Complete Second Branchial Cleft Fistulas: A Clinicosurgical Experience.

A complete second branchial fistula is very rare and has an internal opening at the tonsillar fossa and an external opening at the lower third of the sternocleidomastoid (SCM). Patients commonly present with persistent or intermittent mucoid or mucopurulent discharge from an external opening. The diagnosis is most often clinical and radiological investigations are rarely needed. Treatment of choice is complete surgical excision. The aim of this article is to aware young ENT surgeons of the various clinical and intraoperative surgical findings that can be encountered while dealing with these cases. This observational study was done for a period of 10 years. A total of 20 cases of fistula were included which intraoperatively had a complete track from tonsillar fossa to neck. Excision of the tract was carried out via combined transcervical and transoral approach under general anaesthesia using two incisions in stepladder pattern. Each patient was seen after one year of surgery to assess for any recurrence. Different findings of patients including age/sex at surgery, initial presentation, family history, laterality of the fistula tract, Intraoperative surgical findings, complications, and recurrences. were noted. Of the 20 patients, 13 (65%) were females and 7 (35%) were Females. Most common complaint was fistulous opening with intermittent discharge(15patients; 75%).Branchial cleft fistulae more commonly affected the right neck (14 patients, 78%) among unilateral cases and 2 patients (10%) had bilateral fistulae. No patient had associated congenital anomaly/syndrome, family history or and visible opening in tonsillar area. Glossopharyngeal nerve was identified in 12 cases and track was seen passing lateral to it except in one case. The internal opening of track was seen over posterior tonsillar pillar in 15 cases (75%) while in 5 patient the track was seen entering tonsillar tissue or bed. Tonsillectomy was done in 5 cases while not done in 15 cases where track was seen entering posterior pillar. All patients were seen at one year follow up. No recurrence was seen at one year of follow up. Complete second branchial cleft fistulae are rare. They are usually right sided and unilateral. The track passes between carotid bifurcation and invariably passes lateral to both glossopharyngeal and hypoglossal nerves. Track usually ends at the posterior tonsillar pillar. Tonsillectomy is not routinely indicated. Recurrences are not typically seen.

Retromandibular Vein, Digastric Muscle, and Greater Auricular Nerve in Superficial Parotidectomies for Patients with Pleomorphic Adenoma-A Surgical Experience.

Retromandibular vein (RMV) and posterior belly of digastric muscle are among the landmarks used to identify facial nerve in parotid surgery. This observational cross-sectional study was done in the Department of ENT &HNS at a tertiary care teaching hospital for a period of 8 years with the aim to aware young otorhinolaryngologist about the relationship of posterior belly of digastric muscle & retromandibular vein with facial nerve and share our experience about preservation of posterior branch of greater auricular nerve. A total of 34 cases of superficial parotidectomies done for pleomorphic adenoma were included in this study. Relationship of facial nerve with retromandibular vein and posterior belly of digastric muscle was noted. Greater auricular nerve was identified, and every attempt was made to preserve its posterior branch. Retromandibular vein was medial to the trunks of facial nerve in 33 (97%) patients. It was lateral to lower division and medial to upper division in one case. Greater auricular nerve was seen to bifurcate into two branches (Anterior and posterior) in 21 (62%) cases while in one case(3%) three branches were seen emerging from main trunk and in another case(3%) first two branches were seen emerging and then anterior branch was further dividing into two. Preservation of posterior branch of greater auricular nerve was possible in 23 (68%) of patients. Posterior belly of digastric muscle was seen as a reliable and constant landmark. Facial nerve was seen superior to upper border of posterior belly of digastric muscle in all cases (100%). No anatomical variation of posterior belly was seen. Retromandibular vein is invariably seen medial to the trunks of facial nerve. Facial nerve is always seen superior to upper border of posterior belly of digastric muscle in almost all cases. Preservation of posterior branch of greater auricular nerve is possible in majority of the cases.

Role of Non-contrast Computed Tomography of Nose and Paranasal Sinus in Preoperative Evaluation of Patients with Symptomatic Deviated Nasal Septum.

Symptomatic deviated nasal septum is a commonly encountered clinical condition by otorhinolaryngologist. Non-contrast Computed tomography (NCCT) of nose and Paranasal sinuses is a good tool in the preoperative evaluation of symptomatic deviated nasal septum so as to find hidden sinonasal pathologies in addition to deviated nasal septum. The aim of this article is to find the role and scope of preoperative Computed tomography in the management of symptomatic deviated nasal septum. This cross-sectional observational study was conducted on 120 patients with symptomatic deviated nasal septum, out of which 27 had concomitant hypertrophy of inferior turbinate. All were planned for septoplasty with or without turbinoplasty. Non contrast computed tomography (NCCT) scan was done in all cases. Different findings on NCCT were noted. After NCCT was done, 33 (27.5%) out of 120 patients underwent additional surgical procedures. In conclusion, NCCT of Nose and Paranasal sinus surgery should be given due consideration in the evaluation of symptomatic deviated nasal septum so as to avoid second surgery.

Thyroglossal Duct Cysts: A Clinicosurgical Experience.

Thyroglossal cyst is the most common congenital neck mass and occurs in 7% of the population. They occur due to failure of thyroglossal duct to involute and atrophy thyroglossal duct cysts often occur in pediatric patients. Majority of them are found infrahyoid region. The purpose of the present study is to report our 5 year clinical experience of thyroglossal cysts in terms of clinical features and surgical findings with special emphasis on naked eye extend of patent thyroglossal duct when present. To the best of our knowledge this is first clinical study which has reported the extend of thyroglossal duct on naked eye. This prospective observational study was done in the Postgraduate Department of ENT, Head and Neck surgery of Government medical college, Srinagar for a period of five years from January 2011 to January 2016. Thirty patients of histopathologically confirmed thyroglossal cysts were enrolled in the study. Patients were initially diagnosed on the basis of clinical history, examination and USG findings suggestive of cyst. Clinical data and surgical data in terms of size and location of cyst, presence or absence of thyroglossal duct etc. was analyzed and formulated in tables for patients who had histopathologically confirmed cyst. Mean age was 10 years. Majority (73.3%) were less than 15 years of age. Males were 22 in number (73.3%) while females compromised 26.7% of population. Ninety percent of patients presented with neck swelling. Erythema/redness over swelling was seen in 13.3% of patients. Majority (83.3%) of cysts were subhyoid in location. Thyroglossal ducts were seen to be patent for different lengths and areas. Majority of patients (80%) had tract arising from cyst and disappearing at superior border of hyoid body while three patients (10%) had patent thyroglossal duct from cyst to vallecular mucosa. A complete patent thyroglossal duct was seen in one patient (3.3%) from cyst to base of tongue. Complete Absent tract was seen in two patients (6.7%). Majority (70%) of cysts were having size between 1.6 and 3 cm. Intraoperative 10% of cyst got ruptured. Thyroglossal cysts are most commonly seen in pediatric males. Most of them present with visible midline neck swelling. In few cases cyst can rupture after repeated infections leading to sinus formation. Most of them are subhyoid in location. These cysts are usually of size 1.5-3 cm. Complete patent thyroglossal duct from cyst to tongue musculature is rarely seen while most of the times, a patent duct just disappears at the superior border of body of hyoid. None of our cysts had malignant features.