International Journal of Otorhinolaryngology and Head and Neck Surgery

Myriad manifestations of parathyroid adenoma – clinical insights from a case series

2026-05-26T07:06:18+0530

Parathyroid adenoma is the most common cause of primary hyperparathyroidism and demonstrates a wide spectrum of clinical manifestations, ranging from asymptomatic hypercalcemia detected on routine evaluation to classical “bones, stones, abdominal groans, and psychic moans”. Biochemical markers along with combined imaging modalities help in arriving at the diagnosis. This case series highlights four different cases with diverse clinical scenarios causing diagnostic challenges and their management. Establishing the diagnosis, accurate preoperative localization followed by timely surgical intervention provides excellent cure rates with minimal morbidity, thereby preventing long term complications and significantly improving patient outcomes.

Beyond the usual: a case series of rare foreign bodies in ENT practice

2026-05-26T07:06:04+0530

Foreign bodies (FBs) in the ear, nose, and throat account for about 11% of ENT emergencies, most commonly affecting children under 6 years due to exploratory behaviour. The external auditory canal is the most frequent site (44%), followed by nasal, pharyngeal, oesophageal, and laryngo-bronchial locations. Early diagnosis and appropriate removal are essential to prevent complications, which are more common with delayed presentation or improper prior attempts. Hereby, we are reporting five unique cases of foreign bodies, emphasizing the importance of site- and type-specific management. This cross-sectional study was conducted on 150 patients presenting with foreign body (FB) lodgement in the ear, nose, and throat at the Otorhinolaryngology department of a tertiary care teaching hospital of western Gujarat. Institutional ethical approval and informed consent were obtained. Patients were evaluated using a predesigned questionnaire and appropriate clinical and radiological investigations based on the site of FB, including otoscopy, X-ray imaging, endoscopy, and CT where indicated. Foreign bodies were removed using suitable techniques, and patients were assessed for post-removal complications. Here, we report five unique foreign body cases encountered during the study period. The five unique foreign bodies encountered during the course of the study included a thorn lodged in the right pyriform fossa, a ballpoint pen stuck in the hard palate, a sea shell in the left nostril, a golden tooth in the cervical oesophagus, and a toothbrush in the oesophagus. Foreign bodies in ENT are common emergencies, especially in children. This series presents five unique cases, emphasizing prompt diagnosis, appropriate management, and preventive awareness to reduce morbidity. This study underscores the importance of prompt, systematic management and preventive education in improving patient outcomes.

Comprehensive analysis of patterns, comorbidities and outcomes of patients admitted to ENT under tertiary hospital in Botswana

2026-05-26T07:06:40+0530

Background: Ear, nose and throat (ENT) conditions are a significant yet underrecognized contributor to the global disease burden, particularly in developing countries. In Botswana, there is limited local data on the clinical profiles, comorbidities, and outcomes of ENT patients. This study aimed to evaluate the patterns of disease, associated comorbidities, and treatment outcomes of patients admitted to the ENT department at a major tertiary referral center in Botswana.

Methods: This retrospective, cross-sectional, descriptive study was conducted via systematic chart review of 108 patient records for admissions occurring between January 2020 and December 2023. Data were extracted using a standardized tool and analyzed to assess demographic trends, clinical diagnoses, comorbidities, treatment modalities, and patient outcomes.

Results: The findings from our study indicate that rhinology (29%) and otology (27.8%) cases accounted for the highest proportion of admissions to ENT ward. Nearly half (49.3%) of the patients had comorbidities, with human immunodeficiency virus (21.3%) being the most prevalent. Surgical management was the primary mode of treatment in 56% of cases with total in patient Mortality rate of 0.9%.

Conclusions: The findings underscore the substantial burden of preventable and treatable ENT conditions requiring tertiary-level care, often complicated by comorbidities like HIV. The findings provide clinicians with a clearer understanding of the pattern of ENT conditions. We recommend further comprehensive studies that include data from hospitals across Botswana, inpatient populations, and patient outcomes to better characterize the national burden and trends of ENT conditions.

Factors affecting consultation and intervention for sleep disordered breathing

2026-05-26T07:06:40+0530

Background: This study was to investigate the general public’s treatment preferences for sleep disordered breathing.

Methods: Anonymous online questionnaire distributed using Amazon Mechanical Turk and the Functional Outcomes of Sleep Questionnaire (FOSQ-10) responses were collected. The surveys of the respondents who met inclusion criteria were assessed in data analysis portion of the study. Descriptive statistics, paired t-tests, and Pearson’s chi-squared tests were used to analyze data. This was a survey-based study conducted from October 2014 through June 2024.

Results: Of 3,259 participants, 931 (28.6%) are formally diagnosed with sleep disordered breathing (SDB). 891 (95.7%) sought intervention; 40 (4.3%) did not. Nasal appliance (50.8%), oral appliance (38.8%), and continuous positive airway pressure (CPAP) (32.8%) were the three most preferred treatment modalities. Respondents who have romantic partners who complain of their symptoms were more likely to seek otolaryngology consult (p=0.0001) and surgical intervention (p=0.0087). Most respondents with formal diagnosis had seen an otolaryngologist and done research on their condition.

