Search

Introduction Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality. Case summary We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control. Discussion Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

LTT is a life-threatening incident that is fortunately rare. The presenting symptoms might not correlate with the intensity of trauma and range from mild endolaryngeal edema to complete laryngotracheal transection. An early diagnosis and timely intervention is required for successful outcomes and minimizing complications. This retrospective audit was performed on 18 patients of LTT who presented to the emergency from January 2017 to December 2019. The history, clinical presentation, examination findings, degree and nature of trauma, diagnostic modalities, medical and surgical management, and outcomes were analyzed. A total of 13 males and 5 females were included in this audit, with a mean age of 38.7 years. The most common cause was accidental in 77.7% patients. 61.5% of patients presented with Schaefer grade 3 and higher. Out of which 46% underwent emergent neck exploration and repair. 27.7% (5/18) presented with sequelae which were managed either by T- tube stenting, endoscopic dilatation by coblation, or laryngotracheal resection (LTR) and end-to-end anastomosis (EEA). Out of 14 surgically reconstructed airways, successful decannulation was achieved in 57.1% (8) patients. High clinical suspicion, early referral with emergent intervention is paramount for successful outcomes, fewer recurrences, and reduction of hospital's and patient's financial burden as timely planning and intervention can ensure successful decannulation of around two thirds of the higher grades (grade 3-5) of laryngotracheal traumatic injuries. Early airway establishment is the most critical goal. Definitive treatment protocols are needed in this field which warrants further formulation of multicentric studies and audits.

A palpable thyroid swelling is a very common finding and is seen in almost 12% of Asian Indian population. Thyroid imaging reporting and data system (TI-RADS) can be used as a risk stratification system to determine malignant or benign thyroid nodules and necessity of further intervention.The objective of this study was to determine the positive predictive value (PPV) of TI-RADS category/ultrasound using TI-RADS categories in the diagnosis of malignancy in clinically suspected thyroid nodule and necessity for further intervention in the case of malignant thyroid nodules.We conducted a prospective study evaluating 110 patients (140 thyroid nodules) from March 2018 to April 2020 including patients with thyroid swelling. Ultrasound was performed by a radiologist on the patients, and targeted fine-needle aspiration cytology from thyroid nodules was interpreted by an experienced pathologist. Ultrasound features and TI-RADS category were compared with cytology and surgical histopathology. Sensitivity, specificity, PPV, and positive likelihood ratio in different categories of TI-RADS nodules were calculated.A total of 113 thyroid nodules were assessed. Out of 113 nodules (right lobe - 64, isthmus - 6, and left lobe - 43), 84 nodules were benign and 29 nodules were malignant. Eleven (10%) patients were found to have metastatic cervical lymphadenopathy. There was no significant difference in the occurrence of malignant nodules according to gender, location of the nodule, or size of the nodule. The mean anteroposterior and transverse diameter of benign nodule was 14.1 ± 6.9 mm and 20.9 ± 9.9 mm, respectively, whereas in the case of malignant nodules, it was 15.6 ± 7.1 mm and 19.5 ± 9.0 mm, respectively. A TI-RADS score of ≥4 had 84% PPV for malignancy. The PPV for malignancy was 32.2%, 49.1%, and 100% for TI-RADS 2, 3, and 5 categories.TI-RADS is a simple, practical, and cost-effective tool for assessing the malignancy rates of thyroid nodules. TI-RADS categories 4 and 5 have high PPV for malignancy in thyroid nodules.

Loss of voice is a serious concern for a laryngectomee which should be addressed prior to planning the procedure. Voice rehabilitation options must be educated before the surgery. Even though many devices have been in use, each device has got its limitations. We are searching for probable future technologies for voice rehabilitation in laryngectomees and to familiarise with the ENT fraternity. We performed a bibliographic search using title/abstract searches and Medical Subject Headings (MeSHs) where appropriate, of the Medline, CINAHL, EMBASE, Web of Science and Google scholars for publications from January 1985 to January 2020. The obtained results with scope for the development of a device for speech rehabilitation were included in the review. A total of 1036 articles were identified and screened. After careful scrutining 40 articles have been included in this study. Silent speech interface is one of the topics which is extensively being studied. It is based on various electrophysiological biosignals like non-audible murmur, electromyography, ultrasound characteristics of vocal folds and optical imaging of lips and tongue, electro articulography and electroencephalography. Electromyographic signals have been studied in laryngectomised patients. Silent speech interface may be the answer for the future of voice rehabilitation in laryngectomees. However, all these technologies are in their primitive stages and are potential in conforming into a speech device.

