Introduction: Anthropometric measurement of the nose has a great importance to differentiate gender, race, and ethnicity. Nasal index is an important parameter in forensic sciences and rhinoplasty surgery. Our aim is to compare the nasal index of both males and females and its role to identify gender differences among medical students. Methods: First and second year medical students were chosen and height, breadth and nasal index were calculated. The height and width of the nose was measured using a vernier caliper. The nasal index of both males and females were calculated and compared and based on this, the nasal shape was also determined. Results: Among 184 total participants, 114 (61.9%) were Nepalese and 70 (38.1%) were Indian. In the Nepalese cohort, mean nasal height for male students was 4.58 ± 0.37 cm which was higher than females (4.39 ± 0.34 cm). The mean nasal index was higher among males in students of both the countries. The mesorrhine was most common type of morphology found among all students. Conclusions: Nasal index of male medical students was significantly higher than females. Mesorrhine nose was the commonest type of nose in our study. This information may be used to estimate gender differences.

Here, we present the case of a giant multinodular goiter with retrosternal extension in an old lady with dyspnea for 3 months. The patient was treated with microscopic-assisted total thyroidectomy without any postoperative complications.

Introduction: External carotid artery originated superior thyroid artery are frequently documented in classical anatomical, surgical and radiological textbooks. Knowledge of anatomical variations, proper identification of superior thyroid arteries is very important to avoid major complications during and after neck surgeries. The aim of the study is to find out the prevalence of right superior thyroid artery originating from right external carotid artery in cadavers of a Medical College in Western Nepal. Methods: A descriptive cross-sectional study was carried out at the department of anatomy in Universal College of Medical Sciences, Bhairahawa, Nepal from October 2020 to January 2021 after ethical clearance from the same institution (IRC UCMS, Ref: UCMS/IRC/078/20). Variations in origin of superior thyroid arteries were observed, recorded and photographed. Convenient sampling method was used. Data was analyzed using Microsoft Excel 2016. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage. Results: Out of 30 right superior thyroid arteries of 30 cadavers, 27 (90%) at 90% Confidence Interval (80.22-96.44) originates from right external carotid artery. Conclusions: In our study we observed that almost nine tenths of right superior thyroid arteries originated from the right external carotid artery which was relatively high in comparison to other studies. Thus, Extensive knowledge of variations in origin of superior thyroid artery is important for surgeons prior to various interventional surgeries.

Introduction: Epistaxis is a common otolaryngological emergency condition. It occurs due to local and systemic cause. Local cause lies within the nose bleeding either anterior or posterior. Commonest site of bleeding anterior epistaxis is kiesselbach’s plexus. In posterior epistaxis, it is difficult to locate bleeding site. Epistaxis is controlled by simply pinching of nose, decongested nasal drop and abgel packing. Some cases become more challenging required nasal packing and arterial ligation. Objectives: To study the epidemiological pattern and management of epistaxis. Methods: This was a retrospective study on pattern of epistaxis man­aged at Gandaki Medical College Teaching Hospital over a period from April 2015 to April 2016. Information regarding demographic profile, presentation and management of epistaxis was obtained from the Hospital records, ENT Outpatient clinic, Emergency Department, ENT ward and operation theatre. Results: A total of 78 cases were managed during study period. There was a significant male preponderance with male to female ratio 1.78:1. Patients’ age varied from eight to 80 years with mean age 40.7 years. The peak age of incidence was 21 - 30 years group. Idiopathic nasal bleeding 27 (34.6%) was commonest followed by nasal trauma 23 (29.5%) cases and hypertension 16 (20.5%) cases. Seventeen (21.8%) cases managed in day care basis with decongested nasal drop, chemi­cal cautery and abgel packing. Remaining cases required nasal packing and bipolar cautery and other specific form of treatment. Five (6.4%) cases required sphenopalatine artery ligation with no recurrence of bleeding. Conclusions: Epistaxis is common ENT emergency. Most common causes are idiopathic followed by nasal trauma and hypertension. Prompt management is instituted according to cases. Most of the cas­es are managed by non-surgical method.

