This paper reports the innovative use of a modified nasopharyngeal airway device as a temporary stent in patients with laryngotracheal stenosis. It also discusses the technique of endoscopic stent placement, and our experience in terms of the indications and suitability.

The nasopharyngeal airway device was modified to use as an airway stent by trimming it to the desired length. Next, the stent was inserted endoscopically and anchored using a novel approach.

The surgery was performed successfully without complications. The patients had full use of their voice while the stent was in situ. No significant granulation tissue was observed.

This paper demonstrates the feasibility of using a nasopharyngeal airway device as a temporary stent to prevent restenosis in cases where the patients have a strong demand for phonation. The modified nasopharyngeal airway device is potentially very promising, but cases must be selected carefully to avoid compromising efficacy and safety.

Frontal sinus surgery is challenging as the frontal recess is prone to re-stenosis and there is subsequent occlusion of the frontal sinus outflow tract. In an attempt to maintain the frontal recess calibre and reduce frontal sinus re-stenosis, frontal sinus stents have been used with different materials and varying results.

This paper presents the technique of using a modified Montgomery T-tube as a frontal sinus stent.

The use of a soft, self-retaining and non-absorbable stent that can be used for stenting of the frontal sinus is described. Our technique is safe, effective, inexpensive and well tolerated.

Laryngotracheal stenosis management remains largely discretionary in surgical practice. Duration of stenting remains variable following open reconstruction procedures in absence of clearly established differences. The current study evaluates successful decannulation after short-term periods compared with longer periods.

A comparative study over 18 months evaluated differences in successful decannulation between short- and long-term stent groups. Patients with grade II, III or IV laryngotracheal stenosis were placed on Montgomery T-tube for a short-term period (n = 15), and decannulation rates were compared with age-, sex- and diagnosis-matched patients (n = 15) from historical cases with long-term stent placement.

Thirty patients were included. There was no difference between the two groups at baseline. Nine patients (30 per cent) were successfully decannulated, and there was no difference in rates of decannulation between the two groups (p = 0.8). Granulations at the proximal end of tube (38.7 per cent), superior migration of tube (16.1 per cent) and dysphonia (12.9 per cent) were common complications.

Decannulation was not more successful after placing Montgomery T-tubes for longer periods of time when compared with removal within the first three months. Early removal after proper case selection and planning may be considered for a successful outcome in laryngotracheal stenosis.

Endoscopic frontal sinus surgery is frequently complicated by post-operative stenosis and obstruction of the frontal sinus outflow tract, resulting in recurrent disease. Frontal sinus stents may help prevent re-occlusion of the frontal neo-ostia.

This paper presents a simple and cost-effective approach to frontal sinus stenting using modified Silastic nasal splints.

The current technique provides an effective, reliable and inexpensive method for achieving post-operative frontal sinus outflow tract patency.

Stenting of ostial pulmonary artery stenosis presents several unique challenges. These include difficulty in defining anatomy and need for precise stent placement in order to avoid missing the ostial stenosis or jailing either the contralateral branch pulmonary artery or the ipsilateral upper lobe branch.

A retrospective review of outcomes was conducted in 1.5 or 2-ventricle patients who underwent stent placement for ostial branch pulmonary artery stenosis. Specific catheterisation lab techniques were reviewed.

Forty-seven branch pulmonary arteries underwent stent placement for ostial stenosis in 43 patients. The median age and weight were 3.7 (0.3–18.1) years and 14.2 (5.6–70.0) kg, respectively. Three (2–8) angiographic projections were needed to profile the ostial stenosis. Open-cell stents were used in 23 and stents were modified in 5 cases. Following stent implantation, the minimum diameter improved from 3.6 (0.8–10.5) to 8.1 (4.2–16.5) mm (p < 0.001). The gradient improved from 21 (0–66) to 4 (0–27) mmHg (p < 0.001). Stent malposition occurred in eight (17%) of the stents placed. Five migrated distally causing suboptimal ostial coverage necessitating placement of a second stent in four. Three migrated proximally and partially jailed the contralateral pulmonary artery. Intentional jailing of the upper lobe branch occurred in four additional cases. At a follow-up of 2.4 (0.3–4.9) years, 15 stents underwent further dilation and 1 had a second stent placed within the exiting stent.

Ostial branch pulmonary artery stenosis may require additional angiography to accurately define the ostial stenosis. Treatment with stents is effective but carries high rates of stent malposition.

This prospective, controlled study assessed how placing a stent into a newly formed ostium affects ostial patency, success and complication rates in endoscopic dacryocystorhinostomy patients.

In group 1 (40 eyes of 36 patients), both silicone tube intubation and tube stenting were performed. In group 2 (36 eyes of 34 patients), only silicone tube intubation was performed. Success, operative time and post-surgical complications were investigated two months post-operatively in each group.

The success rates were 92.5 per cent and 83.3 per cent for groups 1 and 2 respectively, but the difference was not statistically significant (p = 0.294). The complication rates also differed between the two groups, but this was again insignificant.

