Closing the Gap: Exploring the Role of Cap Grafts in Tracheocutaneous Fistula Closure.

Exploring the Role of Cap Grafts in tracheocutaneous fistula Closure. A tracheocutaneous fistula (TCF) is an abnormal connection that forms between the trachea (windpipe) and the skin of the neck. If spontaneous closure does not occur, fibrosis of the surrounding tissue may result in a persistent TCF and in some cases, iatrogenic laryngotracheal stenosis at the level of tracheostoma, the so-called A-frame deformity. In all 5 patients, Conchal cartilage was harvested. The new de-epithelialized stoma is measured, and the previously harvested graft is cut to match the defect. Passing through the centre of the tracheal cartilage and into the centre of the auricular cartilage graft, 3-0 PDS, horizontal mattress sutures are placed sequentially around the periphery of the graft, stabilised with Right SCM flap and skin was closed in layers. In each of the five cases, we achieved a resounding success by skilfully closing the fistulas and meticulously restoring the structural integrity. Equally noteworthy, all patients expressed contentment with the cosmetic outcomes at both the donor site and the neck region, deeming it as an acceptable aesthetic result.

Adenotonsillectomy in Arnold Chiari Malformation: Navigating Surgical Complexities.

Navigating Surgical Complexities associated with a case of Adenotonsillectomy in Arnold Chiari Malformation type 2. Arnold-Chiari or Chiari malformations (ACM) describe a group of deformities of the posterior fossa and hindbrain, which includes the cerebellum, pons, and medulla oblongata. Sleep-disordered breathing is a known but poorly evaluated comorbidity in patients with ACM. Obstructive sleep apnoea (OSA) in children is mainly caused by tonsillar and adenoid hypertrophy, and surgical resection of the palatine tonsils and adenoids is indicated depending on OSA severity. A 4-year-old male child suffering from Arnold Chiari type 2 malformation presented to us in OPD with Severe OSA. Clinical and endoscopic examination revealed presence of Grade 4 adenoids tissue and Grade 4 tonsillar hypertrophy. Patient was planned to undergo Coblation adenoidectomy and Tonsillectomy with Uvulopalatoplasty for the management of OSA. Patient tolerated the procedure well and extubating was un-eventful. Patient was kept in PICU for overnight observation and was discharged on next day without any major complications. Patient of Arnold Chiari malformation type 2 presenting with severe OSA due to peripheral cause like Chronic adenoid and tonsillar hypertrophy present an operative challenge due to nil neck extension and minimal oral cavity space. The key is that ACM 2 along with its complications, such as difficult airway, increased intracranial pressure, and autonomic dysfunction, makes it very challenging and requires well-structured and disciplined management by combined anaesthesiology, neurology, and operative team which emphasize on preoperative, intraoperative, and postoperative complications and its timely management.

Uncovering a Novel Site of Ewing's Sarcoma: the Hypopharynx.

Ewing's sarcoma is usually seen in bones but 20-30% are found in extra skeletal soft tissues like in head and neck region. We present the case of Ewing sarcoma of hypopharynx in a 1 year old child who presented to us with acute respiratory distress. Child was intubated using videolaryngoscope and mass was removed using microdebrider. Final histopathological examination revealed Ewing sarcoma. EWSR1 gene rearrangement studies were advised, which the patient refused. Post-operative patient was started on adjuvant chemotherapy. PET CT after 2 months showed no FDG avid lesions within or elsewhere in the region of the body surveyed. There is no case of Ewing's sarcoma in hypopharynx reported to date. The clinical presentation, management and outcome has been discussed with a review of the literature.

Non-thermal atmospheric pressure plasma jet for the bacterial inactivation in an aqueous medium.

This study reports the potential of non-thermal atmospheric pressure plasma jet for the bacterial inactivation in an aqueous medium. All experiments were conducted in a reactor containing aqueous solution i.e., water, pre-inoculated with bacterial suspensions and after plasma exposure solution is inoculated in Petrifilm to know the viable count. The plasma jet exposure to the bacterial aqueous solution was carried out under various gases such as helium, argon, air and also in combination as Argon + Air and Helium + Air. In each case, the oxidizing species such as hydrogen peroxide, nitric acid, hydroxyl radicals and ozone formed in the reactor during the plasma exposure were quantified. The effect of applied voltage and gas flow rate were studied to optimize the conditions for its efficacy. The solution pH plays a prominent role in bacterial inactivation, as the process is effective at low pH exhibiting 7 log reduction of bacterial population. The bacterial inactivation is efficient at below the critical pH (<4.7) and the inactivation process becomes less effective if the pH goes above 4.7. Plasma treatment of deionized water produces some reactive species such as hydrogen peroxide and nitrates, this plasma treated water is used to test the bacterial inactivation. Addition of Fe2+ salt to the plasma treated water improves the efficacy by converting hydrogen peroxide to hydroxyl radicals, which serves to be a major contributor to the bacterial inactivation. Especially, Non-thermal plasma offers an alternative way to sterilize vacuum sensitive and thermo-labile living tissues.

Enhanced photocatalytic and antibacterial activity of plasma-reduced silver nanoparticles.

