International Journal of Head and Neck Surgery

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2021 | January-March | Volume 12 | Issue 1

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Original Article

Nehal R Patel, Pawankumar Sharma

Foreign Bodies in Esophagus: An Experience with Rigid Esophagoscope in ENT Practice

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:5] [Pages No:1 - 5]

   DOI: 10.5005/jp-journals-10001-1401  |  Open Access |  How to cite  | 


Background: Foreign body (FB) ingestion and impaction in the esophagus constitute an important cause of morbidity and mortality worldwide. One-third of foreign bodies retained in the gastrointestinal tract are present in the esophagus and mostly in children require endoscopic removal with rigid esophagoscopy. Aims and objectives: This study seeks to highlight the challenges in the management of esophageal FB using rigid esophagoscopy. It will also evaluate the outcome of management. Their management depends on the anatomic location, shape, size of the foreign body, and duration of impaction. Materials and methods: This was a retrospective study of 60 patients with confirmed esophageal foreign bodies that were managed in the ENT department of SCL Hospital, NHL Medical College, Ahmedabad, from January 2016 to June 2018. Demographic and clinical data were documented, and simple statistical tables were used to illustrate the data. Results: The data of 60 patients were retrieved from ENT emergencies. Fifty (83.33%) patients had radiologic confirmation of foreign bodies in their esophagus, and 10 (16.67%) were further confirmed during esophagoscopy. There were 35 (58.33%) males and 25 (41.67%) females with male:female ratio of 1:1.4. The age range was 1–70 years with a mean of 35 ± 6.88 years. Majority of the foreign bodies, 50 (83.33%), were impacted in the cricopharyngeal sphincter of the esophagus. Dentures ranked highest among the adult population, 15 (25%) cases, while coins ranked highest in the pediatric populations, 20(33.33%) cases. Six (10%) cases presented to the hospital after 72 hours. Complications occurred in 5 (8.33%) cases. Conclusion: The management of impacted esophageal foreign bodies with rigid esophagoscopy was safe, reliable, and an effective procedure despite its challenges.


Original Article

Anuj H Shah, Rupa P Parikh

Clinicopathological Correlation between Depth of Tumor and Neck Node Metastasis in Oral (Tongue and Buccal Mucosa) Carcinoma

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:5] [Pages No:6 - 10]

   DOI: 10.5005/jp-journals-10001-1423  |  Open Access |  How to cite  | 


Aims and objectives: (1) To study the depth of tumor invasion in an oral (tongue and buccal mucosa) carcinoma and its correlation with neck metastasis. (2) To know whether the increase in depth of tumor (depth of invasion) increases the chances of cervical nodal metastasis in the oral tongue and buccal mucosa carcinoma and derive cutoff value of depth of invasion at which the metastasis occurs. Materials and methods: The study was carried out on 14 tongue and 22 buccal mucosa cases to know the correlation between the depth of tumor and neck node metastasis in the oral (tongue and buccal mucosa) carcinoma. Results: Among 36 cases, 10 cases were pN+. Out of 10 cases, 7 (70%) were having depth ≥12 mm and 30% cases (pN+) having depth between 8 and <10. We found it statistically significant and so as the depth of tumor increases the chances of nodal metastasis increases. We found the cutoff for a depth of invasion in both tongue and buccal mucosa carcinomas as 8 out of 22 patients had DOI >10 mm and among them 4 were pN+ and among 14 tongue cases, 3 cases had DOI >8 mm and all of them were pN+. Conclusion: For tongue 8 mm and for buccal mucosa, 10 mm of the depth of tumor invasion was calculated as the cutoff depth, above which the incidence of nodal metastasis increases to 75% and 66.66%, respectively. Clinical significance: Depth of tumor is an important prognostic indicator in the tongue and buccal mucosa carcinoma to know the cervical nodal metastasis. Hence for an increase in depth of tumor cases, neck must be addressed along with primary tumor excision. Radiological investigations [ultrasonography (USG), magnetic resonance imaging (MRI), computed tomography (CT) scan] play an important role in nodal metastasis detection hence should be considered in carcinoma of the oral tongue and buccal mucosa especially in clinically N0 neck.


