Giant Cervical Lymphangioma Extending from Skull Base to Clavicle- A Rare Case.

Lymphangiomas are congenital benign lesions commonly seen in pediatric age group with a rare occurrence in the region of head and neck, commonly presenting as asymptomatic masses. Cervical lymphangioma is a rare entity among adults, and giant sized lymphangiomas in this region have sparse mention in literature. This case report describes the rare presentation of a giant cervical lymphangioma and the challenges involved to treat such masses in the region of head and neck. We encountered a rare case of a 52 year old female who presented with a 10 × 5 cm swelling in the right posterior triangle of neck swelling since 6 months extending from skull base up till clavicle. Pathological and radiological entities confirmed the lesion as a "giant cervical lymphangioma". Head and neck lymphangiomas are congenital lesions of benign origin. Lymphangiomas have been classified as macrocystic if larger than 2 cm, and microcystic if less than 2 cm. Our description of a macrocystic 10 × 6 cm lesion is hence definitely one of the largest cervical lymphangiomas encountered till date. It's a problematic and arduous plan of treatment for such masses in head and neck with a high chance of recurrence if incompletely removed.

Myoepithelioma- An Uncommon Parotid Tumour in An Adolescent.

Myoepitheliomas are uncommon neoplasms of major and minor salivary glands. These tumours are encapsulated and slow growing in nature and are benign in majority of the cases. The mean age of presentation is 40 years and this entity is rarely reported in younger age groups. Here, we seek to report a rare case of a 10-year-old patient who presented with a swelling below the right ear. Clinical and radiological evaluation revealed a mass in the parotid gland. This patient was treated with a superficial parotidectomy and subsequent histopathological examination revealed it to be a myoepithelioma.

Amelanotic Melanoma: A Rare Sinonasal Malignancy.

Mucosal melanomas account for less than 1% of all sinonasal malignancies and are aggressive tumours originating from melanocytes in various mucosal epithelia. Diagnosis is often delayed due to nonspecific symptoms, contributing to challenges in treatment and management. We present a case of a 75-year-old female with epistaxis and nasal blockage, ultimately diagnosed with amelanotic sinonasal melanoma. Despite diagnostic difficulties exacerbated by profuse bleeding during biopsy attempts, a comprehensive approach involving clinical evaluation, imaging, and histopathology led to a definitive diagnosis. Immunohistochemistry played a crucial role in confirming the diagnosis, ruling out differential diagnoses such as olfactory neuroblastoma and lymphoma. Surgical excision, despite intraoperative bleeding, was successful, followed by adjuvant chemotherapy and radiotherapy due to the tumor's advanced stage. The case underscores the importance of a multidisciplinary approach and personalized treatment strategies, considering the tumor's molecular characteristics for improved outcomes in managing this rare malignancy.

Intratemporal mucormycosis: a rare COVID-19 sequelae.

A man in his 50s presented with a 2-month history of left ear discharge associated with hearing loss and weakness of left half of face since 15 days. The patient had no comorbidities, but he gave history of being treated for COVID-19 pneumonia 2 months ago post which he started experiencing left-sided aural symptoms. Clinical examination of ear revealed a subtotal perforation with multiple granulations in middle ear. Facial nerve examination revealed grade 3 lower motor neuron palsy. The biopsy of the granulations was sent to aid in diagnosis which later confirmed left ear mucormycosis. Otological involvement with facial palsy and sudden sensorineural loss in a patient with prior history of COVID-19 has not been reported until in literature. We try to communicate our experience to bridge the gap in understanding and managing this extremely rare occurrence of mucormycosis in the ear of a patient diagnosed with COVID-19 infection.

Solitary Bone Plasmacytoma Mimicking Oral Cavity Neoplasm - A Rare Case.

Plasmacytomas are localized monoclonal plasma cell lesions with no evidence of systemic involvement which are divided into solitary bone plasmacytoma (SBP) and extra-medullary plasmacytoma (EMP). The diagnosis of plasmacytomas (PCM) in the oral regions is challenging given the atypical clinical manifestations and low frequency. Here, we report an extremely rare case of plasmacytoma in an elderly male which initially appeared to be arising from the left buccal mucosa on clinical examination but after radiological imaging and intra-operative findings, the epicentre was found to be in the left infratemporal fossa (ITF). The patient underwent en-bloc compartment resection with high clearance of the ITF which proved to be an effective management strategy. It is crucial for the head and neck surgeon to be aware of the solitary bone plasmacytoma in the oral and maxillofacial region in order to identify it early and provide these patients with the best care possible before complications arise.

Cricopharyngeal Myotomy; a Rescue Surgery for Dysphagia in Lateral Medullary Syndrome.

Lateral medullary syndrome/Wallenberg syndrome, is a neurological disorder occurring due to ischemia in the lateral part of medullary oblongata resulting in wide range of symptoms. Dysphagia is usually exhibited in severe and persistent form in LMS. Hence timely intervention is mandatory before the patient further worsens. We describe a case of Lateral medullary syndrome with persisitent dysphagia who was managed successfully with cricopharyngeal myotomy.

A Rare Case of Submandibular Actinomycosis.

