Sphenopalatine foramen: endoscopic approach with bony landmarks.

OBJECTIVE: To establish whether nasal bony landmarks on computed tomography could be utilised reliably in endoscopic approaches to the sphenopalatine foramen. METHODS: A prospective analysis of 102 consecutive helical computed tomography scans of the paranasal sinuses was carried out by 2 senior ENT surgeons. Distances from the sphenopalatine foramen to endoscopically palpable bony landmarks were measured. RESULTS: There were a total of 102 patients (45 females and 57 males), with a mean age of 62 years. The mean distance from the posterior fontanelle to the sphenopalatine foramen was 14.1 mm (standard deviation = 2.13). The average vertical distance of the sphenopalatine foramen opening from the bony attachment of the inferior turbinate was 14.13 mm. There were no statistically significant differences between any of these measurements (foramen width p-value = 0.714, distance from fontanelle p-value = 0.43 and distance from inferior turbinate p-value = 0.48). CONCLUSION: Determination of reliable bony landmarks is clinically useful in endoscopic surgery and can aid identification of the sphenopalatine foramen. The inferior turbinate concha and posterior fontanelle may be used as reliable computed tomography landmarks for endoscopic approaches to the sphenopalatine foramen.

Dermoid cysts of the Eustachian tube: a transnasal excision.

Congenital dermoid cysts are benign developmental lesions and are a well-recognised entity in head and neck surgery. First reported in 1828 by Berger et al., these lesions have been referred to as dermoids, hairy polyps, teratoid tumours with varying classification systems. This has caused confusion in the medical literature with a lack of consensus regarding optimal diagnosis and management. Within the Eustachian tube, there have been 16 reported cases in the English literature demonstrating the rarity of these lesions. The aim of this report is to present a case of histopathologically confirmed Eustachian tube dermoid, confirm the current classification system and demonstrate the challenges they can pose given the relative inaccessibility of such lesions.

Endoscopic repair of spontaneous cerebro-spinal fluid rhinorrhoea: a report of 3 cases.

Three cases of spontaneous Cerebrospinal Fluid (CSF) rhinorrhea were managed at the National University Hospital, Kuala Lumpur. Case 1 had bilateral leak secondary to empty sella syndrome and the rest two cases had unilateral leak. Four transnasal endoscopic approaches were performed on these three cases since March 1999. The role of intrathecal Sodium Fluorescein is highlighted in localising the CSF fistula. Case 3 required postoperative lumbar drain as an adjunct. No recurrent leak was noted on post operative follow up in Case 2 and 3 ranging from nine to thirty two months. A recurrent left leak at six months was noted in Case 1 which could likely be due to her sudden bout of cough attacks and patient refused further surgical intervention.

The management of postnasal drip.

BACKGROUND: Postnasal drip is a symptom that can be very irritating to both patient and doctor. OBJECTIVE: The aim of this article is to give an approach to diagnosis and treatment of postnasal drip. DISCUSSION: In order to have an approach to management of this problem the pathophysiology needs to be understood. The causes of increased mucus awareness need to be known. Investigations are aimed at trying to clearly define the cause of the increased mucus and then specific treatment can be given to remedy the situation. Treatment is generally medical, however, surgical treatment is required in certain situations.

Lingual thyroid.

Lingual thyroid is a rare cause of dysphagia and airway obstruction. A case is presented, with a discussion of the diagnosis and management.

Endonasal dacryocystorhinostomy--primary and secondary.

An endonasal approach was used to restore lacrimal drainage in both primary and secondary obstructions. Patients in the primary group had a history of keloid scar formation, or wished to avoid a scar and declined to have surgery performed via an external approach. Patients in the secondary group had undergone one or more previous unsuccessful lacrimal drainage repairs. A fibreoptic endonasal telescope, linked to a video monitor, and appropriate nasal and lacrimal instruments, were used. The approach proved highly successful, in both anatomical and functional terms, in each group. In the secondary group, the endonasal approach allowed direct visualisation and repair of both nasal and lacrimal causes of failure; this approach is our preference in this group. In the primary group, endonasal instrumentation had no advantage over a conventional external operation, other than avoiding a scar. The application of laser technology may make the endonasal approach a realistic option in primary DCRs as well.

Otitis media.

It is obvious to any clinician that otitis media is a major health problem among children. As there are numerous presentations of otitis media, treatment needs to be individualised. The author provides guidelines for the treatment of young patients.

Acoustic tumor in a young adult: documented growth rate.

The diagnosis of acoustic neuroma is being made more easily with the advent of late-generation, high-resolution computed tomography. It is known that acoustic tumor growth in the elderly is often slow. On the other hand, it is believed that an acoustic tumor can grow very rapidly in the young. A case of acoustic neuroma in a young man with computed tomographic evidence of extremely rapid growth over a period of fifteen months is presented.

Pneumatic rupture of the posterior pharyngeal wall.

A fourth case of pharyngeal injury after an attempt to open a bottle of 'home brew' is presented. For the first time the potential barotrauma causing this injury is recognized. The principles of diagnosis, investigation and treatment are described. Early surgical intervention will minimize contamination and allow adequate drainage of the contaminated space. Early institution of antibiotics will minimize local and generalized toxic phenomena. Alternate routes of alimentation allow local healing and rapid recovery of the patient.