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BACKGROUND Cancer is expected to rank as the leading cause of death and the single most important barrier to increasing life expectancy in every country of the world in the 21st century.1 Head and neck squamous cell carcinoma is the most commonly diagnosed cancer worldwide. Our aim in this study is to find out the incidence of head and neck cancer cases in Otorhinolaryngology Department of our tertiary care centre in Assam. METHODS This is a retrospective study conducted among 45 cases over a period of one year. All patients who were operated in the Department of Otorhinolaryngology of our tertiary care centre over a period of one year from January 1 st 2019 to 31st December 2019. RESULTS 36 were males and 9 were females. Male to female ratio was 4:1. Age ranged from 17 yrs. to 70 yrs., with a mean of 58 yrs. Maximum number of patients was in the age group 51 to 60 years (26%). Oral cavity cancer included a total of 11 cases, out of which 7 were males 4 were females. Age group of cases was distributed evenly from 30 yrs. to 60 yrs. Pre-operative diagnosis of oral cavity cancer included 5 cases of lower gingiva-buccal sulcus (GBS) squamous cell carcinoma, 3 cases of upper GBS squamous cell carcinoma, and 1 case of retromolar trigone squamous cell carcinoma. CONCLUSIONS Population-based screening, early diagnosis based on awareness of early symptoms and signs and properly linked cancer registry system is needed to decrease the burden of head and neck cancer on government and medical personnel.

Cut neck injury needs prolonged hospitalization, high cost care, reduced quality of life and above all death. Proper exploration is a must in preventing co-morbidities like shock, sepsis, laryngotracheal stenosis or fistula formation. Neck trauma can involve muscles, vessels, nerves, bone and hollow viscera. Though the repair of neck means planning and skill for repair of the structure, the tracheal repair needs special attention to avoid tracheal stenosis. 12 patients were included in the prospective study of 8 months. Management plan was undertaken which were thoroughly studied and discussed with respect to two tracheoplasty cases done in ENT OT, AMCH. Apart from haemodynamic stability all patients were assessed for injury to hollow viscera and planned accordingly as this centre is an important centre for airway reconstruction. Male female ratio was 11:1. Suicidal cut neck injury was the most common cause. Two cases were of tracheal stenosis post tracheostomy. One of the case had associated neurovascular injury but with patent airway. Rest of the cases were repaired under general and/or local anaesthesia. Primary aim should be to maintain airway and to look for the extent of injury to reduce morbidity. Expertise of surgeons' skill is developing every day hence the successfulness of repair will be tested by least of morbidity. From this institute which is skilled in airway reconstruction we could comment that airway reconstruction team should be an integral part of surgeons' team.

BACKGROUND Despite the invigoration of cartilage graft in the last few years, very few literatures have been found regarding the use of the cartilage palisade tympanoplasty from the North-Eastern part of India. The aim of this study is to analyse the results of cartilage palisade graft technique in type 1 tympanoplasty in terms of the graft uptake, hearing improvement and postoperative complications. METHODS This hospital based prospective study was done from September 2018 to September 2019 including 21 patients of tubotympanic type of chronic otitis media. RESULTS Hearing improved significantly (p= 0.000) from 31.29 ± 6.81 dB to 14.95 ± 5.36 dB in the post-operative period in terms of ABG. The mean hearing gain was found to be 6.33 ± 6.96 dB. The graft uptake rate was 95.24%, without any significant post-operative complications. CONCLUSIONS High graft uptake rate, and highly significant audiometric outcomes in our study emphasises upon the usage of cartilage graft after slicing and palisading in the reconstruction of tympanic membrane even in primary cases without compromising the acoustic transfer characteristics.

Introduction: Allergic rhinitis (AR) is clinically dened as a symptomatic disorder of the nose induced after allergen exposure by an IgE- mediated inammation of the nasal mucous membranes. The symptoms include rhinorrhea (anterior or posterior), nasal congestion, nasal itching, and sneezing. In this study, we tried to determine the prevalence of Allergic Rhinitis among the people of North Eastern part of India (Assam) retrospectively. So we did a data based cohort study in a cross sectional pattern of the patients of visited Otorhinolaryngology Department of Assam medical college Dibrugarh, India, from July 2019 to June 2020. Aims And Objectives: To study about the burden of Allergic rhinitis among the people of Upper Assam Region. Methods And Materials: A study was done retrospectively based on data of the 420 patients who visited Otorhinolaryngology OPD in Assam Medical College and Hospital, Dibrugarh from July 2019 to June 2020, with symptoms of Allergic Rhinitis. The diagnosis was made on the basis of history and clinical examination. Discussion: It was found that out of 420 patients, the bulk of patients came to OPD during rainy season of august, autumn months of October and winter months of November. Besides 64% of people were of working age groups of 21-59 years who were exposed to dust , pollens, fungus , house dust mites during seasonal variations. Conclusion: The burden of allergic rhinitis in upper Assam region is largely underestimated. The cause of consistent symptoms of allergic rhinitis was noncompliance with medications, Lack of ability to comply with the advice of prevention of exposure to allergens, lack of education, lack of denitive diagnosis in peripheral health centre.

