Tracheostomy a surgical intervention, emergency or elective in non-ambulatory and upper airway compromised individuals. The utility of this procedure is twofold i.e. tracheo -bronchial toilet in the former and mechanical ventilation by bypassing the upper respiratory tract, in the latter. The simple surgery is sometimes fraught with unexpected complications and consequent significant morbidity and mortality. The likelihood is more so in the pediatric age group, where the trachea is pencil thin almost equal vent to the carotids in its diameter. Incorrect insertion of tracheostomy tube with, a consequent false tract and thereby a mal - positioned ventilation circuit, is a malady with likelihood of untoward consequences and thereby significant morbidity and mortality. This review highlights the utility of appropriate technique, early recognition, and remedial interventions in these false tracheostomy tracts. The etiology, diagnosis, complications and medical or surgical management with recent advances in prevention and treatment strategies shall be emphasized upon.
Spontaneous cerebrospinal fluid (CSF) leaks remain diagnostically challenging, particularly in resource-limited settings where access to Beta-2-transferrin testing and CT cisternography is restricted. The objective was to describe the clinical characteristics, diagnostic approach, and surgical outcomes of spontaneous CSF leaks managed without advanced diagnostic modalities in a tertiary referral centre in Indonesia. A retrospective case series was conducted on six patients diagnosed with spontaneous CSF leak between 2023 and 2025. Diagnosis was established using clinical evaluation, nasal endoscopy, bedside testing, and high-resolution computed tomography (HRCT). Surgical repair was performed using endoscopic techniques. Clinical outcomes and postoperative complications were evaluated. The majority of patients were middle-aged females (83.3%) with elevated body mass index and associated comorbidities. Leak sites were predominantly located at the sphenoid sinus and cribriform plate, with meningoencephaloceles identified in four cases. Despite the absence of β2-transferrin testing and CT cisternography, HRCT combined with clinical assessment successfully localized defects. All patients underwent endoscopic repair with favorable outcomes, minimal complications, and short hospital stays. In resource-constrained settings, a structured diagnostic approach integrating clinical evaluation and HRCT can effectively guide management of spontaneous CSF leaks. Endoscopic repair remains a safe and effective treatment modality even in the absence of advanced diagnostic tools.
Every neck dissection tells a story. The surgeon's operative note captures that story in prose-which structures were preserved, which were sacrificed, and why. For decades, this narrative tradition has served clinicians well. These operative notes are useful not just for the surgeons or patients but also are used for audit, research, coding and digital analysis. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification and terminology of the Modified Radical Neck Dissection (MRND) is widely accepted worldwide primarily because it contains all the relevant information which will aid in the communication and rehabilitation of the patient. However, it also has a drawback in which effective communication cannot be achieved without detailed wordings and we also had this practical discussion in the operating theatre while teaching the post graduate residents.
Plunging sublingual dermoid cysts with cervical extension are rare developmental lesions that may present as combined intraoral and neck swellings and can pose diagnostic and surgical challenges. We present a case series of five patients with giant plunging sublingual dermoid cysts. The patients, aged 14-50 years, presented with long-standing, painless swellings associated with dysphagia and speech difficulty. Clinical examination revealed floor-of-mouth and cervical swellings, while imaging demonstrated well-defined cystic lesions occupying the sublingual space and extending into the cervical region, with posterior displacement of the tongue. Fine-needle aspiration cytology suggested dermoid or epidermoid cysts. All four patients underwent complete surgical excision through a transcervical approach. Histopathological examination confirmed the diagnosis of dermoid cyst in all cases. Postoperative recovery was uneventful, and no recurrence was observed during the available follow-up period. Giant plunging sublingual dermoid cysts should be considered in the differential diagnosis of cystic swellings of the floor of the mouth with cervical extension. Appropriate imaging is valuable for establishing the extent of the lesion and planning surgery, while complete surgical excision provides favorable clinical outcomes.
Hamartomas are benign malformations composed of disorganized mature tissues native to their site of origin. Their occurrence in the supraorbital region is extremely rare and may mimic inflammatory or neoplastic lesions, leading to diagnostic challenges, particularly in paediatric patients. Aim of the study was to report a rare case of a supraorbital cutaneous hamartoma in a child, outlining the clinical features, diagnostic evaluation, surgical management, and histopathological confirmation. An 11-year-old female presented with a 9-month history of a tender, mobile swelling over the left supraorbital region. Clinical examination, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and routine laboratory investigations were performed. The lesion was excised surgically under general anaesthesia, and the specimen was sent for histopathological evaluation. Ultrasonography revealed a hypoechoic collection; CT identified a soft tissue swelling with a calcific fragment, while MRI showed mild local oedema without intracranial extension. Surgical excision revealed a cystic lesion containing a bony fragment. Histopathology demonstrated fibro adipose, fibromuscular, and fibro-collagenous tissues with vascular and neural bundles, confirming a hamartoma. The postoperative course was uneventful, with no recurrence noted at 4-week follow-up. Supraorbital cutaneous hamartomas are exceedingly rare in paediatric patients and may clinically resemble other benign or inflammatory lesions. A combination of imaging and histopathology is essential for accurate diagnosis. Complete surgical excision is curative and prevents recurrence. Long-term follow-up is advisable to monitor for late recurrence or syndromic associations.
