Evidence supports a clear racial variation in the position of the infraorbital foramen (IOF). Therefore detailed knowledge of the population specific data on biometric features of (IOF) will facilitate therapeutic, diagnostic and surgical manipulations in the maxillofacial region. The goal of this study was to elucidate the morphological features and precise anatomical position of the (IOF) with reference to surrounding anatomical landmarks in an adult Egyptian population.

Fifty-nine adult dry Egyptian skulls (32 males and 27 females) were assessed to determine the number, shape, orientation, vertical and transverse diameters of the IOF, transverse distance from the IOF to the maxillary midline, the zygomaticomaxillary suture and the vertical distance from the IOF to the infraorbital rim and accessory infraorbital foramen using a metal casting digital vernier caliper. The position of the IOF was determined in relation to the maxillary teeth. The findings indicated that the size of the IOF and the mean distances from the IOF to the maxillary midline, infraorbital rim and foramen was significantly larger in males than in females.

The majority of IOF among the skulls were semilunarshaped in 59.4% in male skulls and 48.1% in female skulls. The majority were directed inferomedially in 88.9% in female skulls and 78.1 % in male skulls. Accessory foramina were found in 21.87% of male skulls and 18.5% of female skulls. All had bilateral double foramina except for one male skull and one female skull.

The racial and gender differences of the IOF emphasize the need for meticulous preoperative evaluation of the IOF in patients who are candidates for maxillofacial surgeries and regional block anesthesia.

To study the localization and relative of the supratrochlear, supraorbital, infraorbital and mental foramen in Thai cadavers to external landmarks for helps the surgeon to easily and practically identify these foramen.

The localization of the supratrochlear, supraorbital, infraorbital and mental foramen in adult Thai cadavers were studied in 110 cadevers (220 sides) from 2008 until 2012. The analyses were also performed to compare differences between sexes and sides.

Mean length of supraorbital foramen from nasal midline on the right side was 2.76 cm, left side 2.75 cm, above supraorbital rim right side 0.23 cm, left side 0.23 cm. Mean length of supratrochlear foramen from nasal midline on the right side was 1.77 cm, left side 1.76 cm. Mean length of infraorbital foramen from maxillary midline on the right side was 3.06 cm, left side 3.07 cm, from infraorbital rim on the right side was 0.94 cm, left side 0.92 cm. Mean length of mental foramen measurement straight to symphysis menti on the right side was 3.19 cm, left side 3.18 cm. Measurement along curvature of the mandible on the right side was 3.49 cm, left side 3.49 cm.

The knowledge gained from this study is quite important, since it helps the surgeon to easily and practically identify supraorbital notch/foramen, supratrochlea foramen, infraorbital foramen and mental foramen. This will help avoid injury of the neurovascular bundles passing though these sets of foramen.

The oral and oropharyngeal cancer surgery is challenging due to presence of carotid arteries, internal jugular vein and cranial nerves in close proximity to the primary tumor or matastatic lymph node. So surgical incisions should be planned to improve oncologic resection without compromising functional and esthetic outcomes. Macfee and Crile's incision are commonly used in present day oncologic practice. Extension and probable modification of these incisions depending on case scenerio are discussed.

Advances in head and neck reconstruction techniques have improved the results in function and the aesthetic outcome. Several flaps with different composition are available for specific reconstruction to achieve optimum result. Sensate free tissue transfer, dental rehabilitation and epiphyseal transfer for pediatric mandible are also now possible to achieve better function. The specific choice of the flap according to the region of defect and important keypoints in harvesting and reconstruction strategy for head and neck cancer are based on our experience in the last two decades.

Metastasizing pleomorphic adenoma (MPA) is a rarity, and detailed immunohistochemistry (IHC) work-up is being documented in this case. Most cases present with metastasis after a period of several years, ranging from 1.5 to 51 years. The present case deals with a morphologically and immunologically benign pleomorphic adenoma of the parotid, behaving in a paradoxically aggressive fashion at the local site, at the time of initial diagnosis. Regional nodal metastasis and significant local perineural and intraneural infiltration were identified at presentation. In view of the strong tumor neural affinity, the differential diagnosis included an atypical tubular form of adenoid cystic carcinoma (ACC). However, ACC was ruled out on morphology and by IHC. Literature is reviewed and the varied spectrum of reported cases is briefly put forth.