Conclusions: This study describes the public’s preferences related to sleep disorders and the factors that dictate these preferences. Factors that influence this desire to pursue treatment include sex assigned at birth, marital status, and romantic partners who complain of symptoms. Understanding these can help us better identify, understand, educate, intervene and improve the quality of life and health outcomes for patients.

Ninety-day emergency department rebound following pediatric tonsillectomy: a retrospective cohort study

2026-05-26T07:06:12+0530

Background: Tonsillectomy is a very common pediatric surgical procedure. Post-operative complications such as hemorrhage, nausea, and dehydration frequently result in emergency department (ED) visits, leading to increased healthcare resource utilization. Understanding the patterns and predictors of post-tonsillectomy ED visits is crucial for developing strategies to improve care and reduce unnecessary healthcare burden.

Methods: A retrospective cohort study was conducted using administrative datasets to analyse province-wide ED visits within 90 days post-discharge following pediatric tonsillectomy. The study included all pediatric patients (<16 years) who underwent total or partial tonsillectomy at the pediatric health centre between April 1, 2016, and March 31, 2022. The first ED visit post-operation was categorized as either “surgical” or “medical” based on the presenting concern.

Results: A total of 702 ED visits from 527 unique patients were analyzed. The surgical ED rebound rate was 9.6%, with all surgical visits occurring within the first 30 days post-discharge. The most common reasons for surgical ED presentations were pain (20.3%), hemorrhage (14.0%), and nausea/vomiting (5.1%). Notably, 50.9% of surgical ED visits were classified as potentially preventable.

Conclusions: Post-tonsillectomy complications significantly contribute to pediatric ED visits, with pain and haemorrhage being the most frequent concerns. More than half of surgical ED visits did not require admission, suggesting that these visits could be mitigated through improved caregiver education, standardized analgesic regimens, and enhanced outpatient follow-up. Future interventions, including telemedicine, wearable monitoring, and AI-powered patient engagement tools, may reduce preventable ED utilization and optimize post-operative recovery.

Connected speech accuracy in native Nepali-speaking preschool children: a comparative study of typically developing children and children with speech sound disorders

2026-04-09T07:07:56+0530

Background: Speech sound disorders (SSD) are among the most prevalent communication disorders in preschool-aged children; however, empirical data characterizing connected speech performance in native Nepali-speaking children with SSD remain absent from the international literature. Connected speech analysis offers an ecologically valid complement to conventional single-word assessment paradigms, yet no published normative or comparative framework exists for this population. Objective was to compare connected speech accuracy, operationalized through the percentage of syllables correct (PSC) metric, between typically developing children (TDC) and children with SSD among native Nepali-speaking preschoolers aged 4–5 years.

Methods: A comparative cross-sectional design was employed. Participants (n=30) were native Nepali-speaking children aged 4;0 to 5;00 years recruited from a preschool (TDC; n=15) and clinical setting (SSD; n=15) in Kathmandu. Connected speech samples were elicited via a structured sentence repetition task based on the culturally familiar "thirsty crow" narrative, supported by ten illustrated picture stimuli. PSC was calculated from broad phonetic transcription conducted by a qualified speech-language pathologist with expertise in Nepali phonology. Inter- and intra-rater reliability were established. Group differences in PSC were examined using the Mann–Whitney U test following confirmation of non-normality via the Shapiro–Wilk test.

Results: TDC achieved a mean PSC of 93.58% (SD=6.65), reflecting near-ceiling syllable accuracy. Children with SSD demonstrated substantially reduced performance (mean PSC=63.14%; SD=8.62). The Mann–Whitney U test revealed a highly significant between-group difference (U=0.000, Z=−10.887, p<0.001), with complete absence of distributional overlap.

Conclusions: PSC derived from a structured connected speech task demonstrated high discriminative sensitivity in distinguishing TDC from children with SSD in a Nepali-speaking preschool population. These findings support routine integration of connected speech analysis into early speech-language assessment and provide preliminary normative data for an underrepresented linguistic group.

Correlation of adenoid hypertrophy with impedance audiometry findings in children under twelve

2026-05-26T07:08:41+0530

Background: Adenoid hypertrophy is a common cause of nasal obstruction, hearing impairment, and otitis media with effusion (OME) in children. Accurate evaluation of adenoid size and its relationship with middle ear status is essential for appropriate management.

Methods: This cross-sectional observational study included 80 children aged 2–12 years presenting with symptomatic adenoid hypertrophy. Adenoid size was assessed using radiological methods and nasal endoscopy. Endoscopic evaluation was performed using the Adenoid-Choanal-Eustachian (ACE) grading system. Middle ear status was evaluated using impedance audiometry, and tympanogram patterns were correlated with adenoid size and endoscopic findings.

Results: A significant correlation was observed between increasing grades of adenoid hypertrophy and the incidence of OME. Among patients with Grade 2 hypertrophy, 75% had OME, while 90% of those with Grade 3 hypertrophy were affected. Bilateral type B tympanograms, indicative of middle ear effusion, were seen in 33.33% of Grade 2 cases and 55.56% of Grade 3 cases. Nasal endoscopy using the ACE grading system demonstrated a 100% correlation with Type B tympanograms in cases where adenoid tissue abutted the Eustachian tube.

Conclusions: Higher grades of adenoid hypertrophy are strongly associated with OME. The ACE grading system is a reliable tool for predicting Eustachian tube involvement. A combined approach using nasal endoscopy and impedance audiometry improves diagnostic accuracy and supports standardized management in pediatric patients.

