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Glottic web is an abnormal soft tissue adhesion between the vocal cords which occurs due to failure of recanalisation. Congenital glottic webs comprises 5% of laryngeal anomalies. Cohen classified glottic webs into four types based on percentage of airway obliteration. Patients with severe glottic web—grade III and grade IV present with respiratory distress, stridor, phonatory difficulties or recurrent respiratory infections warranting urgent intervention. We are presenting our experience in managing two such patients with severe congenital glottic web. Diagnosis was confirmed by fibreoptic laryngoscopy under monitored anaesthetic care. Combined endoscopic excision of web with laryngofissure approach for keel stenting. In both our patients, we have used a silicone based keel for laryngeal stenting to provide strength and prevent re-webbing. During follow-up, both patients were found to have adequate phonation and normal airway thus demonstrating this method as safe option for adequate phonatory and airway outcomes.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor described by slow progression, vigorous growth, high vascularization, and increased recurrence rate. The aim of this article is to describe a case of JNA from our tertiary hospital and discuss the diagnosis and management in our current practice. A 16-year-old male patient presented with bleeding from the left nasal cavity. On examination, there was a non-pulsatile ovoid like mass occluding the entire left nasal cavity which was able to probe medially, superiorly, and laterally except inferiorly and on probing and it resulted in minimal bleed. Cold spatula test revealed decreased fogging on the left side. Contrast-enhanced computed tomography scan of the paranasal sinuses and nose showed the presence of a large ill-defined heterogeneously enhancing soft-tissue density mass lesion with its epicenter in posterior part of the left nasal cavity and left pterygopalatine fossa and was extending into the left orbit and left cavernous sinus. Complete embolization of the left nasopharyngeal vascular mass was done preoperatively. Two days post-embolization, surgical excision of JNA under general anesthesia was done. The approach was done through sublabial incision. This classic case of JNA was operated endoscopically because of its benefits over the conventional methods.

Covid 19 infection can result in various opportunistic infections. Altered immune response, associated comorbid conditions like diabetes, prolonged steroid and broad spectrum antibiotics usage with ICU interventions lead to increased chance of such superadded infections in covid 19 patients. Here we report a case of 31 year old male with covid 19 infection who had new onset Diabetes Mellitus, developed severe acute fulminant Mucormycosis during the treatment for covid 19 infection. He presented with severe headache, nasal obstruction and discharge, bilateral ophthalmoplegia and blindness with Cavernous Sinus Thrombosis. Patient underwent aggressive surgical debridement with frontal craniectomy, maxillectomy and right orbital evisceration and left endoscopic orbital decompression and judicious efforts to revert back the immunocompromised status with high dose of Liposomal amphotericin. Post operatively patient developed right temporal lobe abscess which was drained through Endonasal Endoscopic Trans Cavernous drainage of Temporal Lobe Abscess. Patient is in 2 months follow up, with bilateral blindness and tolerating oral feeds with improved left eye ophthalmoplegia. It is imperative to note that the rising trend of mucormycosis is there in Covid 19 infections and it should be dealt with high index of suspicion in high risk patients and early aggressive treatment can save the patient as the survival rate is not high in such infections.

Laryngeal stenosis following surgical intervention of larynx is a difficult condition to manage. The extensive adhesions formed between the vocal cords can obstruct the glottis and subglottis region and make decannulation unfeasible. In this report, we describe the challenges faced in the management of Glottosubglotic stenosis formed post Coblation assisted surgery for bilateral abductor cord palsy. The authors emphasize on the prevention techniques and management of laryngeal stenosis with a successful decannulation in such patients.

The ossifying fibroma is a rare fibro-osseous benign lesion of bone in the head and neck region. The mandible is the most common site reported followed by maxilla and other bones of the skull. A paediatric male presented with protrusion of the right eyeball for one-month duration. Further evaluation by diagnostic nasal endoscopy revealed a smooth mass confined to the superior and middle meatus on the right side. Computed tomography of paranasal sinus showed a large heterogenous bony lesion involving the ethmoid and sphenoid sinus and extending laterally into the orbit and superiorly into anterior skull base. Endoscopic biopsy was suggestive of ossifying fibroma. Transnasal endoscopic excision of the lesion was done and the patient is currently on follow-up. This case is reported for the rarity of presentation and the difficulties in management.

