Browsing by Author "Gurung, Urmila"
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Publication A Large Follicular Adenomatoid Odontogenic Tumor Occupying the Maxillary Sinus: A Case Report(Nepal Medical Association, 2023) Maharjan, Leison; Gurung, Urmila; Pradhan, BibhuAbstract Adenomatoid odontogenic tumour is a rare benign, odontogenic tumour with uncertain histogenesis. Whether it is a hamartoma or a neoplasm is still a controversial topic. It is usually associated with an unerupted maxillary canine. Here, we discuss a follicular adenomatoid odontogenic tumour in a young girl with uncommon features such as it arose from two unerupted teeth and partial resorption of the roots of other normal teeth. The tumour was large enough to completely occupy the maxillary sinus. It was treated with enucleation and curettage by lateral rhinotomy approach.Publication Fracture Nasal Bone: Causes, Presentation and Management in a Tertiary Care Center in Nepal(Institute of Medicine, 2020) Mahaseth, Rajeev K; Gurung, Urmila; Thapa, Narmaya; Pradhan, Bibhu; Kharel, BijayaABSTRACT Introduction: Fracture of nasal bone, the commonest facial fracture is frequently encountered in ENT practice. This study was conducted to assess the causes, presentation and management of fracture nasal bone in a tertiary care center. Methods: A retrospective chart review was done of patients admitted from August 2017 to July 2019 for management of isolated nasal bone fracture in the department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital. Results: Thirty-five patients (31 males and 4 females) of 13 to 86 years (mean age 26 years) underwent closed reduction of fracture nasal bone. The injury was sustained following physical assault in 13/35 (37%), fall from height in 10/35 (29%), road traffic accident in 8/35 (23%) and sports injury in 4/35 (11%). Pain, epistaxis, swelling over nasal dorsum, nasal deformity and wound were the presenting symptoms which most often occurred in combination. Close reduction was done under local anesthesia in 28/35 (80 %) and under general anesthesia in 7/35 (20%). The time between trauma and closed reduction ranged from 1 to 16 days with a mean of 6.2 days. Conclusion: Nasal bone fracture needing reduction was common following physical assault in males predominently of 21 to 30 years. A combination of pain, epistaxis and nasal deformity was the commonest presentation. Closed reduction of fracture under local anesthesia within 16 days of trauma was the usual practice. Keywords: Closed reduction, facial trauma, local anesthesia, nasal bone fracturePublication Intranasal Corticosteroid Spray Usage in Patients with Allergic Rhinitis: Correctness in Technique and Compliance(Institute of Medicine, Tribhuvan University, 2024) Gurung, Urmila; Khadgi, SajishAbstract: Introduction Intranasal corticosteroid spray (INCS) needs to be administered correctly and regularly for it to be effective in treating allergic rhinitis. This study aimed to assess the correctness of technique and compliance of intranasal corticosteroid spray usage in patients with allergic rhinitis. Methods It was a cross-sectional study conducted in the Dept of ENT-Head and Neck surgery, Tribhuvan University Teaching Hospital from April to September 2023. Patients aged 18 or more with allergic rhinitis on INCS or had been on INCS in the past three months were assessed for INCS administration technique based on EPOS 2020 checklist and their compliance asked. Factors that could hinder the correct techniques and compliance were assessed. Results A total of 138 patients, 71 males and 67 females, aged 18 to 55 years were included. Most of them (60/138; 43.5%) had completed secondary level education. 97.1% (134/138) had been prescribed INCS spray by ENT doctor and 89.13% (124/ 138) had received verbal instructions mostly by ENT doctor (91.1%). 7.2% (10/138) completed all the steps as per EPOS 2020 checklist whilst 25/138 (18.1%) completed five essential steps. The correctness of the INCS administration technique however did not differ with age, gender, academic qualification, prescriber or whether instructions were given or not. 119/138 (86.2%) patients reported being compliant. Conclusion INCS spray was scarcely administered with the correct technique although the compliance was good. This study emphasizes the need for effective patient and healthcare worker education pertaining to correct INCS technique.Publication Mucormycosis: An unanticipated progeny of COVID-19(Nepal Medical Association, 2021) Shrestha, Gentle Sunder; Bhandari, Sabin; Lamsal, Ritesh; Gurung, UrmilaAbstract: The rapid surge of COVID-19 cases in the second wave of the pandemic has crippled the healthcare delivery system in Nepal and neighboring countries. Unlike in the first wave of the pandemic, several cases of mucormycosis have been reported in patients with COVID-19 from Nepal and India. In this report, we briefly describe the clinical presentation, diagnosis, and risk factors for mucormycosis and explore why patients with COVID-19 are at an increased risk for developing the infection. As treatment of mucormycosis is challenging and consumes a lot of resources, prevention of mucormycosis is pivotal in low-income countries like Nepal. We also highlight some basic steps that are easy to perform and important to reduce the risk of infection.Publication Outcome of Endoscopic Sphenopalatine Artery Cauterization for Posterior Epistaxis(Institute of Medicine, 2019) Kharel, Bijaya; Gurung, Urmila; Tripathi, Prashant; Rayamajhi, Pabina; Silwal, PriyanshaABSTRACT Introduction Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis. Methods Retrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results A