Melon-sized Parotid Pleomorphic Adenoma-A Case Report

This case report describes a 55 year-old gentleman who had been living with an extremely large (1.2 kg) pleomorphic adenoma for 24 years-despite its significant size, weight and appearance. A modified surgical incision and approach were required to remove the tumour, to avoid damaging the facial nerve and its branches.

Short-term results of endonasal dacryocystorhinostomy with a mucosal flap and a bone dissection technique

OBJECTIVE

To determine the short-term results of endonasal dacryocystorhinostomy (DCR) with a mucosal flap and a bone dissection technique.

MATERIALS AND METHODS

A retrospective study including consecutive 22 patients who underwent endonasal DCR between June 2004 and January 2006. The study was designed to look at the patients' symptoms and satisfaction following the procedure; hence, a telephone survey was undertaken. The absence or improvement of symptoms was defined as a successful outcome.

RESULTS

There were 22 patients in the study cohort. The mean follow-up was 12 months. The procedure was successful in 20 patients (90.9%), with no residual epiphora. Failure was noted only in 2 patients.

CONCLUSION

The short-term success rate of endonasal DCR was 90.90%. In a previous study from our unit, the success rate with endonasal laser DCR at 1 year was 83% and the 5-year success rate was only 56%, which made us stop doing the laser approach. We currently favour endonasal DCR with the mucosal flap approach in our unit.

Ossiculoplasty: a UK survey

The aim of this study was to assess and quantify the current surgical practice of ossiculoplasty among British otolaryngology consultants, using a postal questionnaire. Ossiculoplasty is not a very common procedure. It is only performed by otologists with a special interest in ossiculoplasty. Among the 280 respondents (response rate 51.9 per cent), only 179 (63.9 per cent) performed ossiculoplasty. The majority of the consultants (86.5 per cent) used artificial prostheses, and 63.7 per cent used patients' own ossicles (autografts). Most of the consultants (77.6 per cent) performed ossiculoplasty with primary tympanoplasty surgery rather than with primary cholesteatoma surgery (46.3 per cent). The majority of the consultants (50.8 per cent) performed less than 10 ossiculoplasties per year.

This is the first survey on ossiculoplasty surgery in the United Kingdom.

Immunotherapy for allergic rhinitis – a United Kingdom survey and short review

Allergic rhinitis (AR) is a common condition which is treated using different modalities, including immunotherapy. The aim of this study was to survey the current management strategies among ENT consultants in the UK in treating AR, and their views on immunotherapy. The study design was a postal questionnaire survey and the setting a university teaching hospital. Participants were consultant members of the British Association of Otolaryngologists – Head and Neck Surgeons (BAO-HNS). The main outcome measures were common treatment modalities adopted by the survey group to treat AR, and the number of consultants practising immunotherapy. The majority (81.1 per cent) of the consultants surveyed practise medical therapy with or without surgery. Immunotherapy is advised by 26 per cent of ENT consultants, but only 6.6 per cent currently administer immunotherapy.

Blunt laryngeal trauma resulting in arytenoid dislocation and dysphonia

We present a case of left arytenoid dislocation due to blunt laryngeal trauma causing a subsequent large granuloma formation resulting in dysphonia and stridor. The patient underwent emergency excision of the obstructive granuloma and speech therapy was started post-operatively. A few weeks after surgery, the granuloma started to recur and laryngeal manipulation by a specialist osteopath was performed. A few weeks after the conservative management, the recurred granuloma resolved completely and patient's voice improved remarkably. Dislocation of the arytenoid cartilage due to blunt trauma is relatively rare and a consequent spontaneous granuloma formation has not been reported so far in the literature. This is also the first report about efficacy of speech therapy combined with laryngeal manipulation in the management of the arytenoid dislocation and the subsequent laryngeal granuloma.

An unusual case of primary extranodal non-Hodgkin's lymphoma in the muscles of facial expression

Primary extra-nodal non-Hodgkin's lymphoma (NHL) of the skeletal muscles is a well recognized entity although such occurrences are not very common. Presentation in the muscles of the face has only rarely been described. We present a case of primary extra-nodal NHL in a non-immunocompromised patient involving only the muscles of facial expression and not extending to the oral cavity or sinonasal tract. The patient was subsequently treated with chemotherapy and at the time of writing remained in remission. We suggest that lymphoma should be considered among the causes for malignant infiltration of the muscles of the face.

Role of revision adenoidectomy in paediatric otolaryngological practice

Objectives: We aimed to determine the need for revision adenoidectomy following the standard technique of blind curettage with digital palpation.

Methods: Within a district general hospital, we undertook a retrospective study of 3231 children who underwent adenoidectomy between 1996 and 2003, 53 of whom required revision adenoidectomy. The main outcome measure was the number of children needing revision adenoidectomy.

Results: A total of 53 children required a repeated operation for recurrence of symptoms (1.6 per cent); of these, 42 were for treatment of glue ear, five were for nasal symptoms and six were for adenoidal infection.

Conclusion: Adenoidectomy performed without vision may be one of the reasons for recurrence of symptoms. Residual adenoids are acknowledged in the literature as one of the complications of the traditional technique. We highlight the fact that the need for revision adenoidectomy is not uncommon and suggest that we should improve our surgical technique in the UK by visualization of the postnasal space either by a mirror or an endoscope.

Management of nasal injuries: a postal questionnaire survey of UK ENT consultants

Nasal injuries are one of the commonest conditions seen in ENT out-patients. There is no uniform policy or protocol for the management of this condition. A postal questionnaire was sent to all UK-based ENT consultants. The aim of this study was to ascertain current practice in the management of this common problem. We were also interested to know if consultants believed that the septum should be addressed and dealt with at the same time as manipulation to improve cosmetic and functional results. Manipulation of nasal bones without anaesthesia, under local anaesthesia, and general anaesthesia with digital pressure or using instruments are all practised. The digital pressure under general anaesthesia with use of septal and nasal forceps, if needed, is practised by the majority of consultants (55.8 per cent). Only a minority considered the role of the septum to be important in the initial management of the patient.

Impacted foreign body in the hypopharynx and oesophagus

We report a rare case of an unusual impacted foreign body (titanium mesh stent) in the hypopharynx and upper oesophagus of a 66-year-old gentleman. He was a known patient with carcinoma of the mid-oesophagus admitted under the gastroenterologists for dilatation of the carcinomatous stricture with a stent. During the procedure the titanium mesh spring coil got displaced and was impacted in the retropharyngeal space, submucosally in the hypopharynx and upper oesophagus. He was referred to us for surgical removal of the stent, which he underwent successfully. We believe this to be the first case of such an unusual foreign body to be reported in the literature.

Focal myositis of the neck with idiopathic orbital myositis

Focal myositis (of Heffner) in the right trapezius and paraspinal muscles accompanied by a pseudotumour of the left orbit has not been reported previously. The clinical, pathological and radiological features of these unusual benign pseudotumours of the head and neck are discussed. Computerized tomography (CT) scan of the neck and orbital ultrasound were suggestive of an inflammatory process without an abscess formation. This was followed by fine needle aspiration cytology (FNAC), which confirmed the diagnosis. The patient was treated with intravenous steroids and antibiotics, that led to complete resolution of symptoms, and there was no recurrence at six months follow-up. This report highlights the importance of imaging in inflammatory neck swellings.