<p class="abstract">The intra-vascular invasion progressively halts the blood flow in the arterial distributaries and the venous tributaries and finally a “blue black”, wet gangrenous region is noted. Later the underlying bone too becomes fragile and crumbles off. Removal of necrotic debris remains the main stay of management. Removal of foci of infection, the orbital soft tissues utilizing high resolution endoscopic modality is elaborated upon.</p>

<p class="abstract">Reconstitution of the facial profile can be achieved in a depressed‘midface “, by supplementation of the nasal osteo-cartilagious skeleton utilizing autologous tissue or synthetic prosthesis, Bone from the iliac crest and cartilages from the septum, cymba conchal and the rib are the accepted grafts in wide use. The costo-chondral junctional cartilage is ideal in situations demanding excess of graft, then can be harvested from the ear or the septum. Moreover, this graft though easily cut and mouldable, gives a rigid sharp profile to the nose. Utilization of the rib cartilage in a young gentleman with a post traumatic midrace deformity is being described.</p><p> </p>

<p class="abstract">Endo-DCR has a successful outcome when the lacrimal sac is marsuplised on the nasal lateral nasal wall. The lacrimal sac and nasal mucosal edges heal by primary intention rather than by formation of granulation tissue with consequent restenosis or reclosure. An indigenous flap was utilized to cover the exposed bone following Endo-DCR in a young individual. The flap fashioned in an inverted ‘V’ prevented the granulation of secondary intent healing and thereby reclosure.</p>

Tracheal access, accidental deccannulation, peristomal granulation, stenosis and difficult weaning are the laryngologist’s dilemma, wherever tracheostomy has been resorted to, in the paediatric age group. These major problems necessitate a modification in the procedure of tracheostomy where ‘stay’ and ‘maturation’ sutures are utilized. The stay sutures facilitate a quick midline tracheotomy and the maturation ones minimise parastomal granulation and easy tracheal recannulation.

<p class="abstract">A stony hard rigid neck is the typical presentation in the angina of Von Ludwig. Suddenly with excruciating pain generalized severe cellulitis of the neck is noticed. It flares up quickly and extends on either side, in the submandibular, sublingual and submental triangles thereby manifesting as a medical emergency. This necessitates a prompt diagnosis and intervention medical or surgical as the case maybe, lest a life maybe lost. A neck swelling secondary to self-manipulation of a loose dental plate with impacted wire is being reported. This odontogenic infection had accessed the deeper tissues of a neck with elevation of the floor of the mouth obstructing the airway with consequent breathlessness and stridor; with need to regain his airway by emergency tracheostomy. At the same time a cervical fasciotomy was undertaken to drain the potentially involved spaces.</p><p class="abstract"> </p>