bluuebunny/crossref_metadata_2025 huggingface dataset:
Laryngo-tracheo-bronchial foreign bodies in children
Authors: Banerjee Amit , Subba Rao K. S. V. K. , Khanna S. K. , Narayanant P. S. , Gupta B. K. , Sekar J. C. , Retnam C. Rajendra , Nachiappan M.
Published: November 2007

Inhalation of a foreign body into the respiratory passage can be a serious and sometimes fatal childhood accident. In this paper we analyze the management of 223 children with laryngo-tracheo-bronchial foreign bodies. Children below three years of age were found to be the most vulnerable. The majority of the patients were boys. Over a quarter of the patients did not present with a history of inhalation. Only 52 per cent reported within 24 hours of inhalation. Endoscopic removal was possible in all but nine cases. One hundred and fort eight (66.4 per cent) of the recovered foreign bodies were organic in origin, the majority of them being peanuts. In one hundred and five (47.1 per cent) the objects found their way into the right bronchial tree. There were two deaths. The modalities of diagnosis and management are discussed.
Pritt Tak: Another hazard of grommets and swimming
Authors: Clark D. R.
Published: November 2007

There is argument about whether, whilst swimming, water should be excluded from ears which have middle ear ventilation tubes in place in the tympanic membrane.

The adhesive putty substance BLU-TACK (registered Trade Mark, Bostik Ltd, Leicester, England LE4 6BW) has been suggested as an effective ear plug for this purpose.

A case is described in which an alternative adhesive putty substance was used as a waterproof plug. The result was that the plug became semi-solid and impossible to remove without the use of micro instruments and removal would have required general anæstgetic in a less co-operative patient.

Patients should be warned of this risk.
Rare mid-line congenital anomalies of the face
Authors: Farag M. Mokhtar , Ragaie A. , El-Oteify M. A.
Published: November 2007

Three rare cases of congenital anomalies (mid-line nasal proboscis, subintegumental mid-line cleft lip and congenital palatoglossal synechia) are presented with their management. The embryological considerations of these cases are discussed.
Clinical investigation of olfactory and auditory function in type I pseudohypoparathyroidism: participation of adenylate cyclase system
Authors: Ikeda K. , Sakurada T. , Sasaki Y. , Takasaka T. , Furukawa Y.
Published: November 2007

Olfactory and auditory function was examined in five patient with type I pseudohyppoarathyroidism; in two patient the activity of stimulatory guanine nucleotide-binding protein was examined and found to have low values. The olfactory tests were performed by T & T olfactometer and intravenous injection of thiamine propyl disulphide. The four patients receiving olfactory test showed a disturbance in recoginzation of the odorants. All five patients had normal hearing at frequencies with the normal range. An adenylate cyclase system is thought to play an important role in olfactory transduction, whereas cochlear function may be unaffected by this system in the normal state.
Coronal CT examination in the evaluation of small frontoethmodial encephalocoeles
Authors: Lundorf E. , Kjeldgaard A. , Halaburt H.
Published: November 2007

Symptoms producing small front-ethmoidal encephalocoeles are generally identified radiologically. The examination of choice is coronal CT, eventually performed axially with coronal reconstructions, and best with intrathecal contrast material delineating the basal cisterns. Two case reports demonstrate the clinical and radiological problems in identifying and fronto-ethmoidal encephalocoleles.
A modification of the MacFee incisions for neck dissection
Authors: Shaw H. J.
Published: November 2007

The dissection of cervical lymphatics for cancer after radiotherapy imposes a special need to ensure good healing of skin flaps with good access and acceptable aesthetic results. Adaptability of incisions for extended surgery is also desirable.

Although it is felt that the adoption of the basic MacFee incision pattern fulfils these criteria, the author has for years employed curved modifications of the two horizontal incision lines. This develops a waisted skin bridge which in freely mobile and gives better access to the deep structures.

The technique is contrasted with other approaches and described in detail. It complies with the safe principle of join-free linear incisions and is practical for regular use.
The repair of defects in the head and neck region with the latissimus dorsi myocutaneous flap
Authors: Chowdhury C. R. , Mclean N. R. , Harrop-Griffiths K. , Breach N. M.
Published: November 2007

There are many different flaps available for head and neck reconstruction. The latissimus dorsi myocutaneous flap has been widely used in this unit on 80 occasions in the past three years, both as a pedicled and as a free microvascular flap following the excision of head and neck malignancy, the commonest pathology being intraoral squamous cell carcinoma.

There were nine cases of complete or substantial flap loss requiring a further reconstructive procedure. Few of the patients who underwent total glossectomy suffered from overspill or aspiration and the fistula rate was low.

