Tracheal Resection and Cricotracheal Anastomosis

• At our institute, we successfully managed a challenging case of severe post-intubation subglottic stenosis in a 31-year-old male who had a history of prolonged ventilation following a suicide attempt.
• The patient had previously undergone multiple failed procedures including dilatations, laser treatments, and micro-laryngeal excision elsewhere. At our center, he underwent definitive surgical management with tracheal resection and cricotracheal anastomosis, planned using detailed 3D CT imaging.
• Postoperative care included staged bronchoscopy, nutritional management, and airway surveillance. This case highlights the advanced airway reconstructive capabilities at our institution and underscores the importance of a multidisciplinary approach in managing complex airway stenosis.

Recurrent Juvenile Nasopharyngeal Angiofibroma with intracranial extension

• 17Years/ male, presenting with torrential epistaxis. He is a known case of Juvenile Nasopharyngeal Angiofibroma operated twice before. JNA surgery is considered as one of the most difficult of surgeries in Skull base surgery being a vascular tumour and revision JNA surgery requires the highest-level skill set.
• His imaging showed an extensive recurrence. It was a fibrous adherent tumour completely occupying both nasal cavity, nasopharynx, right PPF, Infratemporal Fossa, Middle cranial fossa, Cavernous sinus and 270-degree encasement of right paraclival carotid. After having a multidisciplinary discussion with Neurosurgeon, Interventional radiologist and after embolising the tumour the patient was taken up for surgery.
• It was a six hours long surgery and we successfully dissected the tumour off the middle cranial fossa, cavernous sinus and para-clival carotid and performed a complete excision of the tumour. The patient has clinically improved and is under constant follow up.

Cochlear Re-implantation

• UIORL is a referral center for complex cochlear re-implantation surgeries, offering renewed hearing hope to patients with failed or non-functional implants.
• Re-implantation is a technically demanding procedure requiring precise surgical planning, detailed radiological evaluation, and experience in managing fibrotic beds and electrode damage. The center is equipped with dedicated audiological testing and rehabilitation facilities, allowing for seamless post-operative integration and speech therapy.
• This has been a transformative service for hearing-impaired children and adults across Tamil Nadu and other states.

Angiomatous nasal polyp

• A 60-year-old female came with complaints of right sided nasal obstruction and nasal discharge for 6 months with loss of smell sensation. CECT PNS revealed an enhancing vascular mass in the right nasal cavity extending to the nasopharynx and CT Angiogram showed feeding vessel from the ascending pharyngeal artery.
• Preoperative embolization of the feeding vessels was done and the patient underwent endoscopic excision of the nasal mass which was sent for histopathological examination; results showed the mass to be an angiomatous variant of antrochoanal polyp. Postoperative period was uneventful and patient recovered well

Dentigerous cyst

• A 11-year-old male child Came with Complaint of Right-side facial swelling for 1 year swelling (+) Right side of cheek 3× 2cm. Skin over swelling _ normal. Swelling extend medially from the middle 1/3 rd dorsum of nose & 1cm below lateral canthus – about 3×2cm oval in shape.
• Firm in consistency skin above the swelling normal. CT facial bone: - Soft dense lesion noted in superior alveolar margin extending up to Right maxillary sinus. Right DENTIGEROUS SWELLING. Procedure done: - endonasal endoscopic dentigerous cyst excision done via inferior meatal antrostomy with complete removal of the unerupted tooth lying in the maxillary sinus cavity

• Bilateral neck dissection with composite resection (Marginal mandibulectomy with wide local resection) with Pectoralis Major Myocutaneous Flap Reconstruction
• A 70 year male, came with complaints of swelling in the floor of mouth since 1month. The patient had swelling in the left level IB lymph node level. The patient had difficulty in protruding the tongue and swallowing and hence was on Ryle’s tube feed.
• Biopsy and FNAC revealed the diagnosis of Adenocarcinoma of floor of mouth. The tumour was staged as Stage IVA on further radiological and clinical assessment. The case was taken up for discussion in tumour board and it was decided to perform surgery followed by adjuvant radiation. A multidisciplinary team including ENT, OMFS, plastic surgery and anaesthesia were involved in the procedure.
• The ENT team performed a left Anterolateral comprehensive neck dissection and right Supraomohyoid neck dissection, then the ENT and OMFS team performed a composite resection of the tumour (extended Marginal mandibulectomy and wide local resection). A tracheostomy was performed for maintaining the airway. Then the plastic surgery team took over and performed the reconstruction with a Pectoralis Major Myocutaneous flap (PMMC).
• The patient was later managed in the ICU and after 3 weeks patient was started on oral feeds after performing a Functional endoscopic evaluation of swallowing and was successfully weaned off the tracheostomy. Histopathology was Mucinous adenocarcinoma with left level IB, II and III lymph node positivity. The patient is due for postoperative radiotherapy.

