Insertion of a tracheoesophageal speech valve: a novel approach in a difficult situation.

BACKGROUND: Functional voice rehabilitation is becoming increasingly important following total laryngectomy and pharyngolaryngectomy. Tracheoesophageal voice via a shunt valve is currently regarded as the 'gold standard' for voice rehabilitation. Traditional techniques usually allow for the replacement of valves in the out-patient setting; however, patient factors such as altered anatomy may occasionally prevent this. OBJECTIVE: This paper describes a novel approach for speech valve insertion that is safe, quick and cost-effective, and which uses equipment commonly available in ENT wards and the operating theatre.

Socioeconomic influence on orofacial cleft patient care.

BACKGROUND: Cleft lip and palate is the most common craniofacial birth defect in the UK. Orofacial clefts have functional and aesthetic implications requiring intensive multi-disciplinary follow-up to optimise development. Failure to attend follow-up is likely to have a negative impact on patient outcomes. The aim of this retrospective audit is to establish if socioeconomic status influences attendance, DNA and cancellation rates in cleft patients. METHODS AND RESULTS: A retrospective audit of 74 orofacial cleft patients born and operated on at the Royal Hospital for Sick Children Glasgow between 2006 and 2007. There was higher rate of DNA in more deprived social groups-21% (SIMD 1) against 10% (SIMD 5). A higher rate of DNA in cleft lip and palate patients was noted. This group of patients showed a marked difference in attendance between SIMD 1 (38%) and SIMD 5 (78%). CONCLUSION: More deprived areas have a higher outpatient DNA rate for cleft patients resulting in suboptimal follow-up. Ultimately, causation of poorer outcomes in this group is likely to be multi-factorial but the financial implication of travelling to multiple clinics should be considered and it may be that resource reallocation is the answer to address the current inequality of health care provision.

Asymmetrical nostril axis angle in the post traumatic nose.

BACKGROUND: Nasal tip reconstruction is a challenging part of septorhinoplasty in post-traumatic patients. Aesthetic appearance of the nose is dependent on adequate tip definition, projection and rotation. Our aim is to establish if caudal septal dislocation (secondary to fracture or subluxation) is a significant factor in causing asymmetry in nostril axis angle (NAA) to effect surgical intervention. In addition, to assess if there is an association between the side of dislocation and the magnitude of NAA. METHODOLOGY: Photographic assessment of NAA was measured in a study group of 26 patients with caudal dislocation of the septum and a control group of 26 patients without caudal septal dislocation. All 52 patients were awaiting a septorhinoplasty procedure due to nasal trauma. RESULTS: Caudal septal dislocation causes a mean difference in NAA of 7.95o compared to 1.38o difference in the control group. We also found there is a greater degree of upward tip rotation on the side of the dislocation resulting in a larger NAA. CONCLUSION: Caudal dislocation of the septum causes a significant asymmetry in NAA, with a greater degree of rotation on the side of the dislocation. We should be aware of this fallacy prior to surgery.

Diagnostic utility of freehand core-needle biopsy in head and neck masses.

OBJECTIVE: To review our experience with freehand core-needle biopsy in the assessment of unexplained head and neck masses. METHODS: A total of 770 patients with head and neck masses (referred over a 22-month period) were evaluated. A retrospective chart review was performed on 53 of those patients who underwent core-needle biopsy for an unexplained mass. RESULTS: Correct sampling of the target tissue was achieved in all 53 patients (100 per cent) using a freehand core-needle biopsy technique. The diagnostic accuracy for providing adequate tissue samples for histopathological diagnosis was 96 per cent; the test sensitivity was 92 per cent. Four patients (7 per cent) required open surgical biopsy prior to commencing definitive treatment. CONCLUSION: Out-patient freehand core-needle biopsy can be carried out safely on select patients with head and neck masses, and provides high quality histopathology specimens with high diagnostic utility.

Variation in vein density and mesophyll cell architecture in a rice deletion mutant population.

There is a need to develop rice plants with improved photosynthetic capacity and efficiency in order to enhance potential grain yield. Alterations in internal leaf morphology may be needed to underpin some of these improvements. One target is the production of a 'Kranz-like' anatomy, commonly considered to be required to achieve the desired levels of photosynthesis seen in C(4) crops. Kranz anatomy typically has two or three mesophyll cells interspersing adjacent veins. As a first step to determining the potential for such anatomical modifications in rice leaves, a population of rice deletion mutants was analysed for alterations in vein patterning and mesophyll cells in the interveinal regions. Significant variation is demonstrated in vein arrangement and the sequential distribution of major and minor veins across the leaf width, although there is a significant correlation between the total number of veins present and the width of the leaf. Thus the potential is demonstrated for modifying rice leaf structure. Six distinct rice mutant lines, termed altered leaf morphology (alm) mutants, were analysed for the architecture of their interveinal mesophyll cell arrangement. It is shown that in these mutant lines, the distance between adjacent minor veins and adjacent minor and major veins is essentially determined by the size of the interveinal mesophyll cells rather than changes in mesophyll cell number across this region, and hence interveinal distance changes as a result of cell expansion rather than cell division. This observation will be important when developing screens for traits relevant for the introduction of Kranz anatomy into rice.

Nasal and ophthalmomyiasis: case report.

OBJECTIVE: We report a rare case of a 51-year-old woman with ocular and nasal infestation by Oestrus ovis. METHOD: Clinical case report and review of current literature regarding nasal and ophthalmomyiasis. RESULTS: Myiasis is infestation of the tissues and organs of vertebrates by certain dipteran fly larvae. Oestrus ovis myiasis is endemic in the region from North Africa to South Asia, but few cases are reported within the UK. A 51-year-old patient presented and was treated successfully in Sunderland Royal Hospital for combined ocular and nasal infestation with Oestrus ovis. CONCLUSIONS: Oestrus ovis has a largely subtropical distribution; however, it is important to remember the diversity of disease which can present within the UK from an external source. This point is illustrated by this rare case, which highlights the fact that prompt treatment can avoid poor outcomes for our patients.

The effect of tibial torsion of the pathology of the knee.

Measurements of tibial torsion using a tropometer were made in more than 1200 consecutive patients attending an adult knee clinic. In total 1672 readings from 836 patients in 11 diagnostic categories were analysed. Patients with either patellofemoral instability or Osgood-Schlatter disease had a significant increase in lateral tibial torsion. The most important finding was a significant reduction in this torsion in patients with panarticular disease.