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One-lung ventilation (OLV) is a challenging task in infants and children as few techniques are possible because of narrow anatomy. The aim of this study is to evaluate and experience lung isolation with Fogarty catheters as a bronchial blocker placed by rigid bronchoscope for OLV in infants and children with lung pathologies requiring surgical management in an industrial hospital. This study is a prospective study carried out in J.L.N. Hospital and Research Centre, Bhilai (CG), from January 2011 to December 2014. The study was designed to place Fogarty catheter for achieving OLV using rigid bronchoscope in children. The patient and anaesthesia characteristics, placement and positioning of Fogarty catheters, intraoperative course, complications and recovery of the patient were studied. The data were then compared with the relevant and available literature. Over the study period of 4 years, 27 cases were included, out of which 22 (81.48 %) cases had suppurative lung disease, three cases (11.11 %) had hydatid cyst of the lung, whereas one case (3.7 %) each of congenital lobar emphysema and congenital cystic adenomatoid malformation of the lung, respectively. In all cases general anaesthesia was provided using single lumen endotracheal tube and one lung ventilation achieved by parallel placement of Fogarty catheter as a bronchial blocker with rigid bronchoscope. The surgical management included thoracotomy with decortication in 21 cases, thoracotomy with excision of hydatid cyst in 3 cases, video-assisted thoracoscopic surgery, thoracotomy with left upper lobectomy and thoracotomy with left lower lobectomy in one case each, respectively. There were no major intraoperative and postoperative complications. There was no mortality in our study. We conclude that rigid bronchoscope can be safely and effectively used to place Fogarty catheter in main bronchus in infants and children for achieving OLV.

Lymphangiomas are rare congenital malformations of the lymphatic system that can appear at any age or site. In majority they are diagnosed at birth and 95% of them are found in the neck, the head, or the axilla. Although benign, and commonly asymptomatic, they can sometimes cause pressure and life threatening complications especially massive lesions involving the neck and mediastinum in newborn infants or cause a diagnostic confusion as a result of sudden enlargement following haemorrhage or infection. Lymphangiomas frequently present surgical difficulties and challenges due to their propensity to infiltrate and extend around neighbouring structures. We report a newborn who presented with a huge congenital cervical swelling involving upper 2/3rd of neck on both sides since birth. Complete surgical excision of the lesion was achieved, without damaging any vital structures. After 9 months of surgery, following an episode of upper respiratory tract infection the child developed a large cystic swelling over the lower 1/3rd of neck. Complete surgical excision of the lesion was done. The final histopathological diagnosis was lymphangioma. One year of further follow up showed a cosmetically acceptable scar and no recurrence was noted. The literature is reviewed and the presentation and management of lymphangiomas are discussed.

Basal encephalocele accounts only 1.5% of all encephaloceles. But Sphenorbital encephalocele is the rarest cause of herniation of brain into orbit leading to pulsatile exphothalmos. Authors presenting a case of sphenorbital encephalocele in a 16 yrs old girl successsfully managed by orbitcranioplasty by partilal thickness autologus calvarial bone graft.

Tracheo-oesophageal fistula with oesophageal atresia is common life-threatening congenital malformations with an incidence of 1 in 3500 to 1 in 4500 births. ‘H’ type tracheo-oesophageal fistula is an isolated type with an incidence of 4–5% and least association with congenital anomalies. Its diagnosis is often delayed .We report two cases, one presented as a 3 months female child with ‘nasal regurgitation of feeds, recurrent pneumonia and choking on feeding since 15 days of life, while the other immediately after birth with classic triad of symptoms. A review of the literature is presented, with a focused discussion of presentation and treatment options. Confirmation of diagnosis was done by compiling clinical presentation, high index of suspicion and rigid tracheobronchoscopy findings. Management involved surgery by right transcervical approach. High index of clinical suspicion and early diagnosis can provide a better prognosis.