Introduction: The expression of matrix metalloproteinase-9 (MMP-9), MMP-13, and tissue inhibitor of metalloproteinases (TIMP-1) in head and neck squamous cell carcinoma (HNSCC) could be a useful predictor of tumour differentiation, nodal metastasis, and invasiveness. We conducted this study to ascertain the correlation between the expression of these markers and differentiation of tumour cells. Materials and Methods: A prospective observational study was conducted in a tertiary care center. Forty-three cases of proven HNSCC were recruited after obtaining informed consent. Using the surgically excised specimen, tumour differentiation and invasiveness were assessed and correlated with rates of expression of the markers. Chi-square test was done to correlate immunohistochemical (IHC) marker positivity and the degree of differentiation of the tumour, lymph node metastasis, and invasiveness. Results: MMP-9, MMP-13, and TIMP-1 were expressed in 72%, 34%, and 18% of cases, respectively. p16 expression was not found in any of the cases. MMP-13 expression correlated with poorer differentiation of the tumour (p = 0.03), and relatively younger age at diagnosis (p = 0.01). However, there was no correlation with lymphovascular or perineural invasion or lymph node metastasis. Discussion: In our study, MMP-13 expression correlated with poorer tumour differentiation and younger age at diagnosis, giving indirect evidence of tumour aggressiveness. IHC markers can provide additional information to prognosticate HNSCC. Identifying potential targets for newer biological therapy is essential in the Indian population as there are biological differences in cancer behavior. Increased expression of the proteolytic MMP-13 correlated with poorer differentiation of HNSCC.

Introduction Rhinolith is a calcic deposition formed by mineralization of salts in an impacted nasal foreign body. It is a benign condition that can be troublesome owing to its size and extent of impact. Case Report A 35-year-old man with a history of right nasal obstruction with occasional foul-smelling discharge and right eye pain since ten years was diagnosed with rhinolith. During its removal, it was three times bigger than what could be visualized in nasal endoscopy. Conclusion Proper history, examination, and a high suspicion can clinch the diagnosis in almost all cases. A rigid diagnostic nasendoscopy is an important tool in the diagnosis. The treatment of choice is endoscopic removal under local or general anaesthesia.

Coronavirus disease 2019 (COVID-19) is a type of viral pneumonia that has paralysed the entire world both in terms of health and economy. It has been recently declared as a global pandemic. All the health care professionals must be aware of the disease entity and take precautionary measures to control its transmission from person to person, particularly in hospital settings. In this article, we propose essential steps that can be implemented at the departmental and institutional levels to do endoscopic diagnostic procedures effectively during COVID-19 outbreak and to break the transmission chain.

Introduction Airway foreign bodies are emergencies involving multidisciplinary departments like Pediatrics, Aneasthesiology and Otorhinolaryngology. It is always a challenge to diagnose and manage patients who present late to our emergencies. Objective In the present study, we aim to analyze the various challenges faced during the management of tracheobronchial foreign bodies with delayed presentation. Methods A retrospective hospital record-based analysis of patients who presented to us with tracheobronchial foreign bodies from January 2017 to February 2020 was performed. All patients until the age of 16 years old were included in the present study. We assessed the demographics, preoperative, intraoperative and postoperative data of the patients. Results Seventeen patients were analyzed in the study. Among these, 44.4% of the patients had delayed presentation (> 1 month). The majority of the patients had an organic foreign body (Supari or betel nut). All patients underwent rigid bronchoscopy, followed by optical forceps-assisted removal of the foreign body. A total of 82% of the patients had granulations around the foreign body. Conclusion Management of delayed presentation tracheobronchial foreign body is a big challenge for Otorhinolaryngologists. The key factors for preventing complications in the definitive management of tracheobronchial foreign bodies are preoperative planning, multi-discipline teamwork, surgeon expertise and technique.

