Velopharyngeal insufficiency in patients without a cleft palate: important considerations for the ENT surgeon.

BACKGROUND: Velopharyngeal insufficiency is the inability to close the velopharyngeal port during speech and swallowing, leading to hypernasal speech and food regurgitation. OBJECTIVE: This study aimed to explore the aetiological factors contributing to the development of velopharyngeal insufficiency in a non-cleft paediatric population, especially following adenoidectomy. METHODS: A retrospective case review was conducted of all children without a known cleft palate, born between 2000 and 2013, who were referred to a tertiary cleft centre with possible velopharyngeal insufficiency. RESULTS: The data for 139 children diagnosed with velopharyngeal insufficiency following referral to the cleft centre were analysed. Thirteen patients developed the condition following adenoidectomy; only 3 of these 13 had a contributing aetiological factor. CONCLUSION: Velopharyngeal insufficiency is a rare but significant complication of adenoidectomy. The majority of patients who developed velopharyngeal insufficiency following adenoidectomy did not have an identifiable predisposing factor. This has important implications for the consent process and when planning adenoidectomy.

The use of Tisseel™ fibrin sealant in selective neck dissection--a retrospective study in a tertiary Head and Neck Surgery centre.

OBJECTIVES: To determine the feasibility of drain-free surgery in selective neck dissection (SND) by investigating the effects of the use of synthetic fibrin glue Tisseel™ on the drain output and overall wound healing. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral unit in Head and Neck surgery. PARTICIPANTS: The case notes of 30 patients who had undergone SND in levels I to IV were examined and compared. Tisseel was applied prior to wound closure in fifteen patients only. MAIN OUTCOME MEASURES: Drain output, number of days of drain in situ and total number of days of hospitalisation as well as complications rate and type between the Tisseel and non-Tisseel groups. RESULTS: Patients who had Tisseel applied in the wound had a mean drain output of 67.1 ml, which was significantly lower than 174.4 ml in patients who did not have it. Patients in the Tisseel group had the drain in situ for a shorter period and were hospitalised for fewer days than the ones in the non-Tisseel group. CONCLUSIONS: The use of Tisseel in SND resulted in lower drain output and shorter period of drain in situ and hospitalisation. There was no additional morbidity or complication associated with its use, and the initial conclusion is that this technique may have benefits not only to patient recovery but also for healthcare providers as they could potentially reduce the overall costs of surgery by reducing the length of hospital stay.

Management of an incidental malignant peripheral nerve sheath tumour in the parapharyngeal space.

BACKGROUND: Parapharyngeal space tumours are uncommon and represent 0.5-1 per cent of all head and neck neoplasms; 20-30 per cent of these are malignant. Malignant peripheral nerve sheath tumours are rare and mostly encountered in patients with neurofibromatosis type 1. Only four cases of parapharyngeal space tumours have been reported in the English language in patients without neurofibromatosis type 1. CASE REPORT: We report the case of a 64-year-old man with no stigmata of neurofibromatosis type 1, in whom a mass in the left pre-styloid region of the parapharyngeal space was an incidental finding following magnetic resonance imaging for investigation of cervical spine problems. The mass was consequently removed using a transcervical approach. A histological review revealed a low-grade malignant peripheral nerve sheath tumour. DISCUSSION: We consider the pathophysiology of this highly malignant tumour as well as the challenging anatomy of the parapharyngeal space and the surgical and other therapeutic modalities utilised to treat this condition.

Grisel's syndrome in otolaryngology: a systematic review.

AIMS: to assess etiology, treatment and outcome of Grisel's syndrome. METHODS: A Medline search was performed using the terms Grisel's syndrome, spontaneous atlantoaxial subluxation, head, neck, ear, nose and throat. A systematic review of the literature was performed. Case series of both adult and pediatric cases were included. Only papers focusing on true non-traumatic atlantoaxial subluxation were included. RESULTS: Seventy-one papers have been published from 1950 to 2006. Forty-eight of these fulfilled our inclusion criteria, totaling 103 patients for review. The main causes of Grisel's syndrome were infection (48%) and post-adenotonsillectomy (31%). Less common causes included other postoperative cases such as pharyngoplasty and ear operations. Neurosurgical consultation was paramount in all cases. In the majority of cases conservative management in the form of bedrest, antibiotics, muscle relaxants, traction and collar was effective; in a few cases only surgery in the form of arthrodesis was deemed necessary. Morbidity was significant in those cases where diagnosis was delayed, with the most devastating consequence a permanent neurological deficit in one case. CONCLUSIONS: Grisel's syndrome is a rare but dangerous complication that can go unnoticed in its early phase and can be a major cause of morbidity and mortality following infection or head and neck procedures/interventions. Early recognition of any cervical complication following routine otolaryngological operations together with early neurosurgical consultation is mandatory to prevent devastating consequences.

