bluuebunny/crossref_metadata_2025 huggingface dataset:
Tuberculosis of the pyriform fossa – a rare entity
Authors: Goyal Alka , Nagarkar Nitin M. , Uppal K. S. , Mohan Harsh , Dass Arjun
Published: November 2007

Tuberculosis of the pharynx is less common than tuberculosis of the larynx. We present a rare case of tuberculosis of the pyriform fossa which clinically masqueraded as a malignancy. Our patient showed a prompt improvement in symptoms after commencing antitubercular treatment.
A precricoid swelling in a patient treated with Teflon injection in the vocal fold after idiopathic left vocal fold palsy
Authors: Jol J. A. D. , Seedat R. Y. , Skinner D. W.
Published: November 2007

Vocal fold palsy is a cause of dysphonia. Due to incomplete glottic closure during phonation, patients with a unilateral vocal fold palsy present with a weak and breathy voice and recurrent aspiration. To lessen the clinical manifestations of unilateral vocal fold palsy, polytetrafluoroethylene (Teflon) paste is one agent which has been injected into the paraglottic region, thus causing the vocal fold to move more medially. One of the complications associated with Teflon paste injection is migration of the paste into the surrounding tissues. We present a patient with idiopathic left vocal fold palsy who underwent Teflon injection to the vocal fold and subsequently developed a precricoid nodule, mimicking a cartilaginous swelling.
Well-differentiated liposarcoma of the hypopharynx
Authors: Fahmy Fahmy Fayez , Osborne Jonathan , Khalil Hisham Saleh , Rodgers Brian
Published: November 2007

We present a case of well-differentiated liposarcoma of the hypopharynx in a 51-year-old male, with a review of the literature of this very rare condition.
Primary presentation of spontaneous jugular vein thrombosis to the otolaryngologist - in three different pathologies
Authors: Kale U. S. , Wight R. G.
Published: November 2007

An otolaryngologist is conversant with the potential of middle-ear disease leading to lateral sinus thrombosis and subsequent jugular vein thrombosis, although this is becoming an increasingly rare event. Spontaneous jugular vein thrombosis from non-otological causes, however, is not well described in the otolaryngology literature. We present three cases of jugular vein thrombosis who presented primarily to the Otolaryngology department each attributable to a different pathology including discoid lupus erythematosus, antiphospholipid syndrome and metastatic malignancy. Awareness needs to be increased of this condition in the differential diagnosis of acute neck swelling and neck pain.
Neck abscess: an unusual presentation of a thoracic malignancy
Authors: Thorp M. A. , Carrie S.
Published: November 2007

In general, malignancies presenting as abscesses are uncommon. We report on a patient that presented with a neck abscess originating in a cluster of metastatic lymph nodes from a primary squamous cell carcinoma arising in the thoracic oesophagus.
An endoscopic approach to the deviated nasal septum – a preliminary study
Authors: Nayak Dipak Ranjan , Balakrishnan R. , Murthy K. Deepak
Published: November 2007

The authors have used the nasal endoscope for the precise identification of pathological abnormalities of the nasal septum in relation to the lateral nasal wall including the osteo-meatal complex and in its ultraconservative management. The aim of the study was to compare the efficacies of endoscope-aided septoplasty (EAS) over traditional septoplasty (TS) in treating the pathological septum and turbinates, performed in 30 cases each. The subjective assessment was carried out by visual analogue scores and objective assessment by nasal endoscopy. This study demonstrates the superiority and limitations of the endoscopic approach in managing a deviated nasal septum and the turbinates. The endoscope-aided technique was found to be more effective in relieving the contact areas and nasal obstruction (p = ≤0.05). The authors advocate a combined approach – an endoscopic approach for inaccessible posterior deviation and the conservative traditional technique for accessible anterior deviation of the nasal septum.
Fibrous dysplasia and ossifying fibroma of the paranasal sinuses
Authors: Commins D. J. , Tolley N. S. , Milford C. A.
Published: November 2007

Fibro-osseous lesions involving the paranasal sinuses, the mid-face and anterior skull base are uncommon. In addition, there appears to be no clear pathological or clinical classification that embraces the variety of lesions that exhibit such diverse pathological and clinical behaviour, yet may still be referred to as a fibro-osseous lesion. The diagnosis of fibrous dysplasia and ossifying fibroma is made on a combination of clinical, radiological and pathological criteria.

This paper emphasizes the clinical and pathological differences between fibrous dysplasia and ossifying fibroma. The more aggressive clinical behaviour of the latter is highlighted and a more radical surgical approach i s recommended. In contradistinction, fibrous dysplasia can exhibit a more benign behaviour and radical surgery s i not always justified.

A clinicopathological distinction between these two conditions is important from a management perspective despite the fact that they both may be encompassed under the ‘umbrella’ term fibro-osseous lesion.
Non-Hodgkin's lymphoma of the maxillary sinus in a patient with acquired immunodeficiency syndrome
Authors: Forno Antonio Del , Borgo Cosmo Del , Turriziani Adriana , Ottaviani Fabrizio , Antinori Andrea , Fantoni Massimo
Published: November 2007

Non-Hodgkin's lymphoma (NHL) is one of the most common malignancies in patients infected with human immunodeficiency virus (HIV); it occurs 25–60 times more frequently in HIV-infected patients than in the general population. This neoplasm in acquired immunodeficiency syndrome (AIDS) patients is a highly aggressive tumour with a poor prognosis and tends to develop in extranodal sites, such as the central nervous system, digestive tract and bone marrow. NHL involving the paranasal sinuses is rare in HIV-infected patients, and is likely to be confused clinically and radiographically with sinusitis; moreover, its optimal treatment is currently uncertain.

