Anterior Jugular Vein Hemangioma: A Diagnostic Conundrum and Report of a Rare Case.

Hemangioma is a common tumor accounting for 8 to 10 % of benign neoplasm. However, hemangioma arising from blood vessels is rare and even rarer if the vessel involved is anterior jugular vein (AJV). AJV hemangioma can be confused with jugular phlebectasia, laryngocele, thyroglossal cyst, simple cyst, or other vascular malformation of same origin. They should be considered in differential of midline/paramedian neck swelling. Surgical resection is the treatment of choice whenever possible, and even allows for histopathological evaluation and a confirmatory diagnosis. Being an extremely rare entity, there is paucity in literature about it and more publications are required to extend understanding and eliminate existing doubts about the pathology. We present an extremely rare case of AJV hemangioma that presented as a painless midline swelling and was initially confused as simple neck cyst on radiological assessment. We believe that this is the second only case of AJV hemangioma reported in English literature.

Margin Status and Duration of Surgery in Resection of Tongue Carcinoma with Ultrasound Coagulation Device: a Comparative Study.

Tongue is one of the most common subsites involved by oral cancer. Improved surgical care and adjuvant therapy, along with better rehabilitation has significantly improved long-term survival and quality of life in patients with oral cancer. Primary surgical treatment is the preferred modality of treatment in cancers of the oral tongue. Although the surgical techniques have remained unchanged, various devices have been used to aid primary tumour resection, with a view to reduce bleeding and scarring. The purpose of this study is to compare resection of oral tongue tumours using ultrasonic coagulation device with conventional electrodiathermy. This study was conducted to compare histological margins and duration of surgery between ultrasonic coagulation device and electrodiathermy in the resection of oral tongue tumours. A retrospective analysis was performed comprising patients undergoing wide excision for squamous cell carcinoma of the lateral tongue, with either ultrasonic coagulation device or conventional electrodiathermy at Our Institute in Mumbai, India, from October 2015 to December 2016. Single factor ANOVA with the level of significance set at 95% and alpha value of 0.05. Patients who underwent excision with ultrasonic coagulation device better histologically tumour-free margins (except posterior margin) (p values-anterior margin, posterior margin, lateral margin and deep margin 0.0045, 0.59, 0.011 and 0.00013 respectively) and lesser operative time when compared with conventional electrodiathermy. Ultrasonic coagulation device was effective in providing adequate oncologically safe margins in carcinoma tongue.

"Hanger" in Intubation and Laryngoscopy.

Achieving an adequate exposure in laryngoscopy is an extremely tedious task for the operating surgeon, especially for the anterior commissure lesions. Various maneuvers have been described to overcome this difficulty, but failed in providing an adequate exposure leading to a poor outcome. To create a device that can deliver uniform pressure over the laryngeal cartilage and succeed in providing an adequate exposure of the glottic lesion. A total of 44 patients were included in the study, divided into two groups containing 22 patients each. The distance at the level of anterior commissure from the superior border of the distal end of the laryngoscope was noted and compared. Group A subjected to digital cricoid pressure showed a mean distance of 9.09 of exposure with variance of 1.22 and Group B subjected to cricoid pressure with the cricoid catapult showed a mean distance of 11.76 with variance of 1.59. The groups were statistically analyzed using Anova Test and the test was found to be very significant (p < 0.0001). The catapult is made of a hanger defining its economics, which has a vital role in difficult intubations especially in anterior placed larynx, short neck and obese patients, also succeeds in providing an adequate exposure of the glottic lesion, (especially the anterior commissure) by delivering uniform pressure over the laryngeal cartilage, leading to a superior operative outcome.

Comparison of Application of Mitomycin C Vs Silicon Stenting Vs Conventional Method in Endonasal Dacrocystorhinostomy: A Randomized Controlled Trial of 150 Patients.

