An International Journal of Otorhinolaryngology Clinics

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Volume 15, Number 3, September-December 2023
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Original Article

Tejaswini Honnegowda, Avinash Krishnamurthy, Nagarathna Hosalli Kumaraswamy, Ashwini Guttedar

Frequency Selectivity of the Auditory System in Females with Anemia: An Indian Scenario

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:95 - 98]

Keywords: Anemia, Characteristic frequency, Frequency resolution, Frequency selectivity, Psychophysical tuning curves, Q10

   DOI: 10.5005/jp-journals-10003-1448  |  Open Access |  How to cite  | 


Background: Frequency selectivity is one of the processes of the auditory system to evaluate the individual components of a complex sound. Frequency selectivity is one of the most critical factors that determine speech perception, particularly in the presence of competing signals. Anemia is a clinical scenario in which there is a decreased level of red blood cells. Evidence suggests that anemia is more prevalent in females than males and could be an early indicator of hearing loss. The objective of the study is to compare the frequency selective abilities in normal hearing females with and without anemia. Materials and methods: A total of 30 females in the age range of 20–30 years with hearing sensitivity within normal limits participated, in which 15 females were anemic, and 15 females were non-anemic. A total of 60 ears were evaluated. The auditory system frequency selectivity was measured through psychophysical tuning curves (PTCs) at different characteristic frequencies (500, 1000, 2000, 3000, and 4000 Hz), and Q10 values for the same were calculated at different characteristic frequencies. Results: In this study, there was reduced Q10 value for females with anemia at all the characteristic frequencies compared to females without anemia, indicating poor frequency resolution in females with anemia. Conclusion: The outcomes of the present study will help in understanding the changing frequency selectivity of the auditory system in individuals with anemia.


Original Article

Rashmi P Rajashekhar, Ruchir Dashora, Gundappa D Mahajan, Anis Narayan Sur

Study of HRCT Score, Comorbidities, Specific Blood Findings, and Management of COVID-positive Patients at Dr DY Patil Medical College and Hospital, Pune

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:99 - 102]

Keywords: COVID-19, COVID-19 pneumonia, COVID-19 study, HRCT thorax score

   DOI: 10.5005/jp-journals-10003-1452  |  Open Access |  How to cite  | 


Aim: Study of HRCT score, comorbidities, specific blood findings, and management of COVID-positive patients at Dr DY Patil Medical College and Hospital, Pune. Materials and methods: We conducted a prospective study of all hospitalized cases of COVID infection in Dr DY Patil Medical College and Hospital, admitted between April and May 2021 from COVID ward 405. The study was conducted in respect to the severity of symptoms, comorbidities, HRCT chest score, the specific blood parameters, requirement of oxygen, and different treatment modalities. The inclusion criterion was admitted patients diagnosed with COVID-19. We excluded those with suspected COVID-19 infection but with negative RT-PCR reports. Also, we excluded patients diagnosed with COVID-19 who were advised home quarantine. COVID-19 infection was confirmed by RT-PCR using swab samples from the nasopharynx and oropharynx. Tests were carried out with the COVID-19 RT-PCR. Results: In our study, on CO-RADS score, we found 42% were mild, 32% were moderate, and 26% were severe. We found that out of 50 patients, only 1 received a complete dose of Covishield vaccine and only 4 received the 1st dose of Covishield vaccine. We found that out of 50 patients, only 40 patients required oxygen therapy. Patients who were on high CO-RADS scores, received a dose of remdesivir + clexane + dexamethasone. We found that out of 50 patients, 4 patients were suffering from asthma. We found that out of 50 patients, 15 patients were suffering from diabetes mellitus type 2. We found that out of 50 patients, 1 patient was suffering from chronic renal disease. Conclusion: In this prospective study done at Dr DY Patil Medical College in COVID-positive ward (sample size of 50), we came to find out the most common HRCT thorax score is between 1 and 7 (mild). Out of 50 patients, 15 were suffering from type 2 diabetes mellitus. And out of these, 13 patients were >50 years of age. In this study, out of 50 patients, those who received remdesivir + dexamethasone + clexane were 6 patients. In this study, out of 50 patients with diabetes mellitus and age above 50 years were 13 patients. Only 1 patient received 2 doses of the COVID vaccine (Covishield). One patient was suffering from chronic renal disease and needed dialysis.


