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N R Bleach

Publications and source records attributed to N R Bleach.

At least 19 recordsLinked to original sources
PubMed2004

Sebaceous carcinoma of the nose: multi-focal presentation?

Sebaceous carcinoma of the nose is rare. Here the authors present a case of a 71-year-old man who presented with a mass in the right nasal vestibule. This was removed and a nasolabial flap used to reconstruct the defect. Histology revealed a sebaceous carcinoma. At follow-up, three months later, a new lesion had appeared in the opposite nostril which when removed proved to be a second sebaceous carcinoma. This multi-focal presentation in the nose has not been described in the literature before.

Adenocarcinoma, Sebaceous↗
PubMed1999

Medial orbital protrusion--a potentially hazardous anomaly during endoscopic sinus surgery.

We report the case of a 57-year-old patient with a presumed developmental anomaly of the medial orbital wall. The resultant protrusion of orbital contents into the ethmoidal complex was clearly demonstrated on coronal computed tomography (CT) scans of the paranasal sinuses. This anomaly presents a high risk of iatrogenic injury to the medial rectus and orbit during functional endoscopic sinus surgery and has not previously been described.

Endoscopy↗
PubMed1998

Sudden parotid swelling due to spontaneous haemorrhage.

This paper presents an interesting case of a severe spontaneous haemorrhage within the parotid gland in an adult. A rapidly enlarging parotid mass with absence of causative trauma, inflammation or vascular abnormality, raised the suspicion of a neoplasm. Ultrasound, computed tomography (CT) and tissue biopsy, however, have shown only changes suggestive of previous haemorrhage and no evidence of malignancy. A 30-year review of the literature revealed no similar case reported previously.

Diagnosis, Differential↗
PubMed1997

Congenital anosmia.

Congenital anosmia is well described in conjunction with various sexual and other developmental abnormalities and has been reported to run in families. Congenital anosmia occurring as an isolated defect in a single family member is extremely rare, and tends to present late. We describe a case of a five year old girl with congenital anosmia and we outline the investigations which should be undertaken in such cases.

Algorithms↗
PubMed1997

Parapharyngeal abscess: a rare complication of elective tonsillectomy.

We report a case of parapharyngeal abscess complicating an elective tonsillectomy in a healthy thirty-three-year-old woman. The clinical features and management of this very rare complication are discussed. In addition, we review the possible aetiology and pathogenesis of this potentially life-threatening condition.

Abscess↗
PubMed1995

Multiple oncocytic cysts of the larynx.

Oncocytic metaplasia in laryngeal epithelium is uncommon. Oncocytes have been described in the lining of laryngeal cysts and such cysts have been reported in the literature under a variety of names. There is an ongoing debate about the exact nature of 'oncocytic cysts', which tend to be solitary. An unusual case of multiple oncocytic cysts of the larynx is described. The pathology and treatment are discussed.

Aged↗
PubMed1994

Ultrasound imaging in laryngeal cancer: a preliminary study.

High resolution ultrasound is a promising technique in the assessment of laryngeal carcinoma, yet few published studies have appeared concerning its use. We set out to assess if ultrasound could correctly identify the site and size of known lesions, if unsuspected extralaryngeal spread or nodal involvement could be shown and if the results could be used to influence patient management. Fourteen patients with advanced laryngeal cancer (Stage T2 or above) were prospectively evaluated by systematic ultrasound technique, with the sonologist blind to the clinical findings. The results were correlated with clinical assessment and with histopathological findings in six patients who subsequently underwent surgery. Eleven of 14 tumours were visible on ultrasound and the site and size correctly identified in each. Unsuspected extralaryngeal spread was found in four cases increasing the tumour stage to T4; spread to the pre-epiglottic space was also shown in four cases. Nodal staging was correctly raised in two cases and incorrectly in one. Patient management was significantly influenced in 8/14 cases. Ultrasound can identify the majority of laryngeal tumours of Stage T2 and above, and detect extralaryngeal spread. Small tumours may not be visible but in this preliminary study, ultrasound complemented the clinical assessment and was useful in patient management.

Aged↗
PubMed1994

A pneumatic artificial larynx popularized in Hong Kong.

The 'Taiwan tube' is an inexpensive pneumatic artificial larynx made in Taiwan. The device, which is a tracheo-oral shunt containing a resonator, is popular with laryngectomees in Hong Kong. This paper reports its use and describes its working dynamics which compare favourably with those of other forms of voice restoration.

