Pub Date : 2017-09-06DOI: 10.1017/s0022215117001852
L. Flood
This a topic dear to my heart, the end result being my redundant collection of over three-thousand slide transparencies, a few hundred of which I did manage to digitise, and a collection of 35 mm film cameras that do not even have scrap value now. The opening chapter describes how such images are now captured in the digital age. It does carry a nice illustration of ‘a set up used in past years’, exactly the kit I once used. Fortunately, most of us do now have access to the modern visual aids illustrated in the following Figure 1.7. A nice Preface tells us that ‘Otoscopy alone can establish the diagnosis in some cases, parameters such as history and audiological and neuroradiological evaluation are required in others’. Otoscopy is a bit like oral surgery or even dermatology, where pattern recognition and decades of experience can make all the difference to correct and instant diagnosis. The authors do advise of course that what you see, the red blush, the white bulge, the fluid-filled ear, is ‘the tip of the iceberg’. This book is far more comprehensive than the title, or even the cover, suggests. I expected to flick through countless pictures of typical tympanic membrane and middle-ear lesions, and, with over a thousand illustrations, there are plenty of those. There are countless computed tomography scans, nicely printed and clearly labelled; there are operative images, taken through the microscope, that are of superb quality. There is surprisingly detailed text on the underlying pathology, staging and even management of the various disease processes covered. A typical example is surgery of external canal exostoses, and I was relieved to read that the authors share my success rate in surgicalmanagement of post-inflammatory canal stenosis. They advise against it! I was struck by the coverage of external canal carcinoma, offering differential diagnosis, staging and detailed diagrams of tumour extension, in what is called simply an atlas. The blue drum of cholesterol granuloma is not easily captured, but nicely shown here. Indeed, middle-ear effusion is illustrated, but with farmore coverage of the countless weird and wonderful skull base tumours that may be responsible. Again, one expects nice views of ossicular disorders through perforations or retractions, of cholesteatomas and of middle-ear masses. The surprise is the coverage of tympanoplasty techniques and the excellent microscopy images of mastoidectomy (Figures 8.73–8.111). Chapter 12, ‘Rare Retrotympanic Masses’, reports precisely such, the really obscure, probably reflecting the group’s experience over 30 years, of 32 000 operations and 300 000 consultations! The final chapter ‘Postsurgical Conditions’ shows an unconvincing Schwartz sign, which I will forgive as challenging to capture, with a series of failed tympanoplasties and extruding prostheses. I had expected to see more coverage of otoendoscopic surgery of the ear, so increasingly popular amongst the younger surgeons. Instead, this
{"title":"COLOR ATLAS OF ENDO-OTOSCOPY: EXAMINATION–DIAGNOSIS–TREATMENT M Sanna, A Russo, A Caruso, A Taibah, G Piras Thieme, 2017 ISBN 978 3 13241 523 2 pp 339 Price £89.00 €99.99","authors":"L. Flood","doi":"10.1017/s0022215117001852","DOIUrl":"https://doi.org/10.1017/s0022215117001852","url":null,"abstract":"This a topic dear to my heart, the end result being my redundant collection of over three-thousand slide transparencies, a few hundred of which I did manage to digitise, and a collection of 35 mm film cameras that do not even have scrap value now. The opening chapter describes how such images are now captured in the digital age. It does carry a nice illustration of ‘a set up used in past years’, exactly the kit I once used. Fortunately, most of us do now have access to the modern visual aids illustrated in the following Figure 1.7. A nice Preface tells us that ‘Otoscopy alone can establish the diagnosis in some cases, parameters such as history and audiological and neuroradiological evaluation are required in others’. Otoscopy is a bit like oral surgery or even dermatology, where pattern recognition and decades of experience can make all the difference to correct and instant diagnosis. The authors do advise of course that what you see, the red blush, the white bulge, the fluid-filled ear, is ‘the tip of the iceberg’. This book is far more comprehensive than the title, or even the cover, suggests. I expected to flick through countless pictures of typical tympanic membrane and middle-ear lesions, and, with over a thousand illustrations, there are plenty of those. There are countless computed tomography scans, nicely printed and clearly labelled; there are operative images, taken through the microscope, that are of superb quality. There is surprisingly detailed text on the underlying pathology, staging and even management of the various disease processes covered. A typical example is surgery of external canal exostoses, and I was relieved to read that the authors share my success rate in surgicalmanagement of post-inflammatory canal stenosis. They advise against it! I was struck by the coverage of external canal carcinoma, offering differential diagnosis, staging and detailed diagrams of tumour extension, in what is called simply an atlas. The blue drum of cholesterol granuloma is not easily