Jaiganesh Manickavasagam

Treatment of paediatric laryngeal papillomas: web survey of British Association of Paediatric Otolaryngologists.

BACKGROUND AND OBJECTIVE Recurrent respiratory papillomatosis is the most common benign neoplasm of the larynx in children. Intralesional injection of cidofovir may have some potential as an adjunctive treatment. There is no standardised protocol in the UK for the management of recurrent respiratory papillomatosis. This study aimed to investigate the management practices of surgeons treating paediatric recurrent respiratory papillomatosis in the UK. METHOD A web questionnaire survey was sent by e-mail to all members of the British Association of Paediatric Otorhinolaryngology. RESULTS Out of 35 respondents, 23 were at that time treating children with recurrent respiratory papillomatosis. Nineteen respondents preferred to use a microdebrider, 12 preferred laser, and 5 preferred cold steel along with either laser or a microdebrider. Twelve surgeons used cidofovir for selected patients and 12 surgeons did not use cidofovir for any patients. Cidofovir was considered after 0–4 surgical procedures by seven respondents, after 4–6 surgical procedures by four respondents and after 6 surgical procedures by six respondents. Eleven respondents warned patients about the possible side effects of cidofovir and five gave no warning. CONCLUSION There was no consensus as to when it would be appropriate to use cidofovir, indicating the need for cidofovir usage guidelines.

Alar Suspension Sutures in the Management of Nasal Valve Collapse.

Objective: This study assesses the efficacy of alar suspension sutures in the management of nasal valve collapse causing nasal obstruction. These sutures are inserted between the vestibular skin and lateral crura and hitched to the periosteum of the medial inferior orbital margin; this is a variation of the alar (change everywhere) suspension suture technique. Method: A retrospective review of patients who underwent alar suspension suture insertion between January 2009 and December 2010 in the management of nasal obstruction was undertaken. Symptoms of nasal obstruction were assessed using the Visual Analogue Scale (VAS) and peak inspiratory flow rate (PIFR). This was measured preprocedure and repeated at 3, 6, and 12 months postoperatively. Results: A total of 35 patients were identified, and 26 were included in the study; 90% of patients were satisfied with the outcome of surgery, supported by improvement in the VAS and PIFR scores. The mean difference in VAS preprocedure and postprocedure was 4.97 (P value = 0.00), and the average improvement in PIFR was 25.5 L/min (P value = 0.00). Conclusion: Our study shows a significant improvement in patient’s symptoms following insertion of alar suspension sutures. It is, therefore, a reliable, safe, and effective technique in treating nasal obstruction secondary to nasal valve collapse.

Endoscopic removal of a dermoid cyst via scalp incision.

Nasal dermoid sinus cysts are the most common congenital midline nasal lesions. We describe a novel technique for the excision of a nasal dermoid cyst in a 2-year-old boy using a four hand endoscopic approach via a small scalp incision behind the hairline. The technique, although somewhat challenging, avoids a facial scar. Laryngoscope, 123:1862–1864, 2013Nasal dermoid sinus cysts are the most common congenital midline nasal lesions. We describe a novel technique for the excision of a nasal dermoid cyst in a 2‐year‐old boy using a four hand endoscopic approach via a small scalp incision behind the hairline. The technique, although somewhat challenging, avoids a facial scar. Laryngoscope, 123:1862–1864, 2013

Functional Endoscopic Sinus Surgery Chopstick Technique

We describe a functional endoscopic sinus surgery (FESS) technique that involves the simultaneous use of endoscope and suction in the nondominant hand that bears resemblance to chopstick use. The FESS chopstick technique reduces time for suction and improves operative field visualization. Laryngoscope, 2010

Transoral robotic resection of a large schwannoma in the retropharyngeal space.

BACKGROUND External approaches have been traditionally used for the complete excision of large retropharyngeal space lesions. CASE REPORT This paper describes a case of a large schwannoma of the retropharyngeal space excised transorally with the use of a robotic system. This lesion measured 2.7 × 1.2 cm in axial dimensions and over 5.8 cm in craniocaudal length. The lesion was delivered en bloc with an intact capsule. No peri- or post-operative complications were encountered. The procedure allowed quick resumption of an oral diet and a return to normal activity for the patient. CONCLUSION This is, to our knowledge, the first report of this technique used in the excision of a large retropharyngeal space mass.

