Navigating the post-operative nose as a primary care physician.

BACKGROUND: Rhinology procedures represent a wide and diverse category of procedures, which, on the surface, can appear very similar. Thus, it is difficult to navigate postoperative presentations in the general practice setting. OBJECTIVE: This article provides a comprehensive guide to managing acute presentations that might arise in primary care settings following common rhinology surgeries. It outlines common complications, their potential aetiology and first-aid measures that might be employed to temporise patients prior to escalation. It also provides a guide as to potential red flag symptomatology, and when and how to escalate specific presentations. DISCUSSION: Most acute postoperative complications can be effectively managed, or at the very least temporised, in the community setting. When in doubt, discuss with your local otolaryngologist or nearest centre with otolaryngology cover.

Bony orbital changes in allergic fungal sinusitis are reversible after treatment.

Allergic fungal sinusitis (AFS) arises from a host hypersensitivity reaction to fungi residing within the sino-nasal tract. Computed tomography imaging may show heterogenous sinus opacification with bony erosion and expansion into the orbits. With advanced orbital involvement there is a risk of optic neuropathy and irreversible vision loss. We present a patient with AFS who presented with bilateral proptosis and early optic neuropathy. Radiologically, there was evidence of bony erosion and orbital wall compression. Following oral corticosteroids and full-house endoscopic sinus surgery, these changes reversed considerably. This case shows that bony and anatomical orbital changes from AFS are reversible with adequate surgical treatment.

Diagnosis and Treatment of Hereditary Hemorrhagic Telangiectasia.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disorder known for its debilitating symptoms. More than 90% of patients with HHT experience epistaxis, and they average up to 18 bleeds per month. We review the current literature on the pathophysiology, clinical presentation, and management of HHT. METHODS: We searched MEDLINE, EMBASE, and PubMed and identified 19 articles published since 2000 with current information on HHT. RESULTS: HHT is a disease more commonly associated with significant morbidity rather than mortality. The morbidity of the disease and decreased quality of life are the result of the recurrent and potentially severe epistaxis that the majority of patients with HHT experience. During active epistaxis, the effective emergency techniques of locally applied pressure, nasal packing anteriorly and/or posteriorly, and cauterization are effective. Medical treatment with antiestrogen therapy has shown promising results, but further research is needed to determine the long-term side effects and the limitations of lifelong therapy. Research directed toward bleeding reduction and prevention has yet to have a breakthrough. Although initial reports suggest that intranasal bevacizumab is an effective agent, further research is required. CONCLUSION: Interventional treatments in life-threatening and/or severe circumstances will continue to be used because of their effectiveness. Research into the pathophysiology of HHT has led to the development of potential therapies that prevent and decrease the severity of epistaxis, but the current evidence is insufficient to ascertain best practice. At present, appropriate management of acute epistaxis coupled with early diagnosis and referral to an ear, nose, and throat specialist should be the mainstay of treatment.

Manipulation of nasal fractures with local anaesthetic: a 'how to do it' with online video tutorial.

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Epithelial-myoepithelial carcinoma of the tongue base: a case for the case-report and review of the literature.

A 60 year old lady was referred to the Princess Alexandra Hospital (Brisbane, Queensland, Australia) tertiary Otolaryngology, Head and Neck Unit from a peripheral hospital for investigation and management of a tumour at the base of the tongue. Biopsy of the tumour revealed it to be an epithelial-myoepithelial carcinoma of the base of the tongue. This is an extremely rare tumour in this location with only 2 other case reports in the world literature: the patients were treated with chemo-radiotherapy and surgery respectively. Our patient was made aware of the world literature and was able to make a fully informed decision on her choice of treatment modality and was treated with radiotherapy. Increasingly journals are limiting publication of case reports to "world firsts" only. We present a case where such a policy would have denied patient choice and possibly led to detrimental treatment.We review the world literature of tongue base epithelial-myoepithelial carcinoma of the tongue.