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A rare case of aberrant tortuous common carotid artery (dolichoarteriopathia) presenting as submucosal swellings in bilateral pyriform sinuses, non-pulsatile, mimicking submucosal growths in an elderly female with complaints of dysphagia for solids, is described. CT with contrast by the radiologist opined the swellings as common carotid dolichoarteriopathia. We discussed the presentation of the anomaly in head and neck briefly by reviewing the literature and the hazards of biopsy in such a situation. Flexible fibreoptic videoendoscopy, CT with contrast of the head and neck, and the radiologist's opinion gave the clue to diagnosis. The non-pulsatile masses in the pyriform sinuses, is intriguing and minimally invasive procedure like biopsy would have been fatal. One should be careful in dealing with such non-pulsatile submucosal swellings in the laryngopharynx without proper investigations. Anomalies of common carotid artery (CCA) are rare in clinical experience. Choi et al. (Eur Arch Otorhinolaryngol 255(5):269-270, 1998) reported tortuous CCA in neck dissection for cancer but in clinical practice, the abnormal course of CCA presenting in pyriform sinus is extremely rare.

Objective 1. To highlight the rare presentation of a metallic grommet in the Eustachian tube. 2. To highlight how the metallic grommet entered the Eustachian tube. 3. To suggest how the foreign body can be removed from the Eustachian tube if symptomatic. Case report A 49 year old lady presented with symptoms of tinnitus and intolerance to loud sounds in right ear after tympanoplasty. HRCT showed a metallic grommet in the left Eustachian tube. We conjectured that the metallic grommet accidentally slipped into middle ear and could not be retrieved by the treating surgeon. The foreign body migrated to the Eustachian tube. Conclusion Metallic foreign body in the Eustachian tube is a rare presentation and it posed a diagnostic dilemma how it entered the Eustachian tube. We discussed the possibilities and the method to retrieve when the symptoms appear. A simple or a complicated surgical procedure (Skull Base) may be undertaken if symptomatic.

IgG4-related disease (IgG4-RD) which is a protein disorder presented as a mass in the right carotid triangle in a 30 year male patient, who underwent battery of tests is described. The radiologist opined the mass as paraganglioma and the spindle shaped character of the mass also suggested neurogenic tumor in differential diagnosis. Reference to vascular surgeon also opined the same, and adviced for incisional biopsy. Histopathology report suggested IgG4-RD and immunochemistry confirmed the final diagnosis. The neck mass which we opined as a single organ disease, proved to be multiorgan disease in PET scan.

We report a rare case of tracheocele presenting in an ENT setting. The referral was made on the basis of intermittent dysphonia. The aim of this report is to document the rare condition of tracheocele on the right side and to help raise the level of its awareness among the otolaryngologists. So far approximately thirty cases of this condition have been documented in the literature worldwide. An emphasis is placed on the mode of presentation and the management issues, as early diagnosis is crucial and offers a favorable prognosis. The right sided predilection of the swelling is due to anatomical reason and the cause of recurrent dysphonia is explained.

Superficial siderosis is an uncommon condition occurring in central nervous system (CNS) due to deposition of hemosiderin in the subpial meningeal layer causing progressive neurological dysfunction. The classical clinical manifestation is a triad of chronic ataxia, bipyramidal signs and progressive bilateral symmetrical sensorineural hearing loss (SNHL). It has rarely been reported in Indian literature. We report an unusual case of superficial siderosis in a 60-year-old farmer who presented with the above triad along with involvement of olfactory nerve. We present this case to highlight the fact that progressive SNHL can be an important sign for the early awareness of this rare disorder. The literature on superficial siderosis is reviewed and the pathogenesis is discussed.