Original Article

Balaji Shankarrao Mane, Rushali Madhukar Gavali

A Comparative Study between Lower Pole Silk Ligation and Pillar Suturing Technique of Hemostasis in Tonsillectomy

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:103 - 106]

Keywords: Cold dissection, Hemostasis, Lower pole, Pillar suturing, Post-tonsillectomy bleed, Silk ligation

   DOI: 10.5005/jp-journals-10003-1453  |  Open Access |  How to cite  | 


Introduction: Tonsillectomy operation was first described in the literature in 1000 BC by Celsus and Paul of Aegine. Various attempts have been made till now in the literature to control bleeding, including injection of medicines into peritonsillar area, fibrin glue application to the surgical site, suturing together the pillars, lower pole silk ligation. The aim of this study was to compare the morbidity associated with tonsillectomy using two different methods of hemostasis. Materials and methods: The study design was duration-based prospective observational study which was conducted at the ENT Department of our Institute from August 2021 to August 2022. Total of 200 patients who have undergone tonsillectomy during this 1-year duration were selected for the study. In half number of patients, pillar suturing technique was performed, and in the remaining half number of patients, lower pole silk ligation was used to control bleeding during operation to compare the morbidity associated with each technique. Results: Pillar suturing technique shown statistically significant reduction in primary and secondary post-tonsillectomy hemorrhage as compared to lower pole silk ligation. Conclusion: Tonsillectomy procedure with pillar suturing technique of hemostasis has shown earlier pain relief and significantly faster wound healing than lower pole silk ligation technique. Pillar suturing technique of hemostasis has shown significantly increased pillar edema without significant increase in palatal discomfort sensation, palatal hematoma, suture site infection as compared with lower pole silk ligation technique of hemostasis. However, pillar suturing technique of hemostasis has shown similar results as that of lower pole silk ligation technique in terms of velopharyngeal insufficiency.


Original Article

Ram Kumar, Preethi Umamaheswaran, Deepakraj Venkatesan, Sriram Ramamurthy

Revisiting the Clinical Practices in Laryngopharyngeal Reflux Disease; Measures that Decrease the Duration of Treatment

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:107 - 110]

Keywords: Gastroesophageal reflux disease, Laryngoscopy, Laryngopharyngeal reflux

   DOI: 10.5005/jp-journals-10003-1473  |  Open Access |  How to cite  | 


Introduction: Laryngopharyngeal reflux (LPR) is a very common disease seen in the ENT outpatient department. Reflux symptom index (RSI) and Reflux findings score (RFS) are used to diagnose LPR clinically. The treatment of LPR includes dietary and behavioral modifications for all patients in addition to pharmacotherapy. This study aims to revisit the clinical practices followed in the treatment of LPR and to find out measures that decrease the duration of treatment. Materials and methods: An interventional study was conducted on 50 patients who presented with reflux symptoms. Reflux symptom index and RFS were used to diagnose LPR. Patients started on treatment with the tablet rabeprazole 20 mg twice daily for 6 weeks along with proper counseling regarding lifestyle modification (LSM). Patients were asked to review after 3 weeks and divided into two groups. They were reviewed again at the end of 6 weeks and treatment response was assessed. Patients were divided into two groups with group A having patients who followed the pharmacotherapy and LSM advice without deviation, group B having patients with poor treatment compliance by not following LSM measures. Treatment response was assessed using RSI and RFS. An independent sample t-test was applied to compare the pretreatment and posttreatment RSI and RFS and the results were tabulated. Results: The mean RSI was found to be 12.23 in group A and 12.41 in group B before starting treatment. The mean posttreatment RSI was found to be 6.27 in group A and 8.36 in group B. The mean difference in RSI between the pretreatment and posttreatment values was found to be 5.95 in group A and 4.05 in group B. Independent t-test was applied for the mean difference in RSI and the p-value was found to be 0.002. The mean RFS was 6.73 in group A and 6.77 in group B before starting treatment. The mean posttreatment RFS was 4.09 in group A and 4.55 in group B. The mean difference in RFS was found to be 2.64 in group A and 2.23 in group B. Independent sample t-test was applied for the mean difference in RFS and the p-value was found to be 0.372. Conclusion: Reflux symptom index is found to be a sensitive index of prognosis of LPR and it can be used in monitoring the prognosis of patients undergoing treatment in the outpatient clinic. From our study, we have observed that patients who followed LSM measures effectively had a significant improvement in reflux symptoms sooner than patients who did not follow LSM measures. Lifestyle modifications alone do not suffice in the treatment of LPR. A combination of both, with effective counseling, is needed for the successful treatment of LPR.