We present a case of NHL involving the left maxillary sinus in a patient with AIDS. The patient was treated with systemic chemotherapy (low dose-CHOP), but the malignancy did not respond. Subsequently, he was treated with local maxillary sinus irradiation which resulted in partial regression of the neoplasm and in decrease of local symptoms.
The blastic variant of mantle cell lymphoma arising in Waldeyer's tonsillar ring
Authors: Ives Aguilera Nadine S. , Uusafr M. , Wenig Bruce M. , Abbondanzo Susan L.
Published: November 2007

We present three cases of blastic mantle cell lymphoma with an unusual initial manifestation in Waldeyer's ring with methods for differentiating it from other blastic neoplasms of the head and neck. All cases presented with a feeling of fullness inthe area of the mass. Morphologically, the tumours were blastic with a high mitotic rate (three to nine per high power field). All were B-cell phenotype with coexpression of CD43. In all cases cyclin Dl and bcl-2 were positive and CD23 negative. Blastic mantle cell lymphoma occurring in Waldeyer's tonsillar ring may be mistaken for other high grade haematopoietic neoplasms. Immunohistochemistry and awareness of this type of lymphoma arehelpful in differentiating it from other neoplasms.
A skull base extradural hypoglossal neurilemmoma resected via an extended posterolateral approach
Authors: Myatt H. M. , Holland N. J. , Cheesman A. D.
Published: November 2007

The case of a 43-year-old man with a right skull base hypoglossal neurilemmoma excised via the extended posterolateral approach is presented. There is only one previous case of hypoglossal neurilemmoma in the literature. The surgical technique described is a new approach to the posterior skull base involving a suboccipital craniectomy, mastoidectomy and the removal of the lateral process of the atlas. It provides an inferior approach to the jugular foramen and hypoglossal canal that allows the lower cranial nerves to be identified as they exit from their skull base foraminae. In the discussion we compare this technique to other surgical approaches previously described for access to the region of the jugular foramen.
Late complications of nasal augmentation using silicone implants
Authors: Pak Martin Wai , Yin Chan Eric Sun , van Hasselt Charles Andrew
Published: November 2007

Alloplastic nasal augmentation with silicone elastomer (Silastic) is popular in areas of Asia. Although the silicones are bio-inert, they have been implicated in a number of adverse reactions after implantation. We report our experience of three patients who presented with late complications after nasal augmentation using Silastic implants. The mechanisms of implant failure are proposed. It is advised that this material should only be used on an individual basis in carefully selected cases.
Dysphagia secondary to invasive candidiasis of a jejunal free flap
Authors: Ayshford C. A. , Walsh R. M. , Watkinson J. C.
Published: November 2007

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.
Tympanoplasty in children – a prospective study
Authors: Bajaj Yogesh , Bais A. S. , Mukherjee Bakul
Published: November 2007

Considerable controversy surrounds the subject of tympanoplasty in children. This prospective study looked at the results of type-I tympanoplasty in children. Forty-five children in the age group of five to 14 years were selected for the study. All these cases had a central perforation without any evidence of cholesteatoma. The ear to be operated had to be dry for at least six weeks before surgery. Type I tympanoplasty was performed on these patients with autograft temporalis fascia by either the underlay or overlay technique.

The overall success rates in 45 operations evaluated one year post-operatively was 91.1 per cent. The age of the patient had no influence on the success rate. The two factors which adversely influenced the success rate were the presence of near total perforation and bilateral perforations.

It was concluded that type-I tympanoplasty has a good chance of success in children regardless of age.
Long-term results of vestibular nerve section
Authors: Tewary A. K. , Riley N. , Kerr A. G.
Published: November 2007

Records are available on 27 patients who had vestibular nerve section between 1975 and 1987 giving a follow-up time of 10 to 22 years with a mean of 16 years. Episodic vertigo was fully controlled in 26 patients, one needing a labyrinthectomy 18 months later.

In addition to the patient who had labyrinthectomy, one patient had immediate post-operative profound hearing loss so that long-term follow-up of hearing was possible in 25 patients. After six months there was an overall average improvement in hearing of 1 dB. Thereafter there were average deterioration of 7 dB at two years, 15 dB at 10 years, 23 dB at 15 years and 29 dB at 20 years. This deterioration was more marked in those who had better hearing at the time of surgery, with all 10 whose hearing was classified as good deteriorating to poor by 15 years. At 10 years hearing deteriorated by 25 dB in those with good hearing and by 7 dB in those with poor hearing. In 20 per cent of patients there was audiological evidence of eventual involvement of the other ear.