Introduction Tracheostomy is commonly performed in patients requiring long-term ventilator support. There are many types of tracheostomy tubes like fenestrated and non-fenestrated tubes. This study is to compare the types of fenestrated tubes. Type I is a fenestrated tube with multiple small fenestrae and type II is a fenestrated tracheostomy tube with a single large fenestra. Materials and methods A total of 87 patients who underwent tracheostomy due to prolonged ventilation from January 2015 to January 2016 were included in the study. Type I tube was used in 40 patients and type II tube was used in 47 patients. Tube change was done on the 10th day, at the end of 1 month, and at the end of 3 months. Flexible laryngoscopy is done during every tube change to assess the airway. Results Two groups were compared in terms of granulation through fenestra, stomal granulation, frequency of suctioning, and inner tube block. Statistical analysis was done and the values were compared. A p value Conclusion Type II tubes are more patient compliant. The incidence of inner tube block is comparatively less which makes it safe to use and avoid life-threatening situations. Decannulation can be done earlier and without complications in patients with type II tubes due to the less incidence of stomal granulation. Thus, type II tube is safer to use and has minimal complications. How to cite this article Lakshmanan S, Jeyabalakrishnan SP, Saravanam PK. Use of Fenestrated Tracheostomy Tubes: A Comparative Study. Int J Head Neck Surg 2021;12(1):15–18.

Carotid Anomalies are with significant surgical implication to an Otorhinolaryngologist. The authors discuss the evaluation and management of a child with Pierre Robin Syndrome who presented with severe OSA, secondary to bilateral midline carotids that compromised the airway, and an adult with cervical bolus and dysphagia who presented similar to chronic tonsillitis but found to have Retropharyngeal Carotids. This case study emphasizes the need for awareness and a high index of suspicion to identify the variation of the carotid artery in nasopharyngeal and oropharyngeal surgery that has a propensity to result in catastrophic consequences if operated upon.

Endoscopic sinus surgery (ESS) is one of the common ENT surgeries performed. Various techniques are available for reducing the blood loss during ESS. The efficacy of cauterization of the SPA in reducing the per-operative blood loss has not been explored in the literature. This study evaluates the efficacy of SPA cauterization prior to sinus surgery and its per-operative and post-operative outcomes. To study the outcomes of endonasal SPA cauterization in patients undergoing ESS. This is a prospective observational study conducted in a tertiary care centre from October 2018 to October 2020. 30 patients underwent ESS where SPA was cauterized by bipolar diathermy in one side of the nasal cavity and in the contralateral side, SPA was not cauterized. The results were tabulated and compared between the cauterized and non cauterized side. p value

Ultrasound is one of the accepted modality for the initial assessment of thyroid nodules. Thyroid image reporting and data system (TIRADS) classification system is the most useful of the risk stratification systems of thyroid imaging in predicting malignancy. The purpose of this study is to assess the clinical usefulness of TIRADS in the evaluation of thyroid nodule and compare it with final histopathological results. This was a prospective observational study conducted in a tertiary care hospital over a period of one year. Preoperative ultrasound was performed in 85 patients admitted for thyroid surgery. Thyroid nodules were classified according to TIRADS into five groups. The TIRADS category was compared with the final histopathological diagnosis following surgery. Sensitivity, specificity, positive as well as negative predictive value and risk of malignancy for each TIRADS category was assessed. The risk of malignancy for TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 was 4.2%, 13.3%, 57.9% and 100%, respectively. The usefulness of TIRADS classification in prediction of malignancy was 77.8% sensitive, 89.6% specific, had a positive predictive value of 66.6% and negative predictive value of 93.8%. The probability of a particular nodule being malignant can be inferred from ultrasound based TIRADS system. Hence ACR TIRADS classification is a valuable tool for diagnosis of thyroid nodule and should be adopted in our routine clinical practice.