Advanced Juvenile Nasopharyngeal Angiofibroma with Intracranial Extension

• A 15-year-old male from Trichy presented with a 2-year history of right facial swelling, bilateral nasal obstruction for the past year, nasal discharge, mouth breathing, and snoring.
• Radiological evaluation showed a Radowksi Stage 3B Juvenile Nasopharyngeal Angiofibroma with evidence of intracranial extension into the middle cranial fossa without Dural breach. Preoperative embolization of the right internal maxillary and ascending pharyngeal arteries was performed, followed by surgical excision of the tumour via the maxillary swing approach for optimal access and control

Pituitary thyrotropinoma

• A 28year old female, found to have hyperthyroidism during routine TFT at the time of pregnancy and on antithyroid drugs, presented with palpitations, excessive sweating, oligomenorrhea, tremors and neck swelling.
• On examination, a neck swelling of size 7x8cm in the anterior aspect of the neck was noted. TSH was found to be 72 microIU/ml and FT4 was 3.2 ng/dl. Radiological investigation were as follows: USG neck: p/o MNG Right lobe-3.8*2.2*3.8cm Left lobe -2.5*1.7*3.9cm CT PNS -e/o well defined non enhancing hypodense lesion noted in pituitary region measuring 9.2mm MRI brain with Sella contrast: Well-defined T2 heterogeneous lesion in right side of pituitary gland -hyper enhancing in post contrast region MRI brain - no significant abnormalities Patient was diagnosed as Pituitary macroadenoma (thyrotropinoma) and proceeded with endoscopic trans nasal excision of the mass.
• Histopathology showed it was a pituitary neuroendocrine tumour. Postoperative hormone profile was done including TFT which showed TSH was on the decreasing trend. Now the patient is stable and on regular follow up.

• Spontaneous CSF rhinorrhea: - In this study, patients from age group of 50-60 years old female had complaints of watery nasal discharge and headache, on and off on right side for a period of 2 years.
• Patients had defect of size 2-2.5 mm on right cribriform plate. Patient had no evidence of papilledema. Patients had no fluctuation of ICT. Patients managed conservatively. Another age group of patients from 30-40 years females came with complaints of watery nasal discharge and headache on both right and left nasal cavity with defect of size 2-2.5 mm of both right and left cribriform plate. Patients has no evidence of papilledema. Patients managed conservatively.
• Patients were managed with Tablet Acetazolamide 250mg 2tds.Till the CSF RHINORRHOEA completely stopped. Then the dosage reduced to 1tds & continued for 3-month period.
• Patient reviewed om monthly interval for a period of 2 year. To see the any recurrence of the disease. CSF leak from the Anterior skull base which are SPONTANEOUS in nature & most common in female can be successfully managed conservatively. Surgical intervention needed if the conservative therapy fails, or associated with meningocele or if there is any suspicion of intracranial complications.

Traumatic Optic nerve decompression

• A case of post-traumatic optic neuropathy in a young male who presented with acute vision loss in the right eye following facial trauma. After thorough evaluation and imaging, the patient was diagnosed with compressive optic neuropathy.
• A trans nasal endoscopic optic nerve decompression was performed to relieve pressure on the optic nerve. Postoperatively, the patient showed remarkable visual improvement – progressing from only perception of light to being able to count fingers close to the face.

Diffuse large B cell lymphoma of thyroid

• A 77-year-old female came to our OPD with complaints of a huge neck swelling in front of the neck for the past 2 months. On doing radiological investigations the thyroid gland was found causing mass effect in the form of compression of trachea of minimum diameter 9.6mm (transverse).
• The patient was operated and total thyroidectomy done. A highly challenging surgery and the thyroid gland with isthmus was removed in toto. The specimen was sent for histopathological examination which revealed diffuse large B cell lymphoma. Tumour board opinion was obtained for the same and patient followed up in medical oncology ward with RCVP regimen.

