Sphenoid sinus barotrauma after free diving.

We report 2 cases of a 29- and a 37-year-old male patient both having sphenoid sinus barotrauma associated with free diving at about 12-m depth. A unilateral occupation of the sphenoid sinus was revealed in both cases by computed tomography and magnetic resonance imaging examination of the paranasal sinuses.

Lidocaine spray vs tetracaine solution for transnasal fiber-optic laryngoscopy.

STATEMENT OF PROBLEM: The aim of this study was to evaluate the efficacy of lidocaine spray 10%, compared with tetracaine 2% solution, as a local anesthetic for patients undergoing transnasal fiber-optic laryngoscopy. METHOD OF STUDY: A prospective study was conducted on patients undergoing transnasal fiber-optic laryngoscopy. Microsurgical sponges were applied in each side of the nose for 10 minutes before laryngoscopy. Patients were randomly classified into group A and group B, in which tetracaine 2% solution and lidocaine spray 10% were used, respectively. Patients were asked to evaluate the severity of pain during the procedure by a visual analog scale. Patients data, pain score, and potential complications were placed in a database and statistically assessed. MAIN RESULTS: Our series consisted of 48 patients. Statistical analysis showed significant lower mean nasal discomfort score in favor of the tetracaine group (2.29 vs 3.04 [P < .001]). No tetracaine complications or side effects occurred. PRINCIPAL CONCLUSION: Neurosurgical sponge application of tetracaine 2% solution is an easy, safe, inexpensive, and effective analgesia for transnasal fiber-optic laryngoscopy.

Anaphylactic reactions on the beach: a cause for concern?

BACKGROUND: The commonest causes of anaphylaxis include hymenoptera bites, high-risk food, exercise, and jellyfish bites and may often be encountered on the beach. Therefore, millions of visitors at popular touristic locations are exposed to increased risk of anaphylactic reactions every year. At least 35 cases of acute allergic reactions requiring medical attention took place on the beaches of Crete, Greece during the previous summer. OBJECTIVE: To evaluate the level of training of lifeguards working on the beaches of the island of Crete, Greece, with regard to emergency management of anaphylaxis as well as to assess the sufficiency of medical equipment that lifeguards possess to treat an anaphylactic reaction. METHODS: A questionnaire was prepared by the authors and administered to 50 lifeguards working on various beaches of Crete. Queries included the definition of anaphylaxis, proper medical treatment, and the existence or not and composition of an emergency kit with regard to the management of acute allergic reactions. RESULTS: Our series consisted of 50 lifeguards, 39 (78%) male and 11 female (22%). Although 41 (80%) lifeguards were aware of an acceptable definition of anaphylaxis, no one knew that epinephrine is the first-choice treatment, and 32 (60%) lifeguards replied that steroids should be used for emergency treatment. Additionally, no one possessed an emergency kit that would qualify for management of acute allergic reactions. CONCLUSIONS: The beach should be considered as a high-risk place for the appearance of anaphylactic reactions. Lifeguards who would be the first trained personnel to encounter this condition should be sufficiently trained and equipped for emergency treatment. Our department is currently introducing a training program to local authorities for the proper training and equipping of lifeguards in the island of Crete.

Ectopic internal carotid artery presenting as an oropharyngeal mass.

Ectopic internal carotid artery (ICA) is a very rare variation. The major congenital abnormalities of the ICA can be classified as agenesis, aplasia and hypoplasia, and they can be unilateral or bilateral. Anomalies of the neck artery may be vascular neoplasms or ectopic position. Carotid angiograms provide absolute confirmation of an aberrant carotid artery, while EcoColorDoppler (ECD) gives also important information about the evaluation of carotid vassels. Nevertheless Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the neck provide spatial information about the adjacent pharyngeal anatomy and are less invasive than angiogram. Injuries to the ICA during simple pharyngeal surgical procedures can be catastrophic due to the risk of massive bleeding. We report a case of a 56 year-old male patient suffering from dysphagia associated with aberrant ICA manifesting itself as a pulsative protruding of the left lateral wall of the oropharynx.

Thermal welding technology vs ligasure tonsillectomy: a comparative study.

OBJECTIVE: The objective of the study was to compare and assess parameters related to thermal welding tonsillectomy (TWT) vs ligasure tonsillectomy (LT). STUDY DESIGN: This was a prospective randomized study. METHOD: A prospective study was conducted on 143 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy or any procedure together with tonsillectomy and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the TWT or LT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. RESULTS: There was no measurable intraoperative bleeding in any group. No significant difference regarding mean operative time was noted. Mean postoperative pain score was significantly lower in the TWT group. Late postoperative hemorrhage was noted in 1 subject of the TWT and 2 subjects of the LT group. Mild uvula edema was significantly lower in the TWT group. CONCLUSION: Both TWT and LT procedures provide sufficient hemostasis and reduced operative time, although lower postoperative pain and mild uvula edema were noted in TWT procedures. Furthermore, since both methods use single-use instruments, they provide safety against diseases such as Creutzfeld-Jakob disease.

