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ABSTRACT: Nasal bone fractures are the commonest type of bony facial injury causing aesthetic deformity. The aim of this study was to identify the effect of nasal trauma and fracture manipulation on the aesthetic proportions of the nose, by comparing pre- and post-treatment nasal aesthetics. Thirty-two patients (26 men and 6 women) underwent aesthetic assessment prior to treatment of the injury by closed nasal manipulation, 7 to 10 days after the initial injury. Standard facial aesthetic photographic assessments were performed prior to and following manipulation. Assessment involved measurement of standard nasal aesthetic parameters. In the nasal trauma cohort, the main anomalies in nasal aesthetics were nasal deviation and differences in the nasal aesthetic profile. Nasal fracture manipulation successfully reduced deviation from an average of 35 degrees pre-manipulation to an average of 9 degrees post-manipulation.
The Journal of Laryngology & Otology 02/2008; 122(1):38-41. · 0.60 Impact Factor
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ABSTRACT: To evaluate the benefits of chest computed tomography and X-ray as screening tools in patients with newly diagnosed head and neck squamous cell carcinoma, to determine the incidence of lung metastases or synchronous pulmonary lesions, and to evaluate factors associated with positive radiological findings.
Five-year, retrospective survey of all newly diagnosed cases of head and neck squamous cell carcinoma.
We included 102 patients (63 men and 39 women), with a mean age of 67 years (range 33-91 years). The incidence of pulmonary involvement was 17 per cent. The sensitivity and specificity of computed tomography were 100 and 89.8 per cent, respectively. For chest X-ray, the sensitivity was 35.7 per cent and the specificity 92.7 per cent. The accuracy of computed tomography was 91.5 per cent and that of chest X-ray 83.1 per cent. There was a clear correlation between higher nodal stage and larger tumour with the development of distant metastases. In patients with a positive chest computed tomography scan, 86 per cent had T3 or T4 tumours, in contrast to 38 per cent of those with a negative chest scan (p < 0.05). In addition, 71 per cent of patients with positive findings had N2 or N3 nodal disease, compared with 29 per cent of those with negative findings (p < 0.05).
There is currently no consensus on the use of chest X-ray and computer tomography for screening newly diagnosed cases of head and neck squamous cell carcinoma. We recommend routine scanning of high-staged head and neck squamous cell carcinoma. The National Institute of Health and Clinical Excellence guidelines should be reappraised.
The Journal of Laryngology & Otology 01/2008; 122(9):961-6. · 0.60 Impact Factor
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ABSTRACT: We report a 27-year-old Congolese man with mucoepidermoid carcinoma (MEC) of the tongue base, which presented as spontaneous intraoral bleeding. Optimal treatment of tongue base MEC is unknown. To our knowledge, this is the first reported case treated with transoral excision with carbon dioxide laser and selective neck dissection. Although immunohistochemical studies have revolutionised understanding of the disease, little else is known of the natural history of MEC. The majority of MEC is considered low-grade, with an indolent course without recurrence or metastasis. Nonetheless, MEC requires surgical management, postoperative radiotherapy and close long-term follow-up.
Singapore medical journal 11/2007; 48(10):e272-4. · 0.73 Impact Factor
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Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 03/2007; 32(1):76-7. · 2.39 Impact Factor
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ABSTRACT: On review of admissions over a 12-month period, we noted a significant number of women presenting with gypsy skirt burns. We describe all six cases to highlight the unique distribution of the wounds and the circumstances in which the accidents occurred. Four skirts were ignited by open fire heaters: two skirts ignited whilst the women were standing nearby, distracted with a telephone conversation; one brushed over the flame as she was walking past the heater; other whilst dancing in the lounge. One skirt was ignited by decorative candles placed on the floor during a social gathering. Another skirt was set alight by cigarette ember, whilst smoking in the toilet. Percentage surface area burned, estimated according to the rule of nines, showed that gypsy skirt burns were significant ranging from 7 to 14% total body surface area (TBSA) and averaging 9% TBSA. Two patients required allogenic split-skin grafts. Common sense care with proximity to naked flame is all that is needed to prevent this injury.
Injury 02/2007; 38(1):122-4. · 1.98 Impact Factor
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ABSTRACT: To define the role of medical or surgical treatment in patients with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA syndrome).
A Medline search was performed using the terms PFAPA, periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis, treatment. A systematic review of the English literature was performed. Papers on pyrexia of unknown origin in the pediatric population were excluded; this was because the clinical entities included in the differential diagnosis of pyrexia of unknown origin share many clinical characteristics with PFAPA, and may be ill defined.
Twenty-seven papers have been published since 1989, of which 20 were in English language. There were five single case reports and two papers involving two patients each. There were 6 retrospective reviews of case notes, involving 5-94 patients over a 3-10 year review period. Given that current evidence on the effectiveness of tonsillectomy in PFAPA is extremely weak (level of evidence V), tonsillectomy should not be performed.
PFAPA usually resolves without any long-term adverse effect, and as such, there is no role for tonsillectomy in these patients.
International Journal of Pediatric Otorhinolaryngology 12/2006; 70(11):1841-5. · 1.17 Impact Factor
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Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 11/2006; 31(5):467-8. · 2.39 Impact Factor
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British journal of hospital medicine (London, England: 2005) 10/2005; 66(9):542-3. · 0.19 Impact Factor
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ABSTRACT: Epistaxis is a common, potentially life threatening, emergency but first line medical staff are often not adequately trained in its management. This paper presents an illustrated step by step guide to the management of epistaxis by junior doctors in the emergency department.
Emergency Medicine Journal 08/2005; 22(7):470-2. · 1.44 Impact Factor
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ABSTRACT: Differences in aesthetics between the Oriental and Caucasian nose were examined from a cohort of 118 healthy volunteers of which 61 had an Oriental and 57 had a Caucasian racial origin. The oriental nose projected less from the face, and was broader at the intercanthal level (P < 0.001) and the alar base (P < 0.001), but not at the bony base. The oriental nose projected less at all levels: nasion projection (P < 0.001) and tip projection (P < 0.001). The naso-labial angles for the Orientals in this study exhibited a wider range of variation than the Caucasians, with the oriental male exhibiting the most acute angle (average 86.2 degrees ), because of the forward angulation of the upper lip. Many of the average aesthetic parameters obtained from these two cohorts of healthy subjects did not conform to the published aesthetic standards, set out as the ideal goals for rhinoplasty.
Clinical Otolaryngology 12/2004; 29(6):672-6. · 2.39 Impact Factor
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ABSTRACT: Differences in aesthetics between the Oriental and Caucasian nose were examined from a cohort of 118 healthy volunteers of which 61 had an Oriental and 57 had a Caucasian racial origin. The oriental nose projected less from the face, and was broader at the intercanthal level (P < 0.001) and the alar base (P < 0.001), but not at the bony base. The oriental nose projected less at all levels: nasion projection (P < 0.001) and tip projection (P < 0.001). The naso-labial angles for the Orientals in this study exhibited a wider range of variation than the Caucasians, with the oriental male exhibiting the most acute angle (average 86.2°), because of the forward angulation of the upper lip. Many of the average aesthetic parameters obtained from these two cohorts of healthy subjects did not conform to the published aesthetic standards, set out as the ideal goals for rhinoplasty.
Clinical Otolaryngology 11/2004; 29(6):672 - 676. · 2.39 Impact Factor