Original Article

Simmi Jindal, AGS Bawa, Gurbax Singh, Sumit Prinja, Suchina Parmar

Reflux Symptom Index and Reflux Finding Score in the Diagnosis of Laryngopharyngeal Reflux and Its Improvement with Treatment

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:5] [Pages No:111 - 115]

Keywords: Laryngoscopy, Laryngopharyngeal reflux, Reflux finding score, Reflux symptom index, Symptoms

   DOI: 10.5005/jp-journals-10003-1474  |  Open Access |  How to cite  | 


Aim: The aim of our study was to diagnose laryngopharyngeal reflux (LPR) by scoring systems developed by Belafsky and to see the effect of antireflux treatment in treating laryngopharyngeal reflux. Materials and methods: A prospective study was conducted at a Tertiary Care Hospital on 100 patients. Detailed history and complete examination of patient with GERD followed by flexible fiber optic endoscopy to diagnose LPR by reflux symptom index (RSI) and reflux finding score (RFS) scoring and then improvement at 4 and 8 weeks with treatment was done. Results: In our study, 10 cases showed improvement from 0 to 4 weeks and 23 cases from 4 to 8 weeks after treatment in RSI score. In total 33 cases showed improvement after 8 weeks. In RFS, 20 cases showed improvement from 0 to 4 weeks and 22 cases showed improvement from 4 to 8 weeks after treatment. In total 42 cases showed improvement after 8 weeks. Conclusion: From our study, we concluded that LPR was assessed by using RSI and RFS scoring systems. Patients with LPR showed improvement after treatment over weeks. Clinical significance: Through this study, we can easily make the diagnosis of LPR by scoring systems and see the effectiveness of PPI in the treatment of LPR.


Original Article

VinayKumar Edwin Christopher, Rakesh Vuppala, Rambabu Koka, Jaswinder Singh Saluja, Sruthi Suravarapu, Srinivas Ganji, Srikanth Indlamuri

Cochlear Implants and Its Complications: A Retrospective Study

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:6] [Pages No:116 - 121]

Keywords: Bilateral sensorineural hearing loss, Cochlear implantation, Complications

   DOI: 10.5005/jp-journals-10003-1475  |  Open Access |  How to cite  | 


Aims: Cochlear Implant (CI) surgery is an effective and feasible alternative to restore hearing in severe bilateral hearing loss. Materials and methods: This retrospective study estimated the prevalence of complications associated with CI surgeries done from April 1994 to March 2016. Results: About 1,236 surgeries were performed on 933 pediatric patients and 79 adults. The cause of the deafness was congenital (90.91%), idiopathic (8.30%), and meningitis (0.79%). No speech impairment was seen in eight (0.86%) children. There was a history of consanguinity in 60.02% of patients. Bilateral profound hearing impairment was common in 99.41% of patients. The previous CI was reported at 29.46%. Delayed milestones (13.39%) in children, hypertension (14.29%), and diabetes mellitus (15.18%) in adult patients were noted. Right, cochlear implantation (47.43%), left (31.42%) and bilateral implantation (21.15%) were done. There were 17 (1.68%) complications (major 08, minor, 09) in adults. Superficial wound infection occurred in four patients (median 28 days, range 3–358 days) after implantation resolved on treatment. There was no significant (p > 0.05) relationship between the presence of comorbidities and complications. Conclusion: Cochlear Implant is a safe procedure and the complications are within the acceptable limits. Clinical significance: The complication rate with cochlear implants is within an acceptable range. Infections remain the most common complication. The procedure is safe.


Original Article

Imran Ansari, Tulsi Sao, Debadatta Mahallik

Does the Type of Transducer Influence Digit Span Test for Assessing Short-term Memory?

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:3] [Pages No:122 - 124]

Keywords: Auditory, Digit span, Short-term memory, Transducer, Working memory

   DOI: 10.5005/jp-journals-10003-1454  |  Open Access |  How to cite  | 


Introduction: Digit span is the most widely used to measure the capacity of auditory working memory and administered using two different variants forward digit span and backward digit span test. It was revealed that auditory digit span test is influenced by various extrinsic factors and intrinsic factors, such as rhythm of presentation, language, the material used, method of scoring, rate of presentation, live voice testing, age, sex, race, and pathological condition; however, the mode of stimulus presentation on auditory digit span test was not studied previously. Aim: Hence, in the present study, it is attempted to find out the type of transducer influences digit span test for assessing short-term memory. Methods: A total number of 44 normal hearing participants within the age range of 18–25 years were included in this study. Auditory digits span testing, that is, forward and backward were done by using calibrated headphone and loudspeaker in soundproof room. Results: The results showed no significant differences for both forward (Z-score = 3.692, p > 0.05) and backward digit span test (Z-score = 3.712, p > 0.05) between headphone and loudspeaker. Conclusion: Auditory digit span test is not influenced by types of transducers. Hence, loudspeaker can be used alternatively for easy and convenient way to test auditory working memory especially for difficult-to-test population and children clinically and aural rehabilitation.