INTRODUCTION: Since the days of Hippocrates, many modifications have been proposed in endonasal dacrocystorhinostomy (DCR), with the use of new drugs and implants showing variable results. The objective of this study was to analyze whether the use of silicon tubing or mitomycin C administration has an added advantage over conventional endonasal DCR. MATERIALS AND METHODS: A randomized controlled trial of 150 patients between the ages of 6 and 70 years presenting with epiphora was performed. Patients were randomly divided into three groups: endonasal DCR with mitomycin C administration, endonasal DCR with silicon stenting, or conventional endonasal DCR. Patients were followed up on Days 15, 30, 60 and 90 postoperatively for sac syringing to confirm patency. RESULTS: The majority of patients (28.7%) were in the fourth decade of life, with a female predominance (65.3%). Dacrocystitis was most commonly seen in the left eye (58.7%). An intergroup comparison was performed using the Kruskal-Wallis test at the end of 3 and 5 months. The results suggest that the success rate was significantly higher in patients with a silicone stent (P=0.04) as compared with the other two groups, although no significant difference in failure rate was seen between patients on mitomycin C and conventional therapy (P=0.132 at Month 3 and P=0.481 at Month 5, Mann-Whitney U-test). CONCLUSION: Our study shows that silicone tube stenting had a better success rate compared with the other two groups, with no significant statistical difference between the use of mitomycin C and the conventional technique.

Reconstruction of Maxilla with Titanium Mesh and Fascia Lata - A Case Report.

Maxillary defect reconstruction has been a grave challenge which unfortunately has stopped many ENT surgeons from attempting maxillectomy due to the fear of reconstruction. With our technique of reconstructing the maxillary defect with titanium mesh and fascia lata, the need for microvascular assistance is obviated. Here we describe a revision case of ameloblastoma of maxilla in a 33-year-old female for which total maxillectomy with reconstruction was done without the aid of microvascular tissue transfer. The aim of this article is to encourage and alleviate the fear among the ENT surgeons, in attempting maxillectomy and its reconstruction for delivering an equally good aesthetic and functional outcome especially at the centres where the facility of plastic assistance is not readily available.

As the Nasal Spine Goes, So Goes the Septum.

INTRODUCTION: "As the septum goes, so goes the nose". A well-known phrase by Maurice Cottle forms the pillar of septoplasty. Since the inception of septal surgeries, numerous methods of septoplasty have been described. But, if not performed meticulously, may lead to deformity. For a successful surgery, understanding the anatomy and addressing the anterior nasal spine and maintaining the tip integrity is vital. AIM: To study the outcomes of "ROUND ABOUT technique" to correct deviated nasal septum which focuses on the importance of anterior spine and hence maintain the tip integrity. MATERIALS AND METHODS: This was a prospective, single-centre outcome study of 35 patients with symptomatic nasal obstruction. Here, we describe a method of elevating the mucoperichondrial and mucoperiosteal flaps bilaterally, without transecting the quadrilateral cartilage of the septum. The Sino Nasal Outcome Test-22 (SNOT-22) Questionnaire was administered pre-operatively and after 3 months following surgery. The post-operative follow-up period ranged from 3 to 6 months (mean= 4.5 months) to evaluate the functional and aesthetic outcomes of the performed procedure. RESULTS: A total of 35 patients underwent surgery by this technique who presented with deviated nasal septum and variable degrees of nasal obstruction. To assess the statistical outcome, Paired t-test was applied. Mean SNOT-22 scores decreased significantly from 40.02 pre-operatively to 18.65 three months after surgery. The results sustained after 6 months (p-value <0.0001), 85% of these patients had improved breathing post-operatively and none of the patients complained any aesthetic criticisms. The patients were content and the requirement of medications post-operatively were minimal. CONCLUSION: The ROUND ABOUT technique is a very effective and safe method in correcting the septal deviations especially the ones with caudal or dorsal deflections. It also helps in maintaining the tip integrity and addressing the anterior nasal spine. It avoids the complications of conventional septoplasty.