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The Journal of laryngology and otology [journal]
- Modified midfacial translocation for access to ventral skull base tumours. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 29.:1-7.
Objective: To describe our technical modifications of midfacial translocation for access to the nasopharynx, and anterior, central and lateral skull base. Design: Retrospective chart review of a prospective case series. Setting: Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, Scotland, UK. Methods: Along with demographics, other parameters studied were adequacy of exposure, completeness of resection, aesthetic outcome and complications. Our main outcome measures included adequacy of exposure, partial or total resection of tumour, aesthetic outcome, and complications related to surgical technique. Results: A total of 48 patients underwent modified midfacial translocation at our institution for nasopharyngeal, parapharyngeal, and anterior, central and lateral skull base tumours. In all cases, the exposure was deemed to be adequate. Two patients developed wound dehiscence in previously irradiated fields. Other incisions healed very well and the aesthetic outcome was regarded as satisfactory. Conclusion: Modified midfacial translocation is based on the principle of temporary craniofacial disassembly for access to the skull base. Our modifications offer adequate access and a better aesthetic outcome. All incisions are placed through the aesthetic sub units of the nose with preservation of the lip. Preservation of the bony piriform aperture prevents airway compromise.
- Radiofrequency dissection versus 'knot tying' in conventional total thyroidectomy. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 29.:1-6.
Objective: To evaluate the safety and effectiveness of radiofrequency dissection in conventional 'open' total thyroidectomy. Methods: Thirty-nine patients scheduled for conventional total thyroidectomy were included in a prospective randomised study. Patients were randomly assigned to one of two groups: a radiofrequency dissection method was used in one group, and a knot tying technique was used in the other. Results: Significantly fewer surgical instruments and materials were required for the radiofrequency dissection group than the knot tying group (p < 0.01). There were no significant differences between the two groups in mean operative time, blood loss, post-operative drainage and pain, recurrent palsy, and hypocalcaemia (p > 0.05). Conclusion: Radiofrequency dissection is a safe alternative to the knot tying technique, and enables a significant reduction in the number of surgical instruments required for the operation.
- Intra-operative monitoring of the spinal accessory nerve: a systematic review. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 29.:1-6.
Objective: To investigate evidence that intra-operative nerve monitoring of the spinal accessory nerve affects the prevalence of post-operative shoulder morbidity and predicts functional outcome. Methods: A search of the Medline, Scopus and Cochrane databases from 1995 to October 2012 was undertaken, using the search terms 'monitoring, intra-operative' and 'accessory nerve'. Articles were included if they pertained to intra-operative accessory nerve monitoring undertaken during neck dissection surgery and included a functional shoulder outcome measure. Further relevant articles were obtained by screening the reference lists of retrieved articles. Results: Only three articles met the inclusion criteria of the review. Two of these included studies suggesting that intra-operative nerve monitoring shows greater specificity than sensitivity in predicting post-operative shoulder dysfunction. Only one study, with a small sample size, assessed intra-operative nerve monitoring in neck dissection patients. Conclusion: It is unclear whether intra-operative nerve monitoring is a useful tool for reducing the prevalence of accessory nerve injury and predicting post-operative functional shoulder outcome in patients undergoing neck dissection. Larger, randomised studies are required to determine whether such monitoring is a valuable surgical adjunct.
- Does the human immunodeficiency virus influence the vestibulocollic reflex pathways? A comparative study. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 28.:1-8.
Background: This study compared vestibulocollic reflex and vestibulo-ocular reflex functioning in subjects with and without human immunodeficiency virus. It also described test results throughout progression of the disease and compared the results of human immunodeficiency virus positive subjects who were receiving antiretroviral therapies with those not receiving this treatment. Methods: Subjects comprised 53 adults with human immunodeficiency virus (mean age 38.5 ± 4.4 years) and 38 without human immunodeficiency virus (mean age 36.9 ± 8.2 years). Clinical examinations included cervical vestibular-evoked myogenic potential and bithermal caloric testing. Results: Abnormal cervical vestibular-evoked myogenic potential and caloric results were significantly higher in the human immunodeficiency virus positive group (p = 0.001), with an odds ratio of 10.2. Vestibulocollic reflex and vestibulo-ocular reflex involvement increased with progression of the disease. There were more abnormal test results in subjects receiving antiretroviral therapies (66.7 per cent) than in those not receiving antiretroviral therapies (63.6 per cent), but this difference was insignificant. Conclusion: Human immunodeficiency virus seems to influence vestibulocollic reflex pathways. Combining cervical vestibular-evoked myogenic potential and caloric testing may be useful to detect early neurological involvement in human immunodeficiency virus positive subjects.
- Endoscopic approaches to benign sphenoid sinus lesions: development of an algorithm based on 13 years of experience. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 28.:1-6.
Objective: To develop an algorithm for selecting the optimal endoscopic approach for benign sphenoid lesions. Methods: Charts of 392 patients were reviewed and categorised according to disease nature and extent as follows: group 1 comprised isolated sphenoid sinus lesion cases, group 2 consisted of pansinus lesion cases and group 3 comprised lateral sphenoid recess lesion cases. Surgical approaches, difficulties and complications were noted. Results: A transnasal approach was employed in 40.8 per cent of cases (23.2 per cent were group 1 patients, 16.1 per cent were group 2 patients and 1.5 per cent were group 3 patients), a transethmoidal approach was utilised in 54.3 per cent of cases (group 2 patients) and a transpterygopalatine fossa approach was selected in 4.9 per cent of cases (group 3 patients). Surgical difficulties were encountered in 11.9, 10.8 and 0 per cent of patients in whom transnasal, transethmoidal or transpterygopalatine approaches were utilised, respectively. Conclusion: Radio-pathological categorisation provided a means of developing an algorithm for selecting the most appropriate endoscopic approach. Transnasal sphenoidotomy should be the first choice of approach whenever applicable. Lateral sphenoid recess non-inflammatory diseases should be managed through a transpterygopalatine fossa approach. Revision surgery does not play a key role in the algorithm.
