bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical features of malignant transformation in benign laryngeal papillomata
Authors: Singh Bharath , Ramsaroop Reena
Published: November 2007

Laryngeal papillomata can undergo spontaneous malignant transformation without being detected histologically and, in some instances, the disease may become so advanced, before the diagnosis is confirmed, that it is beyond any form of curative treatment.

Because of this limitation imposed by histopathological investigation, a study was undertaken in 17 adults with benign laryngeal papillomata, (three of whom underwent malignant transformation) to determine whether malignant transformation can be predicted from the clinical behaviour of the tumour. The following features were analysed: age, sex, patient's symptoms, frequency of excision of the papillomata, site of lesion, presence or absence of laryngeal oedema, the need for tracheostomy, vocal fold mobility and presence or absence of cervical lymph nodes.

It was found that decreased vocal fold mobility, the presence of cervical lymph nodes, exuberant and rapid growth requiring very frequent excisions, oedema of the larynx with airway obstruction requiring a tracheostomy are clinical features suggestive of malignant transformation.
Late congenital syphilis of the larynx and pharynx presenting at endotracheal intubation
Authors: Lacy P. D. , Alderson D. J. , Parker A. J.
Published: November 2007

The case of a 73-year-old lady with late congenital pharyngo-laryngeal syphilis is presented. Its finding was at a potentially difficult intubation during the induction of general anaesthesia. She was asymptomatic; there was no evidence of active disease on either clinical examination or serology and no treatment was required. However, it is important to differentiate this condition from others which may require treatment.
Computed tomography of the temporal bone in tuberculous otitis media
Authors: Hoshino Tomoyuki , Miyashita Hiroshi , Asai Yoshihiro
Published: November 2007

Nine cases of tuberculous otitis media were treated by us over the past 10 years. Six patients presenting with large tympanic membrane perforations were treated for suppurative otitis media at various ENT clinics. The remaining three patients presented without perforation. Intractable otorrhoea, aggravation of hearing loss, dizziness, and in one case facial palsy, resulted in eventual referral to us. Histological examination revealed a tuberculous granulation, confirming the diagnosis in most cases. CT in four cases with profound sensorineural hearing loss showed bone destruction of the otic capsule around the oval window and the promontory. Changes noted included a notch in one case, disappearance of the bony contour around the hook in two cases, and a distinct fistula in the final case. A cochlear fistula seemed to be characteristic of advanced tuberculous otitis media.
Adenocarcinoma of the submandibular gland with positive serum and tissue immunohistochemical staining for both CEA and CA 125: report of a case
Authors: Kasuga Yoshio , Nakai Atsushi , Matsunaga Yuji , Toi Makoto , Goto Hirohisa , Nimura Yoshinori , Kurasawa Ryuhei , Moriyama Shin-ichi
Published: November 2007

A rare case of adenocarcinoma of the submandibular gland with positive serum measurements and tissue immunohistochemical stainings for both CEA and CA 125 is presented.
Objective assessment of endoscopic sinus surgery in the management of chronic rhinosinusitis: an update
Authors: Lund Valerie J. , Scadding Glenis K.
Published: November 2007

Whilst clinical success of endoscopic surgery for chronic rhinosinusitis has necessarily depended primarily upon subjective evaluation, a range of objective techniques are now available which may facilitate our interpretation of results. A group of 200 patients underwent assessment of symptoms by sequential visual analogue scoring, olfaction by qualitative and quantitative testing, nasal airflow by forced inspiratory peak flow, anterior rhinomanometry, nasomucociliary function by ciliary beat frequency and nasal topography by acoustic rhinometry performed pre- and post-operatively. Significant improvement was demonstrated in all symptoms examined, olfactory tests and ciliary beat frequency whilst acoustic rhinometry provided an attempt to quantify the surgical cavities. These results offer an interesting perspective on the pathology of rhinosinusitis and the rationale for surgery within the ostiomeatal complex.
An unusual complication of glomus jugulare tumour resection: a case report and literature review
Authors: Vowles R. , Mendoza N. , Cheesman A. , Symon L.
Published: November 2007

A 47-year-old man presented, in 1990, with a short history of left-sided cerebellar ataxia. In 1986 he had undergone excision of a glomus jugulare tumour. A magnetic resonance (MRI) scan demonstrated cerebellar herniation through a defect in his skull base. Surgical repair was undertaken with resolution of his symptoms.
Mesenchymal chondrosarcoma of the maxilla
Authors: Bottrill I. D. , Wood S. , Barrett-Lee P. , Howard D. J.
Published: November 2007

We report, to our knowledge, the 10th recorded case of mesenchymal chondrosarcoma (MC) occurring in the maxilla. Our case is the youngest person reported with a tumour in this location. The prognosis for cure is poor with a high incidence of local recurrence as well as metastases. Treatment is based on radical surgery. Radiotherapy and chemotherapy have a adjuvant role but additional experience with this tumour is required to define the most efficacious treatment.
Scleroma of the eustachian tube: salpingoscleroma
Authors: Soni N. K. , Hemani D. D.
Published: November 2007

