C. Kerawala

Validation of the Sydney Swallow Questionnaire (SSQ) in a cohort of head and neck cancer patients.

Impairment of swallowing function is a common multidimensional symptom complex seen in 50-75% of head and neck cancer (HNC) survivors. Although there are a number of validated swallowing-specific questionnaires, much of their focus is on the evaluation of swallowing-related quality of life (QOL) rather than swallowing as a specific function. The aim of this study was to validate the Sydney Swallow Questionnaire (SSQ) as a swallowing-specific instrument in HNC patients. Fifty-four consecutive patients in follow-up for oral and oropharyngeal cancer completed the SSQ and MD Anderson Dysphagia Inventory (MDADI). Thirty-one patients completed both questionnaires again four weeks later to address test-retest reliability. Internal consistency and test-retest reliability was assessed using Cronbachs alpha and Spearmans correlation coefficient, respectively. Construct validity (including group validity) and criterion validity were determined using Spearmans correlation coefficient and Mann-Whitney U-test. Internal consistency, test-retest reliability, construct validity, group validity and criterion validity of the SSQ was found to be significant (P<0.01). We were able to demonstrate the reliability and validity of the SSQ in HNC patients. The SSQ is a precise, reliable and valid tool for assessing swallow in this patient group.

Evaluation of speech outcomes following treatment of oral and oropharyngeal cancers

Oral and oropharyngeal cancers are amongst the commonest cancers worldwide and present a major health problem. Owing to their critical anatomical location and complex physiologic functions, the treatment of oral and oropharyngeal cancers often affects important functions, including speech. The importance of speech in a patients life can not be overemphasized, as its loss is often associated with severe functional and psychosocial problems and a poor quality of life. A thorough understanding of the speech problems that are faced by these patients and their timely management is the key to providing a better functional quality of life, which must be one of the major goals of modern oncologic practice. This review summarises key methods of evaluation and outcome of speech functions in the literature on oral and oropharyngeal cancer published between January 2000 and December 2008. Speech has been generally overlooked and poorly investigated in this group of patients. This review is an attempt to fill this gap by conducting the first speech-specific review for oral and oropharyngeal cancer patients. We have proposed guidelines for better understanding and management of speech problems faced by these patients in their day-to-day life.

How should we manage oral leukoplakia

The aim of this article is to review the management of oral leukoplakia. The topics of interest are clinical diagnosis, methods of management and their outcome, factors associated with malignant transformation, prognosis, and clinical follow-up. Global prevalence is estimated to range from 0.5 to 3.4%. The point prevalence is estimated to be 2.6% (95% CI 1.72-2.74) with a reported rate of malignant transformation ranging from 0.13 to 17.5%. Incisional biopsy with scalpel and histopathological examination of the suspicious tissue is still the gold standard for diagnosis. A number of factors such as age, type of lesion, site and size, dysplasia, and DNA content have been associated with increased risk of malignant transformation, but no single reliable biomarker has been shown to be predictive. Various non-surgical and surgical treatments have been reported, but currently there is no consensus on the most appropriate one. Randomised controlled trials for non-surgical treatment show no evidence of effective prevention of malignant transformation and recurrence. Conventional surgery has its own limitations with respect to the size and site of the lesion but laser surgery has shown some encouraging results. There is no universal consensus on the duration or interval of follow-up of patients with the condition.

Relocating the site of frozen sections—Is there room for improvement?

In an attempt to improve the marginal control of oropharyngeal carcinoma, some surgeons routinely perform frozen section analysis. Because current methods of relocating the site from which frozen section specimens are harvested can be haphazard, we studied the accuracy of a common technique used to localize specimens to the resected tumour bed.

The basic science of bone induction

The last few decades of basic science research have provided an increased understanding of the role of osteogenic glycoproteins in bone formation. The isolation of such molecules now permits de novo orthotopic induction with increasing evidence of the ability to also induce bone growth in heterotopic sites. The current editorial focuses on the basic science of bone induction with two subsequent issues dedicated to the translation of these principles into both animal subjects and human clinical applications.

ANATOMIC DISTRIBUTION OF CERVICAL LYMPH NODE SPREAD IN PAROTID CARCINOMA

The pattern of distribution of cervical nodal involvement from primary parotid carcinomas has not been extensively described.

FIRST REPORT ON THE RELIABILITY AND VALIDITY OF SPEECH HANDICAP INDEX IN NATIVE ENGLISH-SPEAKING PATIENTS WITH HEAD AND NECK CANCER

Posttreatment speech problems are seen in nearly half of patients with head and neck cancer. Although there are many voice‐specific scales, surprisingly there is no speech‐specific questionnaire for English‐speaking patients with head and neck cancer. The aim of this study was to validate the Speech Handicap Index (SHI) as the first speech‐specific questionnaire in the English language.

Prevention of complications in neck dissection

BackgroundThe neck dissection has remained a pivotal aspect of head and neck cancer management for over a century. During this time its role has expanded from a purely therapeutic option into an elective setting, in part promoted by efforts to reduce its morbidity.ObjectivesThis review will consider the potential complications of neck dissection and on the basis of the available evidence describe both their management and prevention.ConclusionAlthough the neck dissection continues to provide clinicians with a method of addressing cervical disease, its reliability and safety can only be assured if surgeons remain cognisant of the potential complications and aim to minimise such morbidity by appropriate management in the peri-operative period.

Comprehensive review of small bowel metastasis from head and neck squamous cell carcinoma.

Secondary tumours of small intestine account for 10% of all small bowel cancers. The most common sites of primary tumour metastasizing to small bowel are uterus, cervix, colon, lung, breast and melanoma. The majority of these metastatic tumours come from adenocarcinoma primaries; squamous cell carcinoma constitutes a very small proportion of all metastatic small intestinal lesions. Metastasis to small bowel by head and neck squamous cell carcinoma is extremely rare and carries an unfavourable prognosis. Owing to the limited number of published studies, its characteristic features, clinical presentation and outcomes are poorly described. This work aims at specifying these characteristics by reviewing, compiling, analysing and reporting all published cases in the published literature on small bowel metastasis secondary to head and neck squamous cell carcinoma. To the best of our knowledge, this is the first comprehensive review article on the small intestinal metastasis from head and neck squamous cell carcinoma.

Palmar arch backflow following radial forearm free flap harvest.

BACKGROUND Most surgeons advocate an Allen test (for occlusion of the radial or ulnar artery) and Doppler ultrasound examination before harvesting a forearm flap. In this study we attempted to correlate the results of these tests with intraoperative measurement of backflow pressure in the radial artery stump. METHOD Stump pressures were measured in 30 patients after the flap had been harvested and were compared with preoperative assessment and intraoperative measurements of mean arterial pressure (MAP). RESULTS Mean arterial backflow pressure (MABP) in the arterial stump varied from 27 to 55mm Hg (mean 40.5). The ratio of this value to the mean arterial pressure ranged from 0.39 to 0.89 (mean 0.59) and exceeding 0.5 in 21 patients (70%). There was no correlation between this ratio and the preoperative assessment. CONCLUSIONS These findings suggest that in the presence of a satisfactory Allen test and Doppler examination, there is adequate pressure in the palmar system to maintain vascular integrity of the donor hand after sacrifice of the radial artery. Despite the possibility of anatomical variants, the routine use of more invasive imaging is unnecessary.