Indranil Pal

Spectrum of head and neck cancer in children

Aim: To assess the incidence of different head and neck cancers in pediatric age group in a referral hospital. Methods: In this prospective study, children below the age of 12 years underwent a thorough clinical, ENT examination and the diagnosis was conformed histologically in all the cases. Results: Fifty-three were diagnosed to be suffering from different head and neck neoplasms among 21,216 children (0.25%). Male-to-female sex distribution was 1.78:1. The lymphomas were the most common (43.39%) followed by the rhabdomyosarcoma (20.75%) and the nasopharyngeal carcinoma (15.09%). Of the lymphomas, the non-Hodgkins lymphoma was predominant (26.41%). Other lesions were thyroid carcinomas and mucoepidermoid carcinoma of parotid. Conclusions: Malignancy should always be considered in the differential diagnosis of masses in the head and neck region in children.

Benign Calcified Thyroid Cyst With Skin Sinus Formation

Objectives: To present a rare case of calcified thyroid cyst with discharging neck sinus and its probable explanation.

Fourth branchial pouch sinus - an unusually late initial presentation.

ObjectiveHere we present an unusual case of a male patient with 4th branchial pouch sinus with an initial presentation of pseudothyroiditis at an unusually late age of 20 years.MethodCase report and a review of the world literature concerning 4th branchial pouch sinus is presented.ResultThe patient was diagnosed by radiology and endoscopy and treated surgically. Histopathology revealed chronic inflammatory changes, which pointed towards recurrent sub clinical low-grade inflammations over the years keeping the condition occult till 20 years of age.ConclusionAccording to available literature it almost always presents in the first decade of life when it might be misdiagnosed. However our report shows it may also exist with sub clinical inflammations or infections and present at a much later stage in life, when the possibility of such a sinus shouldn’t be ruled out on the basis of lack of history of recurrent neck inflammations.

An attempt to define the type of biopsy in a sinonasal lesion showing bony erosion.

ObjectivesTo present a case of sino-nasal destructive mass initially diagnosed as an inflammatory lesion following punch biopsy from the lesion however the post surgical histopathology was diagnostic of Grade 2 angiocentric immunoproliferative lesion (AIL). The reasons for the initial misdiagnosis are analyzed.Materials and methodsA 76-year-old male patient presenting with progressive bilateral nasal obstruction for 1 year. Repeated punch biopsies from the mass were suggestive of an inflammatory lesion.ResultThe patient underwent surgical exenteration of the mass and the final histopathology report suggested AIL Grade 2. The patient was thereafter treated with chemotherapy and radiotherapy.ConclusionInitial superficial punch biopsies lead to incorrect diagnosis leading to an unnecessary surgical exenteration. The explanations for the initial misdiagnosis are given below and appropriate diagnostic protocols, mode and depth of biopsy are suggested based on the case study.

Iatrogenic injuries leading to suspicion of homicide.

Injuries produced as a result of medical intervention may lead to confusion in certain cases during investigation and postmortem examination. Proper documentation of all interventions with the injuries, if produced, is of vital importance. The present case is a rare case where the iatrogenic injuries produced by a medical practitioner during the course of treatment of a case of suicidal hanging resulted in a suspicion being raised as to the nature of death. The suspicion was further strengthened by the lack of proper documentation and inappropriate/improper use of terminology of medicolegal significance.

Persistent Deciduous Molar as an Etiology for a Maxillary Sinus Mucocele

Mucoceles are accumulations of trapped mucus, forming cystic expansile lesions. Maxillary sinus mucoceles are rare amongst paranasal sinus mucoceles, usually being a late sequel of Caldwell-Luc surgery. We present a case of a maxillary sinus mucocele due to a persistent carious deciduous molar in a middle aged patient, reported to highlight its unusual etiology.

Rhabdomyosarcoma of nose, nasopharynx and paranasal sinuses

Rhabdomyosarcoma is an aggressive malignant soft tissue tumor that arises from primitive striated muscle cells called rhabdomyoblasts. It is the most common soft tissue malignant tumor in children and accounts for about 7–8% of childhood cancers. It can arise from almost anywhere in the body but it is most common in the head and neck region. This article presents six cases of rhabdomyosarcoma involving the nose, nasopharynx and the paranasal sinuses four of which were treated with a combination of radiotherapy and chemotherapy and two were treated with medial maxillectomy combined with chemotherapy and radiotherapy.

Role of early audiological screening and intervention

Objectives: The aim of our study is to find out whether early identification and intervention prevents severe linguistic and communication delays, minimizing the need for more elaborate rehabilitation during the school years. Design and Study Sample: A Cross-sectional study was carried out on one hundred and eleven children with documented deaf-mutism presenting at the Department of Oto-Rhino-Laryngology in two different geographical regions of India. Detailed history, clinical and audiological assessment along with assessment of the language and communication skills according to American Speech Language Hearing Association (ASHA) guidelines was done. Results: The children were predominantly male, of low socio-economic background, presented for rehabilitation, mostly after the age of six years. They commonly had more than 70dBHL (decibel hearing level) hearing threshold. The study found that the children who presented early for diagnosis and hearing aid usage had better response to rehabilitation. Conclusion: It is important that hearing loss be detected at an early age and amplification should be introduced as early as possible once there has been a diagnosis of a hearing loss. So that early intervention can have an impact on speech and language development. Without concurrent follow-up program, identification of hearing loss early in children is meaningless.

Surgical management of bilateral abductor paralysis by extralaryngeal approach

Paralysis of the abductors of both vocal cords causes the vocal cords to lie in the midline or paramedian position. This compromises the airways and causes respiratory distress which may often be acute necessitating tracheostomy. A lateralisation of the vocal cord is required to provide adequate airway without significantly affecting speech. Extralaryngeal approach is our preferred approach. This article reports a study of eight cases who underwent arytenoid abduction by an extralaryngeal approach for bilateral abductor paralysis of vocal cords.