Isolated thyroid abscess is a rare entity in early childhood. Among thyroid disorders, thyroid abscess or acute suppurative thyroiditis constitutes about 0.7%–1% of all cases. The thyroid gland is normally resistant to infections due to its well-enveloped capsule, rich blood supply, and high iodine content.A child presented with tender neck swelling accompanied by fever for 3 days. Ultrasound of the neck showed features suggestive of left parapharyngeal abscess. Laboratory parameters including thyroid function test were within normal limits. Contrast-enhanced CT of the neck was done and showed an isolated thyroid abscess with no other abnormalities. The patient was started on intravenous antibiotics followed by incision and drainage of the abscess. The child improved symptomatically. This report discusses the differential diagnosis and management of this rare entity.

Objective: To assess the levels of Vitamin D in patients with Chronic Rhinosinusitis (CRS) and its correlation with disease severity Methods: The study is an analytical cross -sectional study of patients with Chronic Rhinosinusitis (CRS) and the serum levels of Vitamin D in them.Controls have been used to compare the level of Vitamin D in healthy versus diseased population Results: There is an inverse correlation between severity of chronic rhinosinusitis and serum Vitamin D levels amongst the various subtypes of CRS. Conclusion: This study has observed that Vitamin D levels may have a denitive role in pathogenesis and severity of Chronic Rhinosinusitis. On review of literature, it was noted that very few Studies have discussed this issue.

Ameloblastoma is a group of rare benign odontogenic tumour, accounting for around 1% of all the cysts and tumours in the jaw. Predominantly this tumour occurs in the mandible and rarely crosses the midline. The typical clinical presentation is that of facial dysmorphism and functional dysfunction due to the expansile and compressive nature of the tumour. Of the six histological subtypes described, Acanthomatous variant is relatively very rare. A Large ameloblastoma with acanthomatous variant of maxilla is also unusual. This case discusses the diagnostic and therapeutic challenges in the management of a large maxillary acanthomatous ameloblastoma that had extended into the orbit, ethmoids and sphenoid sinus.

To assess the olfactory outcomes following Endoscopic Sinus Surgery (ESS) in patients diagnosed with Chronic Rhinosinusitis (CRS) and Sinonasal polyposis (SNP). To assess and compare the pre-operative and post-operative olfactory scores of patients undergoing ESS/ ESS + polypectomy/ESS + Septoplasty by subjective and objective methods. This is a prospective, cohort study which included a total of 60 patients. Subjective assessment was done using a Questionnaire. Preoperative olfactory assessment was performed with Sniffing Sticks. Olfactory assessment was done at 1st,3rd, 6th and 12th week following surgery. The preoperative and postoperative scores were statistically analysed and compared. In patients who underwent ESS, there was a significant reduction in olfactory scores in the immediate few weeks after surgery which improved over time by the end of 3 months. In patients who underwent ESS with polypectomy, there was a significant improvement in olfactory scores from the third week following surgery which was sustained over 3rd month follow-up. In patients who underwent ESS with Septoplasy, there was a significant decrease in olfactory scores during the initial few weeks with a marginal improvement during 3 months follow-up. At the end of 12 weeks post ESS, no patient was found to be anosmic. Patients with pre-existing hyposmia did not show statistically significant change post surgery.However patients with anosmia showed statistically significant improvement in olfactory function, but did not become normosmic at 12th post-operative week. Majority of normosmics did not have alteration in their olfactory perception at 12th post-operative week.

The main goals of endoscopic sinus surgery (ESS) is, to enlarge the sinus ostia. Most common cause of failure of ESS is lateralization of the middle turbinate causing recurrent blockade of osteomeatal complex (OMC) and recurrence of disease. Many techniques have been described for preventing lateralization of the middle turbinate. We compared the postoperative outcomes following endoscopic sinus surgery (ESS) for sinonasal polyposis (SNP) with medialization suturing of middle turbinate and partial middle turbinectomy. 60 patients who underwent ESS for SNP were divided into three groups, Group A (Medialization suturing of the middle turbinate with septum), Group B (partial middle turbinectomy) and Group C (control-no middle turbinate intervention). Preoperative Lund Kennedy scoring, Lund McKay scoring, SNOT 22 scoring was done. Post-operatively, Lund Kennedy scoring was done at 1st, 4th, 12th week and SNOT 22 scoring was done at 4th, 12th week. Statistical analysis and comparison of data between the groups was done. Both the techniques, helped to improve OMC patency, mucosal healing, and to minimize adhesions. Medialization of the middle turbinate helped in improvement of SNOT 22 and Lund Kennedy scores in the postoperative period as compared to the non-interventional group. However, between the two middle turbinate interventional groups there was no statistically significant difference. Achieving middle meatal patency by middle turbinate interventions improves the postoperative outcomes. However, long-term follow-up studies are recommended for evaluation of efficacy of these techniques and to look for recurrence of disease in SNP.