Tinnitus became worse in five patients but was a major problem in only one patient. One patient suffered a facial paralysis with partial recovery and, in addition, in one the frontal branch was divided in the incision.
An unusual case of otogenic pneumocephalus
Authors: Lefantzis D. , Triantos S. , Vontetsianos H. , Dokianakis G.
Published: November 2007

Otogenic pneumocephalus is a rare entity usually caused by temporal bone trauma. This paper describes a case of otogenic pneumocephalus of traumatic origin, in which the type of the fracture (a bony spicula was detached from the mastoid) and the location (Trautmann's triangle) were uncommon.
Transorbital penetrating injury of the paranasal sinuses
Authors: Wu Ming-Ru , Shih Chang-Te , Yeh Chi-Wei
Published: November 2007

Penetrating injuries of the paranasal sinuses due to foreign bodies are rare, especially as a result of a traffic accident. Here we report a patient with a ballpoint pen lodged in his left eye following a traffic accident. The pen extended from the medial aspect of the left orbit, through the left ethmoid sinus and the nasal septum, to the right sphenoid sinus. We removed the pen uneventfully using endoscopic sinus surgery. There are no similar reports in the English literature and we therefore present this case because of its rarity.
Current concepts in the management of paediatric rhinosinusitis
Authors: Jones N. S.
Published: November 2007

It is well recognized that adenoid hypertrophy and allergic rhinitis are common in children and that recurrent upper respiratory tract infections are a fact of life. The main causes of symptoms associated with rhinosinusitis in children are rhinorrhoea, nasal obstruction, mouth breathing, hyponasal speech and snoring. Most children grow out of adenoid hypertrophy and recurrent colds by the age of eight to 10 and this means that the main treatment strategy should therefore be conservative and not surgical. An explanation to anxious parents, simple non-invasive measures such as teaching nose-blowing, the use of saline sprays or a trial of allergen avoidance and age-appropriate topical nasal anti-inflammatory sprays should be tried before surgery is even contemplated. Because repeated infections are so common, antibiotics given for chronic nasal discharge often have only short-lived effects.

Rhinosinusitis in children is not a surgical disease and ‘watchful waiting’ is advised. Any treatment should first of all be safe, as even without any intervention the problem usually resolves with time. It is likely that growth and maturation of the immunological response to pathogens play a major role in resolution of the disease. There are few exceptions to this principle: nasal polyps (indicating possible cystic fibrosis), and periorbital cellulitis where an assessment of vision, parenteral antibiotics, and if there is concern about the possibility of a subperiosteal abscess, computerized tomography (CT) and drainage of any pus is indicated.
Unusual cases of congenital cholesteatoma of the ear
Authors: Rashad Usama , Hawthorne Maurice , Kumar Udhaya , Welsh Andrée
Published: November 2007

Congenital cholesteatoma may originate at various sites in the temporal bone. For example, in the petrous apex, the cerebellopontine angle, the middle ear cavity, the mastoid process or the external auditory canal. The least common site being the mastoid process. We present two cases of congenital cholesteatoma of the mastoid process, each presenting with different symptoms and at different ages. Both patients underwent surgical treatment, which confirmed the diagnosis and radiological findings.
Clinical course of acute laryngeal trauma and associated effects on phonation
Authors: Brosch S. , Johannsen H. S.
Published: November 2007

We report the clinical course of blunt laryngeal trauma in three young patients. All three patients underwent several phoniatric examinations as well as indirect microlaryngoscopy and microstroboscopy. The follow-up period ranged from three to eight months. In the first case, there was isolated haemorrhage of the left vocal fold; in the second, dislocation of the arytenoid cartilage with formation of an adhesion in the area of the anterior commissure; and, in the third, non-dislocated fracture of the thyroid cartilage with development of haematoma in the right hemilarynx and transient vocal fold paralysis. One patient required surgical treatment; however, repositioning of the arytenoid cartilage, attempted seven weeks following the injury, proved unsuccessful.

In conclusion, all three patients showed significant limitation of vocal fold vibration many months after trauma which was unrelated to the extent of resulting tissue damage. In all three cases, patients developed secondary posttraumatic functional dysphonia requiring treatment.
Laryngeal paraganglioma in a five-year-old child – the youngest case ever recorded
Authors: Thirlwall A. S. , Bailey C. M. , Ramsay A. D. , Wyatt M.
Published: November 2007

A paraganglioma is a neuroendocrine neoplasm that originates from the paraganglion cells of the parasympathetic system. The average age of presentation is in the fifth decade. We report a case of laryngeal paraganglioma in a five-year-old child, the youngest case ever recorded. The features of paraganglioma which differentiate it from other tumours are also discussed.
Surgical simulation: an animal tissue model for training in therapeutic and diagnostic bronchoscopy
Authors: Ram Bhaskar , Oluwole Matthew , Blair Robin L. , Mountain Rodney , Dunkley Peta , White Paul S.
Published: November 2007

A series of surgical simulation exercises has been developed using an animal model to allow trainees to practise basic instrument handling and develop psychomotor skills in bronchoscopy, without risk to patients. A pig model was found to be most suitable. After suitable preparation the model can be used for diagnostic and therapeutic exercises in bronchoscopy, including lavage, biopsy and the removal of various foreign bodies. The model is a safe, inexpensive and convenient means of bronchoscopic training for otolaryngology trainees. For the trained specialist who has to remove bronchial foreign bodies infrequently, the model is a useful way of maintaining skills.
Dercum's disease (adiposis dolorosa)
Authors: Reece P. H. , Wyatt M. , O'Flynn P.
Published: November 2007

