• Maxillary labial fraenectomy: indications and technique.

      Mittal, Mohit; Murray, Alison; Sandler, Paul Jonathan (201-04)
      A labial fraenectomy is indicated in various clinical situations and is performed to facilitate orthodontic closure of a maxillary midline diastema. In these clinical situations, timing of surgery during the phase of orthodontic treatment is important. Labial fraenectomy can be performed before, during or after the orthodontic closure of the maxillary midline diastema, depending on the individual case. It is important to understand how to perform the procedure efficiently and effectively. Success relies as much on accurate diagnosis of the fleshy, prominent or persistent fraenum as it does on meticulous technique to ensure its complete elimination. This article presents the indications for labial fraenectomy. The appropriate timing of the labial fraenectomy procedure to facilitate orthodontic treatment is discussed.CLINICAL RELEVANCE: A surgical technique to perform maxillary labial fraenectomy procedure in an effective and efficient manner is a useful addition to the clinician's armamentarium.
    • Porcine dermal collagen graft for tracheoesophageal fistula repair.

      Judd, Owen; McClelland, Lisha; Sharp, Jeremy (2010-03)
    • Heiserkeit

      Judd, Owen (2010-10)
    • Chronic granulomatous disease and neovascularisation causing a vitreous haemorrhage.

      Baxter, Julia; Gandhewar, Ravikiran; Holden, Roger (2010-12)
      The authors report the case of a 9-year-old boy with chronic granulomatous disease with longstanding inactive chorioretinal lesions developing a spontaneous vitreous haemorrhage. This was due to an undetected branch retinal vein occlusion and was successfully treated with retinal photocoagulation (laser).
    • Management of nasal polyps in 'aspirin sensitive asthma' triad.

      Kamani, Tawakir (2011-02)
      PURPOSE OF REVIEW: Aspirin-sensitive asthma (ASA) triad is a challenging picture presenting to both the otolaryngologist and the respiratory physicians. Patients present with severe nasal polyposis with a high propensity to recur despite the modality of treatment - medical or surgical. They also often have poorly controlled severe adult onset asthma. We reviewed the scientific literature, focusing on the outcomes of these treatment modalities in the management of nasal polyposis in ASA triad. RECENT FINDINGS: Although initial work described by Widal on the subject continues, in the last decade a number of prospective and retrospective studies on outcomes after aspirin desensitization as well as surgery have been reported. The extent of surgery has also been addressed in some of these studies. Medical as well as surgical treatments have a role but there has been increasing evidence to support the role of aspirin desensitization in achieving long-term control of this condition. SUMMARY: Overall, with the limitation of data, it appears more is better in patients with ASA and nasal polyposis. There is a lack of level 1 evidence in the proposed treatment modalities. Questions on extent of surgery and dosage as well as length of aspirin desensitization require further research with minimally biased controlled studies.
    • An unusual cause for an optic disc haemorrhage.

      Baxter, Julia; Kailasanathan, Anusha; Chen, Hean (2011-02)
      A 51-year-old male on chemotherapy for myeloma presented initially with a unilateral optic disc haemorrhage and signs of optic neuropathy. This rapidly progressed to affect both eyes and within a few days he developed retinal features suggestive of progressive outer retinal necrosis. He was treated with intravenous acyclovir that was subsequently changed to ganciclovir when serological tests for cytomegalovirus were found to be positive for immunoglobulin M antibodies. His visual loss continued to deteriorate despite treatment, and he subsequently developed a retinal detachment in one eye. The causes of optic neuropathy in immunocompromised patients and the importance of eliminating an infective cause are discussed
    • The horizontal and stepped osteotomy technique for mandibular reconstruction using fibular free flap.