Foreign body removal

• A 95-year-old hypertensive female presented to the casualty with alleged history of foreign body ingestion (dentures) at around 11:00 followed by pain during swallowing and foreign body sensation in the throat. Video laryngoscopic examination revealed mucosal injuries and oedema in the vallecula, possibly due to induced vomiting, and the structures further down could not be visualized due to pooling of saliva.
• X-ray lateral view of the neck revealed the presence of large dentures at the level of the cricopharynx. Patient also had scoliosis and thrombocytopenia in addition to hypertension. Emergency anaesthesia fitness was obtained and the patient was immediately taken up for rigid esophagoscopy and foreign body removal. The denture was removed and the patient was observed postoperatively in the ICU. No complications were encountered, the patient recovered well and was discharged.

LEFT COM / CSF OTORHOEA / LABYRINTHITIS

• A 24-year-old male patient came with complaints of severe headache for 4 days, frontal region, left ear discharge for 6 months, on local examination, left ear minimal discharge, pulsatile watery discharge seen deep inside the middle ear. On further radiological imaging, Fungus cerebri (7*2cm) noted. Intracranial abscess managed conservatively with neuro surgery opinion foe 3 weeks with improvement in clinical condition.
• Patient taken up for left revision mastoidectomy with blind sac closure and reconstruction of Tegmen defect. Patient was discharged after a month with complete resolution of intracranial complications.

Recurrent CSF Rhinorrhoea

• A 41year female from Vellore came with complaints of watery nasal discharge from the left nasal cavity for the past 20 days. She had a previous history of undergoing CSF leak repair in a private hospital in Vellore. On undertaking various MRI Cisternogram revealed bilateral CSF leak with left anterior encephalocele.
• Intraoperatively, a defect of size 1cm*0.5 cm seen in left cribriform plate. Defect closed in layers with first layer surgical, fascia lata kept as second layer, hadad flap as third layer and gel foam as final layer, making sure not to obstruct frontal and sphenoid sinus opening. The patient was managed post- operatively with anti-epileptics and T. Acetazolamide.
• The procedure was followed by a positive outcome and the patient has been in follow up for regular CSF pressure checking and placement of lumbar drain if required in view of benign intracranial hypertension

Foreign body removal surgeries in airway

• A 27-year-old male aspirated a glass foreign body into the right lower lobe bronchus. In view of the foreign body's distal location in the right lower lobe bronchus and limited reach using conventional optical forceps, an innovative hybrid bronchoscopic technique was employed.
• A flexible bronchoscope was secured with microlaryngeal forceps and inserted through the barrel of a rigid bronchoscope. This hybrid approach allowed enhanced maneuverability and visualization, better angulation, and successful retrieval of the foreign body- glass piece with minimal mucosal trauma. The technique proved to be a practical and effective alternative in situations where conventional tools may be inadequate or unavailable.

Recurrent juvenile nasopharyngeal angiofibroma

• A 14-year-old male presented with complaints of bilateral nasal obstruction for 6 months with one episode of epistaxis 6 months back. The patient was already diagnosed as a case of juvenile nasopharyngeal angiofibroma in 2020 and 2022 and was operated for the same twice in Vellore Medical College.
• At present. CECT PNS revealed an enhancing mass in the entire nasopharynx with intracranial extension (Radkowski stage IVB) and CT angiogram revealed feeding vessels from the Internal Maxillary Artery. Preoperative embolization of the feeding vessels was done by Interventional Radiology after which the patient underwent revision endoscopic excision of the nasopharyngeal angiofibroma for the third time. Postoperative period was uneventful and the patient was discharged.

Ameloblastoma

• A 28 YEARS old female Patient came with Complaint of swelling in the Right side of cheek in the last 3 year. Biopsy taken from the swelling and proved as Desmoplastic ameloblastoma.
• Swelling (+) Right cheek measuring 5×4cm smooth, skin above the swelling normal. CT PNS: - Desmoplastic ameloblastoma. Ill-defined expansive cystic lesion in Right maxilla. Procedure done: - Right partial maxillectomy with obturator fixation. (sub labial approach) HPE report: - Desmoplastic ameloblastoma.

Multinodular goitre thyroid with retrosternal extension

• 61-year-old female came to the OPD with complaints of swelling in front of the neck for the past 3 years. Thyroid function test showed the patient in euthyroid status.
• On further radiological examination revealed the mass to be compressing the trachea with retrosternal extension of approximately 2cm below thoracic inlet. This challenging case was operated and total thyroidectomy performed.
• The thyroid gland was removed in toto. On further histopathological examination revealed it as Hashimoto’s thyroiditis. Serial serum calcium levels were monitored and medical endocrinology opinion obtained and the patient was successfully discharged

Traumatic Facial nerve decompression

• A 30-year-old male, presented with right lower motor neuron facial nerve palsy following a road traffic accident with temporal bone fracture.
• He had deviation of the mouth and inability to close his right eye. Audiometry showed minimal high-frequency hearing loss, and imaging revealed a fracture involving the facial nerve canal. Despite initial conservative treatment, symptoms persisted. Facial nerve decompression surgery was successfully performed. Postoperative recovery was uneventful, and the patient is under regular follow-up.