Original Article

Ammu Korah, Girija Ghate, Rishikesh Pawar, Srinithya Kancherla

A Clinicopathological Study of Cervical Lymphadenopathy

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:3] [Pages No:125 - 127]

Keywords: Cervical lymphadenopathy, FNAC, Lymph node, Malignancy, Reactive, Tubercular

   DOI: 10.5005/jp-journals-10003-1477  |  Open Access |  How to cite  | 


Background: Cervical lymphadenopathy is one among the common presentations in ENT OPD with its causes ranging from mild infections to life-threatening malignancies. Materials and methods: About 50 patients presenting to ENT OPD with cervical lymphadenopathy were selected after taking informed consent. Routine clinical laboratory and pathological investigations were done. Radiological investigations and open biopsy were done if required. Results: Reactive and malignancy cases accounted for the most cases, contributing 68% (34 out of 50) of all cases, or 34% each. Only a quarter of the cases (12 out of 50) were due to tuberculosis. Out of 50 cases, only two were diagnosed with lymphoma and nonspecific lymphadenitis. In this investigation, out of 50 cases, 44 cases diagnosed clinically matched the FNAC findings, whereas 6 cases were found to be different, resulting in 88% clinical diagnostic accuracy. And 43 of the radiologically diagnosed patients had the same FNAC diagnosis, while 7 of them differed on cytological analysis, resulting in 86% radiological diagnostic accuracy. Conclusion: Clinical evaluation followed by FNAC aids in the diagnosis of a case of cervical lymphadenopathy and can serve as a record for future care. For the diagnosis and treatment of the underlying cause, a thorough clinical examination and thorough investigations are required. If the diagnosis is delayed, the underlying cause may become incurable.


Original Article

Jumroon Tungkeeratichai, Nualwan Leelapatharaphan, Yodying Iamsudjai, Theeraphol Panyaping

Anatomical Study of the Mandibular Canal: The Safe Surgical Landmarks for Mandibular Contouring Surgery

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:128 - 131]

Keywords: Mandibular canal, Mandible, Mandibular contouring surgery, Mandibular angle reduction

   DOI: 10.5005/jp-journals-10003-1478  |  Open Access |  How to cite  | 


Background: Mandibular contouring surgery is a common facial plastic surgery in Asia. The aim of this study was to evaluate the course of intraosseous inferior alveolar nerve within the mandibular canal in Thai population through three-dimensional computed tomography (CT) to find the safe surgical landmarks for mandibular contouring surgery. Materials and methods: This was a retrospective study in 200 patients who underwent computed tomographic assessment of head and neck region at the Faculty of Medicine, Ramathibodi Hospital, Mahidol University from January 2010 to December 2015. The inferior alveolar nerve was identified and traced along the mandibular canal from a three-dimensional image slice, and then the reconstruction of 3D images was performed. The oblique line, the alveolar arch line, the gonion, and O point were identified. Afterwards, the horizontal, oblique, and vertical distances were defined and measured. Comparison of these distances between each side was also analyzed. Results: The mandibular canal was far away from the posterior border of ramus for 17.58–17.62 mm in male, and 15.61–15.68 mm in female. It was far away from the gonion for 25.67–25.75 mm in male, and 22.73–22.77 mm in female. It was far away from the inferior border of mandibular body for 16.62–16.78 mm in male, and 15.75–15.84 mm in female. The statistical analysis showed no significant difference in all distances between each side in both male and female groups. Conclusion: A safe surgical landmark for angle mandible reduction is at a width less than 25 mm from the gonion in Thai men and 22 mm in Thai women.