captured, but nicely shown here. Indeed, middle-ear effusion is illustrated, but with farmore coverage of the countless weird and wonderful skull base tumours that may be responsible. Again, one expects nice views of ossicular disorders through perforations or retractions, of cholesteatomas and of middle-ear masses. The surprise is the coverage of tympanoplasty techniques and the excellent microscopy images of mastoidectomy (Figures 8.73–8.111). Chapter 12, ‘Rare Retrotympanic Masses’, reports precisely such, the really obscure, probably reflecting the group’s experience over 30 years, of 32 000 operations and 300 000 consultations! The final chapter ‘Postsurgical Conditions’ shows an unconvincing Schwartz sign, which I will forgive as challenging to capture, with a series of failed tympanoplasties and extruding prostheses. I had expected to see more coverage of otoendoscopic surgery of the ear, so increasingly popular amongst the younger surgeons. Instead, this","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"1 1","pages":"1157 - 1157"},"PeriodicalIF":0.0,"publicationDate":"2017-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78178683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-09-05DOI: 10.1017/S0022215117001864
L. Flood
{"title":"ENDOSCOPIC SINONASAL DISSECTION GUIDE: INCLUDING ORBIT AND SKULL BASE, 2nd edn R R Casiano, I R Herzallah, J A Eloy Thieme, 2017 ISBN 978 1 62623 210 5 pp 152 Price €94.99 £84.50","authors":"L. Flood","doi":"10.1017/S0022215117001864","DOIUrl":"https://doi.org/10.1017/S0022215117001864","url":null,"abstract":"","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"26 1","pages":"1158 - 1158"},"PeriodicalIF":0.0,"publicationDate":"2017-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82888968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-25DOI: 10.1017/S0022215117001591
C. Saxby, P. Coyle, G. Mochloulis
s presented at the Laryngology and Rhinology Section Meetings, Royal Society of Medicine, 5 May 2017, London, UK Analysis of trueand false-positive results for abnormal vocal fold uptake in positron emission tomography/ computed tomography
{"title":"Abstracts presented at the Laryngology and Rhinology Section Meetings, Royal Society of Medicine, 5 May 2017, London, UK","authors":"C. Saxby, P. Coyle, G. Mochloulis","doi":"10.1017/S0022215117001591","DOIUrl":"https://doi.org/10.1017/S0022215117001591","url":null,"abstract":"s presented at the Laryngology and Rhinology Section Meetings, Royal Society of Medicine, 5 May 2017, London, UK Analysis of trueand false-positive results for abnormal vocal fold uptake in positron emission tomography/ computed tomography","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82205479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-25DOI: 10.1017/S0022215117001608
M. Yung
s presented at the Otology Section Meetings, Royal Society of Medicine, 3 March 2017, London, UK Matthew Yung short paper prize was awarded to Alistair Mitchell-Innes for ‘Implantable microphones as an alternative to external microphones for cochlear implants’. Implantable microphones as an alternative to external microphones for cochlear implants A Mitchell-Innes From the University Hospital Birmingham NHS Foundation Trust Introduction The potential benefits of a fully implantable cochlear implant include improved cosmesis and comfort, and less restriction of activities. The major challenges facing its development relate to microphones. Microphones can be implanted subcutaneously or in the middle ear. Surface contact and physiological noise are barriers to success for subcutaneous microphones (Briggs et al., 2008; Jenkins and Uhler, 2012). We discuss our series investigating a new middleear microphone. Methods Forty cadaveric dissections were conducted, examining four fixation positions and three coupling options. Outcome measures included sensitivity and simulated body noise. Results We have established the most robust position to optimise microphone sensitivity. Contrary to subcutaneous microphones, our data suggest that a middle-ear microphone will keep body noise to a minimum. Conclusion Positioning implantable microphones in the middle ear avoids surface contact and physiological noise, and potentially takes advantage of directionality cues and amplification provided by the external ear. A clinical trial is planned to establish in vivo microphone performance. Is there an association between single-nucleotide polymorphisms in the RELN gene and sporadic otosclerosis in a British population? A Mowat From the University College London Introduction Otosclerosis displays a complex aetiology influenced by both genetic and environmental factors. A genome-wide association study identified variants within RELN that are associated with the condition (Schrauwen et al., 2009). Follow-up replication studies have reported conflicting results (Khalfallah et al., 2010; Priyadarshi et al., 2010). Aim To establish whether an association exists between two single-nucleotide polymorphisms (rs39399 and rs3914132) in RELN and sporadic otosclerosis cases in a British population. Methods DNA was extracted from saliva and blood samples of patients with a confirmed diagnosis of otosclerosis. All patients had fewer than two relatives with the disease. Sufficient DNA samples were extracted to perform 3 TaqMan assays with 96-well otosclerosis plates.