Reference is made to the anatomy and the technique of raising this versatile flap which provides a large volume of tissue and has been particularly useful following total glossesctomy when combined with a hyoid hitch.
Brainstem auditory evoked potentials after irradiation of nasopharyngeal carcinoma—Report on two cases with myelopathy of the brainstem
Authors: Lau S. K. , Wei W. I. , Choyt D. , Sham J. S. T. , Engzell U. C. G.
Published: November 2007

abstract

Brainstem auditory evoked potentials (BAEP) were recorded in two patients with nasopharyngeal carcinoma (NPC) irradiated 14 and three years ago respectively and compared with 15 healthy controls. The patients had features of post- irradiation myelopathy of the brainstem with reduced gag reflex, unilateral vocal cord paralysis and fasciculation of the tongue. The first patient had a blind left eye. The second patient had quadriparesis. All ears revealed post-irradiation otitis media changes and mixed deafness. BAEP was not recognizable in the left ear of the first patient and was normal in the left ear of the second patient. Simultaneous electrocochleogram and BAEP were recorded from the right ear of the first case. The wave I–V latency interval were rolonged in both right ears. In the absence of local recurrence and brain secondaries, these BAEP changes are attributed to the post-irradiation myelopathy of brainstem.
Osteogenic sarcoma of the ethmoid sinus
Authors: Bradley C. , McCloymont L. G. , Reid R.
Published: November 2007

A case of osteogenic sarcoma of the ethmoid sinus is reported in a 45 year old man. The tumour extended superiorly through the frontal sinus and involved the medial wall of the left orbit causing diplopia. Treatment comprised partial excision followed by radiotherapy and chemotherapy with symptomatic improvement, although 13 months later the patient died from progressive local and metastatic disease. A possible relationship to previous radiation exposure is discussed.
Treatment of glue ear in relation to radiographic palatal airway size: a predictor for outcome following adenoidectomy?
Authors: Parker Andrew J. , Maw A. Richard
Published: November 2007

Adenoidectomy performed for ‘glue ear’ accounts for many of the admissions for surgery in childhood. In spite of this there are no objective guidelines to enable the clinician to select those cases in whom a definite benefit is likely, or in whom such procedures might best be avoided. A total of 147 children with established bilateral glue ear randomized to adenoidectomy (A) or no pharyngeal surgery (NS) treatment groups were examined for clearance of effusion in an unoperated ear after one year. Outcome was analysed with respect to the pre-operative Radiographic Palatal Airway size in three groups in relation to mean measurements obtained from matched populations of normal children and those with established disease. Those with small airways had significantly increased clearance following A when compared with NS between the ages of 3–7 years. Adenoidectomy should probably not be performed in those children with large airway measurements, although the outcome may ultimately be related to the age at which surgery is performed.
Traumatic CSF fistula presenting late as a middle ear effusion
Authors: Brandrick J. T.
Published: November 2007

CSF otorrhoea is not uncommon following head injury but late presentation is rare. In the case described an unsuspected temporal bone fracture presented after an interval of ten years with a conductive deafness due to fluid in the middle ear simulating serous otitis media.
Recurrent bilateral peripheral facial palsy
Authors: Stahl N. , Ferit T.
Published: November 2007

Facial nerve paralysis is a common otolaryngological diagnosis. Recurrent unilateral peripheral facial palsy is found in about 7 per cent of the cases. Simultaneous bilateral facial palsy is relatively uncommon and occurs in 0.3–2.0 per cent of cases of facial palsy. Recurrent. simultaneous, bilateral, idiopathic facial palsy to the best of our knowledge has never been reported. A case of recurrent, simultaneous, bilateral, idiopathic facial palsy is presented. No evidence of systemic or local disease was found in both attacks of peripheral facial palsies. The association with states of stress is the only common finding between the two attacks.
Staging in cholesteatoma surgery
Authors: Austin David F.
Published: November 2007

Single stage surgery was used for 174 operations for cholesteatoma. The results were analysed using months at risk (actuarial) statistics. The methods of data collection and of creating a life-table for cholesteatoma follow-up are described. Ninety-one canal-down procedures are compared with 82 canal-up procedures as to the recidivism rate as well as hearing results. The actuarial tables showed a 50 per cent cumulative success rate for canal-up procedures versus a 90 per cent rate for canal-down operations. The successful canal-up procedures, however, demonstrated slightly better hearing results. These success rates seemed to be comparable to those using planned staged surgery.

It was concluded that if single stage canal-up procedures were used with larger mastoids and canal-down procedures with smaller mastoids, 80 per cent of patients could be controlled without either residual or recurrent disease appearing. For the others, it was felt safe to wait for the disease to reappear rather than to do planned two-stage procedures for all patients. It was further urged that actuarial statisties be employed when reporting the results of surgery for cholesteatoma.
Benign paroxysmal positional vertigo resulting from surgical trauma
Authors: Nigam A. , Moffat D. A. , Varley E. W. B.
Published: November 2007

A patient developed benign paroxysmal positional vertigo following partial excision of the upper jaw for squamous carcinoma. It is probable that the trauma sustained by the labyrinth during surgery led to the development of vertigo. Benign paroxysmal positional vertigo may be a preventable post-operative complication.
Haemorrhage during minitracheotomy: reduction of risk by altered incision
Authors: Terry R. M. , Cook P.
Published: November 2007

A 46-year-old male was admitted to an intensive care unit: for 11 days he was ventilated via a naso-tracheal tube. Because of excess tracheal secretions, a mini tracheotomy was attempted on the unit which resulted in profuse arterial haemorrhage, necessitating immediate reintubation and subsequent formal tracheostomy. The authors feel that this complication was due to a mid-line vertical incision and that this could have been avoided by a horizontal incision across the lower part of the cricothyroid membrane, as close to the cricoid cartilage as possible. They describe their recommended technique.
Pedunculated squamous papilloma of the laryngopharynx
Authors: Desai S. , Rajaratnam K.
Published: November 2007

