Management of Giant Frontoethmoid Osteoma by Combined Approach.

Giant osteomas of the frontoethmoidal region often manifest early with ocular symptoms and intracranial complications. The management involves careful surgical planning of both the approach and reconstruction. In the present case report, a case of giant frontoethmoid osteoma presented with ocular symptoms and cosmetic deformity. The case was managed by a combined endoscopic and open surgical approach along with reconstruction of the sinus wall defect using a pericranial flap and titanium mesh. The outcome was found to be satisfactory with the resolution of ocular symptoms and good cosmesis.

Cut throat zone II neck injury and advantage of a feeding jejunostomy.

Penetrating neck injuries account for 5-10% of trauma cases and are potentially life threatening. We report a case of cut- throat zone II neck injury in a 45-year-old male extending up to posterior pharyngeal wall and exposing the underlying cervical vertebra. Tracheostomy was done and wound repair was started from the posterior aspect in layers using 3-0 Vicryl. Intraoperatively, a conscious decision was taken for a feeding jejunostomy for postoperative feeding, which was likely to be prolonged, in view of sensory-nerve damage along the transected pharynx. Prolonged use of Nasogastric tube for postoperative feeding was thus avoided and the discomfort, risk of aspiration and foreign body at injury site eliminated. One week postoperative, the patient experienced severe bouts of coughing and restlessness on oral intake; during this period enteral nutrition was maintained through feeding jejunostomy. At the time of discharge at 1 month, the patient was accepting normal diet orally and was detubated and vocalizing normally. We conclude that postoperative nutrition is an important area to be considered for deep neck wound with nerve injuries due to delayed tolerance to oral feeding till the regeneration of sensory nerves. A feeding jejunostomy or feeding gastrostomy performed simultaneously in such patients with nerve injuries is far superior over nasogastric-tube feeding when prolonged postoperative feeding is expected.