Wound related complications following full thickness skin graft versus split thickness skin graft on patients with bone anchored hearing aids.

OBJECTIVES: The aim of this study was to review complications occurring in bone anchored hearing aid (BAHA) patients in relation to wound healing following full thickness skin graft versus split thickness skin graft. DESIGN: Retrospective study. The medical notes of 22 patients who underwent insertion of BAHA over 24 months were reviewed. SETTING: ENT Department at a District General Hospital in the UK. PARTICIPANTS: All patients were adults and underwent one stage procedure following the standard Branemark technique. In 11 cases the skin abutment interface was established by use of full thickness skin graft inset around the implant, and in the other 11 by use of split thickness skin graft. MAIN OUTCOMES MEASURES: The incidence of delayed wound healing resulting in an increase of number of visits for change of wound dressings. In addition the degree of soft tissue reactions around the interface was examined. RESULTS: There was a clear difference between the split and full thickness skin graft groups in relation to the severity of adverse skin reactions and number of visits required for change of dressings. The split thickness group required from three minimum to 13 maximum (median 4) visits in outpatients during the initial observation period until healing was complete. The full thickness group demonstrated one minimum and three maximum (median 2) visits. CONCLUSIONS: In our hands the full thickness skin graft is superior to a split thickness graft.

Flexible nasopharyngoscopy for fish bone removal from the pharynx.

The use of flexible nasopharyngoscopy with biopsy forceps for the removal of fish bones found in the oropharynx and hypopharynx is described. One hundred and sixty-eight patients with ingested fish bones in the upper aero-digestive tract were studied over a 12-month period. Of these, 73 per cent were removed per-orally, or by indirect laryngoscopy. Fifteen per cent were removed using the fibreoptic nasopharyngoscope. Twelve per cent required a general anaesthetic and rigid oesophagoscopy for removal of fish bones at or below the level of the cricopharyngeus muscle. The technique has proven to be quick, well tolerated and low in morbidity. It is invaluable in patients in whom indirect laryngoscopy is unsatisfactory.

Neonatal vallecular cysts and failure to thrive.

The case of a vallecular cyst in a neonate is described. The presentation was with failure to thrive. This previously unreported mode of presentation is discussed, and aspects of the management are emphasized. In particular, the value of flexible nasopharyngoscopy in assessing the neonatal laryngopharynx is highlighted.

Myringitis bullosa haemorrhagica: clinical course influenced by tympanosclerosis.

Observations based on two contrasting cases of myringitis bullosa haemorrhagica indicate that tympanosclerosis involving the tympanic membrane may have a significant effect on the clinical course of the disease. The evidence suggests that the bullae associated with the condition arise from the epidermal layer of the eardrum.

Polymorphous low-grade adenocarcinoma of the salivary glands: a clinicopathological comparison with adenoid cystic carcinoma.

Six cases of polymorphous low-grade adenocarcinoma (terminal duct adenocarcinoma) of the minor salivary glands are presented. In all but one there was a history of a painless intra-oral mass of fairly long duration. The histopathological appearances were characterized by cytological uniformity in a variety of morphological patterns, including tubular, solid, fascicular and cribriform areas. At a cellular level, the tumours possessed regular, often vesicular nuclei and generally eosinophilic cytoplasm. Five of the patients are still alive, although one had recurrent disease 16 years after her original operation; none died of their tumour. These findings are compared with those of six salivary adenoid cystic carcinomas, a neoplasm with many similar histological features, but with a much worse prognosis. The microscopic differences were mainly cytological and, to a lesser extent, morphological. The immunohistochemical reactions of the two tumours were not sufficiently dissimilar to be of practical value. Polymorphous low-grade adenocarcinoma has only rarely been reported in Britain, but we believe it deserves wider recognition as a distinct clinicopathological entity and, in particular, separation from adenoid cystic carcinoma.

Epithelial-myoepithelial carcinoma of salivary glands.

Four cases of epithelial-myoepithelial carcinoma of the salivary glands arose as painless masses in patients over 60 years old, three in the parotid and one in the submandibular gland. Histologically, all the tumours were composed of small ducts with a double cell lining surrounded by a basement membrane. The inner cells were epithelial and the outer cells myoepithelial, the latter usually possessing clear cytoplasm. There was a variable degree of intervening hyalinised stroma. All the tumours were partly encapsulated, but also displayed local invasiveness. One of the tumours also showed areas of dedifferentiation when it later recurred and metastasised. The other three were apparently cured by initial excision, with adjuvant radiotherapy in one instance. In the past this tumour has been described as clear cell adenoma, and it was only recently that its true malignant nature, albeit low grade, was recognised. Reports of epithelial-myoepithelial carcinoma are still relatively few, with only one case described from Britain. It is recommended that this histologically distinct neoplasm deserves wider recognition.