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ABSTRACT: Background: The management of frontal sinus disease in cystic fibrosis patients represents a challenge for many surgeons. Procedures can vary from the minimally invasive to those involving extensive open surgery. Objective: This study describes the outcomes of the endoscopic modified Lothrop procedure, in terms of safety and morbidity, for cystic fibrosis patients with frontal sinus disease who did not improve following traditional functional endoscopic sinus surgery. Method and results: The study setting was a tertiary referral unit in a London teaching hospital, the largest national base for adult cystic fibrosis patients. Two patients diagnosed in childhood with cystic fibrosis presented with histories of recurrent, severe frontal sinusitis; both had previously undergone multiple endoscopic sinus surgical procedures. The modified Lothrop procedure was performed on both patients. The outcome measures were symptom resolution and post-operative complications. Conclusion: The endoscopic modified Lothrop procedure was beneficial in the cystic fibrosis patients with frontal sinus disease who failed to respond to standard functional endoscopic sinus surgery procedures.
The Journal of Laryngology & Otology 06/2013; · 0.60 Impact Factor
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ABSTRACT: We present the largest recorded case series of holmium:YAG laser use in otolaryngology. This laser's hand-held delivery device is easier to manipulate compared with other ENT lasers, and its pulsed delivery mode gives it enhanced cutting and coagulation properties.
We conducted a 12-year, retrospective study of holmium:YAG laser use in a tertiary referral centre. Sixty-eight patients were included. Nineteen received primary laser treatment of squamous cell carcinoma of the upper aerodigestive tract (nine with simultaneous neck dissection), and 49 underwent either palatine or lingual tonsillectomy for benign disease. One cancer patient developed a pharyngo-cutaneous fistula, and a second suffered a secondary haemorrhage. No other complications were recorded. There were no local recurrences.
The holmium:YAG laser is safe and effective for benign and malignant otolaryngological conditions. In cancer treatment, it may be best to delay neck dissection until the primary site has healed, in order to avoid fistula formation.
The Journal of Laryngology & Otology 04/2010; 124(8):896-8. · 0.60 Impact Factor
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ABSTRACT: We present two cases of dental implant migration into the maxillary sinus, with subsequent removal via image-guided, transnasal endoscopy.
Presentation of clinical cases, together with a literature review of alternative surgical techniques, the theories behind implant migration, and the benefits of an image-guided, endoscopic approach.
One patient was asymptomatic, and the other had begun to experience sinogenic symptoms after implant displacement. Both patients presented to the ENT clinic, and both underwent the BrainLab protocol to generate computed tomography images for navigational reconstruction. Transnasal endoscopy was carried out with this guidance, and the implants were removed successfully in both cases. Previously used surgical techniques such as the Caldwell-Luc procedure or extraction through the tooth socket have higher rates of conversion to open procedures, more damage to the nasal sinuses and higher post-operative complication rates compared with the transnasal endoscopic approach.
Both patients underwent successful removal of their migrated dental implants with no complications, and neither required any follow-up intervention.
The Journal of Laryngology & Otology 10/2009; 124(4):433-6. · 0.60 Impact Factor
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ABSTRACT: Perforation after pharyngo-oesophagoscopy is a serious complication, and its identification, through close patient monitoring, is essential. Yet little is known about when symptoms and signs develop, and thus how long any close monitoring should last.
To examine the timing of individual symptoms and signs of perforation after rigid pharyngo-oesophagoscopy.
Three-centre, retrospective study.
Of 3459 patients undergoing rigid pharyngo-oesophagoscopy, 10 (0.29 per cent) developed perforations, nine of which were suspected intra-operatively. Symptoms and signs developed at 1.5 hours post-operatively at the earliest, and at 36 hours at the latest. Three patients were asymptomatic. The majority of procedures (n = 8) were undertaken for food bolus obstruction or foreign body ingestion.
Pharyngo-oesophagoscopy for food bolus obstruction and foreign body ingestion accounts for a large number of perforations, but symptoms and signs may take longer than 24 hours to develop. A contrast swallow should be considered in high risk patients, and a high index of suspicion maintained in order to detect this complication.
The Journal of Laryngology & Otology 10/2009; 124(2):171-4. · 0.60 Impact Factor
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ABSTRACT: Retrieval of foreign bodies lodged in the orbit present a challenging surgical problem. The trans-nasal approach when combined with image-guided navigation allows clear identification of structures and increased safety. We report a case of a successful removal of a foreign body under image-guidance using a trans-nasal approach.
Orbit (Amsterdam, Netherlands) 01/2009; 28(6):404-7.
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Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 09/2008; 33(4):382-3. · 2.39 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 01/2008; 32(6):496. · 2.39 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 12/2007; 32(6):496 - 496. · 2.39 Impact Factor
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ABSTRACT: Epistaxis is a common ENT complaint. Although casual observation suggested that it is more common in Caucasian, compared with Asian people, a literature search failed to find any studies investigating ethnicity and epistaxis. The aim of this study was to identify any differences in emergency admission rates for epistaxis between Asian and Caucasian people.
Retrospective observational study using hospital computerised data (HISS). Setting: Large University Hospital accepting ENT emergencies.
All Asian and Caucasian patients admitted under ENT care as an emergency (1 January 2000 to 30 November 2005), split into two groups: one composed of epistaxis patients, the other of all other ENT emergency admissions.
The proportions of Asian and Caucasian patients among the two patient groups, either epistaxis admissions or other ENT emergency admissions.
The proportions of Asian and Caucasian patients in the group admitted with emergency epistaxis were 7.1% (100/1410) and 92.9% (1310/1410) respectively. However, the proportions of Asian and Caucasian patients in the group composed of any other ENT emergency were 13.2% (729/5515) and 86.8% (4786/5515), respectively (chi-squared P < 0.01).
Caucasian people form an unexpectedly large, and Asians a smaller proportion of emergency epistaxis admissions. The possibility of an ethnic risk factor for epistaxis warrants further investigation.
Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 10/2006; 31(5):386-9. · 2.39 Impact Factor
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ABSTRACT: Objectives: Epistaxis is a common ENT complaint. Although casual observation suggested that it is more common in Caucasian, compared with Asian people, a literature search failed to find any studies investigating ethnicity and epistaxis. The aim of this study was to identify any differences in emergency admission rates for epistaxis between Asian and Caucasian people.Design: Retrospective observational study using hospital computerised data (HISS).Setting: Large University Hospital accepting ENT emergencies.Participants: All Asian and Caucasian patients admitted under ENT care as an emergency (1 January 2000 to 30 November 2005), split into two groups: one composed of epistaxis patients, the other of all other ENT emergency admissions.Main outcomes measures: The proportions of Asian and Caucasian patients among the two patient groups, either epistaxis admissions or other ENT emergency admissions.Results: The proportions of Asian and Caucasian patients in the group admitted with emergency epistaxis were 7.1% (100/1410) and 92.9% (1310/1410) respectively. However, the proportions of Asian and Caucasian patients in the group composed of any other ENT emergency were 13.2% (729/5515) and 86.8% (4786/5515), respectively (chi-squared P < 0.01).Conclusions: Caucasian people form an unexpectedly large, and Asians a smaller proportion of emergency epistaxis admissions. The possibility of an ethnic risk factor for epistaxis warrants further investigation.
Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 09/2006; 31(5):386 - 389. · 2.39 Impact Factor
