Transoral endoscopic approach to upper cervical spine migrated foreign bodies.

BACKGROUND: Migrated ingested foreign bodies in the aerodigestive tract can lodge within vital organs and vessels, causing potentially devastating complications. It is often difficult to localise these foreign bodies, with extrication resulting in the requirement for open approaches which may cause significant morbidity. CASE REPORT: This paper presents the case of an ingested migrated stingray bone lodged adjacent to the vertebral artery in the upper cervical spine. This was managed via an endoscopic transoral approach, with the assistance of an image-guidance system. RESULTS: Successful extraction of the foreign body was achieved, with minimal residual morbidity. CONCLUSION: Our study showed that image-guided endoscopic surgery is a safe, precise and feasible option for the localisation and removal of migrated foreign bodies in the aerodigestive tract involving critical neurovascular structures.

Respiratory droplet generation and dispersal during nasoendoscopy and upper respiratory swab testing.

Respiratory particle generation and dispersal during nasoendoscopy and swab testing is studied with high-speed video and laser light illumination. Video analysis reveals droplet formation in three manoeuvres during nasoendoscopy - sneezing, vocalization, and nasal decongestion spray. A capillary bridge of mucus can be seen when a nasoendoscope exits wet nares. No droplet formation is seen during oral and nasopharyngeal swab testing. We outline the following recommendations: pull the face mask down partially and keep the mouth covered, only allowing nasal access during nasoendoscopy; avoid nasal sprays if possible; if nasal sprays are used, procedurists should be in full personal protective equipment prior to using the spray; withdrawal of swabs and scopes should be performed in a slow and controlled fashion to reduce potential dispersion of droplets when the capillary bridge of mucus breaks up.

Transoral robotic resection of lingual thyroid: case report.

OBJECTIVE: We present a case of large, symptomatic lingual thyroid which was successfully and safely removed via a transoral approach, using the da Vinci robotic system, in an academic medical centre in Singapore. CASE REPORT: A 17-year-old female adolescent presented with a large lingual thyroid causing upper airway obstruction. She underwent robotic, minimally invasive, transoral resection using the da Vinci system. Post-operative recovery was uneventful; she was able to commence oral feeding almost immediately, and was discharged from hospital on the fourth post-operative day. CONCLUSION: It is surgically feasible and safe to undertake transoral robotic resection of a large lingual thyroid. This approach may allow faster recovery and shorter hospitalisation for patients. Surgical safety requires a full understanding of the intralingual neurovascular anatomy.

Residual cervical lymphadenopathy after definitive treatment of nasopharyngeal carcinoma: fine needle aspiration cytology, computed tomography and histopathological findings.

BACKGROUND: Patients with nasopharyngeal carcinoma may have residual cervical lymphadenopathy after definitive treatment of the primary tumour and regional cervical nodal disease. Whether such lymphadenopathy truly represents persistent disease is unclear. There are few published studies addressing this clinical problem. METHODS: We retrospectively and systematically reviewed the clinical records of 12 patients with nasopharyngeal carcinoma who had presented to a tertiary academic hospital, over an 11-year period, with suspected persistent cervical nodal disease after definitive radiotherapy or concurrent chemoradiotherapy. Findings on fine needle aspiration cytology and computed tomography scanning were correlated with final histopathological results. RESULTS: The incidence of negative neck dissection was 41.7 per cent. The positive and negative predictive values of fine needle aspiration cytology in identifying disease were 100 and 42.9 per cent, respectively. Computed tomography scanning had a positive predictive value of 58.3 per cent in identifying disease. CONCLUSION: In patients treated definitively for nasopharyngeal carcinoma, residual cervical lymphadenopathy may not represent persistent disease. Head and neck surgeons involved in the management of these patients should bear in mind the current limitations of fine needle aspiration cytology and computed tomography in confirming the diagnosis pre-operatively. Salvage neck dissection may over-treat some of these patients.

Incidence of complications after temperature-controlled radiofrequency treatment for sleep-disordered breathing: a Singapore sleep centre experience.