Original Article

Tejasvi Vemuru, Shiva Priya

Clinical Outcomes of Salivary Gland Tumor Surgery: A 10-year-chart View

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:4] [Pages No:11 - 14]

   DOI: 10.5005/jp-journals-10001-1414  |  Open Access |  How to cite  | 


Background: Salivary gland tumors constitute about 3% of all head and neck tumors. We present a series of 104 cases of various salivary gland pathologies and the various modalities of surgeries done between January 2007 and July 2017. Materials and methods: Total 104 patients with salivary gland tumors were included in this study, of which 76 patients had parotid tumors and 28 were submandibular gland tumors. The presence or absence of coexisting salivary gland stones, involvement or noninvolvement of ducts were all considered. Preoperatively, patients underwent fine needle aspiration cytology (FNAC) and imaging studies along with routine blood investigations. Results: All patients underwent surgery and subsequent histopathological examination (HPE). The preoperative FNAC and postoperative HPE were not correlating in 6.5% of parotid tumors and in 3.5% of submandibular gland tumor. Anomalies in the fasciovenous planes were seen in 3% of the patients, which caused intraoperative difficulties. Postoperatively, five patients had salivary leak and three patients had neuropraxia, which was managed conservatively and the patients recovered subsequently between 3 months and 6 months postoperatively. Conclusion: Surgery for salivary gland tumors has its own threats due to the close proximity of nerve, vessels, and ducts. Postoperative complications like nerve palsy is seen more common in malignant tumors in both parotid and submandibular gland tumors. A proper methodical assessment and awareness of the various anatomical anomalies intraoperatively may give good surgical outcomes in surgeries of salivary gland tumors. In our study, various anomalies were encountered and dealt appropriately.


Original Article

Somu Lakshmanan, Prasanna K Saravanam

Use of Fenestrated Tracheostomy Tubes: A Comparative Study

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:4] [Pages No:15 - 18]

   DOI: 10.5005/jp-journals-10001-1419  |  Open Access |  How to cite  | 


Introduction: Tracheostomy is commonly performed in patients requiring long-term ventilator support. There are many types of tracheostomy tubes like fenestrated and non-fenestrated tubes. This study is to compare the types of fenestrated tubes. Type I is a fenestrated tube with multiple small fenestrae and type II is a fenestrated tracheostomy tube with a single large fenestra. Materials and methods: A total of 87 patients who underwent tracheostomy due to prolonged ventilation from January 2015 to January 2016 were included in the study. Type I tube was used in 40 patients and type II tube was used in 47 patients. Tube change was done on the 10th day, at the end of 1 month, and at the end of 3 months. Flexible laryngoscopy is done during every tube change to assess the airway. Results: Two groups were compared in terms of granulation through fenestra, stomal granulation, frequency of suctioning, and inner tube block. Statistical analysis was done and the values were compared. A p value <0.05 was considered to be statistically significant. There was a statistically significant difference between both groups in terms of less incidence of granulation through the fenestra and stomal granulation in type II tube. Conclusion: Type II tubes are more patient compliant. The incidence of inner tube block is comparatively less which makes it safe to use and avoid life-threatening situations. Decannulation can be done earlier and without complications in patients with type II tubes due to the less incidence of stomal granulation. Thus, type II tube is safer to use and has minimal complications.


Otology Research Article

Marcos V Goycoolea, David D Muchow

Sustained Release of Antimicrobials in the Middle Ear Using a Biodegradable Support: Ototoxicity Studies

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:19 - 21]

   DOI: 10.5005/jp-journals-10001-1409  |  Open Access |  How to cite  | 


Introduction: This study was one more step of a systematic approach for the development of a poly-L-lactic biodegradable support matrix incorporating a therapeutically releasable amount of ampicillin. In vitro studies (3 months) documented the sustained release of therapeutic levels of antimicrobial.1 In vivo efficacy was demonstrated in otitis media-induced chinchillas (S. pneumoniae) and cats (Eustachian tube obstruction).2 Histopathological studies in cats documented a lack of inflammatory reaction from the device itself, and its capacity of being biodegradable.2 Aims and objectives: This step evaluates potential hair damage to this device. Materials and methods: Morphometry of the organ of Corti (hair cell count) was done in 14 chinchillas exposed to these devices for 3 weeks (7 with and 7 without ampicillin). Results: There were no qualitative changes in the stereocilia nor in the cell bodies of hair cells. The morphology of hair cells in the control sides and the sides with the experimental devices is the same. Conclusion: Poly-L-lactic acid biodegradable support matrix incorporating a therapeutically releasable amount of ampicillin does not cause hair cell morphological damage when inserted in the middle ear of chinchillas.


