Large volume haemorrhage following transoral robotic surgery (TORS) as a result of fibromuscular dysplasia: first reported case.

We present a case of a 61-year-old woman who suffered a haemorrhagic complication of an aneurysmal left lingual artery, secondary to fibromuscular dysplasia, following transoral robotic surgery (TORS). She was admitted through the emergency department 3 days after resection of a central base of tongue tumour. She suffered a massive haemorrhage requiring intensive care admission, blood transfusion, intubation, operative and endovascular intervention. The diagnosis of fibromuscular dysplasia was made at angiography. During attempts to embolise the culprit left lingual artery, the vessel dissected at its origin leading to arrest of bleeding. Repeat angiograms during her admission demonstrated unchanged appearances and ruled out recanalisation of the vessel. She was extubated and remained stable on the ward, discharged home some days later in good health. To our knowledge, this is the first ever reported case of fibromuscular dysplasia affecting the lingual artery leading to aneurysmal dilation and severe haemorrhage following TORS.

Acinic cell carcinoma of the parotid gland: Auckland experience and literature review.

Acinic cell carcinoma is an uncommon malignancy of the salivary glands and as such it has been difficult to accurately delineate its natural history. The aim of this study is to assess the behaviour of acinic cell salivary cancer of the parotid gland presenting to a single head and neck surgical unit in Auckland. The study is a structured review of cases of acinic cell carcinoma of the parotid gland presenting from 2000 to 2006 to the Head and Neck Unit at Auckland Hospital, those identified from the pathology database and the Otobase head and neck database. Case records and pathology reports were reviewed. Fifteen patients were identified, 9 men and 6 women. The mean age was 67.2 years, with range 50-85 years. The mean follow up was 4.4 years and range 1.1-7 years. There was one case of local recurrence during study period and no deaths. Five of 15 patients received postoperative radiotherapy. Postoperative complications consisted of one wound haematoma and two cases of marginal mandibular weakness (one transient and one permanent). Current management strategies are obtaining appropriate rates of recurrence and postoperative complications within the Auckland population.

Endoscopic orbital decompression for Graves' ophthalmopathy.

Graves' disease may occasionally result in significant proptosis that is either cosmetically unacceptable or causes visual loss. This has traditionally been managed surgically by external decompression of the orbital bony skeleton. Trans-nasal endoscopic orbital decompression is emerging as a new minimally-invasive technique, that avoids the need for cutaneous or gingival incisions. Decompression of the medial orbital wall can be performed up to the anterior wall of the sphenoid sinus. This can be combined with resection of the medial and posterior portion of the orbital floor (preserving the infra-orbital nerve). This technique produces decompression which is comparable to external techniques. We present a series of 10 endoscopic orbital decompressions with an average improvement of 4.4 mm in orbital proptosis. There was an improvement in visual acuity in all patients with visual impairment. Endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques.