Search

Middle ear Neuroendocrine adenomas are rare tumors that can be easily confused as glomus tympanicum of the middle ear. 33-year-old man with no comorbidities who presented with complaints of right ear foreign body sensation and was later diagnosed as a neuroendocrine adenoma of the middle ear.

Studies have demonstrated that poor assessment and planning contribute to airway complications and that current airway assessment strategies have a poor diagnostic accuracy in predicting difficult intubation in the general population. There is a higher risk for difficulties during airway management in patients with pathologies arising from the head and neck region and are more likely to need emergency surgical access. Therefore, thorough assessment and adequate knowledge about the various head and neck pathologies is mandatory. In this chapter, we will briefly go through the preoperative assessment and history & clinical assessment, the investigations. Also we will discuss the airway management at various pathologies involving the head and neck region whether benign/malignant pathologies, OSA (obstructive sleep apnea) and post head & neck operative airway management.

Imminent upper airway obstruction due to life-threatening tracheal stenosis of any cause is a challenging situation. We present a challenging case of total thyroidectomy for a malignant, invasive, and highly vascularized thyroid carcinoma that has invaded the surrounding tissues, including the sternum and mediastinum, resulting in compression of the trachea with indentation. The patient presented with a significant symptomatic tracheal stenosis, the narrowest area of that was 4 mm. Airway management in such cases presents a particular challenge to the anesthesiologists, especially considering that the option of tracheostomy is very difficult most of the time due to the highly swollen thyroid and distorted anatomy. A meticulous history of the patient's illness had been taken, and a comprehensive preoperative evaluation was conducted, including construction of a 3D model airway, virtual endoscopy, and transnasal tracheoscopy. On the day of the surgery, the airway was managed through spontaneous respiration using intravenous anesthesia and the high-flow nasal oxygen (STRIVE-Hi) technique. It was then secured with intubation using a straw endotracheal tube (Tritube®) with an internal diameter (ID) of 2.4 mm and an outer diameter of 4.4 mm with the help of a fiberscope and D-MAC blade of a video laryngoscope. At the end of the procedure, the airway was checked with a fiber optic scope, which showed an improvement in the narrowed area. This enabled us to replace the Tritube with an adult cuffed ETT of size 6.5 mm ID, and the patient was transferred intubated to the surgical ICU. Two days later, the patient's tracheal diameter was evaluated with the help of a fiberoptic scope and extubated successfully in the operating theater.

This chapter covers the skull base lesions involving the jugular foramen, petrous apex, and temporal bone. The anatomy, diagnostics, and management of these disorders are reviewed in this chapter. These skull base lesions can be classified based on their location or by their cell of origin. Glomus tumors considered the most common benign tumor of the temporal bone and middle ear of adults, and glomus jugulare is the most common type involving the jugular fossa. Cholesterol granuloma is the most common pathologic lesion found in the petrous apex. These lesions can be asymptomatic, or it may present with clinical manifestations arising by the compressing effect on the cranial nerves and adjacent structures.

The skull base refers to the most inferior part of the neurocranium, on which the brain rests, and it is the major bony and soft tissue interface for the intracranial and extracranial compartments. Its anatomy is complex, containing multiple traversing foramina that act as conduits for various neurovascular structures. They are divided into anterior, central, and posterior parts. In this chapter, we will be dealing with the anterior skull base and midline aspect of the central skull base and its pathologies.

Salivary glands are tubulo-acinar exocrine organs, which produce and secrete saliva that is important for several physiological functions like protection of teeth and surrounding soft tissue, digestion, immunity, and lubrication of the oral cavity which is important for speech and taste.

Otolaryngologists frequently deal with patients who present with an unknown neck mass. Adequate knowledge of the head and neck anatomy is essential to diagnose and treat such conditions. In order to formulate a differential diagnosis and ensure that the correct treatment is rendered, it is also necessary to know the different pathologies in the head and neck region. This chapter highlights some of the key points needed in the workup of neck masses and reviews some of the available techniques that aid in achieving the correct diagnosis.

Microlaryngoscopy for benign vocal cord lesion excision is a procedure with good outcomes and relatively few complications that is performed worldwide. The anterior one-third of the vocal cords is a relatively common site to find benign polyps, and the excision of cases with adequate laryngeal exposure is relatively easy. However, they can sometimes present a challenge when laryngeal exposure is suboptimal, which leads to trouble in accessing the site. The factors that can lead to difficulties in laryngeal exposure are numerous, such as restricted mouth opening, limited neck extension, large tongue size, and others. The preoperative prediction of difficult laryngeal exposure (DLE) can be obtained by different scoring and grading systems. We have used the Laryngoscore in this case. However, management options for such cases remain limited. Here, we present a case that was managed using channeled cup forceps under fiberoptic endoscopy with the STRIVE-Hi technique used to administer anesthesia.