Pedunculated squamous papillomas usually arise from the soft palate, tonsil or the epiglottis. These lesions can sometimes prove to be fatal. A case of peduculated squamous papilloma, arising from the laryngopharynx, in a young, mentally retarded female, is presented here. The clinical presentation, the site of origin and the size of the lesion were quite unusual. The narrow base of the pedicle made the intra-oral excision possible.
Fibrous histiocytoma of the larynx
Authors: Jordan M. B. , Soames J. V.
Published: November 2007

Fibrous histiocytoma is uncommon in the head and neck region and rare in the larynx. Its behaviour is unpredictable.

A case is reported in a 54-year-old male which was treated conservatively initially and which recurred several times over a seven year period. During that time the appearances of the lesion changed from those of a densely collagenous, cytologically benign tumour to those of a richly cellular and potentially malignant neoplasm. Laryngectomy was eventually undertaken.
Persisting nystagmus following vestibular nerve section for Menière's disease
Authors: Shotton J. C. , Ludman Harold , Davies Rosalyn
Published: November 2007

Unilateral vestibular nerve section (VNS) creates a state of acute dysequlibrium which resolves by a process of central compensation. This disturbance resolves quickly and central compensation is complete generally within a month with resolution of symptoms and signs. The course of central compensation following VNS will be similar to that seen after labyrinthectomy because the detachment of hemi-labyrinthine input that is achieved by both will be identical. Six patients are presented who have undergone VNS at least 2.7 years ago (Average 3.5 years); all of them have persisting spontaneous peripheral type horizontal jerk nystagmus, present with optic fixation in five. This is obvious clinically and was confirmed in each case by agreement of three independent observers and has been recorded by electronystagmography (ENG). They are free from marked vestibular symptoms. The explanations of mechanisms involved in central compensation are discussed with respect to this previously unrecorded clinical observation.
Repair of post-laryngectomy pharyngeal fistulae
Authors: Rubin J. S.
Published: November 2007

Post-laryngectomy pharyngeal fistulization is an unpleasant occurrence. Presented herein is the author's approach to this problem, along with two cases in which closure was effected by sternocleidomastoid (SCM) myoplasty.

SCM myocutaneous flaps have previously been considered for pharyngocutaneous fistulae and then disregarded due to the doubtful nature of the blood supply to the skin. The SCM myoplasty obviates this problem as it relies on muscle rather than skin. SCM myoplasty has been used as a bolster in pharyngeal reconstruction after the pharynx has been closed by pharyngeal mucosal advancement or rotation. The author has extended this idea utilizing the raw muscle of the SCM to directly reconstruct the defect in fistulae deemed too large for primary closure.

Anatomical, oncological and technical considerations are discussed, as well as the author's protocol for post-laryngectomy pharyngocutaneous fistulae.
Head and neck surgery in the elderly: a maturing problem
Authors: Harries M. , Lund V. J.
Published: November 2007

The number of elderly patients requiring oncologic head and neck surgery is increasing as this proportion of the population continues to grow. To establish the specific problems and relative risks, 100 patients, 70 years of age and over have been examined to determine post-operative mortality and morbidity. Results do not show these to be significantly increased in the elderly and support an aggressive approach to head and neck cancer management in these patients.
Complications of mediastinoscopy
Authors: Puhakka Heikki J.
Published: November 2007

From 1968 to 1987, mediastinoscopy was performed on 2021 consecutive patients. The procedure was carried out in 35.7 per cent on patients with a pulmonary infiltrate and in 28.8 per cent with bronchogenic carcinoma. Mediastinoscopy was positive in 54 per cent of the cases. The total number of complications was 2.3 per cent (47/2021). There were four cases with major haemorrhage, three tracheal ruptures and three wound infections. Recurrent nerve paralysis was verified in three patients and pericardial rupture in two patients. The total of major complications was 0.5 per cent (10/2021). There was no deaths in this series. In the authors' opinion, mediastinoscopy can be regarded as an effective and safe procedure in the hands of an experienced surgeon.
Carcinoma arising in a pleomorphic adenoma of the epiglottis
Authors: Milford C. A. , Mugliston T. A. , O'Flynn P. , McCarthy K.
Published: November 2007

Despite the abundance of minor salivary glands within the larynx, pleomorphic adenomas are rarely found. It is therefore not surprising that there are few reports of malignant mixed tumours in this site. We describe a case of carcinoma arising in a pleomorphic adenoma of the epiglottis which, to our knowledge, has not been described previously.

The patient underwent a horizontal partial laryngectomy and functional neck dissection and is well one year post-operatively. We feel this represents a suitable approach to treatment for this rare tumour.
Resection with laser and high frequency cutting loop in tracheo-bronchial diseases
Authors: Illum P.
Published: November 2007

A total of 23 patients have been treated endoscopically during the last three and a half years for a variety of diseases in the tracheo-bronchial tree; nine had a tracheal stenosis. Thirteen patients have been treated by resection with a high frequency cutting loop, eleven with a CO2-laser and one with an argon laser. A total of 44 treatments have been performed. Half of the treatments were given because of various malignant diseases.

