Manish Gupta

In patients with upper airway obstruction and on long-term ventilatory support, tracheostomy is often needed. One rare complication of the same is fracture and aspiration of distal portion into the lower airway, mainly seen in metallic tubes. We report a very rare case, where aspiration of fractured PVC tracheostomy tube occurred, which was successfully removed by rigid bronchoscopy. The etiology and prevention measures are also being reviewed. Keywords: Tracheostomy tube, Airway, Foreign body, Bronchoscopy, Equipment failure, Respiratory aspiration

Mucormycosis is a severe, rapidly progressive fungal infection, seen in immunocompromised patients. We report an unusual case of mucormycosis of maxilla, presenting only with cheek abscess. The patient was a young male with uncontrolled diabetes. This presentation of mucormycosis is rare, complete examination and high degrees of suspicion are necessary. The rapid progression in lack of active treatment is often fatal. Keywords: Acute sinusitis, Fungal, Complication, Sinus surgery, Subperiosteal abscess, Amphotericin B, Maxillary sinusitis

Introduction: Metastasis of head neck squamous cell carcinoma to regional deep cervical nodes is a common and usually are bony hard, solid. But sometimes they may present as a cystic mass which makes it a diagnostic challenge, in absence of evident primary, for the treating doctor. Previously they have been labeled as cancers of branchial cleft cysts which have undergone malignant degeneration. With the advancement in understanding of tumor pathophysiology most researchers now have concluded that these are tumors from tissue of waldeyer’s ring which have the potential of producing cystic cervical metastasis. Case Report : A 57-year-old male presented to our department with a right side slow growing neck swelling for 2 years. The rest of ear, nose, throat examination was normal. The fine needle aspiration cytology revealed clear fluid. The diagnosis of branchial cleft cyst was made and patient counselled for surgery for benign lesion. After a period of one month the patient presented with change in voice, difficulty in swallowing and another swelling on left side of the neck. FNAC from the left side swelling revealed metastatic squamous cell carcinoma and PET-CT revealed a tongue base growth. Patient underwent an excision of growth from tongue base and neck dissection on both sides. Conclusion: Even for cystic neck swelling in an adult over 40 years of age, the possibility of malignancy should be kept, until proven otherwise. Keywords: Cyst, Lymph node, Tonsil, Metastasis, Neck carcinoma, Waldeyers ring.

Active squamosal chronic otitis media is a challenging disease for both patients and doctors. Traditionally performing bilateral mastoidectomy has been feared with a dreadful complication like bilateral sensorineural hearing loss, facial palsy, cerebrospinal fluid leak or retrograde thrombophlebitis and thus was reserved for patients who were chronic ill with bilateral active squamosal disease and couldn’t wait for two staged procedure, or those who want to avoid the hassle of two admissions and operations and those who couldn’t afford two surgeries. In our patient, with single stage bilateral surgery there was no complication and the patient recovered completely. So, we suggest that bilateral mastoidectomies can be performed in squamosal chronic otitis media if needed. Keywords: Cholesteatoma, Middle ear, Otologic surgical procedures, Mastoidectomies, Facial nerve palsy.

Introduction: Tracheocutaneous fistula is a known complication in patient who are tracheostomised for long duration. Case Presentation: A 18-year-old girl presented in our department who was tracheostomised 2 years back, to secure airway, following a road traffic accident and tracheal injury. She underwent multiple surgeries to maintain upper airway, which were successful, but developed a tracheocutaneous fistula due to prolonged tracheostomy. Surgical closure of the fistula was done using a two hinged turnover flap and a fasciocutaneous pivot flap. The patient was discharged on 6th day of the surgery with no complication and no recurrence. Conclusion: Our technique explains one of the many procedures used to close a tracheocutaneous fistula, mentioned in literature. It is minimally invasive and is associated with minimal chance of tracheal stenosis and recurrence. Keywords: Tracheocutaneous fistula, Tracheostomy, Surgery, Hinge flap.

Introduction: Subjective tinnitus is an awareness of a phantom sound which is audible solely to the individual. Intra-tympanic steroid injections especially dexamethasone 8mg/ml have been used with variable success in relieving it; however this desired concentration is unavailable in India. The aim of this study was to assess the comparative efficacy of intra-tympanic methylprednisolone injections in different concentrations in subjective cochlear tinnitus. Materials and Methods: Ninety patients with complaint of abnormal ringing in uni/bilateral ear, with/without hearing loss were enrolled from our outpatient set-up. After written informed consent, the participants received a tinnitus loudness and frequency matching test. They were randomly assigned into three different subgroups (each with 30 patients) by a single-blind method.0.5ml of 40mg/ml concentration methylprednisolone solution was injected intratympanically in study set one (Group A), 125mg/ml in second set (Group B) and 250mg/ml in the third set (Group C). The groups were compared in terms of subjective tinnitus intensity and loudness matching after the intervention. Results: On subjective analysis of tinnitus intensity 1 patient of Group A and 2 each of groups B and C demonstrated improvement. On loudness matching test for tinnitus, no patient in Group A was cured, though 3 each in groups B and C were cured. Conclusions : In the present study, no significant change was observed in the three treatment groups in subjective analysis of tinnitus intensity based on questionnaire. Similarly a non-significant response was obtained in loudness matching test for tinnitus. The intra-tympanic methylprednisolone injection gave suboptimal and inconsistent results at varying concentrations. Further prospective studies to evaluate the effect of intratympanic methylprednisolone on tinnitus are warranted in carefully selected group of patients.  Keywords: Tinnitus, IntraTympanic Perfusion Technique, Inner Ear, Treatment.

Intact nose plays important role in perceptible beauty of face. Any amount of loss of nose has ruinous effect on quality of life. Surgical correction is by reconstruction of nasal pyramid by various surgical techniques. Six hundred years before Christ, Sushruta had described mid-forehead flap, which has an important role in reconstruction of the nose. Here we present our experience of two cases, where reconstruction of nose was done using interpolated paramedian forehead flap (IPFF) and cartilage from conchal region of pinna. Keywords: Nasal reconstruction, Forehead flap, Cartilage, Trauma, Basal cell carcinoma.

Encephalocele is most commonly a defect in the neural tube characterised by herniation of the brain and the membranes in form of protusions that cover it through openings in the skull. It is mostly congenital but can be acquired following trauma. It usually presents with cerebrospinal fluid leak, which may get overlooked because of their subtle or intermittent course. High level of suspicion is required for early diagnosis and treatment. We hereby present a rare scenario, the patient presented more than 12 years after  trauma with complaint of unilateral nasal blockage and discharge. The diagnostic investigations and treatment options are discussed. Patient was treated by endonasal endoscopic resection of mass and multilayered repair of skull base defect and is without  recurrence in last more than 1 year follow up. Keywords: Paediatric encephalocele, Acquired encephalocele, Transnasal endoscopic repair, Intranasal encephalocele, Surgery.