Sixty-eight patients who presented with glottic and glottosupraglottic squamous cell carcinoma and who were managed in this department with supracricoid partial laryngectomy (SCPL) with either cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP), were retrospectively reviewed. The authors analysed the functional and oncological results of the patients. The median follow-up period was 62 months. The average times until decannulation and nasogastric feeding tube removal were 27.7 and 26.4 days, respectively. All patients were successfully decannulated. All patients were able to swallow, but one patient was unable to swallow and had recurrent aspiration. Better functional results were achieved in patients managed with CHEP procedure than the patients managed with CHP procedure. The five-year absolute and cause-specific actuarial survival rates (Kaplan-Meier method) were 78.6 per cent and 93.9 per cent, respectively. The five-year actuarial local control and nodal control rates were 89.5 per cent and 90.4 per cent, respectively. Local recurrence was statistically more likely in patients with positive resection margins (p <0.006). Overall, local control and laryngeal preservation were achieved in 95.6 per cent and 89.7 per cent, respectively. Supracricoid partial laryngectomy procedures (CHEP and CHP) are possible alternatives to total laryngectomy in the treatment of selected advanced glottic and glottosupraglottic carcinomas.

Defects in the system controlling the cell cycle can lead to an increased proliferation of cancer cells. The aim of this study was to analyse the immunohistochemical expression of chosen cell cycle proteins (P16, cyclin D1 and retinoblastoma protein) and their connection with the clinical course of the disease in laryngeal squamous cell cancer (LSCC). Cancer tissue sections obtained from 58 patients after total laryngectomy served to determine the level of the proteins’ expression using immunohistochemical staining and commercial antibodies. A decreased level of P16 expression in 47 per cent, of retinoblastoma protein in 12 per cent and strong cyclin D1 expression in 48 per cent of cases was revealed. Our results show significant correlation between decreased P16 expression and increased tumour dedifferentiation. Overexpression of cyclin D1 was statistically more common in locally advanced tumours (T3–T4). Low expression of retinoblastoma protein was significantly correlated with both positive P16 immunostaining and with strong cyclin D1 expression. Our study confirms that dysfunction of cell cycle regulation is a common event and may play a significant role in the development of squamous cell carcinoma of the larynx.

Respiratory papillomatosis is a life-spoiling disease due to its high recurrence rate. Interferon (IFN) alpha-2b treatment, adjuvant to surgery, was assessed for its contribution to disease control and patient quality of life improvement. One hundred and sixty-nine patients (85 children and 84 adults) were included after surgical removal of the lesions followed by intramuscular IFN alpha-2b (Heberon alfa R, Heber Biotec), starting with 105 IU/Kg weight in children or 6 × 106 IU in adults, three times per week. The dose was reduced monthly, if no relapses occurred, until a monthly maintenance with 5 × 104 IU/Kg of weight in children or 3 × 106 IU in adults up to two years. In case of relapse, it was surgically removed and the patient returned to the higher dose level. The relapse frequency decreased significantly in 77 per cent (69/90) of the recurrent patients both in children (34/46, 74 per cent) and adults (35/44, 79 per cent). Among patients included after their first papilloma, 67 per cent (44/66) had complete (no relapses) or partial (only one relapse) responses (children: 15/33, 45 per cent; adults 29/33, 88 per cent). One hundred and eighteen patients (73 per cent) concluded the treatment without lesions (children: 58 per cent; adults 82 per cent), while the rest showed a significant reduction in the number and size of lesions. IFN was well tolerated. Sixty-two patients (38 per cent) did not have adverse events. The main adverse reactions were fever (59 per cent), chills (24 per cent), arthralgias and myalgias (14 per cent) and headache (10 per cent). One patient developed anti-IFN alpha neutralizing antibodies and became resistant to treatment with recombinant IFN alpha-2b; he responded to natural leucocyte IFN alpha. Treatment with IFN alpha-2b, as an adjuvant to surgery represents a favourable and safe therapeutic alternative for patients with recurrent respiratory papillomatosis.

The aim of this article is to evaluate the role of allergy in the pathogenesis of Ménière’s disease by means of cytokine profiles, allergic parameters and lymphocyte subgroups. A total of 46 patients aged between 26–68 years diagnosed with Ménière’s disease between 1993–2002 were recruited to this study. The control group consisted of 46 healthy volunteers who were from the same age group, living in the same region and possessing similar socioeconomic indicators. Lymphocyte subgroups were measured from the peripheral blood by employing Becton Dickinson (BD) monoclonal CD4, CD8, CD23 antibodies. IFN-γ, IL4, total IgE levels, and specific IgE levels pertaining to tree, fungus, fruit, egg-white, cow’s milk, wheat flour, corn flour, beef, and rice allergens, in all seasons, were measured and compared in the patient and control groups.

