Long-term results of the use of cultured autologous epithelial cell grafting to mastoid cavities.

Thirty-nine patients (42 ears) who have had a cultured autologous epithelial cell graft technique to a continuously discharging mastoid cavity have been evaluated to determine the continued effectiveness of this procedure. A postal questionnaire indicated a 58% improvement in both the smell and quantity of discharge, and our conclusion is that this is a very effective measure to provide extended symptomatic improvement in this troublesome condition.

Fluticasone propionate aqueous nasal spray: a well-tolerated and effective treatment for children with perennial rhinitis.

A total of 535 children aged 4-11 years with perennial rhinitis were recruited to two double-blind studies performed at 56 centres in eight European countries, Israel, and South Africa. One study compared the efficacy and tolerability of fluticasone propionate aqueous nasal spray (FPANS), at either 100 micrograms once daily (od) or 100 micrograms twice daily (bd), with beclomethasone dipropionate (BDPANS) 200 micrograms bd for 12 weeks in 120 children aged 6-11 years. The second study compared FPANS 100 micrograms od with FPANS 200 micrograms od and placebo for 4 weeks in 415 children aged 4-11 years. Efficacy was determined by means of patient assessments of nasal symptoms of perennial rhinitis and by investigator assessments of symptoms and nasal condition. The symptoms of nasal blockage, on waking and during the day, sneezing, rhinorrhoea, and nasal itching were assessed by the investigator at clinic visits and by the completion of a patient daily diary card. Safety was assessed by collection of adverse event information, routine haematology and biochemistry testing, and monitoring plasma cortisol levels. FPANS demonstrated good control of symptoms at each dose regimen, which was equivalent or superior to BDPANS and superior to placebo. There was no difference between the dose regimens of FPANS. FPANS was as well tolerated as placebo and BDPANS. It is concluded that FPANS 100 micrograms od is an effective and well-tolerated treatment for perennial rhinitis in children aged 4-11 years.

Extra-pharyngeal neck pathology complicating pharyngeal pouch surgery.

One case each of: (1) low grade thyroid lymphoma; (2) supraclavicular and para-oesophageal metastasis of a uterine adenocarcinoma; and (3) recurrent multinodular goitre have been encountered in very intimate relationship with the neck of a pharyngeal pouch within the tracheo-oesophageal gutter raising the possibility that the two conditions were interrelated. The practical importance of these cases is that a surgeon excising a pouch from the neck ought to be able to resect a thyroid lobe should it prove necessary, and occasionally endoscopic diverticulotomy is the only reasonable option.

Long-term results of mastoid cavities grafted with cultured epithelium prepared from autologus epidermal cells to prevent chronic otorrhea.

Chronic otorrhea and recurrent infection from open mastoid cavities are common and troublesome clinical problems for which there is no very satisfactory treatment. The authors have previously described a simple procedure to solve this problem, using autologous cultured keratinocyte layers grafted onto the unepithelialized open mastoid cavities. All procedures are carried out on an outpatient basis without anesthesia, except for local anesthesia for the skin biopsy. Twenty-six patients with 28 "difficult" mastoids, in which otorrhea had been present from 2 to 32 years, have been grafted with a follow-up period varying from 10 to 18 months. Seventeen mastoid cavities became symptom-free as a result of this technique. There were 4 failures, and partial success was shown in 7 cavities as judged by both the patient and by clinical examination.

A new technique using cultured epithelial sheets for the management of epistaxis associated with hereditary haemorrhagic telangiectasia.

A new technique for the treatment of severe epistaxis associated with hereditary haemorrhagic telangiectasia is described. The nasal septum and inferior turbinates, surgically denuded of respiratory epithelium, were grafted using autografts of cultured epithelial sheets derived from buccal epithelium. All patients upon whom this technique has been used have shown considerable lessening in the frequency and severity of their epistaxes although two patients received grafts on two occasions, in each case approximately three months apart. It is postulated that a nasal lining of stratified squamous epithelium is likely to be more resistant to trauma than the normal respiratory type, and this is supported by the observation that bleeds very seldom occur from the oral cavity in this syndrome.

Multiple ganglioneuroma of the neck.

A case of multiple ganglioneuroma arising along the entire length of the cervical sympathetic chain of one side of the neck is described. This is a distinctly unusual site and distribution of the disease and computed tomography proved invaluable to demonstrate its extent, in addition to excluding involvement of more caudal regions.

Treatment of chronic mastoiditis by grafting of mastoid cavities with autologous epithelial layers generated by in vitro culture of buccal epithelium.

Autologous cultured epithelial layers were established from biopsies from the mucosa of the cheek, a non-keratinizing region of the oral cavity. These were grafted to the unepithelialized mastoid cavities of nine patients with chronic mastoiditis and severe otorrhoea varying from two to 30 years' duration. All procedures were performed on an out-patient basis, with no anaesthesia except for topical anaesthesia for the mucosal biopsy. In seven of the patients the grafts took well, with complete resolution of the otorrhoea for a minimum follow-up period of eight months. In one patient there was a partial take of the graft with substantial improvement in the rate of discharge. The mastoid cavities of two patients were biopsied five months after grafting, and demonstrated a stratified squamous epithelium, with keratinization of the epithelium clearly evident.