To study the localization and relative of the supratrochlear, supraorbital, infraorbital and mental foramen in Thai cadavers to external landmarks for helps the surgeon to easily and practically identify these foramen.

The localization of the supratrochlear, supraorbital, infraorbital and mental foramen in adult Thai cadavers were studied in 110 cadevers (220 sides) from 2008 until 2012. The analyses were also performed to compare differences between sexes and sides.

Mean length of supraorbital foramen from nasal midline on the right side was 2.76 cm, left side 2.75 cm, above supraorbital rim right side 0.23 cm, left side 0.23 cm. Mean length of supratrochlear foramen from nasal midline on the right side was 1.77 cm, left side 1.76 cm. Mean length of infraorbital foramen from maxillary midline on the right side was 3.06 cm, left side 3.07 cm, from infraorbital rim on the right side was 0.94 cm, left side 0.92 cm. Mean length of mental foramen measurement straight to symphysis menti on the right side was 3.19 cm, left side 3.18 cm. Measurement along curvature of the mandible on the right side was 3.49 cm, left side 3.49 cm.

The knowledge gained from this study is quite important, since it helps the surgeon to easily and practically identify supraorbital notch/foramen, supratrochlea foramen, infraorbital foramen and mental foramen. This will help avoid injury of the neurovascular bundles passing though these sets of foramen.

Tungkeeratichai J, Bhongmakapat T, Saitongdee P, Orathai P. The Surgical Landmark for Facial Foramen. Int J Otorhinolaryngol Clin 2013;5(3):121-124.

Evidence supports a clear racial variation in the position of the infraorbital foramen (IOF). Therefore detailed knowledge of the population specific data on biometric features of (IOF) will facilitate therapeutic, diagnostic and surgical manipulations in the maxillofacial region. The goal of this study was to elucidate the morphological features and precise anatomical position of the (IOF) with reference to surrounding anatomical landmarks in an adult Egyptian population.

Fifty-nine adult dry Egyptian skulls (32 males and 27 females) were assessed to determine the number, shape, orientation, vertical and transverse diameters of the IOF, transverse distance from the IOF to the maxillary midline, the zygomaticomaxillary suture and the vertical distance from the IOF to the infraorbital rim and accessory infraorbital foramen using a metal casting digital vernier caliper. The position of the IOF was determined in relation to the maxillary teeth. The findings indicated that the size of the IOF and the mean distances from the IOF to the maxillary midline, infraorbital rim and foramen was significantly larger in males than in females.

The majority of IOF among the skulls were semilunarshaped in 59.4% in male skulls and 48.1% in female skulls. The majority were directed inferomedially in 88.9% in female skulls and 78.1 % in male skulls. Accessory foramina were found in 21.87% of male skulls and 18.5% of female skulls. All had bilateral double foramina except for one male skull and one female skull.

The racial and gender differences of the IOF emphasize the need for meticulous preoperative evaluation of the IOF in patients who are candidates for maxillofacial surgeries and regional block anesthesia.

Elsheikh E, Nasr WF, Ibrahim AAS. Anatomical Variations of infraorbital Foramen in Dry Human Adult Egyptian Skulls; Anthropometric Measurements and Surgical Relevance. Int J Otorhinolaryngol Clin 2013;5(3):125-129.

To identify the right plane in augmented rhinoplasty to help facilitate the facial plastic surgeons in creating more natural look in oriental noses.

One hundred and ten adult Thai cadavers comprising 61 males and 49 females from Department of Anatomy, Faculty of Science, Mahidol University were included in this study. Augmentation rhinoplasty with the closed technique was performed by using silicone prosthesis; then, surgical incision was done at midline from nasion to nasal tip to identify the correlation between silicone and periosteum in the area of rhinion and nasion.

