The rate of VS recurrence after total removal is exceptionally low in experienced hands. Undetected microscopic deposits left on crucial points such as the facial nerve, the preserved cochlea nerve, or the fundus of the internal auditory canal could be possible causes for the recurrence. A definite advantage of an ETL approach is the excellent internal auditory canal exposure, resulting in an extremely low rate of VS recurrence. The patients should be followed up to 15 years with gadolinium-enhanced magnetic resonance imaging (with fat suppression sequence in ETL approach cases). Recurrent VS may exhibit a faster growth rate than primary VS.

Objectives/Hypothesis:To study the association between sleep apnea and hypertension in a younger age group than previously studied, adding upper airway sizes at endoscopy as important compounding variables not often included in the past.Study Design:Case control.Methods:We analyzed data on sleep‐disordered breathing (based on polysomnography tests), body mass index (BMI), neck circumference, upper airway endoscopy sizes, and habitus and health history in 120 hypertensive and 120 nonhypertensive participants in a clinic‐based setting. Independent t test, χ2, multivariate analysis, and binary logistic regression models were used for case‐control comparison.Results:The mean age of the participants was 27 years; 67.5% were male. The incidence and severity of sleep apnea were significantly higher in the hypertensive than the control subjects. Persons with hypertension had an OR of 2.7 times of having comorbid sleep apnea than patients without hypertension (95% confidence interval [CI] 1.2‐6.1). Persons with sleep apnea (AHI [apnea‐hypopnea index] ≥5) had an OR of 2.76 (95% CI 1.57‐4.86), and persons with severe sleep apnea (AHI ≥30) had an OR 7.94 (95% CI 4.21‐15.33) for having hypertension than did persons without sleep apnea. Although adjustments for the compounding factors, particularly BMI, decreased the OR to a large degree, subjects with severe sleep apnea were still 72% more likely to have hypertension than subjects without sleep apnea.Conclusions:Sleep apnea is related to hypertension in young adults aged 18 to 40 years. The association was more pronounced with the increasing severity of sleep apnea. Screening for sleep apnea should be considered in young adults with hypertension.

Introduction Ranula is a mucous extravasation cyst which occurs as a result of trauma or obstruction of the sublingual or minor salivary gland or the duct itself.Patients and results 14 patients were seen at Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur and Hospital Tunku Ampuan Afzan, Kuantan, Malaysia between 2000 to 2006. There were six cases of intra-oral ranula and eight plunging ranula. Twelve patients underwent surgical intervention while two refused surgery. Four patients (33.3%) from those who had surgical intervention returned with recurrence; two (16.7%) had marsupialization and the other two (16.7%) had excision of the pseudocyst intraorally. Conclusion Excision and marsupialization remain as the treatment of choice in our centres.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. The surgical approaches are either standard open method which include external or intraoral incisions, or the recent advanced approach, i.e. via using the endonasal endoscope. It is widely accepted that the use of preoperative angiographic embolization reduces the occurrence of intraoperative bleeding and facilitates tumour removal. However, angiographic embolization is not available at all centres. The purpose of this article is to present our experience with five patients diagnosed with JNA who were resected without embolization, using various surgical approaches. Two tumours were removed via endonasal endoscopic surgery. None of the tumours were embolized prior to surgery. We highlight the preoperative evaluation of tumour extent, using both computed tomography (CT) and magnetic resonance angiography, and the importance of temporary clamping of the external carotid artery intraoperatively. Our results suggest that the latter procedure is a safe and effective means of facilitating surgery and reducing intraoperative bleeding.

Contrecoup injury is not uncommon in cases of temporal bone fracture, and is significantly associated with petrous temporal bone fracture.