ABSTRACT
OBJECTIVE: To investigate the outcomes from nasal fracture reduction performed under local anaesthesia (LA) and general anaesthesia (GA). METHOD: A randomised multi-centred prospective trial and cohort analysis. Patients were randomised into two groups, 74 (53%) underwent closed reduction under LA, 65 (47%) patients underwent closed reduction under GA. MAIN OUTCOME MEASURES: Pain scores and patient toleration of local or general nasal manipulation was noted. RESULTS: The pain score ranged from 0 (no pain) to 10 (unbearable pain). The mean pain score in the LA group was 3, compared to 2 in the GA group. LA manipulation was tolerated equally well as GA manipulation by 85% of the patients in each group. The number of patients requiring a septorhinoplasty was compared between LA 19/74 (26%), and GA 21/65 (32%). This failed to demonstrate a significant difference with a p value of 0.50. The absolute risk difference was 5% with a 95% confidence interval of (20% to -10%). CONCLUSION: This trial clearly shows LA to be as effective as GA in the first line management of nasal fractures. The degree of septal displacement and presence of nasal tip deviation were associated with persistent nasal deformity following nasal fracture reduction.
Subject(s)
Anesthesia, General , Anesthesia, Local , Nasal Bone/injuries , Skull Fractures/therapy , Adolescent , Adult , Aged , Anesthetics, Local/administration & dosage , Cohort Studies , Female , Humans , Lidocaine/administration & dosage , Male , Manipulation, Orthopedic , Middle Aged , Nasal Obstruction/etiology , Nasal Septum/pathology , Nose/pathology , Nose Deformities, Acquired/etiology , Pain Measurement , Patient Satisfaction , Postoperative Complications , Prospective StudiesABSTRACT
The pharyngeal 'hairy polyp', or 'dermoid' has caused considerable debate as to its origin since the original classification proposed by Arnold in 1870. This classification implies that the hairy polyp is either a teratoma or sequestration dermoid cyst. Many papers contest this view, in favour of a developmental malformation. We describe the first case of a hairy polyp in association with an ipsilateral branchial sinus as further supportive evidence of a developmental malformation of the second branchial arch.
Subject(s)
Branchioma/complications , Nasopharyngeal Neoplasms/etiology , Polyps/etiology , Female , Head and Neck Neoplasms/complications , Humans , Infant, Newborn , Nasopharyngeal Neoplasms/classification , Polyps/classificationABSTRACT
A patient who developed non-cardiogenic pulmonary oedema secondary to acute airway obstruction caused by an aspirated foreign body is presented. The literature is reviewed, discussing the theories regarding the formation of non-cardiogenic pulmonary oedema. The case highlights the importance of this rare complication of foreign body aspiration and surgeons and anaesthetists should be alert to continued respiratory symptoms following relief of acute airway obstruction.
