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Volume 121 - Issue 8 - August 2007

The Journal of Laryngology & Otology Volume 121 - Issue 8 -
Contents

Page 2 of 2

Short Communications

  • Endoscopic technique to mark the site of tracheal stenosis for resection

  • G Lichtenberger, C Sittel, A L Merati, Á Reményi
  • Published online by Cambridge University Press:
    01 May 2007, pp. 790-793
  • Background:

    It is difficult to precisely localise the extent of the diseased segment on the external aspect of a stenotic trachea. A technique has been developed of marking the upper margin of stenosis, in order to open the airway at the appropriate level during segmental resection.

    Materials and methods:

    Prior to the open reconstructive procedure, the stenosis is visualised using microlaryngoscopy. An endo-extraluminal technique is used to drive a suture from inside out through the skin; this then serves to mark the exact top margin of the stenotic segment. This suture serves as a guide for the surgeon during the open approach to tracheal resection.

    Results:

    This technique was performed in 16 cases, and allowed precise localisation of the stenosis in each case.

    Conclusion:

    Transcutaneous localisation of laryngotracheal stenosis, using the Lichtenberger device, is an easy and reliable technique requiring a minimum of additional time.

Clinical Records

  • Endoscopic removal of foreign body from the anterior cranial fossa

  • S Thomas, A Daudia, N S Jones
  • Published online by Cambridge University Press:
    19 March 2007, pp. 794-795

  • Intracranial foreign bodies are typically removed via a craniotomy, which carries significant peri-operative risks. Nasal endoscopy for removal of intracranial foreign bodies is rare and has been attempted only a few times. Here, we describe a case in which nasal endoscopy was employed to successfully remove an air rifle pellet from the anterior cranial fossa, with subsequent repair of the associated cerebrospinal fistula. We thus advocate nasal endoscopy as an alternate line of management for the removal of foreign bodies from the anterior cranial fossa when possible, due to its significantly lower associated morbidity, provided adequate neurosurgical backup is available if required.

  • Idiopathic, inflammatory, medial meatal, fibrotising otitis presenting with lichen planus

  • E Hopsu, A Pitkäranta
  • Published online by Cambridge University Press:
    12 March 2007, pp. 796-799
  • Background:

    Background: Of the acquired ear canal atresias, idiopathic, inflammatory, medial meatal, fibrotising otitis has been suggested as a distinct disease entity, for reasons of aetiology.

    Objective:

    To report three more cases of idiopathic, inflammatory, medial meatal, fibrotising otitis and to further consider the possible relationship between this condition and lichen planus.

    Patients:

    Three adult patients with idiopathic, inflammatory, medial meatal, fibrotising otitis, two with bilateral aural symptoms, treated and followed up at the department of otorhinolaryngology of Helsinki University Hospital.

    Results:

    We found idiopathic, inflammatory, medial meatal, fibrotising otitis, affecting solely the glabrous skin of the osseous part of the external ear canals, in three patients who also suffered from severe oral lichen planus.

    Conclusions:

    The aetiopathology or pathophysiology of idiopathic, inflammatory, medial meatal, fibrotising otitis may be linked with lichen planus. Early, active treatment of idiopathic, inflammatory, medial meatal, fibrotising otitis with local corticosteroids may prevent total medial meatal atresia.

  • Grisel syndrome: a delayed presentation in an asymptomatic patient

  • J Doshi, S Anari, I Zammit-Maempel, V Paleri
  • Published online by Cambridge University Press:
    13 February 2007, pp. 800-802

  • Grisel syndrome is a rare condition characterised by atlanto-axial subluxation following an inflammatory process in the head and neck region. It occurs more commonly in children and usually presents with cervical pain and torticollis, in addition to symptoms of the primary infection. We present the case of an asymptomatic 78-year-old man who was incidentally found to have atlanto-axial subluxation on a routine follow-up computed tomography scan, three months following successful treatment of a skull base infection. This case emphasises the importance of appropriate follow-up imaging for patients with skull base infections, even if they respond clinically to medical treatment.

  • Isolated hypoglossal nerve palsy: a harbinger of malignancy

  • S G Khoo, I Ullah, F Wallis, J E Fenton
  • Published online by Cambridge University Press:
    13 February 2007, pp. 803-805

  • The hypoglossal nerve is an underrated nerve usually consigned to a few words in anatomical text books, under the last four cranial nerves. However, paralysis of this nerve may be the first indication of a serious underlying disorder. Excluding previous surgery, radiotherapy and trauma, 50 per cent of cases of isolated hypoglossal nerve palsy are idiopathic. A further 20 per cent are malignant, 20 per cent are vascular and 10 per cent are due to miscellaneous causes. Presentation of an isolated hypoglossal nerve palsy is therefore an ominous sign. There is confusion over both cause and investigation, and management protocols for isolated hypoglossal nerve palsy are ill-defined. We present a case of isolated hypoglossal palsy which was due to a metastatic skull base deposit. This case illustrates the fact that magnetic resonance imaging is the investigation of choice in assessing the entire course of the hypoglossal nerve.

Book Reviews

Page 2 of 2