Osteoma of the temporal bone is an unusual benign slow-growing tumour composed of mature lamellar bone. It is a single pedunculated mass that often occurs unilaterally. Osteomas of external auditory canal are more common than in the other parts of temporal bone. Clinical presentation includes ear pain, hearing loss, tinnitus or vertigo. More often these lesions are an incidental finding during radiographic evaluation. Surgical excision of the osteoma is preferred in cases with impending complications. Here, we report a 36-year-old woman who came with problems of ear discharge, ear pain, hearing loss and occasional bleeding from the ear. She was diagnosed with osteoma of temporal bone with erosion of lateral semicircular canal and facial canal. Osteoma was excised and the defective areas were reconstructed.

Aetiology of acquired laryngotracheal stenosis (ALTS) is complex and heterogenous. The aim of this study is to discuss the role of primary aetiology of intubation in the development and outcomes of Post intubation Laryngo tracheal stenosis (PILTS). A retrospective review of patients diagnosed and managed as PILTS from May 2008 to January 2017 was conducted. Demography, primary aetiology of intubation, grade of stenosis, length of the stenotic segment, treatment and outcomes of these patients were recorded and analysed. Based on aetiology of intubation, patients were divided into Poisoning (I), Neurogenic (II) and Rest of aetiologies (III) group respectively. Group I had 28/52 patients (53.8%) followed by group II, 15/52(28.8%) and group III, 9/52(17.3%) respectively. Organophosphorus compound poisoning (OPP) (44.2%) was the commonest cause overall followed by Brain injury (23.1%) and Acute Respiratory Distress Syndrome (ARDS) (11.5%). Trachea (46.15%) was the commonest subsite involved in this study. 24/28(85.7%) of patients had advanced (either grade 3 or 4) subglottic stenosis. The average length of stenotic segment in the study was 18.5 ± 9.2 mm (7–34 mm). 39/52(74.9%) of patients underwent open surgical approaches like cricotracheal resection and anastomosis, Laryngotracheal reconstruction or Shian-Yan Lee technique. 48/52(92.3%) patients were decannulated successfully. There was no significant association between primary etiology of intubation and outcomes. We conclude that OPP and neurological disease patients are more susceptible to airway injury. The authors emphasize that clinicians should be aware of these facts and manage these susceptible patients accordingly.

This study aims at identifying the predisposing factors, clinical and radiological features that dictated the treatment outcome of Rhino-orbito-cerebral mucormycosis (ROCM). This is a retrospective observational study. Medical records of 39 patients with ROCM proven by fungal smear or histopathology (HPE), admitted in Sri Ramachandra Institute of Higher Education and Research from Jan 2015 to Dec 2019 were reviewed and audited. The mean age of the patients was 52.6 years and they were predominantly men (76.9%). There is a statistically significant association between uncontrolled diabetes and increasing severity of the disease in this study and an important cause of mortality. Fungal smear and HPE plays a crucial role in diagnosis. Radiological evaluation helps in identifying the extent of spread and in this study 31% of patients had intraorbital and 20% had intracranial extension. In-hospital mortality was 13%. Our results showed better outcome when combined medical and surgical intervention was undertaken. Rhino-orbito-cerebral Mucormycosis is a rapidly spreading invasive fungal infection with significant mortality and morbidity. Early diagnosis and proactive surgical and medical intervention is crucial for better outcome. Hence the clinician should be highly alert to certain subtle clinical signs and radiological features in a diabetic patients for improving the treatment outcomes and avoiding potentially fatal complications.

