Carotid body paraganglioma.

Carotid body tumours are benign neoplasms. This case report describes two patients with this rare tumour with diagnostic workup and treatment options. The first case was a 36-year-old gentleman who presented with 6 months history of painless swelling on the left side of neck. The second patient was 60-years-old man who presented with slowly growing swelling on the right side of neck for the last 20 years. Both patients had transmitted pulsations over the swelling. On suspicion of a vascular lesion, a contrast enhanced CT scan and Doppler's ultrasound of neck was advised which suggested the diagnosis of a carotid body tumour. Magnetic Resonance Angiography (MRA) confirmed the diagnosis. Excision in collaboration with vascular surgeon was planned for the first case. The second case was subjected to radiation therapy due to the large size of tumour and the patient's age.

Multiple thyroid ectopics in a single patient: a rare presentation.

A rare case of multiple thyroid ectopics has been presented. A 16 years old girl presented with swelling on the right side of neck and sense of lump in the throat. Oral examination confirmed presence of lingual thyroid. Examination of neck confirmed a 4 cm rounded soft mass on upper right side of patient's neck. Thyroid scan with I131 showed uptake of radio-iodine at the tongue base and also on right side of neck. Biopsy of mass from tongue dorsum and FNA from neck mass confirmed presence of thyroid tissue at both sites. Hormonal assay showed high TSH and low T3 and T4 level. Treatment with thyroxin for 3 months caused regression of thyroid tissue from both sites and improvement of patient's symptoms. Thyroid hormonal profile improved with thyroxin therapy and patient soon became euthyroid. The patient remained on long-term hormonal replacement with no recurrence of symptoms.

Pulmonary complications associated with head and neck cancer surgery.

OBJECTIVE: To evaluate the frequency of short-term pulmonary complications in the patients undergoing various head and neck cancer surgeries in our setup and to assess possible risk factors responsible for these complications. STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: Department of ENT, Head and Neck Surgery, Combined Military Hospital, Rawalpindi from July 2005 till August 2006. PATIENTS AND METHODS: Seventy patients of age group 20 to 80 years, regardless of gender, treated surgically for head and neck cancers were enrolled. Main outcome measures included development of pulmonary complications following 15 days of oncological surgery. The complications studied were pneumothorax, bronchopneumonia, atelectasis, pulmonary embolism and cardiopulmonary arrest. RESULTS: A total of 24.28% patients suffered from postoperative pulmonary complications; 17.14% developed bronchopneumonia, 5.71% pulmonary embolism, and 1.42% went into cardiopulmonary arrest, none developed pneumothorax or pulmonary atelectasis. A significant correlation of postoperative bronchopneumonia was seen with heavy smoking and assisted ventilation. Pulmonary embolism was associated with extended assisted ventilation and prolonged surgery. Cardiopulmonary arrest was associated with comorbidity and assisted ventilation after surgery. CONCLUSION: The frequency of bronchopneumonia supersedes all of the postoperative pulmonary complications in head and neck oncological surgery. Patients at risk of developing postoperative complications are heavy smokers, diabetics, those undergoing prolonged surgery, tracheostomy, and extended assisted ventilation.

Dentigerous cyst presenting as facial pain.

A rare case is presented in which a maxillary dentigerous cyst had eroded the posterior wall of the right maxillary sinus into the pterygo-palatine fossa causing facial pain due to pressure on the nerves. It had also eroded the lateral wall of sinus and into the oral cavity and got infected resulting in foul smelling oral discharge. The case was dealt with complete removal of cyst using Caldwell Luc's approach.

Management of difficult airway by retrograde tracheal intubation.

A case of difficult intubation is presented in a patient of adenoid cystic carcinoma with a large right-sided facial defect. She was managed with radiotherapy and a myocutaneous flap reconstruction was done with retrograde tracheal intubation

Mandibular reconstruction using osteocutaneous radial forearm flap.

OBJECTIVE: To describe the use of radial forearm osteocutaneous free flap in complex mandibular reconstruction. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Combined Military Hospital, Rawalpindi, from January 1998 to January 2008. METHODOLOGY: Patients having a small bony component and a large soft tissue mandibular defect requiring reconstruction were selected. These defects include composite through-and-through defects of the cheek in the retromolar trigone, small lateral bony defects with large intra and extra oral soft tissue defects and small central bony defects with large extra oral tissue loss. Radial forearm osteocutaneous free flap was employed. Complications and graft acceptance were determined at follow-up. RESULTS: Patients were followed-up for an average period of 28 months. Complications occurred in 8 patients. Wound infection and partial wound dehiscence were the most common complication observed in 3 patients. Non-union at recipient site was seen in 2 patients. Flap donor site healed uneventfully in all patients with no fractures at the donor site. CONCLUSION: The radial forearm osteocutaneous flap covers oromandibular defects with large intra-oral and extra oral soft tissue losses. Lateral and anterior mandibular defects were reconstructed satisfactorily in our series.

Modified palatal stiffening procedure for snoring.

OBJECTIVE: To evaluate the efficacy of a modified procedure of palatal stiffening for the treatment of snoring. STUDY DESIGN: A quasi-experimental study. PLACE AND DURATION OF STUDY: ENT, and Head and Neck Surgery Departments of Pakistan Air Force (PAF) Hospital Masroor, Combined Military Hospital (CMH) Rawalpindi and PAF Hospital Sargodha, from January 2000 to January 2005. METHODOLOGY: Patients of either gender and above 20 years of age having snoring as their primary complaint were registered. Patients with an obvious cause of upper airway obstruction like oropharyngeal swelling, growths and obstructive sleep apnea were excluded. A grading system was designed to classify the patients according to severity and criteria for successful outcome defined; grades were equated with VAS. Palatal stiffening was achieved by using an insulated 22 gauge LP needle for infiltration cautery. Results were analyzed at 6 weeks post operatively on SPSS-16. Paired t-test was applied to compare the improvement in snoring and significance was tested at p-value less than 0.05. RESULTS: Forty four (44) patients underwent the palatal stiffening procedure. Male to female ratio was 42:2. Twenty eight (28) patients (63%) had complete resolution of symptoms after first surgery. Out of the remaining, ten more patients (22.72%) became symptom free after 1st revision surgery while six patients (12.5%) needed 2nd revision. Pain in throat was the main post operative complaint which settled in 10 to 14 days. CONCLUSION: Palatal stiffening procedure causing relatively less morbidity, simple and minimally invasive, but effective at the same time.