CSF rhinorrhea secondary to use of a Mayfield head clamp.

Various complications with use of a Mayfield head clamp have been reported, from minor skin necrosis and lacerations to the more significant extradural hematomas and meningitis. To the best of our knowledge, our report describes for the first time in the medical literature, the uncommon complication of frontal sinus fracture and cerebrospinal fluid leak caused by a scalp pin of a head clamp used during a frontal craniotomy. The cerebrospinal fluid leak settled with conservative management, and no surgical intervention was necessary. Clinicians should appreciate the possibility of such a complication and assess preoperative scans for frontal sinuses that extend to a high level, as in our patient.

A randomised controlled trial comparing Triadcortyl with 10% glycerine-ichthammol in the initial treatment of severe acute otitis externa.

Acute otitis externa is a common clinical condition accounting for a large proportion of patients attending the otolaryngology department, although milder cases are often managed in primary care. Treatment of the most severe forms of otitis externa involves aural toilet, followed by the application of a topical preparation, commonly in the form of an ear canal dressing. A prospective single-blind randomized controlled trial was performed to compare the efficacy of 10% glycerine-ichthammol (GI) solution and Triadcortyl (TAC) ointment, both applied as ear canal dressings, in the initial management of severe acute otitis externa. A total of 64 patients were studied. Both treatment modalities were proven efficacious in the treatment of severe acute otitis externa. Although there was a statistically significant improvement of pain parameters in the TAC group, we found no significant differences in clinical findings between the two groups. Therefore, it is recommended that GI dressing can be used instead of an antibiotic dressing as an initial treatment of severe acute otitis externa on the basis of cost, avoidance of resistance and toxicity.

Usefulness of CT scans in malignant external otitis: effective tool for the diagnosis, but of limited value in predicting outcome.

Computerized tomography (CT) scanning is a well recognised tool for the diagnosis of malignant external otitis. To investigate the degree of correlation between CT findings scan and the patients clinical status focusing on a subgroup of patients with cranial nerve palsies. Diagnosis of malignant external otitis was confirmed in 23 patients (average age 71 years, age range 39-87) based on criteria of severe pain, otitis externa refractory to conventional treatments and possibly diabetes mellitus and pseudomonas detection. CT was performed on 23 of these patients. Results from these scans were analysed and correlated with patient clinical status. Retrospective analysis of CT images and medical notes were used for data analysis.The CT scans of all 23 patients showed evidence of involvement of disease outside the external auditory canal, confirming the diagnosis. Sixteen out of 23 patients (70%) demonstrated evidence of bone erosion. Four of the 16 showed involvement of the petrous apex. From our subset of ten patients with cranial nerve involvement, eight demonstrated evidence of bone erosion and two showed mastoid and middle ear involvement without bone erosion. All four patients with petrous apical involvement presented with cranial nerve palsies (two lower cranial nerve palsies, one seventh nerve palsy and one combined lower and seventh nerve palsy). CT scanning was found to be a fast and economical tool in the initial assessment of patients with malignant external otitis. Petrous apex involvement was constantly associated with cranial nerve palsies, usually the lower cranial nerves. CT findings of temporal bone in itself however, were not closely correlated to the clinical outcome of the patients.

A novel use of photo messaging in the assessment of nasal fractures.

We evaluated a new method of assessing patients referred to the otolaryngology department with nasal injury. Patients possessing a mobile phone with built-in camera took an image of their face and sent it to the department for assessment. A decision was then made as to whether the patient needed further consultation or treatment. This method of nasal fracture assessment might avoid unnecessary referrals to the department. A prospective single blinded study was carried out. Twenty-five patients with a nasal injury took photographs of their face using a mobile phone camera. These images were reviewed and assessment made about whether a nasal fracture was present. The patient was then clinically assessed, the clinical examination being the 'gold standard' method of assessment. There was little agreement between photographic and clinical assessment. Sixty-two percent of patients who were clinically assessed to have a nasal fracture requiring manipulation were not picked up on assessment of their image. The greatest agreement with clinical assessment was the patient's own opinion as to whether there was new deviation of their nasal bone.

Acute rhinosinusitis in adults: an update on current management.

Acute rhinosinusitis is a common disease with worldwide prevalence. It is a significant burden on the health services. It is most commonly caused by viruses and is self-limiting in nature. The diagnosis of acute rhinosinusitis is clinical and sinus radiography is not indicated routinely. Most cases of acute rhinosinusitis are treated symptomatically. However, symptoms may persist beyond 10 days when secondary bacterial infection prevails. Antibiotics are reserved for moderate or severe cases or when there is development of complications of acute rhinosinusitis. This paper provides an update on the current management of acute rhinosinusitis.

A prospective randomised controlled trial comparing Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis.

A prospective study was performed to compare the efficacy and patient tolerance of Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis. A total of 42 patients were studied. There was no significant difference between the two types of pack in efficacy or patient discomfort with pack in situ. Rapid Rhino produced significantly lower scores for subjective patient discomfort during insertion and removal of pack.

Simultaneous contralateral vestibular schwannoma and glomus jugulare tumor: a case report.

To the best of our knowledge, only 3 cases of a simultaneous vestibular schwannoma and a glomus jugulare tumor have been previously reported in the literature. In all 3 cases, the lesions were located on the same side. We report a new case of simultaneous vestibular schwannoma and glomus jugulare tumor that is unique in that the two lesions arose on opposite sides. The glomus tumor was treated with embolization followed by radiotherapy, while the schwannoma was managed via radiologic observation.

Outpatient fibre-optic laryngoscopy for stridor in children and infants.

Many neonates are referred for a diagnosis with stridor. The gold standard investigation has traditionally been a rigid or direct microlaryngoscopy. This impacts on existing theatre schedules, demands a high level of skills from the paediatric anaesthetist along with the risk of exposing a neonate to a general anaesthetic. A bed in paediatric intensive care is often required and must be reserved. As laryngomalacia is the most common diagnosis and less serious than the investigations for infants with stridor themselves, clinicians have been looking to use the flexible fibre-optic laryngoscope to view the upper airway in awake neonatal patients. We present our experience in 66 neonatal patients initially managed by awake per-oral flexible fibre-optic laryngoscopy for stridor. We conclude that the technique is safe, straightforward and allows a diagnosis to be achieved in a significant number of cases. We recommend it as a first line investigation, reserving microlaryngoscopy for the group of patients in whom a diagnosis cannot be made in the outpatient clinic.

Well-circumscribed intramuscular lipoma of the sternocleidomastoid muscle.

Intramuscular lipomas are unusual benign mesenchymal tumours, which infiltrate the skeletal muscle, and are exceedingly rare in the head and neck region. They commonly infiltrate the skeletal muscle fibres from which they arise and are rarely well circumscribed. We present the only documented case of well-circumscribed intramuscular lipoma arising from the sternocleidomastoid muscle. Although the recurrence is commoner in the infiltrative variety the surgeon should be aware that differentiation between infiltrative and well circumscribed is based on histological diagnosis, and hence wide excision in all cases of intramuscular lipomas is essential.

Chondrosarcomas of the temporal bone: presentation and management.

Chondrosarcomas (CSA) of the temporal bone are rare primary malignant tumours that are slow growing, but locally aggressive. The management of CSAs involving the temporal bone is challenging and necessitates a multidisciplinary approach in a tertiary referral unit well practised in skull base surgery. Their management with particular reference to modes of presentation and treatment strategies has been reviewed here.