Dercum's disease (adiposis dolorosa) is a rare condition characterized by progressively painful fatty deposits, usually, in menopausal women with obesity, asthenia and mental phenomena. We report a case of a 48-year-old woman with recurrent neck swelling and pain in the neck and parotid region, and a review of management of this uncommon problem.
Paranasal sinus enlargement in Sturge–Weber syndrome
Authors: Ku Peter K. M. , Kew Jacqueline , Van Hasselt Charles Andrew
Published: November 2007

A case of Sturge-Weber syndrome is described in which all paranasal sinuses were grossly enlarged. The mastoid, petrous and squamous portions of the temporal bone on both sides were fully pneumatized and the right orbit was distorted. There was resistant infection in the left maxillary sinus. These unusual features were well demonstrated by computed tomographic scans.
Tall cell variant of papillary carcinoma arising from ectopic thyroid tissue in the trachea
Authors: Hari C. K. , Brown M. J. K. M. , Thompson I.
Published: November 2007

Ectopic thyroid tissue within the submucosa of the trachea is a rare cause of upper airway obstruction. Primary neoplasms arising from such thyroid nests are rare. This report describes a case of tall cell variant of papillary carcinoma arising from ectopic thyroid tissue in the trachea.
Pharyngeal pouch endoscopic stapling – are post-operative barium swallow radiographs of any value?
Authors: Ong Chun C. , Elton Paul G. , Mitchell David
Published: November 2007

Posterior pharyngeal pouch endoscopic stapling has gained increasing popularity among otolaryngologists especially in elderly patients. Post-operative barium swallow appearances can create confusion with the appearance of persistent pouches. We describe our experience in 10 patients, three of whom had external excision with cricopharyngeal myotomy and the remaining seven had endoscopic stapling approach. All three patients who had external excision showed no residual pouch whereas all seven patients who had endoscopic techniques performed showed some residual pouch. We were unsuccessful in our attempt to correlate post-operative symptoms with radiological appearance. Attempts by other radiologists at identifying pre- and post-operative barium swallow radiographs in patients who had endoscopic stapling of pharyngeal pouch were unsuccessful. We conclude that post-operative barium swallow radiography plays no role in determining the success of endoscopic stapling of pharyngeal pouch.
Parotid sialolithiasis
Authors: Bodner Lipa
Published: November 2007

This report documents an unusual case of buccal mucosa swelling due to a giant (25 × 13 mm), parotid duct sialolith. Review of the literature disclosed that this is the largest parotid sialolith ever reported. Diagnostic imaging and treatment are described.
Laryngeal amyloidosis with laryngocele
Authors: Aydin Ömer , Üstündaǧ Emre , İşeri Mete , Özkarakaş Haluk , Oǧuz Ali
Published: November 2007

Both laryngocele and laryngeal amyloidosis are uncommon, and simultaneous occurrences of these entities are extremely rare. A case of laryngeal amyloidosis with laryngocele in which the computed tomography (CT) and magnetic resonance (MR) imaging of the larynx, clearly demonstrating both disease processes, is discussed. Diagnosis is confirmed by histopathologic specimens. Only two cases have been reported in the world literature, and this is the third case of laryngeal amyloidosis associated with laryngocele.
Transpharyngeal approach for the treatment of dysphagia due to Forestier's disease
Authors: Uppal S. , Wheatley A. H.
Published: November 2007

Forestier's disease (diffuse idiopathic skeletal hyperostosis) is characterized by extensive spinal osteophyte formation and endo-chondral ossification of paravertebral ligaments and muscles. Dysphagia in the setting of Forestier's disease is a rare and hence often unrecognized entity. The dysphagia is due to mechanical obstruction in the initial stages and later by due to inflammation and fibrosis. Most of these patients are treated conservatively in the initial stages and later by excision of osteophytes through a lateral cervical approach. We present a case of dysphagia due to cervical osteophytes in the setting of Forestier's disease causing narrowing of the pharynx. The patient was treated surgically via a peroral-transpharyngeal route with excellent results.
Laser stapedotomy
Authors: Shabana Yousef K. , Allam Hassan , Pedersen C. Brahe
Published: November 2007

Thirty-four ears with conductive hearing loss due to otosclerosis were operated upon using the laser stapedotomy technique. Audiological results were compared with the results of 316 non-laser stapedotomies. The post-operative air-bone gap, calculated as the difference between the postoperative air and bone conduction levels, was smaller with the laser stapedotomy group. Also, the bone conduction showed significant improvement with the use of laser.

Significant sensorineural hearing loss was not found in any of the laser-treated patients. According to our results, we concluded that laser is of benefit in stapes surgery for improving the hearing results and minimizing the inner ear trauma.
Benign disease of the thyroid gland and vocal fold paralysis
Authors: Abboud Bassam , Tabchy Bassam , Jambart Sélim , Hamad Walid Abou , Farah Pierre
Published: November 2007

Development of vocal fold paralysis in the presence of thyroid disease is strongly indicative of thyroid cancer, and requires surgical exploration. At the same time, vocal fold paralysis does not relieve the surgeon of his obligation to identify and preserve the recurrent laryngeal nerves, since the cause of the paralysis may be a benign disease, with a fair chance of functional recovery after surgery. We hereby report a case of recurrent laryngeal nerve palsy secondary to a multinodular goitre.
Extensive and symptomatic cranial pneumatization: caused by frequent performance of Valsalva's manoeuvre?
Authors: Nyrop Mette , Bjerre Per K. , Christensen Johnny , Jørgensen Karsten E.
Published: November 2007

