External Laryngocoele or Anterior Jugular Vein Aneurysm (A Rare Clinical Entity): A Paradox Solved by A Few Simple Non-Invasive Radiological Tests

Introduction     The differential diagnosis of a cystic upper neck mass that becomes prominent on coughing, straining, breath holding, or Valsalva manoeuvre includes mediastinal tumours and cysts, external laryngeal diverticula, and jugular venous aneurysms. Jugular venous aneurysms, while extremely rare, must be considered. We report the fifth case of anterior jugular aneurysm in an adult patient.   Case Report   A 55 year old female patient presented with a swelling in the upper part of right side of neck near the greater cornu of hyoid bone. The swelling increased with Valsalva, straining and while stooping forward. Clinically it was thought to be an external laryngocoele. However Colour Doppler Ultra-sonography and C.T angiogram of neck established it as of anterior jugular venous aneurysm by distinguishing from external laryngocoele.   Discussion   Patient presenting with unilateral cystic swelling in upper neck at upper border of thyroid cartilage which clinically bears the common provisional diagnosis of external laryngocele must be differentiated radiologically from anterior jugular venous aneurysm, (though rare in occurrence) to avoid a catastrophic incident during surgery

Reconstruction of Head and Neck Defects with Lower Trapezius Myocutaneus Flap

Introduction  High lateral and posteriorly based defects are challenging to reconstruct as mobilization of conventional pedicled flaps is difficult. This study was done to evaluate the usefulness of lower trapezius myocutaneous flap (LTMC) in selected cases as a reconstructive alternative to other pedicled flaps which have positional and technical disadvantages and/or in cases where free flap is not possible. Materials and Methods Ten cases of locally advanced (T3 and T4) high and laterally placed head and neck carcinoma (8 cases of SCC involving posterior scalp, ear lobule, skin anterior to tragus and 2 cases of locally advanced salivary gland malignancies involving parotid glands) irrespective of sex had been selected. Due to non-availability of plastic surgeon in the institute none of the patient could be subjected to free flap reconstruction. All the patients received post operative adjuvant radiotherapy and were followed up on a monthly basis for six months at least. Results                      Out of total 10 cases 5 underwent wound infection and dehiscence at recipient site. In 3 cases there were donor site seroma. In 2 cases healing was uneventful.  However in all cases the flap was healthy and flap survival was 100%. There was no flap contracture in long term follow up. Conclusion                       The LTMC flap is ideal for mentioned defects because of its anatomical location, abundant blood flow, minor donor-site morbidity, and long pedicle. The LTMC flap, though less commonly used, is a precious option in situations where free flaps and other pedicled flaps are not feasible

External Laryngocoele or Anterior Jugular Vein Aneurysm (A Rare Clinical Entity): A Paradox Solved by A Few Simple Non-Invasive Radiological Tests

Introduction     The differential diagnosis of a cystic upper neck mass that becomes prominent on coughing, straining, breath holding, or Valsalva manoeuvre includes mediastinal tumours and cysts, external laryngeal diverticula, and jugular venous aneurysms. Jugular venous aneurysms, while extremely rare, must be considered. We report the fifth case of anterior jugular aneurysm in an adult patient.   Case Report   A 55 year old female patient presented with a swelling in the upper part of right side of neck near the greater cornu of hyoid bone. The swelling increased with Valsalva, straining and while stooping forward. Clinically it was thought to be an external laryngocoele. However Colour Doppler Ultra-sonography and C.T angiogram of neck established it as of anterior jugular venous aneurysm by distinguishing from external laryngocoele.   Discussion   Patient presenting with unilateral cystic swelling in upper neck at upper border of thyroid cartilage which clinically bears the common provisional diagnosis of external laryngocele must be differentiated radiologically from anterior jugular venous aneurysm, (though rare in occurrence) to avoid a catastrophic incident during surgery

Late Oesteoradionecrosis of Mandible Five Years after Radiotherapy for Carcinoma Base of Tongue

