RESUMO
Nasal septal perforations present a distinct challenge to the otolaryngologist and a significant cause of symptoms to affected patients. Many surgical techniques for the repair of septal perforations have been described. Connective tissue autografts are commonly used as interpositional grafts between the septal flaps. Recently acellular human dermal allograft has been used with success. In total, 17 patients with symptomatic anterior nasal septal perforations that had failed conservative treatment underwent a closed endoscopic repair of their perforations with acellular human dermal allograft (alloderm) and an anteriorly based inferior turbinate flap; 13 patients had a successful closure of the perforation, two patients, despite initial success, re-perforated as a result of persistent crust picking and, in two patients, the graft failed. With appropriate patient selection and stringent postoperative care the authors consider this technique offers a good surgical outcome for the closure of septal perforations.
Assuntos
Derme/transplante , Endoscopia/métodos , Septo Nasal/lesões , Septo Nasal/cirurgia , Retalhos Cirúrgicos , Conchas Nasais/transplante , Adulto , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transplante HomólogoRESUMO
A case of spontaneous, isolated supraglottic haemorrhage in a patient recently started with warfarin sodium treatment is described. The symptoms of sore throat, dysphonia, stridor, dysphagia or a neck swelling in a patient taking anticoagulants should alert the clinician to the possibility of this rare but potentially fatal complication.
Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Doenças da Laringe/induzido quimicamente , Varfarina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Cervicofacial actinomycosis is known to affect many soft tissues and bony structures in the head and neck. However to the authors' knowledge, actinomycosis of the post-cricoid region has not been previously reported. A case of a 74-year-old male who developed actinomycosis of the post-cricoid region after radiotherapy for a laryngeal carcinoma is presented. Actinomycosis should be considered in the differential diagnosis of dysphagia following radiotherapy for squamous cell carcinoma of the larynx, as early treatment is likely to result in a favourable outcome.
Assuntos
Actinomicose Cervicofacial/complicações , Transtornos de Deglutição/microbiologia , Doenças da Laringe/microbiologia , Actinomicose Cervicofacial/tratamento farmacológico , Idoso , Diagnóstico Diferencial , Humanos , Doenças da Laringe/tratamento farmacológico , Masculino , Radioterapia/efeitos adversosRESUMO
Ear, nose and throat (ENT) specialist outreach clinics, in which hospital-based consultants hold clinics in general practice surgeries, have been popular with general practitioners (GPs) and patients. This prospective study recorded data on 1155 consecutive patients seen by one ENT surgeon in two GP surgeries. At each consultation, a record was kept of the requirement for further investigations that would normally be done at the same time as the consultation in a hospital department. The results showed that 76 per cent of patients needed an investigation, which would be readily available in a hospital but not in a GP surgery (audiometry, endoscopy, microscopy of the ear, a minor procedure or X-ray). This study indicates that despite the apparent convenience of outreach ENT clinics to patients and GPs, patients may need to spend more time being assessed than they would if they were investigated in one visit to a hospital department. Unless an outreach clinic is used frequently, it is difficult to justify the cost of equipping it to the same level as a hospital department. Limited resources would be better spent providing good access to well-equipped regularly-used hospital ENT outpatient departments.
Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Medicina de Família e Comunidade/organização & administração , Otolaringologia/organização & administração , Técnicas de Diagnóstico Otológico/estatística & dados numéricos , Inglaterra , Acessibilidade aos Serviços de Saúde , Humanos , Estudos Prospectivos , Fatores de TempoRESUMO
Diffuse infiltration of the meninges by metastatic carcinoma (meningeal carcinomastosis) is a potential complication of systemic malignancy. It may present with a variety of neurological symptoms as any aspect of the neuraxis can be affected. Often there is a history of pre-existing malignancy. The authors describe a case with an initial presentation of sudden onset profound bilateral sensorineural hearing loss. The underlying pathology was found to be an occult breast carcinoma, a previously unreported finding. The role of cerebrospinal fluid cytology and radio-imaging in diagnosis is discussed. All previously reported cases of sudden hearing loss and meningeal carcinomatosis are reviewed.