Endoscopic sinus and skull base Surgery has gained significant improvement widely all over the world. A computerized tomography (CT) scan provides a detailed anatomy of the skull base especially the bone framework. This study aims to analyze the fixed anatomical bony landmarks of the anterior skull base through coronal and reconstructed CT in the context of the Nepalese population and guide the surgeon to perform endoscopic sinus and skull base surgery safely. This Prospective study includes 70 Computerized Tomography scans of Paranasal sinuses. The different measurement from nasal floor to skull base was taken in coronal and reformatted sagittal CT scan. Mean, standard deviation, minimum and maximum values were analyzed using descriptive statistics. Student T-test was applied to compare between right and left side. This study includes 75 patients between 18 to 77 years. The measurement from nasal floor to the cribriform plate and ethmoidal roof in right and left side were, mean± SD (47± 4.1, 45.3±4.3, 47.9±5.1, and 49±8.5 mm) respectively. Mean Take off angle at the cribriform plate was 43.9 ±10.9°on right side and 43 ± 9.4° on the left side. The distance from the nasal spine to the skull base (mean ± SD) at nasofrontal recess, bulla ethmoidalis, and the junction of sphenoethmoid levels at right sides were 51.5 ± 4.7, 52.9 ± 4.1, and 61.2 ±4.7 little higher at left side. This study provides a detailed analysis of the anterior skull base in coronal and sagittal CT scans which helps to reduces complications.

The branchial cleft cyst (BC) is a soft swelling that develops from the incomplete obliteration of the second branchial cleft mucosa which remains dormant and grows later in life and forms the cyst. 1 They are usually found in the anterior triangle of the neck medial to the upper third of the sternocleidomastoid (SCM) muscle but is rarely reported in the posterior triangle of the neck. 2 It is a slowgrowing, fluctuant soft swelling, congenital in nature that may present later in childhood or even in adults. It can be found in the line of the external ear, angle of the mandible, and upper lateral aspect of the neck consistent with the location of branchial apparatus. The typical location is at the anterior border of SCM at upper 1/3rd and lower 2/3rd but can occur at any level from the hyoid bone to the suprasternal notch. 3 It is rare for the BC to manifest in locations such as in the lower third of the sternocleidomastoid muscle, in the posterior triangle, and on the right side. Here, we report on the case of a branchial cleft cyst situated in the posterior triangle of the neck possibly corresponding to its origin from the third branchial arch.

Fibrous dysplasia is a rare bone condition in which normal bone is replaced by aberrant fibrous tissue. The patient may come to evaluate with other diseases and while doing investigations, it is observed. Here we present a case of 24 years male with fibrous dysplasia who came to our OPD with swelling around the left cheek region for 5 days. The patient underwent a Computerised tomography scan which revealed an expansile, sclerotic, cystic ground-glass appearance that extended to the maxillo-alveolar ridge, right sphenoid sinus wall, right pterygoid plate, and zygomaticofacial suture. The right maxillary sinus was almost obliterated.  These radiographical features of the lesion were indicative of fibrous dysplasia in the maxilla.

Introduction Tumor of the skull base are classified based on their tissue of origin. Tumor originates from epithelium, mesenchyme, and neuroectoderm. Management of tumors depends on location, histologic characteristics, and their behaviors. A sinus endoscopy, Computerized tomography scan, and Magnetic Resonance Imaging should be performed to know the type and extent of the tumor. Treatment includes surgical excision either endoscopic vs open, chemotherapy and immunotherapy. We are highlighting the management option of each tumor according to their type of tissue origin and its location.   Methods: A PubMed search was conducted for relevant publications using the terms “anterior skull base malignancies” and “anterior skull base malignancies treatment and “open vs endoscopic anterior skull base malignancies.” The publication language should be English. Results: Articles published after 2000 that cover the most recent paradigm shift in the treatment of anterior skull base tumors were included. There have been 35 articles found, despite 20 of them are being rejected due to the lack of full text, abstract, and non-english. Three of the fifteen articles have been downloaded twice, thus they have been excluded. Conclusion: Skull base tumors are treated based on findings of diagnostic nasal endoscopy and imaging results. CT scans and MRIs are becoming more significant in the diagnosis of diseases. Endoscopic techniques to the skull base were beneficial in treating the malignancy. Chemotherapy can be used as a gold standard first-line treatment with radiation and surgery for significant types of head and neck tumors. immunotherapy-like checkpoint inhibitors targeting PD1 are the second-line treatments of advanced HNSCC. Prospective research and trials will be required in the future.