Trans-nasal endo-assisted pharyngoplasty: a cadaver study.

A possible new technique of endoscopic pharyngoplasty is described and has been developed in cadavers. The trans-nasal route is used for endoscopic visualisation of the velopharyngeal sphincter. Hynes pharyngoplasty is performed using both trans-oral and trans-nasal routes. This approach allows better visualisation and performance of the Hynes pharyngoplasty at the desired level, "high" in the nasopharynx, without splitting the soft palate.

Simple and safe treatment of pretibial haematoma in elderly patients.

A simple and safe technique is described for evacuation of pretibial haematoma in elderly patients. A Yankauer sucker attached to the wall suction is used to evacuate the haematoma under local anaesthesia. This technique is used in the accident and emergency department and the ward.

Tissue expansion in the limbs: a comparative analysis of limb and non-limb sites.

We present an 8 year retrospective case-note study of 88 patients, who underwent 113 episodes of tissue expansion for a variety of indications. Overall, 31 patients underwent 42 episodes of tissue expansion in the limbs, and 57 patients underwent 71 expansions at other sites. Although the incidence of complications was higher in the limb group (43%) than in the group undergoing expansion at other sites (27%), the overall success in completing expansion was remarkably similar in both groups (86% and 83%, respectively). The indications and contraindications for tissue expansion in our cases are presented, as is the specific management in the presence of infection or exposure. Careful case selection, proper planning and meticulous surgical technique are important in minimising complication rates and ensuring both success and salvage in the case of any mishaps.

Does MRI contribute to the investigation of palatal function?

The results of a pilot study into the value of MRI scanning in investigation of velopharyngeal function are discussed. MRI offers potential advantage over naso-endoscopy in being noninvasive and over video fluoroscopy in avoiding radiation. However, it requires costly equipment and patient cooperation, which limits its use in young patients. Ten normal volunteers and 15 patients with speech problems underwent MRI of the velopharyngeal port at rest and during sustained phonation of word /a/. Optimal planes for scanning were determined. Images were obtained in mid-sagittal, coronal and horizontal planes at the level of the hard palate and in the plane of the levator axis. Computer assisted measurements were possible of the velopharyngeal closure, forward movement of posterior pharyngeal wall, velar lift, velar extensibility and medial movement of the lateral pharyngeal wall. MRI has a potential role in investigation of velopharyngeal incompetence and planning its surgical repair.

Preprosthetic reconstruction of eyesockets with mucosal grafts, and prevention of long term contractures. Case report.

Eight patients had eyesockets reconstructed with mucosal grafts. To prevent contraction of the grafts in the cavities postoperatively, a dental stent was stabilised in the socket by a metal pin attached to the frame of a pair of sunglasses. A similar device was also used in one case to expand a contracted eyesocket.

An irrigation system for large-wound toileting.

A simple system for irrigating large wounds can be made for use in any operating theater or ward. This versatile system allows the surgeon to change the force, volume, and speed of different solutions with an economy of movement and a minimum of manipulation. The same bottles of solutions can be applied in more than one patient, minimizing fluid waste.

Tattooing for the management of white patches.

Although biologically more or less inert, a white patch is a social taboo in India. When a white patch is localized and remains static in spite of conservative treatment, it can be dealt with by tattooing as a camouflage procedure. Inert pigments of skin color match are impregnated into the intradermal plane. The procedure is simpler than melanocyte transfer and serves the purpose of hiding a white patch. In the present study, histology of the tattooed skin was studied to confirm the retention of the pigments into the intradermal plane. The patient remains pain-free in the postoperative period. The procedure does not keep the patient away from work, nor does it require hospitalization or general anaesthesia. It can be dealt with as an office procedure, making it relatively inexpensive.

A new graft spreader.

A new graft spreader for applying the skin graft is described that solves the problems of removing subgraft fluid collection and reverting the curled edge of the graft.