The use of keels in the treatment of anterior glottic stenosis is well established. A variety of methods for keel fixation have previously been documented. We describe a simple technique of securing a Silastic keel, placed endoscopically, with a simple percutaneous suture, after laser vaporization of an anterior commissure web.

Introduction: Due to the ‘modernizing medical careers’ changes, doctors with a firm career intention will be able to enter a speciality-specific training programme after their foundation years.

Materials and methods: A questionnaire was emailed to all 204 final year medical students at Newcastle Medical School asking about their ENT undergraduate experience and if they felt it was sufficient to consider a career in otolaryngology.

Results: One hundred and forty-four completed questionnaires (71 per cent) were returned, with respondents giving the following information: 54 per cent had had a formal ENT attachment (average seven and a half days); 24/144 (17 per cent) and 60/144 (42 per cent) respectively had not attended ENT clinic or theatre; less than 50 per cent had seen common ENT operations; 12/144 (8 per cent) had never heard of a septoplasty; two-thirds (24/36) of aspiring general practitioners had never seen a tonsillectomy or grommet insertion; and only 6/30 (20 per cent) of aspiring surgeons felt their ENT experience had been enough to consider the speciality as a career.

Discussion: Alternative methods of delivering an otolaryngology curriculum should be considered. We must promote otolaryngology to medical students at every opportunity.

Objective: To evaluate the relationship between disease stage and duration of symptoms for squamous cell carcinoma of the larynx.

Method: We evaluated retrospectively data from 102 laryngeal squamous cell carcinoma patients seen in the otorhinolaryngology department of the Gazi University School of Medicine between December 1996 and June 2004. Inclusion criteria were a histologic diagnosis of laryngeal squamous cell carcinoma, no previous medical, surgical or radiological treatment for carcinoma, and the absence of any other primary tumours or distant metastatic disease.

Results: There was no relationship between duration of symptoms and stage of the disease, both for glottic and supraglottic tumours. When glottic and supraglottic tumours were compared, no significant difference in symptom duration could be found.

Conclusion: There is no correlation between symptom duration and the stage of the disease for squamous cell carcinoma of the larynx. Therefore, symptom duration does not reflect the stage of the tumour.

The administration of anaesthetic gases to an infant undergoing an endolaryngeal laser procedure can be difficult. We describe the use of a Magill's nasal sucker and an anaesthetic connector to maintain anaesthesia during laser surgery.

Aortitis and saddle nose deformity are extremely unusual manifestations of a variety of systemic diseases. The concurrent appearance of these apparently disparate clinical features is a clinical rarity. A case of saddle nose deformity in a patient with confirmed Takayasu's arteritis is presented. The relevant literature is reviewed with reference to the possible differential diagnosis of patients with aortitis and saddle nose deformity.

The objectives of this study were to determine (1) the rates of complications, admissions to hospital and requirements for further surgery in patients fitted with tracheoesophageal fistula speech valves, and (2) whether any factors were predictive of complications. A case note review was undertaken of all patients undergoing a laryngectomy at Gartnavel General and Stobhill Hospitals over a 10-year period. One hundred patients were identified.

Forty-five patients had complications from their valves, most commonly granulation tissue formation. Thirty-five had a least one admission related to complications and 34 required further surgery. Sixty-seven were vocalizing with the valve.

Radiotherapy and valve type were not statistically significant in predicting complications in this study. Primary puncture was associated with a higher rate of complications, although the numbers undergoing secondary puncture were small.

We describe a simple technique of replacement Montgomery T-tube insertion in a closed neck under general anaesthetic.

Intracranial penetrating injury through the nose is uncommon. We present the case of a four-year-old girl who sustained a transnasal, intracranial penetrating injury with a sharp wooden object. We performed endoscopic removal of the foreign body and repair of the associated cerebrospinal fluid fistula.

Ring graft is a modified cartilage-perichondrium composite graft (CPCG) with only a peripheral ring shaped cartilage. In this series, tympanic membrane perforations were repaired using (ring graft) during treatment of 18 cases of non-cholesteatomatous chronic suppurative otitis media (CSOM).

This study showed that ring graft has the advantages of both CPCG and perichondrial graft but without their disadvantages. Complete closure of the perforations was achieved in all cases without delay in hearing improvement.

It is recommended to use the ring graft whenever needed to repair central tympanic membrane perforations even with difficult anterior or total perforations.

