The Caucasian Nasal Septum: An In Vivo Computed Tomography Study.

BACKGROUND: The nasal septum is composed of cartilaginous and bony components and an understanding of each component volume is essential in both functional and cosmetic surgery. OBJECTIVES: We sought to radiographically measure septal dimensions on cross sectional computer tomography (CT) images, establishing average parameters for normal anatomy among a single, Caucasian population group. METHODS: One hundred and fifty consecutive sinus CT scan images were examined and 100 cases with appropriate sagittal views were included in the study. On each septum, the sagittal CT images were assessed and 14 points were identified and 23 lengths measured and tabulated. Trigonometric formulae were used to accurately calculate surface areas of 11 resulting triangles which constituted the components of the nasal septum. RESULTS: Measurements from 100 patients were included, with a mean age of 50.2 years, constituting 47 males and 53 females. Our surface area mapping established the following areas for both males and females respectively (mm2): quadrangular cartilage 1148 and 981; vomer 894 and 741; perpendicular plate of ethmoid bone 1244 and 1006; and total surface area 3287 and 2728. Our only statistically significant comparison in the series was found in the female series when age and reducing quadrilateral cartilage size were compared, highlighting reducing size with age (P = 0.04). CONCLUSIONS: The study presents the largest published data series representing nasal septal measurements on CT images in a living Caucasian population. Our data demonstrates that septal size remains constant after adolescence, throughout our age-varied series (18-79 years), except in the female population where the quadrilateral cartilage reduces in size with age.

Coblation tonsillectomy: a systematic review and descriptive analysis.

Coblation is one of the more recent techniques for tonsillectomy; however, it remains unclear whether it exhibits any benefit or increased risk when compared to other techniques. This review provides an updated assessment of coblation tonsillectomy and how it compares to other tonsillectomy techniques. Systematic review and descriptive analysis of published literature. Electronic searches of MEDLINE, EMBASE, Web of Science and the Cochrane Database were performed. We included all randomized control trials comparing coblation tonsillectomy (not 'tonsillotomy') with any other tonsillectomy technique. Studies were excluded if tonsils, rather than individuals, were randomized. 16 eligible studies were identified, including a total of 567 patients, both adults and children. Coblation was compared with a variety of other tonsillectomy techniques. Outcomes included pain, primary and secondary haemorrhage, intraoperative bleeding and operation time. Postoperative pain was the primary outcome in most studies. There was a trend towards less pain in the coblation group in seven of the included studies. More recent studies appeared to fare more favourably in terms of pain outcomes and operating time. The coblation technique appears to be comparable with other commonly employed techniques for tonsillectomy; however, there is still no strong evidence to suggest that it possesses any definitive benefits. Findings would advocate further work being done through carefully designed randomised control trials, which compare coblation with cold dissection as the 'gold standard' and place an emphasis on reducing the amount of adjuvant electrocautery used so as to maximise the benefits of coblation and the lower temperature it generates.

Imaging evaluation of the benign and malignant lesions of the floor of the mouth: Pictorial review.

The floor of the mouth is an important anatomical region of the oral cavity where primary benign and malignant disease processes can originate or secondary pathologies can extend into adjacent spaces. Knowledge of the anatomy is crucial for accurate localisation of pathology and understanding the spread of disease. The sublingual space is the dominant component of the floor of the mouth, bounded inferiorly by the mylohyoid muscle that separates it from the submandibular space. Imaging is immensely important to characterise and map the extent of disease, considering the fact that the bulk of the disease may be submucosal and not visible on clinical inspection. Contribution: The floor of the mouth is a complex anatomical region for radiological evaluation. The purpose of this pictorial review is to present an understanding of the relevant anatomy and to demonstrate the role and appropriate application of different imaging modalities. This article highlights the imaging spectrum of a wide range of various benign conditions including normal variants and a variety of malignant lesions at different tumour stages, with an aim to establish the correct diagnosis, avoid misinterpretation and help in treatment planning.

Size as a Risk Factor for Growth in Conservatively Managed Vestibular Schwannomas: The Birmingham Experience.

This article discusses conservatively managed tumors, whether larger tumors at presentation are more likely to grow, and whether position at presentation corresponds with growth. A review is presented of more than 900 patients managed at Queen Elizabeth Hospital, Birmingham, between 1997 and 2012. Tumors were arbitrarily divided into 3 groups: intracanalicular (IC), and extracanalicular (EC) tumors measuring 1 to 10 mm or 11 to 20 mm at the cerebellopontine angle. This series shows that larger EC tumors grow faster than IC tumors and that EC tumors overall at presentation are more likely to grow than IC tumors.

Intrathymic primary intrathoracic goiter in a patient with breast malignancy.

We report a rare case of an intrathymic primary intrathoracic goiter. The patient with newly diagnosed breast carcinoma was also known to have a distinct large anterior mediastinal mass. This was removed via a median sternotomy, after a thorascopic biopsy had been performed in the past but a diagnosis had not been reached. A discussion relating to the extremely rare occurrence of intrathymic ectopic thyroid tissue and the surgical treatment of primary intrathoracic goiters is included.

The role of freehand needle core biopsy in the diagnosis of isolated axillary lymphadenopathy.

Patients with isolated axillary lymphadenopathy are often referred to rapid-access breast clinics for diagnostic evaluation. In the absence of a discernable breast primary, tissue diagnosis has conventionally been pursued using open biopsy. We aimed to assess the value of freehand needle core biopsy (FNCB) as an alternative to this. A prospective audit was conducted over 6 years from 2002 to 2008. Twenty-eight procedures were performed, all carried out under local anaesthesia in the outpatient setting. The majority of cases (10) revealed metastatic breast cancer. Other diagnoses included metastatic ovarian cancer (2), metastatic melanoma (3), lymphoma (4), silicone granuloma (1) and chronic lymphocytic leukemia (1). Seven patients had inconclusive histology necessitating further open biopsy. This revealed primary lymphoma in 6 cases and benign histology in one. FNCB thus avoided the need for diagnostic excision biopsy in 75% (21/28) patients. However, it was found to be less useful in diagnosing de-novo lymphoma.