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Should we be utilising the pre-lacrimal approach for maxillary sinus inverted papilloma?

For some time now, gold standard management of the maxillary sinus inverted papilloma has been endoscopic medial maxillectomy (EMM). Recently the endoscopic prelacrimal recess approach (EPLRA) has been reported to provide good access whilst preserving the nasolacrimal duct and inferior...

Does minimally invasive surgery under local anaesthesia have a role in the management of chronic rhinusinusitis?

A formal FESS procedure usually done under local anaesthesia is considered as gold standard in the management of chronic rhinusinusitis. However, success is hampered by a significant recurrence rate of polyps requiring revision surgery, long waiting lists, reluctance of elderly...

A cost reducing protocol for magnetic resonance imaging in patients suspected to have acoustic neuroma

Magnetic resonance imaging is the ‘gold standard’ for screening patients suspected to have an acoustic neuroma. However, inappropriate referrals for imaging are not helpful, especially with the growing need to reduce costs. In this study the authors compared two audit...

Salivary pepsin – a simple test for LPR?

A diagnosis of laryngopharyngeal reflux (LPR) can be made on the basis of characteristic symptoms and nasendoscopy findings. Objective tests exist for this condition; for example, 24-hour dual-channel pH-metry which is considered to be the gold standard. Such tests are,...

Rib grafts for mandibular reconstruction

Reconstruction of the mandible following ablation requires good bone stock to allow optimal function and the placement of dental implants. In the developed world, vascularised bony flaps are accepted as the gold standard but these may not be widely available...

Radiological diagnosis of mastoiditis in patients screened for acoustic neuroma

Magnetic resonance imaging is the ‘gold standard’ for screening patients suspected to have acoustic neuroma. Various abnormalities are picked up through this investigation, one of which, not uncommonly reported, is mastoiditis. This requires referral to otolaryngology and further evaluation. In...

An eye-opening resection technique

It is widely accepted that the gold standard treatment of inverted papilloma of the maxillary sinus (IPMS) is endoscopic excision via medical maxillectomy or mega antrostomy, and these approaches can be augmented by a Caldwell-Luc or canine fossa trephination if...

Videofluoroscopic swallowing studies: balancing risks and benefits

Videofluoroscopic swallow studies (VFSS) are an important part of the diagnostic toolkit and arguably the current gold-standard for assessing swallow biomechanics and diagnosing dysphagia. However, the procedure does involve exposure to radiation, and any clinician requesting this should be able...

Peripheral nerve reconstruction using cell-enhanced acellular nerve grafts

Autologous nerve grafts are the current gold standard for peripheral nerve reconstruction. This systematic review analyses the role of cell-enhanced acellular nerve (ANA) grafts on the regeneration of peripheral nerve injuries. Several studies have been published to examine alternatives to...

Post-thyroidectomy vocal cord palsy: are there long-term sequelae?

This is a well written paper utilising the Hospital Episode Statistics dataset for all thyroidectomies performed in England between 2004 and 2012. The study had a very impressive 43,515 participants and only included young, fit patients undergoing thyroidectomy once for...

Managing the most common branchial arch anomaly

This article is a well written, helpful summary of the management of the most common branchial anomaly in children – the second. These are characterised as cysts, sinuses or tracts between the anterior border of sternocleidomastoid, coursing between the internal...