Efficacy of rabeprazole-based therapy in laryngopharyngeal reflux disease: a prospective comparative study

2026-05-26T07:08:40+0530

Background: Laryngopharyngeal reflux disease (LPRD) is a common condition presenting to otolaryngology clinics, yet the role of proton pump inhibitors in treatment remains controversial. This study aimed to evaluate the efficacy of proton pump inhibitor therapy combined with alginate and lifestyle modifications in managing LPRD.

Methods: A prospective, comparative interventional study was conducted at a tertiary care hospital from August 2023 to April 2025. One hundred twenty patients aged 18-80 years with clinically diagnosed LPRD (Reflux Symptom Index ≥13, Reflux Finding Score ≥7) were randomly assigned to case and control groups (n=60 each). The case group received rabeprazole 20 mg twice daily, domperidone 10 mg twice daily, alginate 10 ml three times daily, and lifestyle modifications. The control group received identical treatment except rabeprazole. Primary outcomes were changes in RSI and RFS after 6 weeks of treatment. Statistical significance was evaluated with p-values.

Results: Both groups showed significant baseline comparability. After 6 weeks, the case group demonstrated superior improvement compared to controls. Mean RSI decreased from 20.6±3.5 to 10.5±3.2 in the case group versus 20.8±3.7 to 12.8±2.5 in controls (p<0.001). Mean RFS improved from 11.5±3.6 to 5.8±2.5 in cases versus 11.8±3.5 to 7.7±2.4 in controls (p<0.001). Individual symptoms, including hoarseness (p=0.04) and throat clearing (p=0.012), showed statistically significant improvements favoring the case group.

Conclusions: Proton pump inhibitor therapy with rabeprazole, combined with lifestyle modifications and adjunctive medications, provides superior symptomatic and objective improvement in LPRD compared to lifestyle modifications alone, supporting inclusion of PPIs in first-line LPRD management protocols.

A comparative study of different neck swellings by clinical radiological and pathological findings

2026-05-26T07:06:37+0530

Background: Neck swellings are common clinical conditions encountered by ENT surgeons across all age groups and often present with variable duration of symptoms. This study aimed to classify the different types of neck swellings and assess the diagnostic accuracy of ultrasonography (USG), fine-needle aspiration cytology (FNAC), and computed tomography (CT) in comparison with histopathology. Age and gender distribution were also analyzed.

Methods: This study included patients with neck swellings who underwent appropriate surgical intervention after ethical approval and according to defined inclusion and exclusion criteria. All patients underwent clinical examination, radiological and pathological investigations, and subsequent surgical management. Histopathological examination of excised tissue was considered the gold standard for diagnosis.

Results: A total of 38 patients were included, with ages ranging from 9 to 68 years. There were 27 females and 11 males. The duration of swelling varied, with about 18 patients presenting within 12 months of symptom onset. Compared with histopathology, USG showed a sensitivity of 66.7%, specificity of 92.3%, and diagnostic accuracy of 84.2%. CT demonstrated a sensitivity of 75.0%, specificity of 92.3%, and diagnostic accuracy of 84.0%. FNAC showed the best diagnostic performance, with a sensitivity of 75.0%, specificity of 100%, and diagnostic accuracy of 92.1%.

Conclusions: FNAC was the most reliable diagnostic modality for neck swellings because of its highest specificity and accuracy. CT was a useful adjunct, particularly where FNAC facilities were limited. USG, although valuable as an initial investigation, had lower sensitivity and limited usefulness for definitive diagnosis.

Mandibular bone invasion in oral squamous cell carcinoma: diagnostic concordance between radiology and histopathology

2026-05-26T07:06:36+0530

Background: Oral squamous cell carcinoma (OSCC), constituting 90% of oral cancers, frequently invades the mandible, complicating staging, prognosis, and surgical planning. Contrast-enhanced CT (CECT) is vital for detecting bone invasion and guiding management.

Methods: A retrospective study was conducted on patients diagnosed with OSCC who showed radiological evidence of bone involvement and subsequently underwent surgical intervention between January 2020 and December 2023. Parameters assessed included patient demographics, surgical approach, radiological and histopathological bone involvement, tumor and nodal staging, recurrence patterns, distant metastasis, and adjuvant therapy received.

Results: The study included 74 patients, with a male predominance (65 males, 87.83%; 9 females, 12.16%). The mean age was 54.66±0.49 years, and the median follow-up period was 6 months. In 66 out of 74 patients (89.28%), radiological findings were consistent with histopathological confirmation, supporting the diagnostic reliability of contrast-enhanced computed tomography (CECT). Among the 55 patients who received radiotherapy, local recurrence occurred in 16.4%, while regional and loco-regional recurrences were comparatively lower.

Conclusions: This study highlights a strong agreement between radiological and pathological evaluations in identifying bone involvement in oral carcinoma, affirming the utility of CECT as an effective, non-invasive diagnostic tool.

Impact of functional endoscopic sinus surgery on pulmonary function, sleep quality, and sinonasal quality of life in sinonasal polyposis patients

2026-05-26T07:06:35+0530

Background: To compare pulmonary function, sleep quality, and sinonasal quality of life parameters in patients undergoing conservative management and those undergoing post-functional endoscopic sinus surgeries (FESS).

