Conductive hearing loss after head trauma: review of ossicular pathology, management and outcomes.

INTRODUCTION: This paper reviews our experience of ossicular chain injuries following head trauma treated at Groote Schuur Hospital, Cape Town, South Africa. MATERIALS AND METHODS: We performed a retrospective chart review of all patients with a history of head trauma and a conductive hearing loss who had undergone exploratory tympanotomy. Sixteen patients were included in the study. RESULTS: Injury was most common at the incudostapedial joint (63 per cent). Disarticulations of the icudostapedial joint were treated with cartilage interposition in all cases. Audiography showed an improvement in 12 of the patients, with an average improvement of 35 dB. DISCUSSION: We discuss the various options available to the otologist to repair ossicular disruptions after trauma. In this series, cartilage autografts were used in most incudostapedial joint injuries, with excellent closure of the air-bone gap. CONCLUSION: Cartilage interposition was a very successful method of repairing incudostapedial joint dislocation in this series, at short term follow up.

Retained knife blades in the ear, nose and throat: three cases.

OBJECTIVE: To discuss the management and to review the literature regarding retained knife blades in the head and neck. CASE REPORT: We present three cases in which patients presented with retained knife blades in the head and neck region; in two of these, the diagnosis was delayed by more than eight weeks. In all patients, the retained knife blade was removed through the pathway of insertion, without significant sequelae. DISCUSSION: The methods of removal, appropriate radiological investigations and patient profiles are discussed. CONCLUSIONS: We propose that radiography be performed on all patients presenting with facial stab injuries which are anything more than superficial. We further suggest that the direct extraction of sharp objects through the pathway of insertion is safe if radiological studies show no risk of vascular injury.

Is Total Glossectomy for Advanced Caricinoma of the Tongue Justified?

Total glossectomy (with or without total laryngectomy) followed by postoperative radiotherapy remains the principal treatment method for advanced base of tongue carcinoma. The procedure remains controversial owing to poor cure rates and the inevitable functional deficits associated with it. However; even though total glossectomy is a major surgical procedure that impacts on speech; deglutition and quality of life; it may offer patients the best chance of cure in many centres; especially in the developing world.METHODS. We did a retrospective chart review of all patients at Groote Schuur Hospital; Cape Town; who had undergone total glossectomy; with or without total laryngectomy; for stage IV squamous cell carcinoma (SCC) of the tongue between 1998 and 2004. RESULTS. Eight patients had a total glossectomy performed during the study period. At 2; 3 and 5 years 63; 38and 25of patients respectively were alive without disease. No patient required permanent nasogastric or gastrostomy feeding; and all returned to a full oral diet. Three of 5 patients who had laryngeal preservation and could be assessed for speech had intelligible speech. All but 1 patient (88) reported pain relief following surgical excision. Perineural invasion was present in 75; and 38had positive resection margins. Five patients had recurrence; 2 cervical; 1 local; and 2 local and cervical. Conclusion. Advanced SCC of the tongue is a devastating disease causing severe pain and disorders of speech and swallowing. Total glossectomy (with or without total laryngectomy) and postoperative radiotherapy is a reasonable treatment option; particularly in the developing world setting. It has cure rates superior to primary radiotherapy; and provides motivated patients with excellent pain relief and a reasonable quality of life