Delayed Post-Operative Subcutaneous Emphysema.

The authors present the case of an 87-year-old woman who developed a delayed onset of subcutaneous emphysema post-operatively. We discuss the causative factors - in this case, presumed injury to her hypo-pharynx during a reportedly uneventful endotracheal intubation, the investigations and the management of this rare complication.

Non-Traumatic Carotid Artery Dissection Following an Episode of Orbital Cellulitis: A Case Report.

Carotid artery dissection (CAD) is a haemorrhage into the arterial wall disrupting the intimal layers of the vessel. We present a case of a 16-year-old male with a non-traumatic spontaneous CAD. The patient presented with Horner's syndrome following an episode of orbital cellulitis secondary to sinusitis requiring sinus drainage surgery. Subsequent magnetic resonance imaging (MRI) revealed a CAD. The patient was treated with antiplatelet medication.

A Systematic Review on Outcomes of Anterior Skull Base Reconstruction.

INTRODUCTION: Anterior skull base resection often results in large defects that need to be reconstructed. This can be done using loco-regional, free flaps or both. OBJECTIVE: The aim of this systematic review is to evaluate the surgical outcomes (mortality, complication rates and functional outcomes) for patients undergoing anterior skull base reconstruction. METHODS: Electronic databases (MEDLINE, EMBASE and Scopus) were systematically searched for relevant articles from 1974 to March 2018. A total of 41 studies were included in this systematic review. No randomized controlled trials were identified; therefore, a meta-analysis was not performed. RESULTS: Mortality from anterior skull base reconstruction were about 0-4% for loco-regional flaps while free flaps were around 0-7%. Overall complications ranged from 0% to 43% in loco-regional flaps, while rate of complications for free flaps ranged from 25% to 66.7%. Flap complications ranged from 0% to 14% for free flaps and 0% to 35% for local flaps. Quality-of-life measures did not differ significantly depending on surgical approach but were worse for patients with malignancies. CONCLUSION: Due to varying standards of reporting of outcomes, lack of a standardized classification system for anterior skull base defects and absence of clinical trials, we were unable to perform a meta-analysis in this systematic review. Recommendations to guide future studies are proposed.

Systematic Review of Round Window Operations for the Treatment of Superior Semicircular Canal Dehiscence.

A review of the literature is presented to consider the role of round window (RW) operations in superior semicircular canal dehiscence (SSCD). Primary (PubMed) and secondary sources (TRIP, Cochrane database, Best Practice, and PubMed Clinical Queries) were used to identify relevant studies. Four original studies (three case series and one case report) were identified. All were retrospective reviews and used a number of subjective and objective outcome measures to assess the efficacy of a minimally invasive, transmeatal approach to perform RW surgery for SSCD. The current evidence suggesting that RW operations for SSCD are unlikely to replace more established surgical procedures as first-line treatment may be appropriate in a select group of patients. Further multicenter, randomized controlled trials are required to establish their efficacy in patients with SSCD.