A total of 100 cases hyperthyroid patients were selected for this prospective study. The hyperthyoidism was confirmed by thyroid function tests and scintigraphy. Of these100 patients 60 (60%) patients had elevated serum alkaline phosphatase(ALP)and decreased bone mineral density (BMD) and 20(20%) patients had normal ALP and normal BMD. All 100 patients underwent total thyroidectomy. 20 patients with normal ALP did not show a shift in calcium levels and 80 patients with elevated ALP showed shift in calcium levels (1 to 1.5 gm%) 40 (40%) patients with their calcium levels less than 9.5gm% and elevated ALP developed carpopedal spasm in postoperative period. Hence we conclude that the combination of low normal calcium and elevated ALP has a high predictive value for postoperative carpopedal spasm .

OSTEOMAS ARE BENIGN SLOW-GROWING BONY TUMOUR PREDOMINANTLY OCCURRING IN LONG BONES, RARELY FOUND IN THE SKULL. IN THE SKULL THEY ARE FOUND MOST COMMONLY IN FRONTO-ETHMOID REGION. THEY ARE VERY RARELY FOUND IN THE TEMPORAL BONE. THEY ARE USUALLY ASYMPTOMATIC AND TREATED MAINLY FOR COSMETIC PURPOSES. WE DESCRIBE A CASE OF A 30 YR OLD FEMALE WHO PRESENTED WITH HISTORY OF LEFT EAR DISCHARGE FOR 5 YRS WITH SWELLING IN THE POSTAURAL REGION SINCE CHILDHOOD

Background: Angiomatoid fibrous histiocytoma (AFH) is a rare type of sarcoma with low-grade malignancy that usually occurs in young subjects. AFH is uncommon in the head and neck region. Methods: We describe an exceptional case of localization in the neck. This is the first report of a rare variant of AFH presenting in a 42-year-old woman. The tumor was situated posterior to the carotid artery adhering to the prevertebral plane and invading the sympathetic cervical chain. In this setting, we decided to perform a surgical exploration with frozen section biopsy. The frozen section revealed a fusiform tumor proliferation resembling a sarcoma. A FISH study concluded on the presence of a EWSR1 22q (22) gene rearrangement. Furthermore, the immunohistochemical study revealed anti-EMA positive cells. The final pathological description concluded on the presence of an AFH, which was excised by surgery alone. Results: After a 2 year follow-up period, the patient is free of disease. Angiomatoid fibrous histiocytoma (AFH) is a rare sarcoma subtype, and mis diagnosis can lead to its over treatment. A precise description of the pathological response and a multidisciplinary discussion can lead to a correct decision. Conclusion: AFH is a tumor with local evolution, and surgery is the mainstay of its management. Complete local excision is recommended to hamper local recurrences.

Necrotizing fasciitis is a fulminant infection that affects the deep and superficial fascia while initially sparing the overlying skin and underlying muscle. The involvement of the cervical compartment is associated with a high morbidity and mortality rate. Immunocompromised patients are prone to this infection. We present a case of a 80 year-old diabetic womansuffering from streptococcal cervical NF (probably secondary to a arm injury) with an uncommon involvement of the posterior cervical compartment, highlighting the atypical responsible microorganism (Streptococcus Agalactiae), the role of imaging for early diagnosis and the timely surgical and medical treatment for a successful outcome.

