The three-dimensional anatomy and conspicuous location of the nasal tip makes it one of the most challenging sites of facial plastic surgery. This article reviews literature on nasal tip sculpture using suture techniques, as well as the authors' own experience.

A search was conducted using Pubmed, the Google internet search engine and the authors' files, using the keywords ‘nasal tip’, ‘suture’, ‘rhinoplasty’ and ‘septorhinoplasty’.

Common nasal tip suture techniques and suture algorithms are presented, along with a summary of the indications and side effects of each technique.

Predictable long-term results are more likely to occur with minimal local tissue excision. Suture techniques remodel the shape of the nasal tip by altering the configuration of, and the relationship between, the tip cartilages and their supporting structures; they also preserve nasal tip anatomy and limit resection. Intra-operatively, the effects are immediately visible, and can be adjusted or reversed. Tip sutures should therefore be considered instead of tissue excision whenever possible.

The aim of this review was to assess and describe the pathological characteristics of intraparotid facial nerve schwannoma, in order to facilitate correct prognostic evaluation and appropriate therapeutic decision making.

The literature was reviewed regarding involvement of the various portions of the facial nerve. A classification is proposed, based on anatomical and pathological evaluations, which can supply important information on facial functional outcomes.

From this study, two important characteristics of facial nerve schwannoma emerged: the schwannoma may be capable of surgical dissection from the facial nerve, leaving the latter anatomically preserved; or it may be tightly bound to the nerve, in which case it must be removed along with a variable section of nerve tract, followed by reconstruction.

The extent of the neoplasm and the involvement of different branches of the facial nerve are very important elements to consider when evaluating prognosis and therapy.

To emphasise the usefulness of a classification, based on anatomical and pathological evaluation, which can supply information about post-operative facial function.

The diagnosis and management of olfactory disorders is an often neglected topic in otolaryngology. This article evaluates current clinical practice within the United Kingdom, and provides a literature-based review of the diagnosis, management and prognosis of olfactory pathology.

A questionnaire was sent to consultant and associate specialist members of the British Association of Otolaryngologists and Head and Neck Surgeons. The responses were documented to gain an impression of how olfactory disorders are managed in the United Kingdom. The literature relating to olfactory dysfunction was then evaluated and the findings summarised.

Management of olfactory pathology varies across the United Kingdom. The literature suggests that chemosensory testing is optimal and that both forced-choice and threshold testing should be applied if objective evaluation is required. Imaging can be of value but the appropriate technique should be used. Olfactory function can recover following head injury, viral infection and chronic sinonasal disease, although varying degrees of dysfunction are likely to persist. There is a role for the use of corticosteroids, particularly when administered systemically. More research is needed to establish the appropriate dose and length of treatment.

To evaluate the clinical presentation and outcomes of treatment for patients with chondrosarcomas involving the skull base and temporal bone.

Retrospective review.

Tertiary medical centre.

Cases of histologically confirmed chondrosarcoma involving the skull base and temporal bones.

Surgery.

Demographic features of presenting patients; presenting symptoms and signs; surgical approach employed; use of post-operative radiation therapy; histological grade of tumour; and interval of post-operative follow up.

Results: Twelve patients were identified with chondrosarcomas involving the skull base, with post-operative follow up ranging from three to 33 years. The average age at presentation was 42 years. The most common presenting symptoms were diplopia, decreased visual acuity and headaches. Five of the 12 patients required multiple surgical procedures.

Patients with chondrosarcoma involving the skull base and temporal bone may present in a variety of ways. Surgical resection, even subtotal, in combination with radiation therapy, can often provide good tumour control over many years for these rare tumours.

To establish if the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of the vestibule, after the removal of vestibular schwannoma by a modified translabyrinthine approach, correlate with a successful outcome, defined as hearing preservation.

Our study group consisted of 16 patients with vestibular schwannoma. All patients' pre-operative hearing was graded as class one or two according to the Gardner–Robertson scale. On MRI scans, the schwannoma, including the intracanalicular segment, were less than 2 cm in size in all the patients. The intracanalicular portion involved the fundus of the internal auditory canal in seven patients. In the remaining nine patients, the schwannoma had spread to involve two-thirds of the meatus, sparing its lateral third. The state of the labyrinth, in particular the integrity of the vestibule, was evaluated by CT scans and MRI prior to and following surgery.

