Lupus pernio--a patient case study.

An 80 year old female patient was seen in the Otolaryngology department with a skin manifestation of her sarcoidosis, known as lupus pernio. Around 25% of patients with sarcoidosis have skin disease and the presence of lupus pernio may suggest a more aggressive form of the disease. Photography of this relatively rare presentation not only helped us diagnose her underlying medical condition but also served as a baseline during treatment.

Rhinophyma--a patient case study.

This is a case report about a 62-year-old gentleman who presented at the Otolaryngology department with a rhinophyma. Rhinophyma is a swelling of the soft tissue of the nose due to sebaceous gland hypertrophy, lymphoedema and fibrosis. Photography of the patient's condition highlights not only the features of the disease but is useful when comparing the contours and shape of the nose after surgical excision. Images of a relatively large rhinophyma are useful not only for their visual but also their educational value.

Acute rhinosinusitis in adults: an update on current management.

Acute rhinosinusitis is a common disease with worldwide prevalence. It is a significant burden on the health services. It is most commonly caused by viruses and is self-limiting in nature. The diagnosis of acute rhinosinusitis is clinical and sinus radiography is not indicated routinely. Most cases of acute rhinosinusitis are treated symptomatically. However, symptoms may persist beyond 10 days when secondary bacterial infection prevails. Antibiotics are reserved for moderate or severe cases or when there is development of complications of acute rhinosinusitis. This paper provides an update on the current management of acute rhinosinusitis.

Severe hypo-osmotic hyponatraemia due to chylous leak following radical neck dissection.

Chylous leak is a documented complication of radical neck dissection with well recognised morbidities, including wound breakdown, hypovolaemia and hypoalbuminaemia. Other less well-documented electrolyte imbalances can also ensue. We aim to raise awareness about hypo-osmotic hyponatraemia as a potentially fatal, commonly overlooked complication of high-output chylous leaks. Following identification of his hyponatraemia, this patient underwent successful management in the intensive therapy unit, followed by surgical repair of his chylous leak. Hypo-osmotic hyponatraemia as a complication of chylous leak is not well documented, is likely to be overlooked when present, and is potentially life-threatening. It should be sought after in any patient with a high-output chylous leak following neck dissection.

Cervicomastoidfacial versus modified facelift incision for parotid surgery: a patient feedback comparison.

INTRODUCTION: Traditionally, the cervicomastoidfacial (CMF) incision is used to excise benign tumours of the parotid gland. The rhytidectomy or modified facelift (MF) incision allows an alternative approach which leaves no visible neck scar. The objective of this study was to establish the frequency of each surgical approach used and identify any difference in complication and patient satisfaction between the two incisions for benign conditions of the parotid gland. PATIENTS AND METHODS: A retrospective analysis of 101 case notes for patients who underwent parotidectomy by both ENT and maxillofacial departments between January 2006 and February 2008 was undertaken. All histologically confirmed cases of malignancy were excluded. For each incision, immediate postoperative complications were obtained from the notes. A postal patient outcome evaluation questionnaire sought information regarding persistent and late complications as well as a visual analogue scar satisfaction score for both incisions. RESULTS: Overall, 79 parotidectomies were included (59 CMF incisions, 20 MF incisions). Of CMF incisions, 34% suffered facial weakness immediately postoperatively versus 20% of MF incisions. Of CMF incisions, 4% suffered postoperative haematomas versus none following MF incisions. In the study cohort, 47 (60%) responded to the postal feedback questionnaire (33 CMF versus 14 MF respondents). Information regarding immediate and late postoperative ipsilateral facial paraesthesia and gustatory sweating was obtained. Mean visual analogue scar satisfaction scores were 9.4 for CMF incisions and 8.9 for MF incisions. CONCLUSIONS: Immediate and late complications for CMF and MF approaches for benign disease parotidectomy were comparable, but scar satisfaction following MF incision was not greater than CMF incisions.

A randomised controlled trial comparing Triadcortyl with 10% glycerine-ichthammol in the initial treatment of severe acute otitis externa.

Acute otitis externa is a common clinical condition accounting for a large proportion of patients attending the otolaryngology department, although milder cases are often managed in primary care. Treatment of the most severe forms of otitis externa involves aural toilet, followed by the application of a topical preparation, commonly in the form of an ear canal dressing. A prospective single-blind randomized controlled trial was performed to compare the efficacy of 10% glycerine-ichthammol (GI) solution and Triadcortyl (TAC) ointment, both applied as ear canal dressings, in the initial management of severe acute otitis externa. A total of 64 patients were studied. Both treatment modalities were proven efficacious in the treatment of severe acute otitis externa. Although there was a statistically significant improvement of pain parameters in the TAC group, we found no significant differences in clinical findings between the two groups. Therefore, it is recommended that GI dressing can be used instead of an antibiotic dressing as an initial treatment of severe acute otitis externa on the basis of cost, avoidance of resistance and toxicity.