Why do I favour the endonasal approach?

The endonasal approach to rhinoplasty can deal adequately with the vast majority of nasal problems that present to the facial plastic surgeon. Adequate training of surgeons can overcome the rigid dichotomy of "endonasal" versus "external" approaches and pave the way for a combination of the best of both worlds towards the concept of hybrid rhinoplasty.

The judicious use of grafts in endonasal septorhinoplasty

The use of grafts in rhinoplasty has increased exponentially over the past three decades, specially after the advent of the external approach to the nasal dorsum. The same results can be achieved with the endonasal approach, with judicious use of a small number of grafts, and still maintain the structural integrity of the nose.

Aryepiglottoplasty for laryngomalacia: the Alder Hey experience

Laryngomalacia is the most common cause of stridor in infants. Severely affected children are at risk of feeding difficulties, apnoeic episodes and cor pulmonale secondary to upper airway obstruction. The aim of this study was to assess the outcome of aryepiglottoplasty. This is a simple surgical procedure that relieves the obstruction by dividing the aryepiglottic folds. Thirty children had an aryepiglottoplasty at the Royal Liverpool Children’s Hospital between January 1995 and June 2001. The case notes of all 30 children were reviewed for age, sex, age at operation, indications, operative technique, complications and long-term outcomes. Complete resolution of stridor was obtained in 83 per cent of patients, with an improvement in a further 7 per cent. Post-operative complications included lower respiratory tract infections (13 per cent) and vomiting (7 per cent). In conclusion, simple endoscopic aryepiglottoplasty remains an effective way of treating upper airway obstruction in children. Its high resolution and low complication rate make it a safe, first choice procedure for treatment of moderate to severe laryngomalacia.

Latex allergy and otorhinolaryngological surgery

Latex allergy in the otorhinolaryngology patient requires forward planning and coordination of management plans between the surgical, nursing and anaesthetic departments in order to ensure a safe outcome.

A sinonasal primary Ewing's sarcoma

Nasal fractures are a common complaint familiar to all otolaryngologists. Sinonasal primary Ewing's sarcomas are extremely rare. The case of a 9-year-old boy is presented whose nasal fracture and subsequent lateral nasal wall hematoma revealed an underlying Ewing's sarcoma. There are several unusual features in the history and clinical course of this patient. Following biopsies, immunohistochemistry proved essential in distinguishing a Ewing's sarcoma from other small cell tumours. It is important that a seemingly common condition can be the first presentation of a less common, more sinister pathology.

Hereditary vocal cord palsy

Hereditary vocal cord palsy is an uncommon cause of neonatal stridor that has significant implications for patients, their families, and their future progeny.

An unusual cause for tinnitus

Central giant cell granulomas of the skull base are uncommon entities. They usually present at the epiphyses of long bones such as the proximal femur and distal radius. Otological symptoms are not known as a common presenting symptom of giant cell granulomas.