Compared with the use of a silicone tube alone, the addition of an ostial stent did not significantly increase the success rate of endoscopic dacryocystorhinostomy.

Takayasu’s arteritis is a rare idiopathic arteritis causing stenosis or aneurysms of the aorta, pulmonary arteries, and their branches. It usually occurs in women, but has been described in children.

The objective of this study was to determine the clinical presentation, demographic profile, vascular involvement, origins, management, and outcome of children diagnosed with Takayasu’s arteritis at a Southern African tertiary care centre between 1993 and 2015.

This is a retrospective analysis of all children with Takayasu’s arteritis captured on a computerised electronic database during the study period.

A total of 55 children were identified. The female:male ratio was 3.2:1, and the mean age was 9.7±3.04 years. Most originated outside the provincial borders of the study centre. The majority presented with hypertension and heart failure. In all, 37 (67%) patients had a cardiomyopathy with a mean fractional shortening of 15±5%. A positive purified protein derivative test was documented in 73%. Abdominal aorta and renal artery stenosis were the predominant angiographic lesions. A total of 23 patients underwent 30 percutaneous interventions of the aorta, pulmonary, and renal arteries: eight stents, 22 balloon angioplasties, and seven had nephrectomies. All patients received empiric tuberculosis treatment, immunosuppressive therapy, and anti-hypertensive agents as required. Overall, there was a significant reduction in systolic blood pressure and improvement in fractional shortening (p<0.05) with all treatments.

Takayasu’s arteritis is more common in girls and frequently manifests with hypertension and heart failure. The abdominal aorta and renal arteries are mostly affected. Immunosuppressive, anti-hypertensive, and vascular intervention therapies improve blood pressure control and cardiac function.

Pharyngocutaneous fistula is a cause of significant morbidity following laryngectomy. Routine use of salivary bypass tubes during laryngectomy has been proposed to reduce the incidence of fistulae and neopharyngeal strictures.

Following a systematic search of Embase, Medline and Cochrane databases (1946 – current), included articles were assessed for bias according to the Cochrane Handbook for Systematic Reviews of Interventions.

Three case–control trials showed reduced pharyngocutaneous fistula rates with the use of salivary bypass tubes; six case series reported widely varied fistula rates. With regards to stricture rates, the largest case–control trial found no improvement with salivary bypass tube use. No fatal adverse events were observed among the 204 patients who received a salivary bypass tube.

Low-level evidence suggests salivary bypass tubes may reduce the incidence of fistula in high-risk patient groups. A robust randomised controlled trial, or large, multicentre cohort studies, are needed to further examine this intervention.

To compare the outcomes of endoscopic repair of bilateral congenital choanal atresia using a flap technique without stenting versus endoscopic repair using stenting without a flap.

A prospective randomised controlled study was conducted, comprising 72 patients with bilateral congenital choanal atresia. The patients were randomised into two groups. Group A (42 patients) underwent endoscopic repair using a mirrored L-shaped flap without stenting, and group B (30 patients) underwent endoscopic repair using stenting without a flap.

At a mean follow-up period of 18.2 months, endoscopic assessment revealed a patent posterior choana in 81 per cent and 83.33 per cent of patients in group A and group B respectively. Choanal stenosis occurred in 21.40 per cent and 33.33 per cent of patients in group A and group B respectively. Granulation tissue was observed in 28.6 per cent and 53.3 per cent of patients in group A and group B respectively.

The endoscopic approach utilising a flap without stenting is safe and effective, with a high success rate.

The Montgomery T-tube is used in a number of conditions that require safe tracheal stenting. Specific lengths of T-tube limbs are occasionally needed in patients with complex airway anatomy or differing neck proportions; this requires customisation of the T-tube limbs. This is done either by pre-ordering customised T-tubes from the manufacturer (which needs to be planned ahead of time) or using a tube cutter in the operating theatre. However, the latter does not provide a ‘factory like’ bevelled edge when shortened, which increases the risk of mucosal trauma and granulation formation.

This paper reports a novel technique for customising the length of existing Montgomery T-tubes, with preservation of the bevelled edges. This technique can be easily performed with basic equipment available in operating theatres.

Petrous apex cholesterol granulomas are expansile, cystic lesions containing cholesterol crystals surrounded by foreign body giant cells, fibrous tissue reaction and chronic inflammation. Appropriate treatment relies on an accurate radiological diagnosis and an understanding of the distinguishing radiological features of relevant entities in the differential diagnosis of this condition.

Firstly, this paper presents a pictorial review of the relevant radiological features of petrous apex cholesterol granuloma, and highlights unique features relevant to the differential diagnosis. Secondly, it reviews the histopathological and radiological findings associated with surgical drainage of these lesions.

Radiological features relevant to the differential diagnosis of petrous apex cholesterol granuloma are reviewed, together with radiological and histopathological features relevant to surgical management. Following surgical management, histopathological and radiological evidence demonstrates that the patency of the surgical drainage pathway is maintained.