2017年3月3日，英国伦敦，英国皇家医学学会耳科会议上，Matthew Yung的论文奖授予Alistair Mitchell-Innes，获奖理由是“植入式麦克风作为人工耳蜗外部麦克风的替代品”。伯明翰大学医院NHS基金会信托基金的Mitchell-Innes介绍:完全植入式人工耳蜗的潜在好处包括改善外观和舒适度，减少活动限制。其发展面临的主要挑战与麦克风有关。麦克风可以植入皮下或中耳。表面接触和生理噪声是皮下麦克风成功的障碍(Briggs等人，2008;詹金斯和乌勒，2012)。我们讨论我们的系列调查一种新的中耳麦克风。方法采用40具尸体解剖，研究4种固定位置和3种耦合方式。结果测量包括敏感性和模拟体噪声。结果我们建立了最稳健的位置来优化麦克风灵敏度。与皮下麦克风相反，我们的数据表明，中耳麦克风可以将身体噪音降至最低。结论植入式传声器放置于中耳可避免表面接触和生理性噪声，并可充分利用外耳提供的方向性提示和放大功能。一项临床试验计划建立在体内的麦克风性能。在英国人群中，RELN基因的单核苷酸多态性与散发性耳硬化之间是否存在关联?来自伦敦大学学院的莫瓦特介绍耳硬化症是一种复杂的病因学，受遗传和环境因素的影响。一项全基因组关联研究确定了RELN中与该病症相关的变异(Schrauwen et al.， 2009)。后续重复研究报告了相互矛盾的结果(Khalfallah et al.， 2010;Priyadarshi et al.， 2010)。目的探讨RELN中两个单核苷酸多态性(rs39399和rs3914132)与英国人群中散发性耳硬化病例之间是否存在关联。方法对确诊为耳硬化症的患者进行唾液和血液DNA提取。所有患者的亲属都少于两名患有此病。提取足够的DNA样本，用96孔耳硬化板进行3次TaqMan检测。
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Pub Date : 2017-08-25DOI: 10.1017/S002221511700158X
E. Chevretton, S. Haikel, A. Sandison, S. Connor, A. Siddiqui
Case report A 57-year-old gentleman underwent an oesophagectomy with gastric pull-up for a tumour–node–metastasis stage T3N1M0 lower oesophageal adenocarcinoma. Two years later, he developed an extensive recurrence that was treated surgically with laryngo-pharyngo-oesophagectomy and colonic interposition. Ten months later, he developed recurrent chest infections and sputum production from the stoma. Initial tracheoscopy confirmed lower respiratory tract infection, but showed no fistulation. He was primarily treated with antibiotics, but this did not fully resolve his symptoms.
{"title":"Proceedings of the 151st Semon Club, 23rd May 2016, ENT Department, Guy's and St Thomas’ NHS Foundation Trust, London, UK","authors":"E. Chevretton, S. Haikel, A. Sandison, S. Connor, A. Siddiqui","doi":"10.1017/S002221511700158X","DOIUrl":"https://doi.org/10.1017/S002221511700158X","url":null,"abstract":"Case report A 57-year-old gentleman underwent an oesophagectomy with gastric pull-up for a tumour–node–metastasis stage T3N1M0 lower oesophageal adenocarcinoma. Two years later, he developed an extensive recurrence that was treated surgically with laryngo-pharyngo-oesophagectomy and colonic interposition. Ten months later, he developed recurrent chest infections and sputum production from the stoma. Initial tracheoscopy confirmed lower respiratory tract infection, but showed no fistulation. He was primarily treated with antibiotics, but this did not fully resolve his symptoms.","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75862975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-25DOI: 10.1017/S0022215117001578
E. Chevretton, S. Haikel, A. Sandison, S. Connor, A. Siddiqui
Case report A 24-year old Polish gentleman was referred with longstanding left-sided bloody otorrhoea. He had underwent excision of a left temporal bone tumour 10 years prior, with resulting VIIth cranial nerve weakness and deafness on the same side. Examination showed a large tumour filling the left ear canal, with House–Brackmann grade III facial weakness and reduced sensation on the same side. An audiogram confirmed a dead ear on the left side.