Globus pharyngeus is a common disorder encountered in patients in Otorhinolaryngology out-patient department. Patients often express this as a feeling of foreign body stuck in throat or choking sensation in throat. Detailed history and investigations are needed to rule out malignancy. Patient should be thoroughly counselled to relieve anxiety.

Objective:It has been shown that prolonged use of face masks results in physiological changes in the nasal cavity. The objective of this study was to examine the effect of prolonged use of face masks on nasal mucociliary clearance (NMC).Methods:A single group pre-post study was conducted to determine the effects of prolonged use of N95 face mask (≥4 hours) on the NMC rates in health care workers. Saccharin transit time (STT) was used to measure the NMC. STT before and after using an N95 mask for at least 4 hours was measured for all participants in controlled conditions of temperature and humidity.Results:Forty-eight volunteers (20 female and 28 male) completed the study after the enrollment of 57 volunteers. The mean STT before mask use was 580.27 ± 193.93 seconds (95% CI; 523.95-636.58 seconds) and after mask use was 667.47 ± 237.42 seconds (95% CI; 598.53-736.42 seconds). There was significant prolongation of the NMC after prolonged use of N95 mask on performing the paired t-test ( P = .002). The mean prolongation was 87.20 ± 184.97 seconds with an actual effect size of 0.40. Ambient temperature and humidity were not significantly different at the two test instances.Conclusion:Use of the N95 face masks for 4 hours results in prolongation of the nasal mucociliary clearance as measured by STT. Susceptibility to any respiratory infection may be increased following doffing of the personal protective equipment, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) itself.

Chronic upper airway obstruction caused by adenotonsillar hypertrophy is one of the major cause of morbidity in children. It can lead to Obstructive Sleep Apnoea Syndrome, Pulmonary Hypertension, Cor Pulmonale and right heart failure. The study aimed to evaluate and compare various parameters of cardiac function with the help of echocardiography preoperatively and postoperatively in children undergoing adenotonsillectomy.A prospective cohort study was conducted on 23 patients at an apex care institute, under the age group of 4-12 years, who were diagnosed with adenotonsillar hypertrophy. Preoperative symptom analysis and Echocardiographic examination were done. After the assessment, all patients underwent surgery in the form of adenotonsillectomy. Follow-up symptom analysis and echocardiographic examination was done after 3 months postoperatively.Significant improvement in the obstructive symptoms were noted in postoperative group as expected (p = 0.001) and also in parameters such as mPAP (p = 0.001), TAPSE (p = 0.001), TAV (p = 0.001), Ejection fraction (p = 0.027) and RVMPI (p = 0.044) were improved in postoperative group. 4 patients had Grade 1 Right ventricular diastolic dysfunction, which disappeared in three patients postoperatively.We have concluded that there can be subclinical cardiac dysfunctions which occurs as a result of chronic upper airway obstruction due to untreated adenotonsillar hypertrophy. Routine cardiac screening in children presenting with sleep disordered breathing associated with adenotonsillar hypertrophy may be helpful in identifying and preventing the development of cardiopulmonary complication. These changes can be reversed by performing adenotonsillectomy.

The number of critically-ill coronavirus disease 2019 (Covid-19) patients requiring mechanical ventilation is on the rise. Most guidelines suggest keeping the patient intubated and delay elective tracheostomy. Although the current literature does not support early tracheostomy, the number of patients undergoing it is increasing. During the pandemic, it is important that surgeons and anesthesiologists know the different aspects of tracheostomy in terms of indication, procedure, tube care and complications. A literature search was performed to identify different guidelines and available evidence on tracheostomy in Covid-19 patients. The purpose of the present article is to generate an essential scientific evidence for life-saving tracheostomy procedures.

Tuberculosis can affect almost any organ in the body and have unusual presentations. We hereby report a case of parotid tuberculosis causing osteomyelitis of the mandible in a 3-year-old child presenting with left-sided facial swelling since 4 months. There was a history of repeated incision and drainage for suspected parotid abscess elsewhere. Initial work-up was inconclusive. Radiology revealed a heteroechoic mass lesion of the left parotid gland with extensive destruction of the adjacent ascending ramus of the mandible suggesting an odontogenic tumor. Biopsy of the left parotid gland finally clinched the diagnosis of a tubercular abscess. The child responded remarkably well to antitubercular therapy. This case highlights the importance of complete work-up, including biopsy to avoid unwarranted surgical interventions.