The results of the treatment of this very mixed group of patients were, as a whole, satisfactory with both CO2-laser and cutting loop. A more precise technique can be applied with the CO2-laser than the cutting loop, though the latter is the more efficient and easy to work with. Care must be taken with the loop because of its greater cutting depth.

The argon laser has only limited use in the treatment of diseases in the trachea.
Ossifying lipoma
Authors: Blanshard J. D. , Veitch D.
Published: November 2007

Lipomata are the most common benign tumour of the head and neck. They may undergo a variety of changes, one of which is ossification which, although rarely seen, has a characteristic radiographic appearance. We present a case of a retropharyngeal lipoma which demonstrates ossification and discuss the features which differentiate this from an osseous lipoma. Current theories on the aetiology of lipomata and their ossification are reviewed.
An avoidable occupational hazard during mastoid surgery
Authors: Lannigan F. J. , Jones N. S. , von Schoenberg M. V.
Published: November 2007

Conjunctival innoculation is a previously unrecognized hazard for the otologist during mastoid surgery. This experiment assesses the spread of droplet contamination during temporal bone dissection. The results suggest that otologists and assistants should wear eye protection during exposure of the mastoid antrum by drilling.
Invasive pituitary adenoma presenting with nasal obstruction
Authors: Dent J. A. , Rickhuss P. K.
Published: November 2007

We report two cases of massive invasive pituitary adenoma with the unusual presentation of nasal obstruction. In both cases the diagnosis was only made when the obstructing tissue was removed. Cases reported previously have usually presented with severe focal neurological signs or a long history of neurological symptoms. These two cases are unusual in having minimal neurological deficits despite the extension of tumour into the nasopharynx and the middle and posterior cranial fossae. These extensions were well illustrated by computerised tomography. This unusual presentation is discussed with reference to the literature.
Long term pathological sequelae of neonatal endotracheal intubation
Authors: Gould S. J. , Graham J.
Published: November 2007

In neonates, acquired subglottic stenosis (SGS) is the most serious long term complication of endotracheal intubation. In this case report, we describe the pathological changes in the larynx of a child who died two years after successful treatment, involving corrective surgery, for neonatally acquired SGS. Stenosis, due to dense fibrous connective tissue, was still present at death. However, there was evidence that there had been growth of the laryngeal cartilages. Disruption of the laryngeal cartilages was present anteriorly due to the antecedent surgery but major cricoid cartilage injury secondary to intubation was not seen. The crico-arytenoid joints demonstrated ankylosis and to this was attributed the abnormal quality of voice noted in the child at follow-up. The pathological changes are considered in relation to the pathology of endotracheal intubation and pathogenesis of acquired subglottic stenosis.
Osteoma of the ear canal presenting with headache
Authors: Shenoy P. , Paulose K.O. , Khalifa S. A. , Sharma R.
Published: November 2007

Osteoma of external auditory canal is a rare benign tumour. Usually it is found incidentally and often symptomless. Here we have a case of osteoma arising from the anterior wall of the bony external auditory canal, causing ipsilateral temporal headache which was relieved by removal of tumour
Bilateral facial nerve palsy following secretory otitis media
Authors: Premachandra D. J. , Radcliffe G.
Published: November 2007

Facial nerve palsy is a known complication of acute suppurative otitis media. Cases of facial nerve palsy following secretory otitis media have not been reported in the world literature. We report a case of bilateral facial nerve palsy following secretory otitis media.
Pharyngeal paralysis due to botulinum toxin injection
Authors: Koay C. E. , Alun-Jones T.
Published: November 2007

Botulinum toxin injection is now recognized as an effective treatment for spasmodic torticollis. Complications of this increasingly popular method of treatment include mild and transient dysphagia, with or without dysphonia, lasting up to four weeks. Two cases of paralysis of vocal cord contralateral to the injected sternomastoid have also been reported. A case of severe dysphagia lasting six weeks associated with ipsilateral vocal cord palsy following botulinum toxin injection is presented. The probable mechanism for these complications is discussed.
Agenesis of the cervical internal carotid artery
Authors: Nishimura T. , Takimoto T. , Kamide M. , Ishikawa S. , Umeda R.
Published: November 2007

Total or segmental agenesis of the internal carotid artery is a rare anomaly. The cervical portion of the internal carotid artery was absent in the right side of the patient who was carried out radical surgery due to recurrent oropharyngeal cancer. Post-operative venous digital subtraction angiography revealed that the remaining intracranial portion of the internal carotid artery was normally patent and supplied blood flow via ipsilateral external carotid artery. Otolaryngologist-Head and Neck surgeon should know such a vascular anomaly and avoid a disastrous result on dividing external carotid artery.
Nasal decongestant effect of oxymetazoline in the common cold: An objective dose-response study in 106 patients
Authors: Åkerland Anders , Klint Thorsten , Olén Lars , Rundcrantz Hans
Published: November 2007

Oxymetazoline has been used as decongesting nosedrops for more than 25 years but so far no objective does-response study of the drug has been published. In this double-blind clinical trial the decongestant effect on the nasal mucosa by the doses and concentrations traditionally used of oxymetazoline were studied.

