A limited thoracocervical approach for accessing the anterior mediastinum in retrosternal goiters: Surgical technique and implications for the management of head and neck emergencies.

In this article we describe the surgical management of retrosternal goiters via a limited thoracocervical approach, and we explore how the respective surgical know-how can be used in the management of the carotid blowout syndrome. Four cases involving patients who had undergone thyroidectomy via a limited thoracocervical approach are retrospectively reviewed. An acute blowout of the innominate artery managed with the same principal surgical technique is also reviewed.

A twin-center study of nasal tip numbness following septorhinoplasty or rhinoplasty.

Nasal tip numbness is a recognized postoperative complication after septorhinoplasty and rhinoplasty. We performed a twin-center retrospective study to determine the incidence of short- and long-term (>6 mo) nasal tip numbness after these procedures, and we studied several variables that might have been associated with this complication. Our study group was made up of 65 patients-31 males and 34 females, aged 15 to 67 years (mean: 30.

Medico-legal and ethical aspects of nasal fractures secondary to assault: do we owe a duty of care to advise patients to have a facial x-ray?

Guidelines advise that x-rays do not contribute to the clinical management of simple nasal fractures. However, in cases of simple nasal fracture secondary to assault, a facial x-ray may provide additional legal evidence should the victim wish to press charges, though there is no published guidance. We examine the ethical and medico-legal issues surrounding this controversial area.

National Institute for Clinical Excellence guidelines on the surgical management of otitis media with effusion: are they being followed and have they changed practice?

Objective: UK National Institute of Clinical Excellence (NICE) guidelines on surgical management of otitis media with effusion (OME) in children call for an initial 3 month period of observation, with ventilation tube (VT) insertion considered for children with persistent bilateral OME with a hearing level in better ear of 25-30 dB HL or worse ("core criteria"), or for children not meeting those audiologic criteria but when OME has significant impact on developmental, social or educational status (exceptional circumstances). We aimed to establish whether guidelines are followed and whether they have changed clinical practice.

Methods: Retrospective case-notes review in five different centres, analysing practice in accordance with guidelines in all children having first VT insertion before (July-December 06) and after (July-December 08) guidelines introduction.

Endoscopic endonasal approaches to management of cholesterol granuloma of the petrous apex.

Cholesterol granulomas are the most common lesion of the petrous apex. Traditionally, lesions of the petrous apex have been accessible via open, infracochlear, and transtemporal approaches. We describe two cases in which the endoscopic transsphenoidal approach was used to manage this lesion.

Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus.

Diabetes mellitus is a known risk factor for frozen shoulder. This study was performed to quantify this association and test any relationship with other risk factors for diabetic complications. Patients attending diabetic (n = 865) and general medical (n = 202) clinics were interviewed and examined.