Congenital defect to the foramen of Huschke with a manifestation as temporomandibular joint (TMJ) soft tissue herniation in a radiological study is rare. The patient may present with nonspecific symptoms such as otalgia, mandibular joint pain, tinnitus and conductive hearing loss, and scarcely cervicofacial subcutaneous emphysema. Here, we report a patient presented with cervicofacial subcutaneous emphysema secondary to a congenital defect of the foramen of Huschke. A 45-year-old gentleman presented with right-sided neck swelling and right otalgia with a crackling sound over the right ear upon chewing. Examination shows right-sided fullness with subcutaneous emphysema from the zygoma to the upper neck. Otherwise, it is non-tender with no skin changes, and the facial nerve is intact. Otoendoscopy shows erythematous soft tissue bulging of the anterior wall of the right external auditory canal (EAC) upon closing the mouth and prolapsing upon mouth opening. The right tympanic membrane was intact. Contrast-enhanced computer tomography (CECT) of the neck and temporal region revealed extensive cervicofacial subcutaneous emphysema with a bony defect at the anterior wall of the right EAC, indicating fistulous communication between the right EAC and TMJ. The subcutaneous emphysema resolved on the treatment of the right otitis externa. The patient is subjected to a combined approach of open and endoscopic-assisted repair of the anterior EAC wall defect. TMJ herniation into the anterior EAC is rare; however, the patient presentation may vary. CECT is the gold standard for diagnosing and facilitating treatment options. Treatment choice is based on the patient's condition, including conservative or surgical intervention.

Post-tonsillectomy pain is an undesirable complication that can affect a patient’s emotion and daily activity. There have been many studies on different surgical techniques and medications to find the best treatment to alleviate pain in post-tonsillectomy patients. This study aims to compare the effectiveness of oral gargle and throat spray as different modes of delivery of benzydamine hydrochloride in post-tonsillectomy pain control. We focused on local analgesia using different methods of delivery. A total of 92 patients aged between 13 and 40 who underwent tonsillectomy with or without adenotonsillectomy, were included. They were randomly divided into two groups: gargle group and spray group, with 46 patients in each group. Pain score using Visual Analogue Score (VAS) was assessed for both groups at least six hours post operation as the baseline pain score, followed by assessments at days 1, 4 and 7. There was a significant difference in the VAS pain scores between the two modes of benzydamine hydrochloride delivery. The gargle group reported higher pain scores compared to the throat spray group (p < 0.001). In conclusion, using throat spray as a method to deliver local analgesia provides greater benefit in pain control for post-tonsillectomy patients, to the use of oral gargle. So, we can consider prescribing throat spray for treating the post-tonsillectomy pain perhaps it can prevent further complications such as dehydration, infection and bleeding.

Rhinolith is a calcareous concretion resulting from mineralization and encrustation of an endogenous or exogenous nidus in the nose. This rare clinical entity could be the result of a previous introduction of a foreign body into the nasal cavity. Rhinolith is rarely seen by the clinical practitioner. We report a case of rhinolith in a young healthy lady who presented with epistaxis and highlight the clinical presentation and management of this case. The history of foreign body insertion may be overlooked in such cases. Presence of grittiness on endoscopic probing aid in establishing the diagnosis. Early referral from primary care centre to ENT can avoid misdiagnosis and further complications as removal of the rhinolith is the ultimate treatment.