Rhinoscleroma is a chronic specific granulomatous inflammatory condition that has an affinity with the mucosa of the upper respiratory tract. Involvement of the eustachian tube is uncommon. In the present study nasopharyngoscopy was performed in 20 patients with rhinoscleroma to find out the type, nature and site of the lesion at the orifices of the eustachian tube. A lesion involving the eustachian tube was found in six cases (30 per cent). Lesions occurred in the form of atrophic changes with crusting, granuloma and fibrotic thick areas. Involvement of the eustachian tube was found to be associated with intranasal scleroma and was more common at the granulomatous stage. Eustachian tube scleroma had a possible association with subsequent changes in the tympanogram pattern. Nasopharyngoscopy was found to be of therapeutic value in removing the crust, discharge and granulations at the eustachian tube orifices.
Vestibular schwannoma in an only hearing ear
Authors: Talbot Andrew , Tonkin John , Fagan Paul , Platt-Hepworth Sarah
Published: November 2007

A vestibular schwannoma in an only hearing ear is a difficult management problem. A case is presented of a patient who had a Nucleus-22 channel device implanted into a nonfuctioning ear and auditory rehabilitation prior to resection of a large vestibular schwannoma in the contralateral ear.
Late sino-nasal metastasis from follicular thyroid carcinoma
Authors: Cumberworth V. L. , Ohri A. , Morrissey G. , Stirling R.
Published: November 2007

We report a rare case of metastasis of a follicular carcinoma of the thyroid to the sino-nasal cavity 12 years after diagnosis and treatment of the primary malignancy and review the literature of previously reported cases.
Epistaxis, von Willebrand's type bleeding diathesis and Wilms' tumour: a case report
Authors: Lim P. V. H. , Mason J. D. T. , Walker D. , Gibbin K. P.
Published: November 2007

We report a case of persistent epistaxis in a seven-month-old child with Wilms' tumour who had an associated von Willebrand's type bleeding diathesis. Correction of the bleeding diathesis to control the epistaxis required treatment of the tumour with chemotherapy.
Fibromatosis of the parapharyngeal space
Authors: Porter M. J. , Suen W. M. , John D. G. , Van Hasselt C. A.
Published: November 2007

Tumours of the parapharyngeal space are not common. The majority arise from the deep lobe of the parotid gland or neurovascular structures. We describe a case of fibromatosis, which has not previously been reported at this site.
A leaking aortic aneurysm presenting as a recurrent neck swelling
Authors: El-Naggar Mohamed , Flood Liam
Published: November 2007

We present a case of an 82-year-old lady with recurrent swelling and a history of intermittent stridor who subsequetly developed a contusion over her lower neck and upper chest. The patient collapsed on her way to have to have a CT scan and died 24 hours later of a leaking aortic aneurysen. At initial presentation the complete resolution of poorly localizing symptoms and signs almost allowed her discharge from hospital.
Experience with the xylocaine test as a prognostic aid for surgery in Sluder's neuralgia
Authors: Kamal Syed Akhtar
Published: November 2007

Facial pain is a common symptom. Patients with this symptom without any overt disease of nose and paranasal sinuses are often diagnosed as having chronic rhinosinusitis. Thirty-six cases were seen and treated surgically by middle turbinectomy or septal surgery in this series. The xylocaine (10 per cent) test seemed to be a good prognostic aid for the surgical procedures. Medical treatment did not seem to relieve the symptoms. Larger series with control trials are recommended in order to establish this practice.
The influence of bismuth subgallate and adrenaline paste upon operating time and operative blood loss in tonsillectomy
Authors: Callanan Vincent , Curran Aongus J. , Smyth David A. , Gormley Peter K.
Published: November 2007

The aims of this study were to demonstrate the effect of bismuth subgallate and adrenaline paste application to the tonsillar fossae on operating time and peroperative blood loss during tonsillectomy. Ninety-eight patients were included in a prospective randomized trial.

Bismuth subgallate powder is mixed with 10 ml of normal saline and 0.03 ml of 1:1000 adrenaline to make a paste. This paste is used as a topical haemostatic agent during tonsillectomy. Bismuth subgallate activates Factor XII and therefore accelerates the coagulation cascade. Adrenaline causes vasoconstriction and promotes platelet aggregation. The application of bismuth subgallate and adrenaline paste to the tonsillar fossae during tonsillectomy reduces operating time by 23 per cent for Consultant staff (p<0.05) and 32 per cent for Junior staff (p<0.05). Blood loss is reduced by 21 per cent (p>0.05), for the average paediatric tonsillectomy.
Can obstructive sleep apnoea be a complication of uvulopalatopharyngoplasty?
Authors: Finkelstein Yehuda , Talmi Yoav P. , Raveh Eyal , Orlin Jerome , Rudnicki Carlos , Fried Menachem , Zahavi Yzhar
Published: November 2007