Epiglottis reshaping using CO2 laser: a minimally invasive technique and its potent applications.

Laryngomalacia (LRM), is the most common laryngeal abnormality of the newborn, caused by a long curled epiglottis, which prolapses posteriorly. Epiglottis prolapse during inspiration (acquired laryngomalacia) is an unusual cause of airway obstruction and a rare cause of obstructive sleep apnea syndrome (OSAS). We present a minimally invasive technique where epiglottis on cadaveric larynx specimens was treated with CO2 laser. The cartilage reshaping effect induced by laser irradiation was capable of exposing the glottis opening widely. This technique could be used in selected cases of LRM and OSAS due to epiglottis prolapse as an alternative, less morbid approach.

Septal cartilage reshaping with the use of an Erbium doped glass fiber laser. Preliminary results.

STATEMENT OF PROBLEM: To evaluate the efficacy of Erbium doped glass fiber laser in patients undergoing nasal septal cartilage reshaping. METHOD OF STUDY: A prospective study was conducted in patients undergoing laser nasal septal cartilage reshaping. Microsurgical sponges soaked in a tetracaine solution plus adrenaline were applied in each side of the nose for ten minutes before the procedure. The cartilage of nasal septum was straightened and fixed in the median position using a modified nasal speculum. An optothermomechanical contactor with transparent indenter and thermocouple sensor was placed on septal regions of maximum mechanical stress. Patients were asked to evaluate the severity of pain during the procedure on a visual analog scale. A rhinomanometric evaluation was conducted preoperatively and postoperatively. All patients were asked to evaluate the improvement of their symptoms. All patients' data and potential complications were entered in a database and were statistically assessed. MAIN RESULTS: Our series consisted of 64 patients. Statistical analysis showed significant improvement of their symptoms and of rhinomanometric results. No complications or side effects occurred. The mean operative time was 35 minutes. PRINCIPAL CONCLUSION: Septal cartilage reshaping is an easy painless and bloodless method using en Erbium doped glass fiber Laser. Laser device LSC-701 (Arcuo Medical Inc.) is effective, safe and inexpensive medical equipment.

Non-Candida albicans Candida mediastinitis of odontogenic origin in a diabetic patient.

Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its delayed diagnosis and treatment are associated with high mortality. A rare case of an odontogenic infection in a diabetic patient, complicated by Candida parapsilosis and Candida krusei parapharyngeal space infection, descending mediastinitis and aspiration pneumonia is described. Isolate identification was based on colonial and microscopic morphological characteristics and carbohydrate assimilation test results. The patient was successfully treated with surgical drainage and debridement, broad spectrum antibacterials and liposomal amphotericin B followed by prolonged oral voriconazole therapy.

Diagnosis and management of substernal goiter at the University of Crete.

The objective of this work was to evaluate the diagnosis and management of patients with substernal goiter (SSG) on the basis of our experience. We conducted a retrospective study of all SSGs within a series of 591 thyroidectomies performed in a tertiary referral center over a period of 14 years, analyzing epidemiological data, diagnostic criteria, and surgical results. There were 37 (6%) patients with descending goiter: 28 women (mean age 57.1 years) and 9 men (mean age 61 years). All 37 patients underwent successful surgical treatment without any major postoperative complications. A postoperative histological examination revealed a 16.6% incidence of malignancy. Despite the size and close proximity to vital organs in the mediastinum, all of the SSGs were managed successfully. A neck approach was used in all except for one patient who was operated on via sternotomy. A thorough preoperative evaluation including computed tomography scan of the neck and mediastinum, and an appropriate surgical technique ensure a positive outcome for most patients with an SSG.

Microscopic endonasal surgery of nasal and paranasal cavities.

OBJECTIVE: To present the experience of our department on microscopic surgery of the nose and sinuses and compare our results with those of other standard approaches. Furthermore we attempt to specify the main indications for the use of the method. METHODS: During the period between January 1990 and December 2002, the prementioned technique was performed in a total of 250 patients. The preoperative evaluation, surgical technique and postoperative management of all patients are described in detail. RESULTS: Most common diagnoses included nasal polyps and chronic rhinosinusitis. The average age of patients was 42 years. Males accounted for 48%. No major postoperative complications were noted. Minor complications such as epistaxis and midfacial pain were observed in 24% of cases. While the majority of patients reported severe symptomatology preoperatively, 91% reported substantial improvement of their clinical condition within 3 months after surgery. CONCLUSION: Microscopic surgery is a technique which can be used alternatively to traditional procedures. It provides an excellent, clear, stereoscopic vision and allows the surgeon to work bimanually. Complications are rare and easily controlled. Our experience favors the use of microscopic technique compared to common endoscopic approaches, especially in cases of nasal polyps and chronic rhinosinusitis.