Fibromatosis colli presents in 0.4% of infants as a firm palpable mass in the middle or lower thirds of the sternocleidomastoid muscle.1 The typical age of presentation ranges between two to four weeks of life. It is unilateral in 75% of cases and occurs due to fibrosis within the sternocleidomastoid muscle. Although no single entity has been able to explain the etiology, birth trauma is often attributable. Ultrasonography is the initial investigation of choice. This benign condition is often treated conservatively, rarely requiring surgical intervention. Here are two cases from our centre. Keywords: Fibromatosis colli, forceps delivery, infant, neck swelling, torticollis

The common sites of distant metastatic spread of head and neck malignant tumor are lungs, liver, and bones. Skeletal muscles metastases are extremely rare. We present a case of 61-year-old man who was previously treated with radical chemo radiotherapy for hypopharyngeal squamous cell carcinoma, stage T4bN2cM0. During surveillance follow up 21 months post treatment, he developed a right proximal arm mass. There were no neurological or vascular deficit. MRI revealed an irregular enhancing intramuscular soft tissue mass within the right triceps muscle, with widespread nodal and skeletal muscle metastases. Tissue biopsy revealed a metastatic carcinoma favoring poorly differentiated squamous cell carcinoma. He received palliative chemotherapy but died 4 months later. Skeletal muscle metastases must be high in the list of differential diagnosis in a head and neck cancer patient presented with a muscle mass, even though it is rather rare. Radiological imaging and tissue biopsy helped in the diagnosis and prompt management.

Mucocele of the paranasal sinus is a cystic lesion with accumulation of mucus within the sinus walls, which is capable of expansion. The frontal sinus is most commonly involved, whereas ethmoidal, sphenoid, and maxillary mucoceles are rare. The floor of the frontal sinus is shared with the superior orbital wall, which explains orbital displacement in enlarging frontal mucoceles. This article presents a case of a spontaneous right frontoethmoidal mucocele with non-axial proptosis in a 26-year-old male patient who was referred by an ophthalmologist to our ENT (ear, nose, throat) clinic for a biopsy to rule out a sinonasal malignancy. An intranasal endoscopic approach was done to obtain a tissue biopsy in a clinic setting, which turned out to be a both diagnostic and therapeutic procedure with complete resolution of symptoms. © Pediatr Med Rodz 2021.

Pyogenic granuloma (PG) is a rapidly growing benign lesion of the skin and mucous membrane. Its etiology is still unclear. It is suggested to have arisen either due to trauma or hormonal influences. Pyogenic granuloma is regularly found in the oral cavity. Even though it is rare, it does occur in the nasal cavity and a few cases of pyogenic granuloma have been reported among the paediatric population. We present a case of a 6-year-old boy, who presented with unilateral nasal blockage and recurrent epistaxis. The child has a history of allergic rhinitis and frequent nasal picking. Clinical examination revealed a small broad based reddish mass at the anterior part of the right inferior turbinate. The histopathological examination from complete excisional biopsy was consistent with pyogenic granuloma. Although pyogenic granuloma is relatively rare, we should raise suspicion in young patients who complain of progressive unilateral nasal blockage and recurrent epistaxis, with or without a history of trauma. Thorough clinical examination is adequate in small lesion thus sparing the need for radiological investigation for bigger and extensive lesions. Complete excision is the ultimate treatment to avoid recurrence.

Extranodal natural killer T-cell lymphoma, nasal type (ENKTCL), is a rare form of non-Hodgkin lymphoma that is strongly related to Epstein-Barr Virus (EBV) infection and commonly presents as “midline lethal granuloma.” Herein, we report a middle-aged lady who presented with a two-week history of fever, sore throat and constitutional symptoms. Intraoral examination revealed a lacerated soft palate with an ulcerated uvula. A diagnosis of ENKTCL was confirmed through deep biopsies under general anaesthesia supplemented with a positive serum EBV genome. Unfortunately, she succumbed due to disease progression with left frontal brain metastasis with concurrent pulmonary tuberculosis before treatment was completed. The recommended treatment is multimodality with L-asparaginase-containing regimes chemotherapy in an advanced stage, relapsed, or refractory ENKTCL for better outcomes. The quantification of circulating plasma EBV deoxyribonucleic acid (DNA) is helpful as the baseline of tumour load and a biomarker for monitoring treatment response and prognostication. We advocate repeated and deeper core tissue biopsies.