American college of radiology thyroid imaging reporting and data system score has high diagnostic value in the diagnosis of malignant thyroid nodules: A prospective single-center cross-sectional study.

Introduction: 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. Objective: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.

Résumé Introduction: Un gonflement palpable de la thyroïde est une constatation très courante et est observé chez près de 12 % de la population indienne d'Asie. Le système de rapport et de données d'imagerie thyroïdienne (TI-RADS) peut être utilisé comme système de stratification des risques pour déterminer les nodules thyroïdiens malins ou bénins et la nécessité d'une intervention supplémentaire. Objectif: L'objectif de cette étude était de déterminer la valeur prédictive positive (VPP) de la catégorie/échographie TI-RADS à l'aide des catégories TI-RADS dans le diagnostic de malignité dans un nodule thyroïdien cliniquement suspecté et la nécessité d'une intervention supplémentaire dans le cas d'une tumeur maligne de la thyroïde. nodules. Matériels et méthodes: Nous avons mené une étude prospective évaluant 110 patients (140 nodules thyroïdiens) de mars 2018 à avril 2020 incluant des patients présentant un gonflement de la thyroïde. L'échographie a été réalisée par un radiologue sur les patients, et la cytologie par aspiration à l'aiguille fine ciblée des nodules thyroïdiens a été interprétée par un pathologiste expérimenté. Les caractéristiques échographiques et la catégorie TI-RADS ont été comparées à la cytologie et à l'histopathologie chirurgicale. La sensibilité, la spécificité, la VPP et le rapport de vraisemblance positif dans différentes catégories de nodules TI-RADS ont été calculés. Résultats: Au total, 113 nodules thyroïdiens ont été évalués. Sur 113 nodules (lobe droit - 64, isthme - 6 et lobe gauche - 43), 84 nodules étaient bénins et 29 nodules malins. Onze (10%) patients présentaient une lymphadénopathie cervicale métastatique. Il n'y avait pas de différence significative dans la survenue de nodules malins selon le sexe, la localisation du nodule, ou la taille du nodule. Le diamètre moyen antéropostérieur et transversal du nodule bénin était de 14,1 ± 6,9 mm et 20,9 ± 9,9 mm, respectivement, alors que dans le cas des nodules malins, il était de 15,6 ± 7,1 mm et 19,5 ± 9,0 mm, respectivement. Un score TI-RADS ≥ 4 avait une VPP de 84 % pour la malignité. La VPP pour la malignité était de 32,2 %, 49,1 % et 100 % pour les catégories TI-RADS 2, 3 et 5. Conclusion: TI-RADS est un outil simple, pratique et rentable pour évaluer les taux de malignité des nodules thyroïdiens. Les catégories TI-RADS 4 et 5 ont une VPP élevée pour la malignité des nodules thyroïdiens. Mots-clés : Nodule, système de rapport et de données d'imagerie thyroïdienne, thyroïde, échographie.

Our Experience with Laryngotracheal Trauma (LTT) in a Tertiary Care Centre of Western Rajasthan.

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.

Otology Training in India: Is It Up to the Mark?

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. Supplementary Information: The online version contains supplementary material available at (10.1007/s12070-021-02485-0).

Cervical Thymic Cyst with parathyroid tissue - a diagnostic conundrum.

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.

Challenges in Management of Tracheobronchial Foreign Bodies with Delayed Presentation: An Institutional Experience

Abstract 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.

Challenges in Management of Tracheobronchial Foreign Bodies with Delayed Presentation: An Institutional Experience.

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.

Assessment of preoperative and postoperative cardiac function in children with adenotonsillar hypertrophy: a prospective cohort study.

PURPOSE: 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. METHODOLOGY: 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. RESULTS: 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. CONCLUSION: 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.

Endoscopy in Otorhinolaryngology During Corona Outbreak: A Proposal for Safe Practice.

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.

Correlation of tumour and treatment characteristics to dose received by cochlea in volumetric arc therapy.

PURPOSE: 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. METHODS: 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. RESULTS: 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) CONCLUSION: 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.

Does Prolonged Use of N95 Masks Affect Nasal Mucociliary Clearance? A Single Group Pre-Post Study.

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.

Future Solutions for Voice Rehabilitation in Laryngectomees: A Review of Technologies Based on Electrophysiological Signals.

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.

Cervical Thymic Cyst with parathyroid tissue - a diagnostic conundrum

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.

Relative contributions of radiation and cisplatin-based chemotherapy to sensorineural hearing loss in head-and-neck cancer patients.

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.

Correlation Between the Expression of Matrix Metalloproteinase-9, Matrix Metalloproteinase-13, Tissue Inhibitor of Metalloproteinases-1, p16 and Differentiation of Head and Neck Squamous Cell Carcinoma: A Prospective Observational Study.

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.

Tips and Pearls for Tracheostomy during the Covid-19 Pandemic.

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.

Sensorineural Hearing Loss in Dengue: A Pilot Study.

INTRODUCTION: Association of hearing loss has been found with a couple of febrile illnesses. Dengue fever is an arboviral febrile illness that is transmitted by Aedes mosquito. A case of sensorineural hearing was documented in the literature recently in dengue haemorrhagic fever. We are aiming to find if hearing loss occurs in dengue patients. METHODS AND METHODOLOGY: We assessed the hearing of ten patients diagnosed with Dengue fever from August 2018 to October 2018, prospectively. Patients who had a prior history of hearing loss or chronic suppurative otitis media were excluded from the study. Brief history, clinical examination and audiological assessment were made for all patients. All patients were followed up for three months with repeat audiological evaluation. RESULTS: Two patients complained of hearing loss after the onset of fever. They had a bilateral mild sensorineural hearing loss on audiological evaluation. One other patient was found to have bilateral high-frequency hearing loss although there was no complaint of hearing impairment. On three months follow up, both patients had bilateral mild sensorineural hearing loss with no improvement. CONCLUSION: Hearing loss in dengue fever, even though being mild in nature is irreversible. The cause of hearing loss in dengue is yet to be found. For the definitive association of hearing loss in dengue fever further studies are required.

Identifying the Facial Nerve in Parotid Surgeries: How We Do It.

INTRODUCTION: The facial nerve is an important structure related to parotid gland surgery. Its identification at the time of surgery is critical. Multiple anatomical landmarks have been described to aid in its identification. The objective of this study is to assess whether the tympanomastoid suture is a better surgical landmark than the tragal pointer for identifying the facial nerve while performing parotidectomy. MATERIALS AND METHODS: Sixty patients presenting over a period of 3 years from 2016 to 2018 with a parotid swelling without pre-operative facial weakness were included in the study. The average distances between the facial nerve (FN) and the tragal pointer (TP), and the facial nerve (FN) and tympanomastoid suture (TMS) were calculated intra-operatively and compared. RESULTS: Out of the 60 patients operated, 54 underwent superficial parotidectomy and 6 underwent total conservative parotidectomy. The mean distance between the FN (main trunk) and TP was found to be 18.38 ± 6.85 mm and that between FN and TMS was found to be 2.92 ± 0.6 mm (P<0.0001). CONCLUSION: Tympanomastoid suture is a fairly constant and consistent bony landmark to locate the facial nerve during parotid surgeries as compared to the more commonly used cartilaginous tragal pointer. The results of this study can guide surgeons during parotidectomy, to correctly and promptly identify the facial nerve thereby reducing the risk of injury.

Scary black nodes.

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.