Polysomnography is currently used for diagnosis, evaluation and selection of therapy in patients with obstructive sleep apnoea (OSA), but clinically successful uvulopalatopharyngoplasty (UPPP) is not necessarily reflected by post-operative improvement of polysomnographic recordings. Post-operative polysomnography may suggest deterioration of pre-existing OSA or, in snorers,de-novoprecipitation of OSA. Thus, if polysomnography is a reliable indicator of OSA, then OSA may be a post-operative risk of UPPP. The aims of our study were: (i) to assess the possible deleterious effect of UPPP on sleep patterns; (ii) to further define the role of cardioisotope scanning in the evaluation of OSA; (iii) to assess the reliability of polysomnography given the clinical and cardioisotope scan findings. Symptoms, polysomnography and radionuclide ventriculography were prospectively compared pre- and post-operatively in 41 patients undergoing UPPP. In 12 patients (29 per cent), there were disparate results between pre- or post-operative polysomnography and the clinical and/or radionuclide ventriculography, as follows: In four of 16 patients with abnormal pre-operative ventricular performance, there was pre-operative symptomatology of severe OSA and a bedmate's reports of apnoeic episodes. This was in contrast to normal or near normal sleep apnoea recordings. In eight patients, post-operative improvement of symptoms was reported, despite deterioration of post-operative polysomnographic recordings. In these patients the post-operative improvement of symptoms was also reflected by improved ventricular performance. Worsening of ventricular performance was not demonstrated in any patient. In conclusion, UPPP does not induce OSA. Polysomnography may underestimate or even misdiagnose cases of OSA. The diagnostic importance of patient symptomatology should be stressed particularly in those patients with only mildly abnormal or even completely normal sleep studies. A combination of polysomnographic and cardiovascular evaluation in patients with symptomatology consistent with OSA is recommended.
Cranial fasciitis: presentation as a post-auricular mass
Authors: Iqbal Khalid , Saqulain Ghulam , Udaipurwala I. H. , Ashraf Junaid , Aijaz Farrukh , Jalisi M.
Published: November 2007

Cranial fasciitis is a rare variant of nodular fasciitis. It is a benign condition with features resembling sarcoma, seen principally in young males. It involves the skull bones and grows at a rapid pace. Accurate diagnosis and surgical excision is the key to management. Prognosis is good with recurrence rare. By 1992, 17 cases had been reported in the literature. The present case is the first reported in pakinstan.It presented as post auricular mass.
The Birmingham mummy: the first torticollis in history
Authors: Pahor Ahmes L. , Cole John
Published: November 2007

The Birmingham Mummy is of a warrior, 25–35 years of age, from the Graeco-Roman period. He was struck from the front by an arrow, which penetrated the soft tissues of the neck to some depth and lodged in the right infratemporal fossa. It is suggested that the wound became infected and that muscle spasm induced the torticollis which was not fully corrected on mummification.
Prevalence of eardrum pathology in a cohort born in 1955
Authors: Stangerup S.-E. , Schwer S. , Pedersen K. , Brofeldt S. , Niebuhr M.
Published: November 2007

The aim of this study was to compare the prevalence of the different types of eardrum pathology in a cohort of adults not previously treated by grommet insertion with corresponding findings obtained in a cohort previously treated with grommet insertion.

A cohort born in 1955 were invited to a screening examination including otomicroscopy. In the untreated cohort, retraction of Shrapnell's membrane was found in four per cent of the ears compared to 20 per cent in the cohort treated with grommets. Tensa pathology, including atrophy and myringosclerosis, was found in six per cent of the ears in the untreated cohort and in 17 per cent in the treated cohort. Normal eardrums were found in 91 per cent of the ears. Despite the increased awareness of secretory otitis, as well as the increased rate of surgical treatment, the prevalence of eardrum pathology seems to be increasing. The reasons for this are discussed.
Post intubation laryngeal sequelae in an intensive care unit
Authors: Thomas Ratna , Vijaya Kumar E. , Kameswaran Mohan , Shamim Ahmed , Ghamdii Saeed Al , Mummigatty. Anil P. , Okafor B. C.
Published: November 2007

The incidence, severity and pattern of post-intubation laryngotracheal sequelae in a 12 bed multidisciplinary intensive care unit (ICU) were assessed in this prospective study. One-hundred and fifty consecutive patients requiring intubation for more than 24 hours for various indications were studied. Evaluation of the larynx and trachea was done using a fibreoptic bronchoscope introduced through the endotracheal tube prior to elective extubation. Rigid bronchoscopy and direct laryngoscopy were performed in very small children and adults requiring tracheostomy. One-hundred and thirty-one (87.6 per cent) patients had visible laryngeal pathology in the immediate post-extubation period. Thirteen (8.6 per cent) had long term sequelae. A high incidence of long term sequelae was noted in patients with seizures (25 per cent) followed by patients with head injury (19 per cent). Steroid therapy failed to offer any significant protection but resulted in doubling of pulmonary sepsis. A grading system was adopted to classify acute laryngotracheal injury and a significant correlation was found between the presence of slough in the immediate post-extubation period and subsequent development of long term sequelae. There was also a significant correlation between a deeper insertion of the endotracheal tube and development subsequently of long term sequelae. The significance of these findings is discussed.
Palatal pleomorphic adenoma in a child
Authors: Noghreyan A. , Gatot A. , Maor E. , Fliss D. M.
Published: November 2007

Benign salivary gland tumours in childhood are rare. We present a case of a pleomorphic adenoma arising in a minor salivary gland within the hard palate, review the literature and discuss the diagnostic and therapeutic features of the condition.
The molecular genetics of vestibular schwannoma
Authors: Moffat David A. , Irving Richard M.
Published: November 2007

Vestibular schwannoma occurs both as a sporadic tumour and in the dominantly inherited familial cancer syndrome neurofibromatosis type 2 (NF2). The gene for NF2 has recently beenisolated on chromosome 22, and the demonstration of inactivating germline mutations in NF2 patients and NF2 associated tumours suggests that it acts as a tumour suppressor. The results of recent research in Cambridge suggest that somatic mutations of the NF2 tumour suppressor gene are a critical step in the pathogenesis of both familial and indeed non-familial unilateral sporadic vestibular schwannoma and that the mechanism of tumourigenesis complies with the ‘two-hit’ model. This paper represents a brief review of the current status of molecular biology in relation to vestibular schwannoma in particular and is discussed in relation to the molecular pathology of skull base tumours as a whole.
Cochlear implant extrusion in a young child — a preventative procedure
Authors: Harrison H. C. , Gibson W. P. R. , Thompson P. G.
Published: November 2007

