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Northwich, United Kingdom

The term torticollis is derived from the Latin words 'tortis' for twisted and 'collum' for neck. Typical features include sudden onset of severe unilateral pain, with restriction of movements and deviation of the neck to that side. Although torticollis is a well recognised abnormality, there is minimal literature identifying it as a sole long-standing complication in otological surgery. We present the case of a 15-year-old boy who developed permanent torticollis following a routine tympanoplasty. A CT of the neck revealed an atlantoaxial rotatory fixation with cross fusion between C1 and C2. This case highlights a rare cause of torticollis resulting from a routine otological procedure. It also differentiates between Grisel's syndrome, which is characterised by atlantoaxial subluxation as opposed to fusion. The role of the multidisciplinary team is imperative and in particular the need for urgent discussion with the neurosurgical team to ensure prompt assessment and management of the patient takes place. Source

Di Capite J.L.,University of Oxford | Bates G.J.,Nose and Throat Surgery | Parekh A.B.,University of Oxford
Current Opinion in Allergy and Clinical Immunology

Purpose of Review: This review describes recent advances in our understanding of a major Ca-entry pathway, the Ca release-activated Ca (CRAC) channel, that is central to mast cell activation. Recent Findings: Animals in which the genes encoding the CRAC channel have been deleted have severely compromised mast cell function and reduced allergic responses. These functional consequences reflect the ability of CRAC channels to activate a range of spatially and temporally distinct responses in mast cells, which contribute to both rapid and slow phases of an allergic response. In addition, the cells can sustain their own activation through positive feedback cycles that involve CRAC channels. Drugs that inhibit CRAC channels are proving effective in treatment of allergic responses both in vitro and in animal models of asthma. Summary: CRAC channels comprise a new therapeutic target for combating allergies including asthma. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Aspinall S.R.,Northumbria Healthcare NHS Foundation Trust | Boase S.,Nose and Throat Surgery | Malycha P.,Endocrine and Surgical Oncology Unit
World Journal of Surgery

Background: The affect of the surgical approach for primary hyperparathyroidism (1HPT) on long-term symptom relief has not been studied. This study compares the longterm relief of symptoms assessed by the Parathyroidectomy Assessment of Symptoms (PAS) score in patients undergoing bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP). Methods: In this case-control study, patients with 1HPT who had followed a protocol to assess symptoms before and after parathyroid surgery between 1999 and 2008 were contacted by letter and had blood taken to assess calcium, ionized calcium, and parathyroid hormone (PTH). The main aim was to assess symptoms at long-term follow-up using the PAS score. The incidence of persistent or recurrent 1HPT at long-term follow-up after MIP and BNE was also compared. Results: Two hundred and forty-six patients underwent parathyroid surgery and 142 responded to our correspondence, of which 64 underwent MIP and 78 BNE. Follow-up after BNE was longer than MIP (61 vs. 41 months). At long-term follow-up, the mean PAS score fell by 125 and 175 in the MIP and BNE groups, respectively. There was no statistically significant difference in the decline of the PAS score between the MIP and BNE groups. Six patients developed persistent or recurrent 1HPT following MIP compared to three after BNE; this difference was not statistically significant. Conclusions: This study is the first to report on long-term symptom relief from 1HPT after MIP, and demonstrates that both MIP and BNE can achieve this. In order to establish whether the long-term outcomes from these procedures are equivalent, further adequately powered studies are required. © Société Internationale de Chirurgie 2010. Source

Previously reported cases of iatrogenic sphenopalatine artery (SPA) pseudoaneurysm have occurred only after trans-sphenoidal surgery for pituitary tumors or maxillofacial surgery. In this article, the author presents what to the best of her knowledge is the first reported case of an SPA pseudoaneurysm that developed following endoscopic sinus surgery (ESS). The patient was a 76-year-old woman with myelodysplastic syndrome who presented with a 6-month history of unilateral sinus symptoms. She underwent septoplasty and unilateral ESS, which included frontal recess clearance and sphenoidotomy. However, during surgery, severe generalized bleeding was encountered. The bleeding was arrested only after anterior and posterior nasal packing. After two attempts to remove the packing failed, angiography was obtained. It revealed an SPA pseudoaneurysm, which was immediately and successfully embolized. SPA pseudoaneurysm is a rare but significant complication of ESS, and it should be considered in patients with posterior epistaxis after ESS or prolonged posterior nasal packing. The pathogenesis may include intraoperative trauma, infection, pressure necrosis from packing, or a combination of these factors. Optimal management includes either ligation or embolization, depending on anatomic, patient, staff, and resource factors. The author reviews the pertinent anatomy and the pathophysiology, diagnosis, management, and prevention of this rare complication. © 2011, Vendome Group, LLC. Source

Cobb A.R.M.,Craniofacial Center | Murthy R.,Ipswich Hospital | Toma A.,Nose and Throat Surgery | Uddin J.,Moorfields Eye Hospital | Manisali M.,Maxillofacial Unit
British Journal of Oral and Maxillofacial Surgery

Silent sinus syndrome is defined as a spontaneous and progressive enophthalmos and hypoglobus with hypoplasia of the maxillary sinus and resorption of the orbital floor. It is caused by atelectasis of the maxillary sinus in the presence of ipsilateral chronic hypoventilation of the sinus. The problem may be idiopathic, but the term is now also used to describe cases that follow operation or trauma. We describe three cases, each with a different aetiology, and discuss the clinical and radiographic evaluation of the condition, theories regarding its pathophysiology, and surgical correction. © 2011 The British Association of Oral and Maxillofacial Surgeons. Source

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