{"title":"Proceedings of the 150th Semon Club, 7 December 2015, ENT Department, Guy's and St Thomas’ NHS Foundation Trust, London, UK","authors":"E. Chevretton, S. Haikel, A. Sandison, S. Connor, A. Siddiqui","doi":"10.1017/S0022215117001578","DOIUrl":"https://doi.org/10.1017/S0022215117001578","url":null,"abstract":"Case report A 24-year old Polish gentleman was referred with longstanding left-sided bloody otorrhoea. He had underwent excision of a left temporal bone tumour 10 years prior, with resulting VIIth cranial nerve weakness and deafness on the same side. Examination showed a large tumour filling the left ear canal, with House–Brackmann grade III facial weakness and reduced sensation on the same side. An audiogram confirmed a dead ear on the left side.","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82557866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-18DOI: 10.1017/S0022215117001633
L. Flood
An amusing Preface explains the Spanish influence in authorship of this book, and describes the challenges of performing live surgery, in order to convince the ‘Sauluses’ who doubted the closing statement ‘Nowadays almost nothing is impossible through the nose’. Well, by the end of this book, although neither blinded nor hearing voices (and mercifully not on the road to Damascus), I was a convinced reviewer. Even the otologists amongst us can usually introduce an endoscope and punch a hole from the middle meatus into the antrum, usually without draining orbital fat. We will all open the occasional ethmoid cell and then rely on medication to do the rest. There is the very old gag of asking for the irrigation to be turned down, only to be told that there is no irrigation in use. Sure enough, three-dimensional (3D) coronal reconstructions of the facial skeleton, in the opening chapter, offer a somehow disturbing view, through the nasal aperture, of the entire brainstem. There have been moments, in the depths of a septoplasty, I do admit... This is a lengthy manual, with the expected profusion of high-quality illustrations. Most are full colour images of cadaver dissections; imaging is sharply printed, and even the truly live surgical prints show how rhinology is somehow more photogenic than the practice of the aurist. Anatomy is demonstrated with the best contemporary 3D computed tomography reconstructions. Illustrations of surgery are accompanied by descriptions, for every procedure, of indications, technique, complications and ‘tips and tricks’ (which are really nicely done). To an ignoramus, the text very nicely complemented the images. Now, frankly, by Chapter 4, this reviewer was already getting into unfamiliar territory. Draf’s endonasal frontal sinus drainage procedure types I–III mean little to one who sees the dire emergency route to the frontal sinus as below the eyebrow. Yet, somehow, the descriptions of endoscopic frontal and sphenoid approaches, and medial maxillectomy, made perfect sense. Then there was the hunt for those arteries, and certainly their sphenopalatine arterial pedicle looked much more convincing than the mucosal strand often shown to me by enthusiastic trainees. By page 92, the content was getting serious, passing way beyond the nasal cavity. A ‘suprasellar approach to the third ventricle’ sounded like something I have spent my life trying to avoid doing. Transorbital neuroendoscopic surgery seems challenging considering the important contents, but proves entirely plausible. By ‘The Front Door to Meckel’s Cave’, ‘The Endoscopic Endonasal Approach to the Intrapetrous Carotid Artery’ or ‘The Anteromedial Corridors to the Cranial Nerves’, I knew I was now out of my depth as a reviewer, but could appreciate the quality of what I was reading. Descriptions of combined approaches, simultaneously transnasal and transcranial, reminded me of those tunnelling exercises, where, after months of drilling, the two teams meet under the
{"title":"ENDOSCOPIC APPROACHES TO THE PARANASAL SINUSES AND SKULL BASE. A STEP-BY-STEP ANATOMIC DISSECTION GUIDE M Bernal-Sprekelsen, I Alobid Thieme, 2017 ISBN 978 3 13201 881 5 pp 409 Price €149.99 £133.50","authors":"L. Flood","doi":"10.1017/S0022215117001633","DOIUrl":"https://doi.org/10.1017/S0022215117001633","url":null,"abstract":"An amusing Preface explains the Spanish influence in authorship of this book, and describes the challenges of performing live surgery, in order to convince the ‘Sauluses’ who doubted the closing statement ‘Nowadays almost nothing is impossible through the nose’. Well, by the end of this book, although neither blinded nor hearing voices (and mercifully not on the road to Damascus), I was a convinced reviewer. Even the otologists amongst us can usually introduce an endoscope and punch a hole from the middle meatus into the antrum, usually without draining orbital fat. We will all open the occasional ethmoid cell and then rely on medication to do the rest. There is the very old gag of asking for the irrigation to be turned down, only to be told that there is no irrigation in use. Sure enough, three-dimensional (3D) coronal reconstructions of the facial skeleton, in the opening chapter, offer a somehow disturbing view, through the nasal aperture, of the entire brainstem. There have been moments, in the depths of a septoplasty, I do