Ajay M Bhandarkar

“Atypical Suicidal” cut throat injury – A case report

Suicide is one of the leading causes of death in the world. The incidence and pattern of suicide vary from country to country. Cultural, religious and social value plays a vital role. Hanging, poisoning, drowning are the common methods of committing suicide. Suicide by incising ones own throat without hesitation marks remains a rare, and only few cases have been reported in the forensic literature. We present here an unusual and rare case of self-inflicted cut throat injury of a 45-year old ex-military man without tentative cuts over the neck, which has resulted from a curved sharp weapon.

Acute prevertebral abscess secondary to infected pancreatic pseudocyst

We report a case of a middle aged, man with diabetes who presented with dysphagia and odynophagia. On evaluation, he was diagnosed to have an acute prevertebral abscess with an unusual aetiology, an infected pseudocyst of pancreas. Contrast-enhanced CT revealed an enhancing collection in the prevertebral space extending to the retrogastric space and communicating with the body of the pancreas via the oesophageal hiatus. Transoral incision and drainage of the prevertebral abscess were performed. Nasogastric tube was placed in the prevertebral space for continuous drainage and daily irrigation. Supportive intravenous broad spectrum antibiotic therapy along with the surgical intervention led to the resolution of the prevertebral abscess and the infected pancreatic pseudocyst.

Fungus ball in the nasal cavity mimicking a rhinolith.

A 63-year-old man presented to the outpatient department of our tertiary care hospital, with unilateral left nasal obstruction, foul smelling nasal discharge and occasional mild epistaxis. On examination, a hard greyish black mass was noted in the anteroinferior portion of the inferior turbinate, with extension posteriorly into the inferior meatus with surrounding unhealthy granulation tissue. Provisional diagnosis of rhinolith was surprisingly reversed by histopathology, which suggested the presence of an Aspergillus fungus ball with Actinomyces colonisation.

Recurrent angioleiomyoma of the middle turbinate

We present a case of a middle-aged woman with a history of not only progressive nasal obstruction, facial pain, hyposmia and epistaxis, but also excision of the nasal mass diagnosed as a vascular leiomyoma. On examination, a smooth bulge was seen over the middle turbinate. Surgical excision along with histopathology and immunohistochemistry revealed a diagnosis of recurrent vascular leiomyoma of the middle turbinate.

Neonatal lingual choristoma with thyroid hemiagenesis.

A 45-day-old infant presented with choking spells and cyanosis. Examination revealed a lingual cyst. Contrast-enhanced CT confirmed the diagnosis of lingual cyst with incidental thyroid hemiagenesis. The child underwent excision of the lesion, which was reported as lingual choristoma.

Amelanotic malignant melanoma of the cervical oesophagus

We report the case of a young woman who presented with progressive dysphagia and swelling in the anterior aspect of the neck of short duration. On evaluation, she was diagnosed with amelanotic malignant melanoma of the cervical oesophagus. She underwent total laryngopharyngo-oesophagectomy with gastric transposition with bilateral modified radical neck dissection with feeding jejunostomy and a permanent tracheostomy with postoperative combined chemoradiation therapy. However, in spite of aggressive treatment, the patient expired 8 months after initial presentation with distant metastasis.

Incidental ‘ethmoid sinolith’—an unusual cause of frontal recess obstruction

We report a case of a middle aged, hypertensive man who presented with nasal obstruction, sneezing spells, headache and nasal discharge of long duration. On evaluation, he was diagnosed to have a deviated nasal septum with allergic rhinosinusitis with sinonasal polyposis. CT of the paranasal sinuses revealed a hyperdense, oval structure suggestive of a sinolith in the right anterior ethmoid sinus. The patient underwent septoplasty with right Draf 2B procedure and extraction of the sinolith from the ethmoid sinus.

Intranasal lobular capillary haemangioma

Lobular capillary haemangioma (LCH) is a benign proliferation of capillaries with a characteristic lobular architecture on microscopy; it has an affinity for mucous membrane and skin of the head and neck. It is extremely rare in the nasal cavity. We present the case of a 45-year-old man who presented with epistaxis without any predisposing factors, which was diagnosed as lobular capillary haemangioma.

Phonomicrosurgery for benign vocal fold lesions using medial-microflap technique with cold instruments in a teaching hospital of India

Background: Phonomicrosurgery is a challenging and evolving field. One of the key techniques used for this is micro-flap technique used along with cold micro instruments. Objective: To convey the role of Microflap technique in phonosurgery and the role of basic microlaryngeal instrumnets in such surgery when sophisticated phonomicrosurgical instruments are not available. Methods: This is a retrospective study of 33 patients of benign vocal fold lesions who have undergone phonomicrosurgery using microflap technique from the year January 2011 to January 2016. Majority of these cases were vocal nodules (16cases) followed by Cyst in the vocal cord (10 cases) and 5 cases of polyps. Results: Cases were analyzed using GRBAS scoring and stroboscopic findings. A significant improvement was noted in the voice outcome of these patients except two cases where endoscopic paraglottic fat injection was done along with hyaluronic acid with steroid infiltration into the Reinke’s space, after which there was improvement in voice. Conclusion: Microflap technique for vocal fold lesion is a unique surgical procedure that allows preservation of vocal cord morphology and at the same time prevents post surgical scarring with excellent voice outcome. ThisThis surgery can be performed with good quality regular microsurgical instruments.

Ganglioneuroblastoma of Skull Base.

Neuroblastic tumours are common in childhood and adrenal glands are the most common site. Head and neck ganglioneuroblastomas are extremely rare and nose is a very uncommon site for a ganglioneuroblastoma. The management of this primitive sympathogonic tumour may vary depending on the age of the patient and stage of the tumour. We present a middle-aged man with a ganglioneuroblastoma of skull base, management of this tumour and a review of literature.