- Progressive, reversible sensorineural hearing loss caused by azathioprine. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 28.:1-3.
Objective: This paper describes the first reported case of progressive sensorineural hearing loss caused by azathioprine, which was reversed on stoppage of the drug. Case report: A female patient with previously normal hearing presented with progressive sensorineural hearing loss after being started on azathioprine. Otological and neurological examination findings were unremarkable. After stopping the drug, the patient reported an improvement in hearing, which was confirmed on pure tone audiometry. Conclusion: This previously unreported side effect of azathioprine is highlighted in order to increase clinical awareness. Early recognition of this adverse effect is important to minimise the possibility of permanent sensorineural hearing loss.
- Does pterygopalatine canal injection with local anaesthetic and adrenaline decrease bleeding during functional endoscopic sinus surgery? [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 28.:1-4.
Objective: To determine the effect of pterygopalatine fossa injection with xylocaine and adrenaline on: surgical field bleeding and blood loss during functional endoscopic sinus surgery for chronic rhinosinusitis, and the duration of the procedure. Methods: A prospective, single-blinded, controlled trial was performed in a tertiary care academic centre. A total of 45 patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis, whose disease was symmetrical based on computed tomography grading, were included. A unilateral pterygopalatine fossa injection with 1 per cent xylocaine and 1:100 000 adrenaline was performed after the induction of anaesthesia. The contralateral side served as the control. The operating surgeon, who was blinded to the injected side, assessed the surgical field using a validated six-item grading system. Blood loss, blood pressure, heart rate and end-tidal carbon dioxide were recorded every 15 minutes for each side separately, and duration of surgery was noted. Results: There was no statistically significant difference in the surgical field grade between the injected and non-injected sides (p = 0.161). There were no differences in blood loss or duration of surgery. Conclusion: Pterygopalatine fossa injection prior to functional endoscopic sinus surgery did not decrease intra-operative surgical field bleeding, blood loss or duration of surgery.
- Endoscopy findings affect subjective smell rehabilitation in post-laryngectomy patients using the nasal airflow-inducing manoeuvre. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 28.:1-4.
Objective: To evaluate the characteristics of post-laryngectomy patients, including nasal endoscopy findings, that affect subjective smell improvement in the post-surgical period. Methods: Thirty patients who had undergone total laryngectomy participated in at least three sessions of a smell rehabilitation programme involving the nasal airflow-inducing manoeuvre, under the supervision of a speech-language pathologist. Patient characteristics and nasal endoscopy findings were evaluated. Results: Participants experienced a mean improvement in sense of smell of 61 per cent (p < 0.001) and a significant improvement in appetite (p = 0.002). Male patients and patients with a nasal discharge had a significantly better outcome. Conclusion: The nasal airflow-inducing manoeuvre is an effective method for improving smell perception and appetite in laryngectomy patients. There was no relationship between nasal endoscopy findings and outcome of the nasal airflow-inducing manoeuvre rehabilitation programme in our case series.
- Immunoglobulin G4 related disease isolated to the nasal cavity: a rare cause of nasal obstruction. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 27.:1-3.
Background: Immunoglobulin G4 related disease is a rare condition. Cases involving the sinonasal region are exceptionally uncommon. This paper describes a case of immunoglobulin G4 related disease isolated solely to the nasal cavity. Methods: Case report and literature review. Results: A 34-year-old man presented with painless, progressive bilateral nasal obstruction. Clinical examination and imaging findings demonstrated bilateral submucosal swelling of the anterior septum and right external nasal wall. Biopsy revealed immunoglobulin G4 related disease. The patient responded to oral corticosteroids initially, followed by long-term methotrexate. Conclusion: To the best of our knowledge, this case represents the first report in the literature of immunoglobulin G4 related disease isolated solely to the nasal cavity.
- High jugular bulb in a cohort of patients with definite Ménière's disease. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Aug 27.:1-6.
Objective: To determine the incidence of high jugular bulb in a group of patients with definite Ménière's disease, and to investigate whether the position or size of the jugular bulb is significantly different in the affected ear than in the unaffected ear. Methods: Retrospective review of patient charts, audiograms, and computed tomography scans to determine the position and size of the jugular bulb in the affected and contralateral ears, as well as other abnormalities. Results: High jugular bulb was found in 57.1 per cent of affected ears. Encroachment of the cochlear and vestibular aqueducts was apparent in 39.3 per cent and 35.7 per cent, respectively, of affected ears. Diverticulum and dehiscence were observed in 28.6 per cent of affected ears. High jugular bulb was significantly associated with encroachment of the cochlear aqueduct (p = 0.003). Conclusion: The mediolateral and anteroposterior position of the jugular bulb determines encroachment of the surrounding structures. An abnormal position is postulated to contribute to the development of Ménière's disease.