The frontal osteoplastic flap: does it still have a place in rhinological surgery?

OBJECTIVE: To review outcomes and complications in a series of adults undergoing a frontal osteoplastic flap procedure without obliteration, for endoscopically inaccessible sinus disease. MATERIAL AND METHOD: Retrospective case note review of patients treated at Glasgow Royal Infirmary between January 2004 and October 2008. RESULTS: Ten patients were identified (age range 19-81 years, mean age 46.3 years). No major intra- or post-operative complications occurred. There were three minor complications: superficial discharging wound, forehead swelling and haematoma. CONCLUSION: The frontal osteoplastic flap still has a role in frontal sinus surgery. With minor technical modifications, this procedure may be performed with minimal complication and morbidity for patients with endoscopically inaccessible frontal sinus disease.

An evidence based approach to the management of salivary masses.

BACKGROUND: Salivary lumps are common and constitute 13.8% of all lumps assessed at the North Glasgow neck lump clinic. We present our management plan for these conditions. METHOD: Literature search using key words salivary lumps or glands or cancer or sialadenitis or sialalisthiasis in combination with diagnosis, management, investigation, treatment, intervention and surgery was performed in June 2009 using MEDLINE and Pubmed. Data from the North Glasgow neck lump clinic database are also presented. RESULTS: Published literature on management of salivary lumps is level 2/3 evidence. CONCLUSION: The majority of salivary gland swellings can be adequately assessed with ultrasound and ultrasound guided FNA. The majority of patients with salivary gland tumours are likely to benefit from surgical excision. Due to the higher risk of malignancy in submandibular gland tumours surgical excision should be undertaken, unless there is significant co-morbidity.

Hypoxia in head and neck cancer.

A high level of hypoxia in solid tumours is an adverse prognostic factor for the poor outcome of cancer patients following treatment. This review describes the status of research into finding a practical method for measuring hypoxia and treating hypoxic tumours. The application of such methodology would enable the selection of head and neck cancer treatment based on an individual's tumour oxygenation status. This individualization would include the selection not only of surgery or radiotherapy, but also of novel hypoxia-modification strategies.

Nitinol stents in the treatment of benign proximal tracheal stenosis or tracheomalacia.

Nitinol stents have been used in the treatment of benign tracheal stenosis. A retrospective review of five patients treated at Stobhill Hospital over the last six and a half years is presented. Age at presentation ranged from 17 to 76 years. The minimum follow-up period was 23 months and the maximum was 78 months. All our patients were successfully decannulated, with none requiring recannulation. Four patients developed granulation tissue related to the stent at intervals ranging from three weeks to 41 months post stenting. Topical mitomycin C application has been useful after resection of granulations using the carbon dioxide (CO2) laser. Stent migration occurred in one patient three weeks after insertion. Nitinol stents are easy to insert and effective in the treatment of tracheal stenosis, but can have associated morbidity. Their use should be considered carefully, as insertion should be regarded as permanent. Publications reporting experience and outcome with the use of Nitinol stents in the trachea are reviewed.