In 106 men with acute infectious rhinitis, a significant dose-response relationship was found when the decongestant effect was measured objectively by anterior rhinomanometry and subjectively by symptom scores.

The concentration and volumes of the drug recommended from clinical experience seem to be adequate.
Nasal polyps and sinusitis in children with cystic fibrosis.
Authors: Drake-Lee A. B. , Morgan D. W.
Published: November 2007

Eighteen children suffering from cystic fibrosis and nasal polyps were studied. Two patients presented with nasal polyps at two years of age; the remaining patients had an initial polypectomy at any age up to fifteen years (mean age of seven and a half years). There were no obvious correlations between the cultures of the sinus washouts and the corresponding sputum samples. Organisms were only grown from five of the fifteen wash outs and from nine of the sputum samples. The patients with severe polyposis were not obviously more atopic.
Multiple synchronous carcinoma of the aero-digestive tract
Authors: McCombe Andrew , Lund Valerie J. , Howard David J.
Published: November 2007

Multiple carcinoma of the upper aerodigestive tract is an increasingly recognized problem, and a concept of ‘field cancerization’ has been proposed to explain this phenomena. The initial assessment of a patient with an isolated aerodigestive carcinoma must be extensive so as not to miss any synchronous lesions, and may include radiography and endoscopy. Treatment cannot be standardised but must be tailored to suit individual problems and because of the high incidence of metachronous tumours, follow-up must be both thorough and ‘lifelong’.

A case of three primary synchronous squamous carcinomas of the upper aerodigestive tract is presented. The relevant literature is reviewed.
A coin as a tracheal foreign body for 30 years
Authors: Su Chih-Ying
Published: November 2007

The authors describe an unusual case of a primary chondroid chordoma arising from the base of petrous temporal bone. The patient, a young male, presented with a left sided jugular foramen syndrome. The CT findings of a tumour arising from the base of the left petrous temporal bone were confirmed at infratemporal exploration. The clinical and histopathological and immunohistochemical differences between classical (typical) chordoma and its chondroid variant are highlighted. The rarity of primary chordomas at this site is stressed.
Objective tinnitus and tympanic membrane displacement
Authors: Phillipps J. J. , Reid A. , Marchbanks R. J. , Jarrar R. F.
Published: November 2007

A young girl with objective tinnitus is presented. Using tympanic membrane displacement, the probable origin of the tinnitus has been demonstrated. The patient has responded well to treatment with a tinnitus masker.
Granular cell tumour of the larynx in childhood
Authors: Wight R. G. , Variend S. , Bull P. D.
Published: November 2007

The youngest patient reported to date with granular cell tumour of the larynx is presented, with a review of other reported cases in childhood. The basis of histological diagnosis of granular cell tumour is described.
Histogenesis of salivary gland neoplasms: a postulate with prognostic implications
Authors: Batsakis John G. , Regezi Joseph A. , Luna Mario A. , El-Naggar Adel
Published: November 2007

In a continually renewing cell population, stem cells can be regarded as a reservoir of cells with a high capacity for self renewal that give rise to all differentiated progeny. They are the primary source for the generation and maintenance of cellular diversity and tissue homeostasis. In general, neoplasms manifest differentiation pathways similar to those found in the development and renewal of the normal tissues from which they arise. This feature serves as a basis for classification schemes of neoplasms and, as in the normal tissues, there is usually an inverse correlation between proliferative capacity and differentiation within the neoplasms. In our postulate of the histogenesis of salivary gland neoplasia, we evoke the stem cell model to account for the considerable phenotypic heterogeneity seen with these neoplasms. We further consider the neoplasms and, in particular, their myoepithelial constituencies to be manifestations of escape from normal regulatory mechanisms that determine differentiation pathways which a stem cell and its progeny can take. Clinical and basic scientific evidence are presented to support the postulate and also to point to the mitigating role that myoepithelial differentiation has in the biological course of salivary gland neoplasms.
Immunopathology of polymorphic reticulosis of the larynx
Authors: Nakashima Tadashi , Inamitsu Mayumi , Uemura Takuya , Sugimoto Takuya
Published: November 2007

We treated a 28-year-old woman with initial symptoms of hoarseness. At biopsy, atypical lymphoid cells infiltrate was observed in the submucosa of the larynx and polymorphic reticulosis was diagnosed. Immunohistochemical examination of the laryngeal material obtained at autopsy revealed a strong reaction of lymphoid cells to the monoclonal antibody to human T lymphocytes. The possibility that polymorphic reticulosis is a transitional form of peripheral T cell lymphoma was confirmed.
Pharyngeal cyst arising from second branchial cleft
Authors: Takimoto T. , Akemoto Y. , Umeda R.
Published: November 2007

A rare case of pharyngeal cyst arising from the second branchial cleft in a 14-year-old boy is described. A cyst located in the right posterolateral wall of the oropharynx was completely removed by an intraoral approach. Histopathological examination revealed that the cyst was lined with columnar (respiratory type) epithelium.
Pulsatile tinnitus and dural arteriovenous malformation
Authors: Morrison G. A. J.
Published: November 2007

