Giant Lipoma Involving the Face in a Child: A Rare Case Report.

Lipomas are benign tumours composed of adipose tissue which are rare in paediatric age group, all the more infrequent over head and neck region. We report a case of 15 month old male child who presented with a history of swelling over the left side of the face for the duration and months. Patient was initially operated at 5 months of age elsewhere and presented to us with recurrence of the swelling at 15 months of age.

Atypical Presentation of Skull Base Osteomyelitis Involving the Stylomastoid Foramen-A Case Report.

An atypical presentation of skull base osteomyelitis (SBO) involving the stylomastoid foramen in a diabetic individual without facial palsy or positive otoscopic ear findings has been presented. A case report of a 78 year old poorly controlled diabetic male who had severe ear pain without otoscopic ear findings and was treated prior with IV antibiotics for a period of two months without relief was referred to our tertiary care Center and was operated by us following which he had complete relief of symptoms. SBO presenting without otoscopic ear findings or facial nerve palsy at the region of the stylomastoid foramen is extremely rare.

Outcome of Total Surgical Debridement of Covid Associated Rhino-Orbito-Cerebral Mucormycosis Based on a New Surgical Staging System: A Cohort Study.

To propose a surgical staging system with management protocol for post-covid Rhino-orbito-cerebral mucormycosis (ROCM) with central skull base osteomyelitis. A prospective cohort study of a total of 193 post-covid ROCM patients was conducted between May 2021 and January 2022 at a tertiary care centre. Patients were assessed radiologically and staged from I to V.

A Feasible, Low-Cost, Capsicum and Tomato Model for Endoscopic Sinus and Skull Base Surgery Training.

To describe and standardize an easily available, viable, low-cost capsicum and Tomato model for endoscopic sinus and Skull Base surgery training. Rhinology fellows performed the following stimulated endoscopic sinus exercises using the capsicum and tomato models at our centre using a Karl Storz angled Endoscope and Medtronic Debrider with various angled blades. Each student dissected 10 specimens before training these procedures on human patients, and the benefit of the capsicum and tomato models training was evaluated.

Characterization of outcomes and practices utilized in the management of internal carotid artery injury not requiring definitive endovascular management.

Background: After internal carotid artery (ICA) injury during endoscopic skull base surgery, the majority of patients undergo ICA embolization or stenting to treat active extravasation or pseudoaneurysm development. However, management practices when embolization or stenting is not required have not been well described. The objective of this study was to determine how patients with ICA injury but no embolization, stenting, or ligation do long-term and ascertain the reconstruction methods utilized.

Assessment of Factors Associated With Internal Carotid Injury in Expanded Endoscopic Endonasal Skull Base Surgery.

Importance: Injury to the internal carotid artery (ICA) during endoscopic endonasal skull base surgery does not typically occur as an isolated circumstance but often is the result of multiple factors.

Objective: To assess the factors associated with ICA injury in an effort to reduce its occurrence.

Design, Setting, And Participants: This quality improvement study used a multicenter root cause analysis of ICA injuries sustained during endoscopic endonasal skull base surgery performed at 11 tertiary care centers across 4 continents (North America, South America, Europe, and Asia) from January 1, 1993, to December 31, 2018.

Sphenoid Mucocele: A Complication of Skull Base Reconstruction with Nasoseptal Flap-A Critical Review and Our Experience.

The evolution of expanded endoscopic skull base surgery has enabled development of minimally invasive approaches for resection of large skull base tumors with the nasoseptal flap proving to be an indispensable tool in skull base reconstruction. We here present our experience of sphenoid mucocele development after skull base reconstruction with the nasoseptal flap along with a comprehensive review of the limited literature on the same. With the expanding scope of endoscopic skull base surgery, the nasoseptal flap is increasingly being used for reconstruction.

A Hybrid Approach Towards Successful Resection of a Huge Carotid Body Paraganglioma Using Coil Embolization and Traditional Surgical Techniques.

(CBPGL), is a type of neuroendocrine tumor that should be managed promptly due to their malignant potential and locally aggressive nature making resection at a later stage difficult. The objective of this case report is to explore the benefit of coil embolization and describe the surgical techniques employed in successful resection of a huge CBPGL.

Endoscopic Three-surgeon Six-handed Transorbital Transnasal Technique for Excision of Juvenile Nasopharygeal Angiofibroma: New Frontier Explored.