Original Article

Jumroon Tungkeeratichai, Navarat Apirakkittikul

Single-stage Pinna Reconstruction in Thailand Experience

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:132 - 135]

Keywords: Medpor implant, Single-stage pinna reconstruction, Temporoparietal fascia flap

   DOI: 10.5005/jp-journals-10003-1480  |  Open Access |  How to cite  | 


Background: Microtia reconstruction is one of the most challenging for the surgeon. In 1970, Brent modified Tanzer's technique and became the foremost expert in microtia reconstruction with a 4-stage procedure. The most popular in Asia is Nagata from Japan, who developed Tanzer's technique with 2-stage procedure. Reinisch has proposed to use porous polyethylene (PPE) (Medpor) in microtia reconstruction, and Romo also reported that using temporoparietal fascial flaps to surround the Medpor implant appears to have significantly reduced its failure. In Thailand, single-stage pinna reconstruction was experienced for more than 10 years, but no systematically demonstrated clinical outcome of this procedure. Objective: To study the clinical success rate and complication of single-stage pinna reconstruction in Thailand experience. Materials and methods: The data were recorded from 1 January 2009 to 31 December 2019 from every patient who underwent single-stage microtia reconstruction at Ramathibodi Hospital by a single surgeon (the author). A total of 81 patients were included in this study. Results: Male patients were 50 (62.5%) cases, and female patients were 30 (37.5%) cases. The mean age of the patient was 16 years old (range 1–59 years old). The majority of 78 cases (97.5%) were unilateral microtia reconstruction. About 67 cases (83.75%) underwent single-stage microtia reconstruction successfully without any complications. Only 13 (16.25%) cases had problems and some need solutions. There were 6 cases of early complications and 7 cases of late complications. In the early complication group, there was 1 case of hematoma and 5 cases of implant exposure. In the late complication group, all 7 patients encountered implant exposure problems. Among these patients, 5 patients needed only a single repair, and 2 patients had to undergo multiple surgeries. In our experience since 2009, only 1 patient was necessary to perform removal of prosthesis. Hence, our success rate of a single-stage microtia reconstruction using Medpor prosthesis has been 98.75%. Conclusion: Single-stage microtia reconstruction with porous high-density polyethylene implant is one of the safe and successful techniques to reconstruct microtia problems. The most advantages are that the procedure can be performed in a single procedure at younger age and lower morbidity, compared with costal cartilage uses. However, further study must be performed to decrease complications. In our experience, the successful rate is excellent.



Jahnavi, Honey Ashok

Nasopharyngeal Amyloidosis Extending to Larynx: A Rare Clinical Presentation

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:3] [Pages No:136 - 138]

Keywords: Amyloidosis, Case report, Coblation, Congo red stain, Flexible video laryngoscopy

   DOI: 10.5005/jp-journals-10003-1460  |  Open Access |  How to cite  | 


Aim: Nasopharyngeal amyloidosis is rare, with very few reports in the literature. We report a case of amyloidosis of the nasopharynx extending into the larynx mimicking a tumoral process and compromising the airway, a unique clinical presentation. Background: Amyloidosis is a condition characterized by the deposition of extracellular proteinaceous material, resulting in damage to the tissues. A total of 19% of cases involve the head and neck with the oropharynx and larynx being the most affected organs. Localized amyloidosis is a rare and slow-growing lesion and is considered benign tumor, but it may be aggressive locally. Case description: A 49-year-old female presented with voice change and breathlessness. On clinical evaluation, multiple swellings involving the nasopharynx and larynx compromising the airway were noticed and a biopsy was done, which confirmed our primary clinical suspicion of Amyloidosis and was planned for staged coblation-assisted excision of the lesions to secure adequate airway. Conclusion: A complete clinical and paraclinical work-up is required for the positive diagnosis of primary or secondary amyloidosis. Morbidity is high so postsurgical follow-up is essential. Clinical significance: The localized form usually follows a slow and benign clinical course with a favourable prognosis of 90.6%. The principal differential diagnosis is a malignant tumor, hence the importance of histopathologic diagnosis. The recurrence rate approximates zero, but the extremely rare presentation and slow progression of this pathology make surveillance mandatory.



Shilpa Jha, Sandeep Kumar Jha, Paromita Patra, Windeep Singh Waan

Giant Lipoma of Neck: Case Report and Literature Review

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:2] [Pages No:139 - 140]

Keywords: Case report, Giant, Lipoma, Neck

   DOI: 10.5005/jp-journals-10003-1461  |  Open Access |  How to cite  | 


Lipomas are benign subcutaneous tumors arising from adipocytes. Although they are the most common tumors found in the body, their presentation in the head and neck region is relatively infrequent. Further, the most common site of presentation in the neck is the posterior part. Here we are presenting a case of a giant lipoma occupying both anterior and posterior triangles of the neck, lying deep to the sternocleidomastoid muscle with retrosternal extension.



