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

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

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

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

SAtellite-based Marine Process Understanding, Development, Research and Applications for Blue Economy (SAMUDRA): A Technology Demonstration Program in the Bay of Bengal

SAtellite-based Marine Process Understanding, Development, Research and Applications (SAMUDRA) for blue economy, a technology development program of the Space Applications Centre, is an umbrella program covering research and applications geared toward physical and biological oceanography making use of current and future satellite observations for developing the nation’s blue economy. The main motivation behind this project was to develop satellite and numerical model-based information and value-added products and to demonstrate the implementation of developed applications for operational requirements. The program also aimed at improving existing methodologies for various applications by utilizing space-based inputs. Several field campaigns with the use of NavIC-enabled instruments and NABHMITRA were conducted for measuring biophysical parameters and validation of developed applications in the coastal regions. One of the key aspects of this project was development of web-based customized tools/dissemination system for providing the information to the end users. Some of the key/notable achievements of SAMUDRA were development of a portal OceanEye (tailor-made web-portal for Shipping Corporation of India), storm-surge/inundation system, oil-spill trajectory modeling, level-next potential fishing zone algorithm and rip current alert system