ObjectiveTo review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol.MethodsA review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention.ResultsOf 815 temporal bone fracture cases, records for 165 patients met the inclusion criteria; detailed analysis was performed on the records of these patients.ConclusionTemporal bone fractures represent high-energy trauma. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. Acute ENT intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. The role of nerve conduction assessment for immediate facial palsy is variable across the UK. The administration of high-dose steroids in patients with temporal bone fracture and intracranial injury is not advised. A robust evidence-based approach is introduced for the management of significant ENT complications associated with temporal bone fractures.
Objectives: 1) To determine whether long term (>48 months) symptomatic vertigo control is sustained in patients with Menière's disease from a previous comparative trial of intratympanic methylprednisolone versus gentamicin, and 2) if the two treatments remain non significantly different at long-term follow-up.
Objectives: Basal cell carcinoma is the most frequent neoplasia in Caucasians. Morbidity is mainly related to local invasion. Perineural invasion (PI) was recently included in TNM staging and is rare in this skin malignancy. Our goal was to characterize the cases of basal cell carcinoma with PI submitted to surgery by head and neck surgeons, in its clinical, epidemiological and histopathological features.Methods: From 1994 to 2012, 354 basal cell carcinomas were submitted to surgery under general anesthesia. Sex, age, hystological subtype, localization, size and PI were retrospectively analyzed. The cases with and without PI were compared.Results: PI was positive in 23.1% of the tumors. 58.5% were men, whereas 49.6% were men in the PI negative patients (P = 0.16). Mean age in the positive group was 65.4‚±13.2 years, while in the negative group mean age was 65.0‚±14.4 years (P = 0.8). Mean size of primary tumors in the positive group was 3.8‚±2.2cm and 2.5‚±1.8cm in the negative group (P < 0.01). Morpheaform subtype was predominant in 48.2% in the positive group and 26.4% in the negative group (P < 0,001). Nodular subtype was predominant in 33.7% in the positive and 53.2% in the negative group (P = 0.002).Conclusions: In this series of aggressive and mutilating tumors, with a 8-fold increase of PI, basal cell carcinomas with PI had higher mean tumor size and more frequency of morpheaform as predominant subtype.
Objectives: Determine the surgical, oncological, and functional outcomes of patients treated with the flexible CO2 laser for head and neck lesions without robotic assistance. Methods: Retrospective case review of patients treated with the Omniguide® Flexible CO2 laser in the head and neck unit of a university teaching hospital. Results: 21 patients underwent 24 procedures from January 2009 to January 2013. 15 procedures involved confirmed invasive carcinoma (T1 to T3). 5 patients underwent further surgery due to involved margins/early local recurrence. 6 month disease free survival was 77%. Other pathology included squamous papilloma, lymphoid hyperplasia, vascular lesions and severe dysplasia. Anatomic sites included larynx (n = 15), base of tongue (n = 8), and postnasal space (n = 1). One case required semi-elective intraoperative tracheostomy, nasogastric tube and a 21 day stay. All other patients returned to oral intake prior to discharge (mean length of stay 1.5 days). No other airway complications were reported. Conclusions: Our experience using a CO2 phototonic bandgap laser fiber in head and neck disease without robotic assistance provides the first published oncological and functional outcomes for this new modality. Our data is representative of the diverse cases selected for this technique in our unit. Our 3 cases of T3 squamous cell carcinoma represent patients who declined laryngectomy. All other patients had anatomy which precluded accessing the lesions with a straight-line CO2 laser. The cost per case is a significant factor (approximately GBP £500), but may be offset by reduced length of stay and improved morbidity compared with open resection.
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