Novel technique using tensor fascia lata graft to reconstruct a floor of mouth postablative defect from invasive ectopic papillary carcinoma of the thyroglossal duct tract.

We describe a rare case of ectopic papillary thyroid cancer in the thyroglossal duct tract invading the floor-of-mouth musculature. The postablative defect was reconstructed with a bone-anchored tensor fascia lata graft to resuspend the floor of mouth to the mandible as a neogeniohyoid sling, enabling maintenance of a functional tongue position for normal speech and swallowing. This reconstruction should be considered when suprahyoid musculature is resected without breaching the oral lining.

A novel airway management strategy for cervical necrotising fasciitis secondary to Bezold's abscess.

We describe a rare case of cervical necrotising fasciitis caused by mastoiditis and Bezold's abscess. This case was complicated by a tracheostomy delaying wound healing. A novel strategy to repair the tracheotomy defect using Permacol™, an acellular porcine dermal substitute, and a local muscle flap not previously reported in the literature is described to allow the use of negative pressure wound therapy dressing. This technique may be employed in similar applications for non-healing tracheotomy wounds.

Drug delivery to the ear.

Drug delivery to the ear is used to treat conditions of the middle and inner ear such as acute and chronic otitis media, Ménière's disease, sensorineural hearing loss and tinnitus. Drugs used include antibiotics, antifungals, steroids, local anesthetics and neuroprotective agents. A literature review was conducted searching Medline (1966-2012), Embase (1988-2012), the Cochrane Library and Ovid (1966-2012), using search terms 'drug delivery', 'middle ear', 'inner ear' and 'transtympanic'. There are numerous methods of drug delivery to the middle ear, which can be categorized as topical, systemic (intravenous), transtympanic and via the Eustachian tube. Localized treatments to the ear have the advantages of targeted drug delivery allowing higher therapeutic doses and minimizing systemic side effects. The ideal scenario would be a carrier system that could cross the intact tympanic membrane loaded with drugs or biochemical agents for the treatment of middle and inner ear conditions.

Closed suction drains, reinfusion drains or no drains in primary total knee replacement?

INTRODUCTION: Controversy still surrounds the use of drains after total knee replacement (TKR). We compared closed suction drains, reinfusion drains and no drains by studying haemoglobin (Hb) levels, blood transfusion requirements and functional knee outcome scores in a single surgeon series. METHODS: A total of 102 consecutive primary TKRs were performed by the senior author between September 2006 and July 2008. All were cemented fixed bearing devices with patellar resurfacing. Of the 102 patients, 30 had closed suction drainage, 33 had an unwashed reinfusion drainage system and 39 had no drains. Data regarding pre and post-operative Hb and units transfused were gathered retrospectively. Pre and post-operative American Knee Society scores (AKSS) and Oxford knee scores (OKS) were recorded prospectively. RESULTS: The pre-operative Hb levels were comparable among the groups. There was no statistically significant difference in Hb level reduction or autologous transfusion rates among the groups. Pre-operative AKSS and OKS were statistically comparable in each group. There was no statistical difference between the improvement in AKSS knee and function scores in all three groups. There was a slightly smaller improvement in the OKS of the 'no drain' group. There were no complications of drain usage and no deep infections. No patient required manipulation under anaesthesia and range of movement outcomes were the same for each group. CONCLUSIONS: Our study does not support the use of either closed suction drains or reinfusion drains in primary elective TKR.

Tuberculous cervical lymphadenitis in a patient with laryngeal carcinoma.

OBJECTIVE: We report an extremely rare presentation of concomitant tuberculous cervical lymphadenitis in a patient with carcinoma of the larynx. CASE REPORT: A 66-year-old man presented with a nine-month history of hoarseness. He was found to have an exophytic lesion over the posterior half of the right vocal fold. He also had a palpable right jugulodigastric node. Biopsy of the vocal fold lesion revealed invasive squamous cell carcinoma. Histological analysis of an excision biopsy specimen from the lymph node was highly suggestive of tuberculosis. On further assessment of the slides, one acid-fast bacillus was seen. The patient was treated with radiotherapy to the larynx and concomitant anti-tuberculosis chemotherapy. Five months following treatment, there was no sign of laryngeal cancer recurrence; however, the patient continued to have a productive cough and night sweats. CONCLUSION: To our knowledge, this is the first report of a laryngeal carcinoma with concurrent tuberculous cervical lymphadenitis. In the face of an unhelpful fine needle aspiration cytology examination, an assumption of metastatic neck disease could have been made. Subsequent surgical and/or oncological intervention would have been highly inappropriate, with potentially catastrophic effects. This case highlights the importance of proper diagnosis, and emphasises the fact that tuberculosis should always be borne in mind in the differential diagnosis.

