New Indian Journal of Surgery

Background: In conventional cleft palate surgeries, bleeding is controlled by bipolar cauterization and external pressure. However in case of extensive cauterization, tissue necrosis can result in palatal fistulas post-operatively. We report the application of fibrin sealant as an adjunct hemostatic agent in cleft palate surgeries. Aim: To study the application of fibrin sealant in cleft palate surgery. Settings & Design: Tertiary Care Centre, Case Report. Methods& Material: Five cleft palate patients were selected in non-randomized manner in whom intra-operative bleeding could not be controlled by conventional hemostatic methods. Fibrin sealant was applied to achieve Hemostasis. Statistical Analysis: None Results: Fibrin sealant was used successfully in five patients operated for cleft palate surgery to control bleeding. No complications or adverse reactions were noted. Conclusions: Fibrin sealant can be effectively used as an adjunct to control hemostasis for cleft palate surgery. 

 

Keywords: Fibrin Sealant; Cleft Palate Surgery; Hemostatic Agents.

Neck lymph node metastases from occult primary constitute about 5%-10% of all patients with carcinoma of unknown primary site. Metastases in the upper and middle neck (levels I-II-III-V) are generally attributed to head and neck cancers, whereas the lower neck (level IV) involvement is often associated with primaries below the clavicles. Diagnostic procedures include a careful clinical evaluation and a fiberoptic endoscopic examination of the head and neck mucosa, biopsies from all suspicious sites or blindly from the sites of possible origin of the primary, computerized tomography scan, and magnetic resonance. The most frequent histological finding is Squamous Cell Carcinoma, particularly when the upper neck is involved. Thoracic, and abdominal primaries (especially from lung, oesophagus, stomach, ovary or pancreas) should be sought in the case of adenocarcinoma and involvement of the lower neck. Positron emission tomography with fluoro-2-deoxy-D-glucose allows detection of primary tumour in about 25% of cases, but this procedure is still considered investigational. Therapeutic approaches include surgery (neck dissection), with or without post-operative radiotherapy, radiotherapy alone and radiotherapy followed by surgery. In early stages (N1), neck dissection and radiotherapy seem to have similar efficacy, whereas more advanced cases (N2, N3) require combined approaches. The extent of radiotherapy (irradiation of bilateral neck and mucosa versus ipsilateral neck radiotherapy) remains debatable.