Abstract Glandular odontogenic cyst (GOC) is a rare, locally aggressive developmental cyst predominantly affecting the mandible, with maxillary involvement being uncommon. Here, we report a case of a 76-year-old patient presenting with cystic lesions in the right maxilla after molar extraction. Radiographs revealed well-defined unilocular radiolucencies causing cortical thinning. Surgical enucleation and histopathology showed characteristic mucous cell differentiation, microcyst formation, and absence of features typical of other odontogenic cysts. Accurate diagnosis was challenging due to overlapping features with odontogenic keratocyst and central mucoepidermoid carcinoma; however, it was aided by special staining. Complete surgical removal with long-term radiological follow-up is essential due to the high recurrence risk. This case report underscores the importance of thorough histopathological evaluation to differentiate GOC from other cysts and tumors, especially in unusual locations.
Abstract In the pediatric age group, one of the rare yet hypothetically fatal clinical entity is thyroid abscess accounting for mortality of 3.7%–9% in acute suppurative thyroiditis. The anatomical and physiological characteristics of the gland provide it with resistance to pathogens, but thyroid abscess presents significant diagnostic and therapeutic challenges. Here, we represent a case of a child in middle childhood with a large swelling on the right side of the neck that moved with deglutition and caused tracheal deviation without airway obstruction. Thyroid abscess was diagnosed on ultrasonography and contrast-enhanced computed tomography of the neck. With this report, we want to focus on rarity of pediatric thyroid abscess and the importance of early imaging and surgical intervention when conservative management fails. It emphasizes the need for timely surgical intervention in large or refractory abscesses to prevent complications. Again, the case also highlights the role of ultrasound for diagnosis and intraoperative measures in minimizing surgical risks while ensuring complete resolution.
Abstract Background: Several surgical techniques have been suggested for lip reconstruction. Despite certain limitations, the nasolabial flap remains a straightforward and feasible option associated with lower morbidity. Objective: This study aimed to share our experience using the nasolabial flap in the reconstruction of lip defects. Materials and Methods: This retrospective study was conducted over 6 months following approval from the institution’s research and ethics committee. Histologically confirmed cases of primary lip neoplasms that were reconstructed using a nasolabial flap over 11 years (January 2014–January 2025) were reviewed. Collected data included patient demographics, the affected portion of the lip, definitive diagnosis, characteristics of the lip defect, type of nasolabial flap utilized, and treatment outcomes. Data analysis was performed using IBM Statistical Package for the Social Sciences version 25. Results: This study included 22 patients, comprising 15 males (68.2%) and 7 females (31.8%). The patients’ ages ranged from 43 to 71 years, with a mean ± standard deviation of 56.32 ± 7.6 years. The majority, 18 (81.8%) patients, were over the age of 50 years. Lower lip defects were observed in most cases, affecting 19 (86.4%) patients. Bilateral nasolabial flaps were the most commonly used technique, performed in 12 (54.5%) cases. Neck dissection was recorded in only two patients, and the surgical outcomes were satisfactory in all cases. Conclusion: Although the nasolabial flap offers limited tissue availability, it has proven to be an effective choice for subtotal or total lip reconstruction. Careful case assessment and informed decision-making are key to achieving optimal results.
Abstract Mucosal melanoma of the nasal cavity is one of the rare tumors affecting the head and neck region. It is an aggressive tumor and patients often have advanced disease at the time of presentation. Currently, there are no definite treatment protocols for this rare tumor. The tumor is best managed by radical surgical excision followed by chemoradiotherapy. This is a report on a 77-year-old lady, who presented with symptoms of nasal bleeding and nasal blockage for the past 1 month. Clinical examination showed a polypoidal mass lesion filling the nasal cavity on the left side. A biopsy of the lesion was suggestive of mucosal melanoma. A computed tomography/magnetic resonance imaging scan showed localized disease in the nasal cavity. Surgical excision of the tumor was done via an endoscopic approach. She did not agree to further treatment, the disease recurred within 3 months and she succumbed to the disease 11 months later. Mucosal melanoma of the nasal cavity is one of the aggressive tumors with a very low 5-year survival rate. Radical surgery followed by aggressive chemoradiotherapy is the currently followed treatment modality. Despite the modern advancements in the field of oncology, this tumor still has a very poor prognosis.
Angiosarcoma of scalp is a rare tumor. Management involves multimodality treatment. This case report deals with role of neoadjuvant chemotherapy followed by surgical excision and reconstruction with free flap in a case of angiosarcoma scalp.
Transoral approach to parapharyngeal space (PPS) tumors is a minimally invasive technique. However, its utility is limited to a few carefully selected cases. Adjunct techniques may assist in improved application of this approach and enhance its versatility. Here a case of pleomorphic adenoma of PPS is described, whose excision was facilitated by unconventional use of an Alexis ring retractor.
