mouth washes for gargles. No history of any drug mouth washes for gargles. No history of any drug allergy.allergy.

SOCIOECONOMIC HISTORY-SOCIOECONOMIC HISTORY- Belongs to Belongs to lower middle class.lower middle class.

……HISTORYHISTORY

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GENERAL PHYSICAL GENERAL PHYSICAL EXAMINATIONEXAMINATION

A young man sitting anxiously in bed, well oriented A young man sitting anxiously in bed, well oriented to time, place and person.to time, place and person.

AnaemiaAnaemia JaundiceJaundice ClubbingClubbing Absent Absent CyanosisCyanosis Palpable Nodes:Palpable Nodes: Rt. Middle deep cervical node Rt. Middle deep cervical node

palpable around 2 cm and immobile palpable around 2 cm and immobile

Contd.

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Temp:Temp: AfebrileAfebrile

Pulse:Pulse: 84 beats per min. Regular,84 beats per min. Regular,

BP:BP: 110/80 mm Hg.110/80 mm Hg.

……GENERAL PHYSICAL GENERAL PHYSICAL EXAMINATIONEXAMINATION

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SYSTEMIC SYSTEMIC EXAMINATIONEXAMINATION

Resp. System:Resp. System:

CVS:CVS: NAD NAD

CNS:CNS:

GIT:GIT:..

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E.N.T EXAMINATIONE.N.T EXAMINATION

EAR EXAMINATIONEAR EXAMINATIONNormalNormal

NASAL EXAMINATIONNASAL EXAMINATION

NormalNormal

EXAMINATION OF THROATEXAMINATION OF THROAT

Poor oral hygienePoor oral hygieneGingivitisGingivitis

IDL: Reveals a large growth behind the epiglottis IDL: Reveals a large growth behind the epiglottis covering laryngeal inlet. Cords could not be seen. covering laryngeal inlet. Cords could not be seen.

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INVESTIGATIONSINVESTIGATIONS

CP:CP: Within normal limits with Hb of 14 g/dl Within normal limits with Hb of 14 g/dl

ESR:ESR: 25 mm within 1st hr. 25 mm within 1st hr.

Renal Profile:Renal Profile: Within Normal Limits Within Normal Limits

Blood Sugar (Random):Blood Sugar (Random): 90 mg/dl 90 mg/dl

Contd.

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……INVESTIGATIONSINVESTIGATIONS

X-Ray chest :X-Ray chest : NormalNormal

Histopathology:Histopathology: To obtain a specimen for To obtain a specimen for

histopathology Direct histopathology Direct laryngoscpy was planned laryngoscpy was planned along with tracheostomy for the along with tracheostomy for the impending airway problem. impending airway problem.

Contd.

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Tracheostomy and Direct Laryngoscopy and Tracheostomy and Direct Laryngoscopy and Biopsy was performed under general Biopsy was performed under general anaesthesia on 10.02.04.anaesthesia on 10.02.04.Findings: Extensive growth larynx and Findings: Extensive growth larynx and hypopharynx involving Rt. Arytenoids and hypopharynx involving Rt. Arytenoids and aryepiglottic folds, true and false cords, Rt. aryepiglottic folds, true and false cords, Rt. Pyriform sinus and post cricoid area with Pyriform sinus and post cricoid area with extension onto the posterior pharyngeal wall. extension onto the posterior pharyngeal wall.

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DIAGNOSISDIAGNOSIS

Advanced Squamous Cell Advanced Squamous Cell Carcinoma of LarynxCarcinoma of Larynx

T4 N3 MT4 N3 MXX

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TREATMENT & FOLLOWUPTREATMENT & FOLLOWUP

Patient referred to NORI for whole body Patient referred to NORI for whole body scanning TC-99 m scaning & Radiotherapy, scanning TC-99 m scaning & Radiotherapy, however patient went to Lahore to get however patient went to Lahore to get Radiotherapy from Shoukat Khanum and Radiotherapy from Shoukat Khanum and expired a month later while he was receiving expired a month later while he was receiving his radiotherapy. his radiotherapy.

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Thank you!