Canal-down mastoidectomy: experience in 81 cases.

OBJECTIVES: To identify the common presentation(s) and the clinical and operative finding(s) in patients with cholesteatomatous and long-term noncholesteatomatous chronic suppurative otitis media and to adapt a surgical management best suited to ensure long-term safety in these Papua New Guinean patients for whom postoperative follow-up is minimal. DESIGN: Retrospective case series. SETTING: Port Moresby General Hospital, the tertiary referral center for otolaryngologic services. PATIENTS: Eighty-one patients in all age groups who received a clinical diagnosis of chronic suppurative otitis media, with or without cholesteatoma, with or without its associated complications. INTERVENTION: Canal-down (modified radical) mastoidectomy with wide meatoplasty. MAIN OUTCOME MEASURE AND RESULTS: Adults were more commonly affected than adolescent or pediatric cases, and there was a male preponderance. The median age was 24 years (range, 13 months to 73 years). Otorrhea remained the most common presentation in all age groups. Postauricular abscesses and fistulae were seen frequently. Cholesteatoma and granulation with polypoidal mucosa were frequent operative findings; a high incidence involved both the attic space and the antrum. Five (6%) patients had preoperative facial paralysis; in addition, postoperative facial paralysis developed in three (4%) patients. The incidence of postoperative "wet ear" was high in all age groups. Meningitis was the most common intracranial complication, followed by lateral sinus thrombosis. There were seven (9%) deaths altogether, and all the deaths occurred as a direct result of otogenic intracranial complication. CONCLUSION: Lack of health consciousness, poor socioeconomic status, and lack of health care delivery system resulted in late presentations and poor postoperative follow-up. Hence, the canal-wall-down technique with wide meatoplasty is recommended to ensure a best possible one-time treatment in Papua New Guinean patients with cholesteatomatous or long-term "dangerous" chronic suppurative otitis media with or without complications.

The syndrome of frontonasal dysplasia, spastic paraplegia, mental retardation and blindness: a case report with CT scan findings and review of literature.

Frontonasal dysplasia is defined as hypertelorism, telecanthus and broad bridge of the nose with absent or bifid tip of the nose. The clinical, the CT scan and the operative findings of a case of frontonasal dysplasia with spastic paraplegia, mental retardation, blindness, and cleft lip and cleft palate are discussed. The contemporary literatures on this rare congenital anomaly are also reviewed.

Paediatric tracheostomy: an analysis of 40 cases.

Tracheostomy in the paediatric patient has been associated with significant morbidity and mortality compared to that in the adult. A retrospective analysis was made of 40 patients up to the age of 12 years having tracheostomies. Upper airway obstruction made up the commonest (32 patients, or 80 per cent) indication for paediatric tracheostomy in our series where males slightly outnumbered females. The majority (31 patients, or 77.5 per cent) underwent the operation under general anaesthesia with endotracheal intubation. Thirty-four (85 per cent) patients underwent 'planned' tracheostomies and six (15 per cent) underwent 'crash' procedures. Thirteen (32.5 per cent) patients were under the age of one year when tracheostomies were performed. The maximum duration of tracheostomies was between one week to within a month and after one month to within three months; each containing 11 (27.5 per cent) patients. Sixty-four different surgical procedures were performed on these patients in which laryngoscopy and bronchoscopy were the commonest procedures. Nine (22.5 per cent) had early post-operative and 14 (35 per cent) had late post-operative complications. Among these 40 children with tracheostomies, one (2.5 per cent) died due to a tracheostomy-related cause and 10 (25 per cent) due to the primary disease process itself. Tracheostomies performed to provide access for general anaesthesia for other surgical procedures were associated with a better prognosis.