Fibrous variant of rhinophyma

Rhinophyma is a rare disease which causes disfiguring soft tissue hypertrophy of the nose. The fibrous variant of rhinophyma is still rare which mimics fibrous papule of nose and lupus pernio. We report an unusual fibrous variant which was surgically managed with the good results. The use of scalpel for sculpting and the use of split thickness skin graft is being highlighted.

Follicular dendritic cell tumour of tonsil - is it an under-diagnosed entity?

Neoplasms of follicular dendritic cells are uncommon and while majority of them occur in lymph nodes, they are increasingly recognized at varied sites such as abdominal viscera. Tonsil is the most common extra nodal site for occurrence of FDCT in the head and neck region. We describe three cases of follicular dendritic cell tumour occurring in the tonsil.

Arhinia

We report here a case of arhinia with its complete manifestation, which is a very rare congenital abnormality. The newborn had complete absence of external nose with that area being totally flat and firm on palpation. A tracheostomy was performed on this child as the parents insisted on early discharge from the hospital without any reconstruction.

Bleomycin sclerotherapy in congenital lymphatic and vascular malformations of head and neck

Bleomycin is an established antineoplastic drug, but recently some attempts were made to inject it locally as a sclerosing agent in cases of congenital lymphatic malformations. We present the outcome of this treatment modality tried on 10 paediatric cases of whom 9 had such malformation in the cervical region and one in the parotid region. Seven of these cases had congenital lymphatic malformation while three had haemodynamically less active congenital vascular malformation. All these children were subjected to percutaneous intralesional administration of bleomycin. The size of swelling reduced by 50% or more in seven patients out of which three showed complete or near complete response. There were no major deleterious side effects.

Multi-lobulated cervical pneumatocoele communicating with pyopneumothorax and bronchopleural fistula

Cervical herniation of lung in infants is a very rare condition which may present as a diagnostic dilemma. Reported here is an infant who presented with a swelling apparently looking like an external laryngocoele but was finally diagnosed as an apical pneumatocoele communicating with pyopneumothorax.

Intramural foreign body in oesophagus

Intramural foreign body in oesophagus is very rare and is mostly associated with complications leading to high morbidity and mortality. Recently we came across a coiled metallic wire discovered unexpectedly in a chest X-ray of a 6-month-old male baby. This was further investigated and was found to be located intramurally in the oesophagus. It was successfully removed with rigid oesophagoscopy performed under telescopic guidance. No such foreign body has been reported in an infant so far in English literature.

Simple method of vocal cord lateralization in bilateral abductor cord paralysis in paediatric patients

OBJECTIVE

To simplify the procedure of suture lateralization of a vocal cord in children with bilateral abductor cord palsy and to evaluate its results.

METHODS

Ten tracheostomised infants and children with bilateral abductor cord palsy where there was either minimal or no recovery of vocal cord movement even after 2 years' observation were taken up for suture lateralization of one vocal cord. In this simplified procedure needles were passed twice through the larynx from one side of neck to the other. The aim was to reduce the microlaryngoscopic or telescopic manipulation inside the small larynx. Two techniques (1 and 2) were used to carry out this procedure. In technique 1 the needle used was one with a slit in the eye situated at its tail end whereas in technique 2 it was a lumbar puncture needle. Patient follow-up ranged from 6 months to 5 years.

RESULTS

Intraoperative manipulation inside the larynx was considerably reduced. The technique 2 was even simpler and faster than technique 1. With both techniques the placement of suture was accurate without any knot inside the larynx. All the patients could be decanulated with only minimal stridor on exertion in two and an acceptable voice in all.

CONCLUSIONS

Suture lateralization of one vocal cord using technique 2 can be tried as the first line of management in cases of bilateral abductor cord palsy requiring lateralization.

Torsion of the gall-bladder in the aged

Torsion of the gall-bladder in 2 women in the tenth decade of life is described. The aetiology of the condition is discussed and the importance of keeping the diagnosis in mind in this age-group is stressed.