ABSTRACT
OBJECTIVE: Osteoradionecrosis is a significant complication of head and neck cancer treatment, and its most severe form (grade III) necessitates radical surgery. This study aimed to compare the cost of free-flap reconstructive surgery for grade III osteoradionecrosis and similar non-osteoradionecrosis cases in order to assess the cost burden of osteoradionecrosis treatment. METHODS: All patients who underwent free-flap reconstructive surgery for osteoradionecrosis between July 2004 and July 2010 at Auckland City Hospital (19 patients) were identified, and relevant data were collected retrospectively. These patients were matched in terms of age and sex with patients who underwent free-flap reconstructive surgery. RESULTS: The treatment cost was 44 per cent higher in osteoradionecrosis patients when compared to non-osteoradionecrosis patients. CONCLUSION: The significant financial burden on the health system, and the growing evidence for the effectiveness of pentoxifylline, tocopherol and clodronate, should prompt us to explore this alternative treatment further.
Subject(s)
Free Tissue Flaps , Osteoradionecrosis/economics , Osteoradionecrosis/surgery , Plastic Surgery Procedures/economics , Adult , Aged , Costs and Cost Analysis , Female , Head and Neck Neoplasms/radiotherapy , Humans , Male , Middle Aged , Osteoradionecrosis/etiology , Plastic Surgery Procedures/methods , Retrospective StudiesABSTRACT
INTRODUCTION: Nasal saline lavage forms a cornerstone of chronic rhinosinusitis management. A number of saline lavage recipes and products are currently available but little is known of their relative physical characteristics. AIMS: To determine the osmolarity and pH of nasal lavage solutions, both commercial preparations and home-made recipes, and to determine the reproducibility of saline solution preparation. METHODS: Five home-made recipes and two commercial products were prepared in triplicate and analysed. Eight consecutive clinic patients prepared a commercial product and 11 prepared a home-made recipe, and the osmolarity and pH were measured. RESULTS: The osmolarity of the solutions varied widely, from 140 to 788 mmol/l and the pH varied from 7.88 to 8.50. The commercial and home-made solutions had similar reproducibility when prepared by patients. CONCLUSION: Some recipes were markedly hypo-osmolar and some were hyper-osmolar. All were slightly alkaline. The home-made recipes had similar physical characteristics and reproducibility to commercial preparations.
Subject(s)
Nasal Lavage , Sodium Chloride/chemistry , Humans , Hydrogen-Ion Concentration , Isotonic Solutions/chemistry , Osmolar Concentration , Pharmaceutical Solutions/chemistry , Saline Solution, Hypertonic , Sinusitis/therapyABSTRACT
A recent case report in this journal highlighted the pathophysiology and management of bacterial malignant otitis externa (MOE) (1). We describe the case of an elderly gentleman who had a delayed diagnosis of fungal MOE with advanced diseased at time of diagnosis. This case highlights the changing microbiology of this serious disease and the difficulty in diagnosis given the rarity of this form of otitis externa relative to its uncomplicated form.