Assuntos
Adenocarcinoma/secundário , Neoplasias da Mama/complicações , Perda Auditiva Neurossensorial/etiologia , Neoplasias Meníngeas/secundário , Neoplasias Primárias Desconhecidas/complicações , Adenocarcinoma/patologia , Neoplasias da Mama/patologia , Feminino , Humanos , Neoplasias Meníngeas/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/patologiaRESUMO
The KTP laser is used in both uvulopalatopharyngoplasty and tonsillectomy. However the need to use laser guarded endotracheal tubes represents a sizeable expense to the procedure. The authors describe a modified tongue plate to the oropharyngeal gag that covers all of the endo-tracheal tube, thus enabling the safe use of a non-laser guarded, PVC endotracheal tube. In over a hundred such procedures there has been no laser-related complications. The authors consider that the one off cost of this tongue plate and gag allows a more cost-effective method for performing laser-assisted uvulopalatopharyngoplasty and tonsillectomy.
Assuntos
Terapia a Laser , Terapia a Laser/instrumentação , Orofaringe/cirurgia , Tonsilectomia/instrumentação , Desenho de Equipamento , Humanos , Terapia a Laser/economia , LínguaRESUMO
There is no general consensus as to the best method of reconstruction following total laryngopharyngectomy for hypopharyngeal carcinoma. The aim of this study is to attempt to establish the current practice amongst British ENT Consultants and to ascertain the reasons for their choice of reconstructive technique. An anonymous questionnaire was sent to 546 consultants in the UK and the results of 363 (66.5 per cent) were analysed. One hundred and twenty-eight (35.3 per cent) consultants replied that they performed surgery for hypopharyngeal carcinoma. Sixty-five (50.8 per cent) performed a stomach pull-up procedure, 23 (18 per cent) used a jejunal free flap, 36 (28.1 per cent) used both and four (3.1 per cent) used other techniques. In the stomach pull-up group, the main reasons given for their choice were because there was no lower resection margin (48 out of 65) and because of tradition in the way they were trained (37 out of 65). In the group using the jejunal free flap, lower morbidity (18 out of 23) and mortality (14 out of 23) were the main reasons for their choice. The questionnaire also found that amongst the 60 consultants who would consider using a jejunal free flap, the majority (39) aimed for a lower clearance margin of 2-4 cm, while 17 aimed for > 4 cm clearance. This study provides a good indication of the current practice in the UK of reconstruction following resection for hypopharyngeal carcinoma. It appears that the stomach pull-up remains the most commonly used method of reconstruction, but the jejunal free flap is becoming increasingly more popular because of its lower morbidity and mortality.
Assuntos
Neoplasias Hipofaríngeas/cirurgia , Faringectomia , Procedimentos de Cirurgia Plástica , Padrões de Prática Médica , Retalhos Cirúrgicos , Humanos , Jejuno/cirurgia , Estômago/cirurgia , Reino UnidoRESUMO
Corrosion of silver tracheostomy tubes has previously been reported. In all of these reports, it occurred at the junction between the neck plate and the outer tube where an alloy of inferior corrosion resistance, compared to silver, has been used in the brazed joint. We present, to our knowledge, a previously unreported case of corrosion of the main body of the outer tube of a silver Negus tracheostomy tube where no such alloy is present.
Assuntos
Traqueostomia/instrumentação , Adulto , Corrosão , Falha de Equipamento , Humanos , Higiene , Masculino , Autocuidado , PrataRESUMO
A large vestibular aqueduct is one of the commonest radiological abnormalities of the inner ear. A case of acute profound unilateral sensorineural hearing loss and balance disturbance following minor head trauma in the presence of an abnormally enlarged vestibular aqueduct is described. The significance of a diagnosis of large vestibular aqueduct syndrome, in the presence of serviceable hearing, is that it identifies patients who should refrain from activities that increase intracranial pressure to prevent hearing loss.
Assuntos
Aqueduto Vestibular/patologia , Doenças Vestibulares/diagnóstico , Doença Aguda , Adulto , Traumatismos Craniocerebrais/complicações , Feminino , Futebol Americano/lesões , Perda Auditiva Neurossensorial/etiologia , Humanos , Pressão Intracraniana , Imageamento por Ressonância Magnética , Equilíbrio Postural , Transtornos de Sensação/etiologia , Síndrome , Zumbido/etiologia , Tomografia Computadorizada por Raios X , Vertigem/etiologia , Doenças Vestibulares/complicaçõesRESUMO
The presence of a mass in a jejunal free flap that causes dysphagia less than two years after a pharyngolaryngectomy for carcinoma usually indicates tumour recurrence. We present a case of invasive candidiasis of a jejunal free flap presenting with dysphagia and a mass. To our knowledge this is previously unreported. Such a cause should always be considered in the differential diagnosis, as early recognition and treatment are likely to result in a favourable outcome.