Cholesteatoma is a non-neoplastic cystic lesion arising in the middle ear cleft with the propensity to spread and recur after surgery, but it is unusual to find cholesteatoma invading sternocleidomastoid muscle after 15 years of modified radical mastoidectomy and presenting as Bezold abscess. In this report, the authors highlight the fact that cholesteatoma recurrence if neglected can present as a Bezold abscess with the invasion of cholesteatoma from the mastoid tip into the sternocleidomastoid muscle. This requires complete excision of the cholesteatoma sac along with the surrounding soft tissue.

Tracheostomy a lifesaving procedure done more frequently for critically ill patients for mechanical ventilation, bronchopulmonary toileting, reduce pulmonary effort has variable complications to itself. The common being secondary infection with bacteria and fungi, which in turn lead to granulation formation in stoma and on peristomal region. This prospective study was done with an aim to study, correlate and compare the microbial organisms grown in culture from tracheostomy tubes and peristomal granulation in ventilated and non-ventilated patient. We studied 210 patients out of them 100 patients satisfied the inclusion and exclusion criteria and they were included in this study. We found 89 patients staining positive for bacterial cultures and 8 patients staining positive for fungi and the granulation increases as the time taken for tube change is more than 1 month. So, we concluded it is ideal to change tracheostomy tube within a month duration and most common organism complicating infection in stoma as Pseudomonas aeruginosa followed by coagulase negative Staphylococcus aureus.

A community-based program for the comprehensive management of communication disorders among individuals with cleft lip and/or palate (CLP) was implemented in two rural districts in the state of Tamil Nadu, India. The program was successful in terms of early surgical repair, orthodontic management and speech correction; however, audiological surveillance was challenging due to poor follow-up rates.The aim of the study was to compare tele-audiological and in-person audiological surveillance to identify the most beneficial approach for the identification and treatment of middle ear disease (MED) in individuals with CLP in this rural community-based program.Quasi-experimental study.All beneficiaries older than 5 years actively seeking services in Cuddalore (n = 44) and Thiruvannamalai (n = 65) districts of Tamil Nadu, India, were included in the study. Individuals in Cuddalore district were assigned to the tele-audiological surveillance group, whereas individuals in Thiruvannamalai district were assigned to the in-person audiological surveillance group.In the tele-audiological surveillance group, video-otoscopy examinations were performed by trained community-based rehabilitation workers (CBRWs). Pure-tone audiometry and tympanometry were performed by an audiologist from the tertiary care hospital through remotely accessed equipment using broadband internet at the participants’ homes and monthly camps. Findings from those with suspected MED were forwarded to the otolaryngologist at the tertiary care hospital for remote diagnoses and treatment plans. Subsequently, CBRWs relayed the otolaryngologist’s recommendations to the individuals receiving services at the community. In the in-person audiological surveillance group, video-otoscopy, pure-tone audiometry, and tympanometry were performed by the audiologist following standard testing procedures at monthly camps. Individuals with suspected MED and impacted cerumen were referred for in-person diagnoses and treatment plans. Follow-up audiological surveillance was conducted in both districts after implementation of the otolaryngologist’s recommendations.The coverage, follow-up rate for intervention and cost-outcomes from the provider's perspective were analyzed and compared between two groups.Tele-audiological surveillance provided superior coverage (68%) compared with in-person audiological surveillance (38%). The tele-audiological surveillance group showed greater follow-up compliance (61%) than the in-person audiological surveillance group (19%) for treatment plans such as cerumen management and hearing aid fitting provided locally. Compared with in-person audiological surveillance, tele-audiological surveillance resulted in cost saving of USD 47 per individual.Tele-audiological surveillance was beneficial for the purpose of identifying and providing treatment in patients having CLP with MEDs in rural locations.

