ENT Head and Neck surgery

2. Dr. Junaid Shahzad
Post-graduate Resident
Otolaryngology Department
Capital Hospital, Islamabad

4.  Name: XYZ
 Age: 62
 Gender:Female
 Residence: Islamabad
 Profession: Housewife

5.  Patient presented to OPD in OCTOBER 2013
with history of DYSPHAGIA- 4 months

6.  Patient was in normal state of health till 4
months back,when she experienced dysphagia
for solids which progressed slowly and for the
last one month she had dysphagia for liquids as
well.
 There are no alleviating factors
 Dysphagia was also associated with pain
(odynophagia) during swallowing.
 This was also associated with weight loss.
 There is no history of voice change and
breathlessness or otalgia.
 No history of cough or recurrent chest infection.

7.  Patient was a known hypertensive since the
past decade, but not compliant on
medication.

8.  Patient was a housewife.
 She has 3 children,2 daughters and 1 son, all
married.
 She lives with her son and daughter in law.

9.  Patient has been taking anti hypertensive
medications off and on since the past 10
years.
 Sone times takes medications for heartburn.
 No history of SMOKING or ADDICTION

10.  Belongs to a low socioeconomic back groung.

11.  An old lady sitting on bed, well oriented in
time,place and person.
 Jaundice
 Clubbing NAD
 Cyanosis
 GPE:
 BP: 50/90 mmHg
 TEMP: Afebrile
 R/R: 18/min
 PULSE: 80/min

12.  EAR EXAMINATION:
 External ear unremarkable
 Tympanic membranes intact bilaterally with
normal landmarks.
 Hearing test OK
 NOSE:
 Septum, turbinates and nasal mucosa appeared
normal.
 Normal patency

13.  THROAT:
 Lips, tongue, cheek mucosa, palate, floor of mouth,
gums, teeth, pillars, tonsills and PPW – Normal.
 Tongue mobility, Gag reflex, cough reflex and palatal
movements were normal
 Laryngeal crepitus was present
 Videolaryngoscopy: Revealed
 Epiglottis, Vallecular, Py. Sinuses, aryepiglottic fold,
vocal cords, PPW all appear normal
 Exophytic growth post cricoid area.
 Vocal cords mobile.
 NECK NODES:
 No neck nodes palpable

14.  CVS: S1+S2 audible in all four areas
 RESP: Normal vesicular breathing
 GIT:
NAD
 CNS:

15.  Hb: 11.9g/dl
 Na: 138mmol/l
 K: 3.6mmol/l
 Cl: 92mmol/l
 Urea: 22mg/dl
 Creatinine:0.8mg/dl

16.  DIRECT LARYNGOSCOPY AND
OESOPHAGOSCOPY:
 Exophytic growth involving post cricoid region
and extending to BOTH Pyriform Sinuses,and
Vallecula.
 Sample taken by punch biopsy, sent for
Histopathology.
 Glottis and subglottis clear.

17.  POORLY DIFFERTIATED NON KERATINIZING
SQUAMOUS CELL CARCINOMA
 IMMUNOHISTOCHEMISTRY:
 P-63- Positive.

18.  CT SCAN NECK AND CHEST WITH CONTRAST:
 Obliteration and stenosis oropharyngeal cavity
with effacement of vallecula and pyriform
sinuses.
 Enlarged lymph nodes in bilateral parapharyngeal
spaces and Carotid spaces.
 Non specific nodule in right middle lobe adjacent
to mediastinal pleura.

19.  Poorly differentiated Non keratinizing
Squamous Cell Carcinoma Hypopharynx.
 STAGE: T2 N2C M1

20.  SENT TO N.O.R.I for
CHEMOTHERAPY/RADIOTHERAPY.
 RADIOTHERAPY
 13 Cycles 39 Gy completted
 SUPPORTIVE
 Magic mouth wash
 Tab chymoral forte BD
 Syp Mucain 2tsf tds
 Syp Brufen 2tsf x tds

21.  Monthly follow up maintained.
 AT 5 months follow up:
 VIDEOLARYNGOSCOPY:
 Normal.
 DIRECT LARYNGOSCOPY/OESOPHAGOSCOPY:
 Normal.
 CT SCAN NECK AND CHEST WITH CONTRAST:
 Normal.

23. THANK YOU