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The palisade cartilage technique is suitable to manage difficult pathologic conditions in middle ear surgery. It was demonstrated that the palisade cartilage technique can be combined safely with titanium ossicular replacement prostheses. Regarding postoperative hearing results, the negative preselection of pathologic conditions must be considered.

There is a discrepancy between the occasionally heard opinion that septoplasty is an easy operation and its relatively high failure and complication rates. Here we discuss the specific difficulties and possible pitfalls of functional reconstructive septoplasty. The significance of optimal vision using a binocular operating microscope is emphasized. Most of the important measures needed to avoid postoperative complications such as redeviation, pseudo-hump nose or nasoseptal defect are painstaking subperichondrial dissection without injuring the septal cartilage, use of the so-called Cottle-tunnels, sufficient mobilisation and exact straightening of the anterior septal cartilage without remaining tension, stable reconstruction of the posterior septum with cartilaginous and/or bony fragments after selective resection of deviated septal parts, re-fixation of the mobilized anterior cartilage ("swinging-door") to the periosteum of the anterior nasal spine and, perhaps, primary suture of iatrogenic perforations of the mucoperichondrium during the operation. If postoperative complications such as septal hematoma, septal perforation or saddling of the nose are recognized during the first postoperative week, immediate revision surgery is recommended.

KeywordsACE I/D polymorphism, angio-oedema, bradykinin, bradykinin B2 receptor polymorphism, serum ACE activity ---------------------------------------------------------------------- WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Angiotensin-converting enzyme inhibitor (ACEi)-induced angio-oedema is an underestimated clinical life-threatening problem.• The incidence of this non-allergic, bradykinin-induced drug side-effect is 1 : 4000.• Although most ACEi-treated patients probably have an increased bradykinin plasma concentration, only 0.5% of them develop an angio-oedema and nothing is known about potential risk factors. WHAT THIS STUDY ADDS• In our attempt to elucidate the unpredictable character of ACEi-induced angio-oedema, we investigated bradykinin B2 receptor 2/3 and c.C181T polymorphisms as well as the ACE insertion/deletion polymorphism in combination with serum ACE activity in 65 patients.• ACE insertion/deletion and bradykinin B2 receptor polymorphisms are not involved in the development of ACEi-induced angio-oedema.• Further studies should be carried out to clarify whether a combination of these polymorphisms might be a risk factor for ACEi-induced angio-oedema. AIMSThe pathophysiology of angiotensin-converting enzyme inhibitor (ACEi)-induced angio-oedema remains unclear. We have investigated the impact of ACE insertion/deletion (I/D) polymorphism in combination with serum ACE activity as well as the bradykinin B2 receptor 2/3 and c.C181T polymorphisms. METHODSWe analysed the ACE I/D as well as bradykinin B2 (2/3 and C181T) receptor polymorphisms in 65 patients with documented episodes of ACEi-induced angio-oedema and 65 patients matched for age and sex being under ACEi treatment without history of angio-oedema. Furthermore, we determined serum ACE activity in 47 of the 65 angio-oedema patients 3 months after the angio-oedema attack and compared these values with 51 healthy individuals (control II). ; P = 0.9). RESULTS No risk association was identified between ACE CONCLUSIONSOur data suggest that polymorphism of ACE I/D and the bradykinin B2 receptor polymorphisms are not involved in the development of ACEi-induced angio-oedema when considered individually. Further studies should be carried out to clarify whether a combination of these polymorphisms might be a risk factor for ACEi-induced angio-oedema.