Pleomorphic adenoma is the most common type of all salivary gland tumors, involving more frequently the parotid gland. In most series, it represents 45–75% of all salivary gland neoplasms. We report an unusual case of a huge tumor that measured 9 × 8 cm & 400 g by weight with extensive bone formation, occurring in the parotid gland of a 22 year old man. Thorough clinical examination was done. FNAC was done which showed Myxochondroid matrix with glandular epithelial cells suggesting pleomorphic adenoma. CT scan head & neck revealed a large mass with nodular areas of calcification within soft tissue with marked narrowing of orophayngeal lumen. Total parotidectomy with preservation of facial nerve was done by the Transcervical Transparotid approach. The histopathological findings suggested the possibility of extensive endochondral ossification in pleomorphic adenoma. Preservation of facial nerve functions is a key to successful parotid surgery.

Cervical thymic cysts are among the rarest cysts found in the neck. They may be found at any level of the pathway of normal thymic descent, from the angle of the mandible to the superior mediastinum. Cervical thymic cysts are considered uncommon lesions in the differential diagnosis of paediatric neck masses, their presence is often revealed by pathologic examination of an excised specimen. The main entities to be differentiated are branchial-cleft cysts and cystic hygromas, because of their frequent occurrence and similar clinical presentation. Adolescents and children comprise the majority of the typically asymptomatic patients. We report the clinical presentation, diagnostic evaluation and therapeutic management of one case of multilocular cervical thymic cyst in a 8 year old male child, accompanied by a review of literature.

Cervical teratomas are not reported quite frequently in medical literature, especially from Indian subcontinent. Prenatal diagnosis of this condition is even rarer, making the management protocols difficult. In absence of prompt intervention in the form of airway decompression, morbidity and mortality is very high. Presented here is the case of antenatal diagnosed cervical mass, which was managed successfully in immediate post-natal period with uneventful survival and normalized tumor marker levels.

A 2-year-old female child was referred from a private hospital as a case of recurrent lower respiratory tract infections (LRTI). The chest X ray revealed a hypoplastic right lung and further workup led to the diagnosis of esophageal lung - a rare type of communicating bronchopulmonary foregut malformation. A right posterolateral thoracotomy was done, anamolous bronchial communication with esophagus disrupted, esophageal fistula repaired and the lung resected. Postoperatively, diet was allowed from day 7. The patient tolerated the diet well. Repeat dye study revealed no leak and subsequently the patient was discharged on day 10.

The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.

The present study was carried out to determine the effects of cement content along with varying additions of medium and fine particles in added magnesia on in situ spinel formation in an alumina–magnesia castable. The effects of cement and magnesia on spinel and hibonite formation in the castable, alumina content of spinel, and associated physical changes after exposure to high temperature were studied. The presence of a larger quantity of fines in added magnesia was found to help increase spinel formation, with greater permanent linear change (PLC), provided cement content was not too high. Considering spinel formation and PLC, it appears that optimum levels are 3% cement for 50% of fines in magnesia or 4% cement for 34% of fines in magnesia, for a total addition of 6% magnesia. No clear combined effect of cement content and fines content in added magnesia on alumina content of spinel could be found. It is observed in general only that alumina content of spinel increases with increasing firing t...

The present study was carried out on the matrix composition of spinel forming high alumina castable to determine the effects of silica, magnesia particle size and temperature on spinel formation, the alumina content of the spinel formed, and associated physical characteristics at high temperature. It was found that an increase in silica content and use of finer magnesia helps to increase spinel formation. However to increase the alumina content of the spinel, increased temperature and magnesia particle size were more effective than an increased amount of silica. Furthermore the permanent linear change and porosity of the matrix are adversely affected when the amount of silica is increased or when magnesia is added in the form of fines. These findings suggest that medium and fine magnesia particles and an optimum amount of silica in the matrix composition of a spinel forming castable are necessary to obtain a matrix with increased alumina rich spinel content with controlled permanent linear change...

