Browsing by Department "Division of Otorhinolaryngology"

Now showing 1 - 20 of 179
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    Access to the Parapharyngeal Space
    (University of Cape Town, 2025-03-08) Fagan, Johan; Fagan, Johan
    The parapharyngeal space (PPS) extends from the skull base above, to the hyoid bone below, and contains fat, the carotid artery, internal jugular vein, and the lower cranial nerves and sympathetic nerve. Surgical resection of tumours of the PPS requires a good understanding of the anatomy, likely pathology (if not known), and surgical approaches. The PPS extends as an inverted pyramid from the base of the skull superiorly, to the hyoid bone inferiorly. Figure 1 illustrates an axial view of the prestyloid (yellow) and poststyloid components of the PPS, separated by the styloid process, tensor veli palatini muscle and fascia stretching between (brown). The poststyloid space contains the internal carotid artery and the internal jugular vein, as well as the lower cranial nerves IX -XII, and the sympathetic trunk. It is confined medially by the pharyngobasilar fascia above, and the superior constrictor muscle of the pharynx.
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    Adenoidectomy Surgery Technique
    (University of Cape Town, 2025-03-08) Jonas, Nico; Fagan, Johan
    Adenoidectomy may be done in isolation or combined with tonsillectomy. Adenoidectomy may be either total or partial. Partial adenoidectomy involves leaving a ridge of adenoidal tissue inferiorly in the area of Passavant's ridge to enable apposition of the soft palate to the posterior pharyngeal wall during swallowing; it is indicated when there is concern about causing velopharyngeal insufficiency (VPI) e.g. with a submucous cleft palate. Indications: Adenoidectomy is frequently combined with tonsillectomy and/or insertion of grommets. Other indications include: •Obstructive sleep apnoea •Nasal obstruction •Problematic rhinorrhoea •Recurrent upper respiratory tract infec-tion •Recurrent acute otitis media •Recurrent otitis media with effusion •For histological analysis
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    Adult tonsillectomy - are long waiting lists putting patients at risk?
    (Health and Medical Publishing Group, 2006) Mulwafu, Wakisa; Fagan, Johannes J; Isaacs, Sedick
    There is a paucity of data on morbidity associated with long waiting lists for adult tonsillectomy. The aim of this study was to assess the morbidity associated with long waiting lists for adult tonsillectomy in a developing world setting. Of 350 patients on the waiting list at Groote Schuur Hospital for 18 months or more, only 55 were contactable. This low yield (15.7%) from the telephonic survey highlighted the difficulty of managing long waiting lists efficiently in a developing world setting. As only 1/55 patients on the waiting list had a complication (quinsy), it appears to be safe to delay tonsillectomy in adult patients. Only half of patients ultimately required tonsillectomy because of a natural reduction in the number of episodes of tonsillitis with time. In order to avoid unnecessary tonsillectomy we need to find better prognosticators to identify the subgroup of adult patients likely to have continued recurrent tonsillitis
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    Aluminium acetate solution in the treatment of chronic suppurative otitis media
    (2005) Thorp, Marc A; Prescott, C A J; Harrison, R V
    Includes bibliographical references (p. 99-110).
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    Aminoglycoside-induced hearing loss: South Africans at risk
    (2009) Bardien, Soraya; de Jong, Greetje; Schaaf, H Simon; Harris, Tashneem; Fagan, Johan; Petersen, Lucretia
    South Africa is currently experiencing a TB epidemic with an estimated incidence of 940/100 000 population/year, and the country has been ranked 4th among the 22 high-burden TB countries worldwide by the World Health Organization (WHO). A potentially devastating threat to TB control is the emergence of multidrug-resistant TB (MDR-TB) and, more recently, extensively drug-resistant TB (XDR-TB), mainly as a result of poor drug adherence by TB patients and incorrect management or treatment regimens by health providers; however, direct transmission of drug-resistant strains also plays an important role. The MDR/XDR-TB strains necessitate prolonged chemotherapy for up to 2 years or more, and the use of more toxic second-line drugs including the aminoglycoside (streptomycin, kanamycin and amikacin) and polypeptide (capreomycin) antibiotics. In South Africa, in accordance with WHO guidelines, streptomycin is used for retreatment of TB while kanamycin, amikacin and capreomycin are used to treat MDR/XDR-TB.
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    An approach to the patient with a post-nasal drip and rhinosinusitis
    (2009) Lubbe, D E
    Post-nasal drip (PND) can be a bothersome symptom and one of the main reasons for patients visiting a general practitioner (GP), pulmonologist or ear, nose and throat (ENT) surgeon. It can be either a symptom, sometimes not appreciated by the examining practitioner, or an important clinical sign suggesting rhinosinusitis. This article aims to explain the aetiological factors and initial work-up of the patient with a PND and rhinosinusitis and suggest a treatment paradigm for practitioners.
