A significant reduction in paediatric post-tonsillectomy vomiting through audit.

INTRODUCTION: Postoperative vomiting occurs more frequently after tonsillectomy than any other commonly performed paediatric operation. Postoperative vomiting is also the commonest cause of morbidity and re-admission following tonsillectomy. We present a successful completed audit cycle and literature review on the subject. PATIENTS AND METHODS: Data on the risk factors for postoperative vomiting, whether the patient vomited and details of the patient's vomitus were collected prospectively on consecutive patients and compared with a gold standard. Changes in practice were agreed and a second cycle performed. RESULTS: Two cycles and a total of 107 patients were included in the audit. A significant reduction in vomiting from 27% to 11% was achieved following the introduction of routine use of intravenous dexamethasone during surgery. CONCLUSIONS: This simple prospective audit of paediatric post-tonsillectomy vomiting has resulted in a statistically significant reduction in vomiting which would appear to be due to use of intra-operative steroids.

Vocal cord palsy in pediatric practice: a review of 71 cases.

Seventy-one cases of vocal cord palsy were seen over a 20-year period at the Hospital for Sick Children in Toronto. Forty-four percent of the cases had a bilateral vocal cord palsy. The etiology, management and outcome of all the cases are reviewed. Of the acquired vocal cord palsies, 64% recovered spontaneously. Only 29% of the congenital vocal cord palsies recovered spontaneously. An important consideration in the management of children with vocal cord palsy is the possibility of late spontaneous recovery or compensation. There should, therefore, be no hurry to perform surgical procedures to permanently lateralize the vocal cords or arytenoids.

Cystic hygroma of the head and neck. A review of 37 cases.

37 children with cystic hygroma of the head and neck are reviewed. 92 per cent of the children required surgical excision of the cystic hygroma and one-third of these children suffered a permanent nerve palsy. Spontaneous resolution of the cystic hygroma occurred in 8 per cent of the children over a period of follow-up lasting on average 7 years 2 months (range 3 months-20 years). 41 per cent of the children suffered significant upper airway and feeding problems.

An extensive solitary xanthoma of the temporal bone, associated with hyperlipoproteinaemia.

A rare case of a solitary xanthoma deposit in the temporal bone associated with a primary type V (WHO classification) hyperlipoproteinaemia is presented. Only one other similar case has been found in the literature, and this was also associated with a hyperlipoproteinaemia. This earlier case was most probably a type V although it is difficult to be sure because of the slightly limited information available.

Pleomorphic salivary gland adenomas of the parapharyngeal space. Review of nine cases.

Nine cases of pleomorphic salivary gland adenomas of the parapharyngeal space are reviewed. In the discussion which follows we show that five of these tumours were situated medial to the superior constrictor muscle and arose within pharyngeal mucosa. We also outline our views on the management of pleomorphic salivary gland adenoma of the parapharyngeal space with particular reference to biopsy, surgical excision and post-operative radiotherapy.