Diseases of indigenous chickens in Bokaa village, Kgatleng district, Botswana.

This study examined flock size and management, level of internal and external parasite burden and seroprevalence of antibodies to poultry pathogens in indigenous chickens in Bokaa village, Kgatleng district, Botswana. The mean flock size was 22.6 +/- 6.85 with a range of 11-34. The mean body weights of cocks and hens were 2.28 +/- 0.56 kg and 1.70 +/- 0.38 kg, respectively. Housing and commercial poultry feed were not provided. Ascaridia galli, Heterakis gallinarum and Syngamus trachea were found in some birds. Although the chickens were not vaccinated against any poultry diseases, serum antibodies to Newcastle disease, infectious bursal disease and infectious bronchitis were detected.

Yolk sac utilization in ostrich (Struthio camelus) chicks.

The mass of residual yolk sac expressed as a percentage of initial mass of the egg from which the chick hatched decreased sharply in the first 2 days post-hatching. A gradual reduction occurred between 3 and 10 days after which a sharp decline was noted between 11 and 13 days post-hatching. The highest number of chicks with unabsorbed yolk sac was noted on day 5 post-hatching followed by days 6 and 7. Chick mortality followed the same pattern. The dynamics, causes and clinical consequences of yolk sac utilization are discussed.

A note on endoparasites of wild ostriches (Struthio camelus) in the Mokolodi Nature Reserve, Gaborone, Botswana.

A study was undertaken to investigate the prevalence of endoparasites of wild ostriches at Mokolodi Nature Reserve, Gaborone, over a 7-month period. Large numbers of strongyle eggs were recovered from faecal material in April and September and a decline in the strongyle egg counts was evident during June and July. Noteworthy was the absence of helminth eggs in faecal samples collected from chicks and coccidia oocysts from any of the ostriches.

Seasonal fluctuation of parasitic infestation in donkeys (Equus asinus) in Oodi village, Kgatleng District, Botswana.

During the period March to September 2000, a study was conducted in Oodi village, Kgatleng District, Botswana, to investigate the seasonal fluctuation of internal, external and blood parasites of donkeys. Twelve adult donkeys were randomly selected from a farmer with a herd of 15 donkeys. Monthly visits were made to the farmer when the donkeys were examined for parasites. The only ectoparasites recovered from the donkeys were instars of various tick species. The most prevalent tick was Rhipicephalus evertsi evertsi (98.4%), followed by Amblyomma hebraeum and Hyalomma species. The only haemoparasite seen on microscopy was Babesia equi at low parasitaemia in 26.8% of the donkeys. However, no clinical babesiosis was evident. Coprological examination showed the presence of strongyle eggs in moderate numbers. Very low numbers of coccidia oocysts were found in the faecal samples. High tick numbers and worm egg counts coincided with the warm, wet months in contrast to the low numbers recovered during the cold, dry months. An interview conducted by the authors indicated that donkeys were nutritionally marginalised by owners. Supplementary feeding was therefore recommended, especially during the winter months when grazing is poor.

The effect of mixing and translocating juvenile ostriches (Struthio camelus) in Botswana on the heterophil to lymphocyte ratio.

The possibility was investigated that translocation of juvenile ostriches from concrete-paved to sandfloored pens and mixing of batches of ostriches after such translocation constitute a stress strong enough to evoke changes in the ratio of heterophils to lymphocytes. Blood smears were obtained from 15 ostriches out of a group of 25 birds 4 and 2 days before and then 2 and 4 days after translocation. The heterophil to lymphocyte ratio changed from 0.27 and 0.37 on days 4 and 2, respectively, before mixing and translocation to 0.53 and 0.84 on days 2 and 4, respectively, after translocation. Mixing and translocating juvenile ostriches appears to constitute stress. This information is important for the onfarm management of juvenile ostriches to enhance their welfare and productivity.

Seroprevalence of Toxoplasma gondii and Chlamydia psittaci in domestic pigeons (Columbia livia domestica) at Sebele, Gaborone, Botswana.

