Diathermy epiglottectomy: endoscopic technique.

Endoscopic epiglottectomy is usually performed using a surgical laser. Epiglottectomy may be indicated for the treatment of benign or malignant lesions and for the relief of airway obstruction caused by a floppy epiglottis. We present four patients who had endoscopic partial epiglottectomy using monopolar diathermy to treat a floppy epiglottis. All the four patients were male in their sixth and seventh decades with snoring and/or obstructive sleep apnoea syndrome (OSAS) due partly or wholly to a floppy epiglottis. Diathermy epiglottectomy is easily carried out using the laryngoscope, laryngeal instruments and curved rotating microdissection monopolar scissors (used in laparoscopic surgery). This was found to be safe and effective with minimal morbidity. It requires no elaborate preparation and could be performed in hospitals that have no laser facilities. It may be performed in conjunction with other procedures e.g. uvulopalatopharyngoplasty (UPPP) if necessary.

Management of nasal trauma--widespread misuse of radiographs.

OBJECTIVE: To assess the reasons behind the widespread use of X-ray in the management of nasal trauma despite the fact that it has no useful purpose, comparing the responses of doctors in Accident and Emergency (A&E) departments between the District General Hospitals (DGH) and the Teaching Hospitals. METHOD: A multiple-choice questionnaire was sent to all doctors in Accidents and Emergency departments in the North-West Region of England. RESULT: 212 questionnaires were sent out and 159 were returned. Amongst the 92 (57.9 per cent) doctors who use nasal radiographs, the overall most common reason is medico-legal in 48 (52.1 per cent). A high proportion of DGH doctors use radiographs for diagnostic purposes and 35 (28.9 per cent) will refer patients based on X-ray demonstration of nasal bone fracture. Other stated reasons included detection of unsuspected facial fracture, diagnosis of compound nasal fracture and foreign body detection. CONCLUSION: Doctors need to be better informed that nasal radiography has no useful value. A clear clinical guideline should be set up nationwide to protect patients from unnecessary exposure to radiation. This will also save the time of the doctors, radiographers and patients. It will prevent inappropriate referrals. Money and other resources will therefore be better utilized.