An unusual case of a patient presenting with left sided pulsatile tinnitus is presented. This was later shown to be due to a dural arteriovenous malformation involving the lateral venous sinus. The diagnosis was suspected by the presence of a bruit over the mastoid process and confirmed by a CT scan and angiography. Management involved pre-operative embolisation and neurosurgical excision. The differential diagnosis of pulsatile tinnitus and the management of a dural arterio venous malformation is discussed.
Primary composite squamous cell carcinoma and large cell neuroendocrine carcinoma of the hypopharynx
Authors: Milroy C. M. , Robinson P. J. , Grant H. R.
Published: November 2007

Neuroendocrine carcinomas are rare neoplasms of the larynx and hypopharynx. Tumours composed of both neuroendocrine and Squamous cell elements are very rare. We report a case of a primary hypopharyngeal carcinoma composed of both squamous cell and large cell neuroendocrine carcinoma and discuss the treatment of this patient and management of neuroendocrine carcinomas of the larynx and hypopharynx.
Verification of a new test of endolymphatic hydrops
Authors: Thornton A. R. D. , Farrell G. , Phillips A. J. , Haacke N. P. , Rhys-Williams S.
Published: November 2007

A new objective test of endolymphatic hydrops has been described previously. The test uses auditory brainstem response (ABR) techniques to estimate the basilar membrane travelling wave velocity (TWV). The underlying hypothesis is that raised pressure in the scala media will lead to an increase in the stiffness of the basilar membrane and that this will give rise to a travelling wave velocity that is greater than normal.

It was considered that verification of the technique could be obtained by carrying out the new test before and during a glycerol dehydration procedure. Patients who required this procedure for verification of the diagnosis or as a prognostic indicator for sacculotomy, underwent the following tests. Prior to dehydration an audiogram, the ABR TWV test and a blood sample (for plasma osmolality) were taken. The patient was then given the appropriate amount of glycerol mixed with lemon juice and laid on a bed in a test room. The audiogram and a blood sample were repeated every hour and the ABR TWV test was repeatedly carried out every twenty minutes between the other tests.

Six of these procedures have been carried out. In five of them the 0.5 and 1kHz average threshold improved by at least 10dB and in all those cases the ABR TWV test showed an abnormal pre-dehydration result which moved towards the normal value following dehydration. One patient gave ABR TWV results that were within normal limits before and during the procedure and gave an audiometric change of only 5dB.

These data indicate that the ABR TWV test does detect endolymphatic hydrops. The additional hardware to carry out this test has been constructed and parallel clinical trials at IHR Southampton, Addenbrooke's Hospital, Cambridge, and Queen's Medical Centre, Nottingham, are in hand.
Acute and latent mastoiditis
Authors: Faye-Lund H.
Published: November 2007

The diagnosis ‘acute;’ mastoiditis is not an unambiguous entity. It contains both ‘classical’ and ‘latent’ mastoiditis. ‘Classical’ mastoiditis was often seen before the antibiotic era, had serious complications and was cured by mastoidectomy. After the introduction of antibiotics, the number of cases of ‘classical’ mastoiditis decreased and was replaced by a more prolonged condition called ‘latent’ mastoiditis. Lately in Oslo, we have seen an increase in numbers of ‘classical’ mastoiditis and at the same time a decrease in the incidence of ‘latent’ mastoiditis. A four year study of patients with ‘classical’ mastoiditis is described.
External rhinoplasty in the tropics
Authors: Baser Brajendra , Hiranandani Navin , Grewal D. S.
Published: November 2007

The thick oily and pigmented skin present in majority of tropical patients makes rhinoplasty challenging surgery. Rhinoplasty by the external approach though gaining increasing acceptance all over the world is yet to gain popularity in this country. Hypertrophied scars are not uncommon in coloured skin and the reluctance to give an external incision for a cosmetic procedure is natural. We started the external rhinoplasty approach with some reservations, however in a series of over seventy cases, no significant problem has been encountered, with the columellar scar. Accurate approximation of the columellar wound is probably a more important factor in wound healing than the skin colour. Our experience of external rhinoplasty is presented.
Aberrant intratympanic internal carotid artery: a Potentially hazardous anomaly
Authors: Jacobsson M. , Davidsson Å. , Hugosson S. , Tjellström A. , Svendsen P.
Published: November 2007

A case is presented of a 3-year-old girl with no previous history of ear disease or developmental defects who bled profusely upon (right) myringotomy. The haemorrhage could only be stopped with the aid of an ear insert and a nasopharyngeal balloon catheter. The balloon catheter was removed the following day but the girl had to use an ear insert for a total of 76 days following myringotomy because of repeated haemorrhage from the ear. The subsequent investigation using CT and angiography revealed an aberrant internal carotid artery in the middle ear.

It is concluded that the one most important factor in the handling of these cases is to be aware of the existence of aberrant internal carotid arteries and to have a high degree of suspicion when encountering any abnormal clinical or radiological findings which might point in the direction of vascular abnormalities. The failure to detect this condition before any surgical intervention on the affected ear can have disastrous consequences.