Methods: A total of 60 patients were included in the study, 30 in each group i.e. medically managed labelled as Group 1 and surgically managed labelled as Group 2 and the groups were matched evenly taking care of different variables. Lund-Mackay endoscopic score and radiological score pre- and post-operatively were obtained. Spirometry was done 1 week before surgery and at postoperative 6 weeks. Endoscopic sinus surgery was performed under general anaesthesia. Nasal packing was removed 24 hours postoperatively and discharged on post-op day 1. Follow-up was done at the 1^st, 3^rd, and 6^th post-op weeks. SNOT 22, PSQI, and PFT were repeated at the end of 6 weeks.

Results: There was significant improvement in PSQI score in medically managed patients but not much difference was seen in SNOT 22 score. A significant difference statistically was seen in both PSQI and SNOT 22 scores of surgically managed patients. Patients managed with maximal medical therapy showed improvement in FEV1/FVC after 6 weeks but it was not significant statistically, whereas patients who underwent surgery had statistically significant improvement in all three values of FEV1, FVC, and FEV1/FVC.

Conclusions: By employing pulmonary function tests (PFT), the research unveils objective evidence of underlying lower airway involvement in CRSwNP patients, even in the absence of overt clinical symptoms.

Assessment of hearing loss in type II diabetes mellitus individuals

2026-05-26T07:06:34+0530

Background: Diabetes mellitus is a chronic metabolic disorder associated with multiple microvascular and neuropathic complications. Emerging evidence suggests that diabetes may also affect the auditory system, leading to sensorineural hearing loss. The present study aimed to evaluate the incidence and severity of hearing loss in patients with type 2 diabetes mellitus and to assess its association with disease duration and glycemic control.

Methods: This prospective observational study was conducted in the Department of Otorhinolaryngology at a tertiary care center over a period of 24 months (January 2023–January 2025). A total of 60 subjects were included, comprising 30 patients with type 2 diabetes mellitus of more than five years’ duration and 30 age- and sex-matched non-diabetic controls. All participants underwent detailed clinical evaluation and hearing assessment using pure tone audiometry. Hearing loss was classified according to World Health Organization criteria. Statistical analysis was performed using Student’s t-test and chi-square test, with p<0.05 considered statistically significant.

Results: Hearing loss was more prevalent among diabetic patients compared with controls. High-frequency sensorineural hearing loss was the most common pattern observed. A significant association was found between hearing impairment, longer duration of diabetes, and elevated HbA1c levels.

Conclusions: Type 2 diabetes mellitus is associated with an increased prevalence of sensorineural hearing loss. Longer disease duration and poor glycemic control contribute to greater severity of hearing impairment. Routine audiological screening may facilitate early detection and management.

Clinical spectrum of foreign bodies entrapped in ear, nose, and throat, in a tertiary care centre, Coimbatore

2026-05-26T07:06:13+0530

Background: Foreign bodies (FB’s) lodged in the ears, nose, and throat are common issues encountered by clinicians. The aim was to analyze the clinical spectrum of FBs entrapped in ear, nose, and throat methods of removal, outcomes and complications encountered in a tertiary care hospital.

Methods: A cross-sectional study carried out in a tertiary care center, from March 2021-June 2022 (all patients seeking emergency care for ENT FBs, visiting the Emergency Department, Otorhinolaryngology Department were included). ENT examination was done thoroughly for all the cases and relevant radiological investigations necessary for detecting the anatomical site, in cases of inaccessible areas, were taken.

Results: A total of 55 patients were included in this study among which the major proportion of the FB impactions were found in children <5 years of age. The most common site of FB lodgment was the hypopharynx and upper esophagus (n=25, 45.4%) and the most found objects were inert objects (n=23, 41.8%). The most common foreign body in oropharynx is fish bone, in hypopharynx and esophagus is chicken bone, in larynx and tracheobronchial tree is fish bone. In this study, FB was mostly removed using esophagoscopy.

Conclusions: Foreign bodies entrapped in the ear, nose, and throat most commonly occur in children <5 years. Early presentation with proper intervention reduces the rate of complications and the duration of hospital stay. Direct removal is the mainstay of treatment; however, in inaccessible areas where proper visualization cannot be achieved, radiographs followed by otoendoscopy, nasal endoscopy, laryngoscopy, bronchoscopy, and esophagoscopy are recommended depending on the clinical scenario.

Preoperative high-resolution computed tomography temporal bone evaluation in patients with chronic otitis media-squamous disease and its correlation with intraoperative findings

2026-05-26T07:06:10+0530

Background: Chronic otitis media (COM) with squamous disease is a significant cause of morbidity and may lead to serious intratemporal and intracranial complications if not adequately evaluated. High-resolution computed tomography (HRCT) of the temporal bone plays a key role in preoperative assessment; however, its diagnostic accuracy requires validation with intraoperative findings. Objectives were to evaluate the diagnostic accuracy of HRCT temporal bone in patients with COM-squamous disease and to correlate radiological findings with intraoperative findings.