Otology Research Article

Marcos V Goycoolea, Sonia Neubauer, Raquel Levy, Jacqueline Cornejo, Byanka Cagnacci, Catherine Catenacci

Evaluation of Brain Activation (NeuroSPECT) by Uni- and Bilateral Auditory Stimulation in Patients with Conductive Hearing Loss and Bilateral Bone Conduction Devices

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:9] [Pages No:22 - 30]

Keywords: Adequate sound stimulation, Bilateral bone conduction devices, Bilateral conductive hearing loss, Binaural hearing, Early auditory stimulation, Language development, Real-life lateralization test, Sensory deprivation, Sound lateralization tests, Symmetric hearing, Timely stimulation

   DOI: 10.5005/jp-journals-10001-1410  |  Open Access |  How to cite  | 


Background: This prospective study evaluated sound localization and brain responses to monaural and binaural stimulation via bone conduction devices in 3 individuals with bilateral conductive hearing loss (1 acquired and 2 congenital). Aims and objectives: To determine the (1) Cortical areas that are activated with pure tones. (2) Potential benefits of bilateral devices. Materials and methods: A new audiological test is described (real-life lateralization test) and applied. NeuroSPECT studies were done using pure tones delivered via bone conduction devices (Baha Attract) stimulating monaurally and binaurally. The tests were performed 2–4 months after the placement of the second device. Results: The use of unilateral devices as well as bilateral devices under our testing conditions did not improve sound localization. There was improvement in lateralization with bilateral devices. In the three subjects, cortical activation with binaural auditory stimulation with the Baha Attract occurred in the same auditory areas compared with monaural stimulation. However, while in the individual with acquired loss, the degree of activation was less intense in binaural compared to monaural stimulation; in the congenital cases, binaural stimulation resulted in summation of stimuli. Conclusion: In congenital bilateral conductive hearing losses that have not been stimulated early, there are central auditory areas that are deprived. Even if these are only two cases, this is suggestive of the importance of bilateral early auditory stimulation in cases of congenital conductive hearing losses and supportive of the use of bilateral rather than unilateral devices.



Gaurav Ashish, Gaurav Ashish

Malignant Transformation of Chronic Nonspecific Sialadenitis: A Rare Clinical Presentation

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:31 - 33]

Keywords: Cyst, Mucoepidermoid carcinoma, Nonspecific sialadenitis, Parotid

   DOI: 10.5005/jp-journals-10001-1396  |  Open Access |  How to cite  | 


A 26-year-old man presented with a large, painless, mobile, pedunculated, fluctuant, and nontransilluminant swelling hanging in front of the left ear. He had undergone superficial parotidectomy 9 months ago elsewhere for chronic nonspecific sialadenitis of left parotid gland. The fine needle aspiration was nondiagnostic and revealed turbid dark yellow color fluid. A total parotidectomy was performed to remove the lesion completely as the tumor was involving the deep lobe. Histopathology was consistent with features of low-grade mucoepidermoid carcinoma. Immediate postoperatively the patient had a House and Brackman grade III left facial nerve paresis, which later improved to grade II. This unusual presentation of malignant transformation of chronic nonspecific sialadenitis is one of the rare unique reported cases to our knowledge.



