Volume 2 Issue 3 - 2009

Each day there are increasing pressures on Otorhinolaryngologists in the U.K to be more than just competent clinicians – service delivery forms a large part of the working day for the average U.K. ORL specialist. With the current sad state of economic affairs, I suspect that even more pressure will be put on departments to maintain a high quality service with even greater financial restrictions. Both revalidation and the European Working Time Directive have also had a huge impact on the way we deliver service whilst also ensuring that knowledge and expertise are maintained. This issue has some interesting articles discussing aspects of service delivery as well as the usual good quality review articles.


This review covers the diagnostic management of a patient with an epithelial salivary gland malignancy. It includes description of the clinical behaviour of the more common histological types, diagnostic issues, definitive surgical management, the role of chemotherapy and radiotherapy, newer molecular targeted therapies and clinical controversies.


The length of time patients must wait to receive elective treatment is a key criterion by which hospital services are judged in the UK. Over-reviewing patients in clinic is both inconvenient to patients and places further demands on outpatient services. A specific discharge guideline was designed to address this problem by encouraging clinicians to inform patients of routine test results by letter. The impact of the discharge strategy was then audited.


We present the first published experience of Percutaneous Endoscopic Gastrostomy (PEG) by an otorhinolaryngologist in the United Kingdom. In a series of 65 patients, we demonstrate that PEG can be safely performed by an otorhinolaryngology – head & neck surgical team; with successful insertion and complication rates (major/minor) comparable to other published PEG series from the gastroenterology and head & neck literature (94% and 6%/9% respectively).

In our series, 69.8% of patients.... of patients had PEG in addition to other related procedures, such as tumour resection. Combining PEG with other procedures under a single general anaesthetic may confer a number of benefits compared to PEG under sedation; including better airway protection, greater patient procedure acceptability and a shortened treatment pathway. There are also advantages in health economic terms as only one hospital admission is required.

We advocate formal training before performing PEG, close cooperation with local endoscopy services/gastroenterology colleagues, and participation in regular multidisciplinary audit.


Facial swellings are a common condition presenting either acutely or chronically in childhood. Accurate diagnosis is essential to the provision of adequate treatment. Developing a good technique for making a diagnosis is important, as it will help prompt recognition of serious diseases, adding to the improvement of outcome.

This article uses a practical approach to aid diagnosis, provides clues to aid the interpretation of data obtained from clinical examination, summarises the most common causes of facial swelling in children, and outlines the current views on their management.


Objective: We present the unique case of well defined, thick walled cholesterol granuloma of the mastoid tip associated with bone destruction in the presence of an aberrant sigmoid sinus. We also review the world literature concerning the rare phenomenon of aggressive cholesterol granulomas and even rarer aberrant sigmoid sinus.

Method: Case reports and a review of the world literature concerning cholesterol granulomas and sigmoid sinus anatomy are presented.

Results: The patient presented is a 32 year old male Caucasian who presented to our services complaining of otalgia. An MRI scan was performed and the patient underwent mastoidectomy.


Background: Herpes simplex virus type 1 infections of the head and neck area are common, with a wide variation in presenting symptoms. Isolated involvement of the larynx is rare.

Methods and Results: We describe the case of a 68 year old man who presented with a necrotising mass lesion of the larynx due to herpes simplex virus, confirmed by histopathology and immunohistochemistry studies of a laryngeal biopsy. Clinically and radiologically, this lesion mimicked a neoplasm, leading to diagnostic difficulty.

Conclusion: Laryngeal herpetic infections may present with mass lesions which may simulate a malignant neoplasm.


Objective: We report a rare case of laryngeal myxoma.

Case report: Laryngeal myxomas are rare benign tumors of mesenchymal origin, to our knowledge only six have been reported in the English-language literature. We present the case of a woman seen in the ENT outpatient clinic with a lifelong history of dysphonia. On examination she was found to have bilateral swollen vocal cords. This was thought to represent Reinkes oedema. Pathological analysis after routine microlaryngoscopy showed this to be a vocal cord myxoma. Conclusion: We recommend excision of this lesion and long term follow-up.


Our aim was to assess if adult day case tonsillectomy could be safely introduced to our ENT department and to identify any practical issues that would need addressing.

A prospective audit was performed in three phases. Outcomes included patients who successfully underwent a day case tonsillectomy, postoperative morbidity and patient satisfaction.


The first national survey of out-of-hours facilities in otolaryngology was published in 2005. Since the original publication there has been changes in service provision and delivery.


Our aim was to determine if any changes have occurred in paediatric otolaryngology provision in southwest England since the publication of “Children’s Surgery – a First Class Service” (Royal College of Surgeons England, 2000).

A questionnaire was distributed to the paediatric lead consultant in all ten hospitals in 2000 and 2007.


The current treatment of autogenic brain abscesses is to drain them via burr holes or completely excise them. The aim from this study is to describe the drainage of otogenic brain abscess via a mastoidectomy approach.


Patients presenting with head and neck cancer may have no clinical or radiological evidence of cervical lymph node metastasis – the N0 neck. Despite this, histo-pathological data has confirmed the presence of occult metastases in up to 30% of N0 necks (i.e. N+), depending on the site of the primary tumour. Currently there is no way of identifying affected individuals and consequently, 70% may be overtreated. Using proteomic techniques we attempted to identify a primary tumour phenotype, which would allow the discrimination of oropharyngeal squamous cell carcinoma (OSCC) with metastatic potential.


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