      Aleid, Wesam; Jones, Keith; Laugharne, David (2011-09)
      The mandible is an important component of the orofacial skeleton, and resection of part of the mandible as part of head and neck oncological procedures can have dramatic impact on both function and cosmesis. In this article, we describe a new technique in the resection osteotomy and flap fixation that improves the stability and aesthetic outcome of the reconstruction. The mandibular resection is performed utilizing a horizontal osteotomy above the mandibular angle on one side and a stepped body or angle osteotomy on the other side. Our technique is unique as it allows flexibility in adjusting the chin point projection to give the best possible aesthetic outcome; it allows more bone-to-bone contact, which increases the stability; it reduces rotation; and it allows for use of miniplate fixation, facilitating future rehabilitation with implants. We have been using this technique with great success in our hospital, and we recommend its use for its improved flexibility, stability, and aesthetic outcome.
    • Improving the Standard of Operative Notes within an Oral and Maxillofacial Surgery Department, using an Operative Note Proforma.

      Payne, Karl; Dickenson, Andrew; Jones, Keith (2011-09)
      AIM: The operative note needs to be an accurate and legible account of events occurring in the surgeon's theatre. We set out to discover if operative notes within a British District General Oral and Maxillofacial Surgery department adhered to Royal College of Surgeons (England) guidelines. METHOD: We audited 100 consecutive Oral and Maxillofacial Surgery operations performed within general theatres. As an intervention we designed and piloted a paper based Operative Note Proforma and re-audit was undertaken. RESULTS: Initial audit showed results lacking in certainareas. At re-audit all audit criteria showed improvement. The mean percentage of data point inclusion rose from 76.1 to 98.3% (0.001 < P-value < 0.005). CONCLUSION: Previous papers have discussed various methods of improving operative note standards. We present statistical evidence for the use of an Operative Note Proforma to improve operative note standards within Oral and Maxillofacial Surgery.
    • Transoral laser microsurgery for early glottic cancer.

      McClelland, Lisha; Carr, Esmond; Kamani, Tawakir; Cade, Jennifer; Young, Kate; Mortimore, Sean (2011-11)
      Objectives. To assess the outcome of transoral laser-assisted microsurgery (TLM) with regards to local and distant tumour control, quality of voice and swallowing. Design. Retrospective review of patients with five-year follow-up period. Setting. Royal Derby Hospital Head and Neck Department. Participants. All patients undergoing TLM with a diagnosis of Tis, T1, or T2 glottic tumour following endoscopic biopsy. Main Outcome Measures. Speech, swallowing, cancer-free survival, laryngectomy-free survival, and mortality rate. Results. 22n patients were treated for early glottic carcinoma with TLM. The 5-year local control rate for T1 tumours is 89% and 56% for T2 tumours. The laryngectomy rate was 4.5%. The mortality rate from local and distant disease was 4.5% with an overall mortality rate of 22% from all causes. 40% of patients had normal voices and a further 45% had only mild or moderate voice change. At their last follow up, no patients assessed had any difficulty swallowing relating to their treatment for glottic cancer. Conclusion. Transoral Endoscopic CO2 laser microsurgery is a valid technique for treating early glottic tumours.
    • Worth syndrome as a diagnosis for mandibular osteosclerosis.

      Payne, Karl; Dickenson, Andrew (2011-12)
      This case report presents an unusual incidental radiographic finding on a dental panoramic radiograph that caused diagnostic confusion. A 46-year-old female presented with symmetrical sclerotic cortical thickening of the anterior mandible visible on radiograph, with no other major clinical examination findings. The patient subsequently showed no change in radiographic appearance over a 6 year period. Based on this evidence, and the benign nature of the history, we propose a diagnosis of Worth syndrome. This report aims to clarify the difference in terminology and presentation of two conditions known to produce mandibular osteosclerosis: Worth syndrome and Van Buchem disease, both of which are often quoted synonymously in the literature.
    • Laryngeal sensory testing in the assessment of patients with laryngopharyngeal reflux.

