A mucocele of a para-nasal sinus is an accumulation of mucoid secretion and desqua-mated epithelium within the sinus with distension of its walls and is regarded as a cyst like expansile and destructive lesion. If the cyst invades the adjacent orbit and continues to expand within the orbital cavity, the mass may mimic the behavior of many benign growths primary in the orbit. The frontal sinus is most commonly involved, whereas sphenoid, ethmoid, and maxillary mucoceles are rare. Floor of frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles. Frontal sinus mucoceles are prone to recurrences if not managed adequately. Here, we are evaluating different approaches used to manage various stages of frontal mucoceles which presented to us with orbital complications. Three cases of frontal sinus mucocele are discussed which presented to our OPD with different clinical symptoms and all cases were managed by different surgical approaches according to their severity. We also concluded that it is prudent to collaborate with the neurosurgeons for adequate management of such complex mucoceles by a craniotomy approach.

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Aim: To evaluate clinical and imaging outcomes after ultrasound (US)-guided 3% polidocanol (POL) foam-sclerotherapy of venous malformations (VMs). Methods:We retrospectively evaluated consecutive VM cases over 1.5 years, with 6-month follow-up. US findings were used to classify VMs into four types depending upon extent of anechoic channels, connections to adjacent veins, and dysmorphism. Single or multiple needles were inserted depending upon lesion size, and used to inject up to 8 mL POL per session, every 2 to 4 weeks. We evaluated reduction in pain and swelling, lesion resolution on imaging, and patient satisfaction.Results: There were 15, 24, 9, and 5 patients (total 53) with type I, II, III, and IV VMs, respectively.The average number of sessions was 5.3, 4.3, and 4, and the average amount of POL injected was 14.24 mL, 16.1 mL, and 23.2 mL for type I, II, III VMs, respectively. The number of sessions correlated with lesion volume (P < .0001). Imaging showed good resolution in 4/15, 18/24, 6/9, and 4/ 5 patients respectively with type I, II, III, and IV VMs. Patient satisfaction was not related to lesion type (P 5 .1). ROC analyses showed cut-off values of 4.9 mL lesion volume, three sessions, and 12 mL POL volume for patient satisfaction. At 6 months, 23 patients having pain had significant improvement (P < .00001). Local (n 5 30) and chest pain (n 5 2) were the only complications.Conclusions: US-guided sclerotherapy with 3% POL foam is safe and effective. Lesions with up to 50% anechoic areas had better resolution, without correlation with patient satisfaction. We used foam made by agitating 3% POL with room air, and performed the sclerotherapy under US guidance. We evaluated the clinical and radiological results in a series of consecutive patients.

Background In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. Methods We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. Results Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45–59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. Conclusions Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

Objective. To study the validity of smartphone otoscopy.Setting. Ear, nose, and throat (ENT) outpatient clinic of a tertiary care hospital in eastern India.Study Design. Experimental study design to compare the efficacy of smartphone otoscopy with otoendoscopes.Subjects and Methods. One hundred tympanic membranes (TMs) of 50 patients were examined and photographed by third-year senior residents (6 years of ENT training) using a zero-degree otoendoscope. The same 100 ears were then examined using a smartphone. Assistive light of the phone was used to illuminate the ear canal. The camera of the phone was focused to visualize and photograph the TM.Results. Compared with the gold-standard otoendoscopes, smartphones could correctly diagnose 75% of the cases. Sensitivity and specificity of smartphone otoscopy were 87.8% and 80%, respectively. Positive predictive value was 90.6%, whereas negative predictive value was 75%. Smartphone otoscopy could correctly diagnose 88.57% of normal TMs, 86.36% of retracted TMs, and 82.85% of perforated TMs.Conclusion. This modality of ''smart otoscopy'' has no added cost and can be used by most doctors after minimal training. It is an excellent teaching tool and can be used universally even in resource-limited settings.

Background and Aims:The preservation of recurrent laryngeal nerve (RLN) is an essential part of thyroid surgery. The various methods to test the normal functionality of vocal cords (VCs) include direct visualisation under the fiber bronchoscope, indirect laryngoscopy, laryngeal muscles electromyography, computed tomography (CT), and magnetic resonance imaging (MRI). We aimed to assess the usefulness of ultrasound (USG) in the examination of VC morphology and movement.Methods:After Institutional Ethical Committee (IEC) clearance, 65 American Society of Anesthesiologists physical status I/II patients between the age group 18 and 60 years scheduled for thyroid surgery were enrolled in this observational study. All patients underwent USG examination before, immediately after and 2 days after thyroidectomy. The vocal fold (VF) displacement velocity (VFDV) was recorded and analysed. If any VF disorder was detected, the patients underwent two additional examinations: 2 and 3 months after thyroidectomy. All the findings were correlated with those of video rhinolaryngoscope (VRL).Results:The visualisation rate of the VCs with USG was 96.9% whereas with VRL was 100%. Two patients had preoperative VC palsy that was picked up by USG and confirmed by VRL. The sensitivity and specificity of USG as a tool to detect paralysis were 100% CI = (0.34, 1.00) and 93.44% CI = (0.84, 0.97), respectively.Conclusion:USG examination can prove to be a good, noninvasive, cheap alternative to VRL in examination for functionality of VCs perioperatively.

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Objective: To describe results of image guided sclerotherapy of venous malformations (VM) localized in the masseter muscle. Methods: Retrospective review of prospectively maintained data was done to include consecutive cases treated over 5-year period, with minimum 6 months follow-up. Sclerotherapy was done using ultrasound (US) guided needle puncture(s) of the lesions percutaneously, and 3% polidocanol foam injected under image guidance. Results: Seventeen cases (10 male, 7 female) with mean age 15.6 years (range 6-28 years) were identified. Clinical presentation was with facial asymmetry, becoming pronounced on jaw clenching, and three cases had mild local pain. On US, the lesions appeared as partially compressible masses with anechoic spaces, showing color filling on releasing probe pressure. Fourteen had phleboliths. Eight patients had undergone magnetic resonance imaging, lesions appearing as oval, homogenous, lobulated, T2 hyperintense masses, with heterogeneous contrast enhancement. Number of sclerotherapy sessions were—single in four cases, two in eight cases and three in five cases, for total of 35 sessions (average 2.05 session per patient). The mean dose of drug injected per session was 1.85 mL and total mean dose per patient was 2.79 mL. Post-procedure vomiting occurred in one patient while all had local swelling and mild pain, lasting between 3 to 7 days. No facial nerve palsy or sloughing/ulceration/skin necrosis was noted. On US follow-up (6-26 months, mean 15.9 months), 12 patients had small echogenic masses without any vascularity, and five had small anechoic areas <25%. All patients had complete resolution of swelling and pain. Conclusions: For VMs localized to the masseter muscle, image guided sclerotherapy is highly effective and safe, and recommended as first line treatment.