Optimising endoscopic stapling of pharyngeal pouches.

Background: Endoscopic hypopharyngeal diverticulotomy is now largely performed using an endoscopic stapling device. A poorly applied endoscopic stapling device can result in incomplete division of the cricopharyngeal bar, necessitating the application of a second set of staples. Applying more than one set of staples is associated with an increased risk of complications and greater cost.

An unusual case of intratracheal thyroid.

Intratracheal thyroid is a rare condition. It presents with symptoms of tracheal obstruction and may mimic adult onset asthma. We present a case and discuss the difficulties in diagnosis and management.

Patient satisfaction with NHS elective tonsillectomy outsourced to the private sector under the Patient Choice Programme.

Rationale, Aims And Objectives: An interim goal of the NHS 'Extending choice for patients' initiative was that, by 2004, patients who had been on the NHS waiting list for elective surgery for 6 months were provided with a choice of staying on the waiting list or being treated faster by opting to have their operation with an alternative provider. The aim of this study was to examine patient satisfaction in a cohort of patients who travelled out-of-region to undergo routine tonsillectomy performed by an NHS consultant at a private hospital.

Method: A questionnaire survey was conducted of adult patients undergoing elective tonsillectomy in 2002 and 2003 at The Hampshire Clinic, Basingstoke, UK.

A new head and neck surgical drain fixation technique.

We describe a simple technique of drain fixation in head and neck surgery using a beaded 2/0 nylon suture and a 'clove hitch' to achieve a non-slip fixation to the drain.

Myringitis bullosa haemorrhagica associated with meningo-encephalitis.

An unusual case of a patient presenting with myringitis bullosa haemorrhagica (MBH), who subsequently developed acute otitis media and meningo-encephalitis, is described. The aetiology of MBH is discussed, and recommendations for the management of patients with acute otitis are made.

Hearing loss in adult Refsum's disease.

Refsum's disease is characterized by defective peroxisomal alpha oxidation of phytanic acid, with clinical features that include retinitis pigmentosa, polyneuropathy, anosmia and hearing loss. Although hearing loss in Refsum's disease is common, there are few detailed assessments of the site of the abnormality. We examined the audiometric findings in patients with biochemically diagnosed Refsum's disease in order to assess the site of origin of the hearing loss.

Sublingual packing as an useful adjunct to submandibular gland excision.

We describe a simple preoperative procedure that we have found of great benefit in submandibular gland excision.

Treatment of epistaxis in Accident and Emergency departments in the UK.

This study aims to investigate the facilities available in Accident and Emergency (A&E) departments and the education of casualty officers in the treatment of epistaxis in the UK. Fifty departments were chosen at random and a telephone survey undertaken. The results show a paucity of facilities and inadequate training of A&E officers in a majority of departments.

Solitary fibrous tumour of the deep soft tissues of the neck.

A case of a solitary fibrous tumour arising in the deep soft tissues of the neck is reported. This rare tumour has not previously been described in this site. We discuss the clinical presentation and pathological features.

Rhomboid minigrafts in hair restoration surgery.

Background: The transplantation of large numbers of three- to five-hair minigrafts has superseded the use of traditional punch grafts in hair restoration surgery. The minigrafts are usually designed and cut in a square or rectangular shape for implantation into the recipient slits. Transplanting a large number of these grafts into the recipient slits can lead to a high frequency of complications, especially in cases in which there is a need for dense packing of grafts.

Combined approach intranasal endoscopic and external Lothrop procedure in chronic frontal sinus disease.

The endoscopic approach to the fronto-ethmoidal recess (FER) in the treatment of chronic frontal sinus disease is now widely accepted. The Lothrop procedure was first described in 1914, but was largely replaced with more invasive open frontal sinus procedures until the advent of the rigid Hopkins' rod, since when it has enjoyed renewed popularity. We describe a modification of this technique which allows both transnasal endoscopic and external direct visualization of the FER and frontal sinus and a direct approach to the anterior buttress (or "nasofrontal beak") which allows its quick and simple removal.

Giant cell reparative granuloma of the maxilla.

Giant cell reparative granuloma (GCRG) is a rare nonneoplastic proliferative lesion of unknown etiology. It most commonly occurs in the mandible, but also occurs in other bones of the facial skeleton and cranial vault. Two cases of GCRG arising from the maxilla are presented.

