Direct dorsal excision of skin and subcutaneous tissue is employed in rhinoplasty cases characterized by thick rigid skin to achieve satisfactory esthetic results, in which attempted repair by more conventional means would most likely frustrate both surgeon and patient.

This historical review reminds us of the lesson: ‘History repeats itself.’ Built on a foundation of reconstructive rhinoplasty, modern cosmetic and corrective rhinoplasty have seen the parallel development of both open and closed techniques as ‘new’ methods are introduced and reintroduced again. It is from the perspective of constant evolution in the art of rhinoplasty surgery that the author presents, in Part II, his unique ‘eagle wing’ chevron incision technique of dorsal approach rhinoplasty, to overcome the problems posed by the rigid skin nose.

National trends are showing statistically significant increase in the thyroid surgeries being performed by otorhinolaryngologist surgeons. There is a rising interest among the otorhinolaryngology surgeons subspecializing in head and neck surgeries to increase the horizons in the advancements in thyroid surgeries. Cervical epidural anesthesia (CEA) for thyroid surgeries is gaining popularity over general anesthesia (GA) for the various advantages it offers.

This prospective study was designed to evaluate the effectiveness and ease of thyroidectomy under CEA as compared to GA.

A prospective study of total of 30 patients undergoing thyroid surgery from two teaching hospitals. They were randomly allotted into CEA and GA groups of 15 members each.

In the CEA group, postoperative comfort and economic feasibility were found to be better compared to GA group. The blood volume loss was lesser in the CEA group. The CEA group also offered the added advantage of vocal cord monitoring by voice contact during the surgery. Both the CEA and GA group maintained hemodynamic stability. There were no complications in both the groups.

Even though thyroid surgery is currently being performed mostly under GA, CEA must be considered for thyroid surgeries routinely. CEA offers a number of advantages of GA in selected cases. This study has proved that CEA has distinct advantages over GA in thyroidectomies. Considering the ease and effectiveness of CEA, it is as good as GA, if not better, even in routine thyroidectomies.

This study was conducted with the aim of clinicopathological evaluation of thyroid swellings.

Tertiary referral centre, Davangere, Karnataka, India.

Retrospective study.

Clinical details, sonological reports, laboratory reports were retrieved from the records for the 110 patients with thyroid swellings who were included in our study, between May 2009 and April 2013 and the data was analyzed. Cytological smears in all patients and histopathology slides in operated patients were retrieved and studied.

The highest incidence (37.4%) of thyroid swellings were found in age group of 21 to 30 years. The youngest patient being 10 years. Females (90%) predominated in this study, male to female ratio being 1:9. Majority of patients (35%) came with complaints of swelling of duration less than 6 months. Among 110 patients, 36.36% of them were treated conservatively, out of which 7 cases (17.5%) were hyperthyroid, 10 cases (25%) were hypothyroid and 23 cases (57.5%) were euthyroid and the remaining 63.63% of them underwent surgery. Of the 110 patients subjected to FNAC, 16 patients (14.54%) were neoplastic and 94 patients (85.45%) were non-neoplastic. Upon correlation with the histopathology report, the sensitivity of FNAC was 78.57%, specificity was 91.07%, with a positive predictive value of 68.75% and negative predictive value of 94.44%. Diagnostic accuracy of FNAC is 88.50%.

FNAC and USG are valuable tools in assessing the need for surgical intervention in thyroid swellings. USG guided aspiration will further enhance the cytological yield and diagnostic accuracy.

Rhinofacial zygomycosis is the infection of subcutaneous tissues of maxillofacial region caused by zygomycetes class of fungi. It is commonly caused by the order mucorales and is acute and fulminant. Infections by the order entomophthorales are rare but indolent.

We report an unusual case of rhinofacial zygomycosis due to Conidiobolus coronatus of the order Entomophthorales in an immunocompetent adult male to highlight the clinical presentation, diagnosis and treatment. We treated the patient with multiple drugs, that is amphotericin-B, cotrimoxazole, and itraconazole along with endoscopic debridement of nasal polyps with excellent result.

Rhinofacial zygomycosis due to entomophthorales is rare but treatable condition. Appropriate histopathological diagnosis and a multipronged approach with timely medical as well as surgical management is the key to clinical cure.

Skull base osteomyelitis typically occurs most often as a complication of malignant otitis externa secondary to pseudomonas infection. Common risk factors are increasing age, diabetes mellitus and immunosuppression. If it happens in the absence of external otitis it is called atypical or central type. Medical management is the mainstay of treatment. Surgical management is for a diagnostic biopsy and in some for debridement. Described below is a case report of a 75 years old male patient who was diagnosed to have skull base osteomyelitis and was started on intravenous antibiotics. Following an initial improvement of symptoms, after 4 weeks he developed ear and oropharyngeal bleed. Imaging revealed a massive aneurysm of petrous internal carotid artery with multiple brain infarcts and before we could intervene the patient expired. This case emphasizes a rarity in skull base osteomyelitis and the need for early diagnosis and aggressive treatment.