The schwannoma was completely removed in all patients. None showed any signs of persistence or tumoral relapse on the post-operative MRI. The final follow up showed that seven patients had maintained their hearing function (i.e. four patients with class one hearing and three with class two). The MRI vestibular signal on the T2-weighted images was well depicted only in patients with hearing preservation. Bony vestibular integrity was observed in the CT scans of all cases with hearing preservation, and also in three cases with failure of hearing preservation.

Our results confirm that total isolation and maintenance of an anatomically intact vestibule, as depicted by MRI examination, is one of the fundamental factors for successful preservation of hearing function following modified translabyrinthine approach schwannoma removal.

The aetiology of maxillary mucosal cysts is uncertain. Chronic rhinosinusitis has been proposed as a probable aetiological explanation for their formation.

We recruited 500 consecutive patients who had undergone computed tomography scanning of the paranasal sinuses for possible chronic sinus disease. We identified 110 (22 per cent) cases of maxillary mucosal cysts.

Patients' mean age was 42.65 years, with a female to male ratio of 0.69:1 (45:65). The mean cyst size was 14.27 mm, and most were located on the inferior surface of the antrum. Only in two cases did the cyst obstruct the sinus ostium. Of patients with antral cysts, 52.7 per cent had computed tomography evidence of sinus disease, whereas only 41.3 per cent of noncyst (control) patients had sinus pathology. The total Lund–Mackay score was significantly greater in the cyst group (n=390) compared with the noncyst group (Mann–Whitney; p<0.05).

Chronic rhinosinusitis plays an important role in the aetiology of maxillary mucosal cysts.

Body sprays and perfumes are commonly worn by patients attending ENT out-patients clinics. Their effect on performance in olfactory testing is unknown. The aim of this study was to determine whether olfactory thresholds are altered by the presence of such fragrances.

One hundred and sixty healthy volunteers, aged 18 to 65 years, underwent olfactory thresholds testing. Each was then exposed to one of four strong perfumes, applied in a facemask for two minutes, and the thresholds were retested.

All olfactory thresholds worsened after being exposed to the strong perfumes of LynxTM and ImpulseTM body sprays, with the strongest effect being on olfactory detection of phenylethyl alcohol (p<0.001).

Strong perfumes can have a negative effect on olfactory thresholds.

Patients attending olfactory threshold testing need to be advised not to wear body sprays or perfumes.

There is an increasing choice of voice outcome research tools, but good comparative data are lacking.

To evaluate the reliability and validity of three voice-specific, self-reported scales.

Longitudinal, cohort comparison study.

Two UK voice clinics: the Freeman Hospital, Newcastle upon Tyne, and the Glasgow Royal Infirmary.

One hundred and eighty-one patients presenting with dysphonia.

All patients completed the vocal performance questionnaire, the voice handicap index and the voice symptom scale. For comparison, each patient's voice was recorded and assessed perceptually using the grade–roughness–breathiness–aesthenia–strain scale. The reliability and validity of the three self-reported vocal performance measures were assessed in all subjects, while 50 completed the questionnaires again to assess repeatability.

The results of the 170 participants with completed data sets showed that all three questionnaires had high levels of internal consistency (Cronbach's alpha = 0.81–0.95) and repeatability (voice handicap index = 0.83; vocal performance questionnaire = 0.75; voice symptom scale = 0.63). Concurrent and criterion validity were also good, although, of the grade–roughness–breathiness–aesthenia–strain subscales, roughness was the least well correlated with the self-reported measures.

The vocal performance questionnaire, the voice handicap index and the voice symptom scale are all reliable and valid instruments for measuring the patient-perceived impact of a voice disorder.

To determine the prevalence and type of human papilloma virus deoxyribonucleic acid (DNA) in cases of laryngeal squamous cell carcinoma.

We analysed the prevalence of human papilloma virus infection in archived paraffin block specimens taken from 99 cases of laryngeal squamous cell carcinoma between 1990 and 2005, using polymerase chain reaction techniques. Biopsy specimens from five proven verrucous skin lesions were used as positive controls, and peripheral blood samples from five healthy volunteers were used as negative controls.

