Nasal tip abscess due to adverse skin reaction to Prolene: an unusual long term complication of rhinoplasty.

OBJECTIVES: Allergic reactions to Prolene are rare. This paper reports a nasal tip abscess which developed in a patient with an adverse skin reaction to Prolene after rhinoplasty. METHODS AND RESULTS: A 26-year-old woman presented with painful, progressive nasal tip swelling and redness. She had undergone septo-rhinoplasty two years previously. She was initially treated with endonasal drainage of the abscess and antibiotics, but a revision rhinoplasty three months later became necessary because of recurrent abscess formation. Intra-operative findings included granulation tissue with pockets of pus and knotted Prolene sutures at the tip-defining points of the lower lateral cartilages. She was patch-tested with Prolene and a cutaneous Prolene suture was placed on her back; an adverse skin reaction was seen for the latter. CONCLUSION: Use of non-absorbable sutures, such as Prolene, in the subcutaneous layer may be a potential, rare risk factor for adverse skin reactions.

Relevance of level I and IIB neck dissection in laryngeal cancer.

OBJECTIVES: Dissection of neck levels I and IIB is time-consuming and can cause comorbidity. This study aimed to determine whether level I and IIB neck dissection was necessary in patients with laryngeal cancer and clinically detectable or nondetectable neck nodes. PATIENTS AND METHODS: This was a retrospective review of 73 patients with laryngeal cancer. Essential clinical data were obtained and analysed to determine the incidence of neck node metastasis in levels I and IIB. RESULTS: Of the 48 patients with no clinically apparent neck nodes, none had level I metastases and only one had level IIB metastases. Of the patients with clinically detectable neck nodes, three of 21 patients had level I metastases and three of 25 patients had level IIB metastases; these six patients also had additional metastases in level IIA. CONCLUSION: Dissection of neck levels I and IIB is justifiable in laryngeal cancer patients with clinically detectable neck nodes and suspicious lymph nodes in the respective level or level IIA. However, in patients without clinically detectable neck nodes, preservation of levels I and IIB is oncologically safe, economical and reduces the risk of comorbidity.

The value of spreader grafts in rhinoplasty: a critical review.

The value of spreader grafts in rhinoplasty cannot be underestimated. Various studies have demonstrated that they play a valuable role in the restoration of nasal dorsum aesthetics, provide support for the nasal valve and maintain the straightened position of the corrected deviated cartilaginous septal dorsum. However, there is still controversy on the extent of its value in nasal patency. This study reviews the literature and describes the values and limitations of spreader grafts in rhinoplasty and the alternatives to classic spreader grafts.

Adult Chronic Rhinosinusitis:Spectrum of Clinical Features and Management in aTertiary Health Institution and Literature Review

Background:Rhinosinusitis is defined as inflammation of the nasal and paranasal sinus mucosa.Chronic rhinosinusitis occurs when this inflammation and the symptoms persist for more than 3 months.The objective of this study was to evaluate the clinical features and management of adult chronic rhinosinusitis in a tertiary health institution and to review the literature for its current modalities of management.Methods:This is a 5-year retrospective study of all adult patients managed for clinically and radiologically diagnosed chronic rhinosinusitis at the study center.Their medical records were reviewed for essential data which included demographic data; clinical presentations; skin sensitivity test; radiologic reports and treatment offered.The data were collated and analyzed using simple descriptive statistics.Results: There were 228 patients; 97(42.54) males and 131(57.46) females with a male:female ratio of 1:1.35; age ranged between 18 - 67 years (mean =35.2).The five major presenting symptoms were nasal discharge 228(100.00); nasal obstruction 224 (98.25); equent throat hawking 189 (82.89); itching of eye; ear; nose or throat 138 (60.53) and excessive sneezing 136(59.65).About 6of the patients developed complications.Allergy accounted for the cause in 93 (40.79)patients. Maxillary antral mucosal thickening and engorged inferior turbinates were the commonest radiological features. About 51of the patients were treated with intranasal inferior meatal antrostomy with or thout inferior turbinectomy.There was recurrence of symptoms in about 18of these patients from 3 to 8months after surgery.Conclusions: Both subjective and objective measures should be employed in the diagnosis of chronic rhinosinusitis and intranasal inferior meatal antrostomy may rarely produce satisfactory clinical improvement

Recurrent nasal polyp and pansinus mucopyocele associated with bilateral blindness: a case report.

A 39 year old female with 24-month history of recurrent mucoid rhinorhea associated with progressive bilateral nasal blockage, headache, anosmia and bilateral impaired vision is reported. There was a past history of sinus surgery. The neuro-ophthalmic examination revealed left non-axial proptosis and visual acuity of nil light perception in both eyes at 3 meters. CT scan of the paranasal sinuses and brain showed markedly expanded left frontal sinus with sclerotic walls and expanded mixed density lesion in all the sinuses. She had surgery via trans-nasal, external and skull base approaches for effective clearance of the polypoidal masses and drainage of the sinus mucopyocele. Histological examination confirmed chronic inflammatory polyp. She remains stable to date although visual impairment and anosmia remained persistent. Patients with nasal polyposis require frequent follow-up even after surgical treatment for the early detection and management of complications to avoid consequences such as visual loss.

Tracheostomy Decannulation: Suprastomal Granulation Tissue in Perspective

Background: Suprastomal granulation tissue is a complication of tracheostomy which maymake decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population; determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion. Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital; Ibadan; Nigeria for essential clinical data.Results: Of the 256 patients who had tracheostomy; 133(51.95) had prior orotracheal intubation for 10 21days. Suprastomal granulation tissue complicated 16 (6.25) cases; this accounted for 88.89of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75); tetanus in 3 (18.75)] and intubation granuloma in 1(6.25) of these cases. Sixteen (4.3) cases had stomal infection. Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided

Retropharyngeal abscess: a clinical experience at the University College Hospital Ibadan.

BACKGROUND: Infection within the retropharyngeal space could progress on to an abscess formation resulting into retropharyngeal abscess (RPA), which can either be acute or chronic. RPA can be a life-threatening emergency, with potential for airway compromise and other catastrophic complications. This review is aimed at highlighting our experience with patients with a diagnosis of retropharyngeal abscess. METHODS: Retrospective review of thirty patients with a confirmed diagnosis of retropharyngeal abscess, who were admitted and managed within an eleven-year period (1993 to 2003) in the Otolaryngology department of the University College Hospital Ibadan. RESULTS: There were fifteen males and females each with M:F ratio of 1:1, consisting of twenty-five children and five adults and their median age was 21 months and twenty three (77%) were younger than 5 years. It was observed that while the adult patients presented early for specialist treatment, the paediatric patients presented late. The major complaints were fever (87%), respiratory distress or stridor (57%), cough (53%), neck pain/swelling (43%), and refusal of feeds (30%). Other minor complaints were throat pain, difficulty in swallowing, anorexia, and weight loss. The commonest associated symptoms seen especially among the younger age group were nasal discharge, nasal blockage, tooth-ache, snoring and limitation of neck movement. CONCLUSION: The treatment of retropharyngeal space infections in children and adults should include accurate clinical diagnosis, empirical usage of broad-spectrum antibiotics, and timely surgical drainage.