Methods: This was a hospital-based observational study conducted on 55 patients diagnosed with COM-squamous disease who underwent HRCT temporal bone followed by surgical management. HRCT findings regarding disease extent and bony erosion were compared with intraoperative findings, which were considered the gold standard. Diagnostic performance parameters including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results: HRCT demonstrated high sensitivity (96.3%) in detecting disease involvement, with a specificity of 50.0%. The PPV and NPV were 86.7% and 80.0%, respectively. Good correlation was observed between HRCT and intraoperative findings for major bony structures and ossicular erosion. However, reduced accuracy was noted in assessing smaller structures such as the stapes, facial canal, and lateral semicircular canal.

Conclusions: HRCT is a valuable preoperative imaging modality in COM-squamous disease, demonstrating high sensitivity and good correlation with intraoperative findings. Despite limitations in soft tissue differentiation and evaluation of small structures, HRCT remains an essential tool for surgical planning; adjunctive imaging such as MRI may be useful in selected cases.

Risk stratification of hoarseness of voice: impact of lifestyle factors, symptom duration, and occupation on malignancy

2026-05-26T07:06:02+0530

Background: Hoarseness of voice is a common clinical presentation with causes ranging from benign conditions to laryngeal malignancy. Early identification of high-risk patients is essential for timely diagnosis and improved outcomes. This study evaluated occupational and lifestyle predictors of malignancy in patients presenting with hoarseness of voice.

Methods: A retrospective analytical study was conducted on 60 patients presenting with hoarseness of voice over a two-year period. Clinical and demographic variables including age, sex, residence, occupation, symptom duration, and addictive habits were analysed. Patients were categorized into malignant and non-malignant groups. Associations were assessed using Chi-square test and logistic regression analysis.

Results: Among 60 patients, 21 (35%) had malignant lesions. Malignancy was more common in males, patients above 40 years, and those from rural areas. Combined addictive habits (smoking with alcohol consumption) showed a strong association with malignancy (OR 8.9, p<0.001). Symptoms lasting more than 3 months were also significantly associated with malignancy (OR 7.0, p=0.006). Multivariate analysis identified combined addictive habits (AOR 7.8, p=0.001) and prolonged symptom duration (AOR 6.2, p=0.004) as independent predictors.

Conclusions: Malignancy in patients with hoarseness of voice is strongly associated with combined addictive habits and delayed presentation. Early evaluation of persistent hoarseness, especially in high-risk individuals, is essential for timely diagnosis and improved outcomes.

Temporomandibular joint arthroplasty with tragal cartilage graft in the excision of a ganglion cyst herniating into the external auditory canal: a case report

2026-05-26T07:06:39+0530

Ganglion cysts of the temporomandibular joint (TMJ) are rare, and extension into the external auditory canal (EAC) is uncommon. These lesions may present with otologic symptoms such as aural fullness, conductive hearing loss, and visible protrusion into the canal. We present the case of a 63-year-old man with a 24-month history of preauricular pain, aural fullness, and conductive hearing loss. Clinical examination and otoscopy revealed a translucent mass obstructing more than 50% of the left EAC. Imaging demonstrated a 6 mm bony defect of the anterior EAC wall communicating with the TMJ. Surgical excision was performed through a preauricular approach, followed by reconstruction of the defect with an autogenous tragal cartilage graft. Histopathology confirmed a benign ganglion cyst. Postoperatively, the patient achieved complete resolution of symptoms and normal mandibular function, with no recurrence at 1-year follow-up. TMJ ganglion cysts with EAC extension are rare but should be considered in the differential diagnosis of EAC masses. Reconstruction with autogenous tragal cartilage provides effective anatomical restoration and symptom resolution.

A congenital accessory skin appendage of the nasal columella: a rare anatomical variation

2026-05-26T07:06:38+0530

An accessory skin appendage of the nasal columella is among of the rare congenital malformation of the nose. Still there are few cases reported in the literature. Here, we present a case of a patient with a congenital polypoid mass on the nasal columella. The lesion was unilateral and appeared as a skin- colored tag. The location was upper lateral border of the columella. The location corresponds to the migration route of the medial nasal process during week 4-7 of embryological development. However, there is few proposed pathophysiology or distribution of accessory skin appendages of the nasal columella in the literature. We present a simple, comprehensive pathophysiology based on embryological development. We present a case of a protruding skin appendage of the nasal columella. The lesions were present from birth with no familiar history of similar conditions. The lesions were located on the upper lateral borders of the nasal columella and underwent surgical excision under general anesthesia with no signs of recurrence after 9 months of follow up. Any default occurs during the migration process of embryonic development may result in congenital anomaly. If an obstacle or injury occurs during the medial migration of the medial nasal process, congenital remnant tissue may remain along the migration route, resulting in an accessory skin appendage of the nasal columella.

Awake tracheostomy and caesarian section for full term female with Ludwig’s angina

2026-05-26T07:06:38+0530

Pregnancy is associated with physiologic and immunologic changes that increase the risk of odontogenic infections and their progression to life-threatening conditions such as Ludwig’s angina. Ludwig’s angina, a rapidly progressive cellulitis of the floor of mouth and contiguous spaces, can compromise the airway and requires urgent multidisciplinary management. We present the case of a 32-year-old woman at 36 weeks of gestation who presented with progressive neck swelling, trismus, and dyspnea due to Ludwig’s angina. Given acute airway compromise and inability to tolerate supine positioning, an awake tracheostomy was performed under local anesthesia in a semi-seated position. After securing the airway, urgent cesarean section was completed with delivery of a healthy infant, followed by incision and drainage of the neck abscess. The patient recovered well on intravenous antibiotics, resumed breastfeeding on postoperative day one, and was decannulated by postoperative day 14. This case highlights the elevated risk of severe odontogenic infections in pregnancy, the physiologic changes that further compromise airway reserve, and the importance of prompt multidisciplinary decision-making. Awake tracheostomy, though rarely reported in pregnancy, may be lifesaving when fiberoptic intubation is unavailable, and can facilitate subsequent obstetric and surgical interventions to achieve successful maternal and neonatal outcomes.