This is a radiation field simulation study using CT images designed to see the cochlear dosimetry and its correlation with tumour and treatment characteristics during radiotherapy for head and neck cancers (HNC) for identifying the factors associated with a higher dose delivered to the cochlea. From 2018 to 2020, 80 patients with HNC underwent volumetric arc therapy (VMAT) to a dose of 66–70 Gy at 2 Gy per fraction with bilateral cochlea contoured for VMAT optimization as an organ at risk. Minimum, mean and maximum planned radiation dose to the cochlea based on tumour and treatment characteristics and dose-volume histogram variables of VMAT plans were analysed. Mean (standard deviation, SD) cochlear volume was 0.14 (0.06) cm3 with maximum and mean planned doses of 10.3 (SD = 11.6) Gy and 8.5 (SD = 9.8) Gy, respectively. We found a statistically significant correlation between mean dose received by bilateral cochlea (P—0.000, rright—0.84, rleft—0.78, rmidline—0.92). Tumours of the paranasal sinuses, and the parotids and more advanced T stages were associated with a higher mean dose to cochlea but was not significant statistically. The dose received by the 95% target nodal volume (D95%) showed a significant correlation with the cochlear mean dose (P—0.000, rright—0.85, rleft—0.77, rmidline—0.93) With VMAT we have achieved a better sparing of cochlea. The mean dose to the cochlea of one side significantly differed from the other side in patients with lateralized cancers. D95% of nodal volume also showed a significant correlation with the cochlear mean dose.

Different studies have shown that a significant number of medical graduates do not achieve the necessary preparedness for delivery of effective health care in a safe and acceptable manner. Various studies have been undertaken to explore the competencies of surgical residents in otorhinolaryngology. This study was carried out to find out the status of training in otology being provided across different institutions in India. This is a cross sectional study undertaken at All India Institute of Medical Sciences (AIIMS), Jodhpur. An online survey questionnaire enquiring about different aspects of otologic training being followed at various centres was developed and was sent online to all prospective responders. Out of the 217 responders, 88 were faculty members and 129 residents. 62% of the faculty members and 56.5% of residents mentioned that their centre has a temporal bone dissection lab. 64.7% of the faculty members and 58.2% of the residents responded that temporal bone dissection is mandatory before live surgeries. 44% residents have their thesis topic related to otology. About 79% of faculty members and residents are not happy with the the training module being followed in their centre and feel it needs improvement. There needs to be a standardized curriculum that is followed all over the country for teaching the residents during their residency. Increase in existing centers with well equipped staff and facilites is required to provide the residents with opportunities to hone and refine their surgical skills during their training period.The online version contains supplementary material available at (10.1007/s12070-021-02485-0).

BACKGROUND One of the debilitating complications of head and neck cancer radiotherapy is hearing loss. OBJECTIVE To quantify the magnitude of sensory neural hearing loss (SNHL) in the head and neck cancer patients undergoing chemoradiation therapy. DESIGN AND METHODS This is a prospective study. Eighty patients with head and neck cancers and undergoing volumetric arc therapy were taken up for the study. Regular audiological evaluation was done. The changes in audiological parameters from baseline are correlated with cochlear dose. RESULTS Cochlea received maximum doses of up to 28.52 Gy without causing SNHL in the absence of chemotherapy. But in concurrent chemoradiotherapy, hearing loss was found at least dose of 9 Gy at frequency range of 4 KHz-8 KHz. The risk of SNHL is independent of cumulative doses of Cisplatin. In 106 ears receiving concurrent chemoradiation, 82.1% and 74.5% ears had sensorineural hearing loss at 4 KHz and 8 KHz respectively, following the completion of treatment. Otoacoustic emissions in the chemoradiation group showed a significant change at the completion of treatment. CONCLUSION AND SIGNIFICANCE Volumetric arc therapy have facilitated sparing of cochlea (< 40 Gy). This has resulted in better clinical outcome in terms of SNHL. The inclusion of concurrent cisplatin chemotherapy is a significant risk factor for the development of SNHL at higher frequencies.