A Cochlear Mini System 22 Channel cochlear implant extruded through the skin of a young girl. The implant was saved by use of a transposition flap. Extrusion appeared to be due to pressure necrosis from the implant on the overlying tissues. It is believed that this problem can be prevented by angulation of the implant before insertion so that it conforms to the curvature of the skull, so avoiding pressure on the tissues. The method of angulation is described.
Nasendoscopy guided removal of fish bones from the base of tongue and the vallecula
Authors: Koay C. B. , Herdman R. C. D.
Published: November 2007

Impaction of a fish bone at the base of tongue or the vallecula is a very common problem. Removal of the bone from these sites without a general anaesthesia can be challenging to surgeons and patients alike. Various manoeuvres to facilitate this procedure have been described, some are very successful but may require specialized instruments, while others may cause excessive discomfort to the patients and even inadvertent dislodgement of the bone. We describe a method using a flexible fibreoptic nasendoscope to provide a visual guide in order to facilitate peroral removal of the bone with a pair of forceps. This method is well tolerated by patients and avoids the need for a general anaesthesia in many cases.
Arrangement and number of intralaryngeal ganglia and ganglionic neurons: comparative study of five species of mammals
Authors: Shimazaki Takatsugu , Yoshida Yoshikazu , Hirano Minoru
Published: November 2007

The arrangement and number of intralaryngeal ganglia and their neurons in five mammals (dog, rat, guinea pig, rabbit and cat) were examined morphologically. Intralaryngeal ganglions were situated mainly in branches of the internal branch of superior laryngeal nerve (Int-SLN), dorsal and/or dorsolateral to the posterior cricoarytenoid muscle, and around the inferior laryngeal nerve in dogs, rats, guinea pigs and cats, but they were identified at the branching out point ofthe Int-SLN exclusively in rabbits. The ganglion of each animal was spindle-shaped, with a surrounding fibrous capsule, and it contained many ganglionic neurons, vessels and connective tissue cells. The ganglionic neuron was oval-shaped and had a round nucleus: the diameter was smaller (20–25 μm) in the rat than in the other mammals (25–30 μm). More than 80 percent of ganglionic neurons occurred in the supraglottis of all the animals except the rat. In the rat, this value was approximately 40 percent.
Lemierre syndrome – a forgotten complication of acute tonsillitis
Authors: Koay C. B. , Heyworth T. , Burden P.
Published: November 2007

Lemierre syndrome, also known as postanginal sepsis, is an illness characterized by the development of a fusobacterial septicaemia with multiple metastatic foci following an attack of acute tonsillitis. It typically affects previously healthy adolescents and young adults who, following an attack of sore throat, become acutely ill with hyperpyrexia, rigors and multiple metastatic abscesses. The clinical picture tends to vary widely because of the possible involvement of a number of body systems and organs in the disease process. This serious complication of oropharyngeal sepsis had a mortality rate in excess of 90 percent in the pre-antibiotic era. Although now rarely seen and often forgotten, it remains a potentially life-threatening condition. We present four cases of post-tonsillitis fusobacterial septicaemia to illustrate the variability of the clinical presentation and stormy clinical course frequently associated with this rare syndrome.
Ectopic salivary gland in the posterior triangle of the neck
Authors: Marshall J. N. , Soo G. , Coakley F. V.
Published: November 2007

Ectopic cervical salivary tissue may present as a discharging sinus if a duct system and cutaneous orifice are present. Where described in previous reports these openings have been located along the anterior border of sternomastoid or in the anterior triangle, making this a differential diagnosis of a branchial sinus. We report on a patient who presented with an ectopic salivary gland in the posterior triangle of the neck.
Seeding of a parotid pleomorphic adenoma
Authors: Commins D. J. , Roberts D. , Fisher C. , Breach N. M.
Published: November 2007

Recurrent pleomorphic adenoma of the parotid usually occurs in the distribution of the primary procedure. There are numerous reports of widespread local recurrence and a few reported cases of distant metastases. Extensive seeding throughout the entire ipsilateral neck is rare. Treatment involves a combination of radical surgery and radiotherapy. The potential for malignant transformation demands close follow-up of younger patients particularly.
Osteoplastic changes in attic cholesteatoma
Authors: Hoshino Tomoyuki , Ishizaki Hisayoshi , Iwasaki Satoshi , Sakai Takeo
Published: November 2007

Eighty-nine cases of attic type cholesteatoma were operated on during a three and a half-year period. Of these, eight cases were characterized by bony tissue proliferation at the aditus ad antrum or mastoid antrum. Sex, age, and hearing levels were not significant in these cases. Bony fixation of the incus and the malleus was seen in six cases. Bony tissue blocked further expansion of attic cholesteatoma at the aditus in four cases, narrowed the epithelial tract to the antrum in two cases, and completely separated the cholesteatoma into two cholesteatomas in two cases. Infectious stimuli, at an early stage of the disease, might stimulate such osteoplastic activity at the aditus. Axial CT scans give useful information regarding structure before surgery.
Non-Hodgkin's lymphoma of the external auditory canal in an HIV-positive patient
Authors: kieserman Stefan P. , Finn Douglas G.
Published: November 2007

