Laryngeal Chondrosarcoma: A rare cause of critical upper airway obstruction.

Laryngeal cancers are rare, encompassing around one percent of all cancers. Suspicion should be raised if a patient presents with classical signs and symptoms; i.e. dysphonia, inspiratory stridor, dysphagia, odynophagia, neck mass, or persistent cough. Laryngeal chondrosarcoma is a rare form of laryngeal cancer, the diagnosis of which can be difficult. The case in question describes an unusual presentation of one such case, and its subsequent investigation, management and outcome.

Is treatment de-escalation a reality in HPV related oropharyngeal cancer?

The incidence of HPV related oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing. It is now well recognised as a distinct clinical and biologic entity, compared to traditional OPSCC. The majority of these patients have an excellent prognosis due to the chemo-radiosensitive nature of these tumours. The de-escalation of current treatment regimens have therefore been proposed in an attempt to reduce the long term treatment related morbidity of this much younger patient cohort. Several of the more pertinent points regarding safe de-escalation strategies are considered within this manuscript.

Paediatric tonsillotomy--an Irish perspective on potential evolving indications.

Tonsillotomy is the preferred treatment of some otolaryngologists for younger patients (under 3 years) with low body weight (under 15 kgs) and a history of obstructive sleep apnoea. The use of the technique in the same patient cohort for recurrent tonsillitis remains controversial. The aim of this study was to evaluate the indications and outcomes of paediatric patients undergoing tonsillotomy (with or without adenoidectomy) at a paediatric ENT centre in Ireland. Patients were identified from a prospectively maintained database and chart review was completed. A total of 23 patients were identified who underwent tonsillotomy. The commonest indication was Obstructive Sleep Apnoea (OSA) in 15 patients (65%). Outcomes following tonsillotomy compared favourably with traditional tonsillectomy. No intra-operative or post-operative complications were recorded (0%). No patients required readmission or later tonsillectomy (0%). At follow-up 19/23 patients with OSA (82.6%) had complete symptom resolution. Tonsillotomy appears to represent a safe, effective treatment option in the paediatric population, however, its role in recurrent tonsillitis remains controversial.

General practitioner ENT referral audit.

BACKGROUND: During 2009, there were 3.3 million outpatient attendances at outpatient clinics across Ireland. Up to 20 % of these are directed towards ENT services. AIMS: To determine the compliance rate of general practitioners with the ICGP referral guidelines. METHODS: One-hundred referrals received were compared to the ICGP standardised form and graded accordingly. Each referral letter was graded to a maximum of 37 points. RESULTS: The average score recorded for referrals was 16/37. The referrer detail section scored the highest with a mean of 75.42 % (paediatric referrals) and 72.9 % (adult referrals). The clinical information provided demonstrated compliance rates of 34 % (paediatrics) and 35 % (adults). In total, only 32 letters made any reference to findings on examination. Both paediatric and adult referrals scored an average of 42 % when patients' details are considered. CONCLUSION: This study demonstrates poor compliance rates with the introduced ICGP standardised referral form, which has implications for the accurate grading of referral letters received.

Trans-cervical, trans-tracheal approach to proximal tracheo-oesophageal fistula: a novel technique.

Esophageal atresia and tracheo-esophageal fistula (TEF) occur in 1/2400-4500 births. Whilst the diagnosis of esophageal atresia is readily made shortly after birth, patients with an isolated H type TEF can present with varying degrees of symptomatology which can pose a diagnostic challenge. A combination of contrast esophagogram and endoscopic evaluastion is the most commonly employed localization strategy. Despite accurate pre-operative localization, intra-operative identification of the TEF can prove substantially more challenging. The authors of this report describe a novel approach in the management of a proximal TEF, which allows direct visualization and cannulation via a trans-cervical, trans-tracheal approach.

A case of quinsy following high-pressure water jet injury.

High-pressure water injuries of the oropharynx are uncommon but can cause significant injury and airway compromise when they occur. A small number of cases of high-pressure water injury of the oropharynx have been presented in the literature, detailing a range of effects and outcomes. We describe the first reported case of high-pressure water injury of the oropharynx associated with peritonsillar abscess (quinsy) requiring surgical drainage.

Alternatives to the impact factor.

OBJECTIVE: To explore alternative bibliometric markers to the well-established journal impact factor. The bibliometric evolution of a leading ENT journal over a six year period is discussed with critical analysis of a predetermined set of bibliometric alternatives to the journal impact factor. DESIGN: Retrospective review of the bibliometric performance of Clinical Otolaryngology over a six year period. RESULTS: The results of the study reveal that Clinical Otolaryngology has made steady bibliometric progress when the impact factor (IF) is considered with a gradual increase in impact factor from 1.098 in 2006 to a peak of 2.393 in 2011. Self-citation rates reported by the Journal Citation Report (JCR) demonstrated a significant decline during 2007 with a reported self-citation rate of 0%. The SCImago Journal Rank (SJR) database however recorded a self-citation rate of 67. Independent evaluation demonstrated a 56 self-citations during this period. The percentage of review articles published remained stable during the period in question. A lagged association between the number of review manuscripts and the IF failed to demonstrate any significant correlation (r = -0.19). Comparison between the IF and the Eigen factor (EF) as well as the SJR yielded negative correlation (r = -0.46) and (r = -0.35) respectively. The Article Influence score (AIS) and Source Normalised Impact per Paper (SNIP) were the only bibliometric alternatives to demonstrate a positive correlation when compared to the IF (r = 0.94) and (r = 0.66) respectively. CONCLUSIONS: The necessity of bibliometric markers cannot be called into question however the most widely employed of these, the journal impact factor has come under increased scrutiny of late. Despite some of the advantages offered by novel bibliometric markers, these do not necessarily compare favourably to the IF with regards to bibliometric performance. The only two markers to demonstrate a positive correlation when compared to the IF were the AI score and SNIP which would suggest that these are potential alternatives to the IF and have the added advantage that they are open access.

