The relation between tonsillectomy and snoring.

The aim of this study was to determine the relation between snoring and tonsillectomy. The grossly enlarged tonsils of a heavily snoring child or adult with upper airway obstruction is usually sufficient indication for tonsillectomy. The authors wondered if tonsillectomy could affect snoring, no matter what the age and the indication for surgery. One thousand people took part in this study: a random sample of patients aged between 2 and 89 years of age, and those accompanying them in the ENT outpatients. The prevalence of snoring was 12.5-48%, mainly in men. The degree of snoring was graded from non-snorers to mild, moderate and severe snorers. In 19.8% of the sample tonsillectomy had already been performed, usually in childhood. The authors conclude that tonsillectomy does not reduce the likelihood of becoming a snorer.

Comparison of the effectiveness of uvulopalatopharyngoplasty and laser palatoplasty for snoring.

We present the surgical management of 51 patients with a primary diagnosis of snoring. Patients with sleep apnoea syndrome were eliminated from the study. Four procedures were used: the classical uvulopalatopharyngoplasty, a limited uvulopalatoplasty, laser palatoplasty with tonsillectomy; and laser palatoplasty alone. Fifty-one of the 67 patients (76.1%) responded to a telephone questionnaire with a mean follow-up period of 18.2 months, 78.4% of patients reported improved or absent snoring. There was almost equal patient satisfaction between the conventional technique and the laser technique. The improvement in snoring was not influenced by the type of operation performed.

Second reconstruction of the posterior maxilla with a free latissimus dorsi muscle flap. Case report.

This paper reports a case in which a latissimus dorsi free muscle flap was used for a second reconstruction following resection of a maxillary ameloblastoma when the ipsilateral temporalis muscle flap had already been used. The case illustrates the dilemma of immediate versus delayed reconstruction following excision of maxillary tumours.

Rehabilitation of facial nerve palsy.

Forty-nine patients underwent 158 procedures (including 19 revisions) for complete facial palsy. The variety of causes of facial palsy are enumerated, with the various procedures used to rehabilitate the face. Some improvement is invariably achieved. It is concluded that a readiness to intervene with a wide choice of procedures as early as realistically possible offers the best outcome in function and cosmetic appearance.

Staging carcinoma: its value in cancer of the larynx.

Three thousand four hundred and forty-five cases of cancer of the larynx were examined and 3,235 assigned to their TNM group. While good correlation with prognosis could be seen, the value of the detailed subsite (as opposed to the main laryngeal regions) was limited to defining T1a and T1b and aiding that of T2. T status gives some indication of prognosis, but the N status is of almost overriding importance.

Primary treatment of cancer of the larynx.

Analysis of 3,445 cases of cancer of the larynx with a follow-up of 99.8 per cent shows that over a period in which the survival has improved neither the modality of the treatment nor the severity of the cancer has changed. Improved survival may be due to socioeconomic factors or an improvement in the quality of treatment.

Eyelid gold weights in the management of facial palsy.

We reviewed our experiences with 20 patients with established facial palsy who had a total of 24 gold weights inserted. All patients had corneal symptoms: ulceration, exposure keratitis or discomfort abolished. Functional improvement i.e. reduction of lagophthalamos and restoration of the blink reflex was good in our opinion and that of the patients in all cases. Dissatisfaction with the cosmetic result was expressed by two patients due to the prominence of the weight under the thin eyelid skin. Three patients had to have the weight replaced because it was too light. Two patients had their weights removed because of recurrent eyelid infections. In two patients the weights were removed as they had migrated over the tarsal rim. In one of these patients the weight was replaced immediately in the appropriate position, in the other it was not replaced as dissatisfaction had been expressed due to the bulky appearance of the weight under the eyelid skin.

The role of bupivacaine in post-tonsillectomy pain.

The peritonsillar tissues on one side of 45 consecutive patients undergoing tonsillectomy were infiltrated with bupivacaine and adrenaline, the opposite side serving as a control. Although a significant difference was noted between the two sides this was not a substantial difference in terms of pain relief.

Survival of cancer of the larynx related to treatment.

Analysis of 3445 cases of cancer of the larynx has been made with reference to primary (first) and secondary treatments. It is easy to confirm that while radiotherapy is inferior to laryngectomy in the cure of larger glottic tumours, it is preferable in many cases because salvage surgery is possible and successful. Salvage surgery cannot be shown to be successful in larger supraglottic tumours, which should be considered for primary surgery. Radiotherapy appears better than surgery for small tumours.

BIPP induced methaemoglobinaemia.

Bismuth subnitrate, one of the constituents of BIPP is known to cause methaemoglobinaemia. Ten patients had blood estimations for methaemoglobin levels before and after nasal packing with BIPP impregnated gauze. Only one patient exhibited abnormal levels of methaemoglobin and this was most probably the result of the large quantity of BIPP used. It is unlikely that significant methaemoglobinaemia occurs during the routine use of BIPP in the nose.

Post-laryngectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis?

In the treatment of obstructing laryngeal cancer, an association has often been noted between emergency tracheotomy for airway relief and subsequent post-laryngectomy stomal recurrence. It is however unclear whether this is due to tumour implantation in the tracheotomy track, or paratracheal lymph node metastasis. To investigate the pathophysiology of stomal recurrence, the recurrence rate and clinical outcome of 26 cases of T3N0M0 glottic cancer treated with emergency tracheotomy and subsequent laryngectomy were analysed, and compared with 65 stage-matched cases treated with laryngectomy alone. Analysis shows the 'emergency tracheotomy' group to have a very poor prognosis with a higher incidence of recurrence at the stoma, and also in the regional lymph nodes. These findings suggest that paratracheal lymph node metastasis is an important mechanism in the development of stomal recurrence and thus has considerable implications for the prevention of such a recurrence following laryngectomy in the patient presenting with malignant airway obstruction.

Transpalatal approach to the petrous apex.

A case is described in which a transpalatal, transpharyngeal approach was used for access to a cyst of the petrous apex. Although its indications are limited, in selected patients this conservative procedure has advantages over the more invasive lateral routes.