Assessing psychological morbidity in patients with nasal deformity using the CORE questionnaire.

The aesthetic facial surgeon's evaluation of the patient seeking cosmetic surgery must be thorough. Those with emotional disturbances and overt psychiatric disorders are considered to be poor candidates for elective cosmetic surgery. In patients with nasal deformity, the prevalence of subclinical psychological morbidity and the role of cosmetic surgery in these circumstances are uncertain. This study investigates the use of the CORE questionnaire in assessing the psychological status of patients awaiting rhinoplasty or septorhinoplasty and compares this with the psychological status of patients awaiting septoplasty. A prospective trial of 27 rhinoplasty patients and 16 septoplasty patients revealed that in terms of life functioning, patients with nasal deformity have significantly higher psychological morbidity compared with patients without nasal deformity. However, there was no significant difference in global psychological status. In addition, female patients with nasal deformity are more distressed in terms of general wellbeing than male patients with nasal deformity and there is a tendency for higher global psychological impairment in women. These results may have implications in terms of health care rationing in patients with nasal deformity and preoperative psychological screening.

Functional laryngeal dyskinesia: an important cause of stridor.

Functional laryngeal dyskinesia is a disorder that presents with stridor. Failure to recognize its features can result in inappropriate investigation and treatment for a condition that has a psychogenic origin. The key feature in diagnosis is paradoxical vocal fold adduction on inspiration, as seen on fibre-optic nasendoscopy. This phenomenon together with the associated stridor may disappear after distraction techniques or when the patient is asleep. We present five such cases which presented to hospitals in south west London over a 12 month period.

Retrospective survey of long-term results and patient satisfaction with uvulopalatopharyngoplasty for snoring.

The aim of this study was to retrospectively survey patients who had undergone the uvulopalatopharyngoplasty (UPPP) operation over a two-year period, assessing loudness of snoring, sleep quality and patient satisfaction. A total of 271 patients were sent questionnaires to assess snoring and sleeping habits, with additional questions about pain and satisfaction with surgery. Those who did not reply were contacted by telephone. Seventy-four per cent of the target population were surveyed. Taking an improvement in snoring level of 50 per cent or greater, immediately post-operatively the overall success rate was 76 per cent; however, after two years the success rate fell to 45 per cent. Variables such as alcohol consumption and smoking were not found to influence results. On a post-operative pain scale of 1-10 the average was 7.5 and on a satisfaction scale of 1-10 the average satisfaction with surgery was five, 61 per cent of patients stating that they would not have this operation again. This study shows that the UPPP operation is successful in only 45 per cent of patients after long-term follow-up, that the majority of patients experience severe pain and that the overall satisfaction with surgery is low.

Six cases of fibromatosis of the head and neck in children.

Six cases of aggressive fibromatosis occurring in the head and neck in children are described. Fibromatosis is a rare, benign but locally infiltrative condition. Primary excision is not always possible in the head and neck areas. It is not always appropriate to treat children using the same modalities as adults due to associated growth problems. The case histories illustrate the management difficulties that can be encountered when treating the paediatric population.

Parental satisfaction with paediatric day-case ENT surgery.

Day surgery is increasing to improve the efficient use of NHS resources and it is vital that the quality of patient care is not compromised. The Audit Commission has recommended that there should be a systematic appraisal of the patient's views to monitor quality of day care. A survey of parental satisfaction with paediatric day-case surgery provides valuable information for those providing day surgery. A specific area of dissatisfaction previously identified is inadequate pain control following discharge. It is also suggested that day surgery may incur higher costs for the general practitioner. A retrospective study to investigate parental satisfaction with 100 paediatric otorhinolaryngology cases was performed. This study found 96 per cent of parents were happy with the treatment their child received, 89 per cent were satisfied with self-administered simple analgesia and no patients visited their general practitioner on the day following surgery. It is concluded that with careful selection and adequate support the degree of satisfaction with day surgery is high for a wide variety of procedures.

Management of laryngotracheobronchial sequelae and complications of relapsing polychondritis.

Relapsing polychondritis is a rare multisystem disorder of unknown etiology characterized by recurrent inflammation and degeneration of cartilage and connective tissue. Laryngotracheobronchial complications are the most severe manifestations of the disease and present the most challenging management decisions. We present four cases of relapsing polychondritis with laryngotracheobronchial manifestations that illustrate the clinical features and review the treatment options.

A new alternative to the operating microscope in the temporal bone laboratory.

Cadaveric temporal bone surgery has previously required the use of the operating microscope. However, in this financial climate, the cost of a microscope can prove prohibitive to many departments. We describe a less expensive, alternative form of magnification and illumination in the temporal bone laboratory.

Pharyngeal trauma in children--accidental and otherwise.

Pharyngeal perforation is an uncommon injury in children. Most reported cases to date have been secondary to instrumentation or penetrating wounds. Laceration to the pharyngeal wall may introduce air, secretions and bacteria into the parapharyngeal space and mediastinum and consequently has potentially life-threatening sequelae. The management of these injuries is controversial. We present a series of four children who suffered pharyngeal trauma, accidentally and otherwise, and discuss their management. We recommend a high index of suspicion of pharyngeal injury in all cases of oropharyngeal trauma and overnight admission to hospital for observation until an accurate diagnosis has been established. Non-accidental injury of the child must be seriously considered in all cases.

The value of radiological investigations in pre-endoscopic assessment of children with stridor.

The differential diagnosis of stridor in an infant depends on a careful history and examination, followed by radiological and endoscopic investigations. Currently a chest, lateral neck and antero-posterior, high kilovolt (Cincinnatti) view radiographs in association with a diagnostic barium swallow are performed prior to the definitive diagnostic procedure of microlaryngobronchoscopy. Our impression was that some of the routinely ordered radiological investigations were of limited value in the differential diagnosis. We undertook a retrospective audit study to determine the value of radiological investigations in the pre-endoscopic assessment of infants with stridor. The radiological and endoscopic information of 100 infants presenting over the three-year period 1991-1993 at Great Ormond Street Hospital, London (a tertiary referral centre) was collected. It was found that only five out of 65 barium swallow investigations performed had consistent positive findings at diagnostic microlaryngobronchoscopy. The lateral neck and Cincinnatti views identified many of the more gross pathologies of the larynx and trachea e.g. the space occupying lesions, which occur infrequently. The more common diseases e.g. laryngomalacia or subglottic stenosis are rarely identified radiologically. Our results confirmed that radiology had a limited screening role and that in a child presenting with stridor the initial radiological assessment should be a chest radiograph with further imaging and a barium swallow only if an abnormality is found at microlaryngobronchoscopy.

The buccal pad of fat: a review.

Within the cheek, wedged between masseter and buccinator, is a biconvex pad of fatty tissue, the corpus adiposum buccae, or buccal fat pad (of Bichat). It contributes significantly to the prominence of the cheek of the newborn infant and is sometimes encountered in surgical procedures in the region of the ramus of the mandible or the maxillary tuberosity. This paper reviews the history of the study of the buccal pad of fat, its anatomical location, blood supply, and comparative anatomy. We have also reviewed the pathology of the buccal pad of fat, including traumatic herniation. The fat pad is of interest surgically as it can be used as a free or pedicled graft to close maxillary defects after excision of tumors.