      Dale, Oliver; Alhamarneh, Osama; Young, Kate; Mohan, S (2012-03)
      Laryngopharyngeal reflux is commonly encountered in the ENT out-patient setting. It leads to impaired sensory capacity of the laryngeal mucosa. The sensory integrity of the laryngopharynx can be evaluated through endoscopic administration of pulsed air, which stimulates the laryngeal adductor reflex. The pressure of air needed to elicit this reflex indicates the degree of sensory impairment. Such laryngeal sensory testing gives a quantifiable means of assessment in patients with laryngopharyngeal reflux, and can be used to measure the response to treatment. Laryngeal sensory testing is safe and well tolerated by patients.
    • Patient attitudes to tonsillectomy.

      Ubayasiri, Kishan; Kothari, Ravi; McClelland, Lisha; De, Mriganka (2012-12)
      Introduction. Recent changes to primary care trusts' Procedures of Limited Clinical Value (PLCV) policy mean that otolaryngologists must now follow policy rather than exercising clinical judgment when listing patients for tonsillectomy. Objectives. To gauge perception within the general public of when tonsillectomy is acceptable and to compare this to the current policy. Method. All patients or their parents attending the adult and paediatric outpatient ENT departments were asked to anonymously complete questionnaires. Results. One hundred and twenty-five completed questionnaires were collected. Thirty-one percent of respondents thought tonsillectomy should be offered solely on patient request, 19% after one to three bouts, and 35% after four to six bouts of tonsillitis. Only 9% thought the current guidelines were reasonable. Patients who had suffered recurrent tonsillitis or had undergone previous tonsillectomy generally thought tonsillectomy advisable after more bouts of tonsillitis than those who had not. Fourteen patients fulfilled the SIGN guidelines for tonsillectomy for recurrent tonsillitis. Of these, 13 (93%) felt that suffering 4-6 bouts of tonsillitis was reasonable before tonsillectomy. Conclusion. All patients we surveyed who meet the current PLCV and SIGN guidelines regarding the appropriateness of tonsillectomy for recurrent tonsillitis perceive that they are excessive, believing that 4-6 bouts of recurrent tonsillitis are adequate to justify tonsillectomy.
    • Fibrin glue in the treatment for pilonidal sinus: high patient satisfaction and rapid return to normal activities.

      Elsey, Elizabeth; Lund, Jonathan (2013-02)
      BACKGROUND: Pilonidal sinus is a common condition often managed with invasive surgery associated with a significant morbidity and often a prolonged recovery time. Fibrin glue has been used in our institution as an alternative to conventional surgery. The purpose of this study was to perform a service evaluation of patient satisfaction and recovery following fibrin glue treatment for pilonidal sinus. METHODS: All pilonidal glue procedures for a single surgeon were identified from theatre and consultant diary records from March 2007 to September 2011. A questionnaire was sent by post to all patients. Patient satisfaction, time to return to normal activities, the need for further procedures and whether they would recommend a glue procedure to a friend were evaluated. RESULTS: Ninety-three patients were identified, accounting for a total of 119 glue procedures and 57/93 responses were received (61 %). The median age of respondents was 26 (17-70) years. Seventy-nine per cent (n = 45) were satisfied, pleased or very pleased with the result of their procedure. Fifty-four per cent (n = 31) were back to normal activities within a week with a further 17 % (n = 10) back to normal activities within 2 weeks. Seventy-four per cent (n = 42) required no further treatment. Of the 15 patients requiring a further procedure, 3 went on to have a repeat glue treatment which resulted in complete healing. Eighty-two per cent (n = 47) would recommend a glue procedure to a friend. CONCLUSIONS: Fibrin gluing for pilonidal sinus should be considered as first-line treatment for most pilonidal sinuses. It has a high level of patient satisfaction and allows a rapid return to normal activities in this group of patients of working age.
    • Leptin as a neuroprotective agent in glaucoma.

