Persistent osteoradionecrosis, despite diligent radical treatment, raises the suspicion of recurrent cancer. Extensive osteoradionecrosis with a multiple discharging fistula, a large area of exposed necrotic bone, or a coexistent fracture should be treated primarily with radical sequestrectomy and microvascular free flap reconstruction. Surgery still plays a major role in controlling osteoradionecrosis, and hyperbaric oxygen therapy is adjuvant.

Objective: Osteoradionecrosis is one of the most serious complications in radiotherapy ofnasopharyng al carcinoma. We describe a new endoscopic approach to resolve resultant skull base osteoradionecrosis. The objective of this study is to evaluate the fficacy of endoscopic management of skull base ost oradion crosis. Shidy Design: A prospective study of th outcome of endoscopic management for patient with skull base o teoradionecrosis. Methods: Between 1994 and 1998 six patients who had irradiation previously for nasopharyngeal carcinoma had skull base ost oradionecrosis. A sinoscopic approach was appli d for diagnosis and sequestrectomy. This diagnosis was based on the criterion of exposed necrotic bone after removing aH crust in the nasopharynx and further confirmed on pathological examination after sequestrectomy. Effective cure was defined a intact muco al coverage without any ulcer or expos d n erotic bone observed in the na opharynx and the absence of antecedent accompanying symptoms aft r management. Results: Six patients (100%) were symptom free. Five (83.3%) patients had effective cure. There was no surgical morbidity or mortality. Conclusion: Endoscopic sequestrectomy is a justified approach to skull base osteoradionecrosis.

The incidence of OME accompanying cleft palate has decreased in Asian patients in the past 5 years. Tympanometry is not a very reliable tool for evaluating OME in children with cleft palate younger than 14 months, especially those younger than 9 months. Meticulous examination of the middle ear during palatoplasty is necessary for making a definite diagnosis and deciding on the use of a grommet.