Objective. Thyroid surgery has travelled a long path, from a surgery which once was considered deemed to fail and even led to death, to the current time when newer techniques are being tested to make the incision smaller and smaller. The aim of our study is to give a precise detailed stepwise description of medial and lateral surgical approach with the anatomical basis and to compare their feasibility and safety. Methods. 104 cases presenting with thyroid swelling in the Department of Otorhinolaryngology, Assam Medical College Dibrugarh from January 1, 2019, to December 31, 2019, were selected and randomisation was done based on day of admission from OPD. Basic demographic data, preoperative diagnosis, operative time, blood loss, need for transection of strap muscles, and complications were recorded. Result. The distribution of thyroid cases according to age ranged from 17 to 81 years. The prevalence of thyroid disorders was the highest (37.5%) in the age group of 31–40 yrs. Of a total of 104 thyroid cases, 49 were colloid goitre, 24 were multinodular goitre, 9 were follicular neoplasm category 4, 4 were papillary thyroid carcinoma, 2 were follicular neoplasm category 3, and 3 were follicular neoplasm category 5. Conclusion. Out of the two approaches, lateral approach thyroidectomy showed better results with fewer complications. A single structure (superior belly of omohyoid) can be used as a guide to preserving all vital structures related to the thyroid gland.

Introduction: Epistaxis whether spontaneous or acquired is one of the most common ENT emergencies. Its management can be challenging depending on the origin of bleeding and presence of precipitating factors. Aim: To find out the seasonal variation in epistaxis according to age, gender, region and aetiological factor. Materials and Methods: This cross-sectional study was conducted from June 2019 to June 2020 in a tertiary care centre in Upper Assam. In this study, the seasons were divided according to weather atlas as follows: Winter- December, January, and February; Spring- March and April; Summer- May and June; Rainy season- July, August and September; and Autumn- October and November. Outcome was to find the seasonal variation in epistaxis according to age, gender, region and aetiological factor. The data collected was tabulated in Microsoft Excel Worksheet and the categorical variables were summarised as proportions and percentages. Results: Out of 313 patients, 221 (70.6%) were males and 92 (29.4%) were females. High male preponderance with male to female ratio of 2.4:1 was noticed. Maximum number of patients were seen in month of October 66 cases (21%). Minimum male patients were seen in month of June 2020 (0.6%) 2 cases and minimum number of female patients were seen in the month of February and April (0.3%). Conclusion: The major cause of epistaxis in this region is hypertension, therefore peripheral health facility should be ready for giving treatment.

Background: Chronic suppurative otitis media (CSOM) is an important and a highly prevalent disease of the middle ear and poses serious health problem worldwide especially in developing countries where large percentage of the population lack specialized medical care, suffer from malnutrition and live in poor hygienic environmental conditions. Aim of the study was to study the outcome of tympanoplasty in the light of character of edge of perforation and middle ear mucosa condition.Methods: This prospective study was conducted in 39 patients who underwent tympanoplasty in the department of ENT and head and neck surgery, Assam medical college and hospital, Dibrugarh between 1st June 2019 to 31st May 2020. Rim of perforated tympanic membrane and middle ear mucosa were sent for HPE. Three post-operatives follow up were done and surgical success was measured in terms of graft uptake and improvement in hearing.Results: Out of 39 cases, successful graft uptake was seen in 33 (84.62%) cases. Extension of migration of squamous epithelium in the undersurface of tympanic membrane was found in all 6 cases (3 had complete epidermosis while 3 had partial). All the six graft failure cases had diseased middle ear mucosa, mostly infected hypertrophied mucosa and tympanosclerosis with infiltration of chronic inflammatory cells and 1 patient had keratosis flakes with vascular stroma.Conclusions: Hypertrophic changes with inflammation of middle ear mucosa and epidermosis on the medial surface of tympanic membrane was found to have negative influence on the tympanoplasty outcome.