This study included 61 male and 49 female cadavers. At the rhinion, silicones were placed in subperiosteal plane of 65 cadavers (59.1%) and above periosteum of 45 cadavers (40.9%). In nasion area, silicones were successfully inserted below periosteum of 109 cadavers (99.1%). However, silicone was placed in the supraperiosteum of only one cadaver (0.9%).

Silicone can be inserted into subperiosteal layer in the area of nasion easier than in the area of rhinion. Augmented rhinoplasty by using silicone insertion in subperiosteal plane, at lease in the nasion area, makes it more natural look, stable and can prevent misalignment.

Tungkeeratichai J, Urathamakul S, Chintrakarn C, Bhongmakapat T, Saitongdee P, Orathai P, Kunachak S. Is the Silicone Implant actually in the Subperiosteal Pocket in Augmented Rhinoplasty? Int J Otorhinolaryngol Clin 2013;5(3):130-132.

Cephalometric assessment of Eustachian tube (ET) parameters and audiological evaluation in Down syndrome (DS) and Chronic Otitis Media (COM) and comparison with controls. The ET length, Total Cranial Base (TCB), Posterior Upper Facial Height (PUFH), Maxillary Depth (MD), s-ba (sella-basion) to Palatal Line (PL) and s-ba to ET length were considered.

The study comprised of 75 subjects of both sexes in the age range of 7 to 20 years. Digital lateral cephalometry was performed for DS, COM and controls (n = 25). Pure tone audiometry (PTA) and immittance audiometry (IA) was performed to assess audiological status.

ET length, PUFH, TCB and MD was found to be significantly reduced in DS and COM. s-ba to PL and s-ba to ET was significantly reduced in DS and COM. The s-ba to PL and s-ba to ET length angle in moderate and severe CHL (Conductive Hearing Loss) was decreased significantly. The s-ba to ET length was significantly decreased in patients with B and C tympanogram.

Aberration in the dimension of the region of the ET can be considered as a predisposing factor for otitis media and conductive hearing loss in DS.

Khanna S, Rangasayee R. Cephalometric and Audiological Assessment of Eustachian Tube in Down Syndrome and Chronic Otitis Media. Int J Otorhinolaryngol Clin 2013;5(3):133-138.

Chauhan YS. Imbalance and Falls in Elderly: Review of Literature. Int J Otorhinolaryngol Clin 2013;5(3):139-141.

Gupta AK, Kaushal D, Gupta K, Vaiphei K. Osteochondroma of the Parapharyngeal Space: A Rare Case Report. Int J Otorhinolaryngol Clin 2013;5(3):142-144.

Clear cell carcinoma is a rare form of salivary gland tumor, most commonly affecting the palate and tongue. We present a patient with cervical lymph node metastasis 28 years after treatment for clear cell salivary carcinoma of the soft palate.

A new neck mass was found in a 69-yearold man with a remote history of clear cell salivary carcinoma of the soft palate. Fine-needle aspiration biopsy demonstrated no evidence of malignancy; however, excisional biopsy revealed carcinoma. Neck dissection was performed and final pathologic review demonstrated clear cell salivary carcinoma metastatic to a cervical lymph node.

Clear cell salivary carcinoma may be less indolent than previously believed. Metastases to cervical lymph nodes and distant sites have been reported in one-fourth of patients and can occur many years after treatment. Immunohistochemical staining is a valuable adjunct for differentiating clear cell carcinoma from other neoplasms that demonstrate clear cell components.

This rare case of late neck metastasis after clear cell salivary carcinoma of the soft palate highlights the need for high clinical suspicion of recurrence many years after treatment and indicates the role of neck dissection for diagnosis and treatment in patients with possible nodal spread.

Xu R, Herr MW, Sadow P, Deschler D. Late Neck Metastasis of Clear Cell Salivary Carcinoma of the Soft Palate. Int J Otorhinolaryngol Clin 2013;5(3):145-147.

