Radiological Parameters Predicting the Round Window Niche Visibility through Facial Recess Approach in Cochlear Implantation.

Aim: The aim was to study the radiological parameters using High Resolution Computed Tomography (HRCT) temporal bone to predict the Round Window Niche (RWN) visibility through the facial recess approach and to study radiological types of the round window niche. Materials and Methods: Prospective study was done in the patients underwent CI surgery from 2019 to 2021. HRCT radiological parameters of the patients and their intraoperative visualisation from video recordings were compared to predict the most feasible parameters to predict good visualisation of RWN. Results: Among 51 patients (34 males, 17 females) in 48 children round window membrane insertion was done and in three children cochleostomy was done and in two children partial canal wall drilling was done due to poor visualisation of RWN area. Multiple parameters to assess the visibility of the RWN were used. Facial recess width (4.2 mm), location of the mastoid segment of facial nerve (2 mm), external auditory canal to basal turn of cochlea angle (< 13.50) and the radiological types (tunnel shape and semi-circular shape) of the RWN by HRCT were found to be significant parameters in predicting a good visualisation of the RWN. Conclusion: HRCT parameters prepare the surgeon to face the possibility of a difficult surgery and plan to deal with difficult situations. This would eventually lead to better preparedness of surgeons for management of complications.

Unusual Branchial Cleft Cyst at Parapharyngeal Space: Case Report and a Review of Literature.

Branchial cleft cyst in parapharyngeal space is a very rare occurrence. Only 0.5% of all head and neck tumours constitute parapharyngeal space tumours. It is mainly congenital but can be seen at a later age following infection. MRI is the gold standard for diagnosis. This is a case report of a 19-year-old with right sided neck swelling without any significant history. It has been excised by transcervical approach.

Paediatric Parotid Abscess: A Rare Presentation.

Acute parotitis in children is a common occurrence with predisposing factors including ductal dysfunction, poor oral hygiene or dental infections, immunosuppression, dehydration, or a pre-existing Warthin's tumour. Bacterial or viral infections of the intra-parotid and peri-parotid lymph nodes or the parotid gland parenchyma results in inflammatory followed by suppurative changes which leads to formation of parotid abscess. Surgical drainage is necessary in parotid abscesses not responding to conservative management. Surgical intervention is invasive and has associated risks of injury to the facial nerve and poor cosmetic outcome. We present a case of parotid abscess in a 9-year-old female child which required surgical drainage. In literature, parotid gland abscess arising from a preceeding dental infection in paediatric age group is an uncommon occurence and limited number of cases have been documented. The first line of imaging is ultrasonographic examination of the parotid gland which adds on to the clinical examination. In combination with color doppler, sonography is of immense assistance for diagnosis and evaluation of therapeutic efficacy and also helps guide aspiration or incision and drainage.

Transoral Robotic Excision of Paediatric Lingual Thyroglossal Duct Cyst.

Lingual thyroglossal duct cyst (TGDC) is a rare variant of TGDC that emerges within the tongue base. It presents a unique surgical challenge. There are different approaches to managing this condition. Transoral robotic surgery (TORS) has been successfully used for lesions of the tongue base in adults. This report presents a 7 year old boy with a cystic lesion in the base of tongue, which was diagnosed to be a lingual TGDC. The cyst was excised transorally using Da Vinci Robotic system. The surgery was performed in a short operating time with no complications or recurrence on follow up. TORS is an effective and reliable method of excision of lingual TGDC in the paediatric population. Lingual TGDC can be managed by simple excision of the cyst without excision of hyoid bone. Further studies are needed to confirm the safety and recurrence rates of this technique in paediatric population.

Sigmoid and Transverse Sinus Thrombosis in a Child with Chronic Otitis Media: a Case Report.

Sigmoid sinus and transverse sinus thrombosis may occur as intracranial complications of chronic otitis media. Central venous sinus thrombosis typically presents with picket fence fever along with otalgia, otorrhea, and altered mental status. CT and MRI are investigations of choice for diagnosis. Once diagnosed, one should be started on empiric antibiotics. The use of anticoagulants has been debatable. From a surgical point of view, the current trend is to perform a mastoidectomy with the removal of inflammatory tissue from the sinus walls.

