Edward J. Chisholm

Surgical voice restoration after total laryngectomy: an overview.

Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patients physical, functional, and emotional health, and may result in a decreased quality of life (QOL). Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artificial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration.

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.

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.

Evaluation of speech outcomes using English version of the Speech Handicap Index in a cohort of head and neck cancer patients

The aim of this study was to explore post-treatment speech impairments using English version of Speech Handicap Index (SHI) (first speech-specific questionnaire) in a cohort of oral cavity (OC) and oropharyngeal (OP) cancer patients. Sixty-three consecutive OC and OP cancer patients in follow-up participated in this study. Descriptive analyses have been presented as percentages, while Mann-Whitney U-test and Kruskall-Wallis test have been used for the quantitative variables. Statistical Package for Social Science-15 statistical software (SPSS Inc., Chicago, IL) was used for the statistical analyses. Over a third (36.1%) of patients reported their speech as either average or bad. Speech intelligibility and articulation were the main speech concerns for 58.8% and 52.9% OC and 31.6% and 34.2% OP cancer patients, respectively. While feeling of incompetent and being less outgoing were the speech-related psychosocial concerns for 64.7% and 23.5% OC and 15.8% and 18.4% OP cancer patients, respectively. Worse speech outcomes were noted for oral tongue and base of tongue cancers vs. tonsillar cancers, mean (SD) values were 56.7 (31.3) and 52.0 (38.4) vs. 10.9 (14.8) (P<0.001) and late vs. early T stage cancers 65.0 (29.9) vs. 29.3 (32.7) (P<0.005). The English version of the SHI is a reliable, valid and useful tool for the evaluation of speech in HNC patients. Over one-third of OC and OP cancer patients reported speech problems in their day-do-day life. Advanced T-stage tumors affecting the oral tongue or base of tongue are particularly associated with poor speech outcomes.

Development and validation of first-ever speech-specific perceptual speech evaluation tool for patients with head and neck cancer: the London speech evaluation (LSE) scale.

The aim of this study was to develop and validate the first ever speech‐specific perceptual speech‐evaluation tool for patients with head and neck cancer.

Acoustic parameters of speech: Lack of correlation with perceptual and questionnaire-based speech evaluation in patients with oral and oropharyngeal cancer treated with primary surgery.

Acoustic evaluation of speech is the least explored method of speech evaluation in patients with oral cavity and oropharyngeal cancer. The purpose of this study was to explore acoustic parameters of speech and their correlation with questionnaire evaluation and perceptual evaluation in patients with oral cavity and oropharyngeal cancer.

Pictorial Ultrasound Reports Combined With Fine Needle Washout Thyroglobulin Assay to Aid Thyroid Surgery

INTRODUCTION Thyroid carcinoma patients, despite their generally excellent prognosis, have cervical nodal involvement at presentation in approximately 35% to 40% of cases. Furthermore, the vast majority of the 5% to 20% of recurrences are of a locoregional nature. Ultrasound (US) is commonly employed for both diagnosis and staging of the thyroid and cervical lymph nodes. The cytology of suspicious nodes or thyroid nodules can then be verified by fine needle aspiration (FNA) cytology. US guidance of FNA increases the number of representative samples as compared to non-US guided FNA. If the node is not palpable the US report is used to guide the surgeon to its location. A text description of the location of pathology typically involves mentioning the anatomical location (Union Internationale Contre le Cancer) or numeric level (American Joint Committee on Cancer). Although useful, descriptive methods are far from a definitive way of localizing the abnormality. Still pictures from the dynamic US scan are rarely helpful as a surgical map as they are normally only interpretable by the ultrasonographer. Cases of recurrent thyroid carcinoma are usually managed with radioiodine for small volume, iodine-avid disease or surgery with or without radioiodine for macroscopic cervical recurrence. The operation, as with surgical resection of primary disease, can be highly selective but is dependant on accurate preoperative disease localization. This is usually with iodine uptake scans and US. We describe how we use a simple sketch drawing to aid lymph node localization during therapeutic neck dissections for thyroid carcinomas. We also explain how we employ thyroglobulin assays from FNA samples in recurrent cases to enhance preoperative planning. TECHNIQUE FOR CERVICAL STAGING OF NEWLY DIAGNOSED THYROID CARCINOMA New presentations of suspected thyroid carcinoma not only have ultrasound of both lobes of the thyroid itself but also both sides of the neck. There are several features of lymph nodes that alert the ultrasonographer to an increased likelihood of malignancy within a lymph node. These include round shape, short axis diameter >8 mm, heterogeneous echotexture, cystic or necrotic areas, fatty hilum, ill-defined margins, and invasion of surrounding tissue. FNA cytology of the thyroid and suspicious cervical areas under ultrasound guidance is performed. A simple line drawing of the nodal map of the neck is then sketched with suspicious nodes crosshatched, and the areas from which cytological aspirates were taken are indicated. This produces an easily interpretable picture to use as a surgical map (Fig. 1).