Role of repeat fine needle aspiration cytology in head and neck lesions: preliminary study.

In this preliminary prospective study the value of repeating fine needle aspiration cytology (FNAC) in patients with head and neck lesions was investigated. Few reports exist on the significance of repeating the procedure in head and neck patients. Fifty-seven patients have been sampled twice for the first and second (repeat) FNAC. The second aspirate was performed in the operating theatre under general anaesthesia prior to a surgical procedure. The cytological results were compared with the histology of the 57 resected lesions. It was found that the overall diagnostic results improved after repeating the FNAC. It can be concluded that repeating FNAC is useful and should be considered under some circumstances, especially in the case of non-diagnostic cervical lymph node aspirates.

Bilateral cortical blindness: an unusual complication following unilateral neck dissection.

We present the case of a 50-year-old man who developed bilateral cortical blindness and confusion following a seemingly uneventful right-sided radical neck dissection. Computed tomography (CT) scans confirmed bilateral occipital lobe infarctions. To our knowledge, there are no previously documented reports of this clinical event following head and neck surgical procedures. Although this is a rare occurrence, otolaryngologists should be aware of this potential post-operative complication. The possible aetiologies of this condition are discussed.

De novo laryngeal carcinoma in childhood.

Numerous factors contribute towards a late diagnosis of laryngeal malignancy in childhood. These include its rarity, the similarity of its early symptoms to those of other benign, common childhood conditions as well as the relative difficulty encountered during paediatric laryngeal examination. We believe that these cases are of sufficient interest when they occur to warrant reporting since the consequences of late diagnosis in these young patients can be serious. We present a case of an 11-year-old boy with advanced squamous cell carcinoma of the larynx (T3N0M0), who was successfully treated with primary total laryngectomy and bilateral selective neck dissections to avoid the potential additional morbidity of radical radiotherapy.

A randomized prospective trial to compare four different ear packs following permeatal middle ear surgery.

Surgeons choice of an ear pack is dictated by availability, previous training and personal preference. There has been no recent prospective study evaluating the use of different types of ear packs. This randomized prospective study compares the use of BIPP impregnated ribbon gauze (Aurum), Pope wicks (Xomed-Teace), silastic sheeting (Dow Corning) and tri-adcortyl ointment (Squibb) as an ear dressing following 'clear' middle ear procedures via a permeatal approach. The results showed that there was no statistically significant difference in post-operative pain and discomfort experienced, neither was there any significant difference regarding the otolaryngologist's assessment of the degree of canal granulation, stenosis or discharge with the above named packs. This study concludes that non-traditional dressings such as tri-adcortyl ointment or simply a thin silastic sheet placed on the drum are no worse than time honoured BIPP. They have, as well, the advantage of being well-tolerated by the patients.

The bone anchored hearing aid (BAHA) in chronic suppurative otitis media (CSOM).

Bone anchored hearing aids are gaining wide acceptability in the treatment of patients with congenital ear problems, chronic suppurative otitis media (CSOM) and in some cases otosclerosis. To date little information on the effect of the bone anchored hearing aid on the symptoms of chronic suppurative otitis is available. This retrospective study based on notes review and telephone interviews was to assess the outcome of bone anchored hearing aid surgery in patients with CSOM in terms of: ear discharge; surgical techniques and complications; the number of hours the aid is worn compared with the previous aid. One hundred and forty-two patients were fitted with bone anchored hearing aids without additional prostheses in Birmingham between 1989 and 1995. Sixty-nine (48.5 per cent) of these were for chronic suppurative otitis media, 45 of these were female and 24 were male with a mean age of 58 years. Most (85 per cent) had undergone previous ear surgery with 65 per cent having mastoid surgery. Ninety-eight per cent of this patient group had undergone single stage surgery and 65 per cent under local anaesthetic as a day case. A variety of techniques for soft tissue reduction were employed. The mean follow-up time for these patients was 24 months (range one month to seven years). No patients experienced worse discharge following their BAHA and 84 per cent had significantly reduced discharge, 16 per cent had no change. Complications included skin reactions, 15; failure to integrate, one; late loss of fixture, three. Seventy-three per cent wore their bone anchored hearing aid more than eight hours per day and 58 per cent were more satisfied with their bone anchored hearing aid than their previous aid.