Keshav Gupta, Gaurav Kumar, Shilpa Tomar

First Reported Case of Giant Lipoma in a Child Involving Both Triangles of Neck

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:3] [Pages No:141 - 143]

Keywords: Case report, Child, Giant, Largest, Lipoma

   DOI: 10.5005/jp-journals-10003-1463  |  Open Access |  How to cite  | 


Aim: Pediatric lipomas of the head and neck are rare to find and generally seen as isolated case reports. Here, we report an extremely rare type of giant childhood neck lipoma. Background: Lipomas are a group of benign tumors formed due to abnormal and excessive proliferation of adipose tissue. They are most common in the age-group of 40–60 years. They are rare in the pediatric age-group and rarely occur under the age of 10 years. Case description: A 100 mm × 80 mm × 80 mm, 1011-gm lipoma involving both anterior and posterior triangles of neck with attachments to mastoid process, medial and lateral pterygoids (base of skull), platysma, substance of submandibular gland, pretracheal fascia, and branches of external carotid (posterior auricular artery, occipital artery, and ascending pharyngeal artery) was removed from neck of an 8-year-old pediatric patient. Posterior auricular, occipital, and ascending pharyngeal arteries had taken an aberrant route because of the huge mass, and the ascending pharyngeal artery was forming its inferior boundary. The nasopharynx and the entire viscera of the neck were pushed to one side. The mass was adherent to the submandibular gland and in close relation with the lingual nerve. Conclusion: This is the first case report of giant lipoma of the neck in a pediatric patient which involved both anterior and posterior triangles. This is the largest neck lipoma reported to date in a child. Clinical significance: Excision of a large neck lipoma should be planned after imaging studies and in a fully equipped operation theater preferably in general anesthesia.



Vipin Ram Ekhar, Pradeepti Nayak, Ritesh Shelkar

Primary Hydatid Cyst of the Submandibular Gland: A Diagnostic Rarity

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:5] [Pages No:144 - 148]

Keywords: Case report, Fine needle aspiration cytology, Head and neck region, Hydatid cyst, Imaging, Primary, Submandibular gland, Surgery, Ultrasonography

   DOI: 10.5005/jp-journals-10003-1467  |  Open Access |  How to cite  | 


Aim: To discuss the clinical presentation of a primary hydatid cyst of the submandibular gland and its surgical implications. Background: Hydatid cyst disease is a parasitic, cyclo-zoonotic infestation by cestode of the genus Echinococcus. In humans, the most commonly affected organs are the liver (70%) and lungs (20%) followed by spleen, muscles, bones, kidneys, and the central nervous system. Primary hydatid cyst of the head and neck region; however, is extremely rare and very few cases have been reported in literature so far. Case description: We report the case of a 28-year-old male who presented with a 3-year history of a gradually increasing swelling over the right submandibular region. It was firm, painless with no other relevant features. There was no history of exposure to farm animals or ingestion of tainted meat. Ultrasonography of the neck revealed a simple anechoic cyst followed by fine needle aspiration cytology (FNAC) which confirmed the diagnosis of a hydatid cyst. The patient underwent submandibular gland excision under general anesthesia wherein the entire gland with the cyst was excised in toto. He was also administered oral Albendazole (400 mg OD) over 4 weeks. The patient was completely asymptomatic at the 6 months and 1 year follow-up. Conclusion: Though rare, hydatid cyst should be considered a differential diagnosis for submandibular gland lesions. Hydatid cyst fluid (HCF) is highly antigenic and may cause allergic reactions ranging from mild hypersensitivity to severe anaphylaxis which may be potentially fatal for the patient. This may occur spontaneously, due to accidental trauma or iatrogenic manipulation. Hence, great precision and precaution need to be exercised during the surgical excision to prevent any spillage of contents in the surgical field. Clinical significance: Being extremely rare in the head and neck region, hydatid cyst is liable to be misdiagnosed unless there is a high degree of suspicion. It is imperative that a hydatid cyst be preoperatively diagnosed and positively confirmed as any accidental or iatrogenic trauma may cause release of the HCF. Also, the intraoperative dissection needs to be meticulous and precise and arrangements should be made in anticipation of complications to ensure a favorable outcome for the patient.



