Facial migraine in a rhinological setting.

This study aims to investigate the incidence of migraine involving the face in a rhinology clinic and to describe its characteristics. It is a study of a cohort of 973 patients consecutively presenting to the outpatient clinic with symptoms of facial pain and/or rhinosinusitis. The study subgroup consisted of patients with facial pain and migraine excluding cluster headache and paroxysmal hemicrania. We studied the features of 51 patients who had facial pain with migraine. The diagnosis was based on the criteria used by the International Headache Society and was also supported by the outcome and response to treatment after a mean of 2 years and 2 months. Of the 973 consecutive patients, 409 (42%) had symptoms of facial pain and/or head pain or pressure. Fifty-one (12%) had migraine. Of these, 39 (76%) had unilateral pain and, in 12 (24%), it was bilateral. The distribution affected the forehead and/or eye or cheek in 32 (63%) patients. Twenty-four (47%) had migraine isolated to the second division of the trigeminal nerve. Twelve per cent of patients attending a rhinology clinic with facial pain had migraine. Of particular interest were the 6% of patients with facial pain who had migraine confined to the second division of the trigeminal nerve. This entity is not widely recognized and has rarely been described in the literature.

A morphological study of the thoracic duct at the jugulo-subclavian junction.

Chylous fistulae are uncommon but serious complications of neck surgery, occurring with an incidence of 1-3% after radical neck dissection. The majority occur on the left side (75-92%) and are due to damage to the terminal segment of the thoracic duct as it drains into the great veins of the neck in the region of the venous angle. The risk of trauma to the terminal thoracic duct may be influenced by anatomical variations. The macroscopic arrangement of the termination of the thoracic duct in the left neck was examined in 24 UK cadavers. Twenty-one ducts terminated as a single vessel, two ducts showed a bifid termination and one duct had three terminal branches. The precise site of termination was variable. Five thoracic ducts showed branching and reanastamosing patterns prior to their termination, irrespective of the number of terminal branches. Subsidiary cervical lymph trunks were identified in four dissections. These variations are described and their relevance to surgery involving the left side of the neck is discussed.