Glomangiopericytoma (sinonasal-type haemangiopericytoma).

BACKGROUND: Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours. OBJECTIVE: Discussion of the clinical presentation, histopathological features and advances in the management of sinonasal and skull base glomangiopericytoma. CASE REPORT: A 32-year-old woman presented with worsening nasal obstruction, anosmia, severe frontal headaches and right-sided proptosis. Radiographic and endoscopic examination revealed a right-sided, vascular mass involving the nasal cavity, paranasal sinuses and anterior skull base. Histopathological features were consistent with a glomangiopericytoma. Complete endoscopic resection with free margins was achieved. CONCLUSION: Glomangiopericytomas are rare, vascular, sinonasal tumours. Successful management depends on complete resection, traditionally achieved via an open approach. However, recent advances in endoscopic surgical approaches have enabled complete endoscopic resection of these tumours, minimising morbidity and facilitating subsequent surveillance of the operative site.

The role of pectoralis major myofascial flap in salvage laryngectomy: a single surgeon experience.

CONCLUSIONS: These results support the use of a pectoralis major myofascial flap (PMMF) in patients undergoing salvage surgery. BACKGROUND: Pharyngocutaneous fistula (PCF) is the most common major complication following laryngectomy. Preceding chemoradiotherapy increases the incidence and severity of PCF formation. The aim of this study was to determine whether the use of a PMMF reduces the incidence and severity of PCF formation in patients undergoing salvage surgery. METHODS: This was a retrospective cohort analysis. RESULTS: A total of 33 patients were identified, including 10 patients who underwent salvage surgery after chemoradiotherapy. In all, 80% of salvage surgery patients underwent PMMF reinforcement of the pharyngeal closure. A PCF rate of 50% was recorded for salvage surgery patients without PMMF reinforcement. Identical PCF rates (25%) were recorded for patients who underwent primary total laryngectomy and salvage surgery patients treated with PMMF reinforcement. Mean duration to fistula closure was 57.16 days in the primary laryngectomy group compared with 20.5 days in salvage surgery patients with PMMF reinforcement.

The changing face of informed surgical consent.

OBJECTIVES: To determine whether procedure-specific brochures improve patients' pre-operative knowledge, to determine the amount of information expected by patients during the consenting process, and to determine whether the recently proposed 'Request for Treatment' consenting process is viable on a large scale. METHOD: A prospective, questionnaire-based study of 100 patients admitted for selected, elective surgical procedures. RESULTS: In total, 99 per cent of patients were satisfied with the information received in the out-patient department, regarding the proposed procedure. However, 38 per cent were unable to correctly state the nature of the surgery or specific procedure they were scheduled to undergo. Although the vast majority of patients were able to state the intended benefits to be gained from the procedure, only 54 per cent were able to list at least one potential complication, and 80 per cent indicated that they wished to be informed about all potential complications, even if these occurred in less than 1 per cent of cases. CONCLUSIONS: The introduction of procedure-specific brochures improved patients' pre-operative knowledge. Although the failings of current consenting practice are clear, the Request for Treatment consenting process would not appear to be a viable alternative because of the large number of patients unable to accurately recall the nature of the proposed surgery or potential complications, following consent counselling.

Paediatric blunt laryngeal trauma: a review.

Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries.

Lymphatic malformations: a proposed management algorithm.

OBJECTIVE: The aim of this study was to develop a management algorithm for cervicofacial lymphatic malformations, based on the authors' experience in managing these lesions as well as current literature on the subject. STUDY DESIGN AND METHODS: A retrospective medical record review of all the patients treated for lymphatic malformations at our institution during a 10-year period (1998-2008) was performed. DATA COLLECTED: age at diagnosis, location and type of lesion, radiologic investigation performed, presenting symptoms, treatment modality used, complications and results achieved. RESULTS: 14 patients were identified. Eight (57%) male and six (43%) female. There was an equal distribution between the left and right sides. The majority (71%) of cases were diagnosed within the first year of life. The majority of lesions were located in the suprahyoid region. The predominant reason for referral was an asymptomatic mass in 7 cases (50%) followed by airway compromise (36%) and dysphagia (14%). Management options employed included: observation, OK-432 injection, surgical excision and laser therapy. In 5 cases (36%) a combination of these were used. CONCLUSION: Historically surgical excision has been the management option of choice for lymphatic malformations. However due to the morbidity and high complication rate associated this is increasingly being questioned. Recent advances in sclerotherapy e.g. OK-432 injection have also shown significant promise. Based on experience in managing these lesions as well as current literature the authors of this paper have developed an algorithm for the management of cervicofacial lymphatic malformations.