Journal of Laryngology and Otology

There is continued controversy over the extent of parotidectomy required for removal of a benign pleomorphic adenoma from the parotid gland. Currently, consensus exists that the integrity of the facial nerve must be preserved when the tumour is totally removed.

As a result of experience gained in the first half of the twentieth century, it was recommended that superficial parotidectomy with facial nerve dissection should be the minimal biopsy for pleomorphic adenoma. Since that time, however, research has indicated that partial parotidectomy or extracapsular dissection of benign pleomorphic adenoma can be accomplished with preservation of the facial nerve without an increase in tumour recurrence. Partial parotidectomy or extracapsular dissection results in impaired cosmetic results and a lower incidence of Frey's syndrome, and thus may be the preferred approach when undertaken by experienced surgeons.

Thirty patients with squamous cell carcinoma of the laryngopharynx were treated with surgery (total laryngectomy and hemithyroidectomy) and radiotherapy. Group 1 (n = 7) patients had surgery only; Group 2 (n = 7) had radiotherapy followed by salvage surgery while Group 3 (n = 16) had surgery followed by radiotherapy.

Parathyroid hormone and calcium levels were measured pre- and post-operatively and pdstradiotherapy. In Group 1 no patients were hypoparathyroid. In Group 2, 29 per cent of patients preoperatively and 57 per cent post-operatively, were hypoparathyroid. In Group 3, no patients were hypoparathyroid pre-operatively, while 25 per cent were hypoparathyroid post-operatively and postradiotherapy. Parathyroid honnone and calcium levels were averaged and compared within and between each group. There was no significant difference within each group, when comparing levels postoperatively and post-radiotherapy from those of pre-operatively. There was no significant difference in levels between each of Groups 1, 2 or 3 (p>0.05).

One hundred and twenty-six patients who underwent tonsillectomy because of recurrent acute tonsillitis, tonsillar hypertrophy or sleep apnoea were evaluated by tonsillar core culturing. The sleep apnoea patients served as controls, since none of them had tonsillar hypertrophy at ENT examination or any history of recurrent acute tonsillitis, and thus their tonsillar core flora could be regarded as normal.

The isolation rate ofH. influenzaewas much lower among sleep apnoea controls (2.7 per cent) than among either the patients with recurrent acute tonsillitis (20.3 per cent) or those with tonsillar hypertrophy (36.7 per cent) (p<0.05), as was that of group A streptococci, 5.4 per centversus16.9 and 20 per cent, respectively (though the latter differences were not statistically significant). The isolation frequencies ofB. catarrhalis, pneumococci, group C and G streptococci did not differ between the three groups.

The high tonsillar core recovery rates ofH. influenzaeand group A streptococci both in patients with recurrent acute tonsillitis and in those with tonsillar hypertrophy, as compared with normal controls, suggests the possible involvement of these bacteria in both conditions.

Eight cases of cystic neck lesion of differing causes in whom sonography was carried out as part of investigation are described. These are thyroid cyst with haemorrhage, thyroglossal cyst, branchial cyst, cystic hygroma, parotid abscess of the neck secondary to malignant external otitis, cystic degeneration of a recurrent malignancy in the neck, sebaceous cyst and a cold abscess. They showed that sonography is better than clinical judgement in obtaining a diagnosis. Therefore, we recommend that ultrasound should be performed in all neck lesions prior to needle aspiration or open excisional biopsy.

Puberphonia is predominantly a male condition which, normally affecting teenagers, may present in later life. It is defined as the failure to change from the high-pitched voice of the pre-adolescence to the lower pitched voice of adulthood. Patient previously reported have responded to voice therapy alone. We report the first surgically corrected case.

The purpose of this retrospective study was to describe and evaluate the results of arytenoidopexy performed by the external laterocervical approach in 15 consecutive children presenting bilateral vocal fold paralysis causing life-threatening airway compromise. Mean age at the time of surgery was 20 months and mean follow-up was 42 months. At the end of follow-up all patients were in good health and did not need special care for breathing. No abduction movement has been observed on the opposite vocal fold since arytenoidopexy. One failure subsequently required arytenoidectomy. The findings of this study suggest that arytenoidopexy is an effective surgical treatment for life-threatening bilateral vocal fold paralysis in young children.