Childhood haemangiomas of the head and neck.

Haemangiomas of the head and neck in children may be of several histological types, the clinical course depending on the group to which the haemangioma belongs. Treatment may be required if the haemangioma interferes with the airway, as in the subglottic group, or if the lesion becomes ulcerated with subsequent haemorrhage, as in capillary cavernous haemangiomas. Most haemangiomas require no immediate treatment as they involute spontaneously, though parental reassurance will be of paramount importance. Those lesions which persist may be amenable to treatment at a later date, the laser probably offering the best long-term results in terms of cosmesis as in the case of port-wine stains. Superselective embolization is becoming the treatment of choice for arterial haemangiomas. This paper is designed to clarify the histological and clinical features of these tumours and their management in view of considerable confusion in the literature encountered in our study.

Cat scratch disease in the parotid gland presenting with facial paralysis.

Facial paralysis due to cat scratch disease (CSD) has not been described previously. A case is reported where this self limiting benign condition presented in a child with a parotid lump and a lower motor neurone facial paralysis affecting the marginal mandibular branch of the facial nerve simulating a malignant tumour of the parotid gland. This case demonstrates a highly unusual presentation of CSD.

Treatment of postoperative otorrhoea by grafting of mastoid cavities with cultured autologous epidermal cells.

Autologous cultured keratinocyte layers were grafted onto the unepithelialised open mastoid cavities in 8 patients with otorrhoea for 2 to 32 years. All procedures were done on an outpatient basis without anaesthesia, except for local anaesthesia for skin biopsy. The cultured keratinocyte layers adhered well to the bed of granulation tissue lining the mastoid cavity and formed an excellent protective covering of stratified squamous epithelium. All 8 patients have been free from otorrhoea for the 2 to 6 months since grafting.

Congenital ossicular abnormalities: a review of 68 cases.

Sixty-eight cases of congenital conductive hearing loss due to ossicular abnormalities were reviewed. The clinical and surgical details of each case were documented, and a classification was drawn up on the basis of the abnormalities encountered. Sixty-six percent of the cases were documented as middle ear anomalies in the absence of any other evidence of congenital disease. Improved hearing was obtained in 47% of those cases where corrective surgery was undertaken. Treatment and results are reviewed. The pattern of ossicular abnormality encountered in this series suggests a variable origin of the incus, either from first branchial arch alone or from both first and second branchial arches.

A review of maxillary sinus cholesterol granuloma.

Cholesterol granuloma in sites other than the ear may present to many different specialties. Diagnosis is rarely suspected pre-operatively, and depends on the finding of a characteristic histological picture. It is generally considered that malaeration with haemorrhage into a cavity which is normally aerated is the primary event in the development of this condition. Nine cases of cholesterol granuloma affecting the maxillary sinus are described, together with the radiological appearances in some cases. The main differential diagnosis in these cases were mucoceles of the maxillary antrum, cysts arising within the sinus, or cysts of dental origin, and in those cases showing expansion or erosion of the maxillary sinus, malignant disease. The results of treatment are discussed.

Morbidity study of submandibular gland excision.

Submandibular gland excision is an operation frequently performed by many different surgical specialists. It is often associated with a variety of postoperative complications, the commonest being neurological deficits related to damage to the marginal mandibular, lingual or hypoglossal nerves. Other patients develop further problems at a later date due to the development of calculi from gravel retained in the duct remnant. This study aims to discuss how these complications can be avoided.

Miscellanea: Survey of nameplates in a well known London Street.

In 1951 a well known otolaryngologist recorded 798 brass nameplates in a well known London street. In the 35 years since this last survey was conducted the number has decreased by 23. This surprising finding is attributed to the communal entryphone and to the emergence of the shoddy plate. A definition of a plate is proposed, the concentration described, and the geographical distribution of plates summarised. A new phenomenon is encountered, the ghost plate, type A and type B. Further study is required to elucidate the significance of ghost plates.

Sarcoidosis in ENT practice.

Thirteen cases of sarcoidosis were seen at the Royal National Throat, Nose and Ear Hospital and St George's Hospital, Tooting, between 1963 and 1984 inclusive. In only 5 patients had a diagnosis of sarcoidosis been made prior to attendance. In the remaining 8 patients, there was a considerable delay in making a diagnosis in those cases with predominantly nasal symptoms, ranging from 8 to 18 months. Several patients with nasal sarcoidosis had evidence of systemic disease on investigation, but did not receive appropriate treatment early in the course of their disease because of the delay in initial diagnosis. Both the ENT surgeon and the general practitioner must be aware that symptoms of nasal obstruction, rhinorrhea and crusting are not always due to an allergic or vasomotor rhinitis, and granulomatous conditions should always be considered in the differential diagnosis of patients with these symptoms.

A retrospective study of nasopharyngeal carcinoma presenting over a 10-year period.

67 cases of nasopharyngeal tumours presenting at the Royal National Throat, Nose and Ear Hospital over a 10-year period were examined, of which 47 were poorly differentiated carcinomas. The population under review could be subdivided into three separate groups on the basis of geographical origin: Northern European, Southern European and Middle Eastern. The proportion of poorly differentiated carcinomas in each geographical area was calculated and was found to differ significantly between the Northern European and Middle Eastern groups.