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    Anterior Skull Base Resection: External Approaches
    (University of Cape Town, 2025-03-04) VanKoevering, Kyle; Prevedello, Daniel; Carrau, Ricardo; Fagan, Johan
    The sinonasal cavity and anterior cranial fossa can be involved by a wide variety of diverse, rare neoplasms. Surgical extirpation of these lesions is often the mainstay of multimodal treatment for both benign and malignant diseases. However, these tumours pose a variety of challenges for surgical management, including complex anatomic considerations. The nasal cavity can be imagined as a quadrangular corridor that is narrower at the top and divided into right and left compartments by a midline septum. It communicates with the exterior through anterior openings, the nares (nostrils). Posteriorly, it opens into the nasopharynx through the posterior choanae. Its external shape reflects its skeletal support, which is composed of the paired nasal bones and the upper and lower lateral nasal cartilages as they surround the pyriform aperture. The walls of each nasal fossa include the nasal septum medially, the horizontal portion of the maxillary bone and palatine bone inferiorly, and the inferior turbinates and ethmoid bones laterally.
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    Anterolateral Thigh (ALT) Free Flap for Head and Neck Reconstruction
    (2025-10-31) Pipkorn, Patrik; van Zyl, Ottie
    The Anterolateral Thigh (ALT) flap has gained increased popularity for head and neck reconstruction, mainly due to its minimal donor site morbidity. Although it is a fasciocutaneous flap, it can be harvested with a cuff of vastus lateralis muscle. It is based on perforators of the descending branch of the lateral circumflex femoral artery and can provide large areas of vascularised skin for reconstruction. It can be used for any soft tissue reconstruction including facial skin, oral cavity e.g. partial or total glossectomy, and as semi-tubed or tubed flaps for pharyngeal defects.
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    Avoiding allogenic blood transfusions in endoscopic angiofibroma surgery
    (2016) Wasl, Hisham; McGuire, Jessica; Lubbe, Darlene
    BackgroundSurgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures. Therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature revealed very few case reports. This study investigated the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA).MethodsJNA is a rare vascular nasal tumour and the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to the endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed.ResultsHomologous blood transfusion could be avoided in all cases. Postoperative monitoring revealed transient bacteraemia in two cases where the leukocyte filter was not used, but no evidence of septicaemia.ConclusionsPerioperative cell saver and autologous blood transfusion in endonasal JNA surgery is safe. Homologous blood transfusion can be avoided by using this technique. The use of cell salvage allows for single stage surgery without the need to abandon surgery due to excessive blood loss and its future use is promising.
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    Basic Functional Endoscopic Sinus Surgery (FESS): A Step-By-Step Guide With Surgical Videos and Illustrations of Anatomical Landmarks in Cadaveric Dissection
    (2025-03-25) Brand, Yves; Prepageran, Narayanan
    We consider four important landmarks in basic FESS. These landmarks are important to gain entry to the maxillary sinus, anterior ethmoid, posterior ethmoid and the sphenoid sinus. Each landmark serves as a gate to a defined space within the paranasal sinuses. This chapter presents an overview to better understand this Gate System. To visualise the different structures of the nose, the nasal cavity is decongested. This can be done with cotton ribbon gauze soaked in Moffat’s solution (1ml adrenaline 1:1000, 2mls 10% cocaine, 4mls 8.4% so-dium bicarbonate, 13mls water/saline) for several minutes. Alternatively, adrenaline 1:1000-soaked cotton ribbon gauze can be used. It is important to pack the middle meatus under endoscopic vision (A).
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    A biomechanical study of the movements of the arytenoid cartilage
    (1981) Sellars, Ione; Keen, E N
    The joint between the arytenoid cartilage and the cricoid cartilage is one of the smallest in the body. Its existence has been known since, if not before, the time of Galen (130-201 A.D.). However, little anatomical study has been carried out on this synovial joint and publications based on research into its exact anatomy and function are few. The results of these studies have been rarely questioned or scientifically re-examined, with the consequence that authoritative anatomical texts have perpetuated unconfirmed ideas of the behaviour of the cricoarytenoid joint. The purpose of this thesis is to present in detail the results of research into the anatomy and the functions of the cricoarytenoid joint and of the muscles that act upon it. This research began in 1977 with the dissection of 45 cadaver larynges. In this initial study the most striking anatomical finding was the identification of the so-called "posterior" cricoarytenoid ligament, of which inadequate and often incorrect detail has been presented in standard anatomy texts. Another surprising finding of this work was the variability of the shape and positions of the two cricoid facets. In 1978 these findings were published in detail (Sellars and Keen). An attempt to understand the accepted muscular control of the cricoarytenoid joint led to further research. This was carried out by the dissection of a further 23 larynges, with special care to examine the exact origin, direction and insertion of each muscle concerned. Six of these larynges, which had been surgically excised, were also stimulated electrically immediately after excision and the resultant arytenoid cartilage movements were recorded and analysed. The findings of this study were published in 1978 (Sellars) and these articles (Sellars and Keen, 1978; Sellars, 1978) are referred to in "Gray's Anatomy" and in Grant's "Method of Anatomy" (Sellars and Keen, 1978). Further examination of the reactions of these intrinsic laryngeal muscles to electrical stimulation has since been done on three additional fresh operative specimens. This additional work on laryngeal muscle action suggests that the explanation of specific intrinsic laryngeal muscle actions made in the earlier publication (Sellars, 1978) had been oversimplified. The main experimental work, on which this thesis is based, attempts to clarify and interpret the highly complex synchronized muscle actions that occur at the cricoarytenoid joint. Relevant facts found in both recent and old publications relating to this subject are presented and discussed. Before the review of literature is presented the embryology and basic anatomy of the larynx are described.