Pneumocranium and spontaneous pneumocephalus are very rare disorders. We report a case in which the patient had suffered for some time from neck pain and neurological symptoms which originated from an extensively pneumatized cranium. The symptoms and the abnormal bone pneumatization disappeared after normalization of a high middle-ear pressure. The history and the findings suggest that the pathological pneumatization was caused by the patient's habit of frequently performing Valsalva's manoeuvre, in combination with the Eustachian tube functioning as a valve.
Pleomorphic adenoma of the nasal septum
Authors: Jassar P. , Stafford N. D. , MacDonald A. W.
Published: November 2007

Pleomorphic adenoma is the commonest benign tumour of the major salivary glands. It can also occur in minor salivary glands, mainly in the oral cavity, but also in other sites in the head and neck both within and outwith the upper aerodigestive tract. We present a rare case of pleomorphic adenoma of the nasal septum with consideration of the clinical management and a review of the literature.
Prognostic factors in carcinoma of the larynx: relevance of DNA ploidy, S-fractions and localization of the tumour
Authors: Đanić Davorin , Miličić Damir , Prgomet Drago , Leović Dinko
Published: November 2007

The influence of the cell cycle profile and the site of the primary tumour on the overall survival were examined in 36 patients with squamous cell carcinoma of the larynx. DNA ploidy (p = 0.0091), the overall proliferative activity (p = 0.0001), the overall proliferative activity of diploid tumour cells (p = 0.0017) and primary tumour site (p = 0.0008) were found to be significant single prognostic factors of the overall survival. Multivariate analysis showed that only the overall proliferative activity was prognostically significant (p = 0.013). The results of the study show that the supraglottic site of the tumours correlates significantly with DNA ploidy (p = 0.0334) and the overall proliferative activity of tumour cells (p = 0.0159), whereas the correlation with proliferative activity of diploid tumour cells (p = 0.1416) has not been confirmed by this study. Glottic tumours showed a prognostically significant correlation with the overall proliferative activity (p = 0.0037) and proliferative activity of diploid tumour (p = 0.0054). Such a prognostic correlation was not found for DNA ploidy (p = 0.6542).
Herpes and the head and neck: the difficulties in diagnosis
Authors: Whallett Elizabeth J. , Pahor Ahmes L.
Published: November 2007

A case of primary herpes of the head and neck is presented. The exact source of infection and the precise diagnosis proved difficult to establish, but evidence tended to support a diagnosis of varicella zoster infection as opposed to a herpes simplex infection, though a dual infection was not ruled out.

Herpes simplex has specific clinical features which usually make its distinction from varicella zoster clear cut. In this case we relied heavily on laboratory investigations to improve the accuracy of our diagnosis since the clinical characteristics were blurred.

Unlike varicella zoster there has been little written about herpes simplex infections specifically affecting the ear, face and neck.
Rapidly invading sebaceous carcinoma of the external auditory canal
Authors: Ray J. , Schofield J. B. , Shotton J. C. , Al-Ayoubi A.
Published: November 2007

A very rare case of a sebaceous carcinoma of the external auditory canal with basal cell differentiation is presented. Fewer than 400 cases affecting any part of the body have so far been reported and of that only seven cases have been known to involve the external auditory canal. The clinical features, pathology and treatment are described and the relevant literature has been reviewed.
Are pre-operative vocal fold checks necessary?
Authors: Green K. M. J. , de Carpentier J. P.
Published: November 2007

Over a 26-year period, from 1970 to 1995, 2250 pre-operative vocal fold checks were carried out by the ENT team at Manchester Royal Infirmary in patients undergoing thyroid, parathyroid and cardiothoracic surgery. A register was kept of all pre-operative fold checks. This register was retrospectively analysed and 23 vocal fold palsies were documented. In six of these patients the notes were either missing or incomplete. All of the remaining 17 patients had a history suggestive of vocal fold palsy. We suggest that in the absence of symptoms, either current or on history, a routine pre-operative vocal fold check is unnecessary.
Tracheocarotid artery fistula infected with methicillinresistantStaphylococcus aureus
Authors: Tungekar M. F.
Published: November 2007

Massive life-threatening haemorrhage from a fistula between the trachea and a major blood vessel of the neck is a rare complication of the tracheostomy procedure, well-recognized by anaesthetists and otolaryngologists. Although the lesion is likely to be encountered at autopsy, it is not described in histopathological literature. The possible causes are discussed together with the macroscopic and microscopic appearances of the lesion. Suitable procedures for its identification and for obtaining appropriate histopathological blocks are suggested. Presence of methicillin-resistantStaphylococcus aureus(MRSA) has not been documented before and might have contributed to the genesis of the fistula in this case.
Subtemporal exposure of the intrapetrous internal carotid artery. An Anatomical study with surgical application
Authors: Naguib Maged B. , Sanna Mario
Published: November 2007

This work describes the exposure of the intrapetrous internal carotid artery (ICA) through the subtemporal approach. The anatomical details of 25 fresh temporal bones were studied and provided the initial background for this procedure. Bone drilling in the meatal plane anterior to the internal auditory canal could create a four-sided quadrangular area. The exposure of the ICA through this area was applied on three occasions. It proved safe as regards the surrounding structures and also provided an ample working space for the extirpation of tumours surrounding the artery.
Myxoid chondrosarcoma of the external auditory meatus
Authors: Worley George A. , Wareing Michael J. , Sergeant Robert J.
Published: November 2007