Actinomycotic infections of the cervicofacial region are not uncommon. However, actinomycosis of the tongue is rare. A mass that may mimic both benign and malignant neoplasms can be seen at clinical presentation and may mislead the diagnosis.

We report a patient who presented with a tumour-like tongue mass causing speech disturbance, diagnosed as actinomycosis.

Objectives: Recent studies have shown that the spiral computed tomography (CT) scan is a sensitive imaging modality for predicting neoplastic invasion of thyroid cartilage. The objectives of our study were: to assess the accuracy of pre-operative spiral CT in predicting thyroid cartilage involvement in patients with carcinoma of the larynx; and to elucidate the factors that would accurately indicate cartilage involvement.

Material and methods: Medical records, including spiral CT scans and pathological reports, were reviewed for 27 patients who had undergone laryngectomy in two major hospitals in south Wales. A consultant radiologist with special interest in cross-sectional imaging re-evaluated the scans to assess neoplastic involvement of the thyroid cartilage, based on definite, objective criteria. These criteria included: soft tissue asymmetry; loss of medullary space; spiky or irregular surface; distortion of cartilage framework; and abnormal soft tissue on both sides of the cartilage. The radiological findings were then correlated with the histopathological evidence of cartilage invasion by the tumour.

Results: Out of the 27 cases, 15 had evidence of histological invasion of thyroid cartilage. The most specific criterion to predict thyroid cartilage involvement was the presence of tumour on both sides of the cartilage (specificity of 91 per cent, sensitivity of 66 per cent). Combining two criteria increased both the sensitivity and the specificity to 86 and 91 per cent, respectively.

Introduction: Goitre presenting with acute, life-threatening airway compromise is an uncommon indication for thyroid surgery. The management of this critical condition is controversial.

Aims: To investigate the incidence of life-threatening airway compromise in patients with benign goitre, to investigate the predisposing factors, and to outline an optimal management policy for such critical cases.

Methods: Retrospective review of the medical records of patients presenting with life-threatening, acute airway compromise secondary to benign thyroid disease, treated by the senior author (CT) between July 1994 and July 2005.

Results: Of a total of 505 thyroid surgery procedures over the 11-year period, five patients with benign thyroid disease had presented with life-threatening, acute airway compromise. Three of the five patients had been thyrotoxic and two of these had received an iodine load prior to airway compromise. Immediate endotracheal intubation for airway control followed by admission to the intensive care unit had been the presentation in two patients. An incidental diagnosis of tracheal compression had been made from the computed tomography (CT) scan in two patients who had non-resolved obstructive airway disease. Emergency thyroidectomy had been performed in all five patients. Significant tracheomalacia had been noted in four patients. Following thyroidectomy, two patients had required tracheostomy and one had required tracheal stenting.

Conclusion: Chronic obstructive airways disease, substernal extension and long-standing goitre are considered as risk factors for developing acute, life-threatening airway compromise in the presence of benign thyroid disease. A recent iodine load may lead to airway compromise in thyrotoxic patients. A CT scan is indicated in cases of unresponsive chronic obstructive airways disease to rule out substernal extension of non-palpable goitres. Life-threatening airway compromise secondary to benign goitres is best treated by endotracheal intubation if conservative measures fail, followed by emergency thyroidectomy. Following surgery, close observation is mandatory to exclude airway compromise due to tracheomalacia and laryngeal oedema.

We describe a new technique for inserting grommets which is both easy to master and provides better visualization of the tympanic membrane. This is particularly helpful in patients with narrow ear canals.

Proteus syndrome is a rare and highly variable hamartomatous syndrome that can affect multiple organ systems. It is characterized by hyperplasia of connective tissue, vascular malformations, epidermal naevi and hyperostosis. Most of the cases present to plastic and orthopaedic surgeons. Otolaryngologic presentations are minimal. We report such a rare case, which presented with a huge unilateral tonsillar mass causing dysphagia.

The parathyroid glands are small, inconspicuous, and variable in number, colour and position. Their identification is vital for excision of hyper-functioning glands and for preservation of normally functioning ones in patients undergoing thyroidectomy.

Intravenous infusion of methylene blue at a dose of 7.5 mg/kg is commonly used to aid visualization of the parathyroid glands intra-operatively. Methylene blue is generally considered benign, and there are only two cases published in the literature reporting toxicity following intravenous infusion – such toxicity is a diagnosis of exclusion.