The method of choice in handling these cases is one of avoidance of middle ear manipulation in order not to cause haemorrhage from the aberrant artery.
Infective complications of brief nasotracheal intubation
Authors: Hariri M. A. , Duncan P. W.
Published: November 2007

Two cases are described where infective complications, namely nasal septal abscess and parapharyngeal abscess, occurred after short-term (less than one hour) nasotracheal intubation. These conditions are serious as they can be life-threatening and in one case led to permanent physical disfigurement.
Impedance tympanometry and the home environment in seven-year-old children
Authors: Strachan David P.
Published: November 2007

The distribution of tympanogram types among 872 seven-year-old children from a random population sample was related to 14 features of the home environment reported by parents in a questionnaire. Parental smoking was an important determinant of middle ear underpressure and effusion, and accounted for much of the associations observed with dampness, crowding and rented accommodation. Gas cooking was associated with a higher prevalence of effusion, but a lower prevalence of underpressure; this may deserve further study.

After adjustment for seasonal variation, tenure and household smokers, the weekly mean temperature in the bedrooms of 34 children with Type B tympanograms was 18.2°C, compared to 17.9°C for 190 children with Type A tympanograms. The equivalent figures for bedroom relative humidity were 51.8 percent and 52.7 per cent. It is unlikely that heating or ventilation of the home is an important determinant of middle ear effusion and underpressure in this age-group.
Resection of palatal tumours with the CO2 laser
Authors: Sutter R. , Grossenbacher R.
Published: November 2007

On the basis of the authors' experience with 20 patients, CO2 laser resection of palatal tumours has proved to be a good alternative to conventional surgical resection. The CO2 laser beam permits precise resection, due to only slight intra-operative bleeding coupled with use of the operating microscope. Wound healing is good and post-operative pain remarkably little.
Efficacy of fine needle aspiration cytology in the diagnosis of tuberculous cervical lymphadenopathy
Authors: Lau S. K. , Wei W. I. , Hsu C. , Engzell U. C. G.
Published: November 2007

The results of a consecutive series of 1,349 fine needle aspiration (FNA) biopsies from the head and neck region of 1,193 patients has been reviewed in order to evaluate the efficacy of this method in the diagnosis of tuberculous lymphadenopathy (TBLN). Of the 108 patients whose fine needle aspiration cytology (FNAC) showed granulomatous changes, 68 had subsequent surgery and histological confirmation of the cytological appearance. Sixty-three had TBLN, thus the specificity of FNAC was 93 per cent in diagnosing tuberculous related granulomatous lymphadenopathy. One false positive FNAC was reported histologically to be metastatic mucoepidermal carcinoma.

Of the 1,193 patients, 90 patients had subsequently TBLN confirmed histologically. Of these 90 patients, FNA from 69 showed granulomatous changes or acid fast bacilli (AFB), thus the sensitivity of FNAC in detecting tuberculous lymphadenopathy was 77 per cent. Fifty-two cytological smears were stained for acid fast bacilli. Nineteen (37 per cent) contained AFB. It is evident from this review that FNAC is an efficient way to detect cervical tuberculous lymphadenopathy.
Detection of extrinsic bronchial compression during foreign body removal by pulse oximetry
Authors: Morrissey M. S. C. , Venn P. J. H. , Chan H. Y. , Whittet H.
Published: November 2007

A case of stridor is described which was due to the presence of a foreign body in the larynx of an infant. Following partial removal, compression of the right main bronchus was detected because of continuing low arterial oxygen saturation. The use of pulse oximetry allowed this complication to be identified, and the advantages of this method of monitoring are discussed.
Pathology of the otic capsule
Authors: Milroy C. M. , Michaels L.
Published: November 2007

The otic capsule is unique in retaining calcified cartilage, known as globuli interossei, throughout life and shows changes consequently, which are peculiar to it. In Paget's disease of bone, the otic capsule appears resistant to involvement and this occurs with extensive disease at a late stage. In contrast, otosclerosis is a new bone formation of unknown cause that is limited to the otic capsule. In osteogenesis imperfecta, the poor formation of collagen leads to abnormally thin bony trabeculae with a poorly formed otic capsule. In osteopetrosis, the otic capsule is greatly expanded by increased globuli interossei, as a result of defective osteoclast function. When fractured the middle layer of the otic capsule does not form callus, but heals by fibrosis.
Hearing loss and Waardenburg's syndrome: Implications for genetic counselling
Authors: Newton Valerie
Published: November 2007

Ten families in which there were 79 individuals affected by Waardenburg's syndrome were examined for penetrance of sensorineural hearing loss and expressivity of the gene. There were 47 with Waardenburg syndrome Type 1 and 32 with Waardenburg syndrome Type II. Penetrance of senorineural hearing loss was calculated after exclusion of the probands and was found not to be significantly different between each syndrome type but to show marked interfamilial variation. A bilateral sensorineural hearing loss was present more frequently than unilateral with the proportion varying between families. Certain audiometric shapes were found to recur in the syndrome but, apart from possibly one asymmetric configuration, seem to have been described also in other conditions. The degree of hearing loss was very variable within and between families. The implications for genetic counselling are discussed and the advantages of basing risk factors upon individual families rather than syndrome types emphasized.
Rhinomanometry evaluation of the effects of pre- and post-operative SMR on exercise
Authors: Nofal Farhat , Thomas Michael
Published: November 2007