Munjal M, Garg B, Sood N, Bhardwaj V. Papillary Carcinoma of the Thyroglossal Duct Cyst: A Case Report and Review of Literature. Int J Otorhinolaryngol Clin 2013;5(3):148-150.

Tejendrasingh TR, Laxmanrao SSK. Pleomorphic Adenoma of the Nasal Septum. Int J Otorhinolaryngol Clin 2013;5(3):151-153.

Using neck ultrasound to evaluate the status of the lymph nodes of a patient with a head and neck cancer is common practice but laryngeal ultrasound could help to receive more information of the tumor.

We report a case of an initially T1a N0 M0 G2 R0 squamous-cell carcinoma of the right vocal cord. Despite regular follow-up, the relapse of the tumor remained undetected. The hypopharyngoscopy and laryngoscopy were performed. The tumor was evaluated with laryngeal ultrasound and to confirm the relapse of the tumor a MRI scan was performed. Endoscopically there was no obvious presence of the tumor. Laryngeal ultrasound facilitated the visualization of the tumor in good quality.

Unfortunately, a total laryngectomy was necessary to treat the relapse of the squamous-cell carcinoma (T4a N0 (0/16) M0 G2 R0).

Despite careful follow-up via laryngoscopy a relapse of the laryngeal tumor was not visible. Using laryngeal ultrasound, the relapse might have been detected sooner.

Klinge K, Mueller A. Ultrasound as a Useful Diagnostic Tool in the Follow-up of Laryngeal Carcinoma. Int J Otorhinolaryngol Clin 2013;5(3):154-156.

Öztürk K, Şahin M, Midilli R, Gürsan G, Özsan N, Savaş R. Extramedullary Plasmacytoma of Head and Neck Region: Report of Six Cases with Different Localizations. Int J Otorhinolaryngol Clin 2013;5(3):157-163.

Patil VM, Patil RM, Kushtagi AV. Intranasal Pleomorphic Adenoma. Int J Otorhinolaryngol Clin 2013;5(3):164-165.

Thakur K, Sharma SK, Raina R, Gupta VD. Auricular Schwannoma: A Rare Presentation. Int J Otorhinolaryngol Clin 2013;5(3):166-168.

Malipatil SR. Extranasopharyngeal Angiofibroma from Nasal Vestibule: A Rare Presentation. Int J Otorhinolaryngol Clin 2013;5(3):169-172.

Bhat VS, Aroor R, Bhandary BSK, Shetty S. Traumatic Arteriovenous Malformation of Cheek: A Case Report and Review of Literature. Int J Otorhinolaryngol Clin 2013;5(3):173-177.

IgG4 related disease is a rare entity which can affect almost all parts of the body. The available literature of this entity related to paranasal sinuses is very limited.

We present a case of isolated sphenoid sinus affliction by IgG4 related sclerosing disease manifesting as blindness, which recovered fully with pulsed steroid therapy.

We present this case in view of developing insights toward diagnosis and management of IgG4 related sclerosing disease in paranasal sinuses, specifically the sphenoid sinus.

IgG4 disease involving paranasal sinuses (PNS) is rare entity and is managed with pulse methylprednisolone and immunomodulator drugs. Considering the limit of understanding of etiopathogenesis of this disease, surgeon needs to keep this differential diagnosis in mind. It may present atypically like isolated sinus involvement and optic neuritis.

Chandrasekharan R, Mathew V, Ashish G, Tyagi AK, Job AK. Isolated IgG4-related Disease of Sphenoid Sinus Manifesting as Blindness. Int J Otorhinolaryngol Clin 2013;5(3):178-181.

Sonawane H, Karjodkar FR, Sansare K, Prakash N. Orthokeratinized Odontogenic Cyst: A Rarity. Int J Otorhinolaryngol Clin 2013;5(3):182-186.

Rangappa VB, Suresh R, Manikantan K, Balasubramanya AM. Pleomorphic Lipoma: A Rare Tumor in the Retropharyngeal Space. Int J Otorhinolaryngol Clin 2013;5(3):187-189.