James Bates

Background: Frontal sinus stents have been introduced to reduce frontal sinus re-stenosis after surgery and to improve outcomes.Method: This study was a retrospective analysis of 19 patients who had endoscopic sinus surgery with approach to the frontal sinus and insertion of a soft sinus stent.Results: The frontal recess was patent in 78.9 per cent and stenosed in 21.1 per cent of patients; no completely closed recesses were observed. Mean follow up was 20.7 months, and time period of stenting was 9.8 months on average; complications were observed in 47.4 per cent of the patients, with post-operative sinonasal infection being the most common.Conclusion: In the authors’ experience, indications for frontal sinus stenting include recalcitrant chronic rhinosinusitis after multiple functional endoscopic sinus surgeries (especially in chronic rhinosinusitis with nasal polyps), patients with history of important craniofacial surgery or trauma, and recurrent mucoceles. The stent was overall well tolerated as only minor complications were observed. Close clinical follow up is mandatory.

Primary mucosal melanoma of the tonsil is rare, with 27 reported cases. Careful diagnosis is necessary, as the tonsil is more often a site of metastatic melanoma from a cutaneous primary tumour. In this report, we present a case of primary right tonsillar mucosal melanoma with widespread metastasis in a 31-year-old man who presented with a 3-month history of enlarging neck lumps. On examination, he had cervical lymphadenopathy and a pigmented, vascular lesion of his right tonsil, which was diagnosed as melanoma following investigation. He had widespread metastases upon presentation, and is currently undergoing palliative immunotherapy. Owing to the aggressive behaviour, late presentations and lack of effective treatment to cure mucosal melanomas, they have a poor prognosis. Treatment involves wide local excision in local disease, and immunotherapy as the first-line for metastatic disease.

Background Frontal sinus surgery is challenging as the frontal recess is prone to re-stenosis and there is subsequent occlusion of the frontal sinus outflow tract. In an attempt to maintain the frontal recess calibre and reduce frontal sinus re-stenosis, frontal sinus stents have been used with different materials and varying results. Objective This paper presents the technique of using a modified Montgomery T-tube as a frontal sinus stent. Results and conclusion The use of a soft, self-retaining and non-absorbable stent that can be used for stenting of the frontal sinus is described. Our technique is safe, effective, inexpensive and well tolerated.