Learning Objectives: Developing a close relationship with a senior colleague who is readily accessible in an emergency early in one's career can pay huge dividends.
Introduction: No matter how long a surgeon has been in practice, from time to time they will inevitably find themselves in an unexpected situation where they are in difficulty and out of their depth. At such times it is vital to know where to turn for help.
Method: We describe three cases over a 20 year period which illustrate the value of having such a friend and colleague to turn to.
Case 1: a 60 year old female who had undergone a modified radical mastoidectomy over 20 years previously. She had had several episodes of facial palsy associated with an infected mastoid cavity which had resolved after microsuction under GA. On this occasion a complete palsy persisted for 3 weeks despite microsuction and a decision was made to explore the ear. The nerve was found to be dehiscent and attenuated to less than a quarter of its normal calibre at the second genu. Telephone advice was to excise the damaged segment, mobilise, reroute and perform primary end to end anastomosis.
Case 2: a 50 year old female presented with a persistent ear discharge after grommet insertion for a middle ear effusion. CT imaging suggested chronic mastoiditis, however, upon exploration a dehiscent tegmen and middle fossa dura was found with herniated temporal lobe and profuse CSF leakage. Telephone advice was to resect the herniated brain, repair the dura with fascia, crushed muscle and Surgicel before obliterating the mastoid.
Case 3: a 10 year old girl undergoing tympanoplasty had life-threatening bleeding from a dehiscent and massively dilated sigmoid sinus. Telephone advice was to repair the leak with fascia, crushed muscle, Floseal, Surgicel and bone wax.
Results: The first patient recovered facial nerve function to HB grade 2–3. The second and third patients had uneventful and complete recoveries without the need for further surgery.
Conclusion: Contacting an experienced colleague by telephone from the operating theatre can often save the day.