Management of laryngotracheobronchial sequelae and complications of relapsing polychondritis.

Relapsing polychondritis is a rare multisystem disorder of unknown etiology characterized by recurrent inflammation and degeneration of cartilage and connective tissue. Laryngotracheobronchial complications are the most severe manifestations of the disease and present the most challenging management decisions. We present four cases of relapsing polychondritis with laryngotracheobronchial manifestations that illustrate the clinical features and review the treatment options.

A bone-anchored percutaneous connector system for neural prosthetic applications.

A percutaneous connector system has been developed for use in neural prosthetic applications. It is based on a skin-penetrating, bone-anchored titanium pedestal, housing an II-channel electrode array. Initial applications for the system are in audiology and as such, the proposed fixture site is in the temporal bone.

CO2 laser palatoplasty: early results.

It is now widely accepted that snoring causes significant social dysfunction. In the absence of obstructive sleep apnoea syndrome, palatal surgery offers a very good chance of eliminating or reducing snoring. The traditional operation of uvulopalatopharyngoplasty remains the 'gold standard', but may be complicated by velopharyngeal incompetence, severe post-operative pain and even nasopharyngeal stenosis.

Abductor vocal fold palsy in the Shy-Drager syndrome presenting with snoring and sleep apnoea.

The case of an elderly male with Shy-Drager syndrome is presented. His presentation to the Sleep Clinic for assessment of snoring illustrates bilateral abductor vocal fold palsy as a rare presentation of the syndrome. This case emphasizes the need for thorough investigation of all patients with sleep-related breathing disorders with video and sound recordings prior to anaesthesia and surgery.

Sleep-related breathing disorders in the Shy-Drager syndrome. Observations on investigation and management.

We report on 18 patients with the Shy-Drager syndrome who were referred for assessment of a sleep-related breathing disorder. The main symptoms of snoring, apnoea, stridor and daytime hypersomnolence were detailed and vocal cord movement graded by laryngoscopy as normal, mild weakness of abduction or near paralysis of vocal cord movement Sleep studies involving oximetry and observations were performed. Obstructive and central apnoeas were detected in six patients.

The modified Valsalva manoeuvre to improve visualization of the hypopharynx during flexible nasopharyngoscopy.

A simple, safe and effective procedure for improving the diagnostic accuracy of nasopharyngoscopy is described. It is most useful for the exposure of the hypopharynx, especially in the elderly patient.

A prospective randomized study to assess the efficacy of post-operative nasal medication after endonasal surgery.

Post-operative nasal medications are commonly used following routine septal or turbinate surgery but their efficacy in removing blood clots, improving the sensation of a patent airway and promoting healing are unknown. This prospective randomized trial of patients undergoing septal and/or turbinate surgery assessed the efficacy of three commonly used nasal medicines, 0.5 per cent ephedrine hydrochloride nasal drops, betamethasone sodium phosphate (Betnosol) nose drops and alkaline nasal douches, in producing the sensation of a patent airway in the 14 days following surgery.

A prospective randomised trial of the use of sodium bicarbonate and hydrogen peroxide ear drops to clear a blocked tympanostomy tube.

This randomised prospective trial compared the efficacy of sodium bicarbonate and hydrogen peroxide ear drops in clearing a blocked tympanostomy tube. Tympanostomy tubes, 110 in number, obstructed with blood or inspissated secretions were randomised into treatment and control groups. Details of the operative procedure were retrospectively collected from the patients notes.

The assessment of the risk of cross-infection with a multi-use nasal atomizer.

Atomizers working on the Venturi principle are used by otolaryngology departments in the UK to spray cocaine and other local anaesthetic and vasoconstricting solutions into the nasal cavities. These devices are rarely cleaned, nor is the cocaine in the reservoir changed between patients. This study aimed to assess the risk of cross-infection with such an atomizer of the Down's design.

Laryngeal leishmaniasis.

A patient suffering from persistent hoarseness was eventually shown to have laryngeal leishmaniasis. The incubation period for the disease must have been at least 16 years, following infection in Southern Europe. Mucosal leishmaniasis is rare in the Eastern hemisphere, and laryngeal leishmaniasis has not previously been reported in the UK.