Extraskeletal myxoid chondrosarcoma presenting in the head and neck is extremely rare. Histological diagnosis is difficult and requires close co-operation between clinician, radiologist and pathologist. The tumour has a good prognosis in comparison to myxoid chondrosarcoma of the bone but surgical resection may be difficult due to its gelatinous nature. We present a case of extraskeletal myxoid chondrosarcoma originating in the external auditory meatus of a 42-year-old man. This is the first report of this tumour in this site.
Reversible hyposmia caused by intracranial tumour
Authors: Ishimaru Tadashi , Miwa Takaki , Nomura Motohiro , Iwato Masayuki , Furukawa Mrrusuru
Published: November 2007

Two patients with hyposmia caused by an intracranial tumour recovered olfactory functions after craniotomy. The first case was a 68-year-old male with a tumour metastasized from the lung to the right frontal lobe. The second case was a 75-year-old male with meningioma of the right frontal lobe. Results of T & T olfactometry and venous olfaction tests also indicated suspected central hyposmia. Magnetic resonance imaging (MRI) indicated compression of the frontal lobe by intracranial tumour. Pressure on the olfactory centre located in the frontal lobe produced hyposmia. Decompression of the frontal lobe by craniotomy improved the sense of smell. Therefore, some cases of olfactory disturbance caused by intracranial tumour may be reversible if they are the result of simple compression of the olfactory centre.
Skull base osteomyelitis interpreted as malignancy
Authors: Subburaman N. , Chaurasia M. K.
Published: November 2007

Lesions in the skull base may present difficulties in diagnosis primarily because the access needs to be invasive and one has to rely on imaging that may still be misleading. The case presented here illustrates this example in that the patient had abnormalities on computed tomography (CT) and magnetic resonance image (MRI) scans quite convincing of malignancy but which with time proved, essentially through clinical judgment, to be skull base osteomyelitis secondary to malignant external otitis (OME).
A three-array cochlear implant: a new approach for the ossified cochlea
Authors: Richardson H. C. , Beliaeff M. , Clarke G. , Hawthorne M.
Published: November 2007

The ossified cochlea, although rare, represents a challenge for cochlear implantation. While it is no longer considered an absolute contra-indication to implantation, insertion may be technically difficult and the results may be suboptimal. Techniques which have been employed are reviewed. The new Digisonic™ multi-array implant, which was designed specifically for use in the ossified cochlea is described, along with the technique used for its insertion.

In the first patient to be implanted with this new implant, all electrodes lie within the cochlea and are functional. The new Digisonic™ multi-array implant may have advantages over other solutions for the ossified cochlea.
The use of the pedicled buccal fat pad (BFP) and palatal rotating flaps in closure of oroantral communication and palatal defects
Authors: El-Hakim Ibrahim E. , El-Fakharany Abdel Magid
Published: November 2007

The use of the buccal fat (BFP) and palatal rotating flaps for the closure of oro-antral communication and reconstruction of palatal defects was compared clinically. The BFP proved to be consistently successful in closing oro-antral fistulae and palatal defects resulting from tumour resection, preserving the normal anatomical architecture of the oral mucosa. No denuded area requiring secondary granulation was required as in the case of palatal flaps. In addition, no facial disfigurement was observed on the operated side.

BFP is considered a reliable, convenient method for closure of palatal defects and closure of oro-antral communication. It can also be considered as a reliable back-up procedure in the event of failure of other techniques.
Phlebectasia of left anterior jugular vein
Authors: Uzun Cem , Taskinalp Oguz , Koten Muhsin , Adali Mustafa Kemal , Karasalihoglu Ahmet Rifat , Pekindil Gökhan
Published: November 2007

We present a rare case of unilateral phlebectasia of the anterior jugular vein in a 56-year-old male patient whose complaint is a neck swelling that appears during talking. Although in this age group the most common cause of such a mass in the anterior aspect of the neck increasing in size during any type of straining or Valsalva manoeuvre is a laryngocele, phlebectasia of the anterior jugular vein should be considered in the differential diagnosis. Doppler ultrasound and computed tomography are the most useful and non-invasive methods to use for the investigation. Treatment should be conservative.
The use of toluidine blue gargles to aid the detection of impacted pharyngeal fish bones
Authors: Jassar P. , Murray D. P. , Lee M. S. W.
Published: November 2007

Fishbone impaction is a common clinical problem. In most cases careful examination pinpoints the impacted bone which can then be removed. If no bone is detected a distinction must be drawn between mucosal abrasion mimicking fishbone impaction and a fine or deeply impaled fishbone eluding detection. We present a new method that may be helpful in the detection of pharyngeal fishbones.
Parotid tuberculosis simulating malignancy
Authors: Bhargava Asha K. , Shenoy A. M. , Kumar Rekha V. , M.S. Nanjundappa , Rao Clementina Rama
Published: November 2007

An interesting case of parotid tumour simulating malignancy is reported. The rarity of this lesion and the associated clinical and diagnostic problems are emphasized together with the relevant literature.
Brush cytology and its comparison with histopathological examination in cases of diseases of the nose
Authors: Maru Y. K. , Munjal S. , Gupta Y.
Published: November 2007

Nasal cytology is a simple, easy, bloodless and quite reliable investigation. Although its utility was recognized as early as 1927 by Eyerman, it has not yet gained much popularity. Here, an attempt is made to assess its efficacy for the diagnosis of various inflammatory, benign and malignant conditions in 151 cases of common rhinological problems in the M. Y. Group of Hospitals, Indore MP India.

