Septoplasty: correcting the nasal valve.
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Cartilage↗
Biomedical subjects
A C Urquhart
Publications and source records attributed to A C Urquhart.
Zenker's diverticulum.
Symptomatic Zenker's diverticula are usually treated with diverticulectomy and myotomy. Other, more conservative open procedures consist of diverticulopexy, imbrication, and myotomy alone. These more conservative procedures do not result in a breach of esophageal mucosa and should have more rapid postoperative recovery. We performed a retrospective chart review of all open surgical procedures performed at the Marshfield Clinic and St. Joseph's Hospital between 1975 and 1996. Using Wilcoxon's rank sum test, the conservative procedures were compared with the standard diverticulectomy for duration of hospitalization and length of time to resumption of oral intake. Fifty-nine patients are reported. Statistically significant differences between the surgery groups were found for hospitalization (P < 0.001) and days to resumption of oral intake (P < 0.001). Conservative open surgical procedures for repair of Zenker's diverticula result in decreased hospitalization and earlier resumption of oral diet compared with diverticulectomy.
Aged↗
Nasal septum after sublabial transseptal transsphenoidal pituitary surgery.
Transseptal transsphenoidal approach to the pituitary fossa is a well-described and effective procedure. This article relates our experience with this procedure with specific emphasis on the nasal septum, both before and after surgery. It has been our experience that this surgery has minimal local complications in the nose and it would appear to improve septal alignment with subjective improvement in nasal function as reported by the patient. A total of 55 patients undergoing a sublabial transseptal transsphenoidal approach to the pituitary fossa were included in this study. All other approaches to the pituitary gland were excluded. Visual changes and headaches were the most common presenting symptoms, occurring alone or in combination in 28 (51%) patients. Twelve (22%) patients reported symptoms of nasal obstruction before surgery and only one (2%) after surgery. A moderately or severely deviated septum was noted in 30 (54%) patients before surgery and 4 (7%) patients after surgery. The septum was straight in 21 (38%) patients before the procedure and 49 (89%) patients after the surgery. Sinusitis developed in two patients, and one patient subsequently required surgery. No synechiae or septal perforations were noted.
Adenoma↗
Glomus vagale: paraganglioma of the vagus nerve.
Review of the experience of a single institution with a rare tumor may give inadequate and biased information. In an effort to better understand issues related to diagnosis and subsequent management of paraganglioma of the vagus nerve, review of the experience at two university medical centers was undertaken. A review of the records of all patients with a diagnosis of vagal paraganglioma at the University of Pittsburgh and the Eastern Virginia Medical School was undertaken. Presenting signs and symptoms, treatment, and subsequent outcome were assessed. Data on 19 patients with vagal paraganglioma were available. The most common initial finding was a neck mass. Forty-seven percent (9/19) had vocal cord paralysis at presentation. Angiography was beneficial in helping to make the diagnosis and in identifying synchronous tumors. History of familial paraganglioma was present in 47% (9/19). Multiple paragangliomas were diagnosed in 53% (10/19) cases in our study. Of the patients with familial vagal paraganglioma, 89% (8/9) had multiple paraganglioma. All patients treated with surgery had postoperative vocal cord paralysis. Elective management of patients with bilateral vagal paraganglioma is a special dilemma. Radiation therapy of selected "operable" patients may be indicated because of the potential for bilateral vocal cord paralysis in these patients and its attendant sequela.
Adult↗
Clinical signs of orbital ischemia in rhino-orbitocerebral mucormycosis.
Mucormycosis is the most acutely fatal fungus infection of man (Ferry and Abedi). The most common clinical type of infection is rhino-orbitocerebral mucormycosis. Prompt recognition of the clinical picture is essential if the appropriate urgent management is to be instituted without delay. The presence of black eschar in the region of the nasal passages, palate, midface, and orbit is the best-recognized clinical sign alerting the clinician to the diagnosis. Black eschar is, however, a feature in only a minority of these patients at the time of presentation. This paper discusses other clinical signs, particularly orbital ischemia, which should suggest the diagnosis. The clinical presentation of orbital ischemia in mucormycosis includes proptosis, total external and internal ophthalmoplegia, and early blindness. A lax, nontender periorbital puffiness, which does not feel warm to the examiner's touch, is typical. Proptosis and chemosis, if present, are mild. These signs are compared with those of pyogenic orbital cellulitis, with which the condition might most easily be confused.
Adult↗
Drill-generated sensorineural hearing loss following mastoid surgery.
Drilling during mastoid surgery may result in temporary noise-induced hearing loss. This has practical implications for both the patient and surgeon. In a prospective study of 40 patients, audiometric testing was done both preoperatively and postoperatively to try to detect any significant hearing loss in the immediate postoperative period. The data were analyzed using the Student's paired t test. No statistically significant difference was found. A sensorineural hearing loss soon after mastoid surgery is not due to the noise generated by the drill. In the event of any hearing loss during this period, other causes should be sought.
Adolescent↗
Acute parapharyngeal space infections. A report of 12 cases.
Parapharyngeal space infections are a serious condition with a significant morbidity and mortality. Twelve cases seen between 1987 and 1990 are described. From the clinical findings it was clear that the tonsils appeared to be the most common source of infection and not other aetiological factors, such as dental and salivary gland pathology. Computed tomography was excellent in delineating the mass, but if this is not available ultrasonography appears to be of benefit. Intravenous antibiotics and the appropriate surgical intervention, when indicated, is the treatment of choice. An excellent clinical response was experienced; however, in 25% of patients recovery was complicated by aspiration pneumonia.
Acute Disease↗
Sarcoidosis with nasal obstruction and deformity. A case report.
Sarcoidosis is a relatively uncommon disease, seldom seen by ear, nose and throat departments. There are interesting head and neck and, more specifically, nasal manifestations. A patient with sarcoidosis presented at our department with nasal obstruction and deformity. Although these were the predominant features of the disease, the diagnosis was made together with other systemic signs. A case of sarcoidosis involving the nose is presented, with discussion emphasising the features more commonly seen by the ear, nose and throat surgeon.
Adult↗
Isolated sphenoiditis: a diagnostic problem.
A case of primary isolated sphenoiditis that developed cavernous sinus thrombosis is presented. It is difficult to diagnose and patients are often not seen initially by an ENT surgeon, making it more important for other branches of medicine to be aware of this condition. We discuss isolated sphenoiditis with particular reference to the diagnosis, management and complications of this condition.
Cavernous Sinus↗