Single Stage Nasal Reconstruction in a Near Total Nasal Defect.

Reconstruction of nasal defect is difficult and challenging. A full-thickness defect of nose requires reconstruction of thin inner lining, middle skeletal (bony/cartilaginous) support, and outer skin layer cover. Large full-thickness defects of nose require complex multistage reconstruction to achieve good functional and aesthetic result. We present here a case of 12-year-old boy, a known case of xeroderma pigmentosa, who underwent wide local excision for squamous cell carcinoma of the nose, leaving a near total defect of the external nose. The reconstruction was done with a suprafascial, thin radial artery forearm free-flap for the external cover as well as the inner lining along with the septal cartilage graft for skeletal support in a single stage.

Tuberculous Bronchoesophageal Fistula in Nephrotic Syndrome: A Silent Assassin.

Tuberculosis, a global public health concern, is emerging as an important complication in children with nephrotic syndrome. We report a case of an adolescent with nephrotic syndrome who developed fatal miliary tuberculosis after initiation of steroid therapy, presenting as a bronchoesophageal fistula. The case highlights the importance of maintaining a high index of suspicion prior to starting immunosuppressive therapy in pediatric patients of nephrotic syndrome.

Salvage arterial anastomosis using a microvascular coupler in head and neck free flap reconstruction.

Microvascular free tissue transfer is essential in complex head and neck reconstruction. The mainstay of microvascular anastomosis has classically been the suture technique, but the coupling device has emerged as a valuable alternative. Couplers are commonly used for venous anastomoses, but most head and neck reconstructive surgeons do not routinely couple arteries. However, coupling may afford reconstructive surgeons a unique tool for addressing difficult arterial anastomoses. In this case report, we describe the successful use of a microvascular coupler for salvage arterial anastomosis after recurrent thrombosis following multiple attempts at suture anastomosis in head and neck free flap reconstruction.

Diagnostic Efficacy of Computed Tomography in Detecting Cervical Metastases in Clinically N0 Head and Neck Squamous Cell Carcinoma.

The search for a single non-invasive highly accurate diagnostic modality for identification of cervical metastasis in head and neck squamous cell carcinoma (HNSCC) is yet to bear fruit. Thirty proven cases of HNSCC with no palpable neck nodes were selected, requiring surgery for the primary tumour. Detailed clinical evaluation and contrast enhanced computed tomography (CECT) scans were done. Patients underwent elective neck dissection along with surgery for the primary tumour. Specimens were sent for histopathological examination (HPE), considered gold standard. Results of CECT were compared with HPE. Clinical examination had a NPV of 80 % and CECT had a sensitivity, specificity, PPV, NPV, and accuracy of 83, 75, 45.5, 94.7, and 76.7 % respectively. A CECT may be added to the initial assessment of a patient of HNSCC, allowing for earlier diagnosis of nodal metastasis that may allow for a better chance at survival.

Ewing's Sarcoma Multifocal Metastases to Temporal and Occipital Bone: A Rare Presentation.

Ewing's sarcoma (ES) is a common malignant bone tumour seen to involve long bones, flat pelvic bones and ribs and vertebrae in majority of cases. Here, we present a rare case of aggressive primary ES of pelvic bones with multifocal metastases to temporal bone and occipital bone. The patient presented with facial palsy and an occipital swelling, and was referred for chemotherapy.

Bilateral spontaneous salivary otorrhoea: Case report and a review of the literature.

Spontaneous salivary otorrhoea is an extremely rare clinical entity. Most of the times, salivary otorrhoea results from various forms of trauma. It has also been attributed to the patent foramen of Huschke, and fissures of Santorini. Here, we present a rare case of an 8 year old child presenting with salivary discharge from both the ears. The diagnosis was established on the basis of biochemical and radiological investigations. The patient was managed by surgical exploration and ligation of the fistulous tract.

T-cell lymphoma of the oral cavity: case report.

Lymphomas are heterogenous malignancies of the lymphatic system characterized by lymphoid cell proliferation. They can broadly be divided into Hodgkin's lymphoma (HL) and non- Hodgkin's lymphoma (NHL). NHL can originate from B, T, or natural killer (NK) lymphocytes. Extra-nodal presentation of T-cell NHL is extremely rare, and is often seen in immunocompromised individuals. Here, we report a rare case of T-cell lymphoma of the oral cavity in an immune-competent patient. The patient was diagnosed to have T-cell NHL on the basis of biopsy and immunohistochemistry, and was referred to oncology department for chemotherapy for definite treatment.

Extragonadal primary yolk sac tumour of temporal bone.

Yolk sac tumour, also known as endodermal sinus tumour (EST) is malignant germ cell tumours usually seen in children less than 3 years of age, involving the testis. We describe a rare case of extragonadal primary yolk sac tumour of the temporal bone in a 2.5 years old child presenting with a left sided post auricular mass and facial nerve palsy. Biopsy was consistent with yolk sac tumour showing expression of alpha fetoprotein. Patient was treated with chemotherapy including cisplatin, etoposide, and bleomycin. Post chemotherapy there was decrease in the swelling with improvement in facial nerve palsy.