Arteriovenous malformations are rare in the head and neck region and generally arise from intracranial vessels. We present a rare case of arteriovenous malformation related to pinna. The role of color Doppler sonography in the diagnosis and management of such case is discussed along with review of literature.

To evaluate bipolar scissors tonsillectomy by comparing it with traditional cold dissection tonsillectomy in the same patients, utilizing one technique on either side.

Randomized controlled trial.

The ENT day care unit of the Karolinska University Hospital at Danderyd Hospital, Stockholm.

A total of 50 patients of which 49 were eligible (M/F 20/29), mean age 14.3 (4-41) years and included in the study. Thirty-one patients were operated due to upper airway obstruction and 18 for chronic tonsillitis. Outcome measures: (1) Intraoperative bleeding, (2) operative time, (3) postoperative pain and (4) complication rates, including postoperative primary and secondary hemorrhage.

Modern cold technique; cold scissors, Henke tonsil elevator, bipolar diathermia. Hot technique; bipolar scissors (Ethicon, set on 20 W), bipolar diathermia if needed. Each side was completed separately. Blood loss and total operative time on each side were registered. Pain was evaluated daily on a visual analog scale, VAS (0-100 mm) in patients from 10 years of age.

Mean operative time for the conventional cold technique was 11.6 SD ± 8.5 (range 1.0-55 mins) and for the hot technique 3.1 SD ± 3.1 min (range 0.5-8.5 mins) (Wilcoxon-test, p < 0.001). The corresponding median values were 3 and 1.9 mins, respectively. The mean blood loss was 43.2 SD ± 41.7 ml (range 7-225 ml) vs 3.0 SD ± 4.7 ml (range 0-25 ml) (Wilcoxon-test p < 0.001). The corresponding median values were 30 and 1 ml respectively. No primary or secondary postoperative hemorrhages requiring surgical intervention occurred. There was no difference in pain.

Tonsillectomy with bipolar scissors was almost four times faster and the blood loss significantly less than on the side operated with the conventional cold technique, whereas no difference in morbidity was found.

To describe the treatment of head and neck cancer pain in KHMC and to evaluate the predictive factors for inadequate management between April 2007 and March 2010.

Twenty-five patients with head and neck cancer.

Patients rated prevalence and severity of pain and functional impairment related to pain. Doctors reported patients’ cancer characteristic, performance status, pain severity, and analgesic drugs ordered.

57% (14/25) of patients with cancer reported pain due to their disease, and, of those with pain, 69% (9/13) rated their worst pain at a level that impaired their ability to function. 30% (5/12) were reported as receiving no drugs for their pain. Of the 18 patients in pain for whom information on treatment was available 51% (41/18) were not receiving adequate pain reliefs, according to an index based on the World Health Organization's guidelines. Doctors were found to underestimate the severity of their patients’ pain. Younger patients, patients without metastasis disease, patients with a better performance status, and patients who rated their pain as more severe than their doctors did were at greater risk for under treatment of their pain.

In the light of the high prevalence and the severity of pain among patients with head and neck cancer, the assessment and treatment of cancer pain was inadequate, emphasizing the need for changes in patient care.

A new novel technique was used to manage seroma of the auricle as a primary treatment.

Ten cases of seroma or hematoma auricle was managed using aspiration and splint suturing which added a cosmetic value and also avoided a dressing. All cases were followed up regularly.

Primary aspiration and splint suturing was found to be a simple and effective treatment method for seroma auricle.

In the era of antibiotics, deep neck abscess is a rare complication of acute mastoiditis. Bezold's abscess, the most common cause of the otogenic deep neck abscess in preantibiotic era, is a rare complication of mastoiditis nowadays and it should be considered in the differential diagnosis of neck abscesses as well as unexplained intracranial/extracranial or upper thoracic abscesses. We report a case of 20-year old female with an abscess over anterior chest wall as a sequele of bezold's abscess which was a complication of cholesteatoma with mastoiditis.

Angiectatic nasal polyp (ANP) is a rare entity of inflammatory sinonasal polyp, constituting 4 to 5% of all nasal polyps.¹ An angiomatous polyp originates from a sinochoanal polyp, either an antrochoanal or a sphenochoanal polyp. Their hallmark feature is extensive vascular proliferation and ectasia with deposition of pseudoamyloid and the presence of atypical stromal cells. This pseudoneoplastic entity is the result of extensive reactive and reparative changes in inflammatory SNPs.

We came across an interesting case of angiomatous nasal polyp. CT finding also supported the clinical impression of neoplastic mass but repeated biopsies were negative for malignancy. The mass was excised by lateral rhinotomy and the final impression of angiectatic nasal polyp was made.

Only few studies have been done on this topic and literature is also scant. Thus, awareness of their existence is of considerable importance. Differential diagnosis includes angiofibroma, malignancy, inverted papillomas and hemangiomas.

Impactions of the orofacial region are rare but impactions of the mobile tongue are unique. Hence, very limited literature is available. Foreign bodies embedded in the maxillofacial region frequently result from trauma and dental treatment. This is a compilation of cases of tongue impaction, tooth in maxillary sinus and watch battery impacted in tooth. A brief insight into the incidence of orofacial impactions, radiographic investigations and management is also provided.