Adult↗
PubMed1994

Middle ear deformity in arthrogryposis multiplex congenita.

Arthrogryposis multiplex congenita (AMC) is a rare congenital syndrome consisting of two or more joint contractures in different parts of the body. Otolaryngological abnormalities have been previously described in a significant proportion of cases. However, to date, the only frequent otologic deformity recorded in the published literature has been low-set ears. We present a case with a combination of AMC and a bilateral conductive hearing loss due to an unusual middle ear deformity. To our knowledge, no such case has been previously reported.

Adult↗
PubMed1994

Double maxillary antrum as a cause of maxillary sinus mucocele.

We report a rare case of a mucocele occurring in a naturally compartmentalized maxillary sinus in a 50-year-old woman. Sinus computerized tomography (CT) showed the antrum to be divided by a vertical bony septum, producing a mucocele within an isolated and non-draining anterolateral compartment. Accidental trauma to the thin bony shell precipitated rapid swelling of the pre-existing mass, leading to her initial consultation. A wide sublabial surgical approach allowed complete excision with a good cosmetic result.

Female↗
PubMed1994

Emergency workload in otolaryngology.

A 6-month prospective audit of the otolaryngology emergency workload in a district general hospital was undertaken. A total of 742 cases was referred of whom 193 (26%) were children (< 16 years). The male to female ratio was equal, and 69% of cases were referred from the accident and emergency department. Although most conditions were minor enough to be managed in the ward treatment room and either discharged (40%) or followed up as outpatients (27%), more than one-quarter of patients (28%) needed management by a post-fellowship ENT surgeon. Of the patients, 31% (230/742) were admitted, of whom 107 (46%) required an operation under general anaesthesia. The consequent ENT emergency workload represented 24% of all new patient referrals, 20% of ENT ward admissions and 10% of ENT surgical procedures.

Adolescent↗
PubMed1993

Brachytherapy for recurrent nasopharyngeal and naso-ethmoidal tumours.

Recurrent or persistent carcinoma of the nasopharynx or naso-ethmoid region occurs even after combined surgery and radical external irradiation. The confined bony access and proximity of vital structures may compromise resection margins. Brachytherapy using implantable radioactive gold or iodine seeds is a useful adjunct to the skull base surgeon in eliminating residual microscopic disease. We report nine cases with recurrent or persistent disease of the nasopharynx or naso-ethmoid regions treated with brachytherapy with encouraging results.

Adolescent↗
PubMed1993

Complications of pharyngeal myotomy for alaryngeal voice rehabilitation.

Over the eight-year period to May 1991, 256 patients were referred for post-laryngectomy voice rehabilitation. Videofluoroscopy identified 81 (32 per cent) who required pharyngeal myotomy for a spastic pharyngo-oesophageal segment. Forty-two of these (37 male, 5 female and average age 63 years) had their surgery performed at this unit with a complication rate of 17 per cent and an average post-operative stay of 10 days (range 4-41 days). The place of the operation for pharyngeal myotomy in post-laryngectomy voice rehabilitation is discussed.

Aged↗
PubMed1993

The gag reflex and aspiration: a retrospective analysis of 120 patients assessed by videofluoroscopy.

An absent gag reflex is often employed clinically as an indicator of aspiration risk. Dysphagia clinic records of 120 neurological patients who had undergone speech therapy and ENT assessment, followed by videofluoroscopy, were retrospectively analysed to ascertain if any link between an absent gag reflex and aspiration could be demonstrated. No association between an absent gag reflex and aspiration or laryngeal overspill was found (Mann-Whitney U-test; 2-tailed P = 0.11). Abnormalities on indirect laryngoscopy were seen in 34/120 patients (28%), and these were more closely related to aspiration risk (Mann-Whitney U-test: 2-tailed P = 0.06). An absent gag reflex is not a useful predictor of aspiration, and assessment of the gag reflex should not be relied upon to predict airway safety. However, indirect laryngoscopy is a useful adjunct to standard speech therapy assessment of the dysphagic patient.

Deglutition Disorders↗
PubMed1992

Autosomal dominant palmoplantar hyperkeratosis and sensorineural deafness in three generations.

A family is presented with autosomal dominant progressive palmoplantar hyperkeratosis, which is invariably associated with a slowly progressive, bilateral, high frequency, sensorineural hearing loss. The family show no other ectodermal abnormality. The differential diagnosis and possible mechanisms are discussed. This family appears to represent a unique variant in the hyperkeratosis-deafness association.

Adult↗