Introduction Osteoradionecrosis (ORN) is a process where irradiated bone undergoes necrosis and becomes exposed through soft-tissue. It is a late effect of radiotherapy. Early presentation within 2 years, is thought to be related to high dose of Radiation therapy, whereas late presentation is usually secondary to trauma and delayed wound healing with in compromised tissue. We present a case of late presentation where there was no history of trauma to the associated region; therefore making the case unique. Case report                                              50 years old male patient from rural Bengal presented with history of invasive squamous cell carcinoma (SCC) of right base tongue with bilateral cervical nodal metastasis treated with external beam radiotherapy of 70 Gy in 35 fractions in 2009. In April 2014 he developed pain in the right side of lower jaw with foul breath and progressive difficulty and pain while opening mouth. Biopsy established the diagnosis of oesteoradionecrosis. Discussion ORN can be spontaneous, but most commonly results from tissue injury. The absence of reserve reparative capacity is a result of the prior radiation injury. The irradiated mandible, periosteum, and overlying soft tissue undergo hyperemia, inflammation, and endarteritis. Conclusion During follow up any lesion suspicious of recurrence or second malignancy with clinical features of pain, swelling, trismus, halitosis, mucosal ulceration, bare bone etc a differential diagnosis of oesteoradionecrosis should be kept in mind, even long time after radiotherapy & absence of trauma

Identifying Recurrent Laryngeal Nerve in Thyroid Surgery Using Relationship with Superior Parathyroid Gland and Tubercle of Zuckerkandl

Introduction: Recurrent laryngeal nerves (RLN) are particularly prone to injury during thyroid surgeries due to its intimate relationship and proximity with the gland. Zuckerkandl’s tubercle (ZT) helps in preserving RLN intra operative. Material and Methods: A prospective study for identifying RLN in thyroid surgery using relationship with superior parathyroid gland and tubercle of Zuckerkandl was conducted on 50 thyroidectomy patients between August 2013 and February 2014. Results: In all cases ZT was identified. Temporary paralysis of RLN was seen in 3 (6%) cases and permanent paralysis in 2 (4%) of cases. Discussion: The site of greatest risk during thyroidectomy to the RLN is in the last 2-3 cm extralaryngeal course of the nerve. Relationship of recurrent laryngeal nerve with superior parathyroid gland and tubercle of Zukerkandl (ZT) is known. Conclusion: Use of ZT and superior parathyroids as a landmark allows safe dissection of RLN

A CASE OF ORAL MUCOSAL MALIGNANT MELANOMA IN DISGUISE OF CERVICAL METASTATIC LYPMHADENOPATHY WITH APPARENTLY UNKNOWN PRIMARY.

Introduction: Primary malignant melanoma of the oral cavity is a rare neoplasm. The tumors tend to metastasize or locally invade tissue more readily than other malignant tumors in the oral region. Case Report: A 55 year old male presented with left sided hard cervical lymphadenopathy with unknown primary with cytology of malignant melanoma. 18FDG-PET-C.T scan helped identification of the primary. Discussion: The survival of patients with mucosal melanomas is less than for those with cutaneous melanomas. Tumor size and metastases are related to the prognosis of the disease. Early oral malignant melanomas can be clinically very difficult to distinguish from other benign oral pigmented lesions. Conclusion:  Any case presenting with cervical lymphadenopathy with a cytological diagnosis of Malignant Melanoma and without clinically identifiable primary, early detection using whole body 18FDG-PET CT is utmost important

Late Oesteoradionecrosis of Mandible Five Years after Radiotherapy for Carcinoma Base of Tongue

Introduction Osteoradionecrosis (ORN) is a process where irradiated bone undergoes necrosis and becomes exposed through soft-tissue. It is a late effect of radiotherapy. Early presentation within 2 years, is thought to be related to high dose of Radiation therapy, whereas late presentation is usually secondary to trauma and delayed wound healing with in compromised tissue. We present a case of late presentation where there was no history of trauma to the associated region; therefore making the case unique. Case report                                              50 years old male patient from rural Bengal presented with history of invasive squamous cell carcinoma (SCC) of right base tongue with bilateral cervical nodal metastasis treated with external beam radiotherapy of 70 Gy in 35 fractions in 2009. In April 2014 he developed pain in the right side of lower jaw with foul breath and progressive difficulty and pain while opening mouth. Biopsy established the diagnosis of oesteoradionecrosis. Discussion ORN can be spontaneous, but most commonly results from tissue injury. The absence of reserve reparative capacity is a result of the prior radiation injury. The irradiated mandible, periosteum, and overlying soft tissue undergo hyperemia, inflammation, and endarteritis. Conclusion During follow up any lesion suspicious of recurrence or second malignancy with clinical features of pain, swelling, trismus, halitosis, mucosal ulceration, bare bone etc a differential diagnosis of oesteoradionecrosis should be kept in mind, even long time after radiotherapy & absence of trauma