In patient serum samples there were positive correlations between CD23 and IgE, CD8 and IgE, CD47sol;CD8 and IgE, and CD23 and CD8 (p <0.01). There were negative correlations between IL-4 and IFN-γ , IFN-γ and IgE, and a positive correlation between IL-4 and IgE. Total IgE levels were above the normal values in 19/46 (41.3 per cent) of the patient group, but the ratio was nine out of 46 (19.5 per cent) in the control group. A history of allergy was found in 31/46 (67.3 per cent) when the patients were questioned. The ratio of a history of allergy was 16/46 (34.7 per cent) in the control group. When specific IgE levels were evaluated the ratio of patients with all the panels negative was eight out of 46 (17.9 per cent), but it was 31/46 (67.3 per cent) in the control group.

This study found that the prevalence of allergy was higher in patients with Ménière’s disease than in the control group. Thus the authors suggest that allergy should be taken into account when patients with this disease are treated.

Methicillin resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen worldwide. The objectives of this study were to assess the morbidity and cost associated with the treatment of head and neck cancer patients who become colonized or infected with MRSA following major surgical procedures.

We present a retrospective review of patients who underwent major surgery for head and neck cancer over a one year period and who then became MRSA positive in the post-operative period.

MRSA affected 25/55 (45 per cent) patients who underwent major head and neck procedures during the period studied. The mean time of diagnosis was 13 days post-surgery. Morbidity included cellulitis, osteomyelitis and MRSA pneumonia. Thirteen of the patients who became MRSA positive (52 per cent of the MRSA group) required further surgery including plate removal, new flap formation and wound debridement as a result of the infection. Average in-hospital stay was almost three times more prolonged for patients who became MRSA positive compared to those who did not have MRSA. The costs of the first hospital stay were over three times more in the MRSA-positive group of patients. Antibiotic costs were increased by £2470 per patient because of MRSA.

The extra stay in hospital, together with extra days in intensive care, extra medical and nursing care and additional costly antibiotic treatment, led to major cost implications and loss of health service resources in the unit.

MRSA infection is a serious cause of morbidity in any surgical group of patients and this study focuses on the consequences for treatment of head and neck cancer patients in particular.

Many operative procedures have been described to treat frontal sinus disease with varying results. Obliteration of the frontal sinus is attempted when drainage procedures fail. Most large series of patients undergoing sinus obliteration have reported recurrent disease yet the management of these patients is rarely discussed. We believe Riedel’s procedure has an important role in the management of these patients. Riedel’s procedure can help eradicate frontal sinus disease and symptoms when drainage and obliteration have failed and where there is persistent disease involving the anterior wall of the frontal sinus or the sinus itself. Whilst cranialization has a role in the removal of the mucosa or contents of the frontal sinus in craniofacial resection, the morbidity associated with it make Riedel’s procedure preferable for dealing with chronic infection or locally invasive disease. Riedel’s procedure also maintains a barrier in the form of the posterior wall of the frontal sinus and the intracranial contents. Post-operative disfigurement, the main criticism of this procedure, can be reduced to some extent by chamfering the margins of the frontal sinus along with the supraorbital rims and reconstructing the anterior wall at a later date if necessary. The authors are aware that any report about frontal sinus surgery should be judged after several years follow-up, and whilst not all these cases have been asymptomatic for a decade, several have been reviewed for many years.

The term electronic nose describes an electronic system that is able to mimic the human sense of smell. Electronic noses have been developed over the last 10 or more years to perform a variety of identification tasks in various industries. More recently electronic noses have attracted new interest in their application in the field of medical diagnosis. The aim of this study is to explore the use of an electronic nose to identify and classify pathogens associated with ear, nose and throat (ENT) infections. In this study 90 bacterial swab samples were collected from 90 patients with ENT infections. Some of these samples were analysed immediately with a commercial electronic nose (Cyranose C320). Similar numbers of swabs were also taken from the same site of infection and were sent for microbiology culture and sensitivity. The electronic nose diagnosis was compared with the microbiology diagnosis and it was found that the electronic nose diagnosis was correct in 88.2 per cent of the cases, which is an encouraging result.

Infections with organisms resistant to conventional antibiotics are of increasing concern. This observational study investigates the bacterial colonization of the peristomal area of laryngectomy patients.

Thirty-two consecutive patients who had previously undergone laryngectomy were recruited from the Head and Neck Clinic of a teaching hospital. Swabs were taken from the laryngectomy stoma site, the mouth and both nasal cavities. Microbiological culture and isolation were performed following standard procedures.

Despite no clinical sign of infection, 27 patients were found to be carriers of one or more organism (84.4 per cent). Staphylococcus aureus was detected in the peristomal area of 15 patients (46.9 per cent). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated in seven (21.9 per cent) cases.

In this series the authors found a high incidence of colonization with potentially pathogenic bacteria in laryngectomy stomas with no clinical signs of infection. In a significant number of patients, Gram positive organisms were identified that could potentially cause cellulitis or wound infections.