The oral submucous fibrosis (OSMF) has been managed earlier by various medical and surgical modalities but none of these methods is found to give relief to these patients. Hence, a new method has been developed by us. Patients, who reported with pallor of the palate cheek, oropharyn and the tonsils, due to the fibrosis, leading on to mild, moderate to severe trismus, were given a good long-term rehef by this surgical method. This study involved 60 patients between 1979 and 2000 with a female-to-male ratio of 1∶3 with age ranging from 13 to 60 years suffering from the disease. The surgical method adopted in these cases used a single staged rotation tongue pedicle flap on either side from the dorsum of the tongue sutured to the raw area in the cheek without morbidity. In a 7-year follow up, we found the patients did not develop further fibrosis and the tongue flaps remained intact. The quality of life improved considerably and buccal mucosa is pink throughout the follow-up period. The modalities of treatment adopted are varied. Many tried the retro molar excision of the bands, which did not give long-term results. Others used excision of the whole fibrotic area with skin grafting, which also failed. Some have tried muscle pedicle flap from outside with postoperative morbidity and failure. Some surgeons have tried fat grafts in the cheek region (Yeh, Int J Oral Maxillo facial Surg 1996; 25; 130). The experience of the others who used versatile, vascular tongue flaps in the oral cavity after cancer clearance, prompted us to attempt this new technique in the present series with gratifying results. This is a break through in the surgical management of OSMF, where other treatment modalities failed.

Trans Nasal Esophagoscopy (TME) - a new concept to visualize the esophagus in office practice has obviated the conventional rigid esophagoscope, which is a cumbersome, time consuming procedure and sometimes associated with complications like perforation. Many surgeons in the West using flexible endoscope after air insufflation have tried this procedure. We fabricated a new gadget far the purpose of air insufflation in collaboration with the department of biomedical engineering, Apollo hospitals, Chennai which substitute oxygen insufflation through central supply or through the flow meter connected to an O(2) cylinder. In this article we have discussed various uses of the procedure in diagnosis A therapeutic application in an E.N.T office practice and also the unique technique of air insufflation with the new gadget.

Foresteir's disease or Diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical vertebrae in two patients is being presented as an uncommon cause of snoring and dysphagia. The radiological features of the giant osteophytes involving the cervical vertebrae are detected on routine skiagrams of the neck. A review of literature over ten years showed no such record of such a lesion occurring in C1-C2 vertebrae, whereas the occurrence in the lower cervical vertebrae is occasionally seen causing dysphagia. The relative merits of the surgical approaches are discussed.

Gastroesophageal reflux disease (GERD) is a disease that has come to limelight in the rreent past to account for various ear, nose and throat disorders. Fifty patients from my outpatient department, presenting with chronic dry paroxysmal cough, choking spells, globus sensation, voice change, burning throat syndrome, dysphagia were evaluated, with both invasive and non-invasive techniques like Fibreoptic Nasoendoscopy, Nuclear Scintigraphy with technetium, Barium swallow, sans pH monitoring which is an expensive and laborious method.We have shown evidence of GER with help of Nasoendoscopy, which revealed posterior laryngitis, erythema of arytenoids and interarytenoid oedema. This is corroborated with Scintigraphy done in Nuclear Medicine department, which is our gold standard for labelling the cases as GERD. Basing on the investigations, we have treated successfully fifty cases with medical treatment consisting of H2 Hockers, proton pump inhibitors and microlaryngeal surgery wherever necessary. In this article we are discussing the various symptoms, the fifty patients complained of, and how we are able to pinpoint the diagnosis and the modality we adopted with the facilities available, and also a brief review of literature.

The aim of presenting this case is to highlight the fact that extranodal manifestation of Rosai Dorfman Disease (RDD) without lymphadenopathy was seen in a teenaged girl with recurrent episodes of epistaxis, due to a lobulated mass in the nasopharynx, which mimicked malignancy. This case is a rare presentation because the extranodal manifestation of RDD in multisystem organs are reported in literature, but the nasopharyngeal manifestation without lymphadenopathy is unique. The clinical presentation and surgical management of the case by endoscopic sinus surgery, the aetiopathology, differential diagnosis and review of literature are described here.

Pseudocyst of the pinna, a benign idiopathic cystic swelling is an uncommon condition. In the medline search there are over 113 cases reported in literature. Engel in 1966 reported the incidence in Chinese community. In this review article we describe the etiopathogenesis, demographic statistics and treatment modalities.This is a retrospective study of six cases treated by the senior author in the dept of Otorhinolaryngology, HeadNeck Surgery, Apollo Hospital Chennai, South India between 1993 through 2003. There is preponderance of incidence in adult male (5 cases) and a single case in a female. The author highlights the modalities of treatment and opines that the surgical technique described by Lim et al, with little modification is the gold standard, which retains the architecture of the pinna. Conservative methods adopted by others have failed.

We report a case of arterio-venous malformation (AYM) of the external ear with hypertrophy in a 25 years old male which had been stable for many years, only to expand following trauma, with occasional bleeding episodes. Surgical correction and plastic reconstruction without proximal ligation of the feeding arterial system was contemplated.