Chondroid syringoma is a rare, benign, skin appendageal tumor. Because of the unremarkable clinical presentation of this rare tumor, the diagnosis is made on microscopic examination. The usual presentation is of an asymptomatic, slowly growing mass, typically located in the head and neck region.

We present seven cases of chondroid syringomas located over the head and neck region of seven patients in the age group between 32 and 56 years.

In the evaluation of a small cutaneous nodule in the head and neck region, chondroid syringoma should also be considered in the differential diagnosis. For such a lesion, excisional biopsy without destroying the esthetic and functional structures is the preferred diagnostic as well as therapeutic approach.

Fistulae arising from the second branchial apparatus are the most common anomalies than those arising from the third and fourth branchial apparatus. Third branchial fistula is extremely rare in occurrence.¹ Complete fistulae are uncommon as in the majority of cases the tracts end blindly. Here, we report a case of complete congenital third branchial fistula on left side of the neck with an internal opening near left pyriform fossa in a 12-year-old male patient.

Inflammatory pseudotumor also known as plasma cell granuloma is a space occupying lesion which occurs in wide variety of somatic tissue and visceral organs, including lungs, liver, thyroid and many other organs. Recently, it has been described in the major salivary glands and buccal tissue in children.1 We have described here the clinical, radiological and histological findings of inflammatory pseudotumor in premaxillary subcutaneous tissue in an adult, which is a rare site.

Unilateral maxillary sinus aplasia is one of the rare anomalies of maxillary sinus. Few cases have been reported. Ipsilateral rhinolith with unilateral maxillary sinus aplasia is also a very rare association and no case has been documented till date. We report a case of a 21-year-old female with left maxillary sinus aplasia and ipsilateral rhinolith. Rest of the sinuses being normal.

Intracranial metastases from primary laryngeal carcinoma are extremely rare and to present as diminution of vision has not been reported in published English literature. We present a case of advanced laryngeal carcinoma, who after treatment with surgery and chemo radiation, presented with decreased vision and weakness of lower limbs secondary to brain metastases.

A 35-year-old male presented with dysphonia and L upper neck swelling. Endoscopy revealed a left supraglottic mass with fixed vocal cord and pathology of primary site and neck swelling reported it as moderately differentiated squamous cell carcinoma. Clinical and radiological assessment staged the tumor as T3N2bM0. Patient underwent combined standard surgical and medical treatment. Eight months after completion of treatment patient presented as decreased visual acuity (R > L) and gradually progressing weakness of lower limbs. Evidence of papilloedema on fundus exam prompted an urgent CT brain which showed multiple metastatic deposits in brain. There was no evidence of metastases in lungs, bones or liver.

Brain metastases are a known entity in Head and Neck cancer. Larynx as a primary site for the same should be kept in consideration with an atypical presentation as in present case.

Epidermoid cyst is a rare cyst in head and neck region. We report a case of epidermoid cyst of tongue presented in a girl child.

A female child presented with a swelling in her tongue. The swelling was excised completely. A diagnosis of epidermoid cyst of tongue was made. The diagnosis was confirmed by histopathology. There was no recurrence after 6 months follow-up.

Epidermoid cyst of tongue is a rare tumor of tongue. Complete excision does not cause recurrence.

Frontoethmoidal mucocele can present with a multitude of different symptoms including ophthalmic disturbances. Though benign, they have a tendency to expand by thinning the bony walls. They displace and invade surrounding structures by pressure and bony resorption. If it invades the orbit and continues to expand, the mass may mimic the behavior of many benign growths arising primarily in the orbit. We report a case of a frontoethmoidal mucocele extending into the orbit. Clinically, the patient had an insidious onset of clinical presentation with no intracranial symptoms.

Nasal polyps are pedunculated, edematous, prolapsed mucosa of the paranasal sinuses. These polyps commonly arise around the ostia of the paranasal sinuses in the middle meatus.

The commonest sites of polyp formation are the ethmoid sinuses and maxillary sinus. Rarely polyps may also arise from the other paranasal sinuses. Sites in the nasal mucosa other than the paranasal sinuses are very rare, though polyps arising from the septum have also been reported.

The etiology of nasal polyposis is believed to be due to an inflammatory reaction of the nasal and paranasal sinus mucosa.

In addition to the theory of altered airway dynamics in the middle meatus, there also appears to be a link between polyp formation and preceding chronic inflammation. This is the most likely explanation for the origin of polyps in unusual sites.

We present here a case of a nasal polyp arising from the floor of the nasal cavity. There are no previous records or reports in literature of this unusual site of origin of a nasal polyp.

The authors want to highlight the importance of clinical, radiological and histopathological evaluation in unilateral proptosis. A 17-yearold male presented with left progressive nonpulsatile proptosis, lateral gaze diplopia and decreased visual acuity. It was diagnosed as orbital hydatid cyst on CT scan and MRI. The patient was successfully operated with near total recovery of the vision. Radiological investigation showed a circumscribed cystic lesion lateral to orbit separate from the lacrimal gland. Intraoperative cysts and postoperative histopathology confirmed the primary orbital hydatid cyst.

Although rare there is always a possibility of a primary hydatid in patients with unilateral proptosis, restricted eye movements and lateral decreased visual acuity. This is possible even when the Casoni's test is negative. Surgical excision with postoperative albendazole is the effective treatment for the cure of disease.