A non-thermal atmospheric pressure plasma jet has been used for the green synthesis of highly dispersed colloidal silver nanoparticles. The reducing species such as hydrogen radicals and hydrated electrons are identified, and the change in the solution pH is studied during AgNP formation. The structural properties and size of the plasma-reduced silver nanoparticles are characterized via X-ray diffraction, ultraviolet-visible spectroscopy, fluorescence spectroscopy and transmission electron microscopy. The size of the colloidal AgNPs is tuned by adjusting the initial concentration of AgNO3. The effect of terephthalic acid, a hydroxyl radical scavenger, on the reduction of Ag+ ion is studied. The typical catalytic activity data indicate the better performance of the plasma-reduced colloidal Ag nanoparticles than that obtained from the chemical reduction method. The antibacterial activity of the plasma-reduced Ag nanoparticles also shows a better performance than that of the chemically reduced AgNPs, highlighting the potential of the plasma reduction approach for the synthesis of metal nanoparticles, which are stable even after 30 days without a stabilizing agent. Additionally, the effects of hydroxyl scavengers (isopropyl alcohol) and Fenton's reagent (Fe2+ salt) on CV degradation are studied.

Development and validation of a model of bio-barriers for remediation of Cr(VI) contaminated aquifers using laboratory column experiments.

Bench scale transport and biotransformation experiments and mathematical model simulations were carried out to study the effectiveness of bio-barriers for the containment of hexavalent chromium in contaminated confined aquifers. Experimental results showed that a 10cm thick bio-barrier with an initial biomass concentration of 0.205mg/g of soil was able to completely contain a Cr(VI) plume of 25mg/L concentration. It was also observed that pore water velocity and initial biomass concentration are the most significant parameters in the containment of Cr(VI). The mathematical model developed is based on one-dimensional advection-dispersion reaction equations for Cr(VI) and molasses in saturated, homogeneous porous medium. The transport of Cr(VI) and molasses is coupled with adsorption and Monod's inhibition kinetics for immobile bacteria. It was found that, in general, the model was able to simulate the experimental results satisfactorily. However, there was disparity between the numerically simulated and experimental breakthrough curves for Cr(VI) and molasses in cases where there was high clay content and high microbial activity. The mathematical model could contribute towards improved designs of future bio-barriers for the remediation of Cr(VI) contaminated aquifers.

Bench-scale column experiments to study the containment of Cr(VI) in confined aquifers by bio-transformation.

Bench-scale soil column experiments were conducted to study the effectiveness of Cr(VI) containment in confined aquifers using in situ bio-transformation. Batch adsorption studies were carried out to estimate the adsorption capacities of two different soils for Cr(VI) and Cr(III). Bio-kinetic parameters were evaluated for the enriched microbial system. The inhibition constant, evaluated using Monod's inhibition model, was found to be 11.46 mg/L of Cr(VI). Transport studies indicated that it would not be possible to contain Cr(VI) by adsorption alone. Transport and bio-transformation studies indicated that the pore velocity and the initial bio-mass concentration significantly affect the containment process. In situ bio-remediation is effective in the case of silty aquifers. Cr(VI) concentration of 25 mg/L was effectively contained within 60 cm of a confined silty aquifer. Cr(VI) containment could be achieved in sandy aquifers when the pore velocity was very low and the initial augmented bio-mass was high. A bio-barrier of approximately one meter width would be able to contain Cr(VI) if the initial Cr(VI) concentration is as much as 25 mg/L.

Head and neck teratomas in children: a case series.

Teratomas of the head and neck due to their obscure origin, bizarre microscopic appearance, unpredictable behaviour and often dramatic clinical presentation are a clinical surprise. This article focuses on pediatric head and neck teratomas and on their diversity and rarity and also reviews the recent terminology of this group of tumours.

Lipoma of the deep lobe of parotid gland - a case report and review of literature.

Lipoma of deep lobe of parotid gland is a rare clinical entity. Less than 10 cases have been reported in the literature in our knowledge. Because of their rarity, they are not often considered in the differential diagnosis of parotid tumors. A case of 45-year-old man with an unusually large deep lobe lipoma of parotid gland is presented in this article which was surgically managed by total conservative parotidectmy. The clinical picture, radiological and histopathological features of this entity is being discussed here. Review of literature of this clinical situation has been presented in the present article.

Primary B cell lymphoma of paranasal sinuses: a diagnostic surprise.

Primary lymphomas of paranasal cavities are rather uncommon entities. They have a variable presentation from fulminant destructive manifestations to chronic indolent type of disease. Chronic indolent form may mimic invasive fungal sinusitis in its presentation. Unless high index of suspicion is held and appropriate histopathology sections are taken from specimen, its diagnosis can be deceitful. We here by report a case of primary lymphoma of the paranasal sinuses which was radiologically and clinically suspected to be a invasive fungal sinusitis and later was proven to be a B cell lymphoma. Clinical similarities between lymphoma and invasive fungal sinusitis along with management issues are discussed in this article.

Macroglossia due to venous malformation.

Massive vascular malformation involving tongue can cause significant functional impairment. In this report we describe a rare case of extensive venous malformation involving tongue leading to obstructive sleep apnoea, inability to speak, eat, severe discomfort due to exposure induced dryness and ulceration. Multimodality treatment approach comprising of sclerotherapy, electrocautery and radiation therapy was used in this case.