To determine the frequency of antistreptolysin O (ASLO) positivity in cases of proven chronic tonsillitis.

The present study was conducted in a tertiary care center from January to October 2013. A total of 150 patients who presented with features suggestive of chronic tonsillitis and willing for surgery were included in the study. On admission, following a detailed history taking and clinical examination, preoperative investigations along with ASLO titers were done. Following medical and anesthetic fitness, the patients underwent tonsillectomy with or without adenoidectomy and the tonsillar specimens were sent for histopathological examination.

A total of five out of the 150 patients showed ASLO titer positivity (>200 IU/ml) and all were histopathologically proven cases of chronic tonsillitis.

Early detection and treatment of Streptococcal tonsillar involvement could be a preventive measure against the future predilection of other predisposed organs to more severe and debilitating streptococcal infections.

Santosh UP, Prashanth KB, George NM. Antistreptolysin O Positivity in Chronic Tonsillitis: Rare or Common? Int J Otorhinolaryngol Clin 2014;6(2):53-54.

The aim of this study is to highlight the factors responsible for recurrence and to follow the clinical course to ensure against recurrence of rhinosporidiosis. External surgery in rhinosporidiosis should be avoided for the fear of implantation. With the advent of endoscopes and Lasers allow the surgeon to complete excision of the lesion with cauterization of the base.

A retrospective study of thirty two cases of rhinosporidiosis presented to us over a period of 10 years from 2002 to 2012. Out of which 14 cases presented to us for the first time and 18 cases were recurrent cases. The commonest age group of presentation was between 20 and 30 years in patients presenting for the first time and in recurrent cases the commonest age of presentation was between 50 and 60 years of age. Majority of patients were males with male to female ratio of 9:1. All patients underwent endoscopic excision, electro cautery was used in 30 patients and Laser was used in 2 patients.

Fourteen cases did not have any recurrence and in the 18 cases of recurrent cases three of them again had a recurrence where electro cautery was used to cauterize the base.

Endoscopic excision of rhinosporidiosis has a better result over nonendoscopic approaches with lesser recurrence rate. Our results show that use of endoscopes in patients who presented for the first time have a better results as the mucosa of recurrence patients have already been insulted due to previous surgeries.

Aroor R, Gowda MM, Bhat VS, Bhandary SK. Novel Approach to Rhinosporidiosis. Int J Otorhinolaryngol Clin 2014;6(2):55-57.

Allergic rhinitis affects up to 20% of the general population and is one of the most common reasons for presentations to the outpatient department. We hereby present a case series which attempts to have a correlation between tissue eosinophilia (inferior turbinate) and increased eosinophil count in blood (> 440 cells/mm³).

Thirty-six patients presented to the Outpatient Department of Bapuji Hospital and Chigateri General Hospital (Teaching Hospitals attached to JJM Medical College), Davangere, with nasal obstruction and symptoms suggestive of allergic rhinitis with turbinate hypertrophy who were posted for elective bilateral partial inferior turbinectomy with/without submucous resection/septoplasty. These patients had increased absolute eosinophil count in blood. Formalin fixed inferior turbinectomy specimens were routinely processed for histopathology. Eosinophils in the mucosa and submucosal region were counted by method of Shioda and Mishima.

Ten patients out of 36 showing increased eosinophil count in blood show ‘significant eosinophilia’ in turbinates (27.7%).

Peripheral eosinophilia does not always correlate with tissue eosinophilia which opens up a possibility of using nasal mucosa biopsy for confirmation of presence of eosinophils. Further studies are needed to explore the demonstration of ‘activated’ tissue eosinophils in the diagnosis of allergic rhinitis.

Santosh UP, Sunil KB, Pandurangi AS. Clinicopathological Correlation between Peripheral Blood Eosinophilia and Inferior Turbinate Tissue Eosinophils. Int J Otorhinolaryngol Clin 2014;6(2):58-60.

To present management dilemma in a challenging case of a benign orbitomaxillary pseudotumor and its importance of inclusion in the differential diagnosis of orbital disorders.

Private multispecialty hospital in Kolkata, West Bengal.

A 36-year-old female patient with 1 year history of orbitomaxillary mass, deviation and protrusion of left eyeball, diplopia and left sided headache.

Resection of entire orbitomaxillary mass performed after assessing history, clinical and radiologic presentation of the case. Biopsy report came as mixed inflammatory lesion. Appropriate surgical intervention resulted in a dramatic improvement in patient's clinical condition. At present, patient is disease-free and asymptomatic.

Complete surgical resection is the treatment of choice for inflammatory orbitomaxillary pseudotumors followed by corticosteroids in case of incomplete resection. Radiation therapy is indicated only in case when corticosteroids or surgical intervention is unsuccessful or contraindicated.