The use of topical 5% lignocaine ointment for the relief of pain associated with post-operative nasal packing.

Packing of the nasal cavity remains a common routine precautionary measure following septal surgery. The nasal pack and its removal 24 h later are often cited by patients as the most painful aspects of septal surgery. We present the results of a randomized, prospective controlled trial of the use of topical 5% lignocaine ointment as a method of pain relief following post-operative nasal packing. Post-operative pain as measured using a visual analogue scale at 3 h post-operatively was halved in patients receiving a lignocaine impregnated nasal pack compared with those having a standard vaseline gauze pack (P < 0.05). Pain scores at 6 h post-operatively and at pack removal were also reduced, but these failed to reach significance. No patients suffered reactionary haemorrhage. The use of topical lignocaine ointment is safe and may have a place in the relief of pain due to post-operative nasal packing.

A prospective randomized study to assess the efficacy of post-operative nasal medication after endonasal surgery.

Post-operative nasal medications are commonly used following routine septal or turbinate surgery but their efficacy in removing blood clots, improving the sensation of a patent airway and promoting healing are unknown. This prospective randomized trial of patients undergoing septal and/or turbinate surgery assessed the efficacy of three commonly used nasal medicines, 0.5 per cent ephedrine hydrochloride nasal drops, betamethasone sodium phosphate (Betnosol) nose drops and alkaline nasal douches, in producing the sensation of a patent airway in the 14 days following surgery. Ninety-seven patients were randomized into the three treatment groups and a control group who received no nasal medication. Patients assessed their nasal patency by means of a visual analogue scale (VAS) and any complications of treatment were recorded. Statistical analysis of the 76 complete sets of results using the Mann-Whitney U-test showed that there was a significant difference in the distribution of all of the treatments for each of the time intervals (p < 0.05). Glass rank biserial correlation coefficients were all small (rg < 0.085) but the most significant differences were between ephedrine and the control group at two hours, two, seven and 10 days (0.02, 0.054, 0.057, 0.085 respectively), alkaline nasal douches being most significant at four and 14 days (0.06 and 0.0722 respectively).

Microvascular free flaps in head and neck surgery.

This study is a retrospective review of 60 patients who had microvascular free flap reconstructions in the head and neck region. They were all performed over a 10-year period by a single surgeon. The series includes a wide range of flap types and analyses pre-operative risk factors for flap failure as well as complications and outcome. Smoking and advanced age did not appear to prejudice flap survival but peripheral vascular disease, cardiac disease and alcohol withdrawal were found to increase the likelihood of flap failure. The most frequent complications encountered were thrombosis of one of the anastomosis and haematoma. The most successful flap in terms of survival and function was the fasciocutaneous radial forearm flap. The literature is reviewed in relation to the general principles of microvascular free flap surgery and the results of this series are placed in context.

[Is ex situ surgery of the liver useful for difficult hepatic resections?]. / La chirurgie ex situ du foie est-elle utile au cours des résections hépatiques difficiles?

Five cases of hepatic tumor deemed unresectable by conventional techniques are presented to illustrate the potential benefit offered by complete hepatic vascular exclusion (Pringle maneuver associated with inferior vena cava clamping below and above the liver). The most extensive and difficult liver resections may be achieved, with possible venous reconstruction, if the clamping period is not interrupted. Hepatic vascular exclusion may exceed one hour, up to 85 minutes in this series, with a good liver tolerance, in the absence of preoperative liver dysfunction. The advantages and disadvantages of the ex situ extracorporeal liver resections performed under similar circumstances are discussed. The authors consider that the role of ex situ liver procedures should be very limited.