Objectives Congenital midline cervical cleft (CMCC) is a very uncommon congenital anomaly of the midline anterior neck, and although it has very pathognomonic features (including nipple-like protuberance), it could be mistaken for other congenital neck lesions, such as thyroglossal duct cyst and branchial apparatus anomalies. Thus, it represents a challenging diagnosis. In this 21-patient series, we discuss the clinical features of CMCC, its pathophysiology characteristics, and its modalities management. Material and Methods We conducted a retrospective chart review of children presenting with CMCC at our institution, between January 1998 and January 2016. Results Twenty-one patients were identified with CMCC. Ages ranged between 1 day and 14 years. The length of the lesion varied from 0.5 to 5 cm, and the size of the skin tag varied from 0.2 to 1.5cm. No other significant associated anomalies were found. Surgery was the mainstay treatment, and no recurrence was found. W-plasty was used in most patients to close the defect. Conclusion With a little more than 200 published cases, our series represents the largest series worldwide. The lesion is usually isolated, and no further investigation is required. Surgery is the mainstay of treatment, with complete excision being usually curative. It should be treated at an early age to prevent complications. In our experience, W-plasty was a good alternative to the most commonly used Z-plasty, in skin closure, with respect to both aesthetic and functional results.

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Introduction: Functional endoscopic sinus surgery (FESS) has become the gold standard for treating chronic rhinosinusitis (CRS), and it is regarded as a relatively safe and effective technique. Orbital complications of FESS have been reported for many years owing to the close anatomical relationship between the paranasal sinuses and the orbit. Accidental injury of the lamina papyracea (LP) during FESS, was described in up to 5% of cases. Preventing complications begins with preoperative planning and careful review of computed tomographic (CT) scans. Methods: This was a multicentric national survey to report any case of lamina papyracea defect (LPD) that was not reported by radiologists. Multiple rhinologists from different provinces of Saudi Arabia (SA) were invited to report any patient with such an incidence in the last two years. patient-specific data were all included in this study. Results: The data of 16 patients, 11 males and 5 females, were reviewed retrospectively. The median age at diagnosis was 37.4 years. The right side is the most prevalent location of LPD (8 patients, 50%), despite the fact that most cases (75%) had no history of trauma or sinus surgery. Five patients had left-side LPDs and three had bilateral LPDs. Conclusion: Injury to the LP is a well-known avoidable complication of FESS. Careful and attentive review of CT scan images pre-operatively and by the operating surgeon is of utmost importance. This should always include the integrity and configuration of the medial orbital wall and LP without depending on the report of CT scans.

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