Lipoma neck

• A 32-year-old male presented with complaints of swelling in the right-side anterior aspect of the neck for 2 years, which gradually increased in size, with no other ENT complaints.
• Examination revealed a non-tender swelling 8x9cm over the right side of the neck extending from suprasternal notch to right acromion, with palpable right level 2 lymph nodes. USG neck and FNAC were both suggestive of lipoma. The patient underwent excision of the mass which was sent for histopathological examination. The HPE report showed that the mass was indeed a lipoma measuring 10x8x4cm. Postoperative period was uneventful and patient was discharged.

Glomus typanicum – left residual disease

• A 57-year-old female came with complaints of left ear bleeding for 2 months and left ear pain for 1 week, complaints of giddiness for 2 days.
• On local examination of left ear revealed a left post auricular scar extending to left side of neck till medial point of clavicle, tympanic membrane- pale polypoidal arising behind the floor. TM not visualized. On HRCT Temporal bone revealed glomus tympanicus s/p revision excision of residual glomus tympanicum involving middle ear, mastoid cavity, external auditory canal, erosion of fallopian tube, horizontal semi-circular canal. The patient was taken up for left revision mastoidectomy with blind sac closure

A case of necrotizing fasciitis of neck

• A rare but life-threatening presentation of necrotising fasciitis of the neck in a 46-year-old male, caused by Klebsiella pneumoniae. The patient presented with neck swelling, dysphagia, blackish skin discoloration, and foul-smelling discharge.
• Rapid deterioration led to septic shock, multi-organ dysfunction, and cardiac arrest, requiring ventilatory support and intensive care. Management included extensive surgical debridement, tracheostomy, targeted intravenous antibiotics based on sensitivity, and supportive care. Remarkable clinical improvement was seen with multidisciplinary treatment, and the patient was eventually discharged in stable condition.

Extensive rhinocerebral Mucor mycosis with facial eschar

• A 31-year-old diabetic male presented with facial swelling and black eschar following RTA. Imaging showed pansinusitis with intracranial extension. Prompt endoscopic debridement with orbital exenteration and liposomal Amphotericin B therapy and diabetic control to the successful recovery of patient despite the high mortality associated with cerebral involvement

Post cricoid carcinoma in Young female

• An unusual presentation of a young female presenting with progressive dysphagia, imaging revealing a large post cricoid mass infiltrating the tracheal wall and thyroid gland. Biopsy confirmed as moderately differentiated Squamous cell carcinoma. Case was presented in Tumour board for definitive oncological management.

Epithelioid angiosarcoma of nasal cavity - In a young female

• A 17-year-old female presented to us with history of recurrent epistaxis, nasal obstruction and facial swelling. Preoperative biopsy done in private medical college was positive for angiofibroma.
• Imaging studies was throwing light on to differential diagnosis as inverted papilloma, chronic fungal sinusitis with co-existing Antro choanal polyp. Surgical excision of tumour was done by midfacial degloving approach and histopathological was positive for a rare malignant vascular tumour -Epithelioid angiosarcoma. Patient is under close oncological follow-up

Odontogenic cyst- A maxillofacial presentation

• A 15-year-old female presented with painful swelling in left maxillary region of 1-month duration. Imaging studies showed well defined lesion around unerupted L canine. Patient underwent an endoscopic Denker’s approach with medial maxillectomy- a minimally invasive procedure with no facial incision or oroantral communication

Osteosarcoma of left maxillary sinus

• A 17-year-old male presented with rapidly progressive swelling in left medial canthus and headache. Imaging showed lytic lesion involving left medial maxillary sinus wall and posterior ethmoidal air cells. Patient was managed with left middle metal antrostomy and mass excision via endoscopic midfacial degloving approach. Patient is under close oncologic follow-up up

Spindle cell squamous carcinoma of hard palate

• A 35-year-old female with history of hard palate swelling and deep-seated pain. Imaging revealed infiltrating lesion involving hard palate. Right total maxillectomy was done and HPE report positive for Spindle cell squamous cell carcinoma and is given concurrent chemo radiation.