AIM : To establish the role of Sinusitis as Focal sepsis in Chronic Otitis media active mucosal disease, to emphasize the need of proper diagnostic endoscopic evaluation and improvement in middle ear mucosal disease status after functional endoscopic sinus surgery. METHODS : 60 Patients in the age groups of 18-49 years Chronic otitis media active mucosal disease were identified and screened for evidence of Focal Sepsis in Pasanasal sinus by Diagnostic Nasal endoscopy and computed tomography of paranasal diseases. Then Functional endoscopic sinus surgery was done to clear sinusitis and middle ear mucosal disease status assessed. RESULTS :Evaluation revealed that sinusitis in these patients was the cause for persistent discharge. All patients had one or more evidence of sinusitis like pus in middle meatus, deviated nasal septum and turbinoseptal deformities, prominent enlarged bullae, enlarged middle turbinate on DNE and CT. The otoendoscopy showed inflamed and boggy middle ear mucosal status. All patients underwent septoplasty/FESS depending on findings. Out of 60 patients 52 patient had improvement in middle ear mucosal status with surgery. In the adult population sinusitis is the most important focal sepsis in case of persistent ear discharge in Chronic Otitis Media active mucosal type of disease.A proper diagnostic nasal evaluation of all Chronic Otitis Media active mucosal type of patients is necessary in comprehensive management of the disease. The clearance of sinusitis has improved the middle ear mucosal status. Unilateral ear discharge is associated with sinusitis only on the corresponding side, which is in concurrence with our study. Functional endoscopic sinus surgery has emerged as the best procedure for clearance of sinusitis.

Lingual thyroid is an uncommon disorder which rarely need surgical intervention. Various techniques have been described with the majority requiring morbid procedures. We sought to describe a relatively novel technique for the surgical approach of this uncommon disorder with negligible morbidity and good functional results. The suprahyoid surgical approach for lingual thyroid was undertaken in a 27 year old lady with persistent dysphagia after thyroxine suppression therapy. The procedure was accomplished in 40 minutes with minimal blood loss and does not require morbid procedures like splitting of lip, mandible and tongue. Blood loss was minimal(25 ml). Pa- tient was discharged on the 7th post operative day without any anatomical or functional complications. This novel suprahyoid surgical approach is simple, easily reproducible, without any morbidity ensuring complete removal of the lingual thyroid under direct vision during the entire procedure.

The persistence of adolescent voice even after puberty in the absence of organic cause is known as puberphonia. 1,2,3 The condition is commonly seen in males.1-7 . This case report illustrates a novel surgical method “Retrusion thyroplasty” in the management of puberphonia.

This article reviews the published literature on the topic eosinophilic oesophagitis. This is actually a recent entity. Diagnosis of this condition depends on the awareness of the treating physician. Diagnosis is actually made after excluding the diagnosis of GERD and demonstration of more than 50 eosinophilis / high power field in the mucosal specimen studied. These patients respond well to topical / systemic steroids. Oesophageal dilatation may be needed to treat patients with severe degree of dysphagia which is fortunately rare.

This article is a case report of a case of diphtheria which presented as diphtheritic tonsillitis in stridor and finally succumbed to diphtheritic myocarditis. Here we describe the case presentation, the treatment modalities undertaken, and the fatal course of events followed by an elaborate discussion on diphtheria.

Presence of foreign bodies in the paranasal sinuses are not common findings. Many cases have been reported so far with foreign bodies like dental amalgam, chopsticks, gutta percha pellets, tooth, glue and even bullets. However, presence of foreign bodies in the maxillary sinus as a result of penetrating trauma is uncommon. Most of them have been the results of trauma after vehicle accidents, gunshot injuries and assaults. There are two treatment options – endoscopic and open surgical approach for the removal of sinus foreign bodies. We present a rare case of the transfacial penetrating injuries of maxillary sinus caused by a knife.

Schwannomas of the nasal cavity and paranasal sinuses are very rare. We report the case of a 50-year-old woman with a schwannoma arising from the nasal septum. We discuss the clinical presentation, differential diagnosis, imaging characteristics and treatment of this rarely encountered lesion. Schwannoma (neurilemmoma) is a benign neoplasm arising from Schwann cells in the peripheral nerve sheath. It can arise throughout the body, but is most commonly observed in the head and neck. This region accounts for 25–45% of all schwannoma [1]. Tumors arising from nasal septum are extremely rare with only less than 20 cases been reported in the English literature