Shah PD, Mukherji S. Management Dilemma in a Challenging Case of Inflammatory Pseudotumor of an Orbitomaxillary Mass: A Review of Literature. Int J Otorhinolaryngol Clin 2014;6(2):61-64.

Rhinofacial zygomycosis is the infection of subcutaneous tissues of maxillofacial region caused by zygomycetes class of fungi. It is commonly caused by the order mucorales and is acute and fulminant. Infections by the order entomophthorales are rare but indolent.

We report an unusual case of rhinofacial zygomycosis due to Conidiobolus coronatus of the order Entomophthorales in an immunocompetent adult male to highlight the clinical presentation, diagnosis and treatment. We treated the patient with multiple drugs, that is amphotericin-B, cotrimoxazole, and itraconazole along with endoscopic debridement of nasal polyps with excellent result.

Rhinofacial zygomycosis due to entomophthorales is rare but treatable condition. Appropriate histopathological diagnosis and a multipronged approach with timely medical as well as surgical management is the key to clinical cure.

Chakravarti A, Mishra M. A Rare Case of Rhinofacial Zygomycosis due to Conidiobolus Infection. Int J Otorhinolaryngol Clin 2014;6(2):65-67.

Garg U, Batra R, Salaria N, Garg MK. Scrofula Mimicking Cutaneous Malignancy: A Rare Case Report. Int J Otorhinolaryngol Clin 2014;6(2):68-70.

Suma R, Dahiya V, Chandni R, Devarajan E, Ramachandran K. Skull Base Osteomyelitis Resulting in Petrous Internal Carotid Aneurysm. Int J Otorhinolaryngol Clin 2014;6(2):71-73.

Langerhans cell histiocytosis (LCH) is a relatively rare and unique benign disease characterized by an abnormal proliferation of immature dendritic cells which usually affects children and young adults. Jaws are involved in less than 10% of children with the disease.

To add on to the literature one more case of this rare and unique disease which accounts for less than 1% of all bone tumors and also to discuss its oral manifestation and management.

Private maxillofacial surgery institute, Kolkata, West Bengal.

A 2 years and 8 months old male child with solitary swelling over the lower left jaw since one and half months. Lesion was fixed to underlying bone and there was an expansion of buccal cortical plate at the body of mandible.

Enucleation of the lesion performed after assessing history, clinical and radiological dertails and also considering patient's age. Postoperative biopsy result came as LCH presenting as a unifocal eosinophil granuloma. Appropriate surgical intervention resulted in a dramatic improvement in patient's clinical condition. At present, patient is disease-free and asymptomatic.

Surgical enucleation or curettage is a preferred treatment option for maxillary and mandibular lesion. Potential for the unifocal disease to become multifocal should not be underestimated as the disease can be unpredictable. We recommend long-term follow-up due to uncertainty of the disease.

Shah PD, Mukherji S. Langerhans Cell Histiocytosis Presenting as a Unifocal Eosinophilic Granuloma in the Body of the Mandible: A Rare Report. Int J Otorhinolaryngol Clin 2014;6(2):74-76.

We present an interesting diagnostic dilemma between superior vena cava syndrome and Ludwig Angina to highlight ways to differentiate between these two seemingly similar conditions.

A 50-year-old man presented with complaints of progressive breathing difficulty with diffuse brawny swelling in the neck and clinically gave impression of Ludwig angina, however, on further evaluation was diagnosed with superior vena cava syndrome (SVCS) secondary to non small cell carcinoma of lung.

This paper illustrates an interesting scenario in which clinical presentation of SVCS mimicked Ludwig's Angina. SVCS with a gradual onset may have minimal symptoms with facial edema, erythema and venous distension in the chest and neck. Occasionally atypical presentation of Ludwig's angina may mimic SVCS where high degree of clinical suspicion is needed to discriminate them.

Superior vena cava syndrome may present with symptoms suggestive of Ludwig's angina, especially if the obstruction is slowly progressive. A high index of suspicion is necessary in these cases.

Ashish G, Tyagi AK, Augustine AM, Chandrasekharan R, Varghese AM, Parmar H, Thangakunam B, Christopher DJ. Superior Vena Cava Syndrome vs Ludwig's Angina: A Diagnostic Dilemma. Int J Otorhinolaryngol Clin 2014;6(2):77-80.

Suma R, Jeena KJ, Pavithran VM, Govindan A, Ramachandran K. Glial Heterotopia of Sphenoid in Association with a Patent Sternberg's Canal presenting with Meningitis. Int J Otorhinolaryngol Clin 2014;6(2):81-83.

Malipatil SR. Preauricular Sinus as Recurrent Postaural Abscess: A Rare Presentation. Int J Otorhinolaryngol Clin 2014;6(2):84-86.