Tracheal agenesis is a rare but fatal congenital tracheal malformation. Lack of prenatal symptom and a typical clinical presentation lead to failure to arrive at a correct diagnosis and confusion during resuscitation. We report a case of a newborn male child with type 2 tracheal agenesis. Despite a typical presentation, diagnosis was delayed after unsuccessful intubation, examination under anaesthesia and emergency tracheostomy. The embryology, diagnostic criteria and potential treatment options are discussed. This case report is valuable in increasing awareness of this rare condition and will help us in being better prepared in managing these children. Future studies should aim to find the optimal replacement for the tracheal.

Background Head and neck cancers (HNCs) are one of the commonest cancers in low- and middle-income countries. There is a paucity of data on comorbid psychiatric problems associated with HNCs. The present study is aimed at reporting the pattern of psychiatric caseness in HNC patients who were referred to specialist psycho-oncology service and also investigate the predictors of psychiatric caseness in oral cancer patients. Methods Case records of all patients with HNC referred to an integrated psycho-oncology service over 7 years (October 2011–December 2018) from a cancer hospital were analysed. All patients were assessed by a trained consultant psychiatrist and ICD-10 diagnoses were ascertained based on a clinical interview with the patients and family members. Associations of psychiatric caseness for consecutive oral cancer patients assessed by the psycho-oncology services over 2 years (January 2017–December 2018) were calculated by using univariate and multivariate statistical methods. Simple descriptive statistics of the referred patients were conducted, followed by logistic regression to find the associations of psychiatric caseness in oral cancer patients. Results The psycho-oncology service assessed 771 HNC patients over 7 years. The commonest referrals were patients with oral cancer (75%, 558/771). For the years 2017–2018, 179 consecutive oral cancer patients were evaluated by the psycho-oncology service. Multivariate logistic regression analysis showed that being a woman (OR = 2.33; 95% CI = 1.02–5.32; p = 0.04); having worries about having pain in the post-operative period (OR = 2.55; 95% CI = 1.2–5.38; p = 0.01); worries about implications of the cancer and its treatment on the family (OR = 3.5; 95% CI = 1.19–10.57; p = 0.02); and longer duration of hospital stay period (OR = 1.08; 95% CI = 1.003–1.16; p = 0.04) were independently associated with psychiatric caseness even after controlling for confounders. Discussion Specialist psycho-oncology services are important in the management of oral cancer patients and in addressing the mental health needs of this very vulnerable group of patients. A combination of psychoeducation, pragmatic psychological interventions and medications were used to treat these patients.

<p class="abstract"><strong>Background:</strong> The aim of this study was to assess the accuracy of preoperative contrast enhanced computed tomography (CECT) of neck with or without magnetic resonance imaging (MRI) in determining cartilage erosion in patients with laryngeal and hypo pharyngeal cancers and correlate this with the final histopathology report (HPE).</p><p class="abstract"><strong>Methods:</strong> Forty patients diagnosed clinically with stage 3 laryngeal and hypo pharyngeal cancer were subjected to flexible laryngoscopy and CECT of neck. Patients with doubtful cartilage erosion on CECT were subjected to additional MRI. Radiologic findings including cartilage sclerosis, invasion and penetration on CECT and MRI were then correlated with HPE in patients who underwent total laryngectomy.  </p><p class="abstract"><strong>Results:</strong> CECT scan showed cartilage invasion in 30 cases. There were ten patients with doubtful cartilage erosion on the CECT scan who were then subjected to additional limited MRI which was compared with CECT scan and operative findings. Thyroid cartilage erosion was confirmed on MRI in five of the ten cases where CECT scan findings were equivocal. CECT scan failed to predict cricoid and arytenoid cartilage invasion in five cases and six cases respectively. Though MRI was a problem-solving tool, it had one false positive result.</p><p class="abstract"><strong>Conclusions:</strong> CECT scan helped to identify cartilage erosion in 91.3% of cases which immensely contributed to the staging and treatment planning of laryngeal and hypo pharyngeal cancers. When findings on CECT are equivocal, the addition of MRI improves the accuracy of detecting cartilage involvement.</p>

Unlike most head and neck cancers, the presence of distant metastasis (DM) does not preclude curative intent treatment and surgical interventions are common in metastatic disease. DM has an adverse impact on survival and lends considerable morbidity to the patient. This research attempts to study the demographics, patterns of metastasis, and surgical interventions in this rare subgroup of patients with differentiated thyroid cancer (DTC). Materials and methods: Thirty two patients of DTC with radiologically or histopathologically or cytopathologically confirmed DM who underwent surgery at a tertiary care centre from August 2011 to December 2018 formed the study cohort of this retrospective study. Results:The study population comprised 59% females and had a median age of 55 (19-79) years. Thorax was the most common site of metastasis, documented in 56% of patients, while 53% patients had bone metastases. Multiple DM were noted in 8 patients. All patients underwent total thyroidectomy or completion thyroidectomy with or without neck dissection. Surgery for metastatic sites was possible in 14 patients (44%) with debulking and spine fixation being the commonest surgical intervention for metastasis. Thyroidectomy, with or without neck dissection followed by radioactive iodine (RAI) ablation was used as the primary modality to treat DM in patients who did not undergo specific surgical treatment for distant metastases. The median dose of RAI received by patients was 400 (25 -749) mCi, in one to four sessions (median-2 sessions). Three patients received conventional chemotherapy, while four received Sorafenib. Conclusion: Metastasectomy in differentiated thyroid cancer with distant metastases is feasible in selected patients and surgical interventions are most commonly performed on the spine to prevent neurological complications. RAI ablation is universally administered in this subset of patients and in very high doses, often distributed in multiple sessions. The role of chemotherapy and tyrosine kinase inhibitor is still restricted to palliative settings and cost constraints remain a detriment to more widespread use.