Iatrogenic nasolacrimal duct obstruction: an unforeseen outcome of naso-orbito-ethmoid fracture surgery

2026-05-26T07:06:35+0530

Nasolacrimal duct obstruction can arise as a complication following naso-orbito-ethmoid (NOE) fractures, either due to bone fragments affecting the lacrimal apparatus or as a result of improperly placed implants during reconstructive surgeries. This case report describes a patient who underwent surgery for an NOE fracture with the placement of screws and plates, subsequently presenting with epiphora. The patient underwent endoscopic dacryocystorhinostomy (EDCR) without prior radiological imaging, and a screw was identified in the lacrimal bone during the procedure. Given that radiological imaging is not routinely conducted in all patients scheduled for EDCR, this report discusses the importance of preoperative imaging, particularly for patients with a history of orbital facial reconstruction. The potential benefits of prophylactic silicone stent intubation in patients with orbital facial injuries are also explored.

Allergic fungal rhinosinusitis leading to catastrophic multiple ischemic strokes: a case report

2026-05-26T07:06:11+0530

Allergic fungal rhinosinusitis (AFRS) is a non-invasive subtype of chronic rhinosinusitis. Although bone erosion and cerebrovascular involvement are rare, they may lead to severe complications. Standard management includes endoscopic sinus surgery and perioperative systemic corticosteroids. We describe a case of a 38-year-old immunocompetent man presenting with a 3-month history of nasal obstruction and progressive frontotemporal headache without fever or neurological deficits. Imaging revealed a large expansile sphenoid lesion with bone erosion and parasellar extension. Despite surgery and broad medical therapy, he developed multifocal ischemic events. Histopathology confirmed AFRS, and Aspergillus fumigatus was isolated; other microorganisms were excluded. His condition deteriorated, and he died 37 days after presentation. This case illustrates the rare but life-threatening potential of AFRS, particularly with sphenoid involvement. Although limited by its single-case design, it highlights the need for early recognition and intervention, as progression to fulminant forms may occur.

The great mimicker: a case of neck pilomatricoma masked as submandibular gland

2026-05-26T07:06:16+0530

Lateral neck swelling is common in general population usually it could be from the salivary gland mass namely parotid or submandibular gland. It could also be cervical lymphadenopathy. However, in this case a rare finding was discovered. We report a case of a 12-year-old boy presented with right cervical neck swelling which increase in size over the past 4 weeks and associated with pain. Clinically it measures 2×2 cm located at right lower cheek close to submandibular gland region. Excision biopsy was performed. The microscopic description showed multiple pieces of tissue, many are composed of basaloid cells that show abrupt keratinisation without granular layer into ghost cell. Other pieces show multinucleated giant cell of foreign body type reaction. The final diagnosis is pilomatricoma. This is a benign skin tumour derived from the hair matric. It is relatively uncommon and typically occur on the scalp, face and upper extremities. Although it rare to occur at the submandibular region medical professional should be alert and aware that one of the differential diagnoses for the subcutaneous lateral neck mass could be a pilomatricoma.

Use of trans-nasal humidified rapid insufflation ventilatory exchange in a post-pneumonectomy patient undergoing injection laryngoplasty: a case report

2026-04-01T07:29:02+0530

Post-pneumonectomy patients present significant anesthetic challenges because of severely reduced pulmonary reserve, altered ventilation-perfusion relationships, and limited tolerance to apnea. Airway procedures requiring a shared field further complicate management. We describe the perioperative management of a 40 years old patient with prior left pneumonectomy who presented with hoarseness of voice secondary to left recurrent laryngeal nerve palsy caused by tumor encasement. The patient underwent injection laryngoplasty using filler material under general anesthesia with trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) as the primary oxygenation strategy. THRIVE provided effective oxygenation, a tubeless surgical field, and avoidance of positive pressure ventilation in a single-lung patient. This report highlights the physiological considerations in post-pneumonectomy patients and discusses the advantages and limitations of THRIVE compared with microlaryngeal tube ventilation, jet ventilation, and conventional apneic oxygenation.

A dark intruder – primary oral mucosal melanoma

2026-05-19T07:13:02+0530

Oral mucosal melanoma is an infrequent and rapidly progressive malignancy, accounting for approximately 0.5% among all oral cancers, and is associated with poor prognosis. It is frequently detected at an advanced stage, often with involvement of regional lymph node, due to its rapid progression and painless initial phase. The primary treatment is surgical excision, often followed by adjuvant radiotherapy, chemotherapy, or immunotherapy which lowers the risk of recurrence and distant metastasis. In this article, we describe a patient with oral mucosal melanoma of the left superior gingivobuccal sulcus, managed with palliative radiotherapy followed by chemotherapy due to inoperability and financial constraints. A brief review of the literature is also included.