Rhinoscleroma (RS) is a chronic granulomatous disease that primarily affects the nose and upper respiratory passages, including the nasopharynx, larynx, trachea, and bronchi. It spreads via the droplet route and predominantly affects individuals from low socioeconomic backgrounds, often associated with poor domestic hygiene and overcrowding. The etiological agent of RS is the Gram-negative bacillus Klebsiella rhinoscleromatis , also known as Frisch bacilli or Diplo bacillus. It often follows a viral infection and mostly resides intracellularly, making it difficult to isolate in laboratory settings. Here, we present a case of a 58-year-old male who experienced persistent nasal blockage even after functional endoscopic sinus surgery (FESS) for noninvasive nasal polyposis. Endoscopic findings revealed crust and debris in the postoperative FESS cavity. A follow-up computerized tomography paranasal sinus scan demonstrated mild mucosal thickening with obliteration of the right antrum. Mucosal thickening was noted in the left maxillary sinus, bilateral ethmoid, and frontal sinuses, along with mild bone sclerosis. The patient underwent revision FESS, nasalization, and left DRAF IIB. He was started on mupirocin, budesonide nasal douching, and montelukast. Antifungal therapy was also given despite the negative biopsy as the patient had persistent sinusitis with bone sclerosis. Histopathology ruled out fungal or acid-fast bacilli infection. Ultimately, a granulomatous lesion over the left frontal recess was identified as RS (possibly K. rhinoscleromatis ). Combination therapy with ciprofloxacin and doxycycline led to symptomatic improvement and endoscopic clearance. This underscores that RS also needs to be included in the differential diagnosis of patients with persistent sinusitis and crust formation even in regions like southern India where this condition is uncommon.
Abstract The foreign body in the throat is the most common referral in the otorhinolaryngology department. In this study, we are reporting a case of a rare presentation of vocal cord palsy secondary to a foreign body in the throat. A 59-year-old gentleman presented with hoarseness and odynophagia 3 days after accidental ingestion of chicken bone. His symptoms became worsening and started to develop a fever on the day of admission. Unfortunately, indirect laryngoscopy revealed left vocal cord palsy without a foreign body identified and lateral neck X-ray showed no sign of foreign body. Contrast-enhanced computed tomography of the neck demonstrated prevertebral soft tissue opacification at the C7 level with peripheral air locules. Due to the limitation of resources, the patient was referred to a tertiary care center for surgical removal with rigid esophagoscopy. Intraoperatively, a piece of chicken bone was found partially embedded in the upper esophagus with pus discharge from adjacent mucosa; it was then retrieved without complication. Postoperatively, the patient was strictly on nasogastric tube feeding with intravenous antibiotics until a barium swallow was performed after 1 week, which assured the healing of the perforated esophagus. Eventually, the patient was discharged well. Foreign body in the throat is the most common case encountered with dysphagia or odynophagia as it’s the most common symptom. However, hoarseness is a rare clinical representation with few etiologies discussed in the limited case reports published. Nonetheless, the standard management by removal of foreign body with rigid esophagoscopy under general anesthesia results in the return of normal quality of voice. This case report aims to discuss the etiology of hoarseness in foreign body impaction and the appropriate approach to manage the case.
Abstract The incidence of parapharyngeal space (PPS) tumors is less, approximatively accounting for 0.5%–1.5% of all head and neck neoplasms. Of these PPS tumors, most of them are benign (70%–80%) and 20%–30% are malignant in nature. We present the case of a PPS tumor with atypical presentation on examination and an unusual progression in tumor growth. A 37-year-old female presented with chief complaints of snoring and change in voice, which was muffled in nature, since 6 months and complained of difficulty in breathing since 1 month, especially in performing activities. On examination, the oropharynx, anterior pillar and soft palate, and uvula were normal in appearance and position. A smooth pinkish mucosa-covered lesion with vascularity appeared to be arising from either the vallecular region or tonsillar fossa. On videolaryngoscopy, a mass filling the entire oropharynx was observed. We proceeded with magnetic resonance imaging to know the site of origin and extent of the lesion. The tumor seemed to be arising from the right para pharyngeal space presented as an extensive intraoral mass with minimal extent in PPS. On histopathological examination, the biopsy was suggestive of spindle cell mesenchymal neoplasm with possibilities of A) fibrous histiocytoma and B) low-grade fibrosarcoma and suggested immunohistochemistry for definite final confirmation. The usual diagnostic presentation of the parapharyngeal lesion is lateral pharyngeal swelling or a palatal bulging along with medial tonsillar displacement and lateral displacement of the uvula and/or complaint of neck mass. We present the case of tumor originating from the pre-styloid compartment of PPS with an unusual presentation and an unusual growth pattern.