We report a case of methylene blue toxicity resulting in expressive aphasia, confusion and disinhibition following infusion for parathyroid adenoma localization. The patient made a complete recovery over 48 hours. Methaemoglobinaemia was excluded as a cause. We suggest that the mechanism of toxicity was a direct effect of methylene blue, although an adverse interaction with serotonin re-uptake inhibitors could not be excluded.

In keeping with the UK National Poisons Information Service recommendations, we have altered our practice and now use methylene blue at a dose not exceeding 4 mg/kg. This has not affected our success rate for identification of parathyroid glands. We report this case to highlight the rare occurrence of methylene blue toxicity when used at a dose of 7.5 mg/kg.

The biological changes in recurrent laryngeal cancer following radiotherapy are not fully understood. The authors investigated differences in the expression of p53, proliferating cell nuclear antigen (PCNA) and bcl-2 in laryngeal cancer specimens before radiotherapy and in recurrent laryngeal cancer specimens following radiotherapy in the same patients. The authors investigated the expression of p53, PCNA and bcl-2 by immunohistochemical stain in 30 specimens from 15 patients with primary laryngeal cancer and recurrent laryngeal cancer after radiotherapy.

The expression of p53 protein was significantly different in laryngeal cancer before radiotherapy (4/15, 26.7 per cent) compared with recurrent laryngeal cancer after radiotherapy (8/15, 53.3 per cent) (p < 0.05). The PCNA index was also significantly different in laryngeal cancer specimens before radiotherapy (mean, 11.9 per cent) compared with recurrent laryngeal cancer after radiotherapy (mean, 18.0 per cent) (p < 0.05). However, there was no statistically significant alteration of bcl-2 expression in primary compared with recurrent laryngeal cancer. The expression of p53 and PCNA increased in recurrent laryngeal cancers after radiotherapy, compared with that in laryngeal cancers before radiotherapy. Recurrent laryngeal cancers arising following radiotherapy became biologically aggressive.

A case is presented of a nine-month-old male infant who presented acutely with an anterior neck and mediastinum mass compressing the trachea. Radiological assessment by ultrasound, magnetic resonance imaging and computed tomography suggested the nature of the mass to be a lymphatic malformation (cystic hygroma). The excised specimen was revealed as a mature teratoma. The inability to distinguish between lymphatic malformation and teratoma on multi-imaging modalities confers a risk of mismanaging these lesions with the use of sclerotherapy; surgical excision is the necessary treatment. The potential consequences are discussed.

Angiofibromas rarely localize in extranasopharyngeal sites. The most common site for extranasopharyngeal angiofibromas is the maxillary sinus. The ethmoid and sphenoid sinuses, nasal septum, middle and inferior turbinates, conjunctiva, molar and retromolar region, and larynx are other sites where extranasopharyngeal angiofibromas have been reported. Only one case of buccal extranasopharyngeal angiofibroma has been reported to date. We present a case of buccal extranasopharyngeal angiofibroma that was excised completely following embolization and we also review the literature.

We present a novel method of aspirating a peritonsillar abscess in a patient with severe trismus. In our experience, this method is efficient, allows good access to the peritonsillar area and facilitates rapid resolution of the trismus before definitive drainage can be performed.

Aim: To quantify and qualify the use of quality of life (QOL) measures by head and neck cancer clinicians and to identify any impediments to the use of these measures.

Methods: Questionnaire survey of members of the Australia and New Zealand Head and Neck Society.

Results: One hundred and twenty-eight of 187 (68.5 per cent) responded. Only 43 (34 per cent) had ever used a QOL questionnaire (QLQ), and only 17 (13 per cent) were currently using one. Impediments to QLQ use included clinicians' perceptions that QLQs were too time-consuming and conferred no proven benefit for clinical management. Nevertheless, 113 (88 per cent) respondents indicated willingness to use a minimum core QLQ – for routine clinical use and for research – but indicated a preference for a short (10–15 questions), quick (less than 10 minutes) questionnaire.

Conclusions: Most head and neck cancer clinicians did not use a QOL measure routinely, with impediments to routine use being mainly clinician-based. Most respondents would use a minimum core QOL measure, especially if it were a short, quick consensus questionnaire.