Massive plexiform neurofibroma and spinal deformity presenting as dysphagia.

Dysphagia is a symptom associated with various diseases of the upper gastrointestinal and respiratory tract, and it may be the presenting symptom of numerous tumors of the head and neck. Plexiform neurofibromas (PNFs) are benign tumors of the peripheral nerves and connective tissue, which are usually associated with neurofibromatosis type 1. We present a rare case of a 52-year-old woman presenting with dysphagia and weight loss due to a massive PNF in the subcutaneous adipose tissue of the posterior neck, associated with C1-C2 dislocation, scoliosis of the vertebral column, and 2 meningoceles consistent with the diagnosis of neurofibromatosis type 1. The combination of large PNF and cervical spine dysplasia may cause compression of the upper gastrointestinal tract and chronic progressive dysphagia.

Tonsillectomy with thermal welding technology using the TLS(2) thermal ligating shear.

OBJECTIVE: To introduce and assess a new method of tonsillectomy with thermal welding technology (TWT) using the thermal ligating shear (TLS(2)), in pediatric population. METHOD: TWT provides a new surgical instrument that combines heat and pressure to simultaneously coagulate and divide tissue. Among the headpieces available for the TWT generator, the TLS(2) handpiece was selected. A prospective study was conducted in our Department, on 60 children who underwent tonsillectomy with the use of TWT. Inclusion criteria were obstructive sleep apnea syndrome, peritonsilar abscess history and chronic tonsillitis. Patients undergoing adenoidectomy, or any other procedure together with tonsillectomy were excluded from this study. All patients' data, including intraoperative blood loss, operation time and complication rates were recorded in a database. RESULTS: Our series consisted of 60 patients (39 male and 21 female). There was no measurable bleeding during surgery in any of the cases. The mean operative time was 20 min. Only one case of postoperative hemorrhage occurred. Mild uvula edema was noticed in 25 patients. CONCLUSION: TWT is a safe method for tonsillectomy. Among the several handpieces available for the TWT generator, the TLS(2) is very effective and easy to use in tonsillectomy procedures, providing sufficient heamostasis and diminished operative time.

Optimal time for nasal packing removal after septoplasty. A comparative study.

OBJECTIVE: The objective of this study was to evaluate the efficacy and subjective discomfort of one-day internal dressing compared to that of two-day in patients undergoing nasal septal surgery. STUDY DESIGN/METHODS: Prospective, randomized, clinical trial conducted on 75 patients undergoing septoplasty in a tertiary ENT clinic. Discomfort caused by nasal dressings was evaluated by means of a visual analog scale. Postoperative complications were also compared. RESULTS: Mean discomfort score for group A (nasal packing for 48 hours) was 3.5 (SD 1.15) vs. 2.7 (SD 1.52) for group B (nasal packing for 24 hours). Significant lower discomfort is reported when the nasal packing is removed the first day instead of after two or more days. No increase in complication rate was noticed. CONCLUSION: Our results point out that one-day internal nasal dressing is preferable to that of two or more days, because of less patient discomfort and increased cost-effectiveness without increasing immediate complications.

Nonmicrosurgical reconstruction of the auricle after traumatic amputation due to human bite.

BACKGROUND: Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected. METHODS: We present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases. RESULTS AND DISCUSSION: The prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performed. CONCLUSION: The Baudet technique has been used successfully in two cases of traumatic ear amputation due to human bites. It is a simple technique, without the need for microsurgery, and produces excellent aesthetic results, while preserving all neighboring tissues in case of failure with subsequent need for another operation.

Ligasure versus cold knife tonsillectomy.

OBJECTIVE: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure. STUDY DESIGN: Prospective randomized study. METHODS: A prospective study was conducted on 200 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy, or any procedure together with tonsillectomy, and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the LT or CKT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. RESULTS: The LT and CDT groups consisted of 108 and 92 individuals, respectively. In the LT group, there was no measurable intraoperative bleeding, whereas mean bleeding for CKT group was 125 mL. The mean operative time was 15 +/- 1.43 minutes for the LT group and 21 +/- 1.09 minutes for the CKT group (P < .001). The overall mean pain score for the LT group was 3.63, whereas for the CKT group it was 5.09 (P < .001). Primary hemorrhage occurred in one subject of the CKT group. Secondary postoperative hemorrhage was noticed two subjects of the LT group and two subjects of the CKT group. In 21 subjects of the LT group, limited peritonsillar edema was noticed. No other complication occurred in both groups. CONCLUSION: LT procedure provides sufficient hemostasis, lower postoperative pain, and reduced operative time, as well as safety against Creutzfeld Jakob disease transmission.