Quantitative computer-assisted digital-imaging upper airway analysis for obstructive sleep apnoea.

This was a prospective study of a new objective method which quantitatively analyses the upper airways in patients with obstructive sleep apnoea (OSA). Video-nasopharyngoscopic examinations of the upper airways of 45 patients were carried out with an endoscopic calibrator. Images of the upper airway during quiet respiration and Mueller's manoeuvre in erect and supine positions were digitized by computer to generate the actual dimensions of obstructive sites. Measurements by the new method were validated by comparing 90 pairs of videoendoscopic images with upper airway magnetic resonance imaging (MRI) measurements at two identical levels. Quantitative precision is 100% for the retropalatal level and 95.6% for the retrolingual level with a tolerance of 0.5 cm(2) between the two methods. The absolute mean of the difference between the two methods of measurement is 0.08 cm(2) at the retropalatal level and 0.18 cm(2) at the retrolingual level. The agreement between the digital-imaging videoendoscopic and MRI measurements was 93.3% for the retropalatal level and 95.6% for the retrolingual level. Quantitative computer-assisted digital imaging is a reliable, cost-effective clinical method of upper airway evaluation in OSA patients. This method allows us to examine the dynamic and static morphology objectively, measure surgical outcomes of upper airway, opening up new avenues for OSA management.

An audit of parotidectomy in Singapore: a review of 31 cases.

A series of 31 consecutive parotidectomies was evaluated. FNAC could differentiate tumour from non tumour in 72.8% of cases. For actual histology, FNAC was correct in 66.6%. Frozen section was correct in differentiating between benign, malignant and inflammatory conditions in all cases. Eighty-eight percent of frozen section histology concurred with final histology. The immediate postoperative period had 13 cases of facial nerve dysfunction, but only 3 cases had residual weakness. The branch most commonly affected was the mandibular branch (92.3%). Two patients had Frey's syndrome and one had a traumatic neuroma. FNAC and CT scans improve preoperative planning, providing histological evidence and the extent of the lesion.

Multiple level pharyngeal surgery for obstructive sleep apnoea.

The aim of the study is to evaluate the results of multiple level pharyngeal surgery in patients with moderate to severe obstructive sleep apnoea in Changi General Hospital, Singapore. 13 patients who failed non-surgical treatment underwent surgery which includes uvulopharyngopalatoplasty, genioglossal advancement and modified hyoid myotomy and suspension. Epworth sleepiness scale, Cephalometric analysis and Sleep study were performed pre- and post-operatively to evaluate the results. 76.9% of the patients achieved more than 50% reduction in AHI with post-operative AHI of less than 20. Cephalometric analysis showed an average of 5.2 mm increase in posterior airway space. All patients achieved improvement in Epworth sleepiness scale with an average improvement of 11.8 points. The mean follow-up period of the 13 patients is 12.6 months. Our preliminary results suggest that multiple level pharyngeal surgery is an effective option in the treatment of moderate to severe obstructive sleep apnoea.

Migrating oesophageal foreign body--an unusual case.

Ingested foreign bodies which migrate extraluminally are rare occurrences. If untreated, they may result in life threatening complications. Exploration of the neck via an external approach to remove the foreign body is the recommended treatment. The CT Scan utilising fine cuts is invaluable in localising the foreign body for exploration. The case of a patient with a metallic foreign body in the oesophagus which migrated extraluminally is presented. Hemithyroidectomy was required to gain access for removal of the foreign body. A discussion on the management of such a case follows.

Metastasic oesophageal carcinoma to the paranasal sinuses--a case report.

Metastasis to the paranasal sinuses is rare. We report a case of a patient with metastasis to the paranasal sinuses from carcinoma of the oesophagus. Our patient presented with symptoms mimicking the more common acute sinusitis. Although rare, metastatic disease of the paranasal sinuses should be considered especially in patients with a known primary carcinoma elsewhere presenting with sinu-nasal symptoms.

The incidence and management of post-tonsillectomy haemorrhage: a Singaporean experience.

AIM OF STUDY: To audit the incidence and management of post-tonsillectomy haemorrhage in the Singaporean context. METHODS: Three hundred and sixty-six consecutive tonsillectomies done over a 2-year period were retrospectively studied. Demographic details and indication for operation were evaluated in conjunction with the incidence and management of post-operative haemorrhage. RESULTS: 84.4% of the patients were adults while 58.7% were males. Chronic tonsillitis was the most common indication for operation (84.5%). The incidence of primary and secondary haemorrhage was 0.6% and 7.1% respectively. 3.8% of the patients had to return to the operation theatre to secure haemostasis. The use of post-operative antibiotics did not significantly affect the incidence of haemorrhage. There was no mortality from this complication. The haemorrhage rate was significantly higher among the adults (p = 0.048) and males (p = 0.019) in this study. CONCLUSION: Our overall post-tonsillectomy haemorrhage rate was higher than that reported in most of the Western publications because adults rather than children predominated in our series. We report a low incidence of primary haemorrhage which is in keeping with the results of studies on electrodissection tonsillectomies. Our findings indicate that tonsillectomy is a safe procedure which can be performed on a day surgery basis if the patients are carefully selected.

Penetrating neck trauma from nail guns.

We report 2 unusual cases of penetrating neck trauma arising from nail guns. Nail guns are commonly used in the building industry. The nails are 8 cm long and are driven in by a small explosive charge. The nails are a low velocity projectile and in close proximity can cause penetrating trauma similar to a low powered handgun. Both cases involve a Zone I penetrating injury to the neck.

Diagnostic red herring in an infant with stridor.

Foreign body aspiration in children may present with a variety of symptoms. We report here an unusual case of laryngeal foreign body in an infant masquerading as laryngeal web in its clinical presentation as well as radiological findings. The diagnosis was only made at endoscopy, thus emphasising the limited sensitivity of radiographic studies in identifying this condition.