A Rare Presentation of Malignant Melanoma of the Face: A Case Report.

Melanoma is a malignant neoplasm of melanoblasts, which are the precursors of the melanocytes arising from the neural crest cells. Melanomas can occur at various sites like the skin, eyes, upper esophagus, and meninges due to the migration of neural crest cells. Usually, the prognostic factors are decided based on the Breslow index. This case report describes a 61-year-old female who presented with the complaint of pinkish irregular swelling over the left side of her face for six months. The patient had a surgical resection, and the condition was determined to be invasive melanoma following confirmation by magnetic resonance imaging (MRI) and histological examination. Through our case report, we aim to shed light on the existing protocol for managing malignant melanoma while also exploring new aspects of presentation and multidisciplinary action.

Giant Submucosal Fibromatosis of the Base of Tongue Presenting as Paediatric Obstuctive Sleep Apnoea: A Rare Case Report.

A nodular lesion of the tongue encompasses a range of conditions, from reactive to malignant. It can be challenging to diagnose when a solitary and firm submucosal mass appears in the oral cavity. Following an essential investigation protocol is necessary for reaching a definitive diagnosis. Leiomyomas are benign tumors that infrequently occur in the oral cavity and typically affect individuals between their forties and fifties. This case report presents a rare and unique case of a giant submucosal fibromatosis located at the base of the tongue in a 3-year-old child presenting with features of pediatric OSA. Immunohistochemical analysis revealed the positivity of tumor cells for beta-catenin and CD 34 aberrant expression, though SMA and STAT 6 were negative. The lesion was removed submucosally in toto and post-surgery the patient showed no symptoms and had no evidence of tumors during the one-year follow-up visit.

A Rare Presentation of Cysticercosis in the Sternocleidomastoid Muscle.

Cysticercosis is a rare condition associated with the development of cysticercus (larval form) of Taenia solium (pork tapeworm), within an intermediate host. Accidental ingestion of infectious eggs is most likely the cause of humans becoming intermediate hosts. The most common site for larval cysts is the central nervous system followed by vitreous humor of the eye, striated muscle, and, in rare cases, subcutaneous and other tissues. Isolated muscular involvement with nonspecific symptoms makes this condition challenging to diagnose. We present an unusual case of cysticercus in the sternocleidomastoid muscle diagnosed with ultrasonography and contrast-enhanced scans, which was subsequently treated with surgical excision and a short course of anthelmintics.

Cavernous Hemangioma of the Tongue in an Adult.

Hemangiomas are benign tumors characterized by the proliferation of dilated blood vessels, typically capillaries and veins. They primarily occur in infancy and childhood, with the majority affecting the head and neck region. Oral hemangiomas, though relatively rare, can affect areas such as the lips, tongue, buccal mucosa, and palate. Despite their benign nature, managing vascular malformations is crucial due to potential functional loss and lifelong aesthetic concerns. This case report involves a 76-year-old woman presenting with a soft reddish-blue mass on the dorsal aspect of her tongue, causing functional impairment. While various treatment options exist for oral vascular malformations, including sclerotherapy and cryosurgery, surgical excision was chosen in this case, considering the patient's age and the associated risks of the condition.

Correlation of the Size of Adenoids With Impedance Audiometry Findings.

Introduction Adenoid tissue is part of the first line of immunity of the upper aero-digestive tract. It is located in the postero-superior wall of the nasopharynx behind the choana. Adenoid hypertrophy, a common childhood disorder, significantly contributes to the pathogenesis of otitis media with effusion (OME), which is the leading cause of hearing impairment in young children. This condition can result in delayed speech, poor academic performance, and language development issues. Assessing the size of the adenoids and their correlation with OME is crucial, as undiagnosed cases can lead to complications such as atelectasis of the tympanic membrane and cholesteatoma. Clinical examination of the nose alone is often insufficient, and children do not cooperate for nasal endoscopy. Therefore, a lateral radiograph of the skull is considered the most reliable method for assessing the adenoid size. The size of the adenoids can affect Eustachian tube patency, which is reflected in the results of impedance audiometry. This study aimed to correlate the size of adenoids with impedance audiometry findings. Methods This cross-sectional observational study was conducted in the Department of Otorhinolaryngology of a tertiary care hospital from October 1, 2022, to March 31, 2024. A sample size of 50 patients was taken for the study. The inclusion criterion of selection of the patients included patients aged 3 to 15 years, who suffered from recurrent attacks of upper respiratory tract infections, particularly those with adenoid facies confirmed by X-ray with a non-perforated tympanic membrane. Exclusion criteria encompassed patients below 3 or above 15 years, and those with acute or chronic suppurative otitis media, craniofacial anomalies, or nasal pathologies like polyps. Adenoids were graded using X-ray imaging of the nasopharynx, and correlations between the adenoid size and impedance audiometry findings, such as middle ear pressure and compliance, were analyzed.  Results The study assessed the relationship between the adenoid size and impedance audiometry findings, focusing on middle ear pressure and compliance, as well as the occurrence of OME. The results indicated a significant decline in middle ear pressure with increasing adenoid grades. Specifically, adenoid grade 1 had an average pressure of -3.50 daPa, while grade 4 had the lowest average pressure at -119.72 daPa. This trend was statistically significant with a p-value of 0.00042. Similarly, compliance values also decreased with higher adenoid grades. Grade 1 had an average compliance of 0.64 ml, whereas grade 4 had the lowest average compliance at 0.28 ml. This relationship was statistically significant, as indicated by a p-value of 0.0048. Additionally, the analysis showed that a significant majority of patients with enlarged adenoids also presented with OME, highlighting a strong association between adenoid hypertrophy and this condition. Conclusion The study concluded that larger adenoids were associated with lower middle ear pressure and reduced compliance. Additionally, a significant majority of patients with enlarged adenoids also had OME. This underscores the importance of evaluating adenoid hypertrophy in the context of OME due to its potential impact on childhood hearing and development.

