Self-retaining retractors in head and neck surgery.

The Norfolk and Norwich retractor is a vital tool in head and neck surgery. It is of great aid in training junior surgeons and has become an integral part of the standard neck dissection instrument set in our unit. This retractor enables good exposure of the carotid sheath, its atraumatic blunt tip retracting the carotid sheath without damage. It makes a single skin incision for neck exposure possible, rather than a Y, T or wine glass incision, avoiding a three-point junction, especially in the post-irradiated neck. In thyroid surgery it reduces the need for manual retraction thereby relieving the assistant surgeon and enhancing the quality of the learning experience.

Mesotympanic sarcoidosis.

Sarcoidosis often presents with signs and symptoms within the head and neck. In this region, it most commonly affects the nose, larynx, parotid and cervical lymph nodes. Within the ear, it usually causes sensorineural hearing loss of varying severity. We report a patient in whom sarcoidosis involved the middle ear and presented with a conductive hearing loss. Granulomata were found in the middle ear during an exploratory tympanotomy. The granulomatous process had caused necrosis of the long process of incus and was also encasing the chorda tympani nerve. Histological examination confirmed the diagnosis.

Simple new method of protecting the septum during oxygen delivery via a nasal canula.

Epistaxsis and crustation are common problems associated with long-term use of oxygen through nasal prongs in patients suffering from chronic obstructive pulmonary disease. The nasal prong can cause direct trauma to the septal mucosa. We describe a simple solution to this problem with use of the disposable ear tip used in tympanometry.

Treatment of primary mucosal head and neck squamous cell carcinoma using photodynamic therapy: results after 25 treated cases.

The use of photodynamic therapy for the treatment of malignant and non-malignant conditions is increasing. This paper demonstrates the efficacy of a second-generation photosensitizer, Foscan, in the primary treatment of a wide range of mucosal head and neck squamous cell carcinomas. Tumours ranged in stage from T(1) to T(3). A complete response to primary treatment was seen in 19/21 patients (90 per cent). In laryngeal cancer recurrent after radical radiotherapy, one out of four patients treated obtained a complete response (25 per cent). Six patients (24 per cent) required surgery after photodynamic therapy, for local recurrence or dysplasia. Mean follow up was for 27.3 months (standard deviation 20.6 months).

Intratympanic gentamicin for Ménière's disease: effect on quality of life as assessed by Glasgow benefit inventory.

OBJECTIVES: To evaluate patients' quality of life after receiving intratympanic gentamicin as treatment for Ménière's disease. DESIGN: Retrospective study using the Glasgow benefit inventory scale (GBI) questionnaire. PARTICIPANTS: Patients diagnosed with Ménière's disease, according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) diagnostic criteria (refractory to medical management), who were treated with intratympanic gentamicin injection. MATERIALS AND METHODS: This retrospective study included all patients diagnosed with Ménière's disease (according to AAO-HNS criteria; refractory to medical management) undergoing gentamicin labyrinthectomy in our unit over the preceding three years. Other causes of hearing loss were ruled out as all patients underwent magnetic resonance imaging, electronystagmography and sway magnetometry. Patients underwent gentamicin infiltration at a concentration of 2 ml of 30 mg/ml and were reviewed six weeks later and received a repeat injection if no benefit was evident. Six months after their last follow up, they were sent a GBI questionnaire. Twenty-one questionnaires were posted, and the response rate was 81 per cent. RESULTS: As per the responses received, the total benefit of intratympanic gentamicin injection was found to be +30.3. The three components of GBI were analysed separately; it was found that general benefit was greatest (+33.3), followed by physical benefit (+28.1) and social benefit (+21.6). CONCLUSION: This study suggests that gentamicin definitely improves quality of life in patients with Ménière's disease and should be the first line of treatment if medical management fails.

Post traumatic laryngeal incompetence.

Self-inflicted laryngeal injuries are rare. This is a case of attempted suicide with a knife. The patient was brought into A&E and initial attempts at repair of the laryngo-skeletal structures were performed Later it became evident that the patient had an insensate hypofunctioning larynx. We present a technique aimed at rehabilitating the poorly functioning, incompetent larynx without the necessity for a permanent tracheostomy or laryngectomy. A single surgical procedure combining a cricopharyngeal myotomy, an anterior hyoid suspension and vocal fold angmentations was performed in an attempt to avoid a laryngectomy in non-malignant pathology. The long-term results of this surgery would need to be subjected to further evaluation.