Background: This is a retrospective study of patients who underwent either outpatient department (OPD) clinic or operation theater (OT) procedures between January 2018 and December 2022. The study aims to analyze 5 years of data on the types of procedures performed in a tertiary care hospital in Central India. As the type of procedure is an indirect marker of the pattern of underlying diseases, the study will also determine the impact of COVID-19 waves on the variation of ear, nose, and throat (ENT) subsites involved. The four subsites defined were ear, nose, transoral oral cavity, and neck. Data were obtained from the medical records department, OT register, and OPD procedure register. Results: During this 5-year study period, 15,592 OPD clinic procedures and 3,202 OT complex procedures were performed. Among yearly OPD procedures, videolaryngoscopy (VLS) was common in the years 2018 and 2019, ear examination under microscope (EUM) was common in the year 2020, and diagnostic nasal endoscopy (DNE) was common in the years 2021 and 2022. In totality, the common OPD procedure performed was DNE (5,470) followed by VLS (3,968), EUM (3,368), clinical vertigo evaluation (1,018), and videonystagmography (VNG) (561). In 2018, 2019, 2020, and 2022, the common subsite for surgery was an ear, followed by the nose, transoral and oral cavity, and neck. However, in 2021, nasal surgeries predominated, followed by transoral and ear surgeries. In 5 years, tympanoplasty was the most common individual surgical procedure performed. Conclusion: In 2021, diagnostic nasal endoscopies and nasal surgeries predominated. This documents the unprecedented surge in cases of post-COVID-19 sinonasal mucormycosis. The data on OPD and surgical procedures in 2022 is comparable to pre-COVID-19 data for the years 2018–2019. This documents that we are presently having a similar disease scenario to pre-COVID-19 times.

Objectives: Navigation is a novel technique to aid the surgeon in difficult rhinologic surgeries, such as extensive sinonasal polyposis (SNP), revision surgeries, anatomical variants of the nose and paranasal sinuses, and cerebrospinal fluid leaks. The study aimed to determine the usage of the navigation system for surgeons in functional endoscopic sinus surgery (FESS). Materials and methods: In this study, 60 patients were recruited from KKR ENT Hospital and Research Institute, Chennai, and divided into groups A and B, who underwent FESS with and without image guidance, respectively. Patients with chronic rhinosinusitis (CRS) with sinonasal polyposis (SNP), undergoing revision surgery for recurrent SNP sinonasal tumors (SNT), and frontal sinus disease (FSD) were recruited. Lund-Mackay pre- and postoperative endoscopic scores and Sino-Nasal Outcome Test-22 (SNOT-22) scores were analyzed. Computed tomography (CT) scans of the nose and paranasal sinuses were conducted. The patients were subjected to FESS, and following evaluation and affordability, navigation assistance (Fusion Compact Medtronic Navigation System) was used. During the follow-up period, nasal endoscopy was done and postoperative endoscopic scores were calculated along with the SNOT-22 scores. Results: The pre- and postoperative endoscopic and SNOT-22 values between groups A and B were not significantly different. Intraoperative complications were encountered only in group B, with more recurrences, suggesting a substantial advantage for patients in group A over group B. The correlation between the use of navigation and patient outcomes was significantly different (p < 0.05). Conclusion: Using the navigation system is an advantage for skilled surgeons to identify the boundaries of anatomical structures with greater accuracy and precision.