High antibody titres to Toxoplasma gondii and Chlamydophila psittaci were demonstrated in serum collected from domestic pigeons at average titres of 1:128 and 1:64 respectively. The public health implications of these findings are discussed.

Biochemical composition of urine from farmed ostriches (Struthio camelus) in Botswana.

Biochemical and qualitative evaluation of the supernatant of urine from hydrated farmed ostriches (Struthio camelus) indicated that the urine was comparable to that described by other workers. The disparities obtained between the biochemical constituents in the present and previous studies were partly attributed to the state of hydration influenced by climatic factors. Results of the cytological examination of the supernatant and the sediment concurred with the observations of other workers. It was therefore concluded that parameters from both the quantitative and qualitative analyses could be used as a guideline to monitor the health status of farmed ostriches in Botswana.

Antibodies to Newcastle disease virus in the sera of indigenous chickens in Oodi, Kgatleng, Botswana.

A serological survey was conducted to determine the prevalence of antibodies to Newcastle disease virus in apparently healthy and unvaccinated adult indigenous chickens. Haemagglutination inhibiting antibodies to Newcastle disease virus were found in the sera of 51 out of 89 (57.3%) chickens sampled.

Helminth parasites of domestic pigeons (Columba livia domestica) in Sebele, Gaborone, Botswana.

Twelve adult domestic pigeons from Sebele, Gaborone, Botswana, were examined for the presence of helminth parasites. The cestode genus Raillietina and two species of nematodes, Dispharynx spiralis and Ascaridia columbae were recovered. Most pigeons (75 %) were infected with Raillietina spp. often in concurrence with A. columbae.

Helminth parasites of indigenous chickens in Oodi, Kgatleng District, Botswana.

Thirteen adult indigenous chickens from Oodi, Kgatleng district, Botswana, were examined for helminth parasites. Two species of nematodes, Ascaridia galli and Heterakis gallinarum, and species of the cestode genus Raillietina, were recovered. A. galli and H. gallinarum were the most commonly seen parasites. The nematode A. galli occurred concurrently with Raillietina spp.

Parasites of domestic pigeons (Columba livia domestica) in Sebele, Gaborone, Botswana.

The following parasites were found in apparently healthy pigeons kept in Sebele: a haemoprotozoan, Haemoproteus columbae (80%); endoparasite metazoan nematodes, Ascaridia columbae (30%) and Dispharynx spiralis (10%); a cestode, Raillietina sp. (80%) and coccidian oocysts (40%); 2 ectoparasites, namely the pigeon fly, Pseudolynchia canariensis (50%) and the louse, Columbicola columbae (30%). The pigeons also had highantibody titres, (1:256) to the protozoan parasite Toxoplasma gondii (100%). The latter infection in these domestic pigeons has public health implications.

Limb deformities of farmed ostrich (Struthio camelus) chicks in Botswana.

Limb deformities were detected in 135 out of 885 ostrich chicks, giving a prevalence of 15.3%. Tibiotarsal rotation affected 73% of the chicks with limb deformities, whereas rolled toes accounted for 36%. The right leg was more often affected than the left leg. The incidence of limb deformities was highest in 2- to 3-week-old ostrich chicks. The incidence of limb deformities was highest at the beginning of the breeding season and lowest towards the end, when it was relatively warmer. The mean serum manganese and zinc levels in deformed ostrich chicks were higher than the levels reported for normal chicks.

Seroprevalence of infectious bursal disease in non-vaccinated indigenous and exotic chickens on selected farms around Gaborone, Botswana.

Sera from nine out of 30 (30.0%) apparently healthy unvaccinated indigenous (Tswana) chickens had precipitating antibodies to infectious bursal disease (IBD) virus using the agar gel precipitation test. Similarly, sera from 11 out of 49 (22.4%) chickens of exotic breeds with no history of vaccination against IBD were positive for antibodies against the virus.

Haemoproteus columbae in domestic pigeons in Sebele, Gaborone, Botswana.

Mature and immature stages of Haemoproteus columbae gametocytes, an avian haemosporidian protozoan parasite were found in 75% of blood smears prepared from 30 healthy domestic pigeons in Sebele location, Gaborone, Botswana. Parenteral administration of an immuno-suppressive dose of dexamethasone, lowered the level of parasitaemia, the packed cell volume and the heterophil:lymphocyte ratio in the test pigeons. However, both the dexamethasone-treated and the control pigeons remained clinically normal.