HNO
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To the otolaryngologist, there are multiple causes for head or facial pain: headaches due to ear diseases; idiopathic neuralgias; "referred otalgia" involving cranial nerves V, IX, X; temporomandibular joint dysfunction; rhinological pathologies, including post-traumatic trigeminal neuralgia; "facial sympathalgias"; the styloid process syndrome; and cervical spine problems. Less known causes of head and neck pain are stressed, and emphasis placed on their diagnosis and treatment.
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A unilateral blindness after transnasal ethmoidectomy was diagnosed postoperatively while the patient was still in theatre. Exploration via an external approach was performed immediately, a haematoma was drained and the posteroir ethmoid artery was cauterized. This led to a recovery of vision. The temporary blindness was probably due to increased intraorbital pressure by the retrobulbar haematoma which led to stretching of and pressure on the optic nerve.
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Between 1973 and 1977 seven adults and five children with severe larynx stenosis were operated upon successfully with a modification of Rhéti's technique. The main features of this new technique are: 1. The cricoid and the upper tracheal rings are split longitudinally in their anterior and posterior portion. 2. The stabilisation of the enlarged laryngeal lumen by the interposition of a piece of notched costal cartilage in the posterior wall of the split cricoid.
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Transconioscopy is an additional aid to the diagnosis, localization and functional consequences of laryngeal lesions. This endoscopic examination is especially relevant to management. The technique is described and the findings in a large number of cases are demonstrated.
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The place of direct laryngotracheobronchoscopy since its introduction 80 years ago, and the necessary anaesthetic methods, lighting systems, magnification and recent use of flexible fibreoptic bronchoscopes are discussed and appraised. Its further development is dependent upon that of modern optical instruments, whilst the basic principles of its use diagnostically and therapeutically remain little changed.