Tuberculoma is a rare but known complication of tuberculosis. It rarely occurs in the mastoid bone. When it occurs in the middle ear cleft, it can lead to intracranial complications if there is a delay in the diagnosis and management.A rare case of tuberculosis of the middle ear cleft which presented as tuberculoma of the mastoid bone with infranuclear facial palsy is described. The tuberculoma was removed and a canal wall down tympanomastoidectomy was performed. Post-operatively the patient was kept on antituberculous therapy. The various problems encountered in the diagnosis and management of this case are discussed.

The need for resiliency of electricity supply is increasing due to increasing frequency of natural disasterssuch as hurricanes-that disrupt supply from the power grid. Rooftop solar photovoltaic (PV) panels together with batteries can provide resiliency in many scenarios. Without intelligent and automated decision making that can trade off conflicting requirements, a large PV system and a large battery is needed to provide meaningful resiliency. By using forecast of solar generation and household demand, an intelligent decision maker can operate the equipment (battery and critical loads) to ensure that the critical loads are serviced to the maximum duration possible. With the aid of such an intelligent control system, a smaller (and thus lower cost) system can service the primary loads for the same duration that a much larger system will be needed to service otherwise.In this paper we propose such an intelligent control system. A model predictive control (MPC) architecture is used that uses available measurements and forecasts to make optimal decisions for batteries and critical loads in real time. The optimization problem is formulated as a MILP (mixed integer linear program) due to the on/off decisions for the loads. Performance is compared with a non-intelligent baseline controller, for a PV-battery system chosen carefully for a single family house in Florida. Simulations are conducted for a one week period during hurricane Irma in 2017. Simulations show that the cost of the PV+battery system to provide a certain resiliency performance, duration the primary load can be serviced successfully, can be halved by the proposed control system.

Cemento-ossifying fibromas are benign lesions of the jaw, which arise from the periodontal membrane. Histopathologically these are composed of fibrous tissues with calcified structures resembling bone and cementum. Surgical resection is the treatment of choice. They have rarely been reported in the ethmoid sinus, maxillary sinus and sphenoid sinus Mastoid bone is an extremely rare site of such tumors. Only one case of cemento-ossifying fibroma of petromastoid bone has been reported before. We present a case of cementoossifying fibroma involving the petromastoid bone, with the large intracranial component causing compression on the cerebellum. This unique case may provide insight into the etiopathogenesis of these tumors.

Schwannoma are relatively rare tumor and even rarer in children. Nerve sheath tumors arising from the cervical nerve are extremely rare. We report a 13-year old boy presented with a history of an asymptomatic right cervical swelling since one year. An ultrasound and FNAC revealed schwannoma. He was meticulously evaluated with MRI. Surgical excision of the lesion was carried out and histopathological examination confirmed the diagnosis. Patient recovered completely without any morbidity. We are presenting this case since it is a rare case and patient recovered without morbidity. It is possible to do the complete surgical excision of schwannoma with complete cure and without complication.

Objective: The risk of invasive fungal rhinosinusitis is increased in Coronavirus disease 2019 (COVID-19) because of its direct impact in altering innate immunity and is further exacerbated by widespread use of steroids/antibiotics/monoclonal antibodies. The study aims to describe this recently increased clinical entity in association with COVID-19. Method: A prospective, longitudinal study including patients diagnosed with acute invasive fungal rhinosinusitis (AIFRS) who recently recovered from COVID-19 infection or after an asymptomatic carrier state. A single-center, descriptive study investigating demographic details, clinical presentation, radio-pathological aspects, and advocated management. Result: A total of 21 patients were included with a mean age of 49.62 years (SD: 14.24). Diabetes mellitus (DM) was the most common underlying disorder (90.48%), and 63.16% of all patients with DM had a recent onset DM, either diagnosed during or after COVID-19 infection. Nineteen patients (90.48%) had recently recovered from active COVID-19 infection, and all had a history of prior steroid treatment (oral/parenteral). Remaining 2 patients were asymptomatic COVID-19 carriers. Surprisingly, 2 patients had no underlying disorder, and 5 (23.81%) recently received the Covishield vaccine. Fungal analysis exhibited Mucor (95.24%) and Aspergillus species (14.29%). Most common sign/symptom was headache and facial/periorbital pain (85.71%), followed by facial/periorbital swelling (61.90%). Disease involvement: sinonasal (100%), orbital (47.62%), pterygopalatine fossa (28.58%), infratemporal fossa (14.29%), intracranial (23.81%), and skin (9.52%). Exclusive endoscopic debridement and combined approach were utilized in 61.90% and 38.10%, respectively. Both liposomal amphotericin B and posaconazole were given in all patients except one. Conclusion: A high suspicion of AIFRS should be kept in patients with recent COVID-19 infection who received steroids and presenting with headache, facial pain, and/or facial swelling. Asymptomatic COVID-19 carriers and COVID-19 vaccinated candidates are also observed to develop AIFRS, although the exact immuno-pathogenesis is still unknown. Prompt diagnosis and early management are vital for a favorable outcome.

Several cases of the ectopic supernumerary tooth in the nasal cavity have been reported; however, an eruption of the primary maxillary tooth in the nose following trauma is extremely rare. Clinical evaluation and discriminating features on CT imaging, particularly with bone window setting, are sufficient to confirm the diagnosis. We discuss a case of deciduous central maxillary incisor in the nasal cavity and specifically focus on its clinical and radiological presentation. None of the previous authors have discussed probable theories of the post-traumatic intranasal tooth; we consider two possible theories which might be responsible for the ectopic intranasal tooth after trauma. Additionally, we discuss pertinent features which help distinguish ectopic deciduous tooth from the supernumerary tooth.

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<p class="abstract"><strong>Background:</strong> One of the premalignant conditions in oropharynx is oral submucous fibrosis (OSMF). It is a chronic debilitating condition of unknown etiology leading to fibrosis of mucosa affecting the oropharynx, esophagus and thus causes decreased mouth opening and dysphagia respectively. The disease is of multifactorial etiology with addictions, nutritional, micro elements and antioxidants deficiencies. In India males are more affected than females, due to their stress related excessive, irresponsible chewing habits. The available management is for symptomatic relief and at present there is no definitive treatment is available.</p><p class="abstract"><strong>Methods:</strong> We have studied 60 cases diagnosed with OSMF with mild to moderate restricted mouth opening. Most of patients were between 17 to 55 years of age selected by randomized clinical trial. Its management was divided into 2 groups where group A was treated with a combined intralesional regimen of injection triamcinolone 40mg and hyaluronidase 1500 IU, while group B was treated with injection of 2ml placental extract. Each group has given a single dose intralesional injection per week for six weeks.  </p><p class="abstract"><strong>Results:</strong> It was a comparative study of improvement in effectiveness on mouth opening and reduction in burning sensation of oral cavity seen in group A regimen than group B. Those having persistent trismus, needed surgery.</p><p class="abstract"><strong>Conclusions:</strong> No effective treatment available but along with intralesional injection can give symptomatic relief. In addition, cessation of habits, antioxidants oral hygiene helps in improvement of OSMF.</p>