This is a case report of non-Hodgkin's lymphoma of the external auditory canal, and infratemporal fossa, which presented with multiple cranial nerve palsies. The diagnosis was achieved via biopsy of tissue from the external auditory canal, and treatment with radiation therapy led to improvement of the symptoms. The management of AIDS-related lymphoma of the skull base with cranial neuropathies is reviewed.
Lymphoma and Hashimoto's thyroiditis
Authors: Fenton J. E. , Stack J. , Kelly P. , O'Dwyer T. P.
Published: November 2007

Development of malignant lymphoma in Hashimoto's thyroiditis is well documented. A case of tracheal invasion by a lymphoma which accompanied Hashimoto's disease is described. The clinical and diagnostic difficulties which were encountered are presented. The magnetic resonance imaging (MRI) findings which have not been reported previously are outlined.
Laryngeal squamous cell carcinoma with sebaceous differentiation
Authors: Panayiotides J. G. , Arapantoni-Dadioti P. , Banis C. G.
Published: November 2007

A case of supraglottic laryngeal squamous cell carcinoma with sebaceous differentiation in a 68-year-old Caucasian male is described. A right cervical lymph node metastasis, excised during the laryngectomy operation, consisted exclusively of squamous cells. Despite intensive post-operative chemotherapy. the patient developed metastatic foci in the left cervical area and left pulmonary hilus and died seven months later. This is the second case report of a laryngeal squamous cell carcinoma with sebaceous differentiation in the literature.
A new incision for placement of cochlear implants
Authors: Gibson W. P. R , Harrison H. C. , Prowse C.
Published: November 2007

A straight, vertical post-aural incision for the ‘Cochlear’ multichannel cochlear implants has been evaluated in 52 patients (20 adults and 32 children). Nineteen of the children were under three years of age and five of these were under two years of age.

The 7cm long incision is placed approximately 3 mm behind the post-auricular crease and runs from the tip of the mastoid to a point 3 cm above the superior attachment of the pinna. The incision heals within several days.

Because the incision is straight interruption of the blood supply to the flaps raised is the least possible. This also minimizes the possiblity of scalp necrosis and impaltn exrusion. The likelihood of infection is reduced by the small size of the incision, minimal soft tissue dissection and small amount of dead space. Rapid healing has occurred in all cases despite infection in one.
Recurrent cervical abscess due to piriform sinus fistula
Authors: Yamashita Hiroshi , Noguchi Takaaki , Takahashi Masahiro
Published: November 2007

A case of recurrent abscess on the left anterior neck due to a left piriform sinus fistula is presented. It is known that a piriform sinus fistula may cause acute suppurative thyroiditis, and also that it induces the recurrent anterior cervical abscess described in this case. Here, we suggest that barium swallow is an important aid to diagnosis cases of recurrent cervical abscess.
Tympanosclerosis and mini grommets: the relevance of grommet design
Authors: Dingle Ann F. , Flood Liam M. , Kumar B. Udhi , Newcombe Robert C. , Stat C.
Published: November 2007

Fifty children with otitis media with effusion undergoing grommet insertion had into one ear a Minititanium grommet inserted and into the other ear a Mini-teflon grommet. Post-operative follow-up until after extrusion of the grommets demonstrated only a small difference between the extrusion times of the two grommets (a significant difference of 41 days) and no difference in the degree of tympanosclerosis seen with each grommet. We propose that the mass of a grommet appears to play less of a role than has previously been suggested in the pathogenesis of tympanosclerosis following grommet insertion and that duration of intubation may be the most significant factor.
The use of a CT scan to predict the feasibility of decompression of the first segment of the facial nerve via the transattical approach
Authors: Pellicer M. , Quesada P.
Published: November 2007

Total surgical decompression of the facial nerve can be offered to patients severely affected by Bell's palsy whether via the transattical or middle fossa approach. We prefer, when feasible, the transattical approach because it does not violate the cranial vault. The purpose of this study was to find the anatomical parameter of the temporal bone, measured by means of computed tomography (CT scan) and to decide which of these approaches should be offered. Sixty temporal bones were studied by CT scan, and then dissected in order to perform total facial nerve decompression via the transattical approach. Correlation between the two studies was established. Results suggest that measurement by CT scan of the attical area in the axial plane (AAA) may determine those patients for whom the transattical approach to facial nerve decompression should be undertaken.
Sinogenic intracranial complications
Authors: Singh Bharath , Dellen James Van , Ramjettan Shanil , Maharaj Tejprakash J.
Published: November 2007

Two hundred and nineteen patients, with intracranial complications of sinusitis, are presented. Sinusitis is still a life-threatening condition and if neglected, or mismanaged, can lead to intracranial complications that result in a high mortality and morbidity.

Twenty-two patients had meningitis, 127 subdural empyema, 38 brain abscess, 15 combined brain abscess and subdural empyema and 17 extradural empyema. The diagnosis of intracranial abscess and sinusitis was made with the aid of a CT scan, and that of meningitis on cerebrospinal fluid microscopy, chemistry and culture. The most frequent presenting signs were fever (68 per cent) and headache (54 per cent). The most common localizing neurological sign was hemiparesis (35.5 per cent). Orbital inflammation was present in 41.5 per cent of patients.

Treatment entailed immediate, appropriate, intravenous antibiotic therapy and prompt surgery, performed within 12 hours of admission. In patients with meningitis, the surgery entailed surgery of the sinus disease only. In patients with subdural empyema, brain abscess and extradural empyema, evacuation of the primary source of infection by the radical frontoethmoidectomy approach, immediately after drainage of the intracranial collection of pus, was carried out.