total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31). Conclusion Endoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis. Keywords: Endoscopy, epistaxis, nasal packing, sphenopalatine artery cauterizationPublication Prevalence of Post Tonsillectomy Haemorrhage at a Tertiary Care Centre in Nepal(Nepal Medical Association, 2021) Tripathi, Prashant; Bajracharya, Rohita; Acharya, Kunjan; Kharel, Bijaya; Neupane, Yogesh; Dutta, Heempali; Dongol, Kripa; Gurung, UrmilaAbstract: Introduction: Tonsillectomy is one of the common ENT surgical procedures. Post-tonsillectomy haemorrhage remains a frequent complication which can be potentially life-threatening. The objective of the present study was to calculate the prevalence of haemorrhage following a tonsillectomy at a tertiary care centre. Methods: It was a descriptive cross-sectional study performed by medical chart review of the patients who underwent tonsillectomy from January 2018 to December 2019 at the department of ENT- Head and Neck Surgery of Tribhuvan University Teaching Hospital. Ethical approval was obtained from the institutional review committee (Ref:-282(6-11) E2 076/077). Convenient sampling method was used. All patients of any age who had tonsillectomy for recurrent tonsillitis or tonsillar hypertrophy with or without obstructive sleep apnoea and no missing information on chart review were included in the study. Data were entered in MS-Excel 2007 and analyzed in rate and percentage. Results: Ten (5.18%) out of a total of 193 patients who underwent tonsillectomy had a post tonsillectomy haemorrhage. All 10 (100%) were adults patients, operated for recurrent tonsillitis, and used electrocautery. It was common in male patients 7 (70%). All of the haemorrhages was between a third and sixth postoperative day and were mild in severity. Conclusions: The prevalence of post-tonsillectomy haemorrhage was high at our centre during the study period of two years. It was common in adults, males and surgery done for recurrent tonsillitis using electrocauterization.Publication Relationship Between Ossicular Chain Erosion and Facial Canal Dehiscence in Chronic Otitis Media Squamous(Institute of Medicine, 2020) Kharel, Bijaya; Shreepaili, Ashok; Tripathi,Prashant; Neupane, Yogesh; Gurung, Urmila; Pradhananga, Rabindra B; Rayamajhi, Pabina; Bhattarai, HariABSTRACT Introduction: Chronic otitis media squamous is a gradually expanding destructive lesion and leads to complications by eroding the adjacent structures. Facial canal and ossicles are in close proximity in the middle ear space and they share the same pathogenesis of the bony erosion. Ossicular chain erosion found intraoperatively due to cholesteatoma, may suggest the likelihood of facial canal dehiscence. This study was conducted to assess the relationship between ossicular chain erosion and facial canal dehiscence in chronic otitis media squamous. Methods: It is a retrospective chart review of patients who had mastoidectomy done for chronic otitis media squamous in Tribhuvan University Teaching Hospital from January 2014 to December 2018. The operative findings of facial canal dehiscence were correlated with ossicular chain status. Results: Among 158 cases, facial canal dehiscence was seen in 20 (12.7%), of which, 19/20 (95%) had ossicular erosion. Majority (90%) of dehiscence was in the horizontal segment. Incus was the most common ossicle to be eroded. Among the ossicles, stapes erosion was related to the facial canal dehiscence with odds ratio of 3.216 (1.235-8.374) and p-value 0.03. Conclusion: Among the ossicles, there is a relationship between the stapes erosion and the facial canal dehiscence in chronic otitis squamous. Erosion of ossicular chain especially stapes should alert surgeons towards the possibility of facial canal dehiscence. Keywords: Chronic otitis media squamous, facial canal, ossicular erosionPublication Ringer’s Lactate versus Isotonic Saline: The Nasal Irrigation Solution of Choice in Chronic Rhinosinusitis(Institute of Medicine, Tribhuvan University, 2024) Gurung, Urmila; Devkota, Anuj; Pokhrel, Shishir; Pradhan, BibhuAbstract: Introduction Nasal douching is a simple and highly effective treatment option for chronic rhinosinusitis. This study aimed to compare the efficacy of Ringer’s lactate versus isotonic saline for nasal irrigation in treating chronic rhinosinusitis (CRS) with or without polyposis using the SNOT-22 score. Methods This quasi-experimental study was conducted at the Department of ENT and Head & Neck Surgery, Tribhuvan University Teaching Hospital, from September 2020 to November 2021. Seventy-eight patients aged ≥ 16 years with CRS were included in the study. Patients were grouped into either isotonic saline or Ringer’s lactate groups based on the clinician’s preference. Nasal irrigation was prescribed for four weeks. Pre and post-irrigation SNOT-22 scores were analyzed using paired t-test and Student’s t-test. Results A significant improvement in the SNOT-22 scores before and after nasal irrigation was observed in both the Ringer’s lactate (26.76±14.07 vs 14.41±7.92, p<0.001) and isotonic saline groups (24.64±11.12 vs 12.58±6.62, p<0.001). However, the difference in post-nasal irrigation SNOT-22 scores between these groups remained statistically insignificant (p=0.27). Common symptoms such as nasal blockage and thick nasal discharge showed substantial improvement. The most common side effect was fluid pooling in the paranasal sinuses. Conclusion Both isotonic saline and Ringer’s lactate were effective for nasal irrigation in patients suffering from chronic rhinosinusitis, with no significant difference in their efficacy, making either solution a suitable choice for nasal irrigation in the management of the CRS.