Complications of acute mastoiditis in a paediatric population at a UK Tertiary Centre: A retrospective review.

OBJECTIVES: Acute mastoiditis (AM) and its associated intra and extracranial complications are rare complications of acute otitis media. However, they are associated with a high morbidity. The management of AM with complications carries significant variations in approach. We aimed to evaluate the presentation of children with AM with complications to a tertiary referral centre in the United Kingdom and describe evolution of the treatment approaches. METHODS: We undertook a retrospective chart review of all children admitted with AM to the University Hospitals of Leicester between 2013 and 2022. RESULTS: Twenty-seven children were included in this study: 7 patients had sigmoid sinus thrombosis (SST), 4 had an intracranial collection, 3 had cranial nerve palsy and 16 had a subperiosteal abscess (SPA); some patients had more than 1 complication. In this study, treatment of SPA with incision and drainage (I&D) and grommet insertion was effective, as all patients treated with grommet insertion and I&D recovered well and did not require a subsequent cortical mastoidectomy. All patients with SST received anticoagulation and intravenous (IV) antibiotics; surgical input consisted of grommet insertion alone and cortical mastoidectomy was not routinely performed in these patients. CONCLUSION: In our series, management of SPA with grommet insertion and drainage had good outcomes. SST management mainly consisted of IV antibiotics, anticoagulation and grommet insertion with good recovery. The evidence to guide the management of complications of mastoiditis is of poor quality and further research is needed to clarify the optimal management of these complications.

The assessment and management of deep neck space infections in adults: A systematic review and qualitative evidence synthesis.

OBJECTIVES: To summarise current practices in the diagnosis and management of deep neck space infections (DNSIs). To inform future studies in developing a framework in the management of DNSIs. DESIGN: This review was registered on PROSPERO (CRD42021226449) and reported in line with PRISMA guidelines. All studies from 2000 that reported the investigation or management of DNSI were included. The search was limited to English language only. Databases searched included AMED, Embase, Medline and HMIC. Quantitative analysis was undertaken with descriptive statistics and frequency synthesis with two independent reviewers. A qualitative narrative synthesis was conducted using a thematic analysis approach. SETTING: Secondary or tertiary care centres that undertook management of DNSIs. PARTICIPANTS: All adult patients with a DNSI. MAIN OUTCOME MEASURES: The role of imaging, radiologically guided aspiration and surgical drainage in DNSIs. RESULTS: Sixty studies were reviewed. Thirty-one studies reported on imaging modality, 51 studies reported treatment modality. Aside from a single randomised controlled trial, all other studies were observational (n = 25) or case series (n = 36). Computer tomography (CT) was used to diagnose DNSI in 78% of patients. The mean percentage of management with open surgical drainage was 81% and 29.4% for radiologically guided aspiration, respectively. Qualitative analysis identified seven major themes on DNSI. CONCLUSIONS: There are limited methodologically rigorous studies investigating DNSIs. CT imaging was the most used imaging modality. Surgical drainage was commonest treatment choice. Areas of further research on epidemiology, reporting guidelines and management are required.

Balanced Cantilever Graft for Supporting the Cartilaginous Side Wall of Nose.

BACKGROUND: Many locations for the nasal valve have been suggested, and more recently the concept of the flow-limiting segment was introduced. Rather than being controlled by an internal and external valve, flow through the nose is regulated by the cartilaginous side wall, septum, and inferior turbinate. OBJECTIVES: The aim of this study was to assess the balanced cantilever graft (BCLG) as a technique to support the lateral nasal wall. METHODS: Patients undergoing primary open septorhinoplasty over a 2-year period were studied. Follow-up period was a minimum of 6 months to a maximum of 24 months. Subjective improvement of function was measured with a visual analog scale (VAS) and aesthetic outcomes by FACE-Q score. Objective assessment of the airway was performed with a nasal peak inspiratory flow (NPIF) meter. Strips of septal cartilage of sufficient dimensions were placed in submucosal pockets created under the area of the lateral wall to be supported. RESULTS: Sixty patients received BCLGs. The VAS score for nasal obstruction increased from 2.6 preoperatively to 8.1 postoperatively. FACE-Q increased from 16.7 preoperatively to 36.6 postoperatively. NPIF was 74.9 L/minute preoperatively, improving to 95 L/minute postoperatively. Statistically significant improvements were seen in these functional and aesthetic scores. CONCLUSIONS: BCLGs support the weakened part of lateral nasal wall by their elastance. Minimal cartilage is required and the graft can be altered to support various parts of the lateral nasal wall. This graft does not cause an aesthetic deficiency whilst providing adequate support.

Atrial Fibrillation After Gastrointestinal Surgery: Incidence and Associated Risk Factors.

BACKGROUND: Atrial fibrillation (AF) is a common dysrhythmia that can occur after major physiological stress including surgery (postoperative AF). There are few data on postoperative AF after abdominal surgery. We set out to define the incidence of de novo postoperative AF after abdominal surgery and associated risk factors. METHODS: The Patient History Integrated Data store administrative database was interrogated for patients aged ≥65 y undergoing abdominal surgery from April 2012 to April 2014. Patients with pre-existing AF were excluded. The primary outcome was diagnosis of AF. RESULTS: Two thousand nine hundred and sixty-seven cases were included of whom 187 developed postoperative AF within 90 d (6.3%). The rate of postoperative AF varied by operation and was highest in small bowel resection (17.2%) and lowest in biliary surgery (4.8%). Median time to detection of postoperative AF was 32 d. Patients who developed postoperative AF were significantly older than those who did not develop AF (median age 75.3 y versus 72.4 y, P < 0.01). Logistic regression modeling found increasing age (odds ratio [OR] 1.03 [confidence interval {CI} 1.01-1.06], hypertension OR 1.73 [CI 1.19-2.51]), congestive cardiac failure (OR 3.04 [CI 1.88-4.92], and vascular disease OR 2.29 [CI 1.39-3.37]) were predictive of the development of postoperative AF within 30 d. The area under the curve for this model was 0.733. CONCLUSIONS: Postoperative AF affects a significant number of patients after abdominal surgery. Demographics such as history of cardiovascular disease might aid prediction of postoperative AF. Postoperative AF is mostly identified after discharge, suggesting the need for postoperative screening.