Nasal airway resistance due to uncomplicated DNS was examined in 43 patients, and the results compared with those obtained following corrective surgery. The patients were examined independently by the two authors using a strict examination protocol. Rhinomanometry was carried out pre- and post-operatively at rest and after exercise assessing the worst and the better breathing nostrils separately. The results show that both resting and post-exercise nasal resistance was reduced following septal surgery.
Radiation induced tumours of the Pharynx—can they be avoided?
Authors: Nigam A. , Campbell J. B. , Das Gupta A. R.
Published: November 2007

Three patients who developed a post-cricoid carcinoma 5–21 years after radiotherapy for carcinoma of the larynx are presented. These patients received radiotherapy when they were young. It is suggested that alternative forms of treatment, especially partial laryngectomy with the aid of a laser should be considered in the primary management of small tumours of the larynx of young patients.
Squamous liver matastases from a carcinoma arising within a pleomorphic adenoma of the parotid gland
Authors: Garth R. J. N.
Published: November 2007

A case of liver metastases from a squamous carcinoma arising within a pleomorphic adenoma is presented. The literature is reviewed and the clinical features, pathology and treatment of these tumours are discussed briefly.
Granular cell tumour of the larynx
Authors: Cree Ian A. , Bingham Brian J. G. , Ramesar Keith C. R. B.
Published: November 2007

A granular cell tumour may present as clinically innocuous lesions on the vocal cords and the diagnosis is usually made by histopathology. However, the granular cells characteristic of this tumour may not be obvious and accompanying epithelial hyperplasia may be interpreted by the pathologist as invasive squamous cell carcinoma. Good communication between pathologist and surgeon is required to ensure that clinically benign lesions on the vocal cords are not misdiagnosed. The diagnosis of granular cell tumour can be confirmed by immunocytochemical staining for S100 antigen.
Brainstem auditory evoked potential with increased stimulus rate in minor head trauma
Authors: Podoshin Ludwig , Ben-David Yaacov , Fradis Milo , Pratt Hillel , Sharf B. , Schwartz M.
Published: November 2007

Fifteen Minor Head Trauma patients were investigated by Brainstem Auditory Evoked Potentials at 10/s and 55/s stimulus rate. The results were compared with those of the same patients at a second examination, two months later, as well as with a matched normal control group. Increasing the stimulus rate in MHT patients caused a significant but reversible delay in the central conduction time. No significant difference was found regarding the interpeak latency differences at a 10/s stimulus rate. The present study suggests that the primary lesion in MHT is ischaemic, affecting synaptic efficiency, and not axonal damage. These findings may be informative on the as yet obscure pathophysiological mechanism of minor head trauma.
Osteoradionecrosis of the mandible: Study of 104 cases treated by hemimandibulectomy
Authors: Koka V. N. , Deo R. , Lusinchi A. , Roland J. , Schwaab G.
Published: November 2007

One hundred and four cases of osteoradionecrosis (ORN) of the mandible following irradiation of head and neck cancer are reported.

Conservative management for ORN failed in all cases. Indications of hemimandibulectomy included intractable pain, severe trismus, pathological fracture, oro-cutaneous fistula and persistent exposure of bone.

Surgical approach was intra-oral in 100 cases and extra-oral in four. Immediate soft tissue reconstructions were carried out in 20 per cent cases. Post-operative complications included minor sepsis (8.6 per cent), major sepsis (2.9 per cent), haemorrhage (2.9 per cent) and fistula (3.8 per cent). Major complications occurred only in patients treated exclusively by external irradiation at doses equal to or higher than 65 Gy.

Relief from pain and trismus was obtained and normal swallowing was established following radical surgery.
Epistaxis: anatomical and clinical correlates
Authors: Padgham Nigel
Published: November 2007

One hundred and seven consecutive patients with acute and chronic epistaxis were examined to identify the site and nature of the source. Aetiological factors in the history, nasal anatomy or pathology were noted, along with the blood pressure and laboratory results.

In most presentations an anterior bleeding point was isolated. Cautery usually sufficed in both anterior and posterior sources. No source was hidden behind a septal spur or deflection. Hypertension was associated with bleeding from the middle meatus, but not with the severity of bleeding. Patients on antihypertensive medication were more likely to be admitted.

Point sources of bleeding were from prominent vessels or haemorrhagic nodules; the latter are not well recognized and are easily overlooked.

Routine blood tests did not reveal unsuspected abnormalities or change management; neither did sinus X-rays.

Initial examination of the nose in the acute phase by experienced personnel is suggested, to reduce admissions and avoid nasal packing.
Well-differentiated intra-osseous osteosarcoma in the mandible of a six-year-old child
Authors: James P. L. , O'regan M. B. , Speight P. M.
Published: November 2007

The case of an osteosarcoma arising in the mandible of a six-year-old child is presented. It was originally misdiagnosed as a desmoplastic fibroma, and after initial curettage continued to grow for twelve years. The differential diagnosis is presented and details of the surgical access and difficulties encountered in the surgical removal of this very large tumour are described.

The relationship between pre-existing disease and osteosarcoma of the mandible is discussed, and the difficulties experienced in distinguishing between the fibro-osseous lesions and osteosarcoma of the mandible are highlighted.

The case is presented as a well-differentiated, intra-osseous osteosarcoma with subsequent transformation into a high-grade, conventional osteosarcoma.