Identification of facial nerve during parotidectomy: a combined anatomical & surgical study.

To find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. Ten cadaveric dissections and ten live parotid surgeries for different types of parotid tumours were done. Cadaveric dissection was performed in the Department of Anatomy and the surgeries were done in the Department of ENT and Head and Neck surgery of R. G. Kar Medical College of Kolkata. The distance of the facial nerve trunk from three most commonly used landmarks (viz., tympanomastoid suture, tragal pointer and posterior belly of digastric muscle) was measured in both cadaver and live patients. The ease of identification of the nerve trunk using each of the landmarks, particularly during live surgery was also assessed. The mean distance of the tympanomastoid suture from the facial nerve trunk was 3.5 mm (cadaver) and 3.87 mm (live surgery), the tragal pointer was found to be at a mean distance of 16.61 mm (cadaver) and 16.36 mm (live surgery) and in case of the posterior belly of digastric muscle it was 7.41 mm (cadaver) and 8.03 mm (live surgery). During live surgery the posterior belly of digastric was found to be the most easily identifiable landmark with a consistent anatomical relationship with the nerve trunk. The posterior belly of digastric muscle is the most easily identifiable and a very consistent landmark for facial nerve dissection during parotidectomy. When supplemented with the tragal pointer, accuracy in identifying the facial nerve trunk is very high, thereby avoiding inadvertent injury to the nerve trunk.

Pre and post operative voice analysis after medialization thyroplasty in cases of unilateral vocal fold paralysis.

The present study was undertaken to assess the efficacy of medialization thyroplasty on outcome of voice quality in vocal cord paralysis by analyzing the voice. A total 19 patients with vocal cord paralysis of different etiologies were included in the study. Preoperative voice analysis was done by voice recordings, GRBAS score, maximum phonation time (MPT) and acoustic analysis using Dr Speech software (University version 4.0) using habitual fundamental frequency (F0), jitter %, shimmer % and normalized noise energy (NNE) as parameters. 18 patients underwent type 1 or medialization thyroplasty alone and 1 patient had undergone medialization thyroplasty along with arytenoids adduction. Post operative voice analysis was done using same parameters. There was post operative improvement of voice in 16 patients whereas 3 patients showed no significant improvement. Mean preoperative MPT was 4.8947 s and post operative was 13 s. Mean preoperative GRBAS score was 76.1579 and post operative was 30. On acoustic analysis, mean preoperative habitual fundamental frequency (F0), jitter %, shimmer % and NNE was 278.16 Hz, 1.7, 6.81 and 1.81 dB respectively whereas post operative mean was 132.37 Hz, 0.41, 1.65 and 123.38 dB respectively. Thyroplasty offers good voice outcome in patients of uncompensated vocal cord paralysis. Improvement can be documented in terms of perceptual evaluation of voice and acoustic analysis as well as maximum phonation time in addition to voice recording.

Congenital midline cervical cleft: a 7 year prospective study.

Congenital cervical midline cleft (CCMC) is a rare disease of the head and neck region with only a few reported series. The patients attending the ENT or Plastic surgery OPD of a tertiary referral hospital of eastern India were screened for the presence of CCMC. All the patients found to have the developmental abnormality were included in the study and treated. Five patients were identified as having CCMC within the 7 year study duration. Of them three were female and two male. The youngest patient was a 2 day old baby and 25 years was the maximum age of presentation in the present series. All except the new born were treated by surgical excision and primary repair of the neck defect. In literature CCMC has been described almost exclusively in the Caucasian population. The present series documents the occurrence of this developmental abnormality in the Indian population. This is perhaps the first case series on CCMC to be presented from the Indian subcontinent.

