Uvulopalatopharyngoplasty for nasal blockage 21 years after total rhinectomy.

BACKGROUND: Total rhinectomy is an invasive procedure that significantly impairs the intranasal turbulence, humidification and heating of inspired air. The use of uvulopalatopharyngoplasty for the treatment of sleep-disordered breathing disorders such as primary snoring and obstructive sleep apnoea has diminished over the past years because of the emergence of less invasive procedures and alternative therapeutic options. This clinical record presents the treatment of a long-term side effect of total rhinectomy using uvulopalatopharyngoplasty. CASE REPORT: In 1997, a 62-year-old male underwent total rhinectomy for a nasal schwannoma, followed by rehabilitation with a nasal prosthesis. Twenty-one years later, he presented with severe complaints of nasal blockage and breathing difficulties during both daytime and night-time. Clinical examination revealed no major anomalies besides significant velopharyngeal narrowing. Thus, in 2019, uvulopalatopharyngoplasty was performed to re-establish velopharyngeal patency. Hereafter, the symptoms of nasal blockage disappeared, resulting in an improved quality of life. CONCLUSION: Uvulopalatopharyngoplasty may prove useful to treat selected patients with daytime breathing difficulties due to velopharyngeal narrowing.

Transaxillary robotic thyroidectomy: Belgian team learning from the first 50 cases.

BACKGROUND: In search for less invasive operative techniques, the da Vinci Robot System was introduced in thyroid surgery. Previous studies have reported on safety, effectiveness and improved cosmetics of transaxillary endoscopic thyroidectomy procedures in selected cases. METHODS: We report on the first 50 patients that have been treated with a gasless transaxillary robot-assisted thyroidectomy in a Belgian institution. We describe the implementation, the operative technique and results of robotic thyroid surgery. RESULTS: 48 hemithyroidectomy and 2 total thyroidectomy procedures were performed. The mean ultrasound dimensions of the nodules were 3.4 ± 1.0 cm (range 1.0-8.0 cm). The mean operative time was significantly longer than with a conventional open approach: 215 min ± 55 min (range 133 min-347 min). No major complications were observed. All patients were "satisfied" about the cosmetic outcome. CONCLUSION: Transaxillary robotic thyroid surgery is demanding, but feasible. Selected patients can benefit from this technique with an optimal cosmetic outcome. Ideal indication in the hand of our team is a hemithyroidectomy for benign nodules ranging up to 5 cm.

Intratympanic lidocaine instillation for Menière's disease.

OBJECTIVES: We studied the role of intratympanic lidocaine instillation as part of the treatment for vertigo in Menière's disease. METHODOLOGY: We retrospectively analyzed 40 patients who underwent 74 labyrinth anaesthesias in our center between 1996 and 2006. We studied the attack-free period after instillation, the effect of repetitive procedures and the efficacy according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) (1995) criteria. RESULTS: Labyrinth anaesthesia was effective in 70% of the studied procedures. If effective, the mean duration of the attack-free period was 12.6 months. Repetition was effective in 80.7% of the procedures if the previous procedure was effective as well. Two years after treatment 21 patients had AAO-HNS functional levels of 1 or 2 and 23 patients were class A or B. CONCLUSION: Labyrinth anaesthesia is an effective treatment for Menière's disease and a useful tool for the control of symptoms. Repetitive instillation is effective especially when the previous instillation was also effective.

Surgical findings and post-operative parathormone levels in patients with secondary hyperparathyroidism.

OBJECTIVE: The peri-operative and immediate post-operative outcome of secondary hyperparathyroidism treated with subtotal parathyroidectomy is reported. METHODS: We studied 100 patients with chronic renal failure who underwent subtotal parathyroidectomy at our department. Surgical eligibility was based on hyperparathyroidism stage, defined by symptoms of osteodystrophy and/or the presence of hypercalcemia and hyperphosphatemia refractory to medical treatment. Parathormone levels were measured pre-operatively and during the first post-operative days. RESULTS: During surgery, four parathyroid glands were identified in 86% of patients, five glands in 1%, and less than four glands in 13%. The ratio of hyperplastic to normal glands was 93:7. No correlation was found between anatomic location of the glands and the presence of hyperplasia. Parathormone decreased to normal or very low values in 93% of the patients. In seven cases, the lowest post-operative parathormone value was above 30 pg/ml, although four glands were removed in four of these patients. In 95% of the patients with four or more identified glands, post-operative serum parathormone levels decreased to normal or very low values. In 23% of the patients with less than four glands, parathormone levels remained too high. On the other hand, post-operative parathormone values normalized in 10 patients who had less than four glands identified during surgery; in two of them, parathyroid tissue was found during postoperative pathological examinations of the resected thyroid lobe. CONCLUSIONS: Subtotal parathyroidectomy is an acceptable treatment in patients with refractory hyperparathyroidism. Our results indicate that there was not a perfect correlation between the number of identified glands and post-operative parathormone in a subset of patients.