The good post-operative management is the important half of surgical success. The nasal packs are removed after 2–5 days of surgery. The duration of packing depends on the surgeon’s choice, type of packing material, intraoperative bleeding, disease clearance. The pack is also preventing the adhesion formation. Normal mucociliary function is compromised significantly in the early post-operative period so regular nasal douches is required to clean the post-surgical cavity. Regular removal of clots, curst is the prime goal of follow-up visits and it is for the prevention of formation of fibrous adhesion. Lund Kennedy, Philpott Javer and Kupferberg staging systems are proposed to assess the effectiveness of surgery. Antifungal treatment is indicated for invasive fungal sinusitis. The principles that the clinician should consider whenever faced with the treatment of an invasive mycoses are: 1. The correct identification of the causative organism. 2. The use of standard antifungal regimens. 3. Control of underlying medical or immune-compromised condition is essential. 4. Clinicians must pay attention to the pharmacokinetics and toxicity of the antifungal drugs, and alter the dose accordingly. 5. The cost-effectiveness of the newer, more expensive antifungal drugs.

Anthracosis is associated with smoking, air pollution, tuberculosis infection, and exposure to biomass. Anthracosis commonly involves bronchial trees and rarely lymph nodes. We report an unusual case of a 44-year-old female presented with painless supraclavicular swelling for 1 month. A fine-needle aspiration cytology examination was done from the swelling. The smears were markedly cellular and showed the presence of sheets, clusters, and singly scattered round to oval cells with mild anisonucleosis, fine to coarse chromatin, few with tiny nucleoli, and cytoplasm containing abundant black coarse pigment. At many places, the fibroblasts and lymphocytes were admixed with histiocytes containing pigment. The cell block made showed cell morphology similar to that described above for fine-needle aspiration smears. The immunohistochemistry on the cell block and special stains helped to ascertain the nature of pigment and cell type. The final diagnosis of the anthracofibrosis lymph node was made. Due to its rarity, its awareness is a must; otherwise, it can be mistaken for metastatic deposits from malignant melanoma and can result in unnecessary surgical intervention and morbidity. However, it shall be considered one of the differential diagnoses of neck nodes in nonsmoker females with a history of domestic wood smoke exposure.

Low-grade myofibroblastic sarcoma (LGMS) of the larynx is an uncommon entity. These mesenchymal tumors of the larynx are rare and account for approximately 0.3% to 1.0% of all neoplasms at this site. We report a rare case of LGMS of the larynx that involved the larynx of a 63-year-old man with a history of hoarseness of voice. The patient was treated with total laryngectomy with partial pharyngectomy without any adjuvant treatment. Histopathologically, the tumor was composed of spindle cells that manifested variable cellular anaplasia and expressed smooth muscle actin (SMA). Our patient is disease-free two years after surgery. The authors emphasize the clinical and histopathological findings and treatment of this case with a literature review. This case is among the few reported cases of LGMS of the larynx. It enlightens the classical clinical findings, histopathology, differential diagnosis, and treatment. Surgical excision with negative margins requires no adjuvant therapy.

Total thyroidectomy has evolved from a vilipended surgery owing to its high mortality to one with commonly performed surgery with minimal complications. After a total thyroidectomy many patients are left hypothyroid and/or hypoparathyroid, and thus prone to develop neuropsychiatric complications. Although anxiety and depression are the common manifestations, acute psychosis consequent to total thyroidectomy is rarely reported. Herein, we present the case of a 55-year-old female with a massive neck swelling diagnosed as papillary carcinoma of thyroid with bilateral metastatic cervical lymph nodes for which total thyroidectomy with bilateral modified neck dissection was performed. Postoperatively, she developed symptoms of altered sensorium, disorientation, insomnia, agitation, and delusions of persecution as well as suffered from two episodes of generalized seizures. Initially, suspected to be delirium, the persistence of the psychotic symptoms led to revision of diagnosis to psychotic disorder due to another general medical condition. The acute neuropsychiatric manifestations consequent to major thyroid surgeries may seldom leave the surgeon by surprise. Hence, a multidisciplinary liaising for major thyroid surgeries is the need of hour to avert severe emergencies.

ObjectivesThe primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty.MethodsPatients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function.ResultsSixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome.ConclusionThe FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction.

