OtoRhinoLaryngology Portal

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Congenital External Ear Deformities

                          Microtia.                           Microtia with meatal atresia.


In general, reconstructive otoplasty takes place over few stages. 


Stage One:

Harvesting healthy cartilage from the ribs and the insertion of the prepared cartilage into a pocket of skin under the deformed ear.


Stage Two:

Formation and contouring of the earlobe with removal of excess soft tissue.


Stage Three:

Elevation of the newly formed ear (cartilaginous framework and earlobe) from the side of the head.  Forward tilting of the pinna achieved by insertion of cartilage strut underneath the new pinna attachment posteriorly.


Honour of these images to Dr Sven Olof Wikstrom who had performed the surgery.


See Video of Microtia Ear Reconstruction

Collaural Sinus

Sinus (arrow) with evidence of recent infection (sloughy discharge and blackish materials from otomycosis).  Unexplained recurrent upper lateral neck

infection should give clue to the presence of this sinus tract in the ear canal.

Cleft Palate

                  Intra-oral view                         View by using 70 degree endoscope

         after Dingman retractor applied

   Glue ear                        Myringotomy                Grommet in-situ


Cleft palate is highly associated with eustachian tube dysfunction and presence

of otitis media with effusion (OME).  Myringotomy and grommet (M&G) insertion

is indicated.  This child has bilateral OME and left-sided M&G images are shown.

Cleft Palate: Nasal Structures as Seen Through Oral Cavity

S- septum, R- roof of nasopharynx, IT- inferior turbiate, MT- middle turbinate,

A- alveolus, white dot- superior turbinate, T- tongue, stars- separated uvula.

Nasopharyngeal Eustachian Tube Openings in Cleft Palate

Figures showing abnormal nasopharyngeal eustachian tube openings in a patient with uncorrected cleft palate.  Variable soft tissues and muscular attachment deficiencies lead to eustachian tube dysfunction with its potential complications such as eardrum retraction and otitis media with effusion.

Bifid Uvula- Oedematous

Congenital Choanal Atresia- Unilateral

Figure shows complete membranous obstruction of right posterior choana

on nasal endoscopy with the corresponding CT-scan evidence.

CHARGE Syndrome: An Overview

Choanal Atresia Repair

Capillary Haemangioma

Tongue Tie (Ankyloglossia): Intraoperative View

Intraoperative view of the midline mucosal band connecting ventral surface of tongue and anchoring it to the floor up to the posterior surface of the alveolus.

Brodie disc/retractor (left) nicely designed to retract and protect the

tongue with a midline slit for the phrenulum placement.  Alternatively,

a non-traumatic forceps like Babcock (right) would be a good instrument that

can be used to retract the tongue tip for the necessary exposure.  Diathermy

at low power setting or a radiofrequency device at cut and coagulate

mode (3-4W) will give a precise and bloodless result.

Triangular web (+) occurring simultaneously in a child having tongue tie which needs to be lysed surgically in conjunction with frenectomy.

[Arrows - Wharton's duct openings, I - central lower incisors]

Side view of the lesions. (Arrow - right submandibular duct)



Tongue Tie Release for Ankyloglossia

Upper Lip Tie Release Treatment

Thyroglossal Cyst

Effect of tongue protrusion on thyroglossal cyst.


Intraoperative view of a thyroglossal cyst.

(M-chin, TC- thyroglossal cyst, T- thyrohyoid muscle, arrow- hyoid bone)

Congenital Vallecula Cyst: Intraoperative View

A rounded cystic mass arising from vallecula area. 

[A- anterior, P- posterior, Star- endotracheal tube, X- nasogastric tube]

 Huge cyst with yellowish fluid content (C) which had caused stridor.  [U - uvula, X - endotracheal tube, white arrow - anterior, yellow arrow - posterior]

Posterior compression of epiglottis by a vallecula cyst (circle) causing

ariepiglottic oedema and supraglottic obstruction.

[arrow-epiglottis, stars- arytenoid]

After the cyst uncapped.





More Info:

1. Wikipedia

2. E-Medicine

Congenital Laryngeal Web

Subglottic Stenosis


Narrowing of subglottis can be congenital or acquired in aetiology.  Its nature can be membranous, cartilaginous, or mixed,  with or without combination of glottic or upper tracheal stenosis.


The lower limit of normal subglottis dimension in full term infant is 4.0 mm and in premature infant 3.5 mm.  Circumferential oedema of one milimiter reduces its cross-sectional area by 60%.


Myer-Cotton grading system is a useful classification for mature circumferential subglottic stenosis.


It is divided into 4 grade as below::

  • Grade I    - Obstruction of 0-50% of the lumen obstruction
  • Grade II   - Obstruction of 51-70% of the lumen
  • Grade III  - Obstruction of 71-99% of the lumen
  • Grade IV - Obstruction of 100% of the lumen (ie, no detectable lumen) 


  Grade I                                             Grade II

  Grade III

                [TVF- true vocal fold, triange- anterior commissure]



Video showing laryngeal tugging in severe subglottic stenosis.

Reference: Myer CM, O'Connor RT. Proposed grading system for subglottic stenosis based on endotracheal tube size.  Ann Otol Rhinol Laryngol 1994; 103(3):319-323

           Video of Stridor & Respiratory Distress in An Infant

Innominate artery compression on bronchoscopy.

Further reading