Cerebrospinal fluid rhinorrhea complicating septoplasty: a novel mechanism of injury.

Cerebrospinal fluid (CSF) rhinorrhea after a septoplasty procedure is very rare and potentially life-threatening. We present a case of iatrogenic postseptoplasty CSF rhinorrhea. To the best of our knowledge, only 2 other cases of CSF rhinorrhea complicating septoplasty have previously been reported. However, neither resolved in the manner that our case did, when spontaneous cessation of CSF rhinorrhea unexpectedly occurred upon removal of intranasal splints. We discuss the clinical importance of anatomic variations and potential causative mechanisms of CSF rhinorrhea during septoplasty. Our experience with this case suggests a mechanism of injury to the cribiform plate during septoplasty that has not been described previously.

How I do it: securing tracheostomy tubes.

Securing a tracheostomy tube after insertion is essential to prevent accidental decannulation. Although this is uncommon, its associated mortality is high. Common practice involves suturing the lateral edges of the tube flanges to the skin. This can allow movement along the axis of the flanges. We describe a modification of the suture placement, which provides a more robust fixation.

Tracheoesophageal speech in a developing world community.

OBJECTIVES: To determine the tracheoesophageal speech results in a Third World medical practice; to examine the impact of socioeconomic status, literacy, and proximity to specialist services on tracheoesophageal speech; to assess whether these factors should affect patient selection for fistula speech; and to determine guidelines for voice prosthesis selection. DESIGN: Retrospective analysis. SETTING: Groote Schuur Hospital, Cape Town, South Africa, which serves a Third World community. PATIENTS: Ninety-seven consecutive patients who underwent total laryngectomy between January 1, 1996, and October 1, 1998. Patients who undergo total laryngectomy routinely have a primary tracheoesophageal fistula created for speech. MAIN OUTCOME MEASURES: Speech outcomes after total laryngectomy; tracheoesophageal speech in relation to social class, literacy, and proximity to specialist services; and experience with removable and indwelling valves. RESULTS: Fifty-nine (81%) of 73 patients acquired useful speech. Speech outcome was not affected by employment status or proximity to specialist services. Although speech was affected by literacy and housing, several illiterate shack dwellers acquired good speech. Average device life of removable prostheses was 16 weeks (>4 months in 35% [64/183]). Indwelling prostheses had an average life of 28 weeks. CONCLUSIONS: Tracheoesophageal speech results in a Third World community equate with those in the Developed World. All patients who undergo laryngectomy and have adequate manual dexterity and cognitive function should be given a trial of fistula speech. Removable voice prostheses can successfully be used as indwelling prostheses.