There were 35 deaths (16 per cent). The highest mortality rate was recorded in patients with meningitis (45 per cent) followed by brain abscess (19 per cent) and subdural empyema (11 per cent). Despite advances in medicine, i.e. antibiotics and CT scan for early and accurate diagnosis, the mortality from sinogenic intracranial complications has remained significant. This can only be eliminated through education. This paper emphasizes to younger generations of otolaryngologists and primary care physicians that sinusitis is a serious disease and there is no place for delay or complacency when managing such patients.
Endoscopic management of lesions of the sella turcica
Authors: Sethi Dharambir S. , Pillay Prem K.
Published: November 2007

The excellent visualization and minimally invasive surgical technique of endoscopic sinus surgery was applied to the management of 40 patients with sellar lesions. Endoscopic management of sellar lesions offers, not only the advantage of improved visualization, but also magnification, and a panoramic perspective of the important relationships of the sella turcica. In the past year, we have managed 40 subjects with sellar lesions, endoscopically: 38 patients had pituitary adenomas and two a craniopharyngioma.

At our hospital, the endoscope has replaced the operating microscope for surgery for pituitary adenomas and other sellar lesions. The endoscopic approach to the sphenoid sinus and the sella is performed by an ENT surgeon and the ablative surgery performed by a neurosurgeon.

Our experiences, using the endoscope to perform surgery on sellar and parasellar lesions, are reported and the advantages, over the operating microscope, which is traditionally used are discussed. The technique for endoscopic management of sellar lesions is described.
Migrating foreign body: a new cause of trismus
Authors: Lacy P. D. , Timon C. I. , Ryan C. D. , Donnelly M. P. , McShane D. P.
Published: November 2007

A unique case of delayed trismus secondary to an infratemporal foreign body is presented. The pathophysiology and treatment options are discussed.
Squamous cell carcinoma in thyroglossal duct cyst
Authors: Deshpande Archana , Bobhate S. K.
Published: November 2007

Although a thyroglossal duct cyst (TDC) is a common cyst occurring in the neck, carcinomas arising in the TDC are a rare event. To date, approximately 100 cases have been reported, the majority of them being papillary carcinomas. Squamous cell carcinomas (SCC) are very rare, and Only nine cases have been reported so far in the literature.

We present a 55-year-old female patient with a SCC in a TDC to highlight the clinical and pathological features of this condition.
Facial palsy due to tuberculosis: the value of CT
Authors: Hadfield P. J. , Shah B. K. , Glover G. W.
Published: November 2007

This case report demonstrates the value of CT in the investigation of facial palsy due to tuberculous mastoiditis. This is the best imaging modality available for identifying features suggestive of tuberculosis, the disease extent, presence of complications and demonstration of anatomy prior to surgery.
Can ear irrigation cause rupture of the normal tympanic membrane?: an experimental study in man
Authors: SØRensen Vibeke Z. , Bonding Per
Published: November 2007

Rupture of the tympanic membrane (TM) during ear irrigation is a rare but unhappy event. In this study the maximum overpressures obtained in the deep part of the external auditory meatus (EAM) during ear irrigation were measured postmortem in 20 cadavers. The highest pressures were obtained in normal- or wide-dimension EAMs when a metal syringe was used. With this device the median maximum overpressure was 240 mmHg (range 200–300 mmHg). Experiments with simulation of an obturating wax plug did not increase the maximum overpressure. Compared with the lowest overpressures which can rupture TMs the pressures measured in this study were insufficient to rupture normal TMs but sufficient to rupture atrophic TMs with the lowest tensile strength. This finding may have medicolegal implications.
Analysis of recurrence after surgical treatment of advanced laryngeal carcinoma
Authors: Wing Yuen Anthony Po , Ming Ho Chiu , Ignace Wei William , Lam Lai Kun
Published: November 2007

The pattern of recurrences after surgical treatment of 276 patients with stage T3 and T4 laryngeal carcinoma was reviewed. Nodal recurrence was the commonest site and occurred mainly in patients with supraglottic and transglottic carcinoma. Distant metastasis was the second commonest site of recurrence, and the most distant metastases developed without locoregional recurrence. Local recurrence alone was uncommon in patients treated with primary surgery.
Treatment of head and neck cancer with photodynamic therapy: results after one year
Authors: Dtlkes M. G. , DeJode M. L. , Gardiner Q. , Kenyon G. S. , McKelvie P.
Published: November 2007

Photodynamic therapy (PDT) is a new and promising treatment modality for the treatment of malignant disease. This paper reports the preliminary experience of our group in the use of this therapy for the treatment of tumours arising in the head and neck. The majority of treatments in these cases have used a second generation systemic photosensitizer, meta-tetrahydroxyphenylchlorin (m-THPC). Two other cases were treated with either Photofrin 2 (a first generation systemic sensitizer) or with the topical photosensitizer, delta-aminolaevulinic acid (δ-ALA).