To determine the incidence of otogenic complications of Chronic suppurative otitis media (CSOM) and its management. The study was conducted at the tertiary referral centre and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patient. The data were then compared with the relevant and available literature. Over the study period of 12 years, a total 45 cases of CSOM with complications were reviewed. Out of these 45 cases, 20 cases had extracranial (EC) while 25 cases had intracranial (IC) complications. The prevalence of each complication was 0.17 and 0.13 %, IC and EC respectively. The commonly encountered IC complications were brain abscess, meningitis and lateral sinus thrombophlebitis. Among the EC complications, mastoid abscess followed by labyrinthitis and facial nerve palsy were encountered. The reliable warning signs and symptoms of IC complications were fever, headache, earache vestibular symptoms, meningeal signs and impairment of consciousness. Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus epidermidis were the common organism isolated. Cholesteatoma and granulation in the middle ear were the major findings in both groups of cases. Surgery was main modality of management of these conditions. We observed that two patients fail to regain full facial nerve function despite of surgery. Mortality rate was zero but morbidity was seen in 15 % (3) and 28 % (7) of cases in EC and IC group respectively. The epidemiological presentation, clinical features and results of treatment are discussed. CSOM complications, despite its reduced incidence still pose a great challenge in developing countries, as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity. In this study we emphasize the importance of the accurate and early diagnosis followed by adequate surgical therapy with multidisciplinary approach.

Descending cervical mediastinitis can occur as a complication of oropharyhgeal and cervical space that spread to the mediastinum vis cervical space. Descending mediastinitis represent a virulent form of mediastinal infection requiring prompt diagnosis and treatment to reduce high morality associated with the disease. Surgical management and a particularly optimal form of mediastinal drainage remain controversial.From 1998-2004, eighteen patients were treated in our institution. Surgical treatment consisted more than 2 times. Cervical drainage associated with drainage of the mediastinum through a thoracic approach in 11 patients with pleural drainage in 8 patients.The outcome was favorable in eleven patients who had mediastinum drained through thoracotomy. One patient who was not drained died with tracheo-oesophageal fistula. Main culprit neck space is pre and para tracheal space which lead to anterior, superior and posterior mediastinal collection in our series. The tracheostomy is of immense help not only in opening cervical space collections and also to secure a partially compromised airway.

A case of cervical thymic cyst in a five year old girl is reported. It was found to be extending between the greatvessels of the neck towards the pharynx. This type of presentation is rare which prompted us to document this case.

Pilomatrixoma is a rare, benign, circumscribed, calcifying epithelial neoplasm that arises from the hair follicle on any part of the body. It may present to the otorhinolaryngologist as a palpable mass in the head and neck region. They are usually found in girls during the first two decades of life. These tumors may contain calcification, which, when present, is helpful in suggesting the diagnosis. We present a rare case of ossifying pilomatrixoma in a 15 year old female who presented with a painless hard slow growing swelling over the left cheek region. FNAC could not provide any clue whereas USG and CT scan showed the swelling to be in subcutaneous plane, superficial to the parotid gland. Complete excision of the mass along with the overlying adherent skin in toto with preservation of facial nerve was done. The diagnosis was confirmed after histopathological examination of the excised specimen which revealed pilomatrixoma with extensive ossification and marrow formation.

A case of Goldenhar’s Syndrome in a 10 year old girl is reported. The unusual features are the absence of epibulbar dermoid which is one of the major hallmarks of the Syndrome and the presence of an associated Cyanotic Heart disease.

A classical case of Globulomaxillary Cyst is reported. Under the microscope it showed odontogenic epithelium. This cyst was regarded traditionally as a non odontogenic cyst. However the current embryologic concepts led to a different thinking that it is of odontogenic in origin. We feel that it has been rightly considered as odontogenic cyst in view of the histological evidence of our present case.

Congenital Crocodile Tear Syndrome is rare. There are 21 cases reported in literature. We add one more case to the list. All cases except one are associated with Duane’s Syndrome. Our case had an associated anomaly of the cervical spine. The relevant literature is reviewed.