Carcinoma ex pleomorphic adenoma in the parapharyngeal space

@#<p><strong>OBJECTIVE:</strong> To present a case of carcinoma ex pleomorphic adenoma in the parapharyngeal space and discuss its management.<br /><br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Teaching Hospital<br /><strong>Patient:</strong> One<br /><br /><strong>RESULTS:</strong> A 40-year-old male patient with dysphagia for three months and a left-sided mucosa-covered oropharyngeal mass was found to have a prestyloid parapharyngeal lesion on CT scans. Fine Needle Aspiration Cytology (FNAC) revealed a pleomorphic adenoma. With a past history of parapharyngeal pleomorphic adenoma excised transorally three years before, the present mass was excised by mandibular swing approach. Post-operative recovery was uneventful but the final histopathological report was carcinoma ex pleomorphic adenoma. <br /><br /><strong>CONCLUSION:</strong> Malignant transformation should be suspected in recurrent salivary tumors in the parapharyngeal space. Provided there was truly no pre-existing malignant focus in the originally-excised tumor, and that early recurrence was not due to inadequate initial excision, this patient had a rare condition where the same tumor underwent malignant transformation within three years only. To the best of our knowledge, such an early transformation to malignancy of a minor salivary gland tumor of the parapharyngeal space has not been reported in the English literature.</p>

Infratemporal fossa myoepithelial carcinoma--a rare case report.

INTRODUCTION: Myoepithelial tumours are rare clinicopathological identity. It has been found in parotid glands and salivary glands but never reported in infratemporal fossa or other sites of lateral skull base region. DISCUSSION: Unlike its benign counterpart, myoepithelial carcinoma is biologically very aggressive and prone to recur even after adequate therapy. CASE REPORT: Here, a rare case of myoepithelial carcinoma arising from infratemporal fossa has been described along with its treatment options and outcome.

Cutaneous matastasis from sino-nasal malignant melanoma - a rare case report.

To report a case of disseminated cutaneous metastasis from malignant melanoma of sino-nasal region. A 53-year-old man from rural parts of West Bengal presented with progressive nasal obstruction. CT scanning was done to know the extent of the mass and punch biopsy from the mass was performed. Malignant melanoma of sino-nasal region was diagnosed and chemotherapy was started. The patient developed cutaneous deposits after two cycles of chemotherapy. The patient developed cutaneous deposits during the course of chemotherapy. Excision biopsy from cutaneous deposits revealed malignant melanoma. A rare case of diffuse cutaneous metastasis of malignant melanoma is presented here along with review of literature.

Orbital and para-orbital tumours--a 10 years retrospective study.

A total number of 631 cases of orbital and para-orbital tumours causing proptosis was analysed in a retrospective way in relation to age, anatomic location, histological and clinical profile. CT-scan was considered as the primary modality of investigation as it correctly delineates the extent of the tumour, integrity of bony structures and intracranial spread. Different modalities of surgery like lateral orbitotomy, medial orbitotomy, lateral rhinotomy and endoscopic excision, etc, had been performed depending upon the anatomical locations. Surgical approaches, histological types of various tumours are analysed in detail.

Midline cervical cleft: A report of two cases.

Congenital midline cervical cleft is a rare congenital anomaly. The cardinal diagnostic features are-(1). Fistula's opening are located caudally (2) Internuittent serous fluid discharge in the early neonatal period (3). Nipple like appearance of the cleft in the superior aspect (4). Widened scar and mininual neck contracture in later life. Two such cases are reported herewith with briefreview of literature and it's surgical management.

Orbital and paraorbital tumors-clinicopathological profile and surgical management.

A total number of 31 cases of proptosis caused by primary orbital tumors, paranasal tumor extensions and nasapharyngeal tumors werte analysed in a retrospective study in relation to their age, sex, clinical and histological profile. Surgical management of this group of tumors depends on the anatomical location of the tumor and CT scan was considered as the primary modality of investigation. Different modalities of surgical treatment like lateral orbitotomy, medial orbitotomy, lateral rhinotomy, etc., have been adopted according to location of tumor. Surgical approaches and histopathological profile of the lesions causing proptosis are discussed in details.