HNO
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Visual loss following intranasal injections is extremely rare. A case report of blindness in the only seeing eye after infiltration of the septal mucosa with local anaesthetics and vasopressin is presented. The pathological mechanism and the relationship between different surgical procedures and visual loss are analysed and discussed. Some rules are given to prevent this complication.
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Benign diseases of the parotid gland only rarely cause facial nerve paralysis. A parotid gland tumour with peripheral facial nerve paralysis is generally accepted as being malignant, although this rule is not without exceptions. We report a case of chronic non-specific parotitis with an inflammatory pseudotumour causing a peripheral paralysis of the ipsilateral facial nerve. Antiinflammatory and antibiotic treatment caused the complete remission of the parotitis and facial nerve palsy within 6 weeks.
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The treatment of pain in patients with terminal cancer of the head and neck is discussed. The treatment must be tailored to the individual patient and should use oral agents if possible. ⋯ Neuroleptics are important adjuvant analgesics, which have proved to be particularly valuable for more severe pain in head and neck cancer. This treatment can be carried out either in hospital or in domiciliary practice.
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An endoscopic procedure has been developed to enable constant monitoring of the mucous membrane of the larynx and trachea. The examination can be divided into four stages. 1. Transnasal inspection. 2. ⋯ A final check on the above-mentioned critical points during complete extubation after long-term intubation. Regular examination by this atraumatic method provides an early diagnosis of any mucosal damage caused by tubes. The recommendation that a secondary tracheotomy should be carried out after 48 h, and at the latest after a week, can no longer be supported, provided the necessary modern anaesthetic equipment and management is available.
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Between January 1985 and December 1986 320 patients previously treated for squamous cell carcinoma of the oral cavity, pharynx or larynx made 1200 follow-up visits. During this period 25 recurrences, 4 distant metastases and 2 second primaries were diagnosed. Seven patients received further treatment with curative intention, but only 4 patients are alive with no evidence of disease 3 to 23 months after salvage surgery. Indiscriminate follow-up of all patients with head and neck carcinoma over an extended period of time does not appear to be warranted.