The Evaluation of Upper Labial Swelling: An Arteriovenous Malformation.

Vascular malformations, which include disorders of the lymphatic or vascular systems, can appear in a variety of ways on radiographs, in the radiological department, and histologically. High-flow lesions with direct arteriovenous connections are known as arteriovenous malformations (AVMs). These lesions can cause soft tissue loss and deformity since they are difficult to diagnose early. This case report describes a 75-year-old female who presented with a severe bluish-purple swelling on her top lip. After conducting a thorough investigation, the patient's condition was quickly identified as AVM. After confirmation by USG Doppler and histological examination, the patient underwent a successful surgical resection that revealed a confined vascular lesion suggestive of AVM. The discussion explores the hemodynamic and embryologic factors that contribute to the formation of AVM, pointing out differences in hemodynamic properties and clinical symptoms. Treatment choices are influenced by the categorization of peripheral AVMs according to clinical standards and angiographic flow characteristics.

A Surgical Audit of Tracheostomy.

To study the magnitude of tracheostomy, its various indications and complications. Prospective Observational Study. A Prospective Observational study was carried out on 640 patients with various indications of tracheostomy admitted in ENT or referred from other departments for tracheostomy from July 2015 to March 2022. The epidemiological data regarding their age, sex, symptoms, indication and complications of tracheostomy were recorded. Necessary interventions were done as and when required. Patients ranged from 6 months to 86 yrs. Assisted ventilation was the most common indications for tracheostomy (68.125%, n = 436). The most common complication was subcutaneous emphysema (10.625%, n = 68) followed by tube displacement (5.625%, n = 36. The complication rate was 21.25% and the mortality rate 4.375% (n = 28) with specific mortality rate 0.625% (n = 4). Tracheostomy is one of the commonest surgeries. Data was collected from this study on the various indications of tracheostomy, the epidemiological factors and various complications associated with tracheostomy. Such a data is useful to learn from the mistakes and carry forward the virtouosity.

Voice Restoration after Traumatic Subglottic Tracheal Stenosis.

Tracheal stenosis post intubation is one of the most common complication for which resection and anastomosis is done. Here we present a 21 year male patient who was intubated post organophosphorous poisoning. Diagnosed with tracheal stenosis post intubation and managed with tracheal resection and anastomosis with uneventful recovery. Post intubation tracheal stenosis is one of the serious complications and requires a multidisciplinary team and high volume centre for adequate management. Considering the fact that this case report has tracheal stenosis of grade IV type with resected length of tracheal cartilage of more than 3 cm and trachea- tracheal anastomosis makes this a rare case report.

Frontoethmoid Osteoma Operated by Combined Approach: A Case Report.

Osteoma is the most common benign neoplasm of the nose and paranasal sinuses. Despite their size, (osteomas can often reach several centimeters) they most often remain asymptomatic. Generally conservative treatment is recommended for asymptomatic osteomas, while symptomatic osteomas should be resected. As the frontal sinus is commonly affected, most surgical approaches mainly concentrate on resection of osteoma by external route endoscopic instruments offer an alternative approach to sinus surgery, enabling closer and more direct visualization of the anatomy, avoiding damage to surrounding structures as well as avoiding an external scar. In this article we describe a combined approach i.e. osteoplastic flap technique combined with endosocopic resection of a frontoethmoid osteoma. With proficient use of this method, complete removal of such tumours can be achieved with minimal morbidity.