Endoscopic endonasal transorbital approach has been described for the removal of orbital lesions located anteromedially in temporal fossa. The same has been observed to be a versatile approach to the anterior and middle cranial fossa only in laboratory studies. This is the first clinical report of combined transorbital transnasal endoscopic approach to the cavernous sinus, superior orbital fissure, and middle cranial fossa in a case of recurrent nasopharyngeal angiofibroma using the three-surgeon six-handed technique.

Comprehensive preoperative staging system for endoscopic single and multicorridor approaches to juvenile nasal angiofibromas.

Background: Juvenile nasal angiofibromas (JNA) is a benign lesion with high vascularity and propensity of bone erosion leading to skull base invasion and intracranial extension. It is known to involve multiple compartments, which are often surgically difficult to access. With evolution in surgical expertise and technical innovations, endoscopic and endoscopic-assisted management has become the preferred choice of surgical management.

Trigeminocardiac reflex during endoscopic juvenile nasopharyngeal angiofibroma surgery: an appraisal.

Juvenile nasopharyngeal angiofibroma is a locally aggressive benign tumour which has propensity to erode the skull base. The tumour spreads along the pathways of least resistance and is in close proximity to the extracranial part of trigeminal nerve. Advancements in expanded approaches for endoscopic excision of tumours in infratemporal fossa and pterygopalatine fossa increase the vulnerability for the trigeminocardiac reflex.

Imaging in Juvenile Nasopharyngeal Angiofibroma: Clinical Significance of Ramharan and Chopstick Sign.

Imaging plays an important role in the diagnosis, staging and prognosis of JNA. Certain radiological changes as seen on CECT were observed to be consistent in our case series. This study analysed preoperative and postoperative CECT of large series of JNA patients to evaluate the sites and pattern of spread of tumor.

Multiport Combined Endoscopic Approach to Nonembolized Juvenile Nasopharyngeal Angiofibroma with Parapharyngeal Extension: An Emerging Concept.

. Surgical approaches to the parapharyngeal space (PPS) are challenging by virtue of deep location and neurovascular content. Juvenile Nasopharyngeal Angiofibroma (JNA) is a formidable hypervascular tumor that involves multiple compartments with increase in size.

A Drastic Aftermath of Embolisation in Juvenile Nasopharyngeal Angiofibroma.

The role of preoperative embolization in alleviating intra operative haemorrhage in small to medium sized JNA is dubious. We report an unusual case of JNA who developed cerebral edema, hemiplegia and aphasia following glue embolisation and underwent frontotemporal craniectomy. This drastic aftermath of embolisation challenges the safety of preoperative embolisation in such lesions.

Endoscopic Excision of Non-embolized Juvenile Nasopharyngeal Angiofibroma: Our Technique.

To approach Juvenile nasopharyngeal angiofibroma extending to the sphenoid sinus, pterygoid wedge and minimal involvement of the pterygopalatine fossa (Radkowski Stage 2 A) with an endoscopic technique without embolization with no recurrence and minimal morbidity and mortality. This is a retrospective, descriptive study based on the medical records of 15 patients with histologically confirmed JNA who underwent endoscopic binostril four handed endoscopic excision in our centre without embolisation between 2010 and 2015. All 15 patients were young males with a mean age of 14.

Endoscopic management of cerebrospinal fluid rhinorrhea.

Cerebrospinal fluid (CSF) rhinorrhea occurs due to communication between the intracranial subarachnoid space and the sinonasal mucosa. It could be due to trauma, raised intracranial pressure (ICP), tumors, erosive diseases, and congenital skull defects. Some leaks could be spontaneous without any specific etiology.

Endoscopic Endonasal Repair of Sphenoid Sinus Cerebrospinal Fluid Leaks: Our Experience.

Endoscopic endonasal approaches are becoming increasingly popular over transcranial approaches for repair of cerebrospinal leak defects. Sphenoid sinus CSF leaks pose a significant challenge and carry the risk of life-threatening intracranial complications. Their management depends upon identifying the leak using imaging techniques followed by intraoperative endoscopic localization.

Modified approach to powered endoscopic dacryocystorhinostomy.

Objective: This paper presents modifications to powered endoscopic dacryocystorhinostomy without stenting for the management of acquired nasolacrimal duct obstruction.

Study Design: A retrospective, non-randomised review.

Method: A total of 105 patients with epiphora secondary to acquired nasolacrimal duct obstruction were operated on by our modified powered endoscopic dacryocystorhinostomy approach.

Primary Extracranial Meningioma: The Royal Pearl Experience.

The extracranial occurrence of meningioma, which is a tumour of the central nervous system, is rare. Two cases of primary extracranial meningioma of the psammomatous variant are reported here. Both cases were managed successfully by endoscopic endonasal approach.