Simulation-based ENT induction: validation of a novel mannequin training model.

OBJECTIVE: To ascertain whether simulation-based teaching is superior to lecture-based teaching for an induction programme using a home-made induction model. METHODS: A simulation-based induction programme was designed and separate lecture-based teaching covering the same content was organised for junior doctors. The junior doctors were asked to complete pre- and post-induction surveys regarding confidence and anxiety levels. The skills taught included microsuction, flexible nasendoscopy, and anterior and posterior nasal packing. Structured interviews were conducted after the programme to gain qualitative data for analysis. The trainees' knowledge retention was compared using a standardised written assessment one month after the session. RESULTS: Simulation-based teaching using the induction model was associated with a statistically significant increase in confidence levels and reduction in anxiety levels, and was associated with greater knowledge retention. CONCLUSION: A regular simulation induction programme should be introduced using the induction model, as it leads to better knowledge retention and increased confidence levels.

Advocating the Use of Absorbable Sutures for Columellar Incisions Following Open Rhinoplasty.

Rapidly absorbable skin sutures have been found to be of use in numerous settings including for the closure of the columellar incision following open rhinoplasty. Its removal does not routinely require trimming, and the sutures tend to fall off with minimal intervention 10-14 days postoperatively. This practice has a good acceptance by patients and utilises less resources in the follow-up period. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Doyle-Saleh blink reflex.

OBJECTIVES: When performing septoplasty or septorhinoplasty, we have observed that patients blink on injection of local anaesthetic (lidocaine 1 per cent with adrenaline 1:80 000) into the nasal mucosa of the anterior septum or vestibular skin, despite appropriate general anaesthesia. This study sought to quantify this phenomenon by conducting a prospective audit of all patients undergoing septoplasty or septorhinoplasty. METHODS: Patients were observed for a blink reflex at the time of local anaesthetic infiltration into the nasal vestibule. Also measured at this point were propofol target-controlled infusion levels, remifentanil rate, bispectral index, blood pressure, heart rate, pupil size and position, and patient movement. RESULTS: There were 15 blink reflexes in the 30 patients observed. The average bispectral index value was 32.75 (range, 22-50) in the blink group and 26.77 (range, 18-49) in the non-blink group. No patients moved on local anaesthetic injection. CONCLUSION: The blink reflex appears to occur in 50 per cent of patients, despite a deep level of anaesthesia. Without an understanding and appreciation of the blink reflex, this event may result in a request to deepen anaesthesia, but this is not necessary and surgery can proceed safely.

Outpatient clinic numbers: a review of standards and current practice.

This article explores current recommendations for the safe and efficient running of outpatient clinics, why non-adherence exists, the consequences of non-adherence, and what can be done to improve standards. It promotes adherence to recommendations by both clinical and managerial staff.

Facial transplantation: historical developments and future directions.

OBJECTIVE: To present the clinical outcomes obtained by the first facial transplant teams worldwide, reviewing current practice and addressing controversies. METHODS: A bibliographic search of Medline and Embase databases was performed, and a comparative analysis of all articles published from 1980 to the present was conducted. Two independent investigators screened the manuscripts in accordance with pre-defined criteria. RESULTS: A total of 12 partial and 5 full facial transplants were recorded in the literature. Procedures included partial and near-total facial myocutaneous flaps, and complex osteomyocutaneous grafts. Fifteen patients had fully vascularised grafts, and two patients died of transplant-related and infectious complications. CONCLUSION: Facial transplantation can restore quality of life and enable the social re-integration of recipients. Results published by the first facial transplant teams are promising. However, long-term reports of aesthetic and functional outcomes are needed to more precisely define outcomes. In addition, significant technical, medical and ethical issues remain to be solved.

Prenatal diagnosis and management of a craniofacial glioma detected at 20 weeks' gestation. Case report and review of the literature.

Foetal imaging and anomaly detection is advancing at a rapid rate. As a result, detection of foetal craniofacial abnormalities is increasing. Ultrasound and magnetic resonance imaging are currently the imaging modalities most commonly used. The authors describe the detection of a nasal glioma at 20 weeks' gestation, subsequent prenatal monitoring and postnatal management with surgical excision at 2 months of age. The world literature regarding prenatal diagnosis and management of craniofacial malformations is discussed.

Malignant peripheral nerve sheath tumours of the infraorbital nerve: case report and literature review.

OBJECTIVE: We report a case of malignant peripheral nerve sheath tumour seen in our department. METHOD: We present case reports and a review of the world literature concerning malignant peripheral nerve sheath tumour. RESULTS: A 38-year-old Caucasian woman was diagnosed with malignant peripheral nerve sheath tumour of the infraorbital nerve. She underwent a wide enbloc resection followed by a course of radiotherapy. A five-year post-operative magnetic resonance imaging scan revealed no evidence of recurrence. CONCLUSION: Malignant peripheral nerve sheath tumours are rare in the head and neck. An awareness of their occurrence is important for early diagnosis. Management involves: accurate histological diagnosis; radiological imaging to define tumour extent and plan resection; wide surgical excision with histologically negative margins; reconstruction of the tissue defect; and post-operative radiotherapy.