Nor Hafiza Qualickuz Zanan, Mawaddah Azman, MH Kong, Mohd Razif Mohamad Yunus

Secret Window to the Parapharyngeal Space: The Transcervical Transdigastric Approach

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:34 - 36]

Keywords: Benign tumor, Cervical, Cervicodigastric, Parapharyngeal space, Surgical approach

   DOI: 10.5005/jp-journals-10001-1400  |  Open Access |  How to cite  | 


Aim: To highlight the transcervical transdigastric approach to the parapharyngeal space. Background: The parapharyngeal space (PPS) contains important neurovascular structures and hence requires meticulous dissection when working with tumors in this space. Surgical access to this blind space is limited, and approach would depend on several factors such as location and extension of tumor, fine needle aspiration cytology (FNAC) report if available, as well as surgeon's preference and experience. There are limited publications describing the transcervical transdigastric approach to tumors in the PPS. Case description: We present two cases of tumor in the PPS that were addressed using the transcervical transdigastric approach. One patient presented with a painless submental mass, while the other had incidental finding of a PPS tumor on computed tomography scan. Both tumors were histologically benign. Conclusion: The transcervical transdigastric approach to the PPS gives adequate exposure to the surgical field of interest and enables complete excision of well-encapsulated PPS tumors. Clinical significance: The transcervical transdigastric approach allows access to the PPS without aggressive dissection, therefore, avoiding the potential morbidity associated with PPS tumor resection.



Kanishka S Rao, Vijendra S Shenoy, Panduranga M Kamath, Anas Gomati

Ectopic Lingual Thyroid: A Case Presentation

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:37 - 39]

Keywords: Thyroid, Thyroid scintigraphy, Tongue base

   DOI: 10.5005/jp-journals-10001-1422  |  Open Access |  How to cite  | 


Background: The lingual thyroid gland is a rare clinical entity that was found to occur due to the failure of the thyroid gland to descend into its normal ectopic pretracheal position during embryogenesis. The reported incidence of lingual thyroid is 1 in 100,000, and it is more common in females, with a female:male ratio of 3:1. When located at the base of the tongue, the ectopic gland is often asymptomatic but may cause local symptoms, such as, dysphagia, dysphonia, upper airway obstruction, hemorrhage, and often hypothyroidism. The diagnosis of lingual thyroid is usually made clinically and radionuclide scanning is used to confirm the diagnosis. A case of lingual thyroid is presented for its rarity and differential diagnosis of midline base of the tongue lesions. Case description: A 35-year-old woman presented with complaints of increasing difficulty in breathing and a constant foreign object sensation in the throat (FOSIT) for the past one year. Flexible video-laryngoscopic examination revealed a well-demarcated midline tongue base lesion measuring 3 × 3 cm. Technetium 99m scan reported it to be ectopic thyroid gland tissue. Transoral excision of the lesion was done along with cauterization with bipolar cautery. Conclusion: Lingual thyroid is a rare developmental anomaly, the treatment of which is still controversial in view of the rarity of the condition. It should be included in the differential diagnosis of midline masses of the base of the tongue, especially in children and adolescents. The approach to treatment should be transdisciplinary and should not only take into consideration the clinical condition of the lesion but also the hormonal aspects of the patient.



Pierre Ferrer, Ana S Álvarez, Juan R Penanes

Cervical Transverse Mega-apophysis: A Rare Cause of Plexopathy

[Year:2021] [Month:January-March] [Volume:12] [Number:1] [Pages:3] [Pages No:40 - 42]

Keywords: Cervical, Plexopathy, Spine, Transverse mega-apophysis

   DOI: 10.5005/jp-journals-10001-1418  |  Open Access |  How to cite  | 


Aim: This article aims to describe the case of a 43-year-old male with a neurogenic thoracic outlet syndrome caused by a C7 transverse mega-apophysis. Background: Cervical transverse mega-apophysis, transverse apophysomegaly, or elongation of the transverse vertebral process represents a variation of normal skeletal anatomy. This variation has been little studied and its prevalence in the population is unknown because it often exists without symptoms. It is estimated that less than 10% of cases are symptomatic. Case description: We present a rare case of a man with a neurogenic thoracic outlet syndrome (in this case, a left plexopathy) caused by a cervical transverse mega-apophysis. After surgical intervention, the patient improved and after a 1-year follow-up, he remained asymptomatic. Conclusion: Even though some authors describe cervical pain associated with this condition, we found very few data regarding plexopathy or other neurological symptoms caused by a cervical transverse apophysomegaly.


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