Lymphoepithelial cyst in submandibular region

2026-05-26T07:08:42+0530

The lymphoepithelial cyst is a rare, benign, soft tissue, unilocular or multilocular developmental cyst in the head and neck region. It is seen to occur in the salivary glands (parotid>submandibular gland) and oral cavity (floor of mouth/tongue). Among various investigations, FNAC provides immediate diagnosis whereas ultrasonography and CT scan can also be used. The confirmatory diagnosis is always made postoperatively by histopathological examination. Surgery is the mainstay of treatment which includes complete enucleation of the cyst along with total excision of the involved salivary gland. This rare case has been reported to help clinicians bring lymphoepithelial cyst into their differential diagnosis for lesions affecting the submandibular region.

Basaloid variant of squamous cell carcinoma of the larynx: a rare and aggressive subtype with subglottic extension

2026-05-26T07:08:41+0530

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of oral squamous cell carcinoma (OSCC) that was first identified as a separate histopathological entity. It is regarded as a high-grade tumour with increased propensity for metastasis to distant sites. The histological hallmark of BSCC is its dimorphic pattern of presentation with a characteristic basal cell component associated with a squamous cell component. It was included in the revised edition of the World Health Organization (WHO) classification in 1991. In general, it has a predilection for affecting the head and neck region, particularly the upper aerodigestive tract, i.e., larynx and hypopharynx. In the oral cavity, BSCC has commonly been reported in the tongue, though it has been described in other locations such as floor of the mouth, palate, retromolar trigone, and gingival mucosa. Herein, this report presents a case of BSCC arising in the supraglottis with extension into the subglottic and hypopharynx.

A rare otorhinolaryngologic cause of Collet-Sicard syndrome

2026-05-26T07:08:38+0530

The Collet-Sicard syndrome (CSS) is a rare clinical condition with unilateral palsy of lower cranial nerves IX, X, XI and XII without sympathetic involvement. This was first described by Frederic Collet. Primary or metastatic neoplasms or vascular diseases are the usual causes of CSS. Infection is a very rare cause of CSS. Skull Base Osteomyelitis (SBO) is a rare, complex, and fatal infection of the skull bones that commonly involves parts of the temporal, sphenoid, and occipital bones. The disease was first described in 1959 by Meltzer and Keleman. Malignant otitis externa (MOE) is the most common cause of SBO, particularly in temporal regions. Here we report a case of collet Sicard syndrome due to skull base osteomyelitis resulting from an otogenic infection, malignant otitis externa. This case report aims to create awareness of such a neurologic condition and also the importance of early suspicion, diagnosis and treatment of skull base osteomyelitis to prevent such complications.

A rare case of plexiform ameloblastoma of right maxillary sinus

2026-05-26T07:06:28+0530

Plexiform ameloblastoma is a benign odontogenic neoplasm characterized by locally invasive growth and high recurrence rate with incomplete resection. Plexiform ameloblastomas in the sinonasal tract, particularly the maxillary sinus, are exceptionally rare, comprising about 0.11% of sinonasal tumors, with a male predilection and later presentation age (mean 59.7 years) compared to jaw variants. A 40-year-old male presented with recurrent epistaxis and on examination revealed a reddish nasal mass. Initial CT suggested a right maxillary mucocele or low-grade neoplasm. FESS with total excision of the friable mass was done. Histopathology reported plexiform ameloblastoma. At 2-year follow-up, MRI revealed a recurrent 3.9×3.2×3.6 cm lesion with bony erosion, for which right infrastructural maxillectomy was done followed by obturator placement. The patient remains disease-free on subsequent follow-up. While conservative FESS may suffice initially, complete resection via maxillectomy is crucial to prevent early recurrence (typically 1-2 years post-surgery). Complete surgical excision offers excellent prognosis for sinonasal Plexiform Ameloblastoma, with long-term follow up necessary due to local aggressiveness. This case underscores the value of histopathology and serial imaging in management.

Hidden in the plexus: a case of brachial plexus schwannoma

2026-05-26T07:06:26+0530

Schwannomas are benign, encapsulated, and slow-growing tumors that arise from Schwann cells of peripheral nerves. Although these tumors most commonly involve cranial nerves, brachial plexus schwannomas are rare and often misdiagnosed as other supraclavicular masses. We present the case of a 41-year-old male with a right-sided neck swelling, later diagnosed as a brachial plexus schwannoma. The patient underwent complete surgical excision with preservation of the surrounding neural structures and achieved good recovery. This case highlights the importance of including brachial plexus schwannoma in the differential diagnosis of supraclavicular swellings and discusses the challenges and outcomes of surgical management.

