Should We Give Routine Postoperative Intravenous Fluids After Cleft Surgery?

OBJECTIVE: In 2012, the James Lind Alliance, together with the Craniofacial Society of Great Britain and Ireland and the Cleft Lip and Palate Association, set priorities for unanswered questions in cleft management. One of these priorities included postoperative fluid management. The authors' postoperative regimen does not include intravenous fluids unless the child fails to achieve adequate oral intake by the first evening postoperatively. This audit evaluated whether this is appropriate and safe practice. METHODS: All patients undergoing cleft-related surgery by a single surgeon in a single center during August 2011 to August 2012 were included. Patient age, weight, and surgery type were recorded together with fluid requirement, length of stay, and any returns to theater or readmissions. RESULTS: Of the 79 patients included, none required readmission or return to theater, and the mean length of stay was 1.72 days. Nineteen patients (24%) required intravenous fluids, but these tended to be the older children in the group (P value .034). In the youngest patients undergoing primary lip repair, only 1 of 20 required intravenous fluids. CONCLUSIONS: This study demonstrates that, especially in the younger patients, omitting intravenous fluids as a postoperative routine is associated with a shorter length of stay without an increased complication rate. The authors advocate early postoperative feeding and the return to physiological fluid balance.

Should We Give Routine Postoperative Intravenous Fluids After Cleft Surgery?

OBJECTIVE: In 2012, the James Lind Alliance, together with the Craniofacial Society of Great Britain and Ireland and the Cleft Lip and Palate Association, set priorities for unanswered questions in cleft management. One of these priorities included postoperative fluid management. The authors' postoperative regimen does not include intravenous fluids unless the child fails to achieve adequate oral intake by the first evening postoperatively. This audit evaluated whether this is appropriate and safe practice. METHODS: All patients undergoing cleft-related surgery by a single surgeon in a single center during August 2011 to August 2012 were included. Patient age, weight, and surgery type were recorded together with fluid requirement, length of stay, and any returns to theater or readmissions. RESULTS: Of the 79 patients included, none required readmission or return to theater, and the mean length of stay was 1.72 days. Nineteen patients (24%) required intravenous fluids, but these tended to be the older children in the group (P value .034). In the youngest patients undergoing primary lip repair, only 1 of 20 required intravenous fluids. CONCLUSIONS: This study demonstrates that, especially in the younger patients, omitting intravenous fluids as a postoperative routine is associated with a shorter length of stay without an increased complication rate. The authors advocate early postoperative feeding and the return to physiological fluid balance.

Intraocular Pressure Changes Post Selective Laser Trabeculoplasty in the Contralateral Untreated Eyes of Nigerian Patients With Primary Open Angle Glaucoma.

BACKGROUND: Glaucoma is the commonest cause of irreversible blindness in Nigeria and raised intraocular pressure (IOP) is the only modifiable risk factor. Selective laser trabeculoplasty (SLT), one of the treatment modalities, has been reported to have a cross-over effect on the fellow untreated eyes. OBJECTIVES: To determine the lOP lowering effect of SLT on the contralateral untreated eyes in patients with primary open angle glaucoma. METHODS: This was a retrospective chart review of patients who underwent SLT at Guinness Eye Centre, Lagos from June 2011-June 2012. Information on bio-data, diagnosis and modality of treatment were retrieved. Excluded were patients who had glaucoma surgery or needed additional medications. Each patient had SLT in one eye either as primary or adjunctive treatment. IOPs were measured post-operatively in both treated and untreated eyes at various time points using the Goldmann applanation tonometer. Data was analysed using paired and unpaired two-tailed t-test for comparison of means with level of significance set at p<0.05. RESULTS: Forty eyes of twenty subjects were included. 60% (12) were males and 40% (8) were females. The mean age was 48.9 +/- 17.0 years (range, 23-74 years). Reduction in IOP from baseline was found in both the treated and the fellow untreated eyes at the various time points. Mean IOP reduction was maximal at 3 months; 8 mmHg or 26% (p=0.024) in the treated eyes and 7 mmHg or 25.9% (p=0.097) in the untreated eyes. Mean IOP reduction from baseline-were 1.3 +/- 5.9mmHg or 6.3% (P=.624) in the treated eyes and 2.9 +/- 7.5 mmHg or 9.7% (P=.418) in the untreated eyes at 6 months. CONCLUSION: This study shows that there is a sustained IOP reduction in the fellow untreated eyes following SLT in patients with POAG. In view of the retrospective nature of the study, small sample size, non-randomization and lack of control definite conclusions cannot be drawn from the findings.

Extragnathic odontogenic sinonasal myxoma with mitotic features.

We present the first-ever documented evidence of mitotic figures in a case of sinonasal myxoma diagnosed in a 37 year-old gentleman. A 37 year-old gentleman was referred to the Otolaryngology clinic with left nasal discharge for six months. Preoperative images demonstrated obstruction of the left nasal airway with complete opacification of the left maxillary sinus, obscuration of the osteomeatal complex, as well as expansion and thinning of the medial wall of the maxillary antrum. The patient underwent diagnostic Funtional Endoscopic Sinus Surgery (FESS), therapeutic left Caldwell-Luc antrostomy, and revision FESS following recurrence. The patient was symptom-free at routine follow-up post-op. There has been much debate as to whether the absence of mitotic features in a specimen is absolutely necessary in order to confirm the diagnosis. We postulate that the presence of mitoses is an unusual diagnostic feature in extensive sinonasal myxoma.