Chapters in books

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    Supraglottoplasty for Laryngomalacia
    (University of Cape Town, 2025-04-18) Jonas, Nico; van der Meer, Graeme; Fagan, Johan
    Laryngomalacia is characterised by collapse of the supraglottic tissues on inspiration. It is the most common cause of stridor in infancy. It generally becomes symptomatic 2-3 weeks after birth, and presents as characteristic high-pitched, inspiratory, squeaking stridor. Classically symptoms are worse in the supine position, when the child cries, or is agitated. Males are affected twice as often as females. It usually resolves by the age of 2 years. Laryngomalacia may remain symptomatic beyond 2 years in patients with neuromascular disorders and should be considered in the differential diagnosis of inspiratory stridor even in older children. The aetiology is not fully understood. There does appear to be a familial predisposition. Anatomically, redundant supraglottic soft tissues collapse on inspiration and cause supraglottic airway obstruction. Another theory is that of immature neuromuscular development causing supraglottic compromise. A common coexisting condition is that of acid reflux which may exacerbate laryngomalacia by causing posterior supraglottic oedema.
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    Total Maxillectomy, Orbital Exenteration
    (University of Cape Town, 2025-05-19) Fagan, Johan; Fagan, Johan
    Total maxillectomy refers to surgical resection of the entire maxilla. Resection includes the floor and medial wall of the orbit and the ethmoid sinuses. The surgery may be extended to include orbital exenteration and sphenoidectomy, and resection of the pterygoid plates. It is generally indicated for malignancy involving the maxillary sinus, maxillary bone (sarcomas) and/ or orbit and ethmoids, not amenable to lesser or endoscopic resection. Total maxillectomy is potentially complicated by injury to the orbital contents, lacrimal drainage, optic nerve, ethmoidal arteries, intracranial contents, and may be accompanied by brisk bleeding. A sound understanding of the 3-dimensional anatomy of the maxilla and the surrounding structures is therefore essential. Hence the detailed description of the surgical anatomy that follows.
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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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    Medial Maxillectomy
    (University of Cape Town, 2025-03-08) Fagan, Johan; Fagan, Johan
    Medial maxillectomy refers to surgical resection of the medial and superomedial walls of the maxillary antrum. It is increasingly being done by transnasal endoscopic techniques for suitable cases and when the required expertise and technology are available. This chapter will only deal with the open surgical medial maxillectomy technique. Maxillectomy is potentially complicated by injuries to the orbital contents, lacrimal apparatus, optic nerve, ethmoidal arteries, intracranial contents, and may be accompanied by brisk bleeding. A sound understanding of the 3-dimensional anatomy of the maxilla and the surrounding structures is therefore essential. Hence the detailed description of the surgical anatomy that follows.
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    Total Laryngectomy
    (University of Cape Town, 2025-03-03) Fagan, Johan; Fagan, Johan
    Total laryngectomy is generally done for advanced cancers of the larynx and hypopharynx, recurrence following (chemo) radiation, and occasionally for intractable aspiration and advanced thyroid cancer invading the larynx. Although it is an excellent oncologic procedure and secures good swallowing without aspiration, it has disadvantages such as having a permanent tracheostomy; that verbal communication is dependent on oesophageal speech, and/or tracheoesophageal fistula speech or an electrolarynx; hyposmia; and the psychological and financial / employment implications. Even in the best centers, about 20% of patients do not acquire useful verbal communication.