Laryngeal fracture caused by a lacrosse ball

Neck injuries in lacrosse are rare and mostly involve the musculoskeletal system. The lacrosse ball is a solid rubber ball of approximately 20 cm in diameter and the fastest shot recorded in professional lacrosse is over 100 mph. Despite wearing full protection, the neck remains prone to blunt trauma by this ball. A 23-year man sustained a direct blow to his left neck by a lacrosse ball during play, resulting in immediate aphonia and stridor. CT scan confirmed a left thyroid lamina fracture. The patient was treated conservatively and his airway was monitored for 24 hours. He made a full recovery. It is important that lacrosse players should be aware of this potential injury and appropriate precautions should be taken to avoid this trauma

Severe hypo-osmotic hyponatraemia due to chylous leak following radical neck dissection

Chylous leak is a documented complication of radical neck dissection with well recognised morbidities, including wound breakdown, hypovolaemia and hypoalbuminaemia. Other less well-documented electrolyte imbalances can also ensue. We aim to raise awareness about hypo-osmotic hyponatraemia as a potentially fatal, commonly overlooked complication of high-output chylous leaks. Following identification of his hyponatraemia, this patient underwent successful management in the intensive therapy unit, followed by surgical repair of his chylous leak. Hypo-osmotic hyponatraemia as a complication of chylous leak is not well documented, is likely to be overlooked when present, and is potentially life-threatening. It should be sought after in any patient with a high-output chylous leak following neck dissection

Unilateral pupillary dilatation following septoplasty: cause for concern?

We report and explain unilateral pupillary dilatation following routine septoplasty and trimming of inferior turbinates. The unilateral pupillary dilatation was caused by inadvertent instillation of sympathomimetic, [xylometazoline hydrochloride] in the eye during preparation for nasal surgery. The effect was short-lived and the patient made a full recovery. Unilateral pupillary dilatation after sinonasal surgery can be alarming due to the possibility of injury to the globe and intracranial haemorrhage but can also be explained by the mydriatic effect of the sympathomimetic nasal drops and sprays used to decongest the nose. Such possibility should be borne in mind and would help to explain and reduce the anxiety and avoid unnecessary investigations

Coblation adenotonsillectomy in children

To determine re-admission rate for post-tonsillectomy pain; the primary and secondary post-tonsillectomy bleeding rate; the percentage requiring control of post-tonsillectomy bleeding in children undergoing coblation tonsillectomy. A descriptive study. Royal Hospital for Sick Children [Yorkhill Hospital] between 2004 and 2006. All patients who underwent tonsillectomy with or without adenoidectomy by coblation technique. Patients were identified from operation theatre log book and electronic data base of theatre activity. The hospital case notes were reviewed retrospectively to collect data, regarding demographics, indication and type of surgery, grade of operating surgeon, duration of hospital stay, re-attendance and re-admission, and management of complications. A total of 106 children; males [n = 53, 50%], females [n = 53, 50%] with a mean age 6.3 years underwent surgery using coblation technique. Thirty-one percent had a tonsillectomy while 69% underwent an adenotonsillectomy. Of these, 48% had history of recurrent tonsillitis, 43% had obstructive sleep apnoea and 9% suffered predominantly from obstructive symptoms. Eighty-two percent of patients were discharged on the first postoperative day. Only one patient had primary bleeding requiring re-operation. After discharge, 7 patients [6.7%] were re-admitted with secondary bleeding, 3 [2.8%] of whom were taken back to theatre to control the bleeding under general anaesthesia. Coblation tonsillectomy is a useful technique in having a low primary and secondary bleeding rates in children undergoing tonsillectomy and adenotonsillectomy

Tuberculosis with secondary vasculitis presenting as a nasal septal perforation

A 45 years old man with tuberculosis [TB] and secondary vasculitis presented with perforation of the nasal septum, involving skin and cranial nerves. Vasculitis is a recognized, tough rare complication of tuberculosis and has not been previously described in the literature as a cause of nasal septal perforation. It presents a diagnostic dilemma. The diagnostic challenges of this case are outlined, and the clinical implications are discussed

Transanal small bowel evisceration following digital reduction of a chronically prolapsing rectum

Evisceration of the small bowel through a rectal perforation is rare. This is the case of a 66 year-old female presenting to the Accident and Emergency Department with transanal evisceration of her small bowel resulting from attempted digital reduction and subsequent tear of her chronically prolapsing rectum. Reduction of the prolapsed small bowel and primary repair of the rectal tear were carried out at laparotomy. The management of this case is discussed

Call-fleming syndrome: an extraordinary complication of tonsillectomy

A 36 years old woman underwent tonsillectomy for recurrent tonsillitis. At about one week in the postoperative period, she developed sudden onset severe [[thunderclap]], recurrent headaches and focal neurological signs including visual disturbances, ataxia and myoclonic jerks. Serial imaging with MRI, MRA and CT angiography revealed reversible white matter focal edema and segmental cerebral vasoconstriction. A diagnosis of Call-Fleming syndrome was made based on her symptoms and imaging findings, and she was started on nimodipine. She made a slow recovery but still has slight unilateral foot drop even 12 months since the initial event. This is the first case of Call-Fleming syndrome occurring following an ENT procedure