Cirsoid aneurysms are rare arteriovenous malformations (AVM) of the scalp and extremities. They are commonly congenital but post-traumatic cirsoid aneurysms have also been reported. Clinical features include- gradually increasing swelling, pulsatile mass, bruit, headache and tinnitus. Post-traumatic aneurysms of the scalp are uncommon. We report a case with successful surgical excision of scalp AVM.

BACKGROUNDObjectives-Thyroid surgery, one of the most common surgeries done by a general surgeon has evolved over the years. Surgeons have strived to improve patient outcomes by evolving their surgical technique and thus reducing postoperative morbiditypathophysiological and cosmetic. This study compared conventional thyroidectomy and horizontal lateral incision thyroidectomy. MATERIALS AND METHODSA prospective observational study was done between January 2015 and June 2016 in patients with thyroid swelling who had undergone thyroidectomy. Patients included in the study were those with Solitary nodule thyroid and Multinodular thyroid. Forty patients from both groups are selected. After obtaining Institutional Ethics Committee clearance, the study was carried out. Written informed consents were obtained from patients. Study questionnaire was administered at the onset and during postoperative follow up. Outcome variables such as cosmetic appearance, hypocalcaemia and recurrent laryngeal nerve palsy were compared. Scar was analysed using observer scar assessment scale and patient's scar assessment scale. Scar was assessed at 4 weeks, 8 weeks and 6 months. Hypocalcaemia was assessed by serum calcium and clinical features during postoperative period. Every patient was assessed for recurrent laryngeal nerve palsy by direct laryngoscopy in immediate post-operative period. Patients who have change in voice or stridor postoperatively were further assessed by indirect laryngoscopy. RESULTSThere is statistically significant difference between the two groups with regards to the outcome of the scar in OSAS and PSAS. The scar was significantly better in thyroidectomy done through lateral incision thyroidectomy [p value-0.003 and p value-0.000 for OSAS and PSAS respectively]. Thus, scar in lateral incision thyroidectomy is found to be cosmetically far better compared to the conventional incision thyroidectomy. CONCLUSIONLateral or horizontal incision thyroidectomy is analogous and feasible alternative to conventional thyroidectomy in selected cases. The advantage of this technique is an enhanced aesthetic result. This technique is not recommended in huge thyroid, retrosternal thyroid, thyroiditis and malignancy, so it cannot be recommended as a standard therapy. Study on a large number of patients, preferably randomised double-blinded studies with longer followup periods is recommended.