Recurrent respiratory papillomatosis in Ibadan, Nigeria.

BACKGROUND: Recurrent respiratory papilomatosis (RRP), the most common benign neoplasm of the larynx, usually results in upper airway obstruction that is most often misdiagnosed as lower airway disease in children. The prevalence of RRP and various aspects of its clinical course are still unknown with a dearth of literature on this in Nigeria. This study aims at presenting the clinical profile of RRP as seen in the University College Hospital, Ibadan, Nigeria. METHODOLOGY: A retrospective study of 43 cases of histologically confirmed RRP over a fifteen-year period in the Otorhinolaryngology Department of the University College Hospital Ibadan. RESULTS: There were 28 (65.1%) males and 15 (34.9%) females with mean age of 8.7 years (range 2-23 years). Thirty-two patients (74.4%) were between 110 years with the highest incidence occurring at the 6-10 year age group (39.5%). Forty-one patients (95.3%) belonged to low social classes V and IV. Thirty-one patients (72%) presented within 1 year of onset of symptoms. All the patients were hoarse with 70% of those dyspnoeic at presentation having emergency tracheostomy. The lesions involved the vocal cords and anterior commissure mostly. There were no recurrences in 23 patients (53.5%) while twenty patients (46.5%) had 2 to 5 recurrences. CONCLUSION: Sequelae of RRP in Children may be grave, thus a high index of suspicion is needed in a patient with progressive voice change exceeding six weeks and unresponsive to standard medical therapy.

Stomal recurrence post laryngectomy in University College Hospital, Ibadan.

The outcome of laryngeal carcinoma is favourable and cure rate high if detected early. A major complication experienced post surgery for advanced laryngeal carcinoma is recurrence especially at the tracheostome. This study aimed at evaluating the incidence of stomal recurrence post total laryngectomy with respect to the risk factors. This is a retrospective review of eighteen patients (14 males and 4 females) that had total laryngectomy for histologically confirmed laryngeal carcinoma from 1990 - 2002. Seven patients (38.9%) had stomal recurrence. Seven patients (38.9%) had palpable deep cervical nodes at presentation. Fourteen (77.8%) and four (22.2%) patients had emergency and elective tracheostomy procedures respectively. Twelve patients (66.67%) had neck node dissection during surgery. Post-operatively, twelve patients (66.7%) had only radical radiotherapy; four (22.2%) had both radio-/ chemotherapy while two had preoperative and additional postoperative radiotherapy. The mean duration between the preoperative tracheostomy and total laryngectomy was 62.19 +/- 64.56 days while the mean duration between total laryngectomy and development of stomal recurrence was 7.79 +/- 8.57 months. Ten patients (55.6%) died, (seven with and three without stomal recurrence but who died of distant metastases to the lungs and thoracolumbar vertebral bodies). Stomal recurrence post laryngectomy has a grave prognosis. This present study also showed that advanced stage 3 and 4 tumour, transglottic involvement and the presence of preoperative tracheostomy are the likely risk factors that could be associated with recurrence in our environment. There is therefore the need to reevaluate these preventive measures in a prospective study in order to improve the final outcome in our environment.

Recurrent respiratory papillomatosis mimicking retropharyngeal abscess in a Nigerian child.

UNLABELLED: Recurrent respiratory papillomatosis (RRP) is not an uncommon disease of the aero-digestive tract, usually involving points of narrowing. Involvement of the oropharynx, particularly when florid, may be easily confused with a retropharyngeal abscess. STUDY DESIGN: Case report of a 1 1/2 year-old child with florid pharyngeal RRP. RESULTS: The clinical presentation and features on radiography of this patient mimicked retropharyngeal abscess. The patient successfully had a preoperative tracheosomy and excision of the RRP. CONCLUSION: There was a diagnostic dilemma in this patient because of the identical features of the two conditions. A high index of suspicion and painstaking, careful clinical and radiological evaluation is the key to diagnosis and prompt definitive management.

Arrow injury to the skull base.

An unsual case of penetrating nasal injury with middle skull base involvement, from fired arrow is reported. The arrow was surgically removed and the patient remains well with no sequelae. We therefore present this case because of its rarity. The anatomical principles underlying the surgical management of the lesions are discussed.