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    Biopsy of Head and Neck Tumours & Cervical Lymph Nodes
    (University of Cape Town, 2025-05-21) Fagan, Johan; Taylor, Kathy; Bolding, Ellen; Fagan, Johan
    Almost any mass or tumour requires cytological or histological diagnosis before a management plan can be formulated. Performing tissue biopsy of masses and lymph nodes of the head and neck fills many junior doctors with fear due to the complex anatomy and the vascular structures and nerves that traverse the head and neck. Yet diagnostic material can be safely obtained from most masses in the head and neck in an ambulatory care setting.
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    Bone Conduction Device Surgery - Highlighting the Percutaneous BCD
    (University of Cape Town, 2025-05-31) Hultcrantz, Malou; Fagan, Johan
    Bone Conduction Devices (BCDs) utilise bone conducted sound to assist people with conductive hearing loss, mixed hearing loss and single sided deafness (SSD) who cannot use traditional hearing aids or prefer BCDs to conventional hearing aids. This chapter focuses on the percutaneous BCD (percBCD). There are today several types of BCDs. The major difference between BCDs is whether the skin is penetrated (percutaneous BCDs) or if the skin is intact (transcutaneous BCDs). The most recent BCDs on the market are active transcutaneous BCDs where the skin is intact, the transducer has direct contact with the skull bone and where the sound processor is attached to the skin surface with low magnetic force. The 1st BCD using direct contact with the skull bone to transmit sound to the cochlea was a titanium fixture with a sound processsor attached to it. This innovative way to transmit sound was based on osseointegration, which is the unique bond between titanium and living bone discovered by the Swedish professor of anatomy, Per-Ingvar Brånemark who implanted titanium dental fixtures in the jaw. He then proceeded in collaboration with Professor Anders Tjell-ström, a Swedish otolaryngologist, and an engineer Professor Bo Håkansson to develop a bone conduction hearing aid where a sound processor was attached to an osseointegrated titanium implant in the skull bone behind the ear.
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    Buccal Fat Pad Flap
    (2025-10-31) Fagan, Johan
    The buccal fat pad flap is an axial flap and may be used to fill small-to-medium sized soft tissue and bony defects in the palate, superior and inferior alveoli and buccal mucosa. It is often encountered as it bulges into the surgical field during surgery in the pterygomandibular region. The buccal fat pad (Figure 1) is an encapsulated, mass of specialized fatty tissue the volume of which varies throughout life. It is distinct from subcutaneous fat (Figure 2). It fills the deep tissue spaces and acts as gliding pads when masticatory and mimetic muscles contract, and cushions important structures from forces generated by muscle contraction.
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    Buccinator Myomoucosal Flap
    (2025-10-31) Fagan, Johan
    The Buccinator Myomucosal Flap is an axial flap, based on the facial and/or buccal arteries. It is a flexible and versatile flap well suited to reconstructing soft tissue defects of the oral cavity, oropharynx and nasal septum. Unlike most free flaps, it provides mucosal cover, as opposed to skin cover, and is sensate. The donor site can usually be closed primarily without causing deformity or scarring. The flap is about 5mm thick, and comprises buccal mucosa, submucosa and buccinator muscle, with the feeding vessels and vascular plexus. The buccinator muscle is a thin, quadrilateral muscle in the cheek. It originates from the outer surfaces of the alveolar processes of the maxilla and mandible. Posteriorly it arises from the pterygomandibular raphe. Anteriorly it inserts into the orbicularis oris muscle. Laterally it is related to the ramus of the mandible, the masseter and medial pterygoid muscles, the buccal fat pad and the buccopharyngeal fascia. Medially, it is covered by the submucosa and mucosa of the cheek. It is part of the pharyngealbuccalorbicularis sphincter system and functions to facilitate whistling, sucking, propelling food during mastication and voiding the buccal cavity.
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    Caldwell-Luc (Radical Antrostomy), Inferior Meatal Antrostomy & Canine Fossa and Inferior Meatus Punctures
    (2025-03-03) Fagan, Johan
    The Caldwell-Luc operation involves creating an opening into the maxillary antrum through the canine fossa via a sublabial approach. Canine fossa (CFP) & inferior meatal puncture are used to obtain samples of pus from the antrum, to irrigate the antrum (“antral washout”), or as an adjunct to endoscopic ethmoidectomy. The Caldwell-Luc operation involves enteringthe maxillary sinus via an opening in the thin bone of the canine fossa (Figures 1-3). A series of eminences overlie the roots of the teeth on the inferior part of the face of the maxilla (Figures 2, 3). Just above the eminences of the incisor teeth is a depression called the incisive fossa; it gives origin to the depressor alae nasi. The nasalis muscle arises just lateral to it (Figure 2).