      Gupta, Ankur (2013-11)
      Glaucoma is a disease characterized by progressive optic nerve degeneration and is the leading cause of irreversible blindness worldwide. More than 60 million people globally are affected by glaucoma, of which 8 million people suffer from bilateral blindness, making glaucoma the second leading cause of bilateral blindness worldwide. Current management of glaucoma is aimed at reducing intraocular pressure via a number of different strategies. Current treatments do not attempt to correct the underlying pathology of glaucoma, which is the cell degeneration and ultimate death of retinal ganglion cells, thereby limiting their clinical efficacy. A neuroprotective approach to glaucoma management would address the underlying pathology and would, in theory, be beneficial to all patients regardless of risk and causative factors. Here it is proposed that leptin could be used as a potential neuroprotective agent in the management of glaucoma. Leptin has shown neuroprotective promise in a number of neurodegenerative diseases, and there has been increasing evidence that glaucomatous neurodegeneration is analogous to other neurodegenerative diseases in the central nervous system. Leptin could target retinal ganglion cell death by a number of mechanisms, namely apoptosis, oxidative stress and excitotoxicity reduction. This article presents evidence linking current understanding about leptin's neuroprotective effect and the molecular mechanisms underlying glaucoma.
    • The long and winding road: The journey of a cleft lip and palate patient part 1.

      Murray, Alison (2013-12)
      Patients with a cleft lip and palate (CLP) deformity require the highest standard of care that can be provided and this requires multidisciplinary care from teams located in regional cleft centres. Care of these cases is from birth to adulthood and requires several phases of intervention, corresponding to the stages of facial and dental development. Management ideally starts pre-natally, following the initial diagnosis, and occasionally pre-surgical appliances are prescribed. The lip is ideally repaired within three months, followed by palate closure between 12 and 18 months. Careful monitoring is required in the first few years and ENT referral, where necessary, will diagnose middle ear infection, which commonly affects CLP patients. Speech therapy is an integral part of the ongoing care. Excellent oral hygiene is essential and preventive dietary advice must be given and regularly reinforced. Orthodontic expansion is often needed at 9 years of age in preparation for a bone graft and, once the permanent dentition erupts, definitive orthodontic treatment will be required. Maxillary forward growth may have been constrained by scarring from previous surgery, so orthognathic correction may be required on growth completion. Final orthodontic alignment and high quality restorative care will allow the patients to have a pleasing aesthetic result. CLP patients and their families will need continuing support from medical and dental consultants, specialist nurses, health visitors, speech and language specialists and, perhaps, psychologists. These two articles outline the principles of care for the CLP patient and, secondly, illustrate this with a case report, documenting one patient's journey from birth to 21 years of age. CLINICAL RELEVANCE: A successful outcome for CLP patients requires a sound dentition. The general dental practitioner role is vital to establish and maintain excellent oral hygiene, a healthy diet and good routine preventive and restorative care. Understanding the total needs of CLP patients can help the dentist to provide high quality care as part of the multidisciplinary management.
    • Well-differentiated liposarcoma of the epiglottis.

      Pajaniappane, A; Farzan, J; Green, D; De, Mriganka (2014-03)
      OBJECTIVE: Liposarcomas of the larynx and its sub-sites are rare. Within this group of tumours, well-differentiated liposarcomas of the epiglottis have been only sporadically reported. In view of its infrequent presentation, difficulty still exists over the diagnosis of this pathological entity, together with uncertainty over its exact accepted management. METHOD: We present the case of a well-differentiated liposarcoma of the epiglottis, and we review the associated English-language literature. RESULTS: The reported patient underwent multiple attempts at surgical treatment prior to establishment of a firm diagnosis. In light of the diagnosis and other mitigating factors, a conservative approach was adopted. CONCLUSION: A high index of clinical suspicion and detailed histological analysis are required when encountering a recurrent soft tissue lesion of the larynx. In the presented case, a multidisciplinary approach and conservative management plan were adopted, based on a holistic management approach and a review of the published literature.