F.W. Stafford

The 2-week rule for suspected head and neck cancer in the United Kingdom : Referral patterns, diagnostic efficacy of the guidelines and compliance

A retrospective audit of 1079 2-week referrals between 1 January 2004 and 31 December 2006 was undertaken. The aims of this audit were to assess compliance of referrals with Department of Health (DoH) guidelines; the effectiveness of the 2-week referral route in detecting head and neck cancers, and to determine whether this route identified more early stage cancers. Of 1079 2-week referrals, 71.5% conformed to DoH criteria. DoH guidelines were found to have a high sensitivity of 83.9% (75.5-89.7%, 95% CI) for head and neck cancer, but a low positive predictive value of 12.8% (10.5-15.3%) and a specificity of 30.0% (27.2-33.1%). Only 10.9% of 2-week referrals were diagnosed with a head and neck cancer. The cancer detection rate was higher amongst referrals that conformed to DoH guidelines (12.8%) compared to those that did not 6.2%. This was statistically significant (Chi square, p<0.01). The guidelines had a positive likelihood ratio of 1.20 (1.1-1.3), suggesting that there is a minimal increase in the likelihood of head and neck cancer when DoH guidelines are correctly applied. The diagnostic odds ratio (DOR) of the DoH referral criteria is 2.21. Most head and neck cancers were diagnosed via routine referral routes, 2-week referrals contributing to only 21.4% of all head and neck cancers diagnosed during the study period. The 2-week referral route did not identify more early stage cancers.

Laser debulking in malignant upper airway obstruction

The conventional treatment for patients with upper airway obstruction secondary to malignancy is a tracheostomy. Although this effectively resolves the problem, a tracheostomy can be associated with complications and is irreversible in most patients. An alternative is to debulk part of the tumor causing airway obstruction to maintain the airway until the definitive procedure.

Quality of life in laryngectomees: a post-treatment comparison of laryngectomy alone versus combined therapy

Patients with advanced and recurrent laryngeal and hypopharyngeal cancer often need combined therapy, which is associated with greater morbidity than single modality treatment. The aim of this study was to assess the quality of life in laryngectomees and to assess whether differences exist between the irradiated and the non-irradiated patients. The University of Michigan Head and Neck Quality of Life questionnaire, a validated instrument for assessing the head and neck cancer related functional status and well-being, was used for this purpose. Subjects for the study included patients who had undergone total laryngectomy for laryngeal or hypophyarngeal squamous cancer. No significant difference between the groups was evident in the various domain scores, although a trend towards higher scores was seen in the combined therapy group. This study suggests that long-term side effects induced by radiotherapy do not adversely affect the quality of life in laryngectomised patients.

Occupational rhinitis: possible mechanisms of pathogenesis

Occupational rhinitis has been a prescribed industrial disease in the UK since 1907. It has only relatively recently received significant attention from otorhinolaryngologists although numerous studies have been performed in the past by occupational and industrial health physicians. At the present time the precise mechanisms of pathogenesis are unclear and would appear to be multiple. Recently interest has arisen because of compensation claims. Diagnosis made on the basis of the clinical history is subject to two problems: firstly, there is difficulty in differentiating between occupational and nonoccupational rhinitis, and secondly, clinical histories can easily be feigned. Physical signs would be a more reliable indicator of occupational damage to the nasal mucosa if they differ from the signs normally found in allergic or vasomotor rhinitis. In a series of 100 shipyard workers dry atrophic nasal mucosa was found in 66 and septal ulceration in two. From their clinical histories 78 individuals complained of nasal obstruction, 28 of epistaxis, 42 of hyposmia, 10 of anosmia and 90 of rhinorrhoea. Possible pathogenesis is described.

Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta-analysis of the English literature.

Advanced laryngeal and hypopharyngeal squamous cell carcinomas carry an inherent risk of invading thyroid parenchyma leading to the incorporation of a hemithyroidectomy or total thyroidectomy as part of a total laryngectomy. In some centres, thyroid gland removal occurs routinely during surgery for T3 and T4 laryngopharyngeal carcinoma. However, the incidence of invasion is low, and therefore, thyroid‐sparing surgery must be considered for select cases.

Defining the stenotic post-laryngectomy tracheostoma and its impact on the quality of life in laryngectomees: development and validation of a stoma function questionnaire

Objectives:  The aims of this study were to identify if: (i) size of stoma contributes to quality of life (QoL) in laryngectomees; (ii) stoma size has an impact on routine stoma care and function; and (iii) an optimal stoma size exists below which patients experience stoma problems.

Self-retaining retractors in head and neck surgery

The Norfolk and Norwich retractor is a vital tool in head and neck surgery. It is of great aid in training junior surgeons and has become an integral part of the standard neck dissection instrument set in our unit. This retractor enables good exposure of the carotid sheath, its atraumatic blunt tip retracting the carotid sheath without damage. It makes a single skin incision for neck exposure possible, rather than a Y, T or wine glass incision, avoiding a three-point junction, especially in the post-irradiated neck. In thyroid surgery it reduces the need for manual retraction thereby relieving the assistant surgeon and enhancing the quality of the learning experience.