Background: The school of Bilroth in Vienna started modern thyroid surgeries in 1860s.1 Thyroidectomy was associated with high mortality, recurrent laryngeal nerve injuries and tetany. One and a half century down the timeline, complications still occur. Although, in experienced hands, the thyroid surgeries performed today are associated with minimal mortality and morbidity. Lateral approach thyroidectomy is a commonly practiced approach with fewer complications. We carried out a study to assess the efficacy, safety and advantages of lateral approach thyroidectomy with a new key step.Methods: A prospective study was performed on thirty patients undergoing conventional open thyroidectomy from January to July 2019 at a tertiary care hospital in north east India. All patients underwent open thyroidectomy via lateral approach in which identifying superior belly of omohyoid was considered a key step of surgery. Basic demographic data, preoperative diagnosis, operative time, blood loss, need for transection of strap muscles and complications were recorded. Results: There were no intra-operative complications, without the need to cut strap muscles or sacrifice superior belly of omohyoid in any case. Voice change was seen in one case, improved after steroid administration. One case developed tetany after total thyroidectomy managed with calcium supplements.Conclusions: Results suggested that lateral approach of thyroidectomy is a quick and safe technique where identification of superior belly of omohyoid considered as our key step, enabled easy delivery of superior pole of thyroid and facilitates easy identification and preservation of vital structures; thus, causing least morbid sequelae.

Pleomormpic lipoma of the anterior neck is a rare entity. Although pleomorphic lipomas a benign tumour it may contain atypical cells. Histologically pleomorphic lipoma is composed of mature fat, bland spindle shaped mesenchymal cells and coarse "rope like" collagen bands In addition pleomorphic lopoma contains multi-neucleated florat like giant cells. It Enzinger & Harvey (1) in their original series of pleomorphic lipoma \ spindle cell lipoma where there is little fat or no fat is a diagnostic challange.Immunohostochemical analysis by CD 34 positivity and desmin negativity is a diagnostic criteria. Here with we presenting a huge pleomorphic lipoma in the retropharyngeal space presenting as anterior neck swelling and sleep apnoea.

Natural killer (NK) cells are the key lymphocytes in solid tumors. Its activity is regulated by both germline encoded receptors and cytokine microenvironment. We conducted a case-control study to investigate the activation status of NK cell in oral squamous cell carcinoma (OSCC). NK cell activation was assessed in context of NK cell cytotoxicity and transcript expression of NK cell receptors (NKp46 and KIRs) and NK cell associated cytokines (IL-1β, IL-2, IL-10, IL-12β, IL-15, IL-18, IL-21, IFN-γ, TNF-α and TGF-β). The results revealed possible mechanisms involved in reduced NK cell activation in peripheral circulation: quantitative deficiency of NK cell number and lowered cytotoxicity together with qualitative NK impairments caused by--(1) decreased expression of NK activating receptor NKp46, (2) increased expression of NK suppressive cytokines--IL-10 and TGF-β and (3) induction of FOXP3(+)CTLA4(+) suppressor cells. On the other hand, in the tumor tissue, escape of NK immune surveillance appeared to be modulated by upregulation of TGF-β and IL-10 together with downregulation of NK cell activating cytokines (IL-2, IL-12β, IL-15, IL-18, IL-21 and IFN-γ) and NK receptors (NKp46 and KIRs). In addition, our study supported the earlier contention that TNF-α and IL-1β expression levels may be used as markers of malignant transformation in oral leukoplakia. In conclusion, the study provided an insight into the negative regulation of NK cell in tumor tissue and peripheral blood of OSCC patients, which can be exploited to boost the current NK cell and cytokine based immunotherapy for the treatment of oral cancer.

Killer cell immunoglobulin-like receptors (KIR) are involved in regulating natural killer cell activation through recognition of their human leukocyte antigen (HLA) class I ligands. We conducted a case-control study with 169 oral squamous cell carcinoma (OSCC) patients and 177 healthy participants to study the genomic diversity of KIR and HLA loci and KIR gene expression in context of family history of cancer (FHC) in OSCC. Polymerase chain reaction (PCR) sequence-specific priming approach was used to type 16 KIR genes in individuals. SSP-real-time PCR was used for HLA class I ligand genotyping and real-time quantitative reverse transcriptase PCR was used to determine the expression of KIR gene. KIR2DL1(+)-HLA-C2(+) genotype was higher and positively associated with OSCC. Notably, all KIR2DL1(+)-HLA-C2(+) genotypes occurred exclusively in patients with FHC, showing a strong positive association of KIR2DL1(+)-HLA-C2(+) genotype with FHC. In addition, all younger age group patients (55 years) with FHC were positive for KIR2DL1(+)-HLA-C2(+) genotype suggesting association of the genotype with early onset of disease. RNA transcript abundance of inhibitory KIR2DL1 in FHC patients, particularly of lower age groups (45 and 45-54 years), supports the contention. Further, KIR2DL3(+)-HLA-C(+) genotype was negatively associated with OSCC. Our findings suggest KIR2DL1(+)-HLA-C2(+) genotype as heritable risk factor in OSCC predisposing to OSCC at younger age. Interestingly, KIR2DL3(+)-HLA-C(+) genotype was seen to be protective in OSCC. This study may be useful towards cancer surveillance and early detection of oral cancer in patients with FHC.