Congenital familial subglottic stenosis: A case series and review of literature

Subglottic stenosis is a narrowing of the endolarynx and maybe classified as congenital (primary) or acquired (secondary). Congenital stenosis maybe caused by a small cricoid cartilage, thick submucosa or other laryngeal abnormalities and remains a well-known cause of stridor in infancy. It occurs sporadically and familial occurrence is rare. Our case series identifies three children with congenital subglottic stenosis born to consanguineous parents. Congenital subglottic stenosis in siblings of unrelated parents has been previously reported, but not in consanguineous parents indicating a strong genetic link. We recommend further genetic research to assess the mode of possible heritage in this disease.

A technique for insertion of nasal septal button

child and parent. The child is then bent over backwards and his head is gently rested between the examiner’s thighs (Fig. 1). The parent secures the limbs of the child. Apart from providing support, the examiner can stabilise the child’s head between his thighs, and with the aid of a headlamp visualise and remove foreign bodies from the nose. Although this technique may seem uncomfortable, in our experience, children are compliant and we have had little problems. It also has the advantage of employing only two persons for the procedure.

Effective visualisation of small and mildly radio-opaque foreign bodies in the aero digestive tract – picture archiving and communication systems

Sir, Foreign bodies in the aero digestive tract are frequently encountered in ENT practice and plain X-ray tends to play a significant role in the initial workup. Large radio-opaque foreign bodies can be easily visualised on plain X-ray films but mildly radio-opaque foreign bodies such as fish bones can be easily missed in the X-ray films. Plastic foreign bodies are difficult to visualise during endoscopy and X-ray, hence the difficulty in diagnosis. Viewing apparently normal X-rays (Fig. 1) through picture archiving and communication system (PACS) can enhance visualisation and subsequent identification of certain mildly radio-opaque foreign bodies. PACS is a computer system that allows the digital capture, viewing, storage and transmission of medical images. Most of the hospitals in UK are now equipped with PACS. Adjusting the window width (brightness and contrast) and reversing the background and foreground of any image makes the foreign body more prominent. In addition, magnification and zoom and pan tools allow for the enlarging and detailed examination of images,

Aggressive cutaneous squamous cell carcinoma arising from a human papillomavirus-infected epidermoid cyst of the conchal bowl

to move from their region of training after obtaining their CCT, with comparable results in 2011 and 2016; the percentages prepared to work only in their own region or an adjacent region were 86% in 2011 and 87.5% in 2016, while the percentages of those prepared to move anywhere in the UK were 14% and 13%, respectively. There was a high level of awareness of the current volume of unfilled Consultant posts in the UK, probably due to the impact that staff shortages have on the working environment. Not one respondent believed there to be no Consultant shortages in the UK, compared with 12% in 2011, and this was accompanied by a 130% increase in respondents who were aware of current shortages. In summary, the results of the BAD 2016 trainee survey suggest that trainees plan to work on average for 7.6 years in the 10 years following CCT. There was a 50% decrease in trainees who were interested in academic work. This data collection enables the association to consult with the Department of Health, Public Health England and Health Education England, who provide intelligence to the health and care systems to inform workforce planning decisions at a national and local level. This information on careers choices will help predict consultant vacancies and regional workforce distribution and thereby projected workforce demand. Further investigation is required to understand why trainees are turning from academic careers, which, if confirmed, threatens the future of academic dermatology. Unless national workforce planning takes into account the career plans of trainees that will affect their availability to fill NHS roles, there will be no resolution of the current workforce crisis. N. Goad and N. J. Levell British Association of Dermatologists, London, UK; and Dermatology Department, Norfolk and Norwich University Hospital, Norwich, UK E-mail: nina@bad.org.uk Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 1 July 2017

Not quite Pott’s puffy tumour

Pott’s puffy tumour (PPT) is characterised by a subperiosteal abscess associated with osteomyelitis of the frontal bone—a rare complication of frontal sinusitis, more common in the paediatric population. We describe a case mimicking PPT, where abscess extension was facilitated by previous surgery. Usually patients with PPT would be systemically unwell, but our patient, a 63-year-old Caucasian man, was systemically well with a large swelling of his forehead. A CT was performed to evaluate possible intracranial and intracerebral complications such as epidural, subdural and brain abscesses. Emergent surgical drainage was performed with prolonged administration of antibiotic therapy. 12 weeks later, he had recollection in the frontal sinus requiring incision and drainage. 6 weeks afterwards, he underwent planned Lothrop procedure and endoscopic sinus surgery. Although clinically the patient presented with overwhelming features of PPT, we emphasise that PPT involves osteomyelitis of frontal bone, which is absent in our case.