The carotid sheath enclosing the common carotid artery, internal jugular vein, vagus and the deep jugular lymph nodes continues around the vessels of the superior mediastinum. This sheath formed by the investing fascia, prevertebral fascia and the pre-tracheal fascia is captioned the Lincoln s highway. Suppurative pathology of the Lincoln highway presents as a vertical swelling at the anterior border of the sternomastoid. USG, CT and MRI confirms the diagnosis and prompts surgical intervention and thus prevents intra thoracic spread with its morbidity and mortality.
<p class="abstract">Endo-DCR has a successful outcome when the lacrimal sac is marsuplised on the nasal lateral nasal wall. The lacrimal sac and nasal mucosal edges heal by primary intention rather than by formation of granulation tissue with consequent restenosis or reclosure. An indigenous flap was utilized to cover the exposed bone following Endo-DCR in a young individual. The flap fashioned in an inverted ‘V’ prevented the granulation of secondary intent healing and thereby reclosure.</p>
Tracheal access, accidental deccannulation, peristomal granulation, stenosis and difficult weaning are the laryngologist’s dilemma, wherever tracheostomy has been resorted to, in the paediatric age group. These major problems necessitate a modification in the procedure of tracheostomy where ‘stay’ and ‘maturation’ sutures are utilized. The stay sutures facilitate a quick midline tracheotomy and the maturation ones minimise parastomal granulation and easy tracheal recannulation.
<p class="abstract">Reconstruction of facial infraorbital defects, an untoward sequel of mucormycosis, is an issue confronting the rhinologist.<strong> </strong>Tunneled island flap was used in a patient with a wide defect involving the infraorbital region. Inspite of intricate pedicle dissection and likelihood of a trapdoor deformity these flaps facilitate repair in a single-staged procedure. The flap is so sited that its vascularity is not compromised neither by stretch tension or overlying tissue compression; while in the tunnel. The occasional, slight bulging is observed which is due to the pedicle; just over the undermined tunnel.<strong> </strong>This effect settles down with time and doesn’t need corrective intervention<strong>.</strong> Moreover<strong>,</strong> the donor site scars are merged in the margins of the aesthetic units thereby retaining central facial symmetry.</p>
<p class="abstract">Glues or tissue adhesives have attained a foothold in the arena of otorhinolaryngology.and skull base-head neck surgery. At the sites inaccessible to time tested suture application, they facilitate tissue synthesis and local haemostasis, excellent adhesion, elastic consistency, tissue compatibility, and ability to disintegrate and thereby get completely absorbed with time are the properties of an ideal glue tympanoplasty, ossiculoplasty. CSF leak repair are the widely used applications of this suture less modality. Biological and synthetic glues have been developed. The former being the fibrin glues (1940) and the latter, the cyanoacrylates (1960). Moreover in addition to adequate wound closure, a secure fixation of skin grafts, transplants and implants is vital for the success of a surgical intervention. At these crucial sites, tissue adhesives are the preferred option.</p><p class="abstract"> </p><p class="Default"> </p>
<p>Reconstruction of facial orbital region defects, secondary to wound dehiscence following orbital exentration to treat Mucormycosis is an issue confronting the rhinologist. The transposition flaps have a vital role when expected result is unlikely, neither aesthetic nor functional, with a simple primary closure, secondary intention, advancement sliding flap or by free skin grafts. Glabellar transposition flap was used in a patient with a wide defect involving the medial wall of the orbit. Though there is a delicate dissection of pedicel there is likelihood of a trapdoor deformity but the glabellar flap facilitates repair in a single-staged procedure. Moreover, the donor site scars are merged in the margins of the aesthetic units thereby retaining facial cosmesis.</p><p class="abstract"> </p>
<p>Deep neck infections either cellulitis or abscess are localised initially within the potential spaces and fascial planes of the head and neck. These infections should not be ignored. One should not underestimate the necessity of appropriate and timely treatment of deep neck infections due to the late sequel of serious and potentially life-threatening nature of these infections. An intriguing patient of a limited submental/ suprahyoid pathology secondary to suppuration in the premolar socket was addressed with timely intervention surgically.</p><p><strong> </strong></p>
<p class="abstract">Wry neck or congenital muscular torticollis is consequent to shortened or contracted sternocleidomastoid muscle (SCM). A painless, retracted sternocleidomastoid muscle is the characteristic feature which results in tugging the neck towards affected side, and draws the shoulder upward and forces the chin in the opposite direction. The incidence is between 0.4 to 1.9%. A 17 years old lady with torticollis since childhood is being discussed in detail with the steps of surgical intervention; at three sites to attain a sternocleidomastoid release and resistance free neck and thus a free head movement. This was followed by application of cervical collar, active physiotherapy and postural exercises. The ignorance and improper advice during childhood had led to this marked deformity at adolescence.</p><p class="abstract"> </p>
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