Keshav Gupta, Gaurav Kumar, Shilpa Tomar

The Giant Neck Myolipoma in a Child

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:149 - 152]

Keywords: Case report, Child, Dissection, Excision, First, Giant, Largest, Lipoma, Myolipoma, Neck, Pediatric

   DOI: 10.5005/jp-journals-10003-1468  |  Open Access |  How to cite  | 


Aim: Pediatric lipomas of the head and neck are rarely seen. When reported, they are generally seen as isolated case reports. Here we report an extremely rare type of giant childhood neck lipoma. Background: Lipomas are a group of benign mesenchymal soft tissue tumors formed due to abnormal and excessive proliferation of adipose tissue. They are most common in the age-group of 40–60 years. They are infrequent in the pediatric age-group and rarely occur under the age of 10 years. Case description: A 140 × 80 × 80 mm, 1011 grams lipoma involving both anterior and posterior triangles of the neck with attachments from mastoid process to medial and lateral pterygoids (base of the skull), the substance of submandibular gland, pretracheal fascia and branches of external carotid (posterior auricular artery, occipital artery, and ascending pharyngeal artery) and platysma. The tumor was removed from the neck of 8 years old pediatric patient. Posterior auricular, occipital, and ascending pharyngeal arteries had taken an aberrant route because of the huge mass. The nasopharynx and the entire viscera of the neck were pushed to one side. The mass was adherent to the submandibular gland and in close relation with the lingual nerve. Conclusion: This is the first case report of a giant lipoma of the neck in a pediatric patient which involved both anterior and posterior triangles. To the best of our knowledge, this is the largest neck lipoma reported to date in a child. Clinical significance: Excision of a large neck lipoma should be planned after imaging studies and in a fully equipped operation theater preferably under general anesthesia. Cases of carotid injury and thoracic duct injury have been reported even with utmost precautions and with all modern facilities.



Dwi Juliana Dewi, Marlinda Adham, Respati Ranakusuma

Type of Surgery to Decrease Postoperative Recurrence in Ossifying Fibroma: Case Report

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:5] [Pages No:153 - 157]

Keywords: Case report, Chondroblastoma, Curettage, Fibro-osseous lesion, Maxilla, Maxillectomy, Ossifying fibroma, Osteotomy

   DOI: 10.5005/jp-journals-10003-1469  |  Open Access |  How to cite  | 


Background: Ossifying fibroma (OF) in craniofacial is a rare disease, benign, locally aggressive fibro-osseous tumor. In the recent 2017 WHO classifications, OF was divided into two types, ossifying fibroma of odontogenic origin and juvenile ossifying fibroma (JOF). Determining the right surgical treatment to reduce the postoperative recurrence rate is incredibly challenging. Case description: The author reports two cases of OF in paranasal sinuses with disease onset progressed from prepubertal age. The first case is an example of a recurrent case after undergoing conservative surgery and the second case is a new case. All cases underwent radical surgery with subtotal maxillectomy and reconstructive surgery in one stage. After observing all patients until one year, there were no signs of recurrence through clinical and endoscopic examination. Discussion: There are 2 types of surgery that are compared in this case report, conservative surgery procedure, and radical surgery. Conservative surgical procedures include curettage, enucleation, or peripheral osteotomies. Several studies showed high recurrence levels when curettage or enucleation is conducted in OF patients, residue caused by incomplete excision is most the common reason that is easily caused by conservative surgery. Radical surgery such as open maxillectomy shows as a promising approach for degrading the level of recurrence. Conclusion: Juvenile ossifying fibroma, especially trabecular juvenile ossifying fibroma (TrJOF), show a high recurrence percentage compared to other type. The first-choice management for treating OF was the surgical approach. Types of surgery choose to depend on the aggressiveness and morbidity of the disease. Radical surgery was proven better to decrease the level of recurrence compared with conservative surgery.



Alhabshan Raed Tariq, Keshav Gupta, Mohit Srivastava

Diagnosis and Treatment of Primary Laryngeal Histoplasmosis

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:3] [Pages No:158 - 160]

Keywords: Case report, Diagnosis, Granulomatous inflammation, Histoplasmosis, Laryngeal, Stridor, Treatment

   DOI: 10.5005/jp-journals-10003-1470  |  Open Access |  How to cite  | 


Histoplasmosis is a disease of immunocompromised and has a low incidence. Primary laryngeal histoplasmosis is a rare condition. Less than 100 cases of laryngeal histoplasmosis have been described in the medical literature. Isolated laryngeal involvement leads to the misdiagnosis and mistreatment of tuberculosis or laryngeal cancer. The development of hoarseness in a patient with histoplasmosis or a laryngeal mass leading to hoarseness should be seen with suspicion. The diagnosis becomes more difficult when it presents as a primary disease. Biopsy is a prerequisite for diagnosis.


