Gulcan Gok

Ultrasound guided Core Biopsy, Fine Needle Aspiration Cytology and Surgical Excision Biopsy in the diagnosis of metastatic squamous cell carcinoma in the head and neck: an eleven year experience.

INTRODUCTION This study aims to review our 11 year experience of diagnosing metastatic squamous cell carcinoma presenting as head and neck lumps. The techniques of Ultrasound guided Core Biopsy (USCB), Fine Needle Aspiration Cytology (FNAC) and Surgical Excision Biopsy (SEB) are compared. MATERIALS AND METHODS All patients with metastatic squamous cell carcinoma (SCC) involving the lymph nodes of the head and neck or parotid gland, diagnosed at Eastbourne District General Hospital between January 1998 and November 2009 were identified. The following data items were collated: biopsy location (e.g. cervical lymph node or parotid), any history of likely primary SCC and site, type of biopsy used to establish a conclusive diagnosis (index diagnostic technique), previous biopsies, the technique and their results, subsequent histology results. RESULTS A total of 90 patients were diagnosed with metastatic squamous cell carcinoma. The index diagnostic technique was USCB in 48 patients, FNAC in 29 and SEB in 13. In 72 (80%) patients the index biopsy was the sole tissue sample taken prior to surgery or other treatment. The remaining 18 patients underwent a total of 22 previous biopsies prior to the index biopsy. 95% (21/22) of these previous biopsies were non-definitive FNAC and 5% (1/22) was a non-definitive USCB. FNACs also demonstrated the highest non-diagnostic rate (42%). The accuracy of USCB and FNAC in correlating with final histopathology was 97% and 85% respectively. CONCLUSIONS USCB demonstrates excellent results in the diagnosis of metastatic SCC in the head and neck with higher accuracy and greater reliability than FNAC.

Ultrasound-guided injection of botulinum toxin A into the submandibular gland in children and young adults with sialorrhoea.

Hypersalivation is a common and distressing complaint in children with neuromuscular disorders such as cerebral palsy. Complications associated with severe drooling include daily changes of clothing, perioral dermatitis, dental problems, dehydration, and aspiration pneumonia, which potentially have a detrimental effect on the quality of life of the patient and carer. In this paper we update our previous work to show the potential benefits of ultrasound-guided injection of botulinum toxin A (BTX-A) into the submandibular gland and report on new patients and follow-up data on the existing group.

A rare cause of a parotid mass: spontaneous pseudoaneurysm of the superficial temporal artery

The authors describe a rare presentation of a spontaneous pseudoaneurysm of the superficial temporal artery which mimicked a parotid neoplasm. The clinical presentation, possible aetiology, diagnosis, and management of this condition are discussed.

Warthin's tumour and facial nerve palsy: an unusual association

We describe a man with Warthins tumour diagnosed on core biopsy, who presented with ipsilateral facial palsy. He was managed conservatively with subsequent resolution of the palsy, which suggested many diseases. The association of a benign parotid neoplasm with facial palsy is unusual, and appropriate investigations are essential for accurate diagnosis and surgical planning.

Evaluation of biopsy methods in the diagnosis of submandibular space pathology.

The aim of this study was to evaluate the performance of fine needle aspiration cytology (FNAC), ultrasound-guided core needle biopsy (USCNB), punch biopsy, and surgical excision biopsy in neoplasms presenting within the submandibular space. A retrospective analysis of all patients with a pathological diagnosis of a submandibular space neoplasm within a 12-year period (February 1999 to June 2011) was performed. Biopsy results were compared to histopathological diagnosis obtained from surgical excision biopsy. Eighty-one specimens from 44 patients met the search criteria (15 FNAC, 24 USCNB, 7 punch biopsy, and 35 surgical excision biopsy). The final diagnosis was established by USCNB, punch biopsy, or surgical excision biopsy and not by FNAC alone. Surgical excision biopsy was performed as a primary diagnostic (n = 8), secondary diagnostic (n = 15), or as a post-diagnostic therapeutic procedure (n = 12). Non-diagnostic results were: FNAC 11/15, USCNB 2/24, and punch biopsy 1/7. Diagnostic results were: FNAC 2/15, USCNB 20/24, and punch biopsy 5/7. No complications were reported. Although punch biopsy demonstrated good yield and accuracy, its use is restricted to a small cohort of patients. USCNB is a safe and accurate technique in the submandibular space, with a low non-diagnostic rate.

The T-shape spreader—An easily constructed instruction for facilitating the sagittal split osteotomy

We would like to draw the reader’s attention to two important developments that occurred in anaesthesia in the last 2 years following Chalmers A, Elliot S. What is new in maxillofacial anaesthesia?1 These address the issue of airway management and have particular relevance for OMFS. Firstly, the publication of the Fourth National Audit Project report (NAP4) by the Royal College of Anaesthetists and Difficult Airway Society (DAS) identified several key points.2 Head and neck cases constituted 40% of the total number of airway complications reported nationally. The audit highlighted having more than one back up plan and planning for failure is important under the circumstances, as fiberoptic intubation attempts can fail, maintenance of spontaneous ventilation under gaseous induction can also fail and multiple attempts at intubation can deteriorate an airway. A logical sequence of plans (“airway strategy”), that is discussed with the surgeon after reviewing relevant imaging together, has to be in place when dealing with potentially or overtly compromised airways. On the other hand, failure to consider awake fibreoptic intubation as a primary technique of anaesthesia and failure to recognize the low morbidity and ease of cricothyroidotomy in the patient with upper airway obstruction in a “can’t intubate can’t ventilate” scenario have led to direct harm. Emergency cricothyroidotomy, especially in the hands of the anaesthetists, had a high failure rate, making communication, preparation and choice of adequate location (theatre rather than anaesthetic room, with surgeon and equipment available for surgical airway access) an imperative under certain circumstances. Secondly, the publication of the DAS Extubation Guidelines3 was another important step. This applies to OMFS as all patients will be in the “at risk” category in the immediate post-surgical setting. This makes the existence of an airway strategy for extubation as important as a strategy for intubation. Modern anaesthesia has adopted a lot of the crisis management principles from aviation industry and this is particularly true for OMFS, where safe take-off and landing require very careful assessment and negotiation of circumstances. This is, in our opinion, the most important aspect of maxillofacial anaesthesia. Conflict of interest