Four test samples were found to have inadequate deoxyribonucleic acid purity and were therefore excluded from the study. Human papilloma virus deoxyribonucleic acid was detected in seven of 95 cases of laryngeal squamous cell carcinoma (7.36 per cent). Human papilloma virus genotyping revealed double human papilloma virus infection in three cases and single human papilloma virus infection in the remaining four cases. The human papilloma virus genotypes detected were 6, 11 and 16 (the latter detected in only one case).

In our series, a very low human papilloma virus prevalence was found among laryngeal squamous cell carcinoma cases. The human papilloma virus genotypes detected were mostly 6 and/or 11, and 16 in only one case. To the best of our knowledge, this is the first report of human papilloma virus prevalence in laryngeal squamous cell carcinoma, based on polymerase chain reaction genotyping in a Turkish population.

To determine the prevalence of tonsillar actinomycetes colonization in patients with and without recurrent tonsillitis and to study the association of this condition with recurrent tonsillitis and tonsillar hypertrophy.

A retrospective study of 834 patients who had undergone tonsillectomy for recurrent tonsillitis (group A) and for sleep-disordered breathing without a history of recurrent tonsillitis (group B).

The prevalence of tonsillar actinomycetes colonization was higher in patients who had undergone tonsillectomy for sleep-disordered breathing (44.1 per cent) than in patients who had undergone tonsillectomy for recurrent tonsillitis (33.3 per cent). The prevalence did not differ by sex or age of patient, although the occurrence rate was higher in the adult compared with the paediatric population. There was no statistically significant difference between the mean size of the tonsils removed in the two groups, and actinomycetes colonization did not affect tonsil size. Histopathological analysis of resected tonsils did not show active tissue infection.

The presence of actinomyces does not indicate active disease. We are of the opinion that, although actinomyces colonization is more prevalent in patients with sleep-disordered breathing, it does not contribute to tonsillar hypertrophy nor to recurrent tonsillitis.

To assess the evidence surrounding the use of certain complementary supplements in otolaryngology. We specifically focussed on four commonly used supplements: spirulina, Ginkgo biloba, Vertigoheel® and nutritional supplements (cod liver oil, multivitamins and pineapple enzyme).

A systematic review of the English and foreign language literature. Inclusion criteria: in vivo human studies. Exclusion criteria: animal trials, in vitro studies and case reports. We also excluded other forms of ‘alternative medicine’ such as reflexology, acupuncture and other homeopathic remedies.

Lack of common outcome measures prevented a formal meta-analysis. Three studies on the effects of spirulina in allergy, rhinitis and immunomodulation were found. One was a double-blind, placebo, randomised, controlled trial (RCT) of patients with allergic rhinitis, demonstrating positive effects in patients fed spirulina for 12 weeks. The other two studies, although non-randomised, also reported a positive role for spirulina in mucosal immunity. Regarding the use of Ginkgo biloba in tinnitus, a Cochrane review published in 2004 showed no evidence for this. The one double-blind, placebo-controlled trial that followed confirmed this finding. Regarding the use of Vertigoheel in vertigo, two double-blind RCTs and a meta-analysis were identified. The first RCT suggested that Vertigoheel was equally effective in reducing the severity, duration and frequency of vertigo compared with betahistine. The second RCT suggested that Vertigoheel was a suitable alternative to G biloba in the treatment of atherosclerosis-related vertigo. A meta-analysis of only four clinical trials confirms that Vertigoheel was equally effective compared with betahistine, G biloba and dimenhydrinate. Regarding multivitamins and sinusitis, two small paediatric pilot studies reported a positive response for chronic sinusitis and otitis media following a course of multivitamins and cod liver oil. Regarding bromelain (pineapple enzyme) and sinusitis, one randomised, multicentre trial including 116 children compared bromelain monotherapy to bromelain with standard therapy and standard therapy alone, for the treatment of acute sinusitis. The bromelain monotherapy group showed a faster recovery compared with the other groups.

The positive effects of spirulina in allergic rhinitis and of Vertigoheel in vertigo are based on good levels of evidence, but larger trials are required. There is overwhelming evidence that G biloba may play no role in tinnitus. There is limited evidence for the use of multivitamins in sinus symptoms, and larger randomised trials are required.