OBJECTIVE: To determine the incidence of complications following temperature-controlled radiofrequency treatment of the soft palate, uvula and tongue base. STUDY DESIGN: Retrospective study. SETTINGS AND METHODS: We included all patients who had received temperature-controlled radiofrequency treatment of the soft palate, uvula and tongue base, for sleep-disordered breathing, over a four-year period in a tertiary hospital. Patients' medical records were systematically reviewed for radiofrequency treatment parameters and complications. MAIN OUTCOME MEASURE: Complication rates. RESULTS: Seventy-six patients had been treated, with a total of 127 treatment sessions and 544 lesions to the palate, uvula and tongue base. The incidences of minor and moderate complications were, respectively, 2.6 per cent (14/544 lesions) and 0.4 per cent (2/544 treatment lesions), being 3.0 per cent (16/544 lesions) overall. Subdividing by anatomical region, the incidences of minor and moderate complications following palatal and uvula radiofrequency treatment were, respectively, 3.1 per cent (14/446 lesions) and 0 per cent, and those following tongue base treatment were, respectively, 0 per cent and 2.0 per cent (2/98 lesions). The incidence of minor complications following soft palate and uvula treatment, per treatment session, was 10.9 per cent. The incidence of moderate complications following tongue base treatment, per treatment session, was 4.6 per cent. There were no major complications in our study population. CONCLUSIONS: In this study, the incidence of complications of temperature-controlled radiofrequency treatment of the palate, uvula and tongue base was low. Temperature-controlled radiofrequency is a safe treatment modality for patients with sleep-disordered breathing and can be performed as a day case procedure. We recommend day admission for patients undergoing radiofrequency of the tongue base, in view of the potential for severe complications and airway compromise.

Actinomycetes colonization of tonsils: a comparative study between patients with and without recurrent tonsillitis.

OBJECTIVE: To determine the prevalence of tonsillar actinomycetes colonization in patients with and without recurrent tonsillitis and to study the association of this condition with recurrent tonsillitis and tonsillar hypertrophy. STUDY DESIGN AND SETTING: A retrospective study of 834 patients who had undergone tonsillectomy for recurrent tonsillitis (group A) and for sleep-disordered breathing without a history of recurrent tonsillitis (group B). RESULTS: The prevalence of tonsillar actinomycetes colonization was higher in patients who had undergone tonsillectomy for sleep-disordered breathing (44.1 per cent) than in patients who had undergone tonsillectomy for recurrent tonsillitis (33.3 per cent). The prevalence did not differ by sex or age of patient, although the occurrence rate was higher in the adult compared with the paediatric population. There was no statistically significant difference between the mean size of the tonsils removed in the two groups, and actinomycetes colonization did not affect tonsil size. Histopathological analysis of resected tonsils did not show active tissue infection. CONCLUSION: The presence of actinomyces does not indicate active disease. We are of the opinion that, although actinomyces colonization is more prevalent in patients with sleep-disordered breathing, it does not contribute to tonsillar hypertrophy nor to recurrent tonsillitis.

Prevalence of hearing disorders in Singapore military conscripts: a role for routine audiometry screening?

AIM: To determine the prevalence of hearing disorders in Singapore military conscripts and describe the profile of hearing loss and associated risk factors. METHODS: Population-based descriptive analysis of randomised cohort of 818 Singapore military conscripts presenting for medical examination, using self-administered questionnaire and pure tone audiometry performed for both ears. Main outcome measures are prevalence rate of hearing loss and relative risk of hearing loss by demographic factors and surrogates for noise exposure. RESULTS: Prevalence of hearing loss was 36.7 per 1,000 (95% CI 24.8, 51.9). Of 30 subjects with hearing loss, 19 (63.3%) had loss at high frequency, 7 (23.3%) at low frequency, and 4 (13.4%) in both ranges. Hearing loss was unilateral in 17 (56.7%) subjects and bilateral in 13 (43.3%). Relative risk of hearing loss did not differ by age group, education level, race or frequency of personal stereo use. Relative risk of hearing loss is higher in subjects with frequent discotheque visits compared to those who never do so (RR = 2.72, 95%CI 1.09, 6.76). CONCLUSION: The high prevalence of hearing loss in Singapore military conscripts points to the need for routine audiometry screening prior to enlistment. This will be useful in assigning military vocations, in clinical case management, and for assessing cases of noise-induced hearing loss attributable to military service.