Review Paper

Nitin Gupta, Surinder K Singhal, Vaibhav Saini, Shashikant Pol

Parathyroid Adenoma: Our Experience

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:161 - 164]

Keywords: Parathyroid, Adenoma, Primary hyperparathyroidism, Sestamibi scan

   DOI: 10.5005/jp-journals-10003-1472  |  Open Access |  How to cite  | 


Introduction: Thyroid surgeries are routinely performed in day-to-day practice. However, parathyroid surgery is a rarely performed surgery that calls upon the highest level of skill and knowledge on the part of the surgeon to perform a complication-free surgery. Parathyroid adenomas are the most common tumors of parathyroid glands leading to hyperparathyroidism. Most of these patients are primarily seen by orthopedic surgeons or physicians and are then referred to the ENT Department for surgery. Aim and objective: To present the clinic-radiological – pathological profile of parathyroid adenoma patients. Materials and methods: Study design: Prospective observation study. Setting: Tertiary Care Centre and Government Medical College. Subjects: Clinico-radiological-pathological profile of 47 consecutive patients who underwent parathyroidectomy for adenomas during a 5-year period from 2016 to 2020 in our institute which is a Tertiary Care Hospital and Medical College excluding patients operated for parathyroid carcinoma. Results: Findings were suggestive of adenomas in left inferior parathyroid (18), right inferior parathyroid (11), left superior parathyroid (9), right superior parathyroid (7) and in one patient there were 2 parathyroid adenomas. Conclusion: We conclude that accurate diagnosis and thorough knowledge of anatomy is the key to carry out a successful parathyroid surgery.


Review Paper

Ravi Meher, Vikas Kumar, Vikram Wadhwa, Ishwar Singh, Praveen Kumar Rathore, Munisha Agarwal

Tracheostomy in COVID-19 Patients in India's Largest COVID Hospital: Our Experience

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:4] [Pages No:165 - 168]

Keywords: Coronavirus disease-2019, Tracheostomy, Tracheostomy timing

   DOI: 10.5005/jp-journals-10003-1476  |  Open Access |  How to cite  | 


Objective: To describe our experience of performing open tracheostomy for coronavirus disease-2019 (COVID-19) patients using available equipment and supplies at our institution. Materials and methods: The present study is a narrative review and sharing of experiences of healthcare workers in performing tracheostomies in COVID-19 patients. Twenty-one surgical tracheostomies performed on COVID-19 patients over a period of 9 months (April–December 2020) were considered for the study at a tertiary care teaching hospital and the largest dedicated center to treat COVID-19 patients. Results: There were 14 males and 7 females with severe SARS-CoV2 infection requiring long-term intubation from April to December 2020. The mean age was 49 years. Open surgical tracheostomy was performed in all the patients. The specific indications, contraindications, timing, preoperative protocols, surgical steps, and precautions taken have been discussed. Intubation time range was 5–14 days. Our experience on tracheostomy during the COVID-19 pandemic are presented in this study. Conclusion: Tracheostomy is an aerosol-generating procedure which is a trade-off between healthcare worker's safety and patient care along with proper use of available resources and so there is a need for sharing of experience from various centers.



Shivangi Trivedi, Niral Modi

Use of Sternocleidomastoid Flap in Parotid Surgeries: Our Experience

[Year:2023] [Month:September-December] [Volume:15] [Number:3] [Pages:2] [Pages No:169 - 170]

Keywords: Parotid swelling, Parotidectomy, Sternocleidomastoid

   DOI: 10.5005/jp-journals-10003-1479  |  Open Access |  How to cite  | 


Salivary gland tumors account for 3% of all head and neck tumors, among which parotid gland tumors account for 80% of all salivary gland neoplasms. Superficial or deep parotidectomy is routinely advised according to the extent of the tumor. Surgery is challenging due to the close relation of the seventh cranial nerve to the parotid gland. Although facial nerve palsy being the most dreaded complication, patients also complain of facial contour deformity. In this study, we have divided the patients who presented with parotid swellings and underwent parotidectomy into two groups with and without the usage of the sternocleidomastoid flap. The sternocleidomastoid flap is an acceptable modality to fill the depressed concave facial contour in parotidectomy patients, which helps in decreasing the incidence of skin necrosis and Frey's syndrome and also helps in a significant degree of patient satisfaction.


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