A method of cauterizing the posterior parts of the nose without damage to the anterior mucosa is presented. A silver nitrate stick was sheathed within a cut segment of a nasogastric (NG) tube and endoscopically advanced within the nose until the vessel was reached. The stick was then pushed until the silver nitrate protruded and the vessel was cauterized.

An essential step in septal surgery is the correct identification of the subperichondrial plane. Access to this plane can be improved by hydrodissection under enhanced vision. Hydrodissection consists of pressure insufflation of fluid into an anatomical space with a consequent increase in the hydrostatic pressure that separates the tissue planes. In septal surgery, the subperichondrial plane is hydrodissected by infiltration of 2 ml of xylocaine with adrenaline. This creates a bloodless and wide surgical field that facilitates surgery. With the use of a surgical microscope equipped with a teaching arm, it is possible to teach nasal anatomy and septal surgery to trainees.

Spontaneous cerebrospinal fluid (CSF) leak via the oval window is uncommon and can result in recurrent bacterial meningitis. Current understanding of spontaneous CSF otorrhoea is reviewed and a diagnostic algorithm is presented.

A seven-year-old boy presented with bilateral congenital deafness and recurrent meningitis. High-resolution computed tomography (HRCT) of the temporal bone showed a labyrinthine deformity and communication between the internal auditory canal (IAC) and the cochlea. Subtotal petrosectomy with closure of the external acoustic meatus and eustachian tube was performed. Post-operatively, the child had no further episodes of meningitis.

This rare and obscure cause of recurrent childhood meningitis requires a high index of suspicion and the use of diagnostic tools, especially HRCT.

A facial nerve palsy, as a result of middle-ear high pressure, is a rare complication of sub-aqua diving. It may occur as a result of an acute pressure change in the middle ear during ascent in those patients who have experienced difficulty equalizing their middle-ear pressure during the prior descent. We present the case history of this occurring in a 21-year-old diver and discuss the pathophysiology, management and the previous literature. The correct diagnosis of this condition is important if unnecessary, and potentially hazardous, recompression treatment is to be avoided.

Metastasis is a feature of malignant neoplasms. Although rare, metastasizing pathologically benign mixed tumour has been reported. This report describes a 33-year-old woman with multiple lung metastases from mixed tumour. A small preauricular mass had been removed 23 years earlier. Six years later, the patient had the same symptom; the recurrent mass was resected. She was not aware of the exact pathological diagnosis of the previous tumours. One of the most common features of metastasizing mixed tumour is recurrence at the primary site. Inadequate resection of the primary tumour is often associated with metastasis. Thus, it is important for the head and neck surgeon to be aware of the concept of pathologically benign metastasizing mixed tumour and the importance of adequate surgical procedure.

We report the case of a 60-year-old Caucasian man who presented with choking and airway compromise due to a large pharyngeal polyp. It was resected as an emergency procedure and subjected to macroscopic and microscopic examination.

The fibroepithelial polyp arose from the right pharyngeal wall and consisted of adipose tissue covered by squamous epithelium without evidence of malignancy. This is a particularly rare lesion in adults and there are few references in the medical literature. To our knowledge this is the first English case report of an acute presentation of adult fibroepithelial pharyngeal polyp.

This case report also discusses the issues raised in the management of a potentially fatal lesion that may have resulted in complete airway obstruction.

Pre-tracheal air cysts or aeroceles are rare complications of tracheostomy. This is believed to be the first reported case in an adult presenting with a pre-tracheal air cyst 12 years after a tracheostomy. Only three case reports in children have been reported to date. The pathogenesis and treatment options are discussed and a method of managing this condition is suggested.

Tracheal abnormalities are extremely rare and can occur as a single congenital anomaly, as part of a wider spectrum of abnormalities [such as the syndrome of vertebral defects, anal atresia, tracheoesphageal fistula and/or oesophageal atresia, radial dysplasia, and renal defects (VATER), and the syndrome of vertebral defects, anal atresia, cardiovascular defects, tracheoesphageal fistula and/or oesophageal atresia, radial dysplasia, and renal and limb defects (VACTERL)] or in tracheomalacia. Congenital complete and near-complete tracheal rings are the more common morphological abnormalities that occur.

A case of a long segment of bow-shaped, as opposed to horseshoe-shaped, tracheal rings is presented, along with a review of tracheal anatomy and embryology. This abnormality presented when, during repeated attempts at endotracheal intubation, the anaesthetist was consistently unable to ventilate the patient, whereas they were able to do so with a facemask. Bronchoscopy showed the posterior tracheal wall prolapsing into the airway, and radiology demonstrated this to be due to wide tracheal rings without any intrathoracic abnormality.

We present a case of a laryngectomized patient who underwent re-puncture of tracheo-oesophageal fistula for speaking valve voice restoration, resulting in a previously unreported inherent complication of this procedure: extradural abscess of the cervical spine with transient quadriplegia.