This method can be used as an adjuvant to clinical diagnosis and histopathological diagnosis as an outpatient department (OPD) procedure with the help of a nasal endoscope, as it was found to be a simple, reliable and time-saving procedure for further management. It can also be used as a screening test for the detection of symptomless patients particularly in precancerous lesions.
Hearing loss associated with large internal auditory meatus: a report of five paediatric cases
Authors: Birman Catherine S. , Gibson William P. R.
Published: November 2007

This paper describes the abnormality of a large internal auditory meatus (LIAM). Computed tomography (CT) scans show the otic capsule to be affected by a widened, bulbar internal auditory meatus with loss of or reduction of the bony wall dividing the lateral fundus of the meatus from the cochlea. The vestibule is abnormally dilated. We report five cases of children with LIAM and profound hearing loss. Three of these children are girls and two children were boys. Three had congenital progressive hearing loss, one of these had an accompanying large vestibular aqueduct and dysplasia of the cochlea. Two patients had had meningitis resulting in profound loss.
Primary tuberculosis of the posterior oropharyngeal wall
Authors: Hajioff D. , Snow M. H. , Thaker H. , Wilson J. A.
Published: November 2007

We report a case of primary tuberculosis of the posterior oropharyngeal wall presenting with sore throat, fever and malaise. Pharyngeal tuberculosis is rare and usually occurs with primary pulmonary disease. Primary disease has been reported in small numbers in the nasopharynx and palatine tonsil but never before, to our knowledge, in the posterior oropharyngeal wall.
Metastatic melanoma of the tonsil
Authors: Sood S. , Nair S. B. , Fenwick J. D. , Horgan K.
Published: November 2007

Metastasis to the tonsils from malignant melanoma is rare. This paper describes one such case in a woman with synchronous breast adenocarcinoma and cutaneous malignant melanoma who had a most unusual clinical course.
Ventilation tubes and cholesteatoma in children
Authors: Mortensen E. H. , Lildholdt T.
Published: November 2007

The previous use of ventilation tubes has been investigated retrospectively in a series of children whose ears had been operated on. Within a six-year period, 49 ears had a cholesteatoma documented, and in 14 of these a tube had been used. During the same period, 64 ears were operated on for chronic otitis media without cholesteatoma, and of these only three ears had been treated with a tube. This difference is statistically significant (p = 0.0004). A final conclusion is not possible from this information and more research is needed, but the study indicates the importance of a long-term follow-up of children who have been treated with ventilation tubes.
Cancer of the mouth in an isolated community—the results of treatment
Authors: Williams R. G.
Published: November 2007

A survey is presented of all known cases of cancer of the mouth in a population of nearly half a million in a relatively isolated part of Yorkshire, with the results of treament of squamous carcinoma, adeno-carcinoma, lympho-sarcoma, malignant tumours of odontogenic origin and sarcomas.
A case of tonsillar leishmaniasis
Authors: Laudadio P.
Published: November 2007

Primary mucous leishmaniasis of the tonsil with satellite lymphatic spread but without visceral diffusion is presented.

From fragments of the tonsils and from the satellite cervical lymph nodes it was possible to find, isolate and culture a strain of Leishmania Donovani ‘BO 72’.

The diagnostic problems are discussed caused by the lack of specific clinical findings and the rarity of mucous leishmaniasis in an area frequently the site of other pathological processes.
Otosurgery of incipient adhesive otitis media in children
Authors: Nielsen Kristian Otto , Bak-Pedersen Kristian
Published: November 2007

In 20 children, 21 ears with incipient adhesive otitis media were treated by mobilizing the thin, adherent tympanic membrane, strengthening it with a fascial graft, inserting SilasticR on the promontory, and establishing middle-ear drainage. The evaluation criteria were adhesive, atrophic and retractive changes in the tympanic membrane. The median follow-up period was 19 months. At follow-up, the material showed a statistically significant improvement in hearing, with a median hearing-loss of 17 db. postoperatively against 30 db. pre-operatively. There was a pronounced improvement in the adhesive and atrophic, as well as in the retractive, changes in the tympanic membrane.

The present method of otosurgery is taken to be justified by the threat that incipient adhesive otitis media will develop into total middle-ear atelectasis with maximum hearing-loss and a risk of cholesteatoma. A further justification is afforded by the favourable therapeutic results.
Benign intracranial hypertension caused by mastoiditis and lateral sinus obstruction: The value of computerized tomography in diagnosis
Authors: Schønsted-Madsen U. , Sehested P. , Brask T.
Published: November 2007

A case of benign intracranial hypertension occurring in an 11-year-old boy, and due to lateral sinus obstruction, is reported. Computerized tomographic scan was conclusive, revealing a normal ventricular system and no evidence of a neoplastic lesion. Disappearance of the mastoid air cells and disruption of the trabecular pattern were also shown on the affected side. The diagnosis was confirmed at operation, and the course was favourable. In accordance with other studies cited, our findings suggest that patients suspected of benign intracranial hypertension can be spared invasive neuroradiological procedures if the computerized tomographic scan of the head is normal.
Bromocriptine-associated ototoxicity
Authors: Lanthier Philippe L. , Morgan Marsha Y. , Ballantyne John
Published: November 2007

