Julian Rowe-Jones

Assessment of predictive prognostic factors for functional endoscopic sinus surgery in a 5-year prospective outcome study.

Background Among numerous studies in the literature regarding prognostic factors that might determine outcome in functional endoscopic sinus surgery (FESS), very few have dealt with assessment of their predictive potential regarding outcome, and none have tried to find out the extent of such a prediction. We have developed a composite model to find out the predictive values of various prognostic factors, using an outcome measure based on the need for postoperative medical intervention. Methods One hundred nine patients were recruited for FESS and followed up at regular intervals for 5 years. Ten prognostic factors were identified and were correlated with prospectively recorded outcome measures. A discriminant analysis using SPSS software was performed to identify the prognostic factors that could “predict” the outcome. Results CT scan scores and polyp scores were the strongest predictors. Using our model, the probability to predict correctly the need for postoperative systemic medication was found to be 81.7%. Conclusion We have generated a model to predict the outcome of FESS, with a 5-year follow-up. CT scan scores and polyp scores were found to be the strongest predictors of the need for postoperative systemic medication.

Surgeon radiation exposure in ESS with balloon catheters.

Objective: Less invasive instruments such as balloon catheters are available for sino-ostial dilation during endoscopic sinus surgery (ESS). Currently, balloon catheter position is confirmed under fluoroscopic visualization. Radiation exposure has been an area of concern. This study was initiated to determine surgeon radiation exposure when fluoroscopy is used during ESS with balloon catheters. Study Design: A multi-center, prospective evaluation of surgeon radiation exposure was conducted. Subjects and Methods: For three months, 14 sinus surgeons wore dosimeters to record radiation exposure while using C-arm fluoroscopy during balloon catheter-aided sinus surgery. One dosimeter was placed at collar level (chest), outside the lead apron and another dosimeter was placed on a finger (extremity). These dosimeters were sent for readings. Deep, eye, and shallow radiation dose for each surgeon was calculated. Results: Thirteen chest badges recorded annualized averages of 191.08, 193.54, and 187.69 mrems for deep, eye, and shallow exposure respectively. Eleven ring badges recorded 584.00 mrems. Conclusions: A recent publication reported low levels of surgeon radiation exposure during ESS with balloon catheters. This study validates radiation exposure among experienced surgeons is well below the annual occupational radiation exposure limit of 50,000 mrem. With vigilant technique and education, fluoroscopy reliance can be minimized.

How we do it: Transoral suction diathermy adenoid ablation under direct vision using a 45 degree endoscope

• Adenoid ablation using suction diathermy is associated with a number of difficulties, mainly associated with the use of the mirror. Transoral and transnasal 0 degree endoscopes have also been utilised but again have limitations. We describe a technique that overcomes the above problems.

Facial Aesthetic Surgical Goals in Patients of Different Cultures

The purpose of facial aesthetic surgery is to improve the patients psychological well-being. To achieve this, the surgeon must understand the patients body image and their aesthetic and psychological expectations. These factors must be judged in the context of their cultural background. The patients cultural values must also be understood to optimize the doctor-patient relationship.

Acute and chronic infections of the ear, nose and throat

Abstract The article focuses on infections that present with external signs, require surgery and carry the risk of life-threatening complications. This contribution looks at the infections of the ear, nose, oral cavity and neck.