Pleomorphic adenoma rarely arises from the minor salivary glands. It has been reported at various sites where minor salivary glands are found, including the nasal cavity, oral cavity, nasopharynx, oropharynx, larynx, hypopharynx, trachea, and even lacrimal glands. In the nasal cavity, it usually arises from the minor salivary glands of septal mucosa. Intranasal pleomorphic adenoma may be misdiagnosed because it has high myoepithelial cellularity and fewer myxoid stroma compared to those arising from other sites. We report a case of pleomorphic adenoma in the nasal septum of an elderly woman who was treated for olfactory neuroblastoma 25 years ago. She presented with epistaxis from the left nostril for the last 4 months. Diagnostic nasal endoscopy showed a fleshy growth with crusting attached to the anterior nasal septum. She was evaluated elsewhere, and the histopathology report was suggestive of olfactory neuroblastoma. The slide review at our center was suggestive of pleomorphic adenoma, and immunohistochemistry (IHC) was positive for cytokeratin and p63 and negative for synaptophysin. Her case was discussed by a multidisciplinary team (MDT), and she underwent excision of the lesion with wide surgical margins using a lateral rhinotomy approach. Though pleomorphic adenoma from the septum is rare, it should be kept in mind while evaluating unilateral nasal obstruction/epistaxis in middle-aged patients.

Aim and background: Sarcomatoid squamous cell carcinoma (SSCC) is a rare malignant variant of SCC. Here, we present a rare case of primary cutaneous SSCC of the scalp. Case description: We present a case of a 68-year-old male with a very large pedunculated left scalp mass, first noted several years ago, with rapid expansion of the mass 6 months prior to presentation. The mass was mobile of the cranium and without calvarial involvement. He successfully underwent a wide local excision of the mass with no evidence of recurrence at his 6-month follow-up visit. Conclusion: This case of primary scalp cutaneous SSCC represents a rare head and neck site of involvement. Due to the rarity of primary cutaneous SSCC and very few reports of primary cutaneous SSCC arising in the head and neck, management is guided by case series of SSCC arising in other sites. Surgical resection is the recommended primary modality of treatment, with or without regional lymphadenectomy. Adjuvant radiation therapy may be considered for larger tumors, positive lymph nodes, older age, and high-risk features. Due to the concern for a potentially high rate of recurrence, close follow-up is essential. Clinical significance: Sarcomatoid squamous cell carcinoma is a rare malignant variant of SCC that presents a significant diagnostic challenge, as it shares morphologic and immunohistochemical overlap with other spindle cell tumors. While the majority of SSCC of the head and neck occurs in mucosal sites such as the larynx, the scalp remains an extremely rare presentation, with only a few reported cases in the literature. This review of the literature and case report presents an additional case of primary cutaneous SSCC involving the scalp.

Surgical management of oral cancer in a patient with severe comorbidities can pose many difficult challenges to the surgical team. A 48-year-old male patient who was suffering from long-standing, advanced ankylosing spondylitis (AS) presented with oral cancer. On evaluation, the tumor in the left buccal mucosa was found to be keratinizing squamous cell carcinoma of stage IVA [American Joint Committee on Cancer (AJCC)–tumor, node, metastasis (TNM) staging] and was planned for surgical resection. Due to AS, the patient's trunk and neck movements were severely restricted, along with trismus and restricted jaw movements. Surgical intervention under general anesthesia in such patients is associated with a substantial risk of spinal injury. The trismus and fixity of the neck rendered an exceedingly difficult surgical position for both the anesthesiologist and the head and neck surgeon. The anesthesiologist was successful in establishing a secured airway by performing awake bronchoscope-guided nasotracheal intubation. The neck of the patient had to be supported by pillows instead of a routine neck extension position used for neck dissections. Wide excision of the entire tumor with bite resection and left-sided modified neck dissection was conducted without any positional change of the neck. Reconstruction was conducted with the left anterolateral thigh flap. There were no surgery-related complications, and the healing of the surgical wounds was satisfactory. The patient was discharged from ward care after 8 days. The pathological staging was pT3N3b, and starting from the 5th week of postsurgery, the patient received adjuvant chemoradiation over 6 weeks. Despite many difficulties that were encountered during management, the patient was able to withstand and recover well. Ankylosing spondylitis (AS), as a comorbidity in head and neck cancer cases, can pose significant challenges to the surgical team. Although previous surgical experience and skills matter, good preoperative preparation and adapting the techniques to the needs of the patient will help in achieving surgical goals, prevent any complications, and ensure a good outcome for the patient.