OBJECTIVE: To present two cases of Internal Carotid Artery (ICA) agenesis and conduct a systematic review to assess for associations with other anomalies and intracranial aneurysms.
METHODS: We performed a retrospective review of published cases of patients with ICA agenesis with intercavernous anastomosis in MEDLINE database on August 2022 using search terms \"internal carotid artery\", \"agenesis\" and \"transcavernous anastomosis\". We also included two cases of ICA agenesis with type D collateral that we encountered.
RESULTS: Total of 46 studies that included 48 patients and two of our cases resulted in 50 patients. Only 70% of studies reported the location of a collateral vessel of which more than two-thirds were on the floor of sella. More than half of the vessels connected cavernous segments of ICA. A1 segment ipsilateral to the side of ICA agenesis was absent in most of the cases but was not true for all cases. Aneurysm was seen in more than one-quarter of the patients. It can also mimic microadenoma as in prior reported cases as well as in one of our cases.
CONCLUSIONS: ICA agenesis with type D collateral is a rare anomaly but clinically relevant due to the increased risk of an aneurysm or mimic microadenoma or false alarm for occlusion of ICA but knowledge of this rare variant can help in better management of these patients.

The congenital absence of major salivary glands, particularly the submandibular gland, is a rare condition. Although the etiology of aplasia is unknown, it is thought to occur owing to defects that emerge during early fetal development. Agenesis of 1 or more of the major salivary glands may occur alone or in association with other congenital anomalies. Very few cases of bilateral submandibular gland aplasia have been reported in the literature. Patients with this condition can be either symptomatic or asymptomatic. Due to the probability of there being additional anomalies, patients and their families should be carefully evaluated. We present the ultrasound and computed tomography findings for a case of bilateral submandibular gland aplasia that was detected incidentally. A review of the literature on major salivary gland aplasia was also conducted.

OBJECTIVE: To assess the frequency of frontal sinus aplasia using computed tomography (CT) of the paranasal sinus among Saudi Arabian population.
METHODS: A retrospective case review of medical records from January 2019 to December 2019 in the Otorhinolaryngology Department, King Abdulaziz University, Riyadh, Saudi Arabia.
RESULTS: A total of 449 cases were reviewed. The incidence of bilateral frontal sinus aplasia was 3.3%. The incidence of right sinus agenesis was 5.12% and left was 1.33%. The mean age of reviewed patients was 39.15 years.
CONCLUSIONS: The frequency of frontal sinus aplasia is low; however, this must be considered before surgical operations related to the sinuses.

Reports of isolated anomalies of the medial rectus (MR) muscle in literature are sparse. It has been identified as a subtype of congenital cranial dysinnervation disorder that affects the normal development of brainstem motor neurons. Herein, we report a 37-year-old male presented with large-angle exotropia since the birth of right eye with palpebral fissure widening. On examination of ocular movements, there was -6 limitation of adduction. There was no limitation in other ocular movements. In the preoperative CT scan, all extraocular muscles were present. He underwent surgery in right eye. Intraoperatively in the site of medial rectus, we found an empty sheath without muscle fibers indicating medial rectus hypoplasia. The width of muscle insertion was normal. Surgery consisted of lateral rectus muscle recession 10 mm in hang-back method and vertical muscle transposition procedure, by a modification of Nishida technique, in which the vector of superior and inferior recti was transposed medially by inserting non-absorbable sutures at nasal margins of muscles secured to sclera 8 mm posterior to medial rectus site without tenotomy or splitting. The deviation was decreased to less than 10 PD exotropia in primary position. The adduction was improved from -6 to -4. The palpebral fissure asymmetry was also corrected. Here, we also reviewed clinical features of all cases of medial rectus hypoplasia/aplasia in the literature and discussed surgical approaches. For vertical rectus transposition and horizontal muscle weakening, this technique has the advantages of being simpler and less traumatic to ocular tissues and unlike the traditional transposition procedures, there is no need for tenotomy and splitting.

Sickle cell disease, the most common genetic disease in the world, is a chronic hemolytic disease that can be complicated by severe vaso-occlusive pain crises resulting in tissue necrosis and even death. Due to its increasing incidence, oral surgeons will inevitably be faced with the management of these patients. To limit the risk of crises, our goal is to share recommendations for the management of sickle cell patients in oral surgery. The vaso-occlusive crises (VOC), heart attacks and chronic anemia endured by these patients cause chronic lesions in various organs. Complications include retinal disease, avascular necrosis, priapism, neurological involvement (cerebrovascular accident), cardiomyopathy, lower limb ulceration, renal and hepatic dysfunction, and cardiopulmonary disease. These complications inevitably lead to an increase in mortality rate. Thorough knowledge of this pathology is essential for the management of these patients in oral surgery. Management strategies include prevention and diagnosis of oral lesions related to sickle cell disease and its treatment, as well as methods of preparation and execution of oral surgery procedures. We suggest guidelines for the management of these complications and implementation of preoperative, intraoperative and postoperative surgical protocols for both practitioners and patients.

Agenesis of the pineal gland has rarely been reported in the medical literature. Herein, we report a cadaveric specimen found to have agenesis of the pineal gland. The remaining gross examination of the brain was normal. A review of the literature was performed on this unusual finding.

A case report of trifid and aplastic condyle in a 26-year-old female has been discussed. A marked oval radiolucency in the head of right condyle and absence of left condyle was observed on a panoramic radiograph. Diagnosis of trifid condyle was established and confirmed using computed tomography. Magnetic resonance images showed degenerative changes of the disc.

OBJECTIVE: There are two clinically significant congenital anomalies of the epiglottis, aplasia and hypoplasia. Early mortality in aplasia is significantly higher than in hypoplasia. Early aggressive intervention may improve outcomes. An approach to diagnosis, treatment and outcomes is discussed.
METHODS: A case of congenital aplasia of the epiglottis and a review of the literature of all the cases previously described is presented.
METHODS: A male newborn underwent microlaryngotracheobronchoscopy (MLTB) due to stridor and difficulty in establishing oral feeds and was diagnosed with congenital aplasia of the epiglottis. He has not required tracheostomy and at 11 months of follow-up is gastrostomy fed and thriving. 9 cases of aplasia and 19 cases of hypoplasia have been described previously. The difference between aplasia and hypoplasia is established based on the clinical appearance at endoscopic examination.
CONCLUSIONS: Congenital aplasia and hypoplasia of the epiglottis are rare congenital laryngeal anomalies and the majority are associated with a syndrome. Early diagnosis and management in the form of fundoplication/gastrostomy and tracheotomy when required may improve outcomes.