Ann R Coll Surg Engl 2010; 92: 40-43 40Indications for parotidectomy include benign and malignant tumours as well as inflammatory conditions of the parotid gland.1 Traditionally, the cervicomastoidfacial incision (alternatively known as the modified Blair incision) is used for surgery of the parotid gland which offers excellent surgical access to the parotid gland, but leaves a visible scar in the neck. Alternatively, for suspected benign tumours, a more cosmetic modified facelift (rhytidectomy) incision can be considered which leaves no visible neck scar.2 At the Luton & Dunstable Hospital, parotidectomy is performed by ear nose and throat (ENT) and maxillofacial surgeons. We retrospectively analysed parotidectomies performed by both departments over a 2-year period. The aim of this study was to establish the frequency of each surgical approach used and to identify any difference in complication and patient satisfaction of the operative scar between the two incisions. Patients and MethodsA retrospective analysis of case notes for patients who underwent parotidectomy by both ENT and maxillofacial departments between January 2006 and February 2008 was undertaken. All operations were either performed or supervised by a consultant. Only benign indications for parotidectomy were considered for this study; thus, histologically confirmed cases of malignancy were excluded. The numbers of patients who underwent parotidectomy via a cervicomastoidfacial and modified facelift incision were counted. For each incision, details regarding immediate postoperative facial nerve weakness and wound haematoma were obtained from the notes. A patient-outcome evaluation questionnaire was posted to all included patients at least 6 months following their parotid surgery. Information regarding facial paraesthesia and gustatory sweating was sought, The rhytidectomy or modified facelift (MF) incision allows an alternative approach which leaves no visible neck scar. The objective of this study was to establish the frequency of each surgical approach used and identify any difference in complication and patient satisfaction between the two incisions for benign conditions of the parotid gland. PATIENTS AND METHODS A retrospective analysis of 101 case notes for patients who underwent parotidectomy by both ENT and maxillofacial departments between January 2006 and February 2008 was undertaken. All histologically confirmed cases of malignancy were excluded. For each incision, immediate postoperative complications were obtained from the notes. A postal patient outcome evaluation questionnaire sought information regarding persistent and late complications as well as a visual analogue scar satisfaction score for both incisions. RESULTS Overall, 79 parotidectomies were included (59 CMF incisions, 20 MF incisions). Of CMF incisions, 34% suffered facial weakness immediately postoperatively versus 20% of MF incisions. Of CMF incisions, 4% suffered postoperative haematomas versus none following MF incisions. In the study cohort, 47 (60%) responded to the ...

Bilateral facial nerve palsy is a rare but recognised manifestation of HIV seroconversion illness. The pathophysiology of this clinical presentation is thought to be associated with the immune response of the dissemination of virus throughout the body. We describe a case of bilateral facial nerve palsy, subsequently diagnosed with HIV. Related medical literature is also reviewed. The case highlights the vigilance required in unusual, atypical signs and symptoms if a diagnosis of HIV infection is not to be missed. Clinicians should be aware of the potential presentation of HIV seroconversion illness to provide opportunity for early diagnosis and intervention.

The current role of U tubes for benign andmalignant biliary obstruction. Annals of Surgery; 218, 621-629. Objective. The recent experience with U tubes at Rush-Presbyterian-St. Lukes Medical Center was reviewed in order to assess their current role in hepatobiliary surgery.

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