The initial results have been encouraging with good clinical responses evident in patients presenting with a variety of differing tumour types. We feel there is now sufficient evidence of the efficacy of this treatment to warrant a multicentre prospective study into the treatment of early head and neck cancer with PDT.
Two cases of otolaryngeal tuberculosis in a Danish married couple
Authors: Holm Ellen , Seibæk Marie , Iversen Palle Birger
Published: November 2007

Two cases of otolaryngeal tuberculosis which appeared in a married couple are described.
An unusual case of deafness with speech impairment: lesson in diagnosis and management
Authors: Davies Rosalyn , Prashert Deepak , O'Sullivant Anne
Published: November 2007

Hearing impairment can be the cause of significant disability and handicap. This medico-legal case demonstrates the need for accurate assessment of both the severity and type of hearing loss if the best clinical management is to be provided. In particular, the case identifies the critical role of additional, objective auditory testing when pure tone audiometry, which depends on the subjective response of the individual, is inconsistent or indicates severe hearing impairment.
Long-term ventilation of the middle ear using a tympanotomy technique
Authors: Martin-Hirsch D. P. , Woodhead C. J. , Vize C. E.
Published: November 2007

The technique of long-term middle ear ventilation using a tympanotomy technique is presented. This has proved successful in the management of persistent middle ear effusion despite numerous previous short- and intermediate-term tympanic membrane ventilation tubes. The technique is particularly appropriate in the presence of severe tympanoscierosis as a result of previous tympanostomy tubes, posterior tympanic membrane collapse and adhesion, and atelectasis.
Sleep nasendoscopy: what benefit to the management of snorers?
Authors: Camilleri Andrew E. , Ramamurthy Laxmi , Jones Philip H.
Published: November 2007

It has been proposed that sleep nasendoscopy (SN) will improve the success rate of the uvulopalatopharyngoplasty operation by identifying those patients with palatal snoring. The aim of this study was to test the efficacy of SN in the management of snorers who do not have obstructive sleep apnoea. This study compared a group of 26 snorers managed without SN (group A) to a group of 27 snorers managed with SN (group B). The post-operative results of group A were 61 per cent cured, 27 per cent better and 8 per cent unchanged. Group B results were 76 per cent cured, 19 per cent better and 5 per cent unchanged. However, if patients with only palatal snoring had surgery, the results for group B would have been 94 per cent cured, 6 per cent better and 0 per cent unchanged (95 per cent C.I. of difference +0.14,+0.54, p = 0.017). The results confirm the predictive power of SN in identifying success following uvulopalatopharyngoplasty. A simple grading system is suggested to aid in treatment planning. Patients are divided into three categories on SN: palatal snorers, mixed snorers and non-palatal (tongue base) snorers. It is proposed that uvulopalatopharyngoplasty may cure palatal snorers but mixed snorers will need additional therapies to eliminate their snoring although uvulopalatopharyngoplasty may improve the symptoms.
Pharyngeal trauma in children – accidental and otherwise
Authors: Tostevin P. M. J. , Hollis L. J. , Bailey C. M.
Published: November 2007

Pharyngeal perforation is an uncommon injury in children. Most reported cases to date have been secondary to instrumentation or penetrating wounds. Laceration to the pharyngeal wall may introduce air, secretions and bacteria into the parapharyngeal space and mediastinum and consequently has potentially life-threatening sequelae. The management of these injuries is controversial. We present a series of four children who suffered pharyngeal trauma, accidentally and otherwise, and discuss their management.

We recommend a high index of suspicion of pharyngeal injury in all cases of oropharyngeal trauma and overnight admission to hospital for observation until an accurate diagnosis has been established. Non- accidental injury of the child must be seriously considered in all cases.
Unilateral hearing loss due to a rhabdomyoma in a six-year-old child
Authors: van Leeuwen J. P. P. M. , Pruszczynski M. , Marres H. A. M. , Grotenhuis J. A. , Cremers C. W. R. J.
Published: November 2007

A case report of a six-year-old child is presented, who had had a unilateral sensorineural hearing loss for several years. Because of impairment in the ABR as well as in the caloric testing a MRI and CT scan were performed. A 17 mm tumour in the cerebellopontine angle (CPA) was detected, which after suboccipital surgery proved to be a rhabdomyoma. This tumour has not been described before in the CPA. Unilateral sensorineural hearing loss should, at all ages, be an indication for further (radiodiagnostic) investigations.
Pharyngo-oesophageal fistula following iatrogenic perforation of a pharyngeal pouch
Authors: Martin-Hirsch D. P. , Lannigan F. J.
Published: November 2007

A unique, previously undescribed case of iatrogenic perforation of a pharyngeal pouch which resulted in pharyngo-oesophageal fistulation is described. The correct management of such complications is discussed.
The clunking neck
Authors: Makura Z. G. G. , Nigam A.
Published: November 2007

A patient complaining of pain and noise on turning her neck was diagnosed as having a large greater cornua of the hyoid bone. Excision of the greater cornua relieved the symptoms.
Multiple oncocytic cysts of the larynx
Authors: Dhingra J. K. , Aqel N. M. , McEwen J. , Bleach N. R.
Published: November 2007

Oncocytic metaplasia in laryngeal epithelium is uncommon. Oncocytes have been described in the lining of laryngeal cysts and such cysts have been reported in the literature under a variety of names. There is an ongoing debate about the exact nature of ‘oncocytic cysts’, which tend to be solitary. An unusual case of multiple oncocytic cysts of the larynx is described. The pathology and treament are discussed.
Laryngotracheal separation under local anaesthesia for intractable salivary aspiration: cricoidectomy with fibrin glue support
Authors: Sone Michihiko , Nakashima Tsutomu , Yanagita Noriyuki
Published: November 2007

