Reconstruction of the head and neck continues to pose a variety of difficult functional and aesthetic challenges to the plastic surgeon. While the surgical treatment for midfacial and skull base tumours continues to advance, the three-dimensional reconstruction predicaments continue to increase in complexity. Reconstructive strategies of the head and neck require the restoration of intricate skeletal architecture and large volumes of both internal and external soft tissue envelopes that can withstand adjuvant therapies. Vascularized bone grafts in combination with microsurgical techniques is the current trend of most reconstruction and has replaced local and pedicle flaps as the preferred modality for large defects. This article will focus on concise areas of difficulty in craniofacial reconstruction, including mandibular, midfacial, scalp and base of skull reconstruction. As our goals now move from flap survival to refinement, more complex and innovative reconstructions are executed. The problems with each modality are examined, and the frontiers of head and neck reconstruction are explored. With the potential combination of virtual surgery and tissue engineered biotechnology, we may someday be able to expand our reconstructive capabilities beyond free tissue transfer.

Objective The purpose of this article was to determine the impact of employing a telephone clinic for follow-up of patients with stable lateral skull-base tumours. Method An analysis of 1515 patients in the national lateral skull-base service was performed, and 148 patients enrolled in the telephone clinic to date were identified. The length of time that patients waited for results of their follow-up scans and the travel distance saved by patients not having to attend the hospital for their results was determined. Results The mean time from scan to receiving results was 30.5 +/- 32 days, 14 days sooner than in the face-to-face group (p = 0.0016). The average round-trip distance travelled by patients to the hospital for results of their scans was 256 +/- 131 km. Conclusion The telephone clinic led to a significant reduction in time until patients received their scan results and helped reduce travel distance and clinic numbers in traditional face-to-face clinics.

Objective: The aim of this study was to determine the natural history and clinical outcome following conservative management of patients with unilateral vestibular schwannomas.

Objective: Management options for vestibular schwannomas and glomus tumors have greatly expanded since the introduction of stereotactic radiosurgery (SRS). Optimal outcomes reflect long-term tumor control, preservation of cranial nerve function, and retention of quality of life. The authors review their 11-year experience.

INTRODUCTION:Vestibular symptoms of vertigo, dizziness and dysequilibrium are common complaints which can be disabling both physically and psychologically. Routine examination of the ear nose and throat and neurological system are often normal in these patients. An accurate history and thorough clinical examination can provide a diagnosis in the majority of patients. However, in a subgroup of patients, vestibular function testing may be invaluable in arriving at a correct diagnosis and ultimately in the optimal treatment of these patients.METHOD:Literature review.CONCLUSION:In this review we aim to highlight the new understanding and insight into the underlying pathophysiology of vestibular disorders which in conjunction with technological advancements have led to significant improvements in the clinical and laboratory evaluation of vestibular disease. The vestibular and balance assessment modalities which are available to help optimise the management of vestibular disease are also discussed.

Prior classification of rhinitis was into three categories: acute, subacute and chronic rhinosinusitis. The advantages of this classification were obvious but they were offset by some disadvantages. For example, the previous classification did not take account of the mechanisms underlying the condition or the clinical outcome. Hence, there was a need for evidence-based sinusitis classification guidelines. The American Academy of Otolaryngology-Head and Neck Surgery and other related societies published a classification of the condition and suggested clinical research strategies for patients with rhinosinusitis. The main conclusion was that sinusitis should be divided into four categories: acute (bacterial) rhinosinusitis, chronic rhinosinusitis (CRS) without polyps, CRS with polyps, and allergic fungal sinusitis. The aim of this current paper is to discuss the consensus for nomenclature, outline the proposed classification of different types of rhinosinusitis and to suggest some ways that we may audit these guidelines.

Unexpected intra-cranial pathology is unusually encountered in patients with BPV in the presence of a classically positive Hallpike's response and in the absence of any other neurological signs or symptoms. We carried out a retrospective review to assess the incidence of unexpected intra-cranial pathology in patients with a clinical diagnosis of benign positional vertigo (BPV) and to review the role of radiological imaging in these patients. 145 consecutive patients seen by the senior author with a diagnosis of posterior semi-circular canal BPV over a five-year period were reviewed. In the series of 63 patients who underwent MRI, two cases (3.2%) had cerebral aneurysms, one patient had an epidermoid cyst (1.58%) and one patient had a large right parietal arterio-venous malformation. We would conclude that possible warning signs exist that may alert the clinician to the possibility of unexpected intracranial pathology including failed response to the initial Epley manoeuvre or any asymmetry in hearing. Thus, we would advocate imaging be performed on this sub-group of patients with BPV.

Objectives: Our objective was to examine the presentation, clinical course and management of acute epiglottitis in a recent series of adult patients.Method: All consecutive adults with acute epiglottitis or supraglottitis admitted to a tertiary referral centre over a recent six-month period were included in this retrospective study. The diagnosis of epiglottitis or supraglottitis was established by flexible nasolaryngoscopy.Results: Ten patients were included. Two patients had concurrent acute tonsillitis and one had a peritonsillar abscess. Blood cultures were negative in all cases. Pathogens were isolated by throat swabs only in the two patients with acute tonsillitis. Two patients underwent intubation for management of airway obstruction. A combination of cefotaxime and metronidazole was the most common antibiotic regimen used.Conclusion: The rising incidence of acute epiglottitis in the adult population mandates vigilance on the part of the otolaryngologist. Selective airway intervention is recommended for patients with airway obstruction of more than 50 per cent.

BACKGROUND:Facial nerve schwannoma of the internal auditory canal is a very rare tumour.AIM:While Bell's palsy is the commonest cause of a facial paresis, more serious causes should be excluded if recovery is delayed.METHOD:A case report of a young man who presented with a long standing facial palsy.CONCLUSION:Any facial palsy that does not show evidence of recovery within six weeks should be investigated radiologically to exclude a tumour.

OBJECTIVES/HYPOTHESIS:The objective was to investigate the effectiveness of co-phenylcaine as a topical anesthetic agent for nasal mucosal biopsy.STUDY DESIGN:A prospective study.METHODS:Nasal mucosal biopsy specimens were taken from a site just anterior to the inferior turbinate following topical anesthesia with co-phenylcaine. All volunteers graded pain according to standard visual analogue scale (0-10) (VAS) scoring, and all were followed up after 24 hours for any epistaxis.RESULTS:Ninety nasal biopsy specimens were removed from 41 patients in all. Eight-two percent did not report any discomfort following this procedure (VAS score, 0). Ten patients reported mild discomfort (VAS scores ranging between, 1 and 3) and only six reported pain (VAS scores ranging from 5 to 7). However, five of these patients agreed to further biopsy and documented no discomfort during the repeat procedure. Only one patient required immediate intervention for hemorrhage after the procedure. In cases in which bleeding occurred (seven patients) it was documented within the first 6 hours, was minimal in content, and was controlled with local pressure. No systemic side effects were experienced.CONCLUSION:Co-phenylcaine is a suitable topical anesthetic agent for nasal mucosal biopsy. Removal of nasal tissue from a site anterior to the inferior turbinate can be performed under direct vision and provides sufficient tissue for histological assessment.