To find out the most easily identifiable and anatomically consistent landmark for identification of facial nerve during parotid surgery. Ten cadaveric dissections and ten live parotid surgeries for different types of parotid tumours were done. Cadaveric dissection was performed in the Department of Anatomy and the surgeries were done in the Department of ENT and Head and Neck surgery of R. G. Kar Medical College of Kolkata. The distance of the facial nerve trunk from three most commonly used landmarks (viz., tympanomastoid suture, tragal pointer and posterior belly of digastric muscle) was measured in both cadaver and live patients. The ease of identification of the nerve trunk using each of the landmarks, particularly during live surgery was also assessed. The mean distance of the tympanomastoid suture from the facial nerve trunk was 3.5 mm (cadaver) and 3.87 mm (live surgery), the tragal pointer was found to be at a mean distance of 16.61 mm (cadaver) and 16.36 mm (live surgery) and in case of the posterior belly of digastric muscle it was 7.41 mm (cadaver) and 8.03 mm (live surgery). During live surgery the posterior belly of digastric was found to be the most easily identifiable landmark with a consistent anatomical relationship with the nerve trunk. The posterior belly of digastric muscle is the most easily identifiable and a very consistent landmark for facial nerve dissection during parotidectomy. When supplemented with the tragal pointer, accuracy in identifying the facial nerve trunk is very high, thereby avoiding inadvertent injury to the nerve trunk.

The present study was undertaken to assess the efficacy of medialization thyroplasty on outcome of voice quality in vocal cord paralysis by analyzing the voice. A total 19 patients with vocal cord paralysis of different etiologies were included in the study. Preoperative voice analysis was done by voice recordings, GRBAS score, maximum phonation time (MPT) and acoustic analysis using Dr Speech software (University version 4.0) using habitual fundamental frequency (F0), jitter %, shimmer % and normalized noise energy (NNE) as parameters. 18 patients underwent type 1 or medialization thyroplasty alone and 1 patient had undergone medialization thyroplasty along with arytenoids adduction. Post operative voice analysis was done using same parameters. There was post operative improvement of voice in 16 patients whereas 3 patients showed no significant improvement. Mean preoperative MPT was 4.8947 s and post operative was 13 s. Mean preoperative GRBAS score was 76.1579 and post operative was 30. On acoustic analysis, mean preoperative habitual fundamental frequency (F0), jitter %, shimmer % and NNE was 278.16 Hz, 1.7, 6.81 and 1.81 dB respectively whereas post operative mean was 132.37 Hz, 0.41, 1.65 and 123.38 dB respectively. Thyroplasty offers good voice outcome in patients of uncompensated vocal cord paralysis. Improvement can be documented in terms of perceptual evaluation of voice and acoustic analysis as well as maximum phonation time in addition to voice recording.

Figure 5: 99mTc-MDP bone scan in delayed phase showing diffusely increased concentration of radiotracer over the periphery of the anterior and inferior aspect of the right temporal bone How to cite this article: Saha S, Chowdhury K, Pal S, Saha VP. Malignant otitis externa with bilateral cranial nerve involvement: Report of a unique case. Indian