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Volume 122 - Issue 4 - April 2008

The Journal of Laryngology & Otology Volume 122 - Issue 4 -
Contents

Page 2 of 2

Main Article

  • Laryngotracheal augmentation using titanium mesh

  • A A Gaafar, A A El-Daly, H A Gaafar
  • Published online by Cambridge University Press:
    14 May 2007, pp. 391-396
  • Background:

    The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment.

    Study design:

    Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic® stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken.

    Results:

    Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation was impossible in two cases, one due to excessive granulation tissue and the other due to prolapse of the titanium mesh into the tracheal lumen (the mesh was removed endoscopically and a Montgomery T-tube inserted).

    Conclusion:

    Titanium mesh was found to be a good alternative for augmentation of the anterior laryngotracheal wall. It offered rigid support, with fewer of the complications reported with other grafts.

  • Preliminary report of associated factors in wound infection after major head and neck neoplasm operations — does the duration of prophylactic antibiotic matter?

  • S-A Liu, K-C Tung, J-Y Shiao, Y-T Chiu
  • Published online by Cambridge University Press:
    20 April 2007, pp. 403-408

  • The aim of this study was to investigate whether an extended course of prophylactic antibiotic could reduce the wound infection rate in a subtropical country. Fifty-three consecutive cases scheduled to receive major head and neck operations were randomised into one-day or three-day prophylactic antibiotic groups. Thirteen cases (24.5 per cent) developed wound infections after operations. The duration of prophylactic antibiotic was not related to the surgical wound infection. However, pre-operative haemoglobulin less than 10.5 g/dl (odds ratio: 7.24, 95 per cent confidence interval: 1.28–41.0) and reconstruction with a free flap or pectoris major myocutaneous flap during the operation (odds ratio: 11.04, 95 per cent confidence interval: 1.17–104.7) were associated factors significantly influencing post-operative wound infection. Therefore, one day of prophylactic antibiotic was effective in major head and neck procedures but should not be substituted for proper aseptic and meticulous surgical techniques.

Clinical Record

  • Primitive neuroectodermal tumour of the tongue

  • I Gunawardena, D Kenwright, N Steventon, C Ferguson
  • Published online by Cambridge University Press:
    14 May 2007, pp. 416-418

  • Peripheral primitive neuroectodermal tumours, which belong to the Ewing sarcoma tumour family, are extremely rare. These tumours are highly aggressive and are known to have a poor prognosis. Immunostaining with at least two neural markers and evidence of an abnormal t(11;22)(q24;q12) translocation are hallmark features in this diagnosis. We present the first reported case of peripheral primitive neuroectodermal tumour to occur in the tongue.

  • Stapediovestibular dislocation with pneumolabyrinth

  • S Nishiike, Y Hyo, H Fukushima
  • Published online by Cambridge University Press:
    14 May 2007, pp. 419-421

  • Traumatic luxation of the stapes into the vestibule is a rare entity, and the disease complicated with pneumolabyrinth is extremely rare. We report the case of a 72-year-old woman with pneumolabyrinth associated with a stapediovestibular dislocation. The patient presented with vertigo and nystagmus following penetrating trauma to the middle ear. High resolution computed tomography scans demonstrated air in the vestibule and dislocation of the stapes. Exploratory tympanotomy demonstrated oozing of the perilymph from the oval window and depression of the stapes into the vestibule. Pneumolabyrinth and stapes luxation detected by high resolution computed tomography should be predictive of a perilymphatic fistula.

  • Dual pathology: cervicofacial actinomycosis and nicorandil-induced oral ulceration

  • H E V Cupples, D T McGahey
  • Published online by Cambridge University Press:
    14 May 2007, pp. 422-424
  • Introduction:

    Oral ulceration has many causes and is a common presenting symptom in otolaryngology.

    Case report:

    This article presents an unusual case of dual pathology oral ulceration in an elderly patient. Oral malignancy was initially suspected, but the history, examination and investigation showed that the oral ulceration was caused by actinomycosis infection and by nicorandil use.

    Discussion:

    Cervicofacial acinomycosis is a rare, suppurative bacterial disease in which abscesses can form in the tissues and break through the skin, creating pus-discharging lesions. Nicorandil is a potassium channel blocker used in the treatment of ischaemic heart disease. It has been recently recognised as a cause of persistent ulcerative stomatitis.

    Conclusion:

    This case highlights the importance of a high index of suspicion for unusual and reversible causes of oral ulceration, and of dual pathology as a cause. Such vigilance enables early recognition and treatment of potentially reversible conditions.

  • Unusual presentation of temporal bone involvement in Churg–Strauss syndrome

  • M Martinez Del Pero, D Moffat, H Sudhoff
  • Published online by Cambridge University Press:
    10 April 2007, pp. 425-427
  • Objective:

    To present a case of a 60-year-old male with a history of sudden onset sensorineural hearing loss due to Churg–Strauss syndrome.

    Case report:

    The patient had a 20-year history of asthma and recurrent right otitis media and a nasal polypectomy four years prior to presenting with ear symptoms. Ear, nose and throat involvement is common in Churg–Strauss syndrome, usually manifesting as allergic rhinitis and chronic rhinosinusitis with or without polyps.

    Conclusions:

    Otolaryngologists play an important role in making an early diagnosis of this disease. To our knowledge this is the first case of Churg–Strauss syndrome primarily presenting with otological pathology: left sensorineural hearing loss and right otitis media.

Book Review

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