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Venous malformations are low flow endothelial malformations with aberrant and ectatic venous channels. They are defects in vascular growth which causes functional and cosmetic impairment. Gradual growth in size of the lesion occurs due to venous congestion or thrombosis. Venous malformations in parapharyngeal space are a rare entity and are difficult to diagnose. Case Report. 13 year old boy presented with a history of hyposmia and progressive difficulty in breathing for a duration of 2.5 years. MRI face and neck with contrast showed a 4.5 × 4.3x3.6 cm lesion in the left parapharyngeal space. CT angiogram of brain and neck demonstrated a heterogeneously enhancing mass in the left parapharyngeal region. PET scan illustrated an ill-defined mass in the left pre styloid parapharyngeal space. Biopsy from the lesion showed features consistent with venolymphatic malformation. Flexible laryngoscopy showed a bulge over the left soft palate region with narrowing of nasopharyngeal lumen. Patient underwent transoral robotic surgery for complete excision of the mass. Post-operative period was uneventful. He has been on follow up for the past 1 year with no evidence of any residual or recurrent disease. Venolymphatic malformation is a rare lesion in the parapharyngeal space which is difficult to diagnose pre operatively. Surgical excision is the preferred modality of treatment for deep seated lesions in the parapharyngeal space. The advent of transoral robotic surgery have reduced the morbidity and improved clearance for such cases. [ABSTRACT FROM AUTHOR]

Rare non-odontogenic cysts of the soft tissue of the midface that form between the nasal vestibule and upper lip are known as nasolabial cysts. Treatment can be accomplished by surgical removal, injection of sclerosing material into the cyst, and endoscopic marsupialization. The aim of this study is to compare the effectiveness of Excision with sublabial approach versus Marsupialization with Transnasal Endoscopic approach in patients with Nasolabial cyst in terms of operating time, recurrence rate, postoperative pain and complications. Our study was Duration based prospective observational study with a Duration of four years from August 2018 till July 2022 with study population inclusive of 30 patients aged between 20 and 70 years who were diagnosed with a unilateral nasolabial cyst on the basis of clinical presentation, anatomical location, and computed tomography (CT) findings at ENT Department of our Tertiary Institution. The study used a randomized, single blind, parallel design with a total of 30 patients, which were randomly allocated to undergo Excision with sublabial approach (group A) in 15 patients (15 nasolabial cysts) and Marsupialization with Transnasal Endoscopic approach (Group B) in 15 patients (15 Nasolabial cysts). In the sublabial approach group, the mean operating time was 91.28 ± 3.1 min, whereas in the transnasal marsupialization group, it was 29.7 ± 3.2 min. These differences were statistically significant (P = 0.003). In the excision with sublabial approach and transnasal endoscopic marsupialization groups, the visual analogue scale (VAS) for postoperative pain was 5.9 ± 1.4 and 3.2 ± 0.6, respectively (P = 0.001). Ten patients in the sublabial approach group and five patients in the transnasal marsupialization group had one or more problems during the follow-up period which disappeared spontaneously within 4 weeks without long lasting issues. There were no recurrence lesions or obstructions of the marsupialized cyst opening in either group, according to physical, endoscopic and computed tomography examinations. Nasolabial cysts can be marsupialized transnasally, which offers many advantages over the more traditional sublabial excision method. Transnasal endoscopic marsupialization has the benefits of a shorter operating time, less postoperative pain, and a low complication rate. Therefore, we propose that Transnasal Endoscopic marsupialization be the treatment of choice for nasolabial cyst, replacing the conventional Excision with sublabial approach. [ABSTRACT FROM AUTHOR]