Accurate diagnosis of petrous apex cholesterol granuloma is essential in order to instigate appropriate treatment. Placement of a stent in the drainage pathway may help to maintain patency and decrease the likelihood of symptomatic recurrence.

Frontal sinus surgery continues to challenge even the most experienced endoscopic sinus surgeon. Revision frontal sinus surgery is even more challenging. The use of stents in frontal sinus surgery has long been described, as an attempt to decrease the incidence of synechiae and stenosis.

This study included five patients who had previously undergone functional endoscopic sinus surgery but suffered recurrence of frontal sinusitis. Two had bilateral disease. Double J stents were used after endoscopic frontal sinusotomy. The stents were left in place for six months.

Four of the 5 patients (6 out of 7 sinuses) had a patent frontal outflow tract after 10 to 36 months’ follow up.

Double J stents can be used as frontal sinus stents. They are well tolerated by patients, easily applied, and self-retaining with no need for sutures. The length of the stent can be altered according to the patient's anatomy and pathology.

Major vascular complications in patients with head and neck cancer have previously been thought of as terminal events. However, it is now possible to intervene in many situations, with benefits for quality of life as well as survival. Endovascular techniques have reduced morbidity and mortality in many situations, both emergency and elective.

We describe the techniques that can be employed in such situations, and present illustrative case reports. Life-threatening haemorrhage, carotid compression and radiation-induced carotid stenosis are all discussed.

It is possible to predict where complications may arise, and to take prophylactic steps to allow treatment to continue. Early intervention can reduce both morbidity and mortality in this high-risk patient group.

The frontal sinus outflow tract consists anatomically of narrow channels prone to stenosis. Following both endonasal and external approach surgery, up to 30 per cent of patients suffer post-operative re-stenosis of the frontal sinus outflow tract, with recurrent frontal sinus disease. This paper proposes the surgical placement of a long-term frontal sinus stent to maintain fronto-nasal patency, as an alternative to more aggressive surgical procedures such as frontal sinus obliteration and modified Lothrop procedures.

We present a series of three patients with frontal sinus disease and significant co-morbidity, the latter making extensive surgery a significant health risk. We also review the relevant literature and discuss the use of long-term frontal sinus stenting.

These three cases were successfully treated with long-term frontal sinus stenting. Stents remained in situ for a period ranging from 48 to over 60 months.

Due to the relatively high failure rates for both endonasal and external frontal sinus surgery, with a high post-operative incidence of frontal sinus outflow tract re-stenosis, long-term stenting is a useful option in carefully selected patients.

Maintaining the patency of the nasal vestibule following recanalisation of a modified Young's procedure can be a difficult task, as restenosis is quite common.

Sixteen patients underwent recanalisation of a modified Young's procedure, between January 2005 and December 2007, in the ENT – head and neck surgery department of a tertiary centre. Three different stent types were used following recanalisation: silicone suction tube tips, dental wax plate stents and customised acrylic stents.

The silicone suction tube stents prevented restenosis. They were visible in the post-operative period, and there appeared to be some blunting of the nasal valve region, with no functional impairment. Dental wax plates had a high rate of restenosis and were uncomfortable and unsightly. The customised acrylic stents were more acceptable in the post-operative period, and enabled nasal valve angulation to be maintained.

The customised acrylic stent described was a superior alternative to such stenting methods as repeated packing, silicone suction tubes and dental wax plates, following recanalisation of a modified Young's procedure.

The purpose of this study was to determine the efficacy of balloon expandable stents in the relief of obstructed conduits in the right heart, and to review both the immediate success and longevity of this palliation.

Endovascular stents where placed in 17 children, median age 4.7 yrs (range 0.46–16.2 yrs), at a median of 1.6 yrs (range 0.33–6.7 yrs) after placement of conduits at surgery. A second stent was required in two children, either because of migration of the initial stent or residual proximal stenosis. Mean right ventricular to systemic pressure ratios were reduced from 0.77 ±0.24 to 0.50±0.13, and the minimum area of the pulmonary outflow tract increased from 24±12% to 69±26% of that expected for body surface area. Further surgery was needed in 8 patients following placement of the stent, in 5 within 10 months of implantation, due to inadequate relief of obstruction. Nonetheless, 3 of these 8 children achieved satisfac­tory palliation 18, 21 and 24 months prior to requiring insertion of a new conduit. Actuarial freedom from reoperation was 44% at 24 months. The remaining 9 children continue to benefit from the relief in obstruction provided by the stent at a mean interval from implantation of 24±8 months. In this group, the mean Doppler gradient across the right ventricular outflow tract was 35 ±13 mmHg (n=6).

These early data indicate that endovascular stents are useful in the palliation of obstructed right ventricular conduits. In the short-term, the relief of obstruction achieved is well maintained, and has either delayed or obviated the need for insertion of new conduits.