Three patients treated with bromocriptine for chronic hepatic encephalopathy showed audiometric evidence of bilateral sensori-neural hearing-loss. Audiometrically, the hearing improved in all three patients when the bromocriptine dosage was reduced, thus suggesting that this drug may produce a reversible ototoxicity.
Ciliary beat frequency of human middle-ear mucosa measured in vitro
Authors: Roth Y. , Ostfeld E.
Published: November 2007

Brush biopsies from the middle-ear (ME) and nasal mucosa were taken from a 4-year-old girl with complete situs inversus, recurrent otitis media and tonsillitis, who underwent tonsillectomy, adenoidectomy and bilateral myringotomy with insertion of ventilation tubes. Ciliary beat frequencies (CBF, Hz.) of the ME and nasal samples, measured by a photoelectric system equipped with a fiber-optic probe, were 9.5 Hz. (±1.2) and 13.7 Hz. (±4.1) respectively. These values are similar to CBF of nasal samples obtained from normal subjects. In vitro CBF assessment is a useful investigative tool for the study of mucociliary activity in the ME, as in patients suspected to have ciliary dyskinesia syndrome.
Half Nose
Authors: Beg M. H. A.
Published: November 2007

A very rare abnormality is reported of congenital absence of the right half of the nose in combination with microphthalmia, coloboma, epiphora and median cleft of the alveous.
Normal growth pattern of the middle ear cleft in the human fetus
Authors: Declau F. , Moeneclaey L. , Marquet J.
Published: November 2007

The normal growth pattern of the middle ear cleft was studied on macro- and histological sections of the human fetus.

When compared with adult temporal bones, the inclination of the tympanic ring remains unaltered throughout fetal development.

Expansion of the middle ear cleft is caused by intrinsic growth and by lateral displacement of its constituent elements: tympanic ring, otic capsule and squamous bone. Not only are the two mutually different modes of growth movement quite dissimilar in magnitude and direction, but so is their resultant vector for each constituent; this dissimilarity in growth movement leads to a characteristic change in shape of the middle ear cleft and to the curvature of the tympanic membrane. The intrinsic growth of these elements is simultaneously accompanied by remodelling of their shape; lateral displacement of the squamous bone and tympanic ring is caused by the pressure of the enlarging brain. The consequences of developmental disturbances on the normal growth pattern are discussed.
Parental satisfaction with paediatric day-case ENT surgery
Authors: Hicklin L. , Tostevin P. M. J. , Wyatt M. E.
Published: November 2007

Day surgery is increasing to improve the efficient use of NHS resources and it is vital that the quality of patient care is not compromised. The Audit Commission has recommended that there should be a systematic appraisal of the patient's views to monitor quality of day care. A survey of parental satisfaction with paediatric day-case surgery provides valuable information for those providing day surgery. A specific area of dissatisfaction previously identified is inadequate pain control following discharge. It is also suggested that day surgery may incur higher costs for the general practitioner.

A retrospective study to investigate parental satisfaction with 100 paediatric otorhinolaryngology cases was performed. This study found 96 per cent of parents were happy with the treatment their child received, 89 per cent were satisfied with self-administered simple analgesia and no patients visited their general practitioner on the day following surgery. It is concluded that with careful selection and adequate support the degree of satisfaction with day surgery is high for a wide variety of procedures.
Coagulation studies in patients admitted with epistaxis – current practice in Scotland
Authors: Holland S. , Thaha M. A. , Nilssen E. L. K. , White P. S.
Published: November 2007

Abstract Epistaxis remains the most common ENT emergency. The use of coagulation studies in Scotland to manage these patients was investigated to determine current practice. The study took the form of a postal questionnaire sent to all practising ENT consultants and a telephone survey of ENT senior house officers working in Scotland. Of the 60 questionnaires circulated amongst consultants, 55 responses were received (92 per cent). Thirty-eight consultants (70 per cent) indicated that they did not routinely request a coagulation screen for their patients, however, 30 per cent (16) did. Forty-three of the 45 junior staff were available for interview, 22 (51 per cent) of whom routinely requested coagulation studies. While the majority of consultants did not request routine coagulation studies, there did not appear to be any consensus among the junior staff. Although there is a paucity of scientific information with regard to this aspect of epistaxis patient management, there is support in the literature for targeted rather than blanket testing. There is perhaps a need to address this issue within individual departments, to achieve uniformity of practice, and to improve communication between junior and senior staff.
Pictorial assessment of the delivery of oropharyngeal rinse versus oropharyngeal spray
Authors: Patel S. K. , Ghufoor K. , Jayaraj S. M. , McPartlin D. W. , Philpott J.
Published: November 2007

Oral rinses/gargles and oral sprays are frequently used in the management of oropharyngeal inflammation. This pictorial study, using methylene blue dye as a marker of the distribution of these topical preparations in the oropharynx, suggests that oral sprays are more effective in coating the oropharynx than oral rinses, whilst oral rinses are better at staining the oral cavity and base of tongue. The authors therefore suggest that oral rinses should be used to treat disease in the oral cavity and oral sprays should be used to treat ailments in the oropharynx.