Unusual presentation of a foreign body in the palate

Instead of forcing students to attend lectures, an environment should be created in such a way that they should be eager not to miss a single lecture.An amateur role for a medical teacher is no longer sustainable. Competence in teaching should be a requirement for all teachers.Only when one analyzes the data in its entirety can one start to appreciate the existence and the magnitude of a problem. I end by saying that medical education is not an exception to this.


Unusual presentation of a foreign body in the palate
Dear Sir, We would like to present a case of a foreign body embedded in the palate which was misdiagnosed as a cleft/fistula in the palate. The problem in diagnosis was because of the difficulty in examining the child without anesthesia, the uncooperative attitude of the parents and the clinicians' disregard for the history given by the mother.
Recently a eleven month-old child was referred to the Department of Plastic Surgery in our hospital by a general practitioner with the diagnosis of a cleft palate. The child was uncooperative and would not allow examination of the oral cavity. The parents were equally uncooperative. Although there was no history of food or milk escaping from the nose, there appeared to be a tissue defect in the hard palate appearing as an irregularly shaped black recess in the mid-line. The soft palate could not be visualized in the routine examination of the child. The mother had noticed this phenomenon at the age of one month and it was assumed by everybody that she had missed the finding at birth and a diagnosis of cleft palate was made by the general practitioner and pediatrician treating the patient.
On subjecting the child to examination under anesthesia, a shining plastic disc of the kind used in garment manufacture was found firmly adherent to the hard palate [ Figures 1-3] in the mid-line with some palatal

Giant fi brolipoma mimicking abdominal lipodystrophy
Dear Sir, Fibrolipomas belong to the family of fat-containing lesions and are benign tumor variants of lipomas characterized by the presence of adipose tissue and abundant amounts of fibrous tissues. They are well-separated from the surrounding tissues and usually occur in adults. [1] These lesions may have a broad base or may be pedinculated. [2,3] Fibrolipomas are one of the giant lipomatous tumors (defined as being greater than 5 cm in diameter), which have been reported to be seen in the esophagus, intestinal mesentery, pancreas and the parapharyngeal region. [4][5][6][7] Owing to the peculiarity of this condition and the difficulties encountered in its diagnosis and treatment, we report here a case of a giant fibrolipoma in the abdomen.
A 62-year-old female presented with a giant mass in the abdominal wall [ Figure 1]. The first visual impression resembled a flask abdomen with severe lipodystrophy. Pre-operative evaluation using ultrasonography showed a very large subcutaneous mass with intact anterior abdominal integrity except for a moderate rectus muscle diastasis. Clinical examination revealed that the mass was strictly attached to the abdominal wall with a wide pedicle and there was no tenderness over it. The patient's main complaint was cosmetic. The patient had intermittent cardiac failure and had been undergoing treatment for five years; otherwise, there was no associated medical problem. The mass of 12 × 10 × 3 cm was excised under general anesthesia [ Figure 1]. The surgical approach consisted of excising the mass with a transverse low abdominoplasty incision. No rectus plication or undermining was done. There was no wound healing problem in the postoperative period. The microscopic evaluation of the mass (weighing 1517 g) revealed an admixture of mature adipocytes and fibrous connective tissue [ Figure 2]. Pathological examinations revealed that the tumor was composed of spindle cell-like fibroblasts and mature adipocytes. Immunohistochemical examinations revealed that the tumor was negative for desmin and alpha-smooth muscle actin. Based on these findings, a diagnosis of fibrolipoma