The Journal of laryngology and otology
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The current incidence of missile injury to the temporal bone (MITB) is very low in the United Kingdom. However, the increasing frequency of firearm violence in Britain suggests a greater risk of occurrence. ⋯ The risk of major complications is much higher with MITB than with temporal bone injury following blunt trauma, and surgical management is, therefore, much more common. We present one such case, and review the literature outlining the pathogenesis, clinical features, and recommended management.
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The Doughty split tongue blade is used routinely with the Boyle Davis mouth gag during tonsillectomy. If the width of the slot in the blade is excessive, then the endotracheal tube may herniate through the slot in the blade and become fixed and inseparable from the blade. We report two cases of paediatric tonsillectomy where this potentially serious complication occurred. ⋯ All disposable paediatric Doughty blades and some of the reusable blades were found to have excessively and potentially dangerously wide slots. Compression testing of endotracheal tubes by the manufacturer demonstrated marked increases in deformability on warming to body temperature. Ensuring that the slot width of the Doughty blade is not excessive for the endotracheal tube used is essential and we give recommendations.
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Review Case Reports
Descending necrotizing mediastinitis: report of a case following steroid neck injection.
Cervical necrotizing fasciitis is a rare, rapidly progressive, severe bacterial infection of the soft tissues of the neck. Uncommonly, it may descend into the mediastinum. We describe a case of descending necrotizing mediastinitis in a young man, where there was diagnostic confusion and delay, with an eventual fatal outcome. ⋯ In this case, the signs of mediastinitis were initially masked, and the diagnosis delayed until cardiopulmonary arrest occurred. Early recognition with a low threshold for computed tomography (CT) scanning is essential. Aggressive multidisciplinary therapy with mediastinal drainage is mandatory.
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Prominent ears are the most frequent congenital deformity in the head and neck area. Otoplasty has undergone important developments and numerous techniques have been employed to address the anatomical defects, namely the lack of antihelix and the overdevelopment of the concha. We present a cartilage-sparing technique involving scapha--conchal sutures insertion to recreate the antihelix, conchal setback and cartilage weakening. ⋯ According to our experience the described technique gives good and predictable long-term results with a natural-appearing ear. Significant complications are rare. In case of loss of correction, revisional surgery is straightforward on the intact pinna cartilage.
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Data have been collected prospectively from 11 patients (12 affected ears) with traumatic disruption of the ossicular chain. Isolated dislocation of the incus is the most common finding in our cases, but two had stapes arch features and two had fractures of the tympanic bone. ⋯ This involves a combination of a tympanotomy and a posterior approach to the attic region. The results in five patients (six ears) treated in this way are presented.