Nontuberculous mycobacterial parotitis in an elderly woman with Sjögren’s syndrome and diabetes mellitus: a case report

2026-05-26T07:06:24+0530

Nontuberculous mycobacterial infection of the parotid gland is rare in adults and poses a diagnostic dilemma due to its non-specific presentation and resemblance to bacterial parotitis or neoplastic condition. Coexisting autoimmune salivary gland disease may further obscure diagnosis. We report a case of an elderly woman who presented with a progressive, painful left parotid swelling refractory to multiple courses of antibiotics. Imaging revealed multiple intraparotid micro-abscesses and fatty degeneration of other salivary glands, prompting evaluation for an autoimmune disorder. Sjögren’s syndrome was confirmed serologically, and diabetes mellitus was newly diagnosed. Fine-needle aspiration demonstrated acid-fast bacilli, with cultures confirming Mycobacterium abscessus. The patient was successfully treated with prolonged, targeted combination antimicrobial therapy, resulting in clinical resolution. NTM infection should be considered in refractory parotid infections, particularly in the presence of underlying autoimmune or metabolic comorbidities. Early microbiological diagnosis enables appropriate therapy and may prevent unnecessary surgical intervention.

Schwannoma of the tongue: a case report and review of literature

2026-05-26T07:06:19+0530

Schwannomas are rare slow growing benign tumors arising from Schwann cells lining the nerve sheaths of myelinated nerves. Only 25 to 48% of the cases occur in the head and neck region with only 1% showing an intraoral origin. We present a case of lingual schwannoma in a 20 year old patient who presented with painless mass on right ventral surface of tongue, which was excised. The final histopathology report revealed a schwannoma. We report this case owing to rarity of disease. Tongue Schwannomas are rare, benign tumors with an excellent prognosis. Histology remains the gold standard for its diagnosis and Malignant transformation is rare after complete surgical excision. Schwannomas should be considered in the differential diagnosis whenever a benign looking mass is seen inside the oral cavity.

An atypical presentation of a case of bilateral malignant otitis externa with bilateral simultaneous facial nerve palsy

2026-05-26T07:06:13+0530

An unusual case of bilateral malignant otitis externa (MOE) with bilateral simultaneous facial nerve palsy is presented. A case report of a 77-year-old male, known diabetic on medication, presented with bilateral otorrhoea, severe otalgia with bilateral facial nerve palsy, was diagnosed as a case of bilateral MOE, was managed with medical management followed by surgical debridement. Bilateral MOE with bilateral simultaneous facial palsy is extremely rare. The patient had severe otalgia due to which he had even ‘suicidal thoughts. Due to extremely severe otalgia and bilateral facial nerve palsy, with no improvement with adequate medical management, he was managed by surgical debridement along with continuation of medications. MOE presents with otorrhoea, otalgia, granulation tissue in external auditory canal and occasionally cranial nerve palsies. Surgical debridement along with medical management in this case has fastened the recovery and resolved his symptoms.

Awake airway management for retrograde injection laryngoplasty in a high-risk oncologic patient with severe trismus: a case report

2026-05-19T07:13:00+0530

Advanced head and neck malignancies often present with complex airway and systemic challenges that critically influence anesthetic management. We report a high-risk patient with carcinoma of the tonsil and widespread metastases who had a prior history of pseudoaneurysm rupture of facial artery treated with embolization, complicated by intra-procedural cardiac arrest, atrial fibrillation, and subsequent dialysis-dependent acute renal failure. The patient later presented with unilateral vocal cord palsy requiring injection laryngoplasty. Severe trismus, compromised pulmonary reserve due to metastatic disease, and underlying cardiac dysfunction rendered general anesthesia particularly hazardous. An awake airway approach using 4% lignocaine nebulization, trans-tracheal block, and dexmeditomidine sedation was employed to maintain spontaneous ventilation while providing optimal procedural conditions. This enabled successful completion of the shared airway procedure using a retrograde technique without complications. This case highlights the importance of individualized anesthetic strategies in high-risk oncologic patients and underscores the value of regional airway anesthesia combined with conscious sedation as a safe alternative to general anesthesia.

Sudden sensorineural hearing loss treatment options: a short literature review

2026-05-26T07:06:33+0530

Sudden sensorineural hearing loss (SSNHL) remains a complex, urgent and challenging condition in otology, often presenting without warning and with limited time for intervention. Time is of the essence. Prompt diagnosis and immediate initiation of treatment are crucial to optimizing hearing recovery and minimizing long-term auditory deficits. Patients must be adequately counselled on the emergency nature of SSNHL and the prognosis, which depends on the underlying etiology and early management. Available literature reinforces the critical role of timely therapeutic strategies in preserving auditory function, preventing permanent disability and enhancing the overall quality of life.

Subtotal petrosectomy: a comprehensive review

2026-05-26T07:06:20+0530

Subtotal petrosectomy (STP) is usually recommended for extensive pathology confined primarily to middle ear and mastoid, particularly for treatment of a large post-surgical cavity. It has been associated with middle ear procedure with blind sac closure of the external auditory canal. The Eustachian tube is obliterated in STP. The cavity is obliterated with autologous abdominal fat soaked in antibiotic ear drops. The extended skull base procedures are also sometimes referred to as STP. Because STP offers the potential for a permanent recovery with radical temporal bone clearing, it makes it possible to treat a wide range of diseases. Additionally, STP has a very low risk of complications when used in conjunction with other surgical procedures. STP has gained popularity during the last few decades, and its indications have expanded as well. When treating a complex case of tympanomastoid cholesteatoma, STP is a very safe and effective surgical treatment since it offers radical clearance, which may result in a permanent cure. STP can also be safely combined with hearing implantation procedure. During cochlear implantation, STP has been demonstrated to be useful for making a sterile, closed-off environment in the middle ear and for providing great visualization.