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Acquired anterior glottic web poses a significant challenge to laryngologists given its propensity to recur following treatment, and there are a wide variety of described techniques.
A systematic review of the medical literature was undertaken in order to identify all articles pertaining to the management of acquired anterior glottic web.
Thirteen studies meeting the inclusion criteria were identified and analysed. All were retrospective series, with varying surgical techniques and outcome measures. Only two studies reported on the use of topical mitomycin C.
Mucosal graft techniques and keel placement appear to improve success rates, but both carry risks and disadvantages. Based on the available evidence, the use of topical agents such as mitomycin C cannot be recommended in the management of acquired anterior glottic web.
To investigate the feasibility of a national audit of epistaxis management led and delivered by a multi-region trainee collaborative using a web-based interface to capture patient data.
Six trainee collaboratives across England nominated one site each and worked together to carry out this pilot. An encrypted data capture tool was adapted and installed within the infrastructure of a university secure server. Site-lead feedback was assessed through questionnaires.
Sixty-three patients with epistaxis were admitted over a two-week period. Site leads reported an average of 5 minutes to complete questionnaires and described the tool as easy to use. Data quality was high, with little missing data. Site-lead feedback showed high satisfaction ratings for the project (mean, 4.83 out of 5).
This pilot showed that trainee collaboratives can work together to deliver an audit using an encrypted data capture tool cost-effectively, whilst maintaining the highest levels of data quality.
Hyperpneumatisation of the skull base and upper cervical vertebrae is a very rare condition of uncertain aetiology and pathophysiology.
A case of extensive hyperpneumatisation of the craniocervical junction and upper three cervical vertebrae is described, in a patient who habitually performed the Valsalva manoeuvre to relieve the symptoms of a patulous eustachian tube. Reported symptoms of ear, neck and shoulder pain deteriorated after minor head trauma. There was a drastic radiological and clinical improvement after ceasing to perform the Valsalva manoeuvre.
All reported cases of craniocervical bone hyperpneumatisation have in common a history of raised middle-ear pressure, minor trauma or both. We therefore suggest that chronically raised middle-ear pressure leads to destruction of bony tissue and pneumatisation, and that this process is able to cross joints into the cervical spine, either via micro-fractures following trauma, or as a result of congenital assimilation of the craniocervical junction.
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