Background: Salivary gland tumors are morphologically and histologically diverse group of lesions and their frequency varies in several parts of the world. Better understanding of these tumours will help in assessing the behaviour and outcomes of lesions of this region. The aim of this study was to analyse the charactertistics of different tumours occurring in the salivary gland in a tertiary care centre in South India.Methods: A retrospective study was conducted of salivary gland tumors diagnosed from the year 2015 to 2020. Patient age and gender, tumor site and frequency, histopathological diagnosis were evaluated and analysed.Results: A total of 36 salivary gland tumor cases was identified, 30 (87.3%) of which were classified as benign and 6 (12.7%) as malignant. Most tumors occurred in the parotid gland (81.3%). Pleomorphic adenoma was the most common tumor in 23 patients (63.8%), followed by warthins tumour. The tumors occurred more often in women than men.Conclusion: The results of the present study reinforce prevalence of salivary gland tumours. The parotid gland is the most common location and pleomorphic adenoma are the most frequent lesions. The malignant tumors also can occur in these glands and good clinical suspicion is necessary.

Dentigerous cyst is one of the most common developmental cyst of the jaw which accounts for approximately 20%–30% of bone cyst in the head and neck region. Most common site is the third molar of the mandible. However, maxillary involvement is not uncommon. The clinical presentation of this depends mainly on the size and anatomical compromise that occur due to compression. This case highlights the role of endoscopic approach in the management of large expansible cyst of maxilla involving the palate, thus preserving the anatomy and reducing the morbidity associated with an open procedure.

A stridulous child with failure to thrive needs to be evaluated and emergent management is required to reduce the morbidity and mortality. The reasons for stridor in early childhood are usually due to laryngomalacia. Laryngeal cyst can pose a potential risk and challenge in management, especially in children. Laryngeal cysts have been described to occur in the glottis, laryngeal pouch, epiglottis, aryepiglottic folds, and subglottic areas. Clinical features of the laryngeal cyst depend on the size and localization of the cyst. They may present with voice change, hoarseness, dysphagia, laryngeal stridor, and dyspnea. Prompt diagnosis and early management can prevent major respiratory compromise. This case reports a 6-month old infant who was referred to us with stridor and failure to thrive since birth. The child was evaluated and a diagnosis of aryepiglottic fold cyst was made and treated surgically. The management protocol and available literature are reviewed and discussed.

Juvenile respiratory laryngeal papillomatosis is a subset of a larger clinical entity of recurrent respiratory papillomatosis. It is characterised by the development of recurrent papillomata in the vocal folds. Human papillomavirus types 6 and 11 has been implicated to be the most common strain of virus associated with the formation of laryngeal papilloma. Clinical diagnosis is based on typical appearance of warty lesion on endoscopy. Surgery is the primary line of management along with adjuvant therapy like antiviral drugs and immunomodulators. Thuja occidentalis is a tree native to North America whose leaves and leaf oil have antiviral, antibacterial and antifungal properties. It has been widely used for the treatment of condylomatous skin lesions and warts. Here we discuss the outcome of thuja as an adjuvant therapy in the treatment of laryngeal papillomatosis in an 8-year-old child.

Kimura’s disease is a chronic inflammatory disorder involving subcutaneous tissue and locoregional lymph nodes of head and neck region, characterised by angiolymphoid proliferation. It is typically associated with peripheral eosinophilia, increased serum IgE and lymphadenopathy. Diagnosis is usually based on histopathological examination. Though various treatment modalities have been put forward, surgical management remains the first line of treatment, followed by systemic steroids application. This case report discusses the diagnostic dilemma and therapeutic management of a rare clinical presentation and management of oropharyngeal Kimura’s disease in a young immunocompetent woman.

Injury to the aerodigestive tract following external laryngeal trauma is rare. Reports of acquired laryngopharyngeal fistula are very few. We report a very rare presentation of penetrating neck trauma presenting with fracture of the cricoid cartilage, subglottic stenosis and pharyngosubglottic fistula. The term 'pharyngosubglottic fistula' is used here for the first time to describe a communication tract between hypopharynx and subglottis. The successful surgical management of this case is discussed.

The incidence of congenital stridor is on rise due to improved neonate and infant survival rate. The gold standard investigation for evaluation of stridor is rigid laryngotracheobronchoscopy, but this is invasive and requires general anesthesia. Flexible fibreoptic laryngoscopy, a relatively simple and less invasive procedure can be done under topical anaesthesia for evaluation of stridor. In this study, we have presented our experience of flexible laryngoscopy in children with congenital stridor, their results and management. Laryngomalacia was the commonest cause of stridor accounting for 80% of cases. 15% (6) patients required tracheostomy for relieving airway obstruction and 22.5% (9) patients required a definitive surgical procedure for correcting the cause. Flexible laryngoscopy is safe and gives a comprehensive analysis of airway including its dynamic functions. We also recommend flexible laryngoscopy as a frontline investigation for evaluation of stridor.