admit... This is a lengthy manual, with the expected profusion of high-quality illustrations. Most are full colour images of cadaver dissections; imaging is sharply printed, and even the truly live surgical prints show how rhinology is somehow more photogenic than the practice of the aurist. Anatomy is demonstrated with the best contemporary 3D computed tomography reconstructions. Illustrations of surgery are accompanied by descriptions, for every procedure, of indications, technique, complications and ‘tips and tricks’ (which are really nicely done). To an ignoramus, the text very nicely complemented the images. Now, frankly, by Chapter 4, this reviewer was already getting into unfamiliar territory. Draf’s endonasal frontal sinus drainage procedure types I–III mean little to one who sees the dire emergency route to the frontal sinus as below the eyebrow. Yet, somehow, the descriptions of endoscopic frontal and sphenoid approaches, and medial maxillectomy, made perfect sense. Then there was the hunt for those arteries, and certainly their sphenopalatine arterial pedicle looked much more convincing than the mucosal strand often shown to me by enthusiastic trainees. By page 92, the content was getting serious, passing way beyond the nasal cavity. A ‘suprasellar approach to the third ventricle’ sounded like something I have spent my life trying to avoid doing. Transorbital neuroendoscopic surgery seems challenging considering the important contents, but proves entirely plausible. By ‘The Front Door to Meckel’s Cave’, ‘The Endoscopic Endonasal Approach to the Intrapetrous Carotid Artery’ or ‘The Anteromedial Corridors to the Cranial Nerves’, I knew I was now out of my depth as a reviewer, but could appreciate the quality of what I was reading. Descriptions of combined approaches, simultaneously transnasal and transcranial, reminded me of those tunnelling exercises, where, after months of drilling, the two teams meet under the ","PeriodicalId":22781,"journal":{"name":"The Journal of Laryngology & Otology","volume":"37 1","pages":"1030 - 1031"},"PeriodicalIF":0.0,"publicationDate":"2017-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83168113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-18DOI: 10.1017/S0022215117001645
L. Flood
I have a fond memory of a Fellowship of the Royal College of Surgeons (FRCS) Examiners’ questionsetting meeting, when our esteemed chairperson lamented that we only had five questions in her chosen field of rhinology. In what was meant to be sotto voce, I pronounced to all ‘that is because there are only five questions in rhinology’. If looks could have killed... Well this is clearly no longer the case, to judge by the recent literary output. Professor Alobid has just coauthored Endoscopic Approaches to the Paranasal Sinuses and Skull Base (Thieme, 2017) and now contributes to co-authorship of a more focused, highly subspecialised textbook, packed with practical surgical tips. An international authorship is very much dominated, once more, by the Spanish and Italian contributions. I would have thought it difficult to write a 181-page book on septal perforation repair (especially as, in my hands, nothing worked, and the best plan was simply to make the hole far bigger!), even more so if forced to do it endoscopically. The old cynical otologist is bound to argue that you must justify the cost of the kit, so out comes the 0-degree Hopkins rod, whether needed or not. No, perish the thought; this book is very well thought out, with many novel and practical messages, all supported by some very convincing videos of surgery. It obviously starts with basic sciences. The description of bony, endoscopic and radiological anatomy is followed by the physiology of nasal airflow and mucociliary transport. Chapter 3, on septal anatomy and especially its vascularity, is highly relevant to what then follows. Discussion of trauma and toxins as aetiological factors precedes a nicely updated chapter on associated systemic diseases. The emphasis is on reconstruction, I do accept, but I would have welcomed one illustration of the ‘lethal midline granuloma’, truly of course a lymphoma. The appearance is so characteristic that it is never forgotten, and instant recognition is vital. The chapter on pre-operative clinical evaluation is brief but well-illustrated, with a nice algorithm. Sensibly, the chapters on conservative treatment and especially septal prostheses offer many good and practical clinical tips. Then, the real fun starts for the surgeon. Each flap merits a chapter, so we learn of free, middle turbinate, inferior turbinate, lateral nasal wall (that looks tricky), anterior ethmoidal artery septal, unilateral mucosal advancement and bilateral cross-over flaps. There are several more in practice. A clever addition is a chapter on quality of life, but a true godsend is the final chapter, which offers an algorithm to guide one through the seemingly baffling range of possible reconstructions. This is an inspiring book. It should appeal to anyone with a rhinology interest because it tackles an all too common problem, it does not take the surgeon into the territory of the skull base heroes and because the condition has proved a major challenge to previous generations o
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