CORRESPONDENCE: LETTERS

130 Correspondence

The use of smartphones for intra-operative photography – how we do it 14 January 2014

Sir, Intra-operative photographs are useful for documentation and invaluable as an educational tool and for publications. We propose an inexpensive method of using a readily available smartphone to take high-quality intra-operative photographs. Our technique is easy to use and does not compromise the sterility of the surgical field. The materials required include one alcohol wipe, two TegadermTM films, one sterile glass slide and a smartphone. Step 1

The smartphone is disinfected with alcohol wipes. Step 2

Two sterile Tegaderm™ films and a sterile glass slide are placed on the surgical trolley. The smartphone is carefully placed face down onto the sticky surface of the first Tegaderm™ film. A sterile glass slide is then stuck to the other Tegaderm™. The Tegaderm™ with the glass slide is placed onto the other Tagederm™ film with the camera. The glass slide is then placed carefully over the camera lens and the Tegaderm™ films pasted together. This helps to cover the phone with the glass slide over the camera lens. Both surfaces of the smartphone are covered with sterile Tegaderm™ (Fig. 1).

Step 3

With a number 15 blade, cut out the part of the Tegaderm TM film directly over the camera lens that is now covered by the sterile glass slide. Remove the excised Tegaderm film with a pair of forceps, and a ‘sterile’ camera is ready to use. Discussion

There are several advantages in employing the described method to take intra-operative photographs. Firstly, smartphone ownership amongst doctors is on the rise. EPG Health Media1 reported in 2012 that 91% of doctors in the United States owned smartphones while 81% of their counterparts in Europe did likewise and that this percentage is likely to increase. This means that an image-capturing device is readily available within the operating theatre most of the time and that there is no need to purchase an additional DSLR camera. In addition, rapid advances in both image-capturing hardware and software on a smartphone have made it possible to take high-resolution photographs without the need for a high-end camera. Thirdly, the surgeon is also free to handle the ‘sterile’ smartphone with ease. The phone can be brought close to the operative field without having to worry about contaminating the sterile field with a bulky, non-sterile DSLR camera. Finally, this method of protecting the operative field against contamination by the phone is inexpensive, fast and easy to perform, and the entire process takes less than 5 minutes to complete, with a cost price of $2. Conflict of interests

The authors do not have any potential or actual conflict of interest to declare. Tan, M. & Uppal, S. Department of Otorhinolaryngology, Khoo Teck Puat Hospital, Singapore City, Singapore E-mail: [email protected]

Reference

Fig. 1. Smartphone with sterile glass slide overlying camera lens; covered front and back with sterile TegadermTM.

1 EPG Health Media. Healthcare professional use of mobile devices: a comparative study between Europe and USA in 2010 and 2012. EPG Health Media Focus Group Report. November 2012.

© 2014 John Wiley & Sons Ltd  Clinical Otolaryngology 39, 127–133

Correspondence

Additional Supporting Information may be found in the online version of this article: Fig. S1. Materials required for taking intra-operative photographs without compromising the sterility of the surgical field. Fig. S2. Disinfect smartphone with alcohol wipes. Fig. S3.The smartphone and sterile glass slide on two separate pieces of TegadermTM film. Fig. S4. The two TegadermTM films pasted together after positioning the sterile glass slide to cover the smartphone’s camera lens.

Fig. S5. TegadermTM film overlying the camera lens being cut out with a number 15 blade. Fig. S6. Example of intra-operative photograph taken by this method. Fig. S7. Example of intra-operative photograph taken by this method. Fig. S8. Example of intra-operative photograph taken by this method. Fig. S9. Example of intra-operative photograph taken by this method. Fig. S10. Example of intra-operative photograph taken by this method.

Dental health care for drooling patients – Personal comments 15 February 2014

Sir, I read with interest the recent publication on salivary duct ligation for drooling in 21 children.1 Although this report reveals useful information, there are some areas for discussion upon which I would like to expand. Drooling is not usually caused by excessive salivation, but results from impaired neuromuscular coordination of the oromotor and palatofacial muscles and subsequent poor swallowing function.2–5 Scheffer et al. 1 included paediatric patients who were not or did not expect to receive benefits from conservative therapies, or contradicted to salivary duct rerouting. Their results support those of other investigators.2,5 However, it is important to note that most studies followed the patients up to 1 year. Long-termed adverse events, such as poor oral hygiene and rampant dental caries (as a result of xerostomia), may be missed. In my experience, many drooling children developed oral health deterioration approximately 4–5 years after salivary duct and/or gland surgeries (unpublished data). Hence, the patients require meticulous dental health measures: an oral examination and appropriate preventive dentistry, maintaining good oral hygiene, and fluoride supplementation.2,3 Dental health care for drooling patients undergoing salivary duct and/or gland surgeries is often underemphasised in many reports. Ethical approval

Not required. © 2014 John Wiley & Sons Ltd  Clinical Otolaryngology 39, 127–133

Conflict of interests

The author indicates full freedom of manuscript preparation and no potential conflict of interests. Financial disclosure

There was no grant support for this letter. Authorship disclosure

Poramate Pitak-Arnnop performed conception and data analysis, drafted and revised the article and gave final approval. Pitak-Arnnop, P. Research Group for Clinical and Psychosocial Research, EvidenceBased Surgery and Ethics in Oral and Maxillofacial Surgery, Faculty of Medicine, University Hospital of Leipzig, Leipzig, Germany E-mail: [email protected]

References 1 Scheffer A.R., Bosch K.J., van Hulst K. et al. (2013) Salivary duct ligation for anterior and posterior drooling: our experience in twenty-one children. Clin. Otolaryngol. 38, 425–429 2 Meningaud J.P., Pitak-Arnnop P., Chikhani L. et al. (2006) Drooling of saliva: a review of the etiology and management options. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 101, 48–57 3 Pitak-Arnnop P. (2010) Statistics or ethics? Decision to treat drooling. Arch. Otolaryngol. Head Neck Surg. 136, 315

CORRESPONDENCE: LETTERS

Supporting Information

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The use of smartphones for intra-operative photography - how we do it.

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