Laryngopyocele is a rare complication involving the laryngocele which can present with acute airway compromise. A 31-year-old man presented with acute onset respiratory distress and dysphagia. He had swelling on either side of upper aspect of the neck with tenderness on left side. Videolaryngoscopy using 70° rigid Hopkins rod telescope showed a swelling in the left pyriform sinus pushing the ipsilateral vocal cord. However, glottic space was adequate. Contract-enhanced CT scan of the neck confirmed left-sided mixed laryngopyocele with contralateral mixed laryngocele. Patient underwent excision of both the lesions in a single stage by transcervical approach. Laryngopyocele in a case of bilateral mixed laryngocele presenting as an impending airway emergency has not been reported in literature. The diagnostic and therapeutic challenges are discussed here along with review of literature.

Clear cell variant is a rare histological type of myoepithelioma seen in parotid and soft palate. This article describes clear cell variant of myoepithelioma in the tongue base, which has not been reported in the literature so far. A 34-year-old man presented with dysphagia and foreign body sensation of throat. Video laryngostroboscopy using a 70° rigid telescope showed a smooth globular mass in the oropharynx arising from the tongue base. Based on clinical and radiological findings, the lesion was considered as benign. Fine needle aspiration cytology was not attempted fearing risk of bleeding, aspiration and airway compromise. Hence, an excisional biopsy followed by definitive histopathological examination without frozen section was planned. The patient underwent coblator-assisted excision and subsequently sent for histopathological analysis. There were cuboidal cell nests with abundant clear cytoplasm which stained positive for p63 by immunohistochemistry. This helped in establishing the diagnosis of clear cell myoepithelioma.

A 44-year-old man presented with swelling in the left parotid region. The swelling was firm and Fine Needle Aspiration Cytology report proved pleomorphic adenoma. In the CT scan, the tumour was confined to the superficial lobe of parotid. So, left superficial parotidectomy was planned. Modified Wilson Blair’s incision was used. On course of identifying the facial nerve, a large calibre vein was identified running vertically through the parotid substance. Assuming it as retromandibular vein, further dissection was carried out more meticulously. Marginal mandibularbranch of facial nerve was identified near the angle of mandible and retrograde dissection showed the cervicofacial division running medial to retromandibular vein with the main facial nerve trunk lying unusually medial and posterior to it. Adding to it, the temporofacial division was found ‘forked’ between the branches of retromandibular vein. These variations in head and neck venous channels are not that rare as we believe. All these variations have an embryological basis. Therefore, knowledge and understanding of this complex anatomy will help us preventing devastating complications like bleeding and facial nerve injury in such cases.

AimWe report a rare case of lateral skull base hamartoma. The diagnostic dilemma, the therapeutic challenge and the importance of interdisciplinary approach to decrease the morbidity has been discussed.MethodWe report a rare case of a 48-year-old male with swelling over the left side of face and cheek for a duration of 12 years, who presented to us only for his cosmetic deformity and no functional impairment, after a thorough clinical examination and series of invasive and noninvasive investigations, was diagnosed to have a rare tumor hamartoma of skull base and face. A complete surgical excision without morbidity was made possible only by a multidisciplinary team approach. The investigation and surgical approach to reduce per operative morbidity has been discussed. Microscopic examination of the excised specimen with special staining techniques was conclusive for hamartoma. Patient has been on a regular follow-up for the last 2 years with no evidence of recurrence and functional compromise.DiscussionThe rarity of the tumor, the difficulty in diagnosis, management and prognosis of hamartoma have been discussed.ConclusionHamartoma of the infratemporal fossa is a rare tumor and those originating in this surgically challenging site are even rarer. Further their close proximity to vital structures in head and neck poses a formidable challenge in their diagnosis and surgical management to achieve a good cosmetic and functional result.