KEYPOINTS: Transnasal flexible laryngo-oesophagoscopy (TNFLO) is a safe and well-tolerated procedure that may be performed in a procedure room in the outpatient or day-case/main theatre setting. It requires a local anaesthetic and no sedation. It may be used to histologically diagnose or exclude pathology from the nose to the gastro-oesophageal junction. It provides a "one stop" diagnosis service, reducing diagnostic delays, the need for endoscopy under general anaesthesia, barium swallows and follow-up outpatient appointments. Therapeutic procedures such as vocal cord medialization, endolaryngeal laser surgery, insertion of speech prostheses and foreign body removal may be performed without general anaesthesia.

We describe our technique for the formation of a secondary tracheoesophageal puncture and insertion of a voice prosthesis under local anaesthetic in the out-patient department. We use a trans-nasal flexible laryngo-oesophagoscope (TNFLO) to provide direct visualization of the procedure allowing early detection and rectification of any problems that might arise.

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In this article the authors report back from a colloquium held at Balliol College, Oxford, last September. The meeting, convened by the Oxford School of Surgery, considered the challenges posed to education by the reduced hours brought in August 2009 by the European Working Time Directive (EWTD).

Although a traumatic pseudoaneurysm is a rare occurrence in the facial region, the inclusion of this lesion in the differential diagnosis of soft tissue lesions caused by blunt trauma is important if the serious consequences of haemorrhage or thromboembolic disease are to be avoided. Prompt access to radiological imaging, and multi-disciplinary team input, are essential for effective diagnosis and management.