Objective: The  objective  of  this  study was to review the cases of epistaxis and audit its management at Patan Hospital. Materials and Methods: This was a retrospective study and an audit carried out in patients admitted for epistaxis in Patan Hospital from August 2012 to August 2014. All the patients with primary epistaxis were included. The data were analyzed in terms of the specific defined parameters and were compared with that of Guy’s Hospital, United Kingdom, of year 2011.Results: Out of 146 patients, 111 had primary epistaxis. Ninety-three patients (83.78%) with primary epistaxis had anterior bleeding and 18 patients (16.21%) had posterior bleeding. The majority of the patients (31.53%) were treated with chemical cautery, followed by anterior nasal packing (27.02%). Eleven patients (10%) underwent sphenopalatine artery cauterization. The data of our hospital were optimal or near optimal in some aspects like documented initial nasal examination, and initial cautery attempt whereas, parameters like re-bleeding rate, surgical intervention and endoscopic nasal examination after cessation of bleeding were found to be sub-optimal.Conclusion: The improvements are required in some aspects of management of epistaxis like decreasing the re-bleeding rate, increasing the timely surgical intervention and compulsory endoscopic evaluation of nasal cavity after cessation of bleeding. This can be attained with adherence to the protocol as proposed. A multi-center audit would be required to develop a common consensus regarding its management.Nepalese Journal of ENT Head and Neck Surgery, Vol. 5, No. 2, 2014, Page: 26-30

Objective: To assess the outcome of thyroid surgeries at Patan HospitalMaterials and Methods: It is a retrospective study of in-patient records of patients undergoing thyroid surgeries for various indications from April 2013 to January 2015 at Patan Hospital, Lalitpur.Results: During the period of 21 months, 75 patients underwent thyroid surgeries. Majority of patients underwent hemithyroidectomy (35) followed by total thyroidectomy (28), subtotal thyroidectomy (7) and completion thyroidectomy (5). Out of 28 patients undergoing total thyroidectomy (TT), 11 underwent central compartment clearance (CCC), 5 underwent CCC and lateral neck dissection. Among 5 patients undergoing completion thyroidectomy, CCC was performed in all cases and in one patient lateral neck dissection was also performed.  A total of 13 patients developed unilateral recurrent laryngeal nerve palsy (RLN), among them 5 had permanent palsy. Tracheostomy had to be done in immediate postoperative period for stridor following total thyroidectomy (TT) in one case. Temporary hypocalcaemia was observed in 10 (10/28) cases following TT, out of which 8 had undergone CCC. Permanent hypocalcaemia was observed in 7 (7/28) cases following TT out of which 3 had undergone CCC. Chylous leak occurred in one of the patient undergoing left level II-IV neck dissection which was managed conservatively. None of the patient had to be transfused postoperatively.Conclusion: Complications to thyroid surgery are not uncommon. Visualization of recurrent laryngeal nerve alone in our context is adequate in experienced hands. Identification of parathyroid during thyroidectomy is recommended to avoid hypocalcaemia. Meticulous dissection can reduce the complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Introduction: Most of the guidelines do not recommend routine antibiotics prophylaxis in clean head and neck surgery like thyroidectomy. In contrary to the recommendation, antibiotics are being routinely prescribed in perioperative period for various duration in many centers of Nepal. This study was aimed to find out the need of postoperative antibiotics in surgeries for thyroid related problems. Method: Records of all patients who had undergone surgery for thyroid related problems from Jan, 2019 to Sept, 2022 were retrospectively reviewed for patterns of antibiotic use, apart from preincision antibiotic, in postoperative period which was classified as group A – no antibiotics, group B – shorter course of antibiotics (≤3 days) and group C – longer course of antibiotics (>3 days). The occurrence of surgical site infection (SSI) was recorded. Result: During the study period, 77 patients underwent surgery for thyroid related problems, out of which five were excluded (records not found in four cases and one patient was ASA III). Two out of 72 (2.77 %) patients developed superficial incisional SSI which was managed conservatively. One patient in each group A (50) and group B (8) developed SSI. Conclusion: Postoperative antibiotics can be avoided safely even in our setup in clean head and neck surgeries like thyroidectomy without increase in the risk of SSI thus reducing the cost to the patients.

Papillary carcinoma of thyroid can rarely coexistwith hyperthyroidism and the reported incidence varies widely across the literature. It requires very high degree of suspicion to recognise the malignant nodule preoperatively. We are presenting a case that was initially being treated with carbimazole for hyperthyroidism and he was found to have papillary carcinoma of thyroid on FNAC from cold nodule detected in thyroid scan, probably the first case report from Nepal. Totalthyroidectomy with level VI neck dissection followed by radioiodine ablation was performed. The approach to thyroid nodule in hyperthyroid patients is no different than euthyroid or hypothyroid patients as the risk of malignancy is similar.Thyroid scan is useful for classifying the different causes of hyperthyroidism and hence its management but for characterisation of nodulein terms of benign or malignant, ultrasonography is superior. Fine needle aspiration cytology of any suspicious nodule, in patient with hyperthyroidism,should be advised.