Abstract To establish a new curriculum and attain global recognition, the current residency program in otolaryngology should be extended to include a senior residency for 2–3 years, coupled with sufficient years of experience. Currently, the program requires 3 years for masters certification and 2 years for diploma.
Abstract Accidental neck strangulation via dupatta/gamccha is common mishap in Indian subcontinent due to dress, which is dupaatta/gamccha traditionally worn by people. However, such incidents are quite uncommon in the rest of the world. This study aims to analyze the impact of such injuries over the laryngotracheal region and its psychosocial impact on the patient’s life, which has not been described previously. Retrospective analyses were done on nine patients of accidental neck strangulation age ranging from 14 to 42 years who reported in the emergency department of our tertiary care center. The extent and type of laryngotracheal injury, the type of surgeries, and their current status were noted. Detailed history regarding the impact on their personal life and psychological status postaccident along with their voice and swallowing were documented and analyzed using a self-designed questionnaire. Five out of nine patients were decannulated and less anxious and stressed based on the questionnaire. Accidental neck strangulation has serious physical as well as psychosocial impact on the patients and hence these perspective needs to be taken care of while managing such injuries.
Abstract Background: Otitis externa is the inflammation or infection of the skin of the external auditory canal, may be acute, subacute, or chronic and usually manifests by itching of the ear, otalgia, otorrhoea, aural fullness, and hearing loss. The causative agent is usually bacteria and occasionally fungi but may be associated with a variety of noninfective systemic or local dermatological conditions such as eczema, seborrhea, and contact dermatitis. Aim: This study aimed to determine the risk factors, bacterial profile, and antimicrobial susceptibility pattern of the isolates from patients with Otitis externa . Methods: A descriptive cross-sectional hospital-based study was conducted on 100 patients with Otitis externa . The ear discharge specimens were collected and analyzed by standard microbial techniques. The antibiotic susceptibility profiles were determined for 12 different antibiotics by the standard disk diffusion method. Data were analyzed with SPSS version 25 and the P < 0.05 was considered statistically significant. Results: The age of the 100 participants ranges from 4 to 57 years with a mean age of 18.78 ± 10.67 standard deviation, and the commonly affected age group was 11–20 years. Pathogens were isolated from 77 (62.1%) of the patients. The predominant isolate was Pseudomonas aeruginosa 32 (41.6%), followed by Staphylococcus aureus 13 (16.9%), others include Proteus mirabilis 7 (9.0%), Peptostreptococcus species 5 (6.5%), Escherichia coli 4 (5.2%), Streptococcus pneumonia 4 (5.2%), Klebsiella pneumonia 3 (3.9%), Streptococcus pyogenes 3 (3.9%), Enterobacter aerogenes 2 (2.6%), Fusobacterium species 2 (2.6%), and Bacteroides 2 (2.6%). Ofloxacin showed good susceptibility to isolated aerobes 65 (95.6%), followed by gentamicin 52 (76.5%) and ceftriaxone 50 (73.5%). All isolated anaerobes showed 100% susceptibility to metronidazole and clindamycin. Bacterial isolates identified in this study showed a trend of multiple drug susceptibility, majority (70%) being susceptible to three or more antimicrobials. Conclusions: Majority of the bacterial isolates were susceptible to more than one antimicrobial agent, hence efforts to isolate microorganisms and determine the susceptibility pattern should be strengthened to improve the treatment outcome of Otitis externa instead of the usual trend of empirical treatment.
Abstract Pediatric hearing impairment is a global health problem and has implications on the individual as well as the society. Undiagnosed hearing impairment has immense economic burden on the family, society, and nation. The challenge lies in diagnosing pediatric hearing impairment early so that effective treatment or rehabilitation can be initiated. Even though universal newborn hearing screening has been implemented in many countries, yet the coverage of the program has not been uniform throughout. Further, many cases of childhood deafness are known to manifest later in the school going age. As such, reliance on hearing screening in the newborn period alone will lead to many undiagnosed cases of hearing impairment. Therefore, a viewpoint is provided here for a three-tiered screening strategy so that maximum cases of hearing impairment can be diagnosed and effective treatment can be initiated, thereby reducing the global economic burden of pediatric hearing impairment.
Abstract Any polyploid growth in the laryngeal region may be mistaken for a malignant condition. Histoplasmosis of the larynx rarely causes laryngitis; it often masquerades as malignancy or tuberculosis. The other name of this condition is “Cave’s disease” and is caused by the fungus, Histoplasma capsulatum . Here, we report a 54-year-old diabetic male who presented with a history of progressive hoarseness of voice for 6 months. The patient was a chronic smoker for 15 years. A biopsy of the growth was done, and a histopathological examination of the tissue clinched the diagnosis of laryngeal histoplasmosis. The patient was managed with intravenous liposomal amphotericin B and oral itraconazole with complete resolution of symptoms.
