Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
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Local anaesthetics and vasoconstrictors are essential for pain control and to aid intra-operative haemostasis in nasal procedures. They also improve access, and reduce discomfort when performing nasal endoscopy. There are no clear guidelines on preparing the nose despite evermore diagnostic and therapeutic procedures utilising the nose as a point of access. ⋯ For operative procedures, such as septorhinoplasty, a single agent tetracaine or levobupivicaine provides an improved surgical field. In functional endoscopic sinus surgery, lidocaine-adrenaline preparations have resulted in significantly better surgical and patient outcomes. There is little evidence to support the routine use of pre-procedural nasal preparation for flexible nasendoscopy. Those undergoing rigid endoscopy conversely always require the use of a vasoconstrictor and local anaesthetic. Pre-procedure assessment of patients is recommended, with agents being reserved for those with low pain thresholds, high anxiety and small nasal apertures presenting resistance to the insertion of the endoscope.
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Review Meta Analysis
Resection of subsequent pulmonary metastases from treated head and neck squamous cell carcinoma: systematic review and meta-analysis.
Pulmonary metastasectomy involves the surgical removal of pulmonary nodules. It is a recognised therapeutic modality for the treatment of metastatic disease. There is no consensus as to the role of pulmonary metastasectomy in squamous cell carcinoma of the head and neck. The objective of this study was to determine whether, in selected patients, resection of subsequent pulmonary metastases prolongs survival in patients already treated for head and neck squamous cell carcinoma and to identify independent risk factors that influence 5-year survival of patients undergoing pulmonary metastasectomy. ⋯ This systematic review provides level 2a evidence of the effectiveness of pulmonary metastasectomy for metachronous pulmonary metastases from head and neck squamous carcinoma, which may offer prolonged survival for selected patients. Poor prognostic factors for pulmonary metastasectomy in this cohort of patients include the presence of lymph node metastasis at the diagnosis of the original tumour, squamous cell carcinoma of the oral cavity, incomplete pulmonary resection and the presence of multiple pulmonary nodules.
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Although the literature suggests that non-steroidal anti-inflammatory drugs (NSAIDs) are effective in controlling post-operative pain in the paediatric population, physicians have been reluctant to utilise these medications after tonsillectomy due to concerns of increased bleeding rates. While many surgeons prescribe opioid analgesics postoperatively, these are associated with a number of potential adverse side-effects including nausea, vomiting, constipation, excessive sedation and respiratory compromise. ⋯ These results suggest that NSAIDs can be considered as a safe method of analgesia among children undergoing tonsillectomy.
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We present the current literature surrounding peritonsillar abscess management highlighting areas of controversy. TYPE OF REVIEW AND SEARCH STRATEGY: Literature review using Medline and Embase databases (search terms 'peritonsillar abscess', 'peritonsillar infection' and 'quinsy') limited to articles published from 1991 to 2011 (English language). ⋯ Peritonsillar abscess is a common condition with increasing incidence. We demonstrate the potential for evidence-based modifications in clinical management. However, lack of national consensus may mean that this evidence base is not being adequately exploited in current practice. A national audit of peritonsillar abscess management, in particular looking at recurrence rates and patient experience with different management strategies, appears indicated.
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Although relatively uncommon, penetrating neck trauma has the potential for serious morbidity and an estimated mortality of up to 6%. The assessment and management of patients who have sustained a penetrating neck injury has historically been an issue surrounded by significant controversy. OBJECTIVES OF REVIEW: To assess recent evidence relating to the assessment and management of penetrating neck trauma, highlighting areas of controversy with an overall aim of formulating clinical guidelines according to a care pathway format. ⋯ Although controversy continues to surround the management of penetrating neck trauma, the role of selective non-operative management and the utility of CT angiography to investigate potential vascular injuries appears to be increasingly accepted.