The purpose of presenting these case reports is to highlight the occurrence of heterotopic glial tissue of the tongue and nose in children. So far, literature review has revealed few case reports of such lesions in neonates, but our patients presented with this unique lesion at the age of two and a half years and 3 years. This is a rare congenital anomaly in the tongue, which can mimic a lingual thyroid, teratoma, dermoid cyst etc. Surgical excision is mandatory when the lesion causes obstructive symptoms. The authors discuss the problems in diagnosis, pathology and management and review the literature.

Stricture oesophagus is an unusal complication of thyroid surgery. There is only one case of such nature recorded in literature, which shows that the surgeon who operated may not have had any previous experience of head and neck surgery. Locating the stricture was difficult, more so planning the treatment modality was problematic. Informed consent for oesophagectomy with gastric pull through was taken. However when we explored the neck the stricture was seen just below the level of pyriform sinus. It could be successfully excised without end to end anastomosis.

Thyraphtsty Type I in Phonosurgery is one of the techniques first practised by Prof. Isshiki, a pioneer in this field. The technique that we adopted is a tittle different from his technique, which is highlighted in a series of six cases, done at Apollo Hospitals, Chennai from December 1997 to April 2001. The postoperative results were quite good and the patients could phonate without any effort Patients followed up for one year showed no deterioration in phonation and they are back in their profession. A brief review of literature is documented.

Benign necrotizing osteitis of the bony external canal is a rare entity. The case is reported not only for its rarity but also for its close resemblance to a malignant lesion. This preoperative clinical resemblance resulted in planning for a safe wide line of surgical excision and complete and successful extirpation of the disease. Relevant literature is reviewed.

The sphenoid sinus is rare site for foreign body impaction. A novel method of extraction of the foreign body from sphenoid sinus (an air-rifle bullet) is presented in this discussion following failure of an earlier attempt to remove it.

Lipoma with osseous metaplasia of the external ear is an uncommon and has not been reported so far in Medline search for 30 years. The diagnosis was confirmed only after excision biopsy of the lesion. We report this case for its rarity.

Hypopharyngeal and oesophageal foreign bodies are usually intraluminal but foreign bodies with pointed ends are likely to get impacted submucosally for intramurally due to inadvertent attempts at removal by the patient or by the inexperienced surgeon. These foreign bodies can be removed without any difficulty by the ingenuity of the attending surgeon. However, in this case earlier endoscopic attempts by an ENT Surgeon failed to remove the foreign body. A detailed study of the skiagrams gave an idea that the foreign body was in the lumen. But we were disillusioned to find no foreign body on endoscopic attempts under general anaesthesia.

L'histiocytome fibreux pleomorphe malin est une tumeur mesenchymateuse. Parmi les tumeurs mesenchymateuses les tumeurs histiocytaires du larynx sont rares. L'histiocytome fibreux malin fait partie d'un groupe divers de tumeurs benignes et malignes avec une origine commune dans les histiocytes tissulaires. La chirurgie radicale a ete adoptee dans le cas decrit

The present paper describes two rare cases of epidermolysis bullosa dystrophica (recessive), one with oesophageal stricture and another with laryngeal stenosis, along with other usual features of the disease. Different views on the line of treatment of the oesophageal stricture as a complication of this dreadful disease are discussed. Replacement of the strictured oesophagus by coloplasty may be contemplated in the first case, if the patient develops increasing dysphagia. In the second case, with cicatrical stenosis of the larynx and hoarseness of voice which is a rare complication of the disease, not reported in the literature so far, a tracheostomy is contemplated when the child develops acute respiratory distress. These two cases are under observation.

Carcinosarcoma is a rare pathological entity occurring in the cervical oesophagus. So far six cases have been reported in world literature. This is the seventh case to be reported. The pathological features and treatment are discussed.

A 24 year old male had mitral stenosis with pulmonary hypertension and paralysis of the left recurrent laryngeal nerve. In addition, there was a temporary paralysis of the right recurrent laryngeal nerve, when the patient turned his head to the left side, resulting in aphonia. The right vocal cord paralysis, when the head is turned to the left, recovered, seven months after mitral valvotomy. It is postulated that there was traction on the right recurrent laryngeal nerve when the head was turned to the left.