Actinomycosis is caused by actinomyces israelii, a gram positive nonacid fast, anaerobic, commensal bacterium within the oral cavity. Though it is a commensal in oral cavity, it seldom presents as cervicofacial actinomycosis. But there is limited access to literature proving cervicofacial actinomycosis existence so far. We report a case of 35 year old gentleman who presented with painless progressive neck swelling associated with pain while chewing food. On examination, 3.5*2.5 swelling was noted in right submandibular gland area, radiologically a foreign body was detected in the right submandibular gland. Mass was excised in toto and sent for HPE which revealed submandibular gland actinomycosis. Post operatively, patient was managed with long-term broad-spectrum beta lactams and was on regular follow-up. No evidence of recurrence/ fresh complaints noted till date. Although cervicofacial actinomycosis is rare and dangerous with debilitating complications, timely diagnosis and early intervention with broad spectrum antibiotics and surgical excision (if required) shows promising results with complete eradication of disease leaving no residues. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03498-7.

Assessment of middle ear function after conventional or endoscopic microdebrider assisted adenoidectomy.

Objectives: To compare pre- and post-operative pure tone audiometric and impedance audiometric analysis following conventional and endoscopic microdebrider assisted adenoidectomy and compare the outcomes. Methods: Patients diagnosed with chronic adenoiditis were divided in groups of 25 each. Patients in the first group underwent conventional curettage adenoidectomy, while those in second group underwent endoscopic microdebrider assisted adenoidectomy. Pre- and post-operative pure tone and impedance audiometry were performed for all patients and outcomes were compared. Results: The endoscopic microdebrider assisted method resulted in significantly better outcomes compared to conventional curettage. Criteria such as hearing threshold (p value 0.004 at second follow-up), peak pressure (p value 0.045 at first follow-up) and tympanogram (p value 0.016) showed that the endoscopic method was better, while peak compliance (p value 0.340 at first follow-up) did not show any significant difference between groups. Conclusions: The endoscopic microdebrider assisted method for adenoidectomy has a definite advantage of better visualisation resulting in better clearance of tissue, leading to enhanced middle ear function compared to conventional curettage.

Single Step Treatment of Frontal Sinus Osteomyelitis Using Bone Cement: A Case Report.

Osteomyelitis is an infection of the bone which is accompanied by bony destruction and sequestrum formation. Osteomyelitis of frontal bone requires us to deal with great caution as it can lead to a great deal of morbidity and mortality. Often when surgical treatment provided, it is radical and leaves behind surgical defect over the frontal bone. We report a case of a 14 year old boy diagnosed with frontal bone osteomyelitis of the left side who was treated using antibiotic loaded bone cement. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-021-02667-w.

Unusual Presentation of Otoacariasis: A Prospective Study at Referral Teaching Hospital.

Otoacariasis is the presence of ticks and mites within the ear canal. Though the coexistence of ticks and humans is known for thousands of years, tick infestation is relatively rare in urban population. The most common presenting symptoms are usually itching, otalgia and a foreign body sensation and less frequent ones are tinnitus and otorrhoea. We report cases of otoacariasis with unusual presentation. A total of 43 cases presented to the ENT clinic in our hospital over a period of three years from 2018 to 2021. We present patients who presented with unusual symptoms of conductive hearing loss, ear bleed, and facial palsy. Total of 6 cases of otoacariasis had unusual presentation. 2 cases presented with lower motor neuron palsy, 1 case with ear bleed, and 3 cases with hearing loss. Otocariasis can present with unusual symptoms of hearing loss, ear bleed or facial palsy and this should be included in the differential diagnosis of a patient with history of close proximity to domestic or wild animals. Detailed examination often reveals the presence of the tick and identification and complete removal along with appropriate medication for associated symptoms often results in complete recovery.

Inverted papilloma of atypical origin with unusual extension into the oropharynx.

Inverted papilloma is a benign tumor with malignant potential that commonly arises from the lateral wall of the nose. We present a case of inverted papilloma, in a premalignant stage, of unusual origin and with oropharyngeal extension. The patient presented with complaints of a nasal mass arising from the left nasal cavity and progressively increasing in size since 2 years. On examination a fleshy, firm, sensitive mass was noted, which was attached to the medial wall, and extending posteriorly and inferiorly into the oropharynx. Diagnostic nasal endoscopy and complete excision of the mass was performed with a stable postoperative period. Histopathology of the mass revealed an inverted nasal papilloma of the septum with carcinoma in situ.

Management of head and neck trauma in a developing country.

PURPOSE: To investigate cases of trauma in head and neck region; to elucidate the characteristic problems in a developing country. DESIGN AND SETTING: Prospective study; 324 patients with trauma related to head and neck analysed in a tertiary care center from August 1999 to August 2005 RESULTS: 33.6% of patients fell in 21-30 year age group. Road traffic accidents (41.4%) were the most common cause of trauma. Nasal bone fractures were the most common fractures. 72.84% presented with bleeding and 72.22% with pain. 92.9% had tenderness. Only 15% of the patients could afford a CT scan. Plain radiograph diagnosed fractures in 83.33% of cases. ORIF was the treatment of choice in cases of fractures of the zygoma, maxilla and mandible. Open reduction and internal fixation (ORIF) gave good long-term results with satisfactory cosmosis. Most of our patients did not have any significant sequelae. Cerebral concussion was the most common associated injury (35.48%). CONCLUSION: In developing countries, one cannot follow the approaches used for RTAs in developed countries. Treating surgeons will have to select investigation tools and treatment options according to the socioeconomical and cultural variations, which differ from country to country, and also within different parts of the country.