Balwant Singh Gendeh

By Balwant Singh Gendeh

Part of the book: Advances in Ophthalmology

By Balwant Singh Gendeh

Part of the book: Ophthalmology

By Balwant Singh Gendeh

Epiphora, or abnormal tearing, occurs because of the blockage in the lacrimal drainage system, which impairs normal tearing channeling into the nose. It is essential that with proper history and examination including syringing and probing, a correct diagnosis is made. Syringing and probing are performed only in congenital and acquired nasolacrimal duct obstruction (NLDO). Dacryocystorhinostomy (DCR) is a procedure performed for the treatment of tearing (epiphora) due to blockage of the nasolacrimal drainage system. Endoscopic dacryocystorhinostomy (E-DCR) using telescopes has gained a lot of momentum among otolaryngologists, since the outcomes are comparable to the external approach. Advances in surgical technique and a better understanding of the anatomy have resulted in improvements in outcomes. The anatomy of the lacrimal system will be discussed in detail including the surgical indications and techniques of DCR. The advantages, results, and complications of surgery will be highlighted.

Part of the book: Endoscopy

By Balwant Singh Gendeh

Combining rhinoplasty and endoscopic sinus surgery (ESS) was first reported in 1991 by Sheman and Matarasso. Since then, many authors have documented a large series showing the overall efficacy of combining the two procedures. The focus of this manuscript is to document the author’s recent experience with combining rhinoplasty and endoscopic sinus surgery and highlight the changes that have occurred during the author’s 2-years experience. A retrospective data review was performed on 53 (31 females and 22 men, age range 16–55 years) patients who underwent combined rhinoplasty and ESS between January 2016 and December 2018 at Pantai Hospital Kuala Lumpur by the same surgeon. The mean age was 31.8 years. All patients had severe nasal obstruction with chronic rhinosinusitis and were followed up for a minimum of 6 months post-surgery and underwent ENT workup, which included history, office rigid endoscopy, CT scans of paranasal sinuses and preoperative photography. Initially, the ESS was performed followed by the open rhinoplasty with or without osteotomy. The ESS consisted of middle turbinate reduction [15/53 (28.3%)], maxillary antrostomy [36/53 (67.9%)], ethmoidectomy [38/53 (71.6%)], frontal sinusotomy [7/53 (13.2%)], and sphenoidotomy [9/53 (16.9%)]. Most of the sinus symptoms resolved postoperatively with 47 (88.6%) of 53 patients describing their improvement as significant. Fifty (94.3%) of 53 patients stated that they would recommend the concurrent procedure. The benefits of these advances are illustrated by a review of the literature with good results (functional and cosmetic) and minimal complications.

Part of the book: Rhinosinusitis

By Thomas Heinbockel and Balwant S. Gendeh

Part of the book: Sino-Nasal and Olfactory System Disorders

By Hardip Singh Gendeh and Balwant Singh Gendeh

Anatomical variations of the sinuses are common and may lead to obstruction to the ventilation and drainage of the sinuses. This may lead to osteomeatal complex disease refractory to medications. A preoperative CT of the paranasal sinuses acts as road map guide to identify vital anatomical variations and its relationship to the orbit, skull base, neurological and vascular structures, to prevent iatrogenic injuries. To control intraoperative bleeding, it is critical to identify the anterior and posterior ethmoidal artery indentations and sphenopalatine artery in the anterior and lateral nasal walls. It is essential for the surgeon to familiarize with the anatomy of the ethmoid region, lateral nasal wall, sphenoid sinus, sella and parasellar region and pterygopalatine/infratemporal fossa before embarking on these approaches. The advent of CT scans and state-of-the-art FESS instrumentation has made surgery of the paranasal sinuses less of a mystery for the surgeon. Therefore, identifying and addressing these anatomical variations during FESS is crucial in restoring ventilation and drainage.

Part of the book: Paranasal Sinuses Anatomy and Conditions

By Hardip Singh Gendeh and Balwant Singh Gendeh

Laryngo-pharyngeal reflux (LPR); esophageal reflux; pharyngolaryngeal reflux; or reflux laryngitis refers to the backflow of acid from the stomach to the upper aerodigestive tract of the larynx and pharynx. Repetitive reflux of these contents may lead to LPR. It has been estimated that half of the otolaryngology patients with laryngeal and voice disorders have LPR. The pattern of reflux is different in LPR and gastroesophageal reflux. LPR usually occurs during the daytime in the upright position, whereas gastroesophageal reflux disease more often occurs in the supine position at nighttime or during sleep. Laryngeal edema is an important indicator of LPR that is most often neglected. LPR was previously deemed a controversial topic in laryngology but is now clearer with a better understanding of the pathogenesis. Diagnosis is made based on symptoms, and laryngoscopy aided with investigations and confirmed the response to treatment.

Part of the book: Updates on Laryngology

By Hardip Singh Gendeh and Balwant Singh Gendeh

Endoscopic approaches to the frontal sinus have grown significantly in the last decades and due to its complex anatomy, including the possibility of pneumatization in different cells and anatomical variations, possess numerous challenges to the endoscopic surgeon. Moreover, the proximity to noble structures such as the cribriform plate, orbit and anterior ethmoidal artery can increase the risk of injury. Unlike the maxillary, ethmoidal and sphenoidal sinuses, the frontal sinus is not in line of visualization with a zero-degree endoscope and often requires an angled endoscope. Several anatomical classification methods have already been proposed for frontal sinus, however, these previous systems present limitations of anatomical details. In 2016, the International Frontal Sinus Anatomy Classification (IFAC) was described by Wormald et al. The authors propose improved classification of the frontoethmoidal cell in diagrammatic nomenclature to facilitate greater accessibility in surgical planning.

Part of the book: Paranasal Sinuses

By Hardip Singh Gendeh and Balwant Singh Gendeh

Peritonsillar and intratonsillar abscesses are one of the not too frequent emergencies encountered by the ENT fraternity. Tonsillitis refers to inflammation of the tonsils, whereas peritonsillitis refers to cellulitis with or without an abscess collection within the surrounding soft tissue of the tonsils. Peritonsillar abscess is often unilateral, while peritonsillitis may be bilateral in 20% of cases, whereas intratonsillar abscess is rare with an incidence of 7%. The shared symptoms of peritonsillitis and intratonsillar abscess include fever, trismus, deviation of uvula and referred pain. These shared symptoms have placed many physicians in a dilemma, resulting in an intratonsillar abscess to be missed. The medical therapy consists of intravenous antibiotics and intravenous fluids. A needle aspiration is useful when a diagnosis is uncertain. Aspiration of pus is diagnostic confirming a peritonsillar abscess from a peritonsillar cellulitis. Incision and drainage can be performed for intratonsillar abscess not responding to treatment or a failed needle aspiration, which is preferably performed under general anesthesia for children. Elective tonsillectomy should be indicated for patients with recurrent peritonsillar abscess. CT contrast is useful to identify complications arising mainly in retropharyngeal or parapharyngeal abscess and to know its extension, spread and drainage approaches.

Part of the book: Tonsils and Adenoids