Chronic salivary aspiration can cause life-threatening pneumonia in a patient whose laryngeal function is completely lost. We report a patient who had laryngotracheal separation with cricoidectomy under local anaesthesia. The simplicity and reliability of the procedure were improved by using fibrin glue and the outcome was most satisfactory.
Cellular benign fibrous histiocytoma of the external auditory meatus
Authors: Morrissey G. , Robinson A. C. , Stirling R.
Published: November 2007

A rare case of cellular benign fibrous histiocytoma (BFH) of the external auditory canal is presented with a discussion of its pathology and management.
Septoplasty as a day-case procedure – a two centre study
Authors: Benson-Mitchell R. , Kenyon G. , Gatland D.
Published: November 2007

Day-stay surgery is an integral part of Otolaryngology. Many procedures which have traditionally been thought to require overnight stay can be carried out on a day care basis. We report our experience of treating 163 patients admitted for septal surgery as a day-case procedure. The paper summarizes the experience of two centres. One of these is a London Teaching Hospital, where surgery was performed through a dedicated day-case unit, and the other is a District General Hospital where patients were admitted to a day-case unit but had their surgery on a routine in-patient list.

As the result of this study we conclude that day-stay septoplasty is associated with a low complication rate and is a safe and acceptable procedure provided that strict selection criteria are followed. The cost implications are discussed.
Primary neuroblastoma of the facial nerve presenting as a recurrent facial paralysis
Authors: Fenton C. J. V. , Coddington R. , Ramsay A. D. , Garth R. J. N.
Published: November 2007

A case is described of a primary neuroblastoma of the facial nerve in a 13-year-old boy presenting with a recurrent facial paralysis. This tumour was excised preserving the nerve and followed with post-operative radiotherapy. The pathology of the tumour is described and facial nerve tumours briefly discussed as a cause of facial palsy. There have been no other cases of a primary neuroblastoma of the facial nerve arising at this site reported in the last 20 years.
Osteoma of the internal auditory canal: case report
Authors: Coakley D. J. , Turner J. , Fagan P. A.
Published: November 2007

A 42-year-old man with normal hearing presented with a long history of vertigo and tinnitus. CT scan showed large osteomata of the internal auditory canal. Magnetic resonance imaging (MRI) was normal. The osteomata were removed surgically via the retrosigmoid approach and examined histologically. His symptoms were abolished. As MRI has become the gold standard in the search for small acoustic tumours it is likely that symptomatic bony lesions, rare though they are, will be missed if MRI is the sole imaging modality. A review of the literature is included.
Primary malignant melanoma of the palatine tonsil: a case report
Authors: Xavier R. , Paiva A. , da Silva P. Ribeiro , dos Santos A. Gameiro
Published: November 2007

The authors report a clinical case of a primary malignant melanoma of the right palatine tonsil in a 75-year-old woman.
Schwannoma of the posterior pharyngeal wall: a case report
Authors: Haraguchi Hidetoshi , Ohgaki Tohru , Hentona Hitoshi , Komatsuzaki Atsushi
Published: November 2007

Schwannoma arising in the posterior pharyngeal wall is rare. We report on a 60-year-old man who complained of discomfort in his pharynx, from whom a tumour was excised via an intraoral approach. No recurrence was seen after an 11-year follow-up. The nerve origin of the tumour is most likely to be the peripharyngeal plexus. This is the third such case reported.
Metastatic masseter muscle tumour: a report of a case
Authors: Nakagawa Hajime , Mizukami Yukiko , Kimura Hiroshi , Watanabe Yukio , Kuwayama Naoya
Published: November 2007

Both primary and metastatic malignancies of the masseter muscle are rare. We report a case of metastatic renal cell carcinoma to the masseter muscle. It was incidentally found as a hypervascular mass in carotid angiography for delineating a recurrent metastatic brain tumour. Prior to surgical removal, intravascular embolization via the left facial artery was performed in order to decrease intra-operative bleeding. The tumour was removed with minimum damage to the muscle fibres by the extraoral method, followed by a transient lower lip palsy. Metastatic intramuscular tumours, which are assumed to be due to haematogenous spread, are generally a sign of poor prognosis.
Rectal carcinoma metastatic to the thyroid gland
Authors: Mesko Thomas W. , Friedman Julie , Sendzischew Harry , Nixon Daniel D.
Published: November 2007

Clinically evident metastases to the thyroid gland are rarely found antemortem. A case of a 59-year-old woman with a history of rectal carcinoma, who presented with low back pain and a mass in the right lobe of her thyroid gland, is presented. The tumour of the thyroid was found to be metastatic adenocarcinoma from her previous rectal cancer. Other synchronous metastases were noted in her lumbar spine and kidneys.

The clinical finding of metastases to the thyroid gland is rare, particularly from a colorectal primary. One must consider, however, the possibility of a tumour of the thyroid gland representing a secondary malignancy in any patient with a prior history of cancer.
Temporal bones for dissection. A diminishing asset?
Authors: Jeannon Jean-Pierre
Published: November 2007

In this prospective study, the author studied four local ENT departments to discover how many temporal bones were being harvested. The results show that only eight per cent of routine post mortems have temporal bones removed.
Bilateral hairy polyp of the oropharynx
Authors: Franco V. , Florena A. M. , Lombardo F. , Restivo S.
Published: November 2007

Hairy polyp of the nasopharynx is an unusual but well-recognized entity, generally presenting as a single mass at birth or in the first year of life. We describe the clinico-pathological features of a previously unreported bilateral hairy polyp in an adult and briefly discuss the pathogenesis of this condition.