Reconstruction of Head and Neck Defects with Lower Trapezius Myocutaneus Flap

Introduction  High lateral and posteriorly based defects are challenging to reconstruct as mobilization of conventional pedicled flaps is difficult. This study was done to evaluate the usefulness of lower trapezius myocutaneous flap (LTMC) in selected cases as a reconstructive alternative to other pedicled flaps which have positional and technical disadvantages and/or in cases where free flap is not possible. Materials and Methods Ten cases of locally advanced (T3 and T4) high and laterally placed head and neck carcinoma (8 cases of SCC involving posterior scalp, ear lobule, skin anterior to tragus and 2 cases of locally advanced salivary gland malignancies involving parotid glands) irrespective of sex had been selected. Due to non-availability of plastic surgeon in the institute none of the patient could be subjected to free flap reconstruction. All the patients received post operative adjuvant radiotherapy and were followed up on a monthly basis for six months at least. Results                      Out of total 10 cases 5 underwent wound infection and dehiscence at recipient site. In 3 cases there were donor site seroma. In 2 cases healing was uneventful.  However in all cases the flap was healthy and flap survival was 100%. There was no flap contracture in long term follow up. Conclusion                       The LTMC flap is ideal for mentioned defects because of its anatomical location, abundant blood flow, minor donor-site morbidity, and long pedicle. The LTMC flap, though less commonly used, is a precious option in situations where free flaps and other pedicled flaps are not feasible

Genetic alterations (amplification and rearrangement) of D-type cyclins loci in head and neck squamous cell carcinoma of Indian patients: prognostic significance and clinical implications

In this study, the alterations (amplification/rearrangement) of 3 D-type cyclins loci were analyzed by Southern blot in 5 dysplastic head and neck lesions and 79 primary head and neck squamous cell carcinoma (HNSCC) of Indian patients to understand the role of the cyclins in development of the disease. No alteration was found in the dysplastic lesions. Overall, 54% of alterations were found in bcl-1/CCND1 locus, whereas amplification was only found in CCND2 and CCND3 loci in 12% and 2% samples, respectively. In bcl-1/CCND1 locus amplification was the major type of alteration; however, rearrangement as well as coalterations had been seen in some samples indicating the common mechanism of activation of this locus in different types of tumors. In bcl-1 region, the breakpoint clustered in the MTC (major translocation cluster) region, whereas in CCND1 the breakpoint located near 3' end of the gene. The coamplification of CCND2 locus with bcl-1, bcl-1/CCND1, and CNND3 loci suggests cumulative effect of these genes in this tumor. The significant association was seen between bcl-1/CCND1 locus alteration with HPV prevalence and poor patient outcome indicating its importance as prognostic marker. This indicates that the genetic instability caused due to HPV infection may induce the alterations in the bcl-1/CCND1 locus, which will provide selective growth advantage to the specific malignant clones resulting poor prognosis of the disease

Multi-Impurity Adsorption Model for Modeling Crystal Purity and Shape Evolution during Crystallization Processes in Impure Media

© 2015 American Chemical Society. The impurity effect on the crystal properties, such as particle size and shape distribution, is significant, having significant impact on the downstream processes as well as on the product effectiveness. Currently very few studies exist that provide a quantitative model to describe crystal purity resulting from crystallization processes in impure media, and none to take into account the simultaneous effect of multiple impurities. Hence, the understanding of the effect of multiple impurities on crystallization process is important in order to obtain the desired product properties. Batch crystallization of potassium dihydrogen phosphate from aqueous solution in the presence of impurities was investigated experimentally by using an online particle vision and measurement tool with real-time image analysis. A mathematical model to describe the crystal purity and aspect ratio is proposed based on a morphological population balance equation including primary nucleation, growth of characteristic faces and multisite, competitive adsorption of impurities. The model parameters were identified and validated using crystallization experiments in mixtures of two impurities with variable composition. The developed and validated model can be an efficient tool for the investigation of crystallization processes in impure media with multiple impurities. The model can also serve as an effective tool for process and product design or optimization