Chronic sinusitis and bilateral deafness as a presentation of oesophageal stent failure: case report.

OBJECTIVE: We report an extremely rare upper airway complication of oesophageal stent failure. CASE REPORT: A 58-year-old woman presented four months after having a covered (anti-reflux valve type) oesophageal stent placed for a benign oesophageal stricture. Abdominal radiography showed a broken fragment at the gastroesophageal junction and another fragment in the rectum. On presentation, the patient had pneumonia with sepsis which required intensive care management. After recovery, she developed sinus symptoms of facial pain, green nasal discharge and bilateral hearing loss. ENT review revealed bilateral otitis media with effusion. Flexible naso-endoscopy found a stent fragment lodged in the nasopharynx. The wire mesh fragment was removed under general anaesthetic and bilateral grommets inserted. The patient's symptoms resolved. CONCLUSIONS: To our knowledge, this is the first report in the world literature of a broken and migrated oesophageal stent presenting with chronic sinusitis and bilateral hearing loss. This case highlights the importance of examining the upper airways in such cases, and the need for further, long term studies of the complications of metallic, expandable stents.

Oral hygiene levels and periodontal disease prevalence among residents with mental retardation at various residential settings.

This pilot study compared oral hygiene levels and periodontal disease prevalence among residents with mental retardation in a large traditional state institution, a small regional facility, and community group homes. Plaque scores and periodontal disease levels were high in all groups. However, there was a significant difference (P less than 0.05) among the group home residents, who had lower scores, than the other groups. These results indicate that preventive dental programs are necessary in new residential settings for individuals with mental retardation.

Muscarinic receptors of rat parotid gland enlarged by gland ablation and bulk diet. Effects of denervation.

The density of muscarinic binding sites was increased 10% in the rat parotid gland enlarged (2 times control) as a result of ablation of the submandibular-sublingual glands and maintenance of rats on bulk diet (50% inert cellulose plus 50% solid chow) for 4 weeks. When either the parasympathetic or sympathetic innervation to the gland was unilaterally removed at the time of submandibular-sublingual ablation and introduction of the bulk diet, the density of muscarinic receptors showed an even greater increase from levels of innervated glands of chow-fed controls (29%); with removal of both nerves, the increase was 39%. A 36% increase in cyclic guanosine monophosphate levels accompanied the increase in receptors of the enlarged gland, but when the parotid was denervated, there was no change in cyclic GMP. Absence of either or both nerves led to a maximal decrease of 24-29% in density of muscarinic receptors of parotid gland of chow-fed controls, but to no change in cyclic GMP levels. While autonomic influences mediate the changes in density of muscarinic receptors of parotid gland of chow-fed rats, some additional factor is apparently involved in their increase in the enlarged gland.

Neural and dietary modulation of proline-rich protein and 4 beta-galactosyltransferase biosynthesis in rat parotid glands.

Maintenance of rats on a bulk diet (50 per cent inert cellulose and 50 per cent laboratory chow) before or after the removal of the submandibular-sublingual glands resulted in hypertrophy of the parotid gland, and the induction of basic proline-rich proteins in that gland with apparent molecular weights similar to those found after chronic administration of isoproterenol. Surgical removal of either the sympathetic or parasympathetic nerve, or of both, impeded both gland hypertrophy and the gene expression for proline-rich protein in the denervated gland. Rats fed normal chow did not have induction of these proteins in the innervated control parotid nor in the denervated contralateral gland. The experimental regimen also showed in-vitro translation of mRNA with electrophoretic protein patterns similar to those with isoproterenol treatment. There was also increased synthesis of the enzyme 4 beta-galactosyltransferase (EC 2.4.1.38).