A Trip Down the Bronchus- A Tracheostomy Complication in COVID Pandemic.

Foreign body of the trachea and the bronchus are critical emergencies which can lead to life threatening complications. But the advent of the 2019 novel corona virus disease, pandemic has dramatically changed the comfort of these procedures since aerosol generating medical procedures pose a risk and spread of infection to the health care workers. Even the patients are uncomfortable visiting the hospital due to the fear of acquiring the COVID infection.A 41-year-old obese female with grade 4 subglottic stenosis status post tracheostomy presented with foreign body Fuller's tracheostomy tube flange in the right bronchus during the COVID 19 pandemic. The patient had delayed presentation to the hospital due to fear of getting exposed to COVID and poor access to health care facilities due to lockdown imposed in various places in the nation. The patient was tested for COVID and taken up for surgery where rigid bronchoscopy and foreign body removal was done via the tracheostoma. The details of the procedure, challenges faced during the procedure, the effect of the COVID pandemic on the patients and hospital staffs are discussed. The complications of the broken tracheostomy tube can be most efficiently dispelled by proper tube care by the attenders and frequent tube change.

Microdebrider Assisted Resection of Suprastomal Lesions via Tracheostoma: A Novel Technique.

Subglottic lesions are the commonest airway conditions leading to life threatening complications. Many conditions can present as subglottic lesions and can affect various age groups. There are various methods to manage these conditions described in the literature. We have devised a new method of managing these lesions by using a microdebrider inserted through the tracheal stoma. Here we describe three cases of subglottic lesions with pre-existing tracheostomy managed by this technique. The advantages and the post operative follow up of these patients are described. The follow up of the patients after 1 year showed significant improvement leading to their decannulation. Thus we would like to publish our results with scope of further research of this technique in this area and the treatment of such conditions affecting upper airway.

An Uncommon Differential for Mass in the Middle Ear Cleft-Temporal Meningoencephalocele.

Meningoencephalocoele (ME) of the temporal bone is otherwise known as brain fungus. It is a rare and potentially life-threatening condition. It occurs in cases of chronic otitis media either as a complication or iatrogenically induced following mastoid surgeries. It requires prompt surgical intervention. High-resolution Computer tomography of Temporal bone and Magnetic resonance imaging of the brain are needed to detect these cases. Surgery can be otological, neurosurgical, or combined. We discuss a case of Iatrogenic Temporal meningoencephalocele and its management along with a review of the literature.

Undiagnosed pharyngeal perforation following a penetrating neck trauma in a 5-year-old child: a proposed treatment algorithm.

External penetrating wounds of the neck leading to pharyngeal perforations are relatively uncommon. The small area of the neck contains the vital vascular, aerodigestive and nervous structures, which are difficult to access surgically. Pharyngeal perforations are challenging to treat, especially in children, as primary wound inspection may be difficult, leading to life-threatening complications like retropharyngeal abscesses, mediastinitis or airway compromise. The following is a case report of a 5-year-old girl who had a road traffic accident causing a neck laceration with a pharyngeal tear, which was only identified during emergency neck exploration in the operating room. A review of known literature and a proposed algorithm for managing penetrating neck injuries with pharyngeal injury is described.

Is percutaneous glue injection one of the treatments for arteriovenous malformation pinna?

Arteriovenous malformation (AVM) of the head and neck is a rare phenomenon, more so when it is an extracranial AVM like the auricle. AVMs are caused by genetic mutations. Most are probably present in the subclinical form at birth and then evolve; some may arise postnatally or during adolescence or get aggravated by precipitating factors like trauma, infection or hormonal influence like puberty or pregnancy. Once diagnosed, the feeding vessels have to be identified using radiological investigations. They are then embolised via means of percutaneous embolisation and surgical resection.