Objective: To introduce simple underlay myringoplasty which is widely performed in Japan.

Patients: 391 ears with perforated eardrum underwent simple underlay myringoplasty from 2000 to 2004, and which were followed up for more than six months after surgery.

Methods: After removing the margin of the perforation by a transcanal approach under local anaesthesia, a connective tissue graft was inserted through the perforation and lifted to contact the edge. Fibrin glue was dropped on the contact area. There was no packing in the canal or in the middle-ear cavity. If the perforation remained, re-closure was attempted using the patient's frozen tissue.

Results: The rate of closure after the initial attempt was 304/391 (77.7 per cent), and that after re-closure for unsuccessful cases was 70/87 (80.5 per cent). The overall rate was 374/391 (95.7 per cent). There were no serious complications such as sensorineural hearing loss.

Conclusions: Simple underlay myringoplasty is a simple and minimally invasive procedure employing fibrin glue and has led to a high closure rate of the eardrum.

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by dermal, mucosal, and visceral telangiectases as well as pulmonary and cerebral arteriovenous malformations. Recurrent epistaxis occurs in the majority of patients, and by the very nature of the thin walled vessels involved it is often refractory to conventional forms of treatment. We present the case of an 82-year-old lady with intractable epistaxis secondary to HHT, that was successfully controlled by the application of fibrin glue.

The case notes of 34 patients undergoing rehabilitative facial nerve surgery between 1978 and 1994 were retrospectively examined. Thirteen patients underwent facio-hypoglossal transposition with six achieving a facial nerve grade of IV (House-Brackmann scale) at 24 months post-surgery. Twelve patients underwent cable grafting of the facial nerve defect. Of these, 10 achieved a grade III result at 24 months. Nine patients underwent end to end anastomosis of the facial nerve, seven achieving a grade III result at 24 months after the repair. Re-routing of the facial nerve and the use of tissue glue to effect the anastomosis did not have an adverse effect on the outcome. Comparison of rerouted end to end anastomosis with non-re-routed cable grafting showed no difference. Patients presenting pre-operatively with facial weakness and those in whom nerve repair surgery was delayed for more than six months were less likely to have a good result.

Chronic salivary aspiration can cause life-threatening pneumonia in a patient whose laryngeal function is completely lost. We report a patient who had laryngotracheal separation with cricoidectomy under local anaesthesia. The simplicity and reliability of the procedure were improved by using fibrin glue and the outcome was most satisfactory.

Lateralization of one or both vocal folds is a generally accepted surgical principle for the relief of the airway obstruction caused by bilateral vocal fold paralysis. A modified, entirely endoscopic method of lateralization has been developed, employing a carbon dioxide laser to reduce the bulk of the fold, and fibrin glue to maintain the lateral position. The results of 18 operations on 15 patients, including six who had unsatisfactory results after previous surgery, were analyzed and compared retrospectively with the results from 22 patients operated on before the introduction of the method. The patient's ability to perform everyday activities improved in 12 cases, which paralleled the results of the previous, more cumbersome methods. The incidence of re-operation was comparable, given the shorter follow-up after the more recent method.