Ear,Nose & Throat Journal

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Nasal fractures are usually diagnosed by clinical examination, with or without the support of imaging studies. While plain-film radiography lacks sensitivity and specificity for diagnosing nasal fractures, and computed tomography (CT) is not always practical or cost-effective, ultrasonography (US) may be useful in this regard. The criteria by which adult nasal fractures are reliably identified on US must be clear. We conducted a preliminary prospective, controlled, observational study to define the appearance of nasal fractures on US. We used US to image 12 patients with a clinical or radiologic (CT or x-ray) diagnosis of nasal fracture. All patients presented within 2 weeks of their injury. For comparison purposes, we also obtained US images from 12 control subjects who had no history of nasal trauma or surgery. We found that we could confidently diagnose nasal fractures on lateral-view US on the basis of a disruption of bone continuity and/or displacement of fracture segments. However, our findings were not as consistent with dorsal-view US, and we do not believe it is adequate for diagnosis. We conclude that lateral US can be used to detect nasal fractures in adults, but further studies are needed to assess its sensitivity, specificity, cost-effectiveness, and practicality.

Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case.

Parotid fistula represents an uncommon complication in parotid surgery. Its early recognition contributes to successful management. The condition is distressing for both the patient and the surgeon, since conservative and operative treatment frequently fail. There is no consensus on the optimal management of parotid gland fistula. The aim of this study is to describe a new, simple procedure in the treatment of this condition using transdermal scopolamine. We report 3 cases of salivary fistulae occurring after parotidectomy. The patients were admitted to our department with swelling in the parotid region and an output of clear drainage from the drain site during oral intake. The patients were treated with a scopolamine transdermal release system applied to hairless skin overlying the parotid region. A prompt and remarkable decrease in daily salivary output was observed. Fistulae healed completely within 3 days. No collateral effects were observed. Parotid fistulae do not generally occur as a complication of parotidectomies. Their management can be difficult, and several methods of treatment have been attempted. We believe that the use of transdermal scopolamine is a valid option in the treatment of parotid fistulae without causing collateral effects.