Objective To assess whether cochlear nerve (CN) cross-sectional area as measured with parasagittal magnetic resonance imaging (MRI) in prelingual pediatric deaf patients correlates with auditory performance after cochlear implantation. Study design Prospective Cohort study. Methods Thirty-two prelingual children with bilateral profound sensorineural hearing loss (SNHL) who received unilateral cochlear implant were included in this study. Diameters of CN at Internal auditory canal (IAC) fundus and mid-point of IAC were retrospectively measured on parasagittal images of FIESTA (Fast Imaging Employing Steady-state Acquisition) sequence MRI by two independent observers. Cross-sectional areas [π (Height/2) (Width/2)] were then correlated with post-operative CAPS (Categories of Auditory Performance) and IT-MAIS (Infant-Toddler Meaningful Auditory Integration Scale) scores regularly assessed at 3 monthly intervals post device activation. Results The cochlear nerve was identified in all the 32 patients. Mean cross-sectional areas (CSA) of cochlear nerve were 0.71 ± 0.16 mm2 at IAC fundus and 0.73 ± 0.18 mm2 at mid-point of IAC. The correlation value between CSA at mid-point of IAC and CAPS score at 6 months was 0.271 (p-value- 0.140) and correlation value between CSA at mid-point of IAC and IT-MAIS score at 6 months was 0.282 (p-value- 0.124) which were statistically not significant. Conclusion There was no significant correlation between the cross-sectional areas of the cochlear nerve on MRI and postoperative auditory scores as measured by CAPS and IT-MAIS scores at six months from the device activation. Hence, we conclude that above an adequate diameter, which can affect the minimum required neurons, the changes in the diameter do not have significant bearing on auditory outcomes after cochlear implantation.

Congenital nasal anomalies are rare and occur in 1/20 000–1/40 000 newborns. An 8-year-old boy presented with developmental aplasia of bilateral nasal lower lateral cartilages, with excessive wrinkled and loose skin on the dorsum of the nose and with difficulty breathing through the nose. This is probably the first such case to be reported in the literature. The defect was reconstructed using conchal and septal cartilage grafting through an external rhinoplasty approach. At the end of the 12-month follow-up period, the patient was found to be satisfied with the functional and aesthetic results of the operation. Bilateral congenital aplasia of nasal lower lateral cartilages is extremely rare. Paediatric rhinoplasty is imperative in such cases.

Foreign-body aspiration is a serious and deadly event which can lead to major complications. This is more common in children and if not promptly managed, can lead to significant complications. We here report a rare case of hijab pin inhalation into the trachea which migrated to the carina in a 3-year-old child which was successfully removed by rigid bronchoscopy.

Schwannomas are rare benign encapsulated neoplasms that usually do not arise in the nasal and oral cavities. Only about 25% of the schwannomas are located in the head-and-neck region. The preoperative diagnosis of schwannomas in the head-and-neck region is difficult, as they present with varied clinical manifestations and have nonspecific radiological findings, which can lead to a diagnostic dilemma. We report two cases of schwannomas, one in the nasal cavity and the other in the tongue, that were considered to be an infective lesion and malignant lesion respectively on clinical evaluation. The biopsy and subsequent histopathological examination led to the diagnosis of schwannoma. It is important to be aware of the unusual clinical manifestations of schwannomas and keep it in the differential diagnoses, even at relatively uncommon sites such as the nasal and oral cavities. Lesions that are suspected to be infectious lesions or malignant lesions on clinical and/or radiological evaluation can also be schwannomas. Unnecessary diagnostic evaluations and radical therapeutic measures can be avoided with early diagnosis.

Lingual thyroid results due to aberrant migration during embryological development of thyroid gland Usually asymptomatic but can present as dysphagia respiratory obstruction dysphonia foreign body sensation Here we present a case of an year old male who presented with chief complaints of cough and foreign body sensation for last one month

The results indicate that the modified cervicofacial incision is a better aesthetic option for surgical procedures concerning all benign and malignant neoplasms of the parotid gland. The aim of this study was to present the results of the use of modification of modified Bailey incision in Parotid Surgery. This is a case series comprising 155 consecutive patients who were subjected to either partial or total parotidectomy using the modified incision. All parotid tumors were removed without encountering any problem with exposure, facial nerve delineation or tumor delivery. There was no need for any further extension of the skin incision and all the patients had a good aesthetic result.