Tracheostomy tape: more trouble than it's worth?

In many units where microvascular free-tissue transfer in the head and neck region is practised, tracheostomy is completed with the suturing of the tube in place and the removal of the supporting struts from the tube flange. The thinking is that in removing the struts the risk of occlusion of the vascular pedicle of the free flap, as it lies in the neck, is reduced as the cervical tape cannot be applied. The evidence base for vascular obstruction resulting from a correctly positioned tape is lacking. Presented here is a case in which potential flap failure, as a result of a cervical tracheostomy tape, was avoided by early detection of ischaemia using microdialysis.

Facial asymmetry with severe unilateral hypoplasia of the muscles of mastication: a report of clinical and electromyographic findings

Mild degrees of asymmetry of the human body have been recognised both by classical sculptors and more recently by anatomists as both normal and widely occurring. Morphologic asymmetries of the face of a more severe nature are, however, quite rare. When such deformities occur, both the hard and soft tissues may be involved and the abnormality may be acquired as a result of trauma, infection, neoplasia or surgery or be of a developmental origin as in the syndromes affecting the first pharyngeal arch. Developmental asymmetries of the jaws may also arise as a result of unilateral disruption of mandibular development during the time of normal facial growth leading to hemiretrognathism. Severe hypoplasia of the muscles of mastication on one side only has not previously been reported.