The "INT-EX Technique": Internal to External Approach in Carotid Body Tumour Surgery.

Carotid body tumours are rare and mostly benign neoplasm. They are slow growing but can evade or exert pressure on neighbouring important neurovascular structures. Hence, surgical resection remains the treatment modality of choice for large tumours partially or completely encasing the carotid arteries. But the surgical resection of these tumours with minimum morbidity is challenging because of their highly vascular nature. Earlier literature has dealt with various aspects of management of carotid body tumours including classification, morbidity, work-up, embolisation and extent of resection. However, the options in techniques of dissection for carotid body tumours have not been elaborated much. Here, we describe a stepwise dissection technique of carotid body tumours from the internal carotid towards the external carotid artery. This surgical technique, named as "the internal to external (INT-EX) technique", provides better control of bleeding during the surgery, ease of dissection and lesser post-operative morbidity.

Role of vitamin A in the evolution of cholesteatoma.

The role of vitamin A in the maintenance of epithelial integrity is well known. Several animal studies have dealt with the induction of cholesteatoma in vitamin A deficiency states and prevention and treatment of otitis media with vitamin A treatment. We treated five patients of cholesteatoma with vitamin A oral supplements and no other treatment and found significant resolution of cholesteatoma in four patients. Though this may not be an explanation in